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Xue Lizhai stated: Ear sores (Er Chuang) are attributed to the Shaoyang Sanjiao Meridian or the Foot Jueyin Liver Meridian. The etiology involves blood deficiency with wind-heat invasion, dry fire and wind-heat in the Liver Meridian, or deficient fire in the Kidney Meridian, among other causes. If accompanied by fever and pain, it belongs to wind-heat in the Shaoyang and Jueyin meridians; treat with Chaihu Qinggan San (Bupleurum Decoction for Clearing the Liver). If there is internal heat with itching and pain, it belongs to blood deficiency in these two meridians; treat with Danggui Chuanxiong San (Angelica Sinensis and Ligusticum Wallichii Powder). If chills and high fever occur with pain, it belongs to wind-heat in the Liver Meridian; treat with Xiaochaihu Tang (Minor Bupleurum Decoction) added with Gardenia (Shanzhi) and Ligusticum Wallichii (Chuanxiong). If there is internal heat and dry mouth, it belongs to deficient fire in the Kidney Meridian; treat with Jiadi Dihuang Wan (Modified Rehmannia Pill). If ineffective, use Jiadi Bawei Wan (Modified Eight-Ingredient Pill); otherwise, treat according to the specific syndrome.

I observe that Xue's treatment of ear disorders generally follows these principles: For Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Gardenia (Shanzhi) and Scutellaria Baicalensis (Huangqin). For Blood deficiency, use Bazhen Tang (Eight-Treasure Decoction) added with Bupleurum (Chaihu) and Moutan Cortex (Danpi). For Liver fire with Blood deficiency, use Zhizi Qinggan San (Gardenia Decoction for Clearing the Liver). For Liver fire triggered by anger, use Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder). For injury to the Liver and Spleen, administer Jiawei Guipi Tang (Modified Restore the Spleen Decoction) in the morning and Jiawei Xiaoyao San in the evening. This is the general approach.

I once treated a scholar, nearly thirty years old, who had a chronic ear disease recurring annually, always presenting with swelling and ulceration. In the second month of the Yi Hai year, the attack was severe, extending from the root of the ear down to the neck and up to the temporal angle, with no part around the ear spared from swelling and pain. Treatments by other physicians focused solely on dispersing wind and reducing fire. After one month, thick, swollen bright red blood flowed continuously from the ear, approximately one wine cup every two or three days. However, despite the discharge of pus, the swelling did not subside, nor did the pain diminish; he could not rest his head on a pillow, and his appetite failed. His physical energy was exhausted, and he considered his condition critical. Upon examination, his form and Qi were significantly deficient. Yet, the swelling and pain persisted as if excess pathogenic factors remained. His pulse was sometimes wiry and rapid, sometimes slow and weak. This indicated it was clearly not an excess-heat syndrome. Since the pulse was not tight but occasionally weak, consistent with the constitution of an ulcerative condition, it was still treatable. I first administered Liuwei Tang (Six-Ingredient Decoction) for two or three doses to slightly strengthen the Yuan Qi (Primary Qi). Subsequently, I prescribed Yiyin Jian (One-Yin Decoction) added with Arctii Fructus (Niubangzi), Poria (Fuling), and Alisma Rhizoma (Zexie), heavily emphasizing Tribulus Terrestris (Baijili) as the chief herb. He took over fifty doses. Externally, Jiangyong San (Decocted Poultice for Reducing Abscesses) was applied day and night. He recovered after two months. Although this case appeared to have excess symptoms typical of ulcers, it was essentially a rare syndrome of Liver and Kidney deficiency manifesting as upper excess and lower deficiency. Therefore, I recorded it. (Commentary by Xue Lizhai)