耳衄上焦血热成，鲜血时流耳窍中，肝火柴胡清肝治，胃热生地麦门冬。
【注】此证由上焦血热所致，耳窍中时流鲜血。若肝脉弦数者，以柴胡清肝汤服之；肾
脉虚数者，以生地麦冬饮主之。总以凉血为急，乃抽薪止沸之法也。外以神塞丸塞之即瘥。
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生地麦冬饮
生地黄 麦冬（去心，各五钱）
水二钟，煎八分，食后服。
【方歌】生地麦冬耳衄鲜，上焦血热是其原，各用五钱煎食后，清肺降火保平安。
神塞丸
麝香（一分） 生白矾（一钱） 沉香（三分） 糯米（五十粒）
共研细末，面糊为丸，如梧桐子大。每丸薄绵裹之，如左耳出血塞右鼻，右耳出血
塞左鼻；左鼻出血塞右耳，右鼻出血塞左耳；两耳俱出血塞两鼻，两鼻俱出血塞两耳。
【方歌】神塞麝香生白矾，沉糯同研面糊丸，大如梧子薄绵裹，塞入耳鼻衄血痊。
柴胡清肝汤（见头部鬓疽）
耳痔蕈挺耳窍生，肝肾胃火凝结成，微肿闷疼皮损破，塞久令人必重听。
【注】此三证皆生耳内，耳痔形如樱桃，亦有形如羊奶者；耳蕈形类初生蘑菇，头大
蒂小；耳挺形若枣核，细条而长，努出耳外。俱由肝经怒火、肾经相火、胃经积火凝结而
成。微肿闷疼，色红皮破，不当触犯偶犯之，
痛引脑巅。皆宜服栀子清肝汤，外用 砂散点之，渐渐消化。
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栀子清肝汤
栀子（生研） 川芎 当归 柴胡 白芍（酒炒） 丹皮（各一钱） 甘草（生，五分） 石膏（ ）
牛蒡子（炒，研，各一钱） 黄芩 黄连（各五分）
水二钟，煎八分，食后服。
【方歌】栀子清肝蕈痔挺，肾肝胃火忿怒成，芎归柴芍丹皮草，膏蒡芩连用有功。
砂散
砂（一钱） 轻粉 雄黄（各三分） 冰片（五厘）
共研细末，水调浓，有谷草细梗咬毛，蘸点痔上。
【方歌】 砂散实有奇功，痔蕈挺在耳内生，轻片雄黄研为末，水调点痔消缩形。
Auricular Hemorrhage (bleeding from the ear canal) is caused by blood heat in the Upper Jiao, with fresh blood intermittently flowing from the ear orifice. If due to Liver Fire excess with a wiry and rapid pulse, Chaihu Qinggan Tang (Bupleurum Decoction to Clear the Liver) should be administered; if due to Stomach Heat or Kidney Yin deficiency with empty-heat, Shengdi Maidong Yin (Rehmannia and Ophiopogon Drink) is the primary formula. The general principle is to prioritize cooling the blood, which is a method of "removing the firewood to stop the boiling water." Externally, Shen Sai Wan (Divine Plug Pill) applied locally will lead to recovery.
[Image: Diagram of Six Ear Conditions]
Shengdi Maidong Yin
Shu Di Huang (Prepared Rehmanniae Radix) [Note: Text says Sheng Di Huang, so use Raw Rehmanniae Radix], Mai Dong (Ophiopogonis Radix, heart removed, each 5 qian)
Use two zhong of water, decoct until reduced to eight fen, take after meals.
[Poem] Shengdi and Maidong treat auricular hemorrhage with bright red blood, the root cause is blood heat in the Upper Jiao; decoct five qian of each and take after meals, clearing Lung heat and descending fire to ensure peace and safety.
Shen Sai Wan
She Xiang (Musk, 1 fen) Bai Fan (Alumen, raw, 1 qian) Chen Xiang (Aquilariae Lignum Resinatum, 3 fen) Nuo Mi (Glutinous Rice, 50 grains)
Grind all into fine powder, bind with wheat paste to form pills the size of Sophora japonica seeds. Wrap each pill in thin cotton. For left ear bleeding, plug the right nostril; for right ear bleeding, plug the left nostril; for left nostril bleeding, plug the left ear; for right nostril bleeding, plug the right ear; for both ears bleeding, plug both nostrils; for both nostrils bleeding, plug both ears.
[Poem] Shen Sai contains Musk and raw Alumen, Agarwood and Glutinous Rice ground together and bound with paste into pills; large as Sophora seeds wrapped in thin cotton, plugged into nose or ear to cure hemorrhage.
Chaihu Qinggan Tang (See section on Temporal Furuncle)
Ear Polyp (Er Zhi), Ear Mushroom (Er Xun), and Ear Projection (Er Ting) arise in the ear orifice, formed by the condensation of Fire in the Liver, Kidney, and Stomach channels. There is slight swelling, stifling pain, and skin breakdown; prolonged obstruction inevitably leads to deafness.
[Note] These three conditions all occur inside the ear. Er Zhi resembles a cherry, or sometimes a goat's teat; Er Xun resembles a newly sprouted mushroom, with a large cap and small stalk; Er Ting resembles a jujube pit, slender and long, protruding outside the ear. All are caused by the condensation of Anger-Fire in the Liver channel, Ministerial-Fire in the Kidney channel, and Accumulated-Fire in the Stomach channel. Symptoms include slight swelling, stifling pain, redness, and broken skin. Do not touch them; accidental contact causes pain radiating to the vertex. All cases should be treated internally with Zhizi Qinggan Tang (Gardenia Decoction to Clear the Liver) and externally with Jiuyi San (Nine-to-One Powder) applied topically to gradually resolve the lesions.
[Image: Diagram of Six Ear Conditions]
Zhizi Qinggan Tang
Zhi Zi (Gardeniae Fructus, raw and ground) Chuan Xiong (Ligustici Chuanxiong Rhizoma) Dang Gui (Angelicae Sinensis Radix) Chai Hu (Bupleuri Radix) Bai Shao (Paeoniae Radix Alba, wine-fried) Mu Dan Pi (Moutan Cortex, each 1 qian) Gan Cao (Licorice Root, raw, 5 fen) Shi Gao (Gypsum Fibrosum, dosage unspecified in text) Niu Bang Zi (Arctii Fructus, stir-fried and ground, 1 qian) Huang Qin (Scutellariae Radix) Huang Lian (Coptidis Rhizoma, each 5 fen)
Use two zhong of water, decoct until reduced to eight fen, take after meals.
[Poem] Zhizi Qinggan treats mushrooms, polyps, and projections; caused by Liver, Kidney, and Stomach Fire from anger. Chuanxiong, Danggui, Chaihu, Baishao, Mudanpi, and Licorice; plus Gypsum, Niubangzi, Huangqin, and Huanglian, all contribute merit.
Jiuyi San
Duan Shi Gao (Calcined Gypsum Fibrosum, 1 qian) Qing Fen (Calomelas, 3 fen) Xiong Huang (Realgar, 3 fen) Bing Pian (Borneolum Syntheticum, 5 li)
Grind all into fine powder, mix with thick water solution. Use a fine grass stem tip dipped in the powder to apply topically onto the polyp.
[Poem] Jiuyi San truly has miraculous efficacy; for polyps, mushrooms, and projections growing in the ear. Calomelas, Borneol, and Realgar ground into powder, mixed with water to apply topically to reduce swelling and eliminate shape.