By Dr. Ming Wu

What is Graves' disease？

Graves' disease, also known as toxic diffuse goiter, is an autoimmune disease that affects the thyroid. It frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyroid. Signs and symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea, and unintentional weight loss. Other symptoms may include thickening of the skin on the shins, known as pretibial myxedema, and eye bulging, a condition caused by Graves' ophthalmopathy. About 25 to 80% of people with the condition develop eye problems.

What is Graves’ ophthalmopathy?

Graves’ ophthalmopathy, also known as Graves’ eye disease, represents the most frequent non-thyroidal manifestation of Graves’ disease and is characterized by bulging eyes. Ophthalmopathy occurs in 50 percent of Graves’ cases with severe forms affecting 3 to 5 percent. Graves’ ophthalmopathy is more frequent in women than in men with a 1:4 male-to-female ratio; it is more common among cigarette smokers. Graves’ disease and Graves’ ophthalmopathy are chronic diseases with both physical and psychological symptoms ranging from no manifestations to severe manifestations.

Why do the eyes bulge?

The tissues and muscles behind the eyes become inflamed and swell. Since the eye socket is inflexible and cannot accommodate the larger eyeball, the eye bulges out. This eye condition is caused by an abnormal increase of fat tissue within the orbital cavity as well as overdevelopment of the eye muscles. The result is not just bulging eyes, but headaches, pressure sensation, and tearing. In extreme cases, the pressure can cause optic neuropathy leading to a loss of vision.

What are the symptoms of Graves’ ophthalmopathy?

 Common symptoms:

 Inflamed eyes

Itchy eyes (some call it gritty eyes)

Swelling of the eyelids and tissues around the eyes

Widening of the space between the eyelids

Photophobia (sensitivity to light)

Reddened eyes

Moderate-to-severe symptoms:

 Changes in visual sharpness or color vision

Abnormal protrusion of the eyeball(s)

Eye pain

Severe swelling around the orbit

Severe restriction of ocular motion

Severe symptoms:

 Corticosteroid dependency

Excessive or disfiguring protrusion of the eyeball(s)

Optic neuropathy

Orbital congestion

Severe dry eyes

Blindness

Western medicine treatments for Graves’ disease and side effects

Treatment for Graves’ Disease includes anti-thyroid drugs, radioiodine and thyroidectomy (surgical excision of the gland). There are both minor and major side effects from antithyroid drugs. The minor side effects occur in approximately 5% of patients and include cutaneous reactions (usually urticaria or macular rashes), arthralgia, and gastrointestinal upset. Major side effects occur only occasionally and include polyarthritis (1—2%), agranulocytosis (0.1—0.5%),hepatotoxicity (0.1—0.2%) and vasculitis (rare) .

 Radioiodine therapy is inexpensive, highly effective, easy to administer, and safe. However, radioiodine also causes permanent hypothyroidism in virtually all those receiving this therapy. It also worsens conditions of existing ophthalmology and can also induce post-radioiodine aggravated hyperthyroidism due to radiation related thyroiditis (inflammation of the thyroid) .

Uses of Chinese medicine in treating Graves’ disease

Accumulating research is expanding the understanding of how Chinese medicine helps with Graves Disease and what outcomes we can expect. One research concluded that Chinese herbs are an effective and alternative option for hyperthyroidism induced by Graves’ Disease, especially for patients who have an allergic reaction caused by thioamides. Another research found that a Chinese herbal remedy could significantly improve the symptoms of experimental hyperthyroidism. Yet another study into Graves ophthalmology concluded that a Chinese herbal preparation was capable of inhibiting preadipocyte proliferation and enhancing adipocyte apoptosis.

Studies have also been promising in using Chinese herbal preparations as an adjunct to normal therapy, including reports of improvement in palpitations, hidrosis (excess sweating) and a reduction in adverse reactions. Further studies showed that some Chinese herbs when used in combination with antithyroid drugs could induce cell apoptosis (removal of excess tissue in the thyroid) and that Chinese herbal preparation combination therapy was much more effective on the functional remission of thyroid and energy metabolism in patients than that of using Tapazol therapy alone.

Based on my own experience, I believe the cause for this disease in TCM term is kidney imbalance, maybe kidney yin deficiency or kidney yang deficiency. 

What is kidney yin deficiency?

A term in TCM. It is a type of kidney deficiency. It refers to the deficiency of kidney yin liquid, also known as insufficient kidney water or true yin deficiency. It is due to the loss of kidney yin, lack of nourishment, and endogenous asthenic heat.

Common causes of kidney yin deficiency:

1. Chronic illness

2. Born with a week body

3. Over indulgence in sex

4. Intaking too much food or medicine that can deplete kidney yin

5. Acute heat diseases

6. Emotional reasons

Symptoms of kidney yin deficiency

Kidney yin’s material base is the Qi of the kidney, and it plays a role in nourishing and moisturizing the organs. Together with kidney yang, kidney yin is the basis of human life activities. If the kidney yin is full, the yin of the whole body is full; if the kidney yin is deficient, the yin of the whole body is deficient; if the kidney kin is depleted, the yin of the whole body is depleted, and the life will end. If the kidney yin is insufficient, the secretion of body fluid is reduced, which is characterized by low yin and endogenous heat, and low yin and excess yang.

Common symptoms include: 

1. Soreness and pain in the waist and knees

2. Dizziness and tinnitus

3. Insomnia and excess dreams

4. Nocturnal emission and premature ejaculation

5. Hypomenorrhea or amenorrhea

6. Metrorrhagia

7. Leanness with dry throat and red cheek

8. Hot flashes and night sweats, yellow urine and dry stool

9. Red and dry tongue with no coating, weak pulse

Treatment methods

1. Principle

The general principle is "to replenish what is insufficient, don’t inhibit what seems to be in excess", and "support Yin to consume excess Yang", Liuwei Dihuang Wan is the classic prescription for this purpose. However, the appropriate formula to use should depend on the specific causes and symptoms. For example, for lack of kidney yin, thirst and dry throat due to insufficient saliva production, cleft lip, constipation, one should use cochinchinese asparagus, dwarf lilyturf root, glossy privet fruit, etc. For symptoms such as hot flashes, night sweats, palpitations, insomnia, one should use adhesive rehmannia root, kakuda figwort root, turtle shell, Chinese wolfberry root-bark, etc. For soreness and pain in the waist and knees, nocturnal emission, dizziness and tinnitus, pre-mature graying, menstrual disorder,  one should use Radix rehmanniae, Polygonum multiflorum, medlar, mulberry, etc.

2. Chinese medicines for kidney yin deficiency

（1）Liuwei Dihuang Wan, take 10g with empty stomach 2-3times a day. 

（2）Zuo Gui Wan, suitable for lack of yin fluid and blood.   

（3）Da Bu Yin Wan, suitable for excess internal heat due to yin deficiency。

3. Acupuncture treatment

Use Shen Shu (BL23), Guan Yuan (BL26) and San Yin Jiao (SP6). Use filiform needle and reinforcing method, or even reinforcing and reducing method. Add Shen Men (HT7 ), Xin Shu (BL15), and Bai Hui (DU20) for insomnia and amnesia; add Ting Hui (GB2) and Yi Feng (SJ17) for

tinnitus and deafness; add Zhi Shi (BL52), Da He (KI12) and Tai Xi (KI3) for nocturnal emission; add Yin Bai (SP1), Nei Guan (PC6), and Tai Xi (KI3) for uterine bleeding. Generally, moxibustion is not used.

4. Pay attention to both yin and yang

Regarding the treatment of kidney yin deficiency, we should keep in mind the opposition and interdependence of yin and yang. Kidney deficiency includes kidney yin deficiency, kidney yang deficiency and kidney yin and yang deficiency. Kidney yin deficiency is due to excess consumption of substance, and kidney yang and kidney Qi are functional. If the substance is overly consumed (kidney yin and kidney essence), such as too frequent sexual life, or overexertion of one’s body (mentally or physically), it will lead to kidney yin deficiency. When yin is not enough to oppose yang, it results in endogenous asthenic heat in the body.

 Because the yin and yang of the kidney are Yuan Yin (original yin) and Yuan Yang (original yang), they often affect each other during the course of the disease. When kidney yin deficiency worsens to a certain extent, it could affect kidney yang, and the body becomes both yin and yang deficient, which is called “yin loss harms yang”. Vice versa, when kidney yang deficiency worsens to a certain extent, it could also damage kidney yin, which is called "yang loss harms yin". Therefore, to treat kidney yin deficiency, one should not only use medicines that nourish yin, but also those that will warm yang, because kidney yang is needed to transform nutrients to kidney yin.

What is kidney yang deficiency?

Kidney-yang deficiency is a TCM term for lack of sufficient kidney yang.

Chinese medicine believes that the kidney governs water metabolism. kidney yang is needed for water circulation in the body. If the kidney yang is insufficient, patient will have clear abundant urine, so the kidney yang deficiency can cause pathological change of the kidney. Kidney deficiency is a chronic condition, so one should not attempt a quick fix, but improve the condition through gradual adjustment. Kidney yang is also known as Yuanyang (original yang), Zhenyang (true yang), and Zhenhuo (true fire), because kidney is the root of the twelve meridians in the body. The kidney yang governs the yang of the whole body. Insufficient kidney yang is the root cause of many yang insufficiency syndromes.

Kidney yang deficiency is related to the neuroendocrine immune system (NEIS) of modern medicine. Kidney yang deficiency can be linked to different degrees of dysfunction in the hypothalamic-pituitary-target gland (adrenal cortex, thyroid gland, gonad, thymus) axis. The main pathogenesis is the regulatory dysfunction of hypothalamus (or higher nerve centers).

Common causes of kidney yang deficiency:

1. Born with a week body

2. Aging

3. Chronic illness

4. Over indulgence in sex

Symptoms of kidney yang deficiency

1. Soreness and pain in the waist and knees

2. Decreased sexual function, such as impotence and premature ejaculation in men and infertility in women.

3. Chronic diarrhea and indigestion

4. Clear abundant urine, getting up frequently throughout the night to urinate

5. edema, especially in lower body.

6. Dark and dull skin tone

7. Aversion to cold, cold extremities, especially lower limbs

8. Lack of vigor

9. Pale face, dizziness

10. Fat and pale tongue with white coating. Pulse is slow and weak

Treatment methods

Normal kidney yang deficiency: warm and replenish kidney yang. Main medicine: Jingui Shenqi Wan

Yang deficiency with diarrhea: warm kidney and stop diarrhea. Main medicine: Si Shen Wan

Yang deficiency with water circulation problem: warm kidney and strengthen water circulation. Main medicine: Zhen Wu Tang.

Common herbs used: antler, aconite, cassia twig, atractylodes, licorice, scutellaria, white peony, medlar, hawthorn, Chinese yam, psoralen, medlar, dodder, dongchong xiacao, sea dragon, seahorse, etc.

The Inter-Consuming-Supporting and the Inter-Transforming Relation of Yin and Yang

It should be pointed out that although there are differences in kidney yang, kidney yin, kidney Qi and kidney essence, they are inseparable. The kidney stores the xiantian (original) and houtian (acquired) essence. Kidney essence transforms into kidney Qi. Kidney Qi that warmth, excites, stimulates, seals and restricts yin and coldness is called kidney yang, also known as Yuanyang, Zhenyang. and Zhenhuo. Kidney Qi that moisturizes, tranquilizes, makes form, and inhibits excessive yang heat is called kidney yin, which is also called Yuanyin, Zhenyin and Zhenshui (original yin, true yin, and true water). Kidney yang can promote the metabolism of the human body, and transform substance into energy, so that the progress of various physiological activities of the human body is accelerated, the heat production is increased, and the spirit is uplifted. The kidney yin inhibits or slows down excessive metabolic activities, the heat production is relatively reduced, and the spirit becomes tranquil. In summary, the regulation of both kidney yin and yang assures the normal functions of the human body and its metabolic process.

According to the theory of yin and yang of traditional Chinese medicine, yin and yang can be divided infinitely. The kidney essence is yin essence, however, the yin essence can be divided into yin and yang again. It can be divided into the yang essence in the yin essence and the yin essence in the yin essence. When the yang essence in the yin essence is deficient, symptoms include soreness and pain in waist and knees, lumbar spine weakness, fatigue, among others. When the yin essence in the yin essence is deficient, symptoms include weak and sore waist and knees, heel pain, dry mouth, thirst, insomnia and excess dreams. The yang deficiency in the yin essence is often closely related to the kidney yang deficiency. The yin deficiency in the yin essence is often closely related to the kidney yin deficiency. Therefore, in addition to chills and cold, kidney yang deficiency is often accompanied by symptoms such as soreness and pain in waist and knees, lumbar spine weakness, fatigue, etc. In addition to excess heat, kidney yin deficiency is often accompanied by symptoms such as weak and sore waist and knees, heel pain, dry mouth, and thirst.

Chinese herbal medicines for tonifying kidney, such as hailong, gecko, antler, epimedium, cistanche, yangqishi, cynomorium, leek seed, staghorn gum, Eucommia ulmoides, bajitian, gusuibu, gouji, curculin, etc. can warm kidney yang, and nourish the yang essence (the yang essence in the yin essence). Chinese herbal medicines, such as Rehmannia glutinosa, shouwu, gouji berry, tortoise shell, and Ligustrum lucidum, have the functions of nourishing kidney yin and benefiting the yin essence (the yin essence in the yin essence). Therefore, in the case of kidney essence deficiency, one needs to distinguish between yin essence deficiency and yang essence deficiency, and choose the appropriate Chinese herbal medicines.

 Note: The TCM formulas in this article are only intended as references for medical practitioners. They are not to be used for self-treatment.

Diet Suggestions:

A nutritious and balanced diet. Turmeric has been known to be beneficial for thyroid disease.

Avoid seafood that are rich in iodine, such as seaweed and shrimp.

To consult with Dr. Wu, please call or text: 978-790-8888.

References:

https://en.wikipedia.org/wiki/Graves%27_disease

https://www.sustainhealth.com.au/blog/graves-disease/?locale=en