Tongue: Normal or pale; may be slightly purple.
Pulse: Can be moderate and weak, or deep, thin and tense.

Contraindications: Do no take during acute illness or if there is excess cold in the middle warmer.

Notes: 
1.*When using this formula to treat Grave's Disease, it is advisable to reduce the dosage by half and use only in combination with another appropriate formula, such as, Rehmannia and Scrophularia Formula, Phlegm-Transforming Formula, or Margarita Complexion Formula.
2.**Use with caution when taking for Hashimoto's Disease. Some patients with Hashimoto's Disease are believed to react to the iodine in the thallus (kun bu). When treating Hashimoto's Disease, consider combining small doses (2 tablets twice a day) of Twin Shields Formula with scrophularia (xuan shen) and forsythia (lian qiao) to manage the inflammation. 
3. Dosage varies greatly among patients. Many will improve with 2 tablets three times a day, some will only need to take tablets twice a day, and others may not show significant improvement if they take less than 4 tablets per does. For hyperthyroid, combine with Baked Licorice Formula. 
4. Some patients report gas and bloating when taking this formula. This is often remedied by reducing dosage for a while and then slowly building back up to the patient's full dose. If weak digestion is part of the patient's pattern, it is advisable to begin with smaller dosages and build up.