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Zhang Youkui, in his prime, often suffered from itching in both ears, occurring once daily. During severe episodes, it was almost unbearable; he scratched and picked at them without restraint, yet the condition remained unchanged. He would frequently take a piece of hard bamboo about three cun long, cut it into five or six pieces, scrape them finely to resemble a brush, and forcefully insert them into his ears until the skin broke and bled, sometimes accumulating as much blood as filling a clam shell before stopping. The next day, the same thing would happen again. Due to excessive blood loss, he became exhausted and emaciated. Coincidentally, a physician from Hebei named Zhou Mindao arrived. Upon inquiry, Zhou said: This is due to wind deficiency in the Kidney, causing floating toxins to attack upwards. It is not easy to treat with ordinary methods. One should purchase Toubing Dan (Ice-Penetrating Pill) to take internally, avoid alcohol, and refrain from consuming damp-producing foods such as wet noodles, vegetables, chicken, and pork. Ideally, one should adhere to these dietary restrictions for a month. Zhang followed his advice, and the itching stopped after a few days. However, he could not maintain the dietary restrictions for long, and the itching recurred. He then made a determined effort to strictly abstain from these foods for several tens of days, after which his ears no longer itched.

Yu Zhen commented: Such peculiar itching cannot be cured by ordinary medicines. If it were common ear itching caused by wind or fire, it would be relatively easy to treat.

Xue Lizhai treated a twenty-year-old man who had been suffering from fluid discharge and pain in his ears for over a year. His pulse was surging and rapid, especially in the Chi position, indicating deficient heat in the Liver and Kidney meridians. He prescribed Jiadi Dihuang Wan (Modified Rehmannia Pill), and the patient recovered after one dose.

He also treated a man who experienced ear pain, itching, or discharge after every sexual intercourse. He liked to insert silver hairpins into his ears and preferred coolness. This was identified as deficient fire in the Kidney meridian, and he was cured using Jiabajia Weiwang (Modified Eight-Ingredient Pill with Rehmannia).

He treated another woman who developed fever due to anger. Every time her menstruation occurred, pus discharged from both ears, and she experienced pain in both temples, which subsided slightly upon pressure. Anger caused distending pain in the chest, hypochondrium, and breasts, accompanied by alternating chills and fever, frequent urination, or lower abdominal fullness. These symptoms all belonged to Liver fire and Blood deficiency. She was treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), after which all symptoms disappeared. She was then cured using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Wuweizi (Schisandra Berry).

Yu Zhen commented: In the above three cases, diagnosis was based either on the pulse or on symptoms, making them relatively easy to distinguish. In the case where Jiabajia Weiwang was used, it is presumed that the Chi pulse must have been weak or large and empty, hence warming herbs were added to guide the fire back to its source. If the Chi pulse were surging and rapid, Zhibai Dihuang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill) would likely be more appropriate.

[Appendix] A woman inserted a rolled chicken feather into her ear to clean it. Unbeknownst to her, a centipede had laid eggs on the feather, which hatched inside her ear. The young centipedes burrowed into her brain, causing intense pain and itching. No medicine worked. A physician instructed someone to roast chicken meat, place it hot in a vessel with a small hole covered, and have the patient hold her ear over the hole to inhale the fumes. The chicken aroma attracted all the centipedes onto the meat, and the illness was immediately cured.

Shishan treated a man nearing sixty years old with pale complexion and left-sided deafness for thirty years. In recent years, the left side of his head and ear would occasionally swell, ulcerate, and discharge pus copiously from the ear, recurring periodically. Now, his right ear had also become deaf. He had repeatedly taken drugs to dispel wind, clear heat, and eliminate phlegm without effect. Physician Wang diagnosed the pulse on the left hand as floating, small, and rapid at the Cun position, and deep, small, and rapid at the Chi position corresponding to the Liver and Kidney. The pulses on the right hand were all deficient, scattered, and rapid. Wang suspected this was because the patient had traveled far by carriage, and the pulse had not yet stabilized. The following morning, the pulses had converged somewhat, beating less than five times per breath cycle, not as rapid as before. The left side of the head and the area around the ears belong to the Shaoyang (Lesser Yang) meridian. The Classics state: "The Shaoyang meridian has abundant Qi but scarce Blood." Currently, wind and phlegm-resolving drugs are mostly drying agents. Applying drying agents to a meridian already deficient in Blood further depletes the Blood. Scarcity of Blood leads to stagnation; stagnation causes swelling and obstruction. Moreover, Blood congeals when exposed to cold. Using cold-natured drugs now further condenses the Blood, exacerbating the swelling. Over time, this stagnation transforms into heat, rotting flesh and forming pus that discharges from the ear. The gradual deafness of the right ear occurs because the collaterals are interconnected, and Qi and Blood rely on each other; there is no case of Blood disease without Qi disease. Thus, the disease started on the left and eventually affected the right. This indicates that prolonged illness has led to dual deficiency of Qi and Blood. Furthermore, at age sixty, Qi and Blood naturally decline daily. External labor injures Qi and Blood, excessive use of drying agents damages them, and copious pus discharge exhausts them further. Thus, the state of double deficiency is evident. Theoretically, one should nourish Qi and Blood. When Qi and Blood are robust, their circulation will normalize, and the disease will resolve. Otherwise, not only will the disease persist, but conditions like brain abscess or ear carbuncle may also occur. The prescription consisted of Renshen (Ginseng Root) 2 qian, Huangqi (Astragalus Root) 3 qian, Dangshen (Codonopsis Root) and Baizhu (Atractylodes Macrocephala Rhizome) 1 qian each, Shengjiang (Fresh Ginger) 1 qian, Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Chaihu (Bupleuri Radix), and Chenpi (Citri Reticulatae Pericarpium) 6 fen each, Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqin (Scutellariae Radix), and Baishao (Paeoniae Radix Alba) 7 fen each, and Gancao (Glycyrrhizae Radix et Rhizoma) 5 fen. After decocting and taking more than ten doses, the patient recovered.

Yu Zhen commented: Mr. Wang’s discussion was subtle yet clear, and his medication addressed both root and branch. It truly brought the joy of wandering freely. Even his initial assessment that the pulse was unreliable due to recent travel serves as a warning against rashness.

Jiang Yingsu treated Sun Shunwu, a student of the Imperial Academy, who suffered from tinnitus and hearing impairment. Burdened by complex affairs, he had undergone various treatments for half a year without success. Jiang examined him and found a rapid and slippery pulse. He prescribed Erchen Tang (Two-Cured Decoction) added with Qumai (Dianthi Herba), Pianxu (Polygoni Avicularis Herba), Mutong (Akebiae Caulis), and Huangbai (Phellodendri Cortex). The patient felt relief after one dose and was cured after two doses.

Yu Zhen commented: Although the symptom of tinnitus is the same, the treatment methods in this case and the next differ significantly. If they were swapped, neither would be effective. Thus, we understand that the difficulty in treating diseases lies in accurately identifying the pathology.

Yu Jiayan treated Wang Huweng, Grand Commandant, for tinnitus. He discussed: The orifice of the Kidney opens into the ears, and auditory acuity is governed by the Kidney. The Kidney governs storage and retention. Since Liver Wood is the child of Kidney Water, it can vent the mother's Qi and scatter it outward. Therefore, whenever the fire of frustration and anger arises, the ear orifices become unclear, and hearing distant sounds is slightly impaired. Compared to deafness, this is worlds apart. Deafness involves a membrane within the orifice blocking external air from entering. Hence, treatment focuses on opening the orifices, utilizing herbs like Shichangpu (Acori Tatarinowii Rhizoma) and Shexiang (Moschus), and methods of external application and internal attack. For elderly individuals, however, Kidney Qi has declined, and Yin Qi fails to retain itself, escaping upward through the upper orifices. The ears sound like frogs croaking or mosquitoes buzzing incessantly. External sounds are mixed with internal noises, resulting in unclear hearing. If Qi does not rebel upward, hearing will naturally clear. Treatment should primarily use Cishi (Magnetitum) because its heaviness allows it to reach the lower Jiao, its nature draws downward, and it can restrain the upward rebellion of Liver Wood. This should be assisted by Yin-nourishing herbs such as Dihuang (Rehmanniae Radix) and Guijiao (Colla Corii Asini). Additionally, Suanwei Zi (Schisandrae Chinensis Fructus) and Shanzhuyu (Corni Fructus) with their sour flavor should be used to astringe and consolidate. This ensures Yin Qi remains in its original palace and does not disturb the Yang orifices, creating an open and unobstructed state. This follows the principle that focusing vision improves sight, and turning attention inward improves hearing. For young adults with tinnitus and deafness caused by Phlegm-Fire, Guntan Wan (Rolling Phlegm Pill) is often effective because the bitter flavors of Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma), and Chenxiang (Aquilariae Lignum Resinatum) strongly direct Qi downward, while Mengshi (Calamina) shares a similar heavy-descending function with Magnetite.

Yu Zhen commented: *Danqian Xulu* records that Wang Wanli suffered from ear pain. Wei Wenjing attributed it to the Kan hexagram representing ear pain, caused by fear injuring the Kidney. His theory aligns closely with the above, but he used Qingyan (Natrii Chloridum), Lurong (Cervi Cornu Degelatinatum), Xionghuang (Realgar), and Fuzi (Aconiti Lateralis Radix Praeparata). The yin-yang properties of these drugs differ. Ultimately, differentiation must be based on the pulse.