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The Yin and Yang of the Thyroid
A Look at Traditional Chinese Medicine and Acupuncture for Thyroid Disease, with Dr. Patrick Purdue

by Mary Shomon

In this interview, Dr. Patrick Purdue, Doctor of Oriental Medicine and Acupuncture Physician, talks about the role of Traditional Chinese Medicine for thyroid conditions. Dr. Purdue is a graduate of the Florida Institute of Traditional Chinese Medicine. He completed an eighteen month postgraduate program in Traditional Chinese Medicine gynecology, and regularly attends over 80 hours of continuing education yearly. His practice focuses on women's health, gastrointestinal conditions and autoimmune diseases.

Mary Shomon: Can you tell us about your background, how you became interested in Chinese medicine, and what training you underwent to become a Doctor of Oriental Medicine and acupuncturist?

Dr. Purdue: I really got involved in studying Traditional Chinese Medicine (TCM) in an around-about way. About 13 or 14 years ago, my youngest daughter Dana began to have recurrent middle ear infections. At the time, I was a commercial photographer shooting images for brochures, catalogs and so on. One of our neighbors was an MD, and so we took her to him and he put her on the standard 10-day course of Amoxicillin. The condition resolved, but she got another one not too long afterward. Another course of Amoxicillin resolved that one. But the episodes of ear infection began to become frequent and closer together. Then her tonsils and adenoids became swollen and inflamed, and her nasal passages were chronically congested. So she got to the point of being on antibiotics all the time and was on steroid inhalers for the congestion. The MD then suggested it was time to have her tonsils and adenoids removed, and have tubes put in her ears. That's when we decided that there had to be another way. Luckily, we found a chiropractor who practiced nutritional medicine, and who quickly discovered that she had a dairy allergy. We took all dairy products out of her diet and she shortly afterwards became completely well and had no more ear infections. So I thought, here they were going to do all this surgery on her, not to mention the fact that she'd been on all sorts of medications for the better part of a year, and all it was was a simple allergy which the doctor didn't even think to check out.

I decided I wanted to figure out how to help out other people with natural medicine. Not long afterwards I learned of the TCM medical school in a neighboring town, 20 minutes from my home. I checked into the program and found out I'd have a three year commitment. Now at this point in time I knew absolutely nothing about TCM. All I cared about was that I already had the basic entry-level college requirements done, and it was a year less time commitment than conventional medical school or chiropractic college. I figured I could suffer through three years of anything to get a primary care provider's license so I could practice nutritional medicine. It was in the first couple of weeks of school in my first semester that I fell in love with TCM. It is the world's oldest professional medical system. Basically, saying that the program is three years long is a bit deceiving (a change in state law will increase the training by one more year starting next year). We were using the Shanghai Medical College five year curriculum squeezed into three years. This was done by not spending time on subjects for which our license does not allow us to do (prescribe pharmaceuticals, do surgery, etc.), and squeezing the rest into five and a half month long semesters and 18 hours a week in class. When it became time for the internship phase of the training, we were still required to be in class for eighteen hours plus complete our internship requirements. It has been the most rewarding thing I've ever done.

Incidentally, since I began studying this medicine none of my three daughters have had an antibiotic or any other prescribed drug. It is unusual in our culture for people to go for over ten years without an antibiotic or other medication.

Mary Shomon: The basic premise behind Chinese Medicine is the idea of harmony, the balance of yin and yang. Can you provide a bit of an overview of this concept for those who are unfamiliar with it?

Dr. Purdue: Most people have heard of yin and yang, and most have seen the yin/yang symbol. The interpretation of yin and yang in TCM physiology is a bit different than the definition of those terms in other arenas, such as the martial arts or Taoist philosophy. Yin, represented by the dark field in the yin/yang symbol, equates in medicine to body fluids such as blood, and to the actual structure of the body itself. It is cool in temperature. Yang, represented by the white field in the yin/yang symbol, equates to function and movement. It is warm in temperature.

So, for example, the liver as an organ structure is yin, but its function is yang. So obviously, if we have a balance between structure and function, that organ or body is in balance and everything is working well. And, if you recall, the yin/yang symbol has the opposite color "eyes" in each field. This implies that nothing is 100% yin or 100% yang, that each contain elements of the other. Our goal in TCM is to help the body achieve balance between structure and function.

The other important idea in TCM is the concept of "qi" (pronounced "chee"). It often gets interpreted as "energy," and, loosely, this is correct. There are many forms of qi in TCM. For instance, "clear qi" is their word for the air that we breathe. "Heart qi" is the beating of the heart. "Stomach qi" is the action of the stomach churning up the food. Qi is a yang function. Qi is considered the "commander of the blood." There is a famous statement about pain in TCM which reads, "If there is pain there is no free flow. If there is free flow there is no pain." This implies that as long as the qi and blood are flowing smoothly one has no pain. Any pain, anywhere in the body, is due, in TCM terms, to a blockage or impairment in the flow of qi and blood. So our job, through the use of dietary modification, medicinal formulas or acupuncture, is to remove the obstacles so that qi and blood flow smoothly, or so that function is restored. This is the "return to balance."

Mary Shomon: In Chinese medicine, health is considered balance and disease is evidence of imbalance. Can you describe what Chinese medicine feels can upset those balances?

Dr. Purdue: Diseases in TCM are thought to be the result of extremes, or overabundance, of the "six qi," and the "seven affects." The six qi are wind, cold, summer heat, dampness, dryness and fire. The seven affects are joy, anger, anxiety, thought, sorrow, fear, and fright. The six qi are considered, in excess, to be external disease sources, and the seven affects are, again in excess, considered internal disease mechanisms. Another ancient text also describes the "seven damages," which are food damage, anxiety damage, drink damage, sexual intemperance damage, hunger damage, taxation damage, and channel-network/construction-defense damage ("channel-network" refers to the acupuncture channels, and "construction-defense" refers to the mechanisms that build and repair the body, and the immune system).

So the idea here is that excessive amounts of any of the above can create a problem in one or more organ systems in the body and eventually lead to disease. For instance, too much joy can affect the heart (we've all heard of people who laugh so hard they die of a heart attack). People with conditions of phlegm congestion are considered to have too much dampness. Those who are under stress and worry too much are prone to problems due to anxiety and too much thought.

We are in the beginning of flu/cold season at the moment. What are our environmental conditions currently? We have more wind than usual, cooler temperatures, and dry conditions. "Wind-cold" is the TCM description of a group of symptoms that include pronounced aversion to cold with mild fever, headache, generalized body ache, absence of sweating, nasal congestion and runny nose, cough, clear thin phlegm, and absence of thirst. This is different than "wind-heat" which has the symptoms of cough with thick phlegm, generalized fever, sweating, aversion to wind, dry mouth, sore throat, and yellow nasal mucus. In the West, we'd recognize all of the above symptoms as signs of the flu, and all would be treated with more or less the same medicines. In TCM, these are two distinctly different disease "patterns" and would require two different treatment strategies.

TCM, in addition to the above "six qi" and "seven affects," recognizes external injury (trauma), "toxic qi" or "pestilential qi" (roughly equivalent to our idea of bacteria, viruses, parasites, and so on), and food poisoning as disease-causing mechanisms. They are treated based upon the pattern of symptoms that result.

Mary Shomon: Chinese medicine treats disease by attempting to restore balance to the body. Many different ways are used to diagnose the imbalances. Can you tell us about some of them?

Dr. Purdue: Information used to determine a diagnosis is gathered through the "four examinations." These are inspection, smelling and listening, inquiry, and palpation. Under palpation are included touching the body to determine the type of pain in an area (i.e. sharp, stabbing, aching pain, etc.), zheng jia ji jiu (literally, "conglomerations, concretions, swellings and gatherings" -- in other words, cysts, tumors, edema, and so on), and a very sophisticated method of pulse diagnosis. There are 28 different types, or qualities of pulse. To feel these and know what they mean is a high art. A lot of information as to what is happening in the body can be derived from pulse diagnosis. Under inspection is included tongue diagnosis, which, like pulse diagnosis, is a high art in TCM and can also be very revealing as to what is happening in the body. And, since modern TCM is constantly evolving, modern techniques such as X-ray and blood lab could technically be included under "inspection."

Once information from the four examinations is gathered, a pattern diagnosis is developed. This type of diagnosis is a statement about the unique combinations of symptoms that describe that one patient in front of the practitioner. So, in other words, I could have ten female patients diagnosed by their conventional MD gynecologists as having a uterine myoma, or fibroid tumor, but in our medicine they may have ten completely different patterns and therefore receive ten very different treatments.

Mary Shomon: Chinese medicine does not appear to place much importance on the thyroid gland as a separate entity. Can you explain this a bit?

Dr. Purdue: During the development of TCM, which began over 25 centuries ago, they were not aware of the existence of what we call the endocrine system, which, of course includes the thyroid gland. In fact, the existence of the endocrine system wasn't known about in the West either until a little over a hundred years ago. So it isn't that there isn't much importance placed upon the thyroid gland, they just didn't know of its existence until the last hundred years.

Of course, in modern TCM, current state-of-the-art knowledge of anatomy and physiology are vigorously studied. However, just because TCM up to a hundred years ago didn't know about the existence of the endocrine system, the symptoms caused by thyroid imbalances, or any other endocrine imbalance, would certainly be described and addressed in TCM pattern diagnosis. Again, you could have 10 people with the Western medical diagnosis of "hypothyroidism," but they may well have, according to TCM, 10 unique, separate patterns of symptoms. And that's what we address.

For example, let's say a patient comes in with nodules on the neck that are firm and rubbery accompanied by a dry mouth and throat, a red tongue, and a rapid pulse that has a smooth feel, but is rather thin and firm. We contrast this patient with a second one who also has nodules or masses in the neck but of a more firm, rocklike hardness, are immobile and cause no skin discoloration. The tongue is normal or slightly pale, and the pulse is not rapid. In conventional Western medicine, both patients may be diagnosed with goiter, would have blood tests done to determine thyroid hormone levels, and both be given the same medication, maybe in different dosages. In TCM, these are two completely different patterns and would receive two different medicinal formulas. In the same way, not everyone with hypothyroidism has hair loss, or depression, or dry skin, or fatigue, and so on. So different treatments are required depending upon the entire constellation of that one patient's symptoms.

So just because TCM did not describe a thyroid gland per se, the symptoms of hypo- and hyperthyroidism are well described in the literature. That being said, the famous physician Sun Si-Miao, who lived from 581 - 682 AD, was said to have used what we now know are the thyroid glands of animals to treat goiter. So, whether or not TCM described a thyroid gland as we know it, they obviously had some awareness of this gland and developed various treatments for it.

Mary Shomon: Chinese medicine would rather work to keep the body in balance than to have to treat diseases after the fact. One popular saying goes "Chinese doctors believe that the superior doctor prevents disease, while the mediocre physician treats disease only after it has appeared." In what ways do you think patients can prevent thyroid disease, and can you touch upon some tools Chinese medicine provides to help thyroid problems?

Dr. Purdue: The saying you quoted is attributed to the same Sun Si-Miao mentioned previously. He was quite an innovator. In addition to the use of thyroid gland to treat goiter, he used the liver of animals to treat night blindness, scallion stalk for catheterization, and really advanced acupuncture theory for tough conditions. I believe the quote went something like, "The superior doctor has no patients [because he taught them proper diet and lifestyle habits to prevent illness], the inferior doctor treats disease [meaning that doctors who only spend their time treating disease are missing out on the most important aspect of medicine -- prevention]." He was quite an innovative physician in developing ways to treat disease. In a word, the basic TCM approach to preventing any disease is moderation. Eating a diet that is nutritious and healthy, without having extremes of sweets, hot and spicy and so on, keeping oneself balanced emotionally, moderate exercise, and protecting oneself from environmental extremes is the way to health and long life.

Of course, who can so this nowadays? America is a land of extremes. Even when one attempts to "do the right thing" health-wise, we have a very stressful culture on many levels and I have very few patients who can stay above this stress. We also have air conditioning vents overhead, and ceiling fans. This ensures that, according to TCM theory, we are constantly exposed to an excess of wind, one of the "six qi" disease mechanisms. So the best advice for all is to do the best one can. Depending upon how strong your constitutional nature is, you can keep yourself mostly well by avoiding the extremes of external and internal disease causes as described previously.

Mary Shomon: How does Chinese medicine view a thyroid problem such as hypothyroidism?

Dr. Purdue: Whenever any patient comes to me, regardless of the problem, I have them fill out a very thorough health history. I invite them to bring in any lab tests they have. I proceed through the "four examinations," and then add up all the signs and symptoms I find. This then leads me to a pattern diagnosis, which, as mentioned earlier, will be a statement of that particular patient's uniqueness. A properly worded pattern diagnosis will lead me to a treatment principle, which is a statement of how to proceed. This, in turn, leads the way to a basic medicinal formula which has to be altered to fit the patient's uniquenesses.

So, what symptoms might we have in hypothyroidism? Let's say the patient's complaints are hair loss, dry skin, mental depression, cold hands and feet, weight gain and disturbed sleep. All classic hypothyroid symptoms. But let's say this patient also has dizziness on occasion, blurry vision at night, low back and knee soreness and weakness, night sweats, lateral rib achiness, red eyes, acne, breast distention, is easily angered, has a bitter taste in the mouth, and feels bloated and gassy after meals. To treat only thyroid symptoms would be missing the boat with this patient. Additionally, we couldn't help this patient with the same medicinal formula that we'd treat another patient with who may have the exact same hypothyroid symptoms but an entirely different range of other symptoms. So I would treat this patient with a very complex, customized medicinal formula (we use concentrated powdered extracts of herbs that we load into gelatin capsules) probably consisting of 15 to 25 ingredients, dietary instructions (this patient would need to avoid hot and spicy foods, iced drinks with meals, raw foods, frozen desserts, sugar, and excessively sour foods and drinks), and regular, moderate exercise. I would also encourage the patient to meditate every day as a way to unload some of the stress in her life.

I would also put her on various nutritional supplements. Though nutritional supplements may not sound "Chinese," I'll never forget what my gynecology instructor once said in a lecture. He said that the major contribution of Chinese medicine is not herbs and acupuncture. These were incidentals. The major contribution of TCM is its way of thinking about a case, the whole thinking process. In fact, he said, if Western MD's thought like a TCM physician when they prescribed pharmaceuticals, the amount of adverse reactions they encountered would be dramatically reduced. So, in that spirit, I have no trouble using TCM theory applied to Western nutritional supplements, and even homeopathy, if I think those will help the case.

Mary Shomon: How does Chinese medicine view a thyroid problem such as hyperthyroidism?

Dr. Purdue: Well, again, one can look at some of the classic hyperthyroid symptoms such as weight loss, rapid heartbeat rate, elevated body temperature, insomnia, and profuse sweating, but have other symptoms that would need to be factored in. So let's say we have a patient with the above symptoms who also has a reddish facial complexion, gnawing hunger, acid regurgitation, frequent belching, and ringing in the ears. This patient could not be treated with the same formula and treatment as someone with the same hyperthyroid basic symptoms but a different group of other symptoms. We would follow the same approach as described for hypothyroid cases which would involve a customized formula to treat the patient's uniquenesses, dietary advice, and other lifestyle suggestions as appropriate. Our medicine is based upon pattern diagnosis rather than a Western-style disease "label."

Mary Shomon: When someone has an autoimmune thyroid condition (such as Hashimoto's, Thyroiditis, or Graves' disease), what are your thoughts about using some of the common "immune-boosting" Chinese herbs such as ginseng, codonopsis, astragalus, schisandra, and isatis.

Dr. Purdue: This is a very good question to ask since a lot of people are under the impression that because TCM is "old," and autoimmune conditions are "new," that they would not have a treatment approach. So, if you don't mind, I'd like to explain our approach to autoimmune conditions briefly before answering your questions about whether or not the herbs you asked about would be appropriate.

Another famous Chinese physician from the past was a fellow named Li Dong-Yuan. He was one of the four great master physicians of the Jin-Yuan dynasties period, which spanned a period of time from 1115 - 1368 AD His classic work is a text entitled Treatise on the Spleen and Stomach. In this text, he proposed a very complicated set of diagnostic principles and a group of treatments that is so involved that this was not taught to us in school. I had to learn about it during numerous, extensive postgraduate programs. When one understands what he was describing as far as conditions and symptoms, it is clear that he was observing, diagnosing and treating what we would call autoimmune diseases. So there is definitely nothing "new" about these conditions. And though Dr. Li figured out ways to approach and treat these conditions he still approached the condition in front of him in the same basic way, pattern diagnosis based upon the four examinations, treatment principle, medicinal formula.

Now to answer your question about the herbs you mentioned. Once one understands the TCM description of these medicinals, which is completely different than the Western pharmacological description of their actions, one can safely determine if a medicinal is appropriate. In some, and certainly not all, conditions of autoimmune disorder there may be an appropriate use for the medicinals which are labeled as being "immune-boosting" in the West. Ginseng, codonopsis and schisandra are thought to be "adaptogens" in the West, meaning that they tend to normalize function. Astragalus has been found to increase the activity of white blood cells, and there are several doctors who use it heavily in the treatment of cancer patients as there is some evidence that astragalus can "switch on" natural killer cells, the specialized white blood cells that target malignancies. Isatis has shown to have anti-viral activity and has even been used in some AIDS research. And even in the Western literature it is somewhat controversial as to whether these herbs actually "boost" the immune system in a way that could be a problem for autoimmune patients. However, this has nothing to do with the TCM description of these herbs function. In addition, the formulas that we use are polypharmacy. Many ingredients are involved and the synergistic interactions of the medicinal ingredients changes the function of the herbs if they were used individually.

So the moral of this story is that patients should not experiment with these medicinals on themselves, particularly in autoimmune conditions, and should seek the skills of a TCM practitioner who knows how to work these formulas. This is not an easy medicine to practice. It is far from the simplistic Western herbal approach of "if you have a headache take feverfew, and if you have a bellyache take peppermint tea." It is serious medicine, and should not be experimented with lightly.

Mary Shomon: Are there any books or websites you think are of particular interest to someone who wants to learn more about Traditional Chinese Medicine?

Dr. Purdue: Sure. A great book that explains this whole thing about pattern diagnosis and so on is The Web That Has No Weaver by Ted Kaptchuk. Blue Poppy Press (1-800-487-9296) is a publisher of really excellent TCM textbooks used in the schools, and also has very good publications for the lay public.

The following websites are also good sources:

Mary Shomon: How can people contact you?

Dr. Purdue: Patrick Purdue, D.O.M., A.P.
12800 Indian Rocks Rd., Suite #1
Largo, FL 33774

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