A 54-year-old woman with a one-year history of a recurrent sore throat, hoarse voice, and sleep disturbances was managed using a Liver-soothing and Phlegm-transforming herbal strategy.

Case ID: CHC-0030

Case Summary

This case describes a 54-year-old woman who presented with a recurrent sore throat for over a year, which recently worsened with a hoarse voice and white phlegm. The original report documented a conventional diagnosis of chronic pharyngitis and a TCM assessment of Throat Impediment (Hou Bi) driven by Qi stagnation and Phlegm obstruction. The patient was managed using a combined herbal prescription designed to soothe the Liver, strengthen the Spleen, and resolve the sticky phlegm blocking her throat.

Patient Presentation

• Patient: 54-year-old female (Surname: Zhang).
• Main Complaint: Recurrent sore throat for over one year, currently worsened with hoarseness and white phlegm.
• History: The patient reported a long-standing history of “chronic pharyngitis.” Recently, her sore throat intensified, accompanied by a hoarse voice and the coughing up of white phlegm. She had self-administered medications including Jin Sang Capsules and Omeprazole, but the symptoms showed no significant improvement. Associated symptoms included frequent dreams, easily awakening, and general fatigue. She also reported nighttime back pain (which was relieved after movement) and occasional afternoon occipital discomfort. Her diet, bowel movements, and urination were normal.

Examination and Diagnosis

• Conventional Diagnosis: Chronic pharyngitis. (She also had a history of well-controlled hypertension).
• TCM Tongue and Pulse: The tongue was pale with a white, greasy coating. The pulse was stringy (脉弦).

TCM Assessment

The original practitioner interpreted the presentation as Throat Impediment driven by Qi Stagnation and Phlegm Obstruction (喉痹 – 气滞痰阻).

According to the holistic principles of yin and yang Chinese Medicine the throat is a crucial intersection for the body’s meridians. In this patient, underlying Liver Qi stagnation combined with internal damp-phlegm to create a physical blockage in the throat, resulting in the localized pain, hoarseness, and phlegm. The pale tongue with a white, greasy coating objectively confirmed the presence of this heavy internal dampness. Furthermore, the disrupted flow of Qi disturbed her mind, causing her frequent dreams and easily disrupted sleep, while the blocked meridians contributed to her back and head discomfort.

Treatment Approach

The primary treatment principle was to soothe the Liver, strengthen the Spleen, transform phlegm, and benefit the throat (疏肝健脾，化痰利咽). The strategy aimed to regulate the body’s internal Qi mechanism to naturally dissolve the phlegm from the inside out, rather than relying solely on localized throat-clearing agents.

Herbal Formulas and Modifications

• Initial Formula (June 30, 2022): The practitioner prescribed a customized, 14-herb decoction combining modified versions of two classical formulas: Si Ni San (Frigid Extremities Powder) and Banxia Houpo Tang (Pinellia and Magnolia Bark Decoction).
  • Soothing Liver and Resolving Depression: Bei Chai Hu (15g) and Huang Qin (10g) were used to soothe Liver Qi and clear localized stagnation.
  • Strengthening Spleen and Draining Dampness: Bai Zhu (15g), Fu Ling (20g), and Ze Xie (15g) strongly fortified the digestive system to eliminate the root source of the phlegm, safely draining the excess dampness through the urine.
  • Transforming Phlegm and Benefiting the Throat: Fa Ban Xia (10g), Zhi Shi (10g), Jiang Hou Po (10g), Zhu Ru (15g), and Jie Geng (20g) worked together to powerfully move stagnant Qi, resolve the sticky phlegm, directly open the throat, and restore her voice.
  • Warming the Middle and Moving Qi: Sha Ren (15g), Chen Xiang (10g), and Mu Xiang (10g) were added to warm the digestive tract and enhance the phlegm-transforming power of the formula. Gan Cao (10g) harmonized the decoction.
• Modification (Second Visit – July 6, 2022): The patient reported that her sore throat had improved, but she occasionally experienced stomach discomfort. Recognizing that her Stomach Qi was disharmonious, the practitioner added Hai Piao Xiao (Cuttlefish Bone, ground into powder and taken with the decoction) to the base formula to neutralize acid, stop the pain, and harmonize the stomach.

Follow-Up

• July 6, 2022 (Second Visit): After six doses of the daily decoction, the source reported a noticeable alleviation of the patient’s sore throat. Following the strategic addition of Hai Piao Xiao for her stomach discomfort, the practitioner advised her to adjust her lifestyle, avoid overexertion, and prevent emotional fluctuations to consolidate the healing process and prevent a relapse.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the classical approach to treating a stubborn, chronic throat condition. Chronic pharyngitis is notoriously refractory when treated solely with standard anti-inflammatory herbs or throat lozenges (like the Jin Sang capsules she had initially tried).

The original practitioner recognized that the throat blockage was merely a branch symptom. The root cause was a combination of Liver Qi stagnation (often linked to stress or emotional constraint) and Spleen deficiency (poor fluid metabolism producing phlegm). By utilizing Banxia Houpo Tang—the quintessential classical formula for “plum-pit qi” or throat obstruction—alongside Liver-soothing and Spleen-strengthening herbs, the treatment successfully dismantled the underlying pathological mechanism, highlighting that effective TCM treats the entire organ system, not just the localized site of pain.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：气滞痰阻咽喉痛，疏肝健脾病自除]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 12, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation