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Auscultation
Auscultation is a method of understanding health conditions and diagnosing diseases through listening to sounds and smelling odors. Listening to sounds includes discerning the patient’s voice, speech, breathing, coughing, vomiting, hiccuping, warmth, sighing, sneezing, yawning, bowel sounds, and various other noises. Smelling odors includes detecting abnormal smells emitted by the body, excretions, and the odors in the examination room. The various sounds and smells of the human body are produced during the physiological activities and pathological changes of the organs. Therefore, identifying changes in sounds and smells can help determine the physiological and pathological changes of the organs, providing a basis for diagnosis and pattern differentiation.
Auscultation is one of the important methods for diagnosing diseases and has been highly valued by physicians throughout history, as stated in the “Nanjing, Chapter 61”: “To know by hearing is called a sage.”
As early as in the “Huangdi Neijing,” there are records of assessing internal diseases based on the sounds emitted by patients, such as the theory of the five sounds corresponding to the five organs proposed in the “Suwen, Great Discussion on Yin and Yang Correspondences”; the “Suwen, Discussion on the Essentials of Pulse” uses sounds, speech, and breathing to judge the state of righteousness and evil during the disease process. In the Eastern Han Dynasty, Zhang Zhongjing in the “Shanghan Lun” and “Jinkui Yaolue” also used the patient’s speech, cough, wheezing, vomiting, hiccuping, bowel sounds, and moaning as the main content of auscultation. Later physicians included the odors of the body and the examination room in the scope of auscultation, thus expanding auscultation from listening to smelling, continuously enriching its content. As Wang Bingheng of the Qing Dynasty said: “Although the character ‘wen’ (to hear) comes from the ear, the auscultation in the four examinations is not solely based on hearing sounds.”
1. Listening to Sounds
Listening to sounds refers to discerning the patient’s voice, speech, the pitch, strength, clarity, and urgency of breath, as well as sounds from coughing, vomiting, and bowel sounds, to determine the function of the organs and the nature of the disease.
The production of sounds is mostly the result of the coordinated activities of the lungs, throat, epiglottis, tongue, teeth, lips, and nose. The lungs govern qi and control breathing; when qi moves, there is sound, thus the lungs are the driving force of sound production. The throat is the organ of sound production, and sound comes from the throat, while the other parts play a coordinating role. Additionally, the kidneys govern the intake of qi, which is the root of qi, and must move qi from the kidneys to the tongue to produce sound; the liver governs the smooth flow of qi; the spleen is the source of qi and blood transformation; the heart governs the spirit, and speech is controlled by the heart and spirit, all of which are related to sound production. The sounds of bowel movements are related to the stomach’s harmony and descent and the intestines’ transmission. Therefore, listening to sounds can not only diagnose the lesions of the sound-producing organs but also further diagnose the changes in the internal organs based on the changes in sounds. The “Four Examinations” states: “Listening to sounds can discern prosperity and decline.” It emphasizes the important role of listening to sounds in disease diagnosis.
1. Normal Sounds
Normal sounds refer to the sounds produced by a person in a normal physiological state, also known as “common sounds.” Normal sounds are characterized by natural sound production, harmonious tone, fluent speech, and appropriate responses, indicating sufficient qi and blood and normal function of the sound-producing organs and internal organs. However, due to differences in age, gender, and constitution, normal people’s sounds also vary; generally, men have lower and deeper voices, women have higher and clearer voices, children have sharp and crisp voices, and the elderly have deeper and more resonant voices, each with its unique characteristics. Additionally, changes in voice are also related to emotions; for example, joyful sounds are often cheerful, angry sounds are often harsh and urgent, sad sounds are often tragic and intermittent, happy sounds are often smooth and gentle, respectful sounds are often upright and serious, and loving sounds are often gentle. These sounds, triggered by momentary emotions, are also within the normal range and are not related to diseases.
2. Pathological Sounds
Pathological sounds refer to changes in voice, speech, and other bodily sounds that reflect diseases, excluding normal physiological changes and individual differences. The content of listening to pathological sounds mainly includes discerning the patient’s voice, speech, breathing, coughing, vomiting, hiccuping, warmth, sighing, sneezing, and bowel sounds.
(1) Voice
This mainly involves listening to the patient’s voice during the disease process, including abnormal sounds such as moaning and exclamations. Changes in voice can be used to determine the state of righteousness and evil, the nature of pathogenic factors, and the severity of the disease.
When discerning voice, attention should be paid to the presence or absence of voice, the pitch, strength, clarity, and sharpness of the voice, as well as any abnormal sounds for reference in pattern differentiation. Generally, a loud and powerful voice that is continuous often indicates a yang condition, excess condition, or heat condition, reflecting exuberant yang and qi; a weak and intermittent voice that is quiet and reluctant to speak often indicates a yin condition, deficiency condition, or cold condition, usually due to insufficient constitution or qi and blood deficiency.
1. Heavy and Muffled Voice: A heavy and muffled voice refers to a sound that is dull and unclear or has a nasal tone, also known as a heavy voice. This often results from external invasion of wind-cold or dampness obstructing the lungs, causing lung qi to be unexpressed and nasal passages to be obstructed.
2. Hoarseness and Loss of Voice: A hoarse voice is referred to as hoarseness, while a complete loss of voice is called loss of voice, historically known as “dumbness.” The causes and mechanisms of both are fundamentally the same; the former indicates a lighter condition, while the latter indicates a more severe condition. A new hoarse voice or loss of voice often indicates an excess condition, usually due to external invasion of wind-cold or wind-heat attacking the lungs, or phlegm-damp obstructing the lungs, leading to unexpressed lung qi, which is referred to as “the metal does not sound.” A long-term hoarse voice or loss of voice often indicates a deficiency condition, usually due to various reasons leading to yin deficiency and excessive fire, or insufficient lung qi, or fluid deficiency damaging the lungs, making it difficult to produce sound, referred to as “the metal is broken and does not sound.” If a long-term severe illness suddenly presents with hoarseness, it often indicates a critical state of organ qi nearing exhaustion. Sudden shouting or prolonged loud speaking can exhaust qi and injure yin, leading to dryness in the throat, which can also cause hoarseness or loss of voice. Women in late pregnancy may experience hoarseness or loss of voice, referred to as pregnancy loss of voice, historically known as “child dumbness,” often due to the fetus obstructing the kidney’s collaterals, preventing kidney essence from nourishing the throat, which generally resolves after childbirth.
Additionally, attention should be paid to the distinction between loss of voice and loss of speech. Loss of voice refers to being clear-minded but unable to produce sound, i.e., “speaking without sound”; loss of speech refers to being clear-minded but having difficulty expressing oneself, i.e., “having sound but no speech,” often seen in post-stroke or traumatic brain injury sequelae.
3. Exclamation: An exclamation refers to a sudden sharp sound made by the patient. If the sound is sharp and the expression is fearful, it is often due to severe pain or fright. Children often exclaim due to being startled. In adults, exclamations, aside from fear, often indicate severe pain or mental disturbance.
(2) Language
This mainly involves discerning any abnormalities in the patient’s ability to express and respond, as well as the clarity of articulation. Abnormalities in language are primarily related to changes in the heart and spirit, commonly including the following types.
1. Delirium: Delirium refers to unclear consciousness, incoherent speech, and a loud voice. This is often caused by internal heat disturbing the spirit, indicating an excess condition, as stated in the “Shanghan Lun”: “In excess, there is delirium.” This is seen in externally contracted febrile diseases, warm diseases disturbing the heart, or excess conditions in the Yangming organ, or phlegm-heat disturbing the spirit.
2. Weak Voice: Weak voice refers to unclear consciousness, repetitive speech, and intermittent low and indistinct voice. This is often due to prolonged illness leading to exhaustion of organ qi and disarray of the spirit, indicating a deficiency condition, hence the “Shanghan Lun” states: “In deficiency, there is weak voice.” This is seen in various diseases at late or critical stages.
3. Soliloquy: Soliloquy refers to talking to oneself, mumbling incessantly, stopping when others speak, and lacking continuity. This is often due to insufficient heart qi, loss of nourishment to the spirit, or qi stagnation and phlegm obstruction, obscuring the spirit, indicating a yin condition. This is often seen in epilepsy or depression.
4. Misstatement: Misstatement refers to being clear-minded but occasionally speaking incorrectly, realizing the mistake afterward. This can be divided into deficiency and excess conditions; deficiency conditions often arise from insufficient heart qi and loss of nourishment to the spirit, often seen in long-term illness or elderly individuals with weakened organ qi; excess conditions often arise from phlegm turbidity, blood stasis, or qi stagnation obstructing the spirit.
5. Mania: Mania refers to mental disturbance, incoherent speech, and frenzied talk. The “Suwen, Discussion on the Essentials of Pulse” states: “Clothes are not tucked in, speech is good or bad, and does not avoid kinship, this is a disturbance of the spirit.” This is often due to unfulfilled emotions, qi stagnation transforming into fire, phlegm-fire intermingling, disturbing the spirit, indicating an excess condition, often seen in manic disorders or blood stasis syndrome.
6. Stuttering: Stuttering refers to being clear-minded and having normal thoughts but speaking fluently. If it is habitual, it is called stuttering and is not pathological. In illness, stuttering often occurs with a strong tongue and is often due to wind-phlegm obstructing the collaterals, indicating a precursor to stroke or sequelae of stroke.
(3) Breathing
Listening to breathing involves examining the speed, regularity, and smoothness of the patient’s breathing, as well as the strength and quality of the breath and the clarity of breathing sounds. Generally, normal breathing in the presence of illness indicates a physical disease without qi disease; abnormal breathing indicates both physical and qi diseases. Rough breathing with rapid inhalation and exhalation often indicates an excess condition; weak and slow breathing often indicates a deficiency condition.
1. Wheezing: Wheezing refers to difficulty in breathing, shortness of breath, and even raising the shoulders and flaring the nostrils, making it difficult to lie flat. The onset is often related to the lungs and kidneys, with clinical differentiation between deficiency and excess conditions.
Sudden onset, deep and prolonged breathing, loud and rough sound, with rapid exhalation, strong and forceful pulse indicates excess wheezing. This is often due to wind-cold attacking the lungs or phlegm-heat obstructing the lungs, leading to loss of lung clarity and upward reversal of lung qi or water qi invading the heart and lung.
Gradual onset, low voice, weak breath, short and intermittent breathing, worsening with movement, with deep inhalation being easier, weak and forceless pulse indicates deficiency wheezing. This is often due to insufficient lung qi, deficiency of lung and kidney, or loss of qi regulation.
2. Asthma: Asthma refers to rapid breathing resembling wheezing, with a wheezing sound in the throat, often recurring and difficult to cure. This is often due to phlegm-dampness lurking internally, combined with external pathogens triggering it; it can also be induced by prolonged exposure to cold and damp environments or excessive consumption of sour, salty, or cold foods.
Wheezing does not necessarily accompany asthma, but asthma must accompany wheezing. Ming Dynasty physician Yu Tuan stated in “Medical Transmission – Asthma”: “Wheezing is when breathing is rapid and the sound in the throat resembles a waterfowl; asthma is when breathing is rapid and continuous without being able to pause.” Wheezing is characterized by rapid and difficult breathing; asthma is characterized by a wheezing sound in the throat. Clinically, wheezing and asthma often occur simultaneously, hence they are commonly referred to together as asthma.
3. Shortness of Breath: Shortness of breath refers to rapid and short breathing, insufficient to sustain life, with breaths not connecting, resembling wheezing but without shoulder elevation, and no wheezing sound in the throat. Shortness of breath can be differentiated into deficiency and excess conditions; deficiency shortness of breath often accompanies thinness and fatigue, low voice, and weak breath, usually due to weak constitution or loss of vital energy; excess shortness of breath often accompanies rough breathing sounds, chest tightness, or abdominal distension, usually due to phlegm-dampness, gastrointestinal accumulation, qi stagnation, or blood stasis.
4. Weak Breathing: Weak breathing refers to weak and low sounds, insufficient to sustain life, with weak speech. Weak breathing is also known as weak qi, indicating various deficiencies, often due to prolonged illness or deficiency of lung and kidney qi.
5. Snoring: Snoring refers to a sound produced during sleep or unconsciousness, indicating an abnormal breathing sound due to obstructed airways. Occasional snoring during sleep without other obvious symptoms is often due to chronic nasal diseases or improper sleeping positions, more common in the elderly and those with excessive phlegm. If snoring occurs during deep sleep or unconsciousness, it often indicates high fever and confusion or a critical state of stroke.
(4) Coughing
Coughing refers to a sound produced when qi rises to the throat, with the airway closing and suddenly opening, producing a “cough” sound. This is often due to external pathogens attacking the lungs, internal damage to the lungs, or harmful gases irritating the lungs, leading to loss of lung clarity and upward reversal of lung qi. Coughing is commonly seen in lung-related diseases; however, other organ pathologies can also affect the lungs and cause coughing. Therefore, the “Suwen, Discussion on Cough” states: “All organs can cause coughing, not just the lungs.” The ancients divided coughing into three types: sound without phlegm is called cough, phlegm without sound is called sputum, and phlegm with sound is called cough.
Clinically, it is essential to differentiate the sound of coughing and the color, quantity, and quality of phlegm, as well as the onset time, medical history, and accompanying symptoms to distinguish the cold-heat deficiency-excess conditions of the disease.
Coughing with a heavy, muffled sound often indicates an excess condition, usually due to cold phlegm and dampness accumulating in the lungs, leading to loss of lung clarity.
Coughing with a light, clear, and low sound often indicates a deficiency condition, usually due to prolonged illness damaging lung qi, leading to loss of clarity.
Coughing with a heavy, muffled sound, with white, clear, and thin phlegm, and nasal congestion, often indicates wind-cold attacking the lungs, leading to loss of lung clarity.
Coughing with a loud and sharp sound, with thick yellow phlegm that is difficult to expel, often indicates a heat condition, usually due to heat pathogens invading the lungs, burning lung fluids.
Coughing with abundant phlegm that is easy to expel often indicates phlegm-damp obstructing the lungs.
Dry cough without phlegm or with little sticky phlegm that is difficult to expel often indicates dryness invading the lungs or lung dryness due to yin deficiency.
Coughing in paroxysms, continuous and unending, with a sound resembling a rooster crowing, is called a paroxysmal cough. Due to its prolonged course, it is also known as “whooping cough,” often due to wind pathogens and phlegm-heat intermingling, commonly seen in children.
Coughing with a sound resembling a dog barking, accompanied by hoarseness, difficulty inhaling, and a white membrane growing in the throat that bleeds when scraped, is often due to epidemic toxins attacking the throat, commonly seen in diphtheria.
(5) Vomiting
Vomiting refers to the upward expulsion of food, phlegm, and other contents of the stomach through the mouth, indicating loss of harmony and descent of the stomach, with stomach qi rising. The ancients classified vomiting into three types: sound without material is called dry heaving, material without sound is called vomiting, and sound with material is called vomiting. However, clinically, it is challenging to separate them entirely, so they are generally referred to as vomiting. Based on the strength of the vomiting sound and the urgency of the expulsion, one can determine the cold-heat deficiency-excess conditions. Generally, acute illnesses are often excess, while chronic illnesses are often deficient. For certain special types of vomiting, a comprehensive analysis of the four examinations is necessary to make an accurate diagnosis.
Vomiting with a slow expulsion, weak sound, and clear, thin contents often indicates a deficiency-cold condition, commonly due to spleen and stomach yang deficiency, loss of healthy movement, and stomach qi rising.
Vomiting with a strong expulsion, loud sound, and thick yellow liquid, or sour or bitter contents often indicates an excess-heat condition, commonly due to heat pathogens invading the stomach, leading to loss of harmony and stomach qi rising.
Vomiting in a projectile manner often indicates disturbance of the spirit due to heat, or due to head trauma, or diseases of the brain.
Vomiting with a sour and rotten taste often indicates food stagnation, commonly due to overeating or excessive consumption of rich and heavy foods, damaging the spleen and stomach, leading to food stagnation and stomach qi rising.
If multiple people dining together experience vomiting and diarrhea, it may indicate food poisoning.
Vomiting in the morning after eating in the evening, or vomiting in the evening after eating in the morning, indicates stomach reflux, often associated with spleen and stomach yang deficiency.
Dry mouth and thirst, with vomiting after drinking, is called water reversal, often due to fluid stagnation in the stomach, leading to stomach qi rising.
(6) Hiccuping
Hiccuping refers to an involuntary sound produced from the throat, characterized by short and frequent sounds that cannot be controlled. Hiccuping, commonly known as “burping,” was historically referred to as “he.” It indicates stomach qi rising. Clinically, the pitch and strength of the hiccuping sound, as well as the duration of the intervals, can help determine the nature of the disease’s deficiency or excess, cold or heat.
Frequent hiccuping with a high pitch and strong sound often indicates an excess condition; low, weak hiccuping sounds often indicate a deficiency condition.
New onset hiccuping with a strong sound often indicates cold or heat pathogens affecting the stomach; long-term or severe hiccuping that does not stop with a low, weak sound indicates a critical state of stomach qi exhaustion. Therefore, the “External Diagnosis of Shape and Color” states: “New hiccuping indicates either fire or cold; long-term hiccuping indicates stomach qi is about to be exhausted.”
Sudden hiccuping, with sounds neither high nor low, of short duration, without other medical history or accompanying symptoms, often indicates dietary stimulation or a sudden exposure to wind-cold. This is usually temporary and self-resolving.
(7) Belching
Belching refers to a long and slow sound produced by gas rising from the stomach through the throat. Commonly known as “burping,” historically referred to as “yi,” it indicates stomach qi rising. Clinically, the sound and odor of belching can help determine deficiency or excess, cold or heat.
Sour and rotten belching, accompanied by abdominal distension, often indicates food stagnation, indicating an excess condition.
Frequent and loud belching, with a reduction in abdominal distension after belching, and changes in belching frequency due to emotional fluctuations, often indicates liver qi invading the stomach, indicating an excess condition.
Frequent belching, accompanied by cold abdominal pain that improves with warmth, often indicates cold pathogens invading the stomach or stomach yang deficiency.
Low, intermittent belching without sour or rotten odor, accompanied by reduced appetite, often indicates spleen and stomach weakness, indicating a deficiency condition. This is often seen in the elderly or those with weak constitutions.
Occasional belching after overeating or drinking carbonated beverages, without other accompanying symptoms, is not considered pathological.
(8) Sighing
Sighing, also known as deep sighing, refers to a long or short sigh produced by the patient when feeling emotionally repressed or experiencing chest tightness, often indicating unfulfilled emotions and liver qi stagnation.
(9) Sneezing
Sneezing refers to a sound produced by lung qi rising through the nose. Attention should be paid to the frequency of sneezing and any accompanying symptoms. Occasional sneezing is not considered pathological. If sneezing occurs with new onset, accompanied by chills, fever, nasal congestion, and clear nasal discharge, it often indicates external wind-cold, indicating a superficial cold condition. If sneezing occurs repeatedly with itching and clear nasal discharge during seasonal changes, it often indicates a body constitution prone to wind invasion.
(10) Bowel Sounds
Bowel sounds refer to the sounds produced by the peristalsis of the stomach and intestines. Under normal circumstances, bowel sounds are low and gentle, generally difficult to hear directly; however, when the qi mechanism in the abdomen is obstructed, leading to sounds produced by the interaction of water and qi in the stomach and intestines, they can be heard.
Clinically, the frequency, intensity, and pitch of bowel sounds, combined with eating, belching, vomiting, and bowel movements, can help differentiate conditions.
1. Increased Bowel Sounds: If the sounds in the abdomen are like a bag of liquid, rolling sounds can be heard when walking or pressing the abdomen, this is called a water sound. If this occurs after drinking water, it is often normal; if this sound occurs frequently without drinking, it often indicates water retention in the stomach, indicating obstruction of the middle qi mechanism.
If the sounds in the abdomen resemble hunger pangs, improving with warmth and food, but worsening with hunger and cold, it indicates insufficient middle qi and cold in the stomach and intestines. Therefore, the “Lingshu, Inquiry on the Mouth” states: “Insufficient middle qi… leads to painful bowel sounds.”
If bowel sounds are loud and frequent, accompanied by abdominal fullness and diarrhea, it often indicates invasion of wind-cold-dampness, leading to disordered qi mechanism in the stomach and intestines. If accompanied by abdominal pain, urgent diarrhea, or watery stools, or accompanied by vomiting, it indicates unclean food intake. If bowel sounds occur in paroxysms, accompanied by abdominal pain and a desire to defecate, with pain relief after defecation, and fullness and discomfort in the chest and sides, it indicates disharmony between the liver and spleen.
2. Decreased Bowel Sounds: Decreased bowel sounds often indicate dysfunction in the intestinal transmission. This can be due to excess heat obstructing the intestines, stagnation of qi in the liver and spleen, weakness of the spleen and lung qi, or cold stagnation obstructing the intestines.
If bowel sounds completely disappear, accompanied by abdominal fullness, pain, and resistance to pressure, it often indicates severe intestinal qi stagnation, which can be seen in intestinal obstruction or intestinal knots.
2. Smelling Odors
Smelling odors refers to the method of diagnosing diseases by discerning the odors emitted by the patient’s body and the odors in the examination room. In cases of disease, due to the disturbance of pathogenic qi, abnormal circulation of qi and blood, and dysfunction of organ functions, foul odors may be produced, which can manifest as abnormal body odor, breath, secretions, and excretions. Generally, odors that are sour, rotten, or foul often indicate excess heat; odors that are faint or slightly fishy often indicate cold. Therefore, smelling odors can help understand the cold-heat deficiency-excess conditions of the disease.
1. Body Odor
Body odor refers to various abnormal odors emitted by the body. Clinically, in addition to direct observation by the physician, it can also be obtained through inquiries from the patient or accompanying individuals.
(1) Breath Odor
Breath odor refers to abnormal odors emitted from the mouth. Normal individuals do not emit abnormal odors while breathing or speaking.
Foul breath is called halitosis, often related to poor oral hygiene, dental caries, constipation, and indigestion.
Sour and foul breath, accompanied by reduced appetite and abdominal fullness, often indicates food stagnation in the stomach and intestines.
Foul breath often indicates stomach heat.
Rotten breath, or accompanied by coughing up pus and blood, often indicates internal ulcers or necrotic lesions.
Foul breath that is difficult to tolerate, with decayed gums, indicates dental gangrene.
(2) Sweat Odor
Sweat odor refers to the odor emitted by the patient with sweating.
Sweating with a fishy odor is often seen in wind-warmth, damp-warmth, or febrile diseases, indicating prolonged retention of wind, dampness, and heat in the skin, or due to sweat not being absorbed by clothing.
Sweating with a foul odor is often seen in epidemics or severe heat toxin.
Foul odor emitted from the armpits during sweating often indicates internal damp-heat, which can be seen in axillary osmidrosis.
(3) Phlegm and Nasal Discharge Odor
Under normal conditions, the body discharges a small amount of phlegm and nasal discharge without abnormal odors.
Coughing up clear, thin phlegm in large quantities without specific odors indicates a cold condition.
Coughing up yellow, thick, fishy phlegm indicates lung heat accumulation.
Coughing up turbid phlegm with pus and blood, with a foul odor, often indicates lung abscess, due to severe heat toxin.
Nasal discharge that is turbid and foul, resembling fish brain, indicates nasal phlegm.
Nasal discharge that is clear and odorless often indicates external wind-cold.
(4) Vomitus Odor
Vomitus that is clear and thin, without odor, often indicates stomach cold; odors that are sour, rotten, or foul often indicate stomach heat.
Vomiting undigested food with a sour and rotten odor indicates food stagnation.
Vomiting with pus and blood, with a foul odor, often indicates internal abscesses.
(5) Excretion Odor
Excretion odor includes abnormal odors from urine and feces, as well as women’s menstrual and vaginal discharges, which should be assessed in conjunction with observation and inquiry.
Foul-smelling feces often indicate heat in the intestines; loose, foul-smelling feces often indicate spleen and stomach cold; diarrhea with a foul odor resembling rotten eggs, or containing undigested food, indicates food injury.
Dark yellow, turbid urine with a foul odor often indicates bladder damp-heat; urine that emits a rotten apple-like odor often indicates late-stage diabetes.
Women with foul-smelling menstrual blood often indicate heat conditions; menstrual blood with a fishy odor, or clear and thin, often indicates cold dampness. Abnormal bleeding or vaginal discharge with a foul odor may indicate cancer. Foul-smelling vaginal discharge that is yellow and thick often indicates damp-heat; if accompanied by abnormal colors, further examination is necessary to determine if it is cancer-related.
2. Examination Room Odor
Examination room odor is formed by the body itself or by excretions and secretions. The presence of foul odors in the examination room indicates a serious condition. Clinically, smelling the odors in the examination room can serve as a reference for inferring the condition and diagnosing specific diseases.
Foul odors in the examination room often indicate epidemic diseases. Dai Tianzhang’s “Discussion on Epidemics, Differentiating Qi” states: “Epidemic qi rises from within and reaches the outside, and the patient emits foul odors; if light, it fills the bed curtains; if severe, it fills the entire room.”
A blood-like odor in the examination room often indicates blood loss.
A putrid odor in the examination room often indicates ulcerative lesions.
A corpse-like odor in the examination room often indicates organ failure and severe illness.
A urine-like odor in the examination room often indicates late-stage edema.
A rotten apple-like odor in the examination room often indicates severe diabetes.
A garlic-like odor in the examination room often indicates poisoning from organophosphate pesticides.
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