Auditory Diagnosis in Traditional Chinese Medicine

Auditory Diagnosis

Auditory diagnosis is a method of diagnosing diseases through listening to sounds and smelling odors. Listening to sounds includes examining the patient’s voice, breathing, speech, coughing, heart sounds, vomiting, belching, sighing, sneezing, yawning, and bowel sounds. Smelling odors includes detecting abnormal smells emitted by the body, the odors of excretions, and the smells in the sickroom.Point One Listening to SoundsKey Point One Clinical Manifestations and Significance of Hoarseness and Loss of VoiceHoarseness refers to a raspy voice, while loss of voice, also known as “mutism,” indicates an absence of sound. The former suggests a milder condition, while the latter indicates a more severe illness.1. New cases of hoarseness or loss of voice are often associated with excess conditions, commonly due to external invasion of wind-cold or wind-heat affecting the lungs, or phlegm-damp obstructing the lungs, leading to a failure of the lungs to clear and regulate, known as “the metal does not sound.”2. Chronic cases of hoarseness or loss of voice are often associated with deficiency conditions, typically due to various reasons leading to yin deficiency and excess fire, injuring the lung and kidney essence, referred to as “the metal is broken and does not sound.”3. Hoarseness or loss of voice resulting from shouting in anger or prolonged loud speaking injures the throat, which also indicates qi and yin exhaustion.4. In chronic severe illness, a sudden appearance of hoarseness often indicates a critical condition where the organ qi is about to collapse.5. In women during late pregnancy, hoarseness or loss of voice is termed pregnancy mutism (zi yin), caused by the growing fetus pressing on the kidney’s collaterals, preventing kidney essence from nourishing the tongue and throat.Key Point Two Clinical Manifestations and Significance of Delirium, Repetitive Speech, Soliloquy, Confused Speech, Maniacal Speech, and Stuttering

Speech Type	Manifestation	Pathogenesis	Main Disease
Delirium	Unclear consciousness, incoherent speech, loud and forceful voice	Heat disturbing the heart spirit	Heat entering the pericardium; Yangming organ excess
Repetitive Speech	Unclear consciousness, repetitive language, intermittent and weak voice	Severe deficiency of heart qi, scattered spirit	Chronic illness, severe illness
Weak Speech	Low voice, short of breath, unable to continue speaking	Severe deficiency of the central qi
Soliloquy	Talking to oneself, murmuring continuously, stopping when seeing others, lacking continuity	Weak heart qi, insufficient spirit Yin syndrome: qi stagnation and phlegm obstructing the heart spirit	Epilepsy, depression
Confused Speech	Clear consciousness, normal thinking but occasional speech errors, aware of mistakes after speaking	Weak heart qi, loss of nourishment to the spirit Excess syndrome: phlegm-damp, blood stasis, qi stagnation obstructing the heart orifices	Chronic illness, elderly
Maniacal Speech	Mental confusion, incoherent speech, shouting and cursing	Phlegm-fire disturbing the heart	Mania, febrile disease with blood stasis
Stuttering	Clear consciousness, normal thinking but difficulty in articulation, or unclear speech during illness; often seen with a strong tongue	Wind-phlegm obstructing the collaterals	Stroke (pre-symptom or sequela)

Key Point Three Clinical Manifestations and Significance of Coughing, Wheezing, and Asthma

Cough Sound Characteristics	Clinical Significance
1. Cough Sound is heavy and muffled	Cold-damp cough
2. Cough Sound is light and low	Deficiency of lung qi
3. Cough Sound is not loud, with thick yellow phlegm that is difficult to expel	Heat pathogen invading the lungs
4. Cough with phlegm sound, phlegm is abundant and easy to expel	Phlegm-damp obstructing the lungs
5. Dry cough with little or no phlegm	Dry pathogen invading the lungs or lung yin deficiency
6. Paroxysmal cough is short, spasmodic, continuous, with a crowing sound after coughing (the sound resembles a heron’s call when the cough stops), and recurs frequently	Wind pathogen and phlegm-heat congealing, commonly seen in whooping cough
7. Cough sounds like a dog barking, accompanied by hoarseness and difficulty inhaling	Lung and kidney yin deficiency, epidemic toxin attacking the throat, often seen in diphtheria

Clinical Features	Clinical Significance
Wheezing	Difficulty breathing, short and urgent	Sudden onset, deep and prolonged breathing, coarse and high-pitched sound, quick exhalation	Excess wheezing: wind-cold invading the lungs or phlegm-heat obstructing the lungs, phlegm retention in the lungs
Slowly progressing condition, shallow breathing, weak and low voice, quick inhalation	Deficiency wheezing: lung and kidney deficiency
Asthma	Rapid breathing resembling wheezing, with wheezing sounds in the throat	Phlegm retention internally, triggered by pathogens

Key Point Four Clinical Manifestations and Significance of Vomiting, Hiccups, and Belching(1) Vomiting1. Slow and gentle vomiting, with weak sounds and clear, thin vomitus, often indicates a deficiency-cold condition. This is commonly due to spleen and stomach yang deficiency, leading to a failure of the spleen to transport and the stomach to harmonize and descend, causing stomach qi to rebel.2. Forceful vomiting, with loud sounds and thick yellow or sour or bitter vomitus, often indicates an excess-heat condition. This is commonly due to heat injuring stomach fluids, leading to a failure of the stomach to nourish.3. Projectile vomiting is often due to heat disturbing the spirit, or due to head trauma, with internal bleeding or tumors causing increased intracranial pressure.4. Vomiting with a sour and rotten taste is often due to overeating or excessive consumption of rich foods, leading to food stagnation in the stomach, causing a failure of the stomach to harmonize and descend, resulting in rebellious stomach qi.5. If all who eat together vomit and have diarrhea, it is often due to food poisoning. Vomiting in the morning after eating at night, or vomiting at night after eating in the morning, indicates stomach rebellion, often associated with spleen and stomach yang deficiency.6. Dry mouth and desire to drink, but vomiting after drinking is termed water rebellion, caused by drinking pathogens obstructing the stomach, leading to rebellious stomach qi.(2) HiccupsHiccups refer to an involuntary sound produced from the throat, characterized by short and frequent sounds. Commonly known as “burping,” it was referred to as “huai” before the Tang dynasty. It is a manifestation of rebellious stomach qi.1. Frequent hiccups with a loud and forceful sound often indicate an excess condition. Low and weak hiccup sounds often indicate a deficiency condition.2. New cases of hiccups with a strong sound often indicate cold or heat pathogens affecting the stomach; persistent hiccups in chronic or severe illness with low and weak sounds indicate a critical condition of stomach qi exhaustion.3. Sudden hiccups with no other medical history or accompanying symptoms often indicate dietary irritation or sudden exposure to wind-cold, causing temporary rebellious stomach qi, generally self-resolving without treatment.(3) BelchingBelching refers to a long and slow sound produced from the throat due to gas rising from the stomach. In ancient times, it was called “yi.” It is a manifestation of rebellious stomach qi. Occasional belching after a full meal or after drinking carbonated beverages, without other accompanying symptoms, is due to the expulsion of gas from the stomach and is not pathological. Clinically, the characteristics of the belching sound and odor can help determine deficiency or excess, cold or heat.1. Sour and rotten belching, accompanied by abdominal distension, often indicates food stagnation, belonging to an excess condition.2. Frequent and loud belching, with relief of abdominal distension after belching, and changes in belching frequency due to emotional fluctuations, often indicates liver qi invading the stomach, belonging to an excess condition.3. Frequent belching, accompanied by cold abdominal pain that improves with warmth, often indicates cold pathogens invading the stomach or stomach yang deficiency.4. Low and intermittent belching, without sour or rotten odor, and accompanied by poor appetite and reduced food intake, indicates stomach deficiency and rebellious qi, belonging to a deficiency condition. This is often seen in the elderly or those with weak constitutions.Key Point Five Clinical Manifestations and Significance of SighingSighing, also known as a deep breath, refers to a long sigh or short exhalation emitted when feeling depressed or having chest tightness. Involuntary sighing, followed by a feeling of relief, indicates emotional distress and liver qi stagnation.

Traditional Chinese Medicine Diagnosis

Traditional Chinese Medicine Diagnosis

Observation Diagnosis | Observing the Spirit

Observation Diagnosis | Observing the Complexion

Observation Diagnosis | Observing the Morphology

Observation Diagnosis | Observing the Head and Facial Features

Observation Diagnosis | Observing the Body and Limbs

Observation Diagnosis | Observing the Skin

Observation Diagnosis | Observing Excretions

Observation Diagnosis | Observing Children’s Fingerprints

Observation of the Tongue | Principles and Methods of Tongue Diagnosis

Observation of the Tongue | Normal Tongue Appearance

Observation of the Tongue | Observing Tongue Quality

Observation of the Tongue | Observing Tongue Coating

Observation of the Tongue | Comprehensive Analysis of Tongue Appearance

👇 Click “Read Original” to join theMedical Liaison Officer Club!!