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The classics state that the Kidney opens into the ears. It is also stated that the Heart opens into the ears. Explainers argue that the Heart originally opens into the tongue; because the tongue lacks orifices, it borrows an orifice from the ear. The collaterals of the Lung converge at the ear. The meridians of the Gallbladder and Sanjiao (Triple Burner) all pass in front of the ear, enter the ear, and pass behind the ear. The meridian of the Stomach ascends to the front of the ear, and tendons knot at the front of the ear. The meridians of the Small Intestine and Bladder both knot at the Wanggu point behind the ear. Branches of the Stomach meridian also pass behind the ear. Furthermore, the *Suwen* states that the collaterals of the Heart, Kidney, Lung, Spleen, and Stomach all belong to the middle of the ear. It also states that when Liver Qi rebels, deafness occurs.

Deafness refers to the obstruction of sound due to blockage; external blockage and internal blockage are essentially the same. Internal Qi should flow smoothly; why does it become blocked? This is caused by Wind, Fire, Phlegm, and Blood stasis. In the upper part, it involves the Qi of the Heart and Lung; in the lower part, the Qi of the Liver and Kidney; in the middle, the Qi of the Spleen and Stomach. When Qi moves, it transforms into Fire; when Fire moves, it generates Wind. If these obstruct the Upper Jiao and cause chaos, external sounds will be disturbed by them. If fluids are further steamed into Phlegm, and Yin injury leads to Blood stasis, the ear orifices become blocked. In severe cases, pain and swelling occur, with nodules forming and pus accumulating, resulting not only in deafness but also other symptoms. In milder cases, tinnitus occurs, which is sound produced by Qi escaping from the ear. When Qi is abundant in the upper body, tinnitus is severe; when not abundant, it is mild. Obstruction of Qi in the Upper Jiao belongs to Excess patterns; rebellion of Qi in the Lower Jiao belongs to Deficiency patterns, either due to Yin Deficiency causing Fire to flare upward, or Yang Deficiency causing Fire to float upward. The Middle Jiao often involves Damp-Heat, resulting from the accumulation of alcohol and food. Every organ's meridian can generate Qi, Fire, and sound; why must one strictly adhere to meridians connecting to the ear for this to happen? These statements refer to the obstruction of internal Qi rising upward. However, if Qi Deficiency causes sinking, deafness can also result. Since Clear Qi rises from below and Turbid Qi descends from above, if Clear Qi does not ascend, Turbid Qi cannot descend. Additionally, in elderly people, essence depletion and Qi decline prevent upward transmission. Even without turbid Fire disturbing, the withering of essence and Qi prevents upward passage, causing the orifices to gradually close, like a path overgrown with weeds due to disuse. There are also tranquil individuals who withdraw their senses and store their essence deeply; their upper orifices may gradually close, which is a sign of longevity. Understanding this principle unifies various conflicting theories. Treatment methods for deafness: For Heat patterns, use Xijiao Yinzi (Rhinoceros Horn Decoction); if constipated, add Dahuang (Rhubarb). For obstructive Heat generating Wind, use Xijiao San (Rhinoceros Horn Powder). If accompanied by external Wind, use Fangfeng Tongsheng San (Saposhnikovia Decoction to Unblock the Hinderance) (see Stroke chapter). If accompanied by Phlegm, use Guntan Wan (Rolling Phlegm Pill) (see Phlegm chapter). For Stagnant Fire, use Fangfeng Tongsheng San, adding Dahuang stewed in wine, then stir-fried three times in wine, and finally stir-fried with other herbs in wine. Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) (see Stagnation chapter). For rebellious Jue Qi, often presenting with vertigo, use Chenxiang Jiangqi Tang (Aucklandia Descending Qi Decoction) or Suzi Jiangqi Tang (Perilla Seed Descending Qi Decoction). In severe cases, swallow Yangzheng Dan (Nourishing Righteousness Pill) (see Qi disorders chapter) to anchor and sink. For Kidney Water Deficiency and essence depletion, characterized by blackening of the cheekbones, use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (see Deficiency and Damage chapter) or Dihuang Tang from *Ben Shi Fang* (Rehmannia Decoction from the Capable Formulas), which contains Qianghuo (Notopterygium) and Fangfeng (Saposhnikovia) for Kidney Deficiency complicated by Wind-Evil; remove these if no Wind-Evil is present. For Kidney Deficiency Cold, use Bawei Wan (Eight-Ingredient Pill) (see Deficiency and Damage chapter) or Yishen San (Kidney-Nourishing Powder).

Suspecting Liver Deficiency, use Siwu Tang (Four Substances Decoction) (see Blood chapter) plus Qianghuo, Fangfeng, Chaihu (Bupleurum), Shichangpu (Acorus), and Fushen (Poria with Hostwood). For damage from labor or sexual excess, with Deficient Fire flaring up, emaciation, and dizziness, termed "Labor Deafness," use Yiqi Congming Tang (Qi-Nourishing Brightening Decoction). The ear is where the Zong Mai (Gathering Vessels) attach. If vessels are deficient and external Wind attacks, blocking meridian Qi, it is termed "Wind Deafness," often accompanied by headache. Use Paifeng Tang (Wind-Expelling Decoction) (see Stroke chapter), Guixin San (Cinnamon Heart Powder), or Cishi Wan (Magnetite Pill). For Qi obstruction causing unclear head and eyes, use Qingshen San (Spirit-Clearing Powder). For Qi closure preventing flow, use Tongqi San (Unblocking Qi Powder). External treatments: Tongshen San (Spirit-Unblocking Powder), Tong'er Fa (Ear-Unblocking Method), Zhuifeng San (Wind-Chasing Powder). Gan Sui (Kansui Root), half a cun, wrapped in cotton and inserted into the ear, while chewing Gancao (Licorice). Cangzhu (Atractylodes Rhizome), seven fen long, sharpened at one end for insertion, flat at the other for moxibustion; effective when heat is felt in the ear. For chronic deafness, use Bimazi Wan (Euphorbia Seed Pill) or Shengjin Touguan San (Gold-Overcoming Unblocking Powder).

Tinnitus. The classics state insufficient Qi on top. Also, insufficiency of Brain Marrow causes dizziness and tinnitus. Both are due to weakness of essence and Qi. Wang Ruyan states that severe tinnitus is mostly due to Phlegm-Fire ascending, combined with anger. If tinnitus is due to Kidney Deficiency, the ringing is mild, accompanied by signs of consumption. Xue Lizhai says: If Blood Deficiency with Fire, use Siwu Tang plus Zhizi (Gardenia) and Chaihu. If Qi Deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If both Qi and Blood are deficient, use Bazhen Tang (Eight Treasures Decoction) plus Chaihu. If anger-induced tinnitus indicates Qi Excess, use Xiao Chaihu Tang (Minor Bupleurum Decoction) plus Xiong (Ligusticum) and Gui (Angelica); for Deficiency, use Bazhen Tang plus Zhizi. If worse in the morning, Yang Qi is Excess and Hot; use Xiao Chaihu Tang plus Huanglian (Coptis) and Zhizi; if Yang Qi is Deficient, use Buzhong Yiqi Tang plus Chaihu and Zhizi. If worse in the afternoon, Yin Blood is Deficient; use Siwu Tang plus Baizhu (Atractylodes Macrocephala) and Fuling (Poria). If Kidney Deficiency with Fire stirring, causing buzzing sounds and sore calves, or excessive phlegm with thirst, Dihuang Wan (Rehmannia Pill) is essential. In severe cases, use anchoring methods: Zhengyuan Yin (Origin-Supporting Drink) swallowing Heixi Dan (Black Tin Pill). For Heat, use Longchi San (Dragon Bone Powder). The Kidney is where Zong Mai gather, opening into the ears. If Zong Mai are deficient, Wind-Evil enters the ear along the vessels, and Qi struggles with the pathogen causing tinnitus. First use Shengliao Wuling San (Raw Formula Five-Ling Powder) plus Zhi Zhike (Prepared Aurantium), Juhong (Citrus Peel), Zisu (Perilla), and Shengjiang (Fresh Ginger) decocted together, swallowing Qingmuxiang Wan (Aquilaria Pill) to dispel pathogens, diffuse Wind, and direct Qi downward. Follow with Guixiong Yin (Angelica and Ligusticum Drink) to harmonize and nourish. If accompanied by limb spasms and pain, shivering during sleep, and wind-like itching in the ear, Huangbo Wan (Phellodendron Pill) is very effective.

For swollen, painful ears with sores, use Niubangzi Tang (Arctium Decoction) or Chaihu Qinggan Yin (Bupleurum Liver-Clearing Drink). For damp-swollen painful ears, use Liangge San (Cool the Chest Powder) plus wine-fried Dahuang and Huangqin (Scutellaria), wine-soaked Fangfeng, Jingjie (Schizonepeta), and Qianghuo. If Dampness is heavy, blow Gufan (Alum) into the ear externally. For damp masses in the ear, mix fresh pig fat, earthworm feces, soot from the pot bottom, and scallion juice into a date-seed-sized ball, wrap in cotton, and insert; replace if wet. This formula is also used for dry painful ears. For ear pain feeling like insects crawling, blow Shed Snake Ash for immediate relief.

Ear discharge (Otorrhea). Damage to Qi and Blood allows Heat to enter and accumulate, producing pus. Internally take Chaihu Cong'er Tang (Bupleurum Ear-Brightening Decoction) or Manjingzi San (Vitex Powder). Externally apply Hongmian San (Red Cotton Powder). For robust individuals with accumulated Heat, send down Jiedu Xionghuang Wan (Detoxifying Realgar Pill) using Yuxie Wuyou San (Jade Dust Carefree Powder) as a vehicle; 3-4 bowel movements indicate efficacy. For pus discharge, blow Hair Ash. For ulcerated ear pus, blow Fanhui (Alum Ash) and Qiandan (Lead Tetroxide). Another method: burn Chenpi (Tangerine Peel) to ash (1 qian), mix with Qingfen (Calomel, 3 fen) and Shexiang (Musk, 5 li), and blow in to dry immediately. For ear bleeding, blow Longgu Ash (Dragon Bone) to stop it. Note: At onset, avoid astringents; do not use Qiandan or Alum, nor Hongmian San.

Ear Itch. Shen Cunzhong suffered from red eyes unresponsive to treatment. Qiu Hua asked if his ears itched; itch indicates Kidney Wind. Two to three doses of Sisheng San (Four Freshs Powder) cured him. After two doses, his eyes hurt severely; after two more, he was cured. Sun Hefu said: Lü Jifu had chronic eye disease cured by Toubing Dan (Ice-Penetrating Pill), which also treats Kidney Wind. *Shenghui Fang* states: Some have ear itch stopping only after picking until bleeding; this is Floating Toxin attacking upward due to Kidney Deficiency, suitable for Toubing Dan. Abstain from alcohol, wheat products, chicken, and pork for one month; otherwise, ineffective.

Insect in Ear. Rub cat's nose with fresh ginger to collect urine, drip into ear to expel insect. Or use a tube to suction out.

Ants/Centipedes in Ear. Pour ginger juice or garlic juice, or place roasted pork/chicken near the ear. Fly in Ear. Grind soap bean insect, mix with human blood, and drip into ear. Fleas/Lice in Ear. Stir-fry Acorus powder, wrap in hot cotton, and press against ear. Slug/Snail in Ear. Rub ear with salt, or blow equal parts Borax and Chalcanthite powder to dissolve it. Water in Ear. Drip mint juice for immediate effect. Foreign Body in Ear. Apply good glue to the tip of a bowstring, insert into ear to stick to object, and slowly pull out. Hundred Insects in Ear. Drip one drop of tea oil into ear for immediate relief.