TCM Treatment for Stony Goiter (Thyroid Cancer)

In classical Chinese, "ying" (goiter) is a tumor growing on the neck. Around the year 100 AD, Xu Shen's Shuowen Jiezi (Explaining Graphs and Analyzing Characters) explained this term. Zhang Hua, the naturalist of the Western Jin dynasty, further pointed out in his Bowu Zhi (Record of the Investigation of Things) that "ying" was an endemic disease occurring in the mountainous areas of Hubei and south of the Yangtze River, chiefly because of iodine deficiency there. The "ying" here included both benign goiter and malignant thyroid cancer.

Sun Simiao of the Tang dynasty divided "ying" into five types, one of which was "shiying" (stony goiter); the other four were qiying (qi goiter), laoying (fatigue goiter), tuying (earth goiter), and youying (anxiety goiter). The defining feature of "stony goiter" was that it was "hard and immovable," which is precisely the typical feature of thyroid cancer. It was at this point that a clear record of thyroid cancer finally appeared in TCM classics. But although Sun Simiao divided goiters into five types, he did not subdivide their treatments accordingly.

Sun Simiao's treatment of the five goiter types was uniform. The formulas for treating goiter in Sun's works are as follows:

Formula One: seaweed (Haizao), sea clam (Hai ge), gentian (Longdan), tetrapanax Tongcao (Tongcao), kelp (Kunbu), alum-stone (Yushi, one version says alum stone), and Usnea (Songluo, 3 fen each), wheat yeast (Maiqu, 4 fen), Pinellia (Banxia, 2 fen). Grind the above nine ingredients and sift through a fine sieve; take one fangcunbi (a square-inch spoon) with wine, three times daily. Abstain from pork, fish, the five acrids, raw vegetables, and all foods that are difficult to digest. Effect within ten days; cure in twenty days.

Formula Two: wheat flour (1 sheng), seaweed (Haizao, 1 liang), and special alum-stone (Tesheng Yushi, 10 liang). Soak the wheat flour in three-year-old rice vinegar, sun-dry, separately pound into powder and combine. Take one fangcunbi, four to five times daily; hold the medicine in the mouth until it is very fine before swallowing. Abstain from ginger, the five acrids, pork, fish, raw vegetables, loud blowing, loud recitation, and loud shouting.

Formula Three: kelp (Kunbu), Usnea (Songluo), seaweed (Haizao, 3 liang each), sea clam (Haige), cinnamon bark (Guixin), tetrapanax (Tongcao), and Ampelopsis root (Baishilian, 2 liang each). Grind the above seven and sift; take one fangcunbi with wine, three times daily.

Formula Four: seaweed (Haizao), sea clam (Haige, 3 liang each), kelp (Kunbu), Pinellia (Banxia), Asarum (Xixin), trichosanthes root (Touguagen), Usnea (Songluo, 1 liang each), tetrapanax (Tongcao), Ampelopsis (Bailian), and gentian (Longdan, 2 liang each). Grind the above ten and sift; take one fangcunbi with wine, twice daily. This formula must not be used in heavy dosage.

Formula Five: 2 liang of kelp (Kunbu), washed and cut into finger-sized pieces; soak in vinegar and hold in the mouth, swallowing the juice. When the juice is exhausted, it is cured.

Formula Six: seaweed (Haizao, 1 jin; the Duanduan version says 3 liang), wheat yeast (Maiqu, 1 jin). Moisten the flour with 1 sheng of three-year-old vinegar, sun-dry, and repeat until the vinegar is used up; pound together into powder. Take one fangcunbi with wine, three times daily. Avoid exertion. (Cui's note: treats goiter of thirty years' standing.)

Formula Seven: Acorus (Changpu), sea clam (Haige), Ampelopsis (Bailian), teasel (Xuduan), seaweed (Haizao), Usnea (Songluo), cinnamon bark (Guixin), Sichuan pepper (Shujiao), Daoguacao, Pinellia (Banxia, 1 liang each), medicated leaven (Shenqu, 3 liang). Grind the above twelve and sift; make pills the size of a parasol tree seed with ox and sheep marrow fat. Take three pills daily.

In addition there is the Five Goiters Pill formula: take a deer's thyroid (Luye), soak in fine wine until submerged, roast dry, return to the wine, roast again until fragrant, hold in the mouth and swallow the juice; when the flavor is exhausted replace it; after using ten sets it is cured. Here the Luye is the deer's thyroid gland.

There is also Xianzhong San (Sunken-Swelling Powder): treats goiters of twenty to thirty years' standing, as well as bone tumors, stony tumors, flesh tumors, fatty tumors, pus tumors, and blood tumors, or polyps as large as cups, bowls, sheng, or dou, unhealed for ten years and even discharging and ulcerating, causing bone consumption and wasting, whether hard, soft, or ulcerated, causing fright and palpitations, restless sleep, and a hunched body, and which recur after healing.

Cuttlebone (Wuzeize), sulfur (Liuhuang, 1 fen each), stalactite (Zhongru), purple quartz (Ziyingshi), white quartz (Baiyingshi, 2 fen each), Salvia (Danshen, 3 fen), amber (Hupo), aconite (Fuzi), house-swallow droppings (Huyan shi), rhubarb (Dahuang), and dried ginger (Ganjiang, 4 fen each). Grind the above eleven and sift; store in a leather pouch, taking care not to let the powder lose its potency. If the sore is wet, apply directly; if dry, mix with pig fat and apply. Three to four times daily, until dry. If the discharge does not stop, continue through five to ten doses; the medicine makes the patient pain-free. If the swelling does not resolve, adding 2 liang of mirabilite (Mangxiao) is excellent.

There is also a goiter formula: kelp (Kunbu), cinnamon bark (Guixin, 1 liang each), willow twigs from back-flowing water (Niliushui liuxi, 1 liang), seaweed (Haizao), dried ginger (Ganjiang, 2 liang each), and seven sheep thyroids (Yangye, shade-dried). Powder the above six and make pills with honey the size of small marbles; hold one pill in the mouth and swallow the saliva.

There is also an external formula: alum stone (Fanshi), Sichuan lovage (Chuanxiong), dong quai (Danggui), rhubarb (Dahuang), Coptis (Huanglian), scutellaria (Huangqin), Ampelopsis (Bailian), and peony (Shaoyao, 2 fen each), and evodia (Wuzhuyu, 1 fen). Grind the above nine and sift; mix with egg yolk and spread on old fine cloth, applying according to the size of the tumor, adjusting thickness. Replace when dry. When the medicine has acted, pus and fat will emerge gradually from the openings; be sure to probe until the pus and blood are exhausted, then apply flesh-generating plaster. If the pus is not exhausted, the swelling will recur as before.

In addition, the text records moxibustion methods for treating the five goiters:

For goiter with evil qi, moxa Tianfu fifty cones. (The Qianjin Yi says: also moxa the chest hall one hundred cones.)

For goiter with shortness of breath and panting, moxa Feishu one hundred cones.

For goiter with fatigue qi, moxa Chongyang, number of cones equal to the patient's age.

For goiter qi with facial swelling, moxa Tongtian fifty cones.

For goiter, moxa Tianqu three hundred cones, applied transversely at an interval of three cun between points. Also moxa Zhongfeng, number equal to the patient's age. (Located in the depression on the instep of both feet at the bend of the foot.)

For all goiters, moxa the depressions on the left and right shoulders opposite each other: for men eighteen cones on the left and seventeen on the right; for women eighteen on the right and seventeen on the left; or repeat two or three times until cured. Also, Fengchi one hundred cones, on both sides of the neck. Also, one hundred cones at the hairline behind both ears. Also, Touchong (one version says Jingchong).

In general, do not treat flesh tumors; treating them kills the patient. Be cautious. (The Zhouhou Fang says: neither acupuncture nor moxibustion may be used.)

Sun's records are truly comprehensive! They are only confusing and do not allow one to distinguish which method is most suitable for treating stony goiter. But from the above formulas we can roughly see that the prescriptions Sun collected for treating thyroid tumors basically all use large amounts of iodine-rich seafood such as kelp, seaweed, and sea clam. TCM holds that these medicinals all have the action of softening hard masses and dispersing nodules. In modern medicine, radioactive iodine-131 is likewise used for papillary thyroid carcinoma or follicular adenocarcinoma. To this day, TCM treatment of thyroid cancer still cannot do without these seafoods.

Sun's works also include external methods for treating thyroid tumors, both external applications and moxibustion. But with the development of the times, these methods have basically been abandoned. Modern thyroid cancer patients mostly first undergo surgical resection and then receive other treatments. Surgical treatment has good results; after surgery many patients survive for more than twenty years, or even a lifetime without recurrence. So unless the cancer has already metastasized to sites that are hard to operate on, or signs of recurrence appear after surgery, pure TCM treatment is generally not recommended.

But for thyroid cancer patients who have recurrence or metastasis and have lost the opportunity for surgery, TCM treatment can prolong survival. Contemporary TCM's understanding of stony goiter has advanced a step beyond that of earlier generations. Generally, TCM holds that thyroid cancer is caused by qi-blood deficiency, liver depression and qi stagnation, and blood stasis with toxin accumulation. Treatment should follow the principles of supporting righteous qi and rooting the constitution, boosting qi and nourishing blood, softening hard masses and dispersing nodules, activating blood and resolving stasis, soothing the liver and relieving depression, regulating qi and stopping pain, clearing the liver and draining fire, and transforming toxin and dispersing tumors.

To support righteous qi and root the constitution and boost qi and nourish blood, one commonly uses raw astragalus (Sheng Huangqi), Glehnia/adenophora (Shashen), dong quai (Danggui), polished polygonatum (Huangjing), and Codonopsis (Dangshen); to soften hard masses and disperse nodules, seaweed (Haizao), kelp (Kunbu), clam shell (Walengzi), and air-potato yam (Huangyaozi); to soothe the liver and relieve depression, bupleurum (Chaihu), curcuma (Yujin), and rose (Meiguihua); to regulate qi and stop pain, cyperus (Xiangfu), fried aurantium (Chao Zhiqiao), and corydalis (Yuanhu); to activate blood and resolve stasis, burreed (Sanleng), curcuma zedoaria (Ezhu), ground beetle (Tubiechong), and turmeric slice (Pianjianghuang); to clear the liver and drain fire, wild chrysanthemum (Yejuhua), subprostrate sophora (Shan Dougen), houttuynia (Yuxingcao), selfheal (Xiakucao), and scrophularia (Xuanshen); to transform toxin and disperse tumors, centipede (Wugong) and scorpion (Quanxie). The formula-building approach may generally draw on combinations of Shengmai San, Jiangjiang San, Xiaoluo Wan, and Xiaoyao Wan as a base, modified according to the pattern.

In addition, proprietary Chinese medicines such as Xihuang Wan (or Xihuang Capsules) and Pingxiao Pian (or Pingxiao Capsules) all have a certain therapeutic effect on thyroid cancer and are also commonly used clinically.

Besides these routine medication approaches, some slightly more toxic Chinese medicinals can also be used in treating thyroid cancer, such as realgar (Xionghuang), toad venom (Chansu), julus worm (Shanqiongchong), and blister beetle (Banmao). But such medicines must be used cautiously; the physician must have sufficient experience using toxic drugs, and must also instruct the patient to have liver and kidney function checked frequently, so as to avoid serious cumulative poisoning. The author has applied Chinese sumach gall (Wubeizi) externally for thyroid cancer and obtained a certain efficacy. Wubeizi can also be ground into powder and filled into capsules for oral use.