Dr Win Huang’s Case Studies (1)

A Case of Unexplained “Belching”

By Dr Win Huang, PhD (Chinese Medicine & Acupuncture)

Some time ago, I saw a patient with a rather unusual problem.

For about two years, she had been experiencing repeated episodes of a loud sound that she described as “belching”. Over the previous six months, the problem had become much more noticeable.

I put the word “belching” in quotation marks because, even now, I cannot say with certainty what this sound actually was.

The patient felt that it came from somewhere inside the chest. At times, she described a sensation of air rising from the upper abdomen or oesophageal region, followed by a loud sound.

Was it coming from the stomach, the oesophagus, the throat, or was it related to breathing and diaphragmatic movement?

Based on the history and the sound alone, I could not determine that with confidence.

That uncertainty is one of the reasons I felt this case was worth recording.

A Very Particular Symptom Pattern

The symptom was not present all the time.

During work, walking, or normal daytime activity, she usually had little or no problem. Interestingly, the episodes were more likely to occur when her body became quiet and relaxed.

They were especially common after dinner while resting, during meditation, during yoga, and sometimes while singing or raising her arms.

At its worst, the sound would occur repeatedly during group yoga sessions. It was loud enough to disturb people around her, which had become both embarrassing and socially disruptive.

She also reported occasional reflux or regurgitation when lying down at night, together with some abdominal bloating and occasional difficulty with bowel movements.

However, these symptoms did not fully explain the unusual sound she had been experiencing for two years.

I Did Not Know Exactly What It Was

I did not have a definite diagnosis when I first treated her.

Instead, I paid close attention to the pattern.

Why did the symptom rarely occur while she was working or walking, but become more obvious during rest, meditation, yoga, singing, or when raising her arms?

These situations can all alter breathing pattern, chest movement, cervical muscle recruitment, and pressure relationships between the chest and abdomen.

Because of this, I did not simply assume that the problem was caused by “too much gas in the stomach”.

My clinical thought was more practical: if the symptom appeared to be related to breathing, posture, chest movement, and relaxation, then I would begin by treating the areas I could directly influence.

My Treatment Approach

I treated both the upper and lower parts of the body.

In the cervical and cervicothoracic region, I used acupuncture points including Tianchuang (SI16), Tianrong (SI17), Fengchi (GB20), Wangu (GB12), and Quepen (ST12). I also used cupping and local soft tissue work around the scalenes, sternocleidomastoid, trapezius, and surrounding tissues.

My intention was not to claim that these muscles were directly causing the sound. Rather, I wanted to reduce unnecessary tension around the neck and upper chest, where respiratory accessory muscles and thoracic movement are closely related.

In the abdomen, I used points including Tianshu (ST25), together with manual pressure and soft tissue treatment around the abdominal wall, fascia, and psoas-related region.

The diaphragm itself is difficult to treat directly. My approach was therefore to reduce tension above and below it, hoping that the chest, abdomen, and breathing pattern could move more freely.

In simple terms, my treatment idea was:

relax the neck above, reduce abdominal tension below, and allow the chest and breathing system between them to function more naturally.

I cannot say that this was the true pathological mechanism. It was simply the clinical reasoning I used at the time.

A Traditional Chinese Medicine Perspective

As an acupuncturist, I also considered the case from the perspective of the movement of Qi.

Although I could not define the symptom as a specific Western medical diagnosis, the repeated upward sound could be viewed as a disturbance of the normal ascending and descending movement of Qi, particularly involving failure of Stomach Qi to descend and restriction within the chest and diaphragm.

This was one reason I did not treat the abdomen alone.

Points around the neck and upper chest were used to help release local tension and support the free movement of Qi through the upper body, while abdominal points such as Tianshu were used to support the middle jiao and regulate the movement of Qi through the abdomen.

I did not classify the patient into a rigid TCM pattern. The treatment was based more on the actual clinical presentation: an upward-moving symptom associated with the chest, breathing, posture, relaxation, and abdominal tension.

What Changed After Treatment

The patient received four treatments.

The first clear change appeared after the first two sessions.

She told me that the episodes that had previously occurred after dinner while resting had stopped.

Treatment continued for another two sessions.

By the fourth treatment, she reported that the problem had improved substantially. The loud, frequent episodes that had affected yoga, rest, and daily life had become much less common and were essentially no longer troubling her.

Later, she sent me a video recording of the sound during one of her previous episodes.

The recording confirmed that it was a very obvious sound that seemed to arise from the chest region. However, it still did not allow me to determine exactly how the sound was being produced.

What Could This “Belching” Have Been?

In everyday language, many different sounds may be described simply as “burping” or “belching”, but medically they can arise from different mechanisms.

Gastric belching refers to gas leaving the stomach and travelling upward through the oesophagus.

Supragastric belching is different. Air enters the oesophagus and is then rapidly expelled again without necessarily reaching the stomach.

Hiccup is another separate phenomenon, usually involving a sudden involuntary contraction of the diaphragm or other inspiratory muscles followed by closure of the glottis.

Reflux, rumination, and certain throat or respiratory movement disorders may also produce symptoms that patients describe in similar ways.

In this case, I could not determine whether the sound arose from the stomach, oesophagus, throat, diaphragm, or a combination of respiratory and pressure-related mechanisms.

If it had been necessary to establish the mechanism more precisely, investigations such as 24-hour pH-impedance monitoring could have been considered. This can help determine the direction of air and liquid movement within the oesophagus and may help distinguish gastric from supragastric belching. High-resolution oesophageal manometry may also provide further information about oesophageal movement, sphincter function, and pressure changes.

For that reason, I still prefer to describe this as a case of unexplained “belching” rather than give it a diagnosis that was never properly established.

My Reflection on This Case

The patient improved substantially after treatment, but I do not think that allows me to work backwards and claim that I had therefore identified the exact cause.

Clinical practice does not always give us a clear diagnosis at the beginning.

Sometimes the most useful information comes from observing when a symptom appears, when it disappears, what provokes it, and what does not.

This patient reminded me that when a symptom changes with rest, breathing, posture, chest movement, and body position, it may be worth looking beyond the place where the symptom seems to be coming from.

I still cannot say with certainty what this patient’s “belching” actually was.

What I can do is record the case honestly: what she experienced, how I understood it at the time, what I treated, and what changed afterwards.

That is why I call this simply: A Case of Unexplained “Belching”.

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Disclaimer

This case study is shared for clinical reflection and patient education only. It does not establish a diagnosis, prove a treatment mechanism, or guarantee similar outcomes in other patients. Persistent or unusual belching, swallowing difficulty, chest pain, unexplained weight loss, vomiting blood, or other concerning symptoms should be medically assessed.