The throat and the front of the neck form an area in which practically all channels converge (see Fig 10.1 on p. 109). With the single exception of the Bladder channel, 11 of the 12 channels course either through the front or the side of the throat. Of the eight Extraordinary Vessels, six go through the centre or the side of the throat; the exceptions are the Governing Vessel and the Girdle Vessel. Thus, being influenced by so many channels and therefore Internal Organs, the throat reflects clearly conditions of Yin–Yang, Heat–Cold and Deficiency–Excess and is an important diagnostic area. The throat is influenced particularly by the Lungs, Stomach, Large Intestine, Liver, Kidneys and Directing Vessel channels.

THROAT

Box 36.1 summarizes the patterns underlying sore throats.

BOX 36.1 SORE THROAT

• Invasion of external Wind-Heat: sore throat with acute onset, with aversion to cold, fever or hot body, Floating-Rapid pulse

• Full-Heat in Stomach and Intestines: severe sore throat with swelling and redness

• Kidney-/Lung-Yin deficiency with Empty-Heat: chronic mild sore throat with dryness

• Severe Qi and Yin deficiency: chronic, intermittent mild sore throat aggravated by overwork

• Residual Heat in Lung channel or Heat in Stomach and Large Intestine channel: recurrent, chronic sore throat in children with a history of Wind invasion or digestive upset

• Qi stagnation (Liver or Lungs): chronic ‘sore throat’ that comes and goes, without redness

Dry throat

Symptoms and Signs, Chapter 59

Excluding external invasions of Wind-Heat which may cause a dry throat, the most common cause of chronic dryness of the throat is a deficiency of Yin of the Lung or Kidneys, or both. In fact, in these situations, a dry throat is an important symptom confirming the diagnosis of Yin deficiency. A chronic dryness of the throat from Full-Heat may be related to the Stomach channel, but this is much less common than the former type.

Chronic dryness of the throat may also be related to the Liver and Gall-Bladder channels and be caused by Heat in the Liver and Gall-Bladder or by the Lesser Yang syndrome within the Six Stages or the Gall-Bladder Heat pattern at the Qi level within the Four Levels.

Box 36.2 summarizes the patterns underlying dry throat.

BOX 36.2 DRY THROAT

• External invasion of Wind-Heat

• Lung-Yin deficiency

• Kidney-Yin deficiency

• Stomach-Heat

• Heat in Liver and Gall-Bladder

• Lesser Yang pattern (Six Stages)

• Gall-Bladder Heat (Four Levels)

Itchy throat

Symptoms and Signs, Chapter 59

Itchiness of the throat with sudden onset is always related to invasion of Wind, which may be Wind-Cold, Wind-Heat or Wind-Dryness. Chronic itchiness of the throat is usually due to Lung-Yin deficiency or Lung Dryness; in this case the itchy feeling of the throat is worse in the evening and is associated with a desire to drink water in small sips.

Hoarse voice

Hearing, Chapter 53; Symptoms and Signs, Chapter 59.

In acute cases, hoarse voice is due either to external invasion of Wind-Heat or to Lung-Heat, which may develop from such an invasion. In invasions of external Wind the presence of a hoarse voice by itself indicates Wind-Heat rather than Wind-Cold because the throat is a place where Heat easily accumulates. In such cases, a hoarse voice is accompanied by a sore throat, aversion to cold, fever, a Red tongue in the front or sides and a Floating-Rapid pulse.

A hoarse voice may also occur with acute Lung-Heat after an invasion of Wind-Heat. In such a case, the hoarse voice will be accompanied by a sore throat, a feeling of blockage of the throat, cough with scanty yellow sputum, chest pain, a Red tongue with dry yellow coating and an Overflowing-Rapid pulse.

In chronic cases, by far the most common cause of a hoarse voice is a deficiency of Yin of both Lungs and Kidneys. In such cases, a hoarse voice is accompanied by a dry throat at night, an itchy throat, weak voice, dizziness, tinnitus, night sweating, a tongue without coating and a Floating-Empty pulse. This pattern is more common in the elderly.

A less common cause of a chronic hoarse voice (also in the elderly) is an accumulation of Phlegm and Blood stasis in the throat, in which case there will also be a sore throat, a feeling of obstruction of the throat, thickening of the vocal chords, nodules on the vocal chords, a swelling of the throat, a Purple tongue and a Wiry pulse.

Box 36.3 summarizes the patterns underlying a hoarse voice.

BOX 36.3 HOARSE VOICE

• Invasion of Wind-Heat: sore throat, sudden onset, aversion to cold, fever, Red tongue, Floating-Rapid pulse

• Lung-Heat: sore throat, feeling of blockage of the throat, cough with scanty yellow sputum, chest pain, Red tongue with a dry yellow coating, Overflowing-Rapid pulse

• Lung- and Kidney-Yin deficiency: dry throat at night, itchy throat, weak voice, dizziness, tinnitus, night sweating, tongue without coating, Floating-Empty pulse

• Phlegm and Blood stasis in the throat: sore throat, feeling of obstruction of the throat, thickening of the vocal chords, nodules on the vocal chords, swelling of the throat, Purple tongue, Wiry pulse

Feeling of obstruction in the throat

Symptoms and Signs, Chapter 59

The feeling of obstruction in the throat may be compared to having a piece of meat lodged in the throat; it cannot be swallowed down or coughed up, but there is no redness, no pain and no swelling of the throat. It is commonly referred to as the Plum Stone Syndrome, although the first reference to this syndrome in the ‘Discussion of Cold Induced Diseases’ mentions a piece of meat rather than a plum stone.

This symptom is nearly always caused by a stagnation of Qi due to emotional problems; modern Chinese textbooks always relate this to stagnation of Liver-Qi and to emotional problems such as anger, repressed anger or frustration, but it may also be due to Lung-Qi stagnation and failure of Lung-Qi to descend caused by emotions such as worry, sadness or grief. Whatever the emotion or the channel involved, when due to Qi stagnation the feeling of a foreign body in the throat comes and goes according to the emotional state of the patient.

A feeling of obstruction in the throat may be due also to rebellious Qi of the Penetrating Vessel. In such a case, it would be accompanied by symptoms throughout the course of this channel such as abdominal fullness or pain, or both, menstrual irregularities in women, tightness of the chest, anxiety and palpitations.

However, stagnation of Qi and rebellious Qi of the Penetrating Vessel are not the only possible causes of a feeling of obstruction in the throat. This symptom may also be caused by deficiency of Yin of the Lung or Kidneys, or both. In this case, the feeling of a foreign body in the throat is less severe than in the previous case, it is worse in the evening and is aggravated by overwork.

Box 36.4 summarizes the patterns underlying a feeling of obstruction in the throat.

BOX 36.4 FEELING OF OBSTRUCTION IN THE THROAT

• Liver- or Lung-Qi stagnation: severe, comes and goes according to mood

• Rebellious Qi in the Penetrating Vessel: worse in pregnancy or before menstruation, with abdominal fullness/pain, chest tightness, anxiety, palpitations

• Lung-/Kidney-Yin deficiency: mild, worse in the evening, aggravated by overwork

Swollen and red tonsils

Observation, Chapter 10; Symptoms and signs, Chapter 59.

The tonsils are influenced by the Lung, Stomach and Large Intestine channels and are prone to Heat or Toxic Heat.

Acute conditions

In acute conditions, redness and swelling of the tonsils may occur with an invasion of Wind-Heat; indeed, this sign always indicates that the pathogenic factor is Wind-Heat rather than Wind-Cold. However, swelling and redness of the tonsils with an invasion of Wind also indicate that there is Toxic Heat of external origin (this is an important diagnostic differentiation in the choice of herbs as we will need to address the Toxic Heat).

Chronic conditions

In chronic conditions, redness and swelling of the tonsils indicates either Heat (which may be Full or Empty) or Toxic Heat. These may affect the Stomach or Large Intestine channels. In children, chronic tonsillitis is nearly always related to residual Heat or Toxic Heat (following repeated invasions of Wind-Heat, especially if treated with antibiotics). In adults, chronic tonsillitis is often due to Empty-Heat in the Lung or Stomach channel, or both.

Case history 36.1 illustrates a pattern underlying chronic tonsillitis.

Case history 36.1

A 24-year-old woman complained of chronic tonsillitis suffering two or three bouts each year since the age of 5. Six weeks prior to the consultation she had had her tonsils removed and she had been much worse since then, suffering from sore throat, tiredness, swollen glands, headaches, thirst, a feeling of heaviness and a congested feeling in the sinuses. Her pulse was Slippery on the whole, but Weak on the right. Her tongue was Red in the front, slightly Thin and with a sticky yellow coating.

Diagnosis:

This is a typical example of residual pathogenic factor and specifically Toxic Heat in the throat. This is an unusual case as the residual pathogenic factor stems from an operation, whereas it normally develops after a febrile disease. Toxic Heat is manifested by the swollen glands, the sore throat, a feeling of heaviness, the headache, the Slippery pulse and the Red tongue with a thick, sticky yellow coating. Obviously, Toxic Heat is only the acute, recent cause of her problem and there is an underlying deficiency of Stomach and Spleen, probably stemming from the chronic tonsillitis which she had suffered from since childhood. The deficiency of Stomach and Spleen is manifested by the tiredness and Weak pulse.

Treatment principle:

This is a very good example of a condition characterized by a mixture of Deficiency and Excess: the residual Toxic Heat is an Excess, acute condition and it constitutes the Manifestation (Biao), whereas the deficiency of Stomach and Spleen is an Empty, chronic condition and it constitutes the Root (Ben). In such cases, one should have a clear idea about the priorities of treatment, that is, whether one should treat the Excess, acute condition first or the deficient, chronic condition first. The pulse, tongue and severity of the symptoms are important guidelines to assist us in choosing the proper treatment principle. In this case, it is clear that the residual Toxic Heat should be eliminated first because the symptoms are acute, the pulse is Slippery and the tongue has a thick, sticky yellow coating.

Treatment:

The prescription used was a variation of the formula Li Yan Cha Benefiting the Throat Tea, which is specific for eliminating Toxic Heat from the throat.

Box 36.5 summarizes patterns underlying swollen and red tonsils.