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In general, if a child's voice is loud and resonant, it indicates that the five zang organs and six fu organs are full of qi and blood, and the child will likely grow up healthy. If the infant does not cry loudly at birth, it implies that the yin orifices of one organ are not yet open, and the spirit (shen) and qi are insufficient. The voice may be like chirping or mumbling; such children are likely to have short lifespans. Therefore, after inspection (wang), listening (wen) is also necessary to differentiate the condition. As the poem states: "To know whether a child's illness leads to life or death, observe the complexion and examine the voice." Cyan lips and black ears indicate a difficult-to-save case; a weak cry suggests approaching death.

The five tones correspond to the five zang organs. Metal governs sound resonance, Earth governs turbid sound, Wood governs long sound, Water governs clear sound, and Fire governs dry/rough sound.

The sound produced by the Heart emerges from the Lung. When Lung qi is exhausted, crying is silent. Frequent crying is due to guest wind disturbing the Liver and Gallbladder causing fright. Sluggish qi, weary spirit, and intense convulsions indicate that hoarseness is caused by pathogenic heat insulting the Lung. A clear voice indicates no invasion by toxic fire. Painful sounds come directly without tears. An "crow-like" voice indicates impending death (yellow springs). A light voice indicates weak qi in the child. A heavy and turbid voice indicates pain and wind. Manic shouting indicates heat in the middle jiao. Trembling voice indicates severe cold qi. Rapid, continuous sounds with excessive tearing indicate spirit fright. A muffled voice indicates phlegm in the heart/chest. Wheezing and choking indicate obstructed qi movement. Liver disease presents with sad sounds and rapid breathing; Spleen disease with slow sounds; Heart disease with vigorous sounds. Small Intestine disease presents with short sounds; Large Intestine disease with long sounds. Kidney disease presents with deep sounds; Stomach disease with rapid sounds. Gallbladder disease presents with clear sounds; Bladder disease with faint sounds. Heavy, turbid, and quiet sounds indicate deficiency from malnutrition (gan accumulation). Listening to the voice reveals the origin of the disease. Wind-cold injury involves frequent sneezing. Yawning and fatigue indicate spirit injury. Mouth puckering, crow-like voice, and rapid rising breath indicate urgency. Falling and being startled cause tension.

For infants under three weeks old with illness, observe the Three Passes on the left hand for boys and the right hand for girls. Yin position is the Wind Pass, Mao position is the Qi Pass, and Chen position is the Life Pass; reaching the Life Pass makes treatment difficult by physicians. Veins extending upward from the tiger's mouth must be observed and differentiated into five colors. Red and yellow indicate peace and harmony of the five zang organs. Cyan and purple indicate fright. Veins entering the palm and branching suggest misfortune. (If veins rush through the Three Passes and branch out, the prognosis is ten deaths to one survival, except for chronic cough.) Veins penetrating through the Three Passes indicate certain death. Early entry into the first pass requires early intervention. Invasion of the second section can still be prevented.
Red veins definitely indicate food stagnation in the diaphragm. Cyan veins indicate water-wind injury. Veins connecting to the thumb indicate yin syndrome patterns. (Yin refers to deep cold invasion; flowers appearing at Yin/Mao positions indicate parasites or organ failure, which is ominous.) Flowers appearing on veins indicate misfortune.
Veins resembling a hanging needle indicate vomiting and diarrhea. Veins extending outward make survival difficult. Flaccid limbs and abdominal distension. Vomiting milk due to improper feeding. Forked fish spine pattern, wind-cold extending outward. Rushing past the Life Pass. Reversing towards the Large Intestine.