The Four Examinations, Part 4 (Listening and Smelling Diagnosis)

Some info on the Listening and Smelling exam

Listening and Smelling
Quality of voice: faint, frail, diffic getting words out: Lung qi defic or Yuan qi depleted

Rough, loud, full: repletion of yang qi

Hoarse voice: repletion if something blocking voice (will have other sx)
Defic if other defic sx

Reluctant speech, withdrawn, slow: coldness

Incessant speech: heat

Sudden loss of voice: wind heat

Gradual loss of voice: lung vacuity

5 element sounds:

Quality of Shen thru verbal expression:
full and impaired consciousness and talking loud: dampheat

listless and mumbling: heart qi vacuity

Listening to movements: keeps still but utters groans: joint pain
Clear voice but distinct and low and succinct: headache
Weak and indistinct: chest constriction/weakness
Coarse and loud: repletion/fullness
Difficulty breathing: vacuity/feeble/emptiness

Asthma: Diffic inhaling: feeble/empty: feels better w/ deep breath: Kidney qi not grasping Lung qi (slight wheezing)
Acute: coarse and loud: better w/ exhale (can’t exhale): repletion pathogen in lung: phlegm

Coughs: loud: fullness/repletion
Dry: unproductive, no phlegm: lung yin defic
Dry w/ tickle at night: kidney yin defic (KI 6)

Hiccoughs: if short, just diaphragmatic spasm
Loud: repletion heat –usually stomach qi
Long-term, but low and weak: weak stomach qi (usually coldness)

Smell: bad breath: stomach heat or oral dental decay
Belching: foul or sour belch is retention of food in stomach
5 phase smells:
hepatic problems: sticky sweet
cancer and diabetes: ammonia

strong or foul smells usually associated with heat and repletion.
Absence of smell or ammonia: cold diseases and vacuity

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