Plum Pit Qi (Mei He Qi)
Refers to a subjective feeling of something stuck in the throat which can neither be swallowed down nor spit up. In the Chinese literature the something stuck in the throat is described as feeling similar to a piece of meat. This relatively commonly seen condition corresponds to both physiological and psychological conditions in terms of Western nosology.

Relevant Western Diseases:
Hysteria, anxiety, depression, schizophrenia, psychoneurosis and possibly western medical conditions

Differential Diagnosis:
Medical Disorders:
A. Degenerative neurologic disorders, including multiple sclerosis (MS) and myasthenia gravis
B. Seizure Disorders
C. Cerebrovascular Accident (CVA)
D. Myocardial Infarction
Effects of Substances:
A. Alcohol or illicit substance intoxication or withdrawal
B. Side effects of nonprescription or prescription medications
  1. Psychiatric Disorders
Psychiatric Disorders:
A. Conversion Disorder
B. Somatoform Disorder
C. Somatic Delusion in Schizophrenia
D. Hypochndriasis
E. Disassociative Disorders
F. Malingering
G. Factitious Disorders

TCM Etiology & Pathogenesis:
“The feeling of constriction or something stuck in the throat is believed to be due to phlegm blocking the orifice of the throat. This phlegm may be engendered by spleen vacuity or it may be brewed and transformed by some sort of evil heat. However, no matter where and how it is formed, it is rafted up to lodge up in the throat by either upwardly counterflowing Qi due to liver depression or some species of evil heat.” 1

“Emotional disorder is the primary etiological factor, such as prolonged anger, depression and anxiety which causes Qi and internal Zang Fu disharmony leading to Mei He Qi.
Emotional disharmony causes confusion of the Qi mechanism and injures the internal organs generating the phlegm; the Qi and phlegm stagnate together and get stuck in the throat to cause this disease. Deviated Shen types or phlegm damp types can accelerate the pathology or can easily catch this disease”2

Prognosis:
This disease will be resolved after roper treatment, the treatment may be short or long depending on the pathological situation. In general, Qi level pathology is much easier to resolve; sticky phlegm and blood level pathologies will last longer.

Diagnosis:
A. Feeling of something stuck in the throat and difficulty cleaning it out
B. History of depression, anxiety, anger, and moodiness
C. Phlegm damp constitution
D. No clear evidence in western medicine
Should have A, then refer others

TCM Pattern Differentiation:
Liver Qi and Phlegm Stagnation in the Throat , Shen Irritable2
Feeling of something stuck in the throat and difficulty clearing it out by coughing or swallowing, depression, anxiety, easily angered and moody, chest pressure or abdominal distention
Tongue: pink tongue, white coat
Pulse: wiry
Acupuncture Treatment: CV-17, CV-22, CV-23, LR-2, LR-3, PC-6, ST-36, ST-40, SP-9
Herbal Treatment: Ban Xia Hou Po Tang Modification2
[ Ban Xia, Hou Po, Fu Ling, Zi Su Ye, Sheng Jiang]
Modifications:
More phlegm: + Xing Ren, Jie Gen
Distention by Liver Qi : Chai Hu, Yu Jin
Bloated Stomach: + Zhi Sih, Da Fu Pi, Su Gen
Chong Qi rebellious: + Xiang Fu, Dan Shen
Blood Stagnation: + San Leng, E Ju
Heat: + Huang Qin, Zhu Ru

Phlegm Qi Depression and Binding1
Feeling of something caught in the back of the throat which can neither be spit up or swallowed down, chest and abdominal fullness and oppression, profuse phlegm, irritability, possible PMS, menstrual irregularity, or fibrocystic lumps in the breast in females.
Tongue: slimy white coat
Pulse: slippery, bowstring
Treatment Principle: Move the Qi and downbear counterflow, transform phlegm and disinhibit the throat
Acupuncture Treatment: LR-3, PC-6, ST-40, ST-36, CV-17, CV-12, CV-22. Draining technique
Herbal Treatment: Ban Xiao Hou Po Tang Jia Wei1
[ Ban Xia (10-12g.), Hou Po (10g.), Fu Ling (12g.), Chen Pi (6g.), Su Geng (10g.), Xi Ku Cao (15g.), Bei Mu (6g.), Chang Pu (6g.), Chai Hu (3-6g.), Sheng Jiang (6g.)]
Modifications:
Severe Qi stagnation: + Yu Jin, Qing Pi
Simultaneous abdominal distention: + Sha Ren, Mu Xiang
Serious inhibition of throat: + Jie Geng, Xuan Shen

Phlegm Heat Harassing Above1
Feeling of something caught in the back of the throat which can neither be spit up or swallowed down, chest and abdominal fullness and oppression, profuse phlegm, irritability, possible PMS, menstrual irregularity, or fibrocystic lumps in the breast in females.
Tongue: red tongue, slimy yellow coat
Pulse: slippery, bowstring, rapid
Treatment Principle: Clear Heat and transform phlegm, resolve depression and disinhibit the throat
Acupuncture Treatment: LR-2, ST-41, ST-40, CV-22, CV-17, CV-12. Draining technique
Herbal Treatment: Huang Lian Wen Dan Tang Jia Wei1
[Huang Lian (3-6g.), Huang Qin (10g.), Shi Chang Pu (6g.), Xia Ku Cao (15g.), Xuan Shen (15g.), Ban Xia (10g.), Zhu Ru (6-10g.), Zhi Shi (6g.), Chen Pi (6-10g.), Fu Shen (12g.), Gan Cao (3-6g.), Da Zao (3-5 pieces)]

Yin Vacuity-Liver Depression1
Feeling of something caught in the back of the throat which can neither be coughed up or swallowed down, dry mouth and throat, 5-palm heat, lingering rib-side pain, possible menstrual pain or PMS, possible scanty, delayed, or blocked menstruation
Tongue: red tongue, scanty coat
Pulse: slippery, bowstring, rapid
Treatment Principle: Enrich Yin and downbear fire, emolliate the liver and scatter nodulation
Acupuncture Treatment: Tonify: LU-7, KI-6, SP-6; Even technique: LR-3, LR-14, CV-22, ST-40
Herbal Treatment: Yi Guan Jian Jia Jian1
[Chuan Lian Zi (10g.), Sha Shen (12g.), Mai Dong (12g.), Sheng Di (12g.), Gou Qi Zi (10g.), Dang Gui (10g.), Xuan Shen (15g.), Yu Jin (10g.), Jie Geng (10g.), Bai Shao (10g.)]

Lung-Kidney Yin Vacuity, Phlegm Fire Flaring Upward1
Feeling of something caught in the back of the throat which can neither be spit up or swallowed down, dry mouth and throat, thirst but no great desire to drink, 5-palm heat, afternoon tidal heat, possible night sweats, possible palpitations, vexation and agitation, insomnia, tinnitus, dizziness
Tongue: red tongue, dry and/or scanty, possibly yellow coat
Pulse: bowstring, fine, rapid
Treatment Principle: Nourish the lungs and enrich the kidneys, clear heat and disinhibit the throat
Acupuncture Treatment: LU-7, KI-6, SP-6, ST-40, St-44, CV-22. Even technique
Herbal Treatment: Yi Guan Jian Jia Wei1
[Chuan Lian Zi (6-10g.), Sha Shen (12g.), Mai Dong (12g.), Sheng Di (12g.), Gou Qi Zi (12g.), Dang Gui (10g.), Xuan Shen (10g.), Bei Mu (10g.), Xia Ku Cao (15g.), Mu Li (12g.), Zhi Mu (10g.), Huang Qin (10-12g.), Bai Shao (10g.)]
Modifications:
Insomnia and pronounced disquietude of the heart spirit: + Suan Zao Ren, Bai Zi Ren

Blood Stasis Obstructing the Network Vessels1
Feeling of something caught in the back of the throat which can neither be spit up or swallowed down, chest, rib-side, or abdominal fixed or piercing pain, possible menstrual irregularity and/or dysmenorrheal in females, enduring disease worse symptoms get worse in the afternoon or evening, spider nevi or varicosities, dark dusky complexion
Tongue: dark purplish tongue or possible static spots and macules
Pulse: bowstring, choppy, possibly bound
Treatment Principle: Quicken the Blood and transform stasis, free the flow of the network vessels and disinhibit the throat
Acupuncture Treatment: LU-7, KI-6, SP-6, ST-40, St-44, CV-22. Even technique
Herbal Treatment: Xue Fu Zhu Yu Tang Jia Jian1
[Tao Ren (10g.), Hong Hua (10g.), Dang Gui (10g.), Chuan Xiong (10g.), Chi Shao (10g.), Chai Hu (10g.), Zhi Shi (6g.), Jie Geng (6g.), Chuan Niu Xi (10g.), Yu Jin (10g.), Xia Ku Cao (15g.), Dan Shen (10g.)]
Modifications:
Dry & painful throat: + Xuan Shen, Tian Hua Fen