The Olfactory Diagnosis in Traditional Chinese Medicine—Sweat Odor
Normal human sweat does not have a strong irritating odor; it is a metabolic product of physiological activities, formed by the evaporation of yang qi (阳气) and body fluids. In pathological conditions, sweat can also be a pathway for evil qi (邪气) to exit the body. Due to different external pathogens, the odor of sweat can vary.
① Fishy Odor
[Olfactory Diagnosis] The sweat of the patient has a fishy or fishy-smelling odor, and may even be sticky.
[Clinical Significance] A fishy or fishy armpit odor in sweat is often caused by damp-heat accumulating in the skin. As stated in the “Simple Methods of External Diagnosis in TCM: Olfactory Method”: “If the sweat is thick and sticky, with a fishy odor or yellow color, it indicates that wind-damp has long accumulated in the skin, causing the body fluids to transform. This is common in diseases such as warm-heat, damp-heat, summer heat, and jaundice.”
[Treatment Method] Typically, methods to clear heat and resolve dampness are used, such as Gan Lu Xiao Du Dan (甘露消毒丹) and Yin Chen Song Tang (茵陈嵩汤).
② Sour Odor
[Olfactory Diagnosis] The patient has a large amount of sweat with a sour, rotten odor.
[Clinical Significance] A sour sweat odor is commonly seen in patients with wind-damp-heat or those who have been taking salicylic acid, aspirin, or other antipyretic analgesics for a long time, or in individuals with excess heat in the qi level and long-term yin deficiency.
[Treatment Method] The former often uses methods to dispel wind and overcome dampness, such as Du Huo Ji Sheng Tang (独活寄生汤) with modifications. The latter can use methods to clear heat, drain fire, and nourish yin, such as Bai Hu Tang (白虎汤) and Zhi Bai Di Huang Tang (知柏地黄汤) with modifications.
③ Foul Odor
[Olfactory Diagnosis] The patient’s sweat has a foul odor, or it may only be the sweat from the armpits that has a foul odor, making the person unapproachable, also known as “fox odor” or “axillary odor.”
[Clinical Significance] This is often caused by plague or heat toxins invading the body. Fox odor is often due to internal damp-heat stagnation or hereditary factors.
[Treatment Method] The former should clear plague and detoxify, using Pu Ji Xiao Du Yin (普济消毒饮) with modifications. The latter can be treated with external applications of Ku Ji Fen (枯矶粉) or Mi Tuo Seng San (密陀僧散) with Ku Ji Fen, or through surgical or laser treatments.
④ Urine Odor
[Olfactory Diagnosis] The patient’s sweat has a urine-like odor.
[Clinical Significance] This is often seen in patients with yin water syndrome (阴水证), and is often a sign of a critical condition. It is caused by long-term kidney yang deficiency, which cannot transform qi and move water, leading to turbid qi not being expelled, and toxins being excreted through sweat.
[Treatment Method] Treatment should be based on the specific clinical condition, selecting appropriate methods and prescriptions.
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