1 Speech
In listening to speech , cares should be made to detect whether the speech is strong or weak , whether the words are coherent and whether the expression is clear and fluent . The speech of normal people is natural in pronunciation , smooth in tone , clear in expression and consistent in words . Since the viscera , constitution and physical building are different from person to person , the voice is either high or low , loud or small and clear or full .For example , male voice is low and full , female voice is high and clear , children¡¯s voice is sharp and melodious , and voice of the aged is low and deep .Generally speaking , high and sonorous voice in healthy people is a manifestation of sufficiency of primordial qi and pulmonary qi .
There is close relation between speech and emotions .For example , the voice in joy is lively and cheerful , the voice in rage is stern and quick , the voice in sorrow is sad and disjointed .These are the normal changes of voice .
1.2.1.1.1 Voice
The abnormal changes of voice are either strong or weak , heavy or deep , hoarseness or aphonia .
Strong and weak voice : Generally speaking , sonorous voice with restlessness and polylogia indicates sthenia syndrome and heat syndrome ;low , weak and disjointed voice with quietness and oligologia indicates asthenia syndrome and cold syndrome .
Deep and heavy voice : Deep and heavy voice is usually caused by failure of pulmonary qi to disperse and obstruction of the nose due to exogenous pathogenic wind , cold and dampness , or by obstruction of the airway due to stagnation of dampness .
Hoarseness and aphonia :Hoarseness means harsh voice , while aphonia means complete loss of voice .Hoarseness is similar to aphonia in pathogenesis .If hoarseness is very serious , it will develop into aphonia .Hoarseness or aphonia in new disease pertains to sthenia syndrome due to exogenous pathogenic factors athenia syndrome due to exogenous pathogenic factors attacking on the lung or due to failure of the pulmonary qi to disperse resulting from stagnation of phlegm .Such a pathological condition is known as ¡°a solid bell cannot ring (dysphonia or hoarseness due to sthenia syndrome of the lung¡±. Hoarseness or aphonia in a chronic disease pertains to asthenia syndrome due to exhaustion of fluid and impairment of the lung caused by prolonged speaking or singing or shouting with rage , which impairs both qi and yin and deprives the throat of moisture .Hoarseness at the advanced stage of pregnancy is due to pressure of the fetus on the uterine collaterals which obstructs the kidney meridian and prevents kidney essence to be transported to the upper .It will heal automatically after delivery .
1.2.1.1.2 Paraphasia
Delirium: Delirium means raving with high and sonorous voice in coma. Such a morbid condition pertains to sthenia syndrome due to heat disturbing the mind seen in invasion of pathogenic factors into the pericardium in seasonal febrile disease or sthenia syndrome of yangming fu-organ.
Fading murmuring: Fading murmuring is marked by unconsciousness, repeated and incoherent murmuring in a low voice. It is caused by excessive consumption of heart
qi and is an asthenia syndrome of mental derangement, usually seen in patients with chronic and prolonged diseases.
Soliloquy: Soliloquy is marked by mental depression, talking to oneself, murmuring and incoherent speech, usually caused by coagulation of phlegm confusing the mind or by severe impairment of heart qi. Such a morbid condition is usually seen in epilepsy.
Raving: Raving is marked by manic movement, shouting and sonorous voice usually due to phlegm fire at tacking the heart.
Paraphasia: Paraphasia means that the patient speaks nonsense in consciousness and is aware of it afterwards. Such a morbid state is often due to insufficiency of heart qi and malnutrition of the spirit. Such a morbid condition is often seen among patients with chronic disease or of the aged.
1.2. 1.1.3 Slurred speech
Slurred speech is marked by unclear and slow expression without fluency, usually seen in wind stroke or sequela of wind stroke. It is due to obstruction of the collaterals by wind-phlegm and malnutrition of the tongue musculature and vessels, which make the tongue inflexible. Slurred speech at the advanced stage of febrile disease is due to heat consuming yin and malnutrition of the tongue.
