“There is something in my throat I can neither swallow nor spit.”
A knot that will not go down
A sensation nothing shows from outside, changing with how the week goes, never stopping her eating or drinking.
- Patient
- Woman, 41
- Occupation
- Secondary-school teacher
- Medication
- A mild anxiolytic, only some nights.
- Allergies
- None known
- History
- Normal thyroid on the last blood test.
- Habits
- Non-smoker. Eats from a lunchbox, fast, in twenty minutes.
1 · The consultation
You have 18 minutes. Each question or examination costs 2. Choose carefully what to ask.
Questions
Examination
2 · The tongue
3 · The pulse
Describe the pulse on each axis.
4 · The pattern
5 · Differential diagnosis
You're torn between two patterns. Which is it?
Which finding decides it?
6 · Case twist
Before finishing“«It has been like this since September, but my weight is the same and I eat normally. On holiday I forget about it completely.»”
Mark the warning signs present:
What do you do?
7 · The treatment
Principle
Strategy
Points (choose 4)
Case solved
Reasoned solution
Pattern: Liver Qi stagnation. Supporting signs: A knot that comes and goes, Worse with upset, better when distracted, Frequent sighing, Tension in the flanks, Wiry pulse.
The deciding clue: Comes and goes with mood: Gone on Sundays, back on Monday. Phlegm-Heat does not take weekends off..
Safety: With no true dysphagia, no weight loss and no mass, the intermittent knot is the textbook pattern treated by moving Qi.
Treatment: Move Liver Qi, Descend rebellious Qi; Move and soothe. Points: LV3, CV22, PC6, LI4.
More patients are waiting in the app, with voice, a real timer and a history of your decisions.
See the solution without playing
Pattern: Liver Qi stagnation. Supporting signs: A knot that comes and goes, Worse with upset, better when distracted, Frequent sighing, Tension in the flanks, Wiry pulse.
The deciding clue: Comes and goes with mood: Gone on Sundays, back on Monday. Phlegm-Heat does not take weekends off..
Safety: With no true dysphagia, no weight loss and no mass, the intermittent knot is the textbook pattern treated by moving Qi.
Treatment: Move Liver Qi, Descend rebellious Qi; Move and soothe. Points: LV3, CV22, PC6, LI4.
Teaching case. Fictional patient for study purposes. If you have real symptoms, consult a healthcare professional.
