A 40-year-old man with a post-meal throat blockage sensation triggered by emotional stress was managed using a Phlegm-resolving and Qi-regulating herbal strategy.

Case ID: CHC-0035

Case Summary

This case describes a 40-year-old man who presented with a one-month history of a persistent blockage sensation in his throat, which began after a period of emotional distress. The original report documented a conventional diagnosis of chronic pharyngitis and a TCM assessment of “Plum-pit Qi” (Mei He Qi) driven by Phlegm-Qi Stagnation. The patient was managed through a dynamic herbal approach centered on a modified Banxia Houpo Tang to untangle the Liver Qi, transform the stagnant phlegm, and dissipate the localized nodules in the throat.

Patient Presentation

• Patient: 40-year-old male (Surname: Luo).
• Main Complaint: A sensation of a blockage in the throat after eating, feeling like a foreign object that could neither be coughed up nor swallowed.
• History: The patient sought consultation on January 4, 2018. He reported that his symptoms began one month prior following an episode of emotional stimulation and stress. He constantly felt an obstruction in his throat, particularly after eating. He underwent a conventional gastroscopy, which revealed no structural abnormalities. Associated symptoms included a bitter and dry mouth, as well as significant irritability and restlessness. His appetite, bowel movements, and urination were normal.

Examination and Diagnosis

• Conventional Diagnosis: Chronic pharyngitis.
• TCM Tongue and Pulse: The tongue was pale red with a thin, white coating. The pulse was stringy (脉弦).

TCM Assessment

The original practitioner interpreted the presentation as Plum-pit Qi driven by Phlegm and Qi Stagnation (梅核气 – 痰气郁结).

According to the holistic principles of yin and yang Chinese Medicine the Liver governs the smooth flow of emotions and Qi. The original report noted that the patient’s emotional distress caused his Liver Qi to stagnate and lose its free-flowing nature. This trapped Liver energy subsequently “overacted” on the Spleen and Stomach, impairing their ability to properly transport and transform fluids.

These stagnant fluids gathered and condensed into pathological phlegm. Simultaneously, the disrupted Liver Qi and the heavy phlegm intertwined and became physically knotted in the throat, creating the classic “plum-pit” sensation—an obstruction that feels physically real but cannot be swallowed or coughed up. Furthermore, the trapped stagnation eventually generated internal heat, explaining his bitter and dry mouth and overall irritability. The stringy pulse is a definitive hallmark of this underlying Liver constraint.

Treatment Approach

The primary treatment principle was to move Qi, open stagnation, transform phlegm, and dissipate nodules (行气开郁，化痰散结). The strategy relied on aggressively re-establishing the body’s natural Qi flow to physically dissolve the “knot” in the throat.

Herbal Formulas and Modifications

• Initial Formula (January 4, 2018): A 14-herb decoction, acting as a heavily modified version of the classical Banxia Houpo Tang.
  • Moving Qi and Opening the Chest: Jiang Hou Po (15g), Zi Su Geng (10g), Mu Xiang (10g), and Fu Chao Zhi Ke (15g) forcefully regulate Qi, relieve chest oppression, and break up the stagnation in the middle torso.
  • Descending Rebellious Qi and Phlegm: Jiang Shui Ban Xia (15g) is the chief herb for resolving phlegm and dissipating the “plum-pit” lump, working synergistically with Xuan Fu Hua (15g) and Shi Di (15g) to aggressively direct rebellious Qi downward.
  • Dissipating Nodules and Stopping Acid: Wa Leng Zi (15g) and Hai Piao Xiao (30g) are shell-based medicinals used to physically soften and dissipate the tough phlegm nodules, while naturally neutralizing any excess stomach acid that might be contributing to the throat irritation.
  • Opening the Lungs and Benefiting the Throat: Jie Geng (10g) specifically guides the herbal actions upward to the throat and lungs to expel phlegm.
  • Soothing Liver and Clearing Heat: Yu Jin (15g) and Bei Chai Hu (15g) soothe the Liver and clear damp-heat, while Huang Lian Pian (5g) and Qing Guo (15g) clear the localized fire and toxicity from the throat.
• Second Visit (January 13, 2018): With the throat blockage slightly improved, his tongue appeared pale and puffy with a thick white coating. The practitioner removed the cold, heat-clearing herbs (Huang Lian, Qing Guo, Hou Po) and added Dang Shen Pian (30g) and Chao Lai Fu Zi (15g) to strongly fortify the Spleen and aid digestion.
• Third Visit (January 17, 2018): The blockage was significantly improved, but the patient reported poor sleep. Hai Piao Xiao was removed, and Dan Zhu Ye (15g), Fu Ling (15g), and Qing Guo (15g) were added to drain dampness, clear residual heat, and settle the mind.
• Fourth Visit (January 25, 2018): The throat blockage was completely gone, and sleep had improved. The practitioner added Chen Pi (10g) and Pao Cang Zhu (15g) to the base formula to further dry dampness, strengthen the Spleen, and consolidate the cure.

Follow-Up

• After the fourth visit and taking the final 5 doses of the consolidation formula, follow-up reports indicated the patient was completely cured, with no remaining discomfort or throat obstruction.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the classical management of a psychosomatic symptom. In conventional medicine, when a patient complains of a severe throat blockage but a gastroscopy shows nothing physically there, it is often dismissed purely as anxiety or chronic pharyngitis.

However, the original practitioner utilized the ancient TCM concept of Mei He Qi (Plum-pit Qi). This diagnostic framework recognizes that intense emotional stress (Qi stagnation) can physically combine with bodily fluids (Phlegm) to create a functional, localized knot in the throat. By utilizing Banxia Houpo Tang as the foundation, the treatment dynamically addressed both the emotional root (by soothing the Liver with Chai Hu) and the physical manifestation (by dissolving the phlegm with Ban Xia and Wa Leng Zi), highlighting TCM’s seamless integration of the mind and the physical body.

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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: Qingyuan Maternal and Child Health Hospital (清远市妇幼保健院) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】曾宪进：半夏厚朴汤加减治疗痰气郁结型慢性咽炎案]
• Practitioner: Professor Zeng Xianjin (曾宪进)
• Publication date: September 28, 2024
• Original language: Chinese
• ChineseHerb.org version: English translation and editorial adaptation