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Note states: This refers to confusion. When heat qi is excessive, turbid qi becomes chaotic, leading to mental confusion and obscurity.

Note states: This refers to the stagnation and blockage of heat pathogen, resulting in unsmooth qi movement. It is said that when heat is extreme, the couli (skin pores and interstices) become closed and dense, causing qi stagnation. Just as fire smelts objects, causing them to fuse and adhere rather than separate. Therefore, heat stagnation leads to blockage and unsmoothness. However, cold water governs closure and storage; now it is attributed to heat because when fire-heat is excessively hyperactive, it counteracts itself by generating water transformations (following the principle of "excess causes harm, and restraint brings balance").

Note states: Heat prevailing internally causes qi stagnation and subsequent swelling. Excessive yang-heat leads to abdominal distension. Fire governs growth, height, and luxuriance; its form and appearance are manifest. Ascending, bright, spreading, and flourishing are all images of swelling.

Note states: Zhi (obstruction) means blockage. Fire governs swelling; thus, when the Yangming channel has heat, nasal fullness occurs, leading to obstruction.

Note states: Qiu (rhinorrhea) refers to the discharge of clear mucus from the nose. The way of the Five Constants is that when subtle, it manifests its own transformation; when extreme, it assumes the characteristics of its conquering element ("ghost thief"). Thus, the Classic says: "Excess causes harm, and constraint brings balance." Consequently, when Liver heat is extreme, tears flow; when Heart heat is extreme, sweat flows; when Spleen heat is extreme, saliva flows; when Lung heat is extreme, nasal discharge flows; when Kidney heat is extreme, spit is produced. This often occurs because cold pathogen damages the skin and hair, closing the couli, causing yang-heat to be constrained and郁 (depressed), thereby worsening the disease.

Note states: When yang-heat is constrained in the Foot-Yangming Stomach channel, upper heat becomes extreme, causing blood to move recklessly and resulting in epistaxis (nosebleed).

Note states: Xueyi (blood effusion) refers to bleeding from upper orifices. The Heart nourishes blood; thus, when heat is extreme, blood surplus leads to reckless movement.

Note states: Heat located in the Lower Jiao results in hematochezia and hematuria.

Note states: Dysuria with pain occurs because heat pathogen lodges in the Bladder, causing stagnation and preventing normal excretion. Cold-natured herbs that resolve stagnation and promote urination can be used to dissipate the blockage, reduce heat, promote the free flow of qi and blood, harmonize Ying and Wei, and restore clarity to the spirit.

Note states: Constipation with difficulty in defecation. Heat consumes body fluids, leading to hard, bound feces due to dryness, astringency, and contraction of the Large Intestine. Laypeople refer to this as wind-heat binding, meaning fire is so extreme that it controls Metal (Lung), failing to subdue Wood (Liver), causing Liver Wood to become excessive. Alternatively, loose stools accompanied by burning pain occur because燥热 (dry-heat) is outside the intestines and stomach, while damp-heat is internal.