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Lying facing the wall, not starting up or rising upon hearing the physician's arrival, but merely looking around with moving eyes; speaking hesitantly with pauses, and swallowing saliva—this is feigned illness. If the pulse is harmonious, one should say that the disease is severe and requires acupuncture at dozens of points and administration of emetic or purgative medicines to be cured, thereby frightening the faker into revealing the truth.

Chapter 61 of the *Nan Jing* (Classic of Difficult Issues) states: Distinguish diseases by listening to the five tones. The five Zang organs correspond to five vocalizations which align with the five musical notes: the Liver corresponds to "Hu" (calling out), matching the Jue note; the Heart corresponds to "Yan" (speech), matching the Zhi note; the Spleen corresponds to "Ge" (singing), matching the Gong note; the Lung corresponds to [text missing in source, typically "Ku" weeping/crying], matching the Shang note; the Kidney corresponds to "Shen" (groaning/moaning), matching the Yu note. Groaning indicates pain. If there is a groaning sound during examination, it signifies bodily pain.

Sluggish speech indicates Wind pathogen. Wind stagnates Qi mechanism, causing dysfunction of joints and limbs, resulting in slow, stuttering, and hesitant speech.

A voice sounding as if coming from a confined room indicates dampness obstructing the Middle Jiao. Turbid dampness confuses Qi mechanism, making speech unclear and lacking resonance.

Weak speech that stops for a long time before continuing indicates depletion of Qi (loss of vital energy). This means Qi is short and weak, unable to sustain itself; speech halts for a while before resuming.

Disheveled clothing and bedding, cursing without distinguishing between kin and strangers, indicates disorder of the Shen (Spirit). This belongs to categories such as Wind-manic disorders.

In heat diseases, lazy and timid speech that starts light and becomes heavy indicates internal injury and deficiency.

Robust and fierce speech that starts heavy and becomes light indicates external contraction of pathogenic factors.

Frowning and groaning indicates suffering from headache.

Crying out or groaning while holding the lower epigastrium indicates pain at the Zhongwan point (CV12).

Groaning inability to turn the body, or assuming painful postures when turning, indicates lumbar pain.

Groaning, shaking the head, or frowning while touching cheeks and lips indicates toothache.

Groaning inability to walk or rise indicates pain in the waist and legs.

Frequent sighing during examination indicates Qi stagnation. Sighing allows stagnant Qi to slightly expand.

Head-shaking while speaking indicates interior pain.

Emaciated form with hoarse voice indicates Lao Zhai (consumptive tuberculosis), which is incurable. This is due to sores in the throat where Fire overacts on Metal (Lung); since the Lung governs voice, this occurs.

Sudden aphonia is caused by latent Wind-phlegm transforming into Fire, or by shouting in anger.

Hoarse voice with deteriorated complexion in chronic illness indicates an untreatable condition.

Sitting with rapid breathing and phlegm-rattle in the throat indicates Phlegm-Fire asthma.

Hesitant and slurred speech indicates Wind-phlegm.

Muddy voice in middle-aged individuals indicates Phlegm-Fire.

Speaking alone during examination with disorganized thoughts indicates damage to the Shen by excessive thinking, causing the Spirit to reside elsewhere.

In complicated syndromes of Cold Damage, hoarseness indicates Hu Huo disease (chancroid-like ulcers). Sores on the upper lip indicate worms eating the viscera; sores on the lower lip indicate worms eating the anus. If the voice remains normal despite illness, the prognosis is auspicious.

The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: Patients whose voice is quiet but who frequently startle with loud cries have diseases in the joints. Patients whose voice is dull and indistinct have diseases in the heart and diaphragm region. Patients whose voice is fine and long have diseases in the head. Wanting to speak then suddenly falling silent, followed by sudden cries, indicates deep-seated joint pathology. Since tendons connect to the Liver and bones are governed by the Gallbladder, sudden cries originate from the Liver and Gallbladder. Dull, low voices that are hard to hear clearly indicate obstruction in the heart and diaphragm. Fine, long voices, described as emerging from a jar in a room, indicate dampness in the head confusing Clear Yang, causing nasal congestion and such vocal characteristics.