脉
肾脉浮而盛为风，洪而实为热，短而涩为虚。两尺脉短而微，
或大而数，皆属阴虚。相火上炎，其人必遗精，而两耳蝉鸣，或聋。
病
夫耳者，肾之窍也，其为病亦有数种∶有气厥而聋者；有挟风而聋者；有劳伤而聋者；有热气乘虚，
随脉入耳，而为脓耳者；有耳出津液，风热搏之，结核塞耳，亦令暴聋而为 耳者。然又有左
聋者，有右聋者，有左右俱聋者。不可不分经而治之也。
治
夫左耳聋者，因有所忿怒过度，则动少阳胆火，故从左起，以龙荟丸主之；右耳聋者，因有所色欲过度，
则动太阳膀胱相火，故
从右起，以六味地黄丸主之；左右俱聋者，因有所醇酒浓味过度，则动足阳明胃火，故从中起，以通圣散、
滚痰丸主之。盖左耳聋者，妇人多有之，以其多忿怒故也；右耳聋者，男子多有之，以其多色欲故也；左右
俱聋者，膏粱之家多有之，以其多肥甘故也。总三者而论之，忿怒致耳聋者为多。丹溪曰∶厥阴、少阳热多，
当用开痰散风热，其此之谓乎。
方
通明利气汤 治虚火上升，痰气郁于耳中，或闭，或鸣，痰气炽盛，或忧郁痞满，咽喉不利，烦躁不宁。
苍术（一钱，盐水炒） 白术（一钱，瓦焙） 抚芎（八分） 陈皮（二钱半） 香附
（一钱，童便炒） 生地黄（一钱，姜汁浸） 贝母（三钱） 黄连（一钱半，酒浸，猪胆汁拌炒
）黄芩（一钱半，酒浸，猪胆汁拌炒） 黄柏（二钱，酒炒） 栀子仁（二钱，炒） 玄参（二
钱，酒洗） 木香（五分） 槟榔（一钱） 甘草（炙，四分）
上锉二剂，生姜水煎，入竹沥服。
加减龙荟丸〔批〕（按此方治耳鸣之剂） 聪耳泻火。
当归（一两，酒洗） 龙胆草（一两，酒洗） 栀子仁（一两，炒） 黄芩（一两） 大
黄（五钱，酒蒸） 芦荟（五钱） 青黛（五钱） 木香（二钱半） 柴胡（五钱） 青皮（一两）
胆星（三钱） 麝香（五分）
上为末，神面糊为丸，绿豆大。每二十丸，姜汤下，日进三服。一七后，用针砂酒以通其气，针砂
一两，穿山甲末一钱，拌针砂养一昼夜，播出山甲，以酒一碗，将针砂浸三四日，噙酒口内，
外用磁石一块，绵裹塞耳，忌怒戒色。
玄参贝母汤（陈白野方） 治耳热出汁作痒，乃痰也，肾火上炎也。
防风 天花粉 贝母 黄柏（盐水炒） 白茯苓 玄参 蔓荆子 白
芷天麻（各一钱） 生甘草（五分） 半夏（一钱，泡）
上锉一剂，生姜三片，水煎，食后温服。
黄龙散〔批〕（按此方治耳脓之剂） 治脓耳，因肾经气实，其热上冲于耳，遂使津液壅滞为脓，
久不瘥，变成耳聋，亦有小儿沐浴，水入耳中停留，搏于气血，酝酿成热，亦成脓耳。
枯白矾（一钱） 龙骨（一钱，研） 黄丹（一钱，飞） 胭脂（一钱，烧灰） 麝香（少许）
上为末，先以绵杖子卷去耳中脓水，以药掺入内，日日用之，勿令风入。
鼠粘子汤（陈白野方） 治耳内生肿如樱桃，痛极。
连翘 黄连（酒炒） 玄参 桔梗 栀子（炒） 生甘草 牛蒡子（炒）
龙胆草（炒） 板蓝根（即靛子）
上锉，水煎，食后服，随饮酒一二盏。感脑加香附子一钱。
〔批〕（按此方治耳肿痛之剂） 治耳内忽太痛，如有虫在内奔走，或有血水，或干痛不可忍者。
蛇蜕烧存性，为末，以鹅翎管吹入耳中。
聪耳汤（云林制） 治耳重听。
当归（酒洗，一钱） 白芍（酒炒，一钱） 川芎（一钱） 生地黄（酒洗，一钱） 知
母（酒洗，一钱） 陈皮（一钱） 乌药（一钱） 白芷（一钱） 防风（酒洗，一钱） 羌活（酒
洗，一钱） 独活（酒洗，一钱） 细辛（七分） 薄荷（一钱） 蔓荆子（一钱） 本（酒洗，
一钱） 黄柏（酒炒，一钱）
上作一剂，水煎，食后服，用药后，头低睡一时。
独胜丸 专治耳鸣、耳聋。
黄柏（八两，人乳拌匀，酒浸晒干，再用盐水炒褐色，去皮）
上为末，水糊丸梧子大。每服百丸，空心盐汤下。
熏耳神方（习南泉传） 专治气聋，不论远年近日者神效，实聋难治。
蕲艾（一两，为粗末，后用） 磁石（七钱，烧过） 当门子（即麝香，三粒） 珍珠
（七颗，用铁筒套在铁锅底上 过）
上三味，研为细末，合一处令匀，却将白绵纸一张铺热铁器上，用黄蜡五钱搽纸上，分作数片，纸
上摊艾，艾上掺药，卷作筒子，点火吹灭，侧耳熏之。重者三四根即通，力能隔耳透咽，既通
且用艾塞，不可见风。
透铁关法（贾兰峰传）〔批〕（按此方治耳聋之剂） 治耳聋。
用好活磁石二块，锉如枣大头尖，搽麝香少许于磁石尖上，塞两耳孔，口中噙生铁一块，候一时两耳
气透，飒飒有声为度，勤用三五次即愈。
脉象
肾脉浮而有力，属于风邪；洪大且实，属于热邪；短促且涩，属于虚证。两尺脉短而微弱，或者大而数，都属于阴虚。相火上炎，患者必然出现遗精，以及双耳蝉鸣，或者耳聋。
病症
耳朵是肾的窍穴，其发病也有几种类型：有因气机厥逆而耳聋的；有兼夹风邪而耳聋的；有因劳损伤耗而耳聋的；有热气乘虚而入，顺着经脉进入耳朵，形成脓耳的；有耳中流出津液，风热搏结，形成结核堵塞耳道，也导致突发耳聋并伴有耳鸣的。然而又有左耳聋、右耳聋、左右双耳皆聋的情况。不可不分别经络进行治疗。
治疗
左耳聋，是因为愤怒过度，动摇了少阳胆火，所以从左起病，以龙荟丸为主方治疗；右耳聋，是因为色欲过度，动摇了太阳膀胱相火，所以从右起病，以六味地黄丸为主方治疗；左右双耳皆聋，是因为饮酒厚味过度，动摇了足阳明胃火，所以从中起病，以通圣散、滚痰丸为主方治疗。大概左耳聋者，妇女多有此症，因为她们多易愤怒；右耳聋者，男子多有此症，因为他们多纵色欲；左右双耳皆聋者，富贵人家多有此症，因为他们多食肥甘厚味。综合这三种情况来看，因愤怒导致耳聋的情况较多。朱丹溪说：厥阴、少阳经热盛，应当使用开痰散风热的药物，说的就是这个道理。
方剂
通明利气汤 治疗虚火上升，痰气郁结于耳中，或闭塞，或鸣响，痰气炽盛，或忧郁痞满，咽喉不利，烦躁不安。
苍术（一钱，用盐水炒） 白术（一钱，在瓦上焙干） 抚芎（八分） 陈皮（二钱半） 香附（一钱，用童便炒） 生地黄（一钱，用姜汁浸泡） 贝母（三钱） 黄连（一钱半，用酒浸泡，猪胆汁拌炒） 黄芩（一钱半，用酒浸泡，猪胆汁拌炒） 黄柏（二钱，用酒炒） 栀子仁（二钱，炒） 玄参（二钱，用酒洗） 木香（五分） 槟榔（一钱） 甘草（炙，四分）
以上药材锉碎为两剂量，用生姜水煎煮，加入竹沥服用。
加减龙荟丸〔批注〕（按：此方是治疗耳鸣的药剂） 聪耳泻火。
当归（一两，用酒洗） 龙胆草（一两，用酒洗） 栀子仁（一两，炒） 黄芩（一两） 大黄（五钱，用酒蒸） 芦荟（五钱） 青黛（五钱） 木香（二钱半） 柴胡（五钱） 青皮（一两） 胆星（三钱） 麝香（五分）
以上研为细末，用神曲糊制作成梧桐子大小的丸药。每次二十丸，姜汤送服，每日三次。服药七天后，用针砂酒来疏通气机，取针砂一两，穿山甲末一钱，将穿山甲末拌入针砂中浸泡一个昼夜，捞出穿山甲，用一碗酒，将针砂浸泡三四日，含酒在口中，外用磁石一块，用棉布包裹塞入耳中，忌怒戒色。
玄参贝母汤（陈白野方） 治疗耳热出汁作痒，这是痰湿所致，乃肾火上炎引起。
防风 天花粉 贝母 黄柏（用盐水炒） 白茯苓 玄参 蔓荆子 白芷 天麻（各一钱） 生甘草（五分） 半夏（一钱，泡制）
以上药材锉碎为一剂量，加生姜三片，水煎煮，饭后温服。
黄龙散〔批注〕（按：此方是治疗耳脓的药剂） 治疗脓耳，因肾经气实，热气上冲于耳，致使津液壅滞化为脓，久不痊愈，变成耳聋。也有小儿洗澡时，水进入耳中停留，与气血搏结，酝酿成热，也形成脓耳。
枯白矾（一钱） 龙骨（一钱，研碎） 黄丹（一钱，飞过） 胭脂（一钱，烧成灰） 麝香（少许）
以上研为细末，先用棉杖卷去耳中的脓水，将药粉掺入耳内，每日使用，不要让风邪侵入。
鼠粘子汤（陈白野方） 治疗耳内生肿如樱桃，疼痛剧烈。
连翘 黄连（用酒炒） 玄参 桔梗 栀子（炒） 生甘草 牛蒡子（炒） 龙胆草（炒） 板蓝根（即靛子）
以上药材锉碎，水煎煮，饭后服用，服药后随饮一二杯酒。若感脑痛，加香附子一钱。
〔批注〕（按：此方是治疗耳肿痛的药剂） 治疗耳内忽然剧痛，如有虫在内部奔走，或有血水，或干痛难忍。
蛇蜕烧至存性，研为细末，用鹅毛管吹入耳中。
聪耳汤（云林制） 治疗耳重听。
当归（用酒洗，一钱） 白芍（用酒炒，一钱） 川芎（一钱） 生地黄（用酒洗，一钱） 知母（用酒洗，一钱） 陈皮（一钱） 乌药（一钱） 白芷（一钱） 防风（用酒洗，一钱） 羌活（用酒洗，一钱） 独活（用酒洗，一钱） 细辛（七分） 薄荷（一钱） 蔓荆子（一钱） 藁本（用酒洗，一钱） 黄柏（用酒炒，一钱）
以上作一剂量，水煎煮，饭后服用，用药后低头睡一会儿。
独胜丸 专治耳鸣、耳聋。
黄柏（八两，用人乳拌匀，酒浸晒干，再用盐水炒至褐色，去皮）
以上研为细末，用水糊制作成梧桐子大小的丸药。每次服用一百丸，空腹用盐汤送下。
熏耳神方（习南泉传） 专治气聋，不论多年还是近日发作均神效，实聋难治。
蕲艾（一两，制成粗末，备用） 磁石（七钱，烧过） 当门子（即麝香，三粒） 珍珠（七颗，用铁筒套在铁锅底上煨过）
以上三味药，研为细末，混合均匀。取一张白绵纸铺在热铁器上，用五钱黄蜡涂在纸上，分成几片。在纸上摊开艾绒，艾绒上撒药粉，卷成筒状。点火吹灭，侧耳熏之。重症者三四根即可通窍，效力能隔耳透咽，既通窍后用艾条塞耳，不可见风。
透铁关法（贾兰峰传）〔批注〕（按：此方是治疗耳聋的药剂） 治疗耳聋。
用好活磁石两块，锉成枣核大小，一头尖一头圆，在磁石尖端涂抹少许麝香，塞入两耳孔，口中含一块生铁，等候一时辰，两耳气息通透，发出飒飒声响为止，勤用三五次即可痊愈。
Pulse Diagnosis
A kidney pulse that is floating and vigorous indicates wind; one that is surging and excess indicates heat; one that is short and choppy indicates deficiency. A short and faint double chi (尺) pulse, or a large and rapid double chi pulse, both belong to yin deficiency. When ministerial fire flares upward, the patient will inevitably experience seminal emission, cicada-like tinnitus in both ears, or deafness.
Diseases
The ear is the orifice of the kidney. Its diseases manifest in several types: there is deafness due to qi reversal; deafness complicated by wind; deafness due to labor injury; deafness where heat pathogens enter the ear along the meridians when deficiency exists, resulting in otitis purulenta (pus-filled ear); and sudden deafness with tinnitus caused by fluid exuding from the ear, where wind-heat binds and forms nodules blocking the ear canal. Furthermore, there are cases of left-sided deafness, right-sided deafness, and bilateral deafness. Treatment must differentiate according to the affected meridians.
Treatment Principles
Left-sided deafness arises from excessive anger, which stirs up Shaoyang Gallbladder fire, thus originating from the left; it is primarily treated with Longdan Xiegan Wan (Gentian Liver-Draining Pill). Right-sided deafness arises from excessive sexual desire, which stirs up Taiyang Bladder ministerial fire, thus originating from the right; it is primarily treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Bilateral deafness arises from excessive consumption of rich wine and food, which stirs up Foot-Yangming Stomach fire, thus originating from the center; it is primarily treated with Tongsheng San (Unimpeded Holy Powder) and Guntan Wan (Rolling Phlegm Pill). Generally, left-sided deafness is common in women due to their tendency toward anger; right-sided deafness is common in men due to their tendency toward sexual indulgence; bilateral deafness is common among the wealthy due to their diet rich in fats and sweets. Overall, deafness caused by anger is the most frequent. Danxi stated: "When Jueyin and Shaoyang have excessive heat, one should use formulas to resolve phlegm and disperse wind-heat," which refers to this principle.
Formulas
Tongming Liqi Tang (Clear Brightness Qi-Regulating Decoction) treats ascending deficient fire and phlegm-qii stagnation in the ear, causing blockage or tinnitus; severe phlegm-fire, melancholy, chest fullness, throat discomfort, and restlessness.
Cangzhu (Rhizoma Atractylodis Macrocephalae, 1 qian, stir-fried with salt water) Baizhu (Rhizoma Atractylodis Macrocephalae, 1 qian, baked on tile) Fuxiong (Radix Chuanxiong, 8 fen) Chenpi (Pericarpium Citri Reticulatae, 2.5 qian) Xiangfu (Rhizoma Cyperi Rotundi, 1 qian, stir-fried with children's urine) Shengdihuang (Radix Rehmanniae Preparata, 1 qian, soaked in ginger juice) Beimu (Bulbus Fritillariae Cirrhosae, 3 qian) Huanglian (Rhizoma Coptidis, 1.5 qian, soaked in wine, stir-fried with pig bile) Huangqin (Radix Scutellariae, 1.5 qian, soaked in wine, stir-fried with pig bile) Huangbai (Cortex Phellodendri, 2 qian, stir-fried with wine) Zhizi Ren (Semen Gardeniae, 2 qian, stir-fried) Xuanshen (Radix Scrophulariae, 2 qian, washed with wine) Muxiang (Radix Aucklandiae, 5 fen) Binglang (Semen Arecae, 1 qian) Gancao (Radix Glycyrrhizae Preparata, 4 fen)
Decoct two doses with ginger water, add Zhuli (Bamboo Sap), and take orally.
Jiajian Longhui Wan (Modified Dragon Bile Pill) [Commentary: This formula treats tinnitus.] Benefits the ears and drains fire.
Danggui (Radix Angelicae Sinensis, 1 liang, washed with wine) Longdancao (Radix Gentianae, 1 liang, washed with wine) Zhizi Ren (Semen Gardeniae, 1 liang, stir-fried) Huangqin (Radix Scutellariae, 1 liang) Dahuang (Radix et Rhizoma Rhei, 5 qian, steamed with wine) Lvhui (Resina Aloe, 5 qian) Qingdai (Indigo Naturalis, 5 qian) Muxiang (Radix Aucklandiae, 2.5 qian) Chaihu (Radix Bupleuri, 5 qian) Qingpi (Pericarpium Citri Reticulatae Viride, 1 liang) Danning (Fallo Calamistratus, 3 qian) Shexiang (Moschus, 5 fen)
Grind into powder, form pills with Shenqu paste (Shen Qu dough) to the size of mung beans. Take 20 pills per dose with ginger soup, three times daily. After seven days, use Zhensha Jiu (Needle Sand Wine) to unblock qi: mix 1 liang of Zhensha (Hematitum) with 1 qian of Shanzhijia Mo (Squama Manis, powdered), soak overnight, remove the scale powder, then soak the hematite in one bowl of wine for three to four days. Hold the wine in the mouth, and externally wrap a piece of Cishi (Magnetitum) in cotton and insert it into the ear. Avoid anger and sexual activity.
Xuanshen Beimu Tang (Scrophularia and Fritillaria Decoction) (Formula by Chen Baiye) Treats hot ears with exudate and itching, caused by phlegm and flaming-up of Kidney fire.
Fangfeng (Radix Saposhnikoviae) Tianhuafen (Radix Trichosanthis) Beimu (Bulbus Fritillariae Cirrhosae) Huangbai (Cortex Phellodendri, stir-fried with salt water) Baifuling (Poria, dried mycelium) Xuanshen (Radix Scrophulariae) Manjingzi (Fructus Viticis) Baizhi (Radix Angelicae Dahuricae) Tianma (Rhizoma Gastrodiae) (each 1 qian) Sheng Gancao (Radix Glycyrrhizae, 5 fen) Banxia (Rhizoma Pinelliae Preparata, 1 qian, soaked)
Decoct one dose with three slices of fresh ginger in water. Take warm after meals.
Huanglong San (Yellow Dragon Powder) [Commentary: This formula treats otitis purulenta.] Treats otitis purulenta caused by excess qi in the Kidney meridian, where heat rushes upward to the ear, causing fluid stagnation and pus formation. If untreated, it leads to deafness. It also occurs in children when bathwater enters the ear, interacts with blood and qi, generates heat, and forms pus.
Kubaijian (Alumen, 1 qian) Longgu (Os Draconis et Mammutis, 1 qian, ground) Huangdan (Lithargyrum, 1 qian, refined) Yanzhi (Carthami Flos, processed to ash, 1 qian) Shexiang (Moschus, a small amount)
Grind into powder. First, use a cotton swab to remove pus from the ear, then sprinkle the powder inside. Use daily, avoiding wind exposure.
Niuzi Tang (Arctii Decoction) (Formula by Chen Baiye) Treats swelling in the ear resembling a cherry, with extreme pain.
Lianqiao (Fructus Forsythiae) Huanglian (Rhizoma Coptidis, stir-fried with wine) Xuanshen (Radix Scrophulariae) Jiegeng (Radix Platycodonis) Zhizi (Semen Gardeniae, stir-fried) Sheng Gancao (Radix Glycyrrhizae, raw) Niuzi (Fructus Arctii, stir-fried) Longdancao (Radix Gentianae, stir-fried) Banlangen (Radix Isatidis, i.e., Indigo Naturalis source)
Decoct in water, take after meals, followed by one or two cups of wine. If headache is present, add Xiangfu (Rhizoma Cyperi Rotundi, 1 qian).
[Commentary: This formula treats ear swelling and pain.] Treats sudden severe ear pain, as if insects are running inside, accompanied by bloody discharge or dry, unbearable pain.
She Tui (Ophichthus Skin, burned until carbonized but retaining properties), grind into powder, and blow into the ear using a goose feather tube.
Cong'er Tang (Ear-Benefiting Decoction) (Prepared by Yunlin) Treats hearing impairment (deafness/heavy hearing).
Danggui (Radix Angelicae Sinensis, washed with wine, 1 qian) Baishao (Radix Paeoniae Alba, stir-fried with wine, 1 qian) Chuanxiong (Radix Chuanxiong, 1 qian) Sheng Dihuang (Radix Rehmanniae Preparata, washed with wine, 1 qian) Zhimu (Cortex Anemarrhenae, washed with wine, 1 qian) Chenpi (Pericarpium Citri Reticulatae, 1 qian) Wuyao (Radix Linderae, 1 qian) Baizhi (Radix Angelicae Dahuricae, 1 qian) Fangfeng (Radix Saposhnikoviae, washed with wine, 1 qian) Qianghuo (Rhizoma Notopterygii, washed with wine, 1 qian) Duhuo (Radix Angelicae Pubescentis, washed with wine, 1 qian) Xixin (Herba Asari, 7 fen) Bohe (Herba Menthae, 1 qian) Manjingzi (Fructus Viticis, 1 qian) Gaoben (Rhizoma Ligustici Chuanxiong, washed with wine, 1 qian) Huangbai (Cortex Phellodendri, stir-fried with wine, 1 qian)
Decoct one dose in water, take after meals. After taking the medicine, lie down with head lowered for a while.
Dusheng Wan (Single Victory Pill) Specifically treats tinnitus and deafness.
Huangbai (Cortex Phellodendri, 8 liang, mixed with human milk, soaked in wine, sun-dried, then stir-fried with salt water until brown, skin removed)
Grind into powder, form pills with water paste to the size of wutong seeds. Take 100 pills per dose on an empty stomach with salt water.
Xun'er Shenfang (Divine Smoke-Inhalation Formula for Ears) (Passed down by Xi Nanquan) Specifically treats qi-deafness, effective regardless of duration; organic deafness is difficult to treat.
Qiai (Artemisia argyi, 1 liang, coarsely powdered) Cishi (Magnetitum, 7 qian, calcined) Dangmenzi (Moschus, 3 grains) Zhenzhu (Margarita, 7 pieces, roasted in an iron pot bottom)
Grind the three ingredients into fine powder and mix evenly. Spread a sheet of white cotton paper on a hot iron vessel. Smear 5 qian of yellow wax onto the paper, dividing it into sections. Spread mugwort on the paper, sprinkle the medicine on the mugwort, and roll into a cylinder. Ignite and extinguish the flame. Hold the smoke towards the ear. For severe cases, three cylinders suffice to open the orifice; the efficacy can penetrate through the ear to the throat. After opening, plug the ear with mugwort and avoid wind.
Tou Tie Guan Fa (Iron-Piercing Gate Method) (Passed down by Jia Lanfeng) [Commentary: This method treats deafness.] Treats deafness.
Take two good pieces of living Magnetitum (Cishi), file them into the shape of a jujube pit (one end pointed, one end blunt). Apply a small amount of Moschus (Shexiang) to the pointed end of the magnet. Insert into both ear canals. Hold a piece of raw iron in the mouth. Wait for one shichen (two hours) until breath permeates both ears, producing a rustling sound. Repeat diligently three to five times for cure.