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It is asked: Regarding frequent urination, enuresis (involuntary urination), and incontinence of urine, are there distinctions between excess fire (Shi Huo) and deficiency (Xu)? I reply: When urinating, if there is pain inside the urethra, with urine dripping out drop by drop, and the flow occurs without awareness, this is termed enuresis. "Incontinence" refers to a situation where one attempts to hold back urine but it still flows out spontaneously. This specifically refers to pathology originating from the urinary tract itself. However, if hemiplegia (half-body paralysis) is accompanied by frequent urination and enuresis/incontinence, without any pain in the urethra, this is caused by Qi deficiency failing to secure and lift.

It is asked: Slurred speech was anciently called "speech impediment due to tongue stiffness" (Yu Yan Jian Se). The predecessors argued that tongue disorders were caused by phlegm or fire; is this understanding not correct? I reply: It is not phlegm or fire that causes this. Rather, half of the tongue lacks Qi and Blood, preventing full movement, thus resulting in unclear speech. Observe children who cannot walk due to insufficient Qi, or elderly people whose vitality declines; their speech becomes unclear. This serves as evidence.

It is asked: Since there is no wind or fire, why does trismus (lockjaw/mouth clenching) and bruxism (teeth grinding) occur? I reply: Trismus is trismus, and bruxism is bruxism. The ancients categorized these symptoms under cold damage (Shang Han), epidemic febrile diseases (Wen Yi), miscellaneous diseases, and gynecology. There are cases of trismus due to deficiency syndromes and bruxism due to excess syndromes. Specifically, in patients with hemiplegia, trismus occurs, but bruxism is absolutely absent. In some cases, trismus is so severe that the lower teeth retract inward, producing a sound like filing, resembling bruxism, but it is actually not true bruxism; this too is a deficiency syndrome. If there is no hemiplegia nor other accompanying symptoms, and sudden trismus occurs where the mouth cannot open, this is caused by wind pathogen blocking the meridians, preventing Qi from ascending. Using formulas to unblock the meridians will lead to recovery.

It is asked: After Yuan Qi (Original Qi) has been depleted, before the onset of hemiplegia, are there deficiency signs that can be observed? I have treated the most such cases in my life and know them most thoroughly. Common manifestations include: hearing wind-like sounds in the ears; experiencing spontaneous cicada-like ringing in the ears; frequent twitching of the lower eyelid; one eye gradually becoming smaller; sudden staring straight ahead with eyes; frequently seeing whirlwinds before the eyes; constantly inhaling cold air into the nose; twitching of the upper lip; tightness when upper and lower lips come together; drooling during sleep; sudden loss of memory in previously intelligent individuals; suddenly speaking without beginning or end, incoherently; spontaneous shortness of breath; trembling of one hand; trembling of both hands; the ring finger bending and unable to extend for a period each day; spontaneous movement of the thumb; numbness of the arms without cause; numbness of the legs without cause; spontaneous twitching of muscles; sensation of cold air coming from fingernail seams; sensation of cold air coming from toenail seams; sensation of cold air from knee joints; sudden weakness and outward tilting of the ankle bone; spontaneous cramping of the legs; spontaneous cramping of the toes; walking with legs tangled like garlic stems; sudden chest congestion; feeling empty in the chest with disconnected breath; sudden palpitations or anxiety in the chest; sudden straightening of the head and neck; feeling heavy in the body while sleeping. All these are signs of gradual depletion of Yuan Qi. Because they involve no pain, no itching, no cold, no heat, and do not hinder diet or daily activities, people easily neglect them.