或问医以声色之辨。为神圣妙用。而审切反居其次。何也。答曰。夫色者神之华。声者气之
发。神气为生阳之征验。在诊察之际。不待问而阴阳虚实之机。先见于耳目间矣。予于伤寒绪论。言之颇详。
姑以大略陈之。色贵明润。不欲沉夭。凡暴感客邪之色。不妨昏浊壅滞。病久气虚。只宜瘦削清 。若病邪方锐
。而清白少神。虚羸久困。而妩媚鲜泽。咸非正色。五色之中。青黑黯惨。无论病之新久。总属阳气不振。惟
黄色见于面目。而不至索泽者。皆为向愈之候。若眼胞上下如烟煤者。寒痰也。眼黑颊赤者。热痰也。眼黑而
行步艰难呻吟者。痰饮入骨也。眼黑而面带土色。四肢痿痹。屈伸不便者。风痰也。病患见黄色光泽者。为有
胃气。不死。干黄者。为津液之槁。多凶。目睛黄者。非瘅即衄。目黄大烦为病进。平人黑气起于口鼻耳目者危。
若赤色见于两颧。黑气出于神庭。乃大气入于心肾。暴亡之兆也。至于声者。虽出肺胃。实发丹田。其轻清重
浊。虽由基始。要以不异平时为吉。如病剧而声音清朗如常者。形病气不病也。始病即气壅声浊者。邪
乾清道也。病未久而语声不续者。其人中气本虚也。脉之呻者。病也。言迟者。风也。多言者。火之用事也。声
如从室中言者。中气之湿也。言而微。终日乃复言者。正气之夺也。衣被不敛。言语善恶。不避亲疏者。神明
之乱也。出言懒怯。先重后轻者。内伤元气也。出言壮厉。先
轻后重者。外感客邪也。攒眉呻吟者。头痛也。噫气以手抚心者。中脘痛也。呻吟不能转身。坐而下一脚者。
腰痛也。摇头以手扪腮者。齿颊痛也。呻吟不能行步者。腰脚痛也。诊时吁气者。郁结也。摇头言者。里痛也
。形羸声哑者劳瘵。咽中有肺花疮也。暴哑者。风痰伏火。或怒喊哀号所致也。语言蹇涩者。风痰也。诊时独
言独语。不知首尾者。思虑伤神也。伤寒坏病。声哑。唇口有疮者。狐惑也。平人无寒热。短气不足以息者。
痰火也。声色之诊最繁。无庸琐述。以混耳目。
有人询问医生通过观察面色和听声音来辨别病情的方法，这被认为是医术中神圣精妙的运用，而问诊反而排在次要地位，这是为什么呢？回答说：面色是神气的外在荣华表现，声音是气息的发露。神气和阳气是生命活力的征验，在诊察的时候，不需要经过问诊，阴阳虚实的关键信息就已经显露在医生的耳目之间了。我在《伤寒绪论》中对此论述得很详细，这里姑且简要陈述其大略。
面色贵在明亮润泽，不想要晦暗枯槁。凡是突然感受外邪的面色，不妨碍显得昏浊壅滞；如果是久病导致气虚，面色只宜显得瘦削清瘦。如果病邪正盛锐，但面色却清白少神；或者身体虚弱羸困已久，但面色却妩媚鲜泽，这些都不是正常的颜色。在五色之中，青色、黑色黯淡惨厉，无论病情是新发还是久患，总属于阳气不振。只有黄色出现在面目上，而且不至于干枯无光泽的，都是即将痊愈的征兆。如果眼睑上下像烟煤一样黑，是寒痰；眼睛周围黑而脸颊红赤，是热痰；眼睛周围黑而行走困难、呻吟的，是痰饮深入骨髓；眼睛周围黑而面色带土色、四肢痿软麻痹、屈伸不便的，是风痰。病人见到黄色有光泽的，说明还有胃气，不会死亡；干黄的，是津液枯竭，大多凶险。眼珠黄的，不是黄疸就是鼻衄；目黄且极度烦躁的，表示病情进展。普通人如果在口、鼻、耳、目周围出现黑气，情况危急。如果赤色出现在两颧，黑气出于神庭穴部位，这是大气侵入心肾，是突然死亡的预兆。
至于声音，虽然出自肺胃，实际上发源于丹田。声音的轻清或重浊，虽然由先天基础决定，但重要的是与平时没有差异为吉。比如病情严重但声音清朗如常的，是形体有病而气机未病；刚发病就气息壅塞、声音浑浊的，是邪气侵犯清道；生病不久而说话声音接续不上的，是中气本来虚弱。脉象（此处指患者因痛苦发出的）呻吟声，表明有病；说话迟缓的，是有风邪；多言的，是火邪在起作用。声音好像从密室中传出的，是中焦湿气阻滞；说话声音微弱，整天才说几句话的，是正气耗夺。衣服被子不整理，言语善恶不分，不避亲疏的，是神明混乱。说话懒惰怯弱，先重后轻的，是内伤元气。说话壮烈严厉，先轻后重的，是外感客邪。皱眉呻吟的，是头痛。嗳气并用手抚摸心口的，是中脘痛。呻吟不能转身，坐着时放下一只脚的，是腰痛。摇头并用手摸腮部的，是齿颊痛。呻吟不能行走的，是腰脚痛。诊察时叹息的，是郁结。摇头说话的，是里痛。形体消瘦而声音嘶哑的，是劳瘵（肺结核类疾病），咽喉中有肺花疮。突然失音的，是风痰伏火，或者是愤怒喊叫、哀号所致。语言蹇涩的，是风痰。诊察时独自自言自语，不知道前后内容的，是思虑损伤神气。伤寒坏病，声音嘶哑，嘴唇口角有疮疡的，是狐惑病。平素没有寒热症状，但短气不足以呼吸的，是痰火。声色诊法最为繁杂，无需琐碎叙述，以免混淆视听。
A question was raised regarding the physician's differentiation of illness through observing facial color and listening to voice, which is considered a divine and miraculous application of medical skill, whereas inquiry (Wen Zhen) ranks secondary. Why is this so? The answer is: Facial color is the external splendor of Shen (Spirit), and voice is the emission of Qi (Vital Energy). Shen and Qi are the manifestations of Sheng Yang (Life-giving Yang). During examination, without the need for inquiry, the mechanisms of Yin-Yang deficiency or excess are already revealed before the eyes and ears. I have discussed this in detail in *Shanghan Xulun* (Introduction to Cold Damage Treatises); here, I will briefly outline the general principles.
Facial color should be bright and lustrous, not dull and withered. In cases of sudden contraction of exogenous pathogens, the color may be turbid and obstructed; however, in chronic diseases involving Qi deficiency, the complexion should appear thin and clear. If the pathogenic factor is sharp and vigorous but the complexion is pale and lacks spirit, or if the body has been weak and emaciated for a long time yet the complexion appears charming and fresh, these are all abnormal colors. Among the five colors, dark blue/black and gloomy hues indicate failing Yang Qi, regardless of whether the disease is new or old. Only when yellow appears on the face and head without being dry and lusterless does it signify an impending recovery. If the eyelids resemble soot, it indicates Cold Phlegm; if the periorbital area is dark while the cheeks are red, it indicates Heat Phlegm; if the periorbital area is dark accompanied by difficulty walking and groaning, it indicates Phlegm-Fluid invading the bones; if the periorbital area is dark, the complexion resembles earth, and there is flaccidity and numbness of the four limbs with difficulty in flexion and extension, it indicates Wind-Phlegm. A patient exhibiting lustrous yellow indicates the presence of Wei Qi (Stomach Qi) and implies survival; dry yellow indicates exhaustion of Body Fluids and portends misfortune. Yellowing of the eyeballs suggests either Dan Jaundice (Epidemic Jaundice) or Epistaxis; jaundice accompanied by severe restlessness indicates disease progression. The appearance of black qi around the mouth, nose, ears, and eyes in a healthy person is critical. If redness appears on both cheekbones and black qi emerges from the Shenting (GV24) acupoint region, it signifies the invasion of massive pathogenic factors into the Heart and Kidney, a sign of sudden death.
Regarding voice, although it originates from the Lung and Stomach, it actually emanates from the Dantian. Its clarity or heaviness depends on constitutional foundation, but the key is that it remains consistent with the person's normal state, which is auspicious. For instance, if the voice remains clear and normal despite severe illness, it indicates that the form is diseased but the Qi is not. If the voice becomes hoarse and turbid immediately upon onset, it indicates pathogenic factors invading the clear pathways. If speech is interrupted shortly after illness begins, it indicates inherent deficiency of Middle Qi. Groaning indicates disease; slow speech indicates Wind; excessive talking indicates the activity of Fire. A voice sounding as if coming from a confined room indicates Dampness in the Middle Jiao. A faint voice with only occasional utterances throughout the day indicates the depletion of Righteous Qi. Disheveled clothing and bedding, inappropriate speech, and lack of discrimination between relatives and strangers indicate chaos of Shen (Spirit). Lazy and timid speech, starting heavy and becoming light, indicates internal injury to Yuan Qi (Original Qi). Loud and harsh speech, starting light and becoming heavy, indicates external contraction of exogenous pathogens. Frowning and groaning indicate Headache. Belching while holding the heart region indicates pain in the Zhongwan (CV12) area. Groaning with inability to turn over, sitting with one leg lowered, indicates Lower Back Pain. Shaking the head while touching the cheeks indicates Tooth and Cheek Pain. Groaning with inability to walk indicates Lumbar and Leg Pain. Sighing during examination indicates Qi Stagnation. Shaking the head while speaking indicates interior pain. Emaciation with hoarseness indicates Lao Zhai (Consumption/Tuberculosis) and Fei Hua Chuang (Lung Flower Ulcer) in the throat. Sudden aphonia is caused by latent Wind-Phlegm and Fire, or by shouting and wailing. Slurred speech indicates Wind-Phlegm. Speaking alone and unintelligently during examination indicates mental injury due to overthinking. In complicated cold damage diseases, hoarseness with ulcers on the lips and mouth indicates Hu Huo Disease (Fox Confusion Syndrome). In a person without chills or fever, shortness of breath and insufficient respiration indicate Phlegm-Fire. The diagnostic methods of observing color and listening to voice are numerous; detailed enumeration is unnecessary to avoid confusion.