Traditional Chinese Medicine Approach To Hypothyroidism: International Journal of Complementary & Alternative Medicine
Traditional Chinese Medicine Approach To Hypothyroidism: International Journal of Complementary & Alternative Medicine
Submit Manuscript | http://medcraveonline.com Int J Complement Alt Med 2017, 5(1): 00142
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Traditional Chinese Medicine Approach to Hypothyroidism ©2017 Malikov et al. 2/7
alongside with Conventional Western Medicine. Most hospitals day TCM practice. The treatments may vary from one physician
include departments of complementary medicine which offer to the next, but there are certain consistent features which will
acupuncture treatment and herbal medicine. The acupuncture be discussed mainly in regards to management of patients with
in United States is most often associated with pain management hypothyroidism. The clinical manifestations of hypothyroidism
and builds on a ‘conventional’ interpretation of how the body are associated with consumptive deficiency, edema, goiter and
functions. other signs and symptoms according to the TCM differentiations
and pathogenesis.
Traditional Chinese medicine is every bit as logical and
systematic as Conventional Western medicine and is based on a Etiology and Pathogenesis
different understanding of reality. TCM has for centuries made
use of the same basic concepts like Qi and the balance of Yang and The hypothyroidism, as described in Traditional Chinese
Yin to explain various universal phenomena. Medicine texts, is classified mainly as the deficiency disorder. The
diagnosis must be differentiated and often varies from case to
Although it is difficult to guess when humans first started case depending on the individual patient’s clinical presentation. It
using herbs as medicine; the Traditional Chinese Medicine, as a is important to understand that hypothyroidism is the condition
form of medicine practice today, dates 4000–6000 years back in arising due to the chronic deficiency of one or more vital
time. While acupuncture is the best known modality of TCM in the substances of the body: Qi, Blood, Yang, Yin and Essence. This is
West, this medicine is by no means is just limited to acupuncture. a systemic disorder which may start with general Qi deficiency
Chinese medicine makes great use other therapeutic modalities and affect all organ systems over the long period of disease
like herbal remedies, acupuncture, auricular acupuncture, progression. The Spleen, Kidney and Heart are three primary
cupping, Tui Na; as well as Tai Ji and Qigong as forms of physical organs involved in the pathogenesis of hypothyroidism. The Lung
therapy. and Liver are also affected in an indirect manner. Manifestations
of various deficiencies are diverse and can affect a wide
Differences between TCM and Conventional Western variety of physiological processes. The precipitating causes of
Medicine hypothyroidism include constitutional factors, diet, overexertion,
In Conventional Western schools of medicine body is emotional stress, trauma, chronic debilitating illness, as well as
studied as a sum of its parts, and every organ system of the the side effects of medical treatment. Patterns of deficiency will
body is judged and treated separately. Hospitals are specialized be differentiated by aspect of underlying deficiency of Yin, Yang,
by different departments associated with the diagnoses and Qi or Blood in regards to the deficient organ, or a combination of
treatment of different organ systems: one for the cardiovascular organs, involved in pathogenesis: Spleen, Kidneys, and Heart.
patients; another for the endocrinology; yet another for surgery. The clinical manifestations of the hypothyroidism emerge
Traditional Chinese Medicine is holistic, where the body is treated gradually as the result of slowing metabolism and depletion of
as a ‘whole,’ and every part of the body is seen as a reflection of the body’s Qi which develops into the Yang deficiency. As the Yang qi
wider context. A particular body part is referred to only in relation deficiency becomes more severe it begins to fail in its functions of
to the whole body, and the body must also be seen as intimately warming, motivation, and transformation, resulting in the decline
connected with the spirit and the surrounding environment in of multiple organ functions and classical set of symptoms often
which the patient lives before a doctor of TCM can understand seen in patients with clinical hypothyroidism. The initial stage of
how an illness has arisen and how it should be addressed. the disease is equivalent to the subclinical hypothyroidism, and
marked mainly by the Spleen Qi deficiency and is often associated
Thyroid Deficiency in TCM with its symptoms. As the disease remains untreated the Ming
Thyroid disorders are some of the most common clinically men fire begins to fail to compensate the Spleen Yang deficiency.
encountered endocrine disorders worldwide. Until the resent As the result more, Kidney Yang deficiency symptoms arise and
discovery of the more accurate understanding of the thyroid the Spleen Yang deficiency symptoms worsen, marking the stage
anatomy and its role in human physiology as a major endocrine of clinical hypothyroidism. Thus, Yang deficient Kidney will fail
organ, as well as the introduction of new imaging techniques to warm the Spleen Yang Qi, resulting in severe Yang depletion
and serum thyroid function tests into the modern medical in both organs. When Spleen Qi is deficient the generation of the
practice; the ancient physicians were limited to few general Source Qi and Blood is inadequate, resulting in Kidney Essence
symptoms and basic physical evaluation to diagnose disorders depletion. It may be years before the Kidney Ming men fire
related to the thyroid gland. The diagnosis in the Traditional begins to fail to warm the Heart Yang, which will lead to Heart
Chinese Medicine (TCM) pattern was limited to detection of Yang deficiency. Untreated Yang deficiency will result in the
common signs and symptoms often seen in hypothyroidism and failure of fluids metabolism and will cause in the excess water to
palpation of neck nodules in the area of the thyroid gland. In overflow towards the Heart and lead to cardiac dysfunction and
modern TCM practice objective measurements, such as thyroid associated symptoms commonly seen in patients with advanced
hormone levels, TSH values and the presence of autoreactive stage of overt hypothyroidism. Even though, it is extremely rare to
immunoglobulins, can clarify the nature of the disease and give encounter patients with severe hypothyroidism in the developed
a clue to a various herbal therapeutic approaches that might countries due to proper diet, improved screening, timely
be effectively applied in the treatment of hypothyroidism. Even diagnosis and treatment of the disease, the hypothyroid patients
though, the clinical management of hyperthyroidism cases has who remain untreated may have about ten to fifteen years before
been of a greater interest in the Traditional Chinese Medicine their basic body functions will start failing.1 Thus, the severe Yang
field, the hypothyroidism is no less prevalent in the modern deficiency will inevitably result in the complete depletion and
Citation: Malikov D (2017) Traditional Chinese Medicine Approach to Hypothyroidism. Int J Complement Alt Med 5(1): 00142.
DOI: 10.15406/ijcam.2017.05.00142
Copyright:
Traditional Chinese Medicine Approach to Hypothyroidism ©2017 Malikov et al. 3/7
devastation of the Ming men fire which will manifest as a number exertion, is associated with general Qi deficiency and suggests
of life threatening functional failures. Note that the Kidney Yang the involvement of Spleen in early pathogenesis of the disease.
and Ming men fire refers to the fire at the gate of vitality and will The ‘leg Qi’ and atrophy disorder may arise as the result of
be used interchangeably in this report. either dampness or chronic Spleen deficiency. This pattern is
discussed in the Essential Questions which says “With exposure
Factors Contributing To the Disease to dampness over a period of time, the muscles and flesh will
Common contributing factors of the thyroid deficiency be invaded; this will lead to insensitivity and flesh atrophy” and
include: improper diet, iatrogenic and constitutional factors and “When there is illness in the Spleen it fails to transport body fluids
overexertion. for the Stomach. The four limbs do not receive the nourishment of
water and grain and therefore become weak. There is no free flow
Improper diet through the vessel-pathways and there is no qi to engender the
sinews, bones and muscles which therefore cannot function [5].
Irregular dietary intake, excessive consumptions of raw and
Thus, Spleen Qi deficiency will also lead to development of such
cold foods, like bok choy, will injure Spleen Yang Qi [4]. Chronic
symptoms as decreased appetite, muscle weakness, delayed reflex
iodine and selenium deficiency will also contribute to the rise of
time, anorexia, distention and bloating especially in the latter
hypothyroid state, previously believed to be the ‘evil Qi’ and sand
stage of the disease. Chronic Spleen deficiency will cause blood
in the water of springs and rivers, especially in the mountainous
deficiency and anemia, and also result in Qi stagnation leading to
regions.
muscle spasms, cramps, myalgia and even ataxia.
Iatrogenic factors Cold intolerance
Long term use or unusually high doses of bitter and cold
It is the most definitive symptom of the thyroid deficiency. Qi is
herbs, emetics, and purgatives, have direct impact on Spleen and
yang and possesses a warming quality. Qi maintains and regulates
Stomach Yang Qi, and may impair their functions of transportation
the body temperature. Aversion to cold is classically associated
and transformation of food and fluids.
with the deficiency in Yang qi, which fails to adequately warm the
Constitutional factors body. This symptom may often be missed in the early stages of
the disease because the patient usually starts by compensating
Constitutional factors include congenital deficiency and behavior: avoiding the cold by dressing warmer and increasing
prenatal malnourishment, both of which may play role in the room temperature. As the body’s Yang qi weakens the internal
development of thyroid deficiency. In Women the depletion of cold starts accumulating, this phenomenon is also known as Yang
Essence and Blood from repeated births will directly drain the deficiency generating internal cold, which may lead to slowing
Kidney, Liver and Spleen. or even freezing of physiological processes. Sweat is generated
via the transformation of fluids by the Spleen and Kidney Yang
Overexertion
qi. The deficiency in Yang qi consequently results in hypohidrosis
Overtaxation and exhaustion of Kidney Yang by physical, (partial lack of sweating) and consequently myxedema (internal
mental or sexual activities is also one of contributing factors of fluid accumulation) due to the failure of Qi to open the pores and
hypothyroidism. It is apparent that hypothyroidism is the result regulate the fluid metabolism or cold pathogen closing the pores
of both Qi and Blood deficiency which gradually develops into the shut. Usually patients will complain of the general Qi deficiency
Yang and eventually Yin deficiency. symptoms like pallor, fatigue, lethargy and muscle weakness,
edema, deficient constipation and indigestion, depression,
Clinical Picture impaired memory and slow speech. Tongue and pulse will reflect
Hypothyroidism, like most other endocrine disorders, develops the underlying Qi deficiency and is often pale, swollen with
gradually over the period of several years and even decades. Many teethmarks, with thin slippery coating. The pulse will be deep,
symptoms can erroneously be attributed to general environmental forceless, and slow but regular, suggesting Yang deficient cold.
factors and natural aging. Patients often seek medical help when It is important to differentiate the aversion to cold and the
the symptoms begin to interfere with their daily activities. lack of sweat in hypothyroidism to Wind-Cold invasion. Wind-
As the disease progresses the symptoms will worsen and more Cold is an external pathogen invading the body and resulting in
severe symptoms may manifest. Even though, the symptoms of an ‘excess’ condition which will not be alleviated by warm blanket
hypothyroidism come in a great variety they all arise from the or more clothes.
core pathogenesis of the deficiency in Yang Qi that is failing to Constipation
warm, defend, consolidate and transform.
Constipation is another major symptom of hypothyroidism.
atigue and weakness Diminishing Yang will eventually result in internal deficient
This is the earliest of symptoms of subclinical hypothyroidism cold accumulation in the Large intestine causing reduced bowel
while the thyroid deficiency may not be apparent. It is very motility and obstruction. Other gastrointestinal symptoms may
difficult to diagnose the subclinical hypothyroidism this early include cold epigastric or abdominal pain and spasms, which are
without the serum TSH analysis, and even then the western relieved by warmth and pressure, as well as poor appetite and
physician will often postpone the treatment until more severe indigestion, accompanied by deep slow pulse.
symptoms appear. In TCM fatigue and weakness, especially on
Citation: Malikov D (2017) Traditional Chinese Medicine Approach to Hypothyroidism. Int J Complement Alt Med 5(1): 00142.
DOI: 10.15406/ijcam.2017.05.00142
Copyright:
Traditional Chinese Medicine Approach to Hypothyroidism ©2017 Malikov et al. 4/7
Citation: Malikov D (2017) Traditional Chinese Medicine Approach to Hypothyroidism. Int J Complement Alt Med 5(1): 00142.
DOI: 10.15406/ijcam.2017.05.00142
Copyright:
Traditional Chinese Medicine Approach to Hypothyroidism ©2017 Malikov et al. 5/7
acrid, and somewhat dry in nature. Gan Jiang (zingiberis rz) generative and transforming processes of all other organs, chronic
is one of such herbs used in the treatment of most patterns of Kidney Yang deficiency will result in Spleen Yang deficiency. Water
hypothyroidism. Other frequently used herbs are Fu Zi (aconiti and dampness accumulation, in the late stages of hypothyroidism,
rx lateralis) and Rou Gui (cinnamomi cortex), which can be will impair the Yang Qi from ascending the clear and descending
combined with herbs that strengthen the Spleen and augment the turbid, which may obstruct the sensory orifices. Thus, overtly
the Qi, like Huang Qi (astragali rx), Ren Shen (ginseng rx), and hypothyroid patients often complain of impaired hearing, heavy
Bai Zhu (atractylodis macrocephalae rz) [7]. sensation in the head, dizziness ranging from lightheadedness
and positional vertigo to severe dizziness even when lying down.
Qi and blood deficiency The patient also feels weakness and instability in posture which
It is said that the ‘Qi is the commander of Blood, and Blood is sometimes requires a conscious effort to maintain.
the mother of Qi [8]. Qi and Blood are mutually connected, ‘when When pathogenic water ascends and overflows the Heart, it
Qi moves the Blood follows,’ Blood in turn nourishes the Qi, and causes palpitations and when it overflows the Lungs and disrupts
thus tonifying one will have the indirect effect on the other. Low the Qi, it causes cough and dyspnea. Clinical manifestation of
Red Blood cell count and hypoxia are clinical manifestations of Heart and Kidney Yang deficiency are marked by palpitations,
chronic hypothyroidism associated with Qi and Blood deficiency chest congestion, angina, lassitude, lethargy, aversion to cold, cold
which is marked by fatigue, weakness, slowness, palpitations, extremities, absence of sweating, soreness and weakness of the
sallow complexion, amenorrhea, pale tongue and choppy pulse. lower back and knees, hoarse voice, slow response to stimuli, and
Menorrhagia is a common presentation of clinical severe systemic myxedema. The pale or dark swollen or flabby
hypothyroidism, occasionally accompanied with recurrent pain, tongue with tooth marks, the white, slippery tongue coating,
or restless fetus disorder. From the Traditional Chinese medicine and the deep, slow, thin, forceless, irregular pulse are signs of
perspective the pathogenesis is associated mainly with the Yang deficiency with internal retention of pathogenic water and
complex of functional system of the Liver, Chong Mai, and Uterus, dampness.
known as the ‘sea of Blood [8]. If the Liver Blood is deficient, it a. Herbal treatment
is unable to rise and nourish the head, resulting in dizziness,
vertigo, and impaired vision. When the Sea of Blood is empty the A variation of Zhi Gan Cao Tang (Prepared Licorice Decoction)
menstrual cycle is typically irregular with a scanty flow; however, in combination with Zhen Wu Tang (True Warrior Decoction) can
‘when the Blood becomes disordered, menorrhagia may also be used to warm and unblock the flow of the Heart Yang, warm the
occur [9]. The tongue is usually pale and pulse is thin and wiry; Kidney and promote urination in overtly hypothyroid patients.
choppy pulse may be felt in the condition of Blood stasis.
Depletion and devastation of yang
a. Herbal treatment
If the condition of debilitated Yang and exuberant Yin with
Use modified Shi Quan Da Bu Tang (All-Inclusive Great cold in the interior is left untreated, it will eventually lead to Yin
Tonifying Decoction) to warm and tonify Qi and Yang and repelling Yang, and result in ‘floating Yang’ syndrome. This pattern
stimulate the production and transformation of Blood. of devastated Yang Qi due to its chronic depletion is associated
with myxedema crisis, cold inversion pattern, and characterized
Spleen and kidney yang deficiency by pale and dusky complexion, dizziness and blurred vision, icy-
The difference between the deficient cold and external excess cold extremities, shallow and weak respiration, flaccid and weak
cold is that; cold due to Yang deficiency, may be alleviated by muscles, somnolence, or even myxedema coma; dusky pale tongue
simply wearing more clothing, where as cold sensation and chills and minute almost imperceptible pulse. In severe cases the Yang
associated with an exterior pathogen cannot, even by increasing will float and the patient may break into a strong profuse sweat.
the room temperature. The symptoms like lassitude, lethargy a. Herbal treatment
and withdrawal into oneself, aversion to cold, cold extremities,
soreness and weakness of the lower back and knees, a flabby pale Use Si Ni Jia Ren Shen Tang (Frigid Extremities Decoction
tongue with white moist coating, and deep slow and forceless with Ginseng) to warm and rescues the devastated Yang from
pulse (especially at the right proximal position) seen in severe collapse, reverse peripheral frigidity, and to warm the Middle jiao
clinical hypothyroidism are some of the common manifestations to transform turbidity.
of Spleen and Kidney Yang deficiency.
Treatment of Hypothyroidism with Acupuncture &
a. Herbal treatment Moxibustion
You Gui Wan can be used to treat this Yang deficiency pattern Hypothyroid patients are often deficient in Yang and Qi,
of progressive clinical hypothyroidism, and its primarily focus is long needle retention or strong acupuncture stimulation may
tonification of the Kidney Yang, because the Kidneys’ Ming men drain Qi, tonification techniques are highly advised and the use
fire is the source Yang at the gate of vitality. moxibustion is encouraged where applicable. It is also important
Heart and kidney yang deficiency to keep in mind, that as a general rule, Back-shu points tonify the
Zang organs and regulate the Fu organs, while Front-mu points
Kidney is the root of the body’s Yang Qi, which supports the sedate the Fu and regulate the Zang.
Citation: Malikov D (2017) Traditional Chinese Medicine Approach to Hypothyroidism. Int J Complement Alt Med 5(1): 00142.
DOI: 10.15406/ijcam.2017.05.00142
Copyright:
Traditional Chinese Medicine Approach to Hypothyroidism ©2017 Malikov et al. 6/7
Dan Xi Xin Fa (Dan -xi’s Heart Methods) recommends: “For Treatment Protocols
great disease due to vacuity desertion which is Yin vacuity, use
Ai Ye (artemisiae argyi folium) moxa at the Dan Tian (Ren 6-4) in The key points for the treatment of signs symptoms and the
order to supplement Yang. When Yang grows, Yin is lengthened root cause of clinical hypothyroidism will be discussed in a great
[also grows] [10].” detail in this section. The summary of these points is presented
in Table 1.
Table 1: Nine key points for treatment of hypothyroidism.
Du4 (Ming Men) St36* (Zu San Li) UB17 (Ge Shu) Li4* (He Gu)
Ren4 (Guan Yuan) Sp6* (San Yin Jiao) UB23 (Shen Shu) P6 (Nei Guan)
Ren6 (Qi Hai)
(*) – Points from the song of ‘Nine Needles which Revive the Yang’.
Several treatment plans are presented below. The plans are strength, skin dryness, menstrual cycles, weight, energy and
similar in construction, and can be used independently, depending water metabolism.
on which modality a practitioner prefers, or which therapy the
Despite great progress made in medical technologies, all
patient would best tolerate.
practitioners should strive to make physical and psychological
Supplementary Points for Various Patterns contact with patients, to acquire more complete understanding of
functional disorders, without relying on conventional techniques
For Spleen Qi Deficiency and Spleen Yang Deficiency along. This diagnostic approach, however, requires the sufficient
(Subclinical and Clinical Hypothyroidism) add Ren12 (Zhong medical knowledge to interpret and experience to correlate such
Wan). information.
In Qi and Blood Deficiency (Chronic Clinical Hypothyroidism According to records of accumulated knowledge generated by
with cognitive and psychoemotional deficiencies) add Du20 (Bai the sages of Traditional Chinese Medicine over several millennia,
Hui) [11]. through close observation and experience of treatment of patterns
For Spleen and Kidney Yang Deficiency (Chronic Clinical closely associated with hypothyroidism, it is understood that this
Hypothyroidism) with stifling sensation chest and speech is a condition of true deficiency in Yang Qi of the body. The etiology
impairment add Ren12 (Zhong Wan) and Ren17 (Shan Zhong). of hypothyroidism is rooted in improper diet, overexertion,
or environmental factors. Several patterns were discussed to
In Heart and Kidney Yang Deficiency (Overt Hypothyroidism) reflect the pathogenesis of the thyroid deficiency and explain
use Ren17 (Shan Zhong) in addition to a ‘Guest-Host’ combination the mechanism of the progression of the disease from Spleen Qi
of Sp3 (Tai Bai)-Yuan-host and St40 (Feng Long)-Luo-guest deficiency, to development of Spleen, Kidney and eventually Heart
to resolve Phlegm due to Spleen deficiency to treat pleural Yang deficiency, and further involvement of the Lungs and Liver,
and pericardial effusions, coronary artery disease due to and eventually exhaustion and collapse of Yang, finally resulting
hyperlipidemia and Qi-Phlegm goiter. in coma as the condition continues to worsen.
In Depletion and Devastation or Collapse of Yang Qi (Myxedema In general, the Traditional Chinese Medicine management of
Crisis) add Du20 (Bai Hui) with Ren17 (Shan Zhong). overtly hypothyroid patients in the modern practice will often
be complimentary to standard Conventional Western hormone
For Abandonment Disorder (Myxedema Coma) add Du20 (Bai
replacement therapy. When treating a hypothyroid patient, it
Hui) and needle Du26 (Ren Zhong), to resuscitate the patient
is important to always address the root cause of the thyroid
from acute syncope. Most hypothyroid patients became comatose
deficiency. The herbal and acupuncture therapy can often be used
when their respiration fails, thus it is important to keep patient
in conjunction with the hormone replacement therapy to achieve
conscious until the paramedics arrive.
greater results and to subdue the adverse effects of levothyroxine.
Auricular Acupuncture It is essential to remember, however, that all herbal preparations,
including tonifying formulas have very specific indications and
Few of the points that can be added to acupuncture treatment associated effects, and should never be used thoughtlessly.
protocols for hypothyroid patterns:
The practitioner must be able to most efficiently help to
General points for hypothyroidism use ‘Endocrine’, ‘Thyroid’, promote functional balance and revitalize the patient.
‘Neurogate’, ‘Subcortex.’
Exercise and proper nutrition are also helpful modalities
Conclusion and Review to support the treatment of hyperthyroidism. As always, it is
important to always provide a patient, caring treatment, and to
It is clear, that the thyroid is one of the most important
offer behavioral recommendations about lifestyle factors that
endocrine glands that produce hormones to regulate metabolism
may benefit the patients or consume essence and aggravate the
of the whole body including: brain, respiration, cardiovascular
deficiency in the body.
and nervous system functions, body temperature, muscle
Citation: Malikov D (2017) Traditional Chinese Medicine Approach to Hypothyroidism. Int J Complement Alt Med 5(1): 00142.
DOI: 10.15406/ijcam.2017.05.00142
Copyright:
Traditional Chinese Medicine Approach to Hypothyroidism ©2017 Malikov et al. 7/7
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amounts of thyroid hormones. Human body poses mechanisms Medicine. Bridge Publishing group, USA, P. 66.
of self-restoration, and a caring physician should attempt to help
7. Bensky D, Clavey S, Stoger E (2004) Chinese Herbal Medicine - Materia
the patient by restoring the thyroid glands function, to help the
Medica. (3rd edn), Eastland Press, Inc., Seattle, USA.
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8. Cheng X (1999) Chinese Acupuncture and Moxibustion, Revised
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Citation: Malikov D (2017) Traditional Chinese Medicine Approach to Hypothyroidism. Int J Complement Alt Med 5(1): 00142.
DOI: 10.15406/ijcam.2017.05.00142