耳鸣证，或鸣甚如蝉，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
中而为鸣，郁甚则壅闭矣。若遇此症，但审其平昔饮酒浓味，上焦素有痰火，只作清痰降火治之。大抵此
症多先有痰火在上，又感恼怒而得，怒则气上，少阳之火客于耳也。若肾虚而鸣者，其鸣不甚，其人多欲，
当见在劳怯等症。
愚按前症若血虚有火，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。经云头痛耳鸣，九窍不利，肠胃之所生也。脾胃
一虚，耳目九窍皆为之病。
少宰李蒲汀，耳如蝉鸣，服四物汤耳鸣益甚。余以为足三阴虚，五更服六味地黄丸，食前服补中益气
汤，顿愈。
少司马黎仰之，因怒，耳鸣，吐痰，作呕，不食，寒热，胁痛。用小柴胡合四物加山栀、茯神、陈
皮而瘥。
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，世俗皆以为肺寒，而用解表通利辛
温之药不效。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
肺降火为主，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，清金泻火清痰，或
丸药噙化，或末药轻调，缓服久服，无不效矣。此予所亲见而治验者。其平素原无鼻塞旧症，一时偶感风
寒，而致窒塞声重，或流清涕者，自作风寒治。
愚按前症若因饥饱劳役所伤脾胃，发生之气不能上升，邪害空窍，故不利而不闻香臭者，宜养脾胃，
使阳气上行则鼻通矣。按东垣云∶胆移热于脑，则辛 鼻渊，治之以防风汤。大抵胃气不和之所致者
多矣。
一男子，房劳兼怒，风府胀闷，两胁胀痛。余作色欲损肾，怒气伤肝，用六味地黄丸料加柴胡、当
归，一剂而安。
一男子，面白，鼻流清涕，不闻香臭，三年矣。余以为肺气虚，用补中益气加麦门、山栀而愈。
耳鸣证，有的鸣响剧烈像蝉叫，有的在左边，有的在右边，有时伴有耳道闭塞感。世人大多将其当作肾虚来治疗，但效果不佳。殊不知这是因为痰火上升，郁结在耳中导致鸣响，郁结严重时就会造成壅塞闭塞。如果遇到这种病症，只要审查患者平时是否饮酒、食用肥厚滋腻的食物，以及上焦是否素有痰火，就只按照清化痰热、降泻火邪的方法来治疗。大抵这类病症多先有痰火在上焦，又因恼怒而诱发，愤怒会导致气机上逆，少阳相火客居于耳部所致。如果是肾虚引起的耳鸣，其鸣响程度不严重，患者多有房事过度，应当见到劳损虚怯等症候。
我按语：上述前症，如果是血虚而有火，用四物汤加山栀、柴胡；如果是中气虚弱，用补中益气汤；如果是气血俱虚，用八珍汤加柴胡；如果是发怒后耳聋或兼有耳鸣的，属于肝胆经气实，用小柴胡汤加川芎、当归、山栀，若属虚证则用八珍汤加山栀；如果午前症状加重，是阳气实热，用小柴胡汤加黄连、山栀，若是阳气虚则用补中益气汤加柴胡、山栀；如果午后症状加重，是阴血虚，用四物汤加白术、茯苓；如果是肾虚火动，或者痰盛引起口渴的，必须用地黄丸（此处指六味地黄丸）。《内经》说：“头痛耳鸣，九窍不利，肠胃之所生也。”脾胃一旦虚弱，耳目及九窍都会因此患病。
少宰李蒲汀，耳朵像蝉鸣一样响，服用四物汤后耳鸣更加严重。我认为这是足三阴经阴虚，让他五更天服用六味地黄丸，饭前服用补中益气汤，顿时痊愈。
少司马黎仰之，因为发怒，出现耳鸣、吐痰、作呕、不能进食、寒热往来、胁痛等症状。用小柴胡汤合四物汤加山栀、茯神、陈皮而病愈。
鼻塞闻不到香气和臭味，或者只是在寒冷的月份容易鼻塞，或者稍微感受风寒就鼻塞，不时发作的，世俗都认为是肺寒，而使用解表通利的辛温药物无效。殊不知这是因为肺经素来有火邪，火邪郁结严重时喜欢温暖而厌恶寒冷，所以遇到寒冷就鼻塞，遇到外感就发作。治疗方法：以清肺降火为主，辅以通气散结的药物。如果像平常一样鼻塞闻不到香臭，再审查其平素情况，只按肺热治疗，清金泻火化痰，或者制成丸药含化，或者制成散剂轻微调服，缓慢服药、长期服药，没有不有效的。这是我亲眼所见并验证过的。那些平素原本没有鼻塞旧疾，一时偶然感受风寒，而导致鼻塞声重，或者流清涕的，自然按照风寒来治疗。
我按语：上述前症，如果是因饥饱失调、劳累过度损伤了脾胃，导致发生之气不能上升，邪气侵害空窍，所以不通利且闻不到香臭的，适宜调养脾胃，使阳气上行则鼻子通畅了。据东垣所说：“胆移热于脑，则辛頞鼻渊”，用防风汤治疗。大抵大多是由胃气不和所导致的。
有一个男子，因房劳过度兼有发怒，风府穴处胀闷，两胁胀痛。我认为是色欲损伤肾脏，怒气伤害肝脏，用六味地黄丸的药料加柴胡、当归，一剂药后便安宁。
Tinnitus syndrome, in some cases, the ringing is severe like cicadas, occurring on either the left or right side, or sometimes accompanied by a sensation of blockage. People generally treat it as Kidney deficiency, but with little effect. They fail to realize that this is caused by Phlegm-Fire ascending and stagnating in the ear, leading to tinnitus; when the stagnation is severe, it causes obstruction and blockage. When encountering this syndrome, one should examine whether the patient usually consumes alcohol and rich, greasy foods, and whether there has been pre-existing Phlegm-Fire in the Upper Jiao (Upper Burner). Treatment should focus solely on clearing Phlegm and descending Fire. Generally, this syndrome often arises from pre-existing Phlegm-Fire in the upper body, triggered by anger. Anger causes Qi to ascend, and the Shaoyang (Lesser Yang) Fire lodges in the ear. If tinnitus is due to Kidney deficiency, the ringing is not severe, and the patient typically exhibits excessive sexual desire and symptoms of consumptive deficiency.
My commentary: For the aforementioned syndromes, if it is Blood deficiency with Fire, use Siwu Tang (Four Substances Decoction) with Zhizi (Gardeniae Fructus) and Chaihu (Bupleuri Radix); if it is Middle Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if both Qi and Blood are deficient, use Bazhen Tang (Eight Treasures Decoction) with Chaihu; if deafness or tinnitus occurs after anger, it belongs to Excess of Qi in the Liver and Gallbladder meridians, use Xiaochaihu Tang (Minor Bupleurum Decoction) with Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), and Zhizi; for deficiency patterns, use Bazhen Tang with Zhizi; if symptoms worsen before noon, it indicates Excess Heat of Yang, use Xiaochaihu Tang with Huanglian (Coptidis Rhizoma) and Zhizi; if it is Yang deficiency, use Buzhong Yiqi Tang with Chaihu and Zhizi; if symptoms worsen after noon, it indicates Yin-Blood deficiency, use Siwu Tang with Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria); if it is Kidney deficiency with moving Fire, or Phlegm excess causing thirst, Dihuang Wan (Rehmannia Pill, specifically Liuwei Dihuang Wan) must be used. The Classic states: "Headache and tinnitus, and dysfunction of the nine orifices, arise from the intestines and stomach." Once the Spleen and Stomach are deficient, the ears, eyes, and all nine orifices will suffer.
Li Puting, Vice Minister of Personnel, had tinnitus like cicadas. After taking Siwu Tang, his tinnitus worsened. I diagnosed it as deficiency of the three Yin meridities of the foot. He took Liwei Dihuang Wan (Six-Ingredient Rehmannia Pill) at the fifth watch (early morning) and Buzhong Yiqi Tang before meals, resulting in immediate recovery.
Li Yangzhi, Vice Minister of War, suffered from anger-induced tinnitus, expectoration, vomiting, anorexia, alternating chills and fever, and hypochondriac pain. He was treated with Xiaochaihu Tang combined with Siwu Tang, plus Zhizi, Fushen (Poria cum Radix), and Chenpi (Citri Reticulatae Pericarpium), and recovered.
Nasal congestion with loss of smell, or congestion mainly during cold months, or congestion upon slight exposure to wind-cold, recurring frequently, is commonly regarded by laypeople as Lung Cold. However, using acrid-warm herbs to release the exterior and unblock the orifices is ineffective. This is actually due to pre-existing Fire pathogen in the Lung meridian. When Fire stagnates severely, the patient prefers warmth and dislikes cold, hence congestion occurs in cold weather and upon exposure. The treatment principle is primarily to clear the Lung and descend Fire, assisted by agents that promote ventilation. For chronic nasal congestion with loss of smell, treating it as Lung Heat based on the patient's constitution is appropriate. Clear Metal (Lung), purge Fire, and resolve Phlegm. This can be administered as pills to be held in the mouth for gradual absorption, or as powders taken lightly. Slow, long-term administration yields effective results. This is based on my personal clinical experience. For those without a history of nasal congestion who suddenly develop stuffiness, heavy voice, or clear rhinorrhea due to acute wind-cold exposure, it should naturally be treated as Wind-Cold.
My commentary: For the aforementioned syndromes, if caused by damage to the Spleen and Stomach from irregular diet or overwork, leading to an inability of the generated Qi to ascend, allowing pathogenic factors to harm the empty orifices, resulting in dysfunction and loss of smell, it is advisable to nourish the Spleen and Stomach so that Yang Qi can ascend, thereby clearing the nose. According to Dongyuan: "When Gallbladder heat transfers to the brain, it causes Xin'e Biyuan (nasal sinusitis with foul discharge), treated with Fangfeng Tang." Generally, these cases are mostly caused by disharmony of Stomach Qi.
A man, suffering from kidney damage due to sexual exhaustion and liver injury due to anger, experienced distension and stuffiness at the Fengfu point (GV16) and distending pain in both hypochondria. I diagnosed it as kidney damage from lust and liver damage from anger, and prescribed the ingredients of Liwei Dihuang Wan with added Chaihu and Danggui (Angelicae Sinensis Radix). One dose brought relief.
Another man, pale in complexion, with clear rhinorrhea and loss of smell for three years, was diagnosed with Lung Qi deficiency. He was cured using Buzhong Yiqi Tang with added Maimendong (Ophiopogonis Radix) and Zhizi.