既察其鼻。当观其耳。耳也者。肾之官也。故察耳之好恶。可知肾之强弱也。何则。黑色小理者。肾小。粗理者。
肾大。耳高者肾高。耳后陷者肾下。耳坚者。肾坚。耳薄不坚者。肾脆。耳好前居牙车者。肾端正。耳偏高者。肾
偏倾。此察耳形之常也。以色言之。有左右之殊。有上下之辨。左为左。右为右。上应乎上。下应乎下也。肾之
候也。肾主骨。故耳起五色者。病在骨也。黄赤者。多热气。青白者。少热气。黑色者。多血少气。黄赤为风。青黑
为痛。白为寒。属分五行。亦应乎五脏也。气色之变。可以十法推之。生克之理。可以五行推之。其余望法。有
可比例者。宜察其病。辨其证。而合参之也。若夫耳形之诊。当以浓而大者为形盛。薄而小者为形亏。肿起
者。邪气实。消减者。正气虚。润泽则吉。枯槁则凶。合之于色。亦可辨其寒热虚实焉。他如下消则耳叶焦干。
肠痈则耳叶甲错。肾前病。耳则为之焦枯。肾前死。耳则为之KT 黑焦癖。若天中等分墓色应之。必死不治。
是皆主病之目也。痘科尚有观耳后络脉之诗。因续四句于其后。其诗曰。耳后红筋痘必轻。紫筋起处重
沉沉。兼青带黑尤难治。十个难求三五生。予续之曰。冷暖阴晴色更改。须将痘证辨分明。望闻问切能参
悟。不看红筋彻底清。
After having observed the nose, one should observe the ears. The ears are the external manifestation (Guan) of the Kidney. Therefore, by observing the condition of the ears, one can know the strength or weakness of the Kidney. Why is this so? If the ear color is black and the texture is fine, the Kidney is small; if the texture is coarse, the Kidney is large. If the ears are high, the Kidney is positioned high; if the area behind the ears is sunken, the Kidney is positioned low. If the ears are firm, the Kidney is solid; if the ears are thin and not firm, the Kidney is fragile. If the ears are well-formed and positioned forward near the jaw joint (Yache), the Kidney is upright; if the ears are higher on one side, the Kidley is tilted. This is the general rule for observing ear shape. Speaking of color, there are distinctions between left and right, and upper and lower. The left corresponds to the left, the right to the right, the upper to the upper, and the lower to the lower. These are the manifestations of the Kidney. The Kidney governs the bones; therefore, if five colors appear on the ears, the disease is in the bones. Yellow and red indicate abundant heat qi; blue and white indicate scant heat qi; black indicates abundant blood and scant qi. Yellow and red correspond to Wind; blue and black correspond to Pain; white corresponds to Cold. These correspond to the Five Elements and also to the Zang-Fu organs. Changes in Qi and color can be deduced using ten methods; the principles of generation and restriction can be deduced using the Five Elements theory. Other inspection methods have analogous references; one should carefully examine the disease, differentiate the syndrome, and combine them for reference. Regarding the diagnosis of ear shape, thick and large indicates robust physical constitution (Xing Sheng); thin and small indicates deficient physical constitution (Xing Kui). Swelling and protrusion indicate excess pathogenic factors (Xie Qi Shi); wasting and reduction indicate deficiency of healthy Qi (Zheng Qi Xu). Moisture and luster are auspicious; dryness and withering are ominous. Combined with color, one can also differentiate cold, heat, excess, and deficiency. For example, in Xiao Ke (Wasting-Thirst Disease, specifically Lower Xiao), the earlobes become scorched and dry; in Chang Yong (Intestinal Abscess), the earlobes show Jia Cuo (skin rough like fish scales); if there is disease anterior to the Kidney, the ears become scorched and withered; if death is imminent due to anterior Kidney pathology, the ears become KT-black, scorched, withered, and nodular. If the color at Tianzhong and other points corresponds accordingly, death is certain and untreatable. These are all indicators of primary diseases. In the field of Smallpox (Dou Ke), there are poems regarding observing the collateral vessels behind the ears. I have added four lines following it: "Red veins behind the ears indicate mild smallpox; where purple veins rise, the condition is heavy and deep. Accompanied by blue and black, it is particularly difficult to treat; out of ten cases, three or five may survive." I added: "Colors change with warmth, cold, yin, and yang; one must clearly distinguish the smallpox syndromes. By comprehensively applying Inspection, Auscultation/Olfaction, Inquiry, and Palpation, one can perceive the truth; without relying solely on red veins, one can see clearly to the end."