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Auscultation and Olfaction

Auscultation and Olfaction. Diana Chen OM Diagnosis A (Dr. Chang) 2-9-09. Auscultation (Listening).

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Auscultation and Olfaction

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  1. Auscultation and Olfaction Diana Chen OM Diagnosis A (Dr. Chang) 2-9-09

  2. Auscultation (Listening) • Diagnosis by auscultation (listening) includes listening to the sound and pitch of voices, respiration, coughs, sneezing, hiccups, belching, vomiting, borborygmi, groaning, and any other sounds emitted by the patient

  3. Auscultation of Voices • Normal voice: natural phonation, smooth tone, clear articulation, and meaningful speech • Often affected in LU syndromes • Excess patterns: usually acute and sudden onset • Deficiency patterns: usually chronic and gradual onset

  4. Auscultation of Voices Strength of voice • Loud voice: excess • Weak voice: deficiency • Sudden loss of voice: wind invasion • Gradual loss of voice: LU qi deficiency, LU yin deficiency, or LU and KD yin deficiency

  5. Auscultation of Voices Quality of voice • Muffled voice in acute conditions: wind invasion • Muffled voice in chronic conditions: qi and blood deficiency • Hoarse voice in acute conditions: wind-heat or qi stagnation • Hoarse voice with sudden onset: wind invasion • Hoarse voice with gradual onset: LU and KD yin deficiency • Sudden hoarse voice in chronic conditions: yin or yang collapse

  6. Auscultation of Voices • Hoarse voice in chronic conditions with pharyngeal swelling: phlegm or blood stasis • Hoarse voice during pregnancy: disorder of KD channel • Nasal voice: wind-cold, wind-dampness, phlegm • Difficulty emitting sounds with breathlessness and throat rattling: phlegm in LU • Snoring: phlegm, dampness, or phlegm with qi deficiency • Groaning: pain from dampness or qi stagnation • Stuttering: HT blood deficiency, HT fire

  7. Auscultation of Voices Speech • Dislike speaking: cold, LU/SP qi deficiency • Talkative, like speaking: heat, excess • Excess speech and laughter: manic behavior • Hesitant speech with difficulty finding words: dampness or phlegm • Incoherent, incessant speech: phlegm-fire • Muttering to self: phlegm obstructing mind’s orifices • Murmuring to self, incoherent nonsensical speech in feeble voice, with listlessness and impaired consciousness: severe HT qi deficiency

  8. Auscultation of Voices • Very feeble, interrupted speech: severe qi depletion • Slurred speech: phlegm, wind-stroke • Delirious speech: heat in PC in febrile diseases • Incoherent shouting, raving, or delirious speech with impaired consciousness: excess heat disturbing the mind (HT fire disturbing the mind, phlegm-fire blocking HT orifices, or LV/ GB fire) • Talking in one’s sleep: HT fire, GB heat, ST heat, or HT blood deficiency

  9. Auscultation of Voices Crying in babies • High pitch and moving head side-to-side: accumulation disorder • Low sound and intermittently: SP deficiency • Long and continuous, but soft sound: deficiency and possibly swollen tonsils

  10. Auscultation of Voices Type of voice by 5 elements: organ disharmony

  11. Auscultation of Respiration • Abnormal respiration or breathing usually involves the LU and KD

  12. Auscultation of Respiration Strength of breathing • Coarse, loud breathing: excess, often LU heat • Feeble breathing: qi deficiency • Weak, thin breathing: LU, KD, or both deficiency • Shallow breathing: yang deficiency

  13. Auscultation of Respiration 5 pathological breathing sounds • Dyspnea (difficult, short, urgent breathing) or breathlessness (Chuan) • Difficulty breathing with raised shoulders and irregular loud, coarse sound: phlegm in LU • Difficulty breathing with raised shoulders, lower sound, and weak voice: phlegm in LU with LU/KD deficiency • Coarse, loud, rapid breathing with acute onset and more difficulty exhaling: exterior pathogenic factor invading LU, damp-phlegm obstructing LU • Weak, thin breathing, chronic, with gradual onset and more difficulty inhaling: LU/KD qi deficiency (KD unable to grasp qi)

  14. Auscultation of Respiration • Wheezing (Xiao) – indicates phlegm • Whistling sound emitted upon breathing: phlegm or wind in LU • Feeble breathing with shortness of breath: LU/KD qi deficiency • Shortness of breath (Duan qi): • Feeble, weak, but natural breathing: qi deficiency • Short, irregular, and rapid breathing without pronounced struggling for breath or raised shoulders: phlegm in LU with LU deficiency

  15. Auscultation of Respiration • Weak breathing (Qi shao): • Weak, low, and short breathing sounds: LU or KD qi deficiency or both • Rebellions qi breathing (Shang qi): • Rapid short breaths, cough, oppressing sensation in throat, and anxiety, worse lying down: rebellious qi of the Chong (Penetrating) Vessel or LV fire insulting LU

  16. Auscultation of Respiration Sighing • Sighing from repressed anger or frustration: LV qi stagnation • Sighing from worry and sadness: LU qi stagnation • Sighing with weak sound from sadness, grief, and pensiveness: SP/HT deficiency

  17. Auscultation of Cough • Loud cough: excess • Weak cough: deficiency • Loud, rich, loose cough: damp-phlegm in LU • Loud barking cough: wind-heat, LU heat, or phlegm-heat in LU • Violent bouts of loud barking cough in children: whooping cough (Bordetella pertussis)

  18. Auscultation of Cough • Persistent, dry, loud cough with occasional expectoration of scanty sputum: dryness and phlegm in LU • Persistent, dry, weak cough with low sound: LU yin deficiency • Feeble cough with clear soft sound and weak breathing: LU qi deficiency

  19. Auscultation of Sneezing • Loud sneeze: excess • Weak sneeze: deficiency • Acute sneezing: wind invasion • Weak chronic sneezing: chronic retention of wind in nose (allergic rhinitis) • Sneezing with profuse nasal discharge: wind-cold

  20. Auscultation of Hiccups • High-pitched sound: excess heat • Loud, high-pitched sound: LV qi invading ST, ST qi rebellion, ST heat • Low-pitched sound: deficient cold • Deep and strong sound: cold in ST • Weak with low sound: ST deficiency • Weak and frequent: ST yin deficiency

  21. Auscultation of Belching • Loud and long: food retention, ST heat, LV qi invading ST • Loud with foul breath: food stagnation • Low and short: ST qi deficiency, ST deficient and cold

  22. Auscultation of Vomiting • Loud sound: food retention, ST heat, LV/ST heat, excess cold in ST • Weak, low sound: ST qi deficiency, ST deficient and cold, ST yin deficiency

  23. Olfaction (Smelling) • Diagnosis by olfaction (smelling) is used mostly to confirm the diagnosis and hardly a clinching factor • It includes the smelling of the patient’s breath, sweat, sputum, stools, urine, and other bodily excretions • In most cases, body odors are more apparent with the patient undressed and lying down, especially on the back

  24. Types of Odor • Strong, fetid (foul) odor that is rotten and nauseating, like rancid meat or rotten eggs: heat, often damp-heat • Fishy odor that is les nauseating, but more pungent or fishy: cold and deficiency or heat • Weak or absence of odor: cold

  25. Odor of Breath • Strong, foul: ST heat or food retention • Sour: food retention, accumulation disorder (in children) • Foul, pungent: damp-heat in SP/ST • Rotten: damp-heat in LI Odor of Sweat • Strong smell: damp-heat • Putrid smell: LU, LV, or KD diseases

  26. Odor of Sputum • Strong, rotten smell: phlegm-heat or toxic heat in LU • Fishy smell: LU heat • Sputum without smell: cold • Cough with fishy-smelling purulent or bloody sputum: LU abscess • Nasal congestion with fishy turbid yellow mucus: LU heat

  27. Odor of Urine and Stools • Strong, foul-smelling stools: heat or damp-heat in intestines • Loose stools with fishy smell: KD yang deficiency • Absence of smell in stools: cold • Strong-smelling urine: damp-heat in UB • Absence of smell in urine: cold

  28. Odor of Vaginal Discharge • Strong, leathery smell of leukorrhea: damp-heat • Foul-smelling yellow or green leukorrhea: damp-heat in uterus • Fishy-smelling leukorrhea: damp-cold • Clear thin leukorrhea with fishy smell: KD yang deficiency • Strong-smelling lochia after childbirth: damp-heat or toxic heat in uterus

  29. Odor of Intestinal Gas • Strong, foul smell: damp-heat in LI • Rancid, rotten smell: tonix heat in LI • Absence of smell: SP qi deficiency

  30. Extraordinary (Sickroom) Odors • Rotten apple odor from mouth or body: uncontrolled diabetes mellitus • Urine odor from body: exhaustion of anti-pathogenic qi due to retained fluids (renal failure or uremia) • Foul odor like alcohol: alcohol toxicosis and damp-heat accumulation • Bloody odor: severe hemorrhaging

  31. 5 Elements Odors

  32. Contact Information • E-mail: fishy071@yahoo.com • Webpage of SBU class notes: http://sbuclasses.50webs.com/notes.html

  33. Acknowledgements Thank you to: • Dr. Yae Jin Chang and Dr. Leigh Caldwell for OM Diagnosis A lectures and notes • Other SBU instructors for their lectures and guidance • SBU Clinic supervisors for their advice and guidance • Classmates for their advice and support • SBU administrators for their services

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