既察其鼻。当观其耳。耳也者。肾之官也。故察耳之好恶。可知肾之强弱也。何则。黑色小理者。肾小。粗理者。
肾大。耳高者肾高。耳后陷者肾下。耳坚者。肾坚。耳薄不坚者。肾脆。耳好前居牙车者。肾端正。耳偏高者。肾
偏倾。此察耳形之常也。以色言之。有左右之殊。有上下之辨。左为左。右为右。上应乎上。下应乎下也。肾之
候也。肾主骨。故耳起五色者。病在骨也。黄赤者。多热气。青白者。少热气。黑色者。多血少气。黄赤为风。青黑
为痛。白为寒。属分五行。亦应乎五脏也。气色之变。可以十法推之。生克之理。可以五行推之。其余望法。有
可比例者。宜察其病。辨其证。而合参之也。若夫耳形之诊。当以浓而大者为形盛。薄而小者为形亏。肿起
者。邪气实。消减者。正气虚。润泽则吉。枯槁则凶。合之于色。亦可辨其寒热虚实焉。他如下消则耳叶焦干。
肠痈则耳叶甲错。肾前病。耳则为之焦枯。肾前死。耳则为之KT 黑焦癖。若天中等分墓色应之。必死不治。
是皆主病之目也。痘科尚有观耳后络脉之诗。因续四句于其后。其诗曰。耳后红筋痘必轻。紫筋起处重
沉沉。兼青带黑尤难治。十个难求三五生。予续之曰。冷暖阴晴色更改。须将痘证辨分明。望闻问切能参
悟。不看红筋彻底清。
在已经观察了鼻部之后，应当观察耳朵。耳朵，是肾脏的外候（官窍）。因此，通过观察耳朵的好坏，可以了解肾脏的强弱。为什么呢？耳色黑且纹理细密的，说明肾小；纹理粗大的，说明肾大。耳朵位置高的，说明肾位置高；耳后凹陷的，说明肾位置低。耳朵质地坚硬的，说明肾坚实；耳朵薄而不坚硬的，说明肾脆弱。耳朵好且向前靠近牙车（下颌关节）的，说明肾位置端正；耳朵偏高的，说明肾位置偏斜。这是观察耳形的一般规律。从颜色来说，有左右和上下的区别。左边对应左边，右边对应右边，上部对应上部，下部对应下部。这是肾脏的外候表现。肾主骨，所以耳朵出现五色变化的，病位在骨骼。黄色或赤色的，多表示热气盛；青色或白色的，多表示热气少；黑色的，多血少气。黄赤色属风，青黑色属痛，白色属寒。这分别归属于五行，也对应五脏。气色的变化，可以用十种方法推演；生克的道理，可以用五行理论推演。其他的望诊方法，有可以类比参照的，应当仔细考察疾病，辨别证候，然后综合参考。至于耳形的诊断，应当以厚实宽大为形体盛实，以单薄瘦小为形体亏损。肿胀隆起的，是邪气实证；消瘦减小的，是正气虚证。润泽则预后良好，干枯枯槁则预后凶险。结合颜色来看，也可以辨别寒热虚实等情况。其他如消渴病（下消），耳朵叶片会焦干；肠痈，耳朵叶片会出现甲错（皮肤干燥粗糙如鳞甲）；肾脏前方有病，耳朵就会焦枯；肾脏前方将死，耳朵就会变得KT黑、焦枯且有癖块。如果天中穴等部位的颜色与之相应，必定死亡且无法治疗。这些都是主病的征象。痘科还有观察耳后络脉的诗句，因此续写四句在后面。诗句说：耳后红筋痘疹必轻，紫筋突起处病情沉重深沉。兼见青色带黑色尤其难治，十个病例中难求三五个能存活。我续写道：冷暖阴晴面色改变，必须将痘疹证候辨别分明。望闻问切能够参悟透彻，不看红筋也能彻底看清。
After having observed the nose, one should observe the ears. The ears are the external manifestation (Guan) of the Kidney. Therefore, by observing the condition of the ears, one can know the strength or weakness of the Kidney. Why is this so? If the ear color is black and the texture is fine, the Kidney is small; if the texture is coarse, the Kidney is large. If the ears are high, the Kidney is positioned high; if the area behind the ears is sunken, the Kidney is positioned low. If the ears are firm, the Kidney is solid; if the ears are thin and not firm, the Kidney is fragile. If the ears are well-formed and positioned forward near the jaw joint (Yache), the Kidney is upright; if the ears are higher on one side, the Kidley is tilted. This is the general rule for observing ear shape. Speaking of color, there are distinctions between left and right, and upper and lower. The left corresponds to the left, the right to the right, the upper to the upper, and the lower to the lower. These are the manifestations of the Kidney. The Kidney governs the bones; therefore, if five colors appear on the ears, the disease is in the bones. Yellow and red indicate abundant heat qi; blue and white indicate scant heat qi; black indicates abundant blood and scant qi. Yellow and red correspond to Wind; blue and black correspond to Pain; white corresponds to Cold. These correspond to the Five Elements and also to the Zang-Fu organs. Changes in Qi and color can be deduced using ten methods; the principles of generation and restriction can be deduced using the Five Elements theory. Other inspection methods have analogous references; one should carefully examine the disease, differentiate the syndrome, and combine them for reference. Regarding the diagnosis of ear shape, thick and large indicates robust physical constitution (Xing Sheng); thin and small indicates deficient physical constitution (Xing Kui). Swelling and protrusion indicate excess pathogenic factors (Xie Qi Shi); wasting and reduction indicate deficiency of healthy Qi (Zheng Qi Xu). Moisture and luster are auspicious; dryness and withering are ominous. Combined with color, one can also differentiate cold, heat, excess, and deficiency. For example, in Xiao Ke (Wasting-Thirst Disease, specifically Lower Xiao), the earlobes become scorched and dry; in Chang Yong (Intestinal Abscess), the earlobes show Jia Cuo (skin rough like fish scales); if there is disease anterior to the Kidney, the ears become scorched and withered; if death is imminent due to anterior Kidney pathology, the ears become KT-black, scorched, withered, and nodular. If the color at Tianzhong and other points corresponds accordingly, death is certain and untreatable. These are all indicators of primary diseases. In the field of Smallpox (Dou Ke), there are poems regarding observing the collateral vessels behind the ears. I have added four lines following it: "Red veins behind the ears indicate mild smallpox; where purple veins rise, the condition is heavy and deep. Accompanied by blue and black, it is particularly difficult to treat; out of ten cases, three or five may survive." I added: "Colors change with warmth, cold, yin, and yang; one must clearly distinguish the smallpox syndromes. By comprehensively applying Inspection, Auscultation/Olfaction, Inquiry, and Palpation, one can perceive the truth; without relying solely on red veins, one can see clearly to the end."