Patient: Ms Li29 Years Old
Date：2022ndJuly,20First visit
Chief complaint: Foreign body sensation in the throat for 1 year.
According to TCM, the “globus pharyngis” is a feeling of a foreign body in the throat that cannot be swallowed or spit out.
Ms. Li, an accountant, started experiencing occasional throat discomfort about a year ago. She always had the distinct feeling that something was blocked in her throat and tried numerous times to get it out without success, especially in the wee hours of the morning. This discomfort also affected the quality of her sleep, so she decided to visit the clinic in an effort to resolve the issue.
“Ms. Li, aside from making you feel uneasy, will the sensation actually affect your daily speech or make your breathing slurred?”
“No, it won’t. I simply feel like there’s something foreign in my throat. I went to the hospital to see an ear, nose, and throat specialist, and he diagnosed me with chronic laryngitis and gave me some medication. After I finished the prescription, I skipped the follow-up appointment, and the issue persisted till this point. Recently, I’ve noticed that this feeling is more overt, especially when I wake up in the late night or early morning. This has started to interfere with my sleep, as I frequently wake up about 4 a.m., struggle to fall back, and then sleep for less than 2-3 hours before getting ready for work.”
“Ok, I see. What about your usual eating patterns? Are your meal servings regular and on time?”
“I usually eat regularly, but I don’t eat a lot because my digestion is a little slow. However, as long as I eat, regardless of the portion, I’m fine.”
“What exactly does it mean to have a slow digestion?”
“I noticed that my stomach is easily bloated, whether I am hungry or not, consume a lot or little, especially when I have a busy day, and the bloating can linger all day. Of course, if I cut down on my portion, the bloating will be lessened, so I am used to eating little.”
“Is your job demanding?”
“I believe that work pressure is very typical for my profession. I have been in this industry for almost 5 years, and I have adapted to such pressure and pace of life. Recently, however, it’s possible that because the company is launching new projects, the schedule has tightened and the pressure is indeed higher than before, but I believe that I will be able to adapt soon.”
“What activities do you enjoy doing in your leisure time besides going to work?”
“I didn’t do anything particularly noteworthy in my free time because there is still task that needs to be done after work. Since my company is a distance from where I live, the travel time alone takes almost an hour. I then go home for dinner, take a shower, and continue working until it is finished, which is usually around midnight, before going straight to bed.”
“How about your days off? Do you hang out with friends or engage in activities you’d usually want to but are unable to?”
“I once enjoyed reading books and watching dramas, but ever since I started working, it has become more difficult to fit these activities into my schedule, and I have progressively stopped doing them. On days off, I would allow myself to sleep till I naturally got up, go to the nearby grocery to get some daily essentials, go home and tidy it up, and the day would pass once more.”
I concluded that Ms. Li is a workaholic with a major imbalance between work and life after getting to know her physical characteristics and lifestyle. Due to her fast-paced lifestyle, Ms. Li had to give up her casual interests, leisure time, and regular social interactions in order to focus on her profession. These days lasted for more than five years. She lost interest in interacting with others due to her repetitive life, and she had grown accustomed to holding onto many emotions. Even throughout our appointment, she attempted to be as brief as possible, so I had to keep probing for more information to get to the bottom of things. And because the fluctuation of emotions mostly affects liver qi, it is specifically this “habit” that prevents her from expressing her emotions, leading to liver qi stagnation. The ability of the spleen and stomach to transform and transport nutrition, as well as their function in regulating water and fluid in the body, are all negatively impacted by poor eating habits developed under the pressure of a busy schedule which leads to an increase in dampness and the production of phlegm that could not be seen through naked eyes. This particular kind of “phlegm” builds up in the throat and causes globus pharyngis.
I informed Ms Li of her issue, prescribed her some Chinese medicine to disperse her liver qi stagnation, and promote qi flow by invigorating the spleen, and got her to promise to spend some time with her close friends or family on her next day off. After giving it some thought, she agreed.
Date：31th July, 2022. Second visit.
Ms. Li returned for follow-up after around a week.
“Ms. Chung, although the feeling of a foreign body clogging my throat was considerably lighter after I finished my medication, I still wake up with a dry, bitter taste in my mouth. I had better quality sleep at night.”
“And how’s your appetite? Do you still have a bloated stomach?”
“No, no, in actuality, I think I get hungry more frequently now than I did in the past. Usually, I only felt hungry after mealtime, at which I hurried to grab something to sate my hunger and then rushed back to work, but lately, I’ve had to eat more to feel full. I don’t feel bloated after a meal, even if I eat more than usual.”
“Well, how did you spend your last day off?”
“I reconnected with a college friend I haven’t seen since the epidemic, and we spent the entire day catching up. Initially, I had worried that not seeing her for two years would be awkward, but it won’t be at all. After that day’s meeting, I felt much more at ease when I got home. It turned out that the chat also had a relieving purpose.”
“I’m glad to hear this, you know. Even though I still prescribe you Chinese medicine, start spending your free time on activities other than working or doing housework. Read a book, watch a newly release movie, or even go for a walk outside.”
“ Alright, Ms. Chung.”
Date：7th August, 2022. Third visit
“Ms Chung, the feeling of a foreign body blocking in my throat has subsided recently, and so has the sensation of dry mouth and bitterness.”
“And how was your sleep lately?”
“This week I slept great; I can sleep till sunrise and rarely dream, and I felt more lively than usual.”
“All right, then I’ll modify your prescription again, and you can continue to take Chinese medicine for a few days. If you no longer have the sensation of something blocking your throat after taking the medication, you do not need to return for a follow-up.”
Ms Li finished her last Chinese medicine and returned a month later for another consultation due to additional discomforts, although she stated that she had not noticed the existence of this foreign body in her throat thus far. I instructed Ms Li to go out with friends occasionally, as agreed, and to engage in her interests and hobbies when she has free time, in order to better prevent the recurrence of globus pharyngis.
What should you know about “Globus pharyngis”?
The ancients defined globus pharyngis as “a roasted piece of flesh obstructing in the throat,” which means that there is a sensation of an unknown presence in the throat that cannot be swallowed or expelled. As a result, one of the main symptoms of globus pharyngis is a vague feeling that an unknown item is trapped in the throat, which cannot be swallowed or spit out, especially when mood swings are severe, and it mostly affects women.
The two conditions that lead to the development of globus pharyngis—impairment in spleen and stomach function—as well as liver qi stagnation—are truly inseparable from one another. The impaired function of the spleen and stomach affects both the role of regulating fluid in the body and also the transporting and transforming of nutrients, which will ultimately result in the formation of phlegm; constant mood swings, which affect the dispersing of liver qi, can even result in liver qi stagnation. Long-term liver stagnation will obstruct the qi flow in the chest, which combined with the phlegm will result in the occurrence of globus pharyngis.
Prevention of “globus pharyngis”
- Adjust your mindset
Knowing that emotional factors play a key role in causing or even exacerbating the development of globus pharyngis, it is important to self-regulate, when necessary, in order to reduce stress whenever there are excessive amounts of negative emotions in life. There are several strategies to manage your emotions, but the simplest is to exercise to relieve tension. Additionally, learning how to confide in others is another wise decision.
Life is always a blend of joy and sorrow, and emotions themselves are neither good nor bad but rather a physical manifestation of the mind. Blindly suppressing your emotions is not always a long-term solution. Allowing yourself to occasionally be vulnerable, to occasionally be frustrated and dissatisfied with your existing situation, to occasionally be angry, confused, and afraid—allowing yourself to acknowledge and accept your feelings at that moment—is more likely to enable you to quickly adjust your mindset and avoid overindulging in the state of negative emotions.
- Massage acupressure points
Pressing the Tian Tu and Tai Chong points will help you feel better so you can get the right medical care when you need it if you think you could have “globus pharyngis” or experience frequent mood fluctuations in your daily life.
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