声音之道微妙难通。故闻而知之谓之神。
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。
已详上卷五脏所属条。人能本宫角征羽五音。呼笑歌哭呻五声。以参求五气之邪。则思过半矣。西人审病。至于察
尿之味。亦云苦矣。只因于声音气色。未能辨析。是以出此下策。
中盛脏满气胜伤恐者。声如从室中言。是中气之湿也。言而微。终日乃复言者。此夺气也。言语善恶不避亲疏者。
此神明之乱也。
经意甚明。盖即闻声而知其神与气焉。
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。
此数语系金匮文。寂寂然。不欲语属三阴经。喜惊呼。则又属厥阴肝经。病入三阴。厥阴主筋骨间。知其病在下。
焦。声出不彻。声不扬也。胸中大气不转出入艰滞。知其病在中焦胸膈间。
啾啾然。细而长声自下焦阴分。缘足太阳。而上达于颠顶。故知其病在头中。
按声气根于肾中。上于胸膈。出于肺管。达于鼻转于舌。辨于唇。或气虚而音微或机停而语蹇。或膈间有滞而气碍。
或鼻间有违而音乖。散见各书。细心人当自领取。非笔楮所能尽也。
声音的道理微妙且难以通晓。因此，通过听声音就能诊断疾病，被称为“神”（高超的诊断境界）。
肝属木，在五音中对应角音，在五声中对应呼，在变动表现上对应抽搐握拳；心属火，在五音中对应徵音，在五声中对应笑，在变动表现上对应忧思；脾属土，在五音中对应宫音，在五声中对应歌，在变动表现上对应呃逆；肺属金，在五音中对应商音，在五声中对应哭，在变动表现上对应咳嗽；肾属水，在五音中对应羽音，在五声中对应呻吟，在变动表现上对应战栗发抖。
这些内容在上卷“五脏所属”条文中已有详细记载。人们若能依据宫、角、徵、商、羽五音，以及呼、笑、歌、哭、呻五声，来参悟探究五气之邪的致病情况，那么对医理的领悟就超过了一半。西方人诊病，甚至到了要品尝尿液味道的地步，这也算是很笨拙了，只因为他们未能辨析声音和气色，所以才出此下策。
如果体内湿气盛，导致脏腑胀满，气机亢盛而伤及惊恐者，说话的声音就像从密闭房间中传出来一样沉闷，这是中焦湿气阻滞的表现。如果说话声音微弱，整天断断续续才能说出一句话，这是元气大伤的表现。如果言语善恶不分，不避亲疏，这是神明混乱的表现。
经文的意旨非常明确，大概就是通过听声音来判断患者的神志与元气状态。
病人说话时寂静无声，却喜欢突然惊呼的，是骨节间有病；说话声音低沉浑浊、不通畅的，是心膈间有病；说话声音细碎而长的，是头部有病。
这几句话出自《金匮要略》。“寂寂然”，即不想说话，属于三阴经病变；“喜惊呼”，则又属于厥阴肝经病变。病入三阴，厥阴主司筋骨之间，所以知道病位在下焦；声音出不通畅、不响亮，说明胸中大气运转不畅，出入艰涩滞阻，所以知道病位在中焦胸膈之间。
“啾啾然”，指声音细碎而长，这种声音发自下焦阴分，沿着足太阳膀胱经上行，直达头顶，所以知道病位在头部。
按：声音和气息根源于肾，上行至胸膈，出于肺管，通达于鼻，转动于舌，辨别于唇。或者因为气虚而导致声音微弱，或者因为气机停滞后导致言语蹇涩，或者因为膈间有阻滞而导致气息受阻，或者因为鼻窍不利而导致声音怪异。这些散见于各医书中，细心的人应当自行领会，不是笔墨所能完全详尽表达的。
The principles of voice are subtle and difficult to comprehend. Therefore, diagnosing disease through listening is termed "Shen" (divine/profound diagnostic skill).
The Liver corresponds to Wood; in the Five Tones it corresponds to Jue (Jiao), in the Five Sounds it corresponds to Hu (calling out), and in its pathological changes it manifests as grasping or convulsions. The Heart corresponds to Fire; in the Five Tones it corresponds to Zhi, in the Five Sounds it corresponds to Xiao (laughter), and in its pathological changes it manifests as You (worry/sorrow). The Spleen corresponds to Earth; in the Five Tones it corresponds to Gong, in the Five Sounds it corresponds to Ge (singing), and in its pathological changes it manifests as Yue (hiccup). The Lung corresponds to Metal; in the Five Tones it corresponds to Shang, in the Five Sounds it corresponds to Ku (crying), and in its pathological changes it manifests as Ke (cough). The Kidney corresponds to Water; in the Five Tones it corresponds to Yu, in the Five Sounds it corresponds to Shen (groaning), and in its pathological changes it manifests as Li (shivering/trembling).
These points have been detailed in the previous volume under the section "Correspondences of the Five Zang Organs." If one can base their inquiry on the Five Tones (Gong, Jue, Zhi, Shang, Yu) and the Five Sounds (Hu, Xiao, Ge, Ku, Shen) to investigate the pathogenic factors of the Five Qi, then more than half of the understanding will be achieved. Western medicine diagnoses diseases even to the extent of tasting urine, which is quite crude; this is merely because they fail to analyze voice and complexion, thus resorting to such inferior methods.
When dampness is excessive within, causing fullness in the viscera and excess Qi that injures the spirit of fear, the voice sounds as if coming from a closed room; this indicates dampness in the Middle Jiao. When speech is faint and one can only speak intermittently throughout the day, this indicates depletion of Qi. When speech lacks discernment of good and evil and shows no distinction between relatives and strangers, this indicates chaos of the Shen (Spirit).
The meaning of the classics is very clear: it is precisely through listening to the voice that one knows the state of the Shen and Qi.
If a patient speaks silently but likes to shout suddenly, the disease is in the joints and bones. If the voice is hoarse and not resonant, the disease is in the heart and diaphragm. If the voice is fine and long ("jiu jiu"), the disease is in the head.
These sentences are from the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet). "Silent," meaning unwilling to speak, belongs to the Three Yin meridians. "Likes to shout suddenly" belongs to the Jueyin Liver meridian. Disease entering the Three Yin meridians involves the Jueyin, which governs the sinews and bones; thus, the disease is known to be in the Lower Jiao. Voice that is not unobstructed or resonant indicates that the Great Qi in the chest fails to circulate freely, with difficult entry and exit; thus, the disease is known to be in the Middle Jiao, specifically the chest and diaphragm.
"Jiu jiu," referring to a fine and long sound, originates from the Yin aspect of the Lower Jiao, travels along the Foot-Taiyang Bladder Meridian, and reaches the vertex of the head; thus, the disease is known to be in the head.
Note: Voice and Qi root in the Kidneys, ascend to the chest and diaphragm, emerge from the lung passages, reach the nose, move through the tongue, and are articulated by the lips. It may be that Qi deficiency leads to faint voice, or that stagnation of Qi mechanisms leads to stuttering speech, or that obstruction in the diaphragm hinders Qi flow, or that nasal impediments cause abnormal voice. These are scattered across various texts; attentive practitioners should grasp them intuitively, as they cannot be fully exhausted by pen and paper.