【因】风温时毒。先犯少阳。续感暴寒而发。乃太少两阳合病。状类伤寒。以其两耳发黄。故见形定名曰黄耳伤寒。其病多发于春令。
【证】发热恶寒。脊强背直。状如刚痉。两耳叶黄。耳中策策作痛。继则耳
鸣失聪。赤肿流脓。舌苔白中带红。继即纯红起刺。
【脉】左浮弦。右浮数者。此石顽称为太阳类伤寒。实则外寒搏动内热。两阳合病之
时毒也。
【治】法当内外兼施。内治以荆防败毒散加减。（方药服法载前疫疟门中）辛散
风毒以解表。表解痉止。少阳相火犹盛。耳中肿痛者。继与新加木贼煎去葱白。加连翘
、牛蒡（各二钱）。大青（三钱）。生绿豆（一两）。杜赤豆（四钱。二味煎汤代水）
辛凉解毒以清火。火清毒解。尚觉耳鸣时闭者。终以聪耳达郁汤。（冬桑叶、夏枯草、
鲜竹茹、焦山栀、碧玉散、鲜生地各二钱、女贞子三钱、生甘草四分、鲜石菖蒲汁四
匙冲）。整肃余热以善后。外治、以开水泡制月石（二钱）、和入鲜薄荷汁、苦参、青
木香磨汁（各两匙）。时灌耳中。清火解毒以止痛。
【秀按】黄耳伤寒。非正伤寒也。乃风温时毒类伤寒耳。故石顽老人谓风入于肾。
从肾开窍于耳立言。方用小续命汤去附子。加僵蚕、天麻、蔓荆子、白附子。以驱深入
之恶风。更以苦参及骨碎补取汁滴耳中。清其火以止痛。俞君谓风温时毒先犯少阳。从
胆经亦络于耳立言。推其意。由太阳经外寒搏束。少阳火郁不得发泄。故窜入耳中作痛
。耳叶发黄。犹之阳明经湿热郁蒸。热不得从汗越。身必发黄。其病理一也。故治以辛
凉发散。疏风解毒为首要。遵《内经》火郁发之之法。方亦清灵可喜。虽从浅一层立法。而
对症发药。似较张法为稳健。盖以小续命汤之人参姜桂。时毒症究难浪用。后学宁从俞
而不必从张也。
【廉勘】黄耳伤寒。前清光绪己丑年四五月间。经过七人。皆四乡藜藿体。其证两
耳红肿黄亮。扪之 热而痛。两腮亦红肿痛甚。耳中望之红肿。时有黄涎流出。筑筑然
疼。声如蝉噪。两目白及眼睑。亦皆发黄。身热体痛。恶寒无汗。背脊拘挛串痛。强直
难伸。不能转侧。溺短赤涩。脉右濡滞。左浮弦略紧。舌苔白腻带黄。边尖俱红。断其
病由风热挟湿温时毒。作流行性中耳炎治。以麻黄连翘赤小豆汤加味（蜜炙麻黄五分、
光杏仁三钱、连须生葱白两枚、淡香豉三钱、银花、连翘、牛蒡各二钱、焦山栀、紫
荆皮、梓白皮各三钱、先用杜赤小豆四钱、生绿豆、绵茵陈各八钱、煎汤代水。）
送下聪耳芦荟丸。（生熟川军、芦荟、青黛、柴胡各五钱、龙胆草、黄芩、山栀、当
归、青皮各一两、青木香、杜胆星各二钱、当门子五分、神曲糊丸、每服八分至一钱
。）辛凉开达。疏风散寒以发表。苦寒清利。解毒泻火以治里。外用清涤耳毒水（硼酸
二钱、盐剥一钱、开水九两炀化。）以灌耳。清耳五仙散（猪胆汁炒川柏一钱、酒炒杜
红花三分、制月石七分、冰片一厘、薄荷霜二厘、共研极匀、瓷瓶收藏。）以吹耳。更
以盐鸭蛋灰拌捣天荷叶。涂布耳叶两腮以消肿退炎。似此表里双解。内外并治。速则一
候。缓则两候。七人皆愈。
【荣斋按】“黄耳伤寒”这病名不知起于何时？我最初看到的，是张石顽《伤寒绪
论》，他说∶“黄耳者，耳中策策痛，两耳叶黄，风入于肾也；卒然变恶寒发热，
脊强直如痉状，此属太阳类伤寒也。”所谓“黄耳”，大概由于“两耳叶黄”，从症状
中得出了病名。至于这些症状，巢氏《诸病源候总论》已有记载，他说∶“凡患耳中策
策痛者，皆是风入于肾之经也；不治流入肾，则卒然变脊强直成痉也。”不过，巢氏所
载，无“恶寒发热”，因此，也就不名“类伤寒”。现下我觉得“黄耳”病名，似始于
张石顽，症状则早见于巢元方，其间递嬗变易，有同有异，与俞氏所述。更有不同之外
。据本节所列症状，相当于西医书的“耳疖”和“中耳炎”；西医书描写耳疖的症状说
∶“常有强度耳痛，尤于夜间为甚，患部皮肤红肿，且可波及耳壳周遭，全身恶寒战栗
，或有
发高热者。”描述中耳炎的症状是∶“全身症状──常发高热，恶寒战栗、呕吐、头痛
、不安等，与其他急性传染病之症状同。若发生于小孩，则可有脑膜刺激症状，如感觉
过敏，痉挛、呕吐、谵语与真性脑膜炎同。局部症状──患侧有听力障碍，耳痛、耳鸣
、耳内搏动感等。”（以上是概括大意，非原文。）从中西医学理论所记录的症状，互
相对勘，似乎“黄耳伤寒”的名称，不十分妥贴。至于治法，则俞何两先生所采集的验
方，是足够应用的。
【病因】由风温时毒引起。病邪首先侵犯少阳经，随后又感受暴寒而发病。这是太阳与少阳两经的阳热合病，症状类似伤寒。因为患者双耳发黄，所以根据形态特征定名为黄耳伤寒。这种病多发生在春季。
【证候】发热恶寒，脊柱僵硬、背部挺直，症状如同刚痉（以项背强直、角弓反张为特征的痉挛性疾病）。双耳耳叶发黄，耳中刺痛，继则出现耳鸣、听力丧失，耳部红肿流脓。舌苔白中带红，随后变为纯红色并起刺。
【脉象】左手脉浮弦，右手脉浮数。这被石顽称为太阳类伤寒，实际上是外寒搏动内热，属于两阳合病的时毒。
【治法】应当内外兼治。内治使用荆防败毒散加减。（方药服用方法记载在前面的疫疟章节中）用辛散之法疏散风毒以解表，表邪解除后痉挛停止。若少阳相火仍然旺盛，耳中肿痛者，继用新加木贼煎，去掉葱白，加入连翘、牛蒡子（各二钱）、大青叶（三钱）、生绿豆（一两）、杜赤豆（四钱，这两味药煎汤代替水煎煮）。用辛凉之法解毒以清火。火清毒解后，如果仍感觉耳鸣时有闭塞感，最后使用聪耳达郁汤（冬桑叶、夏枯草、鲜竹茹、焦山栀、碧玉散、鲜生地各二钱、女贞子三钱、生甘草四分、鲜石菖蒲汁四匙冲服）。以此整理清除余热以善后。外治：用开水泡制月石（二钱），混合鲜薄荷汁、苦参、青木香磨成的汁（各两匙），时时灌入耳中。以此清火解毒以止痛。
【秀按】黄耳伤寒，不是真正的伤寒，而是风温时毒类似伤寒的病证。所以石顽老人说风邪侵入肾脏，从肾开窍于耳的角度立论。方剂用小续命汤去掉附子，加入僵蚕、天麻、蔓荆子、白附子，以驱除深入体内的恶风。再用苦参及骨碎补取汁滴入耳中，清其火热以止痛。俞君认为风温时毒首先侵犯少阳，从胆经也络属于耳的角度立论。推究其意，是由于太阳经外寒束缚，少阳火郁结不得发泄，所以窜入耳中作痛。耳叶发黄，就像阳明经湿热郁蒸，热邪不能通过汗液发散，身体必然发黄一样。其病理机制是一样的。所以治疗以辛凉发散、疏风解毒为首要任务，遵循《内经》“火郁发之”的方法。方剂清灵可喜，虽然是从较浅的层面立法，但对症用药，似乎比张氏的方法更稳健。因为小续命汤中的人参、生姜、肉桂等药，对于时毒症终究难以轻易使用。后学者宁可遵从俞氏而不必遵从张氏。
【廉勘】黄耳伤寒，我在前清光绪己丑年（1889年）四五月间，经过七人，都是乡村贫苦体质之人。他们的症状是双耳红肿黄亮，触摸时发热且疼痛，两腮也红肿疼痛严重。耳中望去红肿，时常有黄色涎液流出，疼痛剧烈如虫咬，声音如蝉鸣噪叫。双眼白眼珠及眼睑也都发黄，身热体痛，恶寒无汗，背脊拘挛串痛，强直难以伸展，不能转身侧卧，小便短少赤涩。脉象右濡滞，左浮弦略紧，舌苔白腻带黄，边尖俱红。判断其病因为风热挟湿温时毒，按流行性中耳炎治疗。使用麻黄连翘赤小豆汤加味（蜜炙麻黄五分、光杏仁三钱、连须生葱白两枚、淡香豉三钱、银花、连翘、牛蒡子各二钱、焦山栀、紫荆皮、梓白皮各三钱，先用杜赤小豆四钱、生绿豆、绵茵陈各八钱，煎汤代替水煎煮上述药物。）送服聪耳芦荟丸（生熟川军、芦荟、青黛、柴胡各五钱、龙胆草、黄芩、山栀、当归、青皮各一两、青木香、杜胆星各二钱、当门子五分，神曲糊丸，每服八分至一钱。）用辛凉开达、疏风散寒以发表，苦寒清利、解毒泻火以治里。外用清涤耳毒水（硼酸二钱、盐剥一钱、开水九两溶化。）灌耳。吹入清耳五仙散（猪胆汁炒川柏一钱、酒炒杜红花三分、制月石七分、冰片一厘、薄荷霜二厘，共研极匀，瓷瓶收藏。）并用盐鸭蛋灰拌捣天荷叶，涂敷耳叶和两腮以消肿退炎。像这样表里双解、内外并治，快的一个时辰，慢的两个时辰，七人都痊愈了。
【荣斋按】“黄耳伤寒”这个病名不知起源于何时？我最初看到的是张石顽的《伤寒绪论》，他说：“黄耳，是指耳中刺痛，双耳耳叶发黄，是风邪侵入肾脏；突然变成恶寒发热，脊柱强直如痉状，这属于太阳类伤寒。”所谓“黄耳”，大概是因为“双耳耳叶发黄”，从症状中得出了病名。至于这些症状，巢元方的《诸病源候总论》已有记载，他说：“凡是患耳中刺痛的人，都是风邪侵入肾脏的经脉；如果不治疗流入肾脏，就会突然变成脊柱强直成痉症。”不过，巢氏所载，没有“恶寒发热”，因此，也就不称“类伤寒”。现在我觉得“黄耳”病名，似乎始于张石顽，症状则早见于巢元方，其间演变变化，有同有异，与俞氏所述更有不同之处。据本节所列症状，相当于西医书的“耳疖”和“中耳炎”；西医书描写耳疖的症状说：“常有强度耳痛，尤于夜间为甚，患部皮肤红肿，且可波及耳壳周遭，全身恶寒战栗，或有发高热者。”描述中耳炎的症状是：“全身症状──常发高热，恶寒战栗、呕吐、头痛、不安等，与其他急性传染病之症状同。若发生于小孩，则可有脑膜刺激症状，如感觉过敏，痉挛、呕吐、谵语与真性脑膜炎同。局部症状──患侧有听力障碍，耳痛、耳鸣、耳内搏动感等。”（以上是概括大意，非原文。）从中西医学理论所记录的症状，互相对勘，似乎“黄耳伤寒”的名称，不十分妥贴。至于治法，则俞何两先生所采集的验方，是足够应用的。
[Pathogenesis] Caused by wind-warmth seasonal toxins. The pathogenic factor first attacks the Shaoyang (Lesser Yang) channel, and subsequently is affected by sudden cold, leading to disease onset. This is a combined disease of Taiyang (Greater Yang) and Shaoyang yang heat, with symptoms resembling Shanghan (Cold Damage). Because the patient's ears turn yellow, it is named Huang'er Shanghan (Yellow Ear Cold Damage) based on its morphological features. This disease mostly occurs in spring.
[Symptoms] Fever and aversion to cold, stiffness of the spine and straightening of the back, symptoms similar to Gangjing (Stiff Spasm characterized by rigidity of the neck and back and opisthotonos). The earlobes are yellow, with stinging pain in the ears, followed by tinnitus and hearing loss, redness and swelling of the ears with pus discharge. The tongue coating is white with red patches, which later turns entirely red and develops prickles.
[Pulse] The left pulse is floating and wiry; the right pulse is floating and rapid. Shiwan referred to this as Taiyang-like Shanghan, but it is actually external cold interacting with internal heat, belonging to the seasonal toxin of combined Taiyang and Shaoyang diseases.
[Treatment] Internal and external treatments should be applied simultaneously. For internal treatment, Jingfang Baidu San (Atractylodes and Saposhnikovia Decoction for Resisting Toxins) is used with modifications. (The prescription and administration method are recorded in the preceding Yi Miao section.) Use acrid-dispersing methods to scatter wind-toxin and release the exterior; once the exterior is resolved, spasms cease. If Shaoyang ministerial fire remains vigorous and the ears are swollen and painful, Xinjia Mu Zei Jian (Modified Equisetum Decoction) is used next, removing scallion white and adding Lianqiao (Forsythiae Fructum), Niubangzi (Arctii Fructus) (each 2 qian), Daqingye (Isatidis Folium) (3 qian), Sheng Lv Dou (Vigna radiata seed, raw) (1 liang), and Du Chidou (Adzuki bean) (4 qian, decocted together to replace water for brewing other herbs). Use acrid-cool methods to resolve toxins and clear fire. After fire is cleared and toxins resolved, if tinnitus with intermittent blockage persists, Cong'er Dayu Tang (Ear-Opening Decoction for Releasing Stagnation) is used at the end: Dong Sangye (Mori Folium), Xiakucao (Prunellae Spica), Xian Zhuru (Bambusa Textilis Caulis, fresh), Jiao Shanzhi (Gardeniae Fructus, scorched), Biyu San (Jade Green Powder), Xian Shengdihuang (Rehmanniae Radix, fresh) each 2 qian, Nvzhenzi (Ligustri Lucidi Fructus) 3 qian, Sheng Gancao (Glycyrrhizae Radix et Rhizoma) 0.4 qian, and Xian Shichangpu juice (Acori Tatarinowii Rhizoma, fresh) 4 spoons mixed in. This clears residual heat to conclude treatment. For external treatment, Yueshi (Natrii Sulfas) (2 qian) is soaked in boiling water, mixed with Xian Bohe juice (Menthae Haplocalycis Herba, fresh), Kushen (Sophorae Flavescentis Radix), and Qingmuxiang (Aucklandiae Radix) ground juices (each 2 spoons), and instilled into the ears from time to time. This clears fire and resolves toxins to relieve pain.
[Xiu's Commentary] Huang'er Shanghan is not true Shanghan, but a condition resembling Shanghan caused by wind-warmth seasonal toxins. Therefore, Shiwan stated that wind enters the Kidney, speaking from the perspective that the Kidney opens into the ears. The formula used is Xiao Xuming Tang (Minor Continuation Life Decoction) without Fuzi (Aconiti Lateralis Radix Praeparata), adding Jiangcan (Bombyx Batryticatus), Tianma (Gastrodiae Rhizoma), Manjingzi (Vittariae Spora), and Baifuzi (Typhonii Rhizoma) to drive out deep-seated evil wind. Additionally, Kushen and Gusuibu (Drynariae Rhizoma) juices are dripped into the ears to clear fire and relieve pain. Mr. Yu argues that wind-warmth seasonal toxins first attack Shaoyang, speaking from the perspective that the Gallbladder channel also connects to the ears. Inferring his meaning, it is because external cold from the Taiyang channel binds and constrains, causing Shaoyang fire to stagnate and fail to vent, thus invading the ears and causing pain. Yellowing of the earlobes is analogous to damp-heat stagnation in the Yangming channel where heat cannot dissipate through sweat, resulting in body jaundice. The pathological mechanism is the same. Therefore, treatment prioritizes acrid-cool dispersal and wind-scattering toxin resolution, following the *Neijing* principle of "venting fire stagnation." The formulas are clear and agile. Although the legislation is from a shallower level, the symptomatic medication seems more stable than Zhang's method. This is because Ren Shen (Ginseng Radix), Shengjiang (Zingiberis Rhizoma Recens), and Rougui (Cinnamomi Cortex) in Xiao Xuming Tang are difficult to use indiscriminately for seasonal toxin diseases. Later learners should follow Yu rather than Zhang.
[Lian's Examination] During April and May of the Ji-Chou year of the Guangxu reign in the late Qing Dynasty, I encountered seven cases of Huang'er Shanghan, all poor individuals from rural areas. Their symptoms included red, swollen, and bright yellow ears, which were hot and painful to touch; severe redness, swelling, and pain in both cheeks; redness and swelling inside the ears with occasional discharge of yellow saliva; severe pain like insect bites; tinnitus sounding like cicada noise; yellowing of the sclera and eyelids; fever and body ache; aversion to cold and absence of sweating; cramping and radiating pain in the back, stiffness making extension difficult, inability to turn or lie on side; short, dark, and dysuric urine. The right pulse was soggy and stagnant; the left pulse was floating, wiry, and slightly tight. The tongue coating was white, greasy, and yellowish, with red edges and tips. The disease was diagnosed as wind-heat complicated with damp-warmth seasonal toxin, treated as epidemic otitis media. Modified Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction) was administered: Mi Zhi Ma Huang (Honey-fried Ephedrae Herba) 0.5 qian, Guang Xingren (Prunus armeniaca seed) 3 qian, Lian Xu Sheng Cong Bai (Scallion white with root) 2 pieces, Dan Xiang Chi (Fermented Soybean) 3 qian, Yin Hua (Lonicerae Japonicae Flos), Lian Qiao (Forsythiae Fructum), Niu Bang Zi (Arctii Fructus) each 2 qian, Jiao Shan Zhi (Gardeniae Fructus, scorched), Zi Jing Pi (Pterocarpus indicus bark), Zi Bai Pi (Catalpa ovata bark) each 3 qian. First, Du Chi Xiao Dou (Adzuki bean) 4 qian, Sheng Lv Dou (Vigna radiata seed, raw), and Mian Yin Chen (Artemisiae Scopariae Herba) each 8 qian were decocted to replace water for brewing the above herbs. This was taken with Cong'er Lu Hui Wan (Ear-Opening Aloe Pill): Sheng Shu Chuan Jun (Rhei Radix et Rhizoma, raw and prepared), Lu Hui (Aloe), Qing Dai (Indigo Naturalis), Chai Hu (Bupleuri Radix) each 5 qian; Long Dan Cao (Gentianae Radix), Huang Qin (Scutellariae Radix), Shan Zhi (Gardeniae Fructus), Dang Gui (Angelicae Sinensis Radix), Qing Pi (Citri Reticulatae Pericarpium Viride) each 1 liang; Qing Mu Xiang (Aucklandiae Radix), Du Dan Xing (Arecae Semen cum Myrobalanis) each 2 qian, Dang Men Zi (Moschus) 0.5 fen, formed into pills with Shen Qu (Massa Medicata Fermentata), each dose 0.8 to 1 qian. This employed acrid-cool opening and reaching, wind-scattering cold to release the exterior, bitter-cold clearing and draining, toxin-resolving and fire-purging to treat the interior. Externally, Qing Di Er Du Shui (Ear-Toxin-Cleansing Water) (Peng Suan Borax 2 qian, Yan Bo Halite 1 qian, dissolved in 9 liang boiling water) was used to irrigate the ears. Qing Er Wu Xian San (Five Immortals Powder for Clearing Ears) (Chuan Bai processed with pig bile 1 qian, Du Hong Hua processed with wine 0.3 fen, Zhi Yue Shi prepared Natrii Sulfas 0.7 fen, Bing Pian Borneolum Syntheticum 0.01 fen, Bo He Shuang Menthol 0.02 fen, ground uniformly and stored in porcelain bottles) was insufflated into the ears. Salted duck egg ash mixed with pounded Tian He Ye (Nelumbinis Folia) was applied to the earlobes and cheeks to reduce swelling and inflammation. Such simultaneous exterior-interior resolution and internal-external treatment cured all seven patients within one hour (fast) or two hours (slow).
[Rongzhai's Commentary] The origin of the disease name "Huang'er Shanghan" is unknown. I first saw it in Zhang Shiwan's *Shanghan Xulun*, where he said: "Huang'er refers to stinging pain in the ears and yellowing of the earlobes, indicating wind entering the Kidney; sudden onset of aversion to cold and fever, with spinal stiffness resembling spasm, belongs to Taiyang-like Shanghan." The term "Huang'er" likely originated from the symptom "yellowing of the earlobes," deriving the disease name from the clinical presentation. These symptoms were already recorded in Chao Yuanfang's *Zhubing Yuanhou Zonglun* (General Treatise on the Causes and Manifestations of All Diseases), which stated: "All cases of stinging pain in the ears are due to wind entering the Kidney meridian; if untreated, it flows into the Kidney, causing sudden spinal stiffness and spasm." However, Chao's record lacked "aversion to cold and fever," and thus did not call it "like Shanghan." Currently, I believe the name "Huang'er" seems to have started with Zhang Shiwan, while the symptoms appeared earlier in Chao Yuanfang. There are similarities and differences in their evolution, and further differences from Yu's description. According to the symptoms listed in this section, they correspond to "ear furuncle" and "otitis media" in Western medicine. Western medical texts describe ear furuncle symptoms as: "Intense ear pain, especially severe at night; redness and swelling of the skin at the affected site, potentially spreading to the surrounding auricle; systemic chills and shivering, or high fever." Otitis media symptoms are described as: "Systemic symptoms—often high fever, chills, vomiting, headache, restlessness, similar to other acute infectious diseases. In children, meningeal irritation symptoms may occur, such as hyperesthesia, convulsions, vomiting, delirium, identical to genuine meningitis. Local symptoms—hearing impairment on the affected side, ear pain, tinnitus, pulsating sensation in the ear." (This is a summary, not the original text.) Comparing the symptoms recorded in Chinese and Western medical theories, the name "Huang'er Shanghan" does not seem entirely appropriate. As for treatment, the empirical prescriptions collected by Mr. Yu and Mr. He are sufficient for application.