【歌】肾虚精脱耳应聋，气厥无闻自不同。更有劳聋与虚闭，风邪入耳不能聪。气风相搏嘈嘈响，热气
乘虚耳出脓。
风气热虚何以别？浮沉数涩脉中穷。
【论】夫耳属足少阴肾之经，肾家之寄窍也。经云∶肾气通于耳，肾和则知五音矣。耳所主者精，精气
调和，肾气充足，则耳闻而聪。若劳伤气血，风邪袭虚，使精脱肾惫，则耳转而聋，是肾虚耳聋也。十二经脉
上络于耳，其阴阳诸经通有交并，则脏气逆而厥，厥气搏入耳，是谓厥聋。耳为宗脉之所附，脉虚而风邪乘之，
风入于耳脉，使经气痞而不宣，是谓风聋，必有头痛之证也。有劳碌伤其血气，淫欲耗其精元，瘦瘁力疲，昏
昏愦愦，是谓劳聋，能将息得宜，血气平和，则其聋渐轻。又有耳触风邪，与气相搏，其声嘈嘈而鸣，眼中流
火，谓之虚聋。热气乘虚随脉入耳，热聚不散，脓汁出，谓之脓耳。人或耳间有津液，轻则不能为害，若风
热搏之，津液结成核，塞于耳窍，亦令暴聋，谓之耵耳。
盖风则肾脉必浮，热则肾脉必数，虚则肾脉涩弱，气郁肾脉沉滞。风者疏散之，热者清利之，虚者补之，
气郁开导之，治之活法，不过此也。
【脉】耳病肾虚，迟濡其脉。浮大为风，洪动火贼。沉涩气凝，数实热塞。此久聋者，专于肾责。暴病
浮洪，两尺相同。或两尺数，阴火上冲。
风耳
风触耳鸣及聋，防风通圣散。（方见中风。）风虚耳聋，桂香散。风入耳中虚鸣，芎芷散。（方见头
痛。）风热搏成耵耳，生猪脂、地龙、釜底墨等分，细研，葱汁和，捏如枣大，绵裹塞耳中数日，待软即挑出。
桂香散
治风虚耳聋。
辣桂（二分） 川芎（五分） 当归（六分，酒洗） 细辛（三分） 石菖
蒲（八分） 木香（三分） 木通（五分） 麻黄（去节，三分） 甘草（三分，生用） 南星（炮，二分） 白蒺
藜（炒，三分） 白芷（四分） 紫苏（五分）
锉一剂，水二盏，葱煎服。
热耳
耳聋者，少阳、厥阴热多，通圣散。（方见中风。）耳鸣酒遏者，加枳，桔、柴胡、干葛、南星。阴虚
火动耳鸣者，四物汤（方见血证。）加黄柏、知母。痰气耳鸣者，滚痰丸。（方见痰证。）内热耳聋，桃花散
塞之，蔓荆子散内服。
桃花散
治耳中出脓。
枯矾（一钱） 干胭脂（一钱） 麝香（少许）
共为末，吹耳内。
蔓荆子散
甘草（炙，五分） 升麻（三分） 木通（三分） 赤芍药（五分） 桑白皮（五分） 生地黄（一钱）
麦门冬（去心，四分） 前胡（三分，去芦） 蔓荆子（七分） 赤茯苓（六分） 甘菊花（四分）
上锉，一剂，水二盏，姜三片，枣一枚，煎八分，食后服。
虚耳
肾虚耳聋者，益肾散或六味地黄丸、补阴丸。（方见虚损。）劳损耳聋者，地黄丸、人参养荣汤。（方
见虚损。）大病后元气损伤，精血虚耗，耳聋及鸣，调中益气汤。（方见内伤。）
益肾散
治肾虚耳聋。
磁石（制，一两） 巴戟（去心，一两） 沉香（一两） 石菖蒲（一两） 川椒（一两，去目）
末之，每二钱，用猪肾一枚，细切，和以葱白、食盐，
并药用湿纸裹煨，空心酒下。
气耳
气怒厥逆耳聋，和剂流气饮。气壅于上而聋者，清神散。气实人耳聋或鸣者，槟榔丸、神芎丸。气闭耳
聋，用甘遂为丸，如枣子大，塞耳内，服甘草汤。
和剂流气饮
陈皮（四两） 青皮（四两，炒） 甘草（炙，四两） 浓朴（姜炒，四两） 香附（醋炒，四两） 紫苏
（四两） 木通（二两） 大腹皮（二两） 丁香（一两五钱） 槟榔（一两五钱） 木香（一两五钱） 草果
（一两五钱） 莪术（炮，一两半） 藿香（一两五钱） 肉桂（一两五钱） 人参（去芦，一两） 白术（炒，一
两） 木瓜（一两） 麦门冬（去心，一两） 赤茯苓（一两） 石菖蒲（一两） 白芷（一两） 半夏（一两）
枳壳（炒，一两）
每服三钱，生姜三片，枣二枚，葱煎服。
清神散
气壅耳聋。
甘菊花（五钱） 羌活（去芦，五钱） 僵蚕（炒去嘴，五钱） 木通（四钱） 荆芥（四钱） 川芎（四
钱） 防风（去芦，四钱） 木香（四钱） 甘草（炙，四钱） 石菖蒲（四钱）
末之，每服三钱。
木香槟榔丸
郁李仁（一两） 半夏曲（一两） 皂荚（去皮，炙，一两） 槟榔（五钱） 枳壳（炒，五钱） 木香（五
钱） 杏仁（去皮，炒，五钱） 青皮（五钱）
末之，别用皂荚三两去皮、弦、子，浆水半碗，搓揉，熬膏，入蜜少许，丸如桐子大，每五十丸，食后
姜汤送下。
神芎丸
气实人耳聋。
大黄（一两） 黄芩（一两） 牵牛（一两） 滑石（一两）
末之，滴水丸梧子大，每服六、七十丸，白汤送下。
[Song]
Kidney deficiency leading to the loss of essence causes deafness; deafness due to Qi reversal has a different etiology. There is also deafness from overexertion and closure due to deficiency, as well as impaired hearing when wind pathogens invade the ears. When Qi and wind pathogen contend, a buzzing sound occurs in the ears; heat pathogens enter via deficiency, causing pus discharge from the ears.
How to distinguish between wind, heat, and deficiency? The pulse—floating, sunken, rapid, or choppy—reveals the truth.
[Discussion]
The ear belongs to the Foot-Shaoyin Kidney meridian and serves as the external opening for the Kidneys. The classics state: "Kidney Qi connects to the ears; when the Kidneys are harmonious, one can discern the five tones." The ear is governed by essence and blood. When essence and blood are harmonious and Kidney Qi is sufficient, hearing is acute. If labor damages Qi and blood, and wind pathogens attack the deficient areas, causing essence depletion and Kidney exhaustion, hearing will be lost; this is called Kidney-deficiency deafness. The twelve meridians connect to the ears; the Yin and Yang meridians intersect. If Zang organ Qi becomes rebellious and reverses, the reversing Qi enters the ear, known as Jue-deafness (deafness due to Qi reversal). The ear is the attachment site for the Zong-mai (major vessels); when vessel Qi is deficient and wind pathogens invade, the wind enters the ear meridians, causing Qi stagnation and obstruction, known as Wind-deafness, which must be accompanied by headache. Some suffer from overexertion damaging Qi and blood, or excessive sexual activity depleting Yuan-essence, resulting in emaciation, fatigue, and mental confusion; this is called Labor-deafness. With proper rest and regulation, if Qi and blood become balanced, the deafness gradually improves. Another type involves wind pathogens contacting the ear and contending with Qi, producing a buzzing noise and a sensation of fire in the eyes; this is called Deficient-deafness. Heat pathogens enter the ear via the meridians during deficiency, accumulating and not dispersing, leading to pus discharge; this is called Purulent-ear (Otorrhea). Some have fluid in the ear canal; if mild, it causes no harm. However, if wind and heat contend, the fluid condenses into a mass blocking the ear orifice, causing sudden deafness; this is called Cerumen impaction (Ding-ear).
Generally, wind pathogen involvement makes the Kidney pulse floating; heat pathogen involvement makes it rapid; deficiency makes it choppy and weak; Qi stagnation makes it sunken and sluggish. For wind, use dispersion; for heat, use clearing and draining; for deficiency, use tonification; for Qi stagnation, use guiding and unblocking. These are the flexible methods of treatment.
[Pulse Diagnosis]
For ear disease due to Kidney deficiency, the pulse is slow or soggy. Floating and large indicates wind; surging and moving indicates Fire damage. Sunken and choppy indicates Qi coagulation; rapid and excess indicates Heat obstruction. For chronic deafness, blame primarily the Kidneys. Acute onset with floating and surging pulses, identical in both Chi positions, suggests Yin Fire rushing upward if the Chi pulses are rapid.
Wind-Ear
Deafness and tinnitus triggered by wind: Fangfeng Tongsheng San (Saposhnikovia Decoction to Unblock the Toxin). [Formula see Stroke chapter.] Wind-deficiency deafness: Guixiang San (Cinnamon and Costus Powder). Wind entering the ear causing empty ringing: Xiongzi San (Ligusticum and Chrysanthemum Powder). [Formula see Headache chapter.] Wind-heat contending to form cerumen impaction: Equal parts fresh pig lard, Earthworm (Di Long), and soot from the pot bottom. Grind finely, mix with green onion juice, shape into dates, wrap in cotton, insert into the ear for several days, then remove when soft.
Guixiang San
Treats wind-deficiency deafness.
La Gui (Cinnamon Twig) (2 fen), Chuan Xiong (5 fen), Dang Gui (6 fen, washed with wine), Xi Xin (3 fen), Shi Chang Pu (Acorus Tatarinowii Rhizome) (8 fen), Mu Xiang (3 fen), Mu Tong (5 fen), Ma Huang (Ephedra Stem, nodes removed) (3 fen), Gan Cao (Licorice Root) (3 fen, raw), Nan Xing (Arisaema Cum Bile) (2 fen, processed), Bai Ji Li (Tribulus Fruit) (3 fen, stir-fried), Bai Zhi (Angelica Dahurica Root) (4 fen), Zi Su (Perilla Leaf) (5 fen).
Crush one dose, add two cups of water, decoct with green onions, and take orally.
Heat-Ear
Deafness often stems from excess heat in the Shaoyang and Jueyin meridians: Tongsheng San (Unblocking Toxin Decoction). [Formula see Stroke chapter.] Tinnitus caused by alcohol retention: Add Zhi Shi (Immature Bitter Orange), Jie Geng (Platycodon Root), Chai Hu (Bupleurum Root), Ge Gen (Kudzu Root), and Nan Xing. Tinnitus due to Yin deficiency with Fire hyperactivity: Siwu Tang (Four Substances Decoction). [Formula see Blood Disorders chapter], add Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome). Tinnitus due to Phlegm-Qi: Gun Tan Wan (Rolling Phlegm Pill). [Formula see Phlegm Disorders chapter.] Internal heat deafness: Use Taohua San (Peach Blossom Powder) externally, and Manjingzi San (Vitex Powder) internally.
Taohua San
Treats otorrhea (pus discharge from the ear).
Ku Fan (Alum) (1 qian), Gan Yan Zhi (Dry Carmine/Red Ochre) (1 qian), She Xiang (Musk) (a small amount).
Grind into powder and insufflate into the ear.
Manjingzi San
Gan Cao (Licorice Root, honey-fried) (5 fen), Sheng Ma (Cimicifuga Rhizome) (3 fen), Mu Tong (Akebia Stem) (3 fen), Chi Shao Yao (Red Peony Root) (5 fen), Sang Bai Pi (Mulberry Root Bark) (5 fen), Sheng Di Huang (Rehmannia Root) (1 qian), Mai Men Dong (Ophiopogon Tuber) (4 fen, heart removed), Qian Hu (Peucedanum Root) (3 fen, radix removed), Man Jing Zi (Chaste Fruit) (7 fen), Chi Fu Ling (Red Poria) (6 fen), Gan Ju Hua (Chrysanthemum Flower) (4 fen).
Crush all ingredients. One dose, add two cups of water, three slices of ginger, and one jujube. Decoct to eight-tenths volume, take after meals.
Deficiency-Ear
Kidney-deficiency deafness: Yishen San (Kidney-Tonifying Powder) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Buyin Wan (Nourishing Yin Pill). [Formulas see Deficiency and Damage chapter.] Deafness due to labor injury: Dihuang Wan (Rehmannia Pill), Renshen Yangrong Tang (Ginseng Nourishing the Spirit Decoction). [Formulas see Deficiency and Damage chapter.] Deafness and tinnitus following severe illness, where Yuan Qi is damaged and Essence-Blood are depleted: Tiaozhong Yiqi Tang (Regulate Middle and Boost Qi Decoction). [Formula see Internal Injury chapter.]
Yishen San
Treats Kidney-deficiency deafness.
Ci Shi (Magnetite, prepared) (1 liang), Ba Ji Tian (Morinda Officinalis Root) (1 liang, hearts removed), Chen Xiang (Aquilaria Wood) (1 liang), Shi Chang Pu (Acorus Tatarinowii Rhizome) (1 liang), Chuan Jiao (Sichuan Pepper) (1 liang, eyes removed).
Grind into powder. Take 2 qian per dose. Slice one pig kidney finely, mix with white part of green onion and salt, wrap the medicine and kidney in wet paper, and roast until cooked. Take on an empty stomach with wine.
Qi-Ear
Deafness due to anger causing Qi rebellion and reversal: Heji Liuqi Yin (Official Formulas Flowing Qi Decoction). Deafness due to Qi congestion in the upper body: Qingshen San (Spirit-Clearing Powder). Deafness or tinnitus in individuals with Qi excess: Binglang Wan (Areca Nut Pill), Shenxiong Wan (Divine Ligusticum Pill). Deafness due to Qi blockage: Use Kansui (Euphorbia Lathyris Root) pills, date-sized, inserted into the ear, while administering Gancao Tang (Licorice Decoction) orally.
Heji Liuqi Yin
Chen Pi (Aged Tangerine Peel) (4 liang), Qing Pi (Green Tangerine Peel) (4 liang, stir-fried), Gan Cao (Licorice Root, honey-fried) (4 liang), Hou Po (Magnolia Bark) (4 liang, stir-fried with ginger), Xiang Fu (Cyperus Rhizome) (4 liang, stir-fried with vinegar), Zi Su (Perilla Leaf) (4 liang), Mu Tong (Akebia Stem) (2 liang), Da Fu Pi (Areca Peel) (2 liang), Ding Xiang (Clove) (1.5 liang), Bing Lang (Areca Seed) (1.5 liang), Mu Xiang (Aucklandia Root) (1.5 liang), Cao Guo (Black Cardamom) (1.5 liang), E Zhu (Curcuma Rhizome) (1.5 liang, processed), Huo Xiang (Patchouli Herb) (1.5 liang), Rou Gui (Cinnamon Bark) (1.5 liang), Ren Shen (Ginseng Root) (1 liang, radix removed), Bai Zhu (Atractylodes Macrocephala Rhizome) (1 liang, stir-fried), Mu Gua (Chaenomeles Fruit) (1 liang), Mai Men Dong (Ophiopogon Tuber) (1 liang, heart removed), Chi Fu Ling (Red Poria) (1 liang), Shi Chang Pu (Acorus Tatarinowii Rhizome) (1 liang), Bai Zhi (Angelica Dahurica Root) (1 liang), Ban Xia (Pinellia Tuber) (1 liang), Zhi Ke (Aurantium Fruit, stir-fried) (1 liang).
Take 3 qian per dose, with three slices of ginger, two jujubes, and green onions decocted in water.
Qingshen San
Treats deafness due to Qi congestion.
Gan Ju Hua (Chrysanthemum Flower) (5 qian), Qiang Huo (Notopterygium Rhizome) (5 qian, radix removed), Jiang Can (Bombyx Batryticatus) (5 qian, stir-fried, heads removed), Mu Tong (Akebia Stem) (4 qian), Jing Jie (Schizonepeta Spike) (4 qian), Chuan Xiong (Ligusticum Rhizome) (4 qian), Fang Feng (Saposhnikovia Root) (4 qian, radix removed), Mu Xiang (Aucklandia Root) (4 qian), Gan Cao (Licorice Root, honey-fried) (4 qian), Shi Chang Pu (Acorus Tatarinowii Rhizome) (4 qian).
Grind into powder. Take 3 qian per dose.
Muxiang Binglang Wan
Yu Li Ren (Prunus Serrulata Seed) (1 liang), Ban Xia Qu (Pinellia Fermented Dough) (1 liang), Zao Jiao (Gleditsia Sinensis Fruit) (1 liang, skin removed, roasted), Bing Lang (Areca Seed) (5 qian), Zhi Ke (Aurantium Fruit, stir-fried) (5 qian), Mu Xiang (Aucklandia Root) (5 qian), Xing Ren (Apricot Seed) (5 qian, skin removed, stir-fried), Qing Pi (Green Tangerine Peel) (5 qian).
Grind into powder. Separately, take 3 liang of Zao Jiao, remove skin, strings, and seeds. Rub with half a bowl of sour rice water, boil into a paste, add a little honey, and form pills the size of sesame seeds. Take 50 pills per dose after meals with ginger tea.
Shenxiong Wan
Treats deafness in Qi-excess constitutions.
Da Huang (Rhubarb Root) (1 liang), Huang Qin (Scutellaria Root) (1 liang), Qian Niu (Morning Glory Seed) (1 liang), Hua Shi (Talcum) (1 liang).
Grind into powder. Form pills using water drop method, size of sesame seeds. Take 60-70 pills per dose with plain warm water.