Library

The *Zhi Fa Gang* states: The ear is the orifice of the Kidney, governed by the Foot-Shaoyin (Kidney) meridian. Among the twelve meridians of the human body, except for the Foot-Taiyang (Bladder) and Hand-Jueyin (Pericardium), the remaining ten meridians all enter the ear. Therefore, in treating ear diseases, priority is given to regulating the Kidney. Some may ask: The Heart also opens into the ear; why is this so? Originally, the orifice of the Heart is located in the tongue. Because the tongue has no perforation, it is attached to the ear. Here, the Kidney is the host, and the Heart is the guest. The five Zang organs open into five regions of the head and face. Speaking from the perspective of Yin and Yang: The Kidney and Liver reside in the lower Jiao (Yin region); thus, the ears and eyes, two orifices, are governed by Yin Essence. The Heart, Spleen, and Lung reside in the upper Jiao (Yang region); thus, the mouth, nose, and tongue, three orifices, are governed by Yang Essence.

The *Ling Shu* says: Kidney Qi connects with the ear. When Kidney Qi is harmonious, one can hear the five tones. If the five Zang organs are not in harmony, the nine orifices will be blocked. Therefore, whenever there is an invasion of Deficiency or Excess Qi from any single meridian or collateral into the ear, it is sufficient to disturb one's auditory acuity and lead to deafness. This refers to acute onset conditions.

As for chronic deafness, there are also differences between Deficiency and Excess in the Kidneys. The Left Kidney belongs to Yin and governs Essence; the Right Kidney belongs to Yang and governs Qi. If Essence is insufficient and Qi is excessive (hyperactive), deafness occurs, which is a Deficiency pattern. If a person is thin, has a dark complexion, but strong bones and sinews, this indicates that both Essence and Qi are abundant, leading to blockage due to excessive retention. Such deafness is an Excess pattern and is actually a sign of longevity. Neither of these two cases requires treatment.

There is also sudden deafness. The classics state: Not knowing the way of harmonizing "Seven Damages and Eight Benefits" is the key to premature aging. If one is under fifty years old, feels heavy-bodied, and has dull hearing and vision, and presents with deafness and blackening of the cheeks, this indicates depletion of Essence and exhaustion of Spirit. One should select and use An Shen Wan (Kidney-Anchoring Pill), Ba Wei Wan (Eight-Ingredient Pill), Cong Rong Wan (Cistanche Pill), or Shu Yu Wan (Dioscorea Pill). If there is Empty Heat in the Kidney Meridian, manifesting as red face, dry mouth, profuse phlegm, and internal heat, Liu Wei Wan (Six-Ingredient Pill) is the primary treatment. This discusses deafness caused by Yin Deficiency.

Regarding deafness caused by Yang Deficiency, the classics state: Clear Yang emerges from the upper orifices. Stomach Qi is clear Qi, Yuan Qi, and Spring-rising Qi. Nowadays, people suffer from irregular diet and overwork, causing Spleen and Stomach Qi to become deficient. It fails to ascend and instead flows downward into the Liver and Kidney. Thus, Yang Qi becomes blocked, turbid Yin rises to obscure clarity, pathogenic factors harm the orifices, and one suffers from unclear hearing and vision. This is deafness due to Yang Deficiency, requiring Dongyuan's Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) as the main treatment. If one does not practice self-restraint and increases daily fatigue, it will develop into chronic deafness.

There is also deafness caused by external pathogens taking advantage of deficiency, such as when Shaoyang disease pathogens enter the Shaoyang channel.

For ear pain, tinnitus, ear itching, otorrhea (pus discharge), and otodermatitis (ear sores), treatment should differentiate Cold, Heat, Deficiency, and Excess based on the proper orifice of the Foot-Shaoyin (Kidney) meridian. One must not treat them solely as Fire pathogens or external pathogens.

If tinnitus decreases or stops when pressed with the hand, it is Deficiency; if it worsens when pressed, it is Excess. Wang Jiezhai said: Tinnitus sounding loud like cicadas, occurring on either side or intermittently blocking the ear, is often treated by laypeople as Kidney Deficiency without effect. They fail to realize this is Phlegm-Fire ascending and stagnating in the ear, causing ringing, and severe blockage. If the person usually drinks alcohol and eats rich flavors, having Phlegm-Fire in the Upper Jiao, treatment should focus on clearing Phlegm and reducing Fire. Generally, this condition first involves Phlegm-Fire in the upper part, triggered by anger. Anger causes Qi to rise, and Shaoyang Fire lodges in the ear. If tinnitus is due to Kidney Deficiency, the sound is not intense, and the person likely has excessive sexual activity, presenting with signs of consumptive weakness.

Only Xue Lizhai distinguished these clearly. He stated: For Blood Deficiency with Fire, use Si Wu Tang (Four-Substance Decoction) plus Gardenia (Shan Zhi) and Bupleurum (Chai Hu). For Middle Qi Deficiency, use Bu Zhong Yi Qi Tang. For combined Qi and Blood Deficiency, use Ba Zhen Tang (Eight-Treasure Decoction) plus Chai Hu. If deafness or tinnitus occurs upon anger, it belongs to Excess Qi in the Liver and Gallbladder meridians; use Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Chuanxiong (Xiong), Angelica Sinensis (Gui), and Shan Zhi. For Qi Deficiency, use Bu Zhong Yi Qi Tang plus Chai Hu and Shan Zhi. If symptoms worsen in the afternoon, it is Yin-Blood Deficiency; use Si Wu Tang plus Atractylodes (Bai Zhu) and Poria (Fu Ling). If Kidney Deficiency with Fire stirring, or profuse phlegm with thirst, Di Huang Wan (Rehmannia Pill) is essential.

Buzzing in the ears indicates lack of Yin. In cases of fluid depletion, brain marrow diminishes, calves atrophy, and ears ring frequently; Di Huang Wan is suitable. For Kidney Deficiency causing continuous如潮 (tidal) sounds in the ears, interfering with hearing, one should descend Qi and tonify the Kidney, swallowing Zheng Yuan Yin with Hei Xi Dan (Black Tin Pill), and intermittently administering An Shen Wan. For Wind affecting the Kidneys, causing tinnitus that sounds like war drums or night watches while sleeping at night, accompanied by limb spasms and pain, and strange itching in the ears as if wind is blowing, a pill containing Huang Bo (Phellodendron) is indicated. The Kidney is where the Zong Mai (Gathering Vessels) converge, and the ear is its orifice. When blood and Qi do not circulate, the Zong Mai become deficient, allowing Wind pathogens to enter the ear along the vessels. Wind fighting with healthy Qi causes tinnitus. First, use Sheng Liao Wu Ling San (Raw Material Five-Ling Powder) with processed Zhi Zhi Qiao, Ju Hong, Perilla (Zi Su), and fresh Ginger decocted together, swallowing Qing Mu Xiang Wan (Blue Musk Wood Pill) to disperse pathogens and direct Qi downward. Subsequently, use Xiong Gui Yin (Chuanxiong and Angelica Drink) to harmonize and nourish.

For cerumen (earwax), tinnitus, and deafness caused by dirty blood inside, Chai Hu Cong Er Tang (Bupleurum Ear-Auditing Decoction) is suitable. The *Sheng Hui Fang* states: There was a person whose ears itched once a day, which was terrifying; picking until bleeding provided slight relief. This was due to Kidney Deficiency causing floating toxicity to attack upward, difficult to treat with standard methods; Tou Bing Dan (Ice-Penetrating Pill) is suitable. Avoid alcohol, damp noodles, chicken, and pork. Adherence for one month is ideal; failure to abstain renders treatment ineffective.

Sores inside the ear occur because the Foot-Shaoyin (Kidney) meridian is deficient, allowing Wind pathogens to enter along the vessels and fight with Qi, causing sores at the ear gate. Zeng Qing San (Malachite Powder) is the main treatment; Huang Lian San (Coptis Powder) is also acceptable, with internal administration of Niu Bang Zi Tang (Burdock Seed Decoction). Generally, ear sores belong to the Shaoyang Sanjiao (Triple Burner) meridian or the Foot-Jueyin (Liver) meridian, caused by Blood Deficiency with Wind-Heat, sudden Liver Fire-Wind-Heat, or Kidney Wind-Fire. If fever and pain occur, belonging to Shaoyang and Jueyin Wind-Heat, use Chai Hu Shan Zhi San (Bupleurum and Gardenia Powder). If internal heat causes itching and pain, belonging to Blood Deficiency in these two meridians, use Dang Gui Chuan Xiong San (Angelica and Chuanxiong Powder). If alternating chills and fever cause pain, belonging to Liver Wind-Heat, use Xiao Chai Hu Tang plus Shan Zhi and Chuanxiong. If internal heat and dry mouth occur, belonging to Kidney Empty Heat, use Jia Wei Di Huang Wan (Modified Rehmannia Pill); if ineffective, use Jia Wei Ba Wei Wan (Modified Eight-Ingredient Pill).

Otorrhea (ear pus), known as Er Gan (Ear Fungus), is treated with Hong Mian San (Red Cotton Powder) and She Xiang San (Musk Powder), internally with Chai Hu Cong Er Tang and Tong Qi San. For robust individuals with accumulated Heat attacking upward and persistent pus, Hong Mian San and She Xiang San should not be too astringent; San Huang San (Three-Yellow Powder) is suitable.

If an insect enters the ear causing pain, rub ginger on a cat's nose to induce urination. Drip the urine into the ear to expel the insect. Using sesame oil kills the insect but makes expulsion difficult. Alternatively, using fried sesame seeds as a pillow can expel the insect, though not as quickly as cat urine.

A child suffered from otorrhea for a year with no effect from medication; this was Kidney Deficiency. Treating with Liu Wei Di Huang Wan plus Sang Piao Xiao (Mantis Egg Case) resulted in immediate recovery.

Yu Jiayan said: The human body has nine orifices. The seven Yang orifices are the eyes, ears, mouth, and nose; the two Yin orifices are the anterior and posterior openings. Yang Qi travels to the upper orifices; if it descends into the Yin positions, it causes lower leakage and abdominal borborygmus. Yin Qi travels to the lower orifices; if it ascends into the Yang positions, it causes blockage and tinnitus. Therefore, after age fifty, Kidney Qi gradually declines below and often rebels upward from Yang. The Kidney governs closure and storage, desiring not to leak. Since the Liver (Wood) is the son of the Kidney (Water), it drains the mother's Qi and scatters it outward. Thus, when fire from frustration and anger moves, Yin Qi rebels upward, blocking the ear orifices. This is typical of elderly bodies. However, this differs vastly from Deafness. In deafness, a membrane within the orifice blocks external Qi from entering, so treatment focuses on opening the orifices. Medicines like Shi Chang Pu (Acorus) and She Xiang (Musk), and internal/external therapies, are designed for this. No one has discussed the mechanism of Elderly Yin Qi failing to contain itself and escaping to the upper orifices. Ignorance dictates that Yin Qi reaching the upper orifices is also separated by a membrane, unable to escape outside, but resonates within like frog drums or gongs, continuously blowing, mixing with external sounds and causing unclear hearing. If Qi does not rebel upward slightly, hearing clears slightly; if Qi does not rebel upward at all, hearing clears completely. Having comprehended this principle, I have repeatedly achieved miraculous results treating rebellious Qi in the elderly. The main strategy relies entirely on Ci Shi (Magnetite), because its heaviness reaches downward, its nature draws down, and it controls the Liver Wood's upward suction. It is assisted by Yin herbs like Di Huang (Rehmannia) and Gui Jiao (Turtle Shell Glue), and astringed with Sour herbs like Wu Wei Zi (Schisandra) and Shan Zhu Yu (Cornus), making Yin Qi prosperous in its home palace, preventing contact with Yang orifices, allowing sound entry without obstruction. Medical texts attribute this to excess Heat in the Shaoyang Gallbladder and Jueyin Liver meridians, specifically discussing the left ear distribution. However, Shaoyang Qi ascends to the upper orifices, its acupoints connect to the brain vertex, and there is no logic of tendons touching the ear; thus, it should not be conflated with Jueyin. Feng Tong Sheng San (Wind-Blocking Holy Powder) uses both sweating and purging methods, a technique for Strong Fire. Zhu Danxi's endorsement lacks solid basis. Only Gun Tan Wan (Rolling Phlegm Pill) is effective for the young and strong, due to the bitter properties of Da Huang (Rhubarb), Huang Qin (Scutellaria), and Chen Xiang (Aquilaria) descending Qi, and the heavy sinking property of Meng Shi (Flint Stone), which roughly mimics Magnetite. However, it severely damages the Spleen and Stomach and depletes the vital Qi in the chest. Regarding tinnitus due to Kidney Deficiency, attributing it to Bladder Ministerial Fire ascending implies Yang Fire would penetrate the upper orifices and not ring; this further reveals Danxi's baseless talk. In the elderly, Kidney Water is exhausted, True Fire easily appears, so Kidney Qi is easy to lose and hard to retain, especially with the Jueyin Son drawing it out! Therefore, strengthening Water to control Sunlight (Fire), like adding oil to a lamp to dim the flame, is indeed excellent treatment. Yet claiming treatment for Kidney Deficiency is ineffective—does this establish laws for the elderly? Securing Kidney Qi is the priority for the elderly; how could someone as wise as Danxi make such remarks?