Goiter

A disease characterized by swelling at the front and sides of the neck that moves up and down as the patient swallows. Goiter largely corresponds in Western medicine to enlargement of the thyroid gland. Records of it in Chinese literature first appeared in the 3rd century BCE. The disease is mentioned in Zhuang Zi, and in Lǘ’s Spring and Autumn (吕氏春秋 lǘ shì chūn qiū, jìn shù piān). The latter text states, In places of light (轻) water, there is much baldness and many people with goiters, which indicates that a connection between goiter, environmental factors, and baldness had been observed. In A Thousand Gold Pieces Prescriptions for Emergencies (备急千金要方 bèi jí qiān jīn yào fāng) by Sūn Sī-Miǎo (CE 581–682) of the Táng Dynasty, many formulas contain kelp (Laminariae seu Eckloniae Thallus, 昆布 kūn bù), sargassum (Sargassum, 海藻 hǎi zǎo), and pig’s thyroid gland (Suis Glandula Thyroidea, 猪靥 zhū yè), now all known to be rich in iodine, deficiency of which is now known to be a major cause. A Unified Treatise on Diseases, Patterns, and Remedies According to the Three Causes (三因极一病症方论 sān yīn jí yī bìng zhèng fāng lùn) of the Song classifies goiter into five kinds, stone, flesh, sinew, blood, and qì goiter.

Types of Goiter

Stone goiter is marked by hard, fixed lumps in the neck that feel uneven to the touch. It is accompanied by irascibility, profuse sweating, oppression in the chest, and heart palpitation. In advanced cases, the wind pipe, gullet, and vocal chords are all subjected to pressure. Stone goiter is attributed to qì depression, damp phlegm, and static blood congealing and stagnating.

Biomedical correspondence: tumor of thyroid.

Medicinal therapy: Transform phlegm and relieve depression; move stasis and soften hardness. Use Sargassum Jade Flask Decoction (海藻玉壶汤 hǎi zǎo yù hú tāng). Topical: Apply Harmonious Yáng Decongealing Plaster (阳和解凝膏 yáng hé jiě níng gāo) and dab on powdered asafetida (Ferulae Resina, 阿魏 ē wèi).

Flesh goiter is characterized by single or multiple lumps like upturned cups, whose skin color is normal, and that are soft and spongy or firm like steamed bread. This goiter never ruptures. It may be accompanied by rash temperament, profuse sweating, heart palpitation, and oppression in the chestand is attributed to binding depression damaging the spleen and preventing spleen qì from moving.

Biomedical correspondence: thyroid adenoma and tubercular enlargement of the thyroid gland.

Medicinal therapy: Treat by relieving depression and transforming phlegm, assisted by softening hardness. Use Sargassum Jade Flask Decoction (海藻玉壶汤 hǎi zǎo yù hú tāng). Topical: Apply Harmonious Yáng Decongealing Plaster (阳和解凝膏 yáng hé jiě níng gāo) and dab on Cinnamon Bark and Musk Powder (桂麝散 guì shè sǎn), which comprises ephedra (Ephedrae Herba, 麻黄 má huáng), asarum (Asari Rhizoma et Radix, 细辛 xì xīn), cinnamon bark (Cinnamomi Cortex, 肉桂 ròu guì), small gleditsia (Gleditsiae Fructus Abnormalis, 猪牙皂 zhū yá zào), raw pinellia (Pinelliae Tuber Crudum, 生半夏 shēng bàn xià), raw arisaema (Arisaematis Rhizoma Crudum, 生南星 shēng nán xīng), musk (Moschus, 麝香 shè xiāng), and borneol (Borneolum, 冰片 bīng piàn).

Sinew goiter is characterized by a hard lump with green-blue veins [lit. sinews] knotted like worms. It is attributed to anger qì damaging the liver with effulgent fire and dryness of the blood.

Medicinal therapy: Clear the liver and resolve depression; nourish the blood and soothe the sinews (veins). Use Liver-Clearing Aloe Pill (清肝芦荟丸 qīng gān lú huì wán).

Blood goiter is characterized by lumps on the neck with a purple-red coloration of the skin and entangled red thread-like vessels. It is attributed to fulminant liver fire causing the blood to boil and further complicated by contending external evils.

Biomedical correspondence: hemangioma of the neck.

Medicinal therapy: Enrich yīn and repress fire; nourish the blood and transform stasis. Use Scutellaria and Coptis Two Matured Ingredients Decoction (芩连二陈汤 qín lián èr chén tāng) or combine sargassum (Sargassum, 海藻 hǎi zǎo), clamshell powder (Meretricis seu Cyclinae Concha Pulverata, 海蛤粉 hǎi gé fěn), kelp (Laminariae seu Eckloniae Thallus, 昆布 kūn bù), alisma (Alismatis Rhizoma, 泽泻 zé xiè), pig’s thyroid gland (Suis Glandula Thyroidea, 猪靥 zhū yè), scutellaria (Scutellariae Radix, 黄芩 huáng qín), and coptis (Coptidis Rhizoma, 黄连 huáng lián), with Four Agents Decoction (四物汤 sì wù tāng).

Qì goiter is a large lump on the neck, of normal skin coloration. It is soft to the touch and varies in size according with joyful or angry moods. It is attributed to affect-mind depression or to water and earth (local environmental) factors.

Biomedical correspondence: endemic goiter.

Medicinal therapy: Rectify qì and resolve depression; transform phlegm and soften hardness; fortify the spleen and eliminate dampness. Use variations of Depression-Overcoming Pill (越鞠丸 yuè jú wán), Four Seas Depression-Soothing Pill (四海舒郁丸 sì hǎi shū yù wán), or Sargassum Jade Flask Decoction (海藻玉壶汤 hǎi zǎo yù hú tāng). Analysis of goiter varies considerably. One modern analysis makes a fourfold distinction: qì depression and phlegm obstruction; phlegm bind and blood stasis; exuberant liver fire; and heart-liver yīn vacuity.

Patterns

Qì depression and phlegm obstruction (气郁痰阻 qì yù tán zǔ) can cause diffuse symmetrical lumps at the front of the neck that are soft to the touch and have smooth skin. These are accompanied by oppression in the chest, sighing, and scurrying pain in the chest and rib-side.

Medicinal therapy: Rectify qì and soothe depression; transform phlegm and disperse goiter. Use Four Seas Depression-Soothing Pill (四海舒郁丸 sì hǎi shū yù wán).

Phlegm bind and blood stasis (痰结血瘀 tán jié xuè yū) causes goiter characterized by persistent lumps that are hard and noded. There is oppression in the chest, poor intake of food, and stasis speckles or macules on the tongue.

Medicinal therapy: Rectify qì and transform phlegm; quicken the blood and disperse goiter. Use Sargassum Jade Flask Decoction (海藻玉壶汤 hǎi zǎo yù hú tāng).

Exuberant liver fire (肝火亢盛 gān huǒ kàng shèng) gives rise to soft smooth lumps with heat vexation, profuse sweating, rashness and agitation, baking heat in the face, bitter taste in the mouth, protruding eyeballs, tremors of the extremities, red tongue with yellow fur, and rapid stringlike pulse.

Medicinal therapy: Clear the liver and discharge fire; calm the liver and extinguish wind. Use Gardenia Liver-Clearing Decoction (栀子清肝汤 zhī zǐ qīng gān tāng).

Heart-liver yīn vacuity (肝心阴虚 gān xīn yīn xū) gives rise to soft smooth lumps accompanied by heart palpitation, heart vexation, reduced sleep, dry eyes, dizzy vision, tremor of the hands, emaciation and lack of strength, and a rapid fine stringlike pulse.

Medicinal therapy: Enrich and nourish yīn-essence; quiet the heart and emolliate the liver. Use Celestial Emperor Heart-Supplementing Elixir (天王补心丹 tiān wáng bǔ xīn dān) or All-the-Way-Through Brew (一贯煎 yī guàn jiān).