右耳、右偏头、咽喉均痛，听力下降5天。医诊耳咽管炎。先用抗生素治疗3天不效，继又配用中药清热解毒仍不效。细审其证，在右耳的下部、咽喉、头部均痛，右耳听力下降，全身酸痛，发热，体温38．6℃，舌苔白，脉浮弦数。综合脉证，思之：脉浮者，病在表邪；脉弦者，肝胆之火盛也。合而论之，乃肝胆火炽于内，风热外客于表，内外合邪之证也。治宜内泻肝火，外散风热。处方：夏枯草15克，蝉蜕15克，桑叶9克，连翘12克，黄芩9克，赤芍9克，薄荷10克。
服药1剂，诸证大减；继服1剂，诸证消失而愈。
某医云：前用抗生素与清热解毒之品为何炎症不清也?答日：内外合邪者，若但予治里则表邪闭郁而病甚，若但予解表则内火必炽，故必予表里双解方可。前用清热解毒之不效者，乃未予解表所致也。
卡他性中耳炎
1．仅以证论、不察其脉，以寒作热，以郁作炽，徒施泻火，终归不治
白××，男，38岁。
头晕头痛，耳鸣耳聋半年多。医诊慢性卡他性中耳炎。先以西药治疗4个月不效，继又配合中药清热解毒之剂3个月，诸证不但不减，反见日渐加重。细审其证，除耳鸣耳聋，头晕头痛之外。并见烦躁易怒，喷嚏时作，口苦咽干，舌苔黄白，脉浮弦紧。综合脉证，思之：脉浮紧，喷嚏者，风寒郁表也。烦躁易怒，口苦咽干，脉弦者，肝胆郁火也。治宜外散风寒，内泻肝火，佐用开窍。处方：防风10克，羌活10克，龙胆草10克，菖蒲10克，郁金10克，细辛2克，大黄3克。
服药4剂，头晕头痛，耳鸣耳聋等症大减；继服上药6剂，诸证消失，愈。
某医云：前用耳聋丸治之不效者何也?答曰：耳聋丸者，虽称有通窍之力，然其总以泻火见长，然本证者，以窍闭为主，肝火次之之证，故治之者，用耳聋丸不效，改易上方取效也。
2．仅知开窍，不知审脉，仅知散风，不知除湿，久治难愈
吴××，女，29岁。
两耳憋闷，听力减退2个多月。医诊卡他性中耳炎。先用西药治疗1个多月不见好转，继又配合中药通窍耳聋丸、羌活胜湿汤近1月亦无明显效果。细审其证，除两耳发堵微聋之外，并时见两侧耳道有少量渗液流出，头晕头重，下肢沉重，舌苔薄白，脉濡缓。综合脉证，思之：头重如裹，下肢沉重，脉濡缓者，湿也；阻于耳窍者，风也。合而论之，乃风湿夹热阻于耳窍也。治宜散风除湿清热。处方：羌活4克，独活4克，蔓荆子1．5克，甘草2克，防风1．5克，川芎1．5克，防己6克，藁本1．5克。服药3剂，头重耳聋明显改善；继服5剂，诸证消失，愈。
某医云：此方乃羌活胜湿汤也。余亦曾用数剂，然其不效者何也?答曰：湿邪者，重浊粘滞之邪也，其在上者，当发之，散之，然发之散之太过则但风气去湿气在，故只可小剂风药治之，然你所用者却大剂风药，故治之不效，余所用药量小而效者，即兼去风湿也。
3．但治主证，不治兼证，但知其症，不知其脉，不知弹琴，不知合协，治之不效
王××，男，60岁。
耳堵头重，听力减退3个多月。医诊卡他性中耳炎。先用西药治疗曾一度稍效，但继续应用则无效，后又以中药清热解毒、清热泻火药治之亦未见明显效果。细察其证，除耳堵，头重，听力减退外，并见胸胁苦满，时时叹气，心烦失眠，舌苔白，脉沉弦滑。综合脉证，思之：脉沉者，气郁也。滑脉者，痰热也。胸胁苦满，时时叹气，脉弦者，肝郁也。合而论之，乃肝肺气郁，痰湿不化，窍隧因之不利证也。治宜疏肝理气，宣肺化痰。处方：柴胡10克，枳壳10克，白芍10克，甘草10克，杏仁10克，郁金10克，苏叶10克，薄荷10克，黄芩8克。
服药3剂，耳堵大减，听力恢复60％；继服6剂，愈。
某医云：四逆散者乃疏肝理脾之方，今用于卡他性中耳炎者何也?答曰：本证肝肺气郁之所致者也，故以四逆散疏肝理脾，加杏仁、苏叶、郁金等以理肺，致肺气宣降得复，耳窍自通也。
慢性中耳炎
1．表里合邪，新久并见，但知治标，不知察脉，急缓不明，久治不效
温××，女，32岁。
右耳白色清稀脓汁不断从耳道流出，有时突然剧痛而流出黄绿色脓汁30年。医诊慢性中耳炎。先用西药治之不效，继又配合中药内服、外用亦效果不著。最近1个月来，又发现两侧头部剧烈疼痛，左耳道疖肿堵塞耳道，寒战高热，恶心呕吐．、先以西药抗生素治疗不效，继以中药清热解毒之剂仍无功。细审其证，左侧外耳道疖肿充满耳道，耳下、颈部淋巴结肿大，寒战高热，体温39．5℃，头耳剧痛，舌苔白，脉濡缓。综合脉证，思之：疖肿、寒热者，热毒也，热毒炽盛之脉当见滑数，今脉反见濡缓，濡缓之脉者，为痰湿，为气阴两虚。今宿疾、新感之疾同在，而脉见濡缓，乃气阴两虚，痰热阻滞为主。治当补气养阴，化痰理气，佐以泻火。处方：黄芪15克，当归6克，麦冬10克，党参10克，五味子10克，竹茹10克，枳实10克，半夏10克，茯苓10克，甘草6克，菖蒲10克，远志10克，元参15克，生地10克。同时，两耳周围外涂牛黄解毒丸。
服药3剂，耳道疖肿消失，淋巴结肿大消减80％，但口唇部又发现一小的疖肿，体温37．4℃；继服6剂，诸证消失。
某医云：既有慢性中耳炎，又有急性外耳道疖肿，且体温较高，为什么用清热解毒、抗生素等治之不效，而采用加减十味温胆汤反效也?答曰：《金匮要略》在说明既有痼疾，又有猝病的疾病治疗时，曾有如下两句著名的论断。其一是在一般的情况下应先治猝病，后治痼疾，其二是痼疾在整个发病过程中仍起主要作用时，还应治其痼疾。他说：“夫病痼疾加以卒病，当先治其卒病，后乃治其痼疾也。”“问日：病有急当救里救表者，何谓也?师日：病，医下之，续得下利清谷不止，身体疼痛者，急当救里；后身体疼痛，清便自调者，急当救表也。”这种观点在《伤寒论》的条文中更有充分的体现，故其治伤寒，脉结代，心动悸，不用麻黄、葛根、桂枝诸汤，而但用补益之品的炙甘草汤进行治疗。今之所以用加减十味温胆汤治之者，正因其虽有热毒炽盛之疖肿，而脉却见濡缓也。
2．内外合邪，数疾并见，先审其脉，并及诸证，主次分明，治之始愈
于××，女，36岁。
两耳流脓时轻时重2年多。医诊慢性中耳炎。先以西药治疗1年多不效，后以中药清热解毒配合治疗近1年亦无明显效果。近1个月来，又发现左侧耳、头、下颌关节疼痛难忍，不能张口，勉强张口亦仅能张至能够饮水，不能咀嚼食物。医诊慢性中耳炎急性发作，下颌关节炎。先用西药治疗20多天不见改善，继又配合中药清热泻火之剂半个多月仍然不见好转。细察其证，除左侧耳、头、颌关节疼痛外，并见双侧耳道不断有少量黄白色脓汁排出，张口困难，烦躁不安，舌苔白，脉沉弦稍紧。综合脉证，思之：前以清热泻火解毒不效者，，恐不对证之所致也。又思脉沉弦者，肝气郁结也；紧者风寒也。脓汁呈黄白者，热毒也。合而论之，乃肝胆郁火于内，外受风寒，内外合邪之疾也。治宜内解郁火，外散风寒。处方：当归10克，川芎10克，栀子10克，熟军4克，羌活10克，防风10克，蔓荆子10克。
服药2剂，疼痛消减近70％，惟头晕似有加重之势。思之：此散寒有余，泻火不足所致也。上方加熟军2克、龙胆草10克。
服药6剂，疼痛消失，张口自如，耳脓亦愈。
某医云：患者三病俱在，一药而皆愈者何也?答曰：从脉、证来看，病虽为三，然其病因则二也，故治以外散风寒，内泻肝火均愈。
3．按脉审证，知其为肝肾亏损，耳窍蒙蔽，予滋补肝肾，佐以开窍而愈
黎××，男，15岁。
左耳流脓、听力下降14年。医诊慢性中耳炎，胆脂瘤。先以西药久治不效，继以中药清热泻火，滋阴补肾之剂相配合亦不效，特别是近1年来，左耳道流脓一直不止，近1个月来，又突发寒战高热，剧烈头痛，予抗生素治疗后，虽然寒战高热已减，但却发现左耳流出大量黄绿色脓汁，虽然继续采用抗生素及中药清热泻火、滋阴降火1个多月，始终不见效果。细审其证，左耳黄色脓汁不断流出，按其乳突部有压痛，精神、食欲正常，舌质淡黯，舌苔薄白，脉虚而缓。综合脉证，思之：阴虚火旺者，脉当细数，肝火者脉当弦数，今脉见虚缓，乃肾之阴阳俱虚也。治宜滋补肝肾，佐以开窍。处方：肉苁蓉15克，菟丝子18克，枸杞子12克，煅龙骨30克，煅牡蛎30克，菖蒲6克，怀牛膝12克，白芍15克，白蒺藜3克，熟地30克，五味子9克，沙苑子9克。
服药3剂，脓汁减少；继服20剂，竞愈。
某医云：有的著作中说慢性化脓性中耳炎宜用滋阴降火，然余用之不效者何也?答曰：耳流脓者，似乎是火，然其脉虚缓则非火也，故治宜滋补肝肾，佐以开窍，而不宜泻火也。
神经性耳聋
1．谨察脉色，合之病程，知其为气阴两虚，痰火内郁，治以补气养阴，化痰泻火始安
邓××，女，40岁。
听力日渐下降6年多，近1年来连电话的声音也听不清楚，不得不完全停止一切工作。医诊神经性耳聋。先用西药、针灸治疗4年多不效，继又以中药培补肾气之剂近3年而日渐加重。细察其证，两耳几乎听不见任何声音，心烦失眠，口苦咽干，面色皓白，舌苔薄白，脉虚弦滑。综合脉证，思之：《内经》曾云：肾开窍于耳，心亦开窍于耳。肾之阴虚可以引起耳聋耳鸣，肾之气虚亦可引起耳聋耳鸣，肾之阴虚者与滋阴补肾可愈，肾之气虚者与培补肾气可痊，然本病滋肾不效，益阳无功，说明本病不在。肾脏。今脉虚弦滑者，病在心也，面色皓白，脉虚者，心之气阴两虚也，滑数脉者痰火阻于心窍也。治宜培补心之气阴以扶正，化痰开窍泻火以除其邪。处方：黄芪15克，当归10克，麦冬10克，党参10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克，川芎10克。
服药6剂，耳鸣耳聋好转；继服30剂，诸证消失，愈。
某医云：既云有痰火，何不多用泻火之品，而反加一味川芎也?答曰：脉见弦滑者为痰火，故用温胆汤法以治痰火，然其脉不数且弦说明火邪不盛而兼肝气之郁，故以川芎之入肝解郁者相佐以启闭郁之气机也。
2．谨察其脉，合之于舌，知其病在气阴之虚，湿热之郁，升降失职，治以补气养阴，燥湿清热，升清降浊而安
赵××，男，55岁。
耳鸣耳聋4～5年。医诊神经性耳聋。先以西药治疗2年多不效，继又配合中药补肾、平肝、泻火，以及针灸、磁疗等仍无功。细察其症，两耳已基本上听不见任何声音，舌苔白腻，脉弦大而数，右脉大于左脉。综合脉证，思之：脉弦大者，气阴两虚或气血两虚。数者热也。左脉大于右脉者，肝邪盛也，外感也；右大于左脉者，气血两虚或气阴两虚也。舌苔白腻者，湿热也。舌、脉相参，知其乃气阴俱虚，湿热内郁，清浊升降失职也。治宜补气养阴以扶正，除湿清热，升清降浊以治标。处方：人参10克，甘草6克，黄芪15克，当归6克，麦冬10克，五味子10克，青皮10克，陈皮10克，神曲10克，黄柏10克，葛根15克，苍术15克，白术10克，升麻10克，泽泻10克。
服药6剂，耳鸣大减，左耳似能听见个别声音；继服50’剂，耳鸣消失，听力恢复正常。
某医云：东垣之治耳鸣耳聋多注重升散补益，子和之治耳聋多注重痰火，完素之治耳聋耳鸣多注重火邪，其在临床上何以别之?答曰：神经性耳聋非但有虚，亦且有实，非但有闭，亦且有脱，何以别之?脉象别之即可也。
3．谨察其脉，合之经络，予养阴平肝，开窍宁神，愈郝××，女，18岁。听力全失十几年。医诊神经性耳聋。先以西药治疗数年不效，继以中药补肾、平肝、泻火之剂与针灸相配合2年亦不见明显改善。细察其证，除两耳全聋外，偶而出现耳鸣和两耳堵塞难忍的感觉，舌苔白，脉沉涩。综合脉证，思之：耳者，心肾之开窍也，心气闭塞则两耳失聪。治宜养阴平肝，开窍宁神。处方：龟甲30克，鳖甲15克，远志15克，菖蒲30克，郁金10克，龙骨15克。
服药6剂，耳聋大减；继服6剂，听力竞基本正常，又服10剂以善后。
某医问：前从肾、肝论治久久不效，今但用上方竞霍然有效者何也?答曰：此脉沉涩，乃心窍之被蒙也，治当开其心窍，故以重剂菖蒲、远志而效也。
急性扁桃体炎
1．只知解毒，不知通腑，壅热不解，其热不退
郑××，女，12岁。
Pain in the right ear, right-sided headache, and throat, with decreased hearing for 5 days. The physician diagnosed Eustachian tube inflammation (Eustachian tube catarrh). Antibiotics were used for 3 days without effect, followed by Traditional Chinese Medicine (TCM) formulas for clearing heat and detoxifying, which also failed. Upon careful examination of the symptoms: pain in the lower part of the right ear, throat, and head; decreased hearing in the right ear; generalized body aches; fever with a temperature of 38.6°C; white tongue coating; floating, wiry, and rapid pulse. Synthesizing the pulse and symptoms: A floating pulse indicates pathogenic factors at the exterior level; a wiry pulse indicates excessive fire in the Liver and Gallbladder. In combination, this is a syndrome of blazing Fire in the Liver and Gallbladder internally, with Wind-Heat invading externally—a condition where internal and external pathogens combine. The treatment should be to drain Liver Fire internally and disperse Wind-Heat externally. Prescription: Prunella Vulgaris (Xiakucao, 夏枯草) 15g, Cicada Slough (Chantui, 蝉蜕) 15g, Mulberry Leaf (Sangye, 桑叶) 9g, Forsythia Fruit (Lianqiao, 连翘) 12g, Scutellaria Root (Huangqin, 黄芩) 9g, Red Peony Root (Chishao, 赤芍) 9g, Mint (Bohe, 薄荷) 10g.
After one dose, all symptoms significantly reduced; after another dose, all symptoms disappeared, and the patient recovered.
A certain physician asked: Why did the inflammation not clear with antibiotics and heat-clearing, detoxifying herbs? The answer is: For conditions where internal and external pathogens combine, treating only the interior causes the exterior pathogen to remain trapped and worsens the disease; treating only the exterior allows the internal fire to blaze. Therefore, simultaneous resolution of both exterior and interior is required. The previous failure of heat-clearing, detoxifying herbs was due to the lack of exterior-dispersing action.
Secretory Otitis Media (Catarrhal Otitis Media)
1. Relying solely on symptoms without examining the pulse, mistaking cold for heat and stagnation for blazing fire, applying fire-draining methods in vain leads to untreatable outcomes.
Bai XX, Male, 38 years old.
Dizziness, headache, tinnitus, and deafness for over half a year. Diagnosed with chronic secretory otitis media. Western medicine treatment for 4 months was ineffective. Subsequent TCM treatment with heat-clearing, detoxifying formulas for 3 months resulted in worsening symptoms. Careful examination revealed: besides tinnitus, deafness, dizziness, and headache, there was irritability, frequent sneezing, bitter taste in the mouth, dry throat, yellowish-white tongue coating, and a floating, wiry, tight pulse. Synthesizing pulse and symptoms: Floating-tight pulse with sneezing indicates Wind-Cold stagnating at the exterior. Irritability, bitter taste, dry throat, and wiry pulse indicate Liver-Gallbladder stagnant fire. Treatment should disperse Wind-Cold externally, drain Liver Fire internally, and assist with opening orifices. Prescription: Saposhnikovia Root (Fangfeng, 防风) 10g, Notopterygium Rhizome (Qianghuo, 羌活) 10g, Gentian Root (Longdancao, 龙胆草) 10g, Acorus Rhizome (Shichangpu, 石菖蒲) 10g, Curcuma Tuber (Yujin, 郁金) 10g, Asarum Root (Xixin, 细辛) 2g, Rhubarb (Dahuang, 大黄) 3g.
After 4 doses, dizziness, headache, tinnitus, and deafness significantly reduced; after 6 more doses, all symptoms disappeared, and recovery occurred.
A certain physician asked: Why was Erlong Wan (Deafness Pill) ineffective previously? The answer is: Although Erlong Wan has properties for opening orifices, its strength lies in draining fire. However, this case is primarily characterized by orifice obstruction, with Liver Fire as secondary. Thus, Erlong Wan was ineffective, while the above prescription succeeded.
2. Knowing only to open orifices but not examine the pulse; knowing only to disperse Wind but not remove Dampness leads to difficult-to-cure chronic cases.
Wu XX, Female, 29 years old.
Bloating sensation in both ears and decreased hearing for over 2 months. Diagnosed with secretory otitis media. Western medicine treatment for over 1 month showed no improvement. Subsequent TCM treatment with Tongqiao Erlong Wan and Qianghuo Shengshi Tang for nearly 1 month also yielded no obvious effect. Careful examination revealed: besides ear blockage and mild deafness, small amounts of exudate flowed from both ear canals occasionally; dizziness and heavy head sensation; heaviness in lower limbs; thin white tongue coating; and soggy, slow pulse. Synthesizing pulse and symptoms: Heavy head like being wrapped, heaviness in lower limbs, and soggy-slow pulse indicate Dampness; obstruction in the ear orifices is caused by Wind. In combination, this is Wind-Dampness with Heat obstructing the ear orifices. Treatment should disperse Wind, remove Dampness, and clear Heat. Prescription: Notopterygium Rhizome (Qianghuo, 羌活) 4g, Angelica Pubescens Root (Duhuo, 独活) 4g, Vitex Fruit (Manjingzi, 蔓荆子) 1.5g, Licorice Root (Gancao, 甘草) 2g, Saposhnikovia Root (Fangfeng, 防风) 1.5g, Ligusticum Rhizome (Chuanxiong, 川芎) 1.5g, Stephania Root (Fangji, 防己) 6g, Libanotis Rhizome (Gaoben, 藁本) 1.5g.
After 3 doses, head heaviness and deafness improved significantly; after 5 more doses, all symptoms disappeared, and recovery occurred.
A certain physician asked: This formula is Qianghuo Shengshi Tang. I have used it for several doses, why was it ineffective? The answer is: Dampness is a heavy, turbid, and sticky pathogen. For pathogens in the upper body, they should be dispersed. However, excessive dispersal removes only the Wind while leaving the Dampness. Therefore, only small doses of Wind-dispersing herbs should be used. You used large doses, hence the ineffectiveness. My small doses were effective because they addressed both Wind and Dampness.
3. Treating only the main symptoms and ignoring accompanying symptoms; knowing only the signs but not the pulse; lacking coordination leads to treatment failure.
Wang XX, Male, 60 years old.
Ear blockage, heavy head, and decreased hearing for over 3 months. Diagnosed with secretory otitis media. Western medicine treatment was initially slightly effective but became ineffective upon continued use. Subsequent TCM treatment with heat-clearing, detoxifying, and fire-draining herbs also showed no obvious effect. Careful examination revealed: besides ear blockage, heavy head, and decreased hearing, there was fullness and discomfort in the chest and hypochondrium, frequent sighing, irritability, insomnia, white tongue coating, and deep, wiry, slippery pulse. Synthesizing pulse and symptoms: Deep pulse indicates Qi stagnation. Slippery pulse indicates Phlegm-Heat. Chest/hypochondriac fullness, frequent sighing, and wiry pulse indicate Liver Qi stagnation. In combination, this is Liver-Lung Qi stagnation with transformation failure of Phlegm-Dampness, leading to obstruction of the ear orifices. Treatment should soothe the Liver and regulate Qi, diffuse the Lung and transform Phlegm. Prescription: Bupleurum Root (Chaihu, 柴胡) 10g, Aurantium Fruit (Zhike, 枳壳) 10g, White Peony Root (Baishao, 白芍) 10g, Licorice Root (Gancao, 甘草) 10g, Apricot Seed (Xingren, 杏仁) 10g, Curcuma Tuber (Yujin, 郁金) 10g, Perilla Leaf (Ziyeh, 苏叶) 10g, Mint (Bohe, 薄荷) 10g, Scutellaria Root (Huangqin, 黄芩) 8g.
After 3 doses, ear blockage significantly reduced, and hearing recovered by 60%; after 6 more doses, recovery occurred.
A certain physician asked: Sini San (Four Counterflow Powder) is a formula for soothing the Liver and regulating the Spleen. Why is it used for secretory otitis media? The answer is: This case is caused by Liver-Lung Qi stagnation. Sini San soothes the Liver and regulates the Spleen; adding Apricot Seed, Perilla Leaf, and Curcuma regulates the Lung. Once Lung Qi diffusion and descending functions are restored, the ear orifices naturally open.
Chronic Otitis Media
1. Internal and external pathogens combine; new and old diseases appear together. Knowing only to treat the branch (symptoms) but not examine the pulse, failing to distinguish urgency, leads to long-term treatment failure.
Wen XX, Female, 32 years old.
Continuous discharge of white, clear, thin pus from the right ear for 30 years, sometimes accompanied by sudden severe pain and discharge of yellow-green pus. Diagnosed with chronic otitis media. Western medicine treatment was ineffective. Subsequent internal and external TCM treatments also had poor effects. In the last month, severe bilateral headaches appeared, along with a furuncle in the left ear canal blocking it, chills, high fever, nausea, and vomiting. Antibiotics were ineffective, and TCM heat-clearing, detoxifying formulas also failed. Careful examination revealed: the left external auditory canal furuncle filled the canal; enlarged lymph nodes under the ear and in the neck; chills, high fever (39.5°C); severe headache and ear pain; white tongue coating; and soggy, slow pulse. Synthesizing pulse and symptoms: Furuncles and alternating chills/fever indicate Heat-Toxin. While blazing Heat-Toxin typically presents with a slippery-rapid pulse, the current soggy-slow pulse indicates Phlegm-Dampness and deficiency of both Qi and Yin. With both chronic and acute conditions present, and the soggy-slow pulse indicating Qi-Yin deficiency with Phlegm-Heat obstruction, treatment should tonify Qi and nourish Yin, transform Phlegm and regulate Qi, assisted by draining fire. Prescription: Astragalus Root (Huangqi, 黄芪) 15g, Angelica Sinensis Root (Danggui, 当归) 6g, Ophiopogon Tuber (Maidong, 麦冬) 10g, Codonopsis Root (Dangshen, 党参) 10g, Schisandra Fruit (Wuweizi, 五味子) 10g, Bamboo Shavings (Zhuru, 竹茹) 10g, Immature Bitter Orange (Zhishi, 枳实) 10g, Pinellia Tuber (Banxia, 半夏) 10g, Poria (Fuling, 茯苓) 10g, Licorice Root (Gancao, 甘草) 6g, Acorus Rhizome (Shichangpu, 石菖蒲) 10g, Polygala Root (Yuanzhi, 远志) 10g, Scrophularia Root (Yuanshen, 元参) 15g, Rehmannia Root (Shengdi, 生地) 10g. Simultaneously, Niuhuang Jiedu Wan (Calculus Bovis Detoxification Pill) was applied externally around both ears.
After 3 doses, the ear canal furuncle disappeared, and lymph node enlargement reduced by 80%. A small furuncle appeared on the lip, and temperature was 37.4°C. After 6 more doses, all symptoms disappeared.
A certain physician asked: Given chronic otitis media and acute external auditory canal furuncle with high fever, why were heat-clearing, detoxifying herbs and antibiotics ineffective, while modified Shiwei Wendan Tang was effective? The answer is: *Jin Gui Yao Lue* states regarding the treatment of chronic fixed diseases combined with acute sudden diseases: "Generally, treat the sudden disease first, then the chronic disease." It also states: "If a disease requires urgent rescue of the Interior or Exterior... if diarrhea with undigested food persists after purgation and body pain remains, urgently rescue the Interior; later, if body pain remains and stool normalizes, urgently rescue the Exterior." This view is fully reflected in *Shanghan Lun*. For example, in Taiyang disease with knotted/intermittent pulse and palpitations, Ma Huang Tang, Ge Gen Tang, or Gui Zhi Tang are not used; instead, Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) is used for tonification. Here, modified Shiwei Wendan Tang was used because although there was blazing Heat-Toxin furuncle, the pulse was soggy-slow, indicating underlying deficiency.
2. Internal and external pathogens combine; multiple diseases appear simultaneously. Examining the pulse first and considering all symptoms clearly distinguishes primary and secondary aspects, allowing for cure.
Yu XX, Female, 36 years old.
Intermittent discharge of pus from both ears for over 2 years. Diagnosed with chronic otitis media. Western medicine treatment for over 1 year was ineffective. Subsequent TCM heat-clearing, detoxifying treatment for nearly 1 year also showed no obvious effect. In the last month, severe pain in the left ear, head, and temporomandibular joint appeared, making mouth opening impossible; forced opening allowed only enough space for drinking water, not chewing. Diagnosed with acute exacerbation of chronic otitis media and temporomandibular arthritis. Western medicine treatment for over 20 days showed no improvement. Subsequent TCM heat-clearing, fire-draining treatment for over half a month also failed. Careful examination revealed: besides pain in the left ear, head, and jaw joint, there was continuous discharge of small amounts of yellow-white pus from both ear canals; difficulty opening the mouth; irritability; white tongue coating; and deep, wiry, slightly tight pulse. Synthesizing pulse and symptoms: Previous failure of heat-clearing, fire-draining, detoxifying suggests incorrect diagnosis. Deep-wiry pulse indicates Liver Qi stagnation; tight indicates Wind-Cold. Yellow-white pus indicates Heat-Toxin. In combination, this is Liver-Gallbladder stagnant fire internally, with external Wind-Cold invasion—an internal-external combined pathology. Treatment should resolve internal stagnant fire and disperse external Wind-Cold. Prescription: Angelica Sinensis Root (Danggui, 当归) 10g, Ligusticum Rhizome (Chuanxiong, 川芎) 10g, Gardenia Fruit (Zhizi, 栀子) 10g, Prepared Rhubarb (Shujun, 熟军) 4g, Notopterygium Rhizome (Qianghuo, 羌活) 10g, Saposhnikovia Root (Fangfeng, 防风) 10g, Vitex Fruit (Manjingzi, 蔓荆子) 10g.
After 2 doses, pain reduced by nearly 70%, though dizziness seemed to worsen. Analysis: This was due to excessive cold-dispersing and insufficient fire-draining. Added Prepared Rhubarb 2g and Gentian Root 10g to the formula.
After 6 doses, pain disappeared, mouth opened freely, and ear pus healed.
A certain physician asked: The patient had three diseases, yet one formula cured them all. Why? The answer is: From the pulse and symptoms, although there are three diseases, there are only two etiologies. Therefore, dispersing Wind-Cold externally and draining Liver Fire internally led to recovery.
3. Examining the pulse and symptoms reveals Liver-Kidney deficiency with obscuration of the ear orifices. Tonifying Liver-Kidney and assisting with opening orifices leads to recovery.
Li XX, Male, 15 years old.
Discharge of pus and decreased hearing in the left ear for 14 years. Diagnosed with chronic otitis media and cholesteatoma. Long-term Western medicine treatment was ineffective. Subsequent TCM heat-clearing, fire-draining, and Yin-nourishing, Kidney-tonifying treatments also failed. Specifically, in the last year, left ear pus discharge was continuous. In the last month, sudden chills, high fever, and severe headache occurred. After antibiotic treatment, chills and fever subsided, but large amounts of yellow-green pus flowed from the left ear. Continued antibiotics and TCM heat-clearing, fire-draining, Yin-nourishing, fire-descending treatments for over a month showed no effect. Careful examination revealed: continuous yellow pus discharge from the left ear; tenderness upon palpation of the mastoid process; normal spirit and appetite; pale-dark tongue body; thin white tongue coating; and deficient, slow pulse. Synthesizing pulse and symptoms: Yin-deficiency with fire-blazing typically presents with a fine-rapid pulse; Liver fire with a wiry-rapid pulse. The current deficient-slow pulse indicates deficiency of both Yin and Yang in the Kidney. Treatment should tonify and nourish Liver-Kidney, assisted by opening orifices. Prescription: Cistanche Stem (Roucongrong, 肉苁蓉) 15g, Dodder Seed (Tusizi, 菟丝子) 18g, Goji Berry (Gouqizi, 枸杞子) 12g, Calcined Dragon Bone (Duanyulong, 煅龙骨) 30g, Calcined Oyster Shell (Duanyuming, 煅牡蛎) 30g, Acorus Rhizome (Shichangpu, 石菖蒲) 6g, Achyranthes Root (Huainiuxi, 怀牛膝) 12g, White Peony Root (Baishao, 白芍) 15g, Tribulus Fruit (Bajili, 白蒺藜) 3g, Prepared Rehmannia Root (Shudi, 熟地) 30g, Schisandra Fruit (Wuweizi, 五味子) 9g, Astragalus Complanatus Seed (Shayuanzi, 沙苑子) 9g.
After 3 doses, pus discharge reduced; after 20 more doses, complete recovery occurred.
A certain physician asked: Some texts suggest Yin-nourishing and fire-descending for chronic suppurative otitis media, but my use was ineffective. Why? The answer is: Ear pus discharge seems like Fire, but the deficient-slow pulse indicates it is not Fire. Therefore, treatment should tonify and nourish Liver-Kidney and assist with opening orifices, rather than draining fire.
Sensorineural Hearing Loss
1. Carefully observing pulse and complexion, combined with disease course, reveals Qi-Yin deficiency with internal stagnation of Phlegm-Fire. Tonifying Qi and nourishing Yin, transforming Phlegm and draining Fire leads to stability.
Deng XX, Female, 40 years old.
Gradual decrease in hearing for over 6 years. In the last year, unable to hear phone calls clearly, forcing cessation of all work. Diagnosed with sensorineural hearing loss. Western medicine and acupuncture treatment for over 4 years was ineffective. Subsequent TCM Kidney-Qi tonifying treatment for nearly 3 years resulted in gradual worsening. Careful examination revealed: almost total inability to hear sounds in both ears; irritability, insomnia; bitter taste in mouth, dry throat; bright white complexion; thin white tongue coating; and deficient, wiry, slippery pulse. Synthesizing pulse and symptoms: *Neijing* states: "The Kidney opens into the ears, and the Heart also opens into the ears." Kidney Yin deficiency can cause deafness/tinnitus; Kidney Qi deficiency can also cause deafness/tinnitus. Kidney Yin deficiency responds to Yin-nourishing, Kidney-tonifying; Kidney Qi deficiency responds to Kidney-Qi tonifying. However, this case responded poorly to Kidney tonification (both Yin and Yang), indicating the disease is not in the Kidney. The current deficient-wiry-slippery pulse indicates the disease is in the Heart. Bright white complexion and deficient pulse indicate Heart Qi-Yin deficiency; slippery-rapid pulse indicates Phlegm-Fire obstructing the Heart orifices. Treatment should tonify Heart Qi and Yin to support healthy Qi, and transform Phlegm, open orifices, and drain Fire to eliminate pathogenic factors. Prescription: Astragalus Root (Huangqi, 黄芪) 15g, Angelica Sinensis Root (Danggui, 当归) 10g, Ophiopogon Tuber (Maidong, 麦冬) 10g, Codonopsis Root (Dangshen, 党参) 10g, Schisandra Fruit (Wuweizi, 五味子) 10g, Bamboo Shavings (Zhuru, 竹茹) 10g, Immature Bitter Orange (Zhishi, 枳实) 10g, Pinellia Tuber (Banxia, 半夏) 10g, Tangerine Peel (Chenpi, 陈皮) 10g, Poria (Fuling, 茯苓) 10g, Licorice Root (Gancao, 甘草) 10g, Acorus Rhizome (Shichangpu, 石菖蒲) 10g, Polygala Root (Yuanzhi, 远志) 10g, Ligusticum Rhizome (Chuanxiong, 川芎) 10g.
After 6 doses, tinnitus and hearing loss improved; after 30 more doses, all symptoms disappeared, and recovery occurred.
A certain physician asked: Since there is Phlegm-Fire, why not use more fire-draining herbs, but instead add Ligusticum Rhizome? The answer is: Wiry-slippery pulse indicates Phlegm-Fire, so Wendan Tang method is used. However, the pulse is not rapid and is wiry, indicating that Fire is not excessive but Liver Qi stagnation is present. Therefore, Ligusticum Rhizome, which enters the Liver to resolve stagnation, is added to assist in opening the stagnant Qi mechanism.
2. Carefully observing the pulse, combined with the tongue, reveals Qi-Yin deficiency with Damp-Heat stagnation and failure of ascending/descending functions. Tonifying Qi and nourishing Yin, drying Dampness and clearing Heat, ascending Clear and descending Turbid leads to stability.
Zhao XX, Male, 55 years old.
Tinnitus and deafness for 4-5 years. Diagnosed with sensorineural hearing loss. Western medicine treatment for over 2 years was ineffective. Subsequent TCM Kidney-tonifying, Liver-pacifying, fire-draining, plus acupuncture and magnetic therapy were also ineffective. Careful examination revealed: almost total inability to hear sounds in both ears; white greasy tongue coating; wiry, large, rapid pulse; Right pulse larger than Left pulse. Synthesizing pulse and symptoms: Wiry-large pulse indicates Qi-Yin deficiency or Qi-Blood deficiency. Rapid indicates Heat. Left larger than Right indicates Liver pathogen excess or external contraction; Right larger than Left indicates Qi-Blood or Qi-Yin deficiency. White greasy tongue coating indicates Damp-Heat. Combining tongue and pulse, this is Qi-Yin deficiency with internal Damp-Heat stagnation and failure of Clear/Turbid ascending/descending. Treatment should tonify Qi and nourish Yin to support healthy Qi, remove Dampness and clear Heat, ascend Clear and descend Turbid to treat the branch. Prescription: Ginseng Root (Renshen, 人参) 10g, Licorice Root (Gancao, 甘草) 6g, Astragalus Root (Huangqi, 黄芪) 15g, Angelica Sinensis Root (Danggui, 当归) 6g, Ophiopogon Tuber (Maidong, 麦冬) 10g, Schisandra Fruit (Wuweizi, 五味子) 10g, Green Mandarin Peel (Qingpi, 青皮) 10g, Tangerine Peel (Chenpi, 陈皮) 10g, Medicated Leaven (Shenqu, 神曲) 10g, Phellodendron Bark (Huangbai, 黄柏) 10g, Kudzu Root (Gegen, 葛根) 15g, Atractylodes Rhizome (Cangzhu, 苍术) 15g, Atractylodes Macrocephala Rhizome (Baizhu, 白术) 10g, Cimicifuga Rhizome (Shengma, 升麻) 10g, Alisma Rhizome (Zexie, 泽泻) 10g.
After 6 doses, tinnitus significantly reduced, and faint sounds could be heard in the left ear; after 50 more doses, tinnitus disappeared, and hearing returned to normal.
A certain physician asked: Li Dongyuan focused on ascending, dispersing, and tonifying for tinnitus/deafness; Zhang Zihe focused on Phlegm-Fire; Zhu Wan Su focused on Fire pathogen. How are these distinguished clinically? The answer is: Sensorineural hearing loss involves both deficiency and excess, obstruction and collapse. How to distinguish? By the pulse.
3. Carefully observing the pulse, combined with meridians, applies Yin-nourishing, Liver-pacifying, orifice-opening, and spirit-calming methods, leading to recovery.
Hao XX, Female, 18 years old.
Total hearing loss for over ten years. Diagnosed with sensorineural hearing loss. Western medicine treatment for several years was ineffective. Subsequent TCM Kidney-tonifying, Liver-pacifying, fire-draining, plus acupuncture for 2 years showed no obvious improvement. Careful examination revealed: besides total deafness in both ears, occasional tinnitus and unbearable ear blockage sensation; white tongue coating; and deep, choppy pulse. Synthesizing pulse and symptoms: The ears are the orifices of the Heart and Kidney. Heart Qi obstruction leads to deafness in both ears. Treatment should nourish Yin, pacify the Liver, open orifices, and calm the Spirit. Prescription: Turtle Shell (Guijia, 龟甲) 30g, Softshell Turtle Shell (Biejia, 鳖甲) 15g, Polygala Root (Yuanzhi, 远志) 15g, Acorus Rhizome (Shichangpu, 石菖蒲) 30g, Curcuma Tuber (Yujin, 郁金) 10g, Dragon Bone (Longgu, 龙骨) 15g.
After 6 doses, deafness significantly reduced; after 6 more doses, hearing was basically normal; another 10 doses were taken for consolidation.
A certain physician asked: Previous treatments focusing on Kidney and Liver were ineffective for a long time, yet this formula brought sudden effectiveness. Why? The answer is: The deep-choppy pulse indicates obscuration of the Heart orifice. Treatment should open the Heart orifice. Hence, heavy doses of Acorus Rhizome and Polygala Root were effective.
Acute Tonsillitis
1. Knowing only to detoxify but not to unblock the Fu organs, resulting in unresolved congestion-Heat and persistent fever.
Zheng XX, Female, 12 years old.