Causes from the Oriental Perspective
While Western doctors seek a cause of autoimmune-induced thyroid disease in a combination of genetic determinants and viral initiators, Chinese doctors have attributed the cause of the disorder primarily to emotional disturbance. In the case of hyperthyroidism, the following have been mentioned in the Chinese literature:24
- Disturbance of qi by sorrow and anger. Liver and spleen qi become disharmonious, and, as a result, moist sputum coagulates to form a goiter. The swelling in the neck should be one of the first noted symptoms when this is the primary cause.
- Heart fire. The disorder is often marked by highly agitated emotional condition. Fright, dreaminess, mania, panic, and other distress that may cause insomnia, excessive talking, or heart palpitations belong to this category. Heart fire is often associated with heart yin deficiency. The skin in the area of the thyroid may become discolored (purple).
- Extreme anger may produce liver fire, which dries yin and blood. The vessels surrounding the thyroid may bulge.
- External factors: geography plays a part (iodine deficiency, goiterogenic foods dominant in local crops, or some toxin in the environment induces thyroid disease). Drinking “sandy water” or being exposed to “mountain vapor” have been said to cause the disease, but such explanations are no longer relied on.
The first cause, qi disturbance, is most frequently cited. A weakening of the stomach and spleen qi (which may be the result of emotional factors or dietary influences) produces turbid and moist substances; these are raised to the thyroid area by the stimulus of excessive liver qi (most often the result of emotional stimulus).
There will thus be swelling in the neck and protrusion of the eyes. Or, to put events in a different order, as described in Comprehensive Guide to Chinese Herbal Medicine:When [hyperthyroidism is] due to long-term depression or sudden psychic trauma, the liver no longer properly regulates the flow of vital energy and blood, liver qi stagnates, and fails to transport fluids. The fluids accumulate and transform into phlegm, which then obstructs the neck with qi and gradually induces goiter. Lingering [pathologic] liver qi transforms into fire, which is manifested in fidgeting and irritability. If the fire consumes body fluids and stomach yin, the resulting yin deficiency produces heat. Even though this heat overstimulates the appetite, the patient still loses weight. If the spleen is impaired, it will be unable to transport or transform nutrients, thereby giving rise to diarrhea, gauntness, and lassitude. If heart yin is deficient [a result of lack of transported nutrients], palpitation or severe palpitation with fear, fidgeting, insomnia, and profuse sweating can be observed. …
In the discussion of a clinical trial involving 98 patients,21 the authors present the following explanation:
The etiology of hyperthyroidism involves chiefly the deficiency of genuine qi and insufficiency of kidney fluid. Insufficiency of water leads to excessive heat, which in turn harms the vital energy. Excessive heat also hurts yin, and impairment of yin again affects yang. The excessive heat of the hyperthyroid patient often involves the three internal organs of heart, liver, and stomach. Excessive heat in the heart is manifested by palpitations and forgetfulness. Excessive heat in the liver gives rise to irritability and tremor. Excessive heat in the stomach leads to polyphagia. The impairment of yin that affects yang in the hyperthyroid patient is represented by the damage of spleen yang. Deficiency of spleen yang causes indigestion and loose stool, and produces wet phlegm, which goes up to the neck to cause the enlarged thyroid or nodules, or goes to the eyes to induce exophthalmos. In treatment of this disease, main emphasis should be on replenishment of vital energy. Once the yang of vital energy is replenished, yin will grow to calm down the excessive heat.
An initial problem of deficiency is also described by another experienced doctor.31 According to his observation of patients with hyperthyroidism, yin deficiency of the liver and kidney is a dominant cause of the disease, though it is sometimes caused by yin deficiency of the heart and kidney or deficiency of qi and yin. The yin deficiency can lead to a coexisting yang deficiency. He therefore recommends nourishing the kidney, removing heat from the liver, softening the thyroid mass, and (if necessary) restoring the qi and yang.
From these explanations (see also the explanation given under the section on acupuncture therapy), it should be evident that there is not complete agreement on the initiation of the disease. There is general agreement, however, that ultimately the yin is damaged and must be replenished and that the thyroid swelling, due to a phlegm excess, must be resolved.
In one clinical report on hyperthyroidism,16 investigators determined that the likely causative factors for the 110 patients were: fright, depression, and mental irritability in 84 cases (76.3%), infections in 12 cases, extreme fatigue in 9 cases, and congenital problems in 6 cases. The 26 remaining cases were of undetermined causality. The main cause — emotional distress –has an effect of disturbing the qi.
