经义
闻而知之者，谓之圣。○视喘息，听音声，而知病所苦。○肝在音为角，在声为呼；心在音为征，在声为
笑；脾在音为宫，在声为歌；肺在音为商，在声为哭；肾在音为羽，在声为呻。（《素问》）
哲言
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。○吸而微数，其病在中焦，实也，当下之即愈，虚者不治。在上焦者其吸促，在下焦者其吸远，此皆难治。
呼吸动摇振振者不治。（《金匮》）
声者，气之从喉舌而宣之于口者也。新病之人声不变，小病之人声不变，惟久病、苛病，其声乃变。迨
声变，其病机显呈而莫逃，所可闻而知之者矣。古人闻隔垣之呻吟，未见其形，先得其情。若精心体验，积久
诚通，如瞽者之耳偏聪，岂非不分其心于目耶？（喻嘉言）
肝为呼，心为笑，脾为歌，肺为哭，肾为呻，此声之可知者也。肝为角，心为征，脾为宫，肺为商，肾
为羽，此音之不易知者也。方土不同，语言分别，五音未有不相混者，何从窥其病而别之乎？然常者不易辨，
而变者则可辨，人有生平并未离乡，而
大病忽作他处方言者，则病情之所由见也。不病时五音难别，方病时五音不难别，以其病在一脏，则一脏之音
多，谛聆之而自审也。或一脏之音全无，则一脏已绝，其为病亦彰矣。五音之可辨者∶喉音宫，舌居中。（即
鼻音）； 音商，开口张；舌音角，舌缩却；齿音征，舌点齿；唇音羽，口撮聚。五音如笙簧然，何音哑，则
簧之坏在何孔。○脾虚者，恶闻木声；心虚者，恶闻鼓声；肺虚者，恶闻金声；肾虚者，恶闻人声，肝虚者，恶
闻啾唧之声。（《医参》）
喘粗气热为有余，喘急气寒为不足。息高者，心肺之气有余；吸弱者，肝肾之气不足。怒骂冤苦者，肝逆
气抑也；鼻塞声重喷嚏者，风寒未解也；言语轻迟短促者，中气虚也；呻吟者，痛也；噫者，脾困也，嗳者，
胃不宽也，实嗳声长而紧，得嗳则快；虚嗳声短而促，得嗳虽松，不觉其快。嗳冷气者，胃寒也；呕酸苦者，
肝火也。自言死者，元虚也；喜言食者，胃火也。言家私者，心虑少睡也；言负德者，肝郁多怒也。干咳无痰
者，胃中伏火也。谵语收财帛者，元气竭也；狂言多与人者，邪气实也。（《四诊抉微》）
凡闻声不能分呼、笑、歌、哭、呻，以求五脏善恶，五邪所干，及神气所主之病者，医之过也。○凡辨
息不分呼出、吸入，以求病情，毫厘千里，医之过也。○凡闻声不别雌雄长短，出于三焦何部者，医之过也。
（《医门法律》）
经义
听到病情并据此判断的，称为“圣”。○观察病人的呼吸喘息，聆听其声音，从而知道病人所遭受的痛苦。○肝对应五音中的角音，对应五声中的呼；心对应五音中的徵音，对应五声中的笑；脾对应五音中的宫音，对应五声中的歌；肺对应五音中的商音，对应五声中的哭；肾对应五音中的羽音，对应五声中的呻。（出自《素问》）
哲言
病人说话声音寂静无声，却喜欢突然惊呼的，是骨节间有病。○说话声音低沉不清晰的，是心膈间有病。○说话声音细小而长的，是头部有病。○吸气短促微弱，病在中焦，属于实证，用泻下法治疗即可痊愈；若属虚证则难以治愈。病在上焦的，吸气急促；病在下焦的，吸气深长遥远，这些都属于难治之症。呼吸时身体动摇震颤的，属于不治之症。（出自《金匮要略》）
声音，是气从喉舌发出并在口中宣发的表现。新近患病的人声音不变，轻微患病的人声音不变，只有久病、重病的人，声音才会改变。等到声音改变，疾病的机理就显露无遗而无法逃脱，这就是可以通过听声音来了解病情的原因。古人能隔着墙听到呻吟声，未见其人，先得其情。如果精心体验，积累久了自然通晓，就像盲人耳朵特别灵敏一样，这难道不是将心神专注于听觉而非视觉吗？（喻嘉言）
肝对应呼，心对应笑，脾对应歌，肺对应哭，肾对应呻，这是可以了解的“声”。肝对应角音，心对应徵音，脾对应宫音，肺对应商音，肾对应羽音，这是不容易了解的“音”。各地风俗不同，语言各异，五音没有不混杂的，从哪里去窥探病情并加以辨别呢？然而常态下的五音不易辨别，而异常状态下的五音则可以辨别。有人一生从未离开家乡，但在突发大病时说出他乡的方言，这就显现了病情的所在。不生病时五音难以辨别，生病时五音不难辨别，因为病在一脏，则该脏对应的声音增多，仔细聆听自然能审察清楚。如果某一脏的声音完全没有，说明该脏之气已绝，其病情也就明显了。五种可辨别的声音特征：喉音属宫，舌头居中（即鼻音）；商音，口张开；角音属舌，舌头收缩后退；徵音属齿，舌尖抵住牙齿；羽音属唇，嘴唇撮聚。五音就像笙簧一样，哪个音哑了，就是簧片在哪个孔坏了。○脾虚的人，厌恶听到木质的声音；心虚的人，厌恶听到鼓声；肺虚的人，厌恶听到金属的声音；肾虚的人，厌恶听到人的声音；肝虚的人，厌恶听到细微唧唧的声音。（出自《医参》）
喘促粗重且气息热的是有余（实证），喘急且气息寒的是不足（虚证）。呼气高扬者，是心肺之气有余；吸气微弱者，是肝肾之气不足。愤怒骂人、抱怨冤屈的，是肝气逆乱被抑制；鼻塞声音沉重且打喷嚏的，是风寒邪气未解除；言语轻慢迟缓短促的，是中气虚弱；呻吟的，是有疼痛；打嗝（噫）的，是脾运困阻；嗳气的，是胃气不宽舒，实证的嗳气声音长而紧，嗳出后感觉爽快；虚证的嗳气声音短而急促，虽然嗳出后感觉松快，但不觉舒畅。嗳出冷气的是胃寒；呕吐酸苦水的是肝火。自言自语说死去的，是元气虚弱；喜欢谈论食物的，是胃火。谈论家务私事的，是心虑多导致睡眠少；谈论亏欠恩德的，是肝郁导致易怒。干咳无痰的，是胃中有伏火。胡言乱语收拾钱财的，是元气竭尽；狂言多与人物的，是邪气盛实。（出自《四诊抉微》）
凡是听声音不能区分呼、笑、歌、哭、呻，以探究五脏的善恶、五邪的侵犯以及神气所主的疾病，是医生的过错。○凡是辨息不分呼出、吸入，以探求病情，差之毫厘谬以千里，是医生的过错。○凡是听声音不辨别雌雄长短，不清楚声音出于三焦哪一部，是医生的过错。（出自《医门法律》）
Scripture Meaning
One who hears and understands is called a "Sage." ○ Observe the patient's breathing and listen to their voice to know the suffering of the disease. ○ The Liver corresponds to the Jue (Angle) note in the five tones, and to Hu (shouting) in the five sounds; the Heart corresponds to the Zhi (Chime) note and Xiao (laughter); the Spleen corresponds to the Gong (Palace) note and Ge (singing); the Lung corresponds to the Shang (Market) note and Ku (crying); the Kidney corresponds to the Yu (Feather) note and Shen (groaning). (Su Wen)
Philosophical Sayings
When a patient speaks in a silent manner but likes to suddenly shout out, it indicates disease in the joints. ○ When speech is hoarse and not clear, it indicates disease in the heart and diaphragm. ○ When speech is fine and long, it indicates disease in the head. ○ Shallow and rapid inhalation indicates disease in the Middle Jiao (Middle Burner); if it is excess, purgation will lead to recovery; if it is deficiency, it is difficult to treat. If the disease is in the Upper Jiao, inhalation is hurried; if in the Lower Jiao, inhalation is distant and deep; all these are difficult to treat. If respiration causes the body to tremble and shake, it is incurable. (Jin Gui Yao Lue)
Voice is the manifestation of Qi spreading from the throat and tongue through the mouth. In cases of new-onset disease, the voice remains unchanged; in minor diseases, the voice remains unchanged. Only in chronic or severe diseases does the voice change. Once the voice changes, the pathogenesis becomes evident and cannot be hidden, allowing one to know the condition by listening. Ancient physicians could hear groans through a wall, knowing the situation before seeing the person. With careful experience and accumulation over time, one becomes as perceptive as a blind person whose hearing is heightened, focusing the mind on hearing rather than sight. (Yu Jiayan)
The Liver corresponds to shouting, the Heart to laughter, the Spleen to singing, the Lung to crying, and the Kidney to groaning; these are the "sounds" that can be known. The Liver corresponds to the Jue note, the Heart to Zhi, the Spleen to Gong, the Lung to Shang, and the Kidney to Yu; these are the "tones" that are difficult to discern. Due to different regional customs and languages, the five tones often mix, making it hard to diagnose based on them. However, while normal tones are hard to distinguish, abnormal ones are distinguishable. A person who has never left their hometown may speak with a foreign accent during a sudden severe illness, revealing the location of the pathology. When healthy, the five tones are hard to distinguish; when sick, they are easier to distinguish because the affected Zang organ produces more of its corresponding sound, which can be identified upon close listening. If the sound of a specific Zang organ is completely absent, it indicates the exhaustion of that organ's Qi, making the disease obvious. Distinguishable tone characteristics: Throat sounds belong to Gong, with the tongue centered (nasal sound); Shang sound involves an open mouth; Jue sound belongs to the tongue, with the tongue retracted; Zhi sound belongs to the teeth, with the tongue tip touching the teeth; Yu sound belongs to the lips, with the lips pursed. The five tones are like the reeds of a sheng (mouth organ); if a tone is mute, the reed in that hole is damaged. ○ Patients with Spleen deficiency dislike wooden sounds; those with Heart deficiency dislike drum sounds; those with Lung deficiency dislike metallic sounds; those with Kidney deficiency dislike human voices; those with Liver deficiency dislike chirping sounds. (Yi Can)
Rapid, coarse, and hot panting indicates Excess; rapid panting with cold air indicates Deficiency. High-pitched exhalation indicates Excess of Qi in the Heart and Lungs; weak inhalation indicates Deficiency of Qi in the Liver and Kidneys. Anger, cursing, and complaining indicate rebellious and suppressed Liver Qi; nasal congestion, heavy voice, and sneezing indicate unresolved Wind-Cold. Light, slow, and short speech indicates Deficiency of Middle Qi. Groaning indicates pain. Yawning (Yi) indicates Spleen stagnation; belching (Ai) indicates Stomach disharmony. Excess belching is long and tight, bringing relief after belching; deficiency belching is short and hurried, feeling loose but not truly relieved. Belching cold air indicates Stomach Cold; vomiting sour/bitter fluid indicates Liver Fire. Speaking of death indicates Yuan Qi (Original Qi) deficiency; talking about food indicates Stomach Fire. Discussing family affairs indicates Heart anxiety and poor sleep; discussing ingratitude indicates Liver depression and irritability. Dry cough without phlegm indicates latent fire in the Stomach. Delirium involving counting money indicates exhaustion of Yuan Qi; mania involving giving things away indicates Excess of Pathogenic Qi. (Si Zhen Jue Wei)
It is the physician's fault if they cannot distinguish between shouting, laughter, singing, crying, and groaning to determine the state of the Five Zang organs, the invasion of the Five Pathogens, and diseases governed by Shen Qi. ○ It is the physician's fault if they fail to distinguish exhalation and inhalation to ascertain the disease condition, leading to significant errors. ○ It is the physician's fault if they do not differentiate the gender and length of sounds, nor identify which part of the San Jiao (Triple Burner) they originate from. (Yi Men Fa Lv)