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Prescription: Grind Bai Long Gu (Fossilized Bones, *Os Draconis*) into fine powder and insufflate into the ear.

Another prescription:
Ren Ya (Human Tooth, calcined to retain efficacy, remove fire toxicity) She Xiang (Musk, *Moschus*) (a small amount)
Grind into fine powder. Use a small amount each time to insufflate into the ear, which will dry immediately. (This prescription also treats infantile smallpox that has erupted but fails to crust over; mix with wine and administer one "zi" [approx. 0.5-1g], after which the eruption will proceed smoothly.)

Whenever there is a prickling pain in the ear, it indicates Wind pathogen invading the Kidney Meridian. If untreated, it will transform into symptoms of aversion to cold, fever, stiffness of the spine and straightening of the back, resembling rigidity, known as Huang Er Shang Han (Yellow Ear Cold Damage). This condition should not be treated as ordinary Shang Han (Cold Damage); Xia Xu Ming Tang (Minor Continuation of Life Decoction) with Fu Zi (Aconite Root, *Radix Aconiti Lateralis Preparata*) removed, and Jiang Can (Silkworm, *Bombyx Batryticatus*), Tian Ma (Gastrodia Rhizome, *Gastrodiae Rhizoma*), Qiang Huo (Notopterygium Rhizome, *Notopterygii Rhizoma et Radix*, added, followed by Jing Fang Bai Du San (Schizonepeta and Saposhnikovia Decoction to Expel Toxins) with Xi Xin (Asarum Root, *Asari Radix et Rhizoma*), Bai Zhi (Angelica Dahurica Root, *Angelicae Dahuricae Radix*), Chan Tui (Cicada Slough, *Cicadae Periostracum*), Huang Qin (Scutellaria Root, *Scutellariae Radix*), Chi Shao (Red Peony Root, *Paeoniae Radix Rubra*), and Zi Jing Pi (Chinese Wisteria Bark, *Wisteriae Sinensis Cortex*) added.

Feng Luzhan stated: Deafness caused by Fire may result from sudden rage causing Liver Qi rebellion, indulgence in desires, excess of excess Fire, or deficiency of deficient Fire, thus leading to deafness and pain. The treatment should prioritize herbs such as Huang Qin (Scutellaria Root, *Scutellariae Radix*), Lian Zi (Lotus Plumule, *Nelumbinis Plumula* - note: text says Lian, likely Huang Lian), Dang Gui (Angelica Sinensis Root, *Angelicae Sinensis Radix*), and Bai Shao (White Peony Root, *Paeoniae Radix Alba*). (From *Jin Nang*)

He further stated: Deafness caused by Qi obstruction may arise from anger injuring the Liver, phlegm generated by Fire, sudden stroke, or chronic illness leading to Qi deficiency, resulting in deafness and tinnitus. The treatment should focus on resolving stagnation and harmonizing Blood, employing methods of guiding and unblocking.

He also stated: Furthermore, if Wind enters the brain and stagnates in the Hand Taiyang Meridian, it causes Qi blockage and deafness.

He further stated: If deafness occurs after a severe illness, it indicates exhaustion of Blood and weakness of Qi, and Di Huang Wan (Rehmannia Pill) should be taken. However, post-illness involves deficiency of both Qi and Blood; one must diagnose the pulse of both hands to determine superiority and guide treatment. If the pulse is large but forceless, or the right-hand pulse is fine, thin, deep, and weak, it indicates severe Yang deficiency. A sweet-warm formula should be used, following the principle of Yang generating Yin, with a small addition of Blood-nourishing herbs. If mistakenly viewed solely as Yin deficiency and treated with Yin-nourishing and Fire-descending formulas, Yang will become even weaker. Not only will deafness not resolve, but nausea, chest fullness, and diarrhea may worsen.

He further stated: Deafness generally belongs to Heat. Left-sided deafness is due to Shaoyang Fire, treated primarily with Long Dan Xie Gan Wan (Gentian Liver-Draining Pill); right-sided deafness is due to Taiyang Fire, treated primarily with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill); bilateral deafness is due to Yangming Fire, treated primarily with Fang Feng Tong Sheng San (Saposhnikovia Universal Relief Powder) or Gun Tan Wan (Rolling Phlegm Pill). Excessive anger stirs Shaoyang Gallbladder Fire rising from the left, causing left deafness; excessive sexual desire stirs Taiyang Bladder Ministerial Fire rising from the right, causing right deafness; excessive consumption of rich alcohol and food stirs Yangming Stomach Fire rising from the center, causing bilateral deafness. Women often suffer left deafness due to frequent anger; men often suffer right deafness due to frequent sexual indulgence; wealthy families often suffer bilateral deafness due to excessive rich and greasy foods.

He further stated: The Classics state: Deafness accompanied by shortness of breath and dry throat relates to the Lung. It also states: Headache, tinnitus, and dysfunction of the nine orifices originate from the Intestines and Stomach. Insufficiency of the Intestines and Stomach leads to weak Qi failing to fill the orifices. This pattern often follows Shang Han (Cold Damage) or severe illness and is treated with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Deafness accompanied by fear indicates Liver deficiency. The Classics state: Liver deficiency leads to blurred vision, hearing loss, and timidity. The treatment uses Si Wu Tang (Four Substances Decoction) plus Qiang Huo (Notopterygium Rhizome, *Notopterygii Rhizoma et Radix*), Fang Feng (Saposhnikovia Root, *Saposhnikoviae Radix*), Chai Hu (Bupleurum Root, *Bupleuri Radix*), Fu Shen (Poria with Hostwood, *Poria*), and Shi Chang Pu (Acorus Rhizome, *Acori Tatarinowii Rhizoma*).

He further stated: New-onset deafness is mostly Heat, due to abundance of Shaoyang and Yangming Fire; chronic deafness is mostly Deficiency, due to chronic Kidney insufficiency. One requires clearing Wind and dissipating Heat; the other requires nourishing the Kidney and opening the orifices. Post-severe illness requires nourishing Yin and descending Fire.

Chen Yuan Gong stated: Some experience needle-like pain in the ear without discharge, only a sensation of boiling water. People attribute this to Fire pathogen, unaware it is actually depletion of Kidney Water. The Kidney opens into the ears; insufficient Kidney Qi causes ear closure. Before closure, it does not happen peacefully but involves pain preceding closure, due to Kidney Fire rushing upward. If the Fire cannot escape, the pathway becomes blocked, preventing Fire from exiting via the ear, leading to deafness. This condition requires rapid treatment; otherwise, established deafness is difficult to cure. Treat with Yi Shui Ping Huo Tang (Water-Balancing Fire-Calming Decoction): Shu Di Huang (Prepared Rehmannia Root, *Rehmanniae Radix Praeparata*), Sheng Di Huang (Raw Rehmannia Root, *Rehmanniae Radix*), Mai Dong (Ophiopogon Tuber, *Ophiopogonis Tuber*), Xuan Shen (Scrophularia Root, *Scrophulariae Radix*) each 1 liang, Shi Chang Pu (Acorus Rhizome, *Acori Tatarinowii Rhizoma*) 1 qian. Decoct and take orally. Pain stops after one dose, tinnitus ceases after two doses, full recovery after three doses. This is an excellent method. (This formula nourishes Water while draining Fire within Water, without damaging Kidney Qi. Once Kidney Water is sufficient, Kidney Fire naturally descends. Preventive treatment for impending deafness is essential. Even for established deafness, this formula yields miraculous results, let alone for pre-deafness ear conditions.)

He further stated: Some suffer deafness unable to hear thunder, without pain, occurring after severe illness or in the elderly. This is due to Kidney Fire flashing shut and Qi obstruction, making it difficult to treat. Treatment must combine internal and external approaches, strongly tonifying Heart and Kidney. Although the ear belongs to the Kidney, if Heart Qi does not communicate, Heart and Kidney fail to interact, causing blockage. Thus, one must tonify the Kidney to allow Kidney Fluid to nourish the Heart, using Heart-tonifying agents to descend Heart Qi to Kidney Fire. When Kidney Qi interacts, it naturally rises to open the ear. Treat with Qi Qiao Dan (Orifice-Opening Pill): Shu Di Huang (Prepared Rehmannia Root, *Rehmanniae Radix Praeparata*) 2 liang, Shan Yu Rou (Cornus Fruit, *Corni Fructus*), Mai Dong (Ophiopogon Tuber, *Ophiopogonis Tuber*) each 1 liang, Yuan Zhi (Polygala Root, *Polygalae Radix*), Fu Shen (Poria with Hostwood, *Poria*), Bai Zi Ren (Biota Seed, *Platycladi Semen*), Shu Zao Ren (Processed Sour Jujube Seed, *Ziziphi Spinosae Semen Praeparatum*) each 3 qian, Bei Wu Wei Zi (Schisandra Berry, *Schisandrae Chinensis Fructus*) 2 qian, Shi Chang Pu (Acorus Rhizome, *Acori Tatarinowii Rhizoma*) 1 qian. Decoct and take orally. After four doses, ringing in the ears should occur, signaling impending opening of deafness. Take ten more doses. Externally, grind Long Gu (Fossilized Bones, *Os Draconis*) 1 fen, Male Rat Gallbladder Juice 1 piece, She Xiang (Musk, *Moschus*) 1 li, Bing Pian (Borneol, *Borneolum Syntheticum*) 3 li into powder, form three pills, wrap in cotton, insert into the ear, do not remove for 24 hours, then hearing will clear. Extremely effective. Continue the internal formula for one day, then use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) for maintenance. Otherwise, effects may not last.

The Classics state: The ear is the orifice of the Kidney, which stores Essence. Loss of Essence leads to dark cheeks and deafness. The ear is the gathering place of the Zong (Grand) Vessels. In terms of orifices, it corresponds to Water; in terms of sound, to Metal; in terms of meridians, the Hand and Foot Shaoyang meridians converge here. Deafness arising from internal inability to hear relates to the Zang organs; deafness arising from external inability to enter relates to the meridians. Harmonious Kidney Qi allows hearing the five tones. Furthermore, deafness due to Qi rebellion has two types: Hand Taiyang Qi reversal causes deafness with fullness in the ear; Hand Shaoyang Qi reversal causes deafness with muffled hearing. Both are deafness due to Qi rebellion. Treatment uses Si Wu Tang (Four Substances Decoction) plus herbs that descend Fire and promote Qi flow. However, Zang Qi reversal causing Jue (Reversal) deafness presents with dizziness and fainting; Wind deafness presents with headache; fatigue damaging Qi and Blood, and sexual indulgence depleting Essence, causing confusion and dullness, is called Labor Deafness, presenting with deficiency signs. Noisy tinnitus and seeing black spots indicate Deficiency Deafness.

He further stated: For deafness caused by Damp-Heat, Phlegm, or Excess Qi, Bing Lang Wan (Areca Nut Pill) or Shen Xiong Wan (Divine Celery Pill) should be used to purge.

He further stated: Although the ear is primarily governed by the Foot Shaoyin (Kidney), among the twelve meridians, except for Foot Taiyang and Hand Jueyin, the remaining ten meridians enter the ear. Since the Kidney opens into the ear, treatment focuses on the Kidney. However, the Heart also opens into the ear. Why? Because the Heart's orifice is originally the tongue; since the tongue lacks pores, the orifice resides in the ear. The Kidney is the master of the ear orifice, the Heart is the guest. The Kidney governs internal Yin, the Heart governs external Yang. Clear, pure, and bright Qi ascends to the orifices, enabling acute hearing. Disharmony between these two meridians and imbalance of Yin and Yang cause sudden deafness. The Five Zang organs open into five regions. Differentiating by Yin/Yang: Kidney and Liver reside in Yin, governing the Yin Essence of the ear and eye orifices; Heart, Spleen, and Lung reside in Yang, governing the Yang Essence of the mouth, nose, and tongue orifices. Therefore, disharmony of the Five Zang blocks the seven orifices. Any meridian or collateral carrying Excess or Deficient Qi into the ear disrupts hearing, referring to acute disease. Chronic deafness differs in Kidney Excess or Deficiency. Left Kidney (Yin) governs Essence; Right Kidney (Yang) governs Qi. Insufficient Essence and Excess Qi cause Deficiency Deafness. Thin body, dark complexion, strong bones and muscles indicate Excess Essence and Qi, solid storage and blockage, causing Excess Deafness, a sign of longevity. Both result from congenital endowment. Dark cheeks with deafness indicate Essence depletion and Kidney exhaustion. Use An Shen Wan (Calming Kidney Pill), Ba Wei Wan (Eight-Ingredient Pill), or Cong Rong Wan (Cistanche Pill) as appropriate. Kidney Meridian Deficient Fire with red face, dry mouth, abundant phlegm, and internal heat is treated with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), addressing Yin Deficiency. Yang Deficiency also causes deafness. The Classics state: Clear Yang emerges from the upper orifices. Stomach Qi is Clear Qi, Original Qi, Spring Ascending Qi—same origin, different names. Modern people suffer dietary irregularities and fatigue, weakening Spleen-Stomach Qi. Unable to ascend, it flows downward to Kidney and Liver, blocking Yang Qi. Earthly Qi obscures, pathogens harm the orifices, blinding eyes and deafening ears—this is Yang Deficiency Deafness. Treat with Li Dongyuan's Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Heart Qi imbalance, where deficiency fails to control Yang, allowing it to join Yin, or excess relies on Yang to sever connection with Yin, reflects the Classic: "Extreme Yin deficiency leads to cessation of Heavenly Qi." Treat with modified Bu Xin Wan (Tonify Heart Pill). Earthly Qi obscuring due to unresolved sorrow, blocking Yin from communicating with Yang; or internal/external Damp-Fluids obstructing Qi, preventing ascending/descending, causing muffled hearing, should be treated with Yang-Raising and Damp-Resolving formulas. Regarding Yin Essence and Yang Qi: Ear and Eye are governed by Yin Essence, favoring coolness and disliking irritant heat; Mouth, Nose, Tongue are governed by Yang Qi, favoring warmth and disliking cold. Master Jiegu once argued that eyes and ears should not be tonified with warm herbs. *Ren Zhai Zhi Zhi* states: Kidney connects to the ear, governing Essence. Harmonious Essence and Qi, sufficient Kidney Qi, enable acute hearing. Proper regulation harmonizes Qi and Blood, gradually lightening deafness. Without self-restraint, daily fatigue, unrestrained desire, anger, alcohol, and rich/greasy foods render medication ineffective.