The sensation of a lump in the throat (SLT), also known as globus hystericus, is not a rarely encountered symptom. It has been reported in 7–14% of the population worldwide (1–4). The etiology of SLT appears to be multifactorial, and the psychological characteristics, stress and pressure of a psychiatric disorder may be significant factors in SLT (5). In addition, certain studies suggested that bronchial asthma (6), and gastroesophageal reflux disease (GERD) may be major factors of SLT (7,8). Hangekobokuto (Tsumura Co., Tokyo, Japan), one of the traditional herbal medicines that has been developed by Zhang Zhongjing, a well-known physician of traditional Chinese medicine in the third century, is known as an effective drug on SLT in North-East Asia (9). Treating SLT by hangekobokuto has been previous studied, for example in Jin Gui Yao Lue (a classic clinical book of essential prescriptions of traditional Chinese medicine written by Zhang Zhongjing in the third century). A number of Kampo doctors are experienced in this regard, and the effects of hangekobokuto on SLT have been reported by certain Japanese otolaryngologists, as published in Japanese (10–12). However, to the best of our knowledge, there have been no studies published in English. English publications are required to introduce the usefulness of this traditional herbal medicine to numerous ‘non-Kampo doctors’ in areas other than North-East Asia.

SLT appears to not be a serious symptom, but it is difficult to completely treat in patients with respiratory diseases, particularly in those with bronchial asthma who have even undergone treatment with inhaled corticosteroid/long acting β2-agonist (ICS/LABA) or oral corticosteroids. As aforementioned, treating SLT by hangekobokuto is not a new area of research; however, whether the effect could be achieved in the short-term has not been established. The present study evaluated the effect of a short-term, 2-week prescription of hangekobokuto on SLT in patients with respiratory diseases.

SLT is a nonspecific symptom of throat discomfort. The etiology of SLT appears to be multifactorial, and the psychological characteristics, stress and pressure of a psychiatric disorder may be significant factors in SLT (5). Bronchial asthma may also be a major factor of SLT (6). In the present study, three points were focused on as follows; however, a strong conclusion could not be derived. First, 20 of the 29 patients with bronchial asthma, who were treated with inhaled ICS/LABA, reported CE and ME. These results suggested that prescription of hangekobokuto could be considered for the bronchial asthma patients with SLT. However, the effectiveness of hangekobokuto in patients who were prescribed ICS/LABA simultaneously to hangekobokuto could not be estimated due to the small number of patients, although ICS/LABA was not a predictive factor of the response to hangekobokuto on SLT in the multiple regression analysis (Table III). Second, certain previous studies have suggested that GERD may be a major factor of SLT (7,8). By contrast, other studies did not support GERD as an etiology of SLT (9). In the present study, there was efficacy of hangekobokuto in 4 of the 7 patients who had been prescribed a proton pump inhibitor or H2 antagonist. Third, the majority of patients were female and they exhibit a higher response compared to male patients. However, there was no statistical difference in the response between them. Larger prospective studies are required to confirm these results and explain their mechanisms.

Hangekobokuto (Banxia-Houpo-Tang) is a traditional herbal medicine (formula of magnolia and pinelliae), which has been administered to patients with airway obstructions (by Zhang Zhongjing, a well-known physician of traditional Chinese medicine in the third century). Hangekobokuto modulates cerebral levels of 5-hydroxytryptamine, noradrenaline, dopamine and substance-P (9,11). Improvement of the swallowing function may be associated with their increased cerebral levels (9,11). Hangekobokuto is well-known in North-East Asia for its effective treatment of psychological characteristics, stress and pressure of psychiatric disorder as well as bronchial asthma and impairment of swallowing reflex (9,12). Our previous study reported the successful treatment of an elderly patient with bronchial asthma (6). The patient complained of SLT, which was not controlled by ICS/LABA and oral prednisolone, and was treated by the addition of a 2-week hangekobokuto treatment to these drugs. In the present study, a retrospective study was performed and showed the effect of hangekobokuto on SLT in patients with respiratory diseases, including those with bronchial asthma.

In Kampo traditional herbal medicine, ‘Sho’ is the important concept (13,14). The physical and psychological conditions of the patients are evaluated as having ‘Jitsu-sho’ and ‘Kyo-sho’. Hangekobokuto has been evaluated as more effective in patients with ‘Kyo-sho’, low body mass index and a depressive mood disorder (13,14). In the present study, however, it did not appear that the efficacy of hangekobokuto was obtained in such patients. This may be due to the small sample size of the study.

There were several limitations of the present study. First, it was a small-sized retrospective study. Second, it was not a placebo-controlled study. Third, the study included patients with or without bronchial asthma and GERD, and several drugs for these diseases. Despite these limitations, the results provide important information regarding the treatment of SLT.

The etiology of SLT is likely multifocal. In a patient with SLT, several factors may be associated with SLT. Bronchial asthma and GERD may be two of the etiology associated with SLT. Therefore, therapy for such diseases must be indicated at first; however, if SLT is uncontrolled by such therapies, prescription of hangekobokuto may be considered.