诊其脉小，色不夺者，乃为新病。其脉不夺。其色夺者，乃为久病。脉色俱夺，乃为久病。俱不夺
者，乃为新病。
向壁而卧，闻医惊起，而目 视，三言三止，脉之咽唾，此为诈病。（若脉和平，当言此病须针灸
数处，服吐下药，然后可愈。欲以吓其诈，使彼畏惧，不敢言病耳。）
肝呼应角，心言应征，脾歌应宫，肺哭应商，肾呻应羽。五脏五声，以合五音。
《素问·阴阳应象大论》曰∶“视喘息，听音声，而知所苦。”盖病苦于中，声发于外，有不可诬者也。故
《难经·六十一难》曰∶“闻其五音以别其病。”此之谓也。
大笑不止，乃为心病。喘气太息，乃为肺病。怒而骂詈，乃为肝病。气不足息，乃为脾病。欲言不
言语轻多畏，乃为肾病。前轻后重，壮厉有力，乃为外感。倦不欲言，声怯而低，内伤不足。攒眉
呻吟，必苦头痛。叫喊呻吟，以手扪心，为中脘痛。呻吟身重，转即作楚，乃为腰痛。呻吟摇头，攒
眉扪腮，乃为齿痛。呻吟不起，为腰脚痛。诊时吁气，为属郁结。（凡人吁则气郁得以少伸也。）摇头而言，乃为里痛。
喉中有声，谓之肺鸣；火来乘金，不得其平。形羸声哑，咽中有疮，肺被火囚。（肺主声故耳。）声音暴哑，风
痰伏火；曾系喊伤，不可断病。声嘶色败，久病不治。气促喉声，痰火哮喘。中年声浊，痰火之殃。
独言独语，言谈无绪，思神他寄，思虑伤神。伤寒坏证，哑为狐惑，上唇有疮，虫食其脏；下唇有
疮虫食其肛。
风滞于气，机关不利。出言蹇涩乃为风病。气短不续，言止复言，乃为夺气。衣被不敛骂詈亲
疏，神明之乱，风狂之类；若在热病，又不必论。欲言复寂，忽又惊呼病深入骨。
语声寂寂然者，不欲语而欲默也。则病本缄默，而何以忽又惊呼，知其专系厥阴所主，何也？静默统属
之阴，而厥阴在志为惊，在声为呼，况骨节中属大筋，筋为肝合，非深入骨节之病，不如此也。
声音低渺，听不明彻，必心膈间有所阻碍。
空能传声，气无阻碍，碍则声出不扬，必其胸中大气不转，出入升降之机艰而且迟，可知病在胸膈间
矣。细心静听，其情乃得。
啾然细长，头中之病。
啾啾然细而长者，谓其声自下焦阴分而上，缘足太阳主气，与足少阴为表里，所以肾邪不剂颈而还，
得从太阳部分达于巅顶。肾之本病为呻吟，肾气从太阳经脉直攻于上，则肾之呻并从太阳变动而
啾唧细长，为头中病也。大都湿气混其清阳之气所致耳。仲景只此三段而上中下三焦受病之处，妙
义可彻。盖声者，气之从喉舌而宣于口者也。新病之人声不变，小病之人声不变，惟久病苛病其声乃
变。古人间隔垣之呻吟而知其病，觉无法乎？
诊察其脉象细小，但面色未显衰败的，这是新得的病。如果脉象未显衰败，但面色衰败的，这是久病。如果脉象和面色都衰败的，这也是久病。如果脉象和面色都不衰败的，这是新得的病。
病人面向墙壁躺着，听到医生来了惊恐地起身，眼神游离不定，说话断断续续（三言三止），诊脉时还吞咽口水，这是装病。（如果脉象平和，应当说这个病需要针刺多处穴位，服用催吐或泻下的药物，然后才能痊愈。目的是用这些吓人的话恐吓他，使他产生畏惧，不敢再假装生病。）
肝的声音对应角音，心的声音应征应音，脾的声音对应宫音，肺的声音对应商音，肾的声音对应羽音。五脏与五声相合，以对应五音。《素问·阴阳应象大论》说：“观察病人的呼吸喘息，听辨病人的声音，就能知道病人的痛苦所在。”因为病痛源于体内，声音发于体外，这是无法掩饰的。所以《难经·六十一难》说：“通过听辨五音来辨别疾病。”说的就是这个道理。
大笑不止，是心病的表现。气喘吁吁并长叹气，是肺病的表现。愤怒且骂人，是肝病的表现。气短不足以息，是脾病的表现。想说话却不说，声音轻微且多恐惧，是肾病的表现。声音前轻后重，壮厉有力，是外感病。疲倦不想说话，声音怯懦低沉，是内伤不足。皱眉呻吟，一定是头痛痛苦。叫喊呻吟，用手按着心口，是胃脘痛。呻吟且身体沉重，翻身时感到疼痛，是腰痛。呻吟摇头，皱眉摸脸颊，是牙痛。呻吟不起，是腰脚痛。诊察时叹息，属于气机郁结。（普通人叹息可以使郁结的气机稍微舒展。）边摇头边说话，是体内疼痛。
喉中有痰鸣声，称为肺鸣；这是火邪乘袭肺金，导致肺气不平。形体消瘦且声音嘶哑，咽喉中有疮疡，是肺被火邪囚困。（因为肺主司声音的缘故。）声音突然嘶哑，多是风痰伏火所致；或者是曾经因喊叫受伤，不能据此断定病情。声音嘶哑且面色败坏，是久病难治。气促且喉间有痰声，是痰火哮喘。中年声音浑浊，是痰火的祸患。自言自语，谈话没有条理，精神恍惚仿佛寄托在他处，这是思虑损伤心神。伤寒病转为坏证，出现失音的是狐惑病，上唇有疮疡，是虫蚀内脏；下唇有疮疡，是虫蚀肛门。
风邪阻滞气机，关节机关不利。说话蹇涩不清，是风病。气短接续不上，说话中途停止又继续，是夺气（元气大伤）。穿衣盖被不整齐，不分亲疏地骂人，是神明错乱，属于风狂之类；如果是热病过程中出现这种情况，则不必按此论断。想说话又沉默，忽然又惊呼，说明病邪深入骨髓。
说话声音寂静无声的，是不想说话而想保持沉默。如果病人本性就是缄默，为什么忽然又惊呼？由此可知这专门与厥阴经有关，为什么呢？静默统属于阴，而厥阴经在志为惊，在声为呼，况且骨节中属于大筋，筋与肝相合，如果不是深入骨节的病，不会这样。
声音低微渺茫，听不清楚透彻，一定是心膈间有阻碍。
空腔能传播声音，气机没有阻碍；如果有阻碍，声音就不响亮，一定是胸中的大气不能运转，出入升降的机制艰难且迟缓，可知病位在胸膈之间。细心安静地聆听，病情的真相才能得知。
声音细碎急促（啾然细长），是头部有病。
声音细碎而长（啾啾然细而长），是说声音从下焦阴分向上发出。因为足太阳膀胱经主司气机，与足少阴肾经互为表里，所以肾邪不会只停留在颈部就返回，而是能顺着太阳经脉到达头顶。肾的本病表现为呻吟，肾气沿着太阳经脉直冲向上，那么肾的呻吟声便随着太阳经的变化而变成细碎长音，这是头中病的表现。这大多是湿气混浊了清阳之气所导致的。张仲景仅用这三段文字就阐明了上、中、下三焦受病的情况，其中的精妙义理可以彻底通达。大概声音，是气从喉咙舌头宣发于口部的表现。新得病的人声音不变，小病的人声音不变，只有久病重病的人声音才会改变。古人隔着墙听到呻吟声就知道病人患病，难道没有办法吗？
If the pulse is small but the complexion has not declined, it indicates a recent disease. If the pulse has not declined but the complexion has declined, it indicates an old disease. If both the pulse and the complexion have declined, it indicates an old disease. If neither the pulse nor the complexion has declined, it indicates a recent disease.
When a patient lies facing the wall, rises in alarm upon hearing the physician, looks around with wandering eyes, speaks intermittently (hesitates between speaking and stopping), and swallows saliva during pulse diagnosis, this is feigned illness. (If the pulse is harmonious, one should say that this disease requires acupuncture at several points and administration of emetic or purgative medicines before recovery can be expected. The purpose is to intimidate the feigner with such threats, causing fear so they dare not continue pretending.)
The sound corresponding to the Liver is Jue (角); the sound corresponding to the Heart is Zhi (徵); the sound corresponding to the Spleen is Gong (宫); the sound corresponding to the Lung is Shang (商); and the sound corresponding to the Kidney is Yu (羽). The five Zang organs correspond to the five sounds, which align with the five musical tones. As stated in *Su Wen: Yin Yang Ying Xiang Da Lun* ("Treatise on the Correspondence of Yin and Yang"): "Observe the breathing and listen to the voice to know where the suffering lies." Since pain originates internally and voice manifests externally, it cannot be falsified. Thus, *Nan Jing: Chapter 61* states: "Listen to the five tones to distinguish the disease." This refers to this principle.
Uncontrollable laughter indicates Heart disease. Panting accompanied by deep sighing indicates Lung disease. Anger and cursing indicate Liver disease. Insufficient Qi leading to shortness of breath indicates Spleen disease. Wanting to speak but remaining silent, with a faint voice and excessive fear, indicates Kidney disease. A voice that starts light and becomes heavy, vigorous and powerful, indicates external contraction. Fatigue with reluctance to speak, and a timid, low voice, indicate internal injury and deficiency. Frowning and groaning indicate severe headache. Shouting and groaning while holding the heart region indicate epigastric pain. Groaning with heaviness of the body, where turning over causes pain, indicates lower back pain. Groaning with head shaking, frowning, and touching the cheeks indicates toothache. Inability to rise due to groaning indicates pain in the waist and legs. Sighing during diagnosis indicates Qi stagnation. (Sighing allows stagnant Qi to extend slightly.) Speaking while shaking the head indicates interior pain.
Phlegm-rattling sounds in the throat are called "Lung Ming"; this occurs when Fire attacks Metal (Lung), disrupting its equilibrium. Emaciation with hoarseness, and ulcers in the throat, indicate the Lung is imprisoned by Fire. (The Lung governs voice.) Sudden hoarseness is often caused by Wind-Phlegm and latent Fire; or it may result from previous vocal strain; one cannot definitively diagnose based solely on this. Hoarse voice combined with a ruined complexion indicates an incurable chronic disease. Rapid breathing with rattling sounds in the throat indicates Phlegm-Fire asthma. Turbid voice in middle age is a consequence of Phlegm-Fire. Soliloquy without coherent thread, with spirit seemingly attached elsewhere, indicates mental damage from overthinking. In damaged syndromes of Cold Damage, loss of voice characterizes Hu Huo syndrome (Fox-Horror Disease); ulcers on the upper lip indicate worms eating the viscera; ulcers on the lower lip indicate worms eating the anus.
Wind stagnating in the Qi mechanism leads to dysfunction of joints and articulation. Stuttering speech indicates Wind disease. Shortness of breath with interrupted speech that resumes indicates depletion of Qi (Duo Qi). Disheveled clothing, cursing relatives and strangers indiscriminately, indicates chaos of the Spirit, typical of Wind Mania; however, if occurring during a heat disease, it need not be discussed under this category. Wanting to speak then falling silent, suddenly shouting out, indicates the pathogen has penetrated deeply into the bones.
A quiet, silent voice indicates a desire for silence rather than speech. If the patient is naturally taciturn, why the sudden shout? This indicates exclusive involvement of the Jueyin channel. Why? Silence generally belongs to Yin, but Jueyin is associated with Fear/Shock in emotions and Shouting in sounds. Moreover, large tendons belong to the bone joints, and tendons are connected to the Liver. Only diseases penetrating deep into the bone joints present this way.
Low, faint voices that are unclear and unresonant indicate obstruction in the Heart and Diaphragm region.
Empty cavities transmit sound; if Qi flows without obstruction, sound is clear. Obstruction prevents resonant projection, indicating that the Great Qi in the chest fails to circulate, and the mechanisms of ascending, descending, entering, and exiting are difficult and slow. Thus, the disease is located in the chest and diaphragm. Careful and quiet listening reveals the truth.
A fine, thin, and rapid sound (Jiu Ran) indicates disease in the head.
A fine and long sound (Jiu Jiu Ran) implies the sound originates from the Lower Jiao Yin aspect and ascends. Because the Foot-Taiyang Bladder Channel governs Qi and forms an exterior-interior relationship with the Foot-Shaoyin Kidney Channel, Kidney pathogens do not stop at the neck but reach the vertex via the Taiyang pathway. The primary manifestation of Kidney disease is groaning. When Kidney Qi attacks upward directly through the Taiyang meridian, the Kidney's groaning transforms into a fine, long, chirping sound due to Taiyang changes, indicating Head disease. This is mostly caused by Dampness turbidifying Clear Yang Qi. Zhang Zhongjing’s three paragraphs succinctly cover the sites of disease in the Upper, Middle, and Lower Jiao, revealing profound principles. Voice is essentially Qi emanating from the throat and tongue to the mouth. In recent diseases, the voice remains unchanged; in minor diseases, the voice remains unchanged. Only in chronic or severe diseases does the voice change. Did ancients lack methods to diagnose illness merely by hearing groans through a wall?