总括 五般脓水属肾生，火热上蒸积而成；更有耳聋耳鸣者，皆为阴虚火上升。
脉法 左寸洪数，心火上炎，两尺洪数，相火上炎也。
《内经》曰∶肾者，作强之官，技巧出焉。又曰∶耳为肾之外候，一曰肾通窍于耳，夫耳者乃宗脉之所聚，肾气之
所通，小儿肾脏盛而有热气上冲于耳,津液壅结，则生脓汁也。然有五般，黄脓出者，谓之耵耳；红脓出者谓之脓耳；
耳内干臭者，谓之冱耳；白脓出者谓之缠耳；里而虚鸣有青脓出者，谓之囊耳。病虽有五，其源则一，或由风水入耳，
而内有积热上壅而成者，若不速治，久则成聋矣，以蔓荆子散服之，外用敷药。
凡耳聋耳鸣者，皆属于热，阴虚火动也，治宜泻南方之火，补北方之水，无有不安矣。钱云∶肾有补而无泻有旨哉。
〔附方〕
蔓荆子散 升麻 木通 赤芍 桑皮 生地 麦冬 前胡 甘菊 赤茯苓 蔓荆子 甘草
黄龙散 （敷药） 矾 龙骨末 黄丹（炒，各五钱） 麝香（一匙）
总括 鼻属肺兮体至清，鼻塞皆因风热侵；忽然窒塞声音重，此是风寒外感因。
脉法 右寸浮洪而数为鼻衄，左寸浮缓为伤风，鼻塞流清涕。
《内经》曰∶西方白色入通于肺，开窍于鼻。又曰∶鼻者肺之外候。丹溪曰∶肺之为脏其位高，其体脆，性恶寒又
恶热，故小儿鼻塞者，由肺气通于鼻气为阳。若气受风寒，停滞鼻间，则成鼻塞，气寒而津液不收则多鼻涕。若冷风久
不散，浓涕结聚，使鼻不闻香臭，则为 鼻。若夹热则鼻干，皆阻碍乳。凡产芽儿，三朝五日，六晨一腊，忽然鼻塞吻
乳不能开口呼吸者，多是乳母安睡之时不知所持，鼻中出息吹着儿囟或洗浴用水温冷，气不得通，气邪所感，致儿鼻多
塞也。
节斋云∶鼻塞不闻香臭，或但遇寒月多塞，或略感风寒便塞，不时举发者，俗皆以为肺寒，而用解表通利辛温之剂。
不效，殊不知此是肺经素有火邪火郁，甚则喜得热而恶见寒，故遇寒便塞，遇感便发也。治法清金降火为主，而佐以通
气之剂。若如常，鼻塞不闻香臭者，再审其平素只作肺热治之，清金降火清痰，或丸药噙化，或末药轻调缓服，无不效
矣。其平素无鼻塞之症，一时遇感风寒而致窒塞、声重或流清涕者，自作风寒治。
鼻疮者壅热伤肺，肺主气通于鼻，风湿之气乘虚客于皮毛，入于血脉，故鼻下两旁疮湿痒烂，是名鼻 ，其疮不痛，
汁所流处，却又成疮，以泽泻散服之，以清金散敷之。一方用熊胆泡汤，以新小笔蘸点鼻。
〔附方〕
开关散 香附 川芎 荆芥 僵蚕 细辛 牙皂 为末，葱白捣成膏，用红白绢摊，乘夜睡贴囟门。
川芎膏 川芎 细辛 本 白芷 杏仁 麝香 甘草
牛黄犀角散 牛黄 犀角 川芎 升麻 细辛 麻黄 朱砂 冰片 麝香 甘草 蜜丸服。
泽泻散 泽泻 郁金 栀子 甘草
青金散 铜青 生硫磺（各一钱） 一方用生白矾去硫磺。
总括：五种流脓的耳病皆由肾经产生，火热之邪上蒸积聚而成；更有耳聋、耳鸣的症状，都是因为阴虚导致虚火上炎。
脉法：左寸脉洪大且数，是心火向上炎升；两尺脉洪大且数，是相火向上炎升。
《内经》说：肾是作强之官，技巧由此产生。又说：耳朵是肾脏的外在表现，一种说法是肾通过窍穴与耳相通。耳部是众多经脉汇聚之处，也是肾气通行的通道。小儿肾脏旺盛而有热气上冲至耳，津液壅结，从而生成脓汁。然而有五种情况：流出黄脓的，称为耵耳；流出红脓的，称为脓耳；耳内干燥且有臭味的，称为冱耳；流出白脓的，称为缠耳；内部空虚鸣响且流出青脓的，称为囊耳。病症虽有五种，但根源相同，有的是因风水侵入耳中，内有积热上壅而成，若不及时治疗，日久便会形成耳聋。服用蔓荆子散，外用敷药。
凡是耳聋耳鸣的，都属于热证，是阴虚火动所致，治疗应当泻南方（心）之火，补北方（肾）之水，没有不安定的道理。钱乙曾说：肾只有补法而没有泻法，这话很有深意。
〔附方〕
蔓荆子散：升麻、木通、赤芍、桑皮、生地、麦冬、前胡、甘菊、赤茯苓、蔓荆子、甘草。
黄龙散（外敷药）：矾、龙骨末、黄丹（炒，各五钱）、麝香（一匙）。
总括：鼻属肺脏，体质极其清灵，鼻塞都是因风热侵袭所致；突然窒塞且声音沉重，这是风寒外感的原因。
脉法：右寸脉浮、洪、数，是鼻衄（鼻出血）；左寸脉浮、缓，是伤风，鼻塞流清涕。
《内经》说：西方白色入通于肺，开窍于鼻。又说：鼻子是肺的外在表现。朱丹溪说：肺作为脏腑，位置高，体质脆，性质既恶寒又恶热。所以小儿鼻塞，是因为肺气通于鼻，气属于阳。如果气受到风寒侵袭，停滞在鼻间，就会形成鼻塞；气寒而津液不收摄，则鼻涕多。如果冷风久久不散，浓涕结聚，使鼻子闻不到香臭，就称为鼻渊（注：原文此处可能有缺字或异体字，通常指鼻渊或类似病症，依文意理解为严重鼻塞或鼻渊）。如果夹杂热邪则鼻干，都阻碍吃奶。凡是初生的婴儿，在三朝、五日、六晨、腊日等日子，突然鼻塞，吮乳时不能开口呼吸，多是乳母安睡时不知控制，呼出的气息吹到了婴儿囟门，或者洗浴用水温度冷热不均，气机不通，受气邪影响，导致婴儿鼻子多堵塞。
节斋说：鼻塞闻不到香臭，或者只在寒冷月份容易鼻塞，或者稍微感受风寒就鼻塞，不时发作的，俗人都认为是肺寒，而使用解表通利的辛温药剂。如果不效，殊不知这是因为肺经素来有火邪火郁，严重时喜欢热而厌恶寒，所以遇寒便塞，遇感便发。治疗方法以清金降火为主，辅以通气药剂。如果是平常就鼻塞、闻不到香臭的，再审查其平素只按肺热治疗，清金降火、清痰，或者用丸药含化，或者用药末轻轻调服缓治，没有不有效的。如果平素没有鼻塞症状，一时因感受风寒而导致窒塞、声音重或流清涕的，自然按风寒治疗。
鼻疮是由于壅热损伤肺脏，肺主气通于鼻，风湿之气乘虚客居皮毛，进入血脉，所以鼻子下方两旁疮疡潮湿、瘙痒溃烂，这名叫鼻疳（注：原文此处可能有缺字，根据症状描述及“泽泻散”、“清金散”推断为鼻疳），疮不痛，流出的汁液处又会生疮，服用泽泻散，用清金散外敷。另一方法用熊胆泡汤，用新小笔蘸取点入鼻中。
〔附方〕
开关散：香附、川芎、荆芥、僵蚕、细辛、牙皂，研为末，葱白捣成膏，用红白绢摊开，趁夜间睡觉时贴于囟门。
川芎膏：川芎、细辛、本（藁本）、白芷、杏仁、麝香、甘草。
牛黄犀角散：牛黄、犀角、川芎、升麻、细辛、麻黄、朱砂、冰片、麝香、甘草，蜜丸服用。
泽泻散：泽泻、郁金、栀子、甘草。
青金散：铜青、生硫磺（各一钱）。另一方用生白矾去掉硫磺。
General Principles: The five types of purulent otorrhea arise from the Kidney, formed by the accumulation and upward steaming of Fire-Heat. Deafness and tinnitus are also caused by Yin deficiency leading to the ascent of deficient Fire.
Pulse Diagnosis: A surging and rapid pulse at the Left Cun position indicates Heart Fire flaming upward; a surging and rapid pulse at both Chi positions indicates Ministerial Fire flaming upward.
The *Neijing* states: "The Kidney is the official of strength and vigor, from which skills and techniques emerge." It further states: "The ears are the external manifestation of the Kidney," and another saying goes that the Kidney communicates with the ears through orifices. The ear is the gathering place of numerous meridians and the pathway for Kidney Qi. In children, excessive Kidney Qi combined with Heat rushing upward to the ears causes fluids to stagnate and accumulate, resulting in pus formation. There are five specific types: discharge of yellow pus is called *Ding Er* (Earwax/Discharge); discharge of red pus is called *Nong Er* (Pus Ear); dryness with foul odor inside the ear is called *Hu Er*; discharge of white pus is called *Chan Er*; internal emptiness with ringing and discharge of greenish pus is called *Nang Er*. Although there are five disease manifestations, their source is one. Some result from Wind-Water invading the ear with internal accumulated Heat blocking upwards. If not treated promptly, it may lead to deafness over time. Administer *Man Jing Zi San* internally and apply external medicaments.
For all cases of deafness and tinnitus, they belong to Heat patterns caused by Yin deficiency and Fire agitation. Treatment should involve draining the Fire of the South (Heart) and tonifying the Water of the North (Kidney), ensuring stability. Qian Yi stated: "The Kidney has only tonification methods, no purgation methods," which holds profound significance.
[Attached Formulas]
*Man Jing Zi San*: Shengma (*Cimicifugae Rhizoma*), Mutong (*Akebiae Caulis*), Chishao (*Paeoniae Radix Rubra*), Sangpi (*Mori Cortex*), Shengdi (*Rehmanniae Radix*), Maidong (*Ophiopogonis Radix*), Qianhu (*Peucedani Radix*), Ganju (*Chrysanthemi Flos*), Chifuling (*Poria cum Lignum*, reddish part), Manjingzi (*Viticis Fructus*), Gancao (*Glycyrrhizae Radix et Rhizoma*).
Huang Long San (External Application): Fan (Alumen), Longgu Mo (Fossilized Bones Powder), Huangdan (Minium, fried, 5 qian each), Shexiang (Moschus, one spoon).
General Principles: The Nose belongs to the Lung, possessing a very pure nature. Nasal congestion is caused by Wind-Heat invasion. Sudden obstruction with heavy voice results from external contraction of Wind-Cold.
Pulse Diagnosis: A floating, surging, and rapid pulse at the Right Cun indicates Epistaxis (Nosebleed); a floating and moderate pulse at the Left Cun indicates Wind Injury with nasal congestion and clear rhinorrhea.
The *Neijing* states: "The color White of the West enters into communication with the Lung, opening into the nose." It also states: "The nose is the external manifestation of the Lung." Zhu Danxi said: "As an organ, the Lung is high in position, fragile in constitution, and dislikes both Cold and Heat." Therefore, pediatric nasal congestion occurs because Lung Qi communicates with the nose, and Qi is Yang. If Qi is affected by Wind-Cold and stagnates in the nasal cavity, congestion results. Due to Cold Qi failing to retain fluids, there is excessive runny nose. If cold wind persists, thick mucus accumulates, causing loss of smell, known as *Bi Yuan* (Nasal Sinusitis/Polyps). If mixed with Heat, the nose becomes dry, hindering feeding. For newborn infants, on days such as the third, fifth, sixth, or lunar month-end, sudden nasal congestion preventing mouth-opening for breastfeeding often occurs when the nurse falls asleep and exhales breath onto the infant's fontanelle, or due to inconsistent water temperature during bathing, causing Qi blockage and pathogenic Qi invasion, leading to nasal congestion.
Jie Zhai stated: "Nasal congestion with loss of smell, occurring mainly in cold months or triggered slightly by Wind-Cold, recurring frequently, is commonly mistaken by laypeople as Lung Cold, treated with acrid-warm formulas for releasing the exterior and promoting circulation. When ineffective, it is unknown that this is due to latent Fire pathogens and Fire depression in the Lung Meridian. Severe cases prefer heat and dislike cold, hence congestion upon cold exposure and flare-ups upon pathogen contact. The treatment principle focuses on clearing Metal and descending Fire, assisted by agents that unblock Qi. For chronic cases of congestion and anosmia, review if it was previously treated solely as Lung Heat; use formulas to clear Metal, descend Fire, and resolve phlegm, either as pills to be held in the mouth or fine powders taken gently and slowly, yielding effective results. For acute cases without prior history, triggered by Wind-Cold causing obstruction, heavy voice, or clear rhinorrhea, treat naturally as Wind-Cold."
*Nasal Sores* are caused by obstructive Heat injuring the Lung. The Lung governs Qi and communicates with the nose. Wind-Damp pathogens invade the skin and hair follicles due to deficiency, entering the blood vessels. This results in moist, itchy, and ulcerated sores on both sides below the nose, named *Bi Gan* (Nasal Miasma/Gangrene). The sores are painless, and fluid discharge creates new sores. Administer *Ze Xie San* internally and apply *Qing Jin San* externally. Another method uses Bear Gallbladder (*Xiong Dan*) soaked in water, applied with a new small brush into the nose.
[Attached Formulas]
*Kai Guan San*: Xiangfu (*Cyperi Rhizoma*), Chuanxiong (*Ligustici Chuanxiong Rhizoma*), Jingjie (*Schizonepetae Spica*), Jiangcan (*Bombyx Batryticatus*), Xixin (*Asari Radix et Rhizoma*), Ya zao (*Gleditsiae Sinensis Spina*, fruit horn), powdered. Scallion white (*Cong Bai*) pounded into paste, spread on red-and-white silk, applied to the fontanelle at night.
*Chuanxiong Gao*: Chuanxiong, Xixin, Ben (*Ligustici Wallichii Rhizoma*), Baizhi (*Angelicae Dahuricae Radix*), Xingren (*Armeniacae Semen Amarum*), Shexiang, Gancao.
*Niu Huang Xi Jiao San*: Niu Huang (*Calculus Bovis*), Xi Jiao (*Rhinocerotis Cornu*), Chuanxiong, Shengma, Xixin, Mahuang (*Ephedrae Herba*), Zhusha (*Cinnabaris*), Bingpian (*Borneolum Syntheticum*), Shexiang, Gancao, honey-pilled.
*Ze Xie San*: Ze Xie (*Alismatis Rhizoma*), Yujin (*Curcumae Radix*), Zhizi (*Gardeniae Fructus*), Gancao.
*Qing Jin San*: Tongqing (*Viridissimi Cupri Acetati Crystallis*), Sheng Liuhuang (Sulfur, raw, 1 qian each). Alternative formula uses Sheng Baifan (Alumen, raw) omitting Sulfur.