Spleen-kidney Yang Vacuity Pattern Hypothyroidism
abstracted & translated by
Bob Flaws, L.Ac.
On pages 14-15 of issue #1, 2010 of Xian Dai Zhong Yi (Modern Chinese Medicine), Liang Guo-ping published an article titled “The Treatment of 23 Cases of Spleen-kidney Yang Vacuity Pattern Primary Hypothyroidism with Integrated Chinese-Western Medicine.” A summary of this article is presented below.
Altogether, there were 46 cases of primary hypothyroidism enrolled in this two-wing comparison study. These 46 cases were randomly divided into a treatment group and a comparison group. In the treatment group, there were 11 males and 12 females aged 38-71 years, with a median age of 61.56 ± 23.09 years. These patients’ course of disease had lasted from 1-16 years, with a mean duration of 8.45 ± 3.90 years. In the comparison group, there were 10 males and 13 females aged 41-73 years, with a median age of 63.43 ± 20.68 years. These patients’ course of disease had lasted from 1-15 years, with a mean duration of 9.45 ± 4.75 years. Thus, in terms of sex, age, and disease duration, there were no significant statistical differences between these two groups (P = 0.05). In terms of Western disease diagnosis, symptoms included lack of strength, somnolence, fear of chill, scanty perspiration, slowed reactions, lassitude, decreased memory power, and constipation. In terms of serum analysis, thyroid-stimulating hormone (TSH) was high, while free thyroxine (FT4) was low. In terms of Chinese medical pattern discrimination, symptoms included lassitude of the spirit, lack of strength, somnolence, fatigue, decreased memory power, dizziness, tinnitus, deafness, low back and knee soreness and limpness, dread of cold, chilled extremities, dry, flaky skin, withered, brittle, easily falling hair, decreased intake, constipation, generalized superficial edema, possible impotence in males, menstrual irregularity in females, a pale, enlarged tongue with teeth-marks on its edges and slimy, white fur, and a deep, dine or deep, slow pulse.
All members of the comparison group were administered 25µg of Synthroid per day. Every two weeks, this was increased by 12.5µg until the therapeutic effects were satisfactory. Elderly patients were started at a dose of 12.5µg per day and this was increased by 12.5µg every four weeks until the effects were satisfactory. Outcomes were analyzed after 12 weeks of treatment.
All members of the treatment group received the same basic hormone-supplementation therapy as the comparison group. However, they also received modified Er Xian Tang (Two Immortals Decoction) consisting of:
Xian Mao (Rhizoma Curculiginis), 10g
Xian Ling Pi (Herba Epimedii), 15g
Ba Ji Tian (Radix Morindae Officinalis), 9g
Dang Gui (Radix Angelicae Sinensis), 15g
Huang Qi (Radix Astragali), 20g
Shan Yao (Radix Dioscoreae Oppositae), 10g
Dang Shen (Radix Codonopsis), 10g
Shu Di Huang (cooked Radix Rehmanniae), 15g
Rou Cong Rong (Herba Cistanchis), 15g
One packet of these medicinals per day was decocted in water and administered orally in two divided doses.
Serum TSH, triiodothyronine (FT3), and FT4 all improved in both groups. However, these all improved even more markedly in the treatment group as the following table shows.
|Group||Before/after Tx||TSH (Mu/L)||FT3 (pmol/L||FT4 (pmol/L)|
|Treatment||Before treatment||23.06 ± 5.91||1.67 ± 0.68||6.35 ± 2.53|
|After treatment||4.68 ± 1.97||6.80 ± 1.37||15.99 ± 4.46|
|Comparison||Before treatment||22.47 ± 5.03||1.82 ± 0.97||6.09 ± 3.55|
|After treatment||6.98 ± 2.60||5.56 ± 1.61||13.33 ± 4.68|
In addition, treatment efficacy was also defined in terms of clinical control, marked effect, some effect, and no effect. Clinical control was defined as disappearance of all symptoms and normalization of thyroid function examinations. Marked effect was defined as basic disappearance of symptoms and basic normalization of thyroid function examinations. Some effect was defined as improvement in symptoms and improvement in thyroid function examinations. No effect was defined as no improvement in symptoms or thyroid function examinations. The following table shows the outcomes of the two groups based on these criteria.
|Group||Clinical control||Marked effect||Some effect||No effect||Total effectiveness|
This table shows that the total effectiveness of the integrated Chinese-Western medical protocol was significantly better than the pure Western medicine alone (P < 0.05).
According to Dr. Liang, hypothyroidism corresponds to the traditional Chinese medical disease categories of vacuity taxation and vacuity detriment. Based on its main clinical symptoms, this condition mostly presents a pattern of spleen-kidney yang vacuity. Therefore, one should mainly warm and supplement the spleen and kidneys, and Dr. Liang has chosen modified Er Xian Tang for these purposes. Within the above formula, a heavy use of Huang Qi and Xian Ling Pi warm and supplement spleen and kidney yang. They also greatly supplement the source qi. Hence they treat the root of the spleen-kidney yang qi insufficiency. Xian Mao, Ba Ji Tian, Dang Shen, and Rou Cong Rong assist the spleen and kidneys and strengthen qi transformation. Shu Di Huang and Shan Yao evenly supplement yin and yang. This is based on the saying, “If one wants to supplement yang, one must search for yang within yin.” Dang Gui supplements and quickens the blood. Taken as a whole, this formula fortifies the spleen and supplements the kidneys, warms yang and boosts the qi. Because it both warms and moistens, it is appropriate for long-term administration. Dr. Liang believes that this is an effective formula for the treatment of spleen-kidney yang vacuity pattern primary hypothyroidism.
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