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Yu Chang said: Sound is the manifestation of Qi (vital energy) emanating from the throat and tongue, and being vocalized through the mouth. In patients with new-onset diseases, the voice remains unchanged. In patients with minor diseases, the voice remains unchanged. Only in patients with chronic or severe diseases does the voice change. Once the voice changes, the pathogenesis becomes manifest and cannot be concealed; this is a state where one can know the condition by listening to the sound. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "To know by hearing is called 'Shen' (Divine/Profound)." What cultivation leads to such a state? Ancient physicians, upon hearing moans and cries of pain through a wall without seeing the patient, would first ascertain the nature of the illness. Through careful observation and long-term accumulation, one achieves genuine comprehension. Just as a blind person's hearing becomes acute because their attention is not divided by sight, so too must one focus. However, one must seek guidance from the *Huangdi Neijing* and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to attain intuitive transformation, thereby truly deserving the title of "Shen."

The *Huangdi Neijing* utilizes the five musical tones (Gong, Shang, Jue, Zhi, Yu) and the five vocalizations (Hu, Xiao, Ge, Ku, Shen) to investigate the interior-exterior, excess-deficiency, and pathological conditions of the Zang organs. Regarding the pathogens of the Five Qi: Liver Wood corresponds to the tone Jue, the vocalization Hu, and the movement of grasping/spasms. Heart Fire corresponds to the tone Zhi, the vocalization Xiao, and the movement of sorrow. Spleen Earth corresponds to the tone Gong, the vocalization Ge, and the movement of hiccuping. Lung Metal corresponds to the tone Shang, the vocalization Ku, and the movement of coughing. Kidney Water corresponds to the tone Yu, the vocalization Shen, and the movement of shivering/trembling. "Movement" refers to alterations in normal emotional states. By distinguishing the five Zang organs and their associated movements through subtle variations in sound, one can determine the prognosis of the disease; the methodology is indeed comprehensive. However, what governs the entire body is primarily Qi and Shen (Spirit). The *Neijing* states: "When there is excessive dampness in the middle jiao causing fullness in the viscera, and dampness overcomes fear, the voice sounds muffled as if coming from within a room; this indicates dampness in the Middle Qi." It also states: "Speaking faintly and only speaking once after a whole day indicates depletion of Qi." Furthermore: "Speaking indiscriminately about good and bad, without regard for kinship or distance, indicates chaos of the Shen." Thus, by listening to the voice, one can discern changes in Shen and Qi, which is an even more refined principle.

The *Jingui Yaolue* further correlates vocal sounds with specific disease locations. It states: "If a patient speaks silently but frequently startsle at sudden noises, the disease is in the joints and bones." "If the voice is hoarse and obstructed, the disease is in the heart and diaphragm." "If the voice is fine and prolonged, the disease is in the head." These three statements reveal that diseases in the Upper, Middle, and Lower Jiaos all have observable manifestations. This profound insight allows one to perceive clearly even through walls. "Silent speech" implies a desire for silence and quietude. Quietude generally belongs to the Three Yin channels, but here it specifically relates to the Jueyin channel. How do we know this? Jueyin is associated with fright in emotions and shouting in vocalization. Although the patient is usually silent, occasional shouting reveals the involvement of Jueyin. When Jueyin is affected, the disease inevitably penetrates deeply into the lower jiao, affecting bones and sinews. "Hoarse and obstructed voice" means the voice fails to project clearly. This indicates that the Great Qi in the chest is stagnant, and the mechanisms of ascent and descent are difficult and slow, pointing to disease in the Middle Jiao (chest and diaphragm). "Fine and prolonged voice" indicates sound rising from the Yin aspect of the lower jiao. Since the Foot-Taiyang Bladder Channel governs Qi and forms an interior-exterior relationship with the Foot-Shaoyin Kidney Channel, pathogenic factors from the Kidney do not stop at the neck but travel via the Taiyang channel to the vertex. The natural sound of the Kidney is "Shen" (groaning). Now, when Kidney Qi attacks upward via the Taiyang meridian, the groaning transforms into a fine, prolonged sound due to the Taiyang movement, indicating disease in the head. With Zhang Zhongjing's reinterpretation, the method of diagnosing disease by listening to the voice has become increasingly extensive. Therefore, books cannot fully express all words; students should seek endless knowledge on their own.

[Two Laws]
1. If a physician listens to the voice but fails to distinguish between Hu, Xiao, Ge, Ku, and Shen to determine the health or pathology of the five Zang organs, the invasion of the five pathogens, or the disorders governed by Shen and Qi, it is the physician's fault.
2. If a physician listens to the voice but fails to distinguish its masculine/feminine quality and length, and fails to identify which part of the Sanjiao (Triple Burner) it originates from, it is the physician's fault.