王节斋云∶耳鸣证，或鸣甚如蝉，或左或右，或秘塞。世人多作肾虚治，不效。殊不
知此是痰火上升，郁于耳中而为鸣，郁甚则壅闭矣。遇此证当审平昔饮酒浓味，上焦素有痰
火，只作清痰降火治之。大抵此证多因先有痰火在上，又兼恼怒得者最多。怒则气上，少阳
之火客于耳。若肾虚而鸣者，其鸣不甚，人必多怒，当见劳怯证。
凡人大病之后而耳聋者，多是气虚。若老人耳听渐重，亦是气虚。重而兼鸣者亦有痰，不
宜峻补。
两寸脉洪大，痰火耳鸣。肾脉洪盛为肾火。心脉微涩为耳癫痰。肾脉濡涩为虚，短而
微者阴虚。左心洪数
心火上炎，两尺洪数相火上炎，其人必梦遗耳鸣或聋。耳聋脉缓大而涩者死。
耳聋证，乃气道不通，痰火郁结壅塞而成聋也。凡用清痰降火之药，须兼味辛行气通
窍之药，方得治法之要。古方用酒浸针砂一日，至晚去针砂，将酒含口中，用紧磁石一
块绵裹塞耳，左聋塞左，右聋塞右，此欲导其气而通其闭也。有峻用痰火药则反伤脾胃，
亦不能开其塞。有急补气虚则火愈上，而亦不能开。惟以前法，痰火药中佐以辛温之味，
细细平治，自然痊愈。予见攻之太过反伤正气，变生他疾者有之，此又不可不察也。
忧愁思虑则伤心，心虚血耗必致耳聋、耳鸣。房劳过度则伤肾，肾虚精竭亦必致耳聋、
耳鸣。药宜泻南方补北方，滋阴降火为主。心虚当宁心顺气，宜辰砂妙香散、平补镇心丹
选用之。肾虚者宜益精补肾，肉苁蓉丸。
王节斋说：耳鸣的证候，有的鸣响剧烈像蝉叫，有的在左边，有的在右边，有的伴有耳道闭塞感。世人大多将其当作肾虚来治疗，但往往无效。殊不知这是因为痰火上升，郁结在耳中而引发鸣响，郁结严重时就会导致壅塞闭阻。遇到这种证候应当审视患者平素是否饮酒过多、喜食肥甘厚味，以及上焦是否素有痰火，只需用清化痰热、降泻火邪的方法治疗即可。大抵这类证候多是因为先有痰火在上焦，又兼因恼怒而引发的情况最多。愤怒会导致气机上逆，少阳之火客居于耳部。如果是肾虚引起的耳鸣，其鸣响不会太剧烈，病人一定容易发怒，并且应当见到虚劳羸弱的证候。
凡是人在大病之后出现耳聋的，多是气虚所致。如果是老年人听力逐渐减退，也是气虚的表现。如果听力减退同时伴有耳鸣，其中也可能夹杂痰邪，不适宜使用峻猛的补益药物。
两手寸脉洪大，是痰火导致的耳鸣。肾脉（尺脉）洪盛为肾火。心脉微涩为耳部癫疾夹痰。肾脉濡涩为虚证，短而微弱者为阴虚。左寸脉洪数，是心火上炎；两尺脉洪数，是相火上炎，病人必定会有梦遗、耳鸣或耳聋的症状。耳聋且脉象缓大而涩的，预后不良，主死。
耳聋的证候，是由于气道不通畅，痰火郁结壅塞而形成的耳聋。凡是用清化痰热、降泻火邪的药物时，必须兼用味道辛散、能行气通窍的药物，这才是掌握治疗的关键。古方中使用酒浸泡针砂一天，到了晚上取出针砂，将药酒含在口中，用一块紧密包裹在棉中的磁石塞入耳中，左耳聋塞左耳，右耳聋塞右耳，这是为了引导气机运行并疏通闭塞。如果使用峻猛的化痰泻火药，反而会损伤脾胃，也不能开通闭塞。如果急于补气虚，则火气会更加上逆，同样不能开通闭塞。只有采用前面的方法，在化痰泻火的药物中佐以辛温之味的药物，细细地平和调理，自然会痊愈。我见过攻伐太过反而损伤正气，变生其他疾病的案例，这又是不可不仔细考察的。
忧愁思虑会损伤心脏，心虚血耗必然导致耳聋、耳鸣。房事过度会损伤肾脏，肾虚精竭也必然导致耳聋、耳鸣。用药宜采用“泻南方（心/火）补北方（肾/水）”的原则，以滋阴降火为主。心虚的应当宁心安神、顺调气机，宜选用辰砂妙香散、平补镇心丹。肾虚的应当填补精髓、补肾益精，可用肉苁蓉丸。
Wang Jiezhai stated: In cases of tinnitus (ringing in the ears), the sound may be loud like cicadas, occur on one side or the other, or be accompanied by a sensation of blockage. People generally treat this as Kidney deficiency (Shen Xu), but it is often ineffective. They fail to realize that this is caused by Phlegm-Fire rising and stagnating in the ear, causing ringing; when the stagnation is severe, it leads to obstruction. When encountering such cases, one should examine whether the patient has a history of excessive alcohol consumption and rich foods, and whether there is pre-existing Phlegm-Fire in the Upper Jiao. Treatment should focus solely on clearing Phlegm and descending Fire. Generally, this condition often arises from pre-existing Phlegm-Fire in the upper body, combined with anger. Anger causes Qi to ascend, and the Fire of the Shaoyang channel invades the ear. If tinnitus is due to Kidney deficiency, the ringing is not severe, the person is likely prone to anger, and signs of consumptive disease (Lao Qie) must be present.
In general, deafness occurring after a serious illness is mostly due to Qi deficiency. For the elderly whose hearing gradually declines, this is also due to Qi deficiency. If hearing loss is accompanied by tinnitus, Phlegm may also be involved, and drastic tonification should not be used.
A surging and large pulse at both Cun positions indicates Phlegm-Fire tinnitus. A surging and full pulse at the Shen position (Chi pulse) indicates Kidney Fire. A slightly choppy pulse at the Xin position indicates epilepsy of the ear with Phlegm. A soggy and choppy pulse at the Shen position indicates Deficiency; a short and faint pulse indicates Yin Deficiency. A surging and rapid pulse at the left Cun position indicates Heart Fire flaming upward. Surging and rapid pulses at both Chi positions indicate Ministerial Fire flaming upward; the patient will likely experience nocturnal emissions, tinnitus, or deafness. Deafness with a slow, large, and choppy pulse indicates a fatal prognosis.
The syndrome of deafness results from the obstruction of the Qi pathway, where Phlegm-Fire stagnates and blocks the ear. When using herbs to clear Phlegm and descend Fire, it is essential to include herbs with pungent flavors that move Qi and open orifices; this is the key to treatment. Ancient formulas used needle sand soaked in wine for one day. At night, the needle sand was removed, and the wine was held in the mouth. A piece of lodestone (Cishi) tightly wrapped in cotton was then inserted into the ear—left ear for left-sided deafness, right ear for right-sided deafness. This method aims to guide Qi flow and unblock obstruction. Using drastic Phlegm-clearing and Fire-descending herbs may instead damage the Spleen and Stomach and fail to open the obstruction. Urgently tonifying Qi deficiency may cause Fire to ascend further, also failing to open the obstruction. Only by using the aforementioned method—supplementing Phlegm-clearing and Fire-descending herbs with acrid-warm agents—and treating gently and steadily, can recovery naturally occur. I have seen cases where excessive attacking methods damaged healthy Qi, leading to other diseases; this requires careful consideration.
Worry and overthinking damage the Heart. Heart deficiency and blood depletion inevitably lead to deafness and tinnitus. Excessive sexual activity damages the Kidney. Kidney deficiency and essence exhaustion inevitably lead to deafness and tinnitus. Medication should follow the principle of "draining the South (Heart/Fire) and tonifying the North (Kidney/Water)," focusing primarily on nourishing Yin and descending Fire. For Heart deficiency, calm the Mind and regulate Qi; select Chen Sha Miao Xiang San (Cinnabar Wonderful Fragrance Powder) or Ping Bu Zhen Xin Dan (Peaceful Tonification Heart-Calming Pill). For Kidney deficiency, benefit essence and tonify the Kidney; use Rou Cong Rong Wan (Cistanche Pill).