冯鲁瞻曰∶阴虚耳鸣，其候手足心热，口渴肠燥，两尺脉大，时或作痒，耳聋及
鸣。治当滋阴疏肝为主。（《锦囊》）
又曰∶因痰耳鸣，其候气壅口燥，不痛耳痒，体重脉弦，耳鸣 耳者是也。所
主在二陈、竹沥之类。
陈实功曰∶心肾不交，心劳则火上炎，气结则不下降。盖肾开窍于耳，故心火乘
之，遂有耳鸣耳闭之患矣。（《正宗》）
岐天师曰∶耳中闻蚂蚁战斗之声音，此非祟症，乃肾水耗尽，又加怒气伤肝所致。
宜止喧丹主之。方中纯是补肾平肝之圣药，饮之数日，其战斗之声渐远，服一月即愈。
此乃奇病，而以伯道之方治之也。（《秘录》）
经曰∶肾开窍于耳。夫肾之为脏，水脏也。天一生水，故有生之初，先生二肾
而一阴藏焉。又有相火存乎命门之中，每挟君火之势，而侮所不胜，经所谓一水不
能胜二火也。况又嗜欲无节，劳役过度，或中年之后，大病之余，肾水枯涸，阴火上
炎，故耳痒耳鸣，无日不作也。经曰∶阳气万物，盛上而跃，故耳作鸣也。是以鸣
甚如蝉，或左或右，或时闭塞，然有作为虚治而不效者，何也？此有痰火上升，郁
于耳中，故为鸣；郁甚则壅闭矣。凡遇此疾，若平昔饮酒浓味，上焦素有痰火者，只
作清痰降火治之。多因先有痰火在上，又感恼怒而得；怒则气上，少阳之火生于耳
也。若是肾虚而鸣者，亦是膀胱相火上升，故鸣必不甚，其人必多欲，当兼见劳怯之症。
冯氏曰∶人身有九窍。阳窍七∶耳、目、口、鼻是也；阴窍二∶前后二阴是也。阳
气走上窍，若下入阴位，则有泻泄腹鸣之候；阴气走下窍，若上入阳位，则有窒塞
耳鸣之候。高年之人，肾水已竭，真火易露，故肾水之气易出难收，浮越上窍，窍
内有声如蛙、鼓、蚁声，是以外入之声与内声相混，听之不清；至年迈无气，内竭
不能上通，而听斯失聪矣。非若少壮之人，浊阴遮蔽其窍，外声不得内入，故用麝香、
菖蒲开气导达为事也。故治高年逆上之气，全以磁石为主，取其重能达下，性主下吸，
兼用地黄、龟胶群阴之药佐之，更助五味子、山萸之酸收之，令阴气自旺于本宫，而
不上触于阳窍，由是空旷无碍，耳之受声，犹谷之受响，故耳之妙用，全在虚而能受
也。经曰∶耳黑枯燥者是肾惫。（《锦囊》）
陈远公曰∶人有耳疼虽愈，而耳鸣如故者，人以为风火也，仍用祛风散火而鸣
益甚，以手按耳则鸣少息，此阳虚气塞也。法宜补阳为主，兼理肝肾之虚，用发阳通
阴汤以治之。人参、白术、当归、白芥子各二钱，茯苓、黄 、白芍各三钱，熟地
五钱，柴胡一钱，肉桂、甘草各五分，黑荆芥一钱，水煎服。一剂轻，二剂愈。十
全大补也。（《冰鉴》）
又曰∶人有平居无事，忽耳闻风雨鼓角之响，人以为肾火盛也，谁知心火亢极
乎。凡人心肾交，始能下上清宁以司视听；
心肾不交，皆能使听闻之乱。然肾欲交心，心必能受，心欲交肾，肾必能受，始相安
也。倘肾火大旺，心必畏肾之炎，不敢下交于肾矣，均能使两耳之鸣。但心不交于
肾者，耳鸣轻；肾不交于心者，耳鸣重。今闻风雨鼓角，耳鸣之重也，治法欲肾气之
归于心，必使心气仍归于肾，用两归汤主之。麦冬、熟地各一两，丹参、茯神各三
钱，生枣仁五钱，黄连二钱，水煎服，二剂鸣止，四剂不发也。（此凉心之剂，心凉则肾不
畏心之热，药与来归，不必两相引而合也。全是益心滋肾之品，不但心无过燥之虞，而肾且有大润之药。如夫
妇之同心，有鱼水之欢，又何有乖离之戚也哉。）
申斗垣曰∶蝉鸣，乃肝胆之火也，宜龙胆泻肝汤主之。（《启玄》）
冯鲁瞻说：阴虚导致的耳鸣，其症状表现为手足心发热、口渴、肠道干燥，两尺脉象洪大，有时伴有耳痒，甚至出现耳聋和耳鸣。治疗应当以滋阴疏肝为主。（出自《锦囊》）
他又说：因痰湿引起的耳鸣，其症状表现为气机壅滞、口燥，耳朵不痛但发痒，身体沉重，脉象弦细，耳鸣且耳内作响就是这种情况。治疗主要采用二陈汤、竹沥等方药。
陈实功说：心肾不交，心劳则心火上炎，气机郁结则不能下降。因为肾开窍于耳，所以心火乘袭肾脏，于是产生了耳鸣和耳闭的病患。（出自《正宗》）
岐天师说：耳朵里听到像蚂蚁争斗的声音，这不是鬼祟作怪，而是肾水耗尽，再加上怒气伤肝所致。适宜用止喧丹主治。方中全是补肾平肝的圣药，服用几天后，那争斗的声音逐渐远去，服用一个月即可痊愈。这是奇特的病症，却用伯道的方子治好了。（出自《秘录》）
医经说：肾开窍于耳。肾作为脏腑，是水脏。天一生水，所以在生命初始之时，先生成两个肾脏，其中藏有一阴之气。又有相火存在于命门之中，常常挟带君火的势头，欺侮所不能克制的脏器，医经所说的“一水不能胜二火”就是这个道理。何况如果嗜欲没有节制，劳累过度，或者在中年之后，大病初愈之际，肾水枯涸，阴火上炎，所以耳朵发痒、耳鸣，没有一天不发作的。医经说：阳气使万物生长，旺盛向上而跳跃，所以耳朵会鸣响。因此耳鸣严重时如蝉鸣，或左或右，或时而闭塞，然而有些按照虚证治疗却不奏效，为什么呢？这是因为有痰火上升，郁结在耳中，所以导致鸣响；郁结严重则导致壅塞闭塞。凡是遇到这种疾病，如果平时饮酒过多、口味浓重，上焦素有痰火的人，只当作清化痰热、降火来治疗。多是因为先有痰火在上部，又感受恼怒而得病；愤怒则气机上逆，少阳之火生于耳部。如果是肾虚导致的耳鸣，也是膀胱中的相火上炎，所以鸣响必然不剧烈，其人必定房事过多，应当兼见虚劳羸弱的症状。
冯氏说：人身有九窍。阳窍七个：耳、目、口、鼻是也；阴窍两个：前后二阴是也。阳气走上窍，如果下行进入阴位，则有腹泻、腹鸣的症状；阴气走下窍，如果上行进入阳位，则有窒塞、耳鸣的症状。老年人肾水已枯竭，真火容易显露，所以肾水之气容易外泄难以收敛，浮越于上窍，窍内有声音如同蛙叫、鼓声、蚂蚁声，因此外界进入的声音与内部声音混杂，听不清楚；到了年迈无气力，内部精气衰竭不能上通，听力就丧失了。不像年轻力壮之人，浊阴遮蔽了耳窍，外界声音不得入内，所以使用麝香、石菖蒲开通气机、引导通达为主要手段。因此治疗老年人逆上的气机，完全以磁石为主药，取其质地重能达下，性质主下沉吸收，兼用地黄、龟胶等群阴之药辅助，更增加五味子、山茱萸的酸收作用，使阴气在本宫自然旺盛，而不向上冲击阳窍，由此空旷无障碍，耳朵接受声音，就像山谷接受回响一样，所以耳朵的精妙作用，全在于虚空而能容纳。医经说：耳朵黑而枯燥的是肾气疲惫的表现。（出自《锦囊》）
陈远公说：有人耳朵疼痛虽然好了，但耳鸣依旧，人们以为是风火，仍然使用祛风散火的方法，结果鸣响更加严重，用手按压耳朵则鸣响稍微停止，这是阳虚气机堵塞。治法应当以补阳为主，兼理肝肾的虚弱，使用发阳通阴汤来治疗。人参、白术、当归、白芥子各二钱，茯苓、黄芪、白芍各三钱，熟地黄五钱，柴胡一钱，肉桂、甘草各五分，黑荆芥一钱，水煎服。一剂减轻，二剂痊愈。这是十全大补的方子。（出自《冰鉴》）
他又说：有人平时没事，忽然耳朵听到风雨、战鼓号角的声音，人们以为是肾火旺盛，谁知道其实是心火亢极呢。凡人心肾相交，才能上下清宁以主持视听功能；心肾不交，都能导致听觉混乱。然而肾想要交于心，心必须能接受；心想要交于肾，肾必须能接受，这样才能相安无事。倘若肾火大旺，心必定畏惧肾的火炎，不敢下交于肾了，这都会导致两耳鸣响。但是心不交于肾的，耳鸣较轻；肾不交于心的，耳鸣较重。现在听到风雨鼓角之声，属于耳鸣较重的情况，治法要使肾气归于心，必须使心气仍归于肾，使用两归汤主治。麦冬、熟地黄各一两，丹参、茯神各三钱，生酸枣仁五钱，黄连二钱，水煎服，两剂鸣响停止，四剂不再发作。（这是凉心的方剂，心凉则肾不畏惧心的热，药物与来归相应，不必两者互相牵引而合。全是益心滋肾的药物，不但心没有过燥的忧虑，而且肾也有大润的药物。如同夫妻同心，有鱼水之欢，又怎会有乖离的悲伤呢？）
Feng Luzhan stated: Tinnitus caused by Yin deficiency presents with symptoms such as heat in the palms and soles, thirst, dry intestines, a large pulse at both Chi positions (Kidney position), occasional ear itching, deafness, and tinnitus. Treatment should primarily focus on nourishing Yin and soothing the Liver. (From *Jin Nang*)
He further stated: Tinnitus caused by Phlegm presents with symptoms of Qi stagnation, dry mouth, non-painful but itchy ears, heavy body sensation, and a wiry pulse; tinnitus with internal roaring is characteristic. The primary treatment involves formulas such as Er Chen Tang (Two-Cured Decoction) and Zhu Li (Bamboo Juice).
Chen Shigong stated: When Heart and Kidney fail to interact, Heart labor causes Heart Fire to flare upward, and Qi stagnation prevents it from descending. Since the Kidney opens into the ears, when Heart Fire attacks the Kidney, it leads to disorders of tinnitus and ear obstruction. (From *Zheng Zong*)
Tian Shi (Master Qi) stated: Hearing sounds like ants fighting in the ears is not a manifestation of demonic influence, but rather results from the exhaustion of Kidney Water compounded by anger injuring the Liver. It is appropriate to use Zhi Xuan Dan (Stop Noise Powder) as the main treatment. The formula consists entirely of sacred herbs for tonifying the Kidney and calming the Liver. After drinking it for several days, the fighting sounds gradually recede, and after one month, recovery occurs. This is a rare disease treated successfully by Bo Dao's prescription. (From *Mi Lu*)
The Classics state: The Kidney opens into the ears. As an organ, the Kidney is the Water organ. "Heaven generates One, Water," so at the beginning of life, two Kidneys are formed first, hiding one Yin within. Additionally, Ministerial Fire resides within the Mingmen (Gate of Life), often accompanying the momentum of Sovereign Fire to insult what it cannot overcome, which is what the Classics refer to as "one water cannot conquer two fires." Moreover, if desires are unregulated and physical exertion excessive, or after middle age following a severe illness, Kidney Water becomes withered and dried up, causing Yin Fire to flare upward. Thus, ear itching and tinnitus occur daily. The Classics state: "Yang Qi promotes growth in all things, flourishing upward and leaping, therefore the ears make noise." Consequently, tinnitus may be severe like cicadas, occurring on either side or intermittently obstructed. However, why does treatment based on deficiency sometimes fail? This is due to Phlegm-Fire ascending and stagnating in the ears, causing ringing; severe stagnation leads to blockage. For such diseases, if the patient usually consumes alcohol and rich flavors, having pre-existing Phlegm-Fire in the Upper Jiao, treatment should only focus on clearing Phlegm and reducing Fire. This often arises because Phlegm-Fire was already present above, combined with emotional anger; anger causes Qi to rise, and Shaoyang Fire originates in the ears. If tinnitus is due to Kidney deficiency, it is also due to the ascent of Bladder Ministerial Fire; thus, the ringing is likely not severe, the person likely has excessive sexual activity, and symptoms of consumptive weakness should also be present.
Feng stated: The human body has nine orifices. There are seven Yang orifices: ears, eyes, mouth, and nose; and two Yin orifices: the anterior and posterior apertures. Yang Qi moves toward the upper orifices; if it descends into Yin positions, it causes diarrhea and abdominal borborygmus. Yin Qi moves toward the lower orifices; if it ascends into Yang positions, it causes obstruction and tinnitus. In elderly people, Kidney Water is exhausted, and True Fire is easily exposed. Therefore, Kidney Water Qi escapes easily but is hard to retain, floating upward to the upper orifices. Inside the orifice, sounds resemble frogs croaking, drums beating, or ants crawling. Thus, external sounds mix with internal sounds, leading to unclear hearing. In advanced age, without Qi, internal essence is depleted and cannot ascend, resulting in loss of hearing. This differs from young and strong individuals, where turbid Yin blocks the orifices, preventing external sounds from entering; hence, using Moschus (She Xiang) and Acorus (Shi Chang Pu) to open Qi and guide transmission is the method. Therefore, treating reversed Qi in the elderly relies primarily on Magnetite (Ci Shi), utilizing its heaviness to reach downward and its nature to absorb downward, assisted by Yuzhu (Rehmanniae Radix Preparata) and Testudinis Carapax et Plastrum (Gui Jiao) among other Yin-nourishing herbs. Furthermore, Schisandrae Fructus (Wu Wei Zi) and Corni Fructus (Shan Yu Rou) are added for their sour astringency, causing Yin Qi to flourish in its home palace without attacking the Yang orifices. Consequently, the space is empty and unobstructed, allowing the ear to receive sound like a valley receives echoes. Thus, the miraculous function of the ear lies in its emptiness and capacity to receive. The Classics state: "Black and dry ears indicate Kidney exhaustion." (From *Jin Nang*)
Chen Yuan Gong stated: Some patients have ear pain that resolves, but tinnitus persists. People assume it is Wind-Fire and continue using wind-dispelling and fire-clearing methods, yet the ringing worsens. Pressing the ear with the hand alleviates the ringing slightly, indicating Yang deficiency with Qi blockage. The method should prioritize tonifying Yang while regulating Liver and Kidney deficiency, using Fa Yang Tong Yin Tang (Decoction to Evoke Yang and Unblock Yin). Ingredients include Ginseng Radix (Ren Shen), Atractylodis Rhizoma (Bai Zhu), Angelicae Sinensis Radix (Dang Gui), and Brassicae Semen Album (Bai Jie Zi), each 2 qian; Poria (Fu Ling), Astragali Radix (Huang Qi), and Paeoniae Radix Alba (Bai Shao), each 3 qian; Rehmanniae Radix Preparata (Shu Di Huang) 5 qian; Bupleuri Radix (Chai Hu) 1 qian; Cinnamomi Cortex (Rou Gui) and Glycyrrhizae Radix et Rhizoma (Gan Cao), each 5 fen; and Viticis Fructus Niger (Hei Jing Jie) 1 qian. Decoct in water and take orally. Symptoms lighten after one dose and resolve after two. This is a comprehensive tonic. (From *Bing Jian*)
He further stated: Some people, while resting normally, suddenly hear sounds of wind, rain, war drums, or horns in their ears. People attribute this to excessive Kidney Fire, but who knows it is actually extreme Heart Fire? Only when Heart and Kidney interact can they maintain clarity above and below to govern hearing and vision. Heart-Kidney non-interaction causes auditory chaos. However, for Kidney to interact with Heart, Heart must accept; for Heart to interact with Kidney, Kidney must accept, ensuring harmony. If Kidney Fire is excessively vigorous, Heart fears the Kidney's inflammation and dares not descend to interact with the Kidney, causing bilateral tinnitus. When Heart does not interact with Kidney, tinnitus is mild; when Kidney does not interact with Heart, tinnitus is severe. Hearing wind, rain, drums, and horns indicates severe tinnitus. The treatment aims to return Kidney Qi to Heart and Heart Qi back to Kidney, using Liang Gui Tang (Two-Return Decoction). Ingredients include Ophiopogonis Radix (Mai Dong) and Rehmanniae Radix Preparata (Shu Di Huang), each 1 liang; Salviae Miltiorrhizae Radix (Dan Shen) and Polygalae Semen (Fu Shen), each 3 qian; Ziziphi Spinosae Semen (Sheng Suan Zao Ren) 5 qian; and Coptidis Rhizoma (Huang Lian) 2 qian. Decoct in water and take orally. Tinnitus stops after two doses and does not recur after four. (This is a formula to cool the Heart. When the Heart is cooled, the Kidney does not fear the Heart's heat. The medicines correspond to returning, without needing mutual attraction to combine. They are entirely herbs benefiting the Heart and nourishing the Kidney, avoiding excessive dryness of the Heart and providing great moistening for the Kidney. Like a husband and wife in harmony, enjoying the joy of fish and water, how could there be sorrow of separation?)
Shen Dou Yuan stated: Tinnitus sounding like cicadas is caused by Liver-Gallbladder Fire and should be treated primarily with Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver). (From *Qi Xuan*)