DIAGNOSIS BY SMELLING

Published on 22/06/2015 by admin

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Last modified 22/04/2025

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Chapter 54

imageDIAGNOSIS BY SMELLING

INTRODUCTION

Diagnosis by smelling is not a major part of the diagnostic process. It is used mostly to confirm our diagnosis and is seldom a clinching factor. The Five-Element smells mentioned below are useful mostly to correlate to the patient’s Element type and to indicate accordance with or discordance from it. For example, a rancid smell in a Wood Element is a pathological exaggeration of a constitutional Wood smell and therefore is less serious than another smell would be.

There are two quite distinct aspects to diagnosis by smelling: the first is the odour of the patient’s body itself, which can give us an idea not only of the prevailing pattern of disharmony but also of the patient’s constitutional type; the second is the odour of certain bodily secretions, which is used only to identity the prevailing pattern of disharmony.

Assuming the patient is not wearing perfume or strong after-shave (I normally ask my patients not to use perfume or after-shave when they come for their first consultation), diagnosis by smelling is carried out as the interrogation progresses. In some cases, the body odour is quite clear, even overwhelming. If there is no particular odour emanating from the body at the start of the interrogation, in most cases it will become apparent when the patient is lying down, undressed, for acupuncture.

BODY ODOUR

From a Five-Element perspective, the five body odours are: rancid for Wood, scorched for Fire, fragrant or sweetish for Earth, rotten for Metal and putrid for Water. From this point of view, these body odours reflect a disharmony in the relevant Element, which may be a Deficiency or an Excess. In a few cases, these body odours are very apparent as soon as the patient comes in, but in most cases these odours are detected only when the patient undresses and especially on the back.

Sometimes, the Five-Element body odour emanates after the needles have been in for about 20 minutes. In my experience, the two most common Five-Element body odours are the putrid and rancid ones; the putrid odour is relatively common in the elderly (presumably caused by a decline of Kidney-Qi).

The body odour can be used diagnostically in two ways. In the absence of patterns of disharmony accounting for a particular odour, the body odour reflects the patient’s constitutional Element type in the same way as do the body shape and facial structures. Thus, a slightly rancid odour will emanate from a Wood type, a slightly scorched one from a Fire type, etc. In addition to the constitutional body odour, patients’ body odour reflects the patterns they are suffering from and these may not necessarily accord with their Element type. For example, a Wood type may emanate a slightly scorched smell, indicating the presence of a Heart pattern. Indeed, if the body odour contradicts the constitutional Element type, this is a bad sign. In other words, it is worse for a Wood type to have a scorched odour (for example) than a rancid one.

Box 54.1 summarizes the correspondences between the Five Elements and body odours.

BOX 54.1   FIVE-ELEMENT ODOURS

ODOUR OF BODILY SECRETIONS

Diagnosis by smelling is based also on detecting the smell of bodily secretions. Obviously it is impractical for a practitioner to be able to smell a patient’s urine or vaginal discharge. However, I usually ask patients if they have noticed a strong smell; most people are very aware if any of their bodily secretions are particularly smelly.

Bodily secretions include:

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