张友夔壮岁。常苦两耳痒。日一作。遇其甚时。殆不可耐。挑剔无所不至。而所患自
若
也。常以坚竹三寸许截之。拆为五六片。细刮如洗帚状。极力撞入耳中。皮破血出。或多至
一蚬壳而后止。明日复然。失血既多。为之困悴。适有河北医士周敏道至。询之。曰。此肾
脏风虚。致浮毒上攻。未易以常法治也。宜买透冰丹服之。勿饮酒。啖湿面菜蔬鸡猪之属。
能尽一月为佳。夔用其戒。数日痒止。而食忌不能久。既而复作。乃着意痛断累旬。耳不复
痒。
震按此种奇痒。断非寻常之药所能治。若寻常耳痒。或风或火。亦易治也。
立斋治一人。年二十。耳内出水作痛。年余矣。脉洪数。尺脉为甚。属肝肾二经虚热。
用加减地黄丸料。一剂而愈。
又一男子每交接。耳中作痛。或作痒。或出水。以银簪挖入。甚喜阴凉。此肾经虚火。
用加减八味丸而愈。
又一妇人。因怒发热。每经行。两耳出脓。两太阳作痛。以手按之。痛稍止。怒则胸胁
乳房胀痛。或寒热往来。小溲频数。或小腹胀闷。皆属肝火血虚。用加味逍遥散。诸证悉退
以补中益气加五味而痊。
震按以上三案。或凭脉。或证书。亦皆易辨。惟用加减八味丸者。谅其尺脉必微弱。或
虚大。故加温药以导纳之。若尺脉洪数。似宜用知柏地黄丸。
〔附〕一妇人于壁上取鸡翎卷耳。适蜈蚣生子在翎上。带入耳中。生小蜈蚣。穿脑内。
且痛且痒。百药莫效。一医令烧鸡肉。热置一器内。留一小孔盖上。令病者以耳受之。鸡香
熏入。蜈蚣悉攒鸡肉上。其病立愈。
石山治一人。年近六十。面色苍白。病左耳聋。三十年矣。近年来。或头左边及耳皆肿
溃脓。脓从耳出甚多。时或又肿复脓。今则右耳亦聋。屡服祛风去热逐痰之药。不效。汪
诊左手心脉浮小而快。肝肾沉小而快。右脉皆虚散而数。此恐乘舆远来。脉未定耳。来早脉
皆稍敛。不及五至。非比日前之甚数也。夫头之左边及耳前后皆属于少阳也。经曰。少阳多
气少血。今用风药痰药。类皆燥剂。少血之经。又以燥剂燥之。则血愈虚少矣。血少则涩
滞。涩滞则壅肿。且血逢冷则碍。今复以寒剂凝之。愈助其壅肿。久则郁而为热。腐肉成脓
从耳中出矣。渐至右耳亦聋者。脉络相贯。血气相根据。未有血病而气不病也。故始则左病
而终至于右亦病矣。是为病久气血两虚。且年六十。气血日涸。而又出外劳伤气血。又多
服燥剂以损其气血。脓又大泄以竭其气血。则虚而又虚可知矣。以理论之。当滋养气血。气
血健旺。则营运有常而病自去矣。否则不惟病不除。而脑痈耳疽。抑亦有不免矣。人参二钱
黄三钱。归身、白术、生姜各一钱。鼠粘子、连翘、柴胡、陈皮各六分。川芎、片芩、
白芍各七分。甘草五分。煎服十数帖而愈。
震按汪公之议论精微而又显畅。用药亦标本兼赅。真有掉臂游行之乐。即初诊时乘舆远
来。脉未定。而不足凭之说。更可为卤莽者鉴戒。
江应宿治上舍孙顺吾。患耳鸣重听。人事烦冗。杂治半年不愈。江视之。脉数滑。以二
陈加瞿麦、 蓄、木通、黄柏。一服知。二服已。
震按耳鸣同而此案与下案法各不同。若易而用之。彼此无效。故知治病之难。难于识病
也。
喻嘉言治大司马王岵翁耳鸣。论曰。肾之窍开于耳。耳之聪司于肾。肾主闭藏。因肝木
为子。能疏泄母气而散于外。故凡谋虑郁怒之火一动。耳窍不清。听远稍碍。较之聋病。尚
属天渊。聋病者。窍中另有一膜。遮蔽外气。不得内入。故以开窍为主。而方书所用菖蒲、
麝香等药。及外填内攻等法。皆为此而设。至于高年之人。肾气既衰。阴气不自收摄。越出
上窍。耳中如蛙鼓蚊锣。鼓吹不已。外入之声为其内声所混。听之不清。若得气不逆上。听
必自清。当用磁石为主。以其重能达下。性主下吸。又能制肝木之上吸。再以地黄、龟胶等
群阴之药辅之。更用五味子、山茱萸之酸以收之。令阴气自守于本宫。不上触于阳窍。则空
旷无碍。犹之收视而视愈明。返听而听愈聪之理也。方书治少壮人痰火鸣聋。用滚痰丸多效
者。以黄芩、大黄、沉香之苦。最能下气。而礞石之重坠。大约与磁石之用相仿也。
震按丹铅续录。载王万里患耳痛。魏文靖公谓易之坎为耳痛。恐则伤肾所致。其论与此
颇同。而用青盐、鹿茸、雄、附为剂。则药之阴阳各别。要当以脉辨之。
张友夔在壮年时，常常苦于双耳发痒，每天发作一次。遇到严重时，简直难以忍受，挖抓无所不用其极，但患处依然如故。他常用长约三寸的坚竹截断，劈成五六片，细细刮磨成类似洗帚的形状，用力插入耳中，直到皮肤破损出血，有时甚至多到装满一蚬壳的血量才停止。第二天又重复如此，因失血过多，导致身体困倦憔悴。恰逢河北医生周敏道来到此地，询问病情后说：这是肾脏风虚，导致浮毒上攻，不容易用常规方法治疗。应当购买透冰丹服用，不要饮酒，不要吃湿面、蔬菜、鸡肉、猪肉等食物。如果能坚持一个月忌口为佳。张友夔听从了他的告诫，几天后瘙痒停止，但因饮食禁忌不能长久坚持，不久后又复发。于是便刻意痛下决心断绝这些食物数十天，耳朵不再发痒。
俞震按语：这种奇痒，绝非寻常药物所能治愈。如果是普通的耳痒，或是风邪或火邪所致，也很容易治疗。
薛立斋治疗一人，二十岁，耳内流水作痛，已有一年多。脉象洪数，尺脉尤为明显，属于肝肾二经虚热。使用加减地黄丸料，一剂即愈。
又治一名男子，每次性交后，耳中作痛，或发痒，或流出液体。他用银簪挖入耳中，很喜欢阴凉的感觉。这是肾经虚火，使用加减八味丸而痊愈。
又治一名妇人，因愤怒发热，每次月经来潮时，两耳流脓，两侧太阳穴作痛，用手按压疼痛稍止。发怒时胸胁及乳房胀痛，或有寒热往来，小便频数，或小腹胀闷，都属于肝火血虚。使用加味逍遥散，诸证全部消退，再用补中益气汤加五味子而痊愈。
俞震按语：以上三个医案，有的凭脉象，有的凭症状，也都容易辨别。唯独使用加减八味丸的那一例，推测其尺脉必定微弱，或虚大，所以加入温药以引导接纳（引火归元）。如果尺脉洪数，似乎适宜使用知柏地黄丸。
〔附〕一名妇人在墙上取鸡毛卷耳，恰好蜈蚣在鸡毛上产卵，带入耳中，生出小蜈蚣，钻入脑内。既痛又痒，各种药物无效。一位医生让人烧鸡肉，热着放在一个容器内，留一个小孔盖上，让病人将耳朵对准小孔受熏。鸡香熏入，蜈蚣都聚集到鸡肉上，病立刻痊愈。
石山治疗一人，年近六十，面色苍白，患左耳聋三十年。近年来，有时头部左侧及耳朵都肿胀溃烂流脓，脓液从耳中流出很多，时而再次肿胀化脓。现在右耳也聋了。屡次服用祛风、清热、逐痰的药物，没有效果。汪诊察发现左手心脉浮小而快，肝肾沉小而快；右脉皆虚散而数。这恐怕是因为乘坐车轿远道而来，脉象尚未安定所致。次日早晨脉象都稍微收敛，不到五至，不像前几天那么急促。头部的左侧及耳朵前后都属于少阳经。经书说：少阳经多气少血。现在使用风药和痰药，大多都是燥剂。少血的经络，又被燥剂所燥，那么血液更加虚弱稀少。血少则运行涩滞，涩滞则壅肿。而且血液遇冷则凝滞阻碍，现在又用寒凉药剂使其凝固，更加助长其壅肿。时间久了郁结化为热，腐肉成脓从耳中流出。逐渐发展到右耳也聋，是因为脉络相互贯通，气血相互依存，没有血病而气不病的道理。所以开始是左边生病，最终右边也生病了。这是病久导致气血两虚，且年届六十，气血日渐枯竭，又外出劳伤气血，又多服燥剂损伤气血，脓液大量泄出进一步竭尽气血，则虚上加虚是可以知道的。从理论上分析，应当滋养气血。气血健旺，则运行动行正常，病自然去除。否则不仅病除不了，脑痈耳疽恐怕也难以避免。人参二钱，黄芪三钱，当归身、白术、生姜各一钱，鼠粘子（牛蒡子）、连翘、柴胡、陈皮各六分，川芎、黄芩、白芍各七分，甘草五分。煎服十数帖而痊愈。
俞震按语：汪公的议论精微而又显豁通畅，用药也标本兼顾。真有掉臂游行的快乐。即使是初诊时认为乘坐车轿远来，脉象未定而不足为凭的说法，更可以作为鲁莽者的警戒。
江应宿治疗上舍孙顺吾，患耳鸣重听，事务繁杂冗乱，杂治半年不愈。江应宿诊视，脉象数滑，使用二陈汤加瞿麦、萹蓄、木通、黄柏，一服药见效，两服药痊愈。
俞震按语：耳鸣相同，但此案与下案的治疗方法各不相同。如果互换使用，彼此都无效。所以知道治病之难，难于识别病症。
喻嘉言治疗大司马王岵翁耳鸣，论述说：肾的窍穴开于耳，耳的听力由肾主管。肾主闭藏，因为肝木是肾水的儿子，能疏泄母气而散发于外。所以凡是谋虑郁怒之火一动，耳窍就不清静，听远处声音稍感障碍。比起聋病来，还相差甚远。聋病的人，窍中另有一层膜，遮蔽外气，不得内入。所以以开通窍道为主，而方书中使用的石菖蒲、麝香等药物，以及外填内攻等方法，都是为此而设。至于高龄之人，肾气已经衰退，阴气不能自我收摄，越出上窍，耳中像蛙鼓蚊锣一样，鼓吹不停。外界进入的声音被内部的声音混杂，听起来不清。如果能使气不逆上，听力必然自行清晰。应当以磁石为主药，因为它质重能达下焦，性质主向下吸引，又能制约肝木之气上吸。再以地黄、龟胶等群阴之药辅助它，更用五味子、山茱萸的酸味来收敛它。令阴气自己守在本宫，不向上触犯阳窍，则空旷无碍。就像收视而看得更明，返听而听得更聪的道理一样。方书治疗青壮年人的痰火鸣聋，使用滚痰丸多有效的，是因为黄芩、大黄、沉香之苦味，最能下气，而礞石的沉重坠降，大约与磁石的作用相似。
俞震按语：《丹铅续录》记载王万里患耳痛，魏文靖公认为易卦中的坎卦对应耳痛，是恐惧伤肾所致。他的理论与此颇为相同，但使用青盐、鹿茸、雄黄、附子作为药剂，则药物的阴阳属性各不相同。终究应当通过脉象来辨别。
Zhang Youkui, in his prime, often suffered from itching in both ears, occurring once daily. During severe episodes, it was almost unbearable; he scratched and picked at them without restraint, yet the condition remained unchanged. He would frequently take a piece of hard bamboo about three cun long, cut it into five or six pieces, scrape them finely to resemble a brush, and forcefully insert them into his ears until the skin broke and bled, sometimes accumulating as much blood as filling a clam shell before stopping. The next day, the same thing would happen again. Due to excessive blood loss, he became exhausted and emaciated. Coincidentally, a physician from Hebei named Zhou Mindao arrived. Upon inquiry, Zhou said: This is due to wind deficiency in the Kidney, causing floating toxins to attack upwards. It is not easy to treat with ordinary methods. One should purchase Toubing Dan (Ice-Penetrating Pill) to take internally, avoid alcohol, and refrain from consuming damp-producing foods such as wet noodles, vegetables, chicken, and pork. Ideally, one should adhere to these dietary restrictions for a month. Zhang followed his advice, and the itching stopped after a few days. However, he could not maintain the dietary restrictions for long, and the itching recurred. He then made a determined effort to strictly abstain from these foods for several tens of days, after which his ears no longer itched.
Yu Zhen commented: Such peculiar itching cannot be cured by ordinary medicines. If it were common ear itching caused by wind or fire, it would be relatively easy to treat.
Xue Lizhai treated a twenty-year-old man who had been suffering from fluid discharge and pain in his ears for over a year. His pulse was surging and rapid, especially in the Chi position, indicating deficient heat in the Liver and Kidney meridians. He prescribed Jiadi Dihuang Wan (Modified Rehmannia Pill), and the patient recovered after one dose.
He also treated a man who experienced ear pain, itching, or discharge after every sexual intercourse. He liked to insert silver hairpins into his ears and preferred coolness. This was identified as deficient fire in the Kidney meridian, and he was cured using Jiabajia Weiwang (Modified Eight-Ingredient Pill with Rehmannia).
He treated another woman who developed fever due to anger. Every time her menstruation occurred, pus discharged from both ears, and she experienced pain in both temples, which subsided slightly upon pressure. Anger caused distending pain in the chest, hypochondrium, and breasts, accompanied by alternating chills and fever, frequent urination, or lower abdominal fullness. These symptoms all belonged to Liver fire and Blood deficiency. She was treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), after which all symptoms disappeared. She was then cured using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuweizi (Schisandra Berry).
Yu Zhen commented: In the above three cases, diagnosis was based either on the pulse or on symptoms, making them relatively easy to distinguish. In the case where Jiabajia Weiwang was used, it is presumed that the Chi pulse must have been weak or large and empty, hence warming herbs were added to guide the fire back to its source. If the Chi pulse were surging and rapid, Zhibai Dihuang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) would likely be more appropriate.
[Appendix] A woman inserted a rolled chicken feather into her ear to clean it. Unbeknownst to her, a centipede had laid eggs on the feather, which hatched inside her ear. The young centipedes burrowed into her brain, causing intense pain and itching. No medicine worked. A physician instructed someone to roast chicken meat, place it hot in a vessel with a small hole covered, and have the patient hold her ear over the hole to inhale the fumes. The chicken aroma attracted all the centipedes onto the meat, and the illness was immediately cured.
Shishan treated a man nearing sixty years old with pale complexion and left-sided deafness for thirty years. In recent years, the left side of his head and ear would occasionally swell, ulcerate, and discharge pus copiously from the ear, recurring periodically. Now, his right ear had also become deaf. He had repeatedly taken drugs to dispel wind, clear heat, and eliminate phlegm without effect. Physician Wang diagnosed the pulse on the left hand as floating, small, and rapid at the Cun position, and deep, small, and rapid at the Chi position corresponding to the Liver and Kidney. The pulses on the right hand were all deficient, scattered, and rapid. Wang suspected this was because the patient had traveled far by carriage, and the pulse had not yet stabilized. The following morning, the pulses had converged somewhat, beating less than five times per breath cycle, not as rapid as before. The left side of the head and the area around the ears belong to the Shaoyang (Lesser Yang) meridian. The Classics state: "The Shaoyang meridian has abundant Qi but scarce Blood." Currently, wind and phlegm-resolving drugs are mostly drying agents. Applying drying agents to a meridian already deficient in Blood further depletes the Blood. Scarcity of Blood leads to stagnation; stagnation causes swelling and obstruction. Moreover, Blood congeals when exposed to cold. Using cold-natured drugs now further condenses the Blood, exacerbating the swelling. Over time, this stagnation transforms into heat, rotting flesh and forming pus that discharges from the ear. The gradual deafness of the right ear occurs because the collaterals are interconnected, and Qi and Blood rely on each other; there is no case of Blood disease without Qi disease. Thus, the disease started on the left and eventually affected the right. This indicates that prolonged illness has led to dual deficiency of Qi and Blood. Furthermore, at age sixty, Qi and Blood naturally decline daily. External labor injures Qi and Blood, excessive use of drying agents damages them, and copious pus discharge exhausts them further. Thus, the state of double deficiency is evident. Theoretically, one should nourish Qi and Blood. When Qi and Blood are robust, their circulation will normalize, and the disease will resolve. Otherwise, not only will the disease persist, but conditions like brain abscess or ear carbuncle may also occur. The prescription consisted of Renshen (Ginseng Root) 2 qian, Huangqi (Astragalus Root) 3 qian, Dangshen (Codonopsis Root) and Baizhu (Atractylodes Macrocephala Rhizome) 1 qian each, Shengjiang (Fresh Ginger) 1 qian, Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Chaihu (Bupleuri Radix), and Chenpi (Citri Reticulatae Pericarpium) 6 fen each, Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqin (Scutellariae Radix), and Baishao (Paeoniae Radix Alba) 7 fen each, and Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen. After decocting and taking more than ten doses, the patient recovered.
Yu Zhen commented: Mr. Wang’s discussion was subtle yet clear, and his medication addressed both root and branch. It truly brought the joy of wandering freely. Even his initial assessment that the pulse was unreliable due to recent travel serves as a warning against rashness.
Jiang Yingsu treated Sun Shunwu, a student of the Imperial Academy, who suffered from tinnitus and hearing impairment. Burdened by complex affairs, he had undergone various treatments for half a year without success. Jiang examined him and found a rapid and slippery pulse. He prescribed Erchen Tang (Two-Cured Decoction) added with Qumai (Dianthi Herba), Pianxu (Polygoni Avicularis Herba), Mutong (Akebiae Caulis), and Huangbai (Phellodendri Cortex). The patient felt relief after one dose and was cured after two doses.
Yu Zhen commented: Although the symptom of tinnitus is the same, the treatment methods in this case and the next differ significantly. If they were swapped, neither would be effective. Thus, we understand that the difficulty in treating diseases lies in accurately identifying the pathology.
Yu Jiayan treated Wang Huweng, Grand Commandant, for tinnitus. He discussed: The orifice of the Kidney opens into the ears, and auditory acuity is governed by the Kidney. The Kidney governs storage and retention. Since Liver Wood is the child of Kidney Water, it can vent the mother's Qi and scatter it outward. Therefore, whenever the fire of frustration and anger arises, the ear orifices become unclear, and hearing distant sounds is slightly impaired. Compared to deafness, this is worlds apart. Deafness involves a membrane within the orifice blocking external air from entering. Hence, treatment focuses on opening the orifices, utilizing herbs like Shichangpu (Acori Tatarinowii Rhizoma) and Shexiang (Moschus), and methods of external application and internal attack. For elderly individuals, however, Kidney Qi has declined, and Yin Qi fails to retain itself, escaping upward through the upper orifices. The ears sound like frogs croaking or mosquitoes buzzing incessantly. External sounds are mixed with internal noises, resulting in unclear hearing. If Qi does not rebel upward, hearing will naturally clear. Treatment should primarily use Cishi (Magnetitum) because its heaviness allows it to reach the lower Jiao, its nature draws downward, and it can restrain the upward rebellion of Liver Wood. This should be assisted by Yin-nourishing herbs such as Dihuang (Rehmanniae Radix) and Guijiao (Colla Corii Asini). Additionally, Suanwei Zi (Schisandrae Chinensis Fructus) and Shanzhuyu (Corni Fructus) with their sour flavor should be used to astringe and consolidate. This ensures Yin Qi remains in its original palace and does not disturb the Yang orifices, creating an open and unobstructed state. This follows the principle that focusing vision improves sight, and turning attention inward improves hearing. For young adults with tinnitus and deafness caused by Phlegm-Fire, Guntan Wan (Rolling Phlegm Pill) is often effective because the bitter flavors of Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma), and Chenxiang (Aquilariae Lignum Resinatum) strongly direct Qi downward, while Mengshi (Calamina) shares a similar heavy-descending function with Magnetite.
Yu Zhen commented: *Danqian Xulu* records that Wang Wanli suffered from ear pain. Wei Wenjing attributed it to the Kan hexagram representing ear pain, caused by fear injuring the Kidney. His theory aligns closely with the above, but he used Qingyan (Natrii Chloridum), Lurong (Cervi Cornu Degelatinatum), Xionghuang (Realgar), and Fuzi (Aconiti Lateralis Radix Praeparata). The yin-yang properties of these drugs differ. Ultimately, differentiation must be based on the pulse.