Mr. Lin, 48, visited the clinic because of his hoarse voice for 3 months. His voice was suddenly hoarse and weak with unknown reason 3 months ago. Laryngoscopy examination at local hospital showed that bilateral vocal cord paralysis. He then received acupuncture and Chinese medicine treatment which produced no significant effect.

First visit on November 7th

The patient was clear-minded with good vitality. His voice was hoarse and weak, accompanied with slight cough and discomfort of chest distension and oppression. He had slight white sputum which was hard to be coughed up and occasional choke/cough when drinking water. Without difficulty swallowing, he had dry mouth and desire to drink. He had normal sleep, urination, and bowel movement. His tongue was red with white and slightly slimy coating, and pulse string-like, slippery, and forceful. The patient had a history of cervical spondylosis and did not smoke or drink.

Physical examination

His tongue was in the middle when extended out. The throat was red with pharyngeal reflex, and tonsil not swollen. There was no abnormality in his muscle strength and tension of limbs, and the pathological sign negative.

Diagnosis in Western medicine: vocal cord paralysis

Diagnosis in Chinese medicine: throat Bi (impediment) with wind-heat invading the collaterals.

Principles of treatment

Scatter wind, clear heat, ease-up the voice, and benefit the orifices

Point selection

Three extra points under the tongue, LU 5 (Chize), LU 8 (Jingqu), LU 10 (Yuji), HT 5 (Tongli), KI 6 (Zhaohai)

Treatment

After qi arrival (De Qi), three needles under the tongue were powered up with dilatational wave and then retained for about 15 minutes.

Analysis

Three points under the tongue were selected locally, which can be used with electric dilatational wave to stimulate local points of the throat, nourish local tissues, and promote the movement of qi and blood. LU 5 (Chize), LU 8 (Jingqu), LU 10 (Yuji) are on the Lung Meridian of Hand-Taiyin. As Chapter 10 of The Spiritual Pivot (Ling Shu) points out: “The Lung Meridian of Hand-Taiyin, comes out transversely from the armpit.” They are mainly used for diseases associated with the lung. LU 5 (Chize) is He-sea point of the lung meridian and pertains to water (in five-element theory) which makes it a child point. As the Verses of Twelve Channels and Collaterals Mother-supplementing and Child-draining states: “For diseases associated with the lung, drain LU 5 (Chize) for excess pattern while supplement LU 9 (Taiyuan) for deficiency pattern”, so for excess pattern of the lung meridian, LU 5 (Chize) can be drained to clear pathogenic wind-heat. The 68 Issue in the Classic of Difficult Issues (Nan Jing) states “Jing-river point is indicated for panting, coughing, as well as alternating spells of cold and heat.” Chapter 44 of the Spiritual Pivot (Ling Shu) mentions: “If the disease affects the voice, Jing-river point can be used.” LU 8 (Jingqu), the Jing-river point of the lung meridian, is often combined with LU 10 (Yuji), the Ying-spring point of the lung meridian, to scatter wind, clear heat, ease-up the voice and benefit orifices. HT 5 (Tongli) is the Luo-connecting point of the Heart Meridian of Hand-Shaoyin. Chapter 10 of the Spiritual Pivot (Ling Shu) points out: “The ascending branch of the Heart Meridian of Hand-Shaoyin runs alongside the esophagus.” HT 5 (Tongli) is indicated for sudden aphonia and stiff tongue induced aphasia. KI 6 (Zhaohai), on the Kidney Meridian of Foot-Shaoyin, is the confluent point connecting Yin Motility Vessel and is indicated for dry and/or sore throat and other diseases.

Two doses of modified Mulberry Leaf and Chrysanthemum Beverage (Sang Ju Yin) were used to scatter wind, clear heat, ease-up the voice and benefit orifices.

Ingredients:

Folium Mori (Sang Ye)                                                                           10g

Flos Chrysanthemi (Ju Hua)                                                                   10g

Radix Platycodonis (Jie Geng)                                                               10g

Semen Armeniacae Amarum (Xing Ren)                                               10g

Fructus Forsythiae (Lian Qiao)                                                              10g

Rhizoma Phragmitis (Lu Gen)                                                                20g

Radix et Rhizoma Glycyrrhizae Praeparata cum Melle (Zhi Gan Cao) 10g

Herba Menthae (Bo He) (decocted later)                                                 10g

Radix Scrophulariae (Xuan Shen)                                                           15g

Semen Sterculiae Lychnophorae (Pang Da Hai)                                    10g

Radix Ophiopogonis (Mai Dong)                                                           15g

Radix Rehmanniae (Sheng Di)                                                               15g

Analysis

This disease is due to pathogenic wind-heat invading the lung, which caused lung qi failing to purify and descend, leading to discomfort of the throat and hoarseness. Therefore, the treatment is to scatter wind, clear and diffuse the lung and benefit orifices. Folium Mori (Sang Ye), Flos Chrysanthemi (Ju Hua), Herba Menthae (Bo He) and Fructus Forsythiae (Lian Qiao) are used to clear and scatter wind-heat in the upper energizer (Jiao). Radix Platycodonis (Jie Geng) is to ascend lung qi while Semen Armeniacae Amarum (Xing Ren) is to descend lung qi, so as to regulate the lung qi to relieve cough and benefit the voice. The combination of Rhizoma Phragmitis (Lu Gen), Radix Scrophulariae (Xuan Shen), Radix Rehmanniae (Sheng Di) and Radix Ophiopogonis (Mai Dong) is to clear heat and engender fluids to quench thirst. Semen Sterculiae Lychnophorae (Pang Da Hai) is great to clear and diffuse lung qi, dispel phlegm and relieve sore throat. And Radix et Rhizoma Glycyrrhizae Praeparata cum Melle (Zhi Gan Cao) is to harmonize the actions of all medicinals in the formula. All the medicinals are small in quantity and light in quality, which is to scatter pathogenic wind-heat of upper energizer.

Second visit

The patient visited the clinic with his family member on November 9, 2017. He said thathis speech was apparently better than before about half an hour after the last acupuncture treatment. After taking two doses of Chinese medicine, his hoarse voice was improved significantly, tone of speech obviously higher. His cough, expectoration, and discomfort of chest distension and oppression disappeared. In this morning, he had bowel movement once and the stools were loose. He had no abdominal pain. His tongue was red with thin and white coating, and pulse string-like. The dosage of cold/cool medicinals in the previous formula was reduced, considering that the heat signs were reduced and his stools were loose. Thus, Fructus Forsythiae (Lian Qiao) was removed while Semen Oroxyli (Mu Hu Die) was added to the formula to strengthen the efficacy of easing-up the voice and benefit orifices.

The prescription of acupuncture was the same.

The patient was advised to return to the clinic after 2 days.

From Dr. Chen Zhenhu

Dr. Chen Zhenhu, the inventor of Qi Huang Needle Therapy (QH Therapy) and one of the founders of Qihuang Healthcare, has four medical related patents so far. Since his graduation from GZUCM, he hasbeen working in the Acupuncture and Moxibustion Department, the First Affiliated Hospital of Guangzhou University of Chinese Medicine. He is specialized in using tendon-pricking, surround needling, blood-letting, fire needling, and especially QH therapy to treat a variety of conditions: different pains, Parkinson’s disease, dementia, cervical and lumbar diseases.

For more about Dr. Chen http://www.qihuanghealthcare.com/bbs/detail/149