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A question was asked: "A carbuncle (ju, a type of deep-seated suppurative infection) appearing one inch and three fen behind the ear is considered by ancient texts as an incurable condition. Now there is a patient, twenty-four years old, with a lump behind the ear the size of a fist, unchanged skin color, not very painful, and has not eaten for seven days. What is the prognosis?" The answer was: "This is named 'toxic swelling behind the ear', not a goiter (ying). It should be treated with garlic-separated moxibustion; administer Huoming Yin (Life-Preserving Decoction) added with Chaihu (Bupleuri Radix), Jiegeng (Platycodonis Radix), and Shengma (Cimicifugae Rhizoma), and take Bazhen San (Eight-Array Powder) orally to achieve recovery."

Zhang Tongfu had a swollen lump without a head at the hairline behind the ear, with unchanged skin color and slight pain upon pressure. He believed it was phlegm accumulation. His pulse was soft and occasionally rapid. The Classics state: "A rapid pulse that appears intermittently indicates sores/abscesses, not phlegm." Zhang Zhongjing stated: "A faint and weak pulse indicates deficiency of both qi and blood, and insufficiency of form and spirit." He also said: "Deep, slow, soft, and weak pulses all indicate the suitability of interior-supporting methods." Therefore, I used Renshen (Ginseng Radix et Rhizoma), [missing character, likely Huangqi], Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Zhi Gancao (Prepared Licorice Root) to support the interior, adding small amounts of Jinyinhua (Lonicerae Japonicae Flos), Baizhi (Angelicae Dahuricae Radix), and Jiegeng to resolve toxicity. He disagreed. He internally took fire-draining and phlegm-resolving medicines and externally applied cooling agents. He felt cold penetrating his brain, while the affected area became very hot, his head felt heavier, and his food intake decreased further. Upon reconsultation, I used Sijunzi Tang (Four Gentlemen Decoction) added with Huoxiang (Pogostemonis Herba) and Pao Ganjiang (Prepared Zingiberis Rhizoma). After several doses, his appetite gradually improved. Once pus formed, it was lanced. Subsequently, Shiquan Dabu Tang (Perfect Tonifying Decoction) minus Guizhi (Cinnamomi Ramulus) was administered, along with moxibustion using Douchi Bing (Fermented Soybean Cake). He recovered after more than a month.

Luo Zongbo suffered from toxic swelling and pain at the hairline behind the ear with a rapid pulse. Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Jiegeng, Niubangzi (Arctii Fructus), and Jinyinhua was prescribed. He recovered after four doses.

Another patient had toxic swelling behind the ear with both pulse and symptoms indicating excess patterns. Neishu Huanglian Tang (Internal Draining Coptis Decoction) was indicated. However, during severe winter, he refused to take cold-natured herbs and ultimately died.

Another patient developed a toxic swelling slightly over one cun behind the ear, named Rui Ju (Sharp Carbuncle). He experienced pain, aversion to cold, fever, irritability, and a preference for cold. This was due to heat accumulation in the Gallbladder Meridian. First, Shenxian Huoming Yin (Immortal Life-Preserving Decoction) was given for one dose, reducing the severity by two or three parts. At that time, it was mid-winter. Confused by the prohibition against using cold herbs in cold seasons ("avoid cold when using cold"), he self-administered Shixuan San (Ten-Vitality Powder) and Tuoli medicines. The condition worsened, pus broke out inside the ear, and the throat swelled shut, preventing medication intake, leading to death.

[Xue Ji's Commentary] Ear sores belong to the Hand-Shaoyang Sanjiao Meridian or Foot-Jueyin Liver Meridian. Causes include blood deficiency with wind-heat, dry fire and wind-heat in the Liver Meridian, or deficient fire in the Kidney Meridian. If accompanied by fever and pain, it belongs to Shaoyang and Jueyin wind-heat; use Chaihu Zhizi San (Bupleurum and Gardenia Powder). If accompanied by internal heat, itching, and pain, it belongs to blood deficiency in the aforementioned meridians; use Danggui Chuanxiong San (Angelica and Ligusticum Powder). If accompanied by chills and fever with pain, it belongs to Liver Meridian wind-heat; use Xiao Chaihu Tang added with Zhizi (Gardeniae Fructus) and Chuanxiong. If accompanied by internal heat and dry mouth, it belongs to Kidney Meridian deficient fire; use Jiawei Dihuang Wan (Modified Rehmannia Pill). If ineffective, use Jiawei Bawei Wan (Modified Eight-Ingredient Pill). Other cases should be treated according to syndrome differentiation.

Wenxuan Yao Haishan had red swelling at the root of the ear with chills, fever, and pain, belonging to Sanjiao wind-heat. However, his middle qi was inherently deficient. I treated him with Butong Yiqi Tang (Supplementing Middle and Augmenting Qi Decoction) added with Zhizi, Chao Huangqin (Fried Scutellariae Radix), and Niubangzi, resulting in recovery.

A scholar suffered from ear pain and discharge due to anger. Someone used wind-dispelling agents, causing tendon spasms and pain, making limbs feel bound. This was liver fire injuring blood. Sixwei Wan (Six-Ingredient Pill with Rehmannia) material was taken for several doses, leading to recovery.

The son of Juren Mao Shifeng, aged twenty, had ear discharge or pain for over a year. The pulse was surging and rapid, especially at the left Chi position. This belonged to deficient heat in the Liver and Kidney meridians. Jiawei Bawei Wan material was prescribed, resulting in recovery after one dose.

A man experienced ear itching or discharge after intercourse, often probing with a silver needle, and preferred cool environments. This belonged to Kidney Meridian deficient heat. Jiawei Bawei Wan led to recovery.

A woman, triggered by anger and fever, had pus discharge from both ears during menstruation, pain in both temporal regions (relieved by pressure), distending pain in chest/hypochondrium/breasts upon anger, alternating chills and fever, frequent urination, or lower abdominal fullness. These all belonged to liver fire and blood deficiency. First, Zhizi Qinggan San (Gardenia Clearing Liver Powder) was given for two doses, followed by Jiawei Xiaoyao San (Modified Free Wanderer Powder) for several doses. All symptoms subsided. Finally, Butong Yiqi Tang added with Wuweizi (Schisandrae Fructus) ensured complete recovery.

After menstruation, a woman suffered from fever, chills, and ear pain due to anger and fatigue. Menstruation causes blood deficiency, so Bazhen Tang (Eight-Treasure Decoction) added with Chaihu was used. Anger causes liver fire, so Jiawei Xiaoyao San was used. Fatigue injures qi, so Butong Yiqi Tang added with Zhizi was used, leading to recovery.

A woman had ear pain or swelling, fever, and chills. Her complexion was originally greenish-yellow but turned red during menstruation. This was attributed to anger injuring the Liver and stagnation injuring the Spleen. Jiawei Guipi Tang (Modified Heart-Spleen Tonic Decoction) and Jiawei Xiaoyao San were used, resulting in recovery.

A woman had ear swelling and pain, chills, fever, bitter taste, ear discharge radiating to the neck, and poor appetite. This was severe liver fire injuring the Spleen. Xiao Chaihu Tang added with Zhizi and Mudanpi (Moutan Cortex) showed slight improvement. Then, Jiawei Xiaoyao San, followed by Bazhen Tang added with Chaihu, Zhizi, and Danpi, regulated and tonified the Liver and Spleen, leading to complete recovery.

A widow had intermittent ear pain (inside/outside) or cervical lymph node swelling, internal heat, afternoon fever, irregular menstruation, scanty saliva, poor appetite, and chest diaphragm discomfort. This was depression and anger injuring the Liver and Spleen. Morning administration of Guipi Tang resolved Spleen stagnation and generated Spleen qi; evening administration of Jiawei Xiaoyao San cleared Liver fire and generated Liver blood, leading to recovery.

Taiqing Wei Zhuangqu had ear pain in mid-winter of Gui-Mao year. The left Chi pulse was surging, large, and choppy. I stated: "Kidney water is exhausted, unable to nourish Liver wood. The source of transformation must be nourished." He did not believe this and continued using direct tonics. I told his son-in-law Lu Shiruo: "If Zhuangqu cannot generate Kidney water, he will not recover next spring."

By the 18th day of late spring the following year, he was consulted again. He was confused and mute. Pus had formed at the junction of the jaw and ear. His testicles were retracted, and he had frequent urination. Only then did he believe me and seek treatment. Reluctantly, I prescribed one cup of Sixwei Wan material. His penis extended, urine frequency decreased by six or seven tenths, and his mental clarity suddenly returned. I said: "If the pus is pricked out, life might be extended for a few days, allowing time to arrange for an heir. Otherwise, if pus discharges from the ear, death is imminent." Some suggested survival without pricking. I declined and returned home. The next day, pus indeed discharged from the ear. On the 21st day (Ji-Wei), on a Fire day, he died.

Xiangfu Jiang Shichuan, in winter of Gui-Mao year, had a floating and rapid right Cun pulse with phlegm, and oral lesions resembling sores. I stated: "Stomach fire transmitting to the Lung. Dietary restrictions and careful living are needed to prevent progression." In autumn of Jia-Chen year, the Chi pulse was surging, rapid, and forceless. I stated: "Lung metal fails to generate Kidney water. Rootless fire flares upward. Quiet rest and nourishment of the transformation source are required." He replied: "Now my throat and ears are frequently dry and painful, and limbs frequently feel hot. Indeed, rootless fire leads inevitably to death." Later, Liu Guxia informed me that Jiang's condition matched my prediction. We visited together. The throat was indeed swollen and ulcerated, and the pulse was even more surging and large. Mistakenly diagnosed as toxic sores, bitter-cold herbs were administered. He died on the 28th day of mid-spring. The medicine hastened his death; otherwise, he might have survived until mid-summer.

Danggui Chuanxiong San treats Hand and Foot Shaoyang meridian conditions, blood-deficient sores or wind-heat, ear itching/pain/sores/discharge, unclear head/eyes, chills/fever/poor appetite, women's irregular menstruation, chest/diaphragm discomfort, and hypochondriac/abdominal fullness/pain.
Ingredients: Danggui, Chuanxiong, Chaihu, Baizhu, Shaoyao (each 1 qian), Zhizi (fried, 1.2 qian), Mudanpi, Fuling (each 0.8 qian), Manjingzi, Gancao (each 0.5 qian).
Preparation: Decoct in water and take orally.
Modifications: For Liver qi imbalance with chills/fever, add Digupi. For excess Liver qi, add Chaihu, Huangqin. For qi/blood deficiency, add Renshen, [missing], Danggui, Dihuang. For Spleen deficiency with poor appetite, add Fuling, Baizhu. For Spleen deficiency with chest discomfort, add Renshen, [missing]. For phlegm stagnation in chest, add Baizhu, Banxia. For unsmooth Liver qi with chest discomfort, lower abdominal fullness, or attacking pain, add Qingpi. For insufficient Liver blood with chest discomfort or lower abdominal fullness/pain, add Shudihuang. For Liver blood deficiency-cold with occasional lower abdominal pain, add Rougui. For afternoon fever, add Danggui, Dihuang.

Zhizi Qinggan San (also known as Chaihu Zhizi San) treats Sanjiao and Foot-Shaoyang meridian wind-heat, ear itching/sores/discharge/pain, chest/breast pain, or alternating chills and fever.
Ingredients: Chaihu, Zhizi (fried), Mudanpi (each 1 qian), Fuling, Chuanxiong, Shaoyao, Danggui, Niubangzi (fried, each 0.7 qian), Gancao (0.5 qian).
Preparation: Decoct in water and take orally. For Taiyang headache, add Qianghuo.

Jiawei Dihuang Wan treats Liver-Kidney yin deficiency sores, ear itching/pain/discharge, blurred vision, phlegm, asthma/cough, thirst/fever, and red/scanty urination.
Ingredients: Dry Shanyao, Shanzhuyu, Mudanpi, Zexie, Bai Fuling, Shudihuang, Chaihu, Wuweizi (each ground separately, equal parts).
Preparation: Crush the two types of Dihuang, moisten with wine, pound into paste, mix with the powders, add refined honey to make pills the size of paulownia seeds. Take 100 pills per dose with plain warm water on an empty stomach. If ineffective, use Jiawei Bawei Wan.