Issue : 01 DOI : INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCHVolume : 02
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 152
Abstract
The various sound produced in the body are used as tools in the diagnosis of disease by ancient Ayurvedic
acharyas. Acharya Charaka, in Vimansthana, had asked to examine the bowel sounds, joint crepitation and
other peculiar sounds produced in the body such as cough and hiccups to diagnose the disease condition of
that particular system. Apart from this ancient Ayurvedic scholars have described the typical sound produced
in various disease conditions such as Maha Shwasa (Kussmaul’s breathing), Tamak shwasa (Bronchial
Asthma), Krukaj Kasa (Whooping cough), Swarabheda (Laryngeal disease), Vakastambha (Tongue
paralysis) causing Minminitva (Nasal speech) and Gadgadatva (Spastic speech), Ardita (Facial Palsy)
causing Vaksanga (dysarthria). Sandhivata (Osteoarthritis) causing joint crepitations. Alasaka
(Gastroparesis) causing abdominal gurgling, Apatantraka & Apatanaka (Tetanus) causing laryngeal stridor
with loud audible wheeze. Sangrahani & Ghati Yantra (IBS) causing abdominal gurgling. Pandu (Anemia)
causing tachycardia. In ancient times auscultation was done purely through ears and no any reference to
stethoscope like devices is found in the ancient books. However, the picture depicting the sage Kashyapa
auscultating the infant heart sound with hollow Papaya branch is available which could be world’s first
prototype of stethoscope. The ancient Indian physicians used to directly apply the ear to the chest to hear the
heart and lung sounds. The heart sounds, lung sounds and bowel sounds, were auscultated by keeping the ear
in close contact with chest and abdomen respectively. Acharya Vinodlal Sen had described some heart lung
sounds using this examination. With the advent of stethoscope by French Physician Rinne Lennec (1781-
1836), auscultation has occupied the prime position as physical examination method in the diagnosis of the
chest diseases to such an extent that it has become the symbol of modern day physician. It is observed and
concluded that Auscultation as tool of examining the patient to diagnose the disease is very well mentioned
in Ayurveda.
Keywords – Shrawan , Auscultation, Shwasa , Kasa
P
ISSN No. : 2584-2757
Volume : 03
Issue : 01
Publisher
ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION
FOR PATHOLOGY AND RADIODIGNOSIS
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 6 0 0 1 9
Reg. No. : MAHA-703/16(NAG) Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding author: Dr.Subhash Waghe Article Info: Published on : 15/10/2025
Impact Factor : 1.013
Critical Evaluation of Ayurvedic Shabda Pariksha (Sound Examination) In
Diagnosis of Diseases WSR To Stethoscopic Auscultation
Dr. Subhash Waghe 1, Dr. Dhanashri Joshi 2
1Professor & HOD- Dept. of Rog Nidan, Sardar Patel Ayurvedic Medical College, Dongariya, Balaghat.
2 HOD -Dept. of Sharir Kriya (Physiology)Sardar Patel Ayurvredic Medical College And Hospital, Balaghat
Cite this article as: - Dr.Subhash Waghe (2025) ; Critical Evaluation of Ayurvedic Shabda Pariksha (Sound Examination) In
Diagnosis of Diseases WSR To Stethoscopic Auscultation;Inter .J. Dignostics and Research 3 (1) 152-163,
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 6 0 0 1 9
G AR V
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 152
Abstract
The various sound produced in the body are used as tools in the diagnosis of disease by ancient Ayurvedic
acharyas. Acharya Charaka, in Vimansthana, had asked to examine the bowel sounds, joint crepitation and
other peculiar sounds produced in the body such as cough and hiccups to diagnose the disease condition of
that particular system. Apart from this ancient Ayurvedic scholars have described the typical sound produced
in various disease conditions such as Maha Shwasa (Kussmaul’s breathing), Tamak shwasa (Bronchial
Asthma), Krukaj Kasa (Whooping cough), Swarabheda (Laryngeal disease), Vakastambha (Tongue
paralysis) causing Minminitva (Nasal speech) and Gadgadatva (Spastic speech), Ardita (Facial Palsy)
causing Vaksanga (dysarthria). Sandhivata (Osteoarthritis) causing joint crepitations. Alasaka
(Gastroparesis) causing abdominal gurgling, Apatantraka & Apatanaka (Tetanus) causing laryngeal stridor
with loud audible wheeze. Sangrahani & Ghati Yantra (IBS) causing abdominal gurgling. Pandu (Anemia)
causing tachycardia. In ancient times auscultation was done purely through ears and no any reference to
stethoscope like devices is found in the ancient books. However, the picture depicting the sage Kashyapa
auscultating the infant heart sound with hollow Papaya branch is available which could be world’s first
prototype of stethoscope. The ancient Indian physicians used to directly apply the ear to the chest to hear the
heart and lung sounds. The heart sounds, lung sounds and bowel sounds, were auscultated by keeping the ear
in close contact with chest and abdomen respectively. Acharya Vinodlal Sen had described some heart lung
sounds using this examination. With the advent of stethoscope by French Physician Rinne Lennec (1781-
1836), auscultation has occupied the prime position as physical examination method in the diagnosis of the
chest diseases to such an extent that it has become the symbol of modern day physician. It is observed and
concluded that Auscultation as tool of examining the patient to diagnose the disease is very well mentioned
in Ayurveda.
Keywords – Shrawan , Auscultation, Shwasa , Kasa
P
ISSN No. : 2584-2757
Volume : 03
Issue : 01
Publisher
ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION
FOR PATHOLOGY AND RADIODIGNOSIS
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 6 0 0 1 9
Reg. No. : MAHA-703/16(NAG) Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding author: Dr.Subhash Waghe Article Info: Published on : 15/10/2025
Impact Factor : 1.013
Critical Evaluation of Ayurvedic Shabda Pariksha (Sound Examination) In
Diagnosis of Diseases WSR To Stethoscopic Auscultation
Dr. Subhash Waghe 1, Dr. Dhanashri Joshi 2
1Professor & HOD- Dept. of Rog Nidan, Sardar Patel Ayurvedic Medical College, Dongariya, Balaghat.
2 HOD -Dept. of Sharir Kriya (Physiology)Sardar Patel Ayurvredic Medical College And Hospital, Balaghat
Cite this article as: - Dr.Subhash Waghe (2025) ; Critical Evaluation of Ayurvedic Shabda Pariksha (Sound Examination) In
Diagnosis of Diseases WSR To Stethoscopic Auscultation;Inter .J. Dignostics and Research 3 (1) 152-163,
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 6 0 0 1 9
G AR V
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 153
Introduction :
The various sound produced in the body are used as
tools in the diagnosis of disease by ancient
Ayurvedic acharyas. Acharya Charaka, in
Vimansthana, had asked to examine the bowel
sounds, joint crepitation and other peculiar sounds
produced in the body such as cough and hiccups to
diagnose the disease condition of that particular
system. Apart from this ancient Ayurvedic scholars
have described the typical sound produced in
various disease conditions such as Maha Shwasa
(Kussmaul’s breathing), Tamak shwasa (Bronchial
Asthma), Krukaj Kasa (Whooping cough),
Swarabheda (Laryngeal disease), Vakastambha
(Tongue paralysis) causing Minminitva (Nasal
speech) and Gadgadatva (Spastic speech), Ardita
(Facial Palsy) causing Vaksanga (dysarthria).
Sandhivata (Osteoarthritis) causing joint
crepitations. Alasaka (Gastroparesis) causing
abdominal gurgling, Apatantraka & Apatanaka
(Tetanus) causing laryngeal stridor with loud
audible wheeze. Sangrahani & Ghati Yantra (IBS)
causing abdominal gurgling. Pandu (Anemia)
causing tachycardia. In ancient times auscultation
was done purely through ears and no any reference
to stethoscope like devices is found in the ancient
books. However the picture depicting the sage
Kashyapa auscultating the infant heart sound with
hollow Papaya branch is available which could be
world’s first prototype of stethoscope. The ancient
Indian physicians used to directly apply the ear to
the chest to hear the heart and lung sounds. The
heart sounds, lung sounds and bowel sounds, were
auscultated by keeping the ear in close contact with
chest and abdomen respectively. Acharya Vinodlal
Sen had described some heart lung sounds using
this examination. With the advent of stethoscope by
French Physician Rinne Lennec (1781-1836),
auscultation has occupied the prime position as
physical examination method in the diagnosis of
the chest diseases to such an extent that it has
become the symbol of modern day physician.
Review Of Literature :
Examination of Sound Through Auscultation
Under eight fold examinations, Shabda
Pariksha (sound examination) should be
done.[1]
The sound produced in infective or
gangrenous wound should be noted. [2]
Bowel sounds, Joint crepitation and other
peculiar sounds produced in the body
should be examined through auscultation. [3]
The other peculiar sounds like hiccups and
cough should also be heard. [4]
Disease Condition & Type of sound
Shwasa vyadhi (Dyspnea), the respiratory
sound is harsh like as if blowing the fire in
pot. (Bhinna Kansya Tulya Swara) [5]
In Kasa vyadhi (Cough), the cough sound
is like as if striking the bronze pot. [6]
In Jara Kasa vyadhi (Cough due to old
age), the cough sound is like as if striking
the bronze pot. [7]
In Kshataj Kasa (Bronchitis), there is
pigeon like sound (Paravat Eva Koojanam)
[8]
In Krukkaj Kasa (whooping cough), there is
whoop whoop like sound while coughing.
In Tamak Shwasa there is loud audible
wheeze (Kanthe ghurghurakam) [9]
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 153
Introduction :
The various sound produced in the body are used as
tools in the diagnosis of disease by ancient
Ayurvedic acharyas. Acharya Charaka, in
Vimansthana, had asked to examine the bowel
sounds, joint crepitation and other peculiar sounds
produced in the body such as cough and hiccups to
diagnose the disease condition of that particular
system. Apart from this ancient Ayurvedic scholars
have described the typical sound produced in
various disease conditions such as Maha Shwasa
(Kussmaul’s breathing), Tamak shwasa (Bronchial
Asthma), Krukaj Kasa (Whooping cough),
Swarabheda (Laryngeal disease), Vakastambha
(Tongue paralysis) causing Minminitva (Nasal
speech) and Gadgadatva (Spastic speech), Ardita
(Facial Palsy) causing Vaksanga (dysarthria).
Sandhivata (Osteoarthritis) causing joint
crepitations. Alasaka (Gastroparesis) causing
abdominal gurgling, Apatantraka & Apatanaka
(Tetanus) causing laryngeal stridor with loud
audible wheeze. Sangrahani & Ghati Yantra (IBS)
causing abdominal gurgling. Pandu (Anemia)
causing tachycardia. In ancient times auscultation
was done purely through ears and no any reference
to stethoscope like devices is found in the ancient
books. However the picture depicting the sage
Kashyapa auscultating the infant heart sound with
hollow Papaya branch is available which could be
world’s first prototype of stethoscope. The ancient
Indian physicians used to directly apply the ear to
the chest to hear the heart and lung sounds. The
heart sounds, lung sounds and bowel sounds, were
auscultated by keeping the ear in close contact with
chest and abdomen respectively. Acharya Vinodlal
Sen had described some heart lung sounds using
this examination. With the advent of stethoscope by
French Physician Rinne Lennec (1781-1836),
auscultation has occupied the prime position as
physical examination method in the diagnosis of
the chest diseases to such an extent that it has
become the symbol of modern day physician.
Review Of Literature :
Examination of Sound Through Auscultation
Under eight fold examinations, Shabda
Pariksha (sound examination) should be
done.[1]
The sound produced in infective or
gangrenous wound should be noted. [2]
Bowel sounds, Joint crepitation and other
peculiar sounds produced in the body
should be examined through auscultation. [3]
The other peculiar sounds like hiccups and
cough should also be heard. [4]
Disease Condition & Type of sound
Shwasa vyadhi (Dyspnea), the respiratory
sound is harsh like as if blowing the fire in
pot. (Bhinna Kansya Tulya Swara) [5]
In Kasa vyadhi (Cough), the cough sound
is like as if striking the bronze pot. [6]
In Jara Kasa vyadhi (Cough due to old
age), the cough sound is like as if striking
the bronze pot. [7]
In Kshataj Kasa (Bronchitis), there is
pigeon like sound (Paravat Eva Koojanam)
[8]
In Krukkaj Kasa (whooping cough), there is
whoop whoop like sound while coughing.
In Tamak Shwasa there is loud audible
wheeze (Kanthe ghurghurakam) [9]
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 154
In Maha Shwasam there is noisy respiration
like that of angry bull (Matta Vrushabh
Eva) [10]
In Vataj Swarabheda there is hoarseness of
voice. [11]
In Medoj Swarabheda there is low tone
voice. [12]
In Neela Manya Marmaghat (trauma to
laryngeal nerve), there is hoarseness of
voice. [13]
In Pandu (Anemia) the Dhad Dhad sound
is noticed with tachycardia. [14]
In Sangraha Grahani (IBS), there is
abdominal gurgling (Antra Koojanam). [15]
In Ghati Yantra Grahani (IBS), there is
abdominal gurgling of greater degree
(Gudgud Dhwani). [16]
In Udaradhman (abdominal distension),
there is abdominal gurgling (udar aatop
Gudgud shabda). [17]
In Apatantraka/Apatanaka (Tetanus), there
is pigeon like sound (Kapot Eva Koojanam)
[18]
In pathological states of lungs, the
respiration similar to breath of snake or
flute like sound is produced. If there is
accumulation of cough, pus or blood in
lungs then the crepitation are heard. (sound
produced while cleaning the mudded leaf.
[19]
In cardiac enlargement, the sound is not
heard at its regular site but at the displaced
site. And the pitch of the sound is
comparatively slower. [20]
Discussion :
The various sound produced in the body are used as
tools in the diagnosis of disease by Ayurvedic
acharyas. Acharya Charaka, in Vimansthana, had
asked to examine the bowel sounds, joint
crepitation and other peculiar sounds produced in
the body such as cough and hiccups to diagnose the
particular disease condition of particular system.
Apart from this ancient Ayurvedic scholars have
described the typical sound produced in various
disease conditions such as Tamak shwasa
(Bronchial Asthma) causing audible wheeze. Maha
Shwasa (Kussmaul’s breathing) causing loud
audible wheeze. Krukaj Kasa (Whooping cough)
causing characteristic Whoop sound, Swarabheda
(Laryngeal disease) causing hoarseness of voice.
Vakastambha (Tongue paralysis) causing
Minminitva (Nasal speech) and Gadgadatva
(Spastic speech), Ardita (Facial Palsy) causing
Vaksanga (dysarthria). Sandhivata (Osteoarthritis)
causing joint crepitations. Alasaka (Gastroparesis)
causing abdominal gurgling, Apatantraka &
Apatanaka (Tetanus) causing laryngeal stridor with
loud audible wheeze.
Coughing is characterized by the sudden expulsion
of air from the airways with typical sound. The
quality of cough sound may provide some clue
about the underlying disease.Dog barking cough
with and breathing with whistling is observed in
viral cough.Rattling cough is observed in
bronchitis. Long bouts of cough are observed in
COPD due to collapse of lower lung alveoli.
Whereas wheezing cough is observed in Asthma.
These qualitative acoustic differences of cough
could be well picked up by the trained physicians.
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 154
In Maha Shwasam there is noisy respiration
like that of angry bull (Matta Vrushabh
Eva) [10]
In Vataj Swarabheda there is hoarseness of
voice. [11]
In Medoj Swarabheda there is low tone
voice. [12]
In Neela Manya Marmaghat (trauma to
laryngeal nerve), there is hoarseness of
voice. [13]
In Pandu (Anemia) the Dhad Dhad sound
is noticed with tachycardia. [14]
In Sangraha Grahani (IBS), there is
abdominal gurgling (Antra Koojanam). [15]
In Ghati Yantra Grahani (IBS), there is
abdominal gurgling of greater degree
(Gudgud Dhwani). [16]
In Udaradhman (abdominal distension),
there is abdominal gurgling (udar aatop
Gudgud shabda). [17]
In Apatantraka/Apatanaka (Tetanus), there
is pigeon like sound (Kapot Eva Koojanam)
[18]
In pathological states of lungs, the
respiration similar to breath of snake or
flute like sound is produced. If there is
accumulation of cough, pus or blood in
lungs then the crepitation are heard. (sound
produced while cleaning the mudded leaf.
[19]
In cardiac enlargement, the sound is not
heard at its regular site but at the displaced
site. And the pitch of the sound is
comparatively slower. [20]
Discussion :
The various sound produced in the body are used as
tools in the diagnosis of disease by Ayurvedic
acharyas. Acharya Charaka, in Vimansthana, had
asked to examine the bowel sounds, joint
crepitation and other peculiar sounds produced in
the body such as cough and hiccups to diagnose the
particular disease condition of particular system.
Apart from this ancient Ayurvedic scholars have
described the typical sound produced in various
disease conditions such as Tamak shwasa
(Bronchial Asthma) causing audible wheeze. Maha
Shwasa (Kussmaul’s breathing) causing loud
audible wheeze. Krukaj Kasa (Whooping cough)
causing characteristic Whoop sound, Swarabheda
(Laryngeal disease) causing hoarseness of voice.
Vakastambha (Tongue paralysis) causing
Minminitva (Nasal speech) and Gadgadatva
(Spastic speech), Ardita (Facial Palsy) causing
Vaksanga (dysarthria). Sandhivata (Osteoarthritis)
causing joint crepitations. Alasaka (Gastroparesis)
causing abdominal gurgling, Apatantraka &
Apatanaka (Tetanus) causing laryngeal stridor with
loud audible wheeze.
Coughing is characterized by the sudden expulsion
of air from the airways with typical sound. The
quality of cough sound may provide some clue
about the underlying disease.Dog barking cough
with and breathing with whistling is observed in
viral cough.Rattling cough is observed in
bronchitis. Long bouts of cough are observed in
COPD due to collapse of lower lung alveoli.
Whereas wheezing cough is observed in Asthma.
These qualitative acoustic differences of cough
could be well picked up by the trained physicians.
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 155
Swarbheda refers to change of voice (Bhinna swar)
which is unpleasant (udweg janak) and may
resemble the rough sound of donkey (Gardhbh wat
khar) or crow (Kak wat) due to invasion of sound
tract by morbid doshas.
Sangrahani & Ghati Yantra (IBS) causes
abdominal gurgling due to excessive wind
production in the GI tract.
The joint crepitation (Sandhi Aatopa) occurs due to
release of air in the synovial fluid during movement
of the joint.
Vrudhhasya Swarbheda (Change of voice in old
peoples) mentioned by acharya Sushruta in
Uttartantra, indicate chronic atrophic laryngitis.
Sahaj Swarabheda mentioned by acharya Sushruta
in Uttartantra, refers to congenital hoarseness of
voice.
Chirothha Swarabheda mentioned by acharya
Sushruta in Uttartantra refers to chronic laryngitis.
Swar upghat karak asadhya galganda mentioned
by acharya Sushruta in Nidansthana may refer to
myxoedematous swelling compressing trachea
externally.
Neela Manya Marmaghat mentioned by acharya
Sushruta in Sharisthana six could be trauma to
laryngeal nerve resulting in hoarseness of voice.
Medoj Swarabheda mentioned by acharya Sushruta
in Uttartantra, may occur in obese peoples but as it
has been mentioned as incurable; this could most
likely be fatty infiltration of larynx as may occur in
laryngeal lipoma.
In ancient times auscultation was done purely
through ears and no any reference to stethoscope
like devices is found in the ancient books. The
ancient Indian physicians used to directly apply the
ear to the chest to hear the heart and lung sounds.
The heart sounds, lung sounds and bowel sounds,
were auscultated by keeping the ear in close contact
with chest and abdomen respectively. With the
advent of stethoscope by French Physician Rinne
Lennec (1781-1836), auscultation has occupied the
prime position as physical examination method in
the diagnosis of the chest diseases to such an extent
that it has become the symbol of modern day
physician. However, the first prototype of
stethoscope was invented by Chinese and probably
the Indian sage Kashyapa. We find a sculpture of
sage Kashyapa depicting the auscultation of the
chest of a child with the hollow branch of pappya at
Kaneri matha museum, kolahapur (Maharashtra,
India). However, the antiquity of the original
sculpture from where this is designed could not be
authenticated.
The stethoscope is an instrument that does not
significantly amplify sound, but, more important,
acts as a selective filter of sound. Since sounds
produced by breathing tend to be of relatively high
pitch, the chest is auscultated with the diaphragm of
the stethoscope.
Current Classification of lung sounds[21]
A] Breath Sounds :
1. Normal – It is the sound heard through the
chest wall of a healthy individual. It is a
faint noise with a frequency between 200 to
600 Hz heard through out the inspiration
and at the beginning of expiration.
2. Bronchial breathing – These are the breath
sounds which resemble the noise of
respiration heard through stethoscope on the
neck (trachea). They are loud with a
frequency between 200 to 2000 Hz audible
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 155
Swarbheda refers to change of voice (Bhinna swar)
which is unpleasant (udweg janak) and may
resemble the rough sound of donkey (Gardhbh wat
khar) or crow (Kak wat) due to invasion of sound
tract by morbid doshas.
Sangrahani & Ghati Yantra (IBS) causes
abdominal gurgling due to excessive wind
production in the GI tract.
The joint crepitation (Sandhi Aatopa) occurs due to
release of air in the synovial fluid during movement
of the joint.
Vrudhhasya Swarbheda (Change of voice in old
peoples) mentioned by acharya Sushruta in
Uttartantra, indicate chronic atrophic laryngitis.
Sahaj Swarabheda mentioned by acharya Sushruta
in Uttartantra, refers to congenital hoarseness of
voice.
Chirothha Swarabheda mentioned by acharya
Sushruta in Uttartantra refers to chronic laryngitis.
Swar upghat karak asadhya galganda mentioned
by acharya Sushruta in Nidansthana may refer to
myxoedematous swelling compressing trachea
externally.
Neela Manya Marmaghat mentioned by acharya
Sushruta in Sharisthana six could be trauma to
laryngeal nerve resulting in hoarseness of voice.
Medoj Swarabheda mentioned by acharya Sushruta
in Uttartantra, may occur in obese peoples but as it
has been mentioned as incurable; this could most
likely be fatty infiltration of larynx as may occur in
laryngeal lipoma.
In ancient times auscultation was done purely
through ears and no any reference to stethoscope
like devices is found in the ancient books. The
ancient Indian physicians used to directly apply the
ear to the chest to hear the heart and lung sounds.
The heart sounds, lung sounds and bowel sounds,
were auscultated by keeping the ear in close contact
with chest and abdomen respectively. With the
advent of stethoscope by French Physician Rinne
Lennec (1781-1836), auscultation has occupied the
prime position as physical examination method in
the diagnosis of the chest diseases to such an extent
that it has become the symbol of modern day
physician. However, the first prototype of
stethoscope was invented by Chinese and probably
the Indian sage Kashyapa. We find a sculpture of
sage Kashyapa depicting the auscultation of the
chest of a child with the hollow branch of pappya at
Kaneri matha museum, kolahapur (Maharashtra,
India). However, the antiquity of the original
sculpture from where this is designed could not be
authenticated.
The stethoscope is an instrument that does not
significantly amplify sound, but, more important,
acts as a selective filter of sound. Since sounds
produced by breathing tend to be of relatively high
pitch, the chest is auscultated with the diaphragm of
the stethoscope.
Current Classification of lung sounds[21]
A] Breath Sounds :
1. Normal – It is the sound heard through the
chest wall of a healthy individual. It is a
faint noise with a frequency between 200 to
600 Hz heard through out the inspiration
and at the beginning of expiration.
2. Bronchial breathing – These are the breath
sounds which resemble the noise of
respiration heard through stethoscope on the
neck (trachea). They are loud with a
frequency between 200 to 2000 Hz audible
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 156
3. throughout inspiration and expiration. When
the lung tissue is airless due to
consolidation, the breath sounds are
transmitted to the stethoscope. Bronchial
breathing is generally heard over airless
upper lobes as the mediastinal surface of the
upper lobe is in direct contact with trachea.
B] Voice Sounds :
1. Bronchophony – It is the speech heard
through the chest wall with little loss of
loudness resembling the voice sound heard
through the neck. When the lung between
the trachea and point of auscultation is
airless, the higher frequencies are
transmitted through the solid lung and
speech becomes intelligible. The acoustic
mechanism of bronchial breathing and of
bronchophony is the same.
2. Aegophony – These are the voice sounds
transmitted through the chest wall with
selective amplification of their higher
frequencies and removal of low frequencies
giving nasal bleating quality to the voice.
The sound is distorted due to the presence
of fluid or air in the pleural cavity. when
consolidation is associated with a pleural
effusion, the bronchial breath sounds are
present but often quite decreased in
intensity. Confirmation of the presence of
bronchial breath sounds can be obtained by
listening for egophony ("E to A" sound).
This sound is elicited by asking the patient
to say the letter "E" as one listens over the
suspicious area with the stethoscope. When
consolidation is present, the spoken "E"
sound is converted to an auscultated "A"
sound, similar to that produced by a bleating
goat.
3. Whispering Pectrolioqye –In whispering,
the abducted vocal cords do not oscillate
and voice sound is generated by turbulent
flow of air through the trachea, glottis and
pharynx. Whisper lacks the powerful low
frequencies of normal voice sounds and the
high pitched components of noise of
turbulence and the formants of vowel are
transmitted through the airless lungs so that
whispered speech becomes intelligible. This
is whispering pectroliquy and occurs in
consolidation state.
C] Adventitious Sounds :
There are three types of abnormal breath sounds.
They are collectively referred to as adventitious
breath sounds.
1. Wheezing –Musical lung sounds are
usually referred as wheezes when heard at a
distance or at a mouth and Rhonchii when
heard through the chest wall by stethoscope.
It is produced when a critical velocity of gas
flow passes through a slit like opening.
When wheezes are local, one must consider
external compression of an airway by
enlarged lymph nodes or tumors. A lesion
within the airway, such as an endobronchial
malignancy or foreign body, also can
produce a localized wheeze. Diffuse
wheezing is present in inflammatory
processes such as bronchitis, contraction of
hypertrophied bronchial smooth muscle as
seen in asthma, thick secretions of
pneumonia.
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 156
3. throughout inspiration and expiration. When
the lung tissue is airless due to
consolidation, the breath sounds are
transmitted to the stethoscope. Bronchial
breathing is generally heard over airless
upper lobes as the mediastinal surface of the
upper lobe is in direct contact with trachea.
B] Voice Sounds :
1. Bronchophony – It is the speech heard
through the chest wall with little loss of
loudness resembling the voice sound heard
through the neck. When the lung between
the trachea and point of auscultation is
airless, the higher frequencies are
transmitted through the solid lung and
speech becomes intelligible. The acoustic
mechanism of bronchial breathing and of
bronchophony is the same.
2. Aegophony – These are the voice sounds
transmitted through the chest wall with
selective amplification of their higher
frequencies and removal of low frequencies
giving nasal bleating quality to the voice.
The sound is distorted due to the presence
of fluid or air in the pleural cavity. when
consolidation is associated with a pleural
effusion, the bronchial breath sounds are
present but often quite decreased in
intensity. Confirmation of the presence of
bronchial breath sounds can be obtained by
listening for egophony ("E to A" sound).
This sound is elicited by asking the patient
to say the letter "E" as one listens over the
suspicious area with the stethoscope. When
consolidation is present, the spoken "E"
sound is converted to an auscultated "A"
sound, similar to that produced by a bleating
goat.
3. Whispering Pectrolioqye –In whispering,
the abducted vocal cords do not oscillate
and voice sound is generated by turbulent
flow of air through the trachea, glottis and
pharynx. Whisper lacks the powerful low
frequencies of normal voice sounds and the
high pitched components of noise of
turbulence and the formants of vowel are
transmitted through the airless lungs so that
whispered speech becomes intelligible. This
is whispering pectroliquy and occurs in
consolidation state.
C] Adventitious Sounds :
There are three types of abnormal breath sounds.
They are collectively referred to as adventitious
breath sounds.
1. Wheezing –Musical lung sounds are
usually referred as wheezes when heard at a
distance or at a mouth and Rhonchii when
heard through the chest wall by stethoscope.
It is produced when a critical velocity of gas
flow passes through a slit like opening.
When wheezes are local, one must consider
external compression of an airway by
enlarged lymph nodes or tumors. A lesion
within the airway, such as an endobronchial
malignancy or foreign body, also can
produce a localized wheeze. Diffuse
wheezing is present in inflammatory
processes such as bronchitis, contraction of
hypertrophied bronchial smooth muscle as
seen in asthma, thick secretions of
pneumonia.
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 157
a) Fixed monophonic wheezes – A
single note of constant pitch is a
characteristic sign of incomplete
obstruction of principle or lobar
bronchus by tumour or foreign body.
b) Random monophonic wheezes - It
could be inspiratory, expiratory or
continuous throughout the
respiratory cycle. It is noticed in
widespread airflow obstruction
particularly in asthma.
c) Sequential inspiratory wheezes – It
consists of a series of short musical
sounds each of different pitch and
loudness. It may be noticed in
fibrosing alveolitis, asbestosis and
other diffuse interstitial pulmonary
fibrotic conditions.
d) Expiratory polyphonic wheezes -
They refer to complex musical
sounds (Loud hissing) beginning at
the same time and continuing till the
end of expiration. Polyphonic
wheezing at rest is a reliable sign of
widespread air flow obstruction.
e) Stridor – A loud musical sound
resembling wheezing in its character
and mode of origin. It could be
noticed in tracheal stenosis.
Inspiratory stridor in whooping
cough.In fatal asthma, absence of
wheezing is due to very high
resistance to peripheral flow of air
and as the airways cannot be set into
oscillation.
Absence of wheezing in emphysema with
severe expiratory obstruction is may be due
to loss of elastic recoiling of the lung tissue.
In terminal ventilator failure the expiratory
flow rate may be too low to generate
wheezing.
2. Crackles / Crepitations – The other
abnormal breath sound is the crackle, often
called ‘rale’. They are short explosive moist
sounds heard through the chest wall
attributed to the bubbling of secretions in
the airways. The primary mechanism of
crackling is explosive equalization of gas
pressure between two compartments of the
lung when closed section of the airways
separating them opens suddenly. Crackles
imply the snapping open of previously
collapsed airways or alveoli. When crackles
are heard during the initiation of inspiration,
they are called early inspiratory crackles.
When they occur toward the terminal
portion of the inspiratory maneuver, they
are referred to as late inspiratory crackles.
At times, crackling sounds can be heard
throughout the inspiratory phase and are
called paninspiratory crackles. Since larger
airways open first as inhalation progresses
from residual volume, early inspiratory
crackles may indicate large airways disease
while late inspiratory crackles may indicate
small airways problems as seen in
congestive heart failure, pulmonary fibrosis
or other interstitial pulmonary processes.
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 157
a) Fixed monophonic wheezes – A
single note of constant pitch is a
characteristic sign of incomplete
obstruction of principle or lobar
bronchus by tumour or foreign body.
b) Random monophonic wheezes - It
could be inspiratory, expiratory or
continuous throughout the
respiratory cycle. It is noticed in
widespread airflow obstruction
particularly in asthma.
c) Sequential inspiratory wheezes – It
consists of a series of short musical
sounds each of different pitch and
loudness. It may be noticed in
fibrosing alveolitis, asbestosis and
other diffuse interstitial pulmonary
fibrotic conditions.
d) Expiratory polyphonic wheezes -
They refer to complex musical
sounds (Loud hissing) beginning at
the same time and continuing till the
end of expiration. Polyphonic
wheezing at rest is a reliable sign of
widespread air flow obstruction.
e) Stridor – A loud musical sound
resembling wheezing in its character
and mode of origin. It could be
noticed in tracheal stenosis.
Inspiratory stridor in whooping
cough.In fatal asthma, absence of
wheezing is due to very high
resistance to peripheral flow of air
and as the airways cannot be set into
oscillation.
Absence of wheezing in emphysema with
severe expiratory obstruction is may be due
to loss of elastic recoiling of the lung tissue.
In terminal ventilator failure the expiratory
flow rate may be too low to generate
wheezing.
2. Crackles / Crepitations – The other
abnormal breath sound is the crackle, often
called ‘rale’. They are short explosive moist
sounds heard through the chest wall
attributed to the bubbling of secretions in
the airways. The primary mechanism of
crackling is explosive equalization of gas
pressure between two compartments of the
lung when closed section of the airways
separating them opens suddenly. Crackles
imply the snapping open of previously
collapsed airways or alveoli. When crackles
are heard during the initiation of inspiration,
they are called early inspiratory crackles.
When they occur toward the terminal
portion of the inspiratory maneuver, they
are referred to as late inspiratory crackles.
At times, crackling sounds can be heard
throughout the inspiratory phase and are
called paninspiratory crackles. Since larger
airways open first as inhalation progresses
from residual volume, early inspiratory
crackles may indicate large airways disease
while late inspiratory crackles may indicate
small airways problems as seen in
congestive heart failure, pulmonary fibrosis
or other interstitial pulmonary processes.
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 158
a. Late inspiratory crackles – A series of late
inspiratory high pitched explosive sounds of
variable intensity and spacing is a
characteristic sign of fibrosing alveolitis,
resolving lobar pneumonia and interstitial
pulmonary edema (due to cardiac failure).
When the patient bends forward, the crackles
are silenced and returns on standing upright.
b. Early inspiratory and expiratory crackles –
Crackles during expiration and at the
beginning of the inspiration are common in
widespread airflow obstruction.
c. Crackling in pneumothorax – In left sided
pneumothorax loud crackling is synchronous
with the heart beat and may be heard near the
left sternal border.
3. Gurgling - The final abnormal breath sound is
called a gurgle. It is similar to the sound produced
when one exhales through a straw placed in a glass
of water. Gurgles are produced by airflow through
liquid of varying viscosities in the airways. Gurgles
suggest fluid in the airways. This may be produced
by excessive serous secretion in alveolar cell
carcinoma, infected purulent secretion of acute or
chronic bronchitis or bronchiectasis or due to
transudated fluid entering the airways from the
alveoli as occurs in pulmonary edema.
Cardiac Auscultation[22,23]
The apex, lower left sternal edge, upper left sternal
edge and upper right sternal edge should be
auscultated with the bell and the diaphragm of the
stethoscope. These locations corresponds to mitral,
tricuspid, pulmonary, aortic area respectively and
loosely identify sites at which sounds and murmurs
arising from the four valves are best heard.
First heart sound (S1) – It results from the closure
of the mitral and tricuspid valve at the onset of
systole. It is loud in patients with large cardiac
output, Vasodilatation, Exercise, Fever,
Thyrotoxicosis and Mitral stenosis.It is quite in
Obesity, Emphysema and Impaired left ventricular
Function.
Second heart sound (S2) –It results from the
closure of aortic and pulmonary valve during
ventricular ejection. S2 is single during expiration.
Inspiration causes physiological splitting of S2 into
aortic followed by pulmonary component because
increased right ventricular filling which delays
pulmonary valve closure. The physiological
splitting is most common in children and young
adults. Delayed aortic closure by LBBB leads to
reversed splitting of the S2. Exaggerated splitting
occurs in RBBB. While fixed splitting occurs in
atrial septal defect and pulmonary stenosis.
Third & Fourth heart sounds (S3 & S4) – These
low frequency sounds occur early and late in
diastole respectively. When present they give a
characteristic ‘gallop’ cadence to the cardiac
rhythm. Both sounds are best heard at the cardiac
apex. They are caused by abrupt tensing of the
ventricular walls following rapid diastolic filling.
Rapid filling occurs early in diastole (S3) following
atrioventricular valve opening and again late in
diastole (S4) due to atrial contraction.
Characteristics of 3rd heart sound :
●It is physiological in children and young adults
and disappear after the age 40.
●It is generally pathological after 4o years of age.
Usually occurs in left ventricular failure,
cardiomyopathy and ischemic heart diseases.
● It also occurs in high output states caused by
anemia, fever, pregnancy and thyrotoxicosis.
Characteristics of 4th heart sound :
● It is sometimes physiological in elderly.
● Commonly it is pathological and occurs when
vigorous atrial contraction late in diastole is
required to augment filling of a hypertrophied non
compliant ventricle.
● It occurs in long standing hypertension,
hypertrophic cardiomyopathy, ischemic heart
disease, atrial stenosis.
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 158
a. Late inspiratory crackles – A series of late
inspiratory high pitched explosive sounds of
variable intensity and spacing is a
characteristic sign of fibrosing alveolitis,
resolving lobar pneumonia and interstitial
pulmonary edema (due to cardiac failure).
When the patient bends forward, the crackles
are silenced and returns on standing upright.
b. Early inspiratory and expiratory crackles –
Crackles during expiration and at the
beginning of the inspiration are common in
widespread airflow obstruction.
c. Crackling in pneumothorax – In left sided
pneumothorax loud crackling is synchronous
with the heart beat and may be heard near the
left sternal border.
3. Gurgling - The final abnormal breath sound is
called a gurgle. It is similar to the sound produced
when one exhales through a straw placed in a glass
of water. Gurgles are produced by airflow through
liquid of varying viscosities in the airways. Gurgles
suggest fluid in the airways. This may be produced
by excessive serous secretion in alveolar cell
carcinoma, infected purulent secretion of acute or
chronic bronchitis or bronchiectasis or due to
transudated fluid entering the airways from the
alveoli as occurs in pulmonary edema.
Cardiac Auscultation[22,23]
The apex, lower left sternal edge, upper left sternal
edge and upper right sternal edge should be
auscultated with the bell and the diaphragm of the
stethoscope. These locations corresponds to mitral,
tricuspid, pulmonary, aortic area respectively and
loosely identify sites at which sounds and murmurs
arising from the four valves are best heard.
First heart sound (S1) – It results from the closure
of the mitral and tricuspid valve at the onset of
systole. It is loud in patients with large cardiac
output, Vasodilatation, Exercise, Fever,
Thyrotoxicosis and Mitral stenosis.It is quite in
Obesity, Emphysema and Impaired left ventricular
Function.
Second heart sound (S2) –It results from the
closure of aortic and pulmonary valve during
ventricular ejection. S2 is single during expiration.
Inspiration causes physiological splitting of S2 into
aortic followed by pulmonary component because
increased right ventricular filling which delays
pulmonary valve closure. The physiological
splitting is most common in children and young
adults. Delayed aortic closure by LBBB leads to
reversed splitting of the S2. Exaggerated splitting
occurs in RBBB. While fixed splitting occurs in
atrial septal defect and pulmonary stenosis.
Third & Fourth heart sounds (S3 & S4) – These
low frequency sounds occur early and late in
diastole respectively. When present they give a
characteristic ‘gallop’ cadence to the cardiac
rhythm. Both sounds are best heard at the cardiac
apex. They are caused by abrupt tensing of the
ventricular walls following rapid diastolic filling.
Rapid filling occurs early in diastole (S3) following
atrioventricular valve opening and again late in
diastole (S4) due to atrial contraction.
Characteristics of 3rd heart sound :
●It is physiological in children and young adults
and disappear after the age 40.
●It is generally pathological after 4o years of age.
Usually occurs in left ventricular failure,
cardiomyopathy and ischemic heart diseases.
● It also occurs in high output states caused by
anemia, fever, pregnancy and thyrotoxicosis.
Characteristics of 4th heart sound :
● It is sometimes physiological in elderly.
● Commonly it is pathological and occurs when
vigorous atrial contraction late in diastole is
required to augment filling of a hypertrophied non
compliant ventricle.
● It occurs in long standing hypertension,
hypertrophic cardiomyopathy, ischemic heart
disease, atrial stenosis.
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 159
A] Opening Snap – This is heard midway between
2nd and 3rd heart sound in cases of mitral stenosis
or tricuspid stenosis. It is high pitched loud
snapping or clicking sharp sound due to sudden
tensing of the cusps of mitral valve and tricuspid
valve as it tries to open during early diastole. It is
best heard just inside the apex beat. The interval
between the onset of 2nd heart sound and the
opening snap is good indicator to judge the severity
of mitral stenosis. Shorter the 2 os interval, more
severe is the mitral stenosis.
B] Systolic ejection clicks – They are high pitched
click like sounds which come immediately after the
first heart sound and are best heard in aortic or
pulmonary areas. They are due to excessive
ejection of blood from ventricles into the blood
vessels.
Pulmonary ejection clicks are best heard during
inspiration. They result due to dilatation of the
pulmonary artery, pulmonary stenosis, pulmonary
hypertension.
Aortic ejection clicks are transmitted to apical area.
They occur in aortic stenosis, aortic regurgitation,
aortic aneurysm, coarctation of the aorta,
hypertension.
C] Murmurs – These are caused by turbulent flow
within the heart and great vessels and may indicate
valve disease. Heart murmurs defined by loudness
(Low-medium – high pitched), quality (rumbling ,
blowing), location, radiation and timing (systolic or
diastolic ). Murmurs may occur without underlying
heart disease. Innocent murmur of this type usually
reflects hyperkinetic circulation in conditions such
as anemia, fever, pregnancy and thyrotoxicosis.
The murmur of aortic stenosis is loudest at the right
sternal edge 2nd intercostal space and sometimes
radiates to the carotids, it is termed ejection systolic
because of its increasing and then decreasing
volume in systole. The murmur of mitral
regurgitation is loudest at the apex beat and is
termed pansystolic because it is of equal volume
throughout systole. The murmur of mitral stenosis
occurs over the apex beat during the end of
diastole, and is "rumbling" in character.
D] Pericardial Rub – It is high pitched scratching
noise audible during any part of the cardiac cycle
and over any part of the left precordium. This
caused by the slashing movements imparted by the
heart beat to the exudates within the pericardial sac.
Observations & Results :
Disease Condition & Type Of Sound :Sr. Disease Condition Type of Sound
1 Shwasa (Tachyapnea) Bhastrika Dhmanwat
(like blowing in fire pot)
2 Kasa (Cough) Bhinna Kansya Tulya
(like striking on bronze pot)
3 Hikka (Hiccup) Hik Hik
4 Tamak shwasa (Bronchial Asthma) Kapot Eva Koojanam (Loud wheezing
resembling the sound of pigeons)
5 Apatantraka and Apatanaka (Tetanus) Kapot Eva Koojanam (Loud wheezing
resembling the sound of pigeons)
6 Maha Shwasa (Kussmaul’s breathing) Matta Vrushabh Eva
(Noisy respiration like that of angry bull)
6 Krukkaj Kasa (whooping cough) Whoop whoop like sound
7 Swarabheda (Laryngeal Disease) Gardabha wat swara (Donkey like
hoarseness of voice)
8 Pandu (Anemia) Hritdrava - Eti Dad Dadika (Palpitations)
9 Sandhivata (Osteoarthritis) Sandhi Aatopa (joint crepitation)
10 Alasaka (Gastroparesis) Udara Koojana (Abdominal gurgling)
11 Sangrahani & Ghati Yantra (IBS) Antra Koojana (Abdominal gurgling)
12 Vakastambha (Tongue paralysis) Minminitva (Nasal speech) and
Gadgadatva (Spastic speech)
13 Ardita (Facial Palsy) Vaksanga (dysarthria)
14 Swar upghat karak asadhya galganda
(myxoedema) Swarabheda (change of voice)
15 Vrudhhasya Swarbheda (chronic
atrophic laryngitis)
Swarbheda (Change of voice in old
peoples)
16 Swaraghna (Laryngeal Malignancy) Gardabha wat swara (Donkey
hoarseness of voice)
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 159
A] Opening Snap – This is heard midway between
2nd and 3rd heart sound in cases of mitral stenosis
or tricuspid stenosis. It is high pitched loud
snapping or clicking sharp sound due to sudden
tensing of the cusps of mitral valve and tricuspid
valve as it tries to open during early diastole. It is
best heard just inside the apex beat. The interval
between the onset of 2nd heart sound and the
opening snap is good indicator to judge the severity
of mitral stenosis. Shorter the 2 os interval, more
severe is the mitral stenosis.
B] Systolic ejection clicks – They are high pitched
click like sounds which come immediately after the
first heart sound and are best heard in aortic or
pulmonary areas. They are due to excessive
ejection of blood from ventricles into the blood
vessels.
Pulmonary ejection clicks are best heard during
inspiration. They result due to dilatation of the
pulmonary artery, pulmonary stenosis, pulmonary
hypertension.
Aortic ejection clicks are transmitted to apical area.
They occur in aortic stenosis, aortic regurgitation,
aortic aneurysm, coarctation of the aorta,
hypertension.
C] Murmurs – These are caused by turbulent flow
within the heart and great vessels and may indicate
valve disease. Heart murmurs defined by loudness
(Low-medium – high pitched), quality (rumbling ,
blowing), location, radiation and timing (systolic or
diastolic ). Murmurs may occur without underlying
heart disease. Innocent murmur of this type usually
reflects hyperkinetic circulation in conditions such
as anemia, fever, pregnancy and thyrotoxicosis.
The murmur of aortic stenosis is loudest at the right
sternal edge 2nd intercostal space and sometimes
radiates to the carotids, it is termed ejection systolic
because of its increasing and then decreasing
volume in systole. The murmur of mitral
regurgitation is loudest at the apex beat and is
termed pansystolic because it is of equal volume
throughout systole. The murmur of mitral stenosis
occurs over the apex beat during the end of
diastole, and is "rumbling" in character.
D] Pericardial Rub – It is high pitched scratching
noise audible during any part of the cardiac cycle
and over any part of the left precordium. This
caused by the slashing movements imparted by the
heart beat to the exudates within the pericardial sac.
Observations & Results :
Disease Condition & Type Of Sound :Sr. Disease Condition Type of Sound
1 Shwasa (Tachyapnea) Bhastrika Dhmanwat
(like blowing in fire pot)
2 Kasa (Cough) Bhinna Kansya Tulya
(like striking on bronze pot)
3 Hikka (Hiccup) Hik Hik
4 Tamak shwasa (Bronchial Asthma) Kapot Eva Koojanam (Loud wheezing
resembling the sound of pigeons)
5 Apatantraka and Apatanaka (Tetanus) Kapot Eva Koojanam (Loud wheezing
resembling the sound of pigeons)
6 Maha Shwasa (Kussmaul’s breathing) Matta Vrushabh Eva
(Noisy respiration like that of angry bull)
6 Krukkaj Kasa (whooping cough) Whoop whoop like sound
7 Swarabheda (Laryngeal Disease) Gardabha wat swara (Donkey like
hoarseness of voice)
8 Pandu (Anemia) Hritdrava - Eti Dad Dadika (Palpitations)
9 Sandhivata (Osteoarthritis) Sandhi Aatopa (joint crepitation)
10 Alasaka (Gastroparesis) Udara Koojana (Abdominal gurgling)
11 Sangrahani & Ghati Yantra (IBS) Antra Koojana (Abdominal gurgling)
12 Vakastambha (Tongue paralysis) Minminitva (Nasal speech) and
Gadgadatva (Spastic speech)
13 Ardita (Facial Palsy) Vaksanga (dysarthria)
14 Swar upghat karak asadhya galganda
(myxoedema) Swarabheda (change of voice)
15 Vrudhhasya Swarbheda (chronic
atrophic laryngitis)
Swarbheda (Change of voice in old
peoples)
16 Swaraghna (Laryngeal Malignancy) Gardabha wat swara (Donkey
hoarseness of voice)
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 160
Lung Sounds :
Heart Sounds :
Summary & Conclusion :
1. The concept of sound examination is very
well documented in ancient Indian medical
science under Shrawan Pariksha.
2. The sound examination is helpful in making
the diagnosis of some of the diseases related
respiratory and cardiovascular and
gastrointestinal system.
3. The sound amplifying instruments like
stethoscope is very useful in pinpoint
diagnosis of the underlying pathological
conditions of respiratory and cardiovascular
and gastrointestinal system.
References :
1. Laxmipati Shastri, Yoga Ratnakara of
Nyaychandrashekhar, Roginam Ashtasthanan
Nirikshanam, 7th edition, published by
Chaukhamba Publications,Varanasi –
221001,2002, pg. 5
2. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Sutrasthana 10/5 hindi translation, 5th
edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 35
3. Yadavji Trikamji Charak Samhita of acharya
Agnivesha and Charaka with ‘Ayurved Dipika’
sanskrit commentary by Chakrapani,
Vimansthana 4/7 published by Chaukhamba
Publication, Gopal Mandir lane,Varanasi-
221001,2007, pg. 248Sr.
No. Lung sounds Lung Condition
1 Bronchial breathing Lung consolidation
2 Bronchophony Lung consolidation
3 Aegophony Lung consolidation with Pleural effusion
4 Whispering Pectrolioqye Lung consolidation
5 Fixed monophonic wheezes
Incomplete obstruction of principle or
lobar bronchus by tumour or foreign
body
6 Random monophonic wheezes widespread airflow obstruction (Asthma)
7 Sequential inspiratory wheezes pulmonary fibrotic conditions
8 Expiratory polyphonic wheezes widespread air flow obstruction
9 Late inspiratory crackles
Fibrosing alveolitis, resolving lobar
pneumonia and interstitial pulmonary
edema (due to cardiac failure)
10 Early inspiratory and expiratory
crackles widespread airflow obstruction
11 Stridor Tracheal stenosis. Whooping cough.
12 Gurgling
Alveolar cell carcinoma, Infected
purulent secretion of acute or chronic
bronchitis or bronchiectasis or due to
transudated fluid entering the airways
from the alveoli as in pulmonary edemaSr.
No. Heart sounds Heart Conditions
1 3rd Heart sound
Physiological in children and young adults.
left ventricular failure, cardiomyopathy and ischemic
heart diseases.
High output states like anemia, fever, pregnancy and
thyrotoxicosis
2 4th Heart sound
hypertension, hypertrophic cardiomyopathy,
ischemic heart disease, atrial stenosis.
3 Opening Snap Mitral stenosis or tricuspid stenosis
4 Systolic ejection clicks
pulmonary stenosis, pulmonary hypertension, aortic
stenosis, aortic regurgitation, aortic aneurysm,
coarctation of the aorta, hypertension
5 Pansystolic Murmur Mitral & Tricuspid regurgitation, VSD (Blowing)
6 Mid diastolic Murmur Mitral & Tricuspid Stenosis (Rumbling), ASD
7 Ejection Mid systolic
Murmur Aortic & Pulmonary stenosis (Very loud)
8 Early diastolic Murmurs Aortic & Pulmonary regurgitation (high pitched)
9 Murmurs may occur without
underlying heart disease Anemia, fever, pregnancy and thyrotoxicosis
10 Pericardial Rub Pericardial effusion
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 160
Lung Sounds :
Heart Sounds :
Summary & Conclusion :
1. The concept of sound examination is very
well documented in ancient Indian medical
science under Shrawan Pariksha.
2. The sound examination is helpful in making
the diagnosis of some of the diseases related
respiratory and cardiovascular and
gastrointestinal system.
3. The sound amplifying instruments like
stethoscope is very useful in pinpoint
diagnosis of the underlying pathological
conditions of respiratory and cardiovascular
and gastrointestinal system.
References :
1. Laxmipati Shastri, Yoga Ratnakara of
Nyaychandrashekhar, Roginam Ashtasthanan
Nirikshanam, 7th edition, published by
Chaukhamba Publications,Varanasi –
221001,2002, pg. 5
2. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Sutrasthana 10/5 hindi translation, 5th
edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 35
3. Yadavji Trikamji Charak Samhita of acharya
Agnivesha and Charaka with ‘Ayurved Dipika’
sanskrit commentary by Chakrapani,
Vimansthana 4/7 published by Chaukhamba
Publication, Gopal Mandir lane,Varanasi-
221001,2007, pg. 248Sr.
No. Lung sounds Lung Condition
1 Bronchial breathing Lung consolidation
2 Bronchophony Lung consolidation
3 Aegophony Lung consolidation with Pleural effusion
4 Whispering Pectrolioqye Lung consolidation
5 Fixed monophonic wheezes
Incomplete obstruction of principle or
lobar bronchus by tumour or foreign
body
6 Random monophonic wheezes widespread airflow obstruction (Asthma)
7 Sequential inspiratory wheezes pulmonary fibrotic conditions
8 Expiratory polyphonic wheezes widespread air flow obstruction
9 Late inspiratory crackles
Fibrosing alveolitis, resolving lobar
pneumonia and interstitial pulmonary
edema (due to cardiac failure)
10 Early inspiratory and expiratory
crackles widespread airflow obstruction
11 Stridor Tracheal stenosis. Whooping cough.
12 Gurgling
Alveolar cell carcinoma, Infected
purulent secretion of acute or chronic
bronchitis or bronchiectasis or due to
transudated fluid entering the airways
from the alveoli as in pulmonary edemaSr.
No. Heart sounds Heart Conditions
1 3rd Heart sound
Physiological in children and young adults.
left ventricular failure, cardiomyopathy and ischemic
heart diseases.
High output states like anemia, fever, pregnancy and
thyrotoxicosis
2 4th Heart sound
hypertension, hypertrophic cardiomyopathy,
ischemic heart disease, atrial stenosis.
3 Opening Snap Mitral stenosis or tricuspid stenosis
4 Systolic ejection clicks
pulmonary stenosis, pulmonary hypertension, aortic
stenosis, aortic regurgitation, aortic aneurysm,
coarctation of the aorta, hypertension
5 Pansystolic Murmur Mitral & Tricuspid regurgitation, VSD (Blowing)
6 Mid diastolic Murmur Mitral & Tricuspid Stenosis (Rumbling), ASD
7 Ejection Mid systolic
Murmur Aortic & Pulmonary stenosis (Very loud)
8 Early diastolic Murmurs Aortic & Pulmonary regurgitation (high pitched)
9 Murmurs may occur without
underlying heart disease Anemia, fever, pregnancy and thyrotoxicosis
10 Pericardial Rub Pericardial effusion
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 161
4. Yadavji Trikamji Charak Samhita of acharya
Agnivesha and Charaka with ‘Ayurved Dipika’
sanskrit commentary by Chakrapani,
Vimansthana 4/7 published by Chaukhamba
Publication, Gopal Mandir lane,Varanasi-
221001,2007, pg. 248
5. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit,
12/15 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001,1993, pg. 288
6. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit,
11/2 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 271
7. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Uttartantra 41/19, hindi translation,
5th edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 713
8. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
11/11 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 277
9. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
12/28, 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 296
10. Acharya Vidyadhar Shukla, Ravidutta Tripathi,
‘Charaksamhita of acharya Charak and
Agnivesha, Chikitsasthana 17/46, hindi
translation, 1st edition, reprint, published by
Chaukhamba Sanskrit Pratishthan, 4360/4,
ansari road, Daryaganj, New Delhi – 110 002,
2019, pg. 423
11. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
13/2 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 304
12. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Uttartantra 53/6, hindi translation, 5th
edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 768
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 161
4. Yadavji Trikamji Charak Samhita of acharya
Agnivesha and Charaka with ‘Ayurved Dipika’
sanskrit commentary by Chakrapani,
Vimansthana 4/7 published by Chaukhamba
Publication, Gopal Mandir lane,Varanasi-
221001,2007, pg. 248
5. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit,
12/15 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001,1993, pg. 288
6. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit,
11/2 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 271
7. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Uttartantra 41/19, hindi translation,
5th edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 713
8. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
11/11 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 277
9. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
12/28, 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 296
10. Acharya Vidyadhar Shukla, Ravidutta Tripathi,
‘Charaksamhita of acharya Charak and
Agnivesha, Chikitsasthana 17/46, hindi
translation, 1st edition, reprint, published by
Chaukhamba Sanskrit Pratishthan, 4360/4,
ansari road, Daryaganj, New Delhi – 110 002,
2019, pg. 423
11. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
13/2 , 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 304
12. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Uttartantra 53/6, hindi translation, 5th
edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 768
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 162
13. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, sharirsthana, Sharirsthana 6/27,
hindi translation, 5th edition, published by
Motilal Banarasidas, Jawahar Nagar, Banglo
rd, New Delhi – 110 007, 1975, pg. 330
14. Acharya Vidyadhar Shukla, Ravidutta Tripathi,
‘Charaksamhita of acharya Charak and
Agnivesha, Chikitsasthana 16/12, hindi
translation, 1st edition, reprint, published by
Chaukhamba Sanskrit Pratishthan, 4360/4,
ansari road, Daryaganj, New Delhi – 110 002,
15. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
4/17, 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 171
16. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
4/17 (4), 20th edition, published by
Chaukhamba Surbharati Publication, Gopal
Mandir lane,Varanasi-221001, 1993, pg. 171
17. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Nidansthana 1/88, hindi translation,
5th edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 233
18. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
22/30, 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 422
19. Kaviraj Binlal Sen, Ayurved Vijnana, Vo. 1,
Sutrasthan 49, published by Vasu Publications,
Shaktinagar, Delhi-110007, 2012, pg. 226
20. Kaviraj Binlal Sen, Ayurved Vijnana, Vo. 1,
Sutrasthan 49, published by Vasu Publications,
Shaktinagar, Delhi-110007, 2012, pg. 226
21. Paul Forgacs, Lung Sounds, Published by
Jaypee Brothers, Daryaganj, New Delhi -110
007, 1988, pg 26-55
22. Dr. P.J. Mehata, , Practical Medicine 12th
edition, published by Dr. P.J. Mehata, HUF,
64, Peddar road, Hari bhavan ,Mumbai-
400026.
23. Praveen Kumar and Michael Clark, Clinical
Medicine, 3rd edition, published by Bailliere
Tindal,24-28,Oval Road, London (UK)
Declaration :
Conflict of Interest : None
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 162
13. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, sharirsthana, Sharirsthana 6/27,
hindi translation, 5th edition, published by
Motilal Banarasidas, Jawahar Nagar, Banglo
rd, New Delhi – 110 007, 1975, pg. 330
14. Acharya Vidyadhar Shukla, Ravidutta Tripathi,
‘Charaksamhita of acharya Charak and
Agnivesha, Chikitsasthana 16/12, hindi
translation, 1st edition, reprint, published by
Chaukhamba Sanskrit Pratishthan, 4360/4,
ansari road, Daryaganj, New Delhi – 110 002,
15. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
4/17, 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 171
16. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
4/17 (4), 20th edition, published by
Chaukhamba Surbharati Publication, Gopal
Mandir lane,Varanasi-221001, 1993, pg. 171
17. Vd. Atrideva, Sushruta Samhita of acharya
Sushruta, Nidansthana 1/88, hindi translation,
5th edition, published by Motilal Banarasidas,
Jawahar Nagar, Banglo rd, New Delhi – 110
007, 1975, pg. 233
18. Sudarshanshastri, B.N.Upadhyaya, Madhav
Nidan of Madhavakara with ‘Atank Darpan
commentary by Vachaspati Mishra and
‘Madhukosh’ commentary by Vijayrakshit ,
22/30, 20th edition, published by Chaukhamba
Surbharati Publication, Gopal Mandir
lane,Varanasi-221001, 1993, pg. 422
19. Kaviraj Binlal Sen, Ayurved Vijnana, Vo. 1,
Sutrasthan 49, published by Vasu Publications,
Shaktinagar, Delhi-110007, 2012, pg. 226
20. Kaviraj Binlal Sen, Ayurved Vijnana, Vo. 1,
Sutrasthan 49, published by Vasu Publications,
Shaktinagar, Delhi-110007, 2012, pg. 226
21. Paul Forgacs, Lung Sounds, Published by
Jaypee Brothers, Daryaganj, New Delhi -110
007, 1988, pg 26-55
22. Dr. P.J. Mehata, , Practical Medicine 12th
edition, published by Dr. P.J. Mehata, HUF,
64, Peddar road, Hari bhavan ,Mumbai-
400026.
23. Praveen Kumar and Michael Clark, Clinical
Medicine, 3rd edition, published by Bailliere
Tindal,24-28,Oval Road, London (UK)
Declaration :
Conflict of Interest : None
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 163
ISSN: 2584-2757
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 6 0 0 1 9
Dr. Subhash Waghe Inter. J.Digno. and Research
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Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID00086 |ISSN :2584-2757 163
ISSN: 2584-2757
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 6 0 0 1 9
Dr. Subhash Waghe Inter. J.Digno. and Research
This work is licensed under Creative
Commons Attribution 4.0 License
Submission Link : http://www.ijdrindia.com
Benefits of Publishing with us
Fast peer review process
Global archiving of the articles
Unrestricted open online access
Author retains copyright
Unique DOI for all articles
https://ijdrindia.com