人身有九窍。阳窍七。眼耳鼻口是也。阴窍二。前后二阴是也。阳气走上窍。而下入于阴位。则有溺
泄腹鸣之候。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
主闭藏。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。故能听之近不碍。而听远不无少碍。高年之体。大率类然。然较之聋病。一天一渊。聋病者。其窍中另
有一膜。遮蔽外气。不得内入。故以开窍为主。而方书所用石菖蒲麝香等药。及外填内攻等法者。皆
为此而设。至于高年。阴气不自收摄。越出上窍。此理从无一人会及。反以治少壮耳聋药。及发表散气药。
兼带阴虚为治。是以百无一效。不知阴气至上窍。亦隔一膜。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。为其内声所混。听之不清。若气稍不逆上。则听稍清。
气全不逆上。则听全清矣。不肖悟明此理。凡治高年逆上之气。屡有奇效。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
以收之。令阴气自旺于本宫。不上触于阳窍。繇是空旷无碍。耳之于声。似谷之受响。万籁之音。尚可细聆。
岂更与人声相拒。艰于远听耶。此实至理所在。但医术浅薄之辈。不能知之。试观
人之收视而视愈明。返听而听愈聪者。然后知昌之斯言。非臆说也。谨论。
附答岵翁公祖书 捧读祖台钧论。耳中根原甚悉。且考究方书。揣察仲景。即深于医旨者。不能道只字。
不肖昌竦然于金石之音。从兹倍加深入矣。庆幸庆幸。昨方论中。明知左耳有一
膜遮蔽。姑置未论。但论右耳。所以时清时混之故。在于阴气上触耳。盖人两肾之窍。虽开于耳。而肾气上入
耳际。亦为隔膜所蔽。不能越于耳外。止于耳根下。少则微鸣。多则大鸣。甚且将萦耳之筋。触之跳动。
直似撞穿耳叶之象者。然实必不可出也。设阴气能出耳外。而走阳窍。则阴阳相混。非三才之理矣。故耳
之用。妙在虚而能受也。外入之气。随大随小。至耳无碍。惟内触之气。 有声。所以外入之气。仅
通其半。若郁怒之火动。
内气转增。则外入之气转混。必内气渐走下窍。上窍复其虚而能受之体。然后清清朗朗。声入即通。无壅
碍也。方书指为少阳胆。厥阴肝。二经热多所致。是说左耳分部。然少阳之气。能走上窍。其穴皆络于脑巅。
无触筋中耳之理。不当与厥阴混同立说。其通圣散一方。汗下兼用。乃治壮火之法。丹溪所取。亦无
确见。惟滚痰丸一方。少壮用之。多有效者。则以大黄黄芩沉香之苦。最能下气。而礞石之重堕。大约与磁
石之用相仿也。不肖昌所以不用此方者。以其大损脾胃。且耗胸中氤氲之气耳。至于肾虚耳鸣。指作胱膀相
火上升。则阳火必能透出上窍。不为鸣也。尤见丹溪无据之谭。易言水中有火。原说真火。故坎中之
一点真阳。即真火也。年高之人。肾水已竭。真火易露。故肾中之气。易出难收。况有厥阴之水。为之挹取乎。
然则壮水之主。以制阳光。如盏中添油。而灯焰自小诚为良治。乃云作阴虚治不效者。知其泛论世人。不为
老人立法也。夫收摄肾气。原为老人之先务。岂丹溪明哲而为此等议论乎。不肖昌昨方论中欲返
祖台右耳十余年之聪。以仰答帝鉴。慰藉苍生耳。非为左耳数十年之锢论也。草野不恭。统惟亮宥。谨复。
胡卣臣先生曰。耳鸣之故。从来无人说透。此案方大开法门。
The human body has nine orifices. There are seven yang orifices, namely the eyes, ears, nose, and mouth; and two yin orifices, namely the anterior and posterior yin openings. Yang Qi (vital energy) travels to the upper yang orifices, and if it descends into the yin positions, symptoms such as urinary incontinence, diarrhea, or abdominal borborygmus (intestinal rumbling) will occur. Yin Qi travels to the lower yin orifices, and if it ascends into the upper yang positions, symptoms such as nasal obstruction and tinnitus (ringing in the ears) will occur. Therefore, after the age of fifty, Kidney Qi gradually declines in the lower body, often accompanying an upward reversal of Yang Qi. The orifice of the Kidney opens at the ears, and auditory acuity is governed by the Kidneys. The Kidneys govern closure and storage, desiring not to leak essence outward. Since Liver Wood is the child of Kidney Water, the dispersing function of the Liver draws out the Qi of its mother organ (the Kidneys) and scatters it outward. Thus, when fire from excessive planning or anger arises, Yin Qi reverses upward, causing blockage and turbidity in the ear orifices. Consequently, hearing near objects is unobstructed, but hearing distant objects is slightly impaired. This is generally the case for the elderly. However, this condition is vastly different from deafness; one is superficial, the other profound. In cases of deafness, there is another membrane inside the ear orifice that blocks external air/sound from entering, so treatment focuses on opening the orifices. Medicines such as Rhizoma Acori Tatarinowii (Shichangpu) and Moschus (Shexiang) used in formularies, as well as methods of external application and internal attack, are all designed for this purpose.
As for the elderly, it is because Yin Qi fails to self-restrain and control itself, overflowing and ascending to the upper yang orifices. This principle has never been fully understood by anyone. Instead, people use medicines for treating deafness in young and strong adults, along with medicines that release the exterior and dissipate Qi, combined with treatments for Yin deficiency, resulting in almost no efficacy. They do not realize that when Yin Qi reaches the upper orifices, it is also separated by a membrane and cannot exit the orifice externally; it merely stays within the orifice producing sound, like a frog drum or mosquito gong, blowing incessantly. Therefore, sounds entering from outside are mixed with internal noises, making hearing unclear. If the Qi does not reverse upward slightly, hearing becomes slightly clear; if the Qi does not reverse upward at all, hearing becomes completely clear. I comprehended this principle. Whenever I treat Qi reversal in the elderly, I have achieved remarkable effects. The main idea of the prescription relies entirely on Magnetitum (Cishi) as the principal herb, because its heaviness allows it to reach the lower body, its nature primarily directs downward attraction, and it can restrain the upward suction of Liver Wood. It is assisted by Yin-nourishing herbs such as Radix Rehmanniae Preparata (Dihuang) and Carapax et Plastrum Testudinis (Guijiao). Furthermore, sour herbs such as Fructus Schisandrae Chinensis (Wuweizi) and Fructus Corni Officinalis (Shanzhuyu) are used to astringe, causing Yin Qi to flourish in its home palace (Kidneys) without touching the upper yang orifices. Consequently, the ear orifice becomes open and unobstructed. The ear's reception of sound becomes like a valley receiving echoes; various subtle sounds can be carefully listened to. How could it resist human voices and struggle to hear distant sounds? This is indeed the ultimate truth, but those with shallow medical skills cannot understand it. Observe how people who retract their gaze see more clearly, and who turn their listening inward hear more keenly; then you will know that my words are not baseless speculations. Respectfully discussed.
Attached is the reply to Grandfather Huweng: Having read your esteemed discourse, the root causes of tinnitus are explained in great detail, and you have investigated medical formularies and speculated upon Zhang Zhongjing’s principles. Even those deeply versed in medical intent cannot utter a single word. Hearing your resonant voice like metal and stone, I stood in awe and redoubled my efforts to study deeply. How fortunate. In yesterday’s discussion on prescriptions, knowing that there was a membrane blocking the left ear, I temporarily set it aside, focusing only on discussing the right ear, where the reason for intermittent clarity and turbidity lies in Yin Qi contacting the ear. Generally, although the orifices of both Kidneys open at the ears, Kidney Qi ascending to the vicinity of the ears is also obscured by membranes and cannot pass outside the ears, stopping only below the root of the ear. Slightly, it produces faint ringing; largely, it produces loud ringing. It may even cause the tendons winding around the ear to twitch upon touch, appearing as if they might burst through the earlobe. However, in reality, it is impossible for them to exit. If Yin Qi could exit the ear and travel to the yang orifices, Yin and Yang would mix, violating the principles of Heaven, Earth, and Humanity. Therefore, the function of the ear lies in its subtlety and ability to receive. External Qi, whether large or small, enters the ear without hindrance. Only internally triggered Qi produces sound. Thus, external Qi only passes halfway. If fire from stagnation and anger activates, internal Qi increases, and external Qi becomes mixed. It is necessary for internal Qi to gradually descend to the lower orifices, allowing the upper orifices to regain their state of emptiness and receptivity. Then, clarity returns, sounds enter and flow freely without obstruction.
Medical formularies attribute tinnitus to excessive heat in the Shaoyang Gallbladder and Jueyin Liver meridians, specifically regarding the left ear distribution. However, Shaoyang Qi travels to the upper orifices, and its acupoints connect to the brain vertex; there is no mechanism for it to touch the tendons in the middle ear. It should not be conflated with the Jueyin meridian in theory. Fangfeng Tongsheng San combines sweating and purging methods, which is a treatment for vigorous fire, adopted by Zhu Danxi, yet lacks definitive insight. Only Gun Tan Wan is effective for young and strong individuals, primarily because the bitterness of Radix Rheomi Palmatae (Dahuang), Radix Scutellariae (Huangqin), and Lignum Aquilariae Resinatum (Chenxiang) best descends Qi, while the heavy descending nature of Calamitas Auripigmenti et Antimonii (Mengshi) is roughly similar to the use of Magnetitum (Cishi). I did not use this formula because it severely damages the Spleen and Stomach and depletes the ethereal Qi in the chest. Regarding tinnitus due to Kidney deficiency, attributing it to the ascent of Minister Fire from the Bladder implies that Yang Fire must penetrate the upper orifices and would not produce ringing. This further reveals that Zhu Danxi’s statements are unfounded. The I Ching states "fire within water," originally referring to True Fire. Thus, the single point of True Yang in Kan (Water) is True Fire. In elderly people, Kidney Water is exhausted, and True Fire easily emerges. Therefore, Qi in the Kidneys easily exits but is hard to retain, especially when drawn by Jueyin Water. Consequently, "strengthening the master of Water to control the sunlight" (nourishing Yin to suppress Yang), like adding oil to a lamp to make the flame smaller, is indeed an excellent treatment. To say that treating it as Yin deficiency is ineffective shows that he was speaking generally about ordinary people, not establishing laws specifically for the elderly. Gathering and restraining Kidney Qi is originally the primary task for the elderly. Could Zhu Danxi, a wise man, make such remarks? I, humble Chang, in yesterday’s prescription discussion, sought to restore your grandfather’s right ear hearing of over ten years to repay imperial scrutiny and comfort the common people, not to address the entrenched issue of the left ear lasting decades. As a rustic person, I am impolite; please forgive me. Respectfully replied.
Mr. Hu Youchen said: The causes of tinnitus have never been thoroughly explained by anyone. This case’s prescription opens a wide gate to understanding.