Baitouweng Wan (Pulsatilla Pill) for Treating Goiter
The Qing-dynasty medical compendium Yibu Quanshu (Complete Records of the Medical Section) contains a formula called "Baitouweng Wan" for treating "qi goiter" (qi ying) and "qi tumor" (qi liu)—conditions corresponding to goiter in modern medicine. The composition is: Radix Pulsatillae (baitouweng) 5 qian (15 g); Thallus Eckloniae (kunbu, washed) 3 qian 5 fen (10.5 g); Cortex Cinnamomi (rougui) 1 qian (3 g); Medulla Tetrapanacis (tongcao) and Sargassum (haizao, washed), each 2 qian 5 fen (7.5 g); Fructus Forsythiae (lianqiao) and Radix Scrophulariae (xuanshen), each 2 qian 7 fen (8 g); and Ampelopsis root (bailian) 2 qian (6 g).
To prepare the pills, all the above herbs are ground together into a fine powder; refined honey is used as an excipient to form pills the size of a parasol tree seed (about the size of a soybean). Five pills are taken each time, washed down with wine. Garlic, wheat products, raw scallion, pork, and fish are to be avoided. The formula may also be decocted; at the doses listed above, one decoction is taken daily, morning and evening.
The formula's actions are to soothe the liver and clear heat, resolve phlegm, and soften hard masses. It treats qi goiter and qi tumors on the neck. In this formula, Sargassum, Ecklonia, Scrophularia, Forsythia, and Ampelopsis are all commonly used in Chinese medicine to disperse nodules and reduce swelling, and are basic herbs for treating ulcers and boils. Sargassum and Ecklonia soften hard masses and disperse nodules; Scrophularia cools the blood and disperses nodules; Forsythia clears heat and disperses nodules; Ampelopsis clears heat and resolves toxins, disperses nodules and reduces swelling, and promotes wound healing and tissue regeneration.
Pulsatilla's main action is to clear heat and resolve toxins, cool the blood, and stop dysentery; modern pharmacology shows it has antibacterial and anti-inflammatory effects. Cinnamomum (gui xin, the inner bark of cassia) warms yang and dispels cold and "travels through the twelve regular meridians." In this formula it both moderates the bitter-cold nature of the heat-clearing, toxin-resolving herbs and unblocks the meridians to disperse nodules. Tetrapanax mainly promotes diuresis and reduces edema; in TCM terms, it opens an exit for the pathogen through urination.
Viewed as a whole, the formula's approach is comprehensive. Qi goiter and qi tumor correspond to simple goiter in modern medicine, a benign condition. They feel soft on palpation with clear borders, and their size fluctuates with the patient's emotional state—hence the ancient name "qi goiter" or "qi tumor." Thyroid carcinoma corresponds to the ancient "stony goiter" (shi ying), which feels hard and immovable. Therefore this formula is not for thyroid cancer but for simple goiter.