酒炒龙胆草退湿热之郁翳；白蒺藜散风破血；木贼、防己疗风胜湿；甘菊化风；茺蔚行血。诸药皆入肝经，仍
能上行于肺，用之屡验。
尤在泾曰∶目赤肿痛，人知降火，而不知活血，所以多不得力。只用四物汤内，地黄用生，芍药用赤，加
蒸大黄、赤茯苓、薄荷叶，治之甚妙，此戴复庵法也。余谓目赤肿痛，人知活血，而不知治痰。脾胃壅滞，积
热生痰，积痰生热，辗转相因。气冲头目昏痛不已者，须用半夏、石菖蒲、黄芩、枳实、茯苓、陈皮，微兼菊
花、白蒺藜之属治之。
许叔微治一男子，年二十岁，因疮毒后肾经热，右耳听事不明，每心中拂意，则觉重虚鸣、疼痛。地黄汤、
生地、枳壳、羌活、桑白皮、磁石、甘草、防风、黄芩、木通。上为粗末，每服四钱，水煎，日二三服，不拘
时候。（《纲目》。）
朱丹溪治冯官人左耳鸣，此因劳得之，法当补阴而镇坠之。黄 、人参、当归、陈皮、茯苓、升麻、酒柏、
防风、甘草、白芍，食前热饮，饮了去眠一觉。（《纲目》。其方则似补气而升举之，非补阴镇坠也。）
薛立斋治一人，耳内不时作痛，痛时欲死，痛止如故。六脉皆安，非疮也。语间忽作，度其有虫，令急取
猫尿滴耳，果出一臭虫，遂不复痛。或用麻油滴之，则虫死难出。或用炒芝麻枕之，虫亦出，但不及猫尿之速
也。（取猫尿法，用生姜擦猫鼻，其尿自出。）
赵养葵治一小儿患耳脓，医以药治之，经年累月不效，殊不知此肾疳也。用六味丸加桑螵蛸，服之愈。
吴孚先治张司马，素有火症，两耳肿痛。系少阳风热，劝延针灸科，刺听会、合谷、临泣寻愈。
柴屿青治汪谨堂夫人，两耳蝉鸣，昕夕不歇，服过人参、熟地四两，无少效。柴曰∶肾开窍于耳，心亦寄
窍于耳，治耳必责之肾固矣。但诊得两尺尚属有神，决非肾虚，左寸亦平缓无 ，惟右寸关洪大，此肺胃两部
风热所壅而致，遂不治病而治脉。（雄按∶鼻塞治心，耳聋治肺，非仅治脉也。）用清解之剂，不数服而右耳
已愈，再服数剂两
耳全愈。因思耳、目、口、鼻虽于五脏各有分属，而内实相通，治病惟以切脉为凭。夫固有治在此而效在彼者，
全在一心之圆机活法也。
李元淳尚书在河阳日，蚰蜒入耳，无计可为，脑闷有声，至以头击门柱，奏状危困，御医疗之不验。忽有
人献方，用胡麻油作饼枕卧，须臾自出乃愈。（《图经》、《本草纲目》。）
《江湖记闻》云∶有人壁虱入耳，头痛不可忍，百药不效。用稻秆灰煎水灌入，即死而出也。又莴草捣
汁滴入，亦能出百虫入耳。（《本草纲目》。）
薛立斋治一妇人，耳内或耳后顶侧作痛，寒热口苦，月经不调。此肝胆经火兼伤脾胃，用四君加柴胡、升
麻、黄 、白芍而愈。后因劳役怒气，呕吐胁胀，用六君子汤加山栀、柴胡而安。
一妇人耳内外肿痛，胸胁不利，寒热往来，小便不调。此肝火伤血，先用龙胆泻肝汤四剂，诸症顿退。又
用加味逍遥散而愈。又因怒复作，用小柴胡汤而痊。
一妇人经行后，因劳怒发寒热，耳作痛，以经行为血虚，用八珍汤加柴胡，怒气为肝火，用加味逍遥散，
劳役为气伤，用补中益气汤加山栀而愈。
一妇人素郁怒，耳内作痛，肿 寒热，面色青黄，经行则变赤，用加味归脾汤、加味逍遥散而愈。
一妇人怀抱素郁，因怒耳作肿痛，经行不止，发寒发热，面色青赤，肝脉弦数。此久郁伤脾，暴怒伤肝，
先用加味小柴胡汤，随用加味逍遥散而痊。
一妇人因怒发热，每经行两耳出脓，两太阳作痛，胸胁乳房胀痛，或寒热往来，或小便频数，或小腹胀闷，
皆属肝火血虚。先用栀子清肝散二剂，又用加味逍遥散数剂，诸症悉退，乃以补中益气而痊。
喻嘉言议王大司马耳鸣症曰∶人之阳气走上窍，而下入于阴位，则有溺泄腹鸣之患。阴气走下窍，而上入
于阳位，则有窒塞耳鸣之患。故人当五十以外，肾气渐衰于下，每每从上逆。肾开窍于耳，而以肝木为之子，
是以谋虑郁怒之火一动，即疏泄母气，而阴气从之上逆，与聋病相去天渊。聋病者，窍中另有一膜遮闭，外气
不得内入，故以开窍为主。方书所用菖蒲、麝香，及外填内攻等法，皆为此而设。耳鸣乃阴气冲至上窍，亦隔
一膜，不能越出窍外，止于窍中，薄薄有声，如蛙鼓蝉鸣。外入之声，为内声所混，听之不清。若气稍不逆上，
则听稍清。气全不逆上，则听全清矣。治此之法，以重用磁石为主，以其重能达下，性主下吸，又能制肝木之
上吸也。用地黄、龟胶群阴之药辅之，更用五味、山萸之酸以收之。令阴气自旺于本宫，不上触于阳窍，然
后清清朗朗，声入即通，无壅碍也。方书指为少阳胆、厥阴肝二经热多所致，然少阳之气，能步走上窍，皆络
于巅顶，无触筋冲耳之理，不当与厥阴混同立说。通圣散一方，汗下兼用，乃治壮火之法，惟滚痰九，少壮
用之，多有效者。以黄芩、大黄、沉香之苦，最能下气，而礞石之重坠，与磁石之用相仿也。高年之人，肾水
已竭，真火易露，故肾中之气，易出难收，况有厥阴之子，为之挹取乎。然则壮水之主，以制阳光，如盏中添
油，灯焰自小，岂非良治哉？
一妇人耳内肿痛出水，寒热口苦，肿连颈项，饮食少思，此肝火甚也。用小柴胡汤加山栀、丹皮稍愈，又
加味逍遥散渐愈。用八珍汤加柴胡、丹皮、山栀，调补肝脾全愈。
一妇人耳内肿痛，胸胁不利，寒热往来，小便不调，此肝经发热也。用龙胆泻肝汤四剂，诸症顿退，用加
味逍遥散而愈。又因怒复作，用柴胡清肝散而痊。
一妇人耳内不时胀痛，内热口干，劳则头晕，吐痰，下带，此肝脾气虚也。朝用补中益气，夕用加味逍遥
散而痊。
一寡妇耳内外作痛，不时寒热，脉上鱼际，此血虚之症。用小柴胡加生地，以抑其血而愈。又项间结核如
贯珠，寒热晡热，用加味归脾汤、加味逍遥散，调补肝脾而愈。
一妇人耳内外或作痛，或赤肿，或寒热，月经旬日而止，潮热内热，自汗盗汗。此肝脾气血俱虚而有热，
用归脾汤、六味丸而愈。
一妇人性急，或耳内作痛，或耳外赤肿，发热胁胀，日晡益甚。此怒气伤肝，气血俱虚，朝用加味逍遥散
加黄柏、桔梗，夕用归脾汤送地黄丸而愈。
一孀妇耳内外作痛，或项侧结核，内热晡热，月经不调，吐痰少食，胸膈不利。此郁怒伤肝，朝用归脾汤，
以解脾郁，生脾气，夕用加味逍遥散，以清肝火，生肝血而愈。
一女子耳下肿赤，寒热口苦，月经不调，小腹内结一块，此肝火气滞而血凝也。先用小柴胡加山栀、川芎、
丹皮，又用柴胡清肝散而痊。
一妇人耳肿痛，发寒热，与荆防败毒散四剂，表症悉退。以散肿溃坚汤数剂，肿消大半。再以神效栝蒌散，
四剂而平。
一男子肝经风热，耳下肿痛发热，脉浮数，以薄荷丹治之愈。薄荷、皂角、连翘、三棱、首乌、蔓荆、豆
豉、荆芥。
一男子每怒耳下肿，或胁作痛，以小柴胡汤加青皮、木香、红花、桃仁，四剂而愈。
一妇人耳鸣内热，经行不调，肢体倦怠，饮食无味，以肝脾虚热，用四君加柴胡、山栀、丹皮、甘草而愈。
一男子耳内出脓，或痛或痒，服聪耳益气汤不应，服防风通圣散愈甚，以补肾丸治之而愈。
魏玉横曰∶朱余二女，中表姊妹也，年十六七。朱则耳痛，常发瘾疹，因感冒痛暴甚，耳门连顶皆肿，以
养青汤加黄芩、羚羊、蒌仁，二剂而愈。余则耳痛常流脓水，因患 ，医与荆防发之，遂出血不止，膈间嘈辣，
前方去羚羊加知母、赤芍，二剂血止，数剂脓水干。二人脉皆关弦寸鼓，乃肾与肝胆之火也。
余某早失怙恃，困苦颠连，年十四，就西溪吴氏质库食力，值冬月查盘，提唱劳剧，忽右耳暴痛不可忍，
如刺如锥。约一日夜内起一 ，迸出黄水，涓滴不绝，数日乃干，第水出则痛减，水干则痛除。自后过劳即发，
其痛至欲求死。如是者，年必数次。偶问一医，彼见少年得此，谓由暴怒伤肝，瘀血为患，教服抵当丸，不知
此属劳伤肝肾，龙雷之火上攻而然。幸合药时肆中无虻虫、水蛭，竟因循不服。后年二十余，右耳渐聋，病遂
不作。盖此中经络枯绝，火亦不能透达也。（雄按∶余亦十四岁失怙，而废书服贾，虽困苦备尝，而尚不致
有疾者，以母氏主持家事也。读此既感少境之与先生相类，又憾学术空疏，不能起老母之危 ，涕泪交流，
为之淹卷。）
叶天士治丁某。肾开窍于耳，心亦寄窍于耳，心肾两亏，肝阳亢逆，故阴精走泄，阳不行根据，是以耳鸣时
闭。但病在心肾，其原实由于郁，郁则肝阳独亢，胆火上炎。清晨服丸药，以补心肾，午服汤药，以清少阳，
以胆经亦终于耳也。水煮熟地四两，麦冬一两半，龟板二两，牡蛎两半，白芍两半，北五味一两，建莲两半，
磁石一两，茯神两半，沉香五钱，辰砂五钱为衣。煎方∶夏枯草二钱，丹皮一钱，生地三钱，山栀一钱，女贞
子三钱，赤茯钱半，生甘草四分。
徐灵胎曰∶方极清和可喜。耳聋之法多端，大端不过清上镇下二条。此案方极稳当。至于外治之法，及
虚寒等症，亦不可不知也。
酒炒龙胆草可退除湿热郁结所致的翳障；白蒺藜能疏散风邪、破散瘀血；木贼和防己治疗风邪胜湿之证；甘菊能化散风邪；茺蔚子能行血。这些药物都入肝经，同时又能上行于肺，临床使用屡见疗效。
尤在泾说：眼睛红赤肿痛，人们只知道降火，却不知道活血，所以往往效果不佳。只用四物汤（补血调经的基础方），其中地黄用生地黄，芍药用赤芍，加入蒸大黄、赤茯苓、薄荷叶，治疗效果非常奇妙，这是戴复庵的方法。我认为眼睛红赤肿痛，人们只知道活血，却不知道治痰。脾胃气机壅滞，积热生痰，积痰又生热，两者互为因果。气机上冲导致头目昏痛不止的，必须用半夏、石菖蒲、黄芩、枳实、茯苓、陈皮，稍微配合菊花、白蒺藜等药物治疗。
许叔微治疗一名二十岁的男子，因为疮毒之后肾经有热，右耳听力不明，每当心中不愉快时，就觉得耳朵沉重虚鸣、疼痛。处方用地黄汤加减：生地黄、枳壳、羌活、桑白皮、磁石、甘草、防风、黄芩、木通。将上述药材捣成粗末，每次服用四钱，用水煎煮，每天二至三次，不拘泥于固定时间。（出自《本草纲目》）
朱丹溪治疗冯官人的左耳鸣，这是因为劳累所致，治疗方法应当补阴并加以重镇潜降。处方用黄芪、人参、当归、陈皮、茯苓、升麻、酒黄连、防风、甘草、白芍，饭前热服，服后睡一觉即可。（出自《本草纲目》，其方剂看起来像是补气升举之法，而非补阴镇坠。）
薛立斋治疗一人，耳内不时作痛，痛时痛苦欲死，痛止则如常人。六脉皆平和，并非疮疡所致。言语之间忽然发作，推测是有虫，令其急取猫尿滴入耳中，果然排出一只臭虫，随后不再疼痛。或者用麻油滴入，虫子会死但难以排出。或者用炒芝麻枕在头下，虫子也能出来，但不如猫尿迅速。（取猫尿的方法：用生姜擦拭猫的鼻子，猫尿自然流出。）
赵养葵治疗一名小儿患耳流脓，医生用药治疗，经年累月无效，殊不知这是肾疳（肾虚导致的疳积）。用六味地黄丸加桑螵蛸，服用后痊愈。
吴孚先治疗张司马，素来有火症，两耳肿痛。属于少阳风热，劝其延请针灸科医生，针刺听会穴、合谷穴、临泣穴，不久痊愈。
柴屿青治疗汪谨堂夫人，两耳蝉鸣，早晚不停，服过人参、熟地各四两，毫无效果。柴氏说：肾开窍于耳，心也寄窍于耳，治疗耳朵的疾病必然责之于肾，这固然正确。但诊得两尺脉尚属有神，决非肾虚，左寸脉亦平缓无病象，只有右寸关脉洪大，这是肺胃两部风热壅盛所致，于是他不治病而治脉。（徐灵胎按语：鼻塞治心，耳聋治肺，不仅仅是治脉而已。）用清解风热的药剂，不到几服右耳就好了，再服几剂两耳全愈。因此想到耳、目、口、鼻虽然与五脏各有分属，但实际上内部是相通的，治病唯有以切脉为依据。确实存在治在此处而效应在彼处的情况，全凭医者圆机活法的心智。
李元淳尚书在河阳任职期间，蚰蜒进入耳中，无计可施，头脑闷胀有声，甚至用头撞击门柱，奏报病情时危急困顿，御医治疗无效。忽然有人献上方子，用胡麻油做成饼状枕卧，片刻后蚰蜒自行爬出而痊愈。（出自《图经》、《本草纲目》）
《江湖记闻》记载：有人壁虱进入耳中，头痛不可忍受，百药无效。用稻秆灰煎水灌入耳中，壁虱即死而出。又有莴苣草捣汁滴入，也能排出进入耳中的百虫。（出自《本草纲目》）
薛立斋治疗一妇人，耳内或耳后顶侧作痛，伴有寒热、口苦、月经不调。这是肝胆经火兼伤脾胃，用四君子汤加柴胡、升麻、黄芪、白芍而愈。后来因劳役怒气，出现呕吐、胁胀，用六君子汤加山栀、柴胡而安。
另一妇人耳内外肿痛，胸胁不利，寒热往来，小便不调。这是肝火伤血，先用龙胆泻肝汤四剂，诸症顿退。又用加味逍遥散而愈。后又因怒复发，用小柴胡汤而痊愈。
另一妇人在月经行经后，因劳怒引发寒热，耳作痛。因经行导致血虚，用八珍汤加柴胡；怒气导致肝火，用加味逍遥散；劳役导致气伤，用补中益气汤加山栀而愈。
另一妇人素来忧郁愤怒，耳内作痛，肿胀伴寒热，面色青黄，月经来时变为红色，用加味归脾汤、加味逍遥散而愈。
另一妇人怀抱素来忧郁，因怒导致耳作肿痛，月经不止，发寒发热，面色青赤，肝脉弦数。这是久郁伤脾，暴怒伤肝，先用加味小柴胡汤，随即用加味逍遥散而痊愈。
另一妇人因怒发热，每次月经行经时两耳出脓，两太阳穴作痛，胸胁乳房胀痛，或寒热往来，或小便频数，或小腹胀闷，皆属肝火血虚。先用栀子清肝散二剂，又用加味逍遥散数剂，诸症悉退，乃以补中益气汤而痊愈。
喻嘉言议论王大司马耳鸣症时说：人的阳气走上窍，而下入于阴位，则有溺泄腹鸣的病患。阴气走下窍，而上入于阳位，则有窒塞耳鸣的病患。所以人到了五十岁以外，肾气在下渐衰，每每从上逆。肾开窍于耳，而以肝木为肾水之子，所以当谋虑郁怒之火一动，即疏泄母气，而阴气从之上逆，这与聋病相差天壤之别。聋病患者，窍中另有一层膜遮闭，外气不得内入，所以以开窍为主。方书所用的石菖蒲、麝香，以及外填内攻等方法，都是为此而设。耳鸣则是阴气冲至上窍，也隔着一层膜，不能越出窍外，止于窍中，发出薄薄的声音，如蛙鼓蝉鸣。外界进入的声音，被内部的声音混杂，听起来不清。如果气稍不逆上，则听力稍清。气完全不上逆，则听力全清。治疗此法，以重用磁石为主，因为磁石质重能达下，性主下吸，又能制约肝木的上吸。用地黄、龟胶等群阴的药物辅助它，更用五味子、山萸肉的酸味来收敛它。使阴气在本宫旺盛，不向上触碰阳窍，然后清清朗朗，声音进入即通，没有壅碍。方书指为少阳胆、厥阴肝二经热多所致，然而少阳之气，能步走上窍，皆络于巅顶，没有触筋冲耳的道理，不应当与厥阴混同立论。防风通圣散一方，汗下兼用，乃是治壮火的方法，只有滚痰丸，年轻人使用，多有效者。以黄芩、大黄、沉香的苦味，最能下气，而礞石的沉重坠降，与磁石的作用相似。高年之人，肾水已竭，真火易露，所以肾中之气，易出难收，何况有厥阴之子，为之汲取呢。既然如此，壮水之主，以制阳光，如同盏中添加油，灯焰自然变小，难道不是良好的治疗吗？
另一妇人耳内肿痛出水，寒热口苦，肿连颈项，饮食少思，这是肝火甚也。用小柴胡汤加山栀、丹皮稍愈，又加味逍遥散渐愈。用八珍汤加柴胡、丹皮、山栀，调补肝脾全愈。
另一妇人耳内肿痛，胸胁不利，寒热往来，小便不调，这是肝经发热也。用龙胆泻肝汤四剂，诸症顿退，用加味逍遥散而愈。后又因怒复发，用柴胡清肝散而痊愈。
另一妇人耳内不时胀痛，内热口干，劳累则头晕，吐痰，带下，这是肝脾气虚也。早晨用补中益气汤，晚上用加味逍遥散而痊愈。
一寡妇耳内外作痛，不时寒热，脉上鱼际，这是血虚之症。用小柴胡汤加生地，以抑其血而愈。又项间结核如贯珠，寒热晡热，用加味归脾汤、加味逍遥散，调补肝脾而愈。
另一妇人耳内外或作痛，或赤肿，或寒热，月经旬日而止，潮热内热，自汗盗汗。这是肝脾气血俱虚而有热，用归脾汤、六味地黄丸而愈。
另一妇人性急，或耳内作痛，或耳外赤肿，发热胁胀，日晡益甚。这是怒气伤肝，气血俱虚，早晨用加味逍遥散加黄柏、桔梗，晚上用归脾汤送服地黄丸而愈。
一孀妇耳内外作痛，或项侧结核，内热晡热，月经不调，吐痰少食，胸膈不利。这是郁怒伤肝，早晨用归脾汤，以解脾郁，生脾气，晚上用加味逍遥散，以清肝火，生肝血而愈。
一女子耳下肿赤，寒热口苦，月经不调，小腹内结一块，这是肝火气滞而血凝也。先用小柴胡汤加山栀、川芎、丹皮，又用柴胡清肝散而痊愈。
一妇人耳肿痛，发寒热，给予荆防败毒散四剂，表症悉退。以散肿溃坚汤数剂，肿消大半。再以神效栝蒌散，四剂而平。
一男子肝经风热，耳下肿痛发热，脉浮数，以薄荷丹治之愈。处方：薄荷、皂角、连翘、三棱、首乌、蔓荆子、豆豉、荆芥。
一男子每怒则耳下肿，或胁作痛，用小柴胡汤加青皮、木香、红花、桃仁，四剂而愈。
一妇人耳鸣内热，经行不调，肢体倦怠，饮食无味，以肝脾虚热，用四君子汤加柴胡、山栀、丹皮、甘草而愈。
一男子耳内出脓，或痛或痒，服聪耳益气汤不应，服防风通圣散愈甚，以补肾丸治之而愈。
魏玉横说：朱余二女，是表姊妹，年龄十六七岁。朱某耳痛，常发瘾疹，因感冒痛暴甚，耳门连头顶皆肿，以养青汤加黄芩、羚羊角、瓜蒌仁，二剂而愈。余某耳痛常流脓水，因患某种疾病，医生用荆防发散之，遂出血不止，膈间嘈辣，前方去羚羊角加知母、赤芍，二剂血止，数剂脓水干。二人脉皆关弦寸鼓，乃肾与肝胆之火也。
余某早年失去父母，困苦颠连，十四岁时，在西溪吴氏质库做工，正值冬天查盘，提唱劳作剧烈，忽然右耳暴痛不可忍，如刺如锥。约一日夜内在耳内起一脓肿，迸出黄水，涓滴不绝，数日后乃干，只是水出则痛减，水干则痛除。此后过劳即发，其痛至欲求死。像这样的情况，每年必数次。偶然问一医生，他见少年得此病，谓由暴怒伤肝，瘀血为患，教服抵当丸，不知此属劳伤肝肾，龙雷之火上攻而然。幸合药时药肆中没有虻虫、水蛭，竟因循不服。后年二十余，右耳渐聋，病遂不作。盖此中经络枯绝，火亦不能透达也。（徐灵胎按语：我也十四岁失怙，而废书经商，虽困苦备尝，而尚不致有疾者，以母亲主持家事也。读此既感少年境遇与先生相类，又憾学术空疏，不能起老母之危，涕泪交流，为之淹卷。）
叶天士治疗丁某。肾开窍于耳，心也寄窍于耳，心肾两亏，肝阳亢逆，故阴精走泄，阳不行根据，是以耳鸣时闭。但病在心肾，其原实由于郁，郁则肝阳独亢，胆火上炎。清晨服丸药，以补心肾，午服汤药，以清少阳，因为胆经也终于耳。处方：水煮熟地黄四两，麦冬一两半，龟板二两，牡蛎一两半，白芍一两半，北五味子一两，建莲一两半，磁石一两，茯神一两半，沉香五钱，辰砂五钱为衣。煎方：夏枯草二钱，丹皮一钱，生地三钱，山栀一钱，女贞子三钱，赤茯苓钱半，生甘草四分。
徐灵胎说：方剂极清和可喜。耳聋的治疗方法多端，大端不过清上镇下两条。此案方剂极稳当。至于外治之法，及虚寒等症，也不可不知也。
Jiu Chao Longdan Cao (Gentianae Radix, wine-fried) can resolve the nebula caused by the stagnation of damp-heat; Bai Jili (Tribuli Fructus) disperses wind and breaks blood stasis; Mu Zei (Equiseti Herba) and Fang Ji (Stephaniae Tetrandrae Rhizoma) treat wind overcoming dampness; Gan Ju (Chrysanthemi Flos) transforms wind; Chong Wei Zi (Leonuri Fructus) promotes blood circulation. All these herbs enter the Liver Meridian, yet they can also ascend to the Lung. Their clinical use has proven effective repeatedly.
You Zaijing stated: Regarding redness, swelling, and pain of the eyes, people know how to descend fire but do not know how to invigorate blood, which is why treatment often lacks efficacy. One should simply use Si Wu Tang (Four Substances Decoction), using raw Sheng Di Huang (Rehmanniae Radix) and Chi Shao (Paeoniae Radix Rubra), adding Zheng Da Huang (Rhei Radix et Rhizoma, steamed), Chi Fu Ling (Poria with Red Coir), and Bo He Ye (Menthae Haplocalycis Folium). This treatment is very ingenious, a method from Dai Funan. I believe that for redness, swelling, and pain of the eyes, people know how to invigorate blood but do not know how to treat phlegm. When the Spleen and Stomach qi mechanism is obstructed, accumulated heat generates phlegm, and accumulated phlegm generates heat, causing them to exacerbate each other. When qi rushes upward causing dizziness, tinnitus, and persistent head/eye pain, one must use Ban Xia (Pinelliae Rhizoma), Shi Chang Pu (Acori Tatarinowii Rhizoma), Huang Qin (Scutellariae Radix), Zhi Shi (Aurantii Fructus Immaturus), Fu Ling (Poria), and Chen Pi (Citri Reticulatae Pericarpium), slightly combined with Ju Hua (Chrysanthemi Flos) and Bai Jili (Tribuli Fructus) for treatment.
Xu Shuwei treated a twenty-year-old man who, after suffering from toxic sores, had heat in the Kidney Meridian, resulting in unclear hearing in the right ear. Whenever he felt dissatisfied in his heart, he perceived heaviness, empty tinnitus, and pain in the ear. The prescription modified from Di Huang Tang (Rehmanniae Decoction) included: Sheng Di Huang (Rehmanniae Radix), Zhi Ke (Aurantii Fructus), Qiang Huo (Notopterygii Rhizoma et Radix), Sang Bai Pi (Mori Cortex), Ci Shi (Magnetitum), Gan Cao (Glycyrrhizae Radix et Rhizoma), Fang Feng (Saposhnikoviae Radix), Huang Qin (Scutellariae Radix), and Mu Tong (Akebiae Caulis). These were processed into coarse powder, four qian taken per dose, decocted in water, taken two to three times daily, without restriction on timing. (From *Bencao Gangmu*.)
Zhu Danxi treated Official Feng’s left-sided tinnitus, which was caused by overwork. The treatment method should be to tonify Yin and apply heavy sedation. The prescription used Huang Qi (Astragali Radix), Ren Shen (Ginseng Radix), Dang Gui (Angelicae Sinensis Radix), Chen Pi (Citri Reticulatae Pericarpium), Fu Ling (Poria), Sheng Ma (Cimicifugae Rhizoma), Jiu Bai (Phellodendri Cortex, wine-treated), Fang Feng (Saposhnikoviae Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), and Bai Shao (Paeoniae Radix Alba). It was taken hot before meals, followed by sleep. (From *Bencao Gangmu*. Note: The formula appears to tonify Qi and lift rather than tonify Yin and sedate.)
Xue Lizhai treated a patient whose ear occasionally hurt severely, to the point of wanting to die, but returned to normal when the pain ceased. The six pulses were all peaceful, indicating no abscess. The sudden onset suggested the presence of insects. He instructed to urgently take cat urine and drip it into the ear. Indeed, a foul-smelling insect was discharged, and the pain ceased thereafter. Alternatively, dripping sesame oil could kill the insect but made removal difficult. Sleeping on fried sesame seeds could also expel the insect, though not as quickly as cat urine. (Method to obtain cat urine: rub the cat's nose with ginger, and the urine will flow naturally.)
Zhao Yangkui treated a child suffering from otorrhea. Medical treatment had been ineffective for years. Unbeknownst to the doctors, this was Kidney Gan (pediatric malnutrition due to Kidney deficiency). Treatment with Liu Wei Wan (Six-Ingredient Pill with Rehmannia) plus Sang Piao Xiao (Mantis Ootheca) resulted in recovery.
Wu Fuxian treated Marshal Zhang, who had a history of fire syndromes and suffered from swollen, painful ears. This was determined to be Wind-Heat in the Shaoyang channel. He advised consulting an acupuncture specialist. Needling Ting Hui (GB2), He Gu (LI4), and Lin Qi (GB20 or BL81 depending on context, likely GB20 here given location) led to recovery.
Chai Yuqing treated Madam Wang Jintang, who suffered from ceaseless cicada-like tinnitus in both ears. She had taken four liang each of Ren Shen (Ginseng Radix) and Shu Di Huang (Prepared Rehmanniae Radix) with no effect. Chai said: "The Kidney opens into the ears, and the Heart also has its orifice in the ears. Treating ear diseases must focus on the Kidney, which is correct. However, the Chi pulse at both wrists was vigorous, ruling out Kidney deficiency. The Left Cun pulse was calm, but the Right Cun and Guan pulses were surging and large. This indicates obstruction by Wind-Heat in the Lung and Stomach channels." Thus, he treated the pulse pattern rather than just the disease. (Xu Lingtai’s note: Nasal congestion is treated via the Heart, deafness via the Lung; this is not merely about treating the pulse.) Using clearing and resolving agents, her right ear recovered after a few doses, and both ears fully healed after several more. He reflected that although the ears, eyes, mouth, and nose are associated with the Five Zang organs, they are internally connected. Diagnosis relies primarily on pulse taking. There are cases where treatment targets one area but effects another, relying entirely on the physician's flexible wisdom.
When Li Yuanchun served as Minister in Heyang, a house centipede entered his ear. Despite desperate measures, including banging his head against a doorpost due to severe headache and noise, imperial physicians failed. A remedy was offered: lie down on a cake made of Hu Ma You (Sesami Oleum). The centipede crawled out shortly after, and he recovered. (From *Tu Jing*, *Bencao Gangmu*.)
*Jianghu Jiwen* records: Someone had a tick enter their ear, causing unbearable headache unresponsive to medicines. Pouring water boiled with rice straw ash into the ear killed and expelled the tick. Also, juice pressed from Wo Cao (Lactuca Sativa) dripped into the ear can expel various insects. (From *Bencao Gangmu*.)
Xue Lizhai treated a woman with pain in the ear or behind the ear/top side, accompanied by alternating chills and fever, bitter taste, and irregular menstruation. This was Fire in the Liver and Gallbladder meridians damaging the Spleen and Stomach. She recovered using Si Jun Zi Tang (Four Gentlemen Decoction) plus Chai Hu (Bupleuri Radix), Sheng Ma (Cimicifugae Rhizoma), Huang Qi (Astragali Radix), and Bai Shao (Paeoniae Radix Alba). Later, due to labor and anger, she experienced vomiting and flank distension, which resolved with Liu Jun Zi Tang (Six Gentlemen Decoction) plus Shan Zhi (Gardeniae Fructus) and Chai Hu (Bupleuri Radix).
Another woman had swollen, painful ears inside and out, chest/flank discomfort, alternating chills and fever, and irregular urination. This was Liver Fire injuring Blood. She took Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver) for four doses, reducing symptoms drastically, then recovered with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). Relapse due to anger was cured with Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Another woman developed chills and fever and ear pain after menstruation due to labor and anger. Since menstruation causes Blood deficiency, Ba Zhen Tang (Eight Treasure Decoction) plus Chai Hu (Bupleuri Radix) was used. For Liver Fire from anger, Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) was used. For Qi injury from labor, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shan Zhi (Gardeniae Fructus) was used, leading to recovery.
Another woman, prone to depression and anger, suffered ear pain, swelling with chills/fever, greenish-yellow complexion, turning red during menstruation. She recovered with Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) and Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder).
Another woman, chronically depressed, suffered swollen/painful ears after anger, continuous menstruation, chills/fever, green-red complexion, and wiry-rapid Liver pulse. This was chronic depression damaging the Spleen and acute anger damaging the Liver. She initially took Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction), followed by Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder), recovering fully.
Another woman developed fever after anger, with purulent discharge from both ears during menstruation, temporal headache, chest/flank/breast distension, alternating chills/fever, frequent urination, or lower abdominal fullness. All belonged to Liver Fire and Blood deficiency. She first took Zhi Zi Qing Gan San (Gardenia Powder to Clear the Liver) for two doses, then Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) for several doses to reduce symptoms, finally recovering with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).
Yu Jiayan discussed Marshal Wang’s tinnitus: Yang Qi ascending to upper orifices while descending to Yin positions causes urinary leakage and abdominal borborygmus. Yin Qi descending to lower orifices while ascending to Yang positions causes obstruction and tinnitus. After age fifty, Kidney Qi declines below, often reversing upwards. The Kidney opens into the ears, and the Liver Wood is its son. When frustration and anger stir Fire, it drains the Mother’s Qi, causing Yin Qi to reverse upwards. This differs vastly from Deafness, where a membrane blocks the orifice, preventing external Qi from entering; thus, opening the orifice is primary. Formulas using Shi Chang Pu (Acori Tatarinowii Rhizoma) and She Xiang (Moschus), and methods of external filling/internal attacking, are designed for this. Tinnitus occurs when Yin Qi rushes to the upper orifice, blocked by a membrane, unable to exit, creating a thin sound like frogs or cicadas. External sounds are mixed with internal sounds, causing unclear hearing. If Qi does not reverse upwards, hearing clears slightly; if it does not reverse at all, hearing clears completely. Treatment focuses heavily on Ci Shi (Magnetitum) because its weight reaches downward, its nature attracts downward, and it controls the Liver Wood’s upward attraction. It is assisted by Yin-nourishing herbs like Di Huang (Rehmanniae Radix) and Gui Jiao (Colla Corii Asini), and astringents like Wu Wei Zi (Schisandrae Fructus) and Shan Yu Rou (Corni Fructus). This strengthens Yin in its home, preventing it from touching the Yang orifice, allowing clear sound transmission. Formulas attribute this to excess Heat in Shaoyang Gallbladder and Jueyin Liver channels. However, Shaoyang Qi ascends to the vertex via collaterals and does not strike the ear tendon directly, so it should not be conflated with Jueyin. Feng Zheng Tong Sheng San (Wind-Resisting and Unblocking Holy Powder) uses sweating and purging to treat Strong Fire. Only Gun Tan Wan (Rolling Phlegm Pill) is effective for the young and robust. Huang Qin (Scutellariae Radix), Da Huang (Rhei Radix et Rhizoma), and Chen Xiang (Aquilariae Lignum Resinatum) are bitter and descend Qi well; Meng Shi (Calamina) is heavy and sinking, similar to Ci Shi (Magnetitum). In the elderly, Kidney Water is exhausted, True Fire is exposed, and Kidney Qi escapes easily. With the Jueyin Son drawing it out, strengthening the Master of Water to control Solar Flare (like adding oil to a lamp to dim the flame) is indeed excellent treatment.
Another woman had swollen/painful ears with discharge, chills/fever, bitter taste, swelling extending to the neck, and poor appetite. This was severe Liver Fire. She improved slightly with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Shan Zhi (Gardeniae Fructus) and Dan Pi (Moutan Cortex), then gradually recovered with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). Full recovery came from Ba Zhen Tang (Eight Treasure Decoction) plus Chai Hu (Bupleuri Radix), Dan Pi (Moutan Cortex), and Shan Zhi (Gardeniae Fructus) to harmonize Liver and Spleen.
Another woman had swollen/painful ears, chest/flank discomfort, alternating chills/fever, and irregular urination. This was Heat in the Liver Meridian. She took Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver) for four doses, reducing symptoms, then recovered with Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). Relapse due to anger was cured with Chai Hu Qing Gan San (Bupleurum Powder to Clear the Liver).
Another woman had intermittent ear pain, internal heat, dry mouth, dizziness upon exertion, phlegm expectoration, and leukorrhea. This was Qi and Spleen deficiency. Morning: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction); Evening: Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). Recovery ensued.
A widow had ear pain, alternating chills/fever, and a pulse reaching the Fish Border (Yuchi). This was Blood deficiency. She recovered with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Sheng Di Huang (Rehmanniae Radix) to suppress the condition. Neck lymph nodes like beads, with afternoon fever, resolved with Jia Wei Gui Pi Tang (Modified Restore the Spleen Decoction) and Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) to harmonize Liver and Spleen.
Another woman had ear pain/swelling/chills/fever, menstruation stopping after ten days, tidal fever, spontaneous/diaphoresis. This was Qi and Blood deficiency with Heat in Liver and Spleen. She recovered with Gui Pi Tang (Restore the Spleen Decoction) and Liu Wei Wan (Six-Ingredient Pill with Rehmannia).
Another woman, quick-tempered, had ear pain/swelling, fever, flank distension worsening in the afternoon. This was Anger damaging Liver, with Qi and Blood deficiency. Morning: Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) plus Huang Bo (Phellodendri Cortex) and Jie Geng (Platycodonis Radix); Evening: Gui Pi Tang (Restore the Spleen Decoction) sending Di Huang Wan (Rehmannia Pill). Recovery ensued.
A widowed woman had ear pain, neck lymph nodes, internal/afternoon fever, irregular menstruation, phlegm, poor appetite, chest discomfort. This was Depression/Anger damaging Liver. Morning: Gui Pi Tang (Restore the Spleen Decoction) to resolve Spleen depression and generate Spleen Qi; Evening: Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder) to clear Liver Fire and generate Liver Blood. Recovery ensued.
A girl had swollen/red ears below, chills/fever, bitter taste, irregular menstruation, and a mass in the lower abdomen. This was Liver Fire, Qi stagnation, and Blood coagulation. She first took Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Shan Zhi (Gardeniae Fructus), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Dan Pi (Moutan Cortex), then Chai Hu Qing Gan San (Bupleurum Powder to Clear the Liver). Recovery ensued.
A woman had ear swelling/pain, chills/fever. She took Jing Fang Bai Du San (Aucklandia and Saposhnikovia Powder to Overcome Toxins) for four doses, resolving exterior symptoms. Then San Zhong Kui Jian Tang (Powder to Disperse Swelling and Harden Masses) for several doses, reducing swelling significantly. Finally, Shen Gua Lou San (Miraculous Trichosanthes Powder) for four doses brought peace.
A man with Wind-Heat in the Liver Meridian had swollen/painful ears below, fever, floating-rapid pulse. He recovered with Bo He Dan (Mint Pills). Ingredients: Bo He (Menthae Haplocalycis Herba), Zao Jiao (Gleditsiae Spina), Lian Qiao (Forsythiae Fructus), San Leng (Sparganii Rhizoma), Shou Wu (Polygoni Multiflori Radix), Man Jing (Vittariae Spora), Dou Chi (Sojae Semen Praeparatum), Jing Jie (Schizonepetae Spica).
A man had ear swelling below and flank pain after anger. He recovered with Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Qing Pi (Citri Reticulatae Pericarpium Viride), Mu Xiang (Aucklandiae Radix), Hong Hua (Carthami Flos), and Tao Ren (Persicae Semen) for four doses.
A woman with tinnitus, internal heat, irregular menstruation, limb fatigue, and poor appetite had Liver-Spleen Deficient Heat. She recovered with Si Jun Zi Tang (Four Gentlemen Decoction) plus Chai Hu (Bupleuri Radix), Shan Zhi (Gardeniae Fructus), Dan Pi (Moutan Cortex), and Gan Cao (Glycyrrhizae Radix et Rhizoma).
A man with purulent discharge, pain, or itching in the ear did not respond to Cong Er Yi Qi Tang (Ear-Attending and Qi-Tonifying Decoction) and worsened with Fang Feng Tong Sheng San (Wind-Protecting and Unblocking Holy Powder). He recovered with Bu Shen Wan (Kidney-Tonifying Pill).
Wei Yuheng stated: Zhu and Yu, two cousins aged sixteen-seventeen. Zhu had ear pain, frequent skin rashes, exacerbated by cold, with swelling around the ear gate to the vertex. She recovered with Yang Qing Tang (Clear Green Decoction) plus Huang Qin (Scutellariae Radix), Ling Yang Jiao (Capricornis Cornu), and Gua Lou Ren (Trichosanthis Semen) in two doses. Yu had ear pain with pus/water discharge. After a doctor used Jing Fang (Aucklandia and Saposhnikovia) to disperse a condition, she suffered uncontrollable bleeding and epigastric burning. The previous formula had Ling Yang Jiao removed, replaced by Zhi Mu (Anemarrhenae Rhizoma) and Chi Shao (Paeoniae Radix Rubra). Bleeding stopped in two doses, pus dried in several. Both had wiry Guan pulses and drumming Cun pulses, indicating Fire in Kidney, Liver, and Gallbladder.
Yu lost parents early, living in hardship. At fourteen, working at a pawnshop, after strenuous winter inventory work, his right ear suddenly hurt unbearably, like piercing. Within a day/night, an abscess formed, discharging yellow water continuously until drying after several days. Pain decreased with discharge, ceased when dry. Recurred with overwork, causing suicidal pain, several times yearly. A doctor attributed it to acute anger damaging Liver and Blood stasis, prescribing Di Dang Wan (Break the Accumulation Pill). Yu knew it was Labor damaging Liver/Kidney, with Dragon-Leopard Fire attacking upward. Fortunately, the pharmacy lacked Meng Chong (Tabanidae) and Shui Zhi (Hirudo), so he delayed taking it. By twenty-something, right ear became deaf, and the disease ceased. The meridians there were withered, so Fire could not penetrate. (Xu Lingtai’s note: I also lost parents at fourteen, abandoned studies for business, endured hardship but avoided illness due to my mother managing the household. Reading this, I feel empathy for our similar youth, regret my lack of medical skill to save my mother, weeping as I finish this scroll.)
Ye Tianshi treated Ding. The Kidney opens into the ears, and the Heart also has its orifice in the ears. Heart-Kidney deficiency, Liver Yang hyperactivity, Yin essence leaking, Yang lacking foundation, causing intermittent tinnitus and closure. The root is Depression, causing isolated Liver Yang hyperactivity and Gallbladder Fire flaming upward. Morning: Pills to tonify Heart-Kidney. Noon: Decoction to clear Shaoyang, as the Gallbladder channel ends in the ear. Formula: Shu Di Huang (Prepared Rehmanniae Radix) 4 liang, Mai Dong (Ophiopogonis Radix) 1.5 liang, Gui Ban (Carapax et Plastrum Testudinis) 2 liang, Mu Li (Concha Ostreae) 1.5 liang, Bai Shao (Paeoniae Radix Alba) 1.5 liang, Bei Wu Wei Zi (Schisandrae Fructus) 1 liang, Jian Lian (Nelumbinis Plumula) 1.5 liang, Ci Shi (Magnetitum) 1 liang, Fu Shen (Poria cum Radix Pini) 1.5 liang, Chen Xiang (Aquilariae Lignum Resinatum) 5 qian, Chen Sha (Cinnabar) 5 qian as coating. Decoction: Xia Ku Cao (Prunellae Spica) 2 qian, Dan Pi (Moutan Cortex) 1 qian, Sheng Di Huang (Rehmanniae Radix) 3 qian, Shan Zhi (Gardeniae Fructus) 1 qian, Nv Zhen Zi (Ligustri Lucidi Fructus) 3 qian, Chi Fu Ling (Poria with Red Coir) 1.5 qian, Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma) 0.4 qian.
Xu Lingtai commented: The formula is clear, harmonious, and pleasing. Methods for deafness vary, mainly clearing above and sedating below. This case formula is very stable. External treatments and deficiency-cold syndromes must also be known.