Chapter Two: Auscultation and Olfaction

Question 1

What is auscultation?

Answer 1

It means listening the patient’s voice, breathing, belching, borborygmi, coughing, hiccups, sighing, sneezing, vomiting and language.

Question 2

What is the clinical significance of auscultation?

Answer 2

Listening to the sounds and changes in the voice and breathing can help identify the thermal nature of pathogens as well as the excessive or deficient nature.

Question 3

What does a loud volume with strong force generally indicate?

Answer 3

Heat, excess

Question 4

What does a voice with soft volume and weak force indicate?

Answer 4

Cold, deficiency

Question 5

What are the two aspects within the scope of listening?

Answer 5

1. Listening to changes in speech and breathing. This includes listening to the volume (loud or soft), strength (strong or weak), clarity (clear or turbid), and rate (rapid or slow).
2. Listening to abnormal sounds such as coughing or vomiting which are caused by pathological changes in the zang-fu organs.

Question 6

Which parts of listening pertain to physiology?

Answer 6

Speech

Respiration

Question 7

Which parts of listening pertain to pathology?

Answer 7

• Belching
• Borborygmi
• Coughing
• Hiccups
• Sighing
• Sneezing
• Vomiting

Question 8

The normal voice reflects the _________ of Zang Fu organs and the sufficiency of ____ and ________.

Answer 8

Harmony; qi; blood

Question 9

What are the phonic organs?

Answer 9

Lung (including larynx and vocal cords in TCM), throat, epiglottis, lips, tongue, teeth and nose.

Question 10

Which Zang Fu organs are most closely related to the production of vocal sounds?

Answer 10

Lung and Kidney

Question 11

What creates sound? What causes changes in voice? What is the Lung’s relation to the voice?

Answer 11

• Movements of qi create sound.
• Abnormal changes in qi result in changes of the voice.
• The lung is the gateway of the voice.

Question 12

What organ is the root of source qi and also the root of the voice?

Answer 12

Kidney

Question 13

What about the voice is directly related to the function of the kidney?

Answer 13

The volume of the voice.

Question 14

Kidney is called the _____ of the ______.

Answer 14

root; voice

Question 15

Stomach and Spleen are the _________ _____ of teh ___. The Stomach channel passes through the _____ and influences __________.

Answer 15

acquired; root; qi; throat; vocalization

Question 16

What controls speech and the strength of the voice?

Answer 16

Gathering (zong) qi. Therefore SP/ST are related to the strength of the voice as they are responsible for gu qi which combines with qing qi to create zong qi.

Question 17

Normal vocal sounds differ in what ways?

Answer 17

Volume, tone and clarity

Question 18

What is the definition of pathological vocal sounds?

Answer 18

The voice loses its clarity and smoothness, leading to acute or chronic hoarseness, raspiness or a complete loss of voice (aphonia).

Question 19

Abnormal vocalization is causes by a disorder of the ______ and ______ _____.

Answer 19

larynx, vocal cords

Question 20

What are the three possible causes of pathological vocal sounds and what is their pathogenesis?

Answer 20

1. Loss of moisture in the larynx and vocal cords may be due to an attack of exogenous dryness or a deficiency of Lung and Kidney yin. Yin deficiency can arise from chronic illness, aging, smoking, profuse sweating, bleeding or improper treatment.
2. Loss of force and power to produce sound is caused by stagnation or qi and yang deficiency, which may result from emotional stress or chronic illness.
3. Pathogens obstructing or lodged in the larynx and vocal cords, such as phlegm or blood stasis, which result from dysfunctions of the zang fu organs; or exogenous pathogens such as wind-heat or wind-cold.

Question 21

What does a voice with loud volume indicate?

Answer 21

heat, excess

Question 22

What does a voice with low volume that has a vague sound to it indicate?

Answer 22

exterior wind cold, dampness invasion

Question 23

What does a voice with low volume indicate?

Answer 23

cold, deficiency

Question 24

What are the two main categories of pathological vocalization?

Answer 24

1. Hoarseness
2. Aphonia

Question 25

What are the four main TCM categories of hoarseness?

Answer 25

1. Exterior syndrome
2. Blood stagnation
3. Phlegm heat
4. Lung and Kidney Yin Xu

Question 26

What are the primary and accompanying symptoms of hoarseness caused by exterior syndrome?

Answer 26

1. Sudden onset, voice is low in ptich and raspy
2. Chills and fever, sore or itchy throat, cough, floating pulse

Question 27

What are the main and accompanying symptoms of hoarseness caused by blood stagnation?

Answer 27

1. Chronic hoarseness with gradually increasing intensity
2. Dry and sore throat, mass or nodule on neck, dry mouth without desire to drink, purple tongue

Question 28

What are the main and accompanying symptoms of hoarseness caused by phlegm heat?

Answer 28

1. Hoarseness with plum pit sensation, coughing
2. Cough with thick yellow phlegm, severe sore throat or plum pit sensations, fever, red tongue with slippery rapid pulse

Question 29

What are the main and accompanying symptoms for hoarseness caused by Lung and Kidney yin Xu?

Answer 29

1. Chronic onset, gradually increasing intensity, worse in evenings
2. Dry itchy throat with slight soreness, night sweats, dry cough without phlegm, thready pulse