In martial arts novels, masters often possess the ability to discern a person’s condition through their voice. In fact, doctors also have the capability to diagnose illnesses by listening to sounds. The auditory diagnosis in TCM, one of the four diagnostic methods, includes listening to sounds. This article discusses how to assess a patient’s physical condition through sound by examining the relationship between the five organs and the five sounds, along with clinical judgment standards. At the end of the article, a six-character formula is provided, which the Medicine King Sun Simiao regarded as a method for longevity, and clinical practitioners can teach patients to practice as an adjunct to treatment.
Listening to the Five Sounds and Observing the Five Organs
We often say that sound expresses emotion, and emotions arise from the body.
A person with liver qi deficiency may shout wildly because “the sound of the liver is shouting”; shouting is a form of release. If someone is repressed, such as being reprimanded in the office, they certainly cannot shout wildly but can only let out a soft sigh. In Japan, there are places specifically designed for people to vent their frustrations, where individuals can throw spears at others, break things, or curse. At such times, they often emit an “ah” sound or curse. These are all forms of self-release.
The sound of the heart is laughter; if a person laughs heartily, it indicates that their spirit is scattered.
The proper qi of the spleen is a clear singing voice, while the evil qi is “singing loudly while climbing high,” similar to individuals with mental symptoms. We often find that those with mental symptoms possess immense strength and skills; no matter how high the wall, they can suddenly climb up and act wildly. Generally, a normal person would need martial arts skills to suddenly leap over a wall; otherwise, it is impossible. Those with mental symptoms can do so because of the internal excess of yang evil.
The sound of the lungs is crying; if a person is always crying or their voice carries a tone of sadness, it indicates lung issues.
The sound of the kidneys is moaning; if a person is always groaning, their kidneys are certainly not well.
In summary, the mnemonic is:Liver, Heart, Spleen, Lung, Kidney; Shouting, Laughing, Singing, Crying, Moaning
Clinical Judgment Standards
In TCM, auditory diagnosis includes listening to sounds and smelling odors. For clinical practitioners, how can one assess a person’s physical condition through their voice?
The sounds produced by the human body result from the coordinated work of the mouth, tongue, teeth, lips, nose, throat, epiglottis, and lungs. Healthy individuals share a common characteristic in their voices: they sound natural, harmonious, and balanced in strength and softness. However, differences exist in the sounds produced due to variations in gender, age, constitution, and emotions.
Pathological Changes in the Vocal Organs
When the vocal organs themselves undergo pathological changes, the sounds produced will also change accordingly. For example, a stroke patient may have a stiff tongue or a crooked mouth, often leading to slurred speech and unclear articulation; vocal cord diseases (such as vocal cord polyps or nodules) can cause hoarseness; patients with missing teeth may speak with a lisp due to air leakage, resulting in abnormal speech. These abnormalities are due to pathological changes in the vocal organs.
Diseases
The various signs exhibited by diseases can reflect their essence. For example, consider coughing:
A dull, heavy cough or a “water chicken” sound in the throat often indicates phlegm accumulation in the lungs or trachea; a clear, crisp cough usually signifies dryness injuring the lungs or depletion of body fluids and yin blood, leading to insufficient moisture in the lungs and trachea;
A paroxysmal cough that is loud and worsens with wind often indicates the early stage of a cold, with wind evil attacking the lungs; a persistent cough that leads to nausea, vomiting, or coughing up blood, ending with a “heron” sound, often indicates whooping cough in children; a cough that sounds like a dog barking often indicates diphtheria;
A low, weak cough with ineffective sputum production, resembling foam, often indicates qi deficiency; a high-pitched cough that produces an “empty” sound often indicates depletion of the body’s original yin and floating yang;
The different characteristics of these cough sounds provide significant guidance for disease treatment. For instance, if the cough sound is tight and muffled, with a phlegm sound in the throat, treatment should focus on resolving phlegm to stop the cough; if it is a dry cough without phlegm, nourishing yin and moistening the lungs should be the approach; and if the cough sounds like a drum being struck, producing an “empty” sound, then nourishing yin and subduing yang should be the treatment method.
I once heard of a case where a person had a cough for over half a month without improvement and called a doctor for advice. Since the doctor could not see the tongue coating or feel the pulse over the phone, they listened to the cough sound. The sound was “empty” like striking a drum, so the doctor instructed the patient to buy some wu mei (dried plum) from the supermarket, recommending 3-5 pieces each time, twice a day. After the first day, the cough significantly reduced, and by the third day, it had almost completely resolved. It was not that the dried plum was particularly effective, but rather that the characteristics of the cough sound indicated a condition of yin deficiency and floating yang. Wu mei is sour and has astringent properties, which can help the floating yang return to the kidneys.
Organs
Small Intestine Disease is associated with the small intestine meridian, which runs to the cheeks and nostrils. Therefore, if a person has a very magnetic voice with a heavy nasal tone, speaking beautifully and attractively, they may have a small intestine issue. Some individuals with rhinitis may speak in a “muffled” manner, which sounds pleasant, but this actually indicates stagnation of lung qi.
Spleen disease often leads to frequent belching. When the spleen meridian is affected, the belching sound is usually low and deep.Stomach disease often results in excessive yawning. Yawning is also a sound that indicates weak stomach qi and cold in the stomach, allowing the stomach to relax.
Kidneys may lead to more severe coughing, with blood-streaked saliva, resembling asthma, indicating that the kidneys are unable to hold qi.
Gallbladder disease often results in sighing. Why do they sigh? Because they cannot express themselves, they often feel the urge to do so, leading to frequent sighing or deep breaths. For such individuals, in real life, it is advisable to engage in arm exercises to stretch the gallbladder meridian, and most importantly, to adjust their sleep patterns to allow the gallbladder qi to rise appropriately.
Liver disease often manifests as “hiccups,” which feel like a sensation of fullness in the chest, similar to a series of hiccups.
All of the above are examples of auditory diagnosis, where listening to a person’s voice and the emotions expressed while speaking can reveal the most prominent organ’s pathological changes. This is a crucial part of TCM auditory diagnosis.
Some people now believe that auditory diagnosis is merely about smelling odors; however, smelling is not the main content of auditory diagnosis. Nevertheless, some do smell; as previously mentioned, the “five odors” correspond to the five organs, each associated with a specific scent. For instance, a person with kidney disease may carry a foul odor, reminiscent of decaying matter. However, this is not a significant aspect of TCM auditory diagnosis. The most important aspect of TCM auditory diagnosis is listening to sounds.
The Six Character Formula
The Six Character Formula is a breathing technique passed down from Daoism, which the Medicine King Sun Simiao regarded as a method for longevity, practiced daily. Clinical practitioners can teach patients to practice it as an adjunct to treatment.
It utilizes the different pronunciations and mouth shapes of the six characters: xu (嘘), he (呵), hu (呼), si (呬), chui (吹), and xi (嘻), employing breath to fully mobilize the latent self-healing abilities of the organs to resist disease invasion and prevent aging.
⊕The Six Character Formula has many versions due to its historical transmission. The pronunciation used here follows the version compiled by the General Administration of Sport of China in 2003.Specific Practice Methods
1. Frequently pronounce the character “xu” to protect the liver.
The “xu” technique is one of the important methods for liver protection. Regular practice of the “xu” technique not only nourishes the liver and brightens the eyes but also helps improve eye diseases, liver deficiency, excessive liver fire, indigestion, and alleviates symptoms such as dry eyes, dizziness, and blurred vision.
It is particularly effective for eye diseases, headaches caused by liver qi stagnation or excessive liver yang, and facial muscle spasms or crooked mouth caused by internal liver wind.
Mouth Shape:The pronunciation of “xu” is xū. When pronouncing, the lips and teeth are slightly apart, the corners of the mouth are drawn back, the lips are slightly pulled flat, the upper and lower teeth are aligned with a gap in the middle, and the tongue is flat and slightly retracted, with gaps between the teeth and the sides of the tongue. When producing the sound, the air is exhaled through the gaps between the teeth and the sides of the tongue.
Action:Stand facing east with feet shoulder-width apart, knees slightly bent, head straight, chest in, abdomen in, back straight. Let your arms hang naturally, with armpits relaxed, elbows slightly bent, and palms lightly resting on the outer thighs. Relax your whole body, keep your eyes open, and look straight ahead.For the elderly or those who are weak or ill, they can modify the position to sitting. Slowly raise both hands, palms facing each other, to shoulder height, with arms spread like a bird’s wings, palms facing upward. Inhale while bending the arms and slowly lowering them in front of the chest and abdomen.
Breathing Method:After exhaling, adjust your breath to normal, but still maintain nasal inhalation and oral exhalation, calming your emotions, quieting your mind, slightly closing your eyes, lightly closing your lips, and gently tapping your upper and lower teeth 36 times.
The purpose of adjusting the breath after exhaling is to nourish the body’s righteous qi and promote growth. The “xu” technique should ideally be practiced twice daily, morning and evening, and it is best to maintain consistency.
2. Frequently pronounce the character “he” to nourish the heart.
The “he” technique is a form of the Six Character Formula that is particularly suitable for practice in summer, as it nourishes the heart, replenishes heart qi, and refreshes the mind.
In the hot summer, heart fire can become excessive, leading to symptoms such as sore throat, mouth sores, heat in the lungs, irritability, palpitations, angina, insomnia, forgetfulness, and excessive sweating. The “he” technique can be practiced more frequently during these times.
Mouth Shape:The pronunciation of “he” is hē. The mouth is slightly open, enough to insert one’s thumb, with a slight backward pull of the cheeks, and the tongue resting on the lower jaw; the tip of the tongue lightly touches the lower teeth, and the lower jaw is relaxed.
Action:Stand with feet shoulder-width apart, knees slightly bent, head straight, chest in, abdomen in, back straight, and arms hanging naturally. Use abdominal breathing, inhaling through the nose and exhaling through the mouth, with the tip of the tongue lightly touching the lower teeth. After adjusting the breath, raise both hands with palms facing up, slowly lifting them while pronouncing the “he” sound until shoulder height, then gently massage the face and let the hands naturally lower to the sides of the legs. Practice for 5-10 minutes, then rest for 3 minutes and adjust your breath. This can be practiced morning and evening.
Breathing Method:The “he” technique involves inhaling through the nose and exhaling through the mouth, aiming for deep breathing, fully expelling the turbid air from the lungs, and filling the lungs completely during inhalation. During practice, focus on imagining the inhaled air nourishing the five organs and permeating the limbs, preferably practicing in a park or outdoors with fresh air. Clear your mind and empty your thoughts before practicing.
3. Frequently pronounce the character “hu” to nourish the spleen.
The “hu” character belongs to the earth element and has the effects of strengthening the spleen, treating abdominal distension, diarrhea, loss of appetite, muscle atrophy, and skin edema. In late summer and early autumn, practicing the “hu” sound in a fresh air environment can enhance appetite and protect the stomach and intestines, thereby uplifting the spirit.
Mouth Shape:The pronunciation of “hu” is hū. Form the mouth into a tube shape, with the tongue flat and extended forward, slightly curling upward.
Action:Stand with feet shoulder-width apart, knees slightly bent, head straight, chest in, abdomen in, back straight, and arms hanging naturally. Use abdominal breathing, inhaling through the nose and exhaling through the mouth, with the tip of the tongue lightly touching the lower teeth.
After adjusting the breath, raise both hands from the lower abdomen, palms facing up, to the navel while pronouncing the “hu” sound, looking down in front. At the same time, rotate the left hand upward to the top of the head while pressing the right hand down to the lower abdomen.
As you exhale completely and inhale, the left arm rotates inward with the palm facing inward, descending from the front, while the right arm rotates upward with the palm facing inward, crossing in front of the chest, with the left hand on the outside and the right hand on the inside, lowering both hands to the sides of the body. Practice for 5-10 minutes, then rest for 3 minutes and adjust your breath.
During exhalation, the sides of the tongue should curl upward, and the lips should form a circle, allowing the air to flow from the throat, creating a central airflow in the mouth, which is then exhaled through the rounded lips.
Breathing Method:When practicing the “hu” technique, the breathing should be gentle and silent, avoiding forceful breathing. It is generally practiced before meals or an hour after meals, and it is not advisable to practice the “hu” technique when overly full. The practice time should vary for each individual and should not be forced; if discomfort occurs, practice should be stopped immediately.
4. Frequently pronounce the character “si” to moisten the lungs.
The “si” character is particularly suitable for practice in autumn, as it has the effects of moistening and nourishing the lungs, and replenishing lung qi, which can significantly improve various chronic lung diseases.
External pathogens, colds, fever, cough, phlegm rising, back pain, fear of cold, shortness of breath, frequent urination with little output, burning pain at the urethra, and diseases of the lungs themselves can all be treated with the “si” technique.
Mouth Shape:The pronunciation of “si” is si. The lips are slightly retracted, the upper and lower teeth are together with a gap, and the tip of the tongue touches the gap.
Action:Raise both hands from the lower abdomen, gradually turning the palms upward until they are level with the breasts, with the arms rotating outward, flipping the palms outward to form a hand position, with fingertips pointing to the throat, then spreading the arms wide like a bird spreading its wings.
As you flip the palms, begin to pronounce the “si” sound, exhaling completely, and as you inhale, let the arms naturally lower to the sides of the body, repeating six times, then adjust your breath.
Breathing Method:Use abdominal breathing, exhaling first and then inhaling. During exhalation, pronounce the character while lifting the perineum, allowing the center of gravity to shift naturally to the heels, ensuring there is no feeling of breath-holding. During inhalation, the lips should lightly touch, the tongue should touch the upper palate, and the whole body should relax, allowing the abdomen to naturally rise as air is inhaled. When the air is fully exhaled, the chest and abdomen should be empty.
When exhaling while pronouncing the character, it is important to lift the perineum. This point is crucial as it helps the qi to rise.
5. Frequently pronounce the character “chui” to strengthen the kidneys.
The “chui” technique is a breathing and exhalation method that can harmonize the organs, balance yin and yang, and promote longevity. Elderly individuals can practice the “chui” technique after the “si” technique to replenish kidney qi.
Mouth Shape:The pronunciation of “chui” is chuī. Form the mouth into a tube shape, with the corners of the mouth pulled back slightly, and the tongue tip slightly curled upward.
Action:Slightly bend the knees and squat down, relaxing the hands, rotating the palms outward and slowly spreading them. Stand up, rotating the hands inward and slowly bringing them back, lightly stroking the abdomen.
Circle the palms around the waist and abdomen. Slightly bend the knees and squat down, allowing the hands to slide down the sides of the waist and legs, then swing forward. As the hands begin to slide down from the waist, pronounce the “chui” sound (exhaling first, then inhaling while pronouncing the character).
Repeat this practice six times. After the last repetition, bring the hands back to the front of the abdomen, slightly bend the knees and squat down, slowly spreading the palms. Stand up, rotating the palms inward and slowly bringing them back, crossing the hands at the center and lightly covering the navel, resting for 2-3 breaths.
When practicing the “chui” technique, ensure that the lips are slightly closed and the toes are in a gripping position.
6. Frequently pronounce the character “xi” to regulate the three burners.
The “xi” technique corresponds to the qi of the lesser yang and is closely related to the meridians of various organs. It is a pathway for the regulation of qi throughout the body.
Thus, the “xi” technique can treat conditions caused by obstruction of the three burners, such as dizziness, tinnitus, throat pain, chest and abdominal distension, and difficulty urinating. It is also beneficial for those who are easily angered, have excessive liver fire, feel uncomfortable or depressed, and women experiencing menopause.
Mouth Shape:The pronunciation of “xi” is xī. When producing the sound, the tip of the tongue lightly touches the lower teeth, the corners of the mouth are slightly drawn back and upward, and the upper and lower teeth are gently touching.
Action:Raise both hands from the sides of the body as if holding something, moving them over the abdomen to the chest, with the arms at breast height, rotating the arms outward and lifting them toward the head, with palms facing upward and fingertips pointing toward each other.During inhalation, spread the fingers apart, allowing them to slowly descend along the sides of the body.
The above describes practicing each character individually. If you wish to practice the complete set, you can perform each character for six breaths, practicing three times each morning and evening. Initially, you may find yourself focusing on breathing and forgetting the movements, or concentrating on the movements and neglecting the breathing. This requires a process of familiarization. If time allows, first become proficient in abdominal breathing, and then add the movements, so that you do not neglect one for the other.
Although the mouth shapes for the Six Character Formula have the above requirements, during actual practice, it is essential to ensure that the mouth and lips are relaxed without excessive tension, as this can hinder smooth breathing and the flow of qi and blood.
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