肝声呼。（怒则叫呼，或惊而呼也。）心声言（《洪范》言属火。）笑（狂笑为实热，微笑
为虚热。）脾胃声
歌，（轻颤如歌。）又为哕。（哕，干呕，详呕吐。）肺声哭，又为咳。肾声呻，又为欠，为嚏。（阳
未静而阴引之，故欠。阳欲达而阴发之，故嚏。）声清朗如平日者吉。声浊鼻塞者，伤风也。
声如瓮中出者，（混浊不清之意。）必中湿也。攒眉呻吟者，痛也。暴哑者，风痰伏火，
或怒喊哀号所致也。声哑如破而咳者，客寒裹热也。伤寒坏病，声哑，而唇口
有疮者，狐惑也。声哑形羸者，劳瘵，肺有疮也。骤然声喑，咽痛如刺，而
不肿不赤不发热，二便清利，阴寒也。骤然音喑，而喉颈亦肿胀闭，或发热便秘，
龙火也。鼻息鼾睡者，风温也。诊时吁气者，郁结也。噫气，以手抚心者，中脘痛
也。摇头言者，里痛也。少气不足以息者，气虚也。平人无寒热，而短气不足以息
者，痰火也。言而微，终日乃复言者，正气夺也。语言謇涩者，风痰也。言骤及多
言者，火也。言语善恶，不避亲疏，衣被不敛者，神明乱也。谵语者，邪气实也。
郑声者，正气虚也。
凡平素无病，而突然恶寒发热，多属外感。必有头痛体痛，拘急无汗，或有汗
等表证，浮紧浮大等表脉可据。若无表证表脉，病由渐致者，属内伤。外感则寒热
齐作而无间，内伤则寒热间作而不齐。外感恶寒，虽近烈火不除。（必表解乃已。）内伤恶
寒，得就温暖即解。外感恶风，乃不禁（禁，禁当也。）一切风寒。内伤恶风，惟恶夫些小
贼风。（又外感证显在鼻，故鼻息气促而鸣，壅盛有力，不若内伤之息短而气乏。内伤证显在口，
故口中不和，饮
食无味，不若外感初则知味，传里则不能食也。又外感热传里，渴，其饮甚多，不若内伤液亏
之渴，略饮即止。又
外感则邪气有余，故发言壮厉，先轻而后重。内伤元气不足，故出言懒怯，先重而后轻。又外
感头痛，常常而痛。
内伤头痛，时作时止也。）外感手背热，手心不热。（亦有背热于腹。）内伤手心热，
手背不热。（亦
腹热于背。）背微恶寒者，阳微不能胜阴也。阳明中 亦有此。（宜白虎加人参汤。）
劳役内伤亦
有此，必乍寒乍止，为阳虚内热。（升阳散火汤。）湿痰证亦有此，必身重体痛。（导痰汤。）凡
脾胃素虚之人，暑月饮食生冷冰水，寒气蓄聚，阴上乘阳，多见背寒冷如掌大。（宜温。）
恶寒蜷卧不发热者，阴证也。壮热而渴，不恶寒反恶热者，温热证也。来往寒热，
有定期者，疟也；无定期者，伤寒少阳经证，及内伤虚证也。潮热在日晡所者，伤
寒阳明证也；在子午者，内伤证。
肝脏的声音表现为呼号。（发怒时会叫喊，或因受惊而呼喊。）心脏的声音表现为言语（《洪范》中认为言语属火）。笑声（狂笑属于实热证，微笑属于虚热证）。脾和胃的声音表现为歌唱，（声音轻微颤抖如同唱歌。）又表现为呃逆。（呃逆即干呕，详见呕吐章节。）肺的声音表现为哭泣，又表现为咳嗽。肾的声音表现为呻吟，又表现为呵欠、打喷嚏。（阳气尚未平静而被阴气牵引，所以打呵欠。阳气想要发散而被阴气激发，所以打喷嚏。）声音清亮朗润如平时的是吉兆。声音浑浊且鼻塞的，是伤风病。声音像从瓮中发出的，（指声音混浊不清的意思。）一定是中了湿邪。皱眉呻吟的，是疼痛。突然失音的，是风痰潜伏或内有伏火，或者是因愤怒大喊、悲哀号哭所导致的。声音嘶哑像破锣一样且伴有咳嗽的，是外寒包裹内热。伤寒坏病（伤寒病情恶化后的复杂病症），声音嘶哑，且嘴唇口角有疮疡的，是狐惑病。声音嘶哑且身体消瘦的，是劳瘵（肺结核类消耗性疾病），肺部有疮疡。突然失音，咽喉疼痛如针刺，但不肿胀、不发红、不发热的，是阴寒证。突然声音嘶哑，且喉颈部也肿胀闭塞，或伴有发热、便秘的，是龙火（相火妄动）证。鼻息鼾睡的是风温病。诊察时叹息的是气机郁结。嗳气，用手抚摸心窝部位的，是中脘痛。摇头说话的是体内疼痛。气短不足以呼吸的，是气虚。平素没有疾病的人，如果没有恶寒发热，但气短不足以呼吸的，是痰火证。说话声音微弱，整天才说几句话的，是正气耗夺。语言謇涩（说话不流利）的，是风痰证。说话突然增多或多言的，是火证。言语不分善恶，不顾亲疏关系，衣被不整的，是神明混乱。谵语（胡言乱语）的，是邪气盛实。郑声（语言重复，声音低微）的，是正气虚弱。
凡是平素无病，却突然恶寒发热的，多属于外感病。一定伴有头痛、身体疼痛、拘急无汗，或有汗等表证，以及浮紧、浮大等表脉作为依据。如果没有表证和表脉，病情是逐渐形成的，则属于内伤病。外感病的恶寒发热同时出现且无间歇；内伤病的恶寒发热交替出现且不整齐。外感恶寒，即使靠近烈火也不能缓解。（必须表证解除才会停止。）内伤恶寒，靠近温暖环境即可缓解。外感恶风，是不能忍受一切风寒。内伤恶风，只害怕微小的贼风。（另外，外感证的表现在鼻子，所以鼻息气促且有鸣响，气势旺盛有力，不像内伤那样气息短促且乏力。内伤证的表现在口，所以口中不和，饮食无味，不像外感初起时知道味道，传入里证后不能进食。另外，外感热邪传入里部会口渴，饮水很多，不像内伤津液亏损的口渴，稍微喝一点就停止。另外，外感则是邪气有余，所以发声壮厉，先轻而后重。内伤则是元气不足，所以发声懒怯，先重而后轻。另外，外感头痛，是持续不断的疼痛。内伤头痛，是时作时止的。）外感手背发热，手心不热。（也有背部比腹部热的情况。）内伤手心发热，手背不热。（也有腹部比背部热的情况。）背部微微恶寒的，是阳气微弱不能胜过阴气。阳明经也有这种情况。（适宜用白虎加人参汤。）劳役过度导致内伤也有这种情况，一定是忽冷忽热，属于阳虚内热。（适宜用升阳散火汤。）湿痰证也有这种情况，一定伴有身体沉重、肢体疼痛。（适宜用导痰汤。）凡是脾胃素来虚弱的人，在暑月食用生冷冰水，寒气蓄积，阴气上乘于阳位，多见背部寒冷如手掌大小。（适宜温补。）恶寒蜷缩卧倒而不发热的，是阴证。高热且口渴，不恶寒反而恶热的，是温热证。往来寒热，有固定时间的，是疟疾；没有固定时间的，是伤寒少阳经证，以及内伤虚证。潮热在日晡时分（下午3-5点）发作的，是伤寒阳明证；在子午时分（半夜11-1点和中午11-1点）发作的，是内伤证。
The sound of the Liver is shouting. (Shouting occurs during anger, or crying out due to fright.) The sound of the Heart is speaking (In *Hong Fan*, speech is associated with Fire). Laughter (Manic laughter indicates Excess Heat; gentle smiling indicates Deficiency Heat). The sounds of the Spleen and Stomach are singing, (A slight tremor in the voice resembling song.) It also manifests as hiccups. (Hiccups refer to dry retching; see the section on Vomiting for details.) The sound of the Lung is weeping, and also coughing. The sound of the Kidney is groaning, and also yawning and sneezing. (Yawning occurs because Yin draws down Yang before it has settled. Sneezing occurs because Yin triggers Yang as it attempts to emerge.) A voice that is clear and resonant as usual is auspicious. A voice that is turbid accompanied by nasal congestion indicates Wind-Cold injury. A voice sounding as if coming from a jar (indicating muffled and unclear quality) suggests Dampness invasion. Frowning and groaning indicates pain. Sudden aphonia is caused by Phlegm-Wind lurking with latent Fire, or resulting from angry shouting or mournful wailing. Hoarseness resembling a broken voice accompanied by coughing indicates External Cold enveloping Internal Heat. In complicated cases of Cold Damage (*Shanghan*), hoarseness accompanied by sores on the lips and mouth indicates *Hu Huo* disease. Hoarseness accompanied by emaciation indicates *Lao Zhai* (consumptive disease such as tuberculosis), indicating ulcers in the Lung. Sudden loss of voice with throat pain like stabbing, but without swelling, redness, or fever, indicates Yin Cold. Sudden hoarseness accompanied by swelling and obstruction of the throat and neck, or with fever and constipation, indicates Dragon Fire (Hyperactive Ministerial Fire). Snoring during breathing indicates Wind-Warmth. Sighing during diagnosis indicates Qi stagnation. Belching while touching the heart region indicates pain at Zhongwan (CV12). Shaking the head while speaking indicates internal pain. Shortness of breath and inability to breathe deeply indicates Qi Deficiency. In an otherwise healthy person without chills or fever, shortness of breath and inability to breathe deeply indicates Phlegm-Fire. A voice that is faint, speaking only occasionally throughout the day, indicates depletion of Healthy Qi. Slurred speech indicates Wind-Phlegm. Sudden verbosity or excessive talking indicates Fire. Speaking indiscriminately about good and evil, ignoring kinship and distance, and wearing clothes improperly indicates disorder of the Spirit (*Shen*). Delirious speech indicates Excess pathogenic factors. Monotonous, repetitive low murmurs indicate Deficiency of Healthy Qi.
Sudden onset of chills and fever in a person who was previously healthy mostly belongs to External Contraction. There must be exterior signs such as headache, body ache, stiffness, absence of sweat, or presence of sweat, supported by exterior pulses such as Floating-Tight or Floating-Large. If there are no exterior signs or pulses, and the illness develops gradually, it belongs to Internal Injury. In External Contraction, chills and fever occur simultaneously without interval; in Internal Injury, they alternate and are irregular. Chills from External Contraction cannot be relieved even by approaching a fierce fire. (It resolves only when the exterior condition is resolved.) Chills from Internal Injury resolve upon seeking warmth. Fear of wind from External Contraction implies intolerance to all wind and cold. Fear of wind from Internal Injury implies sensitivity only to minor drafts. (Furthermore, Exterior conditions manifest in the nose; thus, nasal breathing is rapid with wheezing, vigorous and forceful, unlike the short breath and weak qi of Internal Injury. Internal Injury conditions manifest in the mouth; thus, the mouth feels uncomfortable and food lacks taste, unlike External Contraction where taste is perceived initially but lost when the pathogen enters the interior. Additionally, in External Contraction, heat transmitting to the interior causes thirst with large water intake, unlike Internal Injury fluid deficiency where thirst is relieved by slight drinking. Moreover, External Contraction involves excess pathogenic factors, so the voice is strong and loud, starting light and becoming heavy. Internal Injury involves insufficiency of Yuan Qi, so the voice is lazy and timid, starting heavy and becoming light. Additionally, External Contraction headache is constant. Internal Injury headache comes and goes.) External Contraction presents with heat on the back of the hand and no heat in the palm. (There are cases where the back is hotter than the abdomen.) Internal Injury presents with heat in the palm and no heat on the back of the hand. (There are cases where the abdomen is hotter than the back.) Mild aversion to cold on the back indicates Yang Deficiency unable to overcome Yin. This can also occur in Yangming channel conditions. (Baihu Jia Renshen Tang is appropriate.) It also occurs in fatigue-induced Internal Injury, characterized by alternating chills and heat, indicating Yang Deficiency with Internal Heat. (Shengyang Sanhuo Tang is appropriate.) Damp-Phlegm conditions may also present this way, accompanied by heavy body and limb pain. (Daotan Tang is appropriate.) In individuals with inherent Spleen-Stomach Deficiency, consuming raw, cold, or icy foods/drinks during summer months leads to accumulation of Cold Qi. When Yin rises to overwhelm Yang, the back often feels cold over an area the size of a palm. (Warming therapy is appropriate.) Aversion to cold with curling up and no fever indicates Yin Syndrome. High fever with thirst, aversion to heat rather than cold, indicates Warm-Thermal Syndrome. Alternating chills and fever with regular timing indicates Malaria; irregular timing indicates Shaoyang channel syndrome of Cold Damage, or Internal Injury Deficiency syndromes. Tidal fever occurring at Dibu hours (3-5 PM) indicates Yangming syndrome of Cold Damage; occurring at Ziwu hours (11 PM-1 AM and 11 AM-1 PM) indicates Internal Injury syndrome.