张氏女 患头痛，每发须吐尽痰沫，痛乃止，诊其脉沉缓，知为太阴痰厥头痛。仿东垣半夏天麻白术汤加
减，愈。按太阴头痛，必有痰也，苍术半夏汤主之。少阴头痛脉沉细，足寒而气逆，麻黄附子细辛汤主之。
太阴、少阴二经虽不上头，然痰与气逆壅于膈间，则气不畅而头为痛也。
侄 头右偏痛，右上牙龈迄耳根紧掣，右鼻亦窒。一医用大黄、滑石，失之沉降。一医用柴胡、升麻，
失之升提。予谓火郁生风，宜清凉发散，用辛以散风，苦以降火，参气味主治。内用羚羊角、山栀、甘
菊（炒）、连翘、天麻（煨）、桔梗、丹皮、薄荷、钩藤、青荷蒂。外用细辛、白芷、羌活、川芎、当归、
苏叶，煎汤熏洗。日数次，汗泄鼻通，紧痛顿减。后于内服原方去连翘，加知母（为其便燥），数服而平。
此症多由少阳风火郁遏所致，其脉或
左弦右沉，至阳升巅顶，两寸必较浮大，此其验也。
足少阴肾窍于耳，肾气充则耳听聪，故经言精脱者耳聋也。又言肝病气逆，则头痛耳聋，以胆附于肝，而胆
脉上贯耳中也。精脱失聪，治在肾。气逆闭窍，治在胆。凡耳聋以及耳鸣，治法悉准乎此。第就中条析之，有因
劳力伤气者，补中汤加盐水炒黄柏、知母、茯苓、菖蒲。有因房劳伤肾者，滋阴地黄汤、益肾散，加盐炒知、柏。
有因阴虚火动者，磁石六味丸加减。有因病后虚鸣者，四物汤加盐炒知、柏。肾气丸加磁石、龟板。有因心肾
亏，肝阳逆，虚风上旋蒙窍者，用填阴镇逆，佐以酸味入阴，咸以和阳。如山萸、地黄、磁石、龟板、天冬、麦
冬、白芍、五味、牛膝、秋石。有脏气逆为厥聋者，流气散、当归龙荟丸。有风入络为风聋者，必兼头痛，防风
通圣散。有因怒气壅者，流气散、清神散。有因惊火郁者，清胆汤。有气闭猝聋者，芎芷散。有年久耳聋者，
胜金透关散。有小儿耳聋者，通鸣散。有肾经热，右耳重听，兼苦鸣者，地黄汤。有肝胆火升，常闻蝉鸣者，
龙胆泻肝汤、清胆汤。有因痰火升而鸣者，加减龙荟丸。总之，由痰火者其鸣甚，由肾虚者其鸣微。又有耳中津
液结块，名耳 。栀子清肝汤。有风温上郁，耳 右胀者，马勃散。有左耳 痛，挟暑风上郁者，须辛凉轻剂。
菊叶、苦丁茶、山栀、滑石、连翘、淡竹叶。有因暑邪闭窍者，鲜荷叶汤。有耳 胀，少阳火郁，羚羊角汤。
耳流脓，黄柏面，或甲片、麝末，研吹。小儿胎风耳脓，鱼牙散吹。耳忽大痛，如虫蠕动，蛇蜕烧存性，鹅
管吹。寒热耳大痛者，疔也。以疔治之。内外红肿痛者，耳痈也。活命饮加升麻、桔梗。耳蕈耳痔，不寒热，
不作脓，黄连消毒饮、活命饮。皆足少阴、手少阳肾与三焦风热上壅致之，此耳症大概也。
张姓女子患有头痛，每次发作必须将痰沫吐尽，疼痛才会停止。诊察其脉象沉缓，判断为太阴痰厥头痛。仿照李东垣的半夏天麻白术汤进行加减治疗，痊愈。按语：太阴头痛，必定有痰湿，以苍术半夏汤为主治方剂。少阴头痛脉象沉细，足部寒冷且气机上逆，以麻黄附子细辛汤为主治方剂。太阴、少阴两条经络虽然不直接上行至头部，但如果痰湿与气机上逆壅塞于胸膈之间，导致气机不畅，就会引起头痛。
侄子头部右侧偏痛，右上牙龈直至耳根处有紧绷牵拉感，右侧鼻孔也堵塞不通。一位医生使用大黄、滑石，药性失之于沉降；另一位医生使用柴胡、升麻，药性失之于升提。我认为这是火郁生风，宜用清凉发散之法，用辛味药疏散风邪，苦味药降泄火热，参考药物的气味和主治功效来组方。内服方用羚羊角、山栀、甘菊（炒）、连翘、天麻（煨）、桔梗、丹皮、薄荷、钩藤、青荷蒂。外用细辛、白芷、羌活、川芎、当归、苏叶，煎汤熏洗。每日数次，汗出后鼻塞通畅，紧绷疼痛顿时减轻。后来在内服原方中去掉连翘，加入知母（因为其大便干燥），服用数剂后病情平复。此症多由少阳风火郁遏所致，其脉象或左弦右沉，阳气升至巅顶时，两寸脉必较浮大，这是验证的依据。
足少阴肾开窍于耳，肾气充足则听力聪慧，所以医经说精气脱失的人会耳聋。又说肝气上逆，会导致头痛耳聋，因为胆附属于肝，而胆脉上行贯穿耳中。精气脱失导致的失聪，治疗在肾；气机上逆闭塞耳窍，治疗在胆。凡是耳聋以及耳鸣，治疗方法都以此为准。但其中具体细分，有因劳力伤气的，用补中益气汤加盐水炒黄柏、知母、茯苓、石菖蒲。有因房劳伤肾的，用滋阴地黄汤、益肾散，加盐炒知母、黄柏。有因阴虚火动的，用磁石六味丸加减。有因病后虚鸣的，用四物汤加盐炒知母、黄柏，或肾气丸加磁石、龟板。有心肾亏虚，肝阳上逆，虚风上旋蒙蔽耳窍的，用填补真阴、镇逆潜阳的方法，佐以酸味入阴、咸味和阳的药物。如山茱萸、地黄、磁石、龟板、天冬、麦冬、白芍、五味子、牛膝、秋石。有因脏气上逆导致厥聋的，用流气散、当归龙荟丸。有因风邪入络导致风聋的，必定兼有头痛，用防风通圣散。有因怒气壅滞的，用流气散、清神散。有因惊恐火郁的，用清胆汤。有因气闭突然耳聋的，用芎芷散。有患多年耳聋的，用胜金透关散。有小儿耳聋的，用通鸣散。有肾经热盛，右耳重听，兼苦于耳鸣的，用地黄汤。有肝胆火升，常听到蝉鸣声的，用龙胆泻肝汤、清胆汤。有因痰火上升而耳鸣的，用加减龙荟丸。总之，由痰火引起的耳鸣声音大，由肾虚引起的耳鸣声音小。又有耳中津液结成块状，名为耳疳。用栀子清肝汤。有风温上郁，耳疳右侧肿胀的，用马勃散。有左侧耳疳疼痛，挟带暑风上郁的，须用辛凉轻剂。如菊花叶、苦丁茶、山栀、滑石、连翘、淡竹叶。有因暑邪闭塞耳窍的，用鲜荷叶汤。有耳疳肿胀，属少阳火郁的，用羚羊角汤。耳流脓，用黄柏面，或用甲片、麝香末，研碎吹入。小儿胎风耳脓，用鱼牙散吹入。耳朵忽然剧烈疼痛，如虫蠕动，用蛇蜕烧存性，装入鹅管吹入。寒热交替且耳朵剧痛的，是耳疔。按治疗疔疮的方法处理。内外红肿疼痛的，是耳痈。用仙方活命饮加升麻、桔梗。耳蕈、耳痔，不寒热，不化脓，用黄连消毒饮、仙方活命饮。这些都是足少阴肾经与手少阳三焦经的风热上壅导致的，这是耳症的大概情况。
Ms. Zhang suffered from headache, which would cease only after she vomited all the phlegm and saliva during each attack. Her pulse was deep and slow (Chen Huan), indicating Taiyin Phlegm-Jue Headache (Taiyin Phlegm-Jue Tou Tong). Following Li Dongyuan’s Banxia Tianma Baizhu Tang (Pinellia and Gastrodia Atractylodes Macrocephala Decoction) with modifications, she recovered. Note: Taiyin headache is invariably associated with phlegm; Cangzhu Banxia Tang (Atractylodes Rhizome and Pinellia Decoction) is the primary formula. Shaoyin headache presents with a deep and fine (Chen Xi) pulse, cold feet, and rebellious Qi; Mahuang Fuzi Xixin Tang (Ephedra, Prepared Aconite Root, and Asarum Decoction) is indicated. Although the Taiyin and Shaoyin meridians do not ascend directly to the head, if phlegm and rebellious Qi obstruct the chest and diaphragm, causing Qi stagnation, headache ensues.
My nephew experienced pain on the right side of his head, with tightness and pulling sensations extending from the upper right gums to the root of the ear, accompanied by nasal congestion on the right. One physician used Dahuang (Rhei Radix et Rhizoma) and Huashi (Talcum), which was inappropriate due to their sinking nature. Another physician used Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), which was inappropriate due to their ascending nature. I reasoned that this was Wind generated by Fire Stagnation, requiring a cooling and dispersing approach: using Acrid herbs to disperse Wind and Bitter herbs to descend Fire, selecting ingredients based on their flavor, property, and therapeutic action. The internal prescription included Lingyangjiao (Saiga Tataricae Cornu), Zhizi (Gardeniae Fructus), Ganju (Chrysanthemi Flos, stir-fried), Lianqiao (Forsythiae Fructus), Tianma (Gastrodiae Rhizoma, baked), Jiegeng (Platycodonis Radix), Danpi (Moutan Cortex), Bohe (Menthae Haplocalycis Herba), Gouteng (Uncariae Ramulus cum Uncis), and Qinghedi (Nelumbinis Nelumbo). External treatment involved Xixin (Asari Radix et Rhizoma), Baizhi (Angelicae Dahuricae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), and Zisuye (Perillae Folium), decocted for fumigation and washing. Applied several times daily, sweating relieved nasal congestion and immediately reduced the tight pain. Subsequently, Lianqiao was removed from the original internal formula, and Zhimu (Anemarrhenae Rhizoma) was added due to constipation; after several doses, the condition resolved. This syndrome is mostly caused by Shaoyang Wind-Fire stagnation. The pulse may be Wiry (Xian) on the left and Deep (Chen) on the right; when Yang Qi ascends to the vertex, the Cun positions of both pulses will be relatively Floating (Fu) and Large (Da), which serves as verification.
The Kidney opens into the ears via the Foot-Shaoyin meridian. When Kidney Qi is abundant, hearing is acute; thus, classics state that loss of Essence causes deafness. It is also stated that Liver Qi rebellion causes headache and deafness, because the Gallbladder attaches to the Liver, and the Gallbladder meridian ascends through the ear. Deafness due to Essence depletion is treated in the Kidney; deafness due to Qi rebellion blocking orifices is treated in the Gallbladder. All treatments for deafness and tinnitus follow this principle. Specifically: For Qi injury due to overexertion, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Salt-fried Huangbai (Phellodendri Cortex), Zhimu, Fuling (Poria), and Changpu (Acori Tatarinowii Rhizoma). For Kidney injury due to sexual excess, use Ziyin Dihuang Tang (Nourish Yin Rehmannia Decoction) or Yishen San (Tonify Kidney Powder), plus Salt-fried Zhimu and Huangbai. For Yin deficiency with Fire hyperactivity, use Cishi Liuwei Wan (Magnetite Six-Ingredient Pill) with modifications. For post-illness deficiency tinnitus, use Siwu Tang (Four Substance Decoction) plus Salt-fried Zhimu and Huangbai, or Shenqi Wan (Kidney Qi Pill) plus Cishi (Magnetitum) and Guiban (Testudinis Carapax et Plastrum). For Heart-Kidney deficiency, Liver Yang rebellion, and Deficient Wind ascending to cloud the orifices, use methods to tonify Yin and suppress rebellion, assisted by Sour herbs entering Yin and Salty herbs harmonizing Yang. Ingredients include Shanzhuyu (Corni Fructus), Dihuang (Rehmanniae Radix Praeparata), Cishi, Guiban, Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix), Baishao (Paeoniae Radix Alba), Wuweizi (Schisandrae Chinensis Fructus), Niuxi (Achyranthis Bidentatae Radix), and Qiushi (Urea). For Jue-deafness due to Zang-Qi rebellion, use Liqi San (Flow Qi Powder) or Danggui Longhui Wan (Angelica and Gardenia Pill). For Feng-deafness due to Wind entering collaterals, always accompanied by headache, use Fangfeng Tongsheng San (Saposhnikovia Unblocking the Exterior Powder). For obstruction due to Anger, use Liqi San or Qingshen San (Clear Spirit Powder). For depression due to Shock and Fire, use Qingdan Tang (Clear Gallbladder Decoction). For sudden deafness due to Qi blockage, use Xiongzi San (Ligusticum and Angelica Dahurica Powder). For chronic deafness, use Shengjin Touguan San (Victory Gold Penetrating Orifices Powder). For pediatric deafness, use Tongming San (Unblock Hearing Powder). For Heat in the Kidney meridian with heavy hearing in the right ear and distressing tinnitus, use Dihuang Tang (Rehmannia Decoction). For rising Fire of Liver and Gallbladder with cicada-like tinnitus, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction) or Qingdan Tang. For tinnitus due to rising Phlegm-Fire, use Jiajian Longhui Wan (Modified Gardenia Pill). In summary, tinnitus due to Phlegm-Fire is loud, while that due to Kidney deficiency is faint. Also, accumulation of fluid in the ear forming a mass is called Ergan (Ear Carbuncle); treat with Zhizi Qinggan Tang (Gardenia Clearing Liver Decoction). If Wind-Warmth stagnates upward causing swelling on the right side of Ergan, use Mabo San (Mopoe Powder). If the left Ergan hurts with Summerheat-Wind stagnation, use mild Acrid-Cool agents like Juye (Chrysanthemi Indici Folium), Kudingcha (Ilicis Latifoliae Folium), Zhizi, Huashi, Lianqiao, and Danyezhu (Lophatheri Herba). For orifice closure due to Summerheat, use Fresh Heluyetang (Fresh Lotus Leaf Decoction). For Ergan swelling due to Shaoyang Fire stagnation, use Lingyangjiao Tang (Saiga Horn Decoction). For otorrhea, apply Huangbai powder, or crushed shell fragments and Moschus powder externally. For pediatric fetal wind otorrhea, apply Yuya San (Fish Tooth Powder). For sudden severe ear pain resembling insect movement, apply Shtui (Bombyx Batryticatus or Ophidia Skin calcined) via goose quill. For alternating chills and fever with severe ear pain, it is Ding (Carbuncle); treat as such. For internal and external redness, swelling, and pain, it is Eryong (Ear Abscess); treat with Xianfang Huoming Yin (Immortal Life Decoction) plus Shengma and Jiegeng. For Erxiang (Ear Mushroom) and Erzhi (Ear Hemorrhoid), without chills/fever or suppuration, use Huanglian Xiaodu Yin (Coptis Detoxifying Decoction) or Xianfang Huoming Yin. These are all caused by Wind-Heat stagnating upward from the Foot-Shaoyin Kidney and Hand-Shaoyin Sanjiao meridians; this covers the general overview of ear syndromes.