GOITER

GENERAL

Clinical Manifestations

Qi Goiter:	Initially, no prominent systemic symptoms Gradual neck swelling No skin discoloration Mass tends to be flaccid Skin droops locally with a heavy sensation Anger Hoarseness and dyspnea with swelling of the mass Alleviated by feelings of well being
Flesh Goiter:	Most common among women ages 20-30 No systemic symptoms One or more glossy semi-circular nodules around the thyroid The nodules move up and down when the person swallows Pain only with pressure Occasional: Impatience Sweats easily Thoracic constriction Heart palpitations Tachycardia Menstrual irregularity Enlargement may cause difficult breathing
Stone Goiter:	Most common in women ages 40-70 The mass is hard with a rough surface The mass grows suddenly and reduces the ability to swallow The mass does not move aside when pressed When critical, the prognosis is poor: Pain in the ears, occipital bone and shoulders Difficulty breathing Impaired speech Hoarseness
Blood Goiter:	Purple skin Veins and red threads visible beneath the skin Profuse bleeding when bruised Painless
Sinew Goiter:	Associated with Liver Fire Sinews and veins exposed on goiter No aching

Herb Formulas

Hai Zao Yu Hu Tang modified
San Zhong Kui Jian Tang #1
Chai Hu jia long Gu Mu Li Tang modified

Points

GB-20, DU-14, DU-4, UB-11, REN-22, ST-10, SJ-3
UB-10, UB-12, DU-12, DU-3, REN-23, ST-9, GB-26
ST-9 through to SI-17, LI-4, ST-36, Zeqian, KI-3, PC-6, SP-6
Ahshi points around goiter (four points inserted on the top, bottom, left and right of the thyroid, oblique towards the centre), PC-5, PC-6, ST-36, SP-6
Local points: ST-11, REN-22, REN-23, LI-17, ST-9, LI-18, SI-17, ST-10 , extra point Pingying (0.7 cun lateral to the space between 4th and 5th cervical vertebrae), extra point Shangtianzhu (0.5 cun above BL-10)
Huatuojiaji points
Ancient Acupuncture Prescriptions:
Zhen Jiu Jia Yi Jing (The ABC Classic of Acupuncture and Moxibustion): SI-17
Zhen Jiu Da Quan (Complete Works of Acupuncture and Moxibustion): LU-7, LI-18, REN-22, LI-17, ST-12, KI-27, REN-1, LI-4, bleed Shixuan
Qian Jin Yao Fang (Prescriptions worth a Thousand in Gold for Every Emergency): SJ-13 , LU-3 , ST-11
Zhen Jiu Zi Sheng Jing (Classic of Nourishing Life with Acupuncture and Moxibustion): GB-10, ST-11

PHLEGM AND BLOOD STASIS OR QI STAGNATION DUE TO PATHOGENIC INVASION

Clinical Manifestations	Neck swelling The lump is a hard nodular mass that is immovable and grows rapidly The lumps have an irregular surface The lump may move slightly when swallowing The skin over the mass is dark and painful A feeling of chest oppression Palpitations Shortness of breath Exophthalmos Irascibility Insomnia Anxiety Hoarse voice T: Swollen and purple C: Sticky P: Wiry and/or choppy or Wiry and Rolling
Treatment Principle	Regulate Qi Invigorate Blood Eliminate Stasis Resolve Phlegm Soften hardnesses Dissolve goiter
Herb Formulas	Hai Zao Yu Hu Tang Jia Shi Jia Kang Fang Goiter #2 Er Chen Tang Xia Ku Cao Gao Dao Tan Tang Patent: Hai Zao Jing
Points	SJ-6, GB-34, LIV-3, PC-6, SP-4, REN-12, REN-22, SP-10, UB-17, UB-18, ST-40, LI-17 Ahshi points (4 needle technique) ST-9, ST-10, ST-11, REN-22, REN-23, LI-17, LI-18, Pingying (.7 cun lateral to the space between the 4th and 5th cervical vertebra), Shangtianzhu (.5 cun above UB-10) SI-17 LU-7, LI-4, LI-17, LI-18, REN-17, REN-22, ST-12, KI-27, Bleed Shixuan SJ-13, LU-3, ST-11 GB-10, ST-11 SJ-13, LI-4, LI-17, ST-36, SI-17, REN-22 LI-4, LI-17, SP-6, SI-17, REN-22 With neck discomfort: LU-7, KI-6 With depressive Heat: GB-34, LIV-2, eliminate LIV-3 With Spleen Qi Deficiency: ST-36 With Kidney Yang Deficiency: KI-3 SJ-13, LI-4, LI-17, ST-36, SI-17, REN-22 Ahshi points With palpitations: PC-6, HT-7 With Excess sweat: LI-4 With swollen eyes: UB-1, UB-2, UB-5, ST-2, GB-20, DU-20 With high blood pressure: DU-20 Qiying, LI-4, LI-11, Huatuojiaji Points from C-3 to C-5, REN-22, GB-20, SJ-3, Center of mass (no retention) Growth on the front of the neck: REN-22, UB-7, SJ-12, DU-17 Peak of goiter, REN-22, LI-11 (no retention) Zeqian, REN-22, LI-4, LI-11, ST-9, ST-10, plum blossom over affected area Ear: Endocrine, Thyroid, Shenmen, Neck Moxibustion: 1. GB-20, DU-14, LI-14, Extra point (1.5 cun below DU-14) 2. REN-22, REN-17, UB-7, LU-2, LU-3, LI-14, LIV-4, GB-20, DU-14, ST-11, ST- 42 3. REN-22, REN-17, LU-2, LU-3, LI-14, LI-11, LIV-4, GB-20, DU-14, ST-11, ST-42, SJ-13 4. Growth on the front of the neck: GB-20, 10 cones, borderline of one ear, DU-14, 30 cones, 1.5 cun lateral to DU-14, 30 cones, LI-14, 1 cone for each year of age

SPLEEN QI DEFICIENCY

Clinical Manifestations	Lymph adenoid goiter Fatigue Cold hands and feet Obesity Puffy edema Pale face Loose stools T: Thick, pale with teeth marks C: Thin white P: Weak or Soggy
Treatment Principle	Strengthen the Middle Tonify Qi
Herb Formulas	Bu Zhong Yi Qi Tang modified
Points	St-36 + moxa, SP-3, SP-6 +moxa, ST- 12, ST-9, SI-16 With Liver Qi Stagnation: LIV-3 With Blood Deficiency: UB-17, UB-20 With facial edema: SP-9, DU-26 With constipation: ST-25 With Wind-Cold-Damp Invasion: LI-11, SP-9 + Ahshi Points With depressive Heat: ST-44, or GB-34 With cold hands and feet: SJ-5, UB-57 REN-4 + moxa, above UB-10 With facial edema: SP-9, DU-26 With generalized edema: SP-6, SP-9, REN-9

**SPLEEN AND KIDNEY YANG DEFICIENCY**

Clinical Manifestations	Lymph adenoid goiter Fatigue Cold hands and feet Obesity Puffy edema Pale face Loose stools Dizziness Tinnitus Decreased sexual desire Impotence	Sterility Menstrual irregularity Infertility Low back pain and weakness Knee pain and weakness Nocturnal polyuria Fear of cold Colder feet than hands T: Thick, pale with teeth marks C: Thin white P: Weak or Soggy
Treatment Principle	Strengthen the Middle Tonify Qi Supplement the Kidneys Tonify Yang
Herb Formulas	Jia Wei Shen Qi Wan
Points	UB-20, UB-23 + moxa, DU-4 + moxa With constipation: ST-25 With loose stools: St-36 With spine and low back pain and cold sensations: DU-14, DU-6, DU-1 With heart palpitations: PC-6 With abdominal distention: REN-12, ST-25 With anorexia: ST-36 With marked fatigue and weakness: ST-36 With Yin Deficiency: KI-7 With Liver Qi Stagnation: LIV-3 through to KI-1 With goiter: ST-12, ST-9 or SI-16 With Wind-Cold–Damp: LI-11, SP-9, Ahshi points With depressive Heat: ST-44 or GB-34 With cold hands and feet: SJ-5, UB-57

**HEART AND LIVER YIN DEFICIENCY WITH PHLEGM**

Clinical Manifestations	The lump is small or large, relatively soft with a slow onset. Palpitations Restlessness Anxiety Fidgeting Hypochondriac pain Insomnia Afternoon fever Night sweats Hand tremors Dry eyes Dry mouth Blurred vision Tiredness T: Red C: Little or none P: Floating and empty, relatively overflowing on left cun or Thready and rapid
Treatment Principle	Nourish Yin Nourish the Heart and Liver Nourish Liver Blood Calm the mind Soften the Liver Resolve Phlegm Soften hardnesses Dissolve the goiter
Herb Formulas	Tian Wang Bu Xin Dan Tian Wang Bu Xin Dan + Yi Guan Jian Ping Ying Fu Tang Fu Fang Jia Kang Gao Goiter #2 Er Chen Tang Dao Tan Tang Patent: Hai Zao Jing
Points	Ahshi points, PC-6, ST-36, LI-4, LI-17, HT-7, LIV-3, SP-6, REN-4, KI-6, LU-7 Ahshi points (4 needle technique) ST-9, ST-10, ST-11, REN-22, REN-23, LI-17, LI-18, Pingying (.7 cun lateral to the space between the 4th and 5th cervical vertebra), Shangtianzhu (.5 cun above UB-10) SI-17 LU-7, LI-4, LI-17, LI-18, REN-17, REN-22, ST-12, KI-27, Bleed Shixuan SJ-13, LU-3, ST-11. GB-10, SI-17 SJ-13, LI-4, LI-17, ST-36, SI-17, REN-22 Ear: Endocrine, Thyroid, Shenmen, Neck Moxibustion: 1. GB-20, DU-14, LI-14, Extra point (1.5 cun below DU-14) 2. REN-22, REN-17, UB-7, LU-2, LU-3, LI-14, LIV-4, GB-20, DU-14, ST-11, ST-42

LIVER QI STAGNATION WITH PHLEGM

Clinical Manifestations	The lump is soft and not painful and becomes larger or smaller according to the emotional situation The edges are indistinct A swollen feeling in the front of the throat A plum pit sensation in the back of the throat Dysphagia Neck ache Oppressive feeling in the chest Sighing Hypochondriac distention and pain Irritability A tendency toward anger Depression With Heart involvement: Palpitations Anxiety Wheezing Feelings of constriction in the throat Chest discomfort With Lung involvement: Dry cough Slight breathlessness Sadness Due to worry and sorrow: Enlarged thyroid Wheezing Dysphagia Respiratory problems Deafness Disorders of taste T: Normal or Swollen C: Slimy, white P: Wiry, Slippery
Treatment Principle	Regulate Qi Eliminate Stagnation Sooth the Liver Descend Lung Qi Resolve Phlegm Dissolve goiter Descend Heart Qi
Herb Formulas	Si Hai Shu Yu Wan Goiter #2 Er Chen Tang Hai Zao Yu Hu Tang Xia Ku Cao Gao San Zhong Kui Jian Tang Dao Tan Tang Chai Hu Shu Gan Tang Patent: Hai Zao Jing
Points	SJ-6, GB-20, GB-34, LIV-3, PC-6, HT-5, LU-7, LI-4, LI-11, GB-20, UB-60, REN-22, ST-40, SP-6, REN-12, UB-18, UB-15, LU-7 and KI-6 (REN channel), SP-4 and PC-6 (Chong channel), Ahshi points (4 needle technique surrounding the goiter), Huatuojiaji, LI-17 With Heart Involvement: HT-5, HT-7, REN-15 With Lung involvement: LU-3, LU-7, LI-4, REN-17 ST-9, ST-10, ST-11, REN-22, REN-23, LI-17, LI-18. Pingying (.7 cun lateral to the space between the 4th and 5th cervical vertebra), Shangtianzhu (.5 cun above UB-10) SI-17 LU-7, LI-4, LI-17, LI-18, REN-17, REN-22, ST-12, KI-27, Bleed Shixuan SJ-13, LU-3, ST-11 GB-10, ST-11 SJ-13, LI-4, LI-17, ST-36, SI-17, REN-22 LIV-3, ST-12, ST-40, SJ-13, SI-16 With neck discomfort: LU-7, KI-6 With depressive Heat: GB-34, LIV-2, eliminate LIV-3 With Spleen Qi Deficiency: ST-36 With Kidney Yang Deficiency: KI-3, KI-10, DU-20, DU-21, REN-22 With mucus: LI-15, GB-20, DU-14, LI-11 LI-4, Ahshi points ST-9, PC-6, LI-4, SJ-13 With hoarseness: SI-17, REN-22 With dry cough: LU-7, HT-6 LIV-2, LIV-3, LIV-4, LIV-5, LIV-13, LIV-14, PC-6, SP-6, SJ-6, UB-14, GB-40, UB-41 REN-17, LIV-3 Ear: Endocrine, Thyroid, Shenmen, Neck Plum blossom swelling Moxibustion: 1. GB-20, DU-14, LI-14, Extra point (1.5 cun below DU-14) 2. REN-22, REN-17, UB-7, LU-2, LU-3, LI-14, LIV-4, GB-20, DU-14, ST-11, ST- 42 3. REN-22, REN-17, LU-2, LU-3, LI-14, LI-11, LIV-4, GB-20, DU-14, ST-11, ST-42, SJ-13

LIVER QI STAGNATION WITH SPLEEN QI DEFICIENCY WITH PHLEGM

Clinical Manifestations	Feeling of a lump in the throat The lump is soft and becomes larger or smaller according to the emotional situation The edges are indistinct Oppressive feeling in the chest and hypochondrium Difficulty swallowing Loose stools Irregular menstruation Pre-menstrual tension Nausea Vomiting Loose stools Weakness T: Pale or dusky C: White or greasy white P: Wiry or Smooth and soft
Treatment Principle	Soothe the Liver Move Qi Tonify Spleen Qi Soften masses Resolve Phlegm
Herb Formulas	Xiao Yao San + Liu Jun Zi Tang Goiter #2 Er Chen Tang Hai Zao Yu Hu Tang Xia Ku Cao Gao San Zhong Kui Jian Tang Dao Tan Tang Patent: Hai Zao Jing
Points	SJ-6, GB-34, LIV-3, PC-6, REN-12, REN-22, UB-20 Ahshi points (4 needle technique) ST-9, ST-10, ST-11, REN-22, REN-23, LI-17, LI-18, Pingying (.7 cun lateral to the space between the 4th and 5th cervical vertebra), Shangtianzhu (.5 cun above UB-10) SI-17 LU-7, LI-4, LI-17, LI-18, REN-17, REN-22, ST-12, KI-27, Bleed Shixuan SJ-13, LU-3, ST-11 GB-10, ST-11 SJ-13, LI-4, LI-17, ST-36, SI-17, REN-22 Ear: Endocrine, Thyroid, Shenmen, Neck Moxibustion: 1. GB-20, DU-14, LI-14, Extra point (1.5 cun below DU-14) 2. REN-22, REN-17, UB-7, LU-2, LU-3, LI-14, LIV-4, GB-20, DU-14, ST-11, ST- 42

LIVER FIRE BLAZING GENERATING PHLEGM HEAT

Clinical Manifestations	The lump is small or medium sized, relatively soft and slippery Restlessness Insomnia Thirst Feeling of Heat Irritability Red eyes Red face Tremor of the hands Bitter taste in the mouth Exophthalmos Aversion to Heat Profuse sweating Conjunctival congestion T: Red with red tip and edges C: Dry and yellow P: Wiry and rapid
Treatment Principle	Drain Fire Clear the Liver Resolve Phlegm Soften hardnesses Dissolve the goiter Calm the mind
Herb Formulas	Goiter #1 Goiter #2 Er Chen Tang Xiao Luo Wan Hai Zao Yu Hu Tang San Zhong Kui Jian Tang Long Dan Xie Gan Tang modified Dao Tan Tang Patent : Hai Zao Jing
Points	LIV-2, LIV-3, HT-7, HT-8, REN-22, LI-4, LI-17, ST-40, SP-6, PC-5, PC-7, KI-6, KI-7 With Stomach Heat: ST-44 With hand tremors: GB-34 If goiter is large: ST-10, Pingying (.7 cun lateral to the space between C4 and C5) With exophthalmos: Shantianzhu (.5 cun above UB-10), GB-20 Ahshi points (4 needle technique) ST-9, ST-10, ST-11, REN-22, REN-23, LI-17, LI-18, Pingying (.7 cun lateral to the space between the 4th and 5th cervical vertebra), Shangtianzhu (.5 cun above UB-10) SI-17 LU-7, LI-4, LI-17, LI-18, REN-17, REN-22, ST-12, KI-27, Bleed Shixuan SJ-13, LU-3, ST-11 GB-10, ST-11 SJ-13, LI-4, LI-17, ST-36, SI-17, REN-22 Ear: Endocrine, Thyroid, Shenmen, Neck Moxibustion: 1. GB-20, DU-14, LI-14, Extra point (1.5 cun below DU-14) 2. REN-22, REN-17, UB-7, LU-2, LU-3, LI-14, LIV-4, GB-20, DU-14, ST-11, ST- 42

GOITER

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