(增补)
《难经》曰∶“闻其五音,以知其病。”以五脏有五声,以合于
五音。谓肝呼应角,心言应征,脾歌应宫,肺哭应商,肾声应羽是也。然此义深奥,非寻常所能揣测者。
今以古人经验简易之法,列为声诊。脉之呻者,痛也。(言诊时之呻吟。)言迟者,风也。(迟则蹇涩,
风痰之症。)声如从室中言,此中气有湿也。言将终乃复言者,此夺气也。(谓气不续,言未终止而又言
之状也。)衣被不敛,言语骂詈不避亲疏者,神明之乱也。(狂。)出言懒怯,先轻后重,此内伤中气也。出
言壮厉,先重后轻,是外感邪盛也。攒眉呻吟,苦头痛。呻吟不能行起,
腰足痛。叫喊以手按心,中脘痛。呻吟不能转身,腰痛。摇头以手扪腮唇,齿痛。行迟者,腰脚痛。诊时吁
气者,郁结;纽身者,腹痛。形羸声哑,劳瘵之不治者,咽中有肺花疮也。暴
哑者,风痰伏火,或暴怒叫喊所致。声嘶血败,久病不治。坐而气促,痰火哮喘。久病气促危。中年人声浊,
痰火。诊时独言独语,首尾不应,是思虑伤神。伤寒坏病声哑,为狐惑。上唇有疮,虫食其藏;下唇有疮,虫
食其肛。气促喘息,不足以息者,虚甚也。虽病其声音清亮如故者,吉。平日无寒热,短气
不足以息者,实也。(实者,是痰与火也。)
(增补)
《难经》说:“通过听取人的五种声音,来推断其疾病。”这是因为五脏对应五种声音,并与五音相配合。具体而言,肝对应的呼声与角音相应,心对应的言声与徵音相应,脾对应的歌声与宫音相应,肺对应的哭声与商音相应,肾对应的声气与羽音相应。然而这一理论深奥玄妙,不是普通人所能轻易揣测的。
现在采用古人经验总结出的简易方法,列为“声诊”(通过听声音诊断疾病的方法)。脉象中伴有呻吟声的,是疼痛所致。(指在诊察时发出的呻吟声。)说话迟缓的,是风邪所致。(语迟则言语蹇涩,属于风痰病症。)声音好像从密闭房间中传出来的,这是中焦之气有湿邪阻滞。话没说完又接着说的,这是元气耗损所致。(指气息不接续,话未说完却又继续说的状态。)穿衣盖被不能收敛整齐,言语骂人且不避亲疏关系的,这是神明混乱所致。(即狂证。)说话懒散怯懦,先轻后重的,这是内伤中气所致。说话壮烈严厉,先重后轻的,这是外感邪气盛实所致。皱眉呻吟,痛苦于头痛。呻吟且不能行走起身,是腰足疼痛。叫喊并用手按压心口,是中脘部疼痛。呻吟且不能转身,是腰部疼痛。摇头并用手抚摸腮帮和嘴唇,是牙齿疼痛。行走迟缓的,是腰脚疼痛。诊察时叹气吁气的,是气机郁结;扭动身体的,是腹痛。形体消瘦且声音嘶哑,属于劳瘵病(肺结核等慢性消耗性疾病)难以治愈的情况,是因为咽喉中有肺花疮。突然失声的,是风痰潜伏或伏火,或者是由于暴怒、大声叫喊所致。声音嘶哑且气血败坏,久病难治。坐着且呼吸急促,是痰火哮喘。久病出现呼吸急促则病情危重。中年人声音浑浊,是痰火所致。诊察时自言自语,首尾不相呼应,这是思虑过度损伤心神。伤寒病转为坏病后声音嘶哑,属于狐惑病。上唇生疮,说明虫蚀脏腑;下唇生疮,说明虫蚀肛门。呼吸急促喘息,气息不足以维持,是虚损极甚的表现。虽然患病但声音清亮如常的,预后吉祥。平日没有寒热症状,但短气不足以呼吸的,是实证。(所谓实证,是指痰与火邪壅盛。)
(Addition)
The *Nan Jing* (Classic of Difficult Issues) states: "By listening to the five tones, one can ascertain the disease." This is because the five Zang organs correspond to five vocalizations, which align with the five musical notes. Specifically, the Liver's exhalation corresponds to the Jue note; the Heart's speech corresponds to the Zhi note; the Spleen's singing corresponds to the Gong note; the Lungs' crying corresponds to the Shang note; and the Kidneys' voice corresponds to the Yu note. However, this principle is profound and obscure, not easily fathomed by ordinary people.
Now, adopting the simple methods derived from ancient experience, we list them as "Voice Diagnosis" (Sheng Zhen). Moaning during pulse diagnosis indicates pain (referring to groans emitted during examination). Slurred or slow speech indicates Wind syndrome (slow speech implies articulation difficulties, characteristic of Wind-Phlegm disorders). A voice that sounds muffled, as if coming from within a room, indicates Dampness obstructing the Middle Jiao Qi. Speaking repeatedly before finishing a sentence indicates depletion of Qi (a state where breath fails to sustain speech, causing the person to continue speaking before concluding). Inability to dress or cover oneself properly, along with abusive language regardless of kinship or distance, indicates chaos of the Shen (Spirit) (i.e., Mania). Lazy and timid speech, starting soft and becoming louder, indicates internal injury to the Middle Qi. Robust and harsh speech, starting loud and becoming softer, indicates excess external pathogenic factors. Frowning while moaning indicates severe headache. Moaning while unable to walk or rise indicates pain in the waist and feet. Shouting while pressing the hand over the heart indicates pain in the Zhongwan region. Moaning while unable to turn the body indicates lower back pain. Shaking the head while touching the cheeks and lips indicates toothache. Slow walking indicates pain in the waist and legs. Sighing during diagnosis indicates Qi stagnation; twisting the body indicates abdominal pain. Emaciation accompanied by hoarseness indicates incurable Lao Zhai (consumptive disease, such as tuberculosis), caused by Lung Flower Sores in the throat. Sudden loss of voice is caused by latent Wind-Phlegm or hidden Fire, or by sudden rage and shouting. Hoarseness with blood deterioration indicates an untreatable chronic condition. Sitting with shortness of breath indicates Phlegm-Fire Asthma. Shortness of breath in chronic illness indicates critical danger. Turbid voice in middle-aged individuals indicates Phlegm-Fire. Mutters to oneself during diagnosis without responding to context indicates mental damage due to excessive worry. Hoarseness in complicated Shaoyang diseases (Shaoyang Bing) indicates Hu Huo disease (aphthous ulcers of mouth and anus). Ulcers on the upper lip indicate worms eating the viscera; ulcers on the lower lip indicate worms eating the anus. Rapid breathing and panting with insufficient breath indicate extreme deficiency. Although ill, if the voice remains clear and bright, it is auspicious. Absence of chills or fever in daily life, yet suffering from shortness of breath and inability to breathe fully, indicates Excess syndrome (specifically, accumulation of Phlegm and Fire).