Listening and smelling are essential when patients are non-verbal, confused, or unconscious, and especially useful in acute respiratory disease, gastrointestinal disorders, gynecologically Damp-Heat syndromes and emotional or Shen disturbances. They also help differentiate between Cold/Heat, Excess/Deficiency, and organ involvement, guiding both acupuncture and herbal treatment.
Listening and smelling are always used in combination with Looking (望诊) — especially tongue and Shen, asking (问诊) — patient history and symptoms and Palpation (切诊) — pulse and affected areas. They enrich the overall pattern identification (辨证) and help fine-tune treatment strategies.
Rotten odour
Toxin, Blood stasis, or necrosis
Skin wounds
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Listening and Smelling (闻诊 wén zhěn) is one of the Four Pillars of Diagnosis (四诊 sì zhěn), alongside Looking (望 wàng), Asking (问 wèn), and Palpation (切 qiè). Though it may seem secondary to other methods, Listening and Smelling provides subtle but crucial clues about organ function, pathogenic factors, and emotional states, particularly when the patient cannot clearly express their symptoms (e.g. infants, the elderly, or those with speech disturbances).
Listening (听)
-
The sound of the voice and speech
Smelling (嗅)
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Breathing, coughing, vomiting, hiccups, belching, wheezing, crying, etc.
The odour of the body, breath, sweat, sputum, urine, stool, skin secretions
Both senses are used to identify imbalances of Qi, fluids, and organ function, particularly involving the Lung, Spleen, and Stomach, which are connected to sound, digestion, and odours
Listening and Smelling
The quality, strength, tone, rhythm, and clarity of sounds provide diagnostic information. The Lung controls the voice, the Heart controls speech and Shen. Laboured breathing with wheezing and thick sputum → Phlegm-Damp obstructing the Lungs
Listening (听)
Loud, forceful
Excess condition, robust Zheng
Qi
Weak, soft
Deficiency (Qi, Blood, Lung), poor Zheng Qi
Incoherent speech
Shen disturbance, Heart Heat, Phlegm misting Heart
Stuttering, muteness
Wind-Phlegm, Liver Wind, Shen
obstruction
Sighing frequently
Liver Qi Stagnation
The Voice and Speech
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Coarse, loud breathing
Excess Heat, Lung Qi rebellion
Shallow, weak breathing
Lung Qi deficiency, Kidney Qi not grasping
Wheezing
Phlegm retention, Cold or Heat in Lungs
SOB, sighing
Qi deficiency or stagnation
Breathing and Respiratory Sounds
2
Cough
Dry = Lung Yin Deficiency; Productive = Phlegm-Heat or Cold
Belching
Stomach Qi rebellion, Damp-Heat
Hiccups
Stomach Qi not descending, Cold or Heat
Vomiting
ST Qi rebellion; possibly Damp, Heat, or Phlegm
Borborygmus (stomach rumbling)
SP Qi Deficiency, Dampness or Cold in intestines
Crying (in children)
Loud = excess, mild = deficiency; nighttime = Heart or Kidney imbalance
Other Body Sounds
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The odour of the body and secretions can reveal the nature of pathogens (Heat, Damp, Toxin), the Zang-Fu organ involved, or the presence of putrefaction, stagnation, or chronic disease. Foul odours generally suggest Heat or Damp-Heat, while lack of odour or a mild smell suggests Cold or Deficiency.
Smelling (嗅)
Foul, sour
Stomach Heat, Food retention, Phlegm-Heat
Breath
1
Strong, rancid
Damp-Heat or Toxic Heat
Body
2
Sour, pungent
Damp-Heat or Yang Ming Heat
Sweat
3
4
Urine
Strong, burning odour
Damp-Heat in the Bladder or Lower Jiao
5
Stools
Foul, putrid
Heat in Intestines or Food stagnation
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Leukorrhea
Fishy or foul-smelling
Damp-Heat or Toxic Heat in Lower Jiao