1. Sighing is often due to
A. Lung failure to disperse and descend
B. Insufficient lung qi
C. Spleen qi deficiency
D. Liver qi stagnation
E. Kidney failure to hold qi
2. Confused consciousness, incoherent speech, loud and forceful voice belongs to
A. Zheng voice
B. Delirium
C. Erroneous speech
D. Manic speech
E. Stammering
3. Coughing with phlegm, with abundant phlegm that is easy to expectorate, mostly belongs to
A. Dry evil invading the lungs
B. Lung qi deficiency
C. Phlegm-damp obstructing the lungs
D. Cold phlegm obstructing the lungs
E. Wind-heat attacking the lungs
4. Vomiting sour and rotten food, mostly due to
A. Dry evil invading the stomach
B. Spleen and stomach deficiency
C. Phlegm-damp obstructing the spleen
D. Cold phlegm obstructing the stomach
E. Food stagnation in the stomach
5. A rotten apple-like odor in the sickroom (ketone body odor), mostly indicates
A. Complications of diabetes
B. Organophosphate poisoning
C. Epidemic diseases
D. Kidney failure
E. Blood loss
Answer Analysis
1. D
【Answer Analysis】 Sighing, also known as sighing, refers to the long sigh or short exhalation emitted when emotions are repressed and the chest feels tight. Unconsciously emitting a sigh, followed by a feeling of relief, indicates emotional dissatisfaction and liver qi stagnation.
2. B
【Answer Analysis】 Delirium refers to symptoms of unclear consciousness, incoherent speech, and a loud and forceful voice. This is often caused by internal heat disturbing the spirit, classified as a real pattern, hence the “Shang Han Lun” states “real leads to delirium”.
3. C
【Answer Analysis】 Coughing with phlegm, with abundant phlegm that is easy to expectorate, is mostly due to phlegm-damp obstructing the lungs.
4. E
【Answer Analysis】 Vomiting sour and rotten food is often due to overeating or excessive consumption of rich foods, leading to food stagnation in the stomach, causing the stomach to lose its harmony and descend, resulting in upward reversal of stomach qi.
5. A
【Answer Analysis】 A rotten apple-like odor in the sickroom (ketone body odor) is often seen in patients with complications of diabetes, indicating a critical condition.
Unit Four: Olfactory Diagnosis
Olfactory diagnosis is a method of diagnosing diseases through listening to sounds and smelling odors.
Listening to sounds includes examining the patient’s voice, breathing, speech, coughing, heart sounds, vomiting, belching, sighing, sneezing, yawning, bowel sounds, and various other noises; smelling odors includes detecting abnormal odors emitted by the body, excretions, and the odors in the sickroom.
Section One: Listening to Sounds
Key Point One: Clinical manifestations and significance of hoarseness and loss of voice
Hoarse voice indicates hoarseness, while loss of voice, or “darkness”, indicates a more severe condition. The former is a mild illness, while the latter is a severe illness.
1. New onset hoarseness or loss of voice is mostly a real pattern, often due to external wind-cold or wind-heat attacking the lungs, or phlegm-damp obstructing the lungs, leading to the lungs losing their ability to clear and descend, hence the saying “metal does not sound when solid”.
2. Long-standing hoarseness or loss of voice is mostly a deficiency pattern, often due to various reasons leading to yin deficiency and excessive fire, injuring the lung and kidney essence, hence the saying “metal breaks and does not sound”.
3. Sudden hoarseness or loss of voice due to shouting or prolonged loud speaking injures the throat, also indicates qi and yin exhaustion.
4. In severe long-term illness, sudden hoarseness is often a sign of impending organ failure.
5. Women in late pregnancy experiencing hoarseness or loss of voice is termed pregnancy loss of voice (darkness of the child), due to the growing fetus pressing on the kidney’s collaterals, preventing kidney essence from nourishing the tongue and throat.
Key Point Two: Clinical manifestations and significance of delirium, Zheng voice, soliloquy, erroneous speech, manic speech, and stammering
1. Delirium
Delirium refers to symptoms of unclear consciousness, incoherent speech, and a loud and forceful voice. This is often caused by internal heat disturbing the spirit, classified as a real pattern, hence the “Shang Han Lun” states “real leads to delirium”. It is seen in externally contracted febrile diseases, internal heat entering the heart or yangming heat syndrome, or phlegm-heat disturbing the spirit.
2. Zheng voice
Zheng voice refers to unclear consciousness, repetitive speech, intermittent and weak voice symptoms. This is often due to long-term illness leading to organ qi exhaustion and scattered spirit, classified as a deficiency pattern, hence the “Shang Han Lun” states “deficiency leads to Zheng voice”. It is seen in late stages of various diseases, critical conditions.
3. Soliloquy
Soliloquy refers to talking to oneself, mumbling incessantly, stopping when others speak, and not continuing the conversation. This is often due to weak heart qi, insufficient spirit, or qi stagnation and phlegm obstruction, classified as a yin pattern. Commonly seen in epilepsy and depression.
4. Erroneous speech
Erroneous speech refers to a patient being clear-minded yet occasionally speaking incorrectly, realizing their mistakes afterward. This can be classified into deficiency and excess patterns; deficiency patterns are often due to weak heart qi and insufficient spirit, commonly seen in long-term illness or elderly patients with weak organ qi; excess patterns are often due to phlegm-damp, blood stasis, or qi stagnation obstructing the heart orifices.
5. Manic speech
Manic speech refers to mental confusion, incoherent speech, and wild shouting. The “Suwen: Pulse Essentials” states: “Clothing not gathered, speech good or evil, not avoiding kinship, this is confusion of the spirit.” This is often due to emotional dissatisfaction, qi stagnation transforming into fire, phlegm-fire intermingling, disturbing the spirit, mostly classified as a yang pattern, real pattern, commonly seen in manic disorders and blood stasis syndrome.
6. Stammering
Stammering refers to clear consciousness and normal thinking but difficulty in articulation, or unclear pronunciation. If it is habitual, it is not pathological. In illness, stammering often occurs with a strong tongue, indicating phlegm obstructing the collaterals, a precursor or sequela of stroke.
Key Point Three: Clinical manifestations and significance of cough, wheezing, and asthma
(1) Cough
Cough refers to a sound produced when lung qi surges upward to the throat, producing a “cough, cough” sound. Ancient texts classify it into three types: sound without phlegm is called cough, phlegm without sound is called sou, and phlegm with sound is called cough. It is often caused by the six evils invading the lungs, harmful gases irritating the lungs, phlegm and fluids stagnating in the lungs, or deficiency of qi and yin, leading to the lungs losing their ability to clear and descend, causing lung qi to surge upward. Clinically, it is essential to differentiate the sound of the cough and the color, quantity, and quality of the phlegm, and then consider the duration, medical history, and accompanying symptoms to distinguish the cold-heat deficiency-excess nature of the disease.
1. A heavy, turbid, and muffled cough sound mostly indicates an excess pattern, often due to cold phlegm and dampness stagnating in the lungs, leading to the lungs losing their ability to clear and descend.
2. A light, clear, and low cough sound mostly indicates a deficiency pattern, often due to long-term lung qi deficiency, leading to loss of ability to clear and descend.
3. A cough sound that is not loud, with thick yellow phlegm that is difficult to expectorate, mostly indicates a heat pattern, often due to heat evil invading the lungs, leading to lung fluids being scorched.
4. Coughing with phlegm, with abundant phlegm that is easy to expectorate, is mostly due to phlegm-damp obstructing the lungs.
5. A dry cough with little or no phlegm mostly indicates dry evil invading the lungs or lung dryness due to yin deficiency.
6. A short, paroxysmal, spasmodic cough that is continuous, with a crowing sound after coughing, and recurring, is called whooping cough, often due to wind evil and phlegm-heat intermingling, commonly seen in children.
7. A cough that sounds like a dog barking, accompanied by hoarseness and difficulty inhaling, is due to lung and kidney yin deficiency, and pathogenic toxins attacking the throat, often seen in diphtheria.
(2) Wheezing
Wheezing refers to shortness of breath, indicating difficulty in breathing, urgency, with mouth open and shoulders raised, even flaring nostrils, making it hard to lie flat. It is often caused by lung and heart changes, as well as diphtheria and acute laryngitis, and the differentiation also relates to the spleen and kidneys. Wheezing can be classified into deficiency and excess.
1. Excess wheezing
Sudden onset, deep and long breathing, coarse and loud voice, with quick exhalation, is excess wheezing. This is often due to wind-cold attacking the lungs or phlegm-heat obstructing the lungs, leading to the lungs losing their ability to clear and descend, or water qi overwhelming the heart.
2. Deficiency wheezing
Slow progression, shallow and rapid breathing, difficult to continue, weak and low voice, with deep inhalation being easier, and worsened by movement, is deficiency wheezing. This is due to lung and kidney deficiency, loss of ability to hold and absorb, or heart yang deficiency.
(3) Asthma
Asthma refers to rapid breathing resembling wheezing, with a wheezing sound in the throat. This is often caused by phlegm and fluids hidden within, triggered by external evils, or due to prolonged residence in cold and damp areas, or excessive consumption of sour, salty, and cold foods. Wheezing does not accompany asthma, but asthma must accompany wheezing. Wheezing is characterized by urgent breathing and difficulty, while asthma is characterized by a wheezing sound in the throat. Clinically, wheezing and asthma often occur simultaneously, hence they are commonly referred to as asthma.
Key Point Four: Clinical manifestations and significance of vomiting, belching, and eructation
(1) Vomiting
Vomiting refers to the expulsion of food and phlegm from the stomach through the mouth. It is a manifestation of the stomach losing its harmony and descending, with stomach qi surging upward. Ancient texts classify it into three types: with sound and material is vomiting, with material but no sound is expulsion, with sound but no material is dry heaving. However, clinically, it is difficult to distinguish, and it is 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 nature of the condition.
1. A slow and gentle expulsion, with a weak sound, and clear and thin vomitus, mostly indicates a deficiency-cold pattern. This is often due to spleen and stomach yang deficiency, leading to the spleen losing its ability to transport, the stomach losing its harmony and descending, resulting in upward reversal of stomach qi.
2. A more forceful expulsion, with a loud and strong sound, expelling thick yellow fluid, either sour or bitter, mostly indicates a real-heat pattern. This is often due to heat injuring stomach fluids, leading to the stomach losing its nourishing ability.
3. A projectile vomiting is often due to heat disturbing the spirit, or due to head trauma, with internal blood stasis or tumors, leading to increased intracranial pressure.
4. Vomiting sour and rotten food is often due to overeating or excessive consumption of rich foods, leading to food stagnation in the stomach, causing the stomach to lose its harmony and descend, resulting in upward reversal of stomach qi.
5. If all dining companions experience vomiting and diarrhea, it is often due to food poisoning. If one vomits in the morning after eating in the evening, or vice versa, it indicates stomach reflux, mostly indicating spleen and stomach yang deficiency.
6. Dry mouth and desire to drink, but vomiting after drinking, is termed water reversal, due to drinking evil stagnating in the stomach, leading to upward reversal of stomach qi.
(2) Belching
Belching refers to a sound produced involuntarily from the throat, short and frequent, producing a “eh, eh” sound. Commonly known as hiccup, it was referred to as “huai” before the Tang dynasty. It is a manifestation of stomach qi surging upward.
1. Frequent and loud belching, with a strong sound, mostly indicates an excess pattern. Low and weak belching indicates a deficiency pattern.
2. New onset belching, with a strong sound, mostly indicates cold or heat evils in the stomach; long-term or severe belching that does not stop, with a low and weak sound, indicates a critical condition of stomach qi exhaustion.
3. Sudden onset belching, with neither high nor low sound, and no other medical history or accompanying symptoms, mostly indicates dietary stimulation, or occasional exposure to wind-cold, leading to temporary upward reversal of stomach qi, generally self-resolving.
(3) Eructation
Eructation refers to a long and gentle sound produced by gas escaping from the stomach through the throat. Anciently referred to as “yi”. It is a manifestation of stomach qi surging upward. After a full meal or after drinking carbonated beverages, occasional inhalation without other accompanying symptoms is due to dietary factors pushing gas from the stomach upward, not pathological. Clinically, based on the sound and odor of the eructation, one can determine the deficiency-excess cold-heat nature.
1. Sour and rotten eructation, accompanied by abdominal distension, mostly indicates food stagnation, classified as an excess pattern.
2. Frequent and loud eructation, with relief of abdominal distension after eructation, and changes in eructation frequency due to emotional fluctuations, mostly indicates liver qi invading the stomach, classified as an excess pattern.
3. Frequent eructation, accompanied by cold abdominal pain, relieved by warmth, mostly indicates cold evil invading the stomach, or stomach yang deficiency.
4. Low and intermittent eructation, without sour or rotten odor, accompanied by poor appetite and reduced food intake, indicates stomach deficiency and qi reversal, classified as a deficiency pattern. Commonly seen in elderly or weak individuals.
Key Point Five: Clinical manifestations and significance of sighing
Sighing, also known as sighing, refers to the long sigh or short exhalation emitted when emotions are repressed and the chest feels tight. Unconsciously emitting a sigh, followed by a feeling of relief, indicates emotional dissatisfaction and liver qi stagnation.
Section Two: Smelling Odors
Key Point One: Clinical significance of abnormal breath and excretions
(1) Breath
Breath refers to abnormal odors emitted from the mouth. Normal individuals do not emit abnormal odors while breathing or speaking. If foul odors are emitted from the mouth, it is termed halitosis, often related to poor oral hygiene, dental caries, constipation, or indigestion.
1. Sour and foul breath, accompanied by loss of appetite and abdominal distension, mostly indicates food accumulation in the stomach and intestines.
2. Foul breath often indicates stomach heat.
3. Putrid breath, or accompanied by coughing up pus and blood, often indicates internal ulcers or necrotic abscesses.
4. Foul and unpleasant breath, with decayed gums, indicates dental disease.
(2) Excretions
1. Foul-smelling stools often indicate intestinal heat accumulation.
2. Loose stools with a fishy odor often indicate spleen and stomach deficiency-cold.
3. Diarrhea with a smell like rotten eggs, or containing undigested food, with sour and foul gas, indicates food stagnation, a manifestation of food accumulation and decay.
4. Yellow and turbid urine with a foul odor often indicates bladder damp-heat.
5. Sweet urine with a rotten apple-like odor indicates diabetes.
6. Foul menstrual blood often indicates a heat pattern.
7. Menstrual blood with a fishy odor often indicates a cold pattern.
8. Vaginal discharge that is foul and yellow and thick often indicates damp-heat.
9. Vaginal discharge that is fishy and clear often indicates cold-damp.
10. Vaginal discharge that is foul and mixed in color often indicates cancer.
Key Point Two: Clinical significance of abnormal odors in the sickroom
The odors in the sickroom are formed by the disease itself or excretions and secretions. The development of odors from the body to filling the sickroom indicates a severe condition. Clinically, smelling the odors in the sickroom can serve as a reference for inferring the condition and diagnosing specific diseases.
1. A foul odor in the sickroom often indicates epidemic diseases.
2. A bloody odor in the sickroom often indicates blood loss.
3. A putrid odor in the sickroom often indicates necrotic ulcers.
4. A corpse-like odor in the sickroom often indicates organ failure and severe illness.
5. A urine-like odor (ammonia smell) in the sickroom is seen in kidney failure.
6. A rotten apple-like odor in the sickroom (ketone body odor) often indicates patients with complications of diabetes, indicating a critical condition.
7. A garlic-like odor in the sickroom is often seen in organophosphate poisoning.
Editor: Shen Qu
