巢元方曰。耳者。宗脉之所聚。肾气之所通。小儿肾脏盛而有热者。热气上冲于耳。津液壅结。即生脓汁。亦有因
沐浴水入耳内。水湿停积。搏于血气。蕴结成热。亦令脓汁出。皆谓之 耳。日久不瘥。即变成聋也。红蓝花散。
刘完素曰。耳者心肾之窍。肝胆之经也。心肾主内症。若其人精血不足也。肝胆主外症。若其人风热有余也。或聋
聩。细辛膏。或虚鸣者。通鸣散。禀赋虚也。总治六味地黄丸。或胀痛。菖附散。或脓痒者。菖乌散。邪气客也。总治
柴胡清肝汤。若因肾肝疳热。六味丸、芦荟丸、并用。若因热积内热。四味肥儿丸。若因脾经郁热。加味归脾汤。若因
肝经怒火。加味逍遥散。若因乳食膏粱积热。加味清胃散。其药皆令乳母小儿同服。不可 于治外。不惟闭塞耳窍。
且恐变生他症。延留日久。遂成终身聋聩。盖外治方。只可治腑症之轻者。若系肝经风热血燥元虚等症。必根据前方论内。
服各宜之药。或外治以收脓湿亦可。
薛己曰。目者。白睛属肺。黑睛属肝。瞳人属肾。上下胞属脾。两 属心。内 又属膀胱。五脏五色。各有所司。
心主赤。赤甚。心实热也。导赤散。赤微。心虚热也。生犀散。肝主青。青甚。肝热也。泻青丸。淡青。肝虚也。地黄
丸。脾主黄。黄甚。脾热也。泻黄散。淡黄。脾虚也。异功散。目无精光。及白睛多。黑睛少者。肝肾俱不足也。地黄
丸加鹿茸。
昼明夜暗者。阳气衰弱也。冲和养胃汤。凡赤脉翳膜从上而下者。属足太阳。东垣选奇汤。从下而上者。属足阳明。局
方流气饮。盖翳膜者。风热内蕴也。邪气未定。谓之热翳。邪气已定。谓之冰翳。而沉于内。邪气既升。谓之陷翳。宜
用升发。佐以退翳药。上眼皮下出黑白翳者。属太阳寒水。从外至内者。属少阳风热。从下至上绿色者。属足阳明及肺
肾合病也。疳眼者。因肝火湿热上冲。脾气有亏。不能上升清气。故生白翳。睫闭不开。眵泪如糊。久而脓流。遂至损
目。宜益气聪明汤、茯苓泻湿汤、及四味肥儿丸。目闭不开者。因乳食失节。或过服寒凉。使阳气下陷。不能升举也。
柴胡复生汤。若胃气亏损。眼睛少力而不能开。补中益气汤。暴赤肿痛。肝火炽盛也。龙胆泻肝汤。多泪羞明。心肝积
热也。生犀散。风沿烂眼者。肠有积热也。清胃散。时时作痒者。脓溃生虫也。用点药紫苏膏。眼睫连札者。肝经风热
也。柴胡清肝汤。若生下目黄壮热。二便秘。不乳。面赤眼闭。在胎时。感母热毒也。儿服泻黄散。母服地黄丸。若肢
体面目爪甲皆黄。小便如屋尘色者。难治。又有痘疹后余毒未尽。上侵于目者。肾肝虚也。滋阴肾气丸。前症皆当审治
于母。兼调其儿。其外障。宜保命羚羊角散、龙胆饮子。其内障。宜泻肝黄连汤、局方菊睛丸。雀盲。宜复明散。通睛。
宜汤氏牛黄丸。眼白多。宜山茱萸丸。
Chao Yuanfang stated: The ear is the gathering point of numerous meridians and the passage through which Kidney Qi communicates. In children, if the Kidney function is vigorous accompanied by heat pathogen, the heat qi rushes upward to the ear, causing body fluids to stagnate and accumulate, thereby generating pus. There are also cases where water enters the ear during bathing; the retained water-dampness interacts with blood and Qi, brewing into heat, which similarly causes pus discharge. All these are referred to as *Er Gan* (Ear Fungus/Suppuration). If not cured for a long time, it may develop into deafness. Honglanhua San (Safflower Powder) can be used.
Liu Wansu stated: The ear is the orifice of the Heart and Kidney and belongs to the Gallbladder and Liver meridians. The Heart and Kidney primarily govern internal conditions; if a person lacks essence and blood, it falls into this category. The Gallbladder and Liver primarily govern external conditions; if there is excess wind-heat, it falls into this category. For deafness or hearing loss, Xixin Gao (Asarum Ointment) is used. For tinnitus due to deficiency, Tongming San (Tinnitus-Relieving Powder) is used, caused by congenital weakness; the general treatment is Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). For distending pain, Changfu San (Acorus and Aconite Powder) is used. For pus discharge with itching, Changwu San (Acorus and Black Plum Powder) is used, caused by pathogenic factors lodging; the general treatment is Chaihu Qinggan Tang (Bupleurum Liver-Clearing Decoction). If caused by Kidney and Liver *Gan* heat, Liuwei Dihuang Wan and Lushui Wan (Aloe Pill) are used together. If caused by heat accumulation leading to internal heat, Simei Fei'er Wan (Four-Ingredient Stomach-Nourishing Pill) is used. If caused by stagnant heat in the Spleen meridian, Jiawei Guipi Tang (Modified Spleen-Invigorating Decoction) is used. If caused by anger-fire in the Liver meridian, Jiawei Xiaoyao San (Modified Free Wanderer Powder) is used. If caused by accumulated heat from rich foods and milk, Jiawei Qingwei San (Modified Stomach-Clearing Powder) is used. These medicines should be taken simultaneously by both the nursing mother and the infant. Treatment should not be limited to the external ear. Otherwise, not only will the ear orifice become blocked, but other symptoms may arise. Prolonged delay may result in lifelong deafness. Generally, external treatments are only suitable for mild Fu-organ conditions. For conditions such as Liver meridian wind-heat, blood dryness, and primary deficiency, one must follow the previous discussions to take appropriate internal medications, or combine external treatment to absorb dampness and pus.
Xue Ji stated: In the eye, the white sclera belongs to the Lung, the black iris belongs to the Liver, the pupil belongs to the Kidney, the upper and lower eyelids belong to the Spleen, the two canthi (corners of the eyes) belong to the Heart, and the inner canthus also belongs to the Bladder. The five Zang organs correspond to five colors, each having its specific domain. The Heart governs red; deep red indicates Heart Excess Heat, treated with Daochi San (Guide Out Red Powder); slight red indicates Heart Deficiency Heat, treated with Shengxi San (Fresh Rhinoceros Horn Powder). The Liver governs green; deep green indicates Liver Heat, treated with Xieqing Wan (Draining Green Pill); pale green indicates Liver Deficiency, treated with Dihuang Wan (Rehmannia Pill). The Spleen governs yellow; deep yellow indicates Spleen Heat, treated with Xiehuang San (Draining Yellow Powder); pale yellow indicates Spleen Deficiency, treated with Yigong San (Yi-Gong Powder). If the eyes lack luster, or if the sclera is prominent while the iris is small, it indicates insufficiency of both Liver and Kidney, treated with Dihuang Wan plus Lu Rong (Deer Antler). Clarity during the day and darkness at night indicates weak Yang Qi, treated with Chonghe Yangwei Tang (Harmonizing Stomach-Nourishing Decoction). Red vessels and pterygium descending from top to bottom belong to the Foot-Taiyang meridian, treated with Dongyuan Xuanqi Tang (Dongyuan's Selective Marvel Decoction); ascending from bottom to top belong to the Foot-Yangming meridian, treated with Jufang Liuqi Yin (Formula Bureau's Flowing-Qi Decoction). Generally, pterygia are caused by internally accumulated wind-heat. When the pathogen is unsettled, it is called Re Yi (Heat Pterygium); when settled, it is called Bing Yi (Ice Pterygium), sinking internally; when rising, it is called Xian Yi (Sunken Pterygium), requiring uplifting methods assisted by pterygium-resolving herbs. Black and white pterygia appearing under the upper eyelid belong to Taiyang Cold-Water; moving from outside to inside belong to Shaoyang Wind-Heat; green color moving from bottom to top belongs to the combined disease of Foot-Yangming, Lung, and Kidney. Gan Eye (Fungus Eye) is caused by Liver fire and damp-heat rushing upward, with Spleen Qi deficiency failing to ascend clear Qi, thus generating white pterygium, closed eyelids, sticky discharge like paste, eventually leading to pus flow and eye damage. Yiqi Congming Tang (Qi-Replenishing Brightening Decoction), Fuling Xieshi Tang (Poria Draining-Dampness Decoction), and Simei Fei'er Wan are indicated. Closed eyes due to irregular diet or excessive intake of cold-cooling drugs causing Yang Qi to sink and fail to rise are treated with Chaihu Fusheng Tang (Bupleurum Reviving-Decoction). Weak stomach Qi causing inability to open eyes due to lack of strength is treated with Buzhong Yiqi Tang (Middle-Boosting Qi-Replenishing Decoction). Sudden redness, swelling, and pain indicate blazing Liver Fire, treated with Longdan Xiegan Tang (Gentian Liver-Draining Decoction). Excessive tearing and photophobia indicate accumulated heat in Heart and Liver, treated with Shengxi San. Marginal blepharitis indicates intestinal accumulated heat, treated with Qingwei San. Intermittent itching indicates pus ulceration with parasites, treated with Zisu Gao (Perilla Ointment) applied externally. Eyelids adhering tightly indicate Liver meridian wind-heat, treated with Chaihu Qinggan Tang. Jaundice, high fever, constipation, anorexia, red face, and closed eyes present at birth indicate maternal heat-toxin infection during gestation; the infant takes Xiehuang San, and the mother takes Dihuang Wan. If the limbs, face, and nails are all yellow, and urine resembles house dust color, it is difficult to treat. Residual toxins from smallpox/rash invading the eyes due to Kidney-Liver deficiency are treated with Ziyin Shenqi Wan (Nourishing-Yin Kidney-Qi Pill). All preceding conditions require careful diagnosis and treatment of the mother, along with regulating the infant. For exterior syndromes, Baoming Lingyangjiao San (Life-Preserving Antelope Horn Powder) and Longdan Yinzi (Gentian Drink) are indicated. For interior syndromes, Xiegan Lianhuang Tang (Liver-Draining Coptis Decoction) and Jufang Juqing Wan (Formula Bureau's Chrysanthemum-Eye Pill) are indicated. Nyctalopia (Night Blindness) is treated with Fuming San (Restoring-Sight Powder). Strabismus is treated with Tangshi Niuhuang Wan (Tang's Calculus Bovis Pill). Prominent sclera is treated with Shanzhuyu Wan (Cornus Pill).