, Gan Cao 6g, Chuan Xiong 10g, Bai Zhi 6g, Xi Xin 3g, Qiang Du Huo each 10g, Fang Feng 12,

, Gan Cao 6g, Chuan Xiong 10g, Bai Zhi 6g, Xi Xin 3g, Qiang Du Huo each 10g, Fang Feng 12, Zao Xiu 15g, Bai Hua She She Cao 15g, Ban Zhi Lian 15g, Hu Zhang 15g, Xia Ku Cao 15g, Hai Zao 10g, Kun Bu 10g, San Leng 10g, Chai Hu 10g, Zhi Shi 10g, Bai Shao 10g, Gan Cao 6g. Take for 30 doses, Third consultation: All the above symptoms markedly alleviated, but fatigue, poor appetite, pulse deep and thin, tongue body somewhat red and tongue coating white, thick, and greasy. Given Xiang Sha Liu Jun, Yang Yin Qing Fei Tang, and Lan Zhou Fang core formula with modifications: Mu Xiang 6g, Cao Kou 6g, Dang Shen 15g, Bai Shu 10g, Fu Ling 12g, Gan Cao 6g, Ban Xia 6g, Chen Pi 6g, Xuan Shen 10g, Sheng Di 12g, Mai Dong 10g, Zhe Bei Mu 20g, Jie Geng 20g, Bei Sha Shen 15g, Tai Zi Shen 15g, Ren Shen Xu 15g, Shan Yao 10g, Shan Zhu Yu 30g. Take for 30 doses, re-examination shows no recurrence, no special discomfort, regular outpatient follow-ups. Seven, a collection of theories from ancient and modern schools "The Original Disease Style of Su Wen Xuan Ji": "when yang heat is blocked...blood flows abnormally, leading to the nose." "The Authentic Surgery": "Loss of vitality...most cases occur above the shoulders, initially slight swelling, skin color unchanged, over time gradually enlarges, hard as stone, cannot be moved by pressing or palpating; after half a year, pain in the lower abdomen appears, qi and blood gradually decline, body becomes emaciated, purple spots appear, oozing blood. Sometimes swelling spreads like a lotus, foul odor permeates... all such cases are incurable." "The Golden Mirror of Medical Classics": "This carbuncle occurs on both sides of the neck, shaped like peaches and plums, skin color normal, hard as stone, pain in the buttocks but no fever...initially small, gradually enlarges, difficult to dissipate or ulcerate, once ulcerated hard to heal, a stubborn condition." "The Selection of Ulcer Diseases": "Only one occurs on the neck, a single disease...initially solitary, later overlapping occurrences, known as multiple diseases. Medicine and stones have no effect, acupuncture and moxibustion are ineffective, it's a life-or-death situation." Qiu Bao Shan's treatment of nasopharyngeal carcinoma emphasizes comprehensive therapy: First, focus on syndrome differentiation: phlegm turbidity accumulation type, qi and blood stagnation type, fire toxin confinement type; second, attack pathogenic factors without harming vital energy; third, emphasize emotional regulation; fourth, combine herbal medicine with dietary therapy. Yi Fan's treatment of nasopharyngeal carcinoma stresses a holistic approach, combining radiotherapy with Chinese medicine syndrome differentiation for nasopharyngeal carcinoma, and specifically addressing advanced nasopharyngeal carcinoma where pathogenic factors dominate and vital energy declines, with toxins spreading along meridians, emphasizing overall observation and regulating the body's functional balance. Zhang Zhi Yuan emphasizes treating nasopharyngeal carcinoma with clearing heat and detoxifying methods: Tu Bei Mu, Shan Ci Gu, figs, bee hives; headache with Cang Er Zi, Xin Yi, Man Jing Zi; enlarged lymph nodes with Huang Yao Zi, She Mei,蜈蚣; nose with Xian He Cao, Zi Shen, Qing Dai. Anatomy, physiology, and pathology The thyroid gland is located below the thyroid cartilage, flanking the trachea, its upper pole level with the midpoint of the thyroid cartilage, its lower pole level with the sixth tracheal cartilage, normal thyroid weight about 15 to 30 grams; it can synthesize, store, and secrete thyroxine (90% T4 + 10% T3), thyroxine's effects: ① increase oxygen consumption and heat production; ② promote breakdown of proteins, carbohydrates, and fats; ③ promote human growth and development and tissue differentiation. Thyroid cancer pathology is divided into four types: papillary carcinoma, follicular carcinoma, medullary carcinoma, and undifferentiated carcinoma. Among them, papillary carcinoma is most common, accounting for about 70%; follicular carcinoma comes next, accounting for 15% to 20%; medullary and undifferentiated carcinomas each account for about 5%. Ten-year survival rate for papillary thyroid carcinoma after surgery is 93.9%, while follicular carcinoma has a poorer prognosis than papillary, ten-year survival rate 30% to 80%, medullary thyroid carcinoma's malignancy is between differentiated and undifferentiated types, ten-year survival rate 69%, undifferentiated carcinoma has very poor prognosis, most die within one year, five-year survival rate 5% to 15%. Two, diagnosis and treatment (---) Clinical diagnosis Patients with thyroid cancer usually present due to thyroid masses and neck lumps. Papillary carcinoma is more common in patients around 40 years old, more prevalent in women than men, thyroid masses are mostly solitary, sizes vary, texture hard and irregular, poor mobility, larger masses may have some cystic changes, neck metastasis is common, accompanied by lymph node metastasis, hematogenous metastasis is rare. Follicular carcinoma rarely has lymph node metastasis, while hematogenous metastasis is common, often spreading to bones, lungs, brain, etc. Medullary carcinoma is mostly confined to one thyroid lobe, familial medullary carcinoma accounts for 5% to 10%, often affecting both lobes, accompanied by pheochromocytoma, parathyroid adenoma, etc., persistent diarrhea is also common, watery stool, diarrhea disappears after tumor resection, this type has high lymph node metastasis rate and is prone to hematogenous metastasis. Undifferentiated carcinoma mainly affects elderly people, thyroid masses or nodules have existed for many years, recently suddenly enlarge, develop rapidly, soon forming bilateral thyroid or massive neck masses, hard, fixed, invading adjacent organs causing hoarseness and difficulty breathing. High lymph node metastasis rate, often distant metastasis. Cytological diagnosis refers to fine needle aspiration biopsy performed under B-mode ultrasound guidance, which can further improve accuracy, especially beneficial for tumors with small diameters, deep locations, or uneven textures with liquefaction; needle aspiration cytology qualitative diagnosis is reliable, can serve as one of the preoperative screening diagnostic methods; ultrasound diagnosis can accurately determine whether a mass is solid, cystic, or mixed cystic-solid, measure the number and size of nodules, as well as detect enlarged lymph nodes in the neck; high-frequency ultrasound and color Doppler imaging have significantly higher detection and accuracy rates for tiny thyroid cancers than other diagnostics; CT diagnosis is a common method for diagnosing thyroid cancer, typical CT manifestations include blurred boundaries, irregular shapes, uneven lesion density, obvious heterogeneous enhancement, disappearance of fat gaps between lesions and adjacent structures; thyroid radionuclide imaging can provide precise localization for clinically palpable thyroid nodules and understand their functional status, detect potential or tiny cancer foci in high-risk patients, discover primary lesions of regional or distant metastatic thyroid cancer, 3'I imaging can evaluate treatment efficacy, highly sensitive to postoperative recurrence and metastasis of differentiated thyroid cancer, also helpful in ruling out thyroid cancer for hot nodules indicated by scans. (2) Western medical treatment Treatment of thyroid cancer involves multiple disciplines such as surgery, radiotherapy, endocrine therapy, chemotherapy, etc., surgery is the main treatment method. After confirming thyroid cancer, if there are no obvious surgical contraindications, thorough removal of the primary lesion and neck metastases should be performed promptly, striving for complete cure of the tumor. Radiotherapy is an important adjuvant treatment for thyroid cancer, external beam radiation works best for undifferentiated carcinoma, radioactive iodine i3iI has good effects on follicular and papillary carcinomas with distant metastasis or local residual disease, because the boundary between satisfactory and safe doses is very close, it's easy to cause adverse complications. Patients undergoing total thyroidectomy need to take thyroid hormone for life, chemotherapy for thyroid cancer is not ideal.

1. Thyroid-stimulating hormone suppression therapy for differentiated thyroid cancer Proper application of TSH suppression therapy after DTC surgery can bring good therapeutic effects to most patients, significantly reducing local recurrence and distant metastasis rates.
2. Radioactive iodine therapy After oral administration of radioactive iodine, it is quickly absorbed in the upper digestive tract, reaches certain tissues through the bloodstream and concentrates there, and expressed via functional sodium-iodine transport (NIS), the more follicles in the diseased tissue, the better the effect; papillary carcinoma absorbs iodine well; medullary carcinoma absorbs very little or almost no iodine, so the effect is poor; since undifferentiated carcinoma does not absorb iodine, it's hardly treated with radioactive iodine.
3. Radiotherapy Radiotherapy has certain effects in controlling residual lesions and some metastases of thyroid cancer, especially for lesions that do not absorb radioactive iodine, such as spindle cell and giant cell carcinomas, it's an ideal treatment method, can be used in combination with radioactive iodine therapy, can use radiation therapy, or external beam radiation therapy.
4. Chemotherapy Thyroid cancer has relatively poor sensitivity to chemotherapy, doxorubicin is the main drug, other drugs include etoposide, paclitaxel, cisplatin, carboplatin, etc.
5. Targeted drug therapy The US FDA has approved several targeted drugs for treating thyroid cancer, such as multi-kinase inhibitors sorafenib and lenvatinib for iodine-refractory differentiated thyroid cancer; vandetanib and cabozantinib for medullary thyroid carcinoma; dabrafenib and trametinib combined for treating undifferentiated thyroid cancer with BRAFv600 mutation.
6. Percutaneous ethanol injection therapy Mainly used for treating small to medium-sized solid nodules, after finding the area with the richest blood vessels inside the nodule, inject ethanol using 21 to 22 gauge needles. TSH should be monitored before and after treatment. This method can achieve a cure rate of about 60%. Ethanol injection is mainly used for treating non-functional thyroid nodules, but those with metastasis and local compression symptoms should not prioritize ethanol injection treatment. Three, Professor Pei Zhengxue's thinking method Professor Pei Zhengxue believes: Thyroid cancer is mainly caused by internal emotional injury, improper diet and water-soil conditions, liver-spleen disharmony, internal generation of phlegm turbidity, qi stagnation and phlegm turbidity, aggregation without dispersion, qi and blood becoming stagnant, and blood following qi stagnation to form stasis, long-term stasis凝成毒, qi stagnation, phlegm turbidity and toxic stasis all combine to form. Pathologically, qi stagnation, phlegm condensation and neck anterior obstruction, generally mostly real syndrome with pathogenic factors dominating, emphasis on removing pathogenic factors and detoxifying, softening hardness and dispersing nodules. Long-term illness leads to hidden consumption of qi and blood, organs' yin-yang and qi-blood become extremely deficient, resulting in rapid enlargement of masses, hard texture, firmly rooted and immovable, ultimately forming a mixed deficiency-real syndrome, requiring detailed syndrome differentiation. Common formulas: Long Dan Xie Gan Tang, Anti-Cancer Four-Ingredient Formula , Chai Hu Shu Gan San, Hai Zao Yu Hu Wan , Xiao Wan, Tuo Li Tou Nong San, Bao Yuan Tang, Yang Yin Qing Fei Tang , San Shu Qing Cao Zeng Ye Tang. Four, syndrome differentiation and medication 1. Liver qi stagnation and phlegm condensation Symptoms: Neck anterior goiter protrudes, gradually enlarges, hard or firm, distended and tender to touch, swallowing slightly affected or completely immobile, chest tightness and shortness of breath, irritability and anger, dizziness and vertigo, loss of appetite and food aversion, tasteless mouth, limb fatigue. Tongue body red, coating yellow and greasy, pulse stringy and rapid. Should soothe liver qi and regulate qi, clear heat, transform phlegm and disperse nodules. Formulas: Long Dan Xie Gan Tang, Sheng Jiang San, Si Ni San, Chai Hu Shu Gan San with modifications: Long Dan Cao 15g, Huang Qin 10g, Zhi Zi 10g, Chai Hu 9g, Sheng Di 12g, Dan Pi 10g, Dang Gui 10g, Jiang Can 10g, Chan Tui 10g, Jiang Huang 6g, Da Huang 3g, Shan Ci Gu 15g, Bai Jie Zi 10g, Chen Pi 6g, Kun Bu 15g, Hai Zao 15g, San Leng 10g, E Zhu 10g, Yu Jin 9g, Oyster

15g, Xia Ku Cao 15g. Decoct and take one dose daily. Modifications: For throat and neck discomfort add She Gan , Niu Bang Zi, Jie Geng; for excessive phlegm dampness add Ban Xia, Bei Mu, Fu Ling; for severe pain add Yan Hu, Chuan Lian Zi. 2. Qi stagnation and blood stasis Symptoms: Neck anterior goiter hard texture, rapidly enlarges, firmly fixed, shaped like an overturned cup, chest tightness, cough with lots of phlegm, or accompanied by clusters of cold-like illnesses on both sides of the neck, tongue body bluish-purple or with bruising and petechiae, coating greasy, pulse stringy or rough. Should regulate qi and activate blood, transform phlegm and dissolve goiter. Formulas: Hai Zao Yu Hu Wan , Xiao Wan, Fu Ling Xing Ren Gan Cao Tang, Jin Ju He Ji with modifications: Hai Zao 15g, Hai Dai 15g, Kun Bu 15g, Qing Pi 10g, Qing Ban Xia 10g, Zhe Bei Mu 15g, Dang Gui 9g, Chuan Xiong 9g, Yu Jin 6g, Quan Shi 10g, Xuan Shen 15g, San Leng 10g, E Zhu 10g, Chen Pi 6g, Ju He 15g, Chi Shu 15g, Red Shao 15g, Dan Shen 15g . Decoct and take one dose daily. Modifications: For hard masses habitually use Shan Xia Wu Xiao Er ( Shan Ci Gu, Xia Ku Cao, Wu Ling Zhi, Pu Huang, Zhe Bei Mu, Xuan Shen, Oyster, Yuan Hu, Chuan Lian Zi, Hai Zao, Kun Bu, Ruo Xiang, Mo Yao, San Leng, E Zhu ); for poor appetite and constipation add Si Jun Zi Tang, Huai Shan Yao to strengthen spleen and benefit qi; long-term heat accumulation leads to irritability and restlessness, add Xia Ku Cao, Zi Cao, etc. 3. Deficiency of vital energy and excess pathogenic factors Symptoms: Neck anterior goiter protrudes, tightly bound and fixed or ruptured, chest tightness and shortness of breath, palpitations and shortness of breath, limb fatigue and weakness, loss of appetite and food aversion, bowel movement disorders, emaciation. Tongue body dull or slightly plump, coating sparse, pulse deep and weak . Should tonify qi and nourish blood, detoxify and dissolve goiter, formulas: Tuo Li Tou Nong San, Bao Yuan Tang with modifications. Symptoms: San Shu Qing Cao Zeng Ye Tang: Mu Xiang 6g, Sha Ren 6g (added later), Dang Shen 15g, Fu Ling 12g, Huang Qi 30g, Mai Dong 15g, Xuan Shen 15g, Dang Gui 10g, Chuan Xiong 6g, Red Shao 15g, White Shao 15g, Bai Shu 15g, Hai Zao 15g, Kun Bu 15g, Qing Pi 9g, Ban Xia 10g, Wu Wei Zi 6g, Xia Ku Cao 15g, Sheng Oyster 30g, Zhigan Cao 6g Decoct and take one dose daily. Modifications:

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