《治法纲》曰∶耳者肾之窍，足少阴之所主。人身十二经络中，除足太阳、手厥阴，其余十经络皆
入于耳，故治耳者，
以肾为主。或曰心亦开窍于耳，何也？盖心窍本在舌，以舌无孔窍，固寄于耳。此肾为主，心为客。五脏开
于五部，分阴阳言之∶在肾肝居阴，故耳目二藏阴精主之；在心脾肺居阳，故口、鼻、舌三窍阳精主之。
《灵枢》云∶肾气通于耳，肾和则能闻五音。五脏不和则九窍不通。故凡一经一络，有虚实之气入于耳者，
皆足以乱其聪明，而致于聋聩。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。若其
人瘦，而其色黑，筋骨健壮，此精气俱有余，固藏闭塞，是聋为实，寿兆也。二者皆重所致，不须治之。
又有乍聋者。经曰∶不知调和七损八益之道，早衰之节也。其年未五十，体重，耳目不聪明矣。其症耳
聋面颊黑者，为精脱神惫，用安肾丸、八味丸、苁蓉丸、薯蓣丸，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、春升之气也，今人饮食劳倦，脾
胃之气虚，不能上升，而下流于肾肝。故阳气者闭塞，地气者冒明，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。若不知自节，日就烦劳，即为久聋之症矣。
又有因虚而外邪乘之聋者，如伤寒邪入少阳之类。
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，不可专作火与外邪治。
耳鸣以手按之而不鸣，或少减者，虚也；手按之而愈鸣者，实也。王节斋曰∶耳鸣盛如蝉，或左或右，
或时闭塞，世人多作肾虚治，不效。殊不知此是痰火上升，郁于耳而为鸣，
甚则闭塞矣。若其人平昔饮酒浓味，上焦素有痰火，只作清痰降火治之。大抵此症先多有痰火在上，又感恼
怒而得。怒则气上，少阳之火客于耳也。若肾虚而鸣者，其鸣不甚，其人必多欲，当见劳怯等症。
惟薛立斋详分缕晰。云∶血虚有火，用四物加山栀、柴胡。若中气虚弱，用补中益气汤。若气血俱虚，用
八珍加柴胡。若怒便聋，而或鸣者，属肝胆经气实，用小柴胡加芎、归、山栀。气虚用补中益气汤加柴胡、
山栀。午后盛者，阴血虚也，四物加白术、茯苓。若肾虚火动，或痰盛作渴者，必用地黄丸。
耳中哄哄然，是无阴也。又液脱者，脑髓消，胫瘦，耳数鸣，宜地黄丸。肾虚耳中潮声无休止时，妨害
听闻者，当坠气补肾，正元饮咽黑锡丹，间进安肾丸。肾脏风，耳鸣，夜间睡着如打战鼓、更鼓，四肢抽挚痛
，耳内觉风吹奇痒，宜黄 丸。肾者宗脉所聚，耳为之窍，血气不行，宗脉乃虚，风
邪乘虚随脉入耳，风与之搏，故为耳鸣。先用生料五苓散，加制枳壳、橘红、紫苏、生姜同煎，吞青木香丸，
散邪下气。续以芎归饮和养之。
耳中耵聍、耳鸣、耳聋，内有污血，宜柴胡聪耳汤。又《圣惠》云∶有一人耳痒，一日一作，可畏，直
挑剔出血，稍愈，此乃肾脏虚，致浮毒上攻，未易以常法治之，宜服透冰丹。勿饮酒，啖湿面、鸡、猪之属，
能尽一月为佳。不能戒则无效也。
又有耳内生疮，为足少阴，其经虚，风邪乘之，随脉入耳，与气相搏，故令耳门生疮也。曾青散主之，
黄连散亦可，内服鼠粘子汤。盖耳疮属于少阳三焦经，或足厥阴肝经，血虚风热，或肝经暴火风热，或肾经
风火等因。若发热 痛，属
少阳、厥阴风热，用柴胡山栀散。若内热痒痛，属二经血虚，用当归川芎散。若寒热作痛，属肝经风热，
小柴胡汤加山栀、川芎。若内热口干，属肾经虚火，用加味地黄丸；如不应，用加味八味丸。
又耳脓，即 耳，用红绵散、麝香散，内服柴胡聪耳汤、通气散。如壮盛之人，积热上攻，脓水不差，
红绵散、麝香散，不宜收敛太过也，宜三黄散。
若虫入耳痛，将生姜擦猫鼻，其尿自出，取滴耳内，虫即出。用麻油则虫死难出。或用炒芝麻枕之，
虫亦出，但不及猫尿之速也。
有一小儿患耳脓，经年药不效，此肾虚也，用六味地黄丸加桑螵蛸，服之即愈。
喻嘉言曰∶人身有九窍，阳窍七，眼、耳、目、口、鼻是山；阴窍二，前后二阴也。阳气走上窍，
而下入阴位，则有下泄腹鸣之候；阴气走下窍，而上入于阳位，则有窒塞耳鸣之候。故人当五十以外，肾气
渐衰于下，每每从阳上逆。肾主闭藏，不欲外泄，因肝木为子，疏泄母气而散于外。是以谋虑郁怒之火一动，
阴气从之上逆，耳窍窒塞不清。年高之体大率类此。然较之聋病，一天一渊。聋病者，窍中另有一膜，遮蔽
外气不得内入，故以升窍为主。而方书所用石菖蒲、麝香等药，及内外攻法，皆为此而设。至于高年阴气不自
收摄，越出上窍之理，从无一人言及。不知阴气致上窍，亦隔一膜，不能越出窍外，止于窍中如蛙鼓锣鸣，鼓吹不
已，以故外入之声，为其内声所混，听之不清。若气稍不逆上，则听稍清；气全不逆上，则听全清矣。余悟明
此理，治高年逆上之气，屡获奇验。大意全以磁石为主，以其重能达下，性主下吸，又能制肝木之上吸故也。
而用地黄、龟胶群阴之药
辅之，更用五味子、山茱萸之酸以收之，令阴气自旺于本宫，不上触于阳窍，声入即通，无壅碍也。方书指
为少阳胆、厥阴肝二经热多所致，是说左耳分部。然少阳之气能走上窍，其穴皆络于脑巅，无触筋冲耳之
理，不当与厥阴混同立说。其通圣散一方，汗下兼用，乃治壮火之法。丹溪所取，亦无确见。惟滚痰丸一
方，少壮用之多有效者，则以大黄、黄芩、沉香之苦，最能下气。而礞石之重坠，大约与磁石之用相仿也，
然大损脾胃，耗胸中氤氲之气。至于肾虚耳鸣，指作膀胱相火上升，则阳火必能透出上窍，不为鸣也，尤见
丹溪无稽之谈。高年之人，肾水已竭，真火易露，故肾中之气易出难收，况有厥阴之子为之挹取乎！然则壮
水以制阳光，如盏中加油，灯焰自小，诚为良治。乃云作肾虚治不效，岂为老人立法哉？收摄肾气，老人之
先务，以丹溪明哲，而为此等议论乎？
《治法纲》说：耳朵是肾的窍道，由足少阴肾经所主。在人体十二经络中，除了足太阳膀胱经和手厥阴心包经，其余十条经络都进入耳朵，所以治疗耳病，以调理肾脏为主。有人问：心也开窍于耳，这是为什么呢？原来心的窍本在舌，因为舌上没有孔窍，所以寄附在耳。这是肾为主，心为客。五脏分别开窍于头面五部，从阴阳角度分析：肾和肝居于下焦属阴，所以耳目这两窍由阴精主宰；心和脾、肺居于上焦属阳，所以口、鼻、舌这三窍由阳精主宰。
《灵枢》说：肾气通于耳，肾气调和就能听见五音。如果五脏功能不和，就会导致九窍不通。所以凡是有一条经脉或络脉，有虚或实的气邪侵入耳朵，都足以扰乱人的听力聪明，导致耳聋。这是指突发的疾病。
至于长期的耳聋，在肾脏也有虚实之分。左肾属阴主藏精，右肾属阳主司气。如果精气不足、气有余（亢盛），就会耳聋，属于虚证。如果这个人身体瘦弱，面色黑，但筋骨健壮，这是精气都有余，固藏闭塞，这种耳聋属于实证，反而是长寿的征兆。这两种情况都不需要治疗。
又有突然耳聋的情况。医经说：不懂得调和“七损八益”的道理，是早衰的关键。如果年纪不到五十岁，身体沉重，耳目不灵敏。症状表现为耳聋、面颊发黑的，是精气耗脱、精神疲惫，应当选用安肾丸、八味丸、苁蓉丸、薯蓣丸中的一种来使用。如果是肾经虚火，见面红口干、痰多内热的，用六味丸主治。这是论述阴虚导致的耳聋。
至于阳虚导致的耳聋，也有这种情况。医经说：清阳之气出于上窍。胃气，就是清气、元气、春升之气。现在的人饮食不节、劳倦过度，导致脾胃之气虚弱，不能上升，反而下流于肝肾。所以阳气被闭塞，地气（浊阴）上冒遮蔽清明，邪气侵害空窍，使人耳目不明。这是阳虚耳聋，必须用李东垣的补中益气汤主治。如果不知道自我节制，日益烦劳，就会变成久聋的病证了。
又有因为正气虚弱而外邪乘虚入侵导致的耳聋，比如伤寒邪气传入少阳经之类。
又有耳痛、耳鸣、耳痒、耳流脓、耳疮，也应当从足少阴肾经正窍的角度分辨寒热虚实来治疗，不可专门当作火邪或外邪来治。
耳鸣时用手按压声音不响，或者减轻的，是虚证；用手按压后声音更响的，是实证。王节斋说：耳鸣声大如蝉鸣，或左或右，有时闭塞，世人多当作肾虚治疗，无效。殊不知这是痰火上升，郁结在耳朵里导致鸣响，严重时就会闭塞。如果这个人平时喜欢饮酒、吃肥厚滋味食物，上焦素有痰火，只需用清化痰热、降火的方法治疗。大抵这类病症大多先有痰火在上，又因恼怒引发。怒则气上，少阳之火客居在耳朵里。如果是肾虚导致的耳鸣，鸣声不剧烈，其人必定房事过多，应当见到劳损怯弱等症状。
只有薛立斋详细区分条理清晰。他说：血虚有火的，用四物汤加山栀、柴胡。如果中气虚弱，用补中益气汤。如果气血俱虚，用八珍汤加柴胡。如果发怒就耳聋，或者耳鸣的，属于肝胆经气实，用小柴胡汤加川芎、当归、山栀。气虚的用补中益气汤加柴胡、山栀。午后加重的，是阴血虚，用四物汤加白术、茯苓。如果是肾虚火动，或者痰多口渴的，必须用地黄丸。
耳朵里嗡嗡作响，是无阴的表现。又是津液耗脱的，脑髓消减，小腿消瘦，耳朵经常鸣响，宜用地黄丸。肾虚导致耳朵里潮水声不停止，妨碍听力的，应当降气补肾，服用正元饮送服黑锡丹，间歇进服安肾丸。肾脏受风，耳鸣，夜间睡着时像打战鼓、更鼓一样响，四肢抽搐疼痛，耳朵里觉得风吹奇痒，宜用黄柏丸（注：原文缺字，推测为含黄柏之方，此处依原文留空或泛指）。肾是宗脉汇聚之处，耳是其窍道，血气运行不畅，宗脉空虚，风邪乘虚随脉进入耳朵，风与正气相搏，所以导致耳鸣。先用生料五苓散，加制枳壳、橘红、紫苏、生姜同煎，吞服青木香丸，以散邪下气。随后用芎归饮调和滋养。
耳朵里有耵聍（耳垢）、耳鸣、耳聋，体内有污血，宜用柴胡聪耳汤。又《圣惠方》说：有一人耳朵痒，一天发作一次，很可怕，直接挑破出血，稍微好转，这是肾脏虚，导致浮毒上攻，不容易用常规方法治疗，宜服用透冰丹。不要饮酒，不要吃湿面、鸡、猪肉等食物，如果能坚持一个月最好。如果不能戒除就没有效果。
又有耳内生疮，是因为足少阴肾经虚，风邪乘虚而入，随脉进入耳朵，与气相搏，所以导致耳门生疮。用曾青散主治，黄连散也可以，内服鼠粘子汤。大概耳疮属于少阳三焦经，或足厥阴肝经，血虚风热，或肝经暴怒火热，或肾经风火等原因。如果发热疼痛，属于少阳、厥阴风热，用柴胡山栀散。如果内热痒痛，属于这两经血虚，用当归川芎散。如果寒热交替作痛，属于肝经风热，用小柴胡汤加山栀、川芎。如果内热口干，属于肾经虚火，用加味地黄丸；如果无效，用加味八味丸。
又有耳流脓，即耳疳，用红绵散、麝香散，内服柴胡聪耳汤、通气散。如果是体质壮实的人，积热上攻，脓水不止，红绵散、麝香散不宜收敛太过，宜用三黄散。
如果有虫子进入耳朵疼痛，将生姜擦拭猫鼻子，猫的尿液自然流出，取滴入耳内，虫子就会出来。如果用麻油，虫子死了难出来。或者用炒芝麻枕在头下，虫子也会出来，但不如猫尿快。
有一个小孩患耳流脓，经过一年用药无效，这是肾虚，用六味地黄丸加桑螵蛸，服用后即愈。
喻嘉言说：人身有九窍，阳窍七个，眼、耳、口、鼻是；阴窍两个，前后二阴。阳气走上窍，而下入阴位，就有下泄腹鸣的症状；阴气走下窍，而上入于阳位，就有窒塞耳鸣的症状。所以人到了五十岁以外，肾气在下逐渐衰退，常常从阳上逆。肾主闭藏，不想让精气外泄，因为肝木是肾水的儿子，疏泄母气而散发于外。因此谋虑郁怒之火一动，阴气随之向上逆行，耳窍窒塞不清。年老体弱的大率类似这种情况。然而这与聋病相比，有天壤之别。聋病的人，窍中另有一层膜，遮蔽外气不得内入，所以治疗以升开窍窍为主。而医书所用的石菖蒲、麝香等药，以及内外攻法，都是为此而设。至于老年人阴气不能自我收摄，越出上窍的道理，从来没有一个人提到过。不知道阴气导致上窍，也是隔着一层膜，不能越出窍外，只在窍中像蛙鼓锣鸣，鼓吹不已，因此外界进入的声音，被内部的声音混杂，听起来不清楚。如果气稍不逆上，则听力稍清；气完全不逆上，则听力完全清晰。我悟明这个道理，治疗老年人逆上的气，屡次获得神奇疗效。大意全以磁石为主，因为它质重能达下，性质主下吸，又能制约肝木的上吸。而用地黄、龟胶等群阴的药物辅助它，再用五味子、山茱萸的酸味来收敛它，使阴气在本宫旺盛，不上触阳窍，声音进入即通畅，没有壅碍。医书指出这是少阳胆、厥阴肝二经热多所致，这是说左耳分部。然而少阳之气能走上窍，其穴位都联络于脑巅，没有触动筋脉冲撞耳朵的道理，不应当与厥阴混同立论。防风通圣散一方，汗下兼用，是治疗壮火的方法。朱丹溪所推崇，也没有确切的见解。只有滚痰丸一方，年轻人用的多有效，是因为大黄、黄芩、沉香的苦味，最能下气。而礞石的沉重坠降，大约与磁石的作用相似，但是大大损伤脾胃，消耗胸中氤氲之气。至于肾虚耳鸣，指作膀胱相火上升，那么阳火必然能透出上窍，不会鸣响，这更可见丹溪是无稽之谈。老年人，肾水已枯竭，真火容易显露，所以肾中之气易出难收，何况有厥阴之子为之汲取呢！既然如此，壮水以制阳光，就像盏中加油，灯焰自然变小，确实是良好的治疗方法。却说按肾虚治疗无效，难道是专门为老人制定的法则吗？收摄肾气，是老人的当务之急，凭丹溪的明智，却发表这样的议论呢？
The *Zhi Fa Gang* states: The ear is the orifice of the Kidney, governed by the Foot-Shaoyin (Kidney) meridian. Among the twelve meridians of the human body, except for the Foot-Taiyang (Bladder) and Hand-Jueyin (Pericardium), the remaining ten meridians all enter the ear. Therefore, in treating ear diseases, priority is given to regulating the Kidney. Some may ask: The Heart also opens into the ear; why is this so? Originally, the orifice of the Heart is located in the tongue. Because the tongue has no perforation, it is attached to the ear. Here, the Kidney is the host, and the Heart is the guest. The five Zang organs open into five regions of the head and face. Speaking from the perspective of Yin and Yang: The Kidney and Liver reside in the lower Jiao (Yin region); thus, the ears and eyes, two orifices, are governed by Yin Essence. The Heart, Spleen, and Lung reside in the upper Jiao (Yang region); thus, the mouth, nose, and tongue, three orifices, are governed by Yang Essence.
The *Ling Shu* says: Kidney Qi connects with the ear. When Kidney Qi is harmonious, one can hear the five tones. If the five Zang organs are not in harmony, the nine orifices will be blocked. Therefore, whenever there is an invasion of Deficiency or Excess Qi from any single meridian or collateral into the ear, it is sufficient to disturb one's auditory acuity and lead to deafness. This refers to acute onset conditions.
As for chronic deafness, there are also differences between Deficiency and Excess in the Kidneys. The Left Kidney belongs to Yin and governs Essence; the Right Kidney belongs to Yang and governs Qi. If Essence is insufficient and Qi is excessive (hyperactive), deafness occurs, which is a Deficiency pattern. If a person is thin, has a dark complexion, but strong bones and sinews, this indicates that both Essence and Qi are abundant, leading to blockage due to excessive retention. Such deafness is an Excess pattern and is actually a sign of longevity. Neither of these two cases requires treatment.
There is also sudden deafness. The classics state: Not knowing the way of harmonizing "Seven Damages and Eight Benefits" is the key to premature aging. If one is under fifty years old, feels heavy-bodied, and has dull hearing and vision, and presents with deafness and blackening of the cheeks, this indicates depletion of Essence and exhaustion of Spirit. One should select and use An Shen Wan (Kidney-Anchoring Pill), Ba Wei Wan (Eight-Ingredient Pill), Cong Rong Wan (Cistanche Pill), or Shu Yu Wan (Dioscorea Pill). If there is Empty Heat in the Kidney Meridian, manifesting as red face, dry mouth, profuse phlegm, and internal heat, Liu Wei Wan (Six-Ingredient Pill) is the primary treatment. This discusses deafness caused by Yin Deficiency.
Regarding deafness caused by Yang Deficiency, the classics state: Clear Yang emerges from the upper orifices. Stomach Qi is clear Qi, Yuan Qi, and Spring-rising Qi. Nowadays, people suffer from irregular diet and overwork, causing Spleen and Stomach Qi to become deficient. It fails to ascend and instead flows downward into the Liver and Kidney. Thus, Yang Qi becomes blocked, turbid Yin rises to obscure clarity, pathogenic factors harm the orifices, and one suffers from unclear hearing and vision. This is deafness due to Yang Deficiency, requiring Dongyuan's Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) as the main treatment. If one does not practice self-restraint and increases daily fatigue, it will develop into chronic deafness.
There is also deafness caused by external pathogens taking advantage of deficiency, such as when Shaoyang disease pathogens enter the Shaoyang channel.
For ear pain, tinnitus, ear itching, otorrhea (pus discharge), and otodermatitis (ear sores), treatment should differentiate Cold, Heat, Deficiency, and Excess based on the proper orifice of the Foot-Shaoyin (Kidney) meridian. One must not treat them solely as Fire pathogens or external pathogens.
If tinnitus decreases or stops when pressed with the hand, it is Deficiency; if it worsens when pressed, it is Excess. Wang Jiezhai said: Tinnitus sounding loud like cicadas, occurring on either side or intermittently blocking the ear, is often treated by laypeople as Kidney Deficiency without effect. They fail to realize this is Phlegm-Fire ascending and stagnating in the ear, causing ringing, and severe blockage. If the person usually drinks alcohol and eats rich flavors, having Phlegm-Fire in the Upper Jiao, treatment should focus on clearing Phlegm and reducing Fire. Generally, this condition first involves Phlegm-Fire in the upper part, triggered by anger. Anger causes Qi to rise, and Shaoyang Fire lodges in the ear. If tinnitus is due to Kidney Deficiency, the sound is not intense, and the person likely has excessive sexual activity, presenting with signs of consumptive weakness.
Only Xue Lizhai distinguished these clearly. He stated: For Blood Deficiency with Fire, use Si Wu Tang (Four-Substance Decoction) plus Gardenia (Shan Zhi) and Bupleurum (Chai Hu). For Middle Qi Deficiency, use Bu Zhong Yi Qi Tang. For combined Qi and Blood Deficiency, use Ba Zhen Tang (Eight-Treasure Decoction) plus Chai Hu. If deafness or tinnitus occurs upon anger, it belongs to Excess Qi in the Liver and Gallbladder meridians; use Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Chuanxiong (Xiong), Angelica Sinensis (Gui), and Shan Zhi. For Qi Deficiency, use Bu Zhong Yi Qi Tang plus Chai Hu and Shan Zhi. If symptoms worsen in the afternoon, it is Yin-Blood Deficiency; use Si Wu Tang plus Atractylodes (Bai Zhu) and Poria (Fu Ling). If Kidney Deficiency with Fire stirring, or profuse phlegm with thirst, Di Huang Wan (Rehmannia Pill) is essential.
Buzzing in the ears indicates lack of Yin. In cases of fluid depletion, brain marrow diminishes, calves atrophy, and ears ring frequently; Di Huang Wan is suitable. For Kidney Deficiency causing continuous如潮 (tidal) sounds in the ears, interfering with hearing, one should descend Qi and tonify the Kidney, swallowing Zheng Yuan Yin with Hei Xi Dan (Black Tin Pill), and intermittently administering An Shen Wan. For Wind affecting the Kidneys, causing tinnitus that sounds like war drums or night watches while sleeping at night, accompanied by limb spasms and pain, and strange itching in the ears as if wind is blowing, a pill containing Huang Bo (Phellodendron) is indicated. The Kidney is where the Zong Mai (Gathering Vessels) converge, and the ear is its orifice. When blood and Qi do not circulate, the Zong Mai become deficient, allowing Wind pathogens to enter the ear along the vessels. Wind fighting with healthy Qi causes tinnitus. First, use Sheng Liao Wu Ling San (Raw Material Five-Ling Powder) with processed Zhi Zhi Qiao, Ju Hong, Perilla (Zi Su), and fresh Ginger decocted together, swallowing Qing Mu Xiang Wan (Blue Musk Wood Pill) to disperse pathogens and direct Qi downward. Subsequently, use Xiong Gui Yin (Chuanxiong and Angelica Drink) to harmonize and nourish.
For cerumen (earwax), tinnitus, and deafness caused by dirty blood inside, Chai Hu Cong Er Tang (Bupleurum Ear-Auditing Decoction) is suitable. The *Sheng Hui Fang* states: There was a person whose ears itched once a day, which was terrifying; picking until bleeding provided slight relief. This was due to Kidney Deficiency causing floating toxicity to attack upward, difficult to treat with standard methods; Tou Bing Dan (Ice-Penetrating Pill) is suitable. Avoid alcohol, damp noodles, chicken, and pork. Adherence for one month is ideal; failure to abstain renders treatment ineffective.
Sores inside the ear occur because the Foot-Shaoyin (Kidney) meridian is deficient, allowing Wind pathogens to enter along the vessels and fight with Qi, causing sores at the ear gate. Zeng Qing San (Malachite Powder) is the main treatment; Huang Lian San (Coptis Powder) is also acceptable, with internal administration of Niu Bang Zi Tang (Burdock Seed Decoction). Generally, ear sores belong to the Shaoyang Sanjiao (Triple Burner) meridian or the Foot-Jueyin (Liver) meridian, caused by Blood Deficiency with Wind-Heat, sudden Liver Fire-Wind-Heat, or Kidney Wind-Fire. If fever and pain occur, belonging to Shaoyang and Jueyin Wind-Heat, use Chai Hu Shan Zhi San (Bupleurum and Gardenia Powder). If internal heat causes itching and pain, belonging to Blood Deficiency in these two meridians, use Dang Gui Chuan Xiong San (Angelica and Chuanxiong Powder). If alternating chills and fever cause pain, belonging to Liver Wind-Heat, use Xiao Chai Hu Tang plus Shan Zhi and Chuanxiong. If internal heat and dry mouth occur, belonging to Kidney Empty Heat, use Jia Wei Di Huang Wan (Modified Rehmannia Pill); if ineffective, use Jia Wei Ba Wei Wan (Modified Eight-Ingredient Pill).
Otorrhea (ear pus), known as Er Gan (Ear Fungus), is treated with Hong Mian San (Red Cotton Powder) and She Xiang San (Musk Powder), internally with Chai Hu Cong Er Tang and Tong Qi San. For robust individuals with accumulated Heat attacking upward and persistent pus, Hong Mian San and She Xiang San should not be too astringent; San Huang San (Three-Yellow Powder) is suitable.
If an insect enters the ear causing pain, rub ginger on a cat's nose to induce urination. Drip the urine into the ear to expel the insect. Using sesame oil kills the insect but makes expulsion difficult. Alternatively, using fried sesame seeds as a pillow can expel the insect, though not as quickly as cat urine.
A child suffered from otorrhea for a year with no effect from medication; this was Kidney Deficiency. Treating with Liu Wei Di Huang Wan plus Sang Piao Xiao (Mantis Egg Case) resulted in immediate recovery.
Yu Jiayan said: The human body has nine orifices. The seven Yang orifices are the eyes, ears, mouth, and nose; the two Yin orifices are the anterior and posterior openings. Yang Qi travels to the upper orifices; if it descends into the Yin positions, it causes lower leakage and abdominal borborygmus. Yin Qi travels to the lower orifices; if it ascends into the Yang positions, it causes blockage and tinnitus. Therefore, after age fifty, Kidney Qi gradually declines below and often rebels upward from Yang. The Kidney governs closure and storage, desiring not to leak. Since the Liver (Wood) is the son of the Kidney (Water), it drains the mother's Qi and scatters it outward. Thus, when fire from frustration and anger moves, Yin Qi rebels upward, blocking the ear orifices. This is typical of elderly bodies. However, this differs vastly from Deafness. In deafness, a membrane within the orifice blocks external Qi from entering, so treatment focuses on opening the orifices. Medicines like Shi Chang Pu (Acorus) and She Xiang (Musk), and internal/external therapies, are designed for this. No one has discussed the mechanism of Elderly Yin Qi failing to contain itself and escaping to the upper orifices. Ignorance dictates that Yin Qi reaching the upper orifices is also separated by a membrane, unable to escape outside, but resonates within like frog drums or gongs, continuously blowing, mixing with external sounds and causing unclear hearing. If Qi does not rebel upward slightly, hearing clears slightly; if Qi does not rebel upward at all, hearing clears completely. Having comprehended this principle, I have repeatedly achieved miraculous results treating rebellious Qi in the elderly. The main strategy relies entirely on Ci Shi (Magnetite), because its heaviness reaches downward, its nature draws down, and it controls the Liver Wood's upward suction. It is assisted by Yin herbs like Di Huang (Rehmannia) and Gui Jiao (Turtle Shell Glue), and astringed with Sour herbs like Wu Wei Zi (Schisandra) and Shan Zhu Yu (Cornus), making Yin Qi prosperous in its home palace, preventing contact with Yang orifices, allowing sound entry without obstruction. Medical texts attribute this to excess Heat in the Shaoyang Gallbladder and Jueyin Liver meridians, specifically discussing the left ear distribution. However, Shaoyang Qi ascends to the upper orifices, its acupoints connect to the brain vertex, and there is no logic of tendons touching the ear; thus, it should not be conflated with Jueyin. Feng Tong Sheng San (Wind-Blocking Holy Powder) uses both sweating and purging methods, a technique for Strong Fire. Zhu Danxi's endorsement lacks solid basis. Only Gun Tan Wan (Rolling Phlegm Pill) is effective for the young and strong, due to the bitter properties of Da Huang (Rhubarb), Huang Qin (Scutellaria), and Chen Xiang (Aquilaria) descending Qi, and the heavy sinking property of Meng Shi (Flint Stone), which roughly mimics Magnetite. However, it severely damages the Spleen and Stomach and depletes the vital Qi in the chest. Regarding tinnitus due to Kidney Deficiency, attributing it to Bladder Ministerial Fire ascending implies Yang Fire would penetrate the upper orifices and not ring; this further reveals Danxi's baseless talk. In the elderly, Kidney Water is exhausted, True Fire easily appears, so Kidney Qi is easy to lose and hard to retain, especially with the Jueyin Son drawing it out! Therefore, strengthening Water to control Sunlight (Fire), like adding oil to a lamp to dim the flame, is indeed excellent treatment. Yet claiming treatment for Kidney Deficiency is ineffective—does this establish laws for the elderly? Securing Kidney Qi is the priority for the elderly; how could someone as wise as Danxi make such remarks?