Huoxue Sanying Tang (Blood-Activating Goiter-Scattering Decoction) for TCM Treatment of Enlarged Thyroid
Huoxue Sanying Tang is from the 23rd essay "Goiter and Nodules" in volume 2 of Waike Zhengzong (Orthodox External Medicine) by the Ming-dynasty physician Chen Shigong. Its composition: Baishao (Paeonia alba), Danggui (Angelica), Chenpi (Citri Reticulatae Pericarpium), Chuanxiong (Chuanxiong Rhizoma), Banxia (Pinellia), Shudi (prepared Rehmannia), Renshen (Ginseng), Fuling (Poria), Mudanpi (Moutan Cortex), each one qian (one qian about 3 g); Honghua (Carthami Flos), Kunbu (Eckloniae/Thallus Laminariae), Muxiang (Aucklandiae Radix), Gancao Jie (Glycyrrhizae Caulis nodus), each five fen (about 1.5 g); Qingpi (Citri Reticulatae Pericarpium viride), Rougui (Cinnamomi Cortex), each three fen (about 1 g). Preparation: two measures of water, decoct to eight-tenths; dose according to whether the disease is above or below; take after drinking a small cup of wine.
According to Waike Zhengzong, Huoxue Sanying Tang treats goiter-nodules that have formed, slowly enlarged over time, with no pain or itching, in patients of qi and blood deficiency. What the ancients called goiter-nodules mostly corresponds to what modern medicine calls thyroid nodules or thyroid tumors; thyroid tumors are mostly benign, with a few being thyroid cancer.
Thyroid tumors are extremely common. How common? Most adults who die of natural causes have thyroid tumors at death. Thyroid tumors do not grow fast; even thyroid cancer is a relatively favorable malignant tumor, with a high ten-year survival.
Among adults in today's cities, many have thyroid nodules found at checkups; some are not visible on the surface, some are. Those that are visible on the surface or palpable on the doctor's physical exam were called goiter-nodules in ancient times.
Goiter and nodule are actually two conditions — ying and liu — that simply both grow on the neck. How to tell them apart? Waike Zhengzong says: "Ying is yang: it is red and raised, or small-stalked and pendulous; liu is yin: it is white and diffusely swollen, with no pain or itching, unnoticed by the person."
The ying here resembles acute thyroiditis in modern medicine, caused by bacterial, fungal, viral, or parasitic infection; it has an abrupt onset, presenting mainly as thyroid enlargement with spontaneous pain, tenderness, referred pain, fever, and local redness and swelling. What about liu? It corresponds to all thyroid tumors other than acute thyroiditis; the skin over a liu matches normal skin color, with no redness, swelling, heat, or pain.
Huoxue Sanying Tang treats the liu (not the ying) of goiter-nodules; in TCM external-medicine classification this belongs to the yin pattern, and the original text already specifies it for qi and blood deficiency. The formula uses quite a few qi-and-blood-tonifying herbs; it is basically Bazhen Tang (Eight-Treasure Decoction, with one herb, Baizhu, removed) plus additions. Bazhen Tang is the representative TCM formula for simultaneously tonifying qi and blood; it combines the blood-tonifying Siwu Tang (Four-Substance Decoction: Shudi, Chuanxiong, Danggui, Baishao) and the qi-tonifying Sijunzi Tang (Four-Gentleman Decoction: Renshen, Baizhu, Fuling, Gancao).
Chen Shigong considered goiter-nodules to be caused by blood stasis and phlegm turbidity. Waike Zhengzong says: "The goiter-nodule ailment arises not from a binding of yin-yang righteous qi, but from blood stasis in the five zang and stagnation of turbid qi and phlegm." So treatment should combine activating blood and resolving stasis, dissipating phlegm and scattering nodules, and moving qi and reducing swelling. In Huoxue Sanying Tang, Mudanpi and Honghua activate blood and resolve stasis; Banxia and Kunbu soften hardness and scatter nodules while also dispelling phlegm; Chenpi, Muxiang, and Qingpi move qi and reduce swelling; Rougui warms yang and scatters nodules. The result is a compound that simultaneously supports righteous and dispels evil, a good formula for goiter-nodule patients of the qi-blood deficiency type.
To this day, our approach to tumor formulas still cannot escape Chen Shigong's principle of combining righteous support with evil dispelling, and evil dispelling still relies on familiar moves like activating blood and resolving stasis, softening hardness and scattering nodules, and moving qi and reducing swelling. One point to note: when using this formula for thyroid tumor patients, do not have them drink wine afterward, because alcohol promotes tumor growth. Also, this formula contains Kunbu (kelp), an iodine-rich herb; thyroid tumor patients whom the doctor has told to avoid iodine should have the Kunbu removed.