bubble_chart Concept

Loss of smell refers to the reduction or loss of the sense of smell in the nasal cavity. The "Treatise on the Origins and Symptoms of Diseases" states: "When the nasal qi is not properly regulated, one cannot distinguish fragrances and odors, leading to nasal obstruction." Waike Dacheng refers to this as "nasal deafness."

This condition is closely related to stuffy nose and nasal discharge entries and can be cross-referenced.

bubble_chart Pattern Analysis

1. Wind-Heat in the Lung Meridian︰Decreased sense of smell, nasal congestion with yellow nasal discharge, accompanied by fever, cough, copious phlegm, red tongue with thin yellow coating, and floating rapid pulse. Caused by external contraction of wind-heat or prolonged stagnation of wind-cold transforming into heat, leading to heat congestion in the nasal cavity. Treatment should focus on dispelling wind and clearing heat. The recommended formula is Cocklebur Fruit Powder combined with Mulberry Leaf and Chrysanthemum Decoction with modifications.
2. Gallbladder Heat Stagnation︰Decreased sense of smell, nasal congestion, yellow and turbid nasal discharge with foul odor. Generally, the sense of smell gradually recovers after nasal ventilation, accompanied by fever, headache, bitter taste in the mouth, dry throat, excessive phlegm, general lack of strength, red tongue with yellow coating, and wiry-rapid pulse. This is caused by pathogenic heat entering the interior, lodging in the gallbladder channel, stagnating and transforming into fire that ascends to attack the nasal orifices. Treatment should focus on clearing the gallbladder and draining heat, using the formula Gentian Liver-Draining Decoction.
3. Spleen Channel Dampness-Heat︰Decreased or loss of smell, thick yellow nasal discharge with foul odor, nasal congestion accompanied by heaviness of head and headache, cough with yellow phlegm, epigastric and abdominal distension and fullness, poor appetite, sticky and unsmooth stools, yellow urine, yellow and greasy tongue coating, slippery and rapid pulse. Due to dampness-heat obstructing the spleen-earth, leading to dysfunction in transportation and transformation, failure of clear yang to ascend and turbid yin to descend, resulting in nasal obstruction. Skullcap and Talc Decoction can be used.
4. Deficiency of Both Lung and Spleen︰Poor sense of smell, sticky white nasal discharge, nasal congestion, varying in severity, dizziness with a distending sensation, shortness of breath and reluctance to speak, general fatigue, poor appetite, abdominal distension and fullness, thin white tongue coating, and slow pulse. The lung governs qi, and the spleen governs the transportation and transformation of water and grain essence. The spleen is the mother of the lung. Spleen deficiency leads to the inability to disperse essence to the lung, resulting in deficiency of both the lung and spleen. The subtle fluids fail to nourish the nasal orifices, leading to a diminished sense of smell or even anosmia. For cases predominantly due to lung qi deficiency, treatment should focus on warming and tonifying lung qi while dispersing wind-cold. The formula used is the Lung-Warming and Dripping-Stopping Pill. If there is dry nose without discharge, the approach should emphasize nourishing yin and moistening dryness, using the Dryness-Clearing Lung-Rescuing Decoction. For cases predominantly due to spleen deficiency, treatment should aim at tonifying the middle and replenishing qi, banking up earth to generate metal. The formula selected is the Middle-Tonifying Qi-Replenishing Decoction with modifications.
5. Blood Stasis Obstructing the Lung︰Decreased or loss of smell, nasal congestion, or runny nose. Accompanied by dizziness and stuffiness, severe headache, cough. Thin and dark tongue coating, or with ecchymosis, thin and choppy pulse. Mostly caused by lingering pathogens in the nasal cavity, prolonged duration, or nasal trauma leading to qi stagnation and blood stasis, obstruction of the nasal passages, and failure of qi and blood to nourish the upper regions, resulting in loss of smell. Treatment should focus on harmonizing qi and blood, resolving stagnation and dispersing stasis, with the prescription of Angelica and Peony Powder.
6. Deficiency of Both Qi and Blood︰Loss of smell, inability to detect odors, nasal passages remain relatively unobstructed or slightly impeded, scant nasal discharge, may be accompanied by dizziness, flusteredness, shortness of breath, general lack of strength, tongue texture pale with thin coating, pulse thin and weak. Constitutional deficiency of both qi and blood, nasal orifices lacking nourishment, Jingmai insufficient, hence loss of smell and inability to detect odors. Treatment should focus on tonifying and replenishing qi and blood, using Eight Precious Ingredients Decoction with modifications.

Lung channel wind-heat, gallbladder fu depression heat, and spleen channel dampness-heat all belong to the excess heat pattern. The former is an exterior pattern, while the latter two are internal heat pattern. The common characteristics of olfactory dysfunction in these three conditions are: stuffy nose, runny nose, and decreased sense of smell. The degree of olfactory impairment often changes with the variations in stuffy nose and runny nose. The differences are: in wind-heat cases, the onset is rapid, the course is short, and it is often accompanied by fever, cough, and other signs of external contraction of wind-heat. The decreased sense of smell is usually caused by nasal obstruction. In gallbladder fu depression heat and spleen channel dampness-heat cases, the decreased sense of smell is often due to excessive nasal discharge, phlegm, and difficulty in breathing.

This condition can be divided into deficiency and excess types. The excess pattern is related to stuffy nose and sinusitis, mostly caused by the obstruction of wind, heat, and dampness pathogens, with the location of disease primarily in the lung, spleen, liver, and gallbladder, and is relatively easier to treat. Blood stasis and qi-blood deficiency cases are often caused by prolonged invasion of toxic pathogens, making treatment more difficult.

bubble_chart Documentation

1. Zhongcang Jing: "The symptoms of lung wind include fullness of qi in the chest, confusion, sweating, loss of smell, panting and inability to lie down, which can be treated."
2. Xu Mingyi Lei'an Volume 17: "Aunt Sun had suffered from loss of smell for years. Later, due to another illness, her friend Miao Zhong-chun prescribed her a formula, which included mulberry bark in doses of seven to eight qian each time. After taking it for a long time, her stuffy nose suddenly cleared."