In the written examination for practicing physicians, the subject of diagnosis is a key focus throughout the exam, making it quite challenging to master. The knowledge points of auscultation and olfaction are complex and provide a foundation for differential diagnosis. The teacher has compiled a summary of 20 key points for students to pay attention to during their studies:
1. Concept of Auscultation and Olfaction: Auscultation and olfaction are methods to understand health status and diagnose diseases through listening to sounds and smelling odors.
2. Main Content of Listening to Sounds: Listening to sounds refers to discerning the pitch, strength, clarity, and urgency of the patient’s voice, language, and breath, as well as sounds like coughing, vomiting, and bowel sounds, to assess the function of the organs and the nature of the disease.
3. Characteristics of Normal Sounds: Normal sounds are characterized by natural vocalization, harmonious tone, fluent speech, and coherent responses, where words and meanings align.
4. Significance of Normal Sounds: They indicate sufficient qi and blood, and normal function of the vocal organs and internal organs.
5. Characteristics of Abnormal Sounds: Abnormal sounds refer to changes in voice, language, and other bodily sounds that reflect disease, excluding normal physiological variations and individual differences.
6. New Disease with Excess Syndrome (Jin Shi Bu Ming): External invasion of wind-cold or wind-heat, or phlegm-damp obstruction, leads to obstruction of the respiratory passages, causing lung qi to fail to disperse and clear functions to be impaired.
7. Chronic Disease with Deficiency Syndrome (Jin Po Bu Ming): Injury to essence and qi, lung and kidney yin deficiency, and deficiency fire scorching the lungs lead to dryness of fluids and damage to the lungs, making it difficult to produce sound.
8. Special Cases of Loss of Voice: Sudden anger or prolonged loud speaking: injury to qi and yin; loss of voice during pregnancy is termed ‘zi yin’: a physiological phenomenon.
9. Delirium: Characterized by unclear consciousness, incoherent speech, and loud voice, belonging to heat syndrome and excess syndrome: the mechanism involves warm-heat pathogens entering the pericardium, or excess syndrome of the yangming organ, or phlegm-heat disturbing the mind.
10. Zheng Voice: Characterized by unclear consciousness, repetitive speech, and low voice, the mechanism involves weakness of the organ qi and scattered spirit, belonging to deficiency syndrome: late-stage disease or critical condition.
11. Soliloquy: Characterized by talking to oneself, mumbling continuously, stopping when seeing others, and lacking continuity, the mechanism involves weak heart qi and insufficient spirit; qi stagnation producing phlegm, obscuring the heart orifices, belonging to yin syndrome: epilepsy and depression.
12. Stuttering: Characterized by clear consciousness, normal thinking but difficulty or unclear articulation, the mechanism involves wind-phlegm obstructing the channels, belonging to a precursor or sequela of stroke.
13. Miscommunication: The patient is clear-minded but speaks incoherently, realizing their mistakes after speaking. In deficiency syndrome, this occurs in chronic illness or elderly patients with weak bodies; in excess syndrome, the mechanism involves phlegm-damp, blood stasis, or qi stagnation obstructing the heart orifices.
14. Cough with Excess Syndrome: Characterized by heavy, turbid, and muffled cough sounds, the mechanism involves cold phlegm and damp turbidity accumulating in the lungs, causing the lungs to fail to disperse and descend.
15. Cough with Deficiency Syndrome: Characterized by light, clear, and low cough sounds, the mechanism involves lung qi deficiency, failing to disperse and descend.
16. Cough with Heat Syndrome: Characterized by non-loud cough sounds, thick yellow phlegm that is difficult to expel, the mechanism involves heat pathogens invading the lungs, scorching lung fluids.
17. Paroxysmal Cough (Whooping Cough): Characterized by short, abrupt cough sounds with a crowing echo, the mechanism involves wind pathogens and phlegm-heat colliding.
18. Diphtheria: Characterized by cough sounds resembling a dog’s bark, accompanied by hoarseness and difficulty inhaling, the mechanism involves lung and kidney yin deficiency, and epidemic toxins attacking the throat.
19. Excess Asthma: Characterized by sudden onset, deep and prolonged breathing, coarse and loud sounds, with a quick exhalation, the mechanism involves wind-cold attacking the lungs, phlegm-heat obstructing the lungs, or phlegm-damp accumulating in the lungs (lungs failing to disperse and descend, water qi invading the heart).
20. Deficiency Asthma: Characterized by slow progression, shallow and rapid breathing, difficulty sustaining breaths, weak and low sounds, with deep inhalation providing relief, worsening with movement, the mechanism involves lung and kidney deficiency, qi failing to regulate; heart yang qi deficiency.
