Modified Xiao Luo Wan for Thyroid Nodules and Tumors in TCM

Thyroid tumors are benign or malignant growths occurring in the thyroid. Benign tumors are generally thyroid adenomas; malignant ones are thyroid carcinomas. On palpation, the physician can feel thyroid nodules; some patients also have hoarseness and dysphagia.

In TCM, thyroid tumors belong to the category of ying liu (goiter tumors). TCM classifies ying liu into many types, such as blood ying, qi ying, water ying, earth ying, melancholy ying, flesh ying, polyp ying and stone ying. Among these, qi ying corresponds to simple goiter; flesh liu (or polyp ying) resembles thyroid adenoma, a benign tumor; stone ying is characterized by being "hard and immovable," consistent with the clinical features of thyroid carcinoma in modern medicine. Wang Tao wrote in the Wai Tai Mi Yao: "All water ying and qi ying can be cured; stone ying cannot be treated." This shows that ancient TCM already recognized the intractability of thyroid cancer.

I have an empirical formula for thyroid tumors, developed by adding herbs to Xiao Luo Wan. The prescription is: Xuan Shen (Scrophulariae Radix) 15 g, Sheng Mu Li (raw Ostreae Concha) 30 g (decoct first), Huang Yao Zi (Dioscoreae bulbiferae Rhizoma) 10 g, Zhe Bei Mu (Fritillariae thunbergii Bulbus) 12 g, Xia Ku Cao (Prunellae Spica) 15 g, Hai Fu Shi (pumice) 30 g, Xiang Fu (Cyperi Rhizoma) 12 g, Qing Pi (Citri Reticulatae Pericarpium viride) 10 g, Dang Gui (Angelicae sinensis Radix) 12 g, Hai Zao (Sargassum) 30 g, Kun Bu (Eckloniae/ Laminariae Thallus) 30 g, Chai Hu (Bupleuri Radix) 10 g, Hong Hua (Carthami Flos) 15 g, Fa Ban Xia (processed Pinelliae Rhizoma) 10 g, Hou Po (Magnoliae Cortex) 10 g, Shan Ci Gu (Cremastrae/Pleionis Pseudobulbus) 10 g. Decoct in water; one dose per day.

This formula softens hard masses and disperses nodules, reduces swelling and resolves phlegm, activates blood and resolves stasis, and soothes the liver and moves qi. It has good symptomatic effects on benign goiter or thyroid adenoma, and some adjunctive value in thyroid cancer. However, because it contains large amounts of marine products and because Huang Yao Zi and Zhe Bei Mu are also high in iodine, patients whom the doctor has instructed to limit iodine intake should not use it.

Herbs traditionally held by TCM to soften hard masses—Hai Zao, Kun Bu, Mu Li, Huang Yao Zi, Hai Fu Shi, Bei Mu and others—are all high in iodine. In fact, these herbs act mainly on the thyroid, whose chief function is to synthesize thyroid hormone (an organically bound iodine) from inorganic iodide. TCM used iodine-containing herbs for thyroid disease as early as the Han dynasty. The Shen Nong Ben Cao Jing explicitly records: "Hai Zao is bitter, salty, cold and non-toxic; it mainly treats ying liu qi and lumps below the neck."

Most marine products are similar to Hai Zao, but these high-iodine herbs are only appropriate for iodine-deficiency thyroid disorders. Using them for conditions like hyperthyroidism, where iodine intake must be controlled, backfires. Patients using such herbs and formulas should have thyroid function tests; if hyperthyroidism is present, these herbs and formulas must not be used.