Chronic Laryngitis

General

Clinical Manifestations	Chronic simple laryngitis: Episodic hoarseness which is most prevalent upon arising in the morning As the physical activity increases the sound improves The next morning the hoarseness returns Over long periods of time there is fatigue of the voice and sound cannot be emitted for an extended period Throat discomfort and pain upon emitting sounds There is often a habit of clearing ones throat but no evident sputum is coughed up The hoarseness is more evident when attempting to make a high pitched sound Diffuse hyperemia of the laryngeal mucosa The vocal cords have lost their original pearl white color and turned pink or progressed to a deeper red The vertical capillaries running parallel to the border of the vocal cords are enlarged The border is thickened The glottis cannot be closed completely, or The bilateral vibration is not balanced The exterior of the vocal cords are often covered by a sticky secretion which forms sticky silk - like strands connecting the interglottic space Chronic hypertrophic laryngitis: Episodic hoarseness which is most prevalent upon arising in the morning As the physical activity increases the sound improves The next morning the hoarseness returns Over long periods of time there is fatigue of the voice and sound cannot be emitted for an extended period Throat discomfort and pain upon emitting sounds There is often a habit of clearing ones throat but no evident sputum is coughed up The hoarseness is more evident when attempting to make a high pitched sound A long history of hoarseness and aphonia Hoarseness is very evident Coughing is relatively mild Occasionally there are acute flare ups causing a further increase in hoarseness and deterioration in the sound quality Symmetrical swelling of the laryngeal mucosa is observed but the distribution is not even and is more marked in the arythenoid space where it stands out high When a sound is emitted it forms one or several plica in the arythenoid space The vocal cord is thickened, appearing like a stick that is rough and not smooth and often takes on a nodular or polypoid form which is covered by a sticky secretion If the disease progresses to the areas below the glottis, it prevents the vocal cords from uniting and triangular fissures appear If the disease progresses to the areas below the glottis, it prevents the vocal cords from uniting and triangular fissures appear The ventricular folds are enlarged and often press on the vocal folds when a sound is emitted The aryepiglottic fold may also be thickened but enlargement of the epiglottis is extremely rare
Treatment Principle
Herb Formulas	Yue Yin Cha Liang Ge San
Points	Open the Voice # 1 point (1.5 cm medial to ST 9 Renying), with the "Sparrow pecking" method. Insert the needle at the posterior border of the thyroid cartilage with oblique slanting of the needle. Puncture in the direction of the aryepiglottic fold. Needle twice daily. Needling of this point has the effect of reducing hyperemia and edema of the vocal cords. UB-13, UB-23, SP-6, ST-36. Needle four points at a time with intermediate or weak stimulus. Retain the needle for 20 minutes. LI-11, LI-12, LU-7, REN-15, ST-33 To dispel inflammation: LI-4, LI-11, REN-22 Ear: Throat, Lung, Kidney, and Adrenals. Select two points at a time and imbed needle for 7 days, after which select 2 other points.

Tai Yang With Underlying Kidney Yang Deficiency

Clinical Manifestations	Severe chills May have mild fever No sweat Aversion to Cold Cold extremities Cold sensation on back Pale face Extreme fatigue Muscle aching T: Pale with scallop C: White P: Deep, weak and thready
Treatment Principle	Warm Yang Expel Cold from the Exterior Dispel Cold from the Interior
Herb Formulas	Ma Huang Fu Zi Xi Xin Tang
Points	Moxa DU-4, DU-16, DU-20, UB-12, UB-15, UB-23

Lung Yin Deficiency

Clinical Manifestations	Severe, dry hacking cough No sputum expectorated Small amounts of difficult to expectorate sputum Blood tinged sputum (when Yin Deficiency Fire is present) Afternoon fever Night sweats Malar flush (especially in afternoon) Five sole Heat Dry mouth and throat Itching in throat Hoarse voice, low voice or loss of voice Emaciation T: Red and dry C: None P: Thready and rapid
Treatment Principle	Nourish Yin Moisten the Lungs
Herb Formulas	Bai He Gu Jin Tang Yang Yin Qing Fei Tang Qing Zao Jiu Fei Tang With Lung Heat: Qing Fei Tang Bu Fei E Jiao Tang
Points	KI-3, KI-6, LU-1, LU-5, LU-6, LU-7, LU-9, LU-10, ST-36, UB-13, UB-17, UB-23, UB-43

Lung Qi And Yin Deficiency

Clinical Manifestations	Chronic cough with sparse sputum Sputum difficult to expectorate Shortness of breath Spontaneous perspiration Dry mouth and tongue Palpitations with a stifling sensation in chest Fatigue Irritability Thirst Dry throat Insomnia Listless speech T: Red and dry or Pink and dry C: Thin and dry P: Deficient and rapid or Irregular and slow or Thready and deficient or Consistently irregular
Treatment Principle	Augment Qi Clear Heat
Herb Formulas	Qiong Yu Gao Due to Heat and Dryness of the Lungs: Qing Zao Jiu Fei Tang
Points

Lung And Spleen Qi Deficiency

Clinical Manifestations	Protracted, incessant cough Expectoration of copious, clear, watery or white Phlegm Short, weak, breathing Asthma Four limbs tired General lassitude Distention and pain of the epigastrium and abdomen Loose stools T: Pale C: White P: Thready and weak
Treatment Principle	Reinforce the Spleen Benefit the Lungs Warm and transform Phlegm-Dampness
Herb Formulas	Bu Zhong Yi Qi Tang Shen Ling Bai Zhu San Si Jun Zi Tang
Points	LU-9, REN-17, SP-3, ST-36, UB-13, UB-20, UB-43

Lung And Kidney Yin Deficiency

Clinical Manifestations	A chronic or recurrent raspy or hoarse voice which is sometimes more mild then severe The voice is low and talking can be accomplished with great effort only It is difficult to speak for a long time The condition is aggravated with fatigue or excessive speaking gradually getting worse or recurs in the afternoon or evening After rest, the hoarse voice may improve Mild soreness of the laryngeal area which is dry and uncomfortable Dry itch Dry cough with scanty sputum Often the habit of clearing one's throat is noted The larynx and the vocal cords are mildly red, slightly swollen and the borders are dull Often there is a sticky exudate Opening and closing of the glottis is impeded or incomplete Weak and soft lower back and knees Restlessness Insomnia Thirst Dry mouth Dry throat Malar flush in the afternoon Night sweats Five sole Heat Dizziness Tinnitus Insomnia Low back pain T: Red C: Scanty P: Thready and rapid
Treatment Principle	Moisten and nourish the Lung and Kidney Yin Restrain Fire Support the voice
Herb Formulas	Bai He Gu Jin Tang modified Bai He Gu Jin Tang + Run Fei Wan Run Hou Yue Yin Cha Due to Lung Heat Injuring the Yin: Qing Fei Tang If Kidney Deficiency is prominent: Mai Wei Di Huang Wan Inhalation therapy: Jin Sang Wu Lozenges: Run Hou Wan Tie Di Wan With Lung Heat: Er Dong Tang Gargle: Chronic Laryngitis Gargle Chinese patent medicines: Mai Wei Di Huang Wan Li Fei Yang Yin Qing Fei Tang Jiang
Points	Open the Voice # 1 point (1.5 cm medial to ST-9), with the "sparrow pecking" method. Insert the needle at the posterior border of the thyroid cartilage with oblique slanting of the needle. Puncture in the direction of the aryepiglottic fold. Needle twice daily. Needling of this point has the effect of reducing hyperemia and edema of the vocal cords. UB-13, UB-23, SP-6, ST-36. Needle four points at a time with intermediate or weak stimulus. Retain the needle for 20 minutes. KI-3, KI-6, LU-7, LU-9, UB-13, UB-23 With Heat: LU-10 Ear: Throat, Lung, Kidney, and Adrenals. Select two points at a time and imbed needle for 7 days, after which select 2 other points.

Stomach And Lung Yin Deficiency

Clinical Manifestations	Cough with little yellow sputum Spitting saliva Wheezing Shortness of breath Dry, uncomfortable sensation in throat Hiccups Dry mouth Coughing up difficult-to-expectorate Phlegm Nausea Hoarseness Thirst Asthma Flushed face Five sole Heat Vomiting T: Red and dry C: Little or None P: Thready and rapid or Deficient and rapid
Treatment Principle	Benefits the Stomach and Lungs Generate Fluids Descend Qi Harmonize the Middle Jiao
Herb Formulas	Mai Men Dong Tang Sha Shen Mai Men Dong Tang
Points	KI-3, KI-6, LU-1, LU-5, LU-6, LU-7, LU-9, LU-10, REN-12, SP-6, ST-36, UB-13, UB-17, UB-21, UB-23, UB-43

Stomach Fire Blazing

Clinical Manifestations	Burning Heat and pain in the epigastrium Irritating thirst: drinks copious fluids and prefers cold drinks Excessive appetite: hungry again quickly after eating (as if food vanishes) Swelling, pain, ulceration and bleeding of gums Foul breath Toothache Maybe vomiting right after eating Vomiting acid or undigested food Constipation Maybe scanty, red urine T: Red C: Thick, yellow and dry P: Slippery, big, Excess and rapid
Treatment Principle	Clear and Purge Stomach Fire
Herb Formulas	Mai Men Dong Tang
Points	REN-6, REN-10, REN-13, REN-14, ST-25, ST-36, ST-44

Liver Qi Stagnation

Clinical Manifestations	Sudden loss of voice brought on by depression, anger worry, emotional turmoil or sudden upset Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses Premenstrual syndrome Chronic cases: Heat-flushing Red eyes Tidal fever Dry mouth Short temper T: Pink or Dark (Red edges with Heat) C: Thin and white P: Wiry or Choppy (Rapid with Heat)
Treatment Principle	Soothe the Liver Clear Stagnation Benefit the throat Clear Heat if necessary
Herb Formulas	Xiao Jiang Qi Tang modified With Heat: Chai Hu Qing Gan Tang Chinese patent medicines: Xiao Yao Wan Shu Gan Wan
Points	HT-5, LIV-3, PC-5, PC-6, SJ-6, Yintang

Liver Qi Stagnation: Phlegm And Qi Stagnant And Blocked

Clinical Manifestations	Feeling of obstruction in throat as if a slice of roast meat were stuck there which cannot be coughed up nor swallowed down. This sensation becomes more prominent during emotional upset and subsides when relaxed Distention and pain in the sides or flanks Suffocating sensation in the chest and hypochondrium Tendency to sigh Melancholy Depression Irritability Inappropriate anger Hypochondriac pain Coughing with profuse phlegm Vomiting Difficulty swallowing A delicate constitution A tendency towards fatigue Palpitations Abdominal distention Muscular and skin flaccidity Fear Edema Asthma Insomnia Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Slippery and wiry (slippery due to Phlegm)
Treatment Principle	Spread Qi Resolve Phlegm
Herb Formulas	Ban Xia Hou Po Tang
Points	PC-5, LIV-3, SJ-6, LI-18, SI-17

Kidney Yin Deficiency

Clinical Manifestations	Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of low back Spermatorrhea or premature ejaculation Aching in bones Aching in leg and heel T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Reinforce the Kidneys
Herb Formulas	Liu Wei Di Huang Wan modified For Yin and Blood Deficiency: Si Wu Tang modified For Qi and Yin Deficiency: Si Jun Zi Tang modified Chinese Patent Medicines: Liu Wei Di Huang Wan Zhi Bai Di Huang Wan Mai Wei Di Huang Wan Li Fu Yang Yin Qing Fei Tang Jiang Qing Yin Wan Jin Gui Shen Qi Wan
Points	KI-1, KI-3, KI-6, REN-4, SP-6, UB-23 For a sore throat: Bailao, KI-3, KI-6, LI-4, LI-11, LI-18, LU- 7, LU-9, LU-10, ST-6, ST-36, UB-13, UB-23

Kidney Yin Deficiency With Empty Fire Rising

Clinical Manifestations	Dry cough Dizziness Tinnitus or deafness Poor memory Aching, soreness or weakness of low back Spermatorrhea or premature ejaculation Aching in bones Aching in leg and heel Dry mouth Thirst Night sweats Five sole heat Malar flush Low grade fever in the afternoon Dry throat, maybe recurrent sore throat Dry stools and / or constipation Urine short and red Heightened libido T: Red C: Little or None P: Thready and rapid
Treatment Principle	Moisten the Yin Restrain the Fire
Herb Formulas	Zi Yin Jiang Huo Tang
Points	KI-1, KI-2, KI-3, KI-6, KI-9, REN-4, SP-6, UB-23

Qi , Blood And Phlegm Stagnation

Clinical Manifestations	Relatively severe hoarseness and huskiness of the voice A sensation of something in the throat Frequent clearing of the throat Polyps on the vocal cords Thickening, lumpiness and darkness of the vocal cords T: Varies according to the accompanying symptoms C: Varies according to the accompanying symptoms P: Varies according to the accompanying symptoms
Treatment Principle	Activate Blood Move Qi Resolve Phlegm
Herb Formulas	With Lung Yin Deficiency: Bai He Gu Jin Tang modified With Lung and Kidney Yin Deficiency: Bai He Gu Jin Tang modified With Qi Deficiency: Bu Zhong Yi Qi Tang modified With Liver and Kidney Yin Deficiency: Mai Wei Di Huang Wan modified With Phlegm-Heat: Qing Yan Ning Fei Tang modified
Points	LI-18, LU-7, REN-22, SI-17

Phlegm Stagnation

Clinical Manifestations	Hoarseness of the voice Daily worsening of the hoarseness which continues unabated Talking takes a great effort Sensation of an abnormal object in the pharynx Dry cough with scanty phlegm which causes the patient to attempt clear his throat frequently Throat is dark red and swollen The glottis cannot be properly opened or closed and a fissure is visible Vocal cords are dark red swollen and appear like a stick with an uneven, rough surface covered by a sticky exudate Chest, abdominal and epigastric discomfort and distention Dry throat, which is alleviated by drinking small amounts of fluids No desire for large amounts of fluids T: Pink, may be thick and moist C: Thick P: Sticky
Treatment Principle	Astringe leakage of Lung Qi Dry Dampness Transform Phlegm Descend Qi Improve the condition of the throat
Herb Formulas	He Zi Yin
Points	General points

Phlegm-Heat

Clinical Manifestations	Husky, raspy or hoarse voice Throat clearing Expectoration of thick, yellow mucus Maybe worse in the morning Worse with smoking Worse with prolonged use Dry throat Sore throat Throat congestion Dry mouth Bitter taste in the mouth Maybe low-grade fever Cough with yellow mucus T: Normal C: Greasy and yellow P: Slippery and maybe rapid
Treatment Principle	Clear the Lungs Resolve Phlegm Clear Heat Benefit the throat
Herb Formulas	Qing Yan Ning Fei Tang modified Run Hou Wan Gargles: Acute Laryngitis Gargle #1 Liu Shen Wan (dissolve in water and gargle) Chinese patent medicines: Qing Qi Hua Tan Wan Qing Yin Wan
Points	LI-11, LI-18, LU-1, LU-5, LU-6, LU-7, LU-10, REN-17, REN-22, ST-40, UB-13 For wheezing: + Dingchuan For chest fullness: + PC-5

Phlegm And Blood Stagnation

Clinical Manifestations	Hoarseness of the voice Daily worsening of the hoarseness which continues unabated Talking takes a great effort Sensation of an abnormal object in the pharynx Dry cough with scanty phlegm which causes the patient to attempt clear his throat frequently Throat is dark red and swollen Vocal cords are dark red swollen and appear like a stick with an uneven, rough surface covered by a sticky exudate The glottis cannot be properly opened or closed and a fissure is visible Chest, abdominal and epigastric discomfort and distention Dry throat, which is alleviated by drinking small amounts of fluids No desire for large amounts of fluids T: Dark, or with petechiae C: Normal P: Choppy
Treatment Principle	Transform Phlegm Scatter knotting Activate Blood Eliminate Blood Stasis
Herb Formulas	Hui Yan Zhu Yu Tang Fa Sheng San Xuan Bi Kai Yin Cha Tao Hong Si Wu Tang Ke Zi Yin Inhalation therapy: Jin Sang Wu Lozenges: Run Hou Wan Tie Di Wan
Points	Open the Voice # 1 point (1.5 cm medial to ST-9 Renying), with the "Sparrow pecking" method. Insert the needle at the posterior border of the thyroid cartilage with oblique slanting of the needle. Puncture in the direction of the aryepiglottic fold. Needle twice daily. Needling of this point has the effect of reducing hyperemia and edema of the vocal cords. UB-13, UB-23, SP-6, ST-36. Needle four points at a time with intermediate or weak stimulus. Retain the needle for 20 minutes. Ear: Throat, Lung, Kidney, and Adrenals. Select two points at a time and imbed needle for 7 days, after which select 2 other points.

Over Use Of The Voice Irritating The Throat

Clinical Manifestations	Irritated throat Loss of voice Swelling of the vocal cords Inflammation of the oral cavity
Treatment Principle	Clear Lung Heat Cool the throat Dispel Phlegm Disperse accumulations Moisten Dryness Nourish Yin
Herb Formulas	Xiang Sheng Po Di Wan
Points	General points