Listening and olfaction means , listening to various sounds and noises made by the patient and smelling the odor and excreta from the body of the patient so as to understand the pathological conditions of the patient. Since various sounds and noises as well as odor all come from the activities of the viscera, listening to sounds and smelling odors are helpful for examining the morbid conditions
of the viscera.
Listening to sounds
Voice is produced by vibration of air in the cavity and tube organs. The voice made in the mouth is in close relation to the lung, throat, epiglottis, tongue, teeth, lips and nose. All kinds of voice (sounds) are made by means of the activities of the lung and the lung governs qi and respiration. That is why the ancient people believed that" the lung is the governor of qi and the kidney is the root of qi", "the lung is the door of voice" and "the kidney is the root of voice". Since the pathological changes of the other viscera may affect the functions of the lung and the kidney in producing sounds and because the other viscera are under the domination of the heart spirit, listening to sounds not only can examine the conditions of the organs directly related to voice, but also further diagnose visceral disease according to the changes of voice (sounds).
In listening to speech, cares should be made to detect whether the speech is strong or weak, whether the words are coherent and whether the expression is clear and fluent. The speech of normal people is natural in pronunciation, smooth in tone, clear in expression and consistent in words. Since the viscera, constitution and playsical building are different from person to person, the voice is either high or low, loud or small and clear or full. For example, male voice is low and full, female voice is high and clear, children's voice is sharp and melodious, and voice of the aged is low and deep. Generally speaking, high and sonorous voice in healthy people is a manifestation of sufficiency of primordial qi and pulmonary qi.
There is close relation between speech and emotions.For example, the voice in joy is lively and cheerful, the voice in rage is stern and quick, the voice in sorrow is sad and disjointed. These are the normal changes of voice.
The abnormal changes of voice are either strong or weak, heavy or deep, hoarseness or aphonia.
Strong and weak voice: Generally speaking, sonorous voice with restlessness and polylogia indicates sthenia syndrome and heat syndrome; low, weak and disjointed voice with quietness and oligologia indicates asthenia syndrome and cold syndrome.
Deep and heavy voice: Deep and heavy voice is usually caused by failure of pulmonary qi to disperse and obstruction of the nose due to exogenous pathogenic wind, cold and dampness, or by obstruction of the airway due to stagnation of dampness.
Hoarseness and aphonia: Hoarseness means harshvoice, while aphonia means complete loss of voice. Hoarseness is similar to aphonia in pathogenesis. If hoarseness is very serious, it will develop into aphonia. Hoarseness or aphonia in new disease pertains to sthenia syndrome due to exogenous pathogenic factors attacking on the lung or due to failure of the pulmonary qi to disperse resulting from stagnation of phlegm. Such a pathological condition is known as "a solid bell cannot ring (dysphonia or hoarseness due to sthenia syndrome of the lung)". Hoarseness or aphonia in a chronic disease pertains to asthenia syndrome due to exhaustion of fluid and impairment of the lung caused by asthenia of lung and kidney yin and asthenia-fire scorching metal (lung). Such a pathological condition is known as "a broken bell cannot ring (hoarseness due to impaired function of the lung)".Hoarseness or aphonia may be caused by prolonged speaking or singing or shouting with rage, which impairs beth qi and yin and deprives the throat of moisture. Hoarseness at the advanced stage of pregnancy is due to pressure of the fetus on the uterine collaterals which obstructs the kidney meridian and prevents kidney essence to be transported to the upper. It will heal automatically after delivery.
Delirium: Delirium means raving with high and sonorous voice in coma. Such a morbid condition pertains to sthenia syndrome due to heat disturbing the mind seen in invasion of pathogenic factors into the pericardium in seasonal febrile disease or sthenia syndrome of yangming fu-organ.
Fadin9 murmuring: Fading murmuring is marked by unconsciousness, repeated and incoherent murmuring in a low voice. It is caused by excessive consumption of heart qi and is an asthenia syndrome of mental derangement, usually seen in patients with chronic and prolonged diseases.
Soliloquy: Soliloquy is marked by mental depression, talking to oneself, murmuring and incoherent speech, usually caused by coagulation of phlegm confusing the mind or by severe impairment of heart qi. Such a morbid condition is usually seen in epilepsy.
Raving: Raving is marked by manic movement, shouting and sonorous voice usually due to phlegm fire attacking the heart.
Paraphasia: Paraphasia means that the patient speaks nonsense in consciousness and is aware of it afterwards. Such a morbid state is often due to insufficiency of heart qi and malnutrition of the spirit. Such a morbid condition is often seen among patients with chronic disease or of the aged.
Slurred speech is marked by unclear and slow expression without fluency, usually seen in wind stroke or sequela of wind stroke. It is due to obstruction of the collaterals by wind-phlegm and malnutrition of the tongue musculature and vessels, which make the tongue inflexible. Slurred speech at the advanced stage of febrile disease is due to heat consuming yin and malnutrition of the tongue.
The lung governs qi and respiration, while the kidney governs the reception of qi. So the disorders of respiration are usually due to the pathological changes of the lung and kidney. The following is a brief description of the abnor-mal changes in respiration.
Rapid and weak respiration
Generally speaking, the disease with acute onset and rapid breath and high voice pertains to heat syndrome and sthenia syndrome; the disease with long dura tion, weak breath and shortness of breath in movement pertains to asthenia syndrome and cold syndrome.
Dyspnea and bronchial wheezing
Dyspnea refers to difficulty in breath, shortness and rapidity in breath, or even opening the mouth, raising the shoulders and flapping the nose wings in breathing as well as inability to lie flat. Dyspnea is either of asthenia or sthenia nature. Sthenia-dyspnea is marked by rapidity, deep breath and quick exhalation, usually due to sthenia pathogenic factors in the lung and inhibited flow of qi; asthenia-dyspnea is marked by slow and weak breath, less inhalation and more exhalation, discontinued breath, dyspnea in movement and preference for deep breath, usually caused by asthenia-impairment of the lung and kidney as well as insufficient reception of qi.
Bronchial wheezing is marked by rapid breath like dyspnea, stridor in the throat, repeated relapse and difficulty in cure, usually caused by internal retention of phlegm complicated by exogenous pathogenic factors' attacks which stirs up the latent retention of fluid; or by excessive intake of sour, salty, uncooked and cold food.
Clinically dyspnea is not necessarily to occur together with wheezing. Simultaneous appearance of dyspnea and wheezing is called asthma.
Shortness of breath and weak breath
Shortness of breath means that the breath is not continuous like dyspnea and that the patient raises the shoulders when breathing. Usually there is no sputum. Such a morbid condition is usually seen in various diseases of asthenia or sthenia nature. The asthenia syndrome is marked by shortness of breath and low voice, usually accompanied by dispiritedness, lassitude and spontaneous sweating due to weakness and chronic disease which consumes primordial qi and thoracic qi; sthenia syndrome is marked by shortness of breath and hoarseness of voice accompanied by chest oppression, cough and dyspnea due to stagnation of phlegm and retention of fluid as well as inhibited flow of qi.
Weak breath is marked by feeble and short breath and low voice. It is not discontinuous like the manifestation in shortness of breath. Weak breath is usually due to, insufficiency of visceral qi, especially asthenia of lung and kidney qi.
Besides, This conditions is accompanied by sighs due to chest oppression and depression resulting from emotional upsets and depression of liver qi.
Cough is due to failure of the lung to disperse and descend and upward adverse flow of pulmonary qi, usually seen in lung disorders. Cough may be caused by the disorders of other viscera. Cough is usually related to sputum. So in diagnosis, cares should be taken to analyze the characteristics of voice in cough, understand the time and duration of cough and differentiate the syndromes in the light of the colour, nature and quantity of sputum as well as other complications.
Deep cough with whitish thin sputum and nasal obstruction is usually due to wind-cold attacking the lung, or due to retention of pathogenic cold in the lung which prevents the lung from normal dispersing and descending. Low cough with profuse whithish sputum easy to expectorate accompanied by chest oppression and epigastric fullness is often due to stagnation of phlegm and dampness in the lung which stop the lung from normal dispersing and descending. Low cough with yellowish thick sputum easy to expectorate accompanied by dry pain of throat and hot sensation in the nose in breathing is due to invasion of pathogenic heat into the lung which consumes pulmonary fluid and inhibits flow of pulmonary qi. Dry cough without sputum or with scanty and sticky sputum and dry throat is due to invasion of pathogenic dryness into the lung or due to deficiency of pulmonary yin, consumption of pulmonary fluid and failure of the lung to depurate and clear. Weak cough accompanied by shortness of breath or dyspnea is due to lung asthenia or due to consumption of pulmonary qi in chronic diseases.
Besides, cough like barking of a dog accompanied by hoarseness usually indicates diphtheria due to asthenia of lung and kidney yin, pestilent factors attacking the throat and obstruction of the airway. Infantile paroxysmal and continuous cough like the crying of an egret in the end is called "whooping cough" or pertussis, usually caused by mixture of pathogenic wind with latent phlegm which transforms into heat and obstructs the airway.
Hiccup and belching
Hiccup and belching are all caused by upward adverse flow of gastric qi.
Hiccup is marked by upward rise of qi and involuntary gurgling noise in the throat. Syndrome differentiation of hiccup is done according to the hiccup sounds, duration and other complications.
Repeated hiccup with sonorous voice is due to retention of pathogenic heat in the stomach. Deep, long and weak hiccup is due to weakness of the spleen and stomach. Sonorous hiccup with normal sounds, short duration and no other complications is due to urgency in eating or due to postcibal attack by wind-cold. This kind of hiccup is regarded as normal. Sudden hiccup with weak voice and long intermittence in chronic diseases or serious diseases indicates decline of gastric qi and worsening of pathological conditions.
Belching refers to deep, long and slow noise made in the throat due to upward rise of qi from the stomach, Syndrome differentiation of belching should be made according to whether the voice is high or low, whether there is acid and putrid odor and whether there are other complications.
Sonorous belching with acid and putrid odor accompanied by unpressable epigastric and abdominal distending pain as well as thick and greasy tongue fur is due to retention of food in the stomach. Repeated sonorous belching accompanied hypochondriac and epigastric pain and taut pulse to be alleviated after belching is due to emotional upsets caused by invasion of liver qi into the stomach. Belching with deep voice and acid-putrid odor accompanied by no taste for food, light-coloured tongue and weak pulse is due to weakness of the spleen and stomach, usually seen in chronic diseases or the aged. Occasional belching after meal is usually due to overeating and is not morbid.