闻其五音。以别其病。经云言而微。终日乃复言。此夺气也。中盛藏满。声如从室中言
。此
中气之湿也。困于暑汗。烦渴而喘静则多言。衣被不敛。言语善恶。不避亲疏者。此神明之
乱也。病患五脏已夺。神明不守。声嘶者死。病患循衣缝谵语者不治。内伤饮食劳倦症。
不
欲言。纵欲言之。声必怯弱低微。乃不足之验。外伤风寒证。言语必前轻而后重。其言高。
其声壮厉有力。乃有余之验也。
凡声嗄。其言响如从瓮中出。前轻而后重。高揭而有力。皆伤风气壅之验也。痰火咳嗽
。久
而声嘶哑有渐至不出声者。必死也。闻病患言语无力。甚不欲言。气难布息者内伤也。病患
言语有力。动言不厌者。外伤也。病患阴阳俱绝。失错不能言者三日死。病患妄言错乱。及
不能言不治。热病者可治。伤寒有狂言谵语。独语。郑声。及不能言不欲言。或狂谵不休。
皆有虚实之别。
愚按凡病将死之顷。必气促似喘。喉中曳锯。若有痰声。仅呼吸于人迎数
寸之间。盖真阴绝于下孤阳脱于上而为魂飘魄坠。阴阳睽离之候。乃气短之极也。原夫气主
命门。绾于右肾绝则繇肾及肝。繇肝及脾。繇脾及心。繇心及肺。至肺为宗气诸气之会。元
气止此诸气冲合势盛作响。亦犹水风相激而成浪涌之声。水必风恬而浪始息。形因气散而响
方绝。故人之生死。繇气之聚散理必然也。往往医于此际。误为火盛痰升。活络牛黄。促人
快觅。攻痰定喘。无药不投。只速其死。良可慨已。又有当未死之先。或诊色脉之亏。治施
救本。药投参附。至其不愈。垂亡作喘。遂归咎医师谓误服补气。致病家抱终身之恨。而医师
蒙不白之冤。谁有明其为元气上脱。似喘非喘似痰非痰之绝症者乎。每见病中频服耗剂。临
死而亦作喘。将归咎何物耶。岂知参附正纳气之要药。至病已入死法而不即死。留连旬月者
。皆此药之力。人多不知也。又有无病而头目晕眩。喉声似喘。此为气虚暴症。必脉沉伏。
或细如缕。惟急投以大剂参附。亦有生者。若其六脉上脱。数滑洪大。或弦硬搏指。兼以眼
合口
开。手散遗尿。汗泄息粗。面赤如妆。有呼无吸。肉眼顿陷。肢体厥冷。则不治矣。又有暴
厥不省人事。喉息无声者少待气复自苏。切勿扰动此为劳极或因盛怒中气不升所致非元气绝
候也。又有肺伤风寒。痰壅作喘。或牙关紧闭。倘脉症相合。惟投以开关散苏合牛黄丸疏痰
顺气之属。多有得愈者。又有真气久虚。无病暴死。其喉息无声者。此盖非邪。乃气尽自绝
也。如此闻声之诊。不可不详辨也。
听辨患者的五音，以此辨别其病证。《内经》说：说话声音微弱，整天才能再说一句话，这是夺气（正气大伤）的表现。如果胸中邪气盛实而脏腑胀满，说话声音好像从屋子里传出来一样沉闷，这是中焦湿气阻滞的表现。被暑热困住并出汗，感到烦躁口渴且气喘，安静时却多话，穿衣盖被不知收敛，言语不分好坏、不顾亲疏远近的，这是神明（心神）混乱的表现。如果病患五脏精气已极度亏损，神明不能守舍，声音嘶哑的，预后不良主死。如果病患手循衣缝、胡言乱语（谵语）的，属于不治之症。内伤饮食劳倦的病证，患者不想说话，即使想说，声音也必定怯弱低微，这是虚证的验证。外感风寒的病证，说话必定前轻后重，声音高亢，声壮厉有力，这是实证的表现。
凡是声音嘶哑，说话声响好像从瓮中发出，前轻后重，高声揭举且有力的，都是伤于风气壅滞的验证。痰火咳嗽，日久导致声音嘶哑，逐渐发展到发不出声音的，必死无疑。听到病患说话无力，非常不想说话，气息难以布散通畅的，是内伤病。病患说话有力，动辄不厌其烦地说话的，是外伤病。病患阴阳之气俱绝，错乱而不能说话的，三天后死亡。病患胡言乱语、神志错乱，以及不能说话且不欲说话的，属于不治之症；但如果是热病导致的此类症状，尚可治疗。伤寒病出现狂言谵语、自言自语、郑声（语言重复，声音低微），以及不能说话、不想说话，或者狂躁谵语不止的，都有虚实之分。
我按语：凡是疾病即将死亡的瞬间，必定气促似喘，喉中有拖锯般的痰鸣声，若有痰声，呼吸仅在人迎穴附近数寸之间微弱维持。这是因为真阴在下枯竭，孤阳在上脱逸，导致魂飘魄坠，是阴阳离决的征候，也是气短到了极点。原来气的主宰在于命门，维系于右肾。绝则从肾传至肝，从肝传至脾，从脾传至心，从心传至肺。肺为宗气，是诸气交汇之处。元气至此，诸气冲合，气势旺盛而发出声响，这也就像水与风相激而成浪涌之声。只有风平浪静，波浪才会平息；形体因气散而响声方才断绝。所以人的生死，取决于气的聚散，这是必然的道理。往往医生在此时刻，误认为是火盛痰升，使用活络牛黄丸等药，催促人赶快寻找，攻痰定喘，无药不投，只是加速了死亡，实在令人感慨。又有在尚未死亡之前，或诊察到色脉亏虚，治疗施以救本之法，用药投入人参、附子，到了病情未愈，垂危之时出现喘息，于是归咎于医师，说是误服补气药，致使病人抱终身之恨，而医师蒙受不白之冤。谁又能阐明这是元气上脱，似喘非喘、似痰非痰的绝症呢？常见病中频繁服用耗散之剂，临死时也出现喘息，这又将归咎于什么呢？哪里知道人参、附子正是纳气的要药，至于病情已进入死法而不立即死亡，拖延旬月的，都是此药的功效，人们大多不知道这一点。又有无病而头目晕眩，喉间有声似喘的，这是气虚暴症，必定脉象沉伏，或细如发丝，只有紧急投以大剂量的人参、附子，也有存活的可能。如果六脉上脱，数滑洪大，或弦硬搏指，兼有眼合口开、手撒遗尿、汗泄息粗、面赤如妆、有呼无吸、肉眼顿陷、肢体厥冷等症状的，则属不治。又有暴厥不省人事，喉息无声的，稍待片刻，气复自会苏醒，切勿惊扰触动，这是劳极或因盛怒导致中气不升所致，并非元气绝候。又有肺伤于风寒，痰壅作喘，或者牙关紧闭的，倘若脉症相符，只投以开关散、苏合香丸、牛黄丸等疏痰顺气的药物，多有痊愈者。又有真气久虚，无病暴死，其喉息无声的，这不是邪气，而是气尽自绝。像这样通过闻声来诊断的方法，不可不详加辨析。
Listen to the patient's five tones (Wu Yin, referring to sounds associated with the five zang organs) to differentiate the disease. The Classics state: "Speaking faintly, only able to speak again after a whole day" indicates Duo Qi (loss of vital qi). If there is excess in the middle and fullness in the zang-fu organs, and the voice sounds as if coming from inside a room, this indicates dampness of the middle qi obstructed by summerheat and sweating, accompanied by vexation, thirst, and panting; yet when quiet, the patient speaks excessively. If the patient does not adjust clothing or bedding appropriately, speaks without distinguishing between good and bad words, and ignores distinctions between relatives and strangers, this indicates chaos of the Shen Ming (spirit/mind). If the patient's five zang organs have been severely depleted, the spirit cannot be retained, and the voice is hoarse, death ensues. If the patient picks at the seams of their clothes and speaks deliriously (Zhan Yu), it is untreatable. In cases of internal injury due to diet and overexertion, the patient has no desire to speak; even if they do, the voice will necessarily be timid, weak, and low, which is evidence of deficiency. In cases of external contraction of wind-cold, speech is necessarily light at first and heavy later, with a high pitch, strong and vigorous sound, which is evidence of excess.
Whenever the voice is hoarse (Sha), and speech sounds as if coming from an urn, light at first and heavy later, raised high and powerful, all are evidence of damage by wind qi causing stagnation. In cough due to phlegm-fire, if hoarseness gradually progresses to aphonia over time, death is inevitable. Hearing that the patient speaks with little strength and greatly lacks the desire to speak, with difficulty in distributing breath, indicates internal injury. If the patient speaks with strength and speaks incessantly without tiring, it indicates external injury. If both yin and yang qi of the patient are exhausted, leading to confusion and inability to speak, death occurs within three days. If the patient speaks wildly and confusedly, or is unable to speak and has no desire to speak, it is generally untreatable; however, if these symptoms occur in heat diseases, they may be treatable. In Shang Han (Cold Damage) disease, manifestations such as wild speech, delirium, solitary muttering, Zheng Sheng (repetitive, low-pitched speech), inability to speak, lack of desire to speak, or continuous wild delirium, all have distinctions between excess and deficiency.
My commentary: At the moment before death from any disease, there is invariably shortness of breath resembling panting, with a sawing sound in the throat, as if there were phlegm sounds, with respiration barely maintaining itself a few cun below the Renying point (ST9). This is because true yin is exhausted below, and lone yang escapes above, resulting in the floating of the hun and falling of the po, a sign of the separation of yin and yang, representing the extreme of shortness of qi. Originally, qi is governed by the Mingmen (Gate of Life) and tied to the right kidney. Exhaustion proceeds from the kidney to the liver, from the liver to the spleen, from the spleen to the heart, and from the heart to the lung. The lung is the gathering place of Zong Qi (Gathering Qi) and all other qi. When Yuan Qi reaches here, the convergence of various qi becomes vigorous and produces sound, just as water and wind interact to create waves. Only when the wind calms do the waves subside; only when the form dissipates due to the scattering of qi does the sound cease. Therefore, life and death depend on the gathering and scattering of qi, which is a necessary principle. Often, physicians at this juncture mistakenly attribute it to excessive fire and rising phlegm, administering Huoluo Niuhuang Wan (Calming Spirit and Resolving Phlegm Pill) and urging others to find it quickly, using drugs to attack phlegm and calm panting without discrimination, merely accelerating death. This is truly lamentable. Furthermore, before death actually occurs, if pulse and complexion indicate deficiency, treatment should focus on rescuing the root, administering Ginseng Radix et Rhizoma (Renshen) and Aconiti Lateralis Radix Praeparata (Fuzi). If the condition does not improve and the patient approaches death with panting, blame is often placed on the physician for mistakenly administering tonifying qi herbs, causing the patient lifelong regret and the physician unjust accusations. Who can clarify that this is the escape of yuan qi upwards, a terminal syndrome resembling panting but not quite panting, resembling phlegm but not quite phlegm? It is common to see patients frequently taking draining agents during illness, only to exhibit panting at the end; whom should one blame then? Do they not know that Renshen and Fuzi are essential herbs for grasping qi? Even when the disease enters a fatal stage but does not immediately cause death, lingering for ten days or more, it is due to the power of these herbs, though most people are unaware. There are also cases where, without prior illness, dizziness of the head and eyes occurs, with throat sounds resembling panting; this is a sudden syndrome of qi deficiency, characterized by a deep and hidden pulse, or fine as a thread. Only by urgently administering large doses of Renshen and Fuzi is survival possible. However, if the six pulses escape upwards, being rapid, slippery, flooding, and large, or wiry, hard, and beating against the finger, combined with closed eyes and open mouth, scattered hands and urinary incontinence, sweating, coarse breathing, flushed face like makeup, exhalation without inhalation, sunken eyeballs, and cold limbs, it is untreatable. There are also cases of sudden syncope with loss of consciousness and silent breathing; waiting briefly allows qi to recover and spontaneous awakening to occur; do not disturb or agitate. This is caused by extreme fatigue or anger leading to failure of middle qi to ascend, not a sign of yuan qi exhaustion. There are also cases of lung injury from wind-cold, with phlegm obstruction causing panting, or locked jaw; if pulse and symptoms match, administering Kaiguan San (Opening Orifices Powder), Suhexiang Wan (Styrax Pill), or Niuhuang Wan (Calming Spirit Pill) to resolve phlegm and smooth qi often leads to recovery. There are also cases of sudden death due to long-term deficiency of true qi, with silent breathing; this is not due to pathogenic factors, but rather the exhaustion of qi and self-severance. Thus, diagnosis through listening to sounds must be carefully differentiated.