Chapter contents

INTRODUCTION

Chinese medicine talks about the ‘throat’ in general without distinguishing the pharynx (related to both respiratory and digestive systems) from the larynx (pertaining to the respiratory system). There are, however, signs that the ancient Chinese doctors were aware of such a differentiation. For example, even as early as 100BC, the ‘Spiritual Axis’ said in Chapter 69: ‘The throat is the passage for food and drink; the throat is also where Qi goes up and down’.¹ It is interesting that the Chinese text uses two different terms in this sentence: Yan-hou for the passage of food and Hou-long for the passage of Qi; both are translated as ‘throat’ in modern texts.

Bearing in mind the dual function of the throat in respect of respiratory and digestive systems, one can generally differentiate two broad types of throat problems: one related to the respiratory system and in Chinese medicine to the Lungs and Kidney channels, the other related to the digestive system and in Chinese medicine to the Stomach and Large Intestine channels (see next section). In adults, chronic sore throats are more commonly related to the Lung and Kidney channels, and in children more commonly to the Stomach and Large Intestine channels.

With regard to Heat and Cold, the throat is prone only to Heat (whether Full or Empty) and does not have any Cold patterns.

WHY WE ASK

I generally ask about throat symptoms to confirm either a pattern of Heat (because the throat is an area of concentration of Heat) or a pattern of Qi stagnation.

I usually ask about neck symptoms to confirm the presence of a Liver pattern such as Liver-Qi stagnation or Liver-Yang rising, which, barring invasion of external Cold, comprise the most common causes of chronic neck ache.

WHEN WE ASK

It is useful to ask about throat symptoms when there is Heat (Full or Empty) or Qi stagnation. If no earlier mention of throat symptoms has been made, I generally ask about them towards the end of the consultation. I always ask about the throat when I suspect a pattern of rebellious Qi of the Penetrating Vessel.

HOW WE ASK

I usually ask patients whether they experience a feeling of tightness in the throat or a sensation of having a lump in the throat. If the patients speak of discomfort in the neck, it is important to ask them to point clearly to the area involved: the sides of the neck are influenced by the Gall-Bladder channel and often Liver patterns, while the back of the neck is influenced by the Bladder channel (see below).

CHANNELS INFLUENCING THE THROAT AND NECK

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

Sore throat

Symptoms and Signs, Chapter 59

Both acute and chronic sore throat are due to Heat, which may be Full or Empty; however, we should always check this symptom with the findings from observation, especially in acute cases. A redness of the pharynx confirms the presence of Heat, especially Full-Heat.

When diagnosing sore throat, the first thing to establish is whether it is of external or internal origin, and the clinical significance of this symptom will therefore be analysed according to this distinction.

Sore throat of external origin

A sore throat of external origin has a sudden onset and short duration. In external invasions of Wind a sore throat generally points to Wind-Heat rather than Wind-Cold, especially if it is very severe. Other symptoms would include aversion to cold, a fever (or body hot to touch), headache, sneezing and a Floating-Rapid pulse.

Sore throat of internal origin

A sore throat from internal origin is usually due to Heat, which may be Full or Empty. In general, the sore throat from Full-Heat is very severe and the throat is red and swollen, whereas that from Empty-Heat is less severe, worse in the evening and associated with dryness. However, a chronic sore throat may also arise from a long-standing Yin deficiency, without Empty-Heat.

In adults, the most common chronic sore throat is that from Kidney- or Lung-Yin deficiency, or both, with Empty-Heat; this sore throat is not very severe, is worse in the evening, and is associated with dryness of the throat and other Yin deficiency manifestations. A chronic sore throat may also be caused simply by Qi and Yin deficiency without Empty-Heat; in this case the sore throat is mild, it comes in bouts, caused or aggravated by overwork, and is associated with other Qi and Yin deficiency manifestations.

In some cases patients complain of a ‘sore throat’ that comes and goes according to the emotional state; if there is no redness inside the throat and there are no other signs of Heat, this may be due to stagnation of Qi (of the Liver or Lungs) from emotional problems.

In children, external Wind-Heat has a stronger tendency than Wind-Cold to cause interior Heat. If not cleared properly after the initial stages, it is very likely to give rise to residual pathogenic factors. When a child presents with a recurrent, chronic sore throat, the two most common causes are either residual Heat in the Lung channel following an invasion of Wind-Heat or an accumulation of Heat in the Stomach and Large Intestine channels due to retention of food. In the case of residual Heat in the Lung channel, the child will present with a history of repeated invasion of Wind-Heat, which has usually been treated with antibiotics; other manifestations may include a cough, thirst, a feeling of heat, red cheeks and disturbed sleep. In the case of sore throat from accumulation of Heat in the Stomach and Large Intestine channels, there will be no history of repeated invasions of Wind-Heat, but rather one of successive digestive upsets such as vomiting and regurgitation of food; other manifestations may include abdominal pain, constipation, epigastric pain and disturbed sleep.

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

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Related posts:

1. OBSERVATION OF THE GENITALIA
2. PROBLEMS AT PERIOD TIME
3. DIGESTIVE SYSTEM AND TASTE
4. MENTAL AND EMOTIONAL SYMPTOMS

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