大意
北方黑色。入通于肾。开窍于耳。（内经）分新旧治之。新聋多热。少阳阳明火盛也。旧聋多虚。少阴肾气不足也。
（汇补）
内因
肾通乎耳。所主者精。精盛则肾气充足。耳闻耳聪。（心法）若疲劳过度。精气先虚。四气得以外入。七情得以
内伤。遂致聋 耳鸣。（大全）
外候
肾气充盛则耳聪。肾气虚败则耳聋。肾气不足则耳鸣。肾气结热则耳脓。（绳墨）
风聋
耳者宗脉之所附。宗脉虚而风邪乘之。使经气否而不宣。是为风聋。内必作痒。或兼头痛。（丹溪）
厥聋
十二经络上络于耳。其阴阳诸经。适有交并。则脏气逆而为厥。厥气搏于耳。是谓厥聋。痞塞不通。必兼眩
晕。（丹溪）
劳聋
劳役伤于血气。淫欲耗其真元。憔悴力疲。昏昏愦愦。是谓劳聋。有能将息得宜。则其聋自轻。如日就劳伤。
则为久聋。（心法）
虚聋
虚聋由渐而成。必有兼症可辨。如面颊黧黑者。精脱。少气咽干者。肺虚。目KT 善恐者。肝虚。心神恍惚。惊悸
烦躁者。心虚。四肢懒倦。眩晕少食者。脾虚。（汇补）
脉法
脉证以肾为主。迟濡为虚。洪动为火。浮大为风。沉涩为气。数实为热。滑利为痰。（入门）
治法
肾窍于耳。而能听声者。肺也。因肺主气。一身之气贯于耳故也。凡治耳聋。必先调气开郁。（入门）其次。风为
之疏散。热为之清利。虚为之补养。郁为之开导。然后以通耳调气安肾之剂治之。（汇补）
聋分左右
浓味动胃火。则左右俱聋。忿怒动胆火。则左聋。色欲动相火。则右聋。（入门）
用药
风聋。用清神散。加羌活、防风、细辛、独活。气郁。用二陈汤。加香附、菖蒲、乌药、青皮。劳聋。用补中益气
汤。加菖蒲、远志。虚聋。用八珍汤。加菖蒲、远志。精耗。用六味丸。加枸杞、五味。虚炎。用八味丸。加磁石、龟
胶。肝胆实火。用小柴胡。加芎、归、山栀。脾胃实火。用清胃散。加黄芩、山栀。肾虚阴火。用地黄汤。加黄柏、知
母。
【附耳鸣】
耳鸣是痰火上升。壅闭听户。有渐聋之机焉。大抵因痰火在上。又因恼怒而得。怒则气上。少阳之火客于
耳也。若肾虚而鸣者。其鸣不甚。当具劳怯之状。（杂着）
【附耳痛】
如虫走者风痛。干痛者风热。湿痛者风湿。微痛者虚火。（入门）又有耳后攻击作痛作肿。此是少阳经之湿
火。（绳墨）
外用蛇蜕烧灰存性为末。吹入以治风。或用枯矾末吹入治风湿。或青箬烧灰吹之亦效。重者内服凉
膈散。其肾胆二经火动者。实用小柴胡。虚用逍遥散。
【附脓耳】
热气乘虚。随脉入耳。聚热不散。脓汁时出。为之脓耳。（心法）
治宜蔓荆子散。外用轻粉、明矾、黄丹、龙骨、麝香、蚌粉为末。绵缠竹拭耳。或用白矾、胭脂、麝香各一钱。为
末吹之。
【附停耳】
停耳由气郁生痰。内火攻冲。形似赤肉。或兼脓汁溃烂。（绳墨）
治宜二陈加玄参、花粉、黄芩、山栀、连翘、柴胡、蔓荆。
【附耵耳】
人耳间有津液。轻则不能为害。若风热搏之。津液结塞成核。能令暴聋。为之耵耳。（丹溪）
治宜四物加羌活、防风、柴胡、黄芩、连翘、玄参等。外用生猪油、地龙、釜墨等分。研细末。以葱汁和捏如枣
核。薄绵裹入耳。令润则挑出。
【附耳衄】
耳中出血为耳衄。左关脉来弦数者。为少阳经火。尺脉或躁或弱者。少阴经虚。
少阳经火。宜柴胡清肝散。少阴经虚。用六味地黄丸。外治用龙骨末吹入。
【附耳痒】
寻常耳痒。有风有火。易于调治。甚有耳痒不歇。挑剔出血。不能住手。此肾藏风毒上攻于耳。宜透水丹治
之。并戒酒色膏粱浓味。
耳病选方
清神散 治风热上攻于耳。
甘菊 羌活 荆芥 木通 川芎 防风 木香 菖蒲 僵蚕 甘草
二陈汤 治气逆壅闭于耳。（方见痰症）
补中益气汤 治阳虚气陷耳聋。
四物汤 治阴虚血弱耳聋。
六味地黄丸 治耳聋属精气虚脱。
八味丸 治耳聋属元阳虚脱。（以上四方俱见中风）
龙荟丸 治热盛痰火耳聋。
当归 胆草 黄连 黄芩 黄柏 芦荟 大黄 青黛 木香 麝香
益肾散
磁石 巴戟 沉香 菖蒲 川椒
猪肾一枚。和以葱白炒盐并药。用湿纸裹煨。白汤下。
凉膈散
栀子 连翘 薄荷 黄芩 甘草 赤芍 大黄 桔梗
治久聋快捷方式法
用酒一斗。入故铁十斤。煮一炷香。投磁石三两。研末浸酒中。三日。令病患醉饮。复以绵裹磁石一块内
耳中。覆头一卧。酒醒即愈。又治虚症。
又方。用斑蝥三枚。炒巴豆去心皮二两。入麝香少许。丸如枣核大。绵裹塞耳中。以微响黄水出为度。（此治实聋）
【大意】
北方对应黑色，肾气与北方相通。耳为肾之外窍。（《黄帝内经》）将耳聋分为新病和久病两种治法。新近发生的耳聋多属热证，是少阳经和阳明经火气亢盛所致；日久不愈的耳聋多属虚证，是少阴肾气不足所致。
【汇补】
内因
肾气通达于耳，耳的功能由精气主宰。精气旺盛则肾气充足，听觉灵敏。（《医宗心法》）如果过度疲劳，精气首先亏损，风寒暑湿四气得以从外侵入，喜怒忧思悲恐惊七情得以从内损伤，从而导致耳聋、耳鸣。（《景岳全书·大全》）
外候
肾气充盛则听力敏锐，肾气虚衰则耳聋，肾气不足则耳鸣，肾气郁结化热则耳流脓。（《医宗绳墨》）
风聋
耳朵是众多经脉汇聚附着之处。经脉空虚而风邪乘虚侵袭，导致经气阻滞不能宣通，这就叫作风聋。内部必然发痒，有时兼有头痛。（朱丹溪）
厥聋
十二经络上连属于耳。当阴阳各条经脉的气机恰好交汇并逆乱时，脏腑之气上逆形成厥证。厥逆之气冲击耳部，这就叫做厥聋。耳部痞塞不通，必定兼有眩晕。（朱丹溪）
劳聋
过度劳累损伤气血，纵欲过度耗损真元，导致身体憔悴、力气疲乏、头脑昏沉混乱，这就叫做劳聋。如果能适当调养休息，耳聋自然会减轻；如果日复一日地劳伤，就会变成久聋。（《医宗心法》）
虚聋
虚聋是逐渐形成的，一定伴有其他症状可以辨别。如面颊颜色黧黑的是精液脱失，气短咽干的是肺虚，眼睛视物模糊且容易恐惧的是肝虚，心神恍惚、惊悸烦躁的是心虚，四肢懒惰疲倦、眩晕食欲不振的是脾虚。（《证治汇补》）
脉法
诊脉以肾脏为主。脉迟而濡软为虚证，脉洪大跳动为火证，脉浮大为风证，脉沉涩为气滞，脉数实为热证，脉滑利为痰证。（《医学入门》）
治法
肾开窍于耳，但能听声音的是肺。因为肺主气，全身的气都贯通于耳的缘故。凡是治疗耳聋，必须先调畅气机、开通郁结。（《医学入门》）其次，风邪用疏散法，热邪用清利法，虚证用补养法，郁结用开导法，然后用通耳、调气、安肾的方剂进行治疗。（《证治汇补》）
耳聋分左右
食用浓味食物触动胃火，则左右耳都聋；愤怒触动胆火，则左耳聋；色欲触动相火，则右耳聋。（《医学入门》）
用药
风聋，用清神散，加羌活、防风、细辛、独活。气郁，用二陈汤，加香附、石菖蒲、乌药、青皮。劳聋，用补中益气汤，加石菖蒲、远志。虚聋，用八珍汤，加石菖蒲、远志。精血耗损，用六味地黄丸，加枸杞子、五味子。虚火上炎，用八味地黄丸（金匮肾气丸），加磁石、龟甲胶。肝胆实火，用小柴胡汤，加川芎、当归、山栀。脾胃实火，用清胃散，加黄芩、山栀。肾虚阴火，用地黄汤，加黄柏、知母。
【附：耳鸣】
耳鸣是由于痰火上升，壅闭耳道，有逐渐发展为耳聋的趋势。大抵是因为痰火在上，又因恼怒而引发。愤怒则气机上逆，少阳之火客居于耳中。如果是肾虚导致的耳鸣，鸣响程度不严重，应当具备虚劳羸弱的症状。（《杂著》）
【附：耳痛】
像虫子爬一样的疼痛是风痛，干燥疼痛是风热，潮湿疼痛是风湿，轻微疼痛是虚火。（《医学入门》）又有耳后攻冲作痛肿胀的，这是少阳经的湿火。（《医宗绳墨》）
外用蛇蜕烧灰存性研末，吹入耳中以治风痛；或用枯矾末吹入治风湿痛；或用青箬叶烧灰吹入也有效。病情重的内服凉膈散。肾经和胆经火动者，实证用小柴胡汤，虚证用逍遥散。
【附：脓耳】
热气乘虚随经脉进入耳中，聚热不散，脓汁时常流出，这叫做脓耳。（《医宗心法》）
治疗宜用蔓荆子散。外用轻粉、明矾、黄丹、龙骨、麝香、蚌粉研成细末，用棉缠竹签擦拭耳道。或者用白矾、胭脂、麝香各一钱，研末吹入耳中。
【附：停耳】
停耳由气郁生痰，内火攻冲引起，形状像赤肉，有时兼有脓汁溃烂。（《医宗绳墨》）
治疗宜用二陈汤加玄参、花粉、黄芩、山栀、连翘、柴胡、蔓荆子。
【附：耵聍耳】
人耳间有津液，轻微时不能为害。如果风热搏结，津液凝结堵塞成核，能导致突然耳聋，这叫做耵聍耳。（朱丹溪）
治疗宜用四物汤加羌活、防风、柴胡、黄芩、连翘、玄参等。外用生猪油、地龙、釜底墨等分，研成细末，用葱汁调和捏成枣核大小，包在薄绵中放入耳中，使其湿润然后挑出。
【附：耳衄】
耳中出血称为耳衄。左关脉弦数的，为少阳经火；尺脉或躁动或弱小的，为少阴经虚。
少阳经火，宜用柴胡清肝散；少阴经虚，用六味地黄丸。外治用龙骨末吹入耳中。
【附：耳痒】
寻常耳痒，有风有火，易于调治。甚至有耳痒不止，挑剔出血，无法控制手的，这是肾藏风毒上攻于耳，宜用透水丹治疗。并戒除酒色及油腻厚味食物。
耳病选方
清神散 治疗风热上攻于耳。
甘菊、羌活、荆芥、木通、川芎、防风、木香、石菖蒲、僵蚕、甘草。
四物汤 治疗阴虚血弱导致的耳聋。
龙荟丸 治疗热盛痰火导致的耳聋。
当归、龙胆草、黄连、黄芩、黄柏、芦荟、大黄、青黛、木香、麝香。
益肾散
磁石、巴戟天、沉香、石菖蒲、川椒。
猪肾一枚，与葱白炒盐及药物一起，用湿纸包裹煨熟，白开水送下。
治疗久聋快捷方法
用酒一斗，放入旧铁十斤，煮至一炷香的时间，投入磁石三两，研成末浸泡在酒中。三天后，让病人喝醉。再用绵裹住一块磁石放入耳中，头向下卧倒。酒醒后即可痊愈。此方又治虚症。
又一方。用斑蝥三枚，炒巴豆去心皮二两，加入少许麝香，制成如枣核大小的丸药，用绵包裹塞入耳中，以微响且有黄水流出为度。（此方治疗实聋）
[General Principle]
The North corresponds to the color black, and Kidney Qi connects with the North. The ear is the external orifice of the Kidney. (*Huangdi Neijing*) divides deafness into new-onset and chronic types for treatment. New-onset deafness is mostly due to heat, caused by excessive fire in the Shaoyang and Yangming channels. Chronic deafness is mostly due to deficiency, caused by insufficient Qi of the Shaoyin Kidney.
[Huibu (Compendium)]
Internal Causes
Kidney Qi communicates with the ear, which is governed by Essence (Jing). When Essence is abundant, Kidney Qi is sufficient, resulting in acute hearing. (*Yizong Xinfa*) If overfatigue occurs, Essence and Qi are first depleted, allowing the pathogenic factors of Wind, Cold, Summerheat, and Dampness to enter from outside, and the Seven Emotions to injure from inside, leading to deafness and tinnitus. (*Jingyue Quanshu*)
External Manifestations
When Kidney Qi is robust, hearing is acute; when Kidney Qi is deficient and failing, deafness occurs; when Kidney Qi is insufficient, tinnitus arises; when Kidney Qi stagnates and transforms into heat, otorrhea (pus discharge from the ear) appears. (*Yizong Shengmo*)
Wind Deafness
The ear is the attachment site of numerous collaterals. When the collaterals are deficient and Wind pathogen takes advantage of this deficiency, causing the Qi of the meridians to be obstructed and not disseminated, this is called Wind Deafness. Internally, there must be itching, sometimes accompanied by headache. (Zhu Danxi)
Jue Deafness
The twelve meridians connect upwards to the ear. When the Qi of the Yin and Yang meridians intersects and reverses, the Zang organ Qi becomes rebellious, forming Jue syndrome. The Jue Qi strikes the ear, which is called Jue Deafness. There is a sensation of blockage and obstruction, inevitably accompanied by vertigo. (Zhu Danxi)
Fatigue Deafness
Overwork damages Qi and Blood, while excessive sexual activity depletes True Yuan (Primordial Origin), leading to emaciation, physical fatigue, and mental confusion. This is called Fatigue Deafness. If one can rest and recuperate properly, the deafness will naturally lighten. However, if daily labor injuries accumulate, it becomes chronic deafness. (*Yizong Xinfa*)
Deficiency Deafness
Deficiency deafness develops gradually and must be distinguished by accompanying symptoms. For example, darkened cheeks indicate depletion of Essence; shortness of breath and dry throat indicate Lung deficiency; blurred vision and fearfulness indicate Liver deficiency; mental restlessness, palpitations, and irritability indicate Heart deficiency; laziness of the four limbs, vertigo, and poor appetite indicate Spleen deficiency. (*Zhengzhi Huibu*)
Pulse Diagnosis
Pulse diagnosis focuses on the Kidney. A slow and soggy pulse indicates deficiency; a surging and moving pulse indicates Fire; a floating and large pulse indicates Wind; a deep and choppy pulse indicates Qi stagnation; a rapid and excess pulse indicates Heat; a slippery and smooth pulse indicates Phlegm. (*Yixue Rumen*)
Treatment Principles
Although the Kidney opens into the ear, it is the Lung that enables hearing. This is because the Lung governs Qi, and the Qi of the entire body penetrates the ear. Therefore, in treating any deafness, one must first regulate Qi and resolve stagnation. (*Yixue Rumen*) Secondly, use dispersing methods for Wind, clearing and draining methods for Heat, tonifying methods for Deficiency, and guiding methods for Stagnation. Finally, treat with formulas that unblock the ears, regulate Qi, and calm the Kidney. (*Zhengzhi Huibu*)
Deafness Differentiated by Side
Consuming rich and greasy foods stirs Stomach Fire, causing deafness in both ears. Anger stirs Gallbladder Fire, causing left-sided deafness. Sexual indulgence stirs Ministerial Fire, causing right-sided deafness. (*Yixue Rumen*)
Herbal Medication
For Wind Deafness, use Qingshen San, adding Qianghuo, Fangfeng, Xixin, and Duhuo. For Qi Stagnation, use Erchen Tang, adding Xiangfu, Changpu, Wuyao, and Qingpi. For Fatigue Deafness, use Buzhong Yiqi Tang, adding Changpu and Yuanzhi. For Deficiency Deafness, use Bazhen Tang, adding Changpu and Yuanzhi. For Essence depletion, use Liuwei Dihuang Wan, adding Gouqi and Wuweizi. For Deficient Fire, use Bawei Wan (Jinkui Shenqi Wan), adding Cishi and Guijiao. For Excess Fire of the Liver and Gallbladder, use Xiaochaihu Tang, adding Chuanxiong, Danggui, and Shanzhi. For Excess Fire of the Spleen and Stomach, use Qingwei San, adding Huangqin and Shanzhi. For Kidney Deficiency with Yin Fire, use Dihuang Tang, adding Huangbai and Zhimu.
[Appendix: Tinnitus]
Tinnitus is caused by Phlegm-Fire rising and blocking the auditory orifice, presenting a tendency towards gradual deafness. Generally, it is due to Phlegm-Fire located above, triggered by anger. Anger causes Qi to rise, and Shaoyang Fire lodges in the ear. If tinnitus is due to Kidney deficiency, the ringing is not severe, and the patient should exhibit signs of consumptive disease. (*Zazhu*)
[Appendix: Earache]
Pain feeling like insects crawling is Wind pain; dry pain is Wind-Heat; damp pain is Wind-Damp; mild pain is Deficient Fire. (*Yixue Rumen*) Pain and swelling attacking the area behind the ear is Damp-Fire of the Shaoyang channel. (*Yizong Shengmo*)
Externally, burn snake skin until carbonized but retaining its properties, powder it, and insufflate into the ear to treat Wind pain. Or insufflate dried alum powder to treat Wind-Damp pain. Or insufflate ash from burning bamboo leaves, which is also effective. For severe cases, take Liangge San internally. For real Fire moving in the Kidney and Gallbladder channels, use Xiaochaihu Tang for excess patterns and Xiaoyao San for deficiency patterns.
[Appendix: Otorrhea/Pus Ear]
Heat enters the ear through the meridians taking advantage of deficiency. Heat gathers and does not dissipate, causing pus to discharge intermittently. This is called Pus Ear. (*Yizong Xinfa*)
Treatment should use Manjingzi San. Externally, powder Qinfen, Mingfan, Huangdan, Longgu, Muxiang, and Bangfen. Use cotton-wrapped bamboo to wipe the ear canal. Or mix Baifan, Yanzhi, and Muxiang (1 qian each), powder them, and insufflate into the ear.
[Appendix: Ting Ear]
Ting Ear is generated by Qi stagnation producing Phlegm, attacked by internal Fire. It resembles red flesh, sometimes accompanied by pus discharge and ulceration. (*Yizong Shengmo*)
Treatment should use Erchen Tang plus Xuanshen, Huafen, Huangqin, Shanzhi, Lianqiao, Chaihu, and Manjingzi.
[Appendix: Cerumen Ear]
There is fluid in the human ear. Mildly, it causes no harm. If Wind-Heat combats it, the fluid condenses and blocks, forming a nucleus, causing sudden deafness. This is called Cerumen Ear. (Zhu Danxi)
Treatment should use Siwu Tang plus Qianghuo, Fangfeng, Chaihu, Huangqin, Lianqiao, and Xuanshen. Externally, mix fresh pig lard, Dilong, and Fu Mo in equal parts, grind into fine powder, mix with scallion juice, shape into a date pit, wrap thinly in cotton, insert into the ear. Let it moisten, then remove.
[Appendix: Auricular Hemorrhage]
Bleeding from the ear is called Auricular Hemorrhage. A wiry and rapid pulse at the Left Guan position indicates Shaoyang Channel Fire. A restless or weak pulse at the Chi position indicates Shaoyin Channel Deficiency.
For Shaoyang Channel Fire, use Chaihu Qinggan San. For Shaoyin Channel Deficiency, use Liuwei Dihuang Wan. Externally, insufflate Longgu powder.
[Appendix: Ear Itch]
Common ear itch involves Wind and Fire, easy to treat. However, some have incessant ear itch, picking until bleeding, unable to stop. This is Wind-Toxin lodging in the Kidney attacking the ear. Use Toushui Dan. Also, abstain from alcohol, sex, and rich/greasy foods.
Selected Formulas for Ear Diseases
Qingshen San: Treats Wind-Heat attacking the ear upwards.
Ganju, Qianghuo, Jingjie, Mutong, Chuanxiong, Fangfeng, Muxiang, Changpu, Jiangcan, Gancao.
Erchen Tang: Treats rebellious Qi blocking the ear. (See Phlegm Disease section)
Buzhong Yiqi Tang: Treats deafness due to Yang deficiency and Qi sinking.
Siwu Tang: Treats deafness due to Yin deficiency and Blood weakness.
Liuwei Dihuang Wan: Treats deafness belonging to Essence and Qi depletion.
Bawei Wan: Treats deafness belonging to Primordial Yang depletion. (The above four formulas are all seen in Stroke section)
Longhui Wan: Treats deafness due to excessive Heat and Phlegm-Fire.
Danggui, Dancao, Huanglian, Huangqin, Huangbai, Lvhui, Dahuang, Qingdai, Muxiang, Muxiang.
Yishen San
Cishi, Bajiji, Chenxiang, Changpu, Chuanjiao.
One Pig Kidney, stir-fried with Scallion White, Salt, and herbs. Wrapped in wet paper and baked. Taken down with warm water.
Liangge San
Zhizi, Lianqiao, Bohe, Huangqin, Gancao, Chishao, Dahuang, Jiegeng.
Quick Method for Treating Chronic Deafness
Take one dou of wine, add ten jin of old iron, boil for the time it takes to burn one incense stick. Add three liang of Cishi, grind into powder, and soak in the wine. After three days, let the patient drink until drunk. Then wrap a piece of Cishi in cotton and insert it into the ear. Lie down with head covered. Upon waking from the wine, the condition will be cured. This method also treats deficiency patterns.
Another Formula. Take three Banmao, two liang of fried Badou (devoid of heart and skin), add a little Muxiang. Pill into size of a date pit. Wrap in cotton and plug into the ear. Stop when slight ringing occurs and yellow fluid discharges. (This treats Excess Deafness)