口鼻之气粗，疾出疾入者，外感，邪有余。口鼻之气微，徐出徐入者，内伤，正气
虚。发热静默默者，邪在表。发热动躁，谵语者，邪已入里。向里睡者阴症。向外睡者
阳症。仰卧及伸脚者，热症。覆卧及蜷脚者，寒症。全覆衣被不露手足者，非恶寒，即表
症及阴寒。揭去衣被，扬手露足者，非发热，即邪已入腑，或形逸心劳，或形劳心苦，或
郁闷伤中，或病脱后皆耗营气，名为脱营，或先富后贫，忧愁内结，精神丧失，名为失精。
暴喜伤气，暴怒伤血。
新病小病声不变。久病大病声乃变。寒病无声。热病多语。出言懒怯，先轻后重者，
虚症，出言雄壮，先重后轻者，外感邪盛。哼声蹙眉者，头痛。哼声不能行立者，腰脚痛。叫
喊用手摸心者，脘痛。摇头用手托腮者，唇齿痛。言迟者风。言急者火。声重鼻塞者伤风。
声如从瓮中出者，中湿。声哑不出而咳者，水寒伤肺。声如破而咳者，外寒里热。言而弱，
终日乃复言者，气虚。衣被不覆，言语善恶，不避亲疏者，神明乱。言语迟懒者内伤。气少不
足以息者气虚。气喘烦躁谵语者实邪。连声者精气竭。忽然声哑喉痛，不肿红，不发热，二
便清利者，阴寒。语声细小而长者，头中痛。语声喑喑不透者，心胸病。语声寂寂喜呼者，骨
节痛。声如拽锯者死。失音不能言者死。声哑不出，冷厥不回，二便不通者死。病在上焦
者吸促。病在下焦者吸迟。病在中焦者，吸数，当下之，虚者死。喘息不止者死。呼吸动摇者
死。张口气短呼息者肺痿。呼息引胸中气上者，咳嗽。行迟者腰脚痛。叹气者闷气。扭身
者腰痛。声哑形瘦，喉有肺花疮者，劳病死。声哑者血败，久病危。暴哑声者，风痰伏火，或暴
怒叫喊。坐而气促者，哮喘痰火，久病危。中年人声浊者痰火。独言独语者，思虑伤神。气
促喘急不足以息者，虚极。平时无寒热，气短不足以息者痰火。
The breath from the mouth and nose is coarse, exiting and entering rapidly; this indicates an external contraction with excess pathogenic factors. The breath from the mouth and nose is faint, exiting and entering slowly; this indicates an internal injury with deficiency of healthy qi. Fever accompanied by quiet silence indicates that the pathogen is at the exterior level. Fever accompanied by restlessness and delirious speech indicates that the pathogen has entered the interior. Lying facing inward indicates a Yin syndrome (Yin Syndrome). Lying facing outward indicates a Yang syndrome (Yang Syndrome). Lying supine with legs extended indicates a Heat syndrome (Heat Syndrome). Lying prone with legs curled up indicates a Cold syndrome (Cold Syndrome). Covering the whole body with clothes and blankets without exposing hands and feet suggests not merely aversion to cold, but rather an exterior syndrome or Yin-Cold syndrome. Removing clothes and blankets, raising hands and exposing feet suggests not merely fever, but possibly the pathogen having entered the Fu organs, or physical ease with mental labor, or physical labor with mental distress, or depression injuring the Middle Jiao, or depletion of Ying Qi (Nutritive Qi) after a severe illness, termed "Tuoying" (Depletion of Nutritive Qi), or former wealth followed by poverty, sorrow knotting internally, and loss of spirit, termed "Shijing" (Loss of Essence/Spirit). Sudden joy injures Qi; sudden anger injures Blood.
Minor illnesses in new onset do not alter the voice. Major illnesses in long-standing cases change the voice. Cold diseases typically present with no abnormal sounds. Heat diseases involve much talking. Speaking lazily and timidly, with volume starting light and becoming heavy, indicates a Deficiency syndrome (Deficiency Syndrome). Speaking vigorously, with volume starting heavy and becoming light, indicates an external contraction with abundant pathogens. Humming while frowning indicates headache. Humming to the extent of being unable to walk or stand indicates pain in the waist and legs. Shouting while touching the heart area indicates epigastric pain. Shaking the head while supporting the cheek indicates pain in the lips and teeth. Slurred speech indicates Wind. Rapid speech indicates Fire. Heavy voice with nasal congestion indicates Wind-Cold invasion. Voice sounding as if coming from a jar indicates Dampness affecting the center. Hoarse voice without sound and coughing indicates Water-Cold injuring the Lung. Broken-sounding voice with coughing indicates Exterior Cold and Interior Heat. Weak speech, able to speak only once after a whole day, indicates Qi Deficiency. Inability to keep warm with clothes/blankets, erratic speech (sometimes good, sometimes bad), disregarding intimacy or distance, indicates chaos of the Shen (Spirit). Slow and lazy speech indicates internal injury. Shortness of breath insufficient for respiration indicates Qi Deficiency. Panting, irritability, and delirious speech indicate Excess Pathogens. Continuous vocalization indicates exhaustion of Jing-Essence and Qi. Sudden hoarseness and sore throat without swelling/redness, without fever, and with clear urine and normal bowel movements indicate Yin-Cold. Small yet prolonged voice indicates pain inside the head. Low and obstructed voice indicates Heart and Chest pathology. Silent voice but desiring to call out indicates joint pain. A voice like sawing wood indicates death. Complete aphonia indicates death. Hoarseness with failure of cold extremities to recover and obstruction of urination and defecation indicates death. Disease in the Upper Jiao presents with rapid inhalation. Disease in the Lower Jiao presents with slow inhalation. Disease in the Middle Jiao presents with frequent inhalation; purgation should be applied, but if it is a Deficiency pattern, death ensues. Unremitting panting indicates death. Body tremors during respiration indicate death. Gasping with short breath indicates Fei Wei (Lung Atrophy/Withering). Respiration drawing Qi upward from the chest indicates cough. Slow walking indicates pain in the waist and legs. Sighing indicates stagnant Qi. Twisting the body indicates lower back pain. Hoarseness with emaciation and presence of "lung flower sores" in the throat indicates death from Consumption disease. Hoarseness indicates blood deterioration and critical condition in chronic illness. Sudden hoarseness indicates latent Wind-Phlegm and Fire, or shouting due to sudden anger. Sitting with rapid breathing indicates asthma with Phlegm-Fire, a critical condition in chronic illness. Turbid voice in middle-aged individuals indicates Phlegm-Fire. Talking alone indicates mental injury from overthinking. Rapid breathing and panting insufficient for respiration indicate extreme Deficiency. Absence of chills or fever normally, but with shortness of breath insufficient for respiration, indicates Phlegm-Fire.