人病尸臭不可近者死。（《脉经》。）
口气重者，胃热盛也，阳气尚充，其病虽剧，可治。
汗出稠粘，有腥膻气，或色黄者，风湿久蕴于皮肤，津液为之蒸变也，风湿、湿温、热病失汗者，多
有之。
唾腥，吐涎沫者，将为肺痈也。唾脓血腥腐者，肺痈已成也。（肺伤风热，痰多臭气，如腐脓状；肺内
自热，痰多腥气，如啖生豆状。一宜凉散，一宜清降也。）
小便臊甚者，心与膀胱热盛也。不禁而不臊者，火败也。
大便色坏，无粪气者，大肠气绝胃败也。小儿粪有酸气者，停滞也。
病患后气极臭者，为胃有停食，肠有宿粪，为内实，易治，若不臭者，在平人为气滞；
病剧而出多，连连不止者，为气虚下陷，恐将脱也。（以上新订参各家。）
角音人者，主肝声也。肝声呼，其音琴，其志怒，其经足厥阴。厥逆少阳，则荣卫不通，阴阳交杂，阴气
外伤，阳气内击，击则寒，寒则虚，虚则卒然喑哑不声，此为疠风入肝，续命汤主之。但踞坐，不得低头，
面目青黑，四肢缓弱，遗失便利，甚则不可治。赊则旬月之间，桂枝酒主之。若其
人呼而哭，哭而反吟，此为金克木，阴击阳，阴气起而阳气伏，伏则实，实则热，热则喘，喘则逆，逆则闷，闷则恐
畏，目视不明，语声切急，谬说有人，此为邪热伤肝，甚则不可治；若唇色虽青，向眼不应，可治。地黄煎主之。
按，疠风者，清燥之气，即天地肃杀之气也，西医谓之消耗之气，使人阳气消索，津液枯结，血汁败坏，
神明破散也。
若其人本来少于悲恚，忽尔嗔怒，出言反常，乍宽乍急，
言未竟，以手向眼，如有所畏，虽不即病，祸必至矣。此肝病声之候也。
征音人者，主心声也。心声笑，其音竽，其志喜，其经手少阴，厥逆太阳，则荣卫不通，阴阳反错，阳
气外击，阴气内伤，伤则寒，寒则虚，虚则惊掣心悸，定心汤主之。语声前宽后急，后声不续，前混后浊，
口，冒昧好自笑，此为疠风入心，荆沥汤主之。若其人笑而呻，呻而反忧，（《中藏经》作笑不待伸而复
忧。）此为水克火，阴击阳，阴起而阳伏，伏则实，实则伤热，热则狂，闷乱冒昧，言多谬误，不可采听。
此心已伤。若唇口正赤，可疗；其青黄白黑，不可疗也。
若其人本来心性和雅，而忽弊急反常，或言未竟便住，
以手剔脚爪，此人必死。祸虽未及，名曰行尸。此心病声之候也。
宫音人者，主脾声也，脾声歌，其音鼓，其志愁，其经足太阴。厥逆阳明，则荣卫不通，阴阳翻祚，
阳气内击，阴气外伤，伤则寒，寒则虚，虚则举体消瘦，语音沉涩，如破鼓之声，舌强不转，而好咽唾，
口噤唇黑，四肢不举，身重如山，便利无度，甚者不可治，根据源麻黄汤主之。若其人言
声忧惧，舌本卷缩，此是木克土，阳击阴，阴气伏，阳气起，起则实，实则热，热则闷乱，体重不能转侧，语
声拖声，气深不转而心急，此为邪热伤脾，甚则不可治；若唇虽萎黄，语音若转，可治。
若其人本来少于 怒，而忽反常， 喜无度，正言而鼻笑，不答于人，此脾病声之候也，不盈旬月，祸必至矣。
商音人者，主肺声也。肺声哭，其音磬，其志乐，其经手太阴。厥逆阳明，则荣卫不通，阴阳反祚，阳气
内击，阴气外伤，伤则寒，寒则虚，虚则疠风所中，嘘吸战掉，语声
嘶塞而散下，气息短惫，四肢僻弱，面色青葩，遗失便利，甚
则不可治，根据源麻黄续命汤主之。若言音喘急，短气好唾，此为火克金，阳击阴，阴气沉，阳气升，升则实，
实则热，热则狂，狂则闭眼悸言，非常所说，口赤而张，饮无时度，此热伤肺，肺化为血，不治；若面赤而
鼻不欹，可治也。
若其人本来语声雄烈，忽尔不亮，拖气用力方得出言，
而反于常，人呼共语，直视不应，虽曰未病，势当不久。此肺病声之候也。
羽音人者，主肾声也。肾声呻，其音瑟，其志恐，其经足少阴。厥逆太阳，则荣卫不通，阴阳反祚，阳
气内伏，阴气外升，升则寒，寒则虚，虚则疠风所伤，语言蹇吃不转，偏枯，脚偏跛蹇，若在左则左肾伤，
在右则右肾伤，其偏枯分体，从鼻而分，半边至脚，缓弱不遂，口亦欹，语声混浊，便利仰人，耳偏聋塞，
腰背相引，甚则不可治，肾沥汤主之。若呻而好恚，恚而善忘，恍惚有所思，此为土克水，阳击阴，阴气伏
而阳气起，起则热，热则实，实则怒，怒则忘，耳听无闻，四肢满急，小便赤黄，言音口动而不出，笑
而看人，此为邪热伤肾，甚则不可治，若面黑黄耳不应，亦可治。
若其人本来不吃，忽然蹇吃，而好 怒，反于常性，此肾已伤，虽未发觉，已是其候，见人未言，而前
开口笑，还闭口不声，举手叉腹，此肾病声之候也。（《千金方》。）
心为噫，肺为咳，肝为语，脾为吞，肾为欠、为嚏，胃为气逆，为哕。
五脏者中之守也，中盛脏满、气盛伤恐者，声如从室中言，是中气之湿也。言而微，终日乃复言者，
此夺气也。衣被不敛，言语善恶不避亲疏者，此神明之乱也。
不得卧而息有音者，是阳明之逆也。起居如常而息有音者，此肺之络脉逆也。不得卧，卧则喘者，水也。不
能正偃，正偃则咳者，风水也。胃中不安，气上迫肺故也。（《内经》。）
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。息摇
肩者，胸中坚。息引胸中上气者，咳。息张口短气者，肺痿，当唾涎沫，吸而微数，其病在中焦实也，下之
则愈虚者，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。（病并当作痛。）
平人无寒热、短气不足以息者，实也。
师持脉病患呻者，痛也。摇头言者，里痛也。言迟者，风也。（风温为病，鼻息必鼾，语言难出。）
病深者其声哕。（此肾气之失根也，其声必微。哕乃干呕呃噫之通名，不必苦为分明也。）
胃中虚冷不能食者，饮水则哕。（胃气下行，以降为顺，虚则力不能降而气逆矣，是肾败之渐也。）
伤寒潮热，时时哕者，与小柴胡汤。哕而腹满者，视其
前后，何部不利，利之则愈。（此皆热结内实而气上逆也。）
湿家下之早则哕，此丹田有热，胸上有寒。（此暖气在下，寒闭于上，冲激而然也，亦有痰闭而然者。仲景。）
经曰∶虚则郑声。郑声者，邪音也，谓声重而转，失其本音也。凡汗下后，或久病气虚者，往往语声
中变，是正气怯而音不能圆满也。故《素问》曰∶气虚者言无常也。《灵枢》曰∶五脏使五色修明而声章。
声章者，言声与平生异也。
谵语者，言语谬妄，非常所见也，邪热乱其神明故也。（胃中热浊上蒸包络。）
有燥屎，有瘀血，有凝痰，有血热，热入血
室，皆有余之证，下之清之而愈，宜养津液、疏心包络。若亡阳谵语，为神离其舍，喃喃一二句，断续不匀，
是汗多，津液无以养其心也。初起可治，急滋心阴，稍久延，即不治矣。仲景曰∶身热脉浮大者生，逆冷脉
沉细者，不过一日死。又曰直视谵语喘满者死。又曰循衣撮空，直视谵语，脉弦者生，涩者死。《内经》评热
论曰∶狂言者是失志，失志者死，此之谓也。脉弦者，内实也，脉涩者，内虚也。
出言懒怯，先轻后重，此内伤中气也；出言壮厉，先重后轻，是外感邪盛也。攒眉呻吟，苦头痛也。诊
时吁者，郁结也。形羸声哑，痨瘵之不治者，咽中有肺花疮也。暴哑者，风痰伏火或暴怒叫喊所致也。面
起浮光，久哑，无外邪实证者，心衰肺瘪，所谓声嘶血败，久病不治也。独言独语，首尾不续，思虑伤神也。
新病闻呃，非火即寒，久病闻呃，胃气欲绝也。大抵声音清亮，不异于平时者，为吉。
咳声清脆者，燥热也；紧闷者，寒湿也；续续片刻不止
者，风也。日甚者，风也；夜甚者，水也。天明咳甚者，胃有宿食，寒湿在大肠也。
听声之法，岂徒以五音决五脏之病哉，须将患人之语言声音，轻重长短，有神无神，与病家来请之语，
及一切旁观物议，皆当审听，入耳注心，斯乃尽闻之道也。（上参各家。）
When a patient emits a corpse-like odor so strong that it is unbearable to approach, the prognosis is poor and often fatal. (From *Mai Jing*.)
A heavy breath indicates excessive stomach heat. Since yang qi is still abundant, although the condition is severe, it is treatable.
Thick, sticky sweat with a fishy or muttony odor, or yellowish sweat, results from wind-dampness stagnating in the skin for a long time, causing body fluids to be steamed and altered. This is common in wind-dampness, damp-warmth, and febrile diseases where sweating was neglected.
Saliva with a fishy smell accompanied by spitting of frothy saliva indicates impending lung abscess (pulmonary suppurative disease). If pus and blood are expectorated with a foul, putrid odor, the lung abscess has already formed. (Lung affected by wind-heat produces much phlegm with a foul odor resembling rotting pus; internal lung heat produces phlegm with a fishy odor resembling raw beans. The former requires cooling and dispersing, while the latter requires clearing and descending.)
Strongly pungent urine indicates excessive heat in the heart and bladder. Urinary incontinence without a pungent odor indicates the failure of fire (yang qi).
Discolored stool lacking fecal odor indicates the exhaustion of large intestine qi and stomach qi. Sour-smelling stool in children indicates food stagnation.
Extremely foul-smelling excrement in patients indicates retained food in the stomach and old feces in the intestines, constituting an internal excess syndrome, which is easy to treat. If the excrement is not foul, it may indicate qi stagnation in healthy individuals; in severe illness with profuse, continuous discharge, it indicates sinking of deficient qi and potential collapse. (Newly revised based on various schools.)
Individuals with Jue (Wood) tonality primarily correspond to the Liver sound. The Liver sound manifests as shouting, its pitch resembles the Qin (zither), its emotion is anger, and its meridian is the Foot Jueyin Liver Meridian. If Jueyin-Shaoyang reversal occurs, Ying and Wei circulation is blocked, yin and yang become mixed. External injury to yin qi and internal striking by yang qi cause coldness due to striking, leading to deficiency, sudden aphonia, and muteness. This is Li Feng (leprosy or similar severe disease) invading the liver, treated mainly with Xuming Tang. If the patient can only sit upright, cannot bow their head, has a blue-black complexion, flaccid limbs, and incontinence, it is difficult to treat when severe. In chronic cases over ten days to a month, Guizhi Wine is used. If the person shouts while crying, and cries while groaning, this represents Metal overcoming Wood (Lung affecting Liver), Yin striking Yang. Yin rises while Yang hides; hiding leads to excess, excess generates heat, heat causes panting, panting causes counterflow, counterflow causes chest tightness, tightness causes fear, vision becomes unclear, speech is urgent and hurried, and delusions of seeing people occur. This is evil heat damaging the Liver, difficult to treat when severe. If lips are blue but reactive to eye stimuli, it is treatable. Main formula: Dihuang Jian.
Note: Li Feng refers to clear, dry qi, i.e., the肃杀 (solemn and killing) qi of heaven and earth. Western medicine calls it consumptive qi, which depletes yang qi, dries up body fluids, corrupts blood, and scatters the spirit.
If a person who was usually free from sorrow and anger suddenly becomes irritable, behaves abnormally, alternates between relaxation and tension, stops speaking midway, covers their eyes as if afraid, disaster will surely arrive even if immediate illness does not ensue. This is a sign of Liver disease manifested through sound.
Individuals with Zheng (Fire) tonality primarily correspond to the Heart sound. The Heart sound manifests as laughter, its pitch resembles the Yu (reed pipe), its emotion is joy, and its meridian is the Hand Shaoyin Heart Meridian. If Jueyin-Taiyang reversal occurs, Ying and Wei circulation is blocked, yin and yang are reversed. External striking by yang qi and internal injury to yin qi cause coldness due to injury, leading to deficiency, palpitations, convulsions, and fright. Main formula: Dingxin Tang. Speech that starts slow and becomes rapid, with the latter part cut off, muddy front and turbid back, drooling, and spontaneous laughing indicates Li Feng invading the Heart, treated mainly with Jingli Tang. If the person laughs then groans, then worries (*Zhong Zang Jing* notes "laughing without stretching before worrying"), this represents Water overcoming Fire (Kidney affecting Heart), Yin striking Yang. Yin rises while Yang hides; hiding leads to excess, excess damages heat, heat causes mania, restlessness, confusion, and erroneous speech. This indicates Heart damage. If lips and mouth are bright red, it is treatable; if blue, yellow, white, or black, it is untreatable.
If a person who was naturally calm and elegant suddenly becomes irritable and abnormal, stops speaking midway, or picks at toenails, death is certain. Though disaster has not fully arrived, this is called "Walking Corpse." This is a sign of Heart disease manifested through sound.
Individuals with Gong (Earth) tonality primarily correspond to the Spleen sound. The Spleen sound manifests as singing, its pitch resembles the Drum, its emotion is worry, and its meridian is the Foot Taiyin Spleen Meridian. If Jueyin-Yangming reversal occurs, Ying and Wei circulation is blocked, yin and yang are overturned. Internal striking by yang qi and external injury to yin qi cause coldness due to injury, leading to deficiency, emaciation, hoarse and deep voice like a broken drum, stiff tongue unable to move, frequent swallowing of saliva, locked jaw, black lips, inability to lift limbs, heaviness like a mountain, and uncontrolled bowel/bladder movements. It is difficult to treat when severe, treated mainly with Genyuan Mahuang Tang. If speech sounds fearful and the tongue root is curled, this represents Wood overcoming Earth (Liver affecting Spleen), Yang striking Yin. Yin hides while Yang rises; rising leads to excess, excess generates heat, heat causes restlessness, heaviness preventing turning, dragging speech, deep breaths unable to return, and anxiety. This is evil heat damaging the Spleen, difficult to treat when severe. If lips are withered and yellow but speech can recover, it is treatable.
If a person who rarely gets angry suddenly becomes abnormal, excessively joyful, laughs through the nose while speaking seriously, and ignores others, this is a sign of Spleen disease manifested through sound. Disaster will arrive within a month.
Individuals with Shang (Metal) tonality primarily correspond to the Lung sound. The Lung sound manifests as weeping, its pitch resembles the Qing (stone chime), its emotion is pleasure, and its meridian is the Hand Taiyin Lung Meridian. If Jueyin-Yangming reversal occurs, Ying and Wei circulation is blocked, yin and yang are overturned. Internal striking by yang qi and external injury to yin qi cause coldness due to injury, leading to deficiency, susceptibility to Li Feng, trembling during breathing, hoarse and scattered speech, shortness of breath and fatigue, weak limbs, mottled blue complexion, and incontinence. It is difficult to treat when severe, treated mainly with Genyuan Mahuang Xuming Tang. If speech is rapid and panting, with shortness of breath and frequent spitting, this represents Fire overcoming Metal (Heart affecting Lung), Yang striking Yin. Yin sinks while Yang rises; rising leads to excess, excess generates heat, heat causes mania, mania causes closed eyes, palpitations, and erratic speech, red open mouth, and unregulated drinking. This is heat damaging the Lung, transforming into blood, untreatable. If face is red but nose is not deviated, it is treatable.
If a person who normally speaks loudly suddenly loses voice strength, struggles to speak with drawn-out breath, contrary to normal, and stares blankly without responding when addressed, though not yet ill, life expectancy is short. This is a sign of Lung disease manifested through sound.
Individuals with Yu (Water) tonality primarily correspond to the Kidney sound. The Kidney sound manifests as moaning, its pitch resembles the Se (zither), its emotion is fear, and its meridian is the Foot Shaoyin Kidney Meridian. If Jueyin-Taiyang reversal occurs, Ying and Wei circulation is blocked, yin and yang are overturned. Yang hides internally while Yin rises externally; rising causes coldness, leading to deficiency, susceptibility to Li Feng, stuttering speech, hemiplegia, and limping. Left side injury affects left Kidney; right side affects right Kidney. Hemiplegia divides from the nose down one side to the foot, with weakness and paralysis, deviated mouth, turbid speech, dependence on others for toileting, unilateral deafness, and pulling pain in waist and back. It is difficult to treat when severe, treated mainly with Shenli Tang. If moaning is accompanied by anger, forgetfulness, and恍惚 (trance), this represents Earth overcoming Water (Spleen affecting Kidney), Yang striking Yin. Yin hides while Yang rises; rising generates heat, heat leads to excess, excess causes anger, anger causes forgetfulness, deafness, limb fullness and urgency, dark yellow urine, mouth moving without sound, and smiling while looking at people. This is evil heat damaging the Kidney, difficult to treat when severe. If face is black-yellow and ears do not react, it is treatable.
If a person who normally eats well suddenly stutters and gets angry easily, contrary to nature, the Kidney is already damaged. Seeing someone, opening mouth to smile before speaking, then closing mouth silently, raising hand and crossing waist—this is a sign of Kidney disease manifested through sound. (From *Qianjin Fang*.)
Heart abnormality manifests as belching, Lung as cough, Liver as excessive talking, Spleen as swallowing acid, Kidney as yawning and sneezing, Stomach as qi counterflow and hiccups.
The Five Zang organs are the guardians within. If middle jiao is full and qi is excessive causing fright, voice sounds muffled as if from inside a room, indicating dampness in middle qi. Voice is faint, speaking only once a day, indicates Qi depletion. Disheveled clothing, speech ignoring propriety or intimacy, indicates chaos of Spirit.
Inability to lie down with noisy breathing indicates Yangming counterflow. Normal activity but noisy breathing indicates reverse flow in Lung collaterals. Inability to lie down, panting when lying down, indicates water retention. Inability to lie flat, coughing when lying flat, indicates Wind-Water. Stomach discomfort with qi pressing on Lung. (From *Nei Jing*.)
Silent voice but sudden loud shouting indicates joint disease. Muffled and incomplete voice indicates Heart/Diaphragm disease. Fine, long, chirping voice indicates Head disease. Breathing with shoulder movement indicates solid accumulation in Chest. Breathing drawing air up from Chest indicates Cough. Open-mouthed shortness of breath indicates Lung痿 (withering), expectoration of froth, rapid shallow breathing, indicating Middle Jiao excess (purgation cures); if deficiency, untreatable. Upper Jiao: rapid inhalation; Lower Jiao: distant/deep inhalation; both difficult to treat. Trembling during respiration indicates untreatable condition. ("Disease" here likely means "Pain".)
Healthy persons without chills/fever but with shortness of breath have Excess.
Patient moaning during pulse taking indicates Pain. Shaking head while speaking indicates Interior Pain. Slow speech indicates Wind. (Wind-Warmth: snoring breath, difficulty speaking.)
Deep disease manifests as hiccups. (Loss of Kidney Qi root, faint sound. "Huo" is a general term for dry heaves, hiccup, and belching.)
Cold Stomach unable to eat causes hiccups upon drinking water. (Stomach qi descends; deficiency prevents descent, causing counterflow, a sign of Kidney failure.)
Shao Yang tidal fever with frequent hiccups: Xiao Chai Hu Tang. Hiccups with abdominal fullness: check anterior/posterior obstruction, relieve it to cure. (Heat binding internally, qi counterflow.)
Early purgation in Dampness patients causes hiccups: Heat in Dantian, Cold in Chest. (Warm qi below, cold blocking above, conflict causes it; also phlegm blockage. Zhang Zhongjing.)
Classic says: Deficiency manifests as Zheng Sheng (repetitive speech). Zheng Sheng is evil sound, repetitive and losing original tone. After sweating/purging or chronic deficiency, voice changes due to weak Zheng Qi. *Su Wen*: Qi deficiency leads to irregular speech. *Ling Shu*: Healthy Zang organs yield clear complexion and resonant voice. "Resonant voice" means voice differs from usual.
Zhen Yu (delirious speech) is erratic, caused by evil heat disturbing Spirit. (Stomach heat/turbidity steams Pericardium.)
Excess syndromes like dry stool, blood stasis, congealed phlegm, blood heat, or heat entering Blood Chamber are cured by purging/clearing, nourishing fluids, and unblocking Pericardium. Wang Yang delirium (spirit leaving residence) involves mumbling, intermittent, due to sweat loss failing to nourish Heart. Treatable early with Heart Yin nourishment; late is untreatable. Zhang Zhongjing: Fever + floating/large pulse = survival; Cold extremities + deep/fine pulse = death within a day. Direct gaze + delirium + panting = death. Grasping clothes + direct gaze + delirium + string-taut pulse = survival; choppy pulse = death. *Ping Re Lun*: Wild talk is loss of Will, loss of Will is death. String-taut pulse = internal excess; Choppy pulse = internal deficiency.
Lazy/timid speech, light then heavy: Internal injury to Middle Qi. Loud/aggressive speech, heavy then light: External pathogen excess. Frowning/moaning: Headache pain. Sighing during diagnosis: Qi stagnation. Emaciated/hoarse: Incurable Tuberculosis (Fei Hua Chuang in throat). Sudden hoarseness: Wind-phlegm/fire or screaming. Floating facial luster + chronic hoarseness + no exterior signs: Heart failure/Lung atrophy, "Hoarse voice/Blood corruption," incurable. Soliloquy/disconnected thought: Overthinking damages Spirit. New hiccups: Fire or Cold. Chronic hiccups: Stomach Qi perishing. Clear/bright voice = Auspicious.
Crisp cough: Dry-Heat. Tight/stifling cough: Cold-Damp. Continuous brief coughs: Wind. Day worsening: Wind. Night worsening: Water. Morning worsening: Retained food/Stomach, Cold-Damp Large Intestine.
Listening to voice is not just about Five Tones determining Zang diseases. One must listen carefully to voice quality, spirit, family's plea, and bystanders' comments. Only by attentive listening is the Way of Hearing perfected. (Referenced from various schools.)