治肝肾不足，眼目昏暗，常见黑花多泪。
枸杞子（三两） 苁蓉（酒浸，炒） 巴戟（各一两） 甘菊（二两） 蜜丸，
桐子大，每服五十丸，食后酒盐汤送下。
治目珠痛，夜则痛甚，或用苦寒药点上反疼甚者，神效。盖夏枯草夏至阴生则枯草，纯正阳之气
以胜浊阴，补养厥阴血脉，故治厥阴郁火目疼如神不可忍也。
夏枯草 香附子（各一两） 甘草（四钱） 为末，每服一钱五分，茶清调下，才下咽即痛减。
治内障。凡男子肾虚，眼目昏暗，或见黑花，常服明目暖水脏，活血驻颜壮筋骨。
甘菊花 熟地（各一两） 枸杞（四两） 山药（五钱） 为末，蜜丸，桐子大，每服三四十丸，
空心食后服。
治疮疹人眼，及昏暗障翳。
兔矢二钱，茶清调下，或吞服，须待疮疹瘥后服之。此足厥阴阳明药也，兔者，明月之精得金之气，
其矢名玩砂，能解毒杀虫，故专能明目，又可兼治劳疳也。
飞丝芒尘入目，用陈京黑浓磨点之。
《经》云∶耳者，肾之窍也。肾主藏精
者也。故精脱者，则颊黑而耳聋。耳者，宗脉之所聚也。以窍言之，水也。以声言之，
金也。以经言之，手足少阳，俱会其中也。有从内不能听者，主也。有从外不能入者，
经也。肾和则能闻五音矣。
又曰∶耳聋少气隘干者，肺虚也。又曰∶头痛耳鸣，九窍不利，肠胃之所生也。
肠胃不足，故气弱不充，伤寒及大病之后，多有此症，以补中益气汤治之。耳聋多恐
者，肝虚也。《经》云∶肝虚则目KT KT 无所见，耳无所闻，善恐，治法用四物汤，加防
风、羌活、柴胡、菖蒲、茯神主之。
耳聋皆属于热，然有左耳聋者，有右耳聋者，有左右耳俱聋者，不可不分经而治
也。左耳聋者，少阳火也，龙荟丸主之。右耳聋者，太阳火也，六味丸主之。左右耳俱
聋者，阳明之火也，通圣散滚痰丸主之。凡有所忿怒过度，则动少阳胆火，从左起，故
使左耳聋也。有所色欲过度，则动太阳膀胱相火，从右起，故使右耳聋也。有所醇酒浓
味过度，则动阳明胃火，从中起，故使左右耳俱聋也。左耳聋者，妇人多有之，以其多
忿怒也。右耳聋者，男子多有之，以其多色欲也。左右耳俱聋者，膏粱之家多有之，以
其多肥甘也。
新聋多热，少阳阳明火多故也。旧聋多虚，肾常不足故也。一宜散风清热，一宜滋
肾通窍。故大病后耳聋，须用补阴降火，然在病后，则气血俱虚，必诊两手之脉，孰胜
而为之治。若脉大无力，或右手细小沉弱者，阳气大虚也，宜甘温之剂，仿阳生阴长
之义，少加血药佐之。若纯视为阴虚，而用滋阴降火之剂，则阳气愈弱、非惟耳聋不
痊，反增恶心胸满泄泻之患矣。
《经》曰∶肾开窍于耳。夫肾之为脏，水脏也。天一生水，故有生之初，先生二
肾，而一阴藏焉。又有相火存乎命门之中，每挟君火之势，而侮所不胜，《经》所谓一
水不能胜二火也。况又嗜欲无节，劳役过度，或中年之后，大病之余，肾水枯涸，阴
火上炎，故耳痒耳鸣，无日不作也。《经》曰∶阳气万物，盛上而跃，故耳鸣也。是以
鸣甚如蝉，或左或右，或时闭塞，然有作肾虚治而不效者，何也？此有痰火上升，郁于
耳中而为鸣，郁甚则壅闭矣。凡遇此疾，若平昔饮酒浓味，上焦素有痰火者，只作清痰
降火治之，多因先有痰火在上。又感恼怒而得，怒则气上，少阳之火，客于耳也。若是
肾虚而鸣者，亦是膀胱相火上引，故鸣必不甚，其人必多欲，当兼见劳怯之症。
有气逆而聋者，所属有二。凡手太阳气厥而耳聋者，其候聋而耳内气满也。手少阳
气厥而耳聋者，其候耳内浑浑烹烹，此皆气逆而聋也。治法宜四物汤，加降火通气之
药。然脏气逆而为厥聋，必有眩昏之症，风聋必有头痛之症。劳役伤其气血，淫欲耗其
精元，昏昏 是谓劳聋也。必有虚损之症，其声嘈嘈眼见黑花，此乃虚聋症也。
凡耳聋因湿热痰及气实者，并宜槟郎丸，或神芎丸下之。如耳湿肿痛者，用凉膈
散，加（酒炒）大黄、黄芩（酒浸），防风、荆芥、羌活主之。
耳者，虽足少阴之所主，然人身十二经络，除足太阳，手厥阴，其余十经络，皆入
于耳，惟肾开窍于耳，故治耳者，以肾为主。然心亦开窍于耳，何也？盖心窍本在
舌，以舌无孔窍，因寄于耳，肾为耳窍之主，心为耳窍之客，肾治内之阴，心治外之
阳，清净精明之气，上走空窍，而听斯聪矣。若二经不调，阴阳不和，皆令暴聋，然
五脏开于五部，分阴阳言之，在肾肝居阴，故耳目二脏，阴精主之。在心脾肺居阳，故
口鼻舌三窍，阳精主之。是以五脏不和，则七窍不通。凡一经一络有虚实之气入于耳
者，皆足以乱其聪明，此言暴病者也。若夫久聋者，于肾亦有虚实之异，左肾为阴，主
精，右肾为阳，主气，精不足，气有余，则聋为虚。若瘦而色黑，筋骨健壮，此精气俱
有余，固脏闭塞是聋为实，乃高寿之兆，二者，皆禀受所致也。若耳聋颊黑者，为脱精
肾惫，用安肾八味苁蓉等丸选而用之。若肾经虚火，面赤口干，痰盛内热者；六味丸主
之，此论阴虚者也。至于阳虚者，亦有耳聋，《经》曰∶清阳出上窍，胃气者，清气
元气春升之气，同出而异名也。今人饮食劳倦，脾胃之气一虚，不能上升，而下流于肾
肝，故阳气闭塞，地气冒明，邪害空窍，令人耳目不明，此阳虚耳聋，须用东垣补中益
气汤主之。有因心气虚实不调，虚则不能治其阳，下与阴交，实则恃阳强而与阴绝，
《经》曰∶至阴虚天气绝是也，宜以补心丸加减主之。更有地气冒明者，或忧愁不解，
阴气闭塞，不与阳通，或内外湿饮痞膈，其气不得升降，而耳中赤浑浑烹烹者，宜以升
阳除湿之剂主之。然以阴精阳气而论，则耳目二窍，阴精主之。阴精主者，贵清凉而恶
烦热。阳气主者，贵温暖而恶寒凉。洁古老人尝有是论，信乎耳目之不可以温补也！
《仁斋直指》云∶肾通于耳。所主者精，精气调和，肾气充足，则耳得听斯聪矣。故能
调养得所，气血和平，则其聋渐轻。若不知自节，日执劳烦，不禁欲，不戒性，不戒
酒，乃爆炙浓味，虽服药无效也。
又有耳痛，耳鸣、耳痒、耳脓、耳疮，亦当从少阴正窍，分寒热虚实而治之，不可
专作火与外邪。凡耳鸣以手按之而不鸣，或少减者，真虚也。手按之而愈鸣者，火实
也。昔王万里时患耳痛，魏文靖公，劝以服青盐鹿茸，煎雄附为剂，且言此药，非为君
虚损服之，易不观易之，坎为耳痛，坎水藏在肾，开窍于耳，在志为恐，恐则伤肾，故
耳痛。气阳运动常显血阴流行常幽，血在形，如水在天地之间，故坎为血卦，是经中
已着病症矣，竞饵之而愈。
人身有九窍，阳窍七，耳目口鼻是也。阴窍二，前后二阴是也。阳气走上窍，若下
入阴位，则有溺泄腹鸣之候；阴气走下窍，若上八阳位，则有窒塞耳鸣之候。高年之
人，肾水已竭，真火易露，故肾中之气易出难收，浮赵上窍，窍内有声如蛙鼓蚊锣，是
以外入之声，与内声相混，听之不清，至年迈阴气内竭，不能上通，而失听斯聪矣。非
若少壮之人，浊阴遮蔽其窍，外声不得内人，故用菖蒲、麝香，透气导达为事也。故
治高年逆上之气，全以磁石为主，取其重能达下，性主下吸，兼用地黄龟胶群阴之药佐
之，更助五味子山茱之酸收之，令阴气自旺于本宫，而不上触于阳窍，由是空旷无碍，
耳之受声，犹谷之受响，故耳之妙用，全在虚而能受也。
治疗肝肾亏虚，眼睛昏暗，经常看到黑花飞舞、多泪的症状。
枸杞子（三两） 肉苁蓉（酒浸后炒制） 巴戟天（各一两） 甘菊花（二两），制成蜜丸，如梧桐子大小，每次服用五十丸，饭后用酒盐汤送服。
治疗眼球疼痛，夜间疼痛加剧，或者使用苦寒药物点眼反而疼痛剧烈的情况，有显著疗效。这是因为夏枯草在夏至时节阴气初生时枯萎，具有纯正的阳气，能够战胜浊阴之气，补养厥阴经的血脉，所以治疗厥阴经郁火引起的剧烈目痛效果神奇。
夏枯草 香附子（各一两） 甘草（四钱），研为细末，每次服用一钱五分，用清茶调服，药液刚咽下疼痛即减轻。
治疗内障眼病。凡是男子肾虚，眼睛昏暗，或看见黑花飞舞，常服此方可以明目、温暖水脏（肾）、活血、驻颜、强壮筋骨。
甘菊花 熟地黄（各一两） 枸杞子（四两） 山药（五钱），研为细末，制成蜜丸，如梧桐子大小，每次服用三四十丸，空腹及饭后服用。
治疗疮疹患者出现的眼睛问题，以及眼睛昏暗、有翳障的情况。
兔粪二钱，用清茶调服，或者吞服，必须等到疮疹痊愈后再服用。这是足厥阴肝经和足阳明胃经的药物。兔子是明月的精华，禀受金气，其粪便名为“玩砂”，能解毒杀虫，所以专门能明目，还可以兼治劳疳病。
飞丝芒尘进入眼睛，用陈年京墨浓磨成的墨汁滴眼。
《内经》说：耳朵是肾的窍道。肾主藏精。所以精气耗脱的人，会出现脸颊发黑和耳聋。耳朵是众多经脉汇聚的地方。从窍道来说，属水；从声音来说，属金；从经络来说，手足少阳经都汇聚于此。有因内部病变导致听不见的，病在脏（主）；有因外部邪气侵入导致听不见的，病在经（经）。肾气调和就能听到五音了。
又说：耳聋、气短、咽喉干燥的，是肺虚。又说：头痛、耳鸣、九窍不通利的，是由肠胃产生的。肠胃虚弱，所以气弱不能充盈，伤寒及大病之后，多有这种症状，用补中益气汤治疗。耳聋且多恐惧的，是肝虚。《内经》说：肝虚则眼睛看不清，耳朵听不见，容易恐惧，治疗方法用四物汤，加防风、羌活、柴胡、石菖蒲、茯神来主治。
耳聋大多属于热证，但有左耳聋的，有右耳聋的，有双耳都聋的，不可不分别经络进行治疗。左耳聋的，是少阳火旺，用龙胆泻肝丸主治。右耳聋的，是太阳火旺，用六味地黄丸主治。双耳都聋的，是阳明火旺，用防风通圣散或滚痰丸主治。凡是愤怒过度，就会扰动少阳胆火，从左起，所以导致左耳聋。凡是房事过度，就会扰动太阳膀胱相火，从右起，所以导致右耳聋。凡是饮酒吃厚味过度，就会扰动阳明胃火，从中起，所以导致双耳都聋。左耳聋的，妇女多见，因为她们多愤怒。右耳聋的，男子多见，因为他们多房事。双耳都聋的，富贵人家多见，因为他们多吃肥甘厚味。
新发的耳聋多属热证，因为少阳、阳明火旺的缘故。久病的耳聋多属虚证，因为肾气常不足的缘故。一种宜疏散风热，一种宜滋肾通窍。所以大病后的耳聋，须用滋阴降火的方法，但在病后，气血都虚弱，必须诊察两手脉搏，看哪一方偏胜而进行治疗。如果脉大但无力，或者右手细小沉弱的，是阳气大虚，宜用甘温的药剂，仿照“阳生阴长”的道理，少量加入补血药作为辅助。如果单纯视为阴虚，而用滋阴降火的药剂，那么阳气会更弱，不仅耳聋不好，反而会增加恶心、胸闷、腹泻的祸患。
《内经》说：肾开窍于耳。肾这个脏器，是水脏。天一生水，所以在生命初始时，先生出两个肾，其中藏有一阴。又有相火存在于命门之中，常常挟带君火的势头，欺侮所不胜的脏腑，《内经》所说的“一水不能胜二火”。况且又嗜欲无节制，劳累过度，或者中年以后，大病之余，肾水枯竭，阴火上炎，所以耳朵痒、耳鸣，没有一天不发作的。《内经》说：阳气使万物旺盛向上跳跃，所以耳鸣。因此鸣声像蝉叫一样厉害，或在左或在右，有时闭塞，但是有的按肾虚治疗却无效，为什么呢？这是因为有痰火上升，郁结在耳中而发出鸣声，郁结严重时就会壅塞闭塞。凡遇到这种病，如果平时饮酒吃厚味，上焦素有痰火的人，只当作清痰降火治疗，多是因为先有痰火在上焦。又因恼怒而得病，怒则气上，少阳之火客居于耳中。如果是肾虚而耳鸣的，也是膀胱相火上引，所以鸣声一定不很厉害，其人一定多欲，应当兼见虚劳羸瘦的症状。
有因气逆而耳聋的，所属有两种情况。凡是手太阳经气机逆乱而耳聋的，症状是耳聋且耳内气满。手少阳经气机逆乱而耳聋的，症状是耳内浑浑噩噩作响，这都是气逆导致的耳聋。治疗方法宜用四物汤，加降火通气的药物。但是脏气逆乱导致的厥聋，一定有眩晕昏倒的症状，风聋一定有头痛的症状。劳累损伤气血，淫欲耗损精元，昏昏沉沉的是谓劳聋。一定有虚损的症状，耳鸣声嘈嘈，眼前见黑花，这是虚聋症。
凡是耳聋因湿热、痰饮及气实引起的，都宜用槟榔丸，或者神芎丸攻下。如果耳部湿肿疼痛的，用凉膈散，加（酒炒）大黄、黄芩（酒浸），防风、荆芥、羌活来主治。
耳朵，虽然是足少阴肾经所主，然而人身十二经络，除了足太阳膀胱经、手厥阴心包经，其余十条经络，都进入耳中，只有肾开窍于耳，所以治疗耳病，以肾为主。然而心也开窍于耳，为什么呢？大概心的窍本在舌，因为舌没有孔窍，所以寄居在耳，肾是耳窍的主宰，心是耳窍的客人，肾治理内部的阴，心治理外部的阳，清净精明的气，上行至空窍，听力就聪明了。如果这两条经络不调和，阴阳不和，都会导致暴聋。然而五脏开窍于五部，分阴阳来说，在肾肝居于阴，所以耳目这两个脏器，由阴精主宰。在心脾肺居于阳，所以口鼻舌这三个窍道，由阳精主宰。因此五脏不和，则七窍不通。凡是一经一络有虚实之气进入耳中的，都足以扰乱听力聪明，这是指突发的疾病。至于久聋，对于肾也有虚实之分，左肾为阴，主精，右肾为阳，主气，精不足，气有余，则耳聋为虚。如果身体瘦削而面色黑，筋骨健壮，这是精气都有余，固脏闭塞导致的耳聋为实，这是高寿的征兆，这两种情况，都是禀赋所致。如果耳聋且脸颊发黑的，是精气耗脱、肾气疲惫，用安肾八味苁蓉等丸选择使用。如果是肾经虚火，面赤口干，痰多内热的，用六味地黄丸主治，这是论述阴虚的。至于阳虚的，也有耳聋，《内经》说：清阳出于上窍，胃气，就是清气、元气、春升之气，同源而异名。现在人饮食劳倦，脾胃之气一旦虚弱，不能上升，而下流于肝肾，所以阳气闭塞，地气冒犯清明，邪气侵害空窍，使人耳目不明，这是阳虚耳聋，须用李东垣的补中益气汤主治。有因心气虚实不调的，虚则不能治理其阳，下行与阴交合，实则依仗阳强而与阴隔绝，《内经》说：至阴虚天气绝，适宜用补心丸加减主治。更有地气冒犯的，或者忧愁不解，阴气闭塞，不与阳相通，或者内外湿饮痞隔，气不得升降，而耳中赤红浑浑噩噩作响的，宜用升阳除湿的药剂主治。然而从阴精阳气来说，耳目这两个窍道，由阴精主宰。阴精主宰的，贵在清凉而厌恶烦热。阳气主宰的，贵在温暖而厌恶寒凉。洁古老人曾经有这样的论述，确实耳目是不可以用温补的！
《仁斋直指方》说：肾通于耳。所主宰的是精，精气调和，肾气充足，那么耳朵就能听得聪明了。所以如果能调养得当，气血平和，那么耳聋会逐渐减轻。如果不知道自我节制，每天执着于劳累烦扰，不禁欲，不戒怒，不戒酒，吃爆炒厚味，虽然服药也无效。
又有耳痛、耳鸣、耳痒、耳脓、耳疮，也应当从少阴正窍出发，分寒热虚实而治疗，不可专作火邪和外邪论治。凡是耳鸣用手按住而不响，或者稍微减轻的，是真虚。用手按住而更响的，是火实。过去王万里当时患耳痛，魏文靖公，劝他服用青盐鹿茸，煎煮雄黄附子为剂，并且说这药，不是为君主虚损服的，难道没看过《易经》，坎卦代表耳痛，坎水藏在肾，开窍于耳，在情志为恐，恐则伤肾，所以耳痛。气阳运动常显，血阴流行常幽，血在形体中，如水在天地之间，所以坎为血卦，这在经络中已经记载了病症，最终服药而痊愈。
人身有九窍，阳窍七个，是耳目口鼻。阴窍两个，是前后二阴。阳气走上窍，如果下入阴位，则有溺泄、腹鸣的症状；阴气走下窍，如果上入阳位，则有窒塞、耳鸣的症状。高龄之人，肾水已竭，真火易露，所以肾中之气易出难收，浮越至上窍，窍内有声如蛙鼓蚊锣，所以外界的声音，与内部的声音相混，听不清楚，到了年迈阴气在内枯竭，不能上通，而失去听力聪明了。不像年轻力壮之人，浊阴遮蔽其窍，外界声音不得内入，所以用石菖蒲、麝香，透气导达为主要手段。所以治疗高龄者逆上的气，全以磁石为主，取其重能达下，性主下吸，兼用地黄、龟胶等群阴之药辅助它，再助五味子、山茱萸的酸收作用，令阴气自然旺盛于本宫，而不向上触犯阳窍，由此空旷无碍，耳朵接受声音，就像山谷接受回响一样，所以耳朵的妙用，全在于虚而能受。
Treats deficiency of the Liver and Kidney, dim vision, frequent occurrence of black spots (floaters) in vision, and excessive tearing.
Gouqi Zi (Lycii Fructus, 3 liang), Rongrong (Cistanche Caulis, soaked in wine and stir-fried), Bajie (Morinda Officinalis Radix, 1 liang each), Ganju (Chrysanthemi Flos, 2 liang). Make honey pills, size of Sophora seeds. Take 50 pills per dose, administer after meals with a decoction of wine and salt.
Treats pain in the eyeballs, which worsens at night, or cases where application of bitter-cold medicines causes intensified pain; this is highly effective. This is because Prunella Vulgaris (Xiakucao) withers when Yin begins to generate at the Summer Solstice; it possesses pure Yang Qi to overcome turbid Yin, nourishes the blood vessels of the Jueyin channel, thus treating severe eye pain caused by stagnant fire in the Jueyin channel with miraculous effect.
Xiakucao (Prunellae Spica, 1 liang), Xiangfuzi (Cyperi Rhizoma, 1 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 4 qian). Grind into powder. Take 1.5 qian per dose, mix with clear tea water. Pain reduces immediately upon swallowing.
Treats internal cataracts. For men with Kidney deficiency, dim vision, or seeing black spots, regular use brightens the eyes, warms the Water Organ (Kidney), invigorates blood, preserves youthfulness, and strengthens sinews and bones.
Ganju (Chrysanthemi Flos, 1 liang), Shudi (Rehmanniae Radix Praeparata, 1 liang), Gouqi (Lycii Fructus, 4 liang), Shanyao (Dioscoreae Rhizoma, 5 qian). Grind into powder, make honey pills, size of Sophora seeds. Take 30-40 pills per dose, administer on an empty stomach and after meals.
Treats eye conditions in patients with smallpox/rashes, as well as dim vision and visual obstructions (cataracts/pterygium).
Tu Shi (Leporis Faeces, 2 qian), mix with clear tea water for oral administration, or swallow directly. Must be taken only after the rash has healed. This is a medicine for the Foot Jueyin and Foot Yangming channels. The rabbit is the essence of the bright moon, inheriting Metal Qi. Its feces are called "Wansha," capable of detoxifying and killing parasites, thus specifically brightening the eyes and also treating consumptive disease with intestinal parasites (Laoguan).
For flying silk or dust entering the eye, use thickly ground aged Jingmo (Chinese Ink) to apply locally.
The *Classic* states: The ear is the opening of the Kidney. The Kidney stores Essence. Therefore, when Essence is depleted, the cheeks turn black and deafness occurs. The ear is the gathering place of numerous meridians. From the perspective of the orifice, it belongs to Water. From the perspective of sound, it belongs to Metal. From the perspective of meridians, both the Hand-Shaoyang and Foot-Shaoyang converge there. Deafness arising from internal pathology relates to the Zang organs (primary); deafness arising from external invasion relates to the meridians (secondary). When Kidney Qi is harmonious, one can hear the five tones.
It is also said: Deafness accompanied by shortness of breath and dry throat indicates Lung deficiency. It is also said: Headache, tinnitus, and dysfunction of the nine orifices arise from the Stomach and Intestines. Deficiency of the Stomach and Intestines leads to weak Qi that fails to fill the orifices. This symptom often follows Shanghan (Cold Damage) and major illnesses; treat with Buzhong Yiqi Tang (Spleen-Raising Qi-Supplementing Decoction). Deafness accompanied by fear indicates Liver deficiency. The *Classic* states: Liver deficiency leads to blurred vision, deafness, and timidity. Treat with Siwu Tang (Four Substances Decoction), adding Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Chaihu (Bupleuri Radix), Changpu (Acori Tatarinowii Rhizoma), and Fushen (Poria with Hostwood).
Deafness generally belongs to Heat, but must be differentiated by side: left-sided deafness, right-sided deafness, or bilateral deafness. Left-sided deafness is due to Shaoyang Fire; treat with Longdan Xiegan Wan (Gentian Liver-Draining Pill). Right-sided deafness is due to Taiyang Fire; treat with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Bilateral deafness is due to Yangming Fire; treat with Fengtong Sheng San (Wind-Unblocking Reaching Powder) or Guntan Wan (Rolling Phlegm Pill). Excessive anger stirs Shaoyang Gallbladder Fire, starting from the left, causing left-sided deafness. Excessive sexual desire stirs Taiyang Bladder Ministerial Fire, starting from the right, causing right-sided deafness. Excessive consumption of rich alcohol and food stirs Yangming Stomach Fire, starting from the center, causing bilateral deafness. Left-sided deafness is common in women due to frequent anger. Right-sided deafness is common in men due to frequent sexual indulgence. Bilateral deafness is common among the wealthy due to excessive intake of rich and sweet foods.
New-onset deafness is mostly Heat, due to Shaoyang and Yangming Fire. Chronic deafness is mostly Deficiency, due to chronic Kidney insufficiency. One requires dispersing Wind and clearing Heat; the other requires nourishing Kidney and unblocking orifices. Post-illness deafness requires nourishing Yin and descending Fire. However, post-illness involves Qi and Blood deficiency; pulse diagnosis of both hands is necessary to determine dominance. If the pulse is large but forceless, or fine/small/deep/weak on the right, it indicates severe Yang deficiency. Use sweet-warm formulas, following the principle of "Yang generating Yin," with minor additions of Blood-nourishing herbs. If mistakenly treated solely as Yin deficiency using Yin-nourishing and Fire-descending formulas, Yang will weaken further, worsening deafness and potentially causing nausea, chest fullness, and diarrhea.
The *Classic* states: The Kidney opens into the ears. The Kidney is a Water organ. Heaven generates One Water; thus, at conception, two Kidneys form first, storing one Yin. Additionally, Ministerial Fire resides in the Mingmen (Gate of Life), often riding the momentum of Sovereign Fire to oppress what it cannot overcome, as described in the *Classic*: "One Water cannot overcome Two Fires." Moreover, unrestrained desires and overwork, especially after middle age or major illness, deplete Kidney Water, causing Yin Fire to flare upward, resulting in daily ear itching and tinnitus. The *Classic* states: Yang Qi makes all things flourish and leap upward, hence tinnitus. Thus, tinnitus may be loud like cicadas, unilateral or bilateral, or intermittent blockage. Some cases treated as Kidney deficiency fail. Why? This is due to Phlegm-Fire ascending and stagnating in the ear, causing blockage. For those who drink alcohol and eat rich foods, having pre-existing Phlegm-Fire in the Upper Jiao, treat by clearing Phlegm and descending Fire. This often arises from prior Phlegm-Fire combined with anger, which causes Qi to ascend and Shaoyang Fire to lodge in the ear. In Kidney deficiency tinnitus, it is also driven by Bladder Ministerial Fire rising; the sound is usually mild, associated with hypersexuality and symptoms of consumptive weakness.
Deafness due to Qi rebellion has two types. Hand-Taiyang Qi rebellion causes deafness with a sensation of fullness/Qi in the ear. Hand-Shaoyang Qi rebellion causes deafness with a muffled, humming sensation. Both are deafness due to Qi rebellion. Treat with Siwu Tang (Four Substances Decoction) plus herbs that descend Fire and promote Qi flow. However, Zang-Qi rebellion causing Jue-deafness presents with dizziness/fainting; Wind-deafness presents with headache. Fatigue damaging Qi and Blood, and lust consuming Essence, leads to "Fatigue Deafness" (Laolong), characterized by mental fogginess. Deficiency syndromes present with roaring tinnitus and visual floaters, termed "Deficiency Deafness."
Deafness due to Damp-Heat, Phlegm, and Excess Qi should be purged with Binglang Wan (Areca Nut Pill) or Shenxiong Wan (Divine Angelica Pill). For damp-swelling and painful ears, use Liangge San (Cooling the Chest Powder) modified with Jiudahuang (Rhubarb Radix et Rhizoma, wine-fried), Huangqin (Scutellariae Radix, wine-soaked), Fangfeng (Saposhnikoviae Radix), Jingjie (Schizonepetae Spica), and Qianghuo (Notopterygii Rhizoma et Radix).
Although the Foot-Shaoyin Kidney channel governs the ear, ten of the twelve meridians (excluding Foot-Taiyang and Hand-Jueyin) enter the ear. Since the Kidney opens into the ear, treatment focuses on the Kidney. However, the Heart also opens into the ear. The Heart's primary orifice is the tongue; since the tongue lacks a distinct orifice, it shares function with the ear. The Kidney is the master of the ear's interior (Yin), and the Heart is the guest of the ear's exterior (Yang). Clear, refined Qi ascends to the orifices, granting acute hearing. Disharmony between these two meridians and Yin-Yang imbalance causes sudden deafness. The Five Zang open into five regions: Liver and Kidney belong to Yin, governing Eyes and Ears via Yin Essence. Heart, Spleen, and Lung belong to Yang, governing Mouth, Nose, and Tongue via Yang Essence. Disharmony of the Five Zang blocks the seven orifices. Any excess or deficiency Qi entering the ear disrupts hearing, referring to acute disease. Chronic deafness differs by Kidney deficiency/excess: Left Kidney (Yin) governs Essence; Right Kidney (Yang) governs Qi. Essence deficiency and Qi excess lead to Deficiency deafness. Thin individuals with dark complexion and strong sinews/bones have Excess Essence and Qi; solid organ closure causes Excess deafness, a sign of longevity. Both are constitutional. Deafness with black cheeks indicates Essence depletion and Kidney exhaustion; use Anshen Bawei Rongrong Wan (Kidney-Anchoring Eight-Ingredient Cistanche Pill). Kidney channel deficient Fire with red face, dry mouth, and phlegm-heat is treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), addressing Yin deficiency. Yang deficiency also causes deafness. The *Classic* states: Clear Yang emerges from the upper orifices. Stomach Qi, Clear Qi, Yuan Qi, and Spring-rising Qi are synonymous. Dietary irregularity and fatigue damage Spleen-Stomach Qi, preventing ascent and causing downward flow into Liver-Kidney. Yang Qi becomes blocked, Earth Qi obscures clarity, and pathogenic factors harm the orifices, causing dull eyes and ears. This is Yang-deficiency deafness, treated with Dongyuan's Buzhong Yiqi Tang (Spleen-Raising Qi-Supplementing Decoction). Heart Qi disharmony (deficiency failing to control Yang, leading to Yin interaction; or excess relying on Yang strength, severing Yin connection, as stated: "Extreme Yin deficiency cuts off Heavenly Qi") is treated with Xinbu Wan (Heart-Nourishing Pill) modified. Earth Qi obscuring clarity due to unresolved sorrow, Yin blockage preventing Yang communication, or internal/external Damp-Phlegm blocking Qi升降 (ascending/descending), causing red, muffled ears, is treated with Yang-raising and Damp-draining formulas. Regarding Yin Essence and Yang Qi, the eyes and ears are governed by Yin Essence, favoring coolness and disliking irritant heat. They are governed by Yang Qi, favoring warmth and disliking cold. Elder Jiegu stated that eyes and ears should not be tonified with warm herbs.
*Renzhi Zhizhi Fang* states: The Kidney connects to the ear, governing Essence. Harmonized Essence and sufficient Kidney Qi grant acute hearing. Proper regulation of Qi and Blood alleviates deafness. Lack of self-restraint, labor, unchecked desire, anger, alcohol, and spicy/rich foods render medication ineffective.
Ear pain, tinnitus, itching, suppuration, and sores should be treated according to Cold, Heat, Deficiency, and Excess from the Shaoyin proper orifice, not merely as Fire or external pathogens. Tinnitus relieved or silenced by pressure indicates true Deficiency. Tinnitus exacerbated by pressure indicates Fire Excess. Wang Wanli suffered ear pain; Wei Wenjing advised Qingyan Lurong Jian Xiongfu (Green Salt Deer Antler Decoction with Realgar and Aconite). He explained: Kan hexagram represents ear pain; Kan Water resides in the Kidney, opens to the ear, and corresponds to Fear. Fear injures the Kidney, causing ear pain. Yang Qi moves visibly; Yin Blood flows obscurely. Blood in the body is like water in heaven and earth; thus Kan is the Blood hexagram. This pathology was recorded in the classics, and he recovered.
The human body has nine orifices: Seven Yang orifices (eyes, ears, nose, mouth) and two Yin orifices (anterior and posterior urethra/anus). Yang Qi ascends to upper orifices; if it descends to Yin positions, it causes urinary leakage and abdominal rumbling. Yin Qi descends to lower orifices; if it ascends to Yang positions, it causes obstruction and tinnitus. In the elderly, Kidney Water is exhausted, True Fire is exposed, and Kidney Qi escapes easily, floating to upper orifices. Sounds within the orifices resemble frog drums or mosquito gongs, mixing with external sounds and causing unclear hearing. In advanced age, internal Yin Essence is depleted, unable to ascend, leading to loss of hearing. Unlike the young, whose turbid Yin blocks orifices preventing external sound entry, the elderly require aromatics like Changpu (Acori Tatarinowii Rhizoma) and Shexiang (Moschus) to penetrate and guide Qi. Treatment for rebellious Qi in the elderly relies primarily on Cishi (Magnetitum), which is heavy, sinks downward, and attracts Yin. It is assisted by Yin-nourishing herbs like Dihuang (Rehmanniae Radix) and Guijiao (Colla Corii Asini) and Wubeizi (Terminalia Chebula Retusa) and Shanzhuyu (Corni Fructus) for their sour astringency, strengthening Yin in its root and preventing it from harassing Yang orifices. This creates emptiness and openness, allowing the ear to receive sound like a valley receives echoes. The efficacy of hearing lies in emptiness and receptivity.