TCM Diagnosis by Listening (and Smelling) - One of the 4 Pillars

HomeDiagnosis in Chinese Medicne › TCM Diagnosis by Listening (and Smelling) - One of the 4 Pillars

TCM Diagnosis by Listening (and Smelling) - One of the 4 Pillars

1. Listening

The Sound of the Voice

  • A loud and course voice indicated an Excess pattern
  • A weak and low voice indicates a Deficient pattern
  • A lack of desire to speak indicates a Deficient Cold pattern
  • Incessant talking indicates a Heat pattern

Hoarse Voice or Loss of Voice

  • Acute onset of a hoarse voice is usually indicative of Exterior Pathogenic Wind, especially if the throat is red and sore.
  • A chronic or recurrent hoarse voice usually indicates an interior disease such as Deficient Lung Qi or Lung Yin
  • A gradual loss of voice also usually indicates Deficient Lung Qi or Yin
Loud Voice with Incoherent Speech
  • This is usually accompanied by impaired mental function and indicates Heat is disturbing the Shen (Spirit/Mind)

5 Element Associations in the Voice

  • Shouting is a Liver imbalance
  • Constant Laughing is a Heart imbalance
  • Chronic weeping, whimpering, sadness is an Spleen imbalance
  • Groaning is a Kidney imbalance


Coughing is usually related to Lung's ability to properly disperse and descend Lung Qi, leading to rebellious Lung Qi

  • Wheezing or rattling from the Lung is usually mucus or Phlegm in the Lung
  • Explosive or very loud coughing indicates an excess pattern
  • A weak cough indicates a Deficient pattern
  • A dry hacking cough is usually indicative of Heat and Dryness in the Lung
  • An unproductive cough with small amounts of sticky sputum indicates Heat scorching the fluids


  • Loud and coarse breathing indicates an Excess pattern
  • Shortness of breath, weak and/or difficult breathing may indicate the Kidney is too weak to grasp the Qi. This would include a Deficient type asthma.
  • Loud and coarse breathing with a preference for exhaling indicates pathogens retained in the Lung. This would include Excess type asthma.

Frequent Sighing

  • Usually related to Liver Qi Stagnation


  • Usually related to Rebellious Stomach Qi


  • Usually related to Deficient Spleen Qi or Deficient Spleen Yang, especially if there is loose stools and bloating.
  • This can also be due to Liver Qi Stagnation invading the Intestines

2. Smelling

In general, secretions and excretions related to Excess Heat type patterns have a foul odor. Less odorous secretions and excretions usually relate to Cold and Deficiency type patterns.


  • Urgent diarrhea with foul stools indicates Damp-Heat in the Large Intestine.
  • Belching with a foul or sour odor indicates retention of food.
  • Leucorrhoea with a strong or foul odor indicates Damp-Heat in the Lower Jiao affecting the Uterus.
  • Chronic Halitosis (Bad breath) indicates Stomach Heat

5 Element Associations of Smell

  • Rancid "goatish" odors are related to the Liver
  • Scorched or burned odors are related to the Heart
  • Fragrant, sweet, or cloying odors are related to the Spleen
  • Rank or Rotten odors are related to the Lung
  • Putrid odors are related to the Kidney