经义
肾主耳。○南方赤色，入通于心，开窍于耳。○太阳所谓耳鸣者，阳气万物盛上而跃，故耳鸣也。○肺虚
则少气不能报息，
耳聋嗌干。○肝虚则目KT KT 无所见，耳无所闻。（《素问》）
肾气通于耳，肾和则耳能闻五音矣。○耳者，宗脉之所聚也。故胃中空则宗脉虚，虚则下溜，脉有所竭者，
故耳鸣。○精脱者耳聋，液脱者耳数鸣。○髓海不足，则脑转耳鸣。（《灵枢》）
哲言
耳者肾之窍。察耳之好恶，知肾之强弱。肾为人之根本，故耳叶红润者生；或黄、或白、或黑、或青而枯
者死；薄而白、薄而黑、或焦如炭者，皆为肾败。若伤寒耳聋，寒热胁痛，此属少阳，当和解之。若阴证耳聋，
舌卷、唇青，此属厥阴，为难治也。（《伤寒五法》）
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。（《证治汇补》）
耳痛、耳鸣、耳痒、耳脓、耳疮，当从少阴正窍，分寒、热、虚、实而治之，不可专作火与外邪治。（《赵氏医贯》）
肾开窍于耳，心寄窍于耳，胆脉附于耳。体虚失聪，治在心肾；邪干窍闭，治在胆经。盖耳为清空之窍，
清阳交会之所。一受风热火郁之邪，与水衰火亢肾虚气厥者，皆能为患。治法不越通阳、镇阴、益肾、补心、
清胆等法。如温、暑、火、风侵窍，而为耳聋痛胀者，用连翘、山栀、薄荷、竹叶、银花，轻可去实之法，轻清
泄降。如少阳相火上郁，耳聋 胀者，用荷叶、苦丁茶、菊叶、夏枯草、蔓荆、山栀、羚角、丹皮辛凉味薄之
品，清泄少阳郁热。如心、肾两亏，肝阳亢逆，与内风上旋蒙窍而为耳鸣暴聋者，用熟地、磁石、龟甲、二冬、
牛膝、秋石、山萸、白芍味浓质重之药，壮水制阳，填阴镇逆，佐以酸味入阴，咸以和阳。（《临证指南》）
耳聋
未持脉时，病患叉手自冒心。师因教试令咳而不咳者，此必两耳聋无闻也。所以然者，以重发汗，虚，
故如此。（张仲景）
耳者，宗脉之所附。宗脉虚，风邪乘之，经气痞而不宣，是为风聋。必时有头痛之证。○十二经络上络于耳，
其阴阳诸证，适有交并，则脏气逆而为厥，厥气搏于耳，是为厥聋。必时有眩晕之证。○劳役伤其血气，淫欲
耗其真元，惟悴力疲，昏昏愦愦，是谓劳聋。将息得宜，其聋自轻，日就劳伤，则为久聋。（《仁斋直指》）
新聋多热，少阳、阳明火盛也；旧聋多虚，少阴肾气不足也。○虚聋由渐而成，必有兼证可辨∶如面颊黧
黑者，精脱；少气嗌干者，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。（《证治汇补》）
肾乃水窍。耳能听声者，水生于金也。肺主气，一身之气贯于耳，故能听声。凡治耳聋，必先调气开郁。
（《医学入门》）
左耳聋，妇人多有之，以多忿怒故也；右耳聋，男子多有之，以多色欲故也；左右俱聋，膏粱之人多有之，
以多肥甘故也。（《医鉴》）
耳中有穴曰听宫。其形如珠，皮膜包裹真水，最不可犯。皮膜一破，真水去而耳立聋。有为大声所振而聋
者，皮膜破也。有时或聋、或不聋者，心肾不交也。有先耳鸣而后聋者，外邪干，或肾热也。惟伤寒少阳证耳
聋，不关于此。胆脉绕耳叶，邪气壅实，而听宫为其所遮。三焦脉亦入耳，亦能挟邪为病。然总不若听宫为耳
之主，为心肾会合之所而不可犯也。（《张氏医通》）
耳者肾之窍，足少阴之所主。人身十二经络中，除足太阳、手厥阴，其余十经络皆入于耳。惟肾开窍于耳，
故治耳者以肾为主。或曰∶心亦开窍于耳，何也？盖心窍本在舌，以舌无孔窍，因寄于耳。此肾为耳窍之主，
心为耳窍之客尔。以五脏开于五部，分阴阳言之∶在肾、肝居阴，故耳、目二窍，阴精主之；在心、脾、肺居
阳，故口、鼻、舌三窍，阳精主之。《灵枢》云∶肾气通于耳，肾和则能闻五音。五脏不和则七窍不通。故凡一经
一络有虚、实之气入于耳者，皆足以乱其聪明而致于聋聩。此言暴病者也。若夫久聋者，于肾亦有虚、实之异。
左肾为阴，主精；右肾为阳，主气。精不足、气有余，则聋为虚。若其人瘦而色黑，筋健骨壮，此精气俱有余，
固藏闭塞，则聋为实，乃寿征也。又有乍聋者，《经》曰∶不知调和七损八益之道，早衰之节也。其年未五十，
体重、耳目不聪明矣，是可畏也。其证耳聋面颊黑者，为精脱肾惫，安肾丸、八味丸、苁蓉丸、薯蓣丸，选而
用之。若肾经虚火，面赤口干、痰盛内热者，六味丸主之。至于阳虚者，亦有耳聋。《经》曰∶清阳出上窍。
今人饮食劳倦，脾胃气虚，不能上升而下流于肾、肝，故阳气者闭塞，地气者冒明，邪害空窍，令人耳目不聪
明矣。治须补中益气汤。（《赵氏医贯》）
阴气走下窍，而上入于阳位，则有窒塞耳鸣之候。故人当五十以外，肾气渐衰于下，每每从阳上逆。而肾
之窍开于耳，耳之聪司于肾。肾主闭脏，不欲外泄。因肝木为子，疏泄母气而散于外，是以谋虑郁怒之火一动，
阴气从之上逆，耳窍窒塞不清。较之聋病，一天一渊。聋病者，其中另有窍一膜，遮蔽外气，不得内入，故以
开窍为主。至于高年，阴气不自收摄，越出上窍之理，从无一人言及。不知阴气至上，亦隔一窍膜，不能越出
窍外，止于窍中 有声，如蛙鼓、蚊锣，鼓吹不已。以故外入之声，为内声所混，听之不清。方中大意，全
以磁石为主，以其重能达下，性主下吸，又能制肝木之上吸故也。而用地黄、龟胶群阴之药辅之，更用五味子、
山茱萸之酸收之。令阴气自旺于本宫，不上触于阳窍，耳之于聋，似谷之受响，岂更与人声相拒，难于远听耶？（喻嘉言）
耳聋一证，诸家所论虽悉。然以余之见，大都其证有五∶曰火闭、曰气闭、曰邪闭、曰窍闭、曰虚闭。○耳
聋之故，总因气闭不通。盖凡火邪、风邪，皆令气壅，壅则闭也；怒则气逆，逆则闭也；窍伤则气窒，室则闭
也；虚则气不充，不充则闭也。凡
邪盛气逆而闭者，实闭也；气不足而闭者，虚闭也。（张景岳）
耳鸣
耳鸣，以手按之不鸣或少减者，虚也；手按之而鸣愈甚者，实也。（《赵氏医贯》）
凡暴鸣声大者多实，渐鸣声细者多虚。少壮热盛者多实，中衰无火者多虚。饮酒味浓素多痰火者多实，质
清脉细素多劳倦者多虚。耳为肾窍，乃宗脉之所聚。精气调和，肾气充足，则耳目聪明。若劳伤血气，精脱肾
惫，必至聋聩。故人于中年之后，每多耳鸣者，是皆阴衰肾亏而然。○凡耳窍或损、或塞、或震伤，以致暴聋
或鸣不止者，以手中指于耳窍中轻轻按捺，随捺随放，或轻轻摇动，以引其气，气至则窍自通。（张景岳）
耳鸣如蝉，或时闭塞，作肾虚治不效。殊不知此是痰气上升，郁于耳中而为鸣，郁甚则闭塞矣。审其平昔，
饮酒浓味，上焦素有痰火，只作清痰降火治之。若肾虚而鸣者，其鸣不甚，其人多欲，当见劳怯等证。（王节斋）
耳痛
耳痛如虫走者，风也；干痛者，风热也；湿痛者，风湿也；微痛者，虚火也。又有耳后攻击肿痛者，少阳
经风火也。（《证治汇补》）
耳痒
寻常耳痒，有风、有火，易于调治。甚有耳痒挑剔出血不能住手，此肾虚风毒上攻，治宜透冰丹；戒酒色
浓味。（《圣惠方》）
耳脓耳
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，谓之 耳。○热气乘虚入耳，聚而
不散，脓水时出，谓之脓耳。宜服蔓荆子散，外用白矾、胭脂、麝香为末吹之。（杨仁斋）
耳疮
耳疮发热 痛，属少阳、厥阴风热，用柴胡栀子散。若内热
痒痛，属前二经血虚，用当归川芎散。若寒热作痛，属肝经风热，用小柴胡汤加山栀、川芎。若内热口干，属
肾经虚火，用加味地黄丸。（薛立斋）
选案
一人耳内时痛，痛甚欲死，痛止如故。就诊于立斋先生，六脉皆安，非疮也。话间痛忽作，度其有虫。令
取猫尿滴耳中，（将生姜擦猫鼻，其尿自出。）果出一虫，遂不复痛。或用麻油滴之，则虫死难出；或用炒芝
麻枕之，虫出不及猫尿之速。（《赵氏医贯》）
Classical Principles
The Kidney governs the ears. ○ The red color of the South enters and communicates with the Heart, (and the Heart's) opening is in the ears. ○ What the *Neijing* refers to as tinnitus is because Yang Qi, like all things, flourishes and leaps upward, thus causing tinnitus. ○ When the Lung is deficient, there is shortness of breath and an inability to take a deep breath, accompanied by deafness and dryness of the throat. ○ When the Liver is deficient, vision becomes blurred and objects cannot be seen, and hearing is lost. (From *Suwen*)
Kidney Qi connects with the ears; when Kidney Qi is harmonious, the ears can hear the five tones. ○ The ears are the gathering place of the major meridians. Therefore, when the Stomach is empty, the major meridians become deficient; deficiency leads to the downward flow of Qi, and where meridian Qi is exhausted, tinnitus occurs. ○ Those who lose Essence suffer from deafness; those who lose Body Fluids suffer from frequent tinnitus. ○ When the Sea of Marrow is insufficient, dizziness and tinnitus occur. (From *Lingshu*)
Philosophical Remarks
The ear is the external orifice of the Kidney. Observing the condition of the ears allows one to know the strength or weakness of the Kidney. The Kidney is the root of the human body; therefore, if the auricle is ruddy and moist, life is sustained; if it is yellow, white, black, or cyanotic and withered, death ensues; if it is thin and white, thin and black, or scorched like charcoal, these are all signs of Kidney failure. If deafness results from Cold Damage (*Shanghan*), accompanied by alternating chills and fever and hypochondriac pain, this belongs to the Shaoyang syndrome and should be treated with harmonizing methods. If deafness results from Yin syndromes, accompanied by tongue retraction and blue lips, this belongs to the Jueyin syndrome and is difficult to treat. (From *Shanghan Wufa*)
When Kidney Qi is abundant, hearing is acute; when Kidney Qi is deficient and failing, deafness occurs; when Kidney Qi is insufficient, tinnitus occurs; when Kidney Qi stagnates and transforms into heat, otorrhea (pus discharge from the ear) occurs. (From *Zhengzhi Huibu*)
Earache, tinnitus, pruritus auris, otorrhea, and otitis externa should be treated based on the Zheng Qiao (True Orifice) of the Shaoyin Kidney channel, differentiating between Cold, Heat, Deficiency, and Excess. One must not solely attribute them to Fire pathogenic factors or external pathogens. (From *Zhao Shi Yi Guan*)
The Kidney opens into the ears, the Heart has its auxiliary orifice in the ears, and the Gallbladder meridian attaches to the ears. When constitution is weak and hearing declines, treatment focuses on the Heart and Kidney; when pathogens interfere and block the orifices, treatment focuses on the Gallbladder meridian. This is because the ear is an empty and clear orifice, the meeting place of Clear Yang Qi. Once invaded by Wind, Fire, Heat, or Stagnation pathogens, or affected by Water deficiency with Fire hyperactivity and Kidney deficiency with Qi rebellion, pathology arises. Treatment methods do not exceed those of unblocking Yang, suppressing Yin, tonifying the Kidney, nourishing the Heart, and clearing the Gallbladder. For example, if Warmth, Summerheat, Fire, or Wind pathogens invade the orifice causing deafness, pain, and distension, use Forsythiae Fructus (*Lianqiao*), Gardenia Fruit (*Shanzhi*), Mint (*Bohe*), Bamboo Leaves (*Zhuye*), and Honeysuckle Flower (*Yinhua*), employing the method of "light substances removing excess," using light and clear descending actions. If Shaoyang Ministerial Fire is stagnant causing deafness and distension, use Lotus Leaf (*Heye*), Kuding Tea (*Kudingcha*), Chrysanthemum Leaves (*Juye*), Prunella Spike (*Xiakucao*), Thunberg Fritillary Bulb (*Manjingzi*), Gardenia Fruit (*Shanzhi*), Antelope Horn (*Lingjiao*), and Moutan Cortex (*Danpi*), which are acrid-cool and light in flavor, to clear and drain Shaoyang stagnant heat. If both Heart and Kidney are deficient, Liver Yang rebels, and internal Wind swirls upward clouding the orifice causing tinnitus and sudden deafness, use Prepared Rehmannia Root (*Shudihuang*), Magnetite (*Cishi*), Tortoise Plastron (*Guijia*), Asparagus Tuber (*Tongdong*), Dioscorea Rhizome (*Shanyao* - note: text says Er Dong, usually Tian Dong/Mai Dong), Achyranthes Root (*Niuxi), Autumn Stone (*Qiushi*), Cornus Fruit (*Shanyuzhu*), and White Peony Root (*Baishao*). These are heavy and rich in flavor, strengthening Water to control Yang, filling Yin to suppress rebellion, assisted by sour flavors entering Yin and salty flavors harmonizing Yang. (From *Linzheng Zhinan Yize*)
Deafness
Before taking the pulse, the patient crosses their hands over the heart. The master then instructs them to try to cough; if they do not cough, this indicates bilateral deafness with no hearing. The reason for this is excessive sweating leading to deficiency, hence such symptoms. (Zhang Zhongjing)
The ear is the gathering place of the major meridians. When the major meridians are deficient, Wind pathogens attack, causing meridian Qi to become blocked and unventilated, resulting in Wind Deafness. This is invariably accompanied by occasional headaches. ○ The twelve meridians connect upwards to the ears. When various Yin and Yang syndromes intersect, Zang Qi rebels and causes Jue (reversal); Jue Qi clashes with the ear, resulting in Jue Deafness. This is invariably accompanied by occasional vertigo. ○ Labor and fatigue damage Blood and Qi; licentiousness depletes True Yuan; exhaustion and fatigue lead to confusion and dullness, known as Labor Deafness. With proper rest, deafness naturally lightens; with continued daily labor and injury, it becomes chronic deafness. (From *Ren Zhi Zhizhi Fang*)
New-onset deafness is mostly Heat, caused by excess Fire in Shaoyang and Yangming; old deafness is mostly Deficiency, caused by insufficiency of Shaoyin Kidney Qi. ○ Deficiency deafness develops gradually and must have accompanying symptoms for differentiation: darkening of the cheeks indicates Essence depletion; shortness of breath and dry throat indicate Lung deficiency; blurred vision and fearfulness indicate Liver deficiency; mental vagueness, palpitations, and irritability indicate Heart deficiency; lethargy of the four limbs, vertigo, and poor appetite indicate Spleen deficiency. (From *Zhengzhi Huibu*)
The Kidney is the orifice of Water. The ear hears sound because Water is born from Metal (Lung). The Lung governs Qi; the Qi of the entire body penetrates the ear, thus enabling hearing. In treating deafness, one must first regulate Qi and open stagnation. (From *Yixue Rumen*)
Left-sided deafness is common in women due to frequent anger; right-sided deafness is common in men due to excessive sexual activity; bilateral deafness is common among those who consume rich foods due to excessive intake of fatty and sweet foods. (From *Yi Jian*)
There is an acupoint in the ear called Tinggong (SI 19). Its shape is like a pearl, wrapped in skin and membrane containing True Water, which must not be violated. If the membrane breaks, True Water escapes, and immediate deafness occurs. Some become deaf due to loud noises breaking the membrane. Some have intermittent deafness due to lack of communication between Heart and Kidney. Some have tinnitus preceding deafness due to external pathogens or Kidney Heat. Only Shaoyang syndrome deafness in Cold Damage is unrelated to this. The Gallbladder meridian winds around the auricle; when pathogens are abundant and solid, they obstruct Tinggong. The Sanjiao meridian also enters the ear and can carry pathogens to cause disease. However, none are as central to the ear as Tinggong, the meeting place of Heart and Kidney, which must not be violated. (From *Zhang Shi Yi Tong*)
The ear is the orifice of the Kidney, governed by the Foot-Shaoyin Kidney meridian. Among the twelve meridians of the body, except for the Foot-Taiyang Bladder meridian and Hand-Jueyin Pericardium meridian, the other ten enter the ear. Since only the Kidney opens into the ear, treating ear diseases prioritizes the Kidney. Someone might ask: Does not the Heart also open into the ear? The Heart's true orifice is the tongue; because the tongue lacks an orifice, it attaches its orifice to the ear. Thus, the Kidney is the master of the ear orifice, and the Heart is the guest. Considering the five Zang organs opening into five regions and discussing Yin and Yang: the Kidney and Liver reside in Yin, so the ear and eye orifices are governed by Yin Essence; the Heart, Spleen, and Lung reside in Yang, so the mouth, nose, and tongue orifices are governed by Yang Essence. The *Lingshu* states: Kidney Qi connects with the ears; when Kidney Qi is harmonious, the five tones can be heard. When the five Zang organs are not harmonious, the seven orifices are blocked. Therefore, whenever deficiency or excess Qi from any meridian enters the ear, it can disturb hearing and cause deafness. This refers to acute conditions. For chronic deafness, there are also differences between deficiency and excess in the Kidney. The left Kidney is Yin, governing Essence; the right Kidney is Yang, governing Qi. Insufficient Essence and excess Qi result in deficiency deafness. If a person is thin with dark complexion but strong sinews and bones, this indicates excess Essence and Qi; obstruction of storage results in excess deafness, which is actually a sign of longevity. There is also sudden deafness. The Classics state: Not knowing the way of harmonizing the "Seven Damages and Eight Benefits" is the rhythm of premature aging. Before age fifty, if the body feels heavy and the ears and eyes are not sharp, this is terrifying. For symptoms of deafness with dark cheeks, indicating Essence depletion and Kidney exhaustion, select Anshen Wan, Bawei Wan, Congrong Wan, or Shuyu Wan. If there is Empty Fire in the Kidney meridian with red face, dry mouth, and profuse phlegm with internal heat, Liuwei Wan is the main prescription. For Yang deficiency, there is also deafness. The Classics state: Clear Yang emerges from the upper orifices. Nowadays, people suffer from dietary irregularities and fatigue, causing Spleen and Stomach Qi deficiency. Qi fails to ascend and instead flows downward to the Kidney and Liver, causing Yang Qi to be blocked and turbid Yin to obscure clarity. Pathogens harm the orifices, making ears and eyes unsharp. Treatment requires Buzhong Yiqi Tang. (From *Zhao Shi Yi Guan*)
Yin Qi moves to the lower orifices but ascends to the Yang positions, causing stuffiness and tinnitus. Therefore, after age fifty, as Kidney Qi gradually declines below, it often rebels upward along with Yang. The Kidney's orifice is the ear, and hearing is governed by the Kidney. The Kidney governs closure and does not wish for leakage. Since Liver Wood is the child of Kidney Water, it drains the mother's Qi and scatters it outward. Thus, when the fire of frustration and anger moves, Yin Qi rebels upward, causing the ear orifice to become stuffy and unclear. Compared to deafness, this is worlds apart. In deafness, there is another membrane blocking external Qi from entering, so treatment focuses on opening the orifice. For the elderly, the principle of Yin Qi failing to self-restrain and escaping through the upper orifices has rarely been discussed. It is unknown that when Yin Qi reaches the upper region, it is still separated by a membrane and cannot escape the orifice; it remains inside producing sounds like frog drums or mosquito gongs, blowing incessantly. Thus, external sounds are mixed with internal sounds, making hearing unclear. The general idea of the formula relies mainly on Magnetite (*Cishi*) because its heaviness reaches downward, its nature draws down, and it controls the upward drawing of Liver Wood. It is assisted by Yin herbs like Rehmannia Root (*Dihuang*) and Turtle Shell Glue (*Guijiao*), and further restrained by the astringent properties of Schisandra Berry (*Wuweizi*) and Cornus Fruit (*Shanzhuyu*). This allows Yin Qi to flourish in its home palace without touching the Yang orifice. The ear's deafness would then be like a valley receiving echoes; why would it resist human voices and make distant listening difficult? (Yu Jiayan)
Regarding deafness, although various schools have discussed it thoroughly, in my view, there are generally five types: Fire Blockage, Qi Blockage, Pathogen Blockage, Orifice Blockage, and Deficiency Blockage. ○ The cause of deafness is always Qi blockage and non-communication. Fire and Wind pathogens cause Qi stagnation; stagnation leads to blockage. Anger causes Qi rebellion; rebellion leads to blockage. Injury to the orifice causes Qi obstruction; obstruction leads to blockage. Deficiency causes Qi insufficiency; insufficiency leads to blockage. Blockage due to excess pathogens and rebellious Qi is Excess Blockage; blockage due to insufficient Qi is Deficiency Blockage. (Zhang Jingyue)
Tinnitus
If pressing the ear stops the tinnitus or reduces it, it is Deficiency; if pressing makes the tinnitus louder, it is Excess. (From *Zhao Shi Yi Guan*)
Sudden, loud tinnitus is mostly Excess; gradual, faint tinnitus is mostly Deficiency. Young and robust individuals with high heat are mostly Excess; those in decline with little fire are mostly Deficiency. Those who drink alcohol, eat rich flavors, and have phlegm-fire are mostly Excess; those with clear constitutions, fine pulses, and chronic fatigue are mostly Deficiency. The ear is the orifice of the Kidney and the gathering place of major meridians. When Essence and Qi are harmonious and Kidney Qi is sufficient, hearing and vision are sharp. If labor and injury damage Blood and Qi, and Essence is depleted and Kidney Qi exhausted, deafness and muteness will inevitably follow. Therefore, after middle age, many people experience tinnitus, all due to Yin decline and Kidney deficiency. ○ If the ear orifice is damaged, blocked, or traumatized, causing sudden deafness or continuous tinnitus, gently press the orifice with the middle finger, releasing as you press, or gently shake it to guide Qi; when Qi arrives, the orifice will naturally open. (Zhang Jingyue)
Tinnitus sounding like cicadas, or intermittent blockage, may not respond to Kidney deficiency treatment. One must realize this is Phlegm-Qi ascending and stagnating in the ear, causing ringing; severe stagnation causes blockage. Reviewing their habits, if they drink heavily, eat rich flavors, and have upper Jiao phlegm-fire, treat only by clearing Phlegm and descending Fire. If tinnitus is due to Kidney deficiency, the ringing is not severe, the person is lustful, and symptoms of consumption appear. (Wang Jiezhai)
Earache
Pain feeling like insects crawling is Wind; dry pain is Wind-Heat; damp pain is Damp-Wind; mild pain is Empty Fire. Pain attacking and swelling behind the ear is Wind-Fire in the Shaoyang meridian. (From *Zhengzhi Huibu*)
Pruritus Auris
Common ear itching involves Wind and Fire and is easy to treat. Severe cases involve itching so intense that scratching causes bleeding and cannot stop; this is Kidney deficiency with Wind-Toxin attacking upward. Treat with Toubing Dan; abstain from alcohol, sex, and rich flavors. (From *Shenghui Fang*)
Otorrhea
Fluid in the ear is harmless if mild. If Wind-Heat combats it, fluid condenses into nodules, causing sudden deafness, called *Du Er*. ○ Heat pathogens enter the ear via deficiency, gather and do not disperse, and pus flows intermittently, called Nong Er (Pus Ear). Take Manjingzi San; externally apply Alum (*Baifan*), Rouge (*Yanzhi*), and Musk (*Shexiang*) as powder blown into the ear. (Yang Renzhai)
Otitis Externa
Fever and pain in otitis externa belong to Wind-Heat in Shaoyang and Jueyin; use Chaihu Zhizi San. Internal heat with itching and pain belongs to Blood deficiency in the aforementioned meridians; use Danggui Chuanxiong San. Alternating chills and pain belong to Wind-Heat in the Liver meridian; use Xiaochaihu Tang plus Gardenia Fruit (*Shanzhi*) and Ligusticum Rhizome (*Chuanxiong*). Internal heat with dry mouth belongs to Empty Fire in the Kidney meridian; use Jiawei Dihuang Wan. (Xue Lizhai)
Selected Cases
A man suffered intermittent ear pain, so severe he wished to die, but returned to normal when pain ceased. He consulted Master Lizhai. All six pulses were calm; it was not an ulcer. During conversation, pain suddenly struck. Suspecting parasites, he instructed to apply cat urine to the ear. (Rub ginger on the cat's nose to induce urination.) A parasite was indeed expelled, and pain ceased. Using sesame oil kills the parasite but makes expulsion difficult; sleeping on fried sesame seeds expels the parasite slower than cat urine. (From *Zhao Shi Yi Guan*)