Goiter

Goiter denotes an enlargement of the thyroid gland, causing a swelling in thefront part of the neck, which is not accompanied by pain, ulceration or skin discoloration. According to the records of ancient literature, it can be classified as qigoiter, flesh goiter and stone goiter. In thissection only qi goiter and flesh goiter are discussed.

Etiology and Pathogenesis

Goiter may be caused by exasperation, anxiety or mental depression which leads to stagnation of qi and accumulation of fluid forming phlegm. It also occurs in certain localities where the soil and water are not good. In the book General Treatise on the Etiology and Pathogenesis, it says: Mountainous areas with black soil where the spring takes its source are not good for permanent dwelling, because drinking the spring water causes goiter. Generally speaking, qi goiter is mostly caused by drinking mountainous water and qi stagnation, and flesh goiter by stagnation of qi and accumulation of phlegm damp.

Differentiation

Main manifestations: Qi goiter is marked by diffusive swelling in the neck, soft, gradually increasing in size with unclear margins, normal color, absence of pain ; in some cases big and drooping, accompanied with dyspnea and hoarseness of voice. The size of the goiter usually changes with emotions.

Flesh goiter often occurs in individuals below forty, more frequently in women than in men, a few oval movable lumps below the Adam's Apple with smooth surface and without pain, accompanied by exophthalmoses, hot temper, irritability, tremor of the hands, sweating, stuffiness in the chest, palpitation, string - taut, slippery and rapid pulse, and irregular menstruation.

Treatment

Method: Activiate blood circulation and remove blood stasis, and disperse the agglomeration through promoting the qi circulation by reducing method. Points of Hand Shaoyang and Yangming Meridians are selected as the principal points.

Prescription: [TH13 - LI17 - SI17 - RN22 - Li 4 - ST36].

Supplementary points:

Liver qi stagnation: [RN17 - LR3] with even movement.
Palpitation: [MH6 - HT7] with the reinforcing method.
Exophthalmoses: TH23, BL2, BL1, GB20 with even movement.
Hot temper, anxiety and sweating: SP6 and KI7 with even movement.

Explanation: TH13 is a point of the Sanjiao Meridian of Hand - Shaoyang. Sanjiao dominates the qi of the whole body. So TH13 is used to remove obstruction from the meridians in order to relieve qi stagnation and phlegm accumulation for the goiter. LI17, SI17 and RN22 are located on the neck. Puncturing them is to regulate the local circulation of qi and blood, to remove blood stasis and disperse agglomeration. LI4 and ST36 belong respectively to the Hand and Foot Yangming Meridians, which pass through the neck region. They have the action of promoting qi circulation in the Yangming Meridians and eliminating stagnation ofqi and blood. RN17 is an Influential Point of qi, and LR3 is the yuan-primary point of the Liver Meridian. Both are used to regulate the circulation of the liver qi. HT7 is the yuan-primary point of the Heart Meridian, and MH6, the luo-connecting point of the Pericardium Meridian. They are effective for palpitation. TH23, BL2 and BL1 are local points. GB20 connects with the eye region. These four points are used together to readjust the circulation of qi and blood in the eye region so as to control exophthalmoses. SP6 and KI7 are used to reinforce yin and check yang in order to relieve irritability, bulimia and excessive perspiration.

Remarks

The morbid condition described here refers to simple goiter and hyperthyroidism in modern medicine.
The method of puncturing with several needles surrounding the goiter and with one needle in the center has a fairly good effect of reducing the goiter.