经义
闻而知之者，谓之圣。○视喘息，听音声，而知病所苦。○肝在音为角，在声为呼；心在音为征，在声为
笑；脾在音为宫，在声为歌；肺在音为商，在声为哭；肾在音为羽，在声为呻。（《素问》）
哲言
病患语声寂寂然，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。○吸而微数，其病在中焦，实也，当下之即愈，虚者不治。在上焦者其吸促，在下焦者其吸远，此皆难治。
呼吸动摇振振者不治。（《金匮》）
声者，气之从喉舌而宣之于口者也。新病之人声不变，小病之人声不变，惟久病、苛病，其声乃变。迨
声变，其病机显呈而莫逃，所可闻而知之者矣。古人闻隔垣之呻吟，未见其形，先得其情。若精心体验，积久
诚通，如瞽者之耳偏聪，岂非不分其心于目耶？（喻嘉言）
肝为呼，心为笑，脾为歌，肺为哭，肾为呻，此声之可知者也。肝为角，心为征，脾为宫，肺为商，肾
为羽，此音之不易知者也。方土不同，语言分别，五音未有不相混者，何从窥其病而别之乎？然常者不易辨，
而变者则可辨，人有生平并未离乡，而
大病忽作他处方言者，则病情之所由见也。不病时五音难别，方病时五音不难别，以其病在一脏，则一脏之音
多，谛聆之而自审也。或一脏之音全无，则一脏已绝，其为病亦彰矣。五音之可辨者∶喉音宫，舌居中。（即
鼻音）； 音商，开口张；舌音角，舌缩却；齿音征，舌点齿；唇音羽，口撮聚。五音如笙簧然，何音哑，则
簧之坏在何孔。○脾虚者，恶闻木声；心虚者，恶闻鼓声；肺虚者，恶闻金声；肾虚者，恶闻人声，肝虚者，恶
闻啾唧之声。（《医参》）
喘粗气热为有余，喘急气寒为不足。息高者，心肺之气有余；吸弱者，肝肾之气不足。怒骂冤苦者，肝逆
气抑也；鼻塞声重喷嚏者，风寒未解也；言语轻迟短促者，中气虚也；呻吟者，痛也；噫者，脾困也，嗳者，
胃不宽也，实嗳声长而紧，得嗳则快；虚嗳声短而促，得嗳虽松，不觉其快。嗳冷气者，胃寒也；呕酸苦者，
肝火也。自言死者，元虚也；喜言食者，胃火也。言家私者，心虑少睡也；言负德者，肝郁多怒也。干咳无痰
者，胃中伏火也。谵语收财帛者，元气竭也；狂言多与人者，邪气实也。（《四诊抉微》）
凡闻声不能分呼、笑、歌、哭、呻，以求五脏善恶，五邪所干，及神气所主之病者，医之过也。○凡辨
息不分呼出、吸入，以求病情，毫厘千里，医之过也。○凡闻声不别雌雄长短，出于三焦何部者，医之过也。
（《医门法律》）
Scripture Meaning
One who hears and understands is called a "Sage." ○ Observe the patient's breathing and listen to their voice to know the suffering of the disease. ○ The Liver corresponds to the Jue (Angle) note in the five tones, and to Hu (shouting) in the five sounds; the Heart corresponds to the Zhi (Chime) note and Xiao (laughter); the Spleen corresponds to the Gong (Palace) note and Ge (singing); the Lung corresponds to the Shang (Market) note and Ku (crying); the Kidney corresponds to the Yu (Feather) note and Shen (groaning). (Su Wen)
Philosophical Sayings
When a patient speaks in a silent manner but likes to suddenly shout out, it indicates disease in the joints. ○ When speech is hoarse and not clear, it indicates disease in the heart and diaphragm. ○ When speech is fine and long, it indicates disease in the head. ○ Shallow and rapid inhalation indicates disease in the Middle Jiao (Middle Burner); if it is excess, purgation will lead to recovery; if it is deficiency, it is difficult to treat. If the disease is in the Upper Jiao, inhalation is hurried; if in the Lower Jiao, inhalation is distant and deep; all these are difficult to treat. If respiration causes the body to tremble and shake, it is incurable. (Jin Gui Yao Lue)
Voice is the manifestation of Qi spreading from the throat and tongue through the mouth. In cases of new-onset disease, the voice remains unchanged; in minor diseases, the voice remains unchanged. Only in chronic or severe diseases does the voice change. Once the voice changes, the pathogenesis becomes evident and cannot be hidden, allowing one to know the condition by listening. Ancient physicians could hear groans through a wall, knowing the situation before seeing the person. With careful experience and accumulation over time, one becomes as perceptive as a blind person whose hearing is heightened, focusing the mind on hearing rather than sight. (Yu Jiayan)
The Liver corresponds to shouting, the Heart to laughter, the Spleen to singing, the Lung to crying, and the Kidney to groaning; these are the "sounds" that can be known. The Liver corresponds to the Jue note, the Heart to Zhi, the Spleen to Gong, the Lung to Shang, and the Kidney to Yu; these are the "tones" that are difficult to discern. Due to different regional customs and languages, the five tones often mix, making it hard to diagnose based on them. However, while normal tones are hard to distinguish, abnormal ones are distinguishable. A person who has never left their hometown may speak with a foreign accent during a sudden severe illness, revealing the location of the pathology. When healthy, the five tones are hard to distinguish; when sick, they are easier to distinguish because the affected Zang organ produces more of its corresponding sound, which can be identified upon close listening. If the sound of a specific Zang organ is completely absent, it indicates the exhaustion of that organ's Qi, making the disease obvious. Distinguishable tone characteristics: Throat sounds belong to Gong, with the tongue centered (nasal sound); Shang sound involves an open mouth; Jue sound belongs to the tongue, with the tongue retracted; Zhi sound belongs to the teeth, with the tongue tip touching the teeth; Yu sound belongs to the lips, with the lips pursed. The five tones are like the reeds of a sheng (mouth organ); if a tone is mute, the reed in that hole is damaged. ○ Patients with Spleen deficiency dislike wooden sounds; those with Heart deficiency dislike drum sounds; those with Lung deficiency dislike metallic sounds; those with Kidney deficiency dislike human voices; those with Liver deficiency dislike chirping sounds. (Yi Can)
Rapid, coarse, and hot panting indicates Excess; rapid panting with cold air indicates Deficiency. High-pitched exhalation indicates Excess of Qi in the Heart and Lungs; weak inhalation indicates Deficiency of Qi in the Liver and Kidneys. Anger, cursing, and complaining indicate rebellious and suppressed Liver Qi; nasal congestion, heavy voice, and sneezing indicate unresolved Wind-Cold. Light, slow, and short speech indicates Deficiency of Middle Qi. Groaning indicates pain. Yawning (Yi) indicates Spleen stagnation; belching (Ai) indicates Stomach disharmony. Excess belching is long and tight, bringing relief after belching; deficiency belching is short and hurried, feeling loose but not truly relieved. Belching cold air indicates Stomach Cold; vomiting sour/bitter fluid indicates Liver Fire. Speaking of death indicates Yuan Qi (Original Qi) deficiency; talking about food indicates Stomach Fire. Discussing family affairs indicates Heart anxiety and poor sleep; discussing ingratitude indicates Liver depression and irritability. Dry cough without phlegm indicates latent fire in the Stomach. Delirium involving counting money indicates exhaustion of Yuan Qi; mania involving giving things away indicates Excess of Pathogenic Qi. (Si Zhen Jue Wei)
It is the physician's fault if they cannot distinguish between shouting, laughter, singing, crying, and groaning to determine the state of the Five Zang organs, the invasion of the Five Pathogens, and diseases governed by Shen Qi. ○ It is the physician's fault if they fail to distinguish exhalation and inhalation to ascertain the disease condition, leading to significant errors. ○ It is the physician's fault if they do not differentiate the gender and length of sounds, nor identify which part of the San Jiao (Triple Burner) they originate from. (Yi Men Fa Lv)