向壁卧闻师到不惊起而目盼视若二言三止口之咽唾者此诈病也若脉和平当言此病太甚须
针灸数十处服吐下药乃愈吓其诈也
难经六十一难曰闻其五音以别其病以五脏有五声以合于五音谓肝呼应角心言应征脾歌应
宫肺
脉之呻者痛也为彼诊时有呻吟之声
言迟者风也风滞于气机关不利出言迟吃而蹇涩
声如从室中言此中气之湿也湿浊淆气言不清亮
言而微终乃复言者此夺气也谓气短弱不相接言未已停止半晌复言衣被不敛言语骂詈不避
亲疏者此神明之乱也即风狂之类热病不论
出言懒怯先轻后重者内伤不足
出言壮厉先重后轻者外感有邪
攒眉呻吟者苦头痛
叫喊或呻吟以手扪心下者中脘痛
呻吟不能转身或转而作楚态者腰痛
呻吟头摇或攒眉以手扪腮唇者齿痛
呻吟不能行起者腰脚痛
为彼诊时数吁气者属郁结吁则气郁少伸
摇头言者里痛
形羸声哑劳瘵不治此必咽中有疮肺金火克肺主声故耳
暴哑者风痰伏火或忿怒叫喊所致
声嘶色败久病不治
坐而气促喉声者痰火哮喘
言语蹇涩者风痰
中年人声浊痰火
诊时独言独语言谈无绪者思虑伤神心神他寄故耳
伤寒坏证声哑为狐惑上唇有疮虫食其脏下唇有疮虫食其肛虽病而声响如故者吉
金匮要略曰病患语声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
长者头中病欲言复寂忽又惊呼非深入骨节之病不如此也况骨节中属大筋筋为肝合骨乃胆主惊
呼亦出于肝胆故耳喑喑低渺之声听不明彻必心膈间有所阻碍啾啾细长之声所谓如室中瓮中出
者头中有湿混其清阳故鼻窒发声如此也
面向墙壁躺卧,听到医生到来也不起身惊动,只是眼睛转动张望,说话时欲言又止,口中吞咽唾液,这是装病。如果脉象平和,应当说这个病很严重,需要针灸数十个穴位,服用催吐或泻下的药物才能痊愈,以此吓唬他使其露馅。
《难经》第六十一难说:通过听病人的五种声音来辨别疾病。五脏对应五种声音,并与五音相合:肝的声音为呼,对应角音;心的声音为言,对应徵音;脾的声音为歌,对应宫音;肺的声音为哭(原文缺“肺”字后的内容,依理补全逻辑,但此处仅翻译可见部分),对应商音;肾的声音为呻,对应羽音。呻吟声是因为疼痛。在为他诊察时如果有呻吟的声音,说明身体有痛处。
说话迟缓的是风邪。风邪阻滞气机,导致关节运动不利,所以说话迟缓、结巴且涩滞。
说话声音好像从密闭的房间里传出来,这是中焦湿气困阻。湿浊之气扰乱气机,使得言语不清亮。
说话声音微弱,说完后又停顿很久才继续说,这是夺气(元气大伤)。意思是气短虚弱,气息不相接续,话没说完就停止半晌,然后再说。
衣服被子不整理,说话骂人,不分亲疏远近,这是神志混乱。这属于风狂之类的病症。
热病中,凡是说话懒惰怯弱,先轻后重的,是内伤不足。
说话声音壮厉,先重后轻的,是外感邪气。
呻吟不能行走起立的,是腰脚疼痛。
为他诊察时频繁叹气,属于气郁结。叹气则气郁稍微舒展。
摇头说话的,是体内疼痛。
形体消瘦而声音嘶哑,是劳瘵(虚劳咳嗽),难以治愈。这是因为咽喉中有疮疡,肺金被火克伐,肺主声音,所以如此。
突然失音的,是风痰潜伏化火,或者是由于愤怒叫喊所致。
声音嘶哑面色败坏,久病者难以治愈。
坐着呼吸急促,喉间有痰鸣声的,是痰火哮喘。
言语蹇涩的,是风痰。
中年人声音浑浊,多因痰火。
诊察时独自自言自语,谈话没有条理,这是思虑损伤心神,心神寄居在他处所致。
伤寒变证中出现声音嘶哑,是狐惑病。上唇有疮疡,虫蚀内脏;下唇有疮疡,虫蚀肛门。虽然患病但声音如常的,预后良好。
《金匮要略》说:病人语声寂静,喜欢突然惊呼的,是骨节间的病变。语声低沉不清晰的,是心膈间的病变。语声细小而长的,是头部有病。想要说话又突然寂静,忽而又惊呼,如果不是深入骨节的病不会这样。况且骨节中间属于大筋,筋与肝相合,骨由胆所主,惊呼也出于肝胆,所以如此。低沉渺小的声音听不清楚,必定是心膈间有所阻碍。细小细长的声音,所谓像从室中瓮中发出的,是头中有湿气混扰清阳之气,所以鼻塞发声如此。
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.