Listening and Smelling Examination

CHAPTER IV: LISTENING AND SMELLING EXAMINATION

• Listening involves attending to the patient's sounds and smelling their odors to investigate the circumstances of the disease.
• Listening involves distinguishing various sounds, for example, speech, breathing, coughing.
• Smelling involves detecting various odors from the patient's body and abnormal odors from the sickroom, including secretions.
• Sounds and odors reflect physiological activities and pathological changes of the zang-fu organs.
• Content includes listening to and smelling normal sounds and pathological sounds, body odors, and sickroom odors.

SECTION 1: LISTENING TO SOUNDS

• Sound production generally involves qi moving, which produces sound.
• Emitted sounds stem from vocalization and movement of internal organs.

Voice

• The voice relates to the lung, throat, epiglottis, tongue, teeth, lips, and nose.
• The lung governs qi and controls breathing; moving qi causes the voice and generates the sound's power.
• The throat is the air passage and where sound passes.
• The opening and closing of the epiglottis, tongue, lips, teeth, and nostrils also influence the creation of various kinds of sound.
• The kidney governs inspiration and is the root of qi.
• The liver governs the free flow of qi.
• The spleen governs transformation and transportation and is the source of qi and blood production.
• The heart governs the mind and is in charge of speech.
• All aspects of sound production are linked to speech.

Identifying and differentiating through listening to sounds

• Look to high or low pitch, strong or weak volume, clear and husky qualities, slow or acute changes in speech and breath, or abnormal sounds from pathological changes in the zang-fu organs,
• Identify pathological issues such as coughing and vomiting.

LISTENING TO THE VOICE

• Hoarseness, snoring, groaning, and howling can be classified.
• General classification of sounds: Yang or excess related sounds tend to be loud, sonorous, strong, and consistent.
• Yin or deficiency, or cold related sounds tend to be low, weak, feeble, and interrupted.
• Heavy and gross voice can indicate external wind-cold or phlegm damp, leading to lungs failing to diffuse and obstruct the nose.
• Hoarseness and aphonia (sudden onset) can indicate excessive patterns or externally-contracted wind-cold/wind-warm.
• Chronic hoarseness and aphonia indicate deficiency patterns are due to internal damage of essential qi with a possible cause from shouting or screaming.
• Snoring can be due to partial obstruction of respiratory passages.
• Groaning sound alterations can suggest pain and related excessive or deficiency patterns.
• Howling can indicate intense pain.

LISTENING TO THE SPEECH

• Speech analysis assesses patient's expression and response ability.
• Normal speech has clear, smooth, and distinct words.
• Speech is a presentation of mind activity and there's a close relationship between heart patterns and speech and abnormal problems.
• General principles relating back to excess or deficiency, is the degree to which a patient will speak.
• Delirious speech is when mental capacity is unclear and marked by incoherent speech.

LISTENING TO THE RESPIRATION

• Examine the speed of respiratory frequency, strength, roughness or smoothness.
• Normal respiration should be uniform and smooth.
• Movement or agitation makes respiration faster.
• Sleep makes breathing slow and deep.
• Relates also to IU, KID, other zang organs, and zong qi.
• Helps to ID deficiency or access of the 5 zang organs and zong qi.
• Illness creates abnormal breathing sounds, be them abnormalities of physical body or qi.

Abnormal Respiration

• Panting involves shortness of breath, irregular respiration with flaring nostrils, open mouth, raised shoulders, difficulty lying down, obvious dyspnea, and lung and kidney involvement.
• Wheezing creates sounds often related to a phlegm-rheum retained disease.
• Excess patterns involve shortness of breath and husky breathing.

INQUIRING INTO COLD AND HEAD

• Ask patient whether he or she has sensation of fever or aversion to cold.
• Cold and heat are common symptoms and one of the essential contents of inquiry examination
• Cold comes in both yin pathogens and exuberance.
• Heat comes in similar fashion with both yang pathogens and exuberance.
• One important piece of evidence for distinguish the pathogenic nature and exuberance or failure of yin and yang

AVERSION TO COLD WITH FEVER

• Aversion to cold and heat symptoms appearing at the same time
• Important piece of evidence for the diagnosis of exterior invasions
• Aversion and aversion indicates the external pathogens are attacking the fleshy exterior, wei yang is being obstructed and failing to warm the fleshy exterior
• With fever comes as the pathogens are bloacking outside then wei yang is unable to defend and the zheng (healthy) qi and pathogenic qi are struggling, the patient also experiences heat.

Methods of Inquiry:

• 1. Ask patient whether they feel cold or heat
• 2. If yes, ask the following:
• a) when?
• b) degree?
• c) duration?
• d) Related symptoms