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Wang Kentang stated: When white pus frequently discharges from the ear, it is called Chan Er (Tangled Ear). This condition arises from the upward congestion of Wind-Heat in the Foot-Shaoyin Kidney Meridian and Hand-Shaoyin Sanjiao Meridian. (*Yixue Zhunsheng Liuyao*)

Feng Luzhan stated: Discharge of white pus is termed Chan Er (Tangled Ear). It results from excess Qi of the Kidney with accumulated Heat rushing upward, or due to Water-Wind pathogenic factors invading the ear. (*Yizong Jinjian: Jinnang Milu*)

Chen Shigong stated: Ear diseases are caused by reckless movement of the Sanjiao and Liver Wind. In adults, there is a distinction between Deficient Fire and Excess Fire; in children, there is a difference between Fetal Heat and Fetal Wind. The Deficient Fire pattern presents with cicada-like tinnitus in the ear, discharge of fluid causing itching, without external swelling. The Excess Fire pattern presents with swelling of both the ear root and the ear canal, and in severe cases, alternating chills and fever with unceasing pain. (*Waike Zhengzong*)

He further stated: Newborn infants with Fetal Heat, or those whose ear canals are penetrated by water during bathing, may also suffer from ear pain and pus formation. It is crucial not to blow medicinal powders into the ear. If premature treatment leads to swelling inside the neck, it is better to wait for the toxin to exhaust itself and heal spontaneously. If it does not resolve within one month, treat with Hongmian San (Red Silk Powder), and peace will be restored.

Feng Luzhan stated: The ears are the gathering place of all meridians and the passage through which Kidney Qi communicates. In some children, excessive Qi in the Kidney Meridian causes Heat to rush upward to the ear, leading to stagnation of body fluids that transform into pus or clear fluid. However, conditions involving the Jueyin Liver Meridian and Foot-Yangming Stomach Meridian, as well as Hand-Shaoyin Heart Meridian and Foot-Taiyang Bladder Meridian, are particularly severe. Investigating the causes, there are seven primary origins: Excess Heat, Yin Deficiency, Phlegm, Fire, Qi Obstruction, Liver Wind, and disease originating from the fetal constitution. There are five main symptoms: Tinnitus, Pain, Swelling, Deafness, and Suppuration. Treatment should be differentiated according to the etiology. (*Yizong Jinjian: Jinnang Milu*)

He further stated: Frequent discharge of red pus is called Nong Er (Pus Ear).

He further stated: Cases arising from the fetal constitution occur because parents were not careful, leading to congenital Fire-Toxin attacking and rushing upward. Pus flows out with a foul odor forming sores, with surrounding redness and swelling, recurring intermittently. The treatment principle should focus on resolving toxins and nourishing Kidney Yin.

Chen Yuangong stated: When a person suffers from sudden swelling and pain in both ears, with clear fluid flowing internally initially, which later turns into pus and blood, accompanied by systemic chills and fever, and sounds in the ear like boiling water or cicadas, this indicates that Shaoyang Gallbladder Qi is not free-flowing, allowing Wind pathogens to take advantage. The Fire cannot dissipate, thus generating this disease. The therapeutic method should be to soothe and release Gallbladder Qi, assisted by herbs that dispel Wind and purge Fire, leading to recovery. However, why do some treatments fail? Because when the Gallbladder is affected by Wind-Fire pathogens, the bile becomes dry. Using only Wind-dispelling and Fire-purging herbs will further dry the bile, intensify Gallbladder Fire, and allow Wind to borrow the strength of Fire, causing greater burning and damage, worsening the illness. The formula Run Chang Tang (Moisten Intestine Decoction) is indicated: Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Xuan Shen (Scrophulariae Radix) each 1 liang, Hei Zhi Zi (Gardeniae Fructus nigro-coctus) 2 qian, Chai Hu (Bupleuri Radix) 1 qian, Hua Fen (Trichosanthis Radix) 3 qian, Shi Chang Pu (Acori Tatarinowii Rhizoma) 8 fen. Decoct in water and take orally. After one dose, pain lightens; after two doses, swelling subsides; after three doses, pus and blood stop; after four doses, chills and fever disappear; ten doses ensure complete recovery. (Note: Dang Gui and Bai Shao enter not only the Gallbladder but also the Liver meridian. When the Gallbladder is diseased, the Liver is inevitably involved; calming the Liver calms the Gallbladder. Chai Hu and Zhi Zi also soothe the Liver and Gallbladder; soothing the Liver is precisely how one soothes the Gallbladder. When Liver Qi is smooth, Blood becomes abundant, ensuring the bile is moistened. Once the bile is moistened, Wind and Fire pathogens have the opportunity to dissipate spontaneously. Adding Hua Fen expels Phlegm, leaving Wind and Fire without support. Shi Chang Pu opens the orifices of the ear, and Xuan Shen clears floating Fire. Naturally, Wind and Fire are gradually expelled, the Upper Jiao becomes cool, and the ear disease heals.) (*Bianzheng Lu*)

Wang Shengzhi stated: For Deficient Fire patterns, treat with Si Wu Tang (Four Substances Decoction) added with Mu Dan Pi (Moutan Cortex) and Shi Chang Pu (Acori Tatarinowii Rhizoma), or primarily use Shen Qi Wan (Kidney Qi Pill). For Excess Fire patterns, treat primarily with Chai Hu Qing Gan Tang (Bupleurum Liver-Clearing Decoction). (*Lili*)