诊儿之法听五声,聆音察理始能明,五声相应五脏病,五声不和五脏情。心病声急多言笑,肺病声悲音不清,肝
病声呼多狂叫,脾病声歌音颤轻,肾病声呻长且细,五音昭着证分明。啼而不哭知腹痛,哭而不啼将作惊, 煎不安心
烦热,嗄声声重感寒风。有余声雄多壮厉,不足声短怯而轻,多言体热阳腑证,懒语身冷阴脏形。狂言焦躁邪热盛,谵
语神昏病热凶,鸭声在喉音不出,直声无泪命将倾。虚实寒热从声别,闻而知之无遁情。
【注】小儿之病,既观其色,又当细听其声。盖笑、呼、歌、悲、呻五声,内应心、肝、
脾、肺、肾五脏也。五声不和,则知五脏有病之情矣,如心属火病,则声急喜笑;肺属
金病,则声悲音浊;肝属木病,则声狂叫多呼;脾属土病,则声颤轻如歌;肾属水病,则
其声长细如呻吟。有声有泪声长曰哭,有声无泪声短曰啼。如啼而不哭,则气不伸畅,主
腹痛;哭而不啼,则气急心烦,将成惊也。 煎不安者,乃心经内热,故烦躁不宁也。嘎
声,音哑也。声重,声浊也。此为外感风寒也。有余之证其气实,故声雄大而壮厉;不
足之证其气虚,故声怯弱而轻短。多言与身热皆阳也,阳主腑,故曰阳腑证也;懒语与
身凉皆阴也,阴主脏,故曰阴脏证也。狂言焦躁者,邪热盛也;神昏谚语者,热乘于心,
故曰病热凶也。鸭声,声在喉中而哑,气将绝也;直声,声无回转而急,气将散也,二
者俱为不治之证。医者果能以此察之,则知表里脏腑,寒热虚实,诸病之情态无所遁矣!
诊断小儿疾病的方法在于听取五声,通过聆听声音并分析其道理,才能明辨病情。五声与五脏病变相应,五声不和则反映五脏的病理状态。心病的声音急促且多言笑,肺病的声音悲伤且音色不清,肝病的声音呼叫且多狂叫,脾病的声音如歌且音色颤抖轻微,肾病的声音呻吟且长而细,五种音律显著,证候便分明。啼哭有声无泪称为腹痛,哭泣有泪无声或声短将发作惊风;心中烦热不安,声音嘶哑且沉重是感受寒风。声音雄壮有力多为实证,声音短促怯弱多为虚证;多言伴身体发热属阳腑证,懒言伴身体发冷属阴脏证。胡言乱语、焦躁不安为邪热炽盛,谵语神昏为病势凶险的热证;喉中发出鸭叫声且音不出为危重之象,声音直急无回转且无泪为生命垂危之兆。虚实寒热可通过声音辨别,听闻声音即可知晓病情,无所遁形。
【注】小儿的疾病,既要看面色,又应当仔细听声音。因为笑、呼、歌、悲、呻这五声,内应心、肝、脾、肺、肾五脏。五声不和,就知道五脏有病的状况了,比如心属火病,则声音急促喜欢笑;肺属金病,则声音悲伤音色浑浊;肝属木病,则声音狂叫多呼喊;脾属土病,则声音颤抖轻微如唱歌;肾属水病,则声音长细如呻吟。有声有泪且声音长叫做“哭”,有声无泪且声音短叫做“啼”。如果只啼不哭,说明气机不伸畅,主诉腹痛;如果只哭不啼,说明气急心烦,将要形成惊风。“煎不安”(烦躁不宁),是心经内有热,所以烦躁不宁。嘎声,即声音嘶哑。声重,即声音浑浊。这是外感风寒所致。有余的证候其气实,所以声音雄壮宏大且猛烈;不足的证候其气虚,所以声音怯弱轻短。多言与身热都属于阳,阳主腑,所以叫阳腑证;懒语与身凉都属于阴,阴主脏,所以叫阴脏证。胡言乱语焦躁的是邪热盛;神昏谵语的是热邪乘于心,所以叫病热凶险。鸭声,声音在喉中而哑,是气将绝的表现;直声,声音没有回转且急促,是气将散的表现,这两种都是不治之证。医生如果能以此观察,就能知道表里脏腑、寒热虚实,各种疾病的状况就无所遁形了!
The method of diagnosing pediatric diseases lies in listening to the five sounds. By hearing the sounds and analyzing their principles, one can clearly understand the condition. The five sounds correspond to diseases of the five Zang organs; disharmony of the five sounds reflects the pathological state of the five Zang organs. In Heart disease (Xin Bing), the voice is urgent with much talking and laughing; in Lung disease (Fei Bing), the voice is sorrowful and the tone is unclear; in Liver disease (Gan Bing), the voice involves calling out with much wild shouting; in Spleen disease (Pi Bing), the voice resembles singing with a trembling and light tone; in Kidney disease (Shen Bing), the voice is groaning, long, and thin. When the five tones are distinct, the syndromes are clear. Crying without tears indicates abdominal pain; weeping with tears but short or silent voice suggests impending convulsions (Jing Feng). Restlessness and internal heat cause discomfort; hoarseness with a heavy tone indicates contraction of Wind-Cold (Feng Han). A robust and vigorous voice often indicates Excess (Shi) patterns, while a short, timid, and light voice often indicates Deficiency (Xu) patterns. Much talking accompanied by fever belongs to Yang Fu syndromes (Yang Organ Syndromes); reluctance to speak accompanied by cold body temperature belongs to Yin Zang syndromes (Yin Viscera Syndromes). Delirious speech with irritability indicates flourishing pathogenic Heat (Re); delirium with unconsciousness indicates a severe and ominous heat syndrome. A quack-like sound stuck in the throat with inability to vocalize is a critical sign; a straight, urgent voice without resonance and without tears indicates impending death. Deficiency and excess, Cold and Heat can be distinguished by the voice; upon hearing the voice, the condition is revealed without concealment.
[Note] For pediatric diseases, one must observe the complexion and carefully listen to the voice. The five sounds—laughing, calling, singing, grieving, and groaning—correspond internally to the Heart, Liver, Spleen, Lung, and Kidney. Disharmony of the five sounds indicates pathology in the five Zang organs. For instance, Heart disease associated with Fire presents with an urgent voice and a tendency to laugh; Lung disease associated with Metal presents with a sorrowful voice and turbid tone; Liver disease associated with Wood presents with wild shouting and frequent calling; Spleen disease associated with Earth presents with a trembling, light voice resembling singing; Kidney disease associated with Water presents with long, thin groaning. "Ku" (crying) has sound and tears with a long duration; "Ti" (whimpering) has sound but no tears with a short duration. If there is whimpering without crying, it indicates stagnant Qi, primarily abdominal pain. If there is crying without whimpering, it indicates rapid breathing and mental restlessness, suggesting impending convulsions. "Jian bu an" (restlessness/tossing about) refers to internal Heat in the Heart Meridian, causing irritability and agitation. "Ga sheng" refers to hoarseness. "Sheng zhong" refers to a turbid voice. These indicate external contraction of Wind-Cold. In Excess syndromes, Qi is solid, resulting in a loud, grand, and fierce voice; in Deficiency syndromes, Qi is weak, resulting in a timid, weak, and short voice. Much talking and fever are Yang attributes; Yang governs the Fu organs, hence "Yang Fu Syndrome." Reluctance to speak and coolness are Yin attributes; Yin governs the Zang organs, hence "Yin Zang Syndrome." Delirious speech and irritability indicate flourishing pathogenic Heat; delirium and unconsciousness indicate Heat invading the Heart, hence "ominous heat disease." "Ya sheng" (duck-like sound) is a hoarse sound stuck in the throat, indicating impending exhaustion of Qi; "Zhi sheng" (straight sound) is an urgent voice without resonance, indicating dispersion of Qi. Both are untreatable conditions. If physicians can observe thus, they will discern the interior and exterior, Zang and Fu, Cold and Heat, Deficiency and Excess, and the manifestations of all diseases will be fully revealed.