IIntroduction: In Traditional Chinese Medicine (TCM), diagnosis involves the four methods of observation, listening, inquiry, and palpation. The auditory diagnosis includes both the sense of smell and hearing. A specific sound known as e ni (呃逆声) is a sign that may indicate imminent death. Let us explore a diagnostic story from Master Xiong Jibai. (Editor/De Yi)
A Story about Auditory Diagnosis
Author/Xiong Jibai
Dialogue: Please tell us more about TCM diagnostics. Xiong Jibai: Sure, let’s discuss how TCM diagnoses diseases. What is the principle behind it? In a nutshell, it is this: “What is within will manifest outside.” This means that by observing the functions of the organs, we can infer the physiological functions of the body. Regardless of which system is malfunctioning, there will be external manifestations, and when the body is abnormal, it indicates a pathological state. The pathological state due to physiological dysfunction arises from internal issues. The external symptoms are a reflection of internal dysfunction, which is referred to as “What is within will manifest outside.” When the physiological system is normal, the external manifestations will also be normal; when the physiological system is dysfunctional, the external manifestations will reflect that dysfunction. Therefore, we can “infer the internal from the external.” This is the principle and basis of TCM diagnosis, as stated in the Huangdi Neijing: “Observe the external to understand the internal organs, thus knowing the disease.” The earliest famous physician in Chinese history, Bian Que, was said to be able to diagnose patients through walls, which is a myth meant to illustrate his exceptional observational and analytical skills. A skilled TCM practitioner is highly sensitive in diagnosis. What is the foundation of this sensitivity? It is a thorough familiarity with the physiological systems of the human body. As I mentioned earlier, knowledge of organ functions is crucial; without it, one cannot recognize the external manifestations or connect them to the underlying issues, making it impossible to identify the problem. It is like a car that suddenly stalls on the road; a typical driver may not know where the problem lies, while a skilled driver can pinpoint which screw is loose or where the issue is, allowing for a quick fix. As a TCM practitioner, one must have the ability to identify even the slightest abnormality in a patient and immediately determine the underlying issue; this is “observing the internal from the external.” TCM diagnosis is comprehensive, involving the four methods of observation, listening, inquiry, and palpation, which are derived from the Huangdi Neijing and summarized in the Nanjing as the four examinations. The Huangdi Neijing states: “Seeing the color reveals the disease, called ‘ming’; feeling the pulse reveals the disease, called ‘shen’; inquiring about the disease reveals its location, called ‘gong’.” The Nanjing further states: “To know by observation is called ‘shen’; to know by listening is called ‘sheng’; to know by inquiry is called ‘gong’; to know by palpation is called ‘qiao’.” The first method is observation, which includes examining the body shape, facial expression, complexion, and tongue color. Specialists in warm disease theory pay particular attention to tongue observation. Through observation, one can understand changes in the body. For example, a white coating on the tongue indicates exterior conditions, a thick white coating indicates dampness, a yellow coating indicates heat, a thick yellow coating indicates damp-heat, a black and dry coating indicates heat toxin, a black and moist coating indicates cold-dampness, a slippery coating indicates phlegm, a red tongue with little or no coating indicates yin deficiency, and a tongue with cracks indicates deficiency of essence and blood. A tongue with teeth marks indicates spleen qi deficiency; all of these are knowledge from TCM tongue diagnosis. TCM auditory diagnosis includes listening to sounds and breathing. For instance, whether the breathing is labored or if there is a cough can be discerned by ear. For example, whooping cough is characterized by paroxysmal coughing, while diphtheria presents with labored breathing and a barking cough, which can be identified by listening. A slow and labored breath that worsens with movement indicates deficiency-type dyspnea. In asthma, there is often a wheezing sound in the throat. Other auditory signs include incoherent speech, known as delirium. There is also the phenomenon of “speaking softly, only to repeat oneself after a long time,” which refers to speaking very quietly and intermittently, indicating weakness of vital energy. Another aspect of auditory diagnosis involves the sense of smell. For instance, in my experience, severe liver disease can produce a distinctive liver odor, an indescribable scent. Whenever I detect that liver odor, I know the patient is in a dangerous condition. Additionally, I have encountered a specific sound known as “death e ni (死呃声),” where some patients nearing death emit three sounds of e ni. Let me share a story with you: During the early years (during the Cultural Revolution), on the second day of the Lunar New Year, I was bedridden due to illness while heavy snow fell outside. A farmer came to my house before dawn, and I was unable to get out of bed, trembling and very ill. The farmer said his son was suffering from a severe condition, having had bloody stools the day before, and despite consulting many doctors at the hospital, he had not improved. He insisted that I come to see him. After hearing his story, I got out of bed, using a stick for support, and left without having breakfast. His home was about ten miles away, and it took me two to three hours to arrive, still in the heavy snow. The boy’s name was Long Cheng, and I still remember it; he was 18 years old. When I arrived at his home, I saw a pomelo tree outside the playground, with a farmer’s raincoat laid beneath it, and the child was lying there. I said, “Long Cheng, why are you lying there? It’s cold outside!” He replied, “I’m sitting here to cool off.” This statement struck me as abnormal; it was snowing, yet he claimed to be cooling off, which gave me the first impression that this patient was very unusual. I invited him inside, where he sat by the fire pit. At that time, rural fire pits were simply earth pits used for heating. I sat down to rest, as I was already very tired from walking. After about ten minutes, I heard the patient emit a sound of e ni, a long and low sound. I am very sensitive to this type of sound. How did I discern this special e ni? Although it is recorded in books, one cannot recognize it without prior experience. Three years earlier, a farmer had been working in the mountains when a sudden downpour forced everyone to take shelter in a mud house. When the wind blew, the house collapsed, injuring several people. When we arrived to rescue them, we found two had already died. I heard an elderly person emit a sound of e ni just before passing, which gave me that experience. When I heard Long Cheng emit that sound, I was alarmed; this e ni was not right! I immediately took his pulse and found a “yu xiang (鱼翔)” pulse, which was intermittent and similar in both hands. I was concerned that I might not have taken the pulse correctly, as I had walked ten miles while ill, panting and sweating, without having eaten, only having had a cup of tea. So, I decided to check again in a few minutes. Just as I was preparing to check his pulse again, he emitted a second sound of e ni. Upon hearing it, my first instinct told me it was a death e ni, and I confirmed it immediately; upon checking the pulse again, it was still a “yu xiang (鱼翔)” pulse in both hands. I then asked him where he felt uncomfortable, and he said he felt fine except for discomfort in his neck, stating only that. He had started having bloody stools on the 29th of the twelfth lunar month, continued on the 30th, and had not improved at the hospital. However, on the first day of the new year, he had not had any blood. When I visited on the second day, he had not had any blood. I asked him about his symptoms at that time, and he only mentioned discomfort in his neck, which indicated a loss of spirit. Coupled with the “yu xiang (鱼翔)” pulse and the e ni sound, it was clear that the patient was in imminent danger. I prescribed him a formula of Du Shen Tang (独参汤), which contained only Korean ginseng. I told his brother, “You must hurry to the hospital to get the medicine. It’s a ten-mile journey, and if you can get it back in time, give it to him immediately; if not, you can return it to the hospital for a refund.” At that time, a single dose of Korean ginseng cost seven to eight yuan, which was a significant amount for a farmer, unlike today. However, as I was leaving the patient’s home, he emitted a third sound of e ni. I had walked about half a mile from his house when the child died. This illustrates the importance of listening to sounds, which is the essence of auditory diagnosis.
Notes:
Yu Xiang Pulse (鱼翔脉), one of the seven strange pulses. The pulse is felt at the skin, seeming to be there yet not there, like a fish swimming in water. It indicates extreme cold in the three yin channels, with yang lost to the exterior.
Excerpt from A True Master of TCM: Interviews with Xiong Jibai on the Essence of TCM, published by China Traditional Chinese Medicine Press. Author/Xiong Jibai
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