SharonY: October 15, 2020, 1:23am
Hi Everyone,
Great to connect with many of you at the recent seminar. What a lovely community.
I would love some help on the following case.
52 year old woman
Chief complaint: throat pain, globus, SCM pain, possible laryngopharyngeal vagal neuropathy
Globus: constant feeling of phlegm in the throat 7+
Heavy sensation along Left SCM into SJ 12 behind ear. 7+ Worse with stress or lifting weights. Always wants
to massage it.
Tight, swollen throat. In the past, air hunger. Bubbling sensation in throat, hear bubbles in different positions.
Burning numbing sensation along L edge of tongue. Not into teeth or gums.
Occasionally burning numbing sensation along L jaw line and from behind ear to L temple and above eye.
Occasional muffled L ear.
Onset: mother passed 5 years ago. Was under a lot of stress with marriage and brother over mother s estate. 1
year after she passed, she got a bad URI cough, mucus, tired. took 2 rounds of AB, woke up with globus that
never went away.
W diagnosis of silent reflux and vagal neuropathy
Other Symptoms:
ENT: history of frequent sinus infections since her 20s. Green thick mucus. Chronic sinus pressure around eyes,
cheekbones, UB2. Use Tylenol Sinus all the time. Flare up 1/1-2months; last one was 3 weeks ago. Grind teeth at
night;
Appearance and demeanor: thin, sinewy and muscular, came in workout clothes. Dull eyes 7+; Good resources,
husband has a good job, doesn t have to work but still stressed about health and taking care of the kids. Skin
normal-dry.
Digestion: Used to be constipated once every 3-4 days, but started taking mg last year. Always thirsty, drinks a lot
of water.
GYN: beginning to go through menopause. No full period since March; only light spotting twice. Daily hot flashes
1 month ago for 1 week but not in last month. Used to have PMS signs of anger, irritability, sensitive and
emotional.
Mood: anxious person
Energy: tired since perimenopause
Pain: historically holds stress in neck, jaw and shoulders; knots around left GB 21, SJ14, SI 13 areas.19/01/2024, 11:01Throat pain, globus, vagal neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/throat-pain-globus-vagal-neuropathy/1330/print2/5
Temp: Reynaulds in cold weather.
GTITR: tense, talkative. Came into office for the first time and walked right into the back talking. Thin, muscular
and sinewy.
Tongue: small, dusky, thin body, no coat
Pulse: thin
Excess Presentation:
LV: internally focused, dull eyes; thin pulse, pale-ish,small tongue
ST: pain along SCM channel and jaw
LI: dry inside and out
SI: pain, some pain along SI channel, symmetrical
K: perimenopausal
Treatment #1
Dx: Lv Excess
Treat: SJ+
Rationale: pain originating from SJ12 and spreading along outer canthus of eye and down throat; dull eyes;
internally focused
Results: sl less burning on side of tongue, sl less pain along SCM. But reports no lasting change the following
week.
Treatment #2:
Dx: LI Excess
Treat: SP+
Rationale: dry inside and outside, tendency towards constipation; pain along lower jaw; very active doer.
Results: not much change after treatment, will ask when see her next.
Reflections:
The SJ+ treatment made sense to me given her dull eyes, sl lack of social graces, and how the pain radiates from
around SJ12 towards above the eye orbit and the face. But this did not make much of a difference.
With the LI+ treatment, I based it mostly on her body type, but this did little to help. Feedback during this
treatment was that she still had pain along the GB channel in the back.
The location of her pain and areas of discomfort cross over various channels: GB, SI, SJ, ST, LI so it is challenging
to narrow it down.19/01/2024, 11:01Throat pain, globus, vagal neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/throat-pain-globus-vagal-neuropathy/1330/print3/5
I want to consider a ST+ treatment since the pain is along the neck and jaw area and it moves qi downward;
potentially for the silent reflux (although I am not convinced that she has it). But she is quite thin so ST+ doesn t fit
her body type.
I also want to consider PC+ because of some of pain is along the GB channel, anxiety and because the onset of the
issue was around a time of grief and anger. She no longer has the air hunger though.
Any ideas greatly appreciated!
Thank you,
Sharon
KristinWisgirda: October 15, 2020, 1:59pm
Hi Sharon,
Thanks for your case. Head and neck cases can be tricky with so many channels passing through. Her mix of damp
and dry certainly adds further complexity.
Even though it might not be central to her case, I always like to know about the K/SI balance. Symmetry,
grooming, varicosities, pain with periods, fertility history are all useful to note. You can out her dusky tongue under
K excess. I would move the her age/perimenopause into the SI excess listing.
I am also interested in her temperature. There really are no subjective/objective heat/cold signs besides the
reynaud s in cold?
How intense is her talking- if non stop consider H excess. If her voice is loud consider Lung and Gb excess.
SharonY:
I want to consider a ST+ treatment since the pain is along the neck and jaw area and it moves qi downward;
Me too! You don t always have to treat to body type. The Stomach channel location is very prominent. As well she
has plenty of signs that point to Lung excess: Good resources. The chronic sinus pressure, bubbling and the feeling
of phlegm in her throat are not for sure internal damp but very well could be. I definitely want to move qi down
with her too. Toby has shared several cases of globus and throat restriction where ST+ was on the top of the list
and worked. Check out her thenar eminence and her abdomen (right upper quadrant especially) at the next visit too.
SharonY:
I also want to consider PC+ because of some of pain is along the GB channel, anxiety
Me too! P+ would also move downward. The globus could be seen as a convexity too. Any other pointers to her
P/GB balance? Did her walking into the back of your office have any tinge of impatience or aggression? Is she
thoughtful and easily able to take in information from the outside. Is her breathing totally free and open now that19/01/2024, 11:01Throat pain, globus, vagal neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/throat-pain-globus-vagal-neuropathy/1330/print4/5
she doesn t have air hunger? Do you watch her breathing when you ask her to take 3 deep breaths after the needles
are in?
I wonder if SJ+ could be considered again after using some other strategies first. The presence of the left sided
symptoms is another pointer. Her complexity and chronicity, including the background of decades of sinus issues,
suggest that she will be needing a series of visits to resolve her complaints.
Please let us know what happens.
SharonY:
Great to connect with many of you at the recent seminar. What a lovely community.
Mega dittos.
SharonY: October 16, 2020, 12:02am
Thanks for the advice, Kristin. I just saw her again and have some updates below.
KristinWisgirda:
Even though it might not be central to her case, I always like to know about the K/SI balance. Symmetry,
grooming, varicosities, pain with periods, fertility history are all useful to note. You can out her dusky tongue
under K excess. I would move the her age/perimenopause into the SI excess listing.
I am also interested in her temperature. There really are no subjective/objective heat/cold signs besides the
reynaud s in cold?
How intense is her talking- if non stop consider H excess. If her voice is loud consider Lung and Gb excess.
She s quite symmetrical, well-groomed, and no fertility issues so a good candidate for K excess. She s not very
loud just more constant overthinking and trying to make sense of her symptoms. She is more on the cold side.
KristinWisgirda:
Me too! P+ would also move downward. The globus could be seen as a convexity too. Any other pointers to
her P/GB balance? Did her walking into the back of your office have any tinge of impatience or aggression? Is
she thoughtful and easily able to take in information from the outside. Is her breathing totally free and open
now that she doesn t have air hunger? Do you watch her breathing when you ask her to take 3 deep breaths
after the needles are in?
She is less aggressive than I had originally thought, I think her vocalness when walking into the office is bit more
of a K excess, I know my place in the world, sort of vibe. She sighs a lot (is this potential GB excess? or LV?) and
says her labored breathing is more about her tight throat and less about any SOB.19/01/2024, 11:01Throat pain, globus, vagal neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/throat-pain-globus-vagal-neuropathy/1330/print5/5
Inspired by Daniel s patient whose mantra all is well helped him, I spoke with her about incorporating a similar
mantra into her daily life and she seemed open to it. She just seems resigned to feeling these symptoms that I don t
think she even allows herself to define herself outside of them.
Because she came in today primarily with pain along the GB channel and secondarily with globus, sinus pressure,
and what she describes as tightness around the nose, I first tried PC+ on the right. The pain around the temple
decreased noticeably but the pain around GB12 stuck around as did all the secondary symptoms that were more in
line with LU excess. (I forgot to check out her eminence). I added in ST+ on the left with little to no effect so I
don t think this was helpful in narrowing down her presentation.
We ll see what she reports next week and I ll keep you posted.
Thanks again,
Sharon
KristinWisgirda: October 17, 2020, 10:36am
SharonY:
She just seems resigned to feeling these symptoms
SharonY:
her vocalness when walking into the office
Some of my Liver excess patients talk lots, trapped in an internal dialogue that goes nowhere. I wonder if her
talkativeness might have this quality too given the rest of her presentation. Along with the resignation regarding her
symptoms, her overthinking and some at least short term change in her symptoms after the first attempt, SJ+
repeated continues to jump out at me.
SI+ looks promising too.