或问医以声色之辨。为神圣妙用。而审切反居其次。何也。答曰。夫色者神之华。声者气之
发。神气为生阳之征验。在诊察之际。不待问而阴阳虚实之机。先见于耳目间矣。予于伤寒绪论。言之颇详。
姑以大略陈之。色贵明润。不欲沉夭。凡暴感客邪之色。不妨昏浊壅滞。病久气虚。只宜瘦削清 。若病邪方锐
。而清白少神。虚羸久困。而妩媚鲜泽。咸非正色。五色之中。青黑黯惨。无论病之新久。总属阳气不振。惟
黄色见于面目。而不至索泽者。皆为向愈之候。若眼胞上下如烟煤者。寒痰也。眼黑颊赤者。热痰也。眼黑而
行步艰难呻吟者。痰饮入骨也。眼黑而面带土色。四肢痿痹。屈伸不便者。风痰也。病患见黄色光泽者。为有
胃气。不死。干黄者。为津液之槁。多凶。目睛黄者。非瘅即衄。目黄大烦为病进。平人黑气起于口鼻耳目者危。
若赤色见于两颧。黑气出于神庭。乃大气入于心肾。暴亡之兆也。至于声者。虽出肺胃。实发丹田。其轻清重
浊。虽由基始。要以不异平时为吉。如病剧而声音清朗如常者。形病气不病也。始病即气壅声浊者。邪
乾清道也。病未久而语声不续者。其人中气本虚也。脉之呻者。病也。言迟者。风也。多言者。火之用事也。声
如从室中言者。中气之湿也。言而微。终日乃复言者。正气之夺也。衣被不敛。言语善恶。不避亲疏者。神明
之乱也。出言懒怯。先重后轻者。内伤元气也。出言壮厉。先
轻后重者。外感客邪也。攒眉呻吟者。头痛也。噫气以手抚心者。中脘痛也。呻吟不能转身。坐而下一脚者。
腰痛也。摇头以手扪腮者。齿颊痛也。呻吟不能行步者。腰脚痛也。诊时吁气者。郁结也。摇头言者。里痛也
。形羸声哑者劳瘵。咽中有肺花疮也。暴哑者。风痰伏火。或怒喊哀号所致也。语言蹇涩者。风痰也。诊时独
言独语。不知首尾者。思虑伤神也。伤寒坏病。声哑。唇口有疮者。狐惑也。平人无寒热。短气不足以息者。
痰火也。声色之诊最繁。无庸琐述。以混耳目。
A question was raised regarding the physician's differentiation of illness through observing facial color and listening to voice, which is considered a divine and miraculous application of medical skill, whereas inquiry (Wen Zhen) ranks secondary. Why is this so? The answer is: Facial color is the external splendor of Shen (Spirit), and voice is the emission of Qi (Vital Energy). Shen and Qi are the manifestations of Sheng Yang (Life-giving Yang). During examination, without the need for inquiry, the mechanisms of Yin-Yang deficiency or excess are already revealed before the eyes and ears. I have discussed this in detail in *Shanghan Xulun* (Introduction to Cold Damage Treatises); here, I will briefly outline the general principles.
Facial color should be bright and lustrous, not dull and withered. In cases of sudden contraction of exogenous pathogens, the color may be turbid and obstructed; however, in chronic diseases involving Qi deficiency, the complexion should appear thin and clear. If the pathogenic factor is sharp and vigorous but the complexion is pale and lacks spirit, or if the body has been weak and emaciated for a long time yet the complexion appears charming and fresh, these are all abnormal colors. Among the five colors, dark blue/black and gloomy hues indicate failing Yang Qi, regardless of whether the disease is new or old. Only when yellow appears on the face and head without being dry and lusterless does it signify an impending recovery. If the eyelids resemble soot, it indicates Cold Phlegm; if the periorbital area is dark while the cheeks are red, it indicates Heat Phlegm; if the periorbital area is dark accompanied by difficulty walking and groaning, it indicates Phlegm-Fluid invading the bones; if the periorbital area is dark, the complexion resembles earth, and there is flaccidity and numbness of the four limbs with difficulty in flexion and extension, it indicates Wind-Phlegm. A patient exhibiting lustrous yellow indicates the presence of Wei Qi (Stomach Qi) and implies survival; dry yellow indicates exhaustion of Body Fluids and portends misfortune. Yellowing of the eyeballs suggests either Dan Jaundice (Epidemic Jaundice) or Epistaxis; jaundice accompanied by severe restlessness indicates disease progression. The appearance of black qi around the mouth, nose, ears, and eyes in a healthy person is critical. If redness appears on both cheekbones and black qi emerges from the Shenting (GV24) acupoint region, it signifies the invasion of massive pathogenic factors into the Heart and Kidney, a sign of sudden death.
Regarding voice, although it originates from the Lung and Stomach, it actually emanates from the Dantian. Its clarity or heaviness depends on constitutional foundation, but the key is that it remains consistent with the person's normal state, which is auspicious. For instance, if the voice remains clear and normal despite severe illness, it indicates that the form is diseased but the Qi is not. If the voice becomes hoarse and turbid immediately upon onset, it indicates pathogenic factors invading the clear pathways. If speech is interrupted shortly after illness begins, it indicates inherent deficiency of Middle Qi. Groaning indicates disease; slow speech indicates Wind; excessive talking indicates the activity of Fire. A voice sounding as if coming from a confined room indicates Dampness in the Middle Jiao. A faint voice with only occasional utterances throughout the day indicates the depletion of Righteous Qi. Disheveled clothing and bedding, inappropriate speech, and lack of discrimination between relatives and strangers indicate chaos of Shen (Spirit). Lazy and timid speech, starting heavy and becoming light, indicates internal injury to Yuan Qi (Original Qi). Loud and harsh speech, starting light and becoming heavy, indicates external contraction of exogenous pathogens. Frowning and groaning indicate Headache. Belching while holding the heart region indicates pain in the Zhongwan (CV12) area. Groaning with inability to turn over, sitting with one leg lowered, indicates Lower Back Pain. Shaking the head while touching the cheeks indicates Tooth and Cheek Pain. Groaning with inability to walk indicates Lumbar and Leg Pain. Sighing during examination indicates Qi Stagnation. Shaking the head while speaking indicates interior pain. Emaciation with hoarseness indicates Lao Zhai (Consumption/Tuberculosis) and Fei Hua Chuang (Lung Flower Ulcer) in the throat. Sudden aphonia is caused by latent Wind-Phlegm and Fire, or by shouting and wailing. Slurred speech indicates Wind-Phlegm. Speaking alone and unintelligently during examination indicates mental injury due to overthinking. In complicated cold damage diseases, hoarseness with ulcers on the lips and mouth indicates Hu Huo Disease (Fox Confusion Syndrome). In a person without chills or fever, shortness of breath and insufficient respiration indicate Phlegm-Fire. The diagnostic methods of observing color and listening to voice are numerous; detailed enumeration is unnecessary to avoid confusion.