DIAGNOSIS BY HEARING

Chapter 53


imageDIAGNOSIS BY HEARING





VOICE


The sound of the voice is produced by the combined function of many parts of the body which are influenced by various Internal Organs in Chinese medicine (indicated in brackets). They are: the lungs themselves (Lungs), larynx (Lungs), epiglottis (Kidneys), tongue (Heart), teeth (Kidneys), lips (Spleen) and nose (Lungs). For this reason, the voice can reflect the state of Qi in general because several organs are involved in its production and, particularly, the Lungs, Heart, Spleen and Kidneys.



The voice is produced by the following organs:




The voice is an important diagnostic element and one that is used as soon as the patient comes in and greets us. This gives us the very first impression of the person’s Qi in general, a strong voice reflecting a strong Qi (and possibly pathogenic factors) and a weak voice indicating Qi deficiency.


The voice is an important reflection of the state of the Mind and Spirit as well because talking in general is controlled by the Heart. Our voice of course reflects very closely our mental—emotional state and we can easily detect sadness, fear or anger in someone’s voice.


The voice is a direct manifestation of Lung-Qi and it readily reflects the state of the Lung-Qi; the Lungs influence the tone and strength of the voice.


The Heart influences the speech itself in two ways. First, the Heart has a profound influence on the tone and texture of the voice because it controls the tongue, which is a crucial organ in the production of speech. Secondly, the Heart houses the Mind and Spirit, and the tone and strength of the voice are very much affected by the speaker’s mental—emotional state.


The Spleen controls the lips, which are also a crucial factor in the production of speech, and, obviously, this influences the strength and tone of the voice. First, if Spleen-Qi is deficient, the lips may lack strength and the speech may be unclear. Secondly, although the tone and strength of the voice reflect primarily the state of Lung-Qi, they also reflect the state of Qi in general and therefore of the Spleen, which is the root of Postnatal Qi.


The Kidneys influence the pitch and the quality of the voice because the Original Qi emerging from between the Kidneys reaches the root of the tongue allowing the larynx to emit sounds.


When listening to the voice, one should assess the overall strength, tone, pitch and quality of the voice itself and the manner of speech, that is, whether it is rapid, slow, confused, slurred, etc. The manner of speech is discussed in the next section, under the heading ‘Speech’.



Normal voice


The normal voice should be harmonious, relatively soft, rounded, clear and of the right strength (not too loud or too weak). The normal voice is often compared with the sound emitted by a bell and the Lungs are compared with the bell itself. Therefore, when the bell is intact its ringing sound is clear. In a similar way, when Lung-Qi is good and the Lungs are unobstructed by Phlegm, the voice is clear, its tone is melodious and its pitch is not too high and not too low. When assessing whether the quality, pitch and tone of the voice are normal, however, one should be aware that there is no universal standard because the voice should be related to the sex, age and body build of the patient. Therefore what is too weak a voice for a well-built man might be normal for a small-built old lady.


Allowance should be made also for the emotional state of the patient as this will easily affect the voice. For example, the ‘Golden Mirror of Medicine’ (Yi Zong Jin Jian) says: ‘When the Heart is affected by excess joy, the voice becomes scattered; when the Heart is affected by anger, the voice becomes indignant and stern; when the Heart is affected by grief, the voice becomes sad and hoarse … when the Heart is affected by love the voice is warm and harmonious. When the Heart is happy, the voice is slow and relaxed.’1



The voice and the Five Elements


From a Five-Element perspective, there are five tones of voice: shouting for Wood, laughing for Fire, singing for Earth, weeping for Metal and groaning for Water. These tones of voice can be interpreted in two ways: under physiological conditions, these tones are normal for those types, that is, it is normal for a Wood type to have a relatively loud, ‘shouting’ voice; under pathological conditions, the tone of voice may deviate from its standard by excess or deficiency, that is, a Wood type may have a voice that is either ‘too shouting’ or not strong enough.


A shouting voice is loud and is emitted in short, sharp bursts as if that person were reproaching someone. A person with a laughing voice will often have short bursts of laughter within their speech and the voice itself may have an edge of laughter. A singing tone of voice has a relatively high pitch, is melodious and has a flow of high and low tones like a song. A weeping voice is somewhat hesitant, with a relatively low pitch and a sad tone; in some cases it may sound almost as if the person were about to burst into tears. A groaning voice sounds guttural, has a low pitch and is somewhat croaky.


Box 53.1 lists the correspondences between the Five Elements and voice tones.



BOX 53.1   FIVE-ELEMENT VOICES





Strength and quality of the voice


A strong, loud voice generally indicates a Full condition, whereas a weak, low and quiet voice indicates an Empty condition.


When considering the quality of the voice we should include the following various sounds:








Hoarse voice


Symptoms and Signs, Chapter 83


A hoarse voice in acute conditions always indicates an invasion of Wind-Heat with Dryness in the Lung Defensive-Qi system. If we compare the Lungs to a metal instrument or a bell, in this case the voice becomes hoarse because the bell is ‘full’ (i.e. the Lungs are obstructed by Wind); in ancient times this was called ‘Jin full not ringing’, Jin being an ancient, metal percussion instrument.


A sudden hoarse voice may also be due to stagnation of Liver- or Lung-Qi affecting the throat from emotional problems.


A hoarse voice in chronic conditions is due to a deficiency of Yin of the Lungs and Kidneys; in this case, the voice becomes hoarse because the bell is cracked and, in ancient times, this was called ‘Jin broken and not ringing’. If the voice becomes hoarse suddenly in the course of a serious, chronic disease (such as cancer), this indicates a collapse of Yin or Yang and it is a bad prognostic sign.


A chronic hoarse voice with a swelling of the pharynx may be due to Phlegm and Blood stasis obstructing the throat.


A hoarse voice during pregnancy is due to a pathology of the Connecting channel which links the Uterus to the Kidneys. As the Kidney channel reaches the root of the tongue, a disturbance of the Connecting channel connecting the Kidneys to the Uterus during pregnancy prevents Kidney-Qi from rising to the tongue and it affects the voice. This condition is mentioned in Chapter 47 of the ‘Simple Questions’.2 It normally improves by itself and does not require treatment; in fact, the ‘Simple Questions’ says that this problem does not require treatment because ‘it will be resolved in the tenth month’, that is, when the woman gives birth.


A coarse, deep, raucous voice with sudden onset indicates an invasion of Wind; a nasal voice indicates an invasion of Wind-Cold or Wind-Dampness.


A difficulty in producing sound with breathlessness and a rattling sound in the throat like the sound of a saw indicates retention of Phlegm in the Lungs.

Related posts:

  1. OBSERVATION OF THE GENITALIA
  2. MENSTRUAL SYMPTOMS
  3. DIGESTIVE SYSTEM AND TASTE
  4. MENTAL AND EMOTIONAL SYMPTOMS

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Apr 15, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on DIAGNOSIS BY HEARING

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