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(Tinnitus, Ear Swelling and Pain, Ear Rash, Itching in the Ear, Otorrhea, Cerumen Impaction, Insect Entering the Ear)

The *Neijing* (Classic of Internal Medicine) states: Kidney Qi connects with the ears. When Kidney Qi is harmonious, the ears can hear the five tones. If dizziness and vertigo occur, vision becomes blurred, and deafness sets in, this indicates a pattern of deficiency below and excess above, with pathology involving the Foot Shaoyang Gallbladder Meridian and Foot Jueyin Liver Meridian; if severe, the pathogen may enter the Liver. The so-called tinnitus occurs because Yang Qi, like all things flourishing, surges upward and leaps, thus causing tinnitus. The so-called hearing loss (deafness) is entirely due to Qi dysfunction. Zhao Yi-de stated: The ear is the orifice of the Kidney, governed by the Foot Shaoyin Kidney Meridian. However, the Heart also has its orifice associated with the ear. Among the twelve meridians, except for the Foot Taiyang Bladder Meridian and Hand Jueyin Pericardium Meridian, the collateral branches of the remaining ten meridians all enter the ear. Generally, the Kidney governs the Yin within, and the Heart governs the Yang on the exterior, conforming to the Way of Heaven and Earth; Jing-Qi (Essence-Qi) undergoes transformation without obstruction. Thus, clear and bright Qi ascends to the orifices; when received by the ears, hearing becomes acute. The *Lingshu* (Spiritual Pivot) states: Kidney Qi connects with the ears. When Kidney Qi is harmonious, the ears can hear the five tones. If the Five Zang Organs are not harmonious, the seven orifices will be obstructed. 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 the clarity of the orifice, leading to deafness. This refers to sudden onset diseases. As for chronic deafness, the Kidneys also present patterns of Deficiency and Excess. The Left Kidney belongs to Yin and governs Essence; the Right Kidney belongs to Yang and governs Qi. If Essence is insufficient while Qi is excessive, deafness is classified as Deficiency; the patient is emaciated with dark complexion but strong sinews and bones, indicating that both Essence and Qi are abundant yet stored and blocked; this type of deafness is Excess and is a sign of longevity. These are due to innate constitution and require no treatment. There is also sudden deafness. The *Neijing* states: Those who do not understand the way of harmonizing Yin and Yang and applying the "Seven Losses and Eight Benefits" will lose their reproductive capacity prematurely. By age fifty, the body feels heavy, and the ears and eyes lose their acuity. This too is a normal state requiring no treatment. Only in cases of sudden deafness, where the separation of Yin and Yang is not yet severe, and the meridians desire flow but are not yet unobstructed, pathogenic factors surge within, drumming against the auditory passageways. Depending on the severity of the Qi disturbance, sounds such as wind and rain may be heard. Treatment should follow the nature of the pathogen. Additionally, there is exposure to Wind Pathogen affecting the ear, clashing with Qi, producing noisy sounds, with eyes perceiving fire, termed "Empty Tinnitus." Heat Pathogen takes advantage of deficiency, enters the ear via the meridians, accumulates heat without dissipating, and discharges pus, termed "Pus Ear" (Otitis Media). Human ears contain fluids; if mild, they cause no harm. If Wind-Heat binds them, the fluids harden into nodules blocking the ear, causing sudden deafness, termed "Cerumen Impaction." For the aforementioned conditions, the Kidney pulse can be palpated: Wind presents as floating and vigorous; Heat as洪 (Surging) and full; Deficiency as choppy and soft. Wind is treated with dispersing methods; Heat with draining methods; Deficiency with nourishing methods. After the pathogenic factors recede, formulas that unblock meridians, regulate Qi, and calm the Kidney are used. Luo Qianfu stated: Sudden deafness arises from Kidney Deficiency allowing Wind Pathogen to invade, binding in the meridians and ascending via blood vessels into the ear. Zheng Qi (Upright Qi) clashes with Xie Qi (Pathogenic Qi), resulting in sudden deafness. For Wind-Deficiency Deafness, use Paifeng Tang (Wind-Expelling Decoction) or Guixin San (Cinnamon Twig and Asarum Powder). For Kidney Wind-Deficiency, use Huang [missing character] Wan; if accompanied by Qi Deficiency, remove Fuzi (Aconite Root) and add Rougui (Cinnamon Bark) and Renshen (Ginseng). For Liver-Kidney Deficient Fire, use Jiangxie San (Ginger and Scorpion Powder). For Wind-Heat Deafness, use Xijiao Yinzi (Rhinoceros Horn Drink). For Jue Deafness, the *Neijing* states: Sudden Jue with deafness and unilateral blockage is due to internal Qi suddenly pressing inward. Use Fuyuan Tongqi San removing Baiqianniu (White Morning Glory Seed), adding Quanxie (Scorpion), Shichangpu (Acorus), Chuanxiong (Sichuan Lovage Rhizome), Shengjiang (Fresh Ginger), and Congbai (Green Onion White), swallowed with Yangzheng Dan (Nourishing Upright Pill). In treating all deafness, Qi must be regulated. Liver Qi rebellion causes headache, deafness, and cheek swelling; treat with Siwu Tang (Four Substances Decoction) plus Rougui (Cinnamon Bark), swallowing Longhui Wan (Dragon Bile Pill) to descend Fire, along with Fuyuan Tongqi San to regulate Qi. For deafness with Damp-Phlegm, use Guntan Wan (Rolling Phlegm Pill) to purge. For deafness with black cheeks, indicating Essence depletion and Kidney Deficiency, use Shao Shen San (Burning Kidney Powder). For deafness with excessive fear, indicating Liver Deficiency, use Wendan Tang (Warm Gallbladder Decoction) swallowing Yangzheng Dan. External treatments include Tongshen San (Unblocking Spirit Powder) and Bimawan (Castor Bean Pill). One prescription: Use three earthworms (Dilong) and a little salt, placed inside a green onion tube, melted, and dripped into the ear; effective within three to five days. Another method: Use a piece of Magnetite (Cishi) the size of a bean and three scales of Pangolin (Linqiji), calcined until charred but retaining essence, wrapped in cotton and inserted into the ear, while holding a small piece of raw iron in the mouth; healing occurs when a wind-and-rain sound is felt in the ear.

Tinnitus The *Neijing* states: The ear is the gathering place of the Zong Mai (Grand Vessels). Therefore, when the Stomach is empty, the Zong Mai become deficient; deficiency leads to downward sinking, and the vessels become exhausted, causing tinnitus. It also states: When Body Fluids are depleted, the brain marrow diminishes, sinews ache, and the ears ring frequently. All these belong to Deficiency patterns of tinnitus. The *Neijing* states: Regarding the Taiyang channel, tinnitus occurs because Yang Qi, like all things flourishing, surges upward and leaps. It also states: The Jueyin channel's Qi causes tinnitus and vertigo. It further states: The arrival of Shaoyang Qi manifests as tinnitus, treated with cooling and cold methods. All these belong to Excess patterns of tinnitus. Wang Ruming stated: Tinnitus sounding like cicadas, occurring on either side or intermittently blocking the ear, is often mistakenly treated as Kidney Deficiency with poor results. In fact, this is Phlegm-Fire rising and stagnating in the ear, causing ringing; severe stagnation leads to blockage. If one usually drinks alcohol and eats rich flavors, creating Phlegm-Fire in the Upper Jiao, the primary treatment should be clearing Phlegm and descending Fire. Generally, this condition first arises from Phlegm-Fire in the upper region, combined with emotional 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, the person is prone to sexual indulgence, and signs of Consumption (Xu Lao) appear. Yu Jiayan stated: In treating elderly patients with Kidney Qi rebelling upward causing tinnitus, Magnetite (Cishi) should be the main herb because its heaviness reaches downward. However, its nature primarily draws downward and cannot control the upward suction of Liver Wood. It should be assisted by Yin-nourishing herbs such as Dihuang (Rehmannia Root) and Guijiao (Donkey-hide Gelatin), and astringents like Wuweizi (Schisandra Berry) and Shanzhuyu (Cornus Fruit) to consolidate, allowing Yin Qi to flourish in its home palace without touching the Yang orifices. Thus, the space becomes clear, and distant hearing is restored. Danxi used Fangfeng Tongsheng San (Wind-Protecting Universal Rescue Powder) for tinnitus caused by excessive drinking, but this lacks definitive insight. Only Guntan Wan (Rolling Phlegm Pill) is effective for young and robust individuals, as Huangqin (Scutellaria Root), Dahuang (Rhubarb Root), and Chenxiang (Agarwood) are bitter and best at descending Qi, while Mengshi (Calamine) is heavy and sinking, similar to Magnetite. Xue Lizhai stated: If Blood Deficiency with Fire, use Siwu Tang (Four Substances Decoction) plus Zhizi (Gardenia Fruit) and Chaihu (Bupleurum Root). If Middle Qi is weak, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Zhizi (Gardenia Fruit) and Danpi (Moutan Cortex). If deafness or tinnitus occurs after anger, belonging to Liver-Gallbladder Qi Excess, use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Chuanxiong (Sichuan Lovage Rhizome), Danggui (Angelica Sinensis), and Zhizi (Gardenia Fruit). If worse in the morning, it is Yang Qi Excess-Heat; use Xiaochaihu Tang plus Huanglian (Coptis Rhizome) and Zhizi (Gardenia Fruit). If worse in the afternoon, it is Yin-Blood Deficiency; use Siwu Tang (Four Substances Decoction) plus Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria). If Kidney Deficiency with Fire stirring, causing a humming sound in the ears, indicating lack of Yin, use Jiajian Bawei Wan (Modified Eight-Ingredient Pill). For Kidney Deficiency with tidal or cicada-like sounds in the ears, incessant and interfering with hearing, Qi must be anchored and the Kidney tonified; Zhengyuan San (Upright Origin Powder) swallowing Heixi Dan (Black Tin Pill), with Anshen Wan (Calming Kidney Pill) administered intermittently. For Kidney Organ Wind-Deficiency Tinnitus, where sleeping at night sounds like war drums, with limb twitching and pain, and a sensation of wind blowing with extreme itching in the ear, select Huang [missing character] Wan or Sisheng San (Four Living Herbs Powder).

Ear Swelling and Pain Belong to Shaoyang Ministerial Fire; treat with Xijiao Yinzi (Rhinoceros Horn Drink) plus Bingpian (Borneol) and Shexiang (Musk) made into pills. The *Neijing* states: Excess of Shaoyang causes ear pain, treated with pungent-cold methods, which is correct. For pain and sores inside the ear, use Niubangzi (Arctii Fructus), Lianqiao (Forsythiae Fructus), Danggui (Angelica Sinensis), Shaoyao (Peony Root), Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Gancao (Licorice Root), Jiegeng (Platycodon Root), Shengdi (Rehmanniae Radix), Taoren (Prunus Semen), Huangqi (Astragali Radix), Chaihu (Bupleurum Root), and Caolongdan (Gentiana Scabra Root). For damp-swollen painful ears, use Liangge San (Cooling the Diaphragm Powder) plus Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Jingjie (Schizonepetae Spica). Externally, use equal parts Longgu (Fossilized Bones) and Huangdan (Lead Monoxide), with half amount of Kufan (Alum), plus a little Musk blown into the ear. Alternatively, use Longgu (Fossilized Bones), Huangdan (Lead Monoxide), and Ganyanzi (Dried Pomegranate Flower) powdered together. Or burn Wubeizi (Chinese Gall) to ash, mix with Alum, and blow into the ear.

Ear Rash Ear rash belongs to the Shaoyang Sanjiao, or Foot Jueyin Liver Meridian Blood Deficiency with Wind-Heat, or induced by anger stirring Liver Fire. If accompanied by fever and pain, it belongs to Sanjiao-Jueyin Wind-Heat; use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) or Zhizi Qinggan San (Gardenia Liver-Clearing Powder). Do not exclusively treat externally at the expense of damaging Qi and Blood. For itching caused by Kidney Deficiency with Wind-Heat, scratched into sores, use Liuwei Wan (Six-Ingredient Pill) plus Baijili (Tribulus Fruit).

Itching in the Ear Indicates Wind in the Kidney Home; use Sisheng San (Four Living Herbs Powder). Take two or three doses each time it occurs for recovery.

Otorrhea Results from Damp-Heat accumulating in the ear. Use Fuyuan Tongqi San (Restoring Vitality and Unblocking Qi Powder) with modifications as before. Externally, powder Wubeizi (Chinese Gall), Quanxie (Scorpion), and Kufan (Alum), add a little Musk, and blow into the ear. Or burn Jupi (Citrus Peel) until charred but retaining essence, add a little Musk, first wipe the ear clean with cotton to remove pus, then apply. For robust individuals with accumulated Heat attacking upward, where otorrhea persists, use Liangge San (Cooling the Diaphragm Powder) to purge.

Cerumen Impaction With Tinnitus/Deafness and Internal Stagnant Blood: Externally, crush Radish (Laifu) to extract juice, mix with a little ground Musk, and drip into the ear. Other methods refer to the treatment of deafness.

Insect Entering the Ear: Rub cat's nose with fresh ginger to induce urination; take the urine and drip into the ear to expel the insect. Or sleep on fried sesame seeds to expel the insect. If an object is stuck and cannot be removed, cut the end of a bowstring or coin string to fray it, dip in good glue, attach to the object in the ear, and slowly pull out for effectiveness. Xue Lizhai treated a man who experienced ear itching/pain or discharge during intercourse, preferring coolness, probing with a silver needle; this was Kidney Channel Deficient Fire, cured with Jiajian Bawei Wan (Modified Eight-Ingredient Pill). He also treated a woman whose anger flared up, causing bilateral otorrhea and temporal headache upon menstruation, relieved by pressure, with chest/hypochondriac/breast distension/pain upon anger, alternating chills/fever, frequent urination, or lower abdominal fullness; all belonged to Liver Fire and Blood Deficiency. Ten doses of Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) resolved all symptoms, followed by Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Wuweizi (Schisandra Berry) for complete recovery.