立斋曰∶耳疮，属少阳三焦经，或足厥阴肝经，血虚风热，或肝经燥火风热，或肾经虚
火等因。若发热 痛，属少阳厥阴风热，用柴胡清肝散。若内热痒痛，属二经血虚，用当
归
川芎散。若寒热作痛，属肝经风热，用小柴胡汤加山栀、川芎。若内热口干，属肾经虚火，
用加减地黄丸。如不应，用加减八味丸，余当随证治之。
愚按，薛氏所治耳证，凡气虚者，以补中益气汤加山栀、黄芩。血虚者，用八珍汤加柴
胡、丹皮。肝火血虚者，用栀子清肝散。怒动肝火者，用加味逍遥散。肝脾受伤者，朝用加
味归脾汤，暮用加味逍遥散。此其治之大约也。予尝治一儒者，年近三旬，素有耳病，每年
常发，发必肿溃。至乙亥二月，其发则甚，自耳根下连颈项，上连头角，耳前耳后莫不肿痛
。诸医之治，无非散风降火。至一月后，稠胀鲜血自耳迭出，每二三日必出一酒钟许。然脓
出而肿全不消，痛全不减，枕不可近，食不可加，气体俱困，自分其危，延余治之。察其形
气，已大不足。察其病体，则肿痛如旧，仍若有余。察其脉息则或见弦急，或见缓弱。此非
实热可知，然脉不甚紧而或时缓弱，亦得溃疡之体，尚属可治。遂先以六味汤二三剂，而元
气稍振；继以一阴煎加牛蒡、茯苓、泽泻，仍倍加白蒺藜为君，服五十余剂，外用降痈散，
昼夜敷治，两月而后愈。盖此证虽似溃疡有余，而实以肝肾不足，上实下虚一奇证也，故存
识之。（薛按）
薛立斋说：耳疮，归属于少阳三焦经，或足厥阴肝经。其病因多为血虚受风热侵袭，或肝经燥火兼风热，或肾经虚火等所致。如果伴有发热且疼痛，属于少阳、厥阴二经受风热邪气侵袭，应使用柴胡清肝散治疗。如果内部有热感且瘙痒疼痛，属于这两条经脉的血虚证，应使用当归川芎散治疗。如果出现寒战高热并伴随疼痛，属于肝经风热证，应使用小柴胡汤加山栀、川芎治疗。如果内部有热感且口干，属于肾经虚火证，应使用加减地黄丸治疗。如果服用上述方剂无效，则改用加减八味丸，其余情况应当根据具体证候进行治疗。
我认为，薛氏所治疗的耳部病症，凡是气虚的，用补中益气汤加山栀、黄芩。血虚的，用八珍汤加柴胡、丹皮。肝火旺兼血虚的，用栀子清肝散。因愤怒触动肝火的，用加味逍遥散。肝脾受损的，早晨服用加味归脾汤，晚上服用加味逍遥散。这是治疗的大致原则。我曾治疗一位读书人，年龄近三十岁，素有耳病，每年常发作，发作时必然肿胀溃烂。到了乙亥年二月，这次发作特别严重，从耳根向下连及颈项，向上连及头角，耳前耳后无不肿痛。各位医生的治疗方法，无非是疏散风邪、降泄火热。一个月后，浓稠肿胀的鲜血从耳朵里不断流出，每两三天必流出一酒杯左右。然而脓液流出后，肿胀完全不消退，疼痛完全不减轻，枕头不能靠近头部，饮食无法增加，身体气息都感到困倦虚弱，他自己认为病情危重，于是请我诊治。观察他的形体和气色，已经明显不足。观察他的病体，肿痛依旧，似乎仍有实邪。观察他的脉象，有时呈现弦急，有时呈现缓弱。这显然不是实热证，但脉象不甚紧而有时缓弱，也符合溃疡病的体质，尚属可治。于是先给予六味汤二三剂，元气稍微恢复；接着使用一阴煎加牛蒡子、茯苓、泽泻，仍加倍重用白蒺藜作为主药，服用五十多剂，外用降痈散，昼夜敷贴治疗，两个月后才痊愈。这个病症虽然看似溃疡有余（实证），但实际上是由于肝肾不足，上实下虚的一个奇特证候，所以记录下来。（薛立斋按语）
Xue Lizhai stated: Ear sores (Er Chuang) are attributed to the Shaoyang Sanjiao Meridian or the Foot Jueyin Liver Meridian. The etiology involves blood deficiency with wind-heat invasion, dry fire and wind-heat in the Liver Meridian, or deficient fire in the Kidney Meridian, among other causes. If accompanied by fever and pain, it belongs to wind-heat in the Shaoyang and Jueyin meridians; treat with Chaihu Qinggan San (Bupleurum Decoction for Clearing the Liver). If there is internal heat with itching and pain, it belongs to blood deficiency in these two meridians; treat with Danggui Chuanxiong San (Angelica Sinensis and Ligusticum Wallichii Powder). If chills and high fever occur with pain, it belongs to wind-heat in the Liver Meridian; treat with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Gardenia (Shanzhi) and Ligusticum Wallichii (Chuanxiong). If there is internal heat and dry mouth, it belongs to deficient fire in the Kidney Meridian; treat with Jiadi Dihuang Wan (Modified Rehmannia Pill). If ineffective, use Jiadi Bawei Wan (Modified Eight-Ingredient Pill); otherwise, treat according to the specific syndrome.
I observe that Xue's treatment of ear disorders generally follows these principles: For Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Gardenia (Shanzhi) and Scutellaria Baicalensis (Huangqin). For Blood deficiency, use Bazhen Tang (Eight-Treasure Decoction) added with Bupleurum (Chaihu) and Moutan Cortex (Danpi). For Liver fire with Blood deficiency, use Zhizi Qinggan San (Gardenia Decoction for Clearing the Liver). For Liver fire triggered by anger, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). For injury to the Liver and Spleen, administer Jiawei Guipi Tang (Modified Restore the Spleen Decoction) in the morning and Jiawei Xiaoyao San in the evening. This is the general approach.
I once treated a scholar, nearly thirty years old, who had a chronic ear disease recurring annually, always presenting with swelling and ulceration. In the second month of the Yi Hai year, the attack was severe, extending from the root of the ear down to the neck and up to the temporal angle, with no part around the ear spared from swelling and pain. Treatments by other physicians focused solely on dispersing wind and reducing fire. After one month, thick, swollen bright red blood flowed continuously from the ear, approximately one wine cup every two or three days. However, despite the discharge of pus, the swelling did not subside, nor did the pain diminish; he could not rest his head on a pillow, and his appetite failed. His physical energy was exhausted, and he considered his condition critical. Upon examination, his form and Qi were significantly deficient. Yet, the swelling and pain persisted as if excess pathogenic factors remained. His pulse was sometimes wiry and rapid, sometimes slow and weak. This indicated it was clearly not an excess-heat syndrome. Since the pulse was not tight but occasionally weak, consistent with the constitution of an ulcerative condition, it was still treatable. I first administered Liuwei Tang (Six-Ingredient Decoction) for two or three doses to slightly strengthen the Yuan Qi (Primary Qi). Subsequently, I prescribed Yiyin Jian (One-Yin Decoction) added with Arctii Fructus (Niubangzi), Poria (Fuling), and Alisma Rhizoma (Zexie), heavily emphasizing Tribulus Terrestris (Baijili) as the chief herb. He took over fifty doses. Externally, Jiangyong San (Decocted Poultice for Reducing Abscesses) was applied day and night. He recovered after two months. Although this case appeared to have excess symptoms typical of ulcers, it was essentially a rare syndrome of Liver and Kidney deficiency manifesting as upper excess and lower deficiency. Therefore, I recorded it. (Commentary by Xue Lizhai)