Loss of Smell: Unable to Distinguish Fragrance from Stench — Is It Nasal Blockage or the Spirit Failing to Hold Command?

【Self-Assessment for Symptoms: Items 3–5】

1. After a cold, even though your nose feels unblocked, you still cannot smell the aroma of food, and you may not even notice a foul stench?

2. Did the decline in your sense of smell develop gradually, or did it disappear completely all of a sudden?

3. Besides being unable to smell, do you often experience a dry nasal cavity, bouts of sneezing, or accompany these with a heavy head, excessive phlegm, and easy fatigue?

4. Take a careful look: is your tongue pale, or more on the red side? Is the tongue coating white, or yellow and greasy? Do you usually feel more sensitive to cold or to heat?

5. Does this loss of smell worsen after emotional fluctuations or overexertion?

If several of the above points match your condition, this article may help clarify your thinking.

We breathe thousands of times each day, and the nose silently shoulders the important tasks of smelling, filtering, warming, and humidifying the air. When the nose cannot detect odors and cannot distinguish fragrance from stench, it is not merely a loss of the warmth of everyday life — it is also a "coded message" from the body that needs to be interpreted.

How does traditional Chinese medicine view loss of smell? The Huangdi Neijing states: "The qi of the Lung connects to the nose; when the Lung is harmonious, the nose can perceive fragrance and stench." This single sentence reveals the deep relationship between the sense of smell and the internal organs. Normal olfactory function is far more than a matter of the nose alone. If the Lung qi's diffusing and descending functions are coordinated, the nasal passages remain open and the sense of smell is acute. Conversely, if the internal organs become dysfunctional, the nasal passages are closed by pathogenic qi, or clear yang fails to rise and the spirit mechanism fails to operate, the result will be an inability to distinguish fragrance from stench.

In clinical practice, the inability to smell and to distinguish fragrance from stench is most commonly seen in people with Lung qi failing to diffuse and nasal passages being obstructed, or with Spleen deficiency with exuberant Dampness and clear yang failing to rise. At the same time, this symptom may also be related to disharmony of the Heart and Spirit. Traditional Chinese medicine holds that "the Heart governs smell"; if Heart qi is blocked, the sense of smell cannot be perceived. Therefore, when we explore olfactory problems, what lies behind them is an intricate network interweaving the Lungs, Spleen, Heart, and even the Kidneys.

Let us go one level deeper. Classical Chinese medicine theory points out that the transmission and perception of smell depends not only on the Lung qi's diffusing action to send odors upward, but also on the Heart-Spirit's ability to "receive" and "identify" them. The Nanjing states, "The Heart governs smell," and this is precisely the meaning. Some cases of olfactory loss are not due to nasal congestion, but rather the brain "cannot smell" — the Heart-Spirit can no longer govern the sense of smell. From the Lungs to the Heart, there is a complete olfactory chain. This also explains why some people have unobstructed nasal passages yet still cannot distinguish fragrance from stench.

I. Lung Qi Failing to Diffuse: Nasal Passages Shut Like a Door, Odors Cannot Enter

If you find that you cannot smell and cannot distinguish fragrance from stench after a severe cold, or after prolonged exposure to dry air or a dusty environment, the problem most likely lies in "Lung qi failing to diffuse."

The Lungs govern the skin and body hair, and open to the nose. External pathogenic qi (Wind-Cold, Wind-Heat, Dryness) first attacks the Lung-defensive layer. When external pathogens bind the Lung qi, the Lung's diffusing function becomes obstructed — like a window pasted over with a layer of paper, so the breath of the outside world cannot get in. At this time, the nasal passages may still be unobstructed, but the Lung qi is unable to transmit the information of odors upward, so naturally fragrance and stench cannot be distinguished.

This type of condition is often accompanied by other manifestations. If it is predominantly Wind-Cold, you may feel nasal congestion, clear nasal discharge, bouts of sneezing, and aversion to wind and cold. If it is predominantly Wind-Heat, there may be yellow nasal discharge, sore throat, and thirst. If it is predominantly Dryness, the nasal cavity may feel noticeably dry, even with crusting.

Observe your tongue coating. A thin white coating mostly indicates Wind-Cold, while a thin yellow coating leans toward Wind-Heat. In this case, the treatment principle is not "supplementation," but "diffusing and unblocking." What is needed is to help the Lungs restore their natural deficiency of diffusing and descending, so that the closed "window" can be reopened.

Are there any food ingredients that can help? Scallion white (Cong Bai) is one that is often mentioned. It is white in color and enters the Lung meridian; it is pungent in flavor and warm in nature, and can unblock yang qi and disperse Wind-Cold. In the early stage of a cold from cold exposure, when the sense of smell has not yet completely disappeared, boiling a few sections of scallion white in water and gently inhaling its pungent aroma is itself a physical way to diffuse the nasal passages. This is not some mysterious traditional formula, but rather uses its pungent and dispersing nature to help Lung qi move. Most foods with a pungent flavor have an "opening" characteristic — such as fresh ginger and perilla leaf, which are commonly used in folk remedies for the early stage of Wind-Cold for this very reason.

However, it should be noted that this method is not suitable for everyone. If there is thick yellow nasal discharge and a red tongue with yellow coating, indicating Heat, using pungent and warm substances again would be like adding fuel to the fire.

II. Spleen Deficiency with Excessive Dampness: Clear Yang Fails to Rise, Turbid Yin Obscures the Upper Orifices

This is another, more hidden type of situation. In clinical practice, the inability to smell and the failure to distinguish fragrance from stench are also commonly seen in people who are overweight, physically inactive, and whose diets are rich in greasy, fatty, or raw and cold foods. Their noses may have no organic problem, yet they simply cannot detect odors.

Where is the root cause? In the Spleen and Stomach. The Spleen governs the upbearing of clear substances, sending the refined nutrients from food upward to the Lungs, from which they are then distributed throughout the body. If the Spleen is deficient and its transportation and transformation functions are abnormal, water-dampness stagnates within the body and becomes phlegm turbidity. This phlegm turbidity then follows the ascending and descending movements of qi and shrouds the clear orifices of the head and face. If clear yang qi cannot rise and turbid yin qi remains entrenched, the nasal passages — as "clear orifices" — become covered by damp turbidity and naturally cannot perceive odors properly.

A very typical feature is that the tongue coating of such people is often white and greasy, as if covered with a layer of tofu dregs. At the same time, they may have a heavy sensation in the head as if wrapped, generalized body heaviness and fatigue, and sticky, uncomfortable stools.

At this point, "unblocking the nose" only treats the branch. The root lies in "strengthening the Spleen and Stomach." TCM theory points out that the Spleen is the source of phlegm generation. Once water-dampness is eliminated, turbid yin naturally disperses, clear yang can rise, and only then is there a foundation for the recovery of smell.

In daily diet, white hyacinth beans, coix seeds, and tangerine peel are common choices. White hyacinth beans are warm in nature and can strengthen the Spleen and resolve Dampness; tangerine peel can regulate qi and dry Dampness, allowing the stagnant qi movement to flow again. Once qi movement is activated, damp turbidity can gradually be resolved. Cooking these ingredients into porridge or boiling them in water as a daily dietary regimen can be helpful for people with Spleen deficiency and Dampness exuberance.

It is worth reflecting: is your tongue coating always so clean? If a thick coating persists, it may be reminding you that it is time to adjust your dietary structure and reduce the burden on your Spleen and Stomach.

III. Heart-Spirit Failing to Hold Command: The Last Mile of Smell

Earlier we mentioned that "the Heart governs smell," a point that is crucial in olfactory loss yet often overlooked. The pathway of smell can be divided into two levels: "reception" and "recognition." The nasal cavity is responsible for receiving odor molecules, while the Heart-Spirit is responsible for recognizing "whether this is fragrant or foul."

In classical Chinese medical texts, there are systematic and subtle discussions of the relationship between the five viscera and the five sense organs. This shows that the ancients already recognized that the functions of the sense organs are not merely local, but extensions of the functions of the five viscera.

In the classic TCM text Suwen · Jin Gui Zhen Yan Lun, many discussions related to the five viscera are recorded, which make clear the core position of the "Heart" in perception. When we overthink, experience emotional anxiety, suffer from insomnia, or have excessive dreaming, the Heart blood is gradually consumed and the Heart-Spirit becomes unsettled. Even if the nasal passages are clear and odors have entered the brain, we remain "blind" to them — or rather, "nose-blind" to them.

This condition is fundamentally different from the previous two types. Patients often report that their nose is not blocked and ventilates well, yet they simply "cannot make out the smell," as if the world had suddenly been muted. On closer observation, many such people also have shallow sleep, forgetfulness, palpitations, or a tendency to be easily startled. The tongue sign is often a red tip of the tongue.

From the perspective of TCM theory, this is a manifestation of the loss of governance by the Spirit Brightness. The location of the disease is not in the nose, but in the Heart. If pungent, dispersing, and orifice-opening medicinals are used at this point, they will further consume Heart qi and make the condition more complicated. What people with Heart-Spirit failing to hold command need is to quiet the Heart and stabilize the Spirit, nourish the Blood and guard the Spirit.

Suan Zao Ren (sour jujube seed) and Gui Yuan Rou (longan pulp, dried longan) are commonly used substances that are both medicinal and food-grade. Sour jujube seed can nourish the Heart and benefit the Liver, calm the Spirit, and astringe sweat. Longan pulp can supplement the Heart and Spleen, nourish the Blood, and quiet the Spirit. This does not directly "regulate and nourish" the sense of smell; rather, by nourishing the Heart-Spirit, it creates the internal conditions for the recovery of smell. When the "Spirit" is sufficient, the ability to perceive naturally recovers. Think about it: when we are utterly exhausted, are we not often oblivious to everything around us? The sense of smell is the same.

IV. Mixed Deficiency and Excess, and Age-Related Changes: Seeing the Big from the Small

Loss of the sense of smell and inability to distinguish fragrance from stench is sometimes not a single pattern of deficiency or excess, but a mixture of deficiency and excess, and of cold and heat. This is especially true for middle-aged and elderly people, in whom a gradual decline in smell is often dismissed as "just a normal part of getting older." However, in the view of TCM, behind this lies a comprehensive decline of internal organ functions, with Spleen and Kidney deficiency being the main pattern.

The Kidney is the root of prenatal essence and stores essence and generates marrow. The acuity of smell depends on the abundance of essence qi. As one ages, Kidney essence gradually becomes deficient, the sea of marrow is insufficient, brain function declines, and a dulled sense of smell is inevitable. This does not develop overnight, and treatment requires patience.

This type of person often also presents with soreness and weakness of the lower back and knees, dizziness, tinnitus, and increased night urination. The tongue is commonly pale with scanty coating. If one blindly supplements qi with ginseng and astragalus, it often leads to fire. The clinical approach should focus primarily on supplementing the Kidney and replenishing essence, benefiting the marrow and nourishing the brain, but care must be taken not to be too cloying and greasy, which could impair the Stomach.

Walnut kernels (Hu Tao Rou) are a very life-close choice. They can supplement the Kidney and secure essence, while also warming the Lungs and moistening the Intestines — elegantly covering the three levels of Lung, Kidney, and Brain. Eating one or two as a snack each day can serve as one dietary maintenance measure for elderly people with declining smell and insecurity of Kidney qi. Another example is the traditional Chinese yam (Shan Yao), which gently supplements the qi of both the Spleen and Kidney, can be used for both yin deficiency and yang deficiency, and is very safe and stable.

Now, let us broaden our thinking a little further. If the loss of smell occurs suddenly, and is accompanied by a persistent feeling of blockage on one side of the nose, or bloody nasal discharge, this goes beyond the scope of simple "olfactory loss." From the perspective of TCM, prolonged illness can enter the collaterals; this may be a manifestation of blood stasis obstructing the orifices. In such a case, one should not simply remain at the level of dietary adjustment, but should be alert and promptly present to a regular medical institution for relevant examinations to rule out organic lesions in the nasal cavity.

Olfactory loss is often an external signal of internal imbalance in the body. It may be an afterwave of Lung qi not yet recovered after a cold, a cry of protest from a Spleen and Stomach overloaded over the long term, or a whisper from a Heart-Spirit that has been overconsumed. In the face of different causes, the directions of treatment are entirely different. If it leans toward Lung qi failing to diffuse, one should disperse pathogens and diffuse the Lungs. If it leans toward Spleen deficiency with Dampness exuberance, one should strengthen the Spleen and resolve turbidity. If it leans toward Heart-Spirit instability, one should nourish the Heart and calm the Spirit. If it leans toward Kidney essence deficiency, one should supplement essence and fill the marrow.

The core here is to distinguish deficiency from excess and locate the internal organs involved. If pathogenic excess predominates, dispersing and releasing is sufficient; if righteous qi deficiency predominates, one needs to hold the prescription and make slow, lasting progress. Especially for chronic, progressive olfactory decline, patience is especially required. TCM treatment emphasizes restoring the body's own order, rather than directly replacing the body's work. Let the Lungs' diffusing and descending return to normal, let the Spleen and Stomach's upbearing of clear and downbearing of turbid each perform their own duties, let the Heart-Spirit be tranquil, and let the Kidney essence be sufficient — when the "internal environment" of the body regains balance, the external manifestation of smell will naturally have the opportunity to return.

The next time you cannot smell and cannot distinguish fragrance from stench, in addition to pinching your nose and checking the nasal cavity, you might also quietly tune in to feel the state of your Lungs, Spleen and Stomach, Heart-Spirit, and Kidneys. Its disappearance is a reminder that some order deep inside your body may need a fine adjustment. Have you received this silent reminder?

References:

1. The original text of Huangdi Neijing · Suwen can be consulted in the TCM ancient text database: https://tcmdata.cintcm.com/

2. World Health Organization strategic document on traditional medicine: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine

3. Official website of the National Administration of Traditional Chinese Medicine: https://www.satcm.gov.cn/

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