Essential Insights: Understanding the True Art of Auscultation in Traditional Chinese Medicine (Sound Diagnosis)
Sound Diagnosis and Disease Differentiation
Sound diagnosis is a method of understanding the nature of a disease based on various sounds produced by the patient, including their pitch, urgency, strength, and clarity.
①High-pitched sound: Indicates that the vital energy is not deficient, belonging to heat syndrome or excess syndrome.
②Heavy and turbid voice: Indicates external invasion of wind-cold, lung qi not dispersing, lung fluids not distributing, qi stagnation and fluid condensation, dampness obstructing the lung system, leading to a thickened vocal cord and a heavy voice.
③Hoarse voice: Sudden hoarseness indicates wind-cold binding the exterior, lung system affected by cold invasion, leading to qi stagnation and fluid condensation, resulting in inability to produce sound.
④Low voice and short breath, reluctance to speak: Indicates deficiency of middle qi.
⑤Confused speech: Refers to the patient being unclear in mind and speaking incoherently. This is indicative of acute febrile disease, heat invading the pericardium, disturbing the spirit, leading to this condition.
⑥Weak voice: In the late stage of disease, the patient may exhibit confusion, low voice, and repetitive speech, indicating long-term illness leading to deficiency of heart qi and scattered spirit.
⑦Coughing sound can differentiate cold, heat, deficiency, and excess: A clear and high cough, without illness, with a red tongue and lack of fluids, indicates dryness-heat invading the lungs, or water not nourishing wood, leading to wood-fire attacking metal. A heavy and turbid cough with abundant clear phlegm indicates external invasion of wind-cold, internal retention of water, or deficiency of both yin and yang, leading to internal water retention. A rapid and urgent cough, continuous without stopping, indicates cold evil binding the exterior, causing contraction of the qi pathways. If phlegm is expelled, the cough stops, indicating obstruction of the qi pathways.
⑧Hiccups: Indicate spasm of the diaphragm. A high-pitched and continuous hiccup indicates lung qi not dispersing, spleen qi not moving, liver qi not relaxing, leading to diaphragm spasm, indicating an excess condition. If the hiccup is low and intermittent, it indicates a deficiency condition, such as spleen and kidney yang deficiency, leading to loss of warmth; liver and kidney yin deficiency may also cause this.
Sound Diagnosis in TCM – Wheezing
[Sound Diagnosis] The characteristics of wheezing include: rapid breathing resembling asthma, high-pitched and intermittent sounds, phlegm rattling in the throat, often occurring in episodes and difficult to resolve.
[Clinical Significance] In clinical practice, wheezing is often due to internal phlegm disturbance, combined with external cold, binding the exterior, leading to the activation of latent phlegm. It can also result from external evil invasion, failure to disperse at the surface, binding the lung meridian, or due to prolonged residence in cold and damp environments, or excessive consumption of sour, salty, or cold foods, which can trigger asthma.
[Treatment Method] For wheezing caused by internal phlegm disturbance and external cold, the treatment should warm the lungs, disperse cold, transform phlegm, and stop wheezing, using Xiao Qing Long Tang (Minor Blue Dragon Decoction). For wheezing caused by external evil invasion and failure to disperse, leading to heat transformation, the treatment should disperse the lungs, clear heat, transform phlegm, and stop wheezing, using Yue Bi Jia Ban Xia Tang (Modified Yuè Bì Decoction).
Sound Diagnosis in TCM – Soliloquy
[Sound Diagnosis] The characteristic of soliloquy is: talking to oneself, mumbling incessantly, stopping when seeing others, and lacking continuity.
[Clinical Significance] The manifestation of soliloquy suggests that the person has insufficient heart qi and is lacking nourishment for the spirit, often indicating a deficiency condition.
[Treatment Method] To tonify heart qi, use Gan Mai Da Zao Tang (Sweet Wheat and Jujube Decoction) or similar formulas.
Sound Diagnosis in TCM – Delirium
[Sound Diagnosis] The characteristic of delirium includes: laughing and cursing wildly, incoherent speech, singing loudly, and running away while discarding clothes.
[Clinical Significance] Excess heat in the Yangming channel causing delirium is due to evil transmission in the Yangming channel, leading to heat accumulation.
[Treatment Method] For delirium caused by excess heat in the Yangming channel, the treatment should clear and drain Yangming, using Liang Tuo San (Cooling and Draining Powder) or Da Cheng Qi Tang (Major Order the Qi Decoction); for delirium caused by liver and gallbladder qi stagnation, the treatment should clear and soothe the liver and gallbladder, using Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver) combined with Dan Zhi Xiao Yao San (Gardenia and Free and Easy Wanderer Decoction); for delirium caused by phlegm-heat disturbance, the treatment should eliminate phlegm and lower heat, using Meng Shi Gun Tan Wan (Ming Stone Phlegm Pill); for delirium caused by blood stasis, the treatment should invigorate blood and resolve stasis, using Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) or Di Dang Tang (Di Dang Decoction).
Sound Diagnosis in TCM – Eructation
[Sound Diagnosis] Eructation refers to the sound produced by gas rising from the stomach. The sound may have a sour, rotten odor, and if the eructation is low and weak, it may indicate weakness of the spleen and stomach.
[Clinical Significance] Eructation caused by food stagnation in the stomach is often due to irregular eating habits, leading to stagnation in the middle jiao, causing stomach qi to rise; eructation caused by liver qi invading the stomach is often due to worry and anger, leading to liver qi stagnation, which reverses and invades the stomach, causing stomach qi to rise; eructation caused by spleen and stomach weakness is often due to physical weakness or post-illness imbalance, leading to spleen and stomach qi deficiency, resulting in poor digestion and disharmony of stomach qi.
[Treatment Method] For eructation due to food stagnation in the stomach, use Bao He Wan (Preserve Harmony Pill); for eructation due to liver qi invading the stomach, use Chai Hu Shu Gan Tang (Bupleurum Decoction to Soothe the Liver); for eructation due to spleen and stomach weakness, use Li Zhong Tang (Regulate the Middle Decoction).
Sound Diagnosis in TCM – Hiccups
[Sound Diagnosis] Hiccups, commonly known as “打嗝” (dǎgé), are characterized by: gas rising from the stomach, producing a sound. If the hiccup is loud and continuous, it indicates an excess condition; if the hiccup is low and intermittent, it indicates a deficiency condition.
[Clinical Significance] Hiccups that are loud and forceful, occurring continuously, are often due to excess conditions; hiccups that are intermittent and low indicate deficiency conditions. Hiccups can also be associated with cold conditions, leading to cold symptoms; or heat conditions, leading to heat symptoms.
[Treatment Method] For loud and forceful hiccups, the treatment should clear and descend; for low and intermittent hiccups, the treatment should warm and tonify. Cold hiccups can be warmed or dispersed, while heat hiccups can be cleared or descended. If hiccups are due to qi stagnation and phlegm obstruction, the treatment should transform phlegm and smooth the qi. For hiccups caused by weakness of yang qi, tonify the spleen and kidney; for hiccups caused by insufficient stomach yin, nourish the stomach and generate fluids.
Sound Diagnosis in TCM – Vomiting
[Sound Diagnosis] There are three types of vomiting: with sound and material is vomiting; without sound and with material is regurgitation; with sound and without material is dry heaving, also known as “哕” (huǐ). All are caused by stomach qi rising. In clinical practice, it is necessary to differentiate based on the medical history, the sound of vomiting, the characteristics, color, and quantity of the vomit, and accompanying symptoms.
[Clinical Significance] Common patterns of vomiting include:
1.Cold evil directly invading the spleen and stomach, as stated in “Shang Han Lun” (Treatise on Cold Damage): “If stomach qi encounters cold, it will reverse”;
2.Summer heat vomiting, characterized by vomiting, abdominal distension, poor appetite, heaviness of the body, fatigue, sticky mouth, or loose stools, with a greasy tongue coating and a slippery pulse; food stagnation vomiting is more common, resembling acute gastritis in modern medicine, with sudden onset, vomiting, and aversion to food, with a feeling of relief after vomiting, accompanied by abdominal distension and pain, sour belching, thick greasy tongue coating, and wiry pulse;
3.Vomiting due to stomach cold often occurs in those with spleen and stomach yang deficiency or after exposure to cold, with a long course, often indicating deficiency or mixed deficiency and cold, presenting with vomiting accompanied by cold limbs, thin body, abdominal pain, poor appetite, fatigue, and a pale tongue with a white coating and a weak pulse;
4.Vomiting due to stomach heat is often caused by irregular eating habits, such as excessive consumption of rich, fatty foods, alcohol, and spicy foods, leading to damp-heat accumulation in the middle jiao, presenting with vomiting and abdominal fullness.
[Treatment Method] For vomiting due to cold evil invading the stomach, the treatment should use warming and resolving methods; for summer heat vomiting, the treatment should use aromatic methods to transform turbidity and stop vomiting, using Huo Xiang Zheng Qi San (Agastache Correct Qi Powder) with modifications; for food stagnation vomiting, the treatment should use methods to digest food and guide stagnation, using Bao He Wan (Preserve Harmony Pill) with modifications; for vomiting due to stomach cold, the treatment should warm the stomach and stop vomiting, using Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) with modifications; for vomiting due to stomach heat, the treatment should clear heat and eliminate dampness, descending and stopping vomiting, using Wen Dan Tang (Warm the Gallbladder Decoction) with modifications; for vomiting due to liver-stomach disharmony, the treatment should soothe the liver and harmonize the stomach, using Chai Hu Shu Gan San (Bupleurum Decoction to Soothe the Liver) combined with Zuo Jin Wan (Left Metal Pill); for vomiting due to stomach yin deficiency, the treatment should nourish stomach yin, clear fire, and stop vomiting, using Yi Guan Jian (Linking Decoction) with modifications. The above methods are for reference only and should be combined with clinical practice to select appropriate treatment methods.
Sound Diagnosis in TCM – Coughing
[Sound Diagnosis] Coughing is a manifestation of lung qi not descending, with lung qi rising, thus often seen in lung diseases, but also closely related to other organs.
[Clinical Significance] The first step in diagnosing coughing is to differentiate whether it is due to external invasion or internal injury.
1.External invasion cough has a sudden onset, with clear pathogenic causes, and a short course, commonly seen in wind-cold, wind-heat, summer-damp, and dryness-invading lung types, each with its characteristics. Wind-cold invading the lungs may present with heavy cough, clear nasal discharge, chills and fever, itchy throat, heavy body, thin white tongue coating, and floating tight pulse; wind-heat invading the lungs may present with unproductive cough, sore throat, thick and sticky phlegm, dry nasal passages, or dry cough, chest pain, red tongue with thin yellow coating, and floating rapid pulse; summer-damp cough may present with heavy and turbid cough, abundant sticky phlegm, either white or yellow, accompanied by abdominal fullness, poor appetite, fatigue, sweating, white greasy tongue coating, and slippery rapid or slippery pulse; dryness-invading lung may present with dry cough, little phlegm or blood-streaked phlegm, dry and painful throat, thin yellow tongue coating, and floating rapid pulse;
2.Internal injury cough has a gradual onset, a longer course, often without obvious triggers, commonly seen in lung-spleen qi deficiency cough, lung-yin deficiency cough, kidney-yang deficiency cough, and liver-fire invading lung cough, each with its characteristics. Lung-spleen qi deficiency may present with low cough, shortness of breath, thin white phlegm, pale or swollen face, fatigue, easy sweating, susceptibility to colds, poor appetite, pale tongue, thin white coating, and weak pulse; lung-yin deficiency may present with dry cough, or blood-streaked phlegm, persistent cough, little sticky phlegm, dry mouth and throat, hoarseness, five hearts heat, night sweats, chest pain, red tongue, little coating, and thin or rapid pulse; kidney-yang deficiency may present with low and turbid cough, clear and thin phlegm, shortness of breath, worsening with exertion, cold limbs, or edema, pale tongue, and weak pulse; liver-fire invading lung cough may present with cough with qi rising, unproductive phlegm, rib pain, dry throat, irritability, red tongue with thin yellow coating, and wiry rapid pulse. In clinical practice, external invasion cough is often seen as an excess condition, while internal injury cough is often seen as a deficiency condition.
[Treatment Method] Coughing treatment varies according to the type. For external wind-cold cough, the treatment should disperse wind and scatter cold, clear the lungs and stop coughing, using Xing Su San (Apricot and Perilla Powder) with modifications; for external wind-heat cough, the treatment should disperse wind and clear heat, clear the lungs and stop coughing, using Sang Ju Yin (Mulberry and Chrysanthemum Decoction) with modifications; for summer-damp cough, the treatment should clear summer heat and transform dampness, clear the lungs and stop coughing, using Yin Xiang Zhu Yu Tang (Drink of Fragrant and Aromatic Herbs) with modifications; for dryness-invading cough, the treatment should moisten dryness and stop coughing, using Sang Xing Tang (Mulberry and Apricot Decoction) with modifications; for lung-spleen qi deficiency cough, the treatment should tonify the lungs, strengthen the spleen, boost qi, and stop coughing, using Si Jun Zi Tang (Four Gentlemen Decoction) combined with Yu Ping Feng San (Jade Windscreen Powder) with modifications; for lung-yin deficiency cough, the treatment should nourish yin, moisten the lungs, and stop coughing, using Bai He Guo Jin Tang (Lily Preserve the Metal Decoction) with modifications; for kidney-yang deficiency cough, the treatment should warm and tonify kidney yang, and stop coughing, using Liu Wei Di Huang Wan (Six Flavor Rehmannia Pill) with modifications; for liver-fire invading lung cough, the treatment should clear the liver and drain fire, moisten the lungs, and stop coughing, using Qing Jin San (Clear Metal Powder) with modifications. The above treatment methods are for reference only, and clinical practice should select appropriate treatment based on specific conditions.
Sound Diagnosis in TCM – Sighing
[Sound Diagnosis] Sighing, also known as “叹息” (tànxī), refers to the patient feeling a sense of chest tightness and discomfort, often accompanied by long sighs for relief.
[Clinical Significance] Clinically, it is important to differentiate whether the sighing is due to deficiency or excess. Deficiency is often due to qi deficiency, characterized by frequent sighing but insufficient qi to continue, often seen with shortness of breath, spontaneous sweating, fatigue, lack of energy, poor appetite, pale tongue, and weak pulse. Excess conditions are often due to liver qi stagnation, characterized by long sighs, feeling of relief after sighing, accompanied by chest tightness, rib fullness, irritability, breast tenderness in women, dysmenorrhea, irregular menstruation, poor appetite, bitter mouth, dizziness, and headache, with a yellow tongue coating and wiry pulse, which is particularly common in clinical practice.
[Treatment Method] For sighing due to qi deficiency, the treatment should tonify the middle and boost qi, using Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction) or Bao Yuan Tang (Preserve the Original Decoction) with modifications. For sighing due to liver qi stagnation, the treatment should soothe the liver, resolve stagnation, and regulate qi, using Chai Hu Shu Gan San (Bupleurum Decoction to Soothe the Liver) or Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Decoction) with modifications. The above formulas are for reference only, and clinical practice should combine with other symptoms to select appropriate treatment methods.
Sound Diagnosis in TCM – Shortness of Breath
[Sound Diagnosis] Shortness of breath, also referred to as “气微” (qì wēi), indicates weak breathing and lack of strength in speech, often occurring in a continuous manner.
[Clinical Significance] Shortness of breath is often seen in the following patterns. Heat injuring yin may present with shortness of breath, accompanied by reluctance to speak, fatigue, sweating, dry mouth, thin tongue coating, or no coating, and a rapid pulse; spleen qi deficiency may present with shortness of breath, reluctance to speak, poor appetite, fatigue, loose stools, pale complexion, swollen tongue, and weak pulse; heart qi deficiency may present with shortness of breath, palpitations, spontaneous sweating, mental confusion, insomnia, fatigue, pale tongue, and weak pulse; lung qi deficiency may present with shortness of breath, low speech, weak breathing, shortness of breath with exertion, fatigue, and pale tongue with soft pulse. Shortness of breath is often associated with weakness of the lungs, heart, or kidneys.
[Treatment Method] For shortness of breath due to heat injuring qi and yin, the treatment should clear the lungs and stomach, boost qi and fluids, using Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) with modifications; if due to summer heat, the treatment should clear summer heat, boost qi, nourish yin, using Qing Shu Yi Qi Tang (Clear Summer Heat and Boost Qi Decoction). For shortness of breath due to spleen qi deficiency, the treatment should tonify spleen qi, using Liu Shen San (Six Gods Powder) or Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction). For shortness of breath due to heart qi deficiency, the treatment should tonify heart qi, calm the spirit, using An Shen Ding Zhi Wan (Calm the Spirit and Settle the Will Pill) or Zhi Gan Cao Tang (Honey-Fried Licorice Decoction). For shortness of breath due to lung qi deficiency, the treatment should tonify lung qi, using Bu Fei Tang (Tonify the Lungs Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Boost Qi Decoction) combined with Yu Ping Feng San (Jade Windscreen Powder). The above treatment methods are for reference only and should be combined with other symptoms to select appropriate treatment methods.
Sound Diagnosis in TCM – Delirium
[Sound Diagnosis] Delirium is characterized by confusion, incoherent speech, and nonsensical talk. It is often an excess condition, primarily caused by heat entering the pericardium and disturbing the spirit. It is commonly seen in the high fever stage of warm diseases or other febrile illnesses.
[Clinical Significance] The abnormal manifestations of delirium should first be differentiated as excess or deficiency, cold or heat. This condition is primarily seen as an excess heat condition, often occurring in the critical stage of illness when the evil qi is strong and the vital qi is not diminished, making it easier to treat; while deficiency conditions are often seen in the later stages of severe illness when the vital qi is weak and unable to resist the evil qi, making it more difficult to treat.
[Treatment Method] Delirium is often seen as an excess heat condition, thus treatment should primarily focus on clearing heat and expelling evil. If there is excess heat, the treatment should clear heat and generate fluids; if there is heat toxin, the treatment should clear heat and detoxify; if there is damp-heat obstruction, the treatment should expel dampness and clear heat; if heat enters the blood and causes this condition, the treatment should clear heat and cool the blood; if phlegm-heat disturbs the heart or blood stasis invades the heart, the treatment should clear heat and transform phlegm or invigorate blood and resolve stasis. For deficiency conditions leading to delirium, treatment should focus on restoring yin and reviving yang. The above treatment methods are for reference only and should be combined with clinical practice to select appropriate treatment methods.
Sound Diagnosis in TCM – Stuttering
[Sound Diagnosis] Stuttering is characterized by unclear and hesitant speech, often with difficulty in producing sound.
[Clinical Significance] Stuttering may present with symptoms such as stiff tongue, numbness of limbs, and a slippery pulse, indicating wind-phlegm obstructing the channels; or with dark and lost voice, palpitations, shortness of breath, weakness in the lower back and knees, indicating kidney deficiency; or with unclear speech, dizziness, flushed face, irritability, and anger, indicating liver yang rising.
[Treatment Method] For stuttering due to wind-phlegm obstructing the channels, the treatment should expel wind and eliminate phlegm, opening the orifices and unblocking the channels, using Jie Yu Dan (Resolve Speech Pill); for stuttering due to kidney deficiency, the treatment should nourish yin and tonify the kidneys, using Di Huang Yin Zi (Rehmannia Decoction) minus cinnamon and aconite, adding apricot kernel, platycodon, and wood butterfly; for stuttering due to liver yang rising, the treatment should pacify the liver and subdue yang, using Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction) with modifications.
Sound Diagnosis in TCM – Startled Cry
[Sound Diagnosis] Startled cry is characterized by a sudden high-pitched sound from the patient. If the voice is silent and the patient frequently startles, it often indicates a disease in the joints; if the startle is sharp and the expression is fearful, it often indicates a condition of fright wind.
[Clinical Significance] In clinical practice, a startle cry often indicates pain in the bones or fright wind.
[Treatment Method] Support the righteous qi and expel evil, selecting appropriate treatment methods and formulas based on specific conditions.
Sound Diagnosis in TCM – Loud Crying
[Sound Diagnosis] Loud crying is characterized by a loud and prolonged cry.
[Clinical Significance] This is often caused by excessive pain or sorrow.
[Treatment Method] Sorrow can be suppressed by joy, thus “joy overcomes sorrow” can be used to inform the patient of joyful matters, employing mental diversion as a treatment method.
Sound Diagnosis in TCM – Flatulence
[Sound Diagnosis] Flatulence is characterized by the expulsion of gas from the anus.
[Clinical Significance] Flatulence with foul odor and sour smell is often caused by food accumulation; frequent flatulence without strong odor is often caused by abdominal cold.
[Treatment Method] For flatulence caused by food accumulation, the treatment should harmonize the stomach and digest food, using Bao He Wan (Preserve Harmony Pill); for flatulence caused by abdominal cold, the treatment should warm the middle and disperse cold, using Li Zhong Wan (Regulate the Middle Pill) with modifications.
Sound Diagnosis in TCM – Sobbing
[Sound Diagnosis] Sobbing is characterized by quiet crying.
[Clinical Significance] Sobbing generally indicates discomfort in emotions, often due to liver qi stagnation.
[Treatment Method] Soothe the liver and resolve stagnation, using Xiao Yao San (Free and Easy Wanderer Decoction) with modifications.
Sound Diagnosis in TCM – Whimpering
[Sound Diagnosis] Whimpering is characterized by low sobbing.
[Clinical Significance] Whimpering generally indicates emotional discomfort and liver qi stagnation.
[Treatment Method] Soothe the liver and resolve stagnation, using Xiao Yao San (Free and Easy Wanderer Decoction) with modifications.
Sound Diagnosis in TCM – High Exhalation
[Sound Diagnosis] High exhalation is characterized by more exhalation than inhalation, presenting a wheezing appearance.
[Clinical Significance] High exhalation indicates that lung qi is about to fail, and true yang is dispersing. “Shang Han Lun” states: “In Shaoyin disease, after six or seven days, high exhalation indicates death.”
[Treatment Method] The treatment should warm and tonify the lungs and kidneys, selecting appropriate formulas.
Sound Diagnosis in TCM – Stuttering
[Sound Diagnosis] Stuttering is characterized by repetition of sounds or interruption of speech.
[Clinical Significance] Stuttering is a habitual speech defect.
[Treatment Method] Language training methods can be used for correction.
Sound Diagnosis in TCM – Delayed Speech
[Sound Diagnosis] Delayed speech refers to children whose language development is delayed, reaching the age where they should be able to express themselves verbally but cannot even express single words.
[Clinical Significance] Delayed speech is often due to congenital insufficiency, premature birth, or insufficient postnatal nourishment.
[Treatment Method] For those caused by congenital insufficiency or premature birth, the treatment should tonify the kidneys; for those caused by insufficient postnatal nourishment, the treatment should tonify the spleen.
Sound Diagnosis in TCM – Hissing
[Sound Diagnosis] Hissing is characterized by a hoarse voice.
[Clinical Significance] Hissing can be seen in external invasion of wind-heat, dryness-heat evil, phlegm-heat obstructing the lungs, and lung-kidney yin deficiency. Generally, hissing that occurs for a short duration is due to excess, often caused by external invasion of wind-heat or dryness-heat, or phlegm-heat obstructing the lungs. Chronic hissing is often due to deficiency, commonly caused by lung-kidney yin deficiency.
[Treatment Method] Tonify deficiency and drain excess. For external invasion of wind-heat, the treatment should disperse wind and clear heat, using Yin Qiao San (Honeysuckle and Forsythia Powder) with modifications; for external invasion of dryness-heat, the treatment should clear heat and moisten dryness, using Sang Xing Tang (Mulberry and Apricot Decoction) with modifications; for phlegm-heat obstructing the lungs, the treatment should clear heat, transform phlegm, and disperse the lungs, using Qing Jin Hua Tan Wan (Clear Metal and Transform Phlegm Pill) with modifications; for lung-kidney yin deficiency, the treatment should tonify the kidneys and moisten the lungs, using Liu Wei Di Huang Wan (Six Flavor Rehmannia Pill) combined with Sha Shen Mai Dong Tang (Glehnia and Ophiopogon Decoction) with modifications.
Sound Diagnosis in TCM – Gagging
[Sound Diagnosis] Gagging is characterized by a hoarse voice.
[Clinical Significance] Gagging is often seen in wind-heat invading the lungs and damage to body fluids.
[Treatment Method] For wind-heat invading the lungs, the treatment should clear heat and disperse wind, using Sang Ju Yin (Mulberry and Chrysanthemum Decoction); for heat evil invading the lungs and damaging body fluids, the treatment should clear heat, moisten the lungs, and generate fluids, using Bai He Guo Jin Tang (Lily Preserve the Metal Decoction) with modifications.
Sound Diagnosis in TCM – Muteness
[Sound Diagnosis] Muteness is characterized by the patient being completely unable to produce sound.
[Clinical Significance] Sudden muteness is often due to excess conditions, such as external invasion of wind-cold or wind-heat, where the cold and heat qi attack the lungs, or phlegm turbidity obstructs the lungs, leading to inability to express sound. Chronic muteness is often due to deficiency conditions, commonly caused by internal injury to vital energy, lung-kidney yin deficiency, or excessive anger leading to injury of the throat.
[Treatment Method] Tonify deficiency and drain excess. For conditions caused by wind-cold or wind-heat, the treatment should expel wind, disperse cold, or clear heat; for conditions caused by phlegm turbidity, the treatment should expel phlegm and open the orifices; for conditions caused by lung-kidney yin deficiency, the treatment should nourish and tonify the lungs and kidneys.
Sound Diagnosis in TCM – Groaning
[Sound Diagnosis] Groaning is characterized by the patient making groaning sounds due to bodily pain. If groaning is continuous, it often indicates pain in a specific area; if the patient frowns while groaning, it often indicates headache; if the groaning is limited to a specific posture, it often indicates pain in the waist or legs; if the patient groans while holding the chest or abdomen, it often indicates pain in the chest or abdomen; if the patient groans while holding the jaw, it often indicates tooth pain.
[Clinical Significance] The sound of groaning indicates that the patient is experiencing pain or discomfort in a specific area.
[Treatment Method] Support the righteous qi and expel evil, selecting appropriate formulas based on specific conditions.
Sound Diagnosis in TCM – Loss of Voice
[Sound Diagnosis] The clinical characteristic of loss of voice is that the tongue can move in the mouth, but there is no sound from the throat.
[Clinical Significance] Loss of voice can be due to both excess and deficiency conditions. Excess conditions may include external invasion of wind-cold, external invasion of wind-heat, heat attacking the lungs, or liver qi invading the lungs; deficiency conditions may include kidney deficiency or spleen deficiency. Diseases of the five organs can lead to loss of voice.
[Treatment Method] For loss of voice caused by external invasion of wind-cold, the treatment should disperse wind and scatter cold, using appropriate formulas; for loss of voice caused by external invasion of wind-heat, the treatment should clear heat and disperse wind, using appropriate formulas; for loss of voice caused by diseases of the five organs, treatment should be based on excess or deficiency, using tonifying or draining methods with appropriate formulas.
Sound Diagnosis in TCM – Vaginal Gas
[Sound Diagnosis] Vaginal gas is characterized by the expulsion of gas from the vagina, producing a sound.
[Clinical Significance] Vaginal gas with foul odor and sour smell is often caused by food accumulation; frequent vaginal gas without strong odor is often caused by abdominal cold.
[Treatment Method] For vaginal gas caused by food accumulation, the treatment should harmonize the stomach and digest food, using Bao He Wan (Preserve Harmony Pill); for vaginal gas caused by abdominal cold, the treatment should warm the middle and disperse cold, using Li Zhong Wan (Regulate the Middle Pill) with modifications.
Sound Diagnosis in TCM – Yawning
[Sound Diagnosis] Yawning is characterized by opening the mouth and exhaling when feeling tired or waking up. Generally, this is a normal physiological phenomenon. However, if yawning occurs frequently without being tired, it may indicate a pathological condition.
[Clinical Significance] Occasional yawning may indicate depression, lack of joy, fatigue, chest tightness, or throat obstruction, or a tendency to cry; frequent yawning may indicate chest tightness, dizziness, memory loss, irritability, or cold limbs, indicating spleen and kidney yang deficiency.
[Treatment Method] For yawning due to liver qi stagnation, the treatment should soothe the liver and regulate qi, using Chai Hu Shu Gan San (Bupleurum Decoction to Soothe the Liver) with modifications; for yawning due to qi stagnation and blood stasis, the treatment should invigorate blood and resolve stasis, using Xue Fu Zhu Yu Tang (Blood Mansion Disperse Stasis Decoction) with modifications; for yawning due to spleen and kidney yang deficiency, the treatment should warm and tonify the spleen and kidneys, using You Gui Wan (Restore the Right Pill) with modifications.
Sound Diagnosis in TCM – Sneezing
[Sound Diagnosis] Sneezing, commonly known as “打喷嚏” (dǎ pēntì).
[Clinical Significance] Clinically, sneezing may be accompanied by nasal congestion and runny nose, or coughing and wheezing, fever and chills, indicating external evil invading the lungs. Sneezing with nasal itching, fatigue, low voice, and spontaneous sweating indicates lung qi deficiency.
[Treatment Method] For sneezing caused by external evil invading the lungs, if it is wind-cold, the treatment should disperse wind and cold, clear the lungs and relieve the exterior, using Cong Chi Tang (Scallion and Soybean Decoction) with modifications; if it is wind-heat, the treatment should disperse wind and clear heat, clear the lungs and relieve the exterior, using Yin Qiao San (Honeysuckle and Forsythia Powder) with modifications. For sneezing due to lung qi deficiency, the treatment should tonify the lungs and consolidate the exterior, using Yu Ping Feng San (Jade Windscreen Powder) with modifications.
Sound Diagnosis in TCM – Zheng Voice
[Sound Diagnosis] Zheng voice is characterized by confusion, repetitive speech, and low, disconnected speech.
[Clinical Significance] Observing repetitive speech and confusion, with deep-set eyes, sticky sweat, rapid breathing, preference for cold drinks, and warm limbs indicates loss of yin; observing mumbling, repetitive speech, and disconnection, with a weak spirit, unresponsive, cold limbs, shortness of breath, and preference for warm drinks indicates loss of yang.
[Treatment Method] For loss of yin leading to Zheng voice, the treatment should rescue yin and restrain yang, using Sheng Mai San (Generate Pulse Powder) with modifications; for loss of yang leading to Zheng voice, the treatment should revive yang and rescue the reverse, using Shen Fu Tang (Ginseng and Aconite Decoction) or Shen Fu Long Mu Tang (Ginseng and Aconite with Dragon and Moth Decoction) with modifications.
Sound Diagnosis in TCM – Confused Speech
[Sound Diagnosis] Confused speech is characterized by disordered speech, with the patient often realizing their mistakes but unable to control it.
[Clinical Significance] Clinically, confused speech is often accompanied by symptoms such as pale complexion, insomnia, palpitations, forgetfulness, and poor appetite, indicating deficiency of both heart and spleen.
[Treatment Method] For confused speech due to deficiency of heart and spleen, the treatment should regulate the heart and spleen, tonify qi and nourish blood, using Gui Pi Tang (Restore the Spleen Decoction); for confused speech due to liver qi stagnation, the treatment should soothe the liver and resolve stagnation, using Xiao Yao San (Free and Easy Wanderer Decoction); for confused speech due to blood stasis disturbing the heart, the treatment should invigorate blood and resolve stasis, using Tao Hong Si Wu Tang (Peach and Red Four Substance Decoction) or Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill); for confused speech due to phlegm-damp obstruction, the treatment should transform phlegm and eliminate dampness, using Shi Wei Wen Dan Tang (Ten Flavor Warm Gallbladder Decoction) with modifications.
Sound Diagnosis in TCM – Bowel Sounds
[Sound Diagnosis] Bowel sounds are characterized by gurgling sounds in the abdomen.
[Clinical Significance] Clinically, bowel sounds may be heard in the epigastric area, resembling a bag of liquid, vibrating with sound, which may indicate phlegm retention in the stomach; if the sound is heard in the abdomen, resembling a hungry stomach, it may decrease with warmth or food and worsen with cold or hunger, indicating middle deficiency; if the sound is like thunder, it may indicate excess wind, cold, or dampness.
[Treatment Method] For bowel sounds due to phlegm retention, the treatment should warm the spleen and transform phlegm, using Ling Gui Zhu Gan Tang (Poria, Cinnamon, and Licorice Decoction) combined with Xiao Ban Xia Tang (Minor Pinellia Decoction); for bowel sounds due to middle deficiency, the treatment should warm the middle and transform phlegm, using Ling Gui Zhu Gan Tang (Poria, Cinnamon, and Licorice Decoction); for bowel sounds due to excess wind, cold, or dampness, the treatment should warm the middle and disperse cold, using Fu Zi Jiang Mi Tang (Aconite and Glutinous Rice Decoction) with modifications.
Sound Diagnosis in TCM – Wheezing
[Sound Diagnosis] Wheezing is characterized by difficulty in breathing, shortness of breath, and wheezing sounds.
[Clinical Significance] In clinical practice, wheezing may present with coarse and high-pitched sounds, indicating phlegm-heat or phlegm retention in the lungs. Wheezing with low sounds and shortness of breath indicates lung and kidney deficiency.
[Treatment Method] For wheezing due to phlegm-heat, the treatment should clear heat and transform phlegm, using Sang Bai Pi Tang (Mulberry Bark Decoction); for wheezing due to phlegm retention, the treatment should eliminate phlegm and smooth the lungs, using San Zi Yang Qin Tang (Three Seed Nourishing Decoction) or Er Chen Tang (Two Aged Decoction); for wheezing due to lung deficiency, the treatment should tonify the lungs and boost qi, using Sheng Mai San (Generate Pulse Powder) combined with Bu Fei Tang (Tonify the Lungs Decoction); for wheezing due to kidney deficiency, the treatment should tonify the kidneys and regulate qi, using Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill) with modifications.
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