“Sihai Shuyu Wan” (Four Seas Sanity-Restoring Pill) for Hyperthyroidism and Benign Goiter

Nowadays, more and more patients are found on physical examination to have thyroid enlargement or thyroid nodules, and many people worry unduly because of thyroid enlargement. In fact, most thyroid nodules found on physical examination are benign, are very unlikely to become malignant, and need not cause excessive worry.

Benign goiter belongs in TCM to "qi ying" (qi goiter), mostly seen at the Adam’s apple, with qi congealed like a sac; the mass grows or shrinks with joy and anger, shrinking when the mood is relaxed and enlarging when the person is irritable. Traditional TCM holds that this disease is caused by qi stagnation and phlegm congelation, so the principle for treating "qi ying" is to move qi and transform phlegm, dissipate nodules and dispel goiter.

Yangyi Daquan (Complete Compendium of Surgery) contains a formula, "Sihai Shuyu Wan", which is the representative formula for treating "qi ying". The formula is composed of: Qingmuxiang (Aristolochia debilis) five qian (15 g), Chenpi (tangerine peel) three qian (9 g), Haige Fen (clam shell powder) three qian (9 g), Haidai (kelp) two liang (60 g), Haizao (Sargassum) two liang (60 g), Haipiaoxiao (cuttlebone) two liang (60 g).

The preparation and administration method is: grind all the above herbs together into a very fine powder, and make into pills the size of a parasol tree seed; take 2–3 times a day, 30 pills each time (about 6–9 g), with boiled water. Alternatively, a decoction may be prescribed according to the original ratio, taken twice a day, morning and evening. Today this formula is mostly used to treat goiter, thyroid adenoma, thyroiditis and hyperthyroidism presenting with "qi ying" symptoms.

This formula has an outstanding effect in treating iodine-deficiency thyroid disease, because the "four seas" used in the formula are four marine products with a very high iodine content and an iodine-supplementing action; doctors therefore warn that thyroid patients who should avoid iodine should not use this formula. Together with the qi-moving and nodule-dissipating actions of Chenpi and Muxiang, these six herbs combined have a very good goiter-dispersing and nodule-resolving effect.

Edible salt in China is now basically iodized salt, so iodine-deficiency goiter is not as common or severe as in the past. In the past, many mountainous areas had large numbers of thyroid disease patients folk-called "big-neck disease". When I was a child I often saw television films promoting the importance of iodine supplementation, and those films showed many goiter patients. Those patients’ necks were extremely thick, looking as if a gourd-like object had grown on the neck; hence in the past this formula worked remarkably well.

The effect of this formula on hyperthyroidism and goiter has also been confirmed by modern pharmacological research; animal experiments show that this formula can markedly reduce the energy metabolism and blood T3 concentration in hyperthyroid rabbits.

This formula is more effective than simple iodine supplementation, and may be appropriately modified according to the patient’s symptoms. If the patient has marked qi stagnation with stuffiness in the chest and heart, Houpo (Magnolia bark) 10 g and Gualouren (Trichosanthes seed) 10–30 g may be added to broaden the chest and move qi. If the goiter is painful, Shancigu (Cremastra appendiculata), Chonglou (Paris polyphylla) and Qingpi (green tangerine peel) may be added to soften hardness, move qi and stop pain. If qi depression transforms into heat with throat discomfort and hoarseness, Jiegeng (Platycodon), Niubangzi (burdock seed), Shegan (Belamcanda) and Muhudie (Oroxylum indicum seed) may be added to clear the lung and benefit the throat.