Section 2: Olfactory Diagnosis
Olfactory diagnosis includes listening to sounds and smelling odors. Listening to sounds primarily involves observing whether the patient’s speech is coherent, as well as the pitch and strength of their voice and breath, including sounds of belching and regurgitation. Smelling odors involves detecting the patient’s breath, belching, and the smell of excretions.
I. Listening to Sounds*
(1) Speech
1. Strength of Voice
A strong voice in a patient often indicates a heat syndrome or a solid condition, while a weak voice typically suggests a cold syndrome or a deficiency condition. Difficulty in speaking or inability to produce sound indicates aphonia or loss of voice. Aphonia or loss of voice can be differentiated into external pathogenic factors and internal injuries, as well as deficiency and excess conditions. External factors are commonly seen in cases of wind-cold or wind-heat, which are often associated with excess and heat; internal injuries are more likely to be due to lung and kidney yin deficiency, where fluids cannot ascend, leading to chronic conditions that are deficient.
2. Coherence of Speech
The heart governs the spirit, and speech is a manifestation of the heart’s function. Therefore, the coherence of speech reflects the normalcy of the spirit and the heart’s function. If the patient’s speech is coherent and similar to that of a normal person, it indicates that the spirit is normal and the heart qi is intact, suggesting a good prognosis. Conversely, if the spirit is unclear, speech is incoherent, and the voice is strong, it indicates delirium, commonly seen in heat syndromes where heat disturbs the spirit, indicating an excess condition; if the spirit is unclear, speech is repetitive, intermittent, and the voice is weak, it indicates a deficiency condition where evil has harmed the heart qi, preventing the heart from housing the spirit. Additionally, incoherent speech can also be seen in epilepsy or mania, which can be clinically differentiated.
(2) Breath
1. Strength of Breath
Breath refers to the patient’s respiration. Weak breath indicates weak and ineffective breathing, also known as weak qi or weak breath, commonly seen in deficiency conditions; strong breath indicates coarse and forceful breathing, often seen in excess and heat conditions.
2. Wheezing
Wheezing is characterized by difficulty in breathing, with the patient opening their mouth and raising their shoulders, unable to lie flat. Coarse breath sounds indicate an excess condition, while weak breath sounds indicate a deficiency. Wheezing is characterized by difficulty in breathing accompanied by a wheezing sound (similar to a water chicken), commonly seen in phlegm-damp obstructing the lungs. Clinically, wheezing and asthma often occur together, as phlegm-damp obstructs the airways, leading to difficulty in breathing, with the patient opening their mouth and raising their shoulders, while also producing a wheezing sound, thus presenting as both wheezing and asthma.
3. Shortness of Breath
Shortness of breath refers to short or rapid breathing, often accompanied by a sensation of breathlessness, also known as slight breath, commonly seen in deficiency conditions.
4. Sighing
Sighing, also known as “long exhalation,” is often seen in cases of emotional depression, where liver qi is not smooth.
Although asthma originates in the lungs, its source may also be in the heart, liver, spleen, or kidneys. For instance, if spleen and kidney yang is deficient, it cannot transform water and dampness, leading to water and dampness invading the lungs, resulting in asthma. Additionally, the lungs govern qi, and if the kidneys cannot receive qi, it may lead to qi counterflow and asthma. Therefore, the Suwen states that “asthma arises from the kidneys,” “asthma arises from the liver,” and “asthma arises from the lungs.”
Shortness of breath is not solely a lung issue; it can also occur in heart, spleen, or kidney deficiencies. Therefore, in clinical practice, one should trace back to the root cause and distinguish between the root and branch.
(3) Cough
Cough in olfactory diagnosis primarily includes the strength (forceful) and weakness (weak) of the cough sound, the presence of any special cough sounds, the continuity of the cough, and inquiries regarding the presence of phlegm, the amount of phlegm, the ease of expectoration, the quality of phlegm (thin or thick), the color of phlegm, and whether there is blood present.
A forceful cough sound indicates an excess condition, while a weak cough sound indicates a deficiency. In children, a cough that is paroxysmal and continuous, with a flushed face and a crowing sound upon inhalation at the end of the cough, is known as whooping cough. If a child’s cough sounds like a dog barking, attention should be paid to the possibility of diphtheria. A dry cough with little or thick phlegm that is difficult to expectorate indicates lung heat and dryness, with insufficient fluids. Abundant, clear, thin, and white phlegm is often due to cold-dampness injuring the lungs. Yellow phlegm indicates lung heat. Blood-streaked phlegm often indicates heat injuring the lung collaterals or cough injuring the lung collaterals, and can also be seen in qi deficiency where it cannot contain blood.
Cough, like asthma, should also consider the source of the disease in other organs, not just limited to the lungs.
(4) Hiccups and Belching
Hiccups and belching are both caused by the upward rebellion of stomach qi, but they indicate different pathological conditions. Hiccups, referred to as “huǐ” in the Neijing, have also been called “hiccups” by later physicians. Generally, hiccups have little significance, but in patients with chronic or severe illness in a state of exhaustion, the presence of hiccups often indicates a critical and difficult-to-treat condition. Belching, also known as “yì qì,” occurs after meals without any special odor and is not pathological. Pathological belching often occurs some time after eating. If it has a sour or rancid odor, it often indicates food stagnation harming the spleen and stomach; if it has no special odor, it often indicates liver-stomach disharmony or stomach qi deficiency.
II. Smelling Odors
Foul breath is often seen in cases of stomach heat, food stagnation, or dental caries and poor oral hygiene.
The odors of various excretions: foul-smelling stools are often seen in heat conditions or undigested food. Coughing up purulent phlegm with a foul smell indicates lung abscess. Foul-smelling vaginal discharge indicates heat conditions; fishy-smelling discharge indicates cold conditions. Foul-smelling nasal discharge indicates nasal sinusitis, while foul-smelling axillary odor indicates axillary odor (also known as body odor).