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Chapter Two: Auditory Diagnosis
Concept: A method of diagnosing diseases by collecting information through listening to sounds and smelling odors.
Classification:
A. Listening to sounds: voice, language, breathing, coughing, vomiting, hiccuping, belching, sighing, sneezing, snoring, bowel sounds
B. Smelling odors: abnormal odors emitted by the body, odors from excretions, and odors in the examination room
Theoretical Basis: Physiological activities/pathological changes of the organs produce sounds/odors
Theoretical Source: Su Wen · Yin Yang Yin Xiang Da Lun correlates the five sounds with the five organs
Su Wen · Mai Yao Jing Wei Lun uses sounds, tones, and breathing to assess the presence of pathogenic factors
Section One: Listening to Sounds
Concept: A diagnostic method that involves discerning changes in the patient’s speech and breath, such as pitch, strength, clarity, urgency, and abnormal sounds from coughs, vomiting, and bowel sounds, to determine the nature of the disease (cold, heat, deficiency, excess).
1. Driving Force – Lung
2. Passage – Throat
3. Gateway – Epiglottis
4. Mechanism of Sound – Teeth
5. Auxiliary Coordination – Lips, teeth, mouth, nose
6.1 Kidney – Governs the intake of qi
6.2 Liver – Regulates the flow of qi
6.3 Spleen – Source of qi and blood transformation
6.4 Heart – Governs the spirit
1. Normal Sounds: Sounds produced by a person in a normal physiological state.
Characteristics: Natural voice, harmonious tone, soft and rounded, clear speech, responsive, words match intent
1. Age: 1.1 Children: Sharp and clear
1.2 Elderly: Deep and resonant
2. Gender: Male: Low and deep
Variability: Female: High and clear
3.1 Joy: Cheerful and smooth
3.2 Anger: Harsh and urgent
3. State Changes: 3.3 Sadness: Sorrowful and intermittent
3.4 Respect: Upright and serious
3.5 Love: Gentle and harmonious
2. Abnormal Sounds: Sounds that deviate from normal physiological states and individual differences.
<One> Voice (indicates the rise and fall of the righteous qi, nature of pathogenic qi, severity of the condition)
Generally, a loud, clear, and powerful voice indicates yang, excess, heat (hyperfunction)
A weak, low, and intermittent voice indicates yin, deficiency, cold (deficiency of qi and blood)
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Heavy Voice: A dull and unclear sound – indicates lung failure to disperse and regulate, nasal passages obstructed – external invasion of wind-cold/phlegm obstructing the lung
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Mutism and Aphonia: 2.1 Mutism: Hoarse voice
2.2 Aphonia (mutism): Desire to speak but no sound (severe mutism)
A. Jin Shi Bu Ming: External invasion of wind-cold/heat → New onset of mutism/aphonia
(excess) Phlegm obstructing → lung failure to disperse
Classification
B. Jin Po Bu Ming: Injury to essence and qi, lung and kidney yin deficiency, deficiency fire scorching yin lung → fluids depleted, lung exhausted, voice difficult to produce
(deficiency)
Others:
Violent anger and shouting → depletes qi and injures yin → mutism/aphonia
Prolonged loud speaking →
Severe illness presents hoarseness – indicates imminent danger of organ qi exhaustion
(zi yin) Mutism during pregnancy: Mutism or aphonia occurring in late pregnancy (often resolves after childbirth) – indicates obstruction of the kidney meridian, kidney essence unable to ascend and nourish
3. Moaning: Sounds emitted when pain is unbearable – indicates bodily illness or fullness and discomfort
a. New illness moaning, high and powerful sound – indicates excess
b. Severe illness moaning, low and weak sound – indicates deficiency
c1. Frowning and moaning – indicates headache
Classification: c2. Touching teeth and moaning – indicates toothache
c. Protecting the area must be painful: c3. Touching the heart and moaning – indicates chest pain
c4. Protecting the abdomen and moaning – indicates abdominal pain
c5. Touching the waist and legs and moaning – indicates low back and leg pain
4. Crying out: A sharp sound emitted by the patient, expressing fear – indicates severe pain or fright
Children’s crying out – high fever and convulsions
Adult’s crying out – fright/severe pain/mental disorder
<Two>, Language (indicates changes in the heart and spirit)
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Delirium: Unclear consciousness, incoherent speech, loud and powerful voice – indicates excessive pathogenic heat (excess)
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Stuttering: Unclear consciousness, repetitive speech, intermittent and low voice – indicates severe injury to heart qi (deficiency)
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Category Comparison Items |
Delirium |
Stuttering |
|
Characteristics |
Common Points |
Unclear consciousness, repetitive speech |
|
Differences |
Powerful voice |
Weak voice, intermittent |
|
Pathogenesis |
Excessive pathogenic heat, internal disturbance of the heart spirit (excess pattern) |
Severe injury to heart qi, scattered heart spirit (deficiency pattern) |
|
Common Diseases |
Acute febrile disease at its peak |
Late stage of severe illness |
3. Talking to oneself: Talking to oneself incessantly, stopping when seeing others, with no continuity – a. Insufficient heart qi, spirit not nourished, often seen in epilepsy
b. Qi stagnation leading to phlegm, obscuring the heart orifice
4. Mis-speaking: Clear consciousness, normal thinking, but frequent errors in speech, aware of errors after speaking – a. Deficiency pattern: deficiency of heart and spleen, heart spirit not nourished
b. Excess pattern: phlegm turbidity, blood stasis, qi stagnation obstructing the heart spirit
5. Wild talk: Mental disorder, manic and nonsensical speech, incoherent, not avoiding relatives, singing loudly
Emotional distress, qi stagnation transforming into fire / phlegm-fire intermingling, disturbing the spirit
(often seen in manic disorders, febrile diseases with blood stasis)
6. Speech difficulty (stuttering): Clear consciousness, normal thinking, but speech is not smooth. Words are unclear
Normal state: habitual – stuttering
Pathological state: speech difficulty during illness, accompanied by tongue stiffness – indicates wind-phlegm obstructing the channels (pre-stroke or post-stroke sequelae)
<Three> Breathing (indicates the deficiency or excess of the lungs, kidneys, and ancestral qi)
Normal physiology: a. Breathing is even and smooth, neither fast nor slow
b. Exercise/emotional excitement – breathing quickens
c. Sleep – breathing slows and deepens
Pathology: Breathing as usual – indicates physical illness but qi is not yet affected Heat, excess pattern: breathing is coarse and rapid
Abnormal breathing – indicates both physical and qi illness Cold, deficiency pattern: breathing is weak and slow
1. Wheezing: Difficulty breathing, short and urgent
Classification:
Excess wheezing: Sudden onset, coarse voice, chest fullness, strong body, strong pulse
——External pathogen attacking the lung/excess heat obstructing the lung/phlegm retention in the lung
Deficiency wheezing: Gradual onset, weak voice, short breaths, breathless with movement, weak body, weak pulse
——Lung and kidney deficiency, inability to control qi
2. Asthma: Wheezing with a whistling sound in the throat, recurrent – indicates phlegm retention or prolonged stay in cold and damp places or excessive sour and salty foods
3. Shortness of breath: Rapid and short breaths, unable to continue, no wheezing sound in the throat, seems like wheezing but shoulders do not rise
Deficiency pattern: shortness of breath, low voice, weak qi, accompanied by fatigue and dizziness – indicates lung qi deficiency or severe deficiency of original qi
Excess pattern: shortness of breath, coarse breathing, accompanied by chest fullness, abdominal distension – indicates phlegm retention/qi stagnation/gastrointestinal accumulation/blood stasis
4. Weak breathing: Weak and low voice, insufficient to breathe, weak speech – indicates prolonged illness or deficiency of lung and kidney qi
<Four>, Coughing
Concept: The upward surge of lung qi impacting the throat, producing sound due to irritation of the airways
——External pathogens invading the lung/phlegm retention in the lung/deficiency of qi and yin/harmful gas stimulation
Classification: Cough: sound without phlegm
Hacking: phlegm without sound
Coughing: phlegm with sound
| Diagnosis: |
a. Coughing with heavy and turbid sound, clear white phlegm, nasal congestion – indicates external invasion of wind-cold – wind-cold binding the lung, lung failure to disperse and descend
b. Coughing with low sound, thick yellow phlegm, difficult to expel – indicates heat – external pathogens invading the lung, burning lung fluids
c. Coughing with heavy and turbid sound, abundant phlegm, easy to cough – indicates excess pattern – cold phlegm
Coughing with low sound, weak cough, shortness of breath – indicates deficiency pattern – prolonged illness leading to lung qi deficiency, failure to disperse
d. Dry cough without phlegm/phlegm scant and sticky, difficult to expel – indicates dryness invading the lung/lung yin deficiency
e. Paroxysmal cough/coughing fits (common in children): Coughing in bursts, continuous, ending with a crowing sound – indicates wind-phlegm obstruction, stagnation transforming into heat, obstructing the airways
f. Croup: Coughing like a dog barking, accompanied by hoarseness, difficulty breathing – indicates lung and kidney yin deficiency, fire toxin attacking the throat
<Five>, Vomiting (indicates the deficiency or excess of the disease)
Concept: Reversal of stomach contents, expelled through the mouth a. Vomiting: with sound and material
b. Expulsion: with material but no sound
c. Dry heaving: with sound but no material
General Principle: a. Acute illness often indicates excess
b. Chronic illness often indicates deficiency
Diagnosis:
a. Weak vomiting sound, slow expulsion, vomited material is clear phlegm – indicates deficiency cold: a1. Spleen and stomach yang deficiency, failure to transform
a2. Stomach failure to harmonize and descend, stomach qi rising
b. Strong vomiting sound, forceful expulsion, vomited material is sticky yellow phlegm, either sour or bitter – indicates heat pathogen injuring the stomach, stomach failure to moisten, stomach qi rising
c. Vomiting in a projectile manner – indicates severe illness – heat disturbing the spirit/cranial trauma/intracranial hemorrhage, tumor
d. Vomiting of sour and rotten food – indicates food injury – overeating, food stagnation in the stomach, stomach failure to harmonize and descend, stomach qi rising
<Six>, Hiccuping (stomach qi rising)
Concept: Stomach qi rising, producing a sound from the throat involuntarily, short and frequent, making a hiccuping sound
Classification: Excess pattern: frequent hiccuping, high-pitched and short, strong sound
Deficiency pattern: low-pitched hiccuping, weak and powerless sound
New illness hiccuping, loud and strong sound – indicates cold or heat invading the stomach
Chronic illness, severe illness hiccuping that does not stop, low sound, weak and powerless – indicates stomach qi exhaustion, critical condition
<Seven>, Belching (yi)
Concept: A long and slow sound emitted from the throat as gas rises from the stomach.
Classification:
a. Sour and rotten belching, accompanied by abdominal fullness and loss of appetite – indicates food stagnation in the stomach, stomach qi rising
b. Frequent loud belching, with relief of abdominal fullness after belching, belching frequency changes with emotional state – indicates liver qi invading the stomach
c. Low and intermittent belching, without sour or rotten odor, accompanied by poor appetite – indicates spleen and stomach qi deficiency, stomach failure to harmonize and descend
(common in elderly or chronically ill patients)
d. Frequent belching, accompanied by cold abdominal pain, relieved by warmth – indicates cold invading the stomach/
<Eight>, Sighing (tan xi)
Concept: A long sigh emitted involuntarily when the patient feels emotional distress, indicating fullness and discomfort in the chest and sides
——Emotional distress, liver qi stagnation
<Nine>, Sneezing
Concept: A sudden sound produced by the upward surge of lung qi in the throat and nose.
a. New illness with frequent sneezing, accompanied by chills and fever, runny nose – indicates external invasion of wind-cold, nasal passages obstructed
b. In chronic illness, a person with yang deficiency suddenly sneezes – indicates recovery of yang qi, improvement of condition
<Ten>, Snoring
Concept: A sound produced during sleep or unconsciousness, indicating obstruction of the airways
a. Loud snoring during sleep – indicates chronic rhinitis or improper sleeping position
b. Unconsciousness with continuous snoring – indicates heat entering the pericardium or stroke (critical condition)
<Eleven>, Bowel Sounds (abdominal sounds)
Concept: Sounds produced by the peristalsis of the stomach and intestines
a. Physiological: Bowel sounds are low and gentle, difficult to hear
b. Pathological: Water and gas in the stomach and intestines produce loud sounds, easily heard
A. Sounds originating from the stomach, like a bag of water, vibrating sound, moving down when standing – indicates phlegm retention in the stomach
B. Sounds originating from the abdomen, rumbling like a hungry stomach, relieved by warmth and food, worsened by cold or hunger – indicates deficiency of middle qi, stomach and intestines cold
C. High-pitched and frequent bowel sounds, abdominal fullness, loose stools – indicates external invasion of wind-cold-dampness affecting the stomach and intestines, disordered qi movement
D. Few bowel sounds – indicates impaired intestinal conduction function
E. Complete absence of bowel sounds, abdominal distension and pain, refusal to press – indicates intestinal qi stagnation (severe condition)
Section Two: Smelling Odors
Concept: A method of diagnosing diseases by discerning the odors of the patient’s body and the odors in the examination room
A. Physiology: When the organs are balanced, qi and blood flow smoothly, and qi transformation is normal – no abnormal odors are produced
B. Pathology: When pathogenic qi invades, organ function is disordered, and qi and blood circulation is abnormal
——Abnormal odors from body, breath, secretions, and excretions
A. Excess heat: Odors are sour, rotten, and foul
B. Deficiency cold: Odors are not strong or slightly fishy
1. Body Odors
Concept: Various abnormal odors emitted from the patient’s body
Includes: breath, sweat, phlegm, nasal discharge, vomit, urine, menstrual discharge, lochia, etc.
<One> Breath Odor
Concept: Abnormal odors emitted from the mouth
a. Bad breath – indicates poor oral hygiene/cavities/digestive issues
b. Sour and foul breath, accompanied by loss of appetite and abdominal fullness – indicates food stagnation in the stomach
c. Foul breath – indicates stomach heat
d. Rotten breath/coughing up pus and blood – indicates internal ulcers and pus
e. Bad breath, with decayed gums – indicates gingivitis
<Two> Sweat Odor
Concept: Odors emitted from the body through sweat
a. Fishy sweat – indicates wind-dampness/wet heat/heat disease – indicates prolonged wind-damp heat affecting the skin/sweat-soiled clothing
b. Foul sweat – indicates internal fire toxin (epidemic)
c. Underarm sweat with a strong odor – indicates internal damp-heat (body odor)
<Three> Phlegm and Nasal Discharge Odor
a. Coughing up yellow thick phlegm with a fishy odor – indicates heat obstructing the lung
b. Coughing up turbid phlegm with pus and blood, foul odor – indicates severe heat toxin, blood corruption (lung abscess)
c. Coughing up clear phlegm in large amounts, no odor – indicates cold retention in the lung
d. Nasal discharge with no odor – indicates external invasion of wind-cold
e. Chronic nasal discharge: long-term turbid discharge with a foul odor – indicates damp-heat rising
<Four> Vomit Odor
a. Clear and odorless – indicates stomach cold
b. Sour, rotten, and foul odor – indicates stomach heat
c. Vomiting undigested food, sour and rotten odor – indicates food stagnation in the stomach
d. Vomiting pus and blood with a foul odor – indicates internal ulcers
<Five> Excretion Odor
Includes: urine, menstrual discharge, etc.
a. Foul-smelling stool – indicates heat in the intestines
b. Loose stools with a fishy odor – indicates spleen and stomach deficiency cold
c. Diarrhea with a foul odor like rotten eggs/undigested food, sour odor – indicates food injury
Urine: a. Foul-smelling, yellow and turbid – indicates bladder damp-heat
b. Sweet-smelling with a rotten apple odor – indicates diabetes
Menstrual blood: a. Foul odor – indicates heat syndrome
b. Fishy – indicates cold syndrome
Lochia: a. Foul and yellow thick – indicates damp-heat
b. Fishy and clear – indicates cold-damp
c. Extremely ugly and mixed colors – indicates cancer
2. Room Odors
Concept: Odors emitted from the patient’s body and their excretions, secretions, and the room
a. Foul odor – indicates epidemic
b. Cadaveric odor – indicates organ failure (critical condition)
c. Foul odor – indicates ulcerative diseases
d. Blood odor – indicates blood loss syndrome
e. Urine odor – indicates late-stage edema
f. Rotten apple odor – indicates diabetes
g. Garlic odor – indicates organophosphate poisoning
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