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Note states: Speech is the voice of the Heart (Shen). Malicious cursing (Malice in speech) represents the vicious aspect of speech. In cases of Excess Yang and Deficient Yin, Kidney Water is weak while Heart Fire is strong. This fails to control Lung Metal, thereby failing to pacify Liver Wood. Consequently, there is a propensity for vicious words to erupt, with cursing that disregards kinship or distance. This originates from the generation of Heat-Fire pathogenic factors.

Note states: Fright and alarm (Jing Hai) refer to a state of shock and astonishment, which is an effect of Fire.

Note states: This is due to Heat excess affecting muscles and the stagnation of Yang Qi.

Note states: Soreness and pain (Suan Teng). When Fire excess controls Lung Metal, it fails to pacify Liver Wood. Liver Wood becomes hyperactive and undergoes combined transformation (Jian Hua), resulting in soreness and pain.

Note states: This is because the nature of Fire is to flare upward.

Note states: Trembling and aversion to cold. The phrase "as if losing the guardian spirit" implies that while Spirit (Shen) should govern the body, the occurrence of trembling and fear indicates a loss of the Spirit's ability to conserve and protect the physical form.

Note states: Itching in the nose causes air to be expelled with sound. The nose is the orifice of the Lung. Itching arises from Fire transformation. When Heart Fire and evil heat interfere with the Yangming Meridian, manifesting as nasal itching, sneezing occurs.

Note states: The transformation of Ministerial Fire (Jun Huo) is similar [to other fires].

Note states: Bi Syndrome (Bi) refers to numbness and insensitivity, commonly written as "closed," meaning obstruction. Fire governs swelling; thus, when Heat pathogens lodge in the Upper Jiao, it results in throat obstruction, swelling, and distension.

Note states: Tinnitus involves sound and is not a hallucination. The ear is the orifice of the Kidney and intersects with the Hand-Taiyang, Hand-Shaoyin, Foot-Jueyin, Foot-Shaoyin, and Foot-Shaoyang meridians. If Kidney Water is deficient and Fire is excessive, with severe upward-rushing Heat lodging in the meridians and impacting the ears, it vibrates the auditory aperture. Sound is produced according to the strength or weakness of the meridian Qi. Thus, the Classics state: "When Yang Qi acts as a phenomenon, excessive upward rushing causes jumping, hence tinnitus." Since the sound is within the ear, even faint sounds are heard.

Note states: The notion that deafness is caused by Kidney deficiency and cold is a vulgar error. The *Zhengli* states: Heart Fire is inherently hot but becomes cold when deficient; Kidney Water is inherently cold but becomes hot when deficient. If Kidney Water is already scant, how can it transform into Cold Evil? Therefore, the Classics state: When Foot-Shaoyin Kidney Water is deficient, symptoms include abdominal fullness, heavy body, loose stools, sores and ulcers, difficulty in defecation, bitter taste in the mouth, dry tongue, swollen and painful throat, rebellious Qi rising, dry and painful pharynx, vexation and heart pain, jaundice, and blood in the stool. All these are Heat syndromes. In treating deafness, one must match the treatment to the syndrome. If Heat signs have subsided but deafness persists, acrid-warm herbs should be used to disperse it. If ineffective after two or three doses, prolonged use is contraindicated, lest extreme Heat generate other diseases. If deafness is accompanied by Heat signs, wind-dispersing and heat-clearing cooling herbs should be used to regulate the condition; once Heat recedes and stagnation resolves, recovery occurs. However, severe deafness leading to complete closure is difficult to treat. One must strictly avoid aggressive purging, as excessive treatment will damage Righteous Qi (Zheng Qi).