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The sound of the Liver is shouting. (Shouting occurs during anger, or crying out due to fright.) The sound of the Heart is speaking (In *Hong Fan*, speech is associated with Fire). Laughter (Manic laughter indicates Excess Heat; gentle smiling indicates Deficiency Heat). The sounds of the Spleen and Stomach are singing, (A slight tremor in the voice resembling song.) It also manifests as hiccups. (Hiccups refer to dry retching; see the section on Vomiting for details.) The sound of the Lung is weeping, and also coughing. The sound of the Kidney is groaning, and also yawning and sneezing. (Yawning occurs because Yin draws down Yang before it has settled. Sneezing occurs because Yin triggers Yang as it attempts to emerge.) A voice that is clear and resonant as usual is auspicious. A voice that is turbid accompanied by nasal congestion indicates Wind-Cold injury. A voice sounding as if coming from a jar (indicating muffled and unclear quality) suggests Dampness invasion. Frowning and groaning indicates pain. Sudden aphonia is caused by Phlegm-Wind lurking with latent Fire, or resulting from angry shouting or mournful wailing. Hoarseness resembling a broken voice accompanied by coughing indicates External Cold enveloping Internal Heat. In complicated cases of Cold Damage (*Shanghan*), hoarseness accompanied by sores on the lips and mouth indicates *Hu Huo* disease. Hoarseness accompanied by emaciation indicates *Lao Zhai* (consumptive disease such as tuberculosis), indicating ulcers in the Lung. Sudden loss of voice with throat pain like stabbing, but without swelling, redness, or fever, indicates Yin Cold. Sudden hoarseness accompanied by swelling and obstruction of the throat and neck, or with fever and constipation, indicates Dragon Fire (Hyperactive Ministerial Fire). Snoring during breathing indicates Wind-Warmth. Sighing during diagnosis indicates Qi stagnation. Belching while touching the heart region indicates pain at Zhongwan (CV12). Shaking the head while speaking indicates internal pain. Shortness of breath and inability to breathe deeply indicates Qi Deficiency. In an otherwise healthy person without chills or fever, shortness of breath and inability to breathe deeply indicates Phlegm-Fire. A voice that is faint, speaking only occasionally throughout the day, indicates depletion of Healthy Qi. Slurred speech indicates Wind-Phlegm. Sudden verbosity or excessive talking indicates Fire. Speaking indiscriminately about good and evil, ignoring kinship and distance, and wearing clothes improperly indicates disorder of the Spirit (*Shen*). Delirious speech indicates Excess pathogenic factors. Monotonous, repetitive low murmurs indicate Deficiency of Healthy Qi.

Sudden onset of chills and fever in a person who was previously healthy mostly belongs to External Contraction. There must be exterior signs such as headache, body ache, stiffness, absence of sweat, or presence of sweat, supported by exterior pulses such as Floating-Tight or Floating-Large. If there are no exterior signs or pulses, and the illness develops gradually, it belongs to Internal Injury. In External Contraction, chills and fever occur simultaneously without interval; in Internal Injury, they alternate and are irregular. Chills from External Contraction cannot be relieved even by approaching a fierce fire. (It resolves only when the exterior condition is resolved.) Chills from Internal Injury resolve upon seeking warmth. Fear of wind from External Contraction implies intolerance to all wind and cold. Fear of wind from Internal Injury implies sensitivity only to minor drafts. (Furthermore, Exterior conditions manifest in the nose; thus, nasal breathing is rapid with wheezing, vigorous and forceful, unlike the short breath and weak qi of Internal Injury. Internal Injury conditions manifest in the mouth; thus, the mouth feels uncomfortable and food lacks taste, unlike External Contraction where taste is perceived initially but lost when the pathogen enters the interior. Additionally, in External Contraction, heat transmitting to the interior causes thirst with large water intake, unlike Internal Injury fluid deficiency where thirst is relieved by slight drinking. Moreover, External Contraction involves excess pathogenic factors, so the voice is strong and loud, starting light and becoming heavy. Internal Injury involves insufficiency of Yuan Qi, so the voice is lazy and timid, starting heavy and becoming light. Additionally, External Contraction headache is constant. Internal Injury headache comes and goes.) External Contraction presents with heat on the back of the hand and no heat in the palm. (There are cases where the back is hotter than the abdomen.) Internal Injury presents with heat in the palm and no heat on the back of the hand. (There are cases where the abdomen is hotter than the back.) Mild aversion to cold on the back indicates Yang Deficiency unable to overcome Yin. This can also occur in Yangming channel conditions. (Baihu Jia Renshen Tang is appropriate.) It also occurs in fatigue-induced Internal Injury, characterized by alternating chills and heat, indicating Yang Deficiency with Internal Heat. (Shengyang Sanhuo Tang is appropriate.) Damp-Phlegm conditions may also present this way, accompanied by heavy body and limb pain. (Daotan Tang is appropriate.) In individuals with inherent Spleen-Stomach Deficiency, consuming raw, cold, or icy foods/drinks during summer months leads to accumulation of Cold Qi. When Yin rises to overwhelm Yang, the back often feels cold over an area the size of a palm. (Warming therapy is appropriate.) Aversion to cold with curling up and no fever indicates Yin Syndrome. High fever with thirst, aversion to heat rather than cold, indicates Warm-Thermal Syndrome. Alternating chills and fever with regular timing indicates Malaria; irregular timing indicates Shaoyang channel syndrome of Cold Damage, or Internal Injury Deficiency syndromes. Tidal fever occurring at Dibu hours (3-5 PM) indicates Yangming syndrome of Cold Damage; occurring at Ziwu hours (11 PM-1 AM and 11 AM-1 PM) indicates Internal Injury syndrome.