Thyroid Acupuncture & TCM
Thyroid dysfunction, affecting people of all ages, not only damages human growth and energy metabolism but is also comorbid with other illnesses such as cardiovascular disease, kidney disease and gastrointestinal disorders and acupuncture has been found to significantly improve this condition. With the increasing acceptance of alternative and complementary therapies, acupuncture, a traditional Chinese medical practice, has also been employed to address this problem.
Thyroid Gland
The thyroid is a small, butterfly-shaped gland at the base of neck. It is part of the endocrine system, and coordinates and controls many aspects of metabolism, for example, heart beat and calorie consumption. The thyroid manufactures thyroid hormones, including triiodothyronine (T3) and thyroxine (T4); it regulates metabolism through the interaction between the thyroid and iodine. Thyroid hormones affect human growth, metabolism, body temperature, development of body tissue and nutrient absorption [1].
Thyroid disorders are the most common endocrinological diseases [2] and are often caused by abnormal production of thyroid hormones. Both over-production and under-production of thyroid hormones can cause serious diseases, such as hyperthyroidism, hypothyroidism, Grave’s disease, Hashimoto’s thyroiditis, thyrotoxicosis, nodular goitre, thyroid cancer and other thyroid-related illnesses [3,4]. Their causes include autoimmune disorder [5], environmental factors [6], chemicals [7], brain injury [8] and even personality problem [9].
Current treatments in thyroid dysfunctions
A variety of treatments are provided, covering drugs [10], selenium supplementation [11], radioactive iodine therapy [12], thyroxine suppression therapy [13] and surgery [14]. Despite the existence of medication for pregnant women [15], antithyroid drugs are not recommended in early pregnancy [16].
With considerations of safety, quality, efficacy and cost-effectiveness, traditional medicines have been promoted in health care [17]. A rapid increase in their use [18] within the Chinese health care system has been observed [19]. Even so, alternative and complementary therapies are being used to tackle thyroid diseases [20], including traditional Chinese medicine (TCM) [21,22].
In the holistic approach [23,24] of TCM, yin-yang theory focuses on balancing 3 / 22 opposites to stabilise qi (energy) [25], the essence of life in substance and function aspects [26], and prevent or undo the excesses or deficiencies in the qi that underpin disease [27]. The chronic deficiency of qi or blood that negatively affects the heart, spleen or kidney is related to hypothyroidism [28,29]. In contrast, excessive qi or phlegm stagnation can be associated with hyperthyroidism. These symptoms are collectively called “gall diseases” (癭病) in Chinese medical records [30].
Acupuncture in Thyroid Dysfunctions
Acupuncture is an important traditional Chinese clinical technique for regulating qi flow [31], having been used over 3000 years [32], which comprises the insertion of slender, sterile needles into one or more acupoints (specific stimulation points) [33]. Points are selected from among 361 acupoints along 14 meridians and illness-related local points on the body and limbs [34]. Needle insertions can last from a few seconds to several minutes [35], and a treatment session typically takes 30–45 min. Each acupoint corresponds to specific internal organs and tissues [26]; these associations are used to determine which acupoints are used to provide each acupuncture treatment. Individuals undergoing acupuncture may feel sore, numb, tingly, warm or even feel a dull pain [27]. This sensation is called de-qi, indicating effective and efficient qi flow [28]. Acupuncture is cost-effective [29] and safe [30], with minimal side effects [31] not only for adults but also for children [32] and the elderly [30], when a qualified acupuncturist conducts the treatment.
Both Western and Eastern medicine offer various methods to restore thyroid hormone levels. Western treatments rely mainly on drugs and surgery while Eastern treatments aim to restore immune function as well as balance the production and release of thyroid hormones through a variety of approaches ranging from acupuncture and herbal remedies to lifestyle changes and special exercises.
In the treatment to thyroid problems, acupuncture can be used to restore hormonal balance, regulate energy levels, smooth emotions and help manage sleep, emotions and menstrual problems. There are several powerful acupuncture points on the ear and the body that can be used to regulate the production of thyroid hormones. Treatments take all of your symptoms into account and are aimed at balancing the energy within the body to optimize health.
When it comes to lifestyle changes, a diet rich in protein, calcium, magnesium, and iodine helps support thyroid function while certain foods known as goitrogens may interfere with thyroid hormone production and should be limited. These include cruciferous vegetables (such as cauliflower, cabbage, and Brussels sprouts), peanuts, and soy. Stress reducing exercises such as yoga or tai chi can also be beneficial. I have written a long in-depth article regarding how you can help yourself with a healthy thyroid diet.
Overactive Thyroid & Current Acupuncture Research
Hyperthyroidism is a type of thyroid dysfunction that is due to excessive levels of thyroid hormones.
Its common symptoms include hand tremors, irritability, nervousness, anxiety, heat intolerance, heart racing, hair loss, eyeball protrusion and weight loss in spite of good appetite.
In the case of hyperthyroidism, the constant striving of Yang energy creates a deficiency of Yin, and the overall Qi energy is also weakened. The hyperactive energy of hyperthyroidism is interpreted through TCM as being related to heat, and especially too much fiery energy from the liver. We view blockages as being related to stagnation of Qi, or blood, or phlegm. In this case, phlegm stagnation is impeding the flow to and from the thyroid gland.
- Liver heat causes symptoms like: redness of the skin, itchiness, irritability, hunger and high metabolism, and a quickened pulse.
- Weakness of Qi and Yin causes: trouble breathing, trouble sleeping, sweating, and dryness of the eyes and mouth.
- Phlegm stagnation is considered the reason for the swelling of the thyroid gland itself.
TCM treatment for hyperthyroidism uses acupuncture and individualized herbal formulations to clear heat and phlegm, strengthen Qi and Yin, and cool down liver fire and overworked Yang.
In a clinical study, three groups of participants completed an acupuncture programme [33]: patients with hyperthyroidism (n = 46), patients with Hashimoto’s thyroiditis (n = 33) and healthy persons (n = 35). The hyperthyroid group showed decreased levels of thyroid hormones (T3 and T4); in contrast, the Hashimoto’s thyroiditis group showed increased levels. No changes occurred in the healthy group. This experiment illustrated the effectiveness of using acupuncture alone [34] or in combination with Chinese medicine [35,36] to regulate thyroid hormones [37].
Another project included 114 patients, evenly and randomly distributed between acupuncture and drug groups [38]. The latter group took propranolol (20 mg), methimazole (10 mg), diazepam (10 mg) and vitamin B (20 mg) daily. The acupuncture group reported a 98% success rate compared with 91% for the drug group.
Another randomised controlled trial allocated patients into groups receiving acupuncture and Chinese medicine (n = 86) and drugs (n = 85) (propranolol 10–30 mg, methimazole 10–15 mg and vitamin C 200–300 mg daily) [39]. Their effectiveness was reported to be 95% and 73% respectively.
He et al. [40] assigned 118 patients to three experimental groups that received acupuncture and tapazole with different doses (10 mg, 30 mg or 40 mg daily). They reported the highest efficacy rate and lowest relapse rate in the combined treatment group that took 30 mg of tapazole daily.
Sleep problems often plague people with hyperthyroidism [41]. A group of patients suffering from hyperthyroid-induced insomnia was randomly assigned to auricular acupuncture (n = 40), body acupuncture (n = 40) and drug (n = 40) groups [88]. The 10 / 22 body acupuncture group completed 20 thirty-minute sessions, while the drug group took diazepam for 20 days. The efficacy rates were 95% for the auricular acupuncture group, 70% for the acupuncture group and 45% for the drug group.
Underactive Thyroid & Current Acupuncture Research
Hypothyroidism is an endocrine disorder caused by insufficient levels of thyroid hormones and/or iodine deficiency. It presents a spectrum of symptoms such as a hoarse voice, fatigue, weight gain, swelling limbs and feeling cold.
The hypothyroidism, as described in Traditional Chinese Medicine texts, is classified mainly as the deficiency disorder. The diagnosis must be differentiated and often varies from case to case depending on the individual patient’s clinical presentation. It is important to understand that hypothyroidism is the condition arising due to the chronic deficiency of one or more vital substances of the body: Qi, Blood, Yang, Yin and Essence. This is a systemic disorder which may start with general Qi deficiency and affect all organ systems over the long period of disease progression. The Spleen, Kidney and Heart are three primary organs involved in the pathogenesis of hypothyroidism. The Lung and Liver are also affected in an indirect manner. Manifestations of various deficiencies are diverse and can affect a wide variety of physiological processes. The precipitating causes of hypothyroidism include constitutional factors, diet, overexertion, emotional stress, trauma, chronic debilitating illness, as well as the side effects of medical treatment. Patterns of deficiency will be differentiated by aspect of underlying deficiency of Yin, Yang, Qi or Blood in regards to the deficient organ, or a combination of organs, involved in pathogenesis: Spleen, Kidneys, and Heart.
In a study, 27 female patients aged 25–57 years old experienced significantly decreased symptoms of pain and improvements in their physical functioning, social functioning, the roles of physical and emotional factors, bodily pain, general health and vitality [42]. In this project, 7 participants withdrew from the intervention after the first course of treatment because their symptoms vanished; while the remainder completed three courses of treatment.
Zhou [43] recruited 60 patients and randomly assigned them to either the warming acupuncture group (n = 30) or the drug group (n = 30). The former underwent 30 sessions and the latter took 50–150 μg of euthyrox, daily. The efficacy rates reported were 93% and 80%, respectively.
Conclusion
It is clear, that the thyroid is one of the most important endocrine glands that produce hormones to regulate metabolism of the whole body including: brain, respiration, cardiovascular and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, energy and water metabolism.
Despite great progress made in medical technologies, all practitioners should strive to make physical and psychological contact with patients, to acquire more complete understanding of functional disorders, without relying on conventional techniques along. This diagnostic approach, however, requires the sufficient medical knowledge to interpret and experience to correlate such information.
In general, the Traditional Chinese Medicine and acupuncture management of thyroid patients in the modern practice will often be complimentary to standard Conventional Western hormone replacement therapy. When treating a hypothyroid patient, it is important to always address the root cause of the thyroid deficiency with acupuncture and TCM. The herbal and acupuncture therapy can often be used in conjunction with thyroid hormone replacement therapy to achieve greater results and to subdue the adverse effects of levothyroxine. It is essential to remember, however, that all herbal preparations, including tonifying formulas have very specific indications and associated effects, and should never be used thoughtlessly.
The practitioner must be able to most efficiently help to promote functional balance and revitalize the patient.
Exercise and proper nutrition are also helpful modalities to support the treatment of hyperthyroidism. As always, it is important to always provide a patient, caring treatment, and to offer behavioral recommendations about lifestyle factors that may benefit the patients or consume essence and aggravate the deficiency in the body.
The thyroid tissue, even after a partial thyroidectomy, iodine irradiation, autoimmune or inflammatory destruction has a potential to revive and resume the production of adequate amounts of thyroid hormones. Human body poses mechanisms of self-restoration, and a caring physician should attempt to help the patient by restoring the thyroid glands function, to help the patient live a complete life full of vitality.
References
1 Pinto A, Glick M. Management of patients with thyroid disease: oral health considerations. J Am Dent Assoc 2002; 133(7): 849–58.
2 Sarfo-Kantanka O, Kyei I, Sarfo FS, Ansah EO. Thyroid disorders in central Ghana: the influence of 20 years of iodization. J Thyroid Res 2017; 2017: 7843972.
3 Karnath BM, Hussain N. Signs and symptoms of thyroid dysfunction. Hosp Physician 2006; 42(10): 43–8.
4 Vanderpump MP. The epidemiology of thyroid disease. Br Med Bull 2011; 99: 39–51.
5 Antonelli A, Ferrari SM. Corrado A, Di Domenicantonio, Fallahi P. Autoimmune thyroid disorders. Autoimmun Rev 2015; 14(2): 174–80.
6 Ferrari SM, Fallahi P, Antonelli A, Benvenga S. Environmental influences in thyroid diseases. Front Endocrinol (Lausanne) 2017; 8: 1–8.
7 Boas M, Feldt-Rasmussen U, Skakkebæk NE, Main KM. Environmental chemicals and thyroid function. Eur J Endocrinol 2006; 154: 599–611.
8 Bollerslev J, Klibanski A, Tritos N. Traumatic brain injury: effects on the endocrine system. J Clin Endocrinol Metab 2013; 98(3): 27A–8A.
9 Mandincová P. Psychosocial factors in patients with thyroid disease. In: Ward LS. Thyroid and parathyroid diseases—new insights into some old and some new issues. Croatia: InTech; 2012: 279–318.
10 Weetman A. Recommended management of thyroid disorders. Prescriber 2016; 27: 31–8.
11 Ventura M, Melo M, Carrilho F. Selenium and thyroid disease: from pathophysiology to treatment. Int J Endocrinol 2017; 2017: 1297658.
12 Premawardhana LDKE, Lazarus JH. Management of thyroid disorders. Postgrad Med J 2006; 82(971): 552–8.
13 Papaleontiou M, Haymart MR. Approach to and treatment of thyroid disorders in the elderly. Med Clin North Am 2012; 96(2): 297–310.
14 Hannan SA. The magnificent seven: a history of modern thyroid surgery. Int J Surg 2006; 4(3): 187–91.
15 Roti E, Minelli R, Salvi M. Management of hyperthyroidism and hypothyroidism in the pregnant woman. J Clin Endocrinol Metab 1996; 81(5): 1679–82.
16 Andersen SL, Olsen J, Laurberg P. Antithyroid drug side effects in the population and in pregnancy. J Clin Endocrinol Metab 2016; 101(4): 1606–14.
17 World Health Organization. WHO traditional medicine strategy: 2014–2023. Geneva: World Health Organization; 2013.
18 Zhang Q, Zhu LM, Van der Lerberghe W. The importance of traditional Chinese medicine services in health care provision in China. Int J Hum Dev Int Coop 2011; 2(2): 1–8.
19 Zhou LH, Nunes M. Knowledge sharing in Chinese hospitals: identifying sharing barriers in traditional Chinese and Western medicine collaboration. Berlin: Springer-Verlag Berlin Heidelberg; 2015.
20 Onumah BM. Alternative and complementary treatment of thyroid disorders. In: Wartofsky L, Nostrand DV. Thyroid cancer: a comprehensive guide to clinical management. New York: Springer; 2016: 759–65.
21 Luo H, Lu M, Pei XH, Xia ZY. Chinese herbal medicine for subacute thyroiditis: a systematic review of randomised controlled trials. J Tradit Chin Med 2014; 34(3): 243–53.
22 Tao C. How to give TCM differential treatment for hypothyroidism. J Tradit Chin Med 2008; 28(3): 231–2. 17 / 22
23 Chang S. The meridian system and mechanism of acupuncture: a comparative review. Part 3: Mechanisms of acupuncture therapies. Taiwan J Obstet Gynecol 2013; 52(2): 171–84.
24 Yang JW, Li QQ, Li F, Fu QN, Zeng XH, Liu CZ. The holistic effects of acupuncture treatment. Evid Based Complement Alternat Med 2014; 2014(12): 1–10.
25 Lozano F. Basic theories of traditional Chinese medicine. In: Lin YC, Hsu EZ. Acupuncture for pain management. New York: Springer; 2014: 13–22.
26 Tu Y, Fang TY. History and philosophy of Chinese medicine. Beijing: People’s Medical Publishing House; 2014.
27 Chiang HC, Chang HH, Huang PY, Hsu M. On the qi deficiency in traditional Chinese medicine. Taiwan J Obstet Gynecol 2014; 53(3): 317–23.
28 Malikov D. Traditional Chinese medicine approach to hypothyroidism. Int J Complement Altern Med 2017; 5(1): 1–7.
29 Panthi S, Gao TS. Diagnosis and management of primary hypothyroidism in traditional Chinese medicine (TCM) and traditional Indian medicine (Ayurveda). Int J Clin Endocrinol Metab 2015; 1(1): 9–12.
30 Luzina C, Niu X. Autoimmune thyroiditis—an ancient approach of traditional Chinese medicine to a modern disease. (2011) [2017-12-31].
31 Focks C. Atlas of acupuncture. Philadelphia: Churchill Livingstone; 2008.
32 Dvm DR, Buell PD. A true history of acupuncture. Focus Altern Complement Ther 2010; 9(4): 269–73.
95 Chen HP, Hu GS, He JS, Jin SB, Ma JX, Xiang KS, et al. Characteristics of acupuncture and
moxibustion for treatment of autoimmune thyroid diseases. Zhongguo Zhen Jiu 1991; 11(6): 33–6[Chinese].
34 Li R. Effects of acupuncture on hyperthyroidism: a report of fifty cases. Beijing Zhong Yi 1982;
1(1): 45–6 [Chinese with abstract in English].
35 Cai YJ. Clinical observation on 12 cases of hyperthyroidism treated by Shenhai Lianqiao decoction and acupuncture. Neimenggu Yi Ke Da Xue Xue Bao 2004; 26(2): 113–4 [Chinese].
36 Zhang H, Sun J, Sun XD. Using Chinese medicine and acupuncture in treating hyperthyroidism.
Zhongguo Di Fang Bing Fang Zhi Za Zhi 2007; 22(5): 393 [Chinese].
37 Zhu JH, Arsovska B, Kozovska K. Case report—acupuncture treatment for hyperthyroidism. Int J Chin Med 2017; 1(4): 121–3.
38 Tong QJ, Liu G. Using acupuncture in hyperthyroidism. Dang Dai Yi Yao Lun Cong 2014; 12(12): 39–40 [Chinese].
39 Li SJ. Effect of acupuncture combined with Chinese medicine on hyperthyroidism. Zhong Xi Yi Jie He Xin Xue Guan Bing Za Zhi 2015; 3(30): 116–7 [Chinese].
40 He JS, Jin SB, Heng JS, Ma JX, Xiang KS, Chen HP, et al. Effects of acupuncture with medication on hyperthyroidism: a seventy-seven case report. Shanghai Zhong Yi Yao Za Zhi 1987; (5): 17–9 [Chinese].
41 Sridhar GR, Putcha V, Lakshmi G. Sleep in thyrotoxicosis. Indian J Endocrinol Metab 2011; 15(1): 23–6
42 Luzina K, Luzina LL, Vasilenko AM. Acupuncture: altenative approach to subclinical hypothyroidism correction. (2011) [2017-12-31]. http://www.ewg-board.eu/archiv-euromedica/archiv-euromedica-1-2-2011/Kamilla-Luzina-L-Luzina-A -Vasilenko.pdf.
43 Zhou JL. Clinical curative effect of warm acupuncture in treatment of adult thyroid hypofunctions. Zhongguo Dang Dai Yi Yao 2013; 20(16): 139–41 [Chinese with abstract in English].
Other ref https://sci-hub.hkvisa.net/10.1016/j.joim.2018.09.002