It's My Hormones, Doctor
by Stephen Gascoigne
As a boy growing up in Derbyshire in England, I was always confused as to why the Duke of Devonshire had his ancestral home, Chatsworth House, in Derbyshire. It is reputed that when Charles Blount, 8th Baron Mountjoy, was made Earl of Devon in 1603, King James I asked him where he came from. On the reply, “from Derbyshire”, the King said, “Never heard of it, arise Earl of Devon”.
Coming from a county renowned for its poetry:
Derbyshire born, Derbyshire bred
Strong in th'arm, weak in head
and also its knowledge of pathology – Derbyshire neck - such aristocratic ignorance mattered little to me.
Not wishing to dwell on the poetic prowess of my homeland, 'what is 'Derbyshire neck'? This swelling of the neck, due to goitre or thyroid enlargement, is well recognised in areas of the world a distance from the sea. The connection between this clinical appearance and mountainous areas was noted by the Chinese during the Sui dynasty in the 6th century AD. It is also seen in Switzerland. The cause is a lack of iodine in the diet which is rare these days because our diets are more varied and also iodine may be added to some foods including salt. The widespread addition of iodine to salt in the US, for example, since 1924 led to the virtual disappearance of iodine deficiency goitre.
One of the joys of working with Chinese medicine is its ability to help us simply and clearly understand symptoms and their origin. Although, the endocrine system is not recognised as such in Chinese medicine, we can effectively use it to address imbalances which are labelled 'hormonal' in conventional medicine.
In some senses, imbalances in the endocrine system reveal the nature of Yin and Yang. For example, underactivity of the thyroid manifests as chilliness, slowness, lethargy – lack of Yang, whilst overactivity of the thyroid manifests as heat signs with anxiety, rapid pulse and sweating. The balancing of Yin and Yang, therefore, will have direct effects on the balance of hormones.
The endocrine system is one of the few areas in conventional medicine where the concept of balance is acknowledged, at least to some degree. The interaction between the psyche and the environment with the hypothalamus is increasingly recognised. The hypothalamus is the engine which drives the endocrine system through the pituitary and then through various 'end organs' such as the adrenal glands and the thyroid. The wisdom of Chinese medicine concerning living according to the seasons and climate are now seen by conventional medicine as having a physiological correlation.
‘The three months of spring ... It is desirable to sleep at night, get up early in the morning, take a walk in the yard, to loosen up hair and relax the body ... The three months of summer ... It is desirable to sleep at night and get up early in the morning, to have no dislike of sunlight, possess no will of anger so that things will bloom beautifully and so that energy will move outward through perspiration as if in love with the outside world ...The three months of autumn ... It is desirable to sleep early and get up early with the crowing of the rooster, to maintain a peaceful will in order to slow down the killing effects of autumn, to constrict the energy of the spirits in order to calm down the energy of the autumn, to refrain from moving outward in order to clean up the energy of the lungs ... The three months of winter ... It is desirable to sleep early and get up late, to await the arrival of sunlight, so that the will remains dormant as if hiding or pretending, not unlike someone with private intentions, not unlike someone with all his desires already fulfilled.’ Neijing Volume 1, Chapter 2. Translation by Henry Lu.
In my experience, endocrine system disorders are relatively common in clinical practice. They include:
- Cushing’s syndrome
- Diabetes mellitus
- Diabetes insipidus
- Addison’s disease
We could also include female sex hormone imbalances which can manifest as menstrual disturbances, symptoms around the menopause or the use of female sex hormones as HRT (hormone replacement treatment) or as contraception.
There are clearly different levels of severity here. Disorders such as diabetes mellitus and Addison's disease are serious conditions characterised by a deficiency of important hormones necessary for life. Such conditions can lead to severe symptoms or even death within a short period of time. Thyroid disease can also be life-threatening and certainly when people receive conventional treatment for these conditions, we have to take their medication into account.
Women receiving treatment with the female sex hormones of oestrogen and/or progesterone are not going to experience life-threatening symptoms. However, such treatments are strongly influenced by powerful social and cultural contexts.
I intend to explore many of these conditions in the forthcoming months. I wrote in the August 2006 issue of Chinese Medicine Times about a woman, Mary, diagnosed with Addison's disease. She had originally been placed on corticosteroids after her diagnosis yet was keen to explore other options. After some months of treatment, she slowly reduced and then stopped her medication. I saw her regularly for treatment and monitoring and she continues to attend the clinic every 6 weeks or so. I continue to tonify her Kidney Yang and she continues to look after her diet and practise meditation regularly. She feels well, her previous chilliness is much better, her energy is good. Her blood pressure, originally being 95/55, is now consistently 100/70. She had a repeat of her Synacthen stimulation test – sometimes called ACTH test. This is an injection of ACTH (Adrenocorticotropic hormone) to determine the responsiveness of the adrenal glands. The results were as follows:
|1st February, 2006||343 nmol/L||434 nmol/L|
|22nd February, 2007||484 nmol/L||712 nmol/L|
Table 1. Results of Mary’s ACTH test.
Such a recovery is extremely rare and reviewing the literature on Addison's disease, such improvement is only seen if due to a (conventionally) treatable cause such as infection, that is, in cases of secondary Addison's disease.
As practitioners of Chinese medicine, we have to be clear about how to treat these conditions and be circumspect when people are taking conventional medication. Such medication must never be stopped suddenly and then gradual reduction can only be done under careful supervision and in appropriate cases. I discuss these issues in more details in my book, The Prescribed Drug Guide, which clearly outlines the strength of action of different drugs as well as how to manage them appropriately.
As can be seen from this case, benefits can be significant and the prospect of a drug-free existence is a possibility for some. If medication is necessary, then you often find that a reduced dosage is possible and the person has a much improved quality of life. This is true whether the initial diagnosis is Addison's disease, diabetes mellitus or a thyroid imbalance.
The paradox in conventional medicine is that if the particular gland is underactive, giving the hormone leads to a further diminution in function. Chinese medicine is capable of addressing the underlying imbalance so that partial or complete recovery is possible. In my next column, I will discuss cases of thyroid disease and how we can work effectively with people who take either drugs to suppress thyroid function in hyperthyroidism or who take thyroxine supplementation in hypothyroidism.