Appreciation of a Case: Fu Canbing Curing a Goiter (Thyroid Adenoma) by Resolving Phlegm and Softening Hardness
Fu Canbing was born in 1917 in Jiangjin County, Sichuan Province. He was a chief TCM physician who began studying Chinese medicine under his father, Fu Songtao, in childhood. With more than 50 years of clinical experience, he served as director and later as advisor of the Sichuan Provincial Institute of Traditional Chinese Medicine.
During his lifetime, Master Fu once cured a patient with thyroid adenoma (the TCM disease name is goiter, yingliu). The patient, Wu, was a 67-year-old woman who first consulted Master Fu on June 12, 1981. At the visit, there was an oval mass in the thyroid region on the left side of the neck, about 2 cm x 3 cm in size. The overlying skin color was unchanged, the mass was soft, non-tender, smooth, and well-demarcated, and it moved up and down with swallowing. She was accompanied by irritability and a bitter taste in the mouth, palpitations on exertion, numbness of both hands, and a sensation of phlegm obstructing the throat. Her appetite was poor and her stool was unformed. The tongue was red with little fluid, the edges were purplish, the coating was slightly yellow and greasy, and the pulse was fine, wiry, and slippery. Western diagnosis was thyroid adenoma; TCM pattern differentiation was congealed phlegm-fire with blockage of qi and blood.
Master Fu planned treatment along the lines of clearing heat and resolving phlegm, softening hardness and dispersing nodules, and moving qi and invigorating blood.
The first-visit prescription was as follows: Muli (oyster shell) 24 g, Xuanshen (Scrophularia) 15 g, Chuanbeifen (Fritillaria powder) 6 g (taken infused), Haizao (Sargassum) 24 g, Jinyinhua-teng (Lonicera stem) 24 g, Lianqiao (forsythia) 15 g, Niubangzi (burdock) 15 g, Xiangfu (Cyperus) 9 g, Danshen (Salvia) 15 g, Chishao (red peony) 15 g, Yiyiren (Coix seed) 24 g, Xiakucao (prunella spike) 24 g.
Thereafter, using the above as the base formula, he added Gualou (Trichosanthes fruit) to clear heat and resolve phlegm, or included Yujin (Curcuma) and Chaihu (Bupleurum) to soothe the liver and relieve constraint. She took a total of 56 doses. By August 28 of that year, the adenoma had shrunk to 0.7 x 1.2 cm; palpitations, bitter taste, irritability, and numbness of both hands had all disappeared, appetite had improved, and the stool was normal. In the interim she caught a cold; during the cold, Xiangfu and Yiyiren were removed, Jingjie (Schizonepeta) and Fangfeng (Saposhnikovia) were added to dispel wind and release the exterior, and Jiegeng (Platycodon) and Lugen (reed root) were added to clear heat, expel phlegm, and soothe the throat.
On September 4, at her follow-up visit, the cold had resolved and the adenoma had shrunk further to only 0.5 x 0.8 cm, with no other discomfort. The tongue was red with a yellow greasy coating and the pulse was wiry and slippery. Since the formula was proving effective, the principle should be maintained unchanged, with slight adjustment.
The prescription was as follows: Muli 24 g, Xuanshen 15 g, Chuanbeifen 6 g (taken infused), Lianqiao 12 g, Jinyinhua-teng 24 g, Haizao 30 g (washed free of salt), Jiegeng 9 g, Lugen 24 g, Xiakucao 30 g.
After the patient continued taking 18 more doses, the thyroid adenoma had completely resolved. She then continued the last prescription for consolidation, and there was no recurrence thereafter.
Thyroid adenoma is a benign tumor arising from thyroid follicular cells. It is a round or oval mass, usually confined within the capsule of one thyroid lobe, solitary, firm in consistency, well-demarcated, and non-tender, with a complete outer capsule. It is not adherent to surrounding tissue and can move up and down with swallowing. The mass grows slowly; a few cases may become malignant, and many cases need no treatment. But in this patient, because the adenoma had already produced a series of symptoms and was affecting her mood, treatment was required.
In TCM, thyroid adenoma belongs to goiter. Because it is mobile, it does not belong to "stony goiter" (shiying, i.e., thyroid cancer), the hardest-to-treat type of goiter. TCM treatment of such tumors mainly centers on softening hardness and dispersing nodules; the representative formula is Xiaoluo Pill (composed of Xuanshen, Beimu, and Muli). Master Fu's medication in this case was precisely based on this formula, augmented with heat-clearing and detoxifying, hardness-softening and nodule-dispersing, and blood-activating and stasis-resolving herbs. His treatment plan was methodical and the effect was remarkable.