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A question was asked: "What is the condition of a tubercle at the root of the ear?" The answer was: "This is called 'Eergen Du' (Toxin at the Root of the Ear). Its appearance resembles a phlegm-nodule (a subcutaneous nodule formed by phlegm accumulation); it is immovable upon pressure and slightly painful. It belongs to the Foot-Shaoyang Gallbladder Meridian, caused jointly by wind-heat affecting the Sanjiao (Triple Burner) Meridian. Use Huoming Yin (Life-Saving Decoction) with added Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix), decocted in water and wine, or administer Wu Jin San (Black Gold Powder) to induce sweating. For those with robust constitutions, Yili Jindan (One-Pill Golden Pill) should be used to purge; for the elderly and weak, Huangqi Neituo San (Astragalus Internal Support Powder) or Shixuan San (Ten Acupoints Support Powder) should be used to support and expel toxins.

One patient suffered from fatigue and exhaustion, with swelling below the ear, aversion to cold, fever, headache, and thirst. The pulse on the right side was large and soft. He should have taken Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi). However, he self-medicated with diaphoretic agents, leading to vomiting, which finally convinced him of his error. I treated him with Liujunzi Tang (Six-Gentlemen Decoction), followed by Buzhong Yiqi Tang, resulting in recovery. Generally speaking, internal injury leads to the failure of Ying (Nutritive) and Wei (Defensive) Qi to maintain their posts. Without Qi nourishing the skin, one cannot resist wind-cold. If Stomach Qi sinks, Yang Fire rushes upward, causing panting, fever, headache, and a large pulse. This is a deficiency syndrome. If mistakenly treated as an exterior excess syndrome and purged, how can one avoid the disaster of further weakening the deficient? Li Dongyuan stated: In internal injury, the right pulse is large; in external contraction, the left pulse is large. One should distinguish them by this criterion. Note: Although a large left pulse often indicates external contraction, relying solely on this is unreliable. One must examine the physical form and complexion, carefully assess the symptoms, and correlate them with the pulse to avoid errors.

Zhu Danxi treated an elderly man who, due to hunger, cold, and overwork, suffered from headache, fever, aversion to cold, bone and joint pain, absence of sweating, and delirious speech. His pulse was surging and rapid, more pronounced on the left. He was treated with Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Gancao (Glycyrrhizae Radix et Rhizoma), adding one slice of Fuzi (Aconiti Lateralis Radix Praeparata) per dose. He recovered after five doses. Another young man, in September, suffered from fever, headache, delirious speech, and extreme thirst. His body was fat, and his pulse was rapid and large, more pronounced on the left. Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) were used as sovereign drugs, Fu Ling (Poria) and Shaoyao (Paeoniae Radix) as minister drugs, Chenpi (Citri Reticulatae Pericarpium) as assistant drug, and one slice of Fuzi (Aconiti Lateralis Radix Praeparata) as guide drug. Since the patient was fat and the left pulse was larger than the right, the situation was urgent. Without Fuzi (Aconiti Lateralis Radix Praeparata), Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) would not yield quick results. After fifty doses, profuse sweating occurred, and he recovered. In all these cases, the left pulse was large, and Zhu Danxi treated them as internal injuries. If one had followed Li Dongyuan's diagnosis of external contraction, it would have been fatal.

A woman suffered from swelling and pain below the ear, accompanied by chills and fever. She was given Jingfang Baidu San (Decoction of Schizonepeta and Saposhnikovia to Overcome Toxins) for four doses, after which all exterior symptoms subsided. Then, Sansong Kuijian Tang (Decoction to Reduce Swelling and Harden Tumors) was administered for several doses, reducing the swelling by more than half. Finally, Shenxiao Gualou San (Miraculous Trichosanthes Powder) was given for four doses, leading to resolution. Another patient with wind-heat in the Liver Meridian suffered from swelling, pain, and fever below the ear, with a floating and rapid pulse. He was treated with Bohe Dan (Mint Pills), resulting in resolution. A woman, angered, developed swelling and pain below the ear. She was treated with Jingfang Baidu San (Decoction of Schizonepeta and Saposhnikovia to Overcome Toxins) plus Qiaoliao (Forsythiae Fructus) and Huangqin (Scutellariae Radix), recovering in four doses. I once treated cases where such swellings did not resolve for ten days. By using herbs to tonify Qi and Blood, and having the patient drink Yuanzhi Jiu (Polygalae Wine), they were effective; swellings without pus resolved spontaneously, and those with pus ruptured naturally.

Another woman, angered, suffered from swelling and pain below the ear, headache, chills, and fever. Jingfang Baidu San (Decoction of Schizonepeta and Saposhnikovia to Overcome Toxins) plus Huangqin (Scutellariae Radix) was given, resolving all exterior symptoms. However, her appetite decreased, and she experienced afternoon fever. Li Dongyuan said: Even with deficient heat, one should not attack vigorously; if heat is removed, cold will arise. Thus, Xiaochaihu Tang (Minor Decoction of Bupleurum) plus Digupi (Corni Fructus), Xiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Ling (Poria), Zhu (Atractylodis Macrocephalae Rhizoma), and Chenpi (Citri Reticulatae Pericarpium) was prescribed for over ten doses, leading to recovery. The following spring, the area swelled again, becoming hard and unruptured. Bazhen Tang (Eight-Treasure Decoction) plus Xiangfu (Cyperi Rhizoma), Chaihu (Bupleuri Radix), Digupi (Corni Fructus), and Jiegeng (Platycodonis Radix) was administered. After six or seven doses, feeling progress was slow, she took Renshen Baidu San (Ginseng Decoction to Overcome Toxins), causing intensified fever. Taking Liuqi Yin (Flowing Qi Decoction) led to night sweats, fever, dry mouth, and poor appetite. By autumn, when she sought treatment again, her Qi and Blood were extremely depleted. I declined to treat her, and she indeed died.

A man whose ears swelled below upon each anger, or who felt pain in the hypochondrium, was cured in four doses with Xiaochaihu Tang (Minor Decoction of Bupleurum) plus Qingpi (Citri Reticulatae Pericarpium Viride), Honghua (Carthami Flos), and Taoren (Persicae Semen). A female patient, irritable and prone to anger, frequently suffered from swelling and pain below the ear, chills, and fever. Her Liver pulse was wiry and urgent. She was given Xiaochaihu Tang (Minor Decoction of Bupleurum) plus Qingpi (Citri Reticulatae Pericarpium Viride), Niubangzi (Arctii Fructus), Jingjie (Schizonepetae Spica), and Fangfeng (Saposhnikoviae Radix), which resolved the chills and fever. Subsequently, Xiaochaihu Tang (Minor Decoction of Bupleurum) combined with Siwu Tang (Four-Agent Decoction) for several doses reduced the swelling. Her father wished to eradicate the root cause. I said: Internally, the Liver stores Blood; externally, it nourishes the sinews. Anger causes Qi to reverse, injuring the Liver. Since the Liver governs the sinews, accumulated sinews lead to swelling. Self-regulation is necessary to prevent recurrence. Otherwise, repeated Liver injury impairs its ability to store Blood; Blood deficiency makes recovery difficult. Later, failing to exercise caution, three nodules indeed formed. Repeated cauterization failed to heal the wound, and she died.

Another man, exhausted from a long journey, suffered from fever and a large but forceless pulse, with swelling below the ear. This was damage from overwork. He should have taken Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment the Qi) and Yangrong Tang (Nourishing Blood Decoction), which would naturally reduce fever and swelling. He did not listen, taking fire-clearing medicines and Bixiao San (Surely Effective Powder), and died from vomiting, diarrhea, and inability to eat. Overwork damages Qi; when Qi declines, Fire flares up. Fire attacks the Spleen Earth, causing fatigue and fever. This is injury to Yuan Qi (Original Qi). Zhu Danxi said: One should tonify Form and Qi, regulate the meridians, and the sores will resolve spontaneously. Sweating and purging are contraindicated. If one fails to carefully examine the pulse and symptoms, and the differences in meridian pathology, and rashly uses harsh medications, danger is rarely avoided."