第六节鼻耳咽喉科
鼻中隔偏曲
审其脉色，知其病在肺肾，予滋阴降火而愈
文××，男，25岁。
反复发作性鼻衄十几年，鼻衄不止20天。医诊鼻中隔弯曲。先以西药治之不效，后以中药清肝泻火、清泻胃火之剂配合仍无功。细审其证，鼻衄，用药纱条堵住鼻孔后仍时见从口而出，血色素6克，舌苔白，面色皓白无华，脉虚数。综合脉证，思之：脉虚者，肺虚也；数者，热也。面色皓白无华者，肺阴不足。且久病阴虚相火上炎而灼肺金，故衄血也。治宜滋阴降火。处方：生地15克，元参20克，麦冬15克。
服药1剂，鼻衄得止。然思其面色皓白，气阴仍嫌不足，乃予养阴益气治之，后果愈。
某医问：此方乃增液汤也，吴鞠通《温病条辨》用于无水舟停之便秘，何老师独用于鼻中隔弯曲之鼻衄也?答曰：生地、麦冬、元参三味为方，吴鞠通命其名日增液汤，主用于无水舟停之便秘。钱镜湖《辨证奇闻》则因其善于滋阴降火，对衄血有奇效，而命其名日止衄汤。今本病之衄血乃阴虚相火妄动所致，故用之。正如《辨证奇闻》所云：“人在鼻中流血，经年经月而不止者，或愈或不愈，虽鼻中流血，较之口中吐血者少轻，然而听其流血而不治，与治之而不得其法，皆能杀人。盖吐血犯胃，而衄血犯肺，胃为浊道，肺为清道也。犯浊道则五脏尽皆反复，犯清道则止肺经一脏之逆也，然而犯清虽轻于犯浊，而气逆则一，逆则变证多端，故皆能杀人也。治法惟调其肺气之逆，但肺气何以致逆乎，亦成于肺金之火也，夫肺属金本无火也，肺金之火仍是肾水之火也，肾因心火之侵而。肾水来救，久之肾水干涸，而肾火来助，火与火斗，而血乃妄行，从鼻而上越矣。然则调气之法，舍调肾无他法也，而调肾在于补水以制火。方用止衄汤：生地一两、麦冬三两、元参二两。水煎服。一服即止。麦冬直治肺金之匮乏，生地、元参以解肾中遏抑之火，火退而气自顺，气逆既顺，而血自归经矣。”
鼻前庭炎
谨察昼夜阴阳之不同，合之疼痛之差异，知其病位之脏腑，治以滋阴降火始愈
召5××，男，38岁。
两鼻孔前庭粘膜干痛，糜烂结痂1年多。医诊鼻前庭炎。先以西药外敷，内服治疗半年不效，继又配合中药清热解毒、疏风宣肺、健脾利湿等法治疗半年亦不效。细察其证，两侧鼻前庭糜烂结痂，皮肤干痛，破裂出血，夜间痛甚，且近20天来，鼻牙俱痛，有时疼痛不能入睡，有时痛醒，舌苔白，脉弦滑尺大。综合脉证，思之：昼轻夜剧者，肾虚火炎也。糜烂者，湿热也。治以养阴、除湿、泻火。处方：升麻1克，元参30克，地骨皮30克，羌活3克。
服药2剂，糜烂、肿痛均消失，继服6剂，愈。
某医云：清热解毒、健脾利湿、疏风宣肺均为治鼻前庭炎之有效方法，而本证却治之不效者何也?答曰：本证非但鼻烂而痛，亦且牙龈亦痛，此乃肺胃俱病，当肺胃同治，且夜间痛剧，非仅实火，亦且阴虚，故但治其肺，但治其胃，但泻实火，均不得愈。所以采用一滋阴，二除湿，三泻火，酌加引经之药而愈。
慢性鼻炎
审其脉，知其病，予泻火平肝始愈
王××，女，35岁。
鼻塞不闻香臭5～6年。医诊慢性鼻炎。先用西药治疗不效，继又配合中药辛夷、苍耳子加减为剂治疗2年亦不见减。细察其证，除鼻塞不闻香臭之外，并见头晕心烦，每次生气后均见鼻塞鼻不闻香臭加重，舌苔白，脉弦。综合脉证，思之：弦脉者，肝脉也。生气后鼻塞不闻香臭加重者，肝火射肺，肺气不宣也。治宜疏肝泻火。处方：冰片1克(冲)，栀子10克，酒军3克，当归10克，川芎10克，羌活10克，防风10克，薄荷6克。
服药2剂，鼻塞不闻香臭消失，继服2剂，竞愈。
某医云：此当归龙荟丸加减方也。当归龙荟丸清热泻肝，攻下行滞方也，主用于肝胆实火之头痛面赤，目赤目痛，胸胁胀痛，便秘尿赤，形体壮实，脉象弦劲，躁扰不安，甚或抽搐者，然今反用于慢性鼻炎者何也?答曰：中医治病在于理、法、方、药之合拍、在于理、法之相吻合，今慢性鼻炎之发生在于肝火之射肺，故采用治肝胆实火之方而愈也。
变态反应性鼻炎
1.谨察诸证，合之于脉，予健脾理气，疏散风邪，愈
赵××，男，59岁。
喷嚏流涕，身痒1年多。医诊过敏性鼻炎、荨麻疹。先以西药治疗半年多不效，后以中药散寒祛风、益气助阳，养血祛风等剂相配合亦无明显效果。细审其证，经常频发的鼻痒喷嚏，流清涕，头晕，全身酸困，脘腹满胀，遇冷或遇冷水则即刻身痒起片状皮疹，舌苔白，脉弦紧。综合脉证，思之：痒者，风也；遇寒冷或冷水则疹发者，寒湿也；腹脘满胀者，脾虚寒湿也；脉弦紧者，风寒也。证脉合参，乃脾胃寒湿为本，风寒外客为标。治以健脾理气，疏散风邪。处方：羌活3克，防风3克，荆芥10克，川芎10克，厚朴10克，党参10克，茯苓10克，陈皮10克，甘草6克，僵蚕10克，蝉蜕10克，藿香10克，清茶1撮。
服药2剂，喷嚏、流涕，全身酸困消失，用冷水洗衣服时亦未见起疹；继服4剂，愈。
某医云：前用散寒祛风、益气助阳、养血祛风不愈，且时见加重者何也?答曰：本病脾虚夹湿为本，风寒外客为标，不健其脾则祛风必甚，但健其脾则风邪反而内入，所以治疗之时只可在健脾理气化湿的基础上，少佐祛风之品。至于为何散风祛寒而不愈，其因有二：一散风寒之力过大也，二健脾除湿之力不足也。至于益气助阳，养血祛风因何不效，乃因药证不符也。
2．谨察其脉，合之于症，治以补气养阴，除湿升阳，愈
苏××，男，38岁。
鼻痒喷嚏流涕频频而发十几年。医诊过敏性鼻炎。先以西药治疗数年不效，继以中药祛风散寒，调和营卫之剂相配合，治疗4～5年，亦无明显效果。细审其证，除频繁的鼻痒喷嚏流清涕外，并见头晕乏力，脉濡缓。综合脉证，思之：脉濡缓者，湿也，气阴两虚也；久久喷嚏流涕不愈者，气虚也。证脉合参，乃气阴俱虚，湿郁不化，清阳失升也。治宜补气养阴，除湿升阳。处方：升麻10克，葛根10克，蔓荆子10克，党参10克，黄芪15克，黄柏10克，白芍10克，甘草10克。
服药3剂，头晕乏力，鼻痒流涕均好转；继服30剂，愈。
某医云：此方乃东垣治疗目耳病方也，今先生却用于过敏性鼻炎者何也?答曰：此方原为气阴不足，湿郁不化，清阳不升之耳目病方。今过敏性鼻炎亦气阴不足，湿郁不化，清阳不。升所致者也，故亦用其治疗过敏性鼻炎也。
3．谨察时令，合之脉证，予理气疏肝，化痰开肺而愈
索××，男，35岁。
鼻痒喷嚏流涕7～8年。医诊过敏性鼻炎。始以西药治之不效，继以中药散寒祛风，养血祛风相配合亦无效。细审其证，鼻痒喷嚏流涕仅发于秋季，且见胸满，舌苔薄白，脉沉缓。综合脉证，思之：秋季者，燥令也，收令也。脉沉缓，气滞湿郁也。治以理气除湿。处方：人参10克，紫苏10克，陈皮10克，枳壳10克，前胡10克，半夏10克，葛根10克，木香10克，甘草6克，桔梗10克，茯苓10克。
服药3剂，诸证好转；继服30剂，愈。
某医云：参苏饮本为《太平惠民和剂局方》中的治疗虚人外感风寒，内有痰湿之方。今反用于过敏性鼻炎者何也?答日：秋令者，收令也，燥邪用事也，今肺胃气虚，复感凉燥，痰湿阻郁，故每至秋令则病发也，故治宜补胃肺之气，理气化痰可愈。参苏饮者，既能补肺胃之气，又能理气化痰，故予参苏饮亦可治过敏性鼻炎也。
4.谨察时令，合之于脉，予补气养阴，燥湿清热，升清降浊而愈
王××，男，35岁。
鼻塞流涕喷嚏，眼耳发痒十几年。医诊过敏性鼻炎。先以西药治疗不效，继以中药益气聪明、桂枝，以及疏风散寒，养血祛风之剂加减相配合治疗数年亦无明显效果。细审其证，每至夏季天热之时即反复感冒，鼻塞流涕，喷嚏连连，眼耳俱痒，头晕乏力，舌苔白，脉虚大弦紧。综合脉证，思之：夏令者，暑热也，暑令热邪，伤气伤阴，故气阴两虚之质尤易感受暑令之邪也。今脉弦大紧，亦气阴两虚之脉也。治宜补气养阴，除湿清热，升清降浊。处方：人参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克，生姜3片，大枣5个。
服药2剂，诸证消失；继服15剂，追访4年，未见复发。
5.谨遵舌脉，知其枢机不利，营卫失调，治以柴胡桂枝汤得愈
徐××，男，成。
遇风冷或花香则鼻痒、眼痒，喷嚏流涕7年多。医诊过敏性鼻炎。先以西药治疗数年不效，后又以中药祛风、益气等药相配合治疗3年多亦无功。细审其证，除上述诸证之外，别无所苦，舌苔薄白，脉弦缓。综合脉证，思之：弦脉者，少阳枢机不利之脉；缓者，营卫失调之脉。合而论之，乃少阳枢机不利，营卫失调。治宜拟和解少阳，调和营卫。处方：柴胡10克，半夏10克，黄芩10克，党参10克，生姜10克，甘草10克，大枣5个，桂枝10克，白芍10克。
服药6剂，诸证全失，继服6剂，愈。
鼻窦炎
知冷热之微甚，合脉象之脏腑，知其肝火内郁，风寒外客，治以泻火平肝，疏风散寒，愈。
郭××，男，28岁。
头晕头痛8～9年。医诊鼻窦炎。先以穿刺、西药治疗曾一度好转，但一年之后头痛如初，继以辛夷散、苍耳子散半年效仍不著。细审其证，前额、巅顶头痛，遇热或在太阳下走路时头痛尤甚，生气之后头痛亦剧，鼻塞涕多，烦躁易怒，且偶见耳聋耳鸣，舌苔薄黄，舌尖红，脉弦数。综合脉证，思之：头痛，遇热而甚者，火也。鼻塞涕多者，寒也。脉弦数者，肝胆实火也。合脉证论之，乃肝胆实火内郁，风寒闭郁于外也。治宜内清肝火，外散风寒。处方：龙胆草10克，栀子10克，黄芩10克，柴胡10克，生地10克，车前子10克(布包)，泽泻10克，木通10克，甘草10克，当归10克，苍耳子12克，薄荷10克。
服药3剂，头痛大减；继服30剂，诸证消失。
某医云：为何用辛夷散、苍耳子散加减无效?答曰：脉弦数者，肝胆实火为主也，肝胆实火者当泻火平肝，故以辛夷散、苍耳子散等治肺者不效也。
脑脊液鼻漏
谨察其脉，合之于症，知其中气不足，清阳失升，治以补气升阳，愈
郝××，男，25岁。
两侧鼻孔清水样涕不断溢出，视力下降，行动迟缓，对外界事物反应迟钝5个多月。医诊脑脊液鼻漏。先以手术治疗未成功，后以培补肾气之剂亦未效。细审其证，除两个鼻孔不断的流清水样的鼻涕外，并见视力明显下降，走路迟缓，神情痴呆，听力下降，舌苔薄白，脉濡缓。综合脉证，思之：濡缓之脉者，气阴俱虚夹湿也；清水样涕者，虚也。合之于症，乃气阴俱虚，湿郁不化，清阳失升之证也。治宜补气养阴，除湿升阳。处方：蔓荆子10克，升麻10克，葛根15克，人参10克，黄芪20克，黄柏10克，白芍10克，甘草10克。
服药3剂，流涕减少，精神增加；继服30剂，诸证消失，并恢复工作。
耳咽管炎
1.审其脉证，知其内郁肝胆实火，外感风寒客邪，表里同病，予内泻肝胆相火，外疏风寒客邪，愈
汪××，女，35岁。
左耳突然憋胀疼痛，听力下降ll天。医诊耳咽管炎。先以西药治疗7天不效，继又配合中药牛黄解毒丸、牛黄上清丸治疗3天诸证亦不见减。细审其证，右耳听力正常，左耳憋胀疼痛，听力降低达90％左右，且见鼻塞，咽喉干痛，发热头痛，舌苔白，脉浮弦数。综合脉证，思之：脉浮，鼻塞，咽喉干痛者，表证也；脉弦数，头痛者，肝胆实火也。合而论之，乃内郁肝胆实火，外感风寒客邪，表里同病之证也。急拟外疏风寒，内泻肝火。处方：防风10克，羌活10克，龙胆草10克，大黄5克，细辛5克。服药3剂，诸证消失，愈。某医云：既云有火何用泻火之牛黄上清丸不效?答曰：一者经络有异也，本病既病在肝胆，自当从肝胆论治，今反用治他经之法，故不效也。二者但泻其火而未散其寒也，寒邪郁表必予辛温行散方解，若徒施泻火则郁者更郁故不解也。又云：诸医又云龙胆泻肝汤为有效之方，然先生独不用之何也?答日：泻肝胆实火之方有三：一者龙胆泻肝汤，二者当归龙荟丸，三者泻青丸。龙胆泻肝汤者，一者泻火，二者理肝，三者利湿热，若肝胆实火夹郁、夹湿热者用之尤佳。当归龙荟丸者，一者泻火，二者攻下行滞，若肝胆实热或肝胃实火者尤宜用之。至若泻青丸者，非但泻实火，亦且散郁火，故实火夹郁者尤宜用之。今本病既有表邪之闭郁，又有肝胆之实火，故只可用泻青丸法，否则则闭其热而不散也。
2．细审病位，紧合其脉，知其肝胆火炽，外感风邪，予泻肝疏风得愈
霍××，女，36岁。
第六节 鼻、耳、咽喉科疾病
**鼻中隔偏曲**
通过诊察脉象和面色，判断病位在肺和肾，采用滋阴降火的方法治愈。
患者文××，男性，25岁。
反复发作性鼻出血十余年，持续不止20天。西医诊断为鼻中隔弯曲。先用西药治疗无效，后配合中药清肝泻火、清泻胃火的方剂治疗也未能奏效。仔细审查其证候：鼻出血，用药用纱条堵塞鼻孔后，仍有时从口中流出；血红蛋白6克（重度贫血）；舌苔白；面色苍白无光泽；脉象虚而数。综合脉象与证候分析思考：脉虚，说明肺气虚；脉数，说明有热。面色苍白无光泽，说明肺阴不足。且久病导致阴虚，相火（寄居于肝肾的生理之火，病理状态下为虚火）上炎灼伤肺金，从而导致鼻衄血。治疗应当滋阴降火。处方：生地15克，元参20克，麦冬15克。
服用1剂药后，鼻出血停止。但考虑到其面色皓白，气阴仍然嫌不足，于是给予养阴益气的方法治疗，后果痊愈。
某医生问：此方乃是增液汤（Zengye Tang, Fluid-Increasing Decoction），吴鞠通在《温病条辨》中将其用于无水舟停（津液枯竭导致的便秘）之便秘，为何老师唯独将其用于鼻中隔弯曲引起的鼻衄？回答是：生地、麦冬、元参三味药组成方剂，吴鞠通命名为增液汤，主要适用于无水舟停之便秘。钱镜湖在《辨证奇闻》中则因其善于滋阴降火，对衄血有奇效，而将其命名为止衄汤（Zhinu Tang, Epistaxis-Stopping Decoction）。如今本病的衄血乃阴虚相火妄动所致，故使用此方。正如《辨证奇闻》所言：“人在鼻中流血，经年经月而不止者，或愈或不愈，虽然鼻中流血，较之口中吐血者少轻，然而听其流血而不治，与治之而不得其法，皆能杀人。盖吐血犯胃，而衄血犯肺，胃为浊道，肺为清道也。犯浊道则五脏尽皆反复，犯清道则止肺经一脏之逆也，然而犯清虽轻于犯浊，而气逆则一，逆则变证多端，故皆能杀人也。治法惟调其肺气之逆，但肺气何以致逆乎，亦成于肺金之火也，夫肺属金本无火也，肺金之火仍是肾水之火也，肾因心火之侵而。肾水来救，久之肾水干涸，而肾火来助，火与火斗，而血乃妄行，从鼻而上越矣。然则调气之法，舍调肾无他法也，而调肾在于补水以制火。方用止衄汤：生地一两、麦冬三两、元参二两。水煎服。一服即止。麦冬直治肺金之匮乏，生地、元参以解肾中遏抑之火，火退而气自顺，气逆既顺，而血自归经矣。”
**鼻前庭炎**
仔细诊察昼夜阴阳的不同，结合疼痛的差异，判断病位的脏腑，采用滋阴降火的方法始得痊愈。
患者召5××，男性，38岁。
两鼻孔前庭粘膜干痛、糜烂结痂1年多。西医诊断为鼻前庭炎。先以西药外敷，内服治疗半年不效，继又配合中药清热解毒、疏风宣肺、健脾利湿等法治疗半年亦不效。仔细察其证候：两侧鼻前庭糜烂结痂，皮肤干痛，破裂出血，夜间痛甚，且近20天来，鼻牙俱痛，有时疼痛不能入睡，有时痛醒；舌苔白，脉弦滑尺大。综合脉证，思考：昼轻夜剧者，肾虚火炎也。糜烂者，湿热也。治以养阴、除湿、泻火。处方：升麻1克，元参30克，地骨皮30克，羌活3克。
服药2剂，糜烂、肿痛均消失，继服6剂，愈。
某医云：清热解毒、健脾利湿、疏风宣肺均为治鼻前庭炎之有效方法，而本证却治之不效者何也?答曰：本证非但鼻烂而痛，亦且牙龈亦痛，此乃肺胃俱病，当肺胃同治，且夜间痛剧，非仅实火，亦且阴虚，故但治其肺，但治其胃，但泻实火，均不得愈。所以采用一滋阴，二除湿，三泻火，酌加引经之药而愈。
**慢性鼻炎**
审其脉，知其病，予泻火平肝始愈。
王××，女，35岁。
鼻塞不闻香臭5～6年。医诊慢性鼻炎。先用西药治疗不效，继又配合中药辛夷、苍耳子加减为剂治疗2年亦不见减。细察其证，除鼻塞不闻香臭之外，并见头晕心烦，每次生气后均见鼻塞鼻不闻香臭加重，舌苔白，脉弦。综合脉证，思之：弦脉者，肝脉也。生气后鼻塞不闻香臭加重者，肝火射肺，肺气不宣也。治宜疏肝泻火。处方：冰片1克(冲)，栀子10克，酒军3克，当归10克，川芎10克，羌活10克，防风10克，薄荷6克。
服药2剂，鼻塞不闻香臭消失，继服2剂，竞愈。
某医云：此当归龙荟丸加减方也。当归龙荟丸清热泻肝，攻下行滞方也，主用于肝胆实火之头痛面赤，目赤目痛，胸胁胀痛，便秘尿赤，形体壮实，脉象弦劲，躁扰不安，甚或抽搐者，然今反用于慢性鼻炎者何也?答曰：中医治病在于理、法、方、药之合拍、在于理、法之相吻合，今慢性鼻炎之发生在于肝火之射肺，故采用治肝胆实火之方而愈也。
**变态反应性鼻炎**
1. 谨察诸证，合之于脉，予健脾理气，疏散风邪，愈。
赵××，男，59岁。
喷嚏流涕，身痒1年多。医诊过敏性鼻炎、荨麻疹。先以西药治疗半年多不效，后以中药散寒祛风、益气助阳，养血祛风等剂相配合亦无明显效果。细审其证，经常频发的鼻痒喷嚏，流清涕，头晕，全身酸困，脘腹满胀，遇冷或遇冷水则即刻身痒起片状皮疹，舌苔白，脉弦紧。综合脉证，思之：痒者，风也；遇寒冷或冷水则疹发者，寒湿也；腹脘满胀者，脾虚寒湿也；脉弦紧者，风寒也。证脉合参，乃脾胃寒湿为本，风寒外客为标。治以健脾理气，疏散风邪。处方：羌活3克，防风3克，荆芥10克，川芎10克，厚朴10克，党参10克，茯苓10克，陈皮10克，甘草6克，僵蚕10克，蝉蜕10克，藿香10克，清茶1撮。
服药2剂，喷嚏、流涕，全身酸困消失，用冷水洗衣服时亦未见起疹；继服4剂，愈。
某医云：前用散寒祛风、益气助阳、养血祛风不愈，且时见加重者何也?答曰：本病脾虚夹湿为本，风寒外客为标，不健其脾则祛风必甚，但健其脾则风邪反而内入，所以治疗之时只可在健脾理气化湿的基础上，少佐祛风之品。至于为何散风祛寒而不愈，其因有二：一散风寒之力过大也，二健脾除湿之力不足也。至于益气助阳，养血祛风因何不效，乃因药证不符也。
2．谨察其脉，合之于症，治以补气养阴，除湿升阳，愈。
苏××，男，38岁。
鼻痒喷嚏流涕频频而发十几年。医诊过敏性鼻炎。先以西药治疗数年不效，继以中药祛风散寒，调和营卫之剂相配合，治疗4～5年，亦无明显效果。细审其证，除频繁的鼻痒喷嚏流清涕外，并见头晕乏力，脉濡缓。综合脉证，思之：脉濡缓者，湿也，气阴两虚也；久久喷嚏流涕不愈者，气虚也。证脉合参，乃气阴俱虚，湿郁不化，清阳失升也。治宜补气养阴，除湿升阳。处方：升麻10克，葛根10克，蔓荆子10克，党参10克，黄芪15克，黄柏10克，白芍10克，甘草10克。
服药3剂，头晕乏力，鼻痒流涕均好转；继服30剂，愈。
某医云：此方乃东垣治疗目耳病方也，今先生却用于过敏性鼻炎者何也?答曰：此方原为气阴不足，湿郁不化，清阳不升之耳目病方。今过敏性鼻炎亦气阴不足，湿郁不化，清阳不升所致者也，故亦用其治疗过敏性鼻炎也。
3．谨察时令，合之脉证，予理气疏肝，化痰开肺而愈。
索××，男，35岁。
鼻痒喷嚏流涕7～8年。医诊过敏性鼻炎。始以西药治之不效，继以中药散寒祛风，养血祛风相配合亦无效。细审其证，鼻痒喷嚏流涕仅发于秋季，且见胸满，舌苔薄白，脉沉缓。综合脉证，思之：秋季者，燥令也，收令也。脉沉缓，气滞湿郁也。治以理气除湿。处方：人参10克，紫苏10克，陈皮10克，枳壳10克，前胡10克，半夏10克，葛根10克，木香10克，甘草6克，桔梗10克，茯苓10克。
服药3剂，诸证好转；继服30剂，愈。
某医云：参苏饮本为《太平惠民和剂局方》中的治疗虚人外感风寒，内有痰湿之方。今反用于过敏性鼻炎者何也?答日：秋令者，收令也，燥邪用事也，今肺胃气虚，复感凉燥，痰湿阻郁，故每至秋令则病发也，故治宜补胃肺之气，理气化痰可愈。参苏饮者，既能补肺胃之气，又能理气化痰，故予参苏饮亦可治过敏性鼻炎也。
4.谨察时令，合之于脉，予补气养阴，燥湿清热，升清降浊而愈。
王××，男，35岁。
鼻塞流涕喷嚏，眼耳发痒十几年。医诊过敏性鼻炎。先以西药治疗不效，继以中药益气聪明、桂枝，以及疏风散寒，养血祛风之剂加减相配合治疗数年亦无明显效果。细审其证，每至夏季天热之时即反复感冒，鼻塞流涕，喷嚏连连，眼耳俱痒，头晕乏力，舌苔白，脉虚大弦紧。综合脉证，思之：夏令者，暑热也，暑令热邪，伤气伤阴，故气阴两虚之质尤易感受暑令之邪也。今脉弦大紧，亦气阴两虚之脉也。治宜补气养阴，除湿清热，升清降浊。处方：人参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术10克，白术10克，升麻10克，泽泻10克，生姜3片，大枣5个。
服药2剂，诸证消失；继服15剂，追访4年，未见复发。
5.谨遵舌脉，知其枢机不利，营卫失调，治以柴胡桂枝汤得愈。
徐××，男，成。（注：原文此处年龄缺失或误写，依原文翻译）
遇风冷或花香则鼻痒、眼痒，喷嚏流涕7年多。医诊过敏性鼻炎。先以西药治疗数年不效，后又以中药祛风、益气等药相配合治疗3年多亦无功。细审其证，除上述诸证之外，别无所苦，舌苔薄白，脉弦缓。综合脉证，思之：弦脉者，少阳枢机不利之脉；缓者，营卫失调之脉。合而论之，乃少阳枢机不利，营卫失调。治宜拟和解少阳，调和营卫。处方：柴胡10克，半夏10克，黄芩10克，党参10克，生姜10克，甘草10克，大枣5个，桂枝10克，白芍10克。
服药6剂，诸证全失，继服6剂，愈。
**鼻窦炎**
知冷热之微甚，合脉象之脏腑，知其肝火内郁，风寒外客，治以泻火平肝，疏风散寒，愈。
郭××，男，28岁。
头晕头痛8～9年。医诊鼻窦炎。先以穿刺、西药治疗曾一度好转，但一年之后头痛如初，继以辛夷散、苍耳子散半年效仍不著。细审其证，前额、巅顶头痛，遇热或在太阳下走路时头痛尤甚，生气之后头痛亦剧，鼻塞涕多，烦躁易怒，且偶见耳聋耳鸣，舌苔薄黄，舌尖红，脉弦数。综合脉证，思之：头痛，遇热而甚者，火也。鼻塞涕多者，寒也。脉弦数者，肝胆实火也。合脉证论之，乃肝胆实火内郁，风寒闭郁于外也。治宜内清肝火，外散风寒。处方：龙胆草10克，栀子10克，黄芩10克，柴胡10克，生地10克，车前子10克(布包)，泽泻10克，木通10克，甘草10克，当归10克，苍耳子12克，薄荷10克。
服药3剂，头痛大减；继服30剂，诸证消失。
某医云：为何用辛夷散、苍耳子散加减无效?答曰：脉弦数者，肝胆实火为主也，肝胆实火者当泻火平肝，故以辛夷散、苍耳子散等治肺者不效也。
**脑脊液鼻漏**
谨察其脉，合之于症，知其中气不足，清阳失升，治以补气升阳，愈。
郝××，男，25岁。
两侧鼻孔清水样涕不断溢出，视力下降，行动迟缓，对外界事物反应迟钝5个多月。医诊脑脊液鼻漏。先以手术治疗未成功，后以培补肾气之剂亦未效。细审其证，除两个鼻孔不断的流清水样的鼻涕外，并见视力明显下降，走路迟缓，神情痴呆，听力下降，舌苔薄白，脉濡缓。综合脉证，思之：濡缓之脉者，气阴俱虚夹湿也；清水样涕者，虚也。合之于症，乃气阴俱虚，湿郁不化，清阳失升之证也。治宜补气养阴，除湿升阳。处方：蔓荆子10克，升麻10克，葛根15克，人参10克，黄芪20克，黄柏10克，白芍10克，甘草10克。
服药3剂，流涕减少，精神增加；继服30剂，诸证消失，并恢复工作。
**耳咽管炎**
1. 审其脉证，知其内郁肝胆实火，外感风寒客邪，表里同病，予内泻肝胆相火，外疏风寒客邪，愈。
汪××，女，35岁。
左耳突然憋胀疼痛，听力下降11天。医诊耳咽管炎。先以西药治疗7天不效，继又配合中药牛黄解毒丸、牛黄上清丸治疗3天诸证亦不见减。细审其证，右耳听力正常，左耳憋胀疼痛，听力降低达90％左右，且见鼻塞，咽喉干痛，发热头痛，舌苔白，脉浮弦数。综合脉证，思之：脉浮，鼻塞，咽喉干痛者，表证也；脉弦数，头痛者，肝胆实火也。合而论之，乃内郁肝胆实火，外感风寒客邪，表里同病之证也。急拟外疏风寒，内泻肝火。处方：防风10克，羌活10克，龙胆草10克，大黄5克，细辛5克。服药3剂，诸证消失，愈。某医云：既云有火何用泻火之牛黄上清丸不效?答曰：一者经络有异也，本病既病在肝胆，自当从肝胆论治，今反用治他经之法，故不效也。二者但泻其火而未散其寒也，寒邪郁表必予辛温行散方解，若徒施泻火则郁者更郁故不解也。又云：诸医又云龙胆泻肝汤为有效之方，然先生独不用之何也?答日：泻肝胆实火之方有三：一者龙胆泻肝汤，二者当归龙荟丸，三者泻青丸。龙胆泻肝汤者，一者泻火，二者理肝，三者利湿热，若肝胆实火夹郁、夹湿热者用之尤佳。当归龙荟丸者，一者泻火，二者攻下行滞，若肝胆实热或肝胃实火者尤宜用之。至若泻青丸者，非但泻实火，亦且散郁火，故实火夹郁者尤宜用之。今本病既有表邪之闭郁，又有肝胆之实火，故只可用泻青丸法，否则则闭其热而不散也。
Section 6: Nasal, Auricular, and Pharyngeal Diseases
**Deviated Nasal Septum**
By examining the pulse and complexion, it was determined that the disease location is in the Lung and Kidney meridians. The patient was cured by employing the method of nourishing Yin and descending fire.
Patient Wen XX, male, 25 years old.
He suffered from recurrent epistaxis for over ten years, with continuous bleeding for the past 20 days. Western medicine diagnosed a deviated nasal septum. Initial treatment with Western medicines was ineffective. Subsequent combination therapy with Chinese herbal formulas to clear Liver fire and purge Stomach fire also failed. Upon careful examination of the syndrome: epistaxis persisted despite packing the nostrils with medicated gauze, with blood occasionally regurgitating from the mouth; hemoglobin level was 6 g/dL (indicating severe anemia); tongue coating was white; complexion was pale and lusterless; pulse was deficient and rapid. Synthesizing the pulse and symptoms: a deficient pulse indicates Lung Qi deficiency; a rapid pulse indicates heat. A pale, lusterless complexion suggests insufficiency of Lung Yin. Furthermore, chronic illness leads to Yin deficiency, causing ministerial fire (physiological fire residing in the Liver and Kidney, pathologically manifesting as empty heat) to flare upward and scorch the Metal of the Lung, resulting in epistaxis. The treatment principle should be to nourish Yin and descend fire. Prescription: *Shengdi Huang* (Rehmanniae Radix Preparata) 15g, *Yuán Shēn* (Scrophulariae Radix) 20g, *Mài Dōng* (Ophiopogonis Tuber) 15g.
After taking one dose, the epistaxis stopped. However, considering his pale complexion, Qi and Yin were still deemed insufficient. Therefore, a treatment strategy of nourishing Yin and tonifying Qi was adopted, leading to eventual recovery.
A colleague asked: This formula is Zengye Tang (Fluid-Increasing Decoction). Wu Jutong used it in *Wenbing Tiaobian* (Systematic Differentiation of Warm Diseases) for constipation due to "waterless boat" (fluid exhaustion). Why did you apply it specifically for epistaxis caused by a deviated nasal septum? The answer is: The combination of *Shengdi Huang*, *Mài Dōng*, and *Yuán Shēn* constitutes Zengye Tang, primarily indicated for constipation due to fluid exhaustion. Qian Jinghu, in *Bianzheng Qiwén* (Strange Questions on Syndrome Differentiation), named it Zhinu Tang (Epistaxis-Stopping Decoction) because of its efficacy in nourishing Yin, descending fire, and stopping bleeding. Since this patient's epistaxis is caused by erratic movement of ministerial fire due to Yin deficiency, this formula is appropriate. As stated in *Bianzheng Qiwén*: "When blood flows from the nose for months or years without stopping... although less severe than hematemesis, leaving it untreated or treating it improperly can be fatal. Hematemesis affects the Stomach, while epistaxis affects the Lung. The Stomach is the turbid pathway, and the Lung is the clear pathway. Turbidity affecting the Stomach disrupts all five Zang organs, whereas epistaxis only reverses the Qi of the Lung meridian. Although affecting the clear pathway is lighter than affecting the turbid pathway, the reversal of Qi is the same, leading to various complications and potential fatality. The treatment method is to regulate the reversal of Lung Qi. How does Lung Qi reverse? It results from Fire in Lung Metal. Lung Metal inherently has no fire; the fire in Lung Metal is actually the fire of Kidney Water. When Heart Fire invades the Kidney, Kidney Water comes to rescue it. Over time, Kidney Water dries up, and Kidney Fire assists. Fire battles fire, causing blood to flow recklessly upward through the nose. Therefore, to regulate Qi, there is no method other than regulating the Kidney. Regulating the Kidney lies in replenishing water to control fire. Use Zhinu Tang: *Shengdi Huang* 3 liang, *Mài Dōng* 9 liang, *Yuán Shēn* 6 liang. Decoct in water. One dose stops the bleeding. *Mài Dōng* directly treats the deficiency of Lung Metal; *Shengdi Huang* and *Yuán Shēn* resolve the suppressed fire in the Kidney. As fire retreats, Qi becomes smooth; once Qi reversal is smoothed, blood returns to its vessels."
**Nasal Vestibulitis**
Carefully observing the differences in Yin and Yang between day and night, combined with variations in pain, the organ involvement was identified. The condition was cured by nourishing Yin and descending fire.
Patient Zhao 5XX, male, 38 years old.
For over a year, he experienced dryness, pain, erosion, and crusting of the mucosa in the anterior vestibule of both nostrils. Western medicine diagnosed nasal vestibulitis. Half a year of topical Western medicine and internal medication was ineffective. Another half year of Chinese medicine involving clearing heat and detoxifying, dispersing wind and diffusing Lung Qi, and strengthening Spleen and draining dampness also failed. Careful examination revealed erosion and crusting in both anterior vestibules, dry painful skin, rupture and bleeding, worse at night. For the past 20 days, he had simultaneous pain in the nose and teeth, sometimes preventing sleep or waking him up. Tongue coating was white; pulse was wiry, slippery, and large at the Chi position. Synthesizing pulse and symptoms: symptoms lighter by day and severe by night indicate Kidney deficiency with flaming fire. Erosion indicates damp-heat. Treatment involved nourishing Yin, removing dampness, and purging fire. Prescription: *Sheng Ma* (Cimicifugae Rhizoma) 1g, *Yuán Shēn* 30g, *Di Gu Pi* (Lycii Cortex) 30g, *Qiang Huo* (Notopterygii Rhizoma et Radix) 3g.
After two doses, erosion and swelling/pain disappeared. After six more doses, he recovered.
A colleague asked: Clearing heat, strengthening Spleen, draining dampness, and dispersing wind are effective methods for nasal vestibulitis. Why did they fail here? The answer is: This case involves not only nasal erosion and pain but also gum pain, indicating pathology in both Lung and Stomach, requiring simultaneous treatment. Moreover, severe night pain indicates not only excess fire but also Yin deficiency. Treating only the Lung, only the Stomach, or only purging excess fire would not suffice. Thus, the approach was to nourish Yin, remove dampness, purge fire, and add guiding herbs, leading to recovery.
**Chronic Rhinitis**
Examining the pulse reveals the disease; purging fire and calming the Liver leads to recovery.
Wang XX, female, 35 years old.
Nasal congestion and loss of smell for 5–6 years. Diagnosed with chronic rhinitis. Western medicine was ineffective. Two years of Chinese medicine using modified *Xin Yi San* (Magnolia Flower Powder) and *Cang Er Zi San* (Xanthium Powder) showed no improvement. Examination revealed nasal congestion, loss of smell, dizziness, irritability, and worsening of symptoms after anger. Tongue coating was white; pulse was wiry. Analysis: A wiry pulse belongs to the Liver. Worsening after anger indicates Liver fire projecting into the Lung, obstructing Lung Qi diffusion. Treatment: soothe the Liver and purge fire. Prescription: *Bing Pian* (Borneolum Syntheticum) 1g (dissolved), *Zhi Zi* (Gardeniae Fructus) 10g, *Jiu Jun* (Radix Rhei Preparata) 3g, *Dang Gui* (Angelicae Sinensis Radix) 10g, *Chuan Xiong* (Ligustici Chuanxiong Rhizoma) 10g, *Qiang Huo* 10g, *Fang Feng* (Saposhnikoviae Radix) 10g, *Bo He* (Menthae Haplocalycis Herba) 6g.
After two doses, congestion and loss of smell resolved. After two more doses, full recovery occurred.
A colleague asked: This is a modified Danggui Longhui Wan (Angelica and Gardenia Pill). It clears heat and purges Liver fire, promoting downward movement. It is typically used for headache, red face, red eyes, chest/hypochondriac distension, constipation, dark urine, robust physique, wiry-taut pulse, restlessness, or convulsions due to excess fire in Liver/Gallbladder. Why use it for chronic rhinitis? The answer is: TCM treatment relies on the harmony of principle, method, formula, and herb. Chronic rhinitis here arises from Liver fire projecting into the Lung. Therefore, using a formula for excess Liver/Gallbladder fire cures the condition.
**Allergic Rhinitis**
1. Carefully observing symptoms and correlating with the pulse, strengthening the Spleen, regulating Qi, and dispersing wind pathogens led to recovery.
Zhao XX, male, 59 years old.
Sneezing, runny nose, and body itching for over a year. Diagnosed with allergic rhinitis and urticaria. Six months of Western medicine failed. Combination therapy with Chinese medicine to dispel cold, disperse wind, tonify Qi, assist Yang, and nourish Blood to disperse wind showed no obvious effect. Examination revealed frequent nasal itching and sneezing, clear rhinorrhea, dizziness, general fatigue, abdominal distension, and immediate onset of patchy rashes upon exposure to cold or cold water. Tongue coating was white; pulse was wiry and tight. Analysis: Itching indicates wind; rash triggered by cold indicates cold-dampness; abdominal distension indicates Spleen deficiency with cold-dampness; wiry-tight pulse indicates wind-cold. Correlating syndrome and pulse, the root is Spleen/Stomach cold-dampness, and the branch is external wind-cold invasion. Treatment: strengthen Spleen, regulate Qi, disperse wind. Prescription: *Qiang Huo* 3g, *Fang Feng* 3g, *Jing Jie* (Schizonepetae Spica) 10g, *Chuan Xiong* 10g, *Hou Po* (Magnoliae Officinalis Cortex) 10g, *Dang Shen* (Codonopsis Radix) 10g, *Fu Ling* (Poria) 10g, *Chen Pi* (Citri Reticulatae Pericarpium) 10g, *Gan Cao* (Glycyrrhizae Radix et Rhizoma) 6g, *Jiang Can* (Bombyx Batryticatus) 10g, *Chan Tui* (Cicadae Periostracum) 10g, *Huo Xiang* (Agastaches Herba) 10g, a pinch of green tea.
After two doses, sneezing, rhinorrhea, and fatigue disappeared; no rash appeared when washing clothes in cold water. After four more doses, recovery was achieved.
A colleague asked: Why did previous treatments fail or worsen the condition? The answer is: The root is Spleen deficiency with dampness; the branch is external wind-cold. Without strengthening the Spleen, dispersing wind may be excessive; merely strengthening the Spleen might allow wind pathogens to enter internally. Therefore, treatment must focus on strengthening the Spleen, regulating Qi, and resolving dampness, with only minor additions of wind-dispersing herbs. Previous failures were due to either excessive wind-dispersing power or insufficient Spleen-strengthening/damp-resolving power. Tonifying Qi/Yang and nourishing Blood failed because the herbs did not match the syndrome.
2. Carefully observing the pulse and correlating with symptoms, tonifying Qi, nourishing Yin, removing dampness, and raising Yang led to recovery.
Su XX, male, 38 years old.
Frequent nasal itching, sneezing, and rhinorrhea for over ten years. Diagnosed with allergic rhinitis. Years of Western medicine and 4–5 years of Chinese medicine (dispersing wind/cold, harmonizing Ying and Wei) were ineffective. Examination revealed frequent symptoms plus dizziness, fatigue, and a soggy-slow pulse. Analysis: Soggy-slow pulse indicates dampness and dual deficiency of Qi and Yin. Chronic sneezing/rhinorrhea indicates Qi deficiency. Correlating syndrome and pulse, there is dual deficiency of Qi and Yin, stagnation of dampness, and failure of Clear Yang to ascend. Treatment: tonify Qi, nourish Yin, remove dampness, raise Yang. Prescription: *Sheng Ma* 10g, *Ge Gen* (Puerariae Lobatae Radix) 10g, *Man Jing Zi* (Vittariae Semen) 10g, *Dang Shen* 10g, *Huang Qi* (Astragali Radix) 15g, *Huang Bo* (Phellodendri Cortex) 10g, *Bai Shao* (Paeoniae Radix Alba) 10g, *Gan Cao* 10g.
After three doses, dizziness, fatigue, nasal itching, and rhinorrhea improved. After thirty more doses, recovery was achieved.
A colleague asked: This formula resembles Dong Yuan’s prescription for eye/ear diseases. Why use it for allergic rhinitis? The answer is: This formula originally treats eye/ear diseases caused by Qi/Yin deficiency, dampness stagnation, and failure of Clear Yang to ascend. Allergic rhinitis here shares the same pathogenesis, hence its application.
3. Observing seasonal factors and correlating with pulse/symptoms, regulating Qi, soothing Liver, resolving phlegm, and opening the Lung led to recovery.
Suo XX, male, 35 years old.
Nasal itching, sneezing, and rhinorrhea for 7–8 years. Diagnosed with allergic rhinitis. Western medicine and Chinese medicine (dispersing cold/wind, nourishing blood/dispatching wind) were ineffective. Examination revealed symptoms occurring only in autumn, chest fullness, thin white tongue coating, and deep-slow pulse. Analysis: Autumn represents dryness and gathering. Deep-slow pulse indicates Qi stagnation and dampness stagnation. Treatment: regulate Qi and remove dampness. Prescription: *Ren Shen* (Ginseng Radix) 10g, *Zi Su Ye* (Perillae Folium) 10g, *Chen Pi* 10g, *Zhi Ke* (Aurantii Fructus Immaturus) 10g, *Qian Hu* (Peucedani Radix) 10g, *Ban Xia* (Pinelliae Rhizoma) 10g, *Ge Gen* 10g, *Mu Xiang* (Aucklandiae Radix) 10g, *Gan Cao* 6g, *Jie Geng* (Platycodonis Radix) 10g, *Fu Ling* 10g.
After three doses, symptoms improved. After thirty more doses, recovery was achieved.
A colleague asked: Shen Su Yin (Ginseng and Perilla Drink) from *Taiping Huimin Heji Jufang* treats deficiency-type exterior wind-cold with internal phlegm-dampness. Why use it for allergic rhinitis? The answer is: Autumn is the season of dryness. Here, Lung/Stomach Qi is deficient, compounded by cool-dry pathogen invasion and phlegm-damp obstruction, triggering attacks in autumn. Treatment requires tonifying Lung/Stomach Qi and regulating Qi/resolving phlegm. Shen Su Yin achieves both, making it suitable for this type of allergic rhinitis.
4. Observing seasonal factors and correlating with pulse, tonifying Qi, nourishing Yin, drying dampness, clearing heat, raising Clear, and descending Turbid led to recovery.
Wang XX, male, 35 years old.
Nasal congestion, rhinorrhea, sneezing, and eye/ear itching for over ten years. Diagnosed with allergic rhinitis. Western medicine and various Chinese medicine formulas (tonifying Qi/enlightening, Guizhi Tang, dispersing wind/cold, nourishing blood/dispatching wind) were ineffective over several years. Examination revealed recurrent colds, congestion, sneezing, itching, dizziness, fatigue during hot summers. Tongue coating white; pulse deficient-large-wiry-tight. Analysis: Summer heat damages Qi and Yin, making those with Qi/Yin deficiency susceptible. The pulse confirms dual deficiency of Qi and Yin. Treatment: tonify Qi, nourish Yin, dry dampness, clear heat, raise Clear, descend Turbid. Prescription: *Ren Shen* 10g, *Gan Cao* 6g, *Huang Qi* 15g, *Dang Gui* 6g, *Mài Dōng* 10g, *Wu Wei Zi* (Schisandrae Fructus) 10g, *Qing Pi* (Citri Reticulatae Pericarpium Viride) 10g, *Chen Pi* 10g, *Shen Qu* (Massa Medicata Fermentata) 10g, *Huang Bo* 10g, *Ge Gen* 15g, *Cang Zhu* (Atractylodis Rhizoma) 10g, *Bai Zhu* (Atractylodis Macrocephalae Rhizoma) 10g, *Sheng Ma* 10g, *Ze Xie* (Alismatis Rhizoma) 10g, *Sheng Jiang* (Zingiberis Rhizoma Recens) 3 slices, *Da Zao* (Jujubae Fructus) 5 pieces.
After two doses, symptoms disappeared. After fifteen more doses, follow-up over 4 years showed no recurrence.
5. Following tongue/pulse indications, identifying unfavorable pivot mechanism and disharmony of Ying and Wei, treating with Chaihu Guizhi Tang led to recovery.
Xu XX, male, age unspecified (text says "Cheng").
Nasal/eye itching, sneezing, and rhinorrhea triggered by wind/cold or floral scents for over 7 years. Diagnosed with allergic rhinitis. Western medicine and Chinese medicine (dispersing wind, tonifying Qi) were ineffective over 3+ years. Examination revealed no other complaints besides above symptoms; thin white tongue coating; wiry-slow pulse. Analysis: Wiry pulse indicates Shaoyang pivot dysfunction; slow pulse indicates Ying/Wei disharmony. Combined, this is Shaoyang pivot dysfunction and Ying/Wei disharmony. Treatment: harmonize Shaoyang, regulate Ying and Wei. Prescription: *Chai Hu* (Bupleuri Radix) 10g, *Ban Xia* 10g, *Huang Qin* (Scutellariae Radix) 10g, *Dang Shen* 10g, *Sheng Jiang* 10g, *Gan Cao* 10g, *Da Zao* 5 pieces, *Gui Zhi* (Cinnamomi Ramulus) 10g, *Bai Shao* 10g.
After six doses, all symptoms vanished. After six more doses, recovery was achieved.
**Sinusitis**
Assessing the severity of cold/heat and correlating pulse with organs, it was identified as internal depression of Liver fire and external invasion of wind-cold. Purging fire, calming Liver, dispersing wind, and dispelling cold led to recovery.
Guo XX, male, 28 years old.
Dizziness and headache for 8–9 years. Diagnosed with sinusitis. Puncture/Western medicine provided temporary relief, but headache returned after a year. Six months of Xin Yi San and Cang Er Zi San were ineffective. Examination revealed frontal and vertex headache, worse with heat or walking in sun, severe after anger, nasal congestion with copious discharge, irritability, occasional deafness/tinnitus. Tongue coating thin yellow, tip red; pulse wiry-rapid. Analysis: Headache worse with heat indicates fire. Congestion/copious discharge indicates cold. Wiry-rapid pulse indicates excess fire in Liver/Gallbladder. Combined, this is internal depression of Liver/Gallbladder excess fire and external closure by wind-cold. Treatment: clear Liver fire internally, disperse wind-cold externally. Prescription: *Long Dan Cao* (Gentianae Radix) 10g, *Zhi Zi* 10g, *Huang Qin* 10g, *Chai Hu* 10g, *Sheng Di* (Rehmanniae Radix) 10g, *Che Qian Zi* (Plantaginis Semen) 10g (wrapped), *Ze Xie* 10g, *Mu Tong* (Akebiae Caulis) 10g, *Gan Cao* 10g, *Dang Gui* 10g, *Cang Er Zi* (Xanthii Fructus) 12g, *Bo He* 10g.
After three doses, headache significantly reduced. After thirty more doses, all symptoms disappeared.
A colleague asked: Why were Xin Yi San and Cang Er Zi San ineffective? The answer is: The wiry-rapid pulse indicates Liver/Gallbladder excess fire is primary. Excess fire requires purging fire and calming Liver. Formulas targeting the Lung (like Xin Yi/Cang Er Zi) are ineffective against this root cause.
**Cerebrospinal Fluid Rhinorrhea**
Carefully observing pulse and symptoms, identifying deficiency of Middle Qi and failure of Clear Yang to ascend, tonifying Qi and raising Yang led to recovery.
Hao XX, male, 25 years old.
Continuous clear watery discharge from both nostrils, decreased vision, slow movement, and delayed reaction to external stimuli for over 5 months. Diagnosed with cerebrospinal fluid rhinorrhea. Surgery failed. Tonifying Kidney Qi herbs were ineffective. Examination revealed continuous clear rhinorrhea, significant vision loss, slow gait, dull expression, hearing loss. Tongue coating thin white; pulse soggy-slow. Analysis: Soggy-slow pulse indicates dual deficiency of Qi and Yin with dampness. Clear rhinorrhea indicates deficiency. Combined, this is dual deficiency of Qi and Yin, dampness stagnation, and failure of Clear Yang to ascend. Treatment: tonify Qi, nourish Yin, remove dampness, raise Yang. Prescription: *Man Jing Zi* 10g, *Sheng Ma* 10g, *Ge Gen* 15g, *Ren Shen* 10g, *Huang Qi* 20g, *Huang Bo* 10g, *Bai Shao* 10g, *Gan Cao* 10g.
After three doses, rhinorrhea decreased, spirit improved. After thirty more doses, all symptoms disappeared, and work capacity was restored.
**Eustachian Tube Dysfunction**
1. Examining pulse/symptoms, identifying internal depression of Liver/Gallbladder excess fire and external invasion of wind-cold (exterior-interior simultaneous disease), purging Liver/Gallbladder fire internally and dispersing wind-cold externally led to recovery.
Wang XX, female, 35 years old.
Sudden left ear stuffiness and pain, hearing loss for 11 days. Diagnosed with Eustachian tube dysfunction. Seven days of Western medicine failed. Three days of Niuhuang Jiedu Wan and Niuhuang Shangqing Wan failed. Examination revealed normal right ear hearing; left ear stuffiness/pain, ~90% hearing loss, nasal congestion, sore throat, fever, headache. Tongue coating white; pulse floating-wiry-rapid. Analysis: Floating pulse, congestion, sore throat indicate exterior syndrome. Wiry-rapid pulse, headache indicate Liver/Gallbladder excess fire. Combined, this is internal Liver/Gallbladder fire depression and external wind-cold invasion. Urgent treatment: disperse wind-cold externally, purge Liver fire internally. Prescription: *Fang Feng* 10g, *Qiang Huo* 10g, *Long Dan Cao* 10g, *Da Huang* (Rhei Radix et Rhizoma) 5g, *Xi Xin* (Asari Radix et Rhizoma) 5g. After three doses, all symptoms disappeared.
A colleague asked: If there is fire, why didn't Niuhuang Shangqing Wan work? Answer: First, meridians differ. This disease involves Liver/Gallbladder, so treatment must target these meridians. Using formulas for other meridians fails. Second, it purged fire but did not disperse cold. Cold pathogens trapped in the exterior require acrid-warm dispersal; merely purging fire increases stagnation. Another colleague asked: Why not Longdan Xiegan Tang (Gentian Liver-Draining Decoction)? Answer: There are three formulas for purging Liver/Gallbladder excess fire: Longdan Xiegan Tang, Danggui Longhui Wan, and Xieqing Wan. Longdan Xiegan Tang purges fire, regulates Liver, and promotes damp-heat drainage, suitable for excess fire with stagnation/damp-heat. Danggui Longhui Wan purges fire and promotes downward movement, suitable for excess heat/fire. Xieqing Wan purges excess fire and disperses stagnant fire, suitable for excess fire with stagnation. This case has both exterior closure and Liver excess fire, so only the Xieqing Wan method applies; otherwise, heat remains trapped.
2. Carefully examining disease location and closely correlating with pulse, identifying blazing Liver/Gallbladder fire and external wind invasion, purging Liver and dispersing wind led to recovery.
Huo XX, female, 36 years old.