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If the pulse is small but the complexion has not declined, it indicates a recent disease. If the pulse has not declined but the complexion has declined, it indicates an old disease. If both the pulse and the complexion have declined, it indicates an old disease. If neither the pulse nor the complexion has declined, it indicates a recent disease.

When a patient lies facing the wall, rises in alarm upon hearing the physician, looks around with wandering eyes, speaks intermittently (hesitates between speaking and stopping), and swallows saliva during pulse diagnosis, this is feigned illness. (If the pulse is harmonious, one should say that this disease requires acupuncture at several points and administration of emetic or purgative medicines before recovery can be expected. The purpose is to intimidate the feigner with such threats, causing fear so they dare not continue pretending.)

The sound corresponding to the Liver is Jue (角); the sound corresponding to the Heart is Zhi (徵); the sound corresponding to the Spleen is Gong (宫); the sound corresponding to the Lung is Shang (商); and the sound corresponding to the Kidney is Yu (羽). The five Zang organs correspond to the five sounds, which align with the five musical tones. As stated in *Su Wen: Yin Yang Ying Xiang Da Lun* ("Treatise on the Correspondence of Yin and Yang"): "Observe the breathing and listen to the voice to know where the suffering lies." Since pain originates internally and voice manifests externally, it cannot be falsified. Thus, *Nan Jing: Chapter 61* states: "Listen to the five tones to distinguish the disease." This refers to this principle.

Uncontrollable laughter indicates Heart disease. Panting accompanied by deep sighing indicates Lung disease. Anger and cursing indicate Liver disease. Insufficient Qi leading to shortness of breath indicates Spleen disease. Wanting to speak but remaining silent, with a faint voice and excessive fear, indicates Kidney disease. A voice that starts light and becomes heavy, vigorous and powerful, indicates external contraction. Fatigue with reluctance to speak, and a timid, low voice, indicate internal injury and deficiency. Frowning and groaning indicate severe headache. Shouting and groaning while holding the heart region indicate epigastric pain. Groaning with heaviness of the body, where turning over causes pain, indicates lower back pain. Groaning with head shaking, frowning, and touching the cheeks indicates toothache. Inability to rise due to groaning indicates pain in the waist and legs. Sighing during diagnosis indicates Qi stagnation. (Sighing allows stagnant Qi to extend slightly.) Speaking while shaking the head indicates interior pain.

Phlegm-rattling sounds in the throat are called "Lung Ming"; this occurs when Fire attacks Metal (Lung), disrupting its equilibrium. Emaciation with hoarseness, and ulcers in the throat, indicate the Lung is imprisoned by Fire. (The Lung governs voice.) Sudden hoarseness is often caused by Wind-Phlegm and latent Fire; or it may result from previous vocal strain; one cannot definitively diagnose based solely on this. Hoarse voice combined with a ruined complexion indicates an incurable chronic disease. Rapid breathing with rattling sounds in the throat indicates Phlegm-Fire asthma. Turbid voice in middle age is a consequence of Phlegm-Fire. Soliloquy without coherent thread, with spirit seemingly attached elsewhere, indicates mental damage from overthinking. In damaged syndromes of Cold Damage, loss of voice characterizes Hu Huo syndrome (Fox-Horror Disease); ulcers on the upper lip indicate worms eating the viscera; ulcers on the lower lip indicate worms eating the anus.

Wind stagnating in the Qi mechanism leads to dysfunction of joints and articulation. Stuttering speech indicates Wind disease. Shortness of breath with interrupted speech that resumes indicates depletion of Qi (Duo Qi). Disheveled clothing, cursing relatives and strangers indiscriminately, indicates chaos of the Spirit, typical of Wind Mania; however, if occurring during a heat disease, it need not be discussed under this category. Wanting to speak then falling silent, suddenly shouting out, indicates the pathogen has penetrated deeply into the bones.

A quiet, silent voice indicates a desire for silence rather than speech. If the patient is naturally taciturn, why the sudden shout? This indicates exclusive involvement of the Jueyin channel. Why? Silence generally belongs to Yin, but Jueyin is associated with Fear/Shock in emotions and Shouting in sounds. Moreover, large tendons belong to the bone joints, and tendons are connected to the Liver. Only diseases penetrating deep into the bone joints present this way.

Low, faint voices that are unclear and unresonant indicate obstruction in the Heart and Diaphragm region.

Empty cavities transmit sound; if Qi flows without obstruction, sound is clear. Obstruction prevents resonant projection, indicating that the Great Qi in the chest fails to circulate, and the mechanisms of ascending, descending, entering, and exiting are difficult and slow. Thus, the disease is located in the chest and diaphragm. Careful and quiet listening reveals the truth.

A fine, thin, and rapid sound (Jiu Ran) indicates disease in the head.

A fine and long sound (Jiu Jiu Ran) implies the sound originates from the Lower Jiao Yin aspect and ascends. Because the Foot-Taiyang Bladder Channel governs Qi and forms an exterior-interior relationship with the Foot-Shaoyin Kidney Channel, Kidney pathogens do not stop at the neck but reach the vertex via the Taiyang pathway. The primary manifestation of Kidney disease is groaning. When Kidney Qi attacks upward directly through the Taiyang meridian, the Kidney's groaning transforms into a fine, long, chirping sound due to Taiyang changes, indicating Head disease. This is mostly caused by Dampness turbidifying Clear Yang Qi. Zhang Zhongjing’s three paragraphs succinctly cover the sites of disease in the Upper, Middle, and Lower Jiao, revealing profound principles. Voice is essentially Qi emanating from the throat and tongue to the mouth. In recent diseases, the voice remains unchanged; in minor diseases, the voice remains unchanged. Only in chronic or severe diseases does the voice change. Did ancients lack methods to diagnose illness merely by hearing groans through a wall?