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General Principles: The five types of purulent otorrhea arise from the Kidney, formed by the accumulation and upward steaming of Fire-Heat. Deafness and tinnitus are also caused by Yin deficiency leading to the ascent of deficient Fire.

Pulse Diagnosis: A surging and rapid pulse at the Left Cun position indicates Heart Fire flaming upward; a surging and rapid pulse at both Chi positions indicates Ministerial Fire flaming upward.

The *Neijing* states: "The Kidney is the official of strength and vigor, from which skills and techniques emerge." It further states: "The ears are the external manifestation of the Kidney," and another saying goes that the Kidney communicates with the ears through orifices. The ear is the gathering place of numerous meridians and the pathway for Kidney Qi. In children, excessive Kidney Qi combined with Heat rushing upward to the ears causes fluids to stagnate and accumulate, resulting in pus formation. There are five specific types: discharge of yellow pus is called *Ding Er* (Earwax/Discharge); discharge of red pus is called *Nong Er* (Pus Ear); dryness with foul odor inside the ear is called *Hu Er*; discharge of white pus is called *Chan Er*; internal emptiness with ringing and discharge of greenish pus is called *Nang Er*. Although there are five disease manifestations, their source is one. Some result from Wind-Water invading the ear with internal accumulated Heat blocking upwards. If not treated promptly, it may lead to deafness over time. Administer *Man Jing Zi San* internally and apply external medicaments.

For all cases of deafness and tinnitus, they belong to Heat patterns caused by Yin deficiency and Fire agitation. Treatment should involve draining the Fire of the South (Heart) and tonifying the Water of the North (Kidney), ensuring stability. Qian Yi stated: "The Kidney has only tonification methods, no purgation methods," which holds profound significance.

[Attached Formulas]
*Man Jing Zi San*: Shengma (*Cimicifugae Rhizoma*), Mutong (*Akebiae Caulis*), Chishao (*Paeoniae Radix Rubra*), Sangpi (*Mori Cortex*), Shengdi (*Rehmanniae Radix*), Maidong (*Ophiopogonis Radix*), Qianhu (*Peucedani Radix*), Ganju (*Chrysanthemi Flos*), Chifuling (*Poria cum Lignum*, reddish part), Manjingzi (*Viticis Fructus*), Gancao (*Glycyrrhizae Radix et Rhizoma*).
Huang Long San (External Application): Fan (Alumen), Longgu Mo (Fossilized Bones Powder), Huangdan (Minium, fried, 5 qian each), Shexiang (Moschus, one spoon).

General Principles: The Nose belongs to the Lung, possessing a very pure nature. Nasal congestion is caused by Wind-Heat invasion. Sudden obstruction with heavy voice results from external contraction of Wind-Cold.

Pulse Diagnosis: A floating, surging, and rapid pulse at the Right Cun indicates Epistaxis (Nosebleed); a floating and moderate pulse at the Left Cun indicates Wind Injury with nasal congestion and clear rhinorrhea.

The *Neijing* states: "The color White of the West enters into communication with the Lung, opening into the nose." It also states: "The nose is the external manifestation of the Lung." Zhu Danxi said: "As an organ, the Lung is high in position, fragile in constitution, and dislikes both Cold and Heat." Therefore, pediatric nasal congestion occurs because Lung Qi communicates with the nose, and Qi is Yang. If Qi is affected by Wind-Cold and stagnates in the nasal cavity, congestion results. Due to Cold Qi failing to retain fluids, there is excessive runny nose. If cold wind persists, thick mucus accumulates, causing loss of smell, known as *Bi Yuan* (Nasal Sinusitis/Polyps). If mixed with Heat, the nose becomes dry, hindering feeding. For newborn infants, on days such as the third, fifth, sixth, or lunar month-end, sudden nasal congestion preventing mouth-opening for breastfeeding often occurs when the nurse falls asleep and exhales breath onto the infant's fontanelle, or due to inconsistent water temperature during bathing, causing Qi blockage and pathogenic Qi invasion, leading to nasal congestion.

Jie Zhai stated: "Nasal congestion with loss of smell, occurring mainly in cold months or triggered slightly by Wind-Cold, recurring frequently, is commonly mistaken by laypeople as Lung Cold, treated with acrid-warm formulas for releasing the exterior and promoting circulation. When ineffective, it is unknown that this is due to latent Fire pathogens and Fire depression in the Lung Meridian. Severe cases prefer heat and dislike cold, hence congestion upon cold exposure and flare-ups upon pathogen contact. The treatment principle focuses on clearing Metal and descending Fire, assisted by agents that unblock Qi. For chronic cases of congestion and anosmia, review if it was previously treated solely as Lung Heat; use formulas to clear Metal, descend Fire, and resolve phlegm, either as pills to be held in the mouth or fine powders taken gently and slowly, yielding effective results. For acute cases without prior history, triggered by Wind-Cold causing obstruction, heavy voice, or clear rhinorrhea, treat naturally as Wind-Cold."

*Nasal Sores* are caused by obstructive Heat injuring the Lung. The Lung governs Qi and communicates with the nose. Wind-Damp pathogens invade the skin and hair follicles due to deficiency, entering the blood vessels. This results in moist, itchy, and ulcerated sores on both sides below the nose, named *Bi Gan* (Nasal Miasma/Gangrene). The sores are painless, and fluid discharge creates new sores. Administer *Ze Xie San* internally and apply *Qing Jin San* externally. Another method uses Bear Gallbladder (*Xiong Dan*) soaked in water, applied with a new small brush into the nose.

[Attached Formulas]
*Kai Guan San*: Xiangfu (*Cyperi Rhizoma*), Chuanxiong (*Ligustici Chuanxiong Rhizoma*), Jingjie (*Schizonepetae Spica*), Jiangcan (*Bombyx Batryticatus*), Xixin (*Asari Radix et Rhizoma*), Ya zao (*Gleditsiae Sinensis Spina*, fruit horn), powdered. Scallion white (*Cong Bai*) pounded into paste, spread on red-and-white silk, applied to the fontanelle at night.
*Chuanxiong Gao*: Chuanxiong, Xixin, Ben (*Ligustici Wallichii Rhizoma*), Baizhi (*Angelicae Dahuricae Radix*), Xingren (*Armeniacae Semen Amarum*), Shexiang, Gancao.
*Niu Huang Xi Jiao San*: Niu Huang (*Calculus Bovis*), Xi Jiao (*Rhinocerotis Cornu*), Chuanxiong, Shengma, Xixin, Mahuang (*Ephedrae Herba*), Zhusha (*Cinnabaris*), Bingpian (*Borneolum Syntheticum*), Shexiang, Gancao, honey-pilled.
*Ze Xie San*: Ze Xie (*Alismatis Rhizoma*), Yujin (*Curcumae Radix*), Zhizi (*Gardeniae Fructus*), Gancao.
*Qing Jin San*: Tongqing (*Viridissimi Cupri Acetati Crystallis*), Sheng Liuhuang (Sulfur, raw, 1 qian each). Alternative formula uses Sheng Baifan (Alumen, raw) omitting Sulfur.