向壁卧。闻师到，不惊起而目盼视，若二言三止，脉之咽唾者，此诈病也。若
脉和平，当言此病太甚，须针灸数十处，服吐下药乃愈。（吓其诈也。）
《难经》六十一难曰∶闻其五音以别其病。以五脏有五声，以合于五音。谓肝呼
应角，心言应征，脾歌应宫，肺哭应商，肾呻应羽是也。然此义深奥，非寻常所可
仿佛者。今惟以名贤简易之法，汇着于下。
脉之呻者，痛也。（为彼诊时，有呻吟之声。）
言迟者，风也。（风滞于气，机关不利，出言迟吃而蹇涩。）
声如从室中言，此中气之湿也。（湿浊淆气，言不清亮。）
言而微，终乃复言者，此夺气也。（谓气短弱不相接，言未已，停止半晌复言。）
衣被不敛，言语骂詈不避亲疏者，此神明之乱也。（即风狂之类。热病不论。）
出言懒怯，先轻后重者，内伤不足。
出言壮厉，先重后轻者，外感有邪。
攒眉呻吟者，苦头痛。
叫喊，或呻吟，以手扪心下者，中脘痛。
呻吟不能转身，或转而作楚态者，腰痛。
呻吟摇头，或攒眉以手扪腮唇者，齿痛。
呻吟不能行起者，腰脚痛。
为彼诊时，数吁气者，属郁结。（吁则气郁少伸。）
摇头言者，里痛。
形羸声哑，劳瘵不治。（此必咽中有疮，肺金火克。肺主声故耳。）
暴哑者，风痰，伏火或忿怒叫喊所致。
声嘶色败，久病不治。
坐而气促喉声者，痰火哮喘。
言语蹇涩者，风痰。
中年人声浊，痰火。
诊时独言独语、言谈无绪者，思虑伤神。（心神他寄故耳。）
伤寒坏证，声哑为狐惑。上唇有疮，虫食其脏。下唇有疮，虫食其肛。
虽病而声音响如故者，吉。
《金匮要略》曰∶病患语声寂然喜惊呼者，骨节间病。语声喑喑然不彻者，心膈
间病。语声啾啾然细而长者，头中病。（欲言复寂，忽又惊呼，非深入骨节之病，不如此也。况骨节中属
大筋。筋为肝合，骨乃胆主，惊呼亦出于肝胆故耳。）喑喑，低渺之声，听不明彻，必心膈间有所阻碍。
啾啾，细长之声，所谓如室中、瓮中出者。头中有湿，混其清阳，故鼻窒发声如此也。
Lying with the face to the wall. Upon hearing the physician's arrival, the patient does not startle up but merely looks sideways with the eyes; speaks hesitantly, stopping and starting repeatedly; and swallows saliva during pulse diagnosis. This is feigned illness (Zha Bing). If the pulse is harmonious, one should state that the disease is severe and requires acupuncture at dozens of points, followed by emetic or purgative herbs for recovery. (This is intended to frighten the faker.)
Chapter 61 of the *Nan Jing* (Classic of Difficult Issues) states: "Listen to the five tones to differentiate the disease." The five Zang organs correspond to five vocalizations, which align with the five musical tones. Specifically, the Liver's vocalization "Hu" corresponds to the Jue tone; the Heart's "Yan" corresponds to the Zhi tone; the Spleen's "Ge" corresponds to the Gong tone; the Lung's "Ku" corresponds to the Shang tone; and the Kidney's "Shen" corresponds to the Yu tone. However, this principle is profound and not easily grasped by ordinary people. Herein, only the simplified methods of renowned physicians are compiled as follows.
Groaning during pulse diagnosis indicates pain. (During examination, groaning sounds are heard.)
Slurred or slow speech indicates Wind pathogen. (Wind stagnates Qi, causing joint dysfunction, resulting in slow, hesitant, and slurred speech.)
A voice sounding as if coming from inside a room indicates dampness in the Middle Jiao. (Damp-turbidity disrupts Qi mechanism, making speech unclear and dull.)
Speech that is faint, pauses, and then resumes indicates depletion of Qi (Duo Qi). (Qi is short and weak, lacking continuity; speech stops for a while before resuming.)
Disheveled clothing, cursing without distinction between kin and strangers indicates chaos of the Shen Spirit (Ming Shen). (Similar to manic disorders due to Wind. Excludes heat diseases.)
Lazy and timid speech, starting soft and becoming heavy indicates internal injury and deficiency.
Robust and harsh speech, starting heavy and becoming light indicates external contraction with pathogenic factors.
Frowning and groaning indicates painful headache.
Crying out, or groaning while pressing the hand below the heart (Xin Xia), indicates pain at Zhongwan (CV12).
Groaning unable to turn the body, or assuming painful postures when turning, indicates lower back pain.
Groaning, shaking the head, or frowning while touching the cheeks/lips indicates toothache.
Groaning unable to walk or rise indicates pain in the waist and legs.
Frequent sighing during pulse diagnosis indicates Qi stagnation and constraint. (Sighing allows stagnant Qi to briefly expand.)
Speaking while shaking the head indicates interior pain.
Emaciated form with hoarse voice indicates incurable Lao Zhai (Consumption/Tuberculosis). (This must involve ulcers in the throat, with Fire overcoming Metal. The Lungs govern voice.)
Sudden loss of voice indicates Wind-phlegm, latent Fire, or caused by anger and shouting.
Hoarse voice with sallow complexion indicates incurable chronic disease.
Sitting with shortness of breath and stridor indicates Phlegm-Fire asthma.
Slurred speech indicates Wind-phlegm.
Muddy voice in middle-aged individuals indicates Phlegm-Fire.
Talking to oneself alone, or speaking without coherence during diagnosis indicates mental injury from overthinking. (The Shen Spirit resides elsewhere.)
In complicated stages of Cold Damage (Shang Han), hoarseness indicates Hu Huo disease. Ulcers on the upper lip indicate worms devouring the viscera; ulcers on the lower lip indicate worms devouring the anus.
If the voice remains loud and clear despite illness, the prognosis is auspicious.
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: Patients who speak quietly but suddenly cry out in alarm have disease in the joints. Patients whose speech is muffled and indistinct have disease in the Heart and Diaphragm region. Patients whose speech is fine and long like chirping have disease in the head. (To speak and then fall silent, then suddenly cry out, implies disease has penetrated deep into the joints. Moreover, joints belong to large tendons. Tendons correlate with the Liver, bones with the Gallbladder, and alarm cries originate from the Liver and Gallbladder.) "Yin Yin" refers to low, faint sounds that are hard to hear clearly, indicating obstruction in the Heart-Diaphragm area. "Jiu Jiu" refers to thin, long sounds, such as those emanating from a room or jar. Dampness in the head turbidifies Clear Yang, causing nasal congestion and such vocalizations.