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Spleen Yang qi is responsible for generating Qi, Blood, and Essence.

Understanding vomiting from the perspective of traditional Chinese medicine

The deficiency in Spleen Yang qi in hypothyroidism results in the failure of the Spleen to distribute nutrients to the body, resulting in Blood and Qi deficiency causing dry and flaky skin. The kidney manifests in the hair, thus as the Kidney Yang and Essence is depleted the hair becomes dull, thin, and more scares. Qi is one manifestation of Essence.

The patency of Liver Qi is important to help Spleen Qi function well. Severe Qi and Blood deficiency in hypothyroid women often disrupts the circulation of Liver Qi and Chong Mai which are responsible for smooth menstrual cycles and release of the menstrual blood, and results in menses which are often irregular and sometimes anovulatory, causing infertility. Pale menorrhagia is also common.

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In hypothyroid men chronic Kidney Yang Qi and consequent Essence deficiency may manifest as impotence and infertility. Many patient with the progressive hypothyroidism present with Heart and Kidney deficiency leading to Shen disturbance manifesting as depression, reduced attention span, memory deficit, slowed reaction, husky voice and vertigo. Second step is to differentiate, the suspected diagnosis to create the most efficient treatment plan.

The disorder may then be treated with herbs and acupuncture, or even cupping, Tai Ji, Qi Gong or Tui Na if so desired. One may begin by asking the patient about the symptoms, checking the signs, including pulse and tongue diagnosis. The key is to find a pattern in the balance between Yin and Yang and of the flow of Qi in the body, using the information gathered in order to gain an understanding of how the various organs are working together, and what went wrong. An experienced physician, may also perform an examination of the ear, by visual inspection and palpation; and any changes in color, shape and possibly sore points or points with a changed electrical resistance will be noted.

The early stage of subclinical hypothyroidism is associated with Spleen Qi deficiency, which if untreated will develop into more serious Spleen Yang deficiency, which will further affect the function of all remaining organs. General symptoms of Qi deficiency include lethargy and fatigue, which are precipitated by physical activity and improve with rest, which are key symptoms associated with subclinical hypothyroidism. Other common symptoms of Spleen Qi deficiency are shortness of breath on exertion , concise, slow and occasionally slurred speech, husky voice, dusky complexion, reduced appetite, loose stools, and a weak pulse.

Since, the Spleen and Stomach control the transformation and transportation of food and nutrients they play an essential role in regulating the ascension and discretion of the Qi. In clinical hypothyroidism, when the Yang Qi of the Middle jiao is weak, the patient may suffer an invasion of external cold, which may hinder the normal Qi flow and result in epigastric and abdominal distention or even pain. Spleen Yang deficiency is characterized by intolerance and aversion to cold, clod extremities, poor appetite, pallor, fatigue cold type , epigastric and abdominal cold pain relieved by warmth and pressure, constipation, distention and excessive thin white leucorrhea in women.

The tongue is usually flabby and pale with teethmarks and with white and slippery coating. The pulse is deep, slow and forceless or faint in severe thyroid deficiency. Herbal treatment: The treatment principle for the Middle jiao Yang deficiency would be to warm the Yang, disperse cold, augment the Qi and to strengthen the Spleen. Thus, most herbs used to treat this condition are warming and acrid, and somewhat dry in nature. Gan Jiang zingiberis rz is one of such herbs used in the treatment of most patterns of hypothyroidism. Other frequently used herbs are Fu Zi aconiti rx lateralis and Rou Gui cinnamomi cortex , which can be combined with herbs that strengthen the Spleen and augment the Qi, like Huang Qi astragali rx , Ren Shen ginseng rx , and Bai Zhu atractylodis macrocephalae rz [7].

Low Red Blood cell count and hypoxia are clinical manifestations of chronic hypothyroidism associated with Qi and Blood deficiency which is marked by fatigue, weakness, slowness, palpitations, sallow complexion, amenorrhea, pale tongue and choppy pulse. Menorrhagia is a common presentation of clinical hypothyroidism, occasionally accompanied with recurrent pain, or restless fetus disorder.

If the Liver Blood is deficient, it is unable to rise and nourish the head, resulting in dizziness, vertigo, and impaired vision.

1. Introduction

The tongue is usually pale and pulse is thin and wiry; choppy pulse may be felt in the condition of Blood stasis. The difference between the deficient cold and external excess cold is that; cold due to Yang deficiency, may be alleviated by simply wearing more clothing, where as cold sensation and chills associated with an exterior pathogen cannot, even by increasing the room temperature.

The symptoms like lassitude, lethargy and withdrawal into oneself, aversion to cold, cold extremities, soreness and weakness of the lower back and knees, a flabby pale tongue with white moist coating, and deep slow and forceless pulse especially at the right proximal position seen in severe clinical hypothyroidism are some of the common manifestations of Spleen and Kidney Yang deficiency.

Kidney is the root of the body's Yang Qi, which supports the generative and transforming processes of all other organs, chronic Kidney Yang deficiency will result in Spleen Yang deficiency. Water and dampness accumulation, in the late stages of hypothyroidism, will impair the Yang Qi from ascending the clear and descending the turbid, which may obstruct the sensory orifices.

Thus, overtly hypothyroid patients often complain of impaired hearing, heavy sensation in the head, dizziness ranging from lightheadedness and positional vertigo to severe dizziness even when lying down. The patient also feels weakness and instability in posture which sometimes requires a conscious effort to maintain.

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When pathogenic water ascends and overflows the Heart, it causes palpitations and when it overflows the Lungs and disrupts the Qi, it causes cough and dyspnea. Clinical manifestation of Heart and Kidney Yang deficiency are marked by palpitations, chest congestion, angina, lassitude, lethargy, aversion to cold, cold extremities, absence of sweating, soreness and weakness of the lower back and knees, hoarse voice, slow response to stimuli, and severe systemic myxedema.

The pale or dark swollen or flabby tongue with tooth marks, the white, slippery tongue coating, and the deep, slow, thin, forceless, irregular pulse are signs of Yang deficiency with internal retention of pathogenic water and dampness. This pattern of devastated Yang Qi due to its chronic depletion is associated with myxedema crisis, cold inversion pattern, and characterized by pale and dusky complexion, dizziness and blurred vision, icy-cold extremities, shallow and weak respiration, flaccid and weak muscles, somnolence, or even myxedema coma; dusky pale tongue and minute almost imperceptible pulse.

In severe cases the Yang will float and the patient may break into a strong profuse sweat.

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Hypothyroid patients are often deficient in Yang and Qi, long needle retention or strong acupuncture stimulation may drain Qi, tonification techniques are highly advised and the use moxibustion is encouraged where applicable. It is also important to keep in mind, that as a general rule, Back-shu points tonify the Zang organs and regulate the Fu organs, while Front-mu points sedate the Fu and regulate the Zang. When Yang grows, Yin is lengthened [also grows] [10].

The key points for the treatment of signs symptoms and the root cause of clinical hypothyroidism will be discussed in a great detail in this section. The summary of these points is presented in Table 1. Several treatment plans are presented below. The plans are similar in construction, and can be used independently, depending on which modality a practitioner prefers, or which therapy the patient would best tolerate.

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Most hypothyroid patients became comatose when their respiration fails, thus it is important to keep patient conscious until the paramedics arrive. Few of the points that can be added to acupuncture treatment protocols for hypothyroid patterns:. 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.

According to records of accumulated knowledge generated by the sages of Traditional Chinese Medicine over several millennia, through close observation and experience of treatment of patterns closely associated with hypothyroidism, it is understood that this is a condition of true deficiency in Yang Qi of the body. The etiology of hypothyroidism is rooted in improper diet, overexertion, or environmental factors.

Several patterns were discussed to reflect the pathogenesis of the thyroid deficiency and explain the mechanism of the progression of the disease from Spleen Qi deficiency, to development of Spleen, Kidney and eventually Heart Yang deficiency, and further involvement of the Lungs and Liver, and eventually exhaustion and collapse of Yang, finally resulting in coma as the condition continues to worsen. In general, the Traditional Chinese Medicine management of overtly hypothyroid patients in the modern practice will often be complimentary to standard Conventional Western hormone replacement therapy.

Complementary & Alternative Medicine

When treating a hypothyroid patient, it is important to always address the root cause of the thyroid deficiency. The herbal and acupuncture therapy can often be used in conjunction with the 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. Data extraction and management Two reviewers LW and MRC will extract the necessary information for the systematic review from the documents included. The following data will be extracted: 1. Assessment of risk of bias in included studies The quality assessment of the literature will be assessed using the ROB assessment tool in the Cochrane.

Unit of analysis issue We will only extract the first experimental period data of crossover trials to avoid carryover effects. Dealing with missing data If we find that data information is missing when we include the data, first, we will consider the reason for the information loss.

Assessment of heterogeneity We will use complete case data as analysis data. Subgroup analysis For the primary outcome, when there is significant heterogeneity in the meta-analysis, subgroup analysis is performed on different interventions, controls, and outcome measures. Sensitivity analysis We will perform sensitivity analysis for primary outcomes to test the robustness of the review conclusions, and we will still evaluate the impact of methodological quality, sample size, and missing data.

Discussion In recent years, attention has been paid to the pathogenesis of neurobiology of PE, especially the 5-HT theory has become a hot topic.


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Author contributions QZ is the guarantor of the article. Conceptualization: Hai song Li, Bin Wang. Data curation: Qi Zhao, Hengheng Dai. Resources: Minran Cao.

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