喻昌曰∶声者，气之从喉舌而宣于口者也。新病之人，声不变。小病之人，声不变。惟久病苛病，其声乃变。迨声
变，其病机显呈而莫逃，所可闻而知之者矣。《经》云∶闻而知之谓之神，果何修而若是？古人闻隔垣之呻吟叫哀，未
见其形，先得其情，若精心体验，积久诚通。如瞽者之耳偏聪，岂非不分其心于目耶？然必问津于《内经》、《金匮》，
以求生心变化，乃始称为神耳。《内经》本宫商角征羽五音，呼笑歌哭呻五声，以参求五脏表里虚实之病。五气之邪，
其谓肝木在音为角，在声为呼，在变动为握。心火在音为征，在声为笑，在变动为忧。脾土在音为宫，在声为歌，在变
动为哕。肺金在音为商，在声为哭，在变动为咳。肾水在音为羽，在声为呻，在变动为栗。变动者，迁改其常志也，以
一声之微，分别五脏，并及五脏变动，以求病之善恶，法非不详。然人之所以主持一身者，尤在于气与神焉。《经》谓
中盛藏满，气胜伤恐者，声如从室中言，是中气之湿也。谓言而微，终日乃复言者，此夺气也。谓言语善恶，不避亲疏
者，此神明之乱也。是听声中，并可得其神气之变动，义更精矣。《金匮》复以病声内合病情，谓病患语声寂寂然喜惊
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。只此三语，而下中上三焦受病，莫不有变动可征，妙义
天开，直可隔垣洞晰。语声寂寂然者，不欲语而欲嘿也。静嘿统属三阴，此则颛系厥阴所主。何以知之？厥阴在志为惊，
在声为呼，病本缄默，而有时惊呼，故知之耳。惟在厥阴，病必深入下焦骨属筋节间也。喑喑然声出不彻者，声出不扬
也。胸中大气不转，出入升降之机，艰而且迟，是可知其病在中焦胸膈间也。啾啾然细而长者，谓其声自下焦阴分而上。
缘足太阳主气，与足少阴为表里，所以肾邪不剂颈而还，得从太阳部分，达于巅顶。肾之声本为呻，今肾气从太阳经脉，
直攻于上，则肾之呻并从太阳变动，而啾唧细长，为头中病也。得仲景此段更张其说，而听声察病，愈推愈广。所以书
不尽言，学人当自求无尽之藏矣。
【律二条】
凡闻声，不能分呼笑歌哭呻，以求五脏善恶，五邪所干，及神气所主之病者，医之过也。
凡闻声，不别雌雄长短，出于三焦何部者，医之过也。
喻昌说：声音，是气从喉咙和舌头发出，通过口腔宣发出来的。患新病的人，声音不改变。患小病的人，声音不改变。只有患久病或重病的人，声音才会改变。等到声音改变了，疾病的机理就明显呈现而无法逃脱，这是可以通过听声音来了解病情了。《黄帝内经》说：通过听声音就能知道病情叫做“神”，究竟要修养到什么程度才能这样呢？古人隔着墙听到病人的呻吟哀叫，还没见到病人，就先知道了病情，如果精心体验，积累久了就会真诚通达。就像盲人耳朵特别灵敏，难道不是因为他不把心思分给眼睛吗？然而必须向《黄帝内经》、《金匮要略》请教，以求得心中灵妙的变化，这才配称为“神”。《黄帝内经》依据宫、商、角、徵、羽五音，呼、笑、歌、哭、呻五声，来参验推求五脏表里虚实病变。五气之邪，其中肝木在音为角，在声为呼，在变动为握（抽搐）。心火在音为徵，在声为笑，在变动为忧。脾土在音为宫，在声为歌，在变动为哕（呃逆）。肺金在音为商，在声为哭，在变动为咳。肾水在音为羽，在声为呻，在变动为栗（战栗）。所谓变动，是指改变了其常态的情志，凭借一声的细微差别，分别五脏，并涉及五脏的变动，以探求疾病的吉凶，方法并非不详尽。然而人之所以能主持一身，尤其在于气和神。《黄帝内经》说：中焦湿盛导致脏腑胀满，湿气胜则伤肾恐，声音像从屋子里传出来一样闷浊，这是中气有湿的表现。如果说话声音微弱，整天才说一句话，这是夺气（正气大虚）的表现。如果说话不分好坏，不顾亲疏，这是神明混乱的表现。所以在听声音中，还可以得到神气变动的信息，义理更加精微。《金匮要略》又结合病人的声音与病情，说病人说话声音寂静无声却喜欢惊呼的，是骨节间有病。说话声音低沉不畅的，是心膈间有病。说话声音细而长的，是头部有病。仅这三句话，上下中三焦受病的状况，没有不能通过变动来验证的，妙义如天开一般，简直可以隔着墙壁看得清清楚楚。说话声音寂静无声的，是不想说话而想要沉默。静默总体属于三阴经，这里专门关联厥阴经所主。怎么知道的？厥阴经在志为惊，在声为呼，病人本来缄默，却有时惊呼，所以知道是厥阴病。只有在厥阴经，病必然深入下焦骨骼筋节之间。声音低沉不畅的，是声音出不来、不响亮。胸中大气不运转，出入升降的机制艰难且迟缓，由此可知病在中焦胸膈之间。声音细而长的，是说声音从下焦阴分向上发出。因为足太阳膀胱经主气，与足少阴肾经互为表里，所以肾邪不会只到颈部就返回，而是借助太阳经的部分，到达头顶。肾的声音本是呻，现在肾气顺着太阳经脉，直接攻冲于上，那么肾的呻声便随着太阳经的变动，变成唧唧细长之声，这是头部有病。得到张仲景这一段重新阐述其说，使得听声察病的方法，越推演越广泛。所以书本不能完全表达言语，学习的人应当自己去寻求无尽的宝藏啊。
【律二条】
凡是听声音，不能分辨呼、笑、歌、哭、呻，来探求五脏的善恶、五邪的侵犯，以及神气所主的疾病，是医生的过错。
凡是听声音，不辨别声音的雌雄长短，不清楚声音出自三焦哪一部分，是医生的过错。
Yu Chang said: Sound is the manifestation of Qi (vital energy) emanating from the throat and tongue, and being vocalized through the mouth. In patients with new-onset diseases, the voice remains unchanged. In patients with minor diseases, the voice remains unchanged. Only in patients with chronic or severe diseases does the voice change. Once the voice changes, the pathogenesis becomes manifest and cannot be concealed; this is a state where one can know the condition by listening to the sound. The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "To know by hearing is called 'Shen' (Divine/Profound)." What cultivation leads to such a state? Ancient physicians, upon hearing moans and cries of pain through a wall without seeing the patient, would first ascertain the nature of the illness. Through careful observation and long-term accumulation, one achieves genuine comprehension. Just as a blind person's hearing becomes acute because their attention is not divided by sight, so too must one focus. However, one must seek guidance from the *Huangdi Neijing* and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) to attain intuitive transformation, thereby truly deserving the title of "Shen."
The *Huangdi Neijing* utilizes the five musical tones (Gong, Shang, Jue, Zhi, Yu) and the five vocalizations (Hu, Xiao, Ge, Ku, Shen) to investigate the interior-exterior, excess-deficiency, and pathological conditions of the Zang organs. Regarding the pathogens of the Five Qi: Liver Wood corresponds to the tone Jue, the vocalization Hu, and the movement of grasping/spasms. Heart Fire corresponds to the tone Zhi, the vocalization Xiao, and the movement of sorrow. Spleen Earth corresponds to the tone Gong, the vocalization Ge, and the movement of hiccuping. Lung Metal corresponds to the tone Shang, the vocalization Ku, and the movement of coughing. Kidney Water corresponds to the tone Yu, the vocalization Shen, and the movement of shivering/trembling. "Movement" refers to alterations in normal emotional states. By distinguishing the five Zang organs and their associated movements through subtle variations in sound, one can determine the prognosis of the disease; the methodology is indeed comprehensive. However, what governs the entire body is primarily Qi and Shen (Spirit). The *Neijing* states: "When there is excessive dampness in the middle jiao causing fullness in the viscera, and dampness overcomes fear, the voice sounds muffled as if coming from within a room; this indicates dampness in the Middle Qi." It also states: "Speaking faintly and only speaking once after a whole day indicates depletion of Qi." Furthermore: "Speaking indiscriminately about good and bad, without regard for kinship or distance, indicates chaos of the Shen." Thus, by listening to the voice, one can discern changes in Shen and Qi, which is an even more refined principle.
The *Jingui Yaolue* further correlates vocal sounds with specific disease locations. It states: "If a patient speaks silently but frequently startsle at sudden noises, the disease is in the joints and bones." "If the voice is hoarse and obstructed, the disease is in the heart and diaphragm." "If the voice is fine and prolonged, the disease is in the head." These three statements reveal that diseases in the Upper, Middle, and Lower Jiaos all have observable manifestations. This profound insight allows one to perceive clearly even through walls. "Silent speech" implies a desire for silence and quietude. Quietude generally belongs to the Three Yin channels, but here it specifically relates to the Jueyin channel. How do we know this? Jueyin is associated with fright in emotions and shouting in vocalization. Although the patient is usually silent, occasional shouting reveals the involvement of Jueyin. When Jueyin is affected, the disease inevitably penetrates deeply into the lower jiao, affecting bones and sinews. "Hoarse and obstructed voice" means the voice fails to project clearly. This indicates that the Great Qi in the chest is stagnant, and the mechanisms of ascent and descent are difficult and slow, pointing to disease in the Middle Jiao (chest and diaphragm). "Fine and prolonged voice" indicates sound rising from the Yin aspect of the lower jiao. Since the Foot-Taiyang Bladder Channel governs Qi and forms an interior-exterior relationship with the Foot-Shaoyin Kidney Channel, pathogenic factors from the Kidney do not stop at the neck but travel via the Taiyang channel to the vertex. The natural sound of the Kidney is "Shen" (groaning). Now, when Kidney Qi attacks upward via the Taiyang meridian, the groaning transforms into a fine, prolonged sound due to the Taiyang movement, indicating disease in the head. With Zhang Zhongjing's reinterpretation, the method of diagnosing disease by listening to the voice has become increasingly extensive. Therefore, books cannot fully express all words; students should seek endless knowledge on their own.
[Two Laws]
1. If a physician listens to the voice but fails to distinguish between Hu, Xiao, Ge, Ku, and Shen to determine the health or pathology of the five Zang organs, the invasion of the five pathogens, or the disorders governed by Shen and Qi, it is the physician's fault.
2. If a physician listens to the voice but fails to distinguish its masculine/feminine quality and length, and fails to identify which part of the Sanjiao (Triple Burner) it originates from, it is the physician's fault.