耳聋皆属于热，少阳厥阴热多，当用开痰散风热，通圣散、滚痰丸之类。大病
后耳聋，须用四物汤降火。阴虚火动耳聋者，亦用四物汤。
因郁而聋者，以通圣散纳大黄酒煨，再用酒炒二次后，入诸药，通用酒炒。耳鸣因酒遏
大剂通圣散加枳壳、柴胡、大黄、甘草、南星、桔梗、青皮、荆芥。不愈，用四物汤妙。
耳鸣必用龙荟丸食后服。气实，入槟榔丸或神芎丸下之。聋病必用龙荟丸、四物汤养阴。
湿痰者，神芎丸、槟榔丸。耳湿肿痛，
凉膈散加酒炒大黄、黄芩、酒浸防风、荆芥、羌活服，脑多射少。湿加枯矾吹。耳内哄哄
然，亦是阴虚。
戴云∶亦有气闭者，盖亦是热，气闭者，耳不鸣也。
入方
蓖麻子（四十九粒） 枣肉（十个）
上入人乳汁，捣成膏，石上略晒干，便丸如指大。绵裹，塞于耳中。
又方
鼠胆汁滴入耳中，尤妙。
又方
将龟放漆桌上，尿出用绵渍之，捏入青葱管中，滴入耳中。
〔附录〕耳，属足少阴之经，肾家之寄窍于耳也。肾通乎耳，所主者，精。精气调和，肾
气充足，则耳闻而聪。若劳伤气血，风邪袭虚，使精脱肾惫，则耳转而聋。又有气厥而聋者，
有挟风而聋者，有劳损而聋者。盖十二经脉上络于耳，其阴阳诸经适有交并，则脏气逆而为
厥，厥气搏入于耳，是谓厥聋，必有眩晕之证。
耳者，宗脉之所附。脉虚而风邪乘之，风入于耳之脉，使经气痞而不宣，是谓风聋。必
有头痛之证。劳役伤于血气，淫欲耗其精元，瘦悴力疲，昏昏 ，是为劳聋。有能
将息得所，血气和平，则其聋暂轻。
又有耳触风邪，与气相搏，其声嘈嘈，眼见光，为之虚聋。热气乘虚随脉入耳，聚热不散
浓汁出，为之脓耳。人耳间有津液，轻则不能为害，若风热搏之，津液结
成核塞耳，亦令暴聋，为之耵耳。前是数者，肾脉可推。风则浮而盛
热则洪而实，虚则涩而濡。风为之疏散，热为之清利，虚为之调养，邪气屏退，然后以通
耳调气安肾之剂主之。于此得耳中三昧。
附方
《和剂》流气饮 治厥聋。
方见气类，内加菖蒲、生姜、葱，同煎服。治聋皆当调气。
桂星散 治风虚耳聋。
辣桂 川芎 当归 细辛 石菖蒲 木通 白蒺藜（炒） 木香 麻黄（去节） 甘草（炙，
各二钱半） 南星（煨） 白芷梢（各四钱） 紫苏（一钱）
上锉。每服二钱，水煎，葱二茎，食后服。
地黄丸 治劳损耳聋。
熟地黄 当归 川芎 辣桂 菟丝子 川椒（炒） 故纸（炒） 白蒺藜（炒） 胡芦巴（炒）
杜仲（炒） 白芷 石菖蒲（各一钱半） 磁石（火烧醋淬七次，研，水飞，一钱二分半）
上为末，炼蜜丸，如桐子大。服五十丸，葱白温酒下。
益智散 治肾虚耳聋。
磁石（制如前） 巴戟（去心） 川椒（各一两，炒） 沉香 石菖蒲（各半两）
上为末。每服二钱，用猪肾一枚细切，和以葱白少盐，并药湿纸十重裹煨令熟。空心嚼
，以酒送下。
芎芷散 治风入耳虚鸣。
白芷 石菖蒲（炒） 苍术 陈皮 细辛 浓朴 半夏 桂 木通 紫苏（茎叶） 甘草（炙，
各二钱半） 川芎（五钱）
上锉散。每服三钱，姜三片，葱二枝，水煎，食后临卧服
耳鸣方
草乌（烧） 石菖蒲
上等分为末。用绵裹塞耳，一日三度。
耳鸣暴聋方
川椒 石菖蒲 松脂（各二钱半） 山豆肉（半钱）
上为末，溶蜡丸如枣核大。塞入耳。
蔓荆子散 治内热，耳出脓汁。
甘草（炙） 川升麻 木通 赤芍 桑白皮（炒） 麦门冬（去心） 生地黄 前胡 甘菊
赤茯苓 蔓荆子
上等分，每服三钱，姜三片，枣一枚煎，食后温服。
又方 治耳内出脓。
真龙骨 枯白矾 赤小豆 黄丹 乌贼骨 胭脂（一钱一分）
上为末掺耳。
又方 治耳内脓出或黄汁。
石膏（新瓦上 ） 明矾（枯） 黄丹（炒） 真蚌粉 龙骨（各等分） 麝香（少许）
上为末。绵缠竹签拭耳，换绵蘸药入耳。
耵耳方 治风热搏之，津液结 成核塞耳。
生猪脂 地龙 釜下墨（等分）
上件细研，以葱汁和捏如枣核。薄绵裹入耳，令润，即挑出。
耳烂
贝母为末，干糁。
桃花散 治耳中出脓。
枯矾 干胭脂（各一钱） 麝香（一字）
上为末。绵杖子蘸药捻之。
通圣散 见斑疹类。
滚痰丸
大黄（半斤） 黄芩（半斤） 青礞石（一两） 沉香（五钱）
上为末，水丸，桐子大。
龙荟丸 见胁痛类。
槟榔丸 见痢类。
神芎丸 见痛风类。
凉膈散 见自汗类。
耳聋多归属于热证，少阳经和厥阴经的热证较多，应当使用开痰散风热的方药，如防风通圣散、滚痰丸之类。大病之后出现耳聋，必须使用四物汤来降火。因阴虚导致虚火上炎而耳聋的，也使用四物汤。
因气郁而导致耳聋的，将防风通圣散加入大黄（酒煨），再用酒炒制两次后，与其他药物混合，通用酒炒法处理。耳鸣若因饮酒阻滞所致，可用大剂量防风通圣散，加入枳壳、柴胡、大黄、甘草、天南星、桔梗、青皮、荆芥。若无效，使用四物汤效果奇妙。治疗耳鸣必须服用龙胆泻肝丸（此处原文为龙荟丸，即龙胆泻肝丸类方），在饭后服用。若气实者，可服用槟榔丸或神芎丸以攻下泄热。治疗耳聋病必须使用龙胆泻肝丸配合四物汤以滋养阴液。若是湿痰所致，使用神芎丸或槟榔丸。耳部湿肿疼痛，使用凉膈散加酒炒大黄、黄芩、酒浸防风、荆芥、羌活服用，此症多表现为头部充血多而精气亏损少。若有湿气，可将枯矾研末吹入耳中。耳内嗡嗡作响，也是阴虚的表现。
戴元礼说：也有因气机闭塞导致的耳聋，这本质上也是热证，气闭型的耳聋特点是耳不鸣响。
【入方】
蓖麻子（四十九粒） 枣肉（十个）
以上药物加入人乳汁，捣烂成膏状，在石头上稍微晒干，制成如手指大小的丸剂。用绵纱包裹，塞入耳中。
又一方
将乌龟放在漆桌上，待其排尿，用绵纱浸渍尿液，捏入青葱管中，滴入耳内。
〔附录〕耳朵，属于足少阴肾经，是肾脏寄居窍穴于耳的表现。肾气通达于耳，所主宰的是精。精气调和，肾气充足，则听力灵敏聪慧。如果劳损伤及气血，风邪侵袭虚弱之处，导致精气耗脱、肾气疲惫，则听力下降转为耳聋。又有因气机逆乱而耳聋的，有挟带风邪而耳聋的，有因劳损而耳聋的。大概十二经脉上行联络于耳，当阴阳各经恰好发生交并时，脏气逆乱而发生厥证，厥气搏结进入耳中，称为厥聋，必然伴有眩晕的症状。
耳朵，是众多经脉依附汇聚之处。脉象虚弱而风邪乘虚而入，风邪进入耳部经脉，使经气痞塞不通畅，称为风聋，必然伴有头痛的症状。劳累过度伤及血气，淫欲耗损精元，身体消瘦憔悴、力气疲乏，昏昏沉沉，这是劳聋。如果能调养得当，血气平和，则耳聋暂时减轻。
又有耳部触犯风邪，与气相互搏结，声音嘈杂，眼前见光，称为虚聋。热气乘虚随经脉进入耳中，聚热不散，流出浓稠汁液，称为脓耳。人耳间本来有津液，轻微时不能造成危害，如果风热搏结，津液凝结成核堵塞耳道，也会导致突发耳聋，称为耵聍栓塞（耵耳）。前述几种情况，可以通过推察肾脉来判断。风邪所致脉象浮而盛，热邪所致脉象洪大而实，虚证所致脉象涩而濡软。风邪用疏散法治疗，热邪用清利法治疗，虚证用调养法治疗，邪气退去后，然后用通耳调气安肾的方剂为主进行治疗。掌握了这些，就得到了治疗耳病的精髓。
【附方】
《和剂局方》流气饮：治疗厥聋。
方剂见于气类章节，内部加入石菖蒲、生姜、葱白，共同煎煮服用。治疗耳聋都应当调理气机。
桂星散：治疗风虚耳聋。
辣桂、川芎、当归、细辛、石菖蒲、木通、白蒺藜（炒）、木香、麻黄（去节）、甘草（炙，各二钱半）、天南星（煨）、白芷梢（各四钱）、紫苏（一钱）。
以上切碎。每次服用二钱，水煎，加葱白二茎，饭后服用。
地黄丸：治疗劳损耳聋。
熟地黄、当归、川芎、辣桂、菟丝子、川椒（炒）、故纸（炒，即补骨脂）、白蒺藜（炒）、胡芦巴（炒）、杜仲（炒）、白芷、石菖蒲（各一钱半）、磁石（火烧醋淬七次，研磨，水飞，一钱二分半）。
以上研为末，炼蜜为丸，如梧桐子大。每次服用五十丸，用葱白温酒送服。
益智散：治疗肾虚耳聋。
磁石（按前法炮制）、巴戟天（去心）、川椒（各一两，炒）、沉香、石菖蒲（各半两）。
以上研为末。每次服用二钱，用猪肾一枚切细，加入少许葱白和盐，并用湿纸十层包裹，煨至熟透。空腹嚼食，用酒送下。
芎芷散：治疗风入耳虚鸣。
白芷、石菖蒲（炒）、苍术、陈皮、细辛、厚朴、半夏、桂枝、木通、紫苏（茎叶）、甘草（炙，各二钱半）、川芎（五钱）。
以上切碎成散剂。每次服用三钱，加姜三片、葱二枝，水煎，饭后临睡前服用。
耳鸣方
草乌（烧制）、石菖蒲。
以上等分为末。用绵纱包裹塞入耳中，一日三次。
耳鸣暴聋方
川椒、石菖蒲、松脂（各二钱半）、山豆根肉（半钱）。
以上研为末，溶化蜡丸如枣核大。塞入耳中。
蔓荆子散：治疗内热，耳出脓汁。
甘草（炙）、川升麻、木通、赤芍、桑白皮（炒）、麦门冬（去心）、生地黄、前胡、甘菊、赤茯苓、蔓荆子。
以上等分，每次服用三钱，加姜三片、枣一枚煎煮，饭后温服。
又一方：治疗耳内出脓。
真龙骨、枯白矾、赤小豆、黄丹、乌贼骨、胭脂（一钱一分）。
以上研为末，掺入耳中。
又一方：治疗耳内脓出或黄汁。
石膏（新瓦上煅烧）、明矾（枯）、黄丹（炒）、真蚌粉、龙骨（各等分）、麝香（少许）。
以上研为末。用绵缠竹签擦拭耳道，换绵蘸取药物放入耳中。
耵耳方：治疗风热搏结，津液凝结成核堵塞耳道。
生猪脂、地龙、釜下墨（等分）。
以上细研，用葱汁调和捏如枣核大小。薄绵包裹放入耳中，使其湿润，即可挑出。
桃花散：治疗耳中出脓。
枯矾、干胭脂（各一钱）、麝香（一字）。
以上研为末。用棉杖蘸药捻入耳中。
Deafness is generally attributed to Heat. There is a predominance of Heat in the Shaoyang (Lesser Yang) and Jueyin (Terminal Yin) channels; treatment should employ methods to resolve phlegm, disperse wind, and clear heat, using formulas such as Fangfeng Tongsheng San (Wind-Protecting Universal Relief Powder) or Guntan Wan (Phlegm-Rolling Pill). Deafness occurring after a major illness requires Siwu Tang (Four Substances Decoction) to descend fire. Deafness caused by Yin deficiency with hyperactive ministerial fire also utilizes Siwu Tang (Four Substances Decoction).
For deafness due to Qi stagnation, add Rhubarb (Rhubarb Root and Rhizome, Da Huang) steamed in wine to Fangfeng Tongsheng San (Wind-Protecting Universal Relief Powder), stir-fry twice with wine, then mix with other herbs, all processed with wine stir-frying. For tinnitus caused by alcohol obstruction, use a large dose of Fangfeng Tongsheng San (Wind-Protecting Universal Relief Powder) added with Aurantium Fructus (Zhi Ke), Bupleurum Radix (Chai Hu), Rhubarb (Da Huang), Licorice Root (Gan Cao), Arisaema Rhizome (Nan Xing), Platycodon Root (Jie Geng), Tangerine Peel (Qing Pi), and Schizonepeta Spike (Jing Jie). If ineffective, Siwu Tang (Four Substances Decoction) yields excellent results. Tinnitus must be treated with Longhui Wan (Dragon Gallbladder Pill) taken after meals. In cases of excess Qi, Binglang Wan (Areca Nut Pill) or Shenxiong Wan (Divine Celery Pill) may be used to purge downward. Deafness requires Longhui Wan (Dragon Gallbladder Pill) combined with Siwu Tang (Four Substances Decoction) to nourish Yin. For damp-phlegm patterns, Shenxiong Wan (Divine Celery Pill) or Binglang Wan (Areca Nut Pill) are indicated. For ear dampness with swelling and pain, Liangge San (Cool the Chest Powder) is administered with additions of Rhubarb (Da Huang) stir-fried in wine, Scutellaria Root (Huang Qin), Saposhnikovia Root (Fang Feng) soaked in wine, Schizonepeta Spike (Jing Jie), and Notopterygium Rhizome (Qiang Huo); this pattern often presents with excessive head congestion and deficient essence. If dampness is present, Calcined Alum (Ku Fan) powder can be insufflated into the ear. A buzzing sensation in the ear also indicates Yin deficiency.
Dai Yuanli stated: There are also cases of deafness due to Qi blockage, which essentially stem from Heat; in Qi-blockage deafness, there is no tinnitus.
[Prescription for Insertion]
Cannabis Seed (Bimazi, 49 seeds) and Date Flesh (10 dates).
Mix with human breast milk, pound into a paste, dry slightly on stone, and form pills the size of a finger. Wrap in cotton and insert into the ear.
Another prescription:
Drop Rat Gallbladder Juice into the ear; this is particularly effective.
Another prescription:
Place a turtle on a lacquered table, collect its urine, soak cotton in it, insert the cotton into a green onion tube, and drip into the ear.
[Appendix] The ear belongs to the Foot-Shaoyin Kidney meridian; it is the orifice where the Kidney manifests. Kidney Qi communicates with the ear, governing Essence (Jing). When Essence and Qi are harmonious and Kidney Qi is sufficient, hearing is acute and clear. If labor injures Qi and Blood, and Wind pathogen attacks the deficiency, causing Essence depletion and Kidney exhaustion, hearing declines leading to deafness. There is also deafness due to Qi reversal, deafness accompanied by Wind, and deafness due to overexertion. Generally, the twelve meridians connect to the ear. When Yin and Yang meridians intersect abnormally, Zang organ Qi becomes rebellious and reverses, entering the ear, termed Jue Deafness (Reversal Deafness), which must be accompanied by vertigo.
The ear is the attachment site for the Grand Vessels (Zong Mai). When vessels are deficient and Wind pathogen exploits this, Wind enters the ear vessels, causing Qi stagnation and obstruction, termed Feng Deafness (Wind Deafness), which must be accompanied by headache. Overwork injures Qi and Blood, and sexual excess depletes Essence and Yuan Qi, leading to emaciation, fatigue, and dizziness; this is Lao Deafness (Exhaustion Deafness). If one rests properly, allowing Qi and Blood to harmonize, the deafness temporarily alleviates.
There is also deafness where Wind pathogen touches the ear and combats with Qi, causing noisy sounds and visual hallucinations (seeing light), termed Xu Deafness (Deficiency Deafness). Heat pathogen enters the ear via vessels due to deficiency, accumulating heat that does not dissipate, resulting in thick discharge, termed Nong Er (Pus Ear). Normally, fluids exist in the ear; if mild, they cause no harm. However, if Wind-Heat combats them, fluids condense into nodules blocking the ear, causing sudden deafness, termed Ding Er (Cerumen Impaction). The aforementioned conditions can be diagnosed by palpating the Kidney pulse. Wind presents as floating and vigorous; Heat as surging and excess; Deficiency as choppy and soft. Wind is treated by dispersing, Heat by clearing and draining, and Deficiency by nourishing and regulating. After pathogenic factors are repelled, formulas that unblock the ear, regulate Qi, and calm the Kidney are primarily used. Mastering these principles constitutes the essence of treating ear diseases.
[Attached Formulas]
Heji Liqi Yin (Harmonizing Bureau Flowing-Qi Decoction): Treats Jue Deafness.
See the Qi category; add Stone Calamus (Shi Chang Pu), Ginger, and Scallion, decoct together and take. Treating deafness always requires regulating Qi.
Guixing San (Cinnamon Star Powder): Treats Wind-Deficiency Deafness.
Cinnamon Twig (La Gui), Ligusticum Chuanxiong Rhizome (Chuan Xiong), Angelica Sinensis Radix (Dang Gui), Asarum Root (Xi Xin), Stone Calamus (Shi Chang Pu), Akebia Caulis (Mu Tong), Tribulus Fruit (Bai Ji Li, stir-fried), Costus Root (Mu Xiang), Ephedra Stem (Mahuang, nodes removed), Licorice Root (Gan Zhi, each 2.5 qian), Arisaema Rhizome (Nan Xing, baked), Angelica Dahurica Root Tip (Bai Zhi Shao, each 4 qian), Perilla Leaf (Zi Su, 1 qian).
Cut into pieces. Take 2 qian per dose, decoct in water with two scallion stalks, take after meals.
Dihuang Wan (Rehmannia Pill): Treats Exhaustion Deafness.
Prepared Rehmannia Root (Shu Di Huang), Angelica Sinensis Radix (Dang Gui), Ligusticum Chuanxiong Rhizome (Chuan Xiong), Cinnamon Twig (La Gui), Dodder Seed (Tu Si Zi), Sichuan Pepper (Chuan Jiao, stir-fried), Psoralea Fruit (Gu Zhi/Bu Gu Zhi, stir-fried), Tribulus Fruit (Bai Ji Li, stir-fried), Fenugreek Seed (Hu Lu Ba, stir-fried), Eucommia Bark (Du Zhong, stir-fried), Angelica Dahurica Root (Bai Zhi), Stone Calamus (Shi Chang Pu, each 1.5 qian), Magnetite (Ci Shi, calcined in vinegar seven times, ground, water-washed, 1.25 qian).
Grind into powder, make pills with refined honey the size of paulownia seeds. Take 50 pills, washed down with warm wine containing scallion white.
Yizhi San (Wisdom Powder): Treats Kidney-Deficiency Deafness.
Magnetite (Ci Shi, prepared as above), Morinda Root (Ba Ji, heart removed), Sichuan Pepper (Chuan Jiao, each 1 liang, stir-fried), Agarwood (Chen Xiang), Stone Calamus (Shi Chang Pu, each 0.5 liang).
Grind into powder. Take 2 qian per dose. Slice one pig kidney finely, mix with scallion white and a little salt, wrap in ten layers of wet paper, and bake until cooked. Chew on an empty stomach, wash down with wine.
Xiongzi San (Celery-Anthracnose Powder): Treats Wind-entering-Ear Deficient Tinnitus.
Angelica Dahurica Root (Bai Zhi), Stone Calamus (Shi Chang Pu, stir-fried), Atractylodes Rhizome (Cang Zhu), Tangerine Peel (Chen Pi), Asarum Root (Xi Xin), Magnolia Bark (Hou Po), Pinellia Tuber (Ban Xia), Cinnamon (Gui), Akebia Caulis (Mu Tong), Perilla (Zi Su, stems and leaves), Licorice Root (Gan Zhi, each 2.5 qian), Ligusticum Chuanxiong Rhizome (Chuan Xiong, 5 qian).
Cut into coarse powder. Take 3 qian per dose, with three slices of ginger and two scallion stalks, decoct in water, take after meals before bed.
Tinnitus Prescription
Aconite Root (Caowu, roasted), Stone Calamus (Shi Chang Pu).
Grind equally into powder. Wrap in cotton and insert into the ear, three times a day.
Sudden Tinnitus and Deafness Prescription
Sichuan Pepper (Chuan Jiao), Stone Calamus (Shi Chang Pu), Pine Resin (Song Zhi, each 2.5 qian), Sophora Root Meat (Shan Dou Gen, 0.5 qian).
Grind into powder, melt wax to form pills the size of a date pit. Insert into the ear.
Manjingzi San (Vitex Powder): Treats Internal Heat with Ear Pus Discharge.
Licorice Root (Gan Zhi, roasted), Cimicifuga Rhizome (Chuan Sheng Ma), Akebia Caulis (Mu Tong), Red Peony Root (Chi Shao), Mulberry Root Bark (Sang Bai Pi, stir-fried), Ophiopogon Tuber (Mai Men Dong, heart removed), Raw Rehmannia Root (Sheng Di Huang), Peucedanum Root (Qian Hu), Chrysanthemum Flower (Gan Ju), Red Poria (Chi Fu Ling), Vitex Fruit (Man Jing Zi).
Equal parts. Take 3 qian per dose, decoct with three slices of ginger and one jujube, take warm after meals.
Another Prescription: Treats Ear Pus Discharge.
Real Dragon Bone (Zhen Long Gu), Calcined White Alum (Ku Bai Fan), Adzuki Bean (Chi Xiao Dou), Lead Monoxide (Hong Dan), Cuttlefish Bone (Wu Zei Gu), Madder Root (Yan Zhi, 1.1 qian).
Grind into powder and insufflate into the ear.
Another Prescription: Treats Ear Pus or Yellow Fluid Discharge.
Gypsum (Shi Gao, calcined on new tile), Refined Alum (Ming Fan, calcined), Lead Monoxide (Hong Dan, stir-fried), Real Pearl Powder (Zhen Bang Fen), Dragon Bone (Long Gu, equal parts), Musk (She Xiang, a small amount).
Grind into powder. Wipe the ear with a cotton-wrapped bamboo stick, then insert cotton dipped in medicine into the ear.
Ding Er Prescription: Treats Wind-Heat Combustion causing Fluid Condensation into Nodules Blocking the Ear.
Fresh Pig Lard, Earthworm (Di Long), Soot from Cauldron Bottom (Fu Xia Mo, equal parts).
Grind finely, mix with scallion juice to form pills the size of a date pit. Wrap thinly in cotton, insert into the ear to moisten, then pick out.
Ear Ulceration
Powdered Fritillaria Bulb (Beimu), sprinkle dry onto the lesion.
Taohua San (Peach Blossom Powder): Treats Ear Pus Discharge.
Calcined Alum (Ku Fan), Dry Madder Root (Gan Yan Zhi, each 1 qian), Musk (She Xiang, one zi).
Grind into powder. Dip a cotton swab in the medicine and twist into the ear.
Fangfeng Tongsheng San: See Rash Category.
Guntan Wan (Phlegm-Rolling Pill)
Rhubarb Root and Rhizome (Da Huang, 0.5 jin), Scutellaria Root (Huang Qin, 0.5 jin), Qingmengshi (Qing Meng Shi, 1 liang), Agarwood (Chen Xiang, 5 qian).
Grind into powder, make water pills the size of paulownia seeds.
Longhui Wan (Dragon Gallbladder Pill): See Hypochondriac Pain Category.
Binglang Wan (Areca Nut Pill): See Dysentery Category.
Shenxiong Wan (Divine Celery Pill): See Gout Category.
Liangge San (Cool the Chest Powder): See Spontaneous Sweating Category.