耳者。肾之窍。足少阴之所主。人身十二经络中。除足太阳手厥阴。其余十经络。皆入于耳。惟肾开窍于
耳。故治耳者。以肾为主。或曰。心亦开窍于耳。何也。盖心窍本在舌。以舌无孔窍。因寄于耳。此肾为耳
窍之主。心为耳窍之客尔。以五脏开于五部。分阴阳言之。在肾肝居阴。故耳目二窍。阴精主之。在心
脾肺居阳。故口鼻舌三窍。阳精主之。灵枢云。肾气通乎耳。肾和则能闻五音。五脏不和。则七窍不通。故
凡一经一络有虚实之气入于耳者。皆足以乱其聪明。而致于聋聩。此言暴病者也。若夫久聋者。于肾亦有虚实
之异。左肾为阴主精。右肾为阳主气。精不足气有余。则聋为虚。若其人瘦而色黑。筋骨健壮。此精气俱有
余。固藏闭塞。是聋为实。乃高寿之兆也。二者皆禀所致。不须治之。又有乍聋者。经曰。不知调和七损八益
之道。早衰之节也。其年未五十。体重耳目不聪明矣。是可畏也。其证耳聋面颊黑者。为脱精肾惫。安肾丸
八味丸苁蓉丸薯蓣丸。选而用之。若肾经虚火面赤口干痰盛内热者。六味丸主之。此论阴虚者也。至于阳虚
者。亦有耳聋。经曰。清阳出上窍。胃气者。清气元气春升之气也。同出而异名也。今人饮食劳倦。脾胃之
气一虚。不能上升。而下流于肾肝。故阳气者闭塞。地气者冒
明。邪害空窍。今人耳目不明。此阳虚耳聋。须用东垣补中益气汤主之。有能调养得所。气血和平。则其耳聋
渐轻。若不知自节。日就烦劳。即为久聋之证矣。
又有因虚而外邪乘袭者。如伤寒邪入少阳。则耳聋胁痛之类。当各经分治之。
又有耳痛耳鸣耳痒耳脓耳疮。亦当从少阴正窍。分寒热虚实而治之者多。不可专作火与外邪治。耳鸣以手
按之而不鸣。或少减者。虚也。手按之而愈鸣者。实也。王节斋云。耳鸣盛如蝉。或左或右。或时闭塞。世
人多作肾虚治不效。殊不知此是痰火上升。郁于耳而为鸣。甚则闭塞矣。若其人平昔饮酒浓味。上焦素有痰
火。只作清痰降火治之。大抵此证多先有痰火在上。又感恼怒而得。则气上少阳之火客于耳也。若肾虚而鸣
者。其鸣不甚。其人必多欲。当见劳怯等证。惟薛立斋详分缕析。云血虚有火。用四物加山栀柴胡。若中气虚
弱。用补中益气汤。若血气俱虚。用八珍汤加柴胡。若怒便聋而或鸣者。属肝胆经气实。用小柴胡加芎归山
栀。虚用八珍汤加山栀。若午前甚者。阳气实热也。小柴胡加黄连山栀。阳气虚。用补中益气汤。加柴胡山
栀。午后甚者。阴血虚也。四物加白术茯苓。若肾虚火动。或痰盛作渴者。必用地黄丸。
耳中哄哄然。是无阴也。又液脱者。脑髓消。胫瘦。耳数鸣。宜地黄丸。
肾虚耳中潮声蝉声。无休止时。妨害听闻者。当坠气补肾。正元饮咽黑锡丹。间进安肾丸。肾脏风耳鸣。
夜间睡着。如打战鼓。更四肢抽掣痛。耳内觉风吹奇痒。宜黄 丸。肾者宗脉所聚。耳为之窍。血气不足。
宗脉乃虚。风邪乘虚。随脉入耳。气与之搏。故为耳鸣。先用生料五苓散。加制枳壳橘红紫苏生姜同
煎。吞青木香丸。散邪风下气。续以芎归饮和养之。耳中耵聍。
耳鸣耳聋。内有污血。宜柴胡聪耳汤。
其余耳痛耳痒耳肿等证。悉与薛氏论相参用之。丹铅续录云。王万里时患耳痛。魏文靖公劝以服青盐
鹿茸煎雄附为剂。且言此药非为君虚损服之。曷不观易之坎为耳痛。坎水藏在肾。开窍于耳。而在志为恐。恐
则伤肾。故耳痛。气阳运动常显。血阴流行常幽。血在形。如水在天地间。故坎为血卦。是经中已
着病证矣。竟饵之而悉愈。
圣惠云。有耳痒。一日一作。可畏。直挑剔出血稍愈。此乃肾脏虚。致浮毒上攻。未易以常法治也。
宜服透冰丹。勿饮酒啖湿面鸡猪之属。能尽一月为佳。不能戒无效。
耳朵，是肾的窍道，由足少阴经所主管。在人体十二经络中，除了足太阳经和手厥阴经之外，其余十条经络都进入耳部。只有肾开窍于耳，所以治疗耳病，以调理肾脏为主。有人问：心也开窍于耳，这是为什么呢？原来心的窍本在舌，因为舌上没有孔窍，所以借居于耳。这样看来，肾是耳窍的主人，心只是耳窍的客人罢了。从五脏开窍于五体部位，分阴阳来说，肾和肝居于阴位，所以耳目两个窍道由阴精主司；心和脾、肺居于阳位，所以口、鼻、舌三个窍道由阳精主司。《灵枢》说：肾气通于耳，肾气调和就能听见五音。如果五脏不和，就会七窍不通。所以凡是有一条经脉或络脉有虚实之气侵入耳部，都足以扰乱人的听力视力，导致耳聋失聪。这是指突发的疾病而言。至于长期的耳聋，在肾脏也有虚实的区别。左肾属阴主藏精，右肾属阳主化气。如果精气不足而气有余，则耳聋属于虚证；如果其人形体消瘦且面色黑，但筋骨健壮，这是精气都有余，导致固藏闭塞，这种耳聋属于实证，反而是高寿的征兆。这两种情况都是禀赋所致，不需要治疗。又有突然耳聋的情况，《内经》说：不懂得调和“七损八益”的道理，是早衰的节律。年纪不到五十岁，身体沉重，耳目不聪明，这是值得警惕的。其症状为耳聋且面颊发黑的，属于精气耗脱、肾气疲惫，可选用安肾丸、八味丸、苁蓉丸、薯蓣丸等方剂服用。如果是肾经虚火旺盛，见面红、口干、痰多、内热的症状，用六味丸主治。这是论述阴虚导致的耳聋。至于阳虚导致的耳聋，也有这种情况。《内经》说：清阳之气出于上窍。胃气，就是清气、元气、春升之气，名称不同但来源相同。现在的人饮食不节、劳倦过度，导致脾胃之气虚弱，不能上升，反而下流于肝肾，使得阳气闭塞，地气（浊阴）蒙蔽清明，邪气侵害空窍，导致现代人耳目不明。这是阳虚导致的耳聋，必须使用东垣的补中益气汤主治。如果能调养得当，气血平和，那么耳聋会逐渐减轻。如果不知道自我节制，日益烦劳，就会变成久聋的病证。
又有因正气虚弱而外邪乘虚侵袭的情况，比如伤寒邪气传入少阳经，就会出现耳聋、胁痛等症状，应当根据各经分别治疗。
又有耳痛、耳鸣、耳痒、耳流脓、耳疮等病症，大多也应该从少阴正窍出发，分辨寒热虚实来治疗，不能专门当作火邪或外邪来治。耳鸣时用手按压后声音不响或减轻的，属于虚证；用手按压后声音反而加剧的，属于实证。王节斋说：耳鸣声大如蝉鸣，有时在左耳有时在右耳，有时伴有闭塞感，世人多当作肾虚治疗却无效，殊不知这是因为痰火上升，郁结于耳而导致鸣响，严重时甚至闭塞。如果其人平时喜欢饮酒和厚味，上焦素有痰火，只需用清热化痰、降火的方法治疗。大抵这类病症多先有痰火在上焦，又因恼怒引发，导致少阳之火客居耳部。如果是肾虚导致的耳鸣，鸣响程度不重，其人必定房事过多，会出现劳怯等证候。只有薛立斋详细分析，指出血虚有火的，用四物汤加山栀、柴胡；中气虚弱的，用补中益气汤；气血俱虚的，用八珍汤加柴胡；因愤怒导致耳聋或耳鸣的，属于肝胆经气实，用小柴胡汤加川芎、当归、山栀；虚证用八珍汤加山栀。如果午前症状加重，是阳气实热，用小柴胡汤加黄连、山栀；阳气虚的用补中益气汤加柴胡、山栀。午后症状加重，是阴血虚，用四物汤加白术、茯苓。如果是肾虚火动，或痰盛口渴的，必须用地黄丸。
耳中嗡嗡作响，是无阴的表现。另外津液耗脱的，脑髓消减，小腿瘦弱，耳朵经常鸣响，宜用地黄丸。
肾虚导致耳中如潮声、蝉声般鸣响，没有休止时间，妨碍听力的，应当降气补肾，服用正元饮，吞服黑锡丹，间歇进服安肾丸。肾脏风引起的耳鸣，夜间睡着时感觉像打战鼓一样，并且四肢抽搐疼痛，耳内感觉风吹般的奇痒，宜用某丸（原文缺字，推测为祛风类丸剂）。肾是宗脉汇聚之处，耳是其窍道，血气不足，宗脉就会空虚，风邪乘虚随脉进入耳部，气与邪相搏，所以产生耳鸣。先用生料五苓散，加制枳壳、橘红、紫苏、生姜同煎，吞服青木香丸，以疏散邪风、下气。随后用芎归饮调和滋养。耳中有耵聍（耳屎）。
其余耳痛、耳痒、耳肿等证候，全部参考薛氏的论述来应用。《丹铅续录》记载：王万里当时患耳痛，魏文靖公劝他服用青盐、鹿茸、雄黄、附子制成的药剂，并且说这个药不是给君主虚损之人服的，为什么不看看《易经》中坎卦对应耳痛？坎水藏在肾，开窍于耳，在情志上对应恐。恐惧会伤肾，所以导致耳痛。气属阳，运动时常显现；血属阴，流行时常幽隐。血存在于形体中，就像水存在于天地间，所以坎卦是血卦。这在经络中已经涉及病证了。最终服用此药而全部痊愈。
《圣惠方》说：有耳痒，一天发作一次，很可怕。直接挑破出血后会稍微好转。这是肾脏虚弱，导致浮毒上攻，不容易用常规方法治疗。宜服用透冰丹，不要饮酒和吃湿面、鸡、猪等食物，能坚持一个月最好，如果不能戒除则无效。
The ear is the orifice of the Kidney (Shen, 肾), governed by the Foot Shaoyin (Zu Shao Yin, 足少阴) meridian. Among the twelve meridians of the human body, except for the Foot Taiyang (Zu Tai Yang, 足太阳) and Hand Jueyin (Shou Jue Yin, 手厥阴) meridians, the remaining ten meridians all enter the ear. Only the Kidney opens into the ear; therefore, in treating ear diseases, regulation of the Kidney is primary. One might ask: The Heart (Xin, 心) also opens into the ear. Why is this? Originally, the orifice of the Heart is located in the tongue. Because the tongue has no orifice, it resides provisionally in the ear. Thus, the Kidney is the master of the ear's orifice, while the Heart is merely its guest. Speaking from the perspective of Yin and Yang regarding the five Zang organs opening into five body parts: the Kidney and Liver (Gan, 肝) reside in the Yin aspect, so the two orifices of the eye and ear are governed by Yin Essence (Yin Jing, 阴精). The Heart, Spleen (Pi, 脾), and Lung (Fei, 肺) reside in the Yang aspect, so the three orifices of the mouth, nose, and tongue are governed by Yang Essence (Yang Jing, 阳精). The *Ling Shu* states: "Kidney Qi connects to the ear. When Kidney Qi is harmonious, one can hear the five tones. If the five Zang organs are not harmonious, the seven orifices will be blocked." Therefore, whenever there is excess or deficiency Qi entering the ear through any single meridian or collateral, it is sufficient to disturb one's hearing and vision, leading to deafness and dullness. This refers to acute conditions. As for chronic deafness, there are also differences between deficiency and excess in the Kidneys. The Left Kidney belongs to Yin and governs Essence; the Right Kidney belongs to Yang and governs Qi. If Essence is insufficient but Qi is excessive, deafness is a deficiency syndrome. If a person is thin with dark complexion but has strong sinews and bones, this indicates that both Essence and Qi are abundant, causing obstruction in storage and closure; such deafness is an excess syndrome and is actually a sign of longevity. Both types are due to constitutional endowment and require no treatment. There is also sudden deafness. The Classics state: "Not knowing the way of harmonizing the 'Seven Losses and Eight Benefits' is the pattern of premature aging." Before the age of fifty, if the body feels heavy and the ears and eyes are not sharp, this is alarming. For symptoms of deafness with blackish cheeks, it indicates exhaustion of Essence and fatigue of the Kidney; select from An Shen Wan (Ankid Pill), Ba Wei Wan (Eight-Ingredient Pill), Cong Rong Wan (Cistanche Pill), or Shu Yu Wan (Dioscorea Pill) for use. If there is deficient fire in the Kidney meridian presenting with red face, dry mouth, profuse phlegm, and internal heat, Liu Wei Wan (Six-Ingredient Pill) is the main prescription. This discusses deafness due to Yin deficiency. As for deafness due to Yang deficiency, it also occurs. The Classics state: "Clear Yang emerges from the upper orifices." Stomach Qi is clear Qi, Yuan Qi, and Spring-rising Qi; they share the same origin but have different names. Nowadays, people suffer from irregular diet and overwork, causing Spleen and Stomach Qi to become deficient. Unable to ascend, it flows downward into the Liver and Kidney. Consequently, Yang Qi becomes obstructed, and Earth Qi (turbid Yin) obscures clarity, allowing pathogenic factors to harm the orifices, resulting in unclear hearing and vision in modern people. This is deafness due to Yang deficiency, requiring Dongyuan's Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) as the main treatment. If one can nourish oneself properly, achieving harmony of Qi and Blood, the deafness will gradually lessen. If one fails to self-regulate and becomes increasingly fatigued, it will develop into chronic deafness.
There are also cases where external pathogens invade due to deficiency, such as when Cold Damage pathogens enter the Shaoyang (Lesser Yang) meridian, causing symptoms like deafness and hypochondriac pain. These should be treated according to the respective meridians.
Other conditions such as earache, tinnitus, pruritus auris, otorrhea, and otic ulcers should mostly be treated by distinguishing cold, heat, deficiency, and excess from the perspective of the Shaoyin proper orifice. They should not be exclusively treated as Fire pathogens or external pathogens. Tinnitus that diminishes or stops when pressed with the hand indicates deficiency; tinnitus that intensifies when pressed indicates excess. Wang Jiezhai stated: "Tinnitus sounding loud like cicadas, occurring on either side or accompanied by blockage, is often mistakenly treated as Kidney deficiency by the public, yielding no effect. In fact, this is caused by Phlegm-Fire ascending and stagnating in the ear, causing ringing, and severe blockage if intense." If the patient usually consumes alcohol and rich flavors, having Phlegm-Fire in the Upper Jiao, treat only by clearing Phlegm and reducing Fire. Generally, this condition arises from pre-existing Phlegm-Fire in the upper region, combined with anger, causing Shaoyang Fire to lodge in the ear. If tinnitus is due to Kidney deficiency, the sound is not severe, and the patient likely has excessive sexual activity, manifesting as consumptive syndromes. Only Xue Lizhai analyzed this in detail: for Blood deficiency with Fire, use Si Wu Tang (Four-Substance Decoction) plus Gardenia (Shan Zhi, 山栀) and Bupleurum (Chai Hu, 柴胡); for Middle Qi weakness, use Bu Zhong Yi Qi Tang; for dual Qi and Blood deficiency, use Ba Zhen Tang (Eight-Treasure Decoction) plus Bupleurum; for deafness or tinnitus triggered by anger, belonging to excess Qi in the Liver and Gallbladder meridians, use Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Ligusticum (Xiong Gui, 川归/川芎当归), Gardenia; for deficiency, use Ba Zhen Tang plus Gardenia. If symptoms worsen before noon, it is Yang excess heat; use Xiao Chai Hu Tang plus Coptis (Huang Lian, 黄连) and Gardenia. For Yang deficiency, use Bu Zhong Yi Qi Tang plus Bupleurum and Gardenia. If symptoms worsen after noon, it is Yin-Blood deficiency; use Si Wu Tang plus Atractylodes (Bai Zhu, 白术) and Poria (Fu Ling, 茯苓). For Kidney deficiency with moving Fire, or profuse Phlegm with thirst, Di Huang Wan (Rehmannia Pill) must be used.
A humming sensation in the ear indicates lack of Yin. Additionally, when Body Fluids are depleted, Marrow of the Brain diminishes, calves become emaciated, and the ears ring frequently; Di Huang Wan is appropriate.
For Kidney deficiency causing tidal or cicada-like sounds in the ears without cessation, interfering with hearing, one should descend Qi and tonify the Kidney, taking Zheng Yuan Yin (Orthodox Origin Drink) and swallowing Hei Xi Dan (Black Tin Pill), with intermittent administration of An Shen Wan. For tinnitus due to Wind-Dampness in the Kidney, where during sleep at night one feels like war drums beating, accompanied by spasmodic pain in the four limbs and strange itching in the ears as if wind is blowing, a certain pill (text missing, likely wind-dispelling) is indicated. The Kidney is the gathering place of the Zong Mai (Master Vessels), and the ear is its orifice. Insufficiency of Qi and Blood leads to emptiness in the Master Vessels; Wind pathogens invade following the vessels into the ear. Qi struggles with the pathogen, thus causing tinnitus. First, use Sheng Liao Wu Ling San (Raw Formula Five-Ling Powder) decocted with processed Zhi Ke (Aurantii Fructus), Ju Hong (Citri Reticulatae Pericarpium Rubrum), Zi Su (Perillae Folium), and Sheng Jiang (Zingiberis Rhizoma Recens), swallowed with Qing Mu Xiang Wan (Aquilariae Pill) to disperse Wind pathogens and direct Qi downward. Subsequently, use Xiong Gui Yin (Ligusticum and Angelica Drink) to harmonize and nourish. For cerumen (earwax) in the ear...
For tinnitus and deafness caused by foul blood inside, Chai Hu Cong Er Tang (Bupleurum Ear-Auditing Decoction) is suitable.
Other conditions such as earache, pruritus, and swelling should be referred to Xue's discussions for application. *Dan Qian Xu Lu* records: Wang Wanli suffered from earache. Wei Wenjing advised him to take a preparation made of Green Salt (Qing Yan, 青盐), Deer Antler (Lu Rong, 鹿茸), Realgar (Xiong Huang, 雄黄), and Prepared Aconite (Fu Zi, 附子). He said this medicine is not for sovereign deficiency. Have you not observed that in the *I Ching*, Kan (Water) corresponds to earache? Kan Water resides in the Kidney, opens into the ear, and corresponds to Fear in emotions. Fear injures the Kidney, thus causing earache. Qi (Yang) moves and manifests constantly; Blood (Yin) flows and remains hidden. Blood exists within form, just as water exists in heaven and earth; thus Kan is the hexagram of Blood. This pathology is already embedded in the meridians. Ultimately, he took this medicine and was completely cured.
*Sheng Hui Fang* states: Pruritus auris occurring once a day is terrifying. Directly piercing it until bleeding brings slight relief. This is due to Kidney deficiency causing floating toxicity to attack upward, difficult to treat with routine methods. Take Tou Bing Dan (Ice-Penetrating Pill). Avoid alcohol, damp noodles, chicken, and pork. Adherence for one month is ideal; failure to abstain renders it ineffective.