Hai Zao Yu Hu Tang (海藻玉壶汤), known in English as Seaweed Jade Pot Decoction, is a classical TCM formula for transforming phlegm, softening hardness, and dispersing nodules. It is particularly indicated for goiter (thyroid enlargement), scrofula (lymph node lumps), and phlegm nodules in the neck caused by phlegm and Qi stagnation. In modern clinical practice, Hai Zao Yu Hu Tang is used for thyroid nodules, enlarged lymph nodes, and other phlegm masses. By powerfully transforming phlegm, softening hardness, and moving Qi, it effectively disperses nodules and reduces swelling in the neck.

I. Origins and History

1. Legend of Origins

The origin of Hai Zao Yu Hu Tang is accompanied by an intriguing legend. It is said that in ancient times, a young fisherman's wife suffered for years from a swelling in her neck and sought treatment everywhere without improvement. In his distress, the fisherman happened to discover a peculiar seaweed at the ocean's edge, shaped like a jade pot. On a whim, he boiled the seaweed into a decoction and gave it to his wife to drink. After some time, the lump in her neck gradually subsided. Word spread, attracting the attention of local physicians who, through study and practice, continued to refine the formula — ultimately bringing Hai Zao Yu Hu Tang into being as a classical prescription.

2. Historical Records

Hai Zao Yu Hu Tang was first recorded in the Waike Zhengzong (Orthodox Manual of External Medicine) compiled by Chen Shigong of the Ming dynasty. This monograph on external medicine provides a detailed account of the formula's composition, actions, and applications. The Waike Zhengzong is a landmark work that synthesised the accumulated achievements of Chinese surgical medicine up to the Ming dynasty, exerting a far-reaching influence on the development of Chinese medicine surgery. As one of its important formulas, Hai Zao Yu Hu Tang provided an effective treatment method for goitre, scrofula, and related conditions for later generations, and has been widely applied in clinical practice. Through the transmission and development of successive medical generations, its content has been continuously enriched.

3. Transmission and Development

Over time, Hai Zao Yu Hu Tang has been widely applied and transmitted in Chinese medicine clinical practice. In the course of its use, physicians of successive generations made appropriate adjustments and additions to the formula based on different disease characteristics and clinical experience — including changes in herb dosages, processing methods, and combinations — making it more closely aligned with clinical needs. Simultaneously, the development of modern medicine has provided new perspectives and methods for the study of Hai Zao Yu Hu Tang, promoting its further exploration and application in the treatment of thyroid diseases and related conditions.

II. Herb Composition (Sovereign, Minister, Assistant, Envoy)

1. Chief Herb — Haizao (Sargassum)

Haizao is salty in flavour and cold in nature, entering the Liver, Stomach, and Kidney channels. It has the actions of softening hardness and dissipating binds, and transforming phlegm and promoting urination. In Hai Zao Yu Hu Tang, Haizao serves as the chief herb, targeting the masses of goitre, scrofula, and related conditions. Its power to soften hardness and dissipate binds is relatively strong, capable of dispersing phlegm-bind accumulations within the body. For conditions such as thyroid nodules and breast hyperplasia, Haizao gradually softens and dissipates masses through its hardness-softening and bind-dissipating action.

2. Deputy Herb — Kunbu (Kelp)

Kunbu is salty in flavour and cold in nature, entering the Liver, Stomach, and Kidney channels. Its function is similar to Haizao, likewise possessing the actions of softening hardness, dissipating binds, and transforming phlegm. Combined with Haizao, it reinforces the formula's efficacy in softening hardness, dissipating binds, transforming phlegm, and reducing swelling. The two act synergistically against conditions caused by phlegm-bind and blood stasis. In clinical application, for stubborn goitre and scrofula, the addition of Kunbu can augment Haizao's medicinal potency and improve the therapeutic outcome.

3. Assistant Herbs — Banxia (Pinellia), Chenpi (Dried Tangerine Peel) and Qingpi (Green Tangerine Peel)

Banxia is acrid in flavour and warm in nature, entering the Spleen, Stomach, and Lung channels. It has the actions of drying dampness and transforming phlegm, directing counterflow downward to stop vomiting, and dispersing glomus and dissipating binds. In Hai Zao Yu Hu Tang, Banxia dries dampness and transforms phlegm; combined with hardness-softening and bind-dissipating herbs such as Haizao and Kunbu, it helps eliminate the phlegm-dampness pathogen from the body, making the masses more readily dispersed. Chenpi is acrid and bitter in flavour and warm in nature, entering the Spleen and Lung channels. It regulates qi and strengthens the spleen, dries dampness and transforms phlegm — reinforcing Banxia's dampness-drying and phlegm-transforming potency whilst simultaneously regulating the qi movement, ensuring that as qi moves, phlegm is resolved. Qingpi is bitter and acrid in flavour and warm in nature, entering the Liver, Gallbladder, and Stomach channels. It soothes the liver and breaks qi, disperses accumulation and guides stagnation. For phlegm-bind conditions arising from liver qi stagnation, Qingpi provides the supplementary action of soothing the liver and regulating qi, keeping qi movement free and facilitating the dispersal of phlegm-bind.

4. Envoy Herbs — Chuanxiong (Chuanxiong Rhizome), Danggui (Angelica Root), Lianqiao (Forsythia Fruit) and Gancao (Licorice Root)

Chuanxiong is acrid in flavour and warm in nature, entering the Liver, Gallbladder, and Pericardium channels. It has the actions of activating blood and moving qi, and dispelling wind and relieving pain. In the formula, Chuanxiong activates blood and resolves stasis, promotes qi-blood circulation, ensures free flow of qi and blood, and assists in dispersing masses. Its qi-moving action also assists the other herbs in better exerting their efficacy. Danggui is sweet and acrid in flavour and warm in nature, entering the Liver, Heart, and Spleen channels. It nourishes blood, activates blood, regulates menstruation, relieves pain, and moistens the intestines. Danggui's blood-nourishing and blood-activating properties enrich and nourish the qi and blood, improving mass conditions caused by qi-blood insufficiency, whilst its blood-activating action also assists in dispersing phlegm-bind and blood stasis. Lianqiao is bitter in flavour and slightly cold in nature, entering the Lung, Heart, and Small Intestine channels. It has the actions of clearing heat and resolving toxicity, and reducing swelling and dissipating binds. For situations where prolonged phlegm-bind may transform into heat, Lianqiao clears heat and resolves toxicity, preventing further disease progression. Gancao is sweet in flavour and neutral in nature, entering the Heart, Lung, Spleen, and Stomach channels. It tonifies the spleen and boosts qi, moistens the lungs to relieve cough, clears heat and resolves toxicity, and harmonises all the herbs. Within the formula, Gancao both moderates the cold nature of Haizao and Kunbu and coordinates the interactions among all the herbs, making the medicinal force of the entire formula more balanced and harmonious.

III. Pathomechanism, Actions, and Indications

1. Pathomechanism Analysis

The pathomechanism targeted by Hai Zao Yu Hu Tang is primarily phlegm-qi binding and qi-blood stasis. When the body is affected by factors such as emotional disturbance and dietary irregularity, liver qi stagnation results; when qi is stagnant, fluid movement becomes impaired and fluid accumulates to form phlegm. Phlegm and qi bind together in the neck, forming goitre; if phlegm-qi stasis persists, the movement of qi and blood becomes obstructed, causing the masses to enlarge and harden, and even giving rise to pain and other symptoms. In addition, phlegm-bind and blood stasis can affect the normal function of the zang-fu organs and the normal movement of qi and blood, further worsening the condition.

2. Actions

Based on the above pathomechanism, Hai Zao Yu Hu Tang has the actions of transforming phlegm and softening hardness, regulating qi and dissipating binds, and activating blood and resolving stasis. Through transforming phlegm and softening hardness, accumulated phlegm-bind within the body is dispersed, causing masses to gradually soften and shrink; regulating qi and dissipating binds harmonises the qi movement, eliminating phlegm-bind caused by qi stagnation; activating blood and resolving stasis promotes qi-blood circulation, improves local blood circulation, and assists in dispersing phlegm-bind and blood stasis. Combining these actions, Hai Zao Yu Hu Tang can fundamentally regulate the pathological state of phlegm-qi binding and qi-blood stasis, achieving the therapeutic goal of treating goitre, scrofula, and related conditions.

3. Indications

Hai Zao Yu Hu Tang is primarily used to treat goitre and scrofula. Goitre typically manifests as a mass on one or both sides of the neck that is relatively soft or moderate in consistency, with clearly defined borders, able to move up and down with swallowing, and generally without marked pain. Scrofula typically presents as multiple masses of varying sizes on both sides of the neck that are relatively hard, and may fuse together into a single mass that does not shift with pressure; in the early stage there may be mild pain, and in the later stage rupture and pus drainage may appear. In addition, for conditions such as thyroid nodules and breast hyperplasia that correspond to the pattern of phlegm-qi binding and qi-blood stasis, Hai Zao Yu Hu Tang also produces good therapeutic results.

IV. Formula Analysis

1. Transforming Phlegm, Softening Hardness and Dissipating Binds

Haizao and Kunbu, as the chief herbs, possess a powerful hardness-softening and bind-dissipating action, acting directly on the site of the masses to soften and disperse phlegm-bind. Assistant herbs such as Banxia, Chenpi, and Qingpi eliminate the phlegm-dampness pathogen from the body and reduce phlegm-bind formation through dampness-drying and phlegm-transforming, and qi-regulating and phlegm-transforming actions. Acting in concert, all the herbs jointly exert the action of transforming phlegm, softening hardness, and dissipating binds, treating conditions caused by phlegm-qi binding.

2. Regulating Qi and Activating Blood

Herbs such as Chuanxiong and Danggui in the formula perform the role of regulating qi and activating blood. Chuanxiong activates blood and moves qi, promoting qi-blood circulation and ensuring free flow of qi and blood to assist in dispersing masses. Danggui nourishes blood and activates blood — both enriching and nourishing qi and blood and improving local blood circulation — assisting the phlegm-transforming and hardness-softening herbs to exert their actions more effectively. The qi-regulating and blood-activating actions improve the state of impeded qi-blood caused by phlegm-qi stasis, restoring normal qi-blood circulation throughout the whole organism and thereby facilitating recovery from the condition.

3. Clearing Heat and Resolving Toxicity to Prevent Heat Transformation

The addition of Lianqiao provides the action of clearing heat and resolving toxicity. When phlegm-bind has persisted for a prolonged period, it readily transforms into heat; Lianqiao can promptly clear interior heat-toxin, preventing further deterioration of the condition and ensuring the safety and efficacy of the formula in treating phlegm-qi binding conditions.

4. Harmonising All the Herbs

Gancao is sweet and neutral in nature and has the action of harmonising all the herbs. It moderates the cold nature of Haizao and Kunbu, making the medicinal force of the formula more balanced and easier for the body to absorb and tolerate. Simultaneously, Gancao coordinates the interactions among all the herbs in the formula, making the overall combination more rational and allowing the treatment to be exerted more effectively.

V. Comparison with Related Formulas

1. Comparison with Xiaoluo Wan

Xiaoluo Wan is composed primarily of Xuanshen (Figwort Root), Muli (Oyster Shell), and Beimu (Fritillary Bulb), with the actions of clearing heat, nourishing yin, transforming phlegm, and softening hardness. Compared with Xiaoluo Wan, it places greater emphasis on nourishing yin and clearing heat, and produces better results for phlegm-bind conditions caused by yin deficiency with fire hyperactivity. Hai Zao Yu Hu Tang, by contrast, focuses on transforming phlegm, softening hardness, regulating qi, and activating blood, and is more suitable for goitre conditions where phlegm-qi binding and qi-blood stasis are more pronounced. In clinical application, if a patient's yin deficiency symptoms are prominent — such as dry mouth and throat, tidal fever, and night sweating — Xiaoluo Wan may be selected; if the presentation is dominated by phlegm-qi binding with distinct masses accompanied by qi stagnation and blood stasis, Hai Zao Yu Hu Tang is more appropriate.

2. Comparison with Sihai Shuyu Wan

Sihai Shuyu Wan is composed of Qingmuxiang (Aristolochia Root), Chenpi (Dried Tangerine Peel), Haigepen (Clam Shell Powder), Haidai (Kelp), Haizao (Sargassum), and Kunbu (Kelp), with the actions of regulating qi, transforming phlegm, softening hardness, and dissipating binds. Compared with Sihai Shuyu Wan, whose medicinal potency is relatively moderate with an emphasis on regulating qi and transforming phlegm, Hai Zao Yu Hu Tang builds upon regulating qi and transforming phlegm to place greater emphasis on the action of activating blood and resolving stasis. For conditions where qi stagnation and phlegm-bind symptoms are mild and the primary goal is phlegm transformation and hardness softening alone, Sihai Shuyu Wan may be more suitable; for patients with more severe phlegm-qi stasis, larger masses, and blood stasis symptoms such as pain, Hai Zao Yu Hu Tang may offer better efficacy.

VI. Clinical Applications

1. Thyroid Disorders

In the treatment of thyroid disorders such as thyroid nodules and thyroid adenoma, when a patient presents with a neck mass that is soft in consistency with a sensation of chest oppression, or is accompanied by emotional disturbance, frequent sighing, and other qi stagnation symptoms, along with a pale red tongue with dental impressions on the edges, a thin white or white greasy coating, and a wiry and slippery pulse reflecting phlegm-qi binding, Hai Zao Yu Hu Tang may be selected for treatment. Clinical research has demonstrated that Hai Zao Yu Hu Tang can reduce thyroid nodules and relieve symptoms by regulating thyroid cell proliferation and apoptosis and improving local thyroid blood circulation.

2. Breast Disorders

For breast disorders such as breast hyperplasia and breast fibroadenoma, when breast masses of moderate or slightly firm consistency with clearly defined, movable borders appear, accompanied by breast distension and pain whose intensity correlates with the menstrual cycle — worsening before menstruation and improving after — along with liver qi stagnation symptoms such as chest oppression and hypochondriac distension, and proneness to depression and irritability, Hai Zao Yu Hu Tang also has certain therapeutic effects. Its qi-regulating and phlegm-transforming, blood-activating and stasis-resolving actions help to disperse breast masses, regulate the endocrine system, and improve breast distension and pain.

3. Cervical Lymphadenopathy

For cervical lymphadenopathy — such as that caused by inflammation or tuberculosis — presenting as local masses with or without pressure pain, relatively firm in consistency, possibly accompanied by systemic symptoms such as fever, night sweating, and fatigue, and whose pattern corresponds to phlegm-qi binding and qi-blood stasis, Hai Zao Yu Hu Tang may serve as an adjunctive treatment formula. Through transforming phlegm, softening hardness, regulating qi, and activating blood, it helps promote the resolution of enlarged lymph nodes and reduce inflammatory responses.

VII. Clinical Modifications

1. Pronounced Liver Qi Stagnation

When a patient's liver qi stagnation symptoms are more prominent, Chaihu (Bupleurum Root) and Xiangfu (Cyperus Rhizome) may be added to reinforce the liver-soothing and qi-regulating potency. Chaihu is acrid and bitter in flavour and slightly cold in nature, entering the Liver and Gallbladder channels, with the actions of harmonising exterior and interior, soothing the liver and resolving depression, raising yang, and clearing heat. Xiangfu is acrid, slightly bitter, and slightly sweet in flavour and neutral in nature, entering the Liver, Spleen, and Triple Burner channels, with the actions of soothing the liver and regulating qi, and regulating menstruation to relieve pain. Combined with Hai Zao Yu Hu Tang, the two can more effectively regulate the state of liver qi stagnation and act synergistically with the other herbs in the formula.

2. Interior Accumulation of Phlegm-Heat

When symptoms of interior phlegm-heat accumulation appear — such as a bitter taste in the mouth and dry throat, a red tongue with a yellow greasy coating, and a slippery and rapid pulse — heat-clearing and phlegm-transforming herbs such as Huangqin (Scutellaria Root) and Huanglian (Coptis Root) may be added. Huangqin is bitter in flavour and cold in nature, entering the Lung, Gallbladder, Spleen, Large Intestine, and Small Intestine channels, with the actions of clearing heat and drying dampness, draining fire and resolving toxicity, stopping bleeding, and calming the fetus. Huanglian is bitter in flavour and cold in nature, entering the Heart, Spleen, Stomach, Liver, Gallbladder, and Large Intestine channels, with the actions of clearing heat and drying dampness, and draining fire and resolving toxicity. The addition of these herbs reinforces the formula's heat-clearing and phlegm-transforming action, making it suitable for conditions where phlegm-qi binding has transformed into heat.

3. Marked Blood Stasis

When blood stasis symptoms are pronounced — such as hard masses, severe pain, petechiae or ecchymosis on the tongue, and a choppy pulse — blood-activating and stasis-resolving herbs such as Sanleng (Bur-reed Rhizome) and Ezhu (Curcuma Rhizome) may be added. Sanleng is acrid and bitter in flavour and neutral in nature, entering the Liver and Spleen channels; Ezhu is acrid and bitter in flavour and warm in nature, entering the Liver and Spleen channels. Both have the actions of breaking blood, moving qi, dispersing accumulation, and relieving pain. They reinforce the blood-activating and stasis-resolving action of Hai Zao Yu Hu Tang, enabling masses to disperse more rapidly and pain to be relieved more markedly.

VIII. Dosage and Preparation

1. Traditional Method

2. Modern Concentrated Granules

Modern concentrated granules are produced from traditional Chinese herbs through extraction, concentration, and related processes, and are convenient to take. When using Hai Zao Yu Hu Tang concentrated granules, dissolve in hot water according to the dosage specified in the product instructions. A common specification is 10 grams per sachet; one dose per day, divided into two administrations, one sachet per administration, dissolved in hot water. Modern concentrated granules retain the active constituents of the herbs and are easy to store and carry, making them well suited to modern fast-paced lifestyles.

IX. Precautions and Contraindications

1. Dietary Restrictions

During the course of taking Hai Zao Yu Hu Tang, spicy, greasy, and irritating foods such as chilli peppers, fried foods, strong tea, and coffee should be avoided, as these foods may aggravate the phlegm-dampness pathogen within the body and compromise the therapeutic effect of the formula. Smoking and alcohol should also be avoided; a light diet should be maintained with an emphasis on vegetables and fruit rich in vitamins and nutrition, which helps facilitate recovery.

2. Use with Caution in Pregnancy

Many of the herbs in Hai Zao Yu Hu Tang have blood-activating, stasis-resolving, hardness-softening, and bind-dissipating actions; use by pregnant women may have adverse effects on the fetus, potentially leading to fetal restlessness and miscarriage. Therefore, pregnant women should use this formula with caution; if use is necessary, it must be carried out under medical supervision.

3. Attention for Those with Drug Allergies

For those with a history of drug allergies, an allergy test should be conducted before using Hai Zao Yu Hu Tang. If an allergic reaction occurs — such as skin itching, rash, or difficulty breathing — the formula should be immediately discontinued and medical attention sought without delay.

4. Regular Monitoring

During the course of treatment with Hai Zao Yu Hu Tang, patients should undergo regular monitoring to observe changes in their condition. For conditions such as thyroid nodules and breast hyperplasia, the size, morphology, and consistency of the masses can be assessed by means of ultrasound examination, enabling timely adjustment of the treatment plan as needed.

X. Modern Research

1. Pharmacological Research

Hai Zao Yu Hu Tang is a classical formula for treating the initial stage of goitre and fleshy goitre, with the actions of transforming phlegm and dissipating binds, dissipating binds and resolving goitre, and regulating qi and blood. It is applicable for breast hyperplasia and thyroid tumours caused by qi stagnation and phlegm congealment. The formula includes Haidai (Kelp) 1.5 g, Duhuo (Pubescent Angelica Root), and other herbs in combination, taken as a water decoction, and produces good results for goitre. It is commonly used clinically for the pattern of qi stagnation and phlegm congealment.

Modern research has demonstrated that the herbs in Hai Zao Yu Hu Tang possess multiple pharmacological actions. Hardness-softening and bind-dissipating herbs such as Haizao and Kunbu are rich in iodine and other minerals, which can regulate thyroid function and inhibit abnormal proliferation of thyroid cells. Qi-regulating and phlegm-transforming herbs such as Banxia and Chenpi can regulate gastrointestinal function, promote digestive secretion, improve gastrointestinal peristalsis, and assist in eliminating phlegm-dampness from the body. Blood-activating and stasis-resolving herbs such as Chuanxiong and Danggui can dilate blood vessels, improve microcirculation, increase local blood flow, and promote the absorption and dispersal of masses. Heat-clearing and toxicity-resolving herbs such as Lianqiao have anti-inflammatory and antibacterial properties, preventing the inflammatory responses that may arise when prolonged phlegm-bind transforms into heat.

2. Clinical Efficacy Observation

Clinical research has shown that Hai Zao Yu Hu Tang produces good results in treating thyroid disorders, breast disorders, and related conditions. For patients with thyroid nodules, after a period of taking Hai Zao Yu Hu Tang, some patients' nodules noticeably shrink and symptoms improve. In the treatment of breast hyperplasia, Hai Zao Yu Hu Tang can effectively relieve breast distension and pain and reduce the size of breast masses. In addition, this formula can also provide certain adjunctive therapeutic benefits in treating conditions such as cervical lymphadenopathy, promoting the resolution of lymph node inflammation and the relief of enlargement.

3. Dosage Form Improvement Research

In order to improve the clinical application effectiveness of Hai Zao Yu Hu Tang and patient compliance, modern medicine is also conducting dosage form improvement research. In addition to the modern concentrated granules mentioned above, exploration is underway to produce capsule and dropping pill forms as well. These new dosage forms offer the advantages of convenient administration, accurate dosing, and easy storage, better meeting the needs of clinical treatment. Simultaneously, through optimised manufacturing processes, the stability and bioavailability of the herbs can be improved, further enhancing the therapeutic effect of Hai Zao Yu Hu Tang.