• Listening
• Smelling

This part of TCM examination skills include checking the sound and odor changes in patients.

Listening

Auscultation is a diagnostic method whereby the doctor listens to the patient's speech, breathing, cough, and special sounds like vomit, sighing, belch and hiccup etc. Healthy sounds are natural, balanced and smooth, which reflect harmony between the organs and sufficient qi (vital energy) and blood. In general, if the sound is rough and sonorous and its form is strong, then it tends to be a excess (shi) condition; if the sound is low and faint then it tends to be a deficiency (xu) condition.

• Speech: According to TCM, vocalization depends on the activities of qi; that means it is associated not only with the phonatory organ (vocal cords) but also with the functional activities of the lungs, heart, kidneys. Feeble speech in low tones indicates a deficiency (xu) condition, while lusty speech indicates a excess (shi) condition.

• Incoherent speech in a loud voice accompanied by impaired consciousness indicates a disturbance of the spirit by fire evils. Repeated speech in a feeble voice accompanied by listlessness suggests a severe damage of heart energy.

• Breathing: Feeble breathing accompanied by shortness of breath on slight exertion reflects deficiency of heart or lungs. Forceful and coarse breathing accompanied by a loud sound suggests excess heat in the interior. Feeble asthmatic breathing accompanied by shortness of breath indicates deficiency of lungs and kidneys.

• Coughing: Coughing with a coarse voice usually indicates the lungs were attacked by wind-cold or cold-phlegm. Intermittent coughing with a clear voice indicates the lungs were disturbed by wind-heat or phlegm-heat accumulated in the lungs. Dry cough with little sputum is often due to a lung damage caused by dryness or deficiency of lung yin.

Smelling

The smelling examination includes abnormal odors emitted from the patient's body, excretions and secretions. Foul or rotten odor usually indicates heat syndromes of excess (shi) type; while fishy odor indicates cold syndromes of deficiency (xu) type. For example:

• Thick sputum with a foul smell indicates heat in the lungs; while dilute, clear and odorless sputum indicates cold in the lungs.

• Foul breath usually indicates heat in the stomach or dysfunction of the gastrointestinal track; food retention that causes a delay in stomach emptying will lead to a sour foul breath. 

• Stools with a sour foul smell suggests fire accumulated in the intestines; loose stools with a fishy foul smell suggests cold accumulated in the intestines.

• Turbid, smelly and burning urination indicates damp heat in the lower burner.

• Menses and vaginal discharges that are sticky, thick, turbid and smelly suggest a damp-heat disharmony; if the discharges are thin, clear and fishy smell, a cold disharmony is likely; while thin, clear and odorless discharges usually indicate a deficient condition.