Auditory and olfactory examination (闻诊) is one of the four diagnostic methods in Traditional Chinese Medicine (TCM), which utilizes auditory and olfactory senses to infer diseases based on the sounds emitted by the patient and the various odors from bodily excretions. In clinical practice, auditory examination is combined with visual examination (望诊), inquiry (问诊), and palpation (切诊) to comprehensively and systematically understand the patient’s condition and make accurate judgments about the disease.
Sounds
1Voice
① A loud, clear, and powerful voice, continuous—yang syndrome, excess syndrome, heat syndrome.
② A low, weak voice, reluctant to speak and quiet, intermittent—yin syndrome, deficiency syndrome, cold syndrome.
③ Heavy voice—thick and muddy voice—external invasion of wind-cold, damp obstruction, nasal diseases—lung qi not dispersing, nasal passages obstructed.
2Hoarseness and Loss of Voice
① New illness with excess syndrome—external invasion of wind-cold, wind-heat attacking the lungs, phlegm-damp obstructing the lungs, “metal not resonating”.
② Chronic illness with deficiency syndrome—yin deficiency with excess fire, internal injury to lung and kidney essence—”metal broken and not resonating”.
③ Sudden anger or prolonged loud speaking injures the throat—qi and yin exhaustion.
④ In chronic severe illness, sudden onset of hoarseness—danger of organ qi being exhausted.
⑤ “Fetal silence”—loss of voice during pregnancy, as the fetus grows, kidney essence cannot nourish the tongue and throat.
⑥ Distinction:
Loss of voice—clear consciousness, unable to produce sound—speaking without sound.
Loss of speech—confused consciousness or unclear, unable to speak—stroke, brain injury.
3Snoring
① No consciousness alteration—chronic nasal disease, improper sleeping posture, obesity, elderly.
② With consciousness alteration—high fever and delirium, stroke entering the organs.
4Moaning
① New illness moaning—loud and powerful voice—excess syndrome, severe pain.
② Chronic illness moaning—low and weak voice—deficiency syndrome.
5Exclamations
① Sharp voice, fearful expression—severe pain, fright.
② Children’s intermittent exclamations—frightened.
③ Children’s night crying: a. Overeating cold food causing abdominal pain. b. Heart and spleen heat. c. Food accumulation. d. Worm accumulation. e. Fright.
④ Adult exclamations—fright, severe pain, mental disorder.
6Sneezing
① Occasional sneezing—not pathological.
② New illness sneezing—accompanied by chills and fever, clear nasal discharge—exterior cold syndrome.
③ Chronic yang deficiency, sudden sneezing—yang qi recovering, improvement in condition.
7Yawning
① Drowsy and wanting to sleep—not pathological.
② Frequent yawning due to illness—body deficiency, yin excess and yang deficiency.
8Sighing
① Sighing—long exhalation or short sigh emitted when emotions are repressed and chest feels tight.
② Feeling relaxed after sighing—emotions not going smoothly, liver qi stagnation.
Language
Delirium—confused consciousness, incoherent speech, loud and powerful voice—heat disturbing the spirit—excess syndrome.
Repetitive Speech—confused consciousness, repetitive language, intermittent and low voice—organ qi exhaustion, scattered heart spirit—deficiency syndrome.
Breathlessness—low voice, shortness of breath, wanting to speak but unable to continue—great deficiency of ancestral qi.
Soliloquy—talking to oneself, mumbling continuously, stopping when seeing others, incoherent—① insufficient heart qi. ② qi stagnation and phlegm obstruction—epilepsy, depression.
Incoherent Speech—clear consciousness but occasionally speaking incorrectly, aware of mistakes after speaking.
Deficiency syndrome—weak heart qi, insufficient spirit qi.
Excess syndrome—① phlegm-damp. ② blood stasis. ③ qi stagnation obstructing the heart orifices.
Manic Speech—mental disorder, incoherent speech, shouting and cursing—qi stagnation transforming into fire, phlegm-fire mutually binding, disturbing the heart spirit—yang syndrome, excess syndrome.
Difficulty in Articulation—clear consciousness, normal thinking but difficulty in pronouncing words or unclear articulation, habitual—non-pathological, often seen with tongue stiffness during illness—wind-phlegm obstructing the channels—stroke. Insufficient heart qi—soliloquy, incoherent speech.
Breathing
1. Wheezing—difficulty breathing, short and rapid, may raise shoulders and flare nostrils, difficult to lie flat.
[Excess Wheezing]—deep and long breathing, coarse and loud voice—wind-cold attacking the lungs, phlegm-heat obstructing the lungs, phlegm fluid stagnating in the lungs, water qi invading the heart.
[Deficiency Wheezing]—short and shallow breathing, low voice and short breaths—lung and kidney deficiency, qi unable to regulate.
2. Asthma—rapid breathing resembling wheezing, wheezing sound in the throat—phlegm retained in the lungs, often triggered by external factors “asthma must accompany wheezing”.
3. Shortness of breath—feeling of breath being short and not continuous, mild difficulty in breathing.
① Deficiency syndrome—characterized by shortness of breath and weak voice, physical weakness, and loss of original qi.
② Excess syndrome—fatigue, food stagnation, qi stagnation, blood stasis.
4. Weak breathing—weak voice, insufficient breath, inability to speak—deficiency syndrome (lung, spleen, kidney qi deficiency), prolonged illness leading to weakness.
Cough
1 Cough with tight and muffled sound: excess syndrome—cold-dampness obstructing the lungs.2 Cough with light, clear, and low sound: deficiency syndrome—prolonged illness leading to weak lung qi, failure to disperse and descend.3 Cough with no loud sound, thick yellow phlegm, difficult to expectorate: heat syndrome—heat evil invading the lungs, lung fluids being scorched.4 Cough with phlegm sound, abundant phlegm easy to expectorate: phlegm-damp obstructing the lungs.5 Dry cough with little or no phlegm: dry evil invading the lungs, yin deficiency leading to lung dryness.6 Sudden cough lasting for days: short, paroxysmal, spasmodic cough, continuous and repetitive, resembling a rooster’s crow—wind evil and heat fatigue binding.7 Croup: cough resembling a dog’s bark, accompanied by hoarseness, difficulty inhaling—lung and kidney yin deficiency, epidemic toxins attacking the throat.8 Cough with heavy and muddy sound, accompanied by white, clear, and thin phlegm: external invasion of wind-cold.1 Cough with clear and crisp sound: dry heat.10 Unable to cough forcefully, low cough sound, expectorating white foam, accompanied by shortness of breath: lung deficiency.11 Severe cough at night: kidney water deficiency.12 Severe cough at dawn: spleen deficiency, cold-dampness in the large intestine.
Gastrointestinal Sounds
Vomiting
1. Slow vomiting, weak sound, clear and thin vomitus, no odor—deficiency cold syndrome—spleen and stomach yang deficiency.
2. Forceful vomiting, loud sound, thick yellow water vomitus, sour or bitter, with odor—excess heat syndrome—stomach heat syndrome.
3. Projectile vomiting—serious condition disturbing the spirit; head trauma; internal bleeding, phlegm fluid, or tumors (increased intracranial pressure).
4. Vomiting with sour and rotten food—food stagnation in the stomach.
Hiccups
1. Frequent hiccups, loud and short, powerful sound—excess syndrome—qi stagnation, food stagnation.
2. Low and weak hiccup sound—deficiency syndrome—spleen and stomach yang deficiency, spleen and kidney yang deficiency, stomach yin deficiency.
3. New illness hiccups, powerful sound—cold evil or heat evil in the stomach.
4. Chronic severe illness hiccups that do not stop, low sound, weak and powerless—danger of stomach qi exhaustion.
5. Sudden hiccups, sound neither high nor low, without other discomfort—dietary stimulation, occasional exposure to wind-cold, self-resolving.
Warm Air
① Retained food. ② Cold. ③ Liver invading. ④ Stomach yang deficiency. ⑤ Stomach qi counterflow.
1. Overeating or drinking carbonated beverages occasionally causing warm air, without other discomfort—non-pathological, self-resolving.
2. Warm air with sour and rotten odor, accompanied by abdominal distension—excess syndrome—retained food.
3. Frequent and loud warm air, occurring due to emotions—excess syndrome—liver qi invading the stomach.
4. Frequent warm air, without sour and rotten odor—cold syndrome—cold evil invading the stomach, stomach yang deficiency.
5. Low and intermittent warm air, without sour and rotten odor—deficiency syndrome—stomach deficiency and qi counterflow, often seen in elderly or weak individuals.
Intestinal Sounds
1. Increased intestinal sounds: ① water retention. ② stomach and intestines cold deficiency. ③ external invasion of wind-cold-dampness. ④ liver and spleen disharmony.
Sounds in the abdominal area like a bag of liquid, rumbling—water sound—water retention in the stomach.
Sounds in the abdominal area, hungry and rumbling, relieved by warmth and food, worsened by hunger and cold—middle qi deficiency, stomach and intestines cold deficiency.
High-pitched and frequent intestinal sounds, abdominal fullness, diarrhea—exposure to wind-cold-dampness.
Intermittent intestinal sounds, accompanied by abdominal pain and diarrhea, pain relieved after defecation, chest and hypochondriac fullness and discomfort—liver and spleen disharmony.
2. Decreased intestinal sounds
① Intestinal qi obstruction—excess heat binding the stomach and intestines.
② Qi stagnation, insufficient passage of intestinal qi—liver and spleen disharmony.
③ Weak intestines, insufficient transmission—spleen and lung qi deficiency.
④ Qi obstruction, intestinal blockage—yin cold stagnation.
⑤ Complete absence of intestinal sounds, abdominal distension—severe condition of intestinal qi stagnation—intestinal obstruction, intestinal blockage.
