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

References Used

The TCM information presented here has been referenced from numerous sources; including teachers, practitioners, class notes from Five Branches University, the following books, as well as other sources. If you have benefited from this information, please consider supporting the authors and their works by purchasing the books below.

Browse All Chinese Medicine Reference Texts ▶