耳者心肾之窍，肝胆之经也。心肾主内症精血不足；肝胆主外症风热有余，或聋聩，或虚鸣
者，禀赋虚也。或胀痛，或脓痒者，邪气客也。禀赋不足，宜用六味地黄丸。肝经风热，宜
用柴胡清肝散。若因血燥，用栀子清肝散，未应，佐以六味丸，间服九味芦荟丸。若因肾肝
疳热，朝用六味丸，夕用芦荟丸。若因食积内热，用四味肥儿丸。若因乳母膏粱积热而致者，
宜加味清胃散；脾经郁结而致者，加味归脾汤；肝经怒火而致者，加味逍遥散，皆令乳母服之
，兼与其儿少许。不可专于治外，不惟闭塞耳窍，抑亦变生他症，延留日久，遂成终身之聩
矣。慎之！
治验
一小儿耳内出脓，秽不可近，连年不愈，口渴足热，或面色微黑，余谓肾疳症也。用六味
地黄丸，令母服加味逍遥散而愈。后因别服伐肝之药，耳症复作，寒热面青，小便频数，此
肝火血燥也。用柴胡栀子散以清肝，六味地黄丸以滋肾，遂痊。
一小儿耳内出脓，久不愈。视其母，两脸青黄，属乳母郁怒致之也，遂朝用加味归脾汤，夕
用加味逍遥散，母子皆愈。
一小儿十二岁，素虚羸，耳出脓水，或痛或痒，至十四，稍加用心，即发热倦怠，两腿乏力
八年矣，用补中益气汤及六味地黄丸，稍愈。毕姻后，朝寒暮热，形气倦怠，两足心热，气
喘唾痰，仍用前二药，佐以六君子汤而愈。因后不守禁忌，恶寒发热，头晕唾痰，余谓肾虚
不能摄水而似痰，清气不能上升而头晕，阳气不能护守肌肤而寒热。遂用补中益气汤加蔓荆
、附子一钱，四剂不应，遂用人参一两，附子一钱，二剂而应，乃用十全大补汤，百余剂而
痊。又因大劳入房，喉喑痰涌，两腿不遂，用地黄饮子顿愈，仍用十全大补汤而安。后又起
居失宜，朝寒暮热，四肢逆冷，气短痰盛，两寸脉短，用十全大补汤加附子一钱，数剂而愈
，乃去附子，用人参三钱，常服始安。
一小儿耳中流脓，项中结核，眼目或札或赤痛，小便或痒或赤涩，皆肝胆经风热之症也，用
四味肥儿丸悉愈。
一小儿因乳母恚怒，兼经行之后，多食炙 ，儿遂耳内作痛出脓，余先用加味小柴胡汤，次
用加味逍遥散，令其母服之，子母并愈。
一小儿耳出秽水，属肝肾不足，先用九味芦荟丸而痊。毕姻后，面黄发热多病，又用黄柏、
知母等药，更胸膈痞满，饮食少思，痰涎上壅，又利气化痰，加噫气下气，余用六君子、补中益
气二汤，干姜、木香等味，治之寻愈。
田氏红玉散 治小儿 耳。
枯矾 麝香 干胭脂（各等分）
上为末研匀，先以绵杖子捻脓净，掺入少许。
汤氏龙黄散 治如前。
枯矾 龙骨 黄丹（各半两） 麝香（一钱）
上制法同前。
愚按∶前二方可以治腑症之轻者，若系肝经风热血燥等症，必根据前方论内，服合宜之药，外
用此以收脓湿，亦无不可。若专泥外攻，而失内治，谬矣。
六味地黄丸（方见肾脏）
柴胡清肝散（方见胁痈）
栀子清肝散（方见热症）
九味芦荟丸（方见疳症）
四味肥儿丸（方见呕吐）
加味清胃散
加味归脾汤
加味逍遥散（三方见内钓）
加味栀子散
加味小柴胡汤（方见痉症）
六君子汤
四君子汤（二方见内钓）
地黄丸（方见肾脏）
七味白术散（方见积滞）
补中益气汤（方见虚羸）
二陈汤（方见寒吐）
耳朵是心肾的窍道，也是肝胆经脉所过之处。心肾主管内症，多因精血不足所致；肝胆主管外症，多因风热有余引起。出现耳聋或耳鸣的，是由于先天禀赋虚弱。出现耳胀痛或流脓瘙痒的，是由于邪气客居耳部。对于禀赋不足的，适宜使用六味地黄丸。对于肝经风热的，适宜使用柴胡清肝散。如果是由于血燥引起的，使用栀子清肝散，若无效，辅以六味地黄丸，交替服用九味芦荟丸。如果是由于肝肾疳热引起的，早晨服用六味地黄丸，晚上服用芦荟丸。如果是由于食积内热引起的，使用四味肥儿丸。如果是由于乳母食用膏粱厚味导致积热而传给孩子的，适宜使用加味清胃散；如果是由于脾经郁结引起的，使用加味归脾汤；如果是由于肝经怒火引起的，使用加味逍遥散，这些药物都让乳母服用，并给孩子少量服用。不可专门治疗外部症状，这不仅会闭塞耳窍，而且还会引发其他病症，拖延日久，最终成为终身耳聋。务必谨慎！
治验记录：
有一个小孩耳内流出脓液，气味秽臭难以靠近，连年不愈，口渴且足部发热，有时面色微黑，我认为这是肾疳症。使用六味地黄丸，让母亲服用加味逍遥散，病就好了。后来因为另外服用了损伤肝脏的药物，耳症复发，出现寒热往来、面色发青、小便频数，这是肝火血燥的表现。使用柴胡栀子散以清肝火，六味地黄丸以滋肾阴，于是痊愈。
有一个小孩耳内流脓，久治不愈。观察其母亲，两颊呈现青黄色，属于乳母郁怒导致的，于是早晨服用加味归脾汤，晚上服用加味逍遥散，母子俩都痊愈了。
有一个十二岁的小孩，平时身体虚弱消瘦，耳中流出脓水，有时疼痛有时瘙痒。到了十四岁时，稍微用一点心思，就出现发热倦怠、双腿乏力，这种情况持续了八年。使用补中益气汤及六味地黄丸，病情稍有好转。结婚后，出现早晨怕冷傍晚发热的症状，形体气息倦怠，两脚心发热，气喘且咳痰，仍然使用前两种药，辅以六君子汤而痊愈。后来因为没有遵守禁忌，出现恶寒发热、头晕、咳痰，我认为这是肾虚不能摄纳水液而表现为似有痰，清气不能上升而导致头晕，阳气不能护卫肌肤而导致寒热往来。于是使用补中益气汤加上蔓荆子、一钱附子，服用四剂没有反应，于是将人参用量增至一两，附子一钱，服用两剂后见效，接着使用十全大补汤，服用百余剂后痊愈。后来又因为过度劳累和房事，出现声音嘶哑、痰涌、双腿不能随意运动，使用地黄饮子立刻痊愈，随后仍用十全大补汤调理而安定。之后又因起居不当，出现早晨怕冷傍晚发热、四肢逆冷、气短痰多、两手寸脉短促，使用十全大补汤加上一钱附子，服用数剂后痊愈，然后去掉附子，加入三钱人参，常服才安定下来。
有一个小孩耳中流脓，颈部有结核，眼睛有时眨动或红肿疼痛，小便有时痒或红涩，这些都是肝胆经风热的症状，使用四味肥儿丸全部治愈。
有一个小孩因为乳母愤怒，加上月经结束后，吃了许多烤炙食物，孩子随即耳内作痛并出脓，我首先使用加味小柴胡汤，接着使用加味逍遥散，让乳母服用，母子一同痊愈。
有一个小孩耳中流出秽水，属于肝肾不足，首先使用九味芦荟丸而痊愈。结婚后，面色发黄、发热且多病，又使用了黄柏、知母等药物，反而导致胸膈痞满、饮食减少、痰涎上壅，又使用理气化痰、降气止噫的药物，我用六君子汤、补中益气汤二方，加上干姜、木香等药味，治疗不久即愈。
田氏红玉散 治疗小儿耳疮。
枯矾、麝香、干胭脂（各等分）
以上研成细末混合均匀，先用棉签捻净脓液，掺入少许药粉。
汤氏龙黄散 治疗方法同上。
枯矾、龙骨、黄丹（各半两）、麝香（一钱）
以上制作方法同前。
我按语：前两个方子可以治疗腑症中较轻的情况，如果是肝经风热血燥等症状，必须根据前面的论述，服用合适的内服药，外用此药来收敛脓湿，也是可以的。如果专门拘泥于外部攻伐，而忽视内部治疗，那就错了。
六味地黄丸（方剂见肾脏章节）
柴胡清肝散（方剂见胁痈章节）
栀子清肝散（方剂见热症章节）
九味芦荟丸（方剂见疳症章节）
四味肥儿丸（方剂见呕吐章节）
加味清胃散
加味归脾汤
加味逍遥散（三方见内钓章节）
加味栀子散
加味小柴胡汤（方剂见痉症章节）
六君子汤
四君子汤（二方见内钓章节）
地黄丸（方剂见肾脏章节）
七味白术散（方剂见积滞章节）
补中益气汤（方剂见虚羸章节）
二陈汤（方剂见寒吐章节）
The ear is the orifice of the Heart and Kidney, and the pathway of the Liver and Gallbladder meridians. The Heart and Kidney govern internal conditions, often due to insufficiency of essence and blood; the Liver and Gallbladder govern external conditions, often due to excess wind-heat. Deafness (Tingling/Deafness) or tinnitus (Empty ringing) arises from congenital deficiency. Distending pain or pus with itching arises from pathogenic factors lodging in the area. For congenital deficiency, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is suitable. For Liver meridian wind-heat, Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) is suitable. If caused by blood dryness, Zhizi Qinggan San (Gardenia Liver-Clearing Powder) is used; if ineffective, it is assisted by Liuwei Dihuang Wan, alternating with Jiwei Lushui Wan (Nine-Ingredient Aloe Pill). If caused by Liver-Kidney guan-heat (pediatric malnutrition heat), Liuwei Dihuang Wan is taken in the morning, and Lushui Wan in the evening. If caused by food stagnation generating internal heat, Siwei Fei'er Wan (Four-Ingredient Fattening Children Pill) is used. If caused by the mother's consumption of rich foods leading to accumulated heat transmitted to the child, Jiawei Qingwei San (Modified Stomach-Clearing Powder) is suitable; if caused by Spleen meridian depression/stagnation, Jiawei Guipi Tang (Modified Spleen-Supplementing Decoction) is used; if caused by Liver meridian fire anger, Jiawei Xiaoyao San (Modified Free Wanderer Powder) is used. These medications are administered to the nursing mother, with a small amount given to the infant. One must not treat only the external symptoms, as this will not only block the ear orifices but also induce other conditions. Prolonged delay may result in lifelong deafness. Be cautious!
Clinical Cases:
A child had pus oozing from the ear, foul-smelling and unbearable, persisting for years without healing, accompanied by thirst and hot feet, sometimes with a slightly dark complexion. I diagnosed this as Kidney guan syndrome. Liuwei Dihuang Wan was prescribed, and the mother took Jiawei Xiaoyao San, resulting in recovery. Later, due to taking drugs that damaged the Liver, the ear condition recurred with chills and fever, greenish complexion, and frequent urination, indicating Liver fire and blood dryness. Chaihu Zhizi San (Bupleurum Gardenia Powder) was used to clear the Liver, and Liuwei Dihuang Wan to nourish the Kidney, leading to full recovery.
Another child had persistent ear pus. Observing the mother, her cheeks were blue-yellow, indicating the cause was maternal depression and anger. She took Jiawei Guipi Tang in the morning and Jiawei Xiaoyao San in the evening, curing both mother and child.
A twelve-year-old child, constitutionally weak and emaciated, had pus and water oozing from the ears, with intermittent pain and itching. By age fourteen, after slight mental exertion, he developed fever, fatigue, and weakness in both legs, lasting eight years. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan were used, bringing slight improvement. After marriage, he experienced morning chills and evening fevers, physical and qi fatigue, hot soles, asthma, and phlegm sputum. The previous two formulas were continued, assisted by Liujunzi Tang (Six-Gentlemen Decoction), leading to recovery. Later, failing to observe dietary/lifestyle taboos, he developed aversion to cold, fever, dizziness, and phlegm sputum. I reasoned this was Kidney deficiency failing to control water (manifesting as phlegm), clear qi failing to ascend (causing dizziness), and yang qi failing to protect the skin (causing chills and fever). Buzhong Yiqi Tang was used with Manjingzi (Vitex Fruit) and 1 qian of Fuzi (Prepared Aconite Root). After four doses showed no effect, the dose of Renshen (Ginseng Root) was increased to 1 liang, with 1 qian of Fuzi. After two doses, there was a response. Then, Shiquan Dabu Tang (Ten-Tonics Great Supplement Decoction) was used for over one hundred doses until recovery. Subsequently, due to excessive labor and sexual activity, he developed hoarseness, surging phlegm, and inability to move his legs. Dihuang Yinzi (Rehmannia Infusion) brought immediate relief, followed by Shiquan Dabu Tang for stabilization. Later, due to improper daily routine, he again had morning chills/evening fevers, cold extremities, shortness of breath, abundant phlegm, and short pulses at both cun positions. Shiquan Dabu Tang with 1 qian of Fuzi cured him in several doses. Fuzi was then removed, and 3 qian of Renshen was added for long-term maintenance to ensure stability.
A child had ear pus, cervical lymph node swelling, blinking eyes, red/painful eyes, and itchy/red/difficult urination. These are all symptoms of Wind-Heat in the Liver and Gallbladder meridians. Siwei Fei'er Wan cured them all.
A child suffered ear pain and pus because the nursing mother was angry and consumed many roasted foods after menstruation. I first used Jiawei Xiao Chaihu Tang (Modified Minor Bupleurum Decoction), followed by Jiawei Xiaoyao San, administered to the mother, curing both.
A child had foul fluid from the ear, attributed to Liver-Kidney insufficiency. Jiwei Lushui Wan cured him initially. After marriage, he had a yellow face, fever, and frequent illness. He took Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome), which worsened his condition with chest oppression, poor appetite, and surging phlegm. Further use of qi-regulating and phlegm-resolving drugs led to belching. I treated him with Liujunzi Tang and Buzhong Yiqi Tang, plus Ganjiang (Dried Ginger) and Muxiang (Aucklandia Root), leading to quick recovery.
Tian's Hongyu San treats pediatric ear sores.
Mingfan (Alum), Shexiang (Musk), Ganyanzhi (Dry Carmine) (equal parts)
Grind into fine powder. First clean the pus with a cotton swab, then sprinkle a small amount of powder.
Tang's Longhuang San treats as above.
Mingfan (Alum), Longgu (Fossilized Bones), Huangdan (Red Lead), Shexiang (Musk) (1 qian)
Preparation method same as above.
My Commentary: The previous two formulas can treat mild Fu organ conditions. If the condition involves Liver meridian wind-heat and blood dryness, one must follow the internal treatment principles discussed earlier and take appropriate internal medicine. Using these externally to absorb dampness and pus is acceptable. However, relying solely on external attack while neglecting internal treatment is erroneous.
Liuwei Dihuang Wan (Formula see Kidney section)
Chaihu Qinggan San (Formula see Hypochondriac Carbuncle section)
Zhizi Qinggan San (Formula see Heat Syndrome section)
Jiwei Lushui Wan (Formula see Guan Syndrome section)
Siwei Fei'er Wan (Formula see Vomiting section)
Jiawei Qingwei San
Jiawei Guipi Tang
Jiawei Xiaoyao San (Three formulas see Internal Hook section)
Jiawei Zhizi San
Jiawei Xiao Chaihu Tang (Formula see Spasm section)
Liujunzi Tang
Sijunzi Tang (Two formulas see Internal Hook section)
Dihuang Wan (Formula see Kidney section)
Qiwei Baizhu San (Formula see Food Stagnation section)
Buzhong Yiqi Tang (Formula see Emaciation section)
Erchen Tang (Formula see Cold Vomiting section)