Baihe Dihuang Pingkang Tang and the Author's Empirical Formula for Hyperthyroidism
Hyperthyroidism (hyperthyreosis) belongs in TCM to the pattern of yin deficiency with internal heat. This disease is caused by excessive production of thyroid hormone. Hyperthyroid patients have hypermetabolism and increased systemic excitability; clinically they show palpitations, hand tremor, a thickened neck, exophthalmos, irritability, increased eating frequency, and emaciation. Some patients also develop thyroid nodules because of hyperthyroidism.
TCM treatment of hyperthyroidism should mainly enrich yin and clear heat. Based on the TCM idea of treatment by pattern differentiation, Wang Xiaoping et al. added herbs to the classical formulas Baihe Dihuang Tang and Baihe Zhimu Tang to form Baihe Dihuang Pingkang Tang, treating 49 cases of hyperthyroidism with a total effective rate of 87.75%.
The basic formula of Baihe Dihuang Pingkang Tang is: Baihe (Lily bulb) 30 g, raw Dihuang (Rehmannia) 18 g, Zhimu (Anemarrhena) 10 g, Taizishen (pseudostellaria) 12 g, Xiakucao (Prunella) 15 g, fried Baishao (white peony) 12 g, Beishashen (Glehnia) 30 g, raw Muli (oyster shell) 30 g.
Baihe Dihuang Tang and Baihe Zhimu Tang come from the “Baihe, Huohuo, and Yinydu Poison Diseases” chapter of the Jingui Yaolue (Essential Prescriptions from the Golden Cabinet); both are formulas that nourish yin and clear heat. The Jingui Yaolue describes lily disease as follows: “In lily disease, the hundred vessels share one origin, and all become diseased. The patient wants to eat but cannot eat, is often silent, wants to lie down but cannot lie down, wants to walk but cannot walk; sometimes the appetite is good, sometimes one does not want to smell food; like cold without cold, like heat without heat; bitter mouth, red urine; no medicine works, and upon taking medicine one has violent vomiting and diarrhea; as if possessed by a spirit, the body seems normal, and the pulse is slightly rapid.” In TCM this condition is called a “spirit-mind disease,” analogous to neurological and psychiatric diseases in modern medicine.
Hyperthyroidism causes psychiatric symptoms such as irritability and palpitations; one function of thyroid hormone is to maintain nervous system excitability. When thyroid secretion is normal we maintain sufficient vitality, but when thyroid hormone is secreted excessively, the nervous system is in a state of overexcitation, making the patient restless and unable to sit or lie peacefully. These match the Jingui Yaolue description of lily disease.
Of course, these lily-disease symptoms can also be seen in depression, bipolar disorder, anxiety, menopausal syndrome, hysteria, and insomnia. So Baihe Dihuang Tang, Baihe Zhimu Tang, and other formulas for lily disease can be used not only for hyperthyroidism but also widely for the above diseases.
In clinical practice I have also encountered cancer patients with hyperthyroidism; while treating their cancer I also attend to their hyperthyroidism. I have found that combining Wuwei Xiaodu Yin (Five-Ingredient Toxin-Dispersing Drink) with Erzhi Wan (Two-Mature Pill) also has quite an effect on hyperthyroidism. But I have not, like scholars such as Wang Xiaoping, done statistical data, because I have encountered relatively few hyperthyroid patients and my treatment experience is scattered.
My common formula for hyperthyroidism is: Pugongying (dandelion) 30 g, Jinyinhua (honeysuckle) 30 g, Yejuhua (wild chrysanthemum) 10 g, Tiankuizi (semiaquilegia) 10 g, Zihuadiding (Viola) 10 g, Mohanlian (Eclipta) 30 g, Nüzhenzi (Ligustrum) 30 g. This formula is consistent in TCM treatment principle with Wang Xiaoping's Baihe Dihuang Tang: Wuwei Xiaodu Yin clears heat and resolves toxin, Erzhi Wan nourishes yin and tonifies the kidney; the two combined precisely enrich yin and clear heat.
For treating hyperthyroidism, combining Wang Xiaoping's empirical formula with mine may work even better, because this medication combination gives greater strength in enriching yin and clearing heat.