Olfactory Diagnosis: Listening to Sounds + Smelling Odors
1. Sounds
[Speech Sounds]
1. Heavy and Muffled Speech: The voice is dull and unclear. External invasion of wind-cold; phlegm-damp obstruction.
2. Hoarse Voice: The voice is hoarse. Loss of voice: Speech without sound, anciently referred to as “yin”.
(Terminology Explanation: Jin Shi Bu Ming, Jin Po Bu Ming)
Jin Shi Bu Ming (Excess Syndrome)
New illness with hoarseness or loss of voice.
Wind-cold or wind-heat attacking the lungs, phlegm-damp obstructing the lungs. Evil obstructs the airway, lung qi cannot disperse, making it difficult to produce sound.
Jin Po Bu Ming (Deficiency Syndrome)
Chronic illness with hoarseness or loss of voice.
Lung and kidney yin deficiency. Deficiency fire scorching the lungs, throat lacking nourishment, making it difficult to produce sound.
Zi Yin
Women in late pregnancy who experience hoarseness or loss of voice are referred to as “pregnancy loss of voice”, anciently called “zi yin”, often due to obstruction of the meridians (the uterus obstructs the kidney’s connecting vessels, preventing kidney essence from nourishing the throat). Generally resolves after delivery.
Distinction: Loss of Voice vs. Loss of Speech
Loss of voice: Clear consciousness but unable to produce sound, i.e., “speech without sound”;
Loss of speech: Clear consciousness, can produce sound but has difficulty expressing language, i.e., “sound without speech”. Commonly seen after stroke or brain injury sequelae.
[Language — Heart Spirit]
Mainly observe language expression ability, response ability, and articulation.
The heart governs the spirit, and speech is the voice of the heart; abnormal language primarily reflectsheart spirit pathology.
1. Delirium:Unclear consciousness, incoherent speech, loud and forceful voice. Heat disturbing the heart spirit, belonging to excess syndrome.
2. Confused Speech:Unclear consciousness, repetitive language, intermittent and low and indistinct voice.Severe damage to heart qi, scattered spirit, belonging to deficiency syndrome.
Distinction: Delirium vs. Confused Speech
Similar: Both belong to the state of confused consciousness.
Different: “Excess leads to delirium, deficiency leads to confused speech.”
Delirium: Acute phase of severe heat illness. Commonly seen in heat entering the pericardium, phlegm-heat disturbing the heart, yangming organ excess, heat entering the blood chamber, toxic evil invading, and other conditions. Excessive evil leads to loss of consciousness.
Confused speech: Late critical stage of chronic or severe illness. Often due to organ qi exhaustion and scattered heart spirit. Deficiency leads to loss of consciousness.
3. Shortness of Breath: Low voice, shortness of breath, unable to continue speaking. Severe deficiency of ancestral qi.
4. Talking to Oneself: Talking to oneself, murmuring continuously, stopping when seeing others, with no continuity. Belongs to yin syndrome, deficiency syndrome. Commonly seen in epilepsy or depression.
Deficiency: Insufficient heart qi, spirit lacks nourishment;
Excess: Qi stagnation produces phlegm, phlegm obstructs the heart orifices.
5. Raving: Mental disorder, manic and nonsensical speech, incoherent. Phlegm-fire disturbing the heart, belonging to yang syndrome, excess syndrome. Commonly seen in manic disorders.
6. Miscommunication: Clear consciousness, disordered speech, with self-awareness.
Deficiency: Chronic illness, physical weakness, aging, organ qi decline. Heart qi and blood deficiency, heart spirit lacks nourishment.
Excess: Phlegm turbidity, blood stasis, qi stagnation obstructing heart orifices.
7. Stuttering: Clear consciousness, normal thinking, but speech is not fluent or articulation is unclear. Wind-phlegm obstructing the channels, commonly seen in stroke precursors or sequelae. (Due to habit, it becomes “stuttering”, not pathological.)
[Breathing — Lung and Kidney]
Mainly observe: Breathing rate, strength and quality of breath, clarity and muddiness of breath sounds, whether breathing is even and smooth, etc.
The lungs are the master of qi, the kidneys are the root of qi, ancestral qi accumulates in the chest, travels through the airway, and governs breathing. Abnormal breathing primarily reflectslung and kidney pathology.
Rough breathing, rapid inhalation and exhalation, mostly belong to excess syndrome, heat syndrome.
Weak breathing, slow inhalation and exhalation, mostly belong to deficiency syndrome, cold syndrome.
1. Wheezing: Difficulty breathing, short and urgent, severe cases may open the mouth and raise the shoulders, flaring nostrils, unable to lie flat.
Excess:
Rapid onset, loud and rough voice, quick exhalation, and strong body, pulse is strong and forceful. Wind-cold attacking the lungs, phlegm-heat obstructing the lungs, phlegm-fluid stagnating in the lungs, water qi overwhelming the heart. Deficiency: Gradual onset, weak voice, shortness of breath, worsens with movement, quick inhalation, and weak body, pulse is weak and forceless. Lung and kidney deficiency, qi fails to control.
2. Asthma: Rapid breathing, wheezing sound in the throat. Often due to phlegm-fluid hidden and then re-exposed to external evils, or triggered by cold/stimulating gases, excessive consumption of sour and salty foods.
Distinction: Asthma vs. Wheezing
Wheezing: Difficulty breathing, rapid breath
Asthma: Wheezing sound in the throat + wheezing
Asthma must accompany wheezing, wheezing does not necessarily accompany asthma
3. Shortness of Breath: Rapid and short breathing, insufficient breath, unable to continue, resembles wheezing but does not raise shoulders, no phlegm sound.
Excess: Phlegm-fluid, qi stagnation, blood stasis
Deficiency: Insufficient lung qi, severe deficiency of original qi
4. Weak Breathing: Weak breath, insufficient to sustain, weak speech, low voice. Indicates internal injury, prolonged illness, or lung and kidney qi deficiency.
[Cough — Five Zang and Six Fu]
Sound without phlegm is called cough, phlegm without sound is called sputum, phlegm with sound is called cough.
“All five zang and six fu can cause coughing, not just the lungs.”
“Coughing does not stop at the lungs, but does not leave the lungs.”
Determine cold-heat deficiency-excess: Combine phlegm quantity and quality, onset time, medical history, accompanying symptoms, etc.
1. External invasion of wind-cold: Coughing with heavy and muffled sound, phlegm is white and clear, accompanied by nasal congestion.
2. Heat evil invading the lungs: Coughing with low sound, phlegm is thick and yellow.
3. Phlegm-damp obstructing the lungs: Coughing with heavy and muffled sound, phlegm is abundant and easy to cough up.
4. Dry evil invading the lungs, lung yin deficiency: Dry cough with little phlegm, throat dryness.
5. Wind evil phlegm-heat colliding: “Sudden cough”, “whooping cough”. Coughing in paroxysms, continuous sounds, prolonged and difficult to cure. Commonly seen in children.
6. Diphtheria: Coughing like a dog barking, accompanied by hoarseness, difficulty inhaling, white membrane growth in the throat, bleeding when scraped, followed by regrowth. Lung and kidney yin deficiency, epidemic toxins attacking the throat.
[Vomiting — Stomach]
Sound with material is vomiting, material without sound is spitting, sound without material is dry heaving. Collectively referred to as “vomiting”, caused by stomach disharmony and rising stomach qi.
Acute illness is mostly excess, chronic illness is mostly deficiency.
1. Deficiency cold syndrome: Weak sound, slow force, vomiting material is clear and thin, without sour or foul smell. Spleen and stomach yang deficiency, failure to transport and transform, stomach disharmony and rising stomach qi.
2. Excess heat syndrome: Strong sound, fierce force, vomiting material is yellow and thick, sour and bitter. Evil heat invading the stomach, stomach disharmony and rising stomach qi.
3. Heat disturbing the spirit, head trauma, cerebral hemorrhage, tumors: Vomiting presents in a projectile manner.
4. Food stagnation: Vomiting sour and undigested food.
5. Stomach reflux: Morning food vomited in the evening or evening food vomited in the morning. Spleen and stomach yang deficiency syndrome.
6. Food poisoning: Vomiting and diarrhea occurring in multiple people after a meal.
7. Water reflux: Dry mouth and desire to drink, but vomiting after drinking. Water fluid stagnating in the stomach, rising stomach qi.
[Hiccups]
Hiccups (Hiccup, Hic): Stomach qi rising, producing involuntary sounds from the throat, short and frequent, making hiccup sounds. (Terminology Explanation)
[Belching]
Belching (Burping, Eructation): Gas from the stomach rising through the throat producing sound, long and slow. This is a manifestation of rising stomach qi. (Terminology Explanation)
Note the distinction between hiccups and belching.
[Sighing]
When patients are emotionally depressed, they may involuntarily emit long sighs or short gasps, feeling relieved afterward. This indicates liver qi stagnation.
[Sneezing]
Sneezing is the sound produced when lung qi rises through the nose, suddenly erupting from the nostrils.
Those with yang deficiency may suddenly sneeze: Yang qi is recovering.
[Snoring]
During deep sleep or coma, a sound produced from the throat and nose during breathing, indicating airway obstruction.
[Borborygmi]
Sounds produced by gastrointestinal peristalsis, also known as “abdominal rumbling”.
Normal: Low and gentle, difficult to hear.
Abnormal: Water and qi in the gastrointestinal tract agitate, causing audible borborygmi.
1. Increased Borborygmi
① Gurgling sounds in the epigastric area, moving down when walking or pressing the epigastric area
——Phlegm-fluid stagnating in the stomach, obstructing the middle qi mechanism.
(If borborygmi occurs after drinking water, it is mostly normal)
② Sounds originating from the abdomen, like hunger pangs, decrease with warmth and food, worsen with cold and hunger
——Middle qi deficiency, gastrointestinal cold.
③ Borborygmi is loud and frequent, with abdominal distension and loose stools
——External invasion of wind-cold-damp evil, disturbing the gastrointestinal qi mechanism.
2. Decreased Borborygmi
Gastrointestinal function transmission disorder.
① Decreased borborygmi sounds
——Mostly due to excess heat, liver-spleen disharmony, yin-cold stagnation causing gastrointestinal qi obstruction, or spleen-lung qi deficiency, gastrointestinal weakness, and poor transmission.
② Absence of borborygmi, with abdominal distension and resistance to pressure
——Severe condition, gastrointestinal qi stagnation, can be seen in intestinal obstruction or intestinal blockage.
[Yawning]
Frequent yawning indicates deficiency. Physical weakness, excessive yin, and yang deficiency.
2. Odors
Foul, rotten, and stinky odors indicate excess heat, while light, fishy, and stinky odors indicate deficiency cold.
1. Body Odors
① Breath: Stomach heat (foul + swollen gums), gastrointestinal stagnation (sour + loss of appetite + abdominal distension), internal pus or ulceration (foul + coughing up pus and blood), dental disease (gum decay: periodontal disease).
② Sweat: Long-standing damp-heat on the skin (fishy), internal damp-heat (body odor).
③ Phlegm and nasal discharge: Lung heat congestion (coughing up yellow, thick, foul phlegm), excessive heat toxins (lung abscess: fishy, purulent phlegm with blood), cold syndrome (clear, thin phlegm, odorless), external invasion of wind-cold (nasal discharge, clear, no obvious odor), damp-heat steaming upward (nasal congestion: foul, turbid nasal discharge).
④ Vomitus: Stomach cold (clear and thin, odorless), stomach heat (foul and turbid), food stagnation (sour and rotten + undigested food), ulceration (fishy, purulent blood).
⑤ Excretions (urine and stool)
Stool:
Sour and foul — intestinal heat
Loose stools, fishy — spleen and stomach deficiency cold
Diarrhea, foul like rotten eggs, undigested food, sour gas — food stagnation
Urine:
Yellow, turbid, foul — bladder damp-heat
Rotten apple smell — diabetes
Menstrual blood:
Foul — heat
Fishy — cold
Leukorrhea:
Yellow, thick, foul — damp-heat
Clear, thin, fishy — cold damp
Strange odor, abnormal color — can be seen in cancer
2. Room Odors
Blood-stained — blood loss
Foul — sores, ulceration
Cadaveric — organ failure, severe illness
Urine odor — late-stage edema
Rotten apple smell — late-stage diabetes
Garlic smell — organophosphate pesticide poisoning
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The cover image was taken at Beijing University of Chinese Medicine