Olfactory diagnosis is an essential part of the “listening and smell diagnosis” in the four diagnostics of traditional Chinese medicine (TCM)—inspection, listening/smell, inquiring, and palpation. It is a method of diagnosing diseases by smelling the odor emitted from the patient’s body, secretions and excretions, as well as the odor of the sick room. In recent years, with the continuous development of medical-engineering integration and interdisciplinarity, TCM has been promoted to gradually move towards precision, efficiency and personalized medicine. This has initiated a new era of smart TCM. At the same time, the development of smart TCM has boosted the study of non-invasive diagnosis by olfactory diagnosis. This paper reviewed the research progress on the analysis process of olfactory diagnosis in smart TCM. The advances in sample collection, analyte enrichment, and data processing for smart TCM olfactory diagnosis were summarized, the metabolic pathways of biomarkers for different diseases in humans were outlined, the challenges faced in the field of olfactory diagnosis of smart TCM were discussed. This will provide a path and basis for the innovative development of olfactory diagnosis of smart TCM in the future. It can also provide a new perspective for promoting the development of objectification, standardization and intelligence of smart TCM olfactory diagnosis.

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