How did the ancients solve goiter since they didn’t have iodized salt?

Goiter is a very common disease in Chinese history, and it has been recorded at least 2,000 years ago. It has a special word called "瘿". "婴" originally refers to the shell necklace on the neck of women, and "疒" refers to neck diseases, that is, goiter.

There are many descriptions of goiter in ancient texts, some of which coincide with modern medical views, which is amazing.

Geographical environment

Ancient people found that goiter is related to the geographical environment, especially in mountainous areas, such as Qinling Mountains, Taihang Mountains, and the Three Gorges. Modern science believes that these places are often inland, with few seafood, and the surface has been washed away for tens of millions of years, so the iodine content in the water and soil is very low. The most typical iodine-deficient areas in the world, such as the Alps in Europe, the Himalayas in Asia, and the Andes in America are also mountainous.

-The Huainanzi Dizhixun from the Western Han Dynasty records that "dangerous and obstructive areas are prone to goiters."

-The Western Jin Dynasty's "Bowuzhi" records that "people living in the mountains often suffer from goiter, which is caused by drinking stagnant spring water."

-Wang Guiling of the Tang Dynasty wrote in his poem "Kuizhou", "Kuizhou has no wells, and the people suffer from goiter, which is extremely pitiful."

There are many records of goiter in the collection of essays by Fan Chengda of the Song Dynasty, such as "The weather is different when entering the gorge at the beginning, and women in cloth skirts and barefoot all have goiters" and "When entering the gorge from Dongchuan, there is a custom of goiter on the way to Gongzhou."

-There are records from the Yuan Dynasty that in the Wudang Mountain area, "all the palaces, temples, and cave dwellers were plagued by goiters."

Water Source

The ancients believed that drinking water sources may be one of the culprits of goiter, which is consistent with the view of modern science. In areas with high water iodine, people are not iodine deficient even if they do not eat iodized salt. Unfortunately, most areas in China are low water iodine areas, which are prone to iodine deficiency.

-Lüshi Chunqiu from the Warring States Period recorded that "wherever there is light water, there are many bald people and people with goiters."

-The Western Han Dynasty's "Health Preservation Prescriptions" records that "any place with springs in the black soil of mountains and waters should not be lived in for a long time, as eating them frequently will cause goiter."

-Ji Kang's "Theory of Health Preservation" during the Three Kingdoms period recorded that "the neck is dangerous and goiter is caused by the water and soil."

-The "Tea Classic" by Lu Yu, the "Tea Saint" of the Tang Dynasty, records that "Any turbulent water will cause neck pain if drunk."

-In the Jin Dynasty, Chen Yanzhi's "Xiaopin Fang" records that "the barbarians in Chang'an and Xiangyang drink sand and are prone to goiters."

-Li Daoyuan of the Northern and Southern Dynasties recorded in "Notes on the Water Classic and the Mian River" that "salt wells, drinking from them can cause goiter."

female

Ancient people also found that women seemed to be more susceptible to goiter. Modern epidemiological studies have also found that women are more likely to suffer from thyroid diseases, especially pregnant women and nursing mothers, who are more deficient in iodine because they are responsible for the needs of two people. In some countries where iodine supplementation is mandatory, such as New Zealand, the government also recommends that pregnant women and nursing mothers take additional iodine supplements.

- In the Song Dynasty, Fan Chengda's "Wuchuanlu" recorded that "there are miasma in all mountains and rivers, and the water vapor is particularly poisonous. People are prone to goiters, especially women", and "The water in the gorges and rivers is very evil. Drinking it will cause goiters, especially women."

-Wang Xiangchun of the Ming Dynasty recorded in "Qi Yin": "Women living by the river often suffer from goiters", "There is a Black Tiger Spring in the east of the city. It is said to be a water god, so a temple is built to worship it. The spring has strong power, and women who drink from it will suffer from goiters."

mood

Although the ancients did not know medical terms such as hormones and endocrines, they were aware of the relationship between emotional factors and thyroid disease. Modern medicine believes that when people are in a state of mental stress, anxiety, depression or overwork for a long time, they are more likely to suffer from various diseases, thyroid disease being one of them.

- In the Song Dynasty, Lu You said in "Sending Mr. Fan Back to the Court" that "If you always think about this, you will get goiter."

- In the Yuan Dynasty, Yang Weizhen's "Broken Jade Cup" said "The old minister of Yuancheng developed a goiter due to anger."

-People also use the phrase "red face and thick neck" to describe the state of being angry. Modern medicine has confirmed that some patients with hyperthyroidism do have symptoms of irritability, but the ancients mistakenly believed that irritability caused the thick neck disease, which is actually putting the cart before the horse.

treat

The ancients not only observed goiter, but also discovered through practice that seafood, especially seaweed, can treat iodine deficiency. There are many records of this in Chinese medicine classics. For example, "Shennong's Herbal Classic" records that "seaweed is the main treatment for goiter and gas accumulation." The "Si Hai Shu Yu Tang" in "Yang Yi Da Quan" adds kelp, sea cucumber sheath, and sea clam powder.

In addition, "Wai Tai Mi Yao" records that goiter can be treated with the cheeks of sheep and deer. The cheeks refer to the face. I guess the ancients probably used like to cure like, and cut off the neck of the animal, which happened to include the thyroid gland, which is rich in iodine.

Ancient people also tried to remove goiters surgically, but due to the limitations of the medical level at that time, this kind of surgery had a low success rate and a high mortality rate. In ancient times, there was a saying that "ten out of ten people who have goiters removed will die." Xin Qiji, a poet in the Song Dynasty, said, "If you have a goiter under your neck, you will die if you remove it."

A relatively successful treatment is food therapy. For example, in the Song Dynasty, Zhang Gao's "Medical Theory" records, "There was an old monk in Huating who used to travel to Guanxia Temple in Henan. All the monks and servants in the temple were suffering from goiter. At that time, there was a monk from Luoyang who shared the dormitory with him. He would take the dried moss he brought with him to eat with him. After several months, the monk's neck growth disappeared completely, as if he had never been sick. The monks and servants in the temple sighed and praised him, and then they realized that salty food from sea cliffs could cure this disease." In the Eastern Jin Dynasty, Ge Hong's "Elbow Prescriptions" also recorded the method of "seaweed wine" to treat goiter: put seaweed in a silk bag and soak it in wine.

Now we know that goiter is actually caused by iodine deficiency, but in ancient times, people did not know about iodine and thyroid gland, had no scientific means to study epidemics and endemic diseases, and had no concept of evidence-based medicine. The ancients summarized the high-risk factors of goiter such as geographical environment, water source, gender, emotional state, etc. through simple observation, and even explored the treatment method of using seaweed. Isn’t it admirable?

Trivia

In the TV series "Legend of Miyue", there is a Qin nobleman named "Chu Li Ji". He is humorous and resourceful, but he suffers from goiter. The Qin people thought that the lump on his neck was full of wisdom, so they called him "brain trust". If the "brain trust" we are talking about now was put in ancient times, it would be a row of goiters. Just imagine.