王肯堂曰∶耳中常出白脓,名曰缠耳。乃足少阴、手少阳二经风热上壅而成。(《准绳》)
冯鲁瞻曰∶白脓出者名曰缠耳。仍肾气有余,积热上冲,或风水入耳所致。(《锦囊》)
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陈实功曰∶耳病乃三焦、肝风妄动而成,大人有虚火实火之分。小儿有胎热、胎
风之别。虚火者,耳内蝉鸣,出水作痒,外无 肿;实火者,耳根耳窍俱肿,甚则寒
热交作,疼痛无时。(《正宗》)
又曰∶初生小儿胎热,或洗浴水灌窍中,亦令耳窍作痛生脓。切记不可吹药,若
治早项内生肿,莫若候毒尽自愈。如一月不瘥,以红绵散治之,自安。
冯鲁瞻曰∶耳者,宗脉之所聚,肾气之所通也。有小儿肾经气实,其热上冲于
耳,遂使使津液壅而为脓,或为清汁,然则厥阴之与足阳明,手少阴之与足太阳,为
证尤甚。推其所致之由,其原有七∶有实热,有阴虚,有因痰,有因火,有气闭,有
肝风,有胎元所发而为病也。证有五∶为鸣、痛、肿、聋、 是也。当分其所因而
治之。(《锦囊》)
又曰∶常出红脓,谓之脓耳。
又曰∶胎元而成者,是因父母不谨,故先天火毒攻冲,脓臭流处成疮,四傍肿赤,
时发时愈。所主宜化毒滋肾。
陈远公曰∶人有双耳忽肿痛,内流清水,久则变脓血,身发寒热,耳内如沸汤
响,或如蝉鸣,此少阳胆气不舒,而风邪乘之,火不得散,故生此病。法宜舒发胆
气,佐以散风泻火之味,则愈矣。然有不效者,何也?盖胆受风火之邪,燥干胆汁,
徒用祛风泻火,则胆汁益干,胆火益炽,风藉火威,愈焚灼也,病益甚矣。润肠汤主
之,当归、白芍、玄参各一两,黑栀子二钱,柴胡一钱,花粉三钱,石菖蒲八分,水
煎服。一剂疼轻,二剂肿消,三剂脓血止,四剂寒热除,十剂全可也。(此方归、芍不但入胆,
且入肝也。胆病,肝亦必病,平肝则胆亦平也。柴、栀亦舒肝胆之味,舒肝正所以舒胆也。肝舒则血必旺,而
胆汁有不濡润者乎!胆汁既濡,邪风邪火,已有不治自散之机,加天花粉逐痰,则风火无党,以石菖蒲通耳中
之窍,玄参退浮游之焰,自然风火渐祛,上焦清凉,耳病随痊也。《冰鉴》)
汪省之曰∶虚火治以四物汤加牡丹皮石菖蒲、肾气丸主之。实火,治以柴胡清
肝汤主之。(《理例》)
王肯堂说:耳中经常流出白色脓液,称为缠耳。这是由足少阴肾经和手少阳三焦经的风热之邪上壅所致。(《医学准绳六要》)
冯鲁瞻说:流出白色脓液的称为缠耳。这仍是肾气有余,积热上冲,或者是风水之邪侵入耳朵所致。(《医宗金鉴·锦囊秘录》)
陈实功说:耳病是由于三焦、肝风妄动而形成的。成人有虚火和实火的区别;小儿有胎热和胎风的分别。虚火证,表现为耳内蝉鸣,出水作痒,外部没有肿胀;实火证,表现为耳根和耳窍都肿胀,严重时寒热交替发作,疼痛无时休止。(《外科正宗》)
他又说:初生婴儿若有胎热,或者洗浴时水灌入耳窍,也会导致耳窍疼痛并生成脓液。切记不可向耳内吹药,如果治疗过早导致颈部内部出现肿胀,不如等待毒邪排尽后自愈。如果一个月不痊愈,用红绵散治疗,自然平安。
冯鲁瞻说:耳朵是诸脉汇聚之处,也是肾气通达的器官。有些小儿肾经气盛,热气上冲于耳,致使津液壅滞化为脓液,或者成为清稀汁液。然而厥阴肝经与足阳明胃经、手少阴心经与足太阳膀胱经相关的病症尤为严重。推究其致病原因,主要有七种:有实热,有阴虚,有因痰,有因火,有气闭,有肝风,有胎元引发疾病。症状有五种:鸣、痛、肿、聋、流脓。应当根据病因分别治疗。(《医宗金鉴·锦囊秘录》)
他又说:经常流出红色脓液的,称为脓耳。
他又说:因胎元而成的,是因为父母不慎,导致先天火毒攻冲,脓液臭秽流出形成疮疡,四周红肿,时发时愈。主治宜化解毒素、滋补肾阴。
陈远公说:人有双耳突然肿痛,内部流出清水,久了则变为脓血,身体出现寒热,耳内像沸水响声,或者像蝉鸣,这是少阳胆气不舒畅,风邪乘虚而入,火邪不得疏散,所以产生此病。治法应当舒展胆气,辅以散风泻火的药物,就能痊愈。然而有无效的,为什么呢?因为胆受风火之邪,燥干胆汁,如果只用祛风泻火的药,则胆汁更加干燥,胆火更加炽盛,风借火势,更加焚烧灼伤,病情更加严重。用润肠汤主治,当归、白芍、玄参各一两,黑栀子二钱,柴胡一钱,花粉三钱,石菖蒲八分,水煎服。一剂疼痛减轻,二剂肿胀消退,三剂脓血停止,四剂寒热消除,十剂即可痊愈。(这个方子中的当归、白芍不仅入胆经,而且入肝经。胆有病,肝也必然有病,平抑肝气则胆气也平和。柴胡、栀子也是舒缓肝胆的药物,舒缓肝气正是为了舒缓胆气。肝气舒缓则血液必旺盛,胆汁怎能不濡润呢!胆汁既已濡润,邪风邪火,已有不治自散的契机,加上天花粉驱逐痰浊,则风火无所依附,再用石菖蒲开通耳中之窍,玄参退去浮游之火,自然风火逐渐祛除,上焦清凉,耳病随之痊愈。)(《辨证录》)
Wang Kentang stated: When white pus frequently discharges from the ear, it is called Chan Er (Tangled Ear). This condition arises from the upward congestion of Wind-Heat in the Foot-Shaoyin Kidney Meridian and Hand-Shaoyin Sanjiao Meridian. (*Yixue Zhunsheng Liuyao*)
Feng Luzhan stated: Discharge of white pus is termed Chan Er (Tangled Ear). It results from excess Qi of the Kidney with accumulated Heat rushing upward, or due to Water-Wind pathogenic factors invading the ear. (*Yizong Jinjian: Jinnang Milu*)
Chen Shigong stated: Ear diseases are caused by reckless movement of the Sanjiao and Liver Wind. In adults, there is a distinction between Deficient Fire and Excess Fire; in children, there is a difference between Fetal Heat and Fetal Wind. The Deficient Fire pattern presents with cicada-like tinnitus in the ear, discharge of fluid causing itching, without external swelling. The Excess Fire pattern presents with swelling of both the ear root and the ear canal, and in severe cases, alternating chills and fever with unceasing pain. (*Waike Zhengzong*)
He further stated: Newborn infants with Fetal Heat, or those whose ear canals are penetrated by water during bathing, may also suffer from ear pain and pus formation. It is crucial not to blow medicinal powders into the ear. If premature treatment leads to swelling inside the neck, it is better to wait for the toxin to exhaust itself and heal spontaneously. If it does not resolve within one month, treat with Hongmian San (Red Silk Powder), and peace will be restored.
Feng Luzhan stated: The ears are the gathering place of all meridians and the passage through which Kidney Qi communicates. In some children, excessive Qi in the Kidney Meridian causes Heat to rush upward to the ear, leading to stagnation of body fluids that transform into pus or clear fluid. However, conditions involving the Jueyin Liver Meridian and Foot-Yangming Stomach Meridian, as well as Hand-Shaoyin Heart Meridian and Foot-Taiyang Bladder Meridian, are particularly severe. Investigating the causes, there are seven primary origins: Excess Heat, Yin Deficiency, Phlegm, Fire, Qi Obstruction, Liver Wind, and disease originating from the fetal constitution. There are five main symptoms: Tinnitus, Pain, Swelling, Deafness, and Suppuration. Treatment should be differentiated according to the etiology. (*Yizong Jinjian: Jinnang Milu*)
He further stated: Frequent discharge of red pus is called Nong Er (Pus Ear).
He further stated: Cases arising from the fetal constitution occur because parents were not careful, leading to congenital Fire-Toxin attacking and rushing upward. Pus flows out with a foul odor forming sores, with surrounding redness and swelling, recurring intermittently. The treatment principle should focus on resolving toxins and nourishing Kidney Yin.
Chen Yuangong stated: When a person suffers from sudden swelling and pain in both ears, with clear fluid flowing internally initially, which later turns into pus and blood, accompanied by systemic chills and fever, and sounds in the ear like boiling water or cicadas, this indicates that Shaoyang Gallbladder Qi is not free-flowing, allowing Wind pathogens to take advantage. The Fire cannot dissipate, thus generating this disease. The therapeutic method should be to soothe and release Gallbladder Qi, assisted by herbs that dispel Wind and purge Fire, leading to recovery. However, why do some treatments fail? Because when the Gallbladder is affected by Wind-Fire pathogens, the bile becomes dry. Using only Wind-dispelling and Fire-purging herbs will further dry the bile, intensify Gallbladder Fire, and allow Wind to borrow the strength of Fire, causing greater burning and damage, worsening the illness. The formula Run Chang Tang (Moisten Intestine Decoction) is indicated: Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Xuan Shen (Scrophulariae Radix) each 1 liang, Hei Zhi Zi (Gardeniae Fructus nigro-coctus) 2 qian, Chai Hu (Bupleuri Radix) 1 qian, Hua Fen (Trichosanthis Radix) 3 qian, Shi Chang Pu (Acori Tatarinowii Rhizoma) 8 fen. Decoct in water and take orally. After one dose, pain lightens; after two doses, swelling subsides; after three doses, pus and blood stop; after four doses, chills and fever disappear; ten doses ensure complete recovery. (Note: Dang Gui and Bai Shao enter not only the Gallbladder but also the Liver meridian. When the Gallbladder is diseased, the Liver is inevitably involved; calming the Liver calms the Gallbladder. Chai Hu and Zhi Zi also soothe the Liver and Gallbladder; soothing the Liver is precisely how one soothes the Gallbladder. When Liver Qi is smooth, Blood becomes abundant, ensuring the bile is moistened. Once the bile is moistened, Wind and Fire pathogens have the opportunity to dissipate spontaneously. Adding Hua Fen expels Phlegm, leaving Wind and Fire without support. Shi Chang Pu opens the orifices of the ear, and Xuan Shen clears floating Fire. Naturally, Wind and Fire are gradually expelled, the Upper Jiao becomes cool, and the ear disease heals.) (*Bianzheng Lu*)
Wang Shengzhi stated: For Deficient Fire patterns, treat with Si Wu Tang (Four Substances Decoction) added with Mu Dan Pi (Moutan Cortex) and Shi Chang Pu (Acori Tatarinowii Rhizoma), or primarily use Shen Qi Wan (Kidney Qi Pill). For Excess Fire patterns, treat primarily with Chai Hu Qing Gan Tang (Bupleurum Liver-Clearing Decoction). (*Lili*)