Diagnosis Through Auditory ExaminationAuditory examination is a method of diagnosing diseases based on various sounds produced by the patient, assessing their pitch, urgency, strength, and clarity.① High-pitched sounds: Indicate that the vital energy is not deficient, belonging to heat syndrome or excess syndrome.② Heavy and muddy voice: Indicates external invasion of wind-cold, unregulated lung qi, and thickened vocal cords, resulting in a heavy and muddy voice.③ Hoarse voice: A sudden hoarseness indicates a new illness caused by wind-cold binding the exterior, leading to lung qi being invaded by cold, resulting in an inability to produce sound. This is described in the “Lingshu: Worry and Anguish Without Words” as: “Sudden loss of sound occurs when cold qi invades the larynx, preventing sound from being produced.” This condition is associated with cold and excess, referred to as “metal not sounding”. Prolonged hoarseness indicates lung and kidney yin deficiency, where water cannot control fire, leading to fire scorching the lung metal. This condition is associated with deficiency, referred to as “metal breaking and not sounding”. If a long-term illness suddenly leads to hoarseness, it indicates a critical condition where the organ qi is about to fail.④ Low and short breaths, lack of energy and reluctance to speak: This is a sign of deficiency of the middle qi. Thus, the “Suwen: Pulse Essentials” states: “If one speaks softly and only recovers to speak after a whole day, this is due to qi depletion.”⑤ Confused speech: Refers to the patient being unclear in their thoughts and speaking incoherently. This is indicative of acute febrile diseases, where heat invades the heart and disturbs the spirit, leading to this condition.⑥ Zheng voice: In the late stages of illness, the patient may exhibit confusion, low speech, and repetitive content, indicating prolonged illness with declining vitality, deficiency of heart qi, and scattered spirit.⑦ Coughing sounds can distinguish between cold and heat, deficiency and excess: A clear and high cough, without illness, with a red tongue and lack of fluids, indicates dryness and heat invading the lungs, or water not nourishing wood, leading to wood-fire harming metal. A heavy and muddy cough with abundant clear phlegm indicates external invasion of wind-cold, internal stagnation of water, or deficiency of both yin and yang, leading to internal stagnation of water. A rapid and urgent cough, continuous without stopping, indicates cold evil binding the exterior, causing constriction of the qi pathways. If phlegm is expelled and the cough stops, it indicates obstruction of the qi pathways.⑧ Hiccups: This is a spasm of the diaphragm. A high-pitched, continuous hiccup indicates excess, where lung qi is unregulated, spleen qi is not moving, and liver qi is not smooth, leading to diaphragm spasms. A low-pitched hiccup occurring occasionally indicates deficiency, where spleen and kidney yang is deficient, leading to a lack of warmth and causing hiccups; liver and kidney yin deficiency can also lead to this condition.Auditory Examination in TCM: Wheezing[Auditory Examination] The characteristics of wheezing include: rapid breathing resembling asthma, high-pitched and intermittent sounds, and phlegm rattling in the throat, often occurring sporadically and difficult to cure. The “Zhengzhi Huibu: Wheezing Disease” states: “Wheezing is a long-standing phlegm asthma that frequently occurs due to internal obstruction of qi, external invasion of inappropriate factors, and phlegm that solidifies in the diaphragm, leading to obstruction of the qi pathways and producing wheezing sounds.”[Clinical Significance] In clinical practice, wheezing is often due to internal phlegm disturbance, combined with external cold, binding the muscle surface and triggering latent phlegm. It can also be caused by external evil, failing to disperse at the surface, binding the lung meridian, or due to prolonged residence in cold and damp places, or excessive consumption of sour, salty, or cold foods, which can trigger asthma. The “Yipian: Wheezing” states: “Excessive sour and salty flavors penetrate the trachea, leading to phlegm accumulation, and upon encountering wind-cold, qi stagnation and phlegm obstruction will occur.” The “Classification of Syndromes and Treatments: Wheezing Symptoms” states: “Generally, new illnesses are often excess, while long-standing illnesses are often deficient; a throat that sounds like snoring indicates deficiency, while a sound like a water chicken indicates excess. If it occurs with wind-cold, it is cold wheezing, indicating excess.”[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; for those who have suffered from external evil and failed to disperse at the surface, leading to stagnation and transformation into heat, the treatment should disperse the lungs, clear heat, transform phlegm, and stop wheezing, using Yue Bi Jia Ban Xia Tang with modifications.Auditory Examination in TCM: Soliloquy[Auditory Examination] The characteristic of soliloquy is: talking to oneself, murmuring 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 syndrome. The “Popular Treatise on Cold Damage” states: “When a patient talks to themselves without knowing the beginning or end, it is due to excessive thinking harming the spirit.”[Treatment Method] To tonify and nourish heart qi, use formulas like Gan Mai Da Zao Tang.Auditory Examination in TCM: Mad Speech[Auditory Examination] The characteristic of mad speech includes: laughing and scolding, incoherent speech, singing loudly, and running away while discarding clothes. This may include delusions and erratic speech, singing loudly, discarding clothes, and a flushed face, or not eating for several days, often indicating excessive yangming heat; signs of irritability and anger, incoherent speech, or alternating between singing and laughing, often indicate liver-gallbladder qi stagnation; signs of irritability and anger, erratic behavior, and incessant scolding or destruction of property often arise from phlegm-fire disturbance; signs of alternating between excessive speech and silence, or incessant scolding and restlessness, often indicate blood stasis internally obstructing the heart.[Clinical Significance] Excessive yangming heat leading to madness is due to evil invading the yangming, causing heat to bind in the yangming. The “Suwen: Yangming Pulse Explanation” states: “The limbs are the foundation of all yang; when yang is excessive, the limbs are full, and when full, one can climb high… Excessive heat in the body causes one to discard clothes and want to run… Excessive yang causes one to speak erratically and scold without regard for kinship, and one does not want to eat, hence the erratic behavior.” The “Suwen: Discussion on Syncope” states: “When yangming is in syncope, one may exhibit madness and want to run, with abdominal fullness and inability to lie down, a flushed and hot face, and erratic speech…” Liver-gallbladder qi stagnation leading to madness is due to emotional injuries causing liver-gallbladder qi stagnation, which transforms into fire and disturbs the spirit; phlegm-fire disturbance leading to madness is due to excessive heart and stomach fire scorching fluids, leading to phlegm-fire binding and disturbing the heart or blood stasis obstructing the heart.[Treatment Method] For madness due to excessive yangming heat, the treatment should clear and drain the yangming, using Liang Tuo San or Da Cheng Qi Tang; for madness due to liver-gallbladder qi stagnation, the treatment should clear and soothe the liver and gallbladder, using Long Dan Xie Gan Tang combined with Dan Zhi Xiao Yao San; for madness due to phlegm-fire disturbance, the treatment should eliminate phlegm and lower fire, using Meng Shi Gun Tan Wan; for madness due to blood stasis obstructing the heart, the treatment should invigorate blood and resolve stasis, using Tao Ren Cheng Qi Tang or Di Dang Tang.Auditory Examination in TCM: Belching[Auditory Examination] Belching is referred to as “yi” in the “Neijing”. In the “Shanghan Lun”, it is called “yi qi”. The “Jingyue Quanshu” states: “Yi refers to the breath of fullness, that is belching.” Belching refers to the sound produced by gas rising from the stomach. When belching is accompanied by a sour and rotten smell, or a muffled sound, or if it occurs infrequently, it is often caused by food stagnation in the stomach; frequent belching with a weak sound and vomiting clear water often indicates spleen and stomach deficiency.[Clinical Significance] Belching caused by food stagnation in the stomach is often due to irregular eating habits, leading to stagnation in the stomach, obstructing the qi mechanism, causing stomach qi to rise; belching 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; belching caused by spleen and stomach deficiency is often due to physical weakness or post-illness imbalance, leading to spleen and stomach qi deficiency, resulting in disordered intake and stomach qi disharmony.[Treatment Method] For belching caused by food stagnation in the stomach, use formulas that promote digestion and guide stagnation, such as Bao He Wan; for belching caused by liver qi invading the stomach, use formulas that soothe the liver and regulate qi, such as Chai Hu Shu Gan Tang; for belching caused by spleen and stomach deficiency, use formulas that tonify the spleen and stomach, such as Li Zhong Tang.Auditory Examination in TCM: Hiccups[Auditory Examination] Hiccups, commonly known as “dabei”, were referred to as “huo” in ancient times. The characteristics include: gas rising and bursting from the throat, with frequent short sounds that cannot be stopped. The sound of hiccups can vary in frequency and intensity, with intervals that are irregular, sometimes occurring every few minutes or half an hour, and sometimes occurring continuously for several times before stopping.[Clinical Significance] The initial onset of hiccups, with loud and forceful sounds, often indicates excess; intermittent hiccups with low and long sounds, indicating weak qi, often suggest deficiency. A deep and slow sound, with cold limbs and loose stools, often indicates a cold syndrome; a loud and short sound, with a flushed and hot face, and thirst, often indicates a heat syndrome. The onset of hiccups is often related to the stomach’s inability to harmonize and descend. The “Lingshu: Questions on the Mouth” states: “When food enters the stomach, the stomach qi rises to the lungs; if there is a problem, cold qi and the new food qi both return to the stomach, causing confusion between the new and old, and true evil attacks, leading to a reversal of qi, which then emerges from the stomach, resulting in hiccups.” The Sui Dynasty’s Chao Yuanfang believed this condition is caused by spleen and stomach weakness combined with wind evil. The “Zhubing Yuanhou Lun: Hiccups” states: “The main causes of hiccups are three: first, cold hiccups; second, heat hiccups; third, hiccups due to deficiency.”[Treatment Method] For hiccups with a loud and strong sound, and a slippery and solid pulse, it is advisable to clear and descend; for those with a small sound and weak pulse, it is advisable to warm and tonify. Cold hiccups can be warmed or dispersed, while heat hiccups can be cleared or descended. For hiccups caused by qi stagnation and phlegm obstruction, it is advisable to transform phlegm and smooth the qi. For hiccups caused by weakness of yang qi, it is advisable to warm and tonify the spleen and kidney; for those caused by insufficient stomach yin, it is advisable to nourish the stomach and generate fluids.Auditory Examination in TCM: Vomiting[Auditory Examination] There are three types of vomiting: with sound and material is vomiting; without sound and material is regurgitation; with sound but no material is dry heaving, also known as “huo”. 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, quantity of the vomit, and accompanying symptoms. Generally, vomiting due to excess heat is characterized by forceful vomiting, high-pitched sounds, and the vomit being mucus, yellow water, or sour or bitter. Vomiting due to deficiency cold is characterized by gentle vomiting, low sounds, and the vomit being mostly clear water or phlegm. Vomiting that occurs rapidly from the mouth is known as projectile vomiting. Projectile vomiting can be classified into external and internal causes. External causes are often seen in febrile diseases during spring warmth, summer dampness, etc., where heat evil disturbs the stomach qi, causing it to rise; internal causes are often due to phlegm, blood stasis, or abdominal masses. In clinical practice, vomiting should be distinguished from dry heaving and nausea, as dry heaving refers to the desire to vomit without material, or only a small amount of saliva is produced. Vomiting and nausea often occur together, with nausea possibly being an early symptom of vomiting, while vomiting often accompanies nausea, but nausea does not necessarily lead to vomiting. Ancient medical texts have extensively discussed the causes and treatments of vomiting. For example, the “Shen’s Book of Respecting Life: The Source of Vomiting” states: “Vomiting bitter water is due to evil in the gallbladder, which ascends to the stomach, causing the reverse flow of bile, resulting in bitter water being vomited. Vomiting clear water indicates a desire to drink water, but water enters and is vomited, known as water reversal. Vomiting saliva indicates spleen deficiency, which cannot contain fluids, leading to saliva being expelled… However, there are general treatment methods for vomiting.”[Clinical Significance] Common patterns of vomiting include the following: cold evil directly invading the spleen and stomach, as stated in the “Shanghan Guanzhu Ji”: “When stomach qi encounters cold, it reverses”; summer dampness vomiting, characterized by vomiting, abdominal distension, poor appetite, heavy limbs, and sticky tongue coating; food stagnation vomiting is more common, resembling acute gastritis in modern medicine, characterized by sudden onset, vomiting, aversion to food, and abdominal distension and pain, with thick and greasy tongue coating and wiry pulse; vomiting due to stomach cold is often seen in those with spleen and stomach yang deficiency or after exposure to cold, with a long course of illness, often presenting as deficiency or mixed deficiency-cold, characterized by vomiting with cold limbs, thin body, abdominal pain, poor appetite, fatigue, and relief from warmth, worsening with cold, with pale tongue and white coating, and thin weak pulse; vomiting due to stomach heat is often caused by irregular eating habits, such as excessive consumption of rich foods, alcohol, and spicy items, leading to damp-heat accumulating in the middle burner, characterized by vomiting with abdominal fullness; bad breath, constipation, sour regurgitation, and thick yellow tongue coating, with rapid pulse; liver-stomach disharmony vomiting is characterized by frequent vomiting of sour bitter water, abdominal fullness, and pain in the hypochondrium, with bitter mouth, thick tongue coating, and wiry pulse; stomach yin deficiency vomiting is often seen in the later stages of febrile diseases, with insufficient stomach yin, stomach qi rising, characterized by vomiting with dry mouth and desire to drink, lack of appetite, red tongue with little fluid, and thin rapid pulse.[Treatment Method] For vomiting due to cold evil invading the stomach, the treatment should be warming and dispersing, using spicy warm formulas to stop vomiting; for summer dampness vomiting, the treatment should be aromatic and transform dampness, using formulas like Huo Xiang Zheng Qi San with modifications; for food stagnation vomiting, the treatment should promote digestion and guide stagnation, using Bao He Wan with modifications; for vomiting due to stomach cold, the treatment should warm the stomach and stop vomiting, using Fu Zi Li Zhong Tang with modifications; for vomiting due to stomach heat, the treatment should clear heat and eliminate dampness, using Wen Dan Tang with modifications; for liver-stomach disharmony vomiting, the treatment should soothe the liver and harmonize the stomach, using Chai Hu Shu Gan San; for vomiting due to stomach yin deficiency, the treatment should nourish stomach yin, clear fire, and stop vomiting, using Yi Guan Jian with modifications. The above methods are for reference only and must be combined with clinical conditions to select appropriate treatment methods.Auditory Examination in TCM: Coughing[Auditory Examination] Coughing is a manifestation of lung qi failing to descend and lung qi rising, thus it is often seen in lung diseases, but it is also closely related to other organs. As stated in the “Suwen: Cough Theory”: “All organs can cause coughing, not just the lungs.” The sound of coughing varies according to the type of syndrome, such as heavy and muddy cough, low and weak cough, dry cough, or paroxysmal cough. Coughing, coughing, and coughing have historically been differentiated. The “Suwen: Disease Mechanism and Qi Should Be Preserved” states: “Coughing refers to having sound without phlegm, indicating lung qi injury and lack of clarity. Coughing is soundless but has phlegm, indicating spleen movement causing phlegm. Coughing refers to having phlegm and sound, indicating injury to lung qi and movement of spleen dampness, leading to coughing as a result.” In clinical practice, these three often occur together, so there is no need to differentiate. Coughing is relatively simple to diagnose through auditory examination, but differentiating the type of cough through auditory examination can be somewhat challenging. For example, a dry cough is often due to external dryness or lung yin deficiency, while a heavy and muddy cough is often due to internal dampness obstructing the lungs, or cold evil invading the lungs, etc. Therefore, careful differentiation of the sound of coughing can guide correct clinical medication.[Clinical Significance] The first step in auditory examination is to distinguish whether it is an external or internal cough. External coughs have a sudden onset, with clear pathogenic causes, and a short course of illness, commonly seen in wind-cold, wind-heat, summer dampness, and dry evil invading the lungs, each with its characteristics. Wind-cold invading the lungs can be seen with heavy cough and clear nasal discharge, chills and fever, itchy throat, heavy body, thin white tongue coating, and floating tight pulse; wind-heat invading the lungs can be seen 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 is characterized by heavy and muddy cough, thick and sticky phlegm, either white or yellow, accompanied by fullness in the abdomen, poor appetite, fatigue, sweating, white greasy tongue coating, and slippery rapid or slippery pulse; dry evil invading the lungs can be seen with dry cough, little phlegm or blood-streaked phlegm, dry and painful throat, thin yellow tongue coating, and floating rapid pulse; internal coughs have a slower onset, 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 the lungs, each with its characteristics. Lung-spleen qi deficiency can be seen with low cough, shortness of breath, thin white phlegm, pale or swollen face, fatigue, easy sweating, and poor appetite, with pale tongue and thin white coating, and weak pulse; lung yin deficiency can be seen with dry cough, or blood-streaked phlegm, persistent cough, little sticky phlegm, dry mouth and throat, or hoarseness, five hearts heat, night sweats, chest pain, red tongue with little coating, and thin rapid pulse; kidney yang deficiency can be seen with low and muddy cough, clear and thin phlegm, shortness of breath, worsening with exertion, cold limbs, or swelling of the limbs, with pale tongue and thin coating, and weak pulse; liver fire invading the lungs can be seen with cough with qi reversal, unproductive phlegm, pain in the hypochondrium, dry throat, irritability, red tongue with thin yellow coating, and wiry rapid pulse. In clinical practice, external coughs are often seen as excess, while internal coughs are often seen as deficiency.[Treatment Method] The treatment for coughing varies according to the type. For external wind-cold cough, the treatment should disperse wind and cold, clear the lungs, and stop coughing, using formulas like Xing Su San with modifications; for external wind-heat cough, the treatment should disperse wind and heat, clear the lungs, and stop coughing, using Sang Ju Yin with modifications; for summer damp cough, the treatment should clear summer heat and transform dampness, clear the lungs, and stop coughing, using Yin Xiang San with modifications; for dry evil cough, the treatment should moisten dryness and stop coughing, using Sang Xing Tang with modifications; for lung-spleen qi deficiency cough, the treatment should tonify the lungs, strengthen the spleen, benefit qi, and stop coughing, using Si Jun Zi Tang combined with Yu Ping Feng San with modifications; for lung yin deficiency cough, the treatment should nourish yin, moisten the lungs, and stop coughing, using Bai He Gu Jin Tang with modifications; for kidney yang cough, the treatment should warm and tonify kidney yang, and stop coughing, using Liu Wei Di Huang Wan with modifications; for liver fire invading the lungs cough, the treatment should clear the liver and drain fire, moisten the lungs, and stop coughing, using Qing Jin San with modifications. The above treatment methods are for reference only, and clinical practice must select appropriate treatment methods based on specific conditions.Auditory Examination in TCM: Sighing[Auditory Examination] Sighing, also known as “tanxi”, refers to the patient feeling a sense of chest tightness and discomfort, often letting out long sighs to feel comfortable. This symptom must be distinguished from “belching” during auditory examination, as belching refers to gas rising from the stomach and producing sound, historically known as “yi” or commonly referred to as “belching”. In clinical practice, it is not difficult to differentiate. Sighing is often caused by emotional distress, leading to liver qi stagnation, but there are also cases of deficiency, though these are less common. The “Zhengzhi Zhunsheng: Miscellaneous Diseases” states: “Huangdi asked: What qi causes sighing? Qibo replied: Worry and anxiety cause the heart to be anxious, leading to qi stagnation, which is not beneficial, hence sighing occurs to release it… Furthermore, the gallbladder is the pathway of the Shaoyang meridian, which, when disturbed, causes bitter mouth and frequent sighing. The diagnosis should consider deficiency and excess, cold and heat, and take appropriate measures accordingly.”[Clinical Significance] Clinically, it is essential to distinguish between deficiency and excess in sighing. Deficiency is often due to qi deficiency, characterized by frequent sighing but insufficient qi to continue, often seen with deep inhalation followed by sighing, accompanied by shortness of breath, spontaneous sweating, fatigue, lack of energy, poor appetite, pale tongue, and thin white coating, with weak pulse. Excess is often due to liver qi stagnation, characterized by long sighs, feeling relieved after sighing, with a sense of chest tightness, irritability, breast tenderness, menstrual pain, irregular menstruation, poor appetite, bitter mouth, dizziness, and headache, with 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 benefit qi, using formulas like Bu Zhong Yi Qi Tang or Bao Yuan Tang with modifications. For sighing due to liver qi stagnation, the treatment should soothe the liver and resolve stagnation, using formulas like Chai Hu Shu Gan San or Jia Wei Xiao Yao San with modifications. The above formulas are for reference only, and clinical practice must combine other symptoms to select appropriate treatment methods.Auditory Examination in TCM: Shortness of Breath[Auditory Examination] Shortness of breath, also referred to as “qi weak”, indicates weak breathing and lack of strength in speech, often occurring in a continuous manner. This is primarily due to insufficient organ qi, especially lung and kidney qi deficiency. In cases of lung qi deficiency, it is often accompanied by weak cough, excessive phlegm, and other symptoms; in cases of kidney qi deficiency, it is often accompanied by bone soreness, fatigue, and other manifestations. In ancient literature, it is believed that shortness of breath and “shortness of breath” are not entirely the same. For example, the “Yizong Jinjian: Essentials of Miscellaneous Diseases” states: “Shortness of breath refers to being unable to continue breathing; shortness of breath refers to having little breath but unable to express oneself.” The “Miscellaneous Diseases: General Principles” states: “Shortness of breath is due to insufficient organ qi.” “Shortness of breath” can be classified into deficiency and excess; the deficiency type is due to qi deficiency, while the excess type is due to qi stagnation.[Clinical Significance] Shortness of breath is often seen in the following syndromes. Heat injuring yin shortness of breath is often accompanied by lethargy, fatigue, sweating, dry mouth, thin tongue coating, or no coating, with thin rapid pulse; spleen qi deficiency shortness of breath is often accompanied by lethargy, poor appetite, fatigue, loose stools, pale yellow complexion, pale tongue, and weak pulse; heart qi deficiency shortness of breath is often accompanied by palpitations, spontaneous sweating, mental confusion, fatigue, pale tongue, and weak pulse; lung qi deficiency shortness of breath is often accompanied by spontaneous sweating, low speech, weak breathing, shortness of breath with exertion, fatigue, and susceptibility to colds, with pale tongue and weak pulse. Shortness of breath is often associated with weakness of the lungs, heart, and kidneys.[Treatment Method] For shortness of breath due to heat injuring yin, the treatment should clear the lungs and stomach, benefit qi, using formulas like Zhu Ye Shi Gao Tang with modifications; for shortness of breath due to summer heat, the treatment should clear summer heat, benefit qi, and nourish yin, using formulas like Qing Shu Yi Qi Tang with modifications; for shortness of breath due to spleen qi deficiency, the treatment should tonify spleen qi, using formulas like Liu Shen San or Bu Zhong Yi Qi Tang with modifications; for shortness of breath due to heart qi deficiency, the treatment should tonify heart qi, calm the spirit, using formulas like An Shen Ding Zhi Wan or Zhi Gan Cao Tang with modifications; for shortness of breath due to lung qi deficiency, the treatment should tonify lung qi, using formulas like Bu Fei Tang or Bu Zhong Yi Qi Tang combined with Yu Ping Feng San. The above treatment methods are for reference only and must be combined with other symptoms to select appropriate treatment methods.Auditory Examination in TCM: Confused Speech[Auditory Examination] Confused speech is characterized by unclear thoughts, incoherent speech, and nonsensical utterances. This is often associated with excess syndrome, primarily due to heat invading the heart and disturbing the spirit. It is commonly seen in the high fever stage of warm diseases or other febrile diseases. The “Suwen: Heat Theory” refers to this as “confused speech”. The “Classification of Syndromes and Treatments” refers to it as “confused speech”. The “Suwen: Qi Exchange and Change” describes it as “delirium”; however, delirium, in addition to having unclear thoughts and incoherent speech, often presents with emotional fear, excitement, and agitation. This condition must be distinguished from “erroneous speech”, “mad speech”, and “Zheng voice”. Erroneous speech occurs when the mind is clear, but speech is disordered or the speaker realizes they have spoken incorrectly; mad speech occurs due to excessive heat or phlegm-fire disturbance, where the patient speaks erratically, scolding incessantly, discarding clothes, or singing loudly; Zheng voice occurs when the mind is clouded, speech is weak, low, and disconnected, often seen in critical stages of internal damage to heart qi, leading to scattered spirit.[Clinical Significance] The abnormal manifestations of confused speech must first distinguish between deficiency and excess. This condition is primarily seen in excess heat, where the patient often exhibits high fever, rapid pulse, and other signs of excess heat. In contrast, deficiency cold is less common. Generally, excess heat is often seen in the acute phase of illness, where the evil qi is strong, and the vital qi is not weakened, making it easier to treat; while deficiency cold is often seen in the later stages of illness, where the vital qi is weakened, making it more difficult to treat. The “Jingyue Quanshu: Discussion on Warm Diseases” states: “Confused speech is most common in those with deficiency; it should not be present. Therefore, if there is a slight fever and a rapid pulse, it indicates life; if the heart is restless and the pulse is weak and rapid, it indicates death. Therefore, if there is confusion due to deficiency, it is a sign of great danger and should not be ignored.” In clinical practice, excess heat syndrome often presents with: heat-accumulated yangming confused speech, yangming organ excess confused speech, heat toxin disturbing confused speech, damp-heat obscuring confused speech, heat invading the heart and nourishing confused speech, heat in the blood causing confused speech, phlegm-fire disturbing confused speech, and blood stasis disturbing the heart causing confused speech. Deficiency cold syndrome is less common: excess yin obstructing yang confused speech, and yin exhaustion leading to yang collapse confused speech. In clinical practice, the above syndromes, in addition to the confused speech manifestations, must also consider other diagnostic findings, integrating the four diagnostic methods to analyze and make a reasonable diagnosis before treatment can be effective.[Treatment Method] Confused speech is often seen in excess heat, so treatment should primarily focus on clearing heat and expelling evil. If there is excess heat, the treatment should focus on clearing heat and generating fluids; if there is heat toxin disturbing, the treatment should focus on clearing heat and detoxifying; if there is damp-heat obscuring, the treatment should focus on expelling dampness and clearing heat; if there is heat in the blood causing confused speech, the treatment should focus on clearing heat and cooling the blood; if there is phlegm-fire disturbing or blood stasis disturbing the heart, the treatment should focus on clearing heat and transforming phlegm or invigorating blood and resolving stasis. In contrast, deficiency cold causing confused speech is less common in clinical practice. In treatment, if there is excess yin obstructing yang, the treatment should focus on breaking yin and restoring yang; if there is yin exhaustion leading to yang collapse, the treatment should focus on restoring yang and saving the reverse. In all cases, the treatment must be based on comprehensive analysis of other diagnostic findings to achieve effective results.Auditory Examination in TCM: Stomach Sounds[Auditory Examination] Stomach sounds are characterized by gurgling sounds in the abdomen.[Clinical Significance] Clinical observation of stomach sounds in the epigastric region, like a bag of liquid, vibrating with sound, occurs when phlegm and fluids are retained in the stomach; if the sound is heard in the abdomen, like a hungry stomach, it decreases with warmth or food, and increases with cold or hunger, it often indicates middle deficiency and the stomach not being solid; if the sound is like thunder in the abdomen, it often indicates the dominance of wind, cold, and dampness.[Treatment Method] For stomach sounds caused by phlegm and fluids retention, the treatment should warm the spleen and transform fluids, using Ling Gui Zhu Gan Tang combined with Xiao Ban Xia Tang; for stomach sounds caused by middle deficiency, the treatment should warm the middle and transform fluids, using Ling Gui Zhu Gan Tang; for stomach sounds caused by dominance of wind, cold, and dampness, the treatment should warm the middle and disperse cold, using Fu Zi Jiang Mi Tang with modifications.Auditory Examination in TCM: Wheezing[Auditory Examination] Wheezing is characterized by difficulty in breathing, shortness of breath, and in severe cases, the patient may open their mouth and raise their shoulders, with flaring nostrils and an inability to lie flat. Wang Kentang’s “Zhengzhi Zhunsheng: Miscellaneous Diseases” states: “Wheezing is characterized by rapid and shallow breathing, with a high-pitched sound and a feeling of fullness in the chest, where the patient feels they cannot contain their breath, and only feels relief when exhaling.” The “Jingyue Quanshu: Wheezing” states: “Excess wheezing is characterized by prolonged and abundant breath; deficient wheezing is characterized by short and weak breath. Excess wheezing is characterized by chest fullness and coarse breath, with a high-pitched sound and a feeling of fullness in the chest, while deficient wheezing is characterized by shortness of breath and a feeling of anxiety, with a low sound and a feeling of breathlessness, where the patient feels they cannot breathe deeply, and only feels relief when they can take a long breath.”[Clinical Significance] In clinical practice, wheezing is often seen with coarse breath and high-pitched sounds, where the patient feels they cannot contain their breath, indicating excess heat or phlegm retention in the lungs. In contrast, wheezing with low sounds and anxiety indicates deficiency of lung and kidney qi, where the patient feels they cannot breathe deeply, and only feels relief when they can take a long breath.[Treatment Method] For wheezing due to excess heat, the treatment should clear heat and transform phlegm, using formulas like Sang Bai Pi Tang; for wheezing due to phlegm retention, the treatment should eliminate phlegm and clear the lungs, using formulas like San Zi Yang Qin Tang or Er Chen Tang; for wheezing due to lung deficiency, the treatment should tonify lung qi, using formulas like Sheng Mai San or Bu Fei Tang; for wheezing due to kidney deficiency, the treatment should tonify kidney qi, using formulas like Jin Gui Shen Qi Wan or Shen Qi Wan with modifications. The above treatment methods are for reference only and must be combined with other symptoms to select appropriate treatment methods.