【歌】肾虚精脱耳应聋，气厥无闻自不同。更有劳聋与虚闭，风邪入耳不能聪。气风相搏嘈嘈响，热气
乘虚耳出脓。
风气热虚何以别？浮沉数涩脉中穷。
【论】夫耳属足少阴肾之经，肾家之寄窍也。经云∶肾气通于耳，肾和则知五音矣。耳所主者精，精气
调和，肾气充足，则耳闻而聪。若劳伤气血，风邪袭虚，使精脱肾惫，则耳转而聋，是肾虚耳聋也。十二经脉
上络于耳，其阴阳诸经通有交并，则脏气逆而厥，厥气搏入耳，是谓厥聋。耳为宗脉之所附，脉虚而风邪乘之，
风入于耳脉，使经气痞而不宣，是谓风聋，必有头痛之证也。有劳碌伤其血气，淫欲耗其精元，瘦瘁力疲，昏
昏愦愦，是谓劳聋，能将息得宜，血气平和，则其聋渐轻。又有耳触风邪，与气相搏，其声嘈嘈而鸣，眼中流
火，谓之虚聋。热气乘虚随脉入耳，热聚不散，脓汁出，谓之脓耳。人或耳间有津液，轻则不能为害，若风
热搏之，津液结成核，塞于耳窍，亦令暴聋，谓之耵耳。
盖风则肾脉必浮，热则肾脉必数，虚则肾脉涩弱，气郁肾脉沉滞。风者疏散之，热者清利之，虚者补之，
气郁开导之，治之活法，不过此也。
【脉】耳病肾虚，迟濡其脉。浮大为风，洪动火贼。沉涩气凝，数实热塞。此久聋者，专于肾责。暴病
浮洪，两尺相同。或两尺数，阴火上冲。
风耳
风触耳鸣及聋，防风通圣散。（方见中风。）风虚耳聋，桂香散。风入耳中虚鸣，芎芷散。（方见头
痛。）风热搏成耵耳，生猪脂、地龙、釜底墨等分，细研，葱汁和，捏如枣大，绵裹塞耳中数日，待软即挑出。
桂香散
治风虚耳聋。
辣桂（二分） 川芎（五分） 当归（六分，酒洗） 细辛（三分） 石菖
蒲（八分） 木香（三分） 木通（五分） 麻黄（去节，三分） 甘草（三分，生用） 南星（炮，二分） 白蒺
藜（炒，三分） 白芷（四分） 紫苏（五分）
锉一剂，水二盏，葱煎服。
热耳
耳聋者，少阳、厥阴热多，通圣散。（方见中风。）耳鸣酒遏者，加枳，桔、柴胡、干葛、南星。阴虚
火动耳鸣者，四物汤（方见血证。）加黄柏、知母。痰气耳鸣者，滚痰丸。（方见痰证。）内热耳聋，桃花散
塞之，蔓荆子散内服。
桃花散
治耳中出脓。
枯矾（一钱） 干胭脂（一钱） 麝香（少许）
共为末，吹耳内。
蔓荆子散
甘草（炙，五分） 升麻（三分） 木通（三分） 赤芍药（五分） 桑白皮（五分） 生地黄（一钱）
麦门冬（去心，四分） 前胡（三分，去芦） 蔓荆子（七分） 赤茯苓（六分） 甘菊花（四分）
上锉，一剂，水二盏，姜三片，枣一枚，煎八分，食后服。
虚耳
肾虚耳聋者，益肾散或六味地黄丸、补阴丸。（方见虚损。）劳损耳聋者，地黄丸、人参养荣汤。（方
见虚损。）大病后元气损伤，精血虚耗，耳聋及鸣，调中益气汤。（方见内伤。）
益肾散
治肾虚耳聋。
磁石（制，一两） 巴戟（去心，一两） 沉香（一两） 石菖蒲（一两） 川椒（一两，去目）
末之，每二钱，用猪肾一枚，细切，和以葱白、食盐，
并药用湿纸裹煨，空心酒下。
气耳
气怒厥逆耳聋，和剂流气饮。气壅于上而聋者，清神散。气实人耳聋或鸣者，槟榔丸、神芎丸。气闭耳
聋，用甘遂为丸，如枣子大，塞耳内，服甘草汤。
和剂流气饮
陈皮（四两） 青皮（四两，炒） 甘草（炙，四两） 浓朴（姜炒，四两） 香附（醋炒，四两） 紫苏
（四两） 木通（二两） 大腹皮（二两） 丁香（一两五钱） 槟榔（一两五钱） 木香（一两五钱） 草果
（一两五钱） 莪术（炮，一两半） 藿香（一两五钱） 肉桂（一两五钱） 人参（去芦，一两） 白术（炒，一
两） 木瓜（一两） 麦门冬（去心，一两） 赤茯苓（一两） 石菖蒲（一两） 白芷（一两） 半夏（一两）
枳壳（炒，一两）
每服三钱，生姜三片，枣二枚，葱煎服。
清神散
气壅耳聋。
甘菊花（五钱） 羌活（去芦，五钱） 僵蚕（炒去嘴，五钱） 木通（四钱） 荆芥（四钱） 川芎（四
钱） 防风（去芦，四钱） 木香（四钱） 甘草（炙，四钱） 石菖蒲（四钱）
末之，每服三钱。
木香槟榔丸
郁李仁（一两） 半夏曲（一两） 皂荚（去皮，炙，一两） 槟榔（五钱） 枳壳（炒，五钱） 木香（五
钱） 杏仁（去皮，炒，五钱） 青皮（五钱）
末之，别用皂荚三两去皮、弦、子，浆水半碗，搓揉，熬膏，入蜜少许，丸如桐子大，每五十丸，食后
姜汤送下。
神芎丸
气实人耳聋。
大黄（一两） 黄芩（一两） 牵牛（一两） 滑石（一两）
末之，滴水丸梧子大，每服六、七十丸，白汤送下。
【歌诀】肾虚导致精气脱失，耳朵应当听不见；气机厥逆导致的耳聋，其成因自然不同。还有因劳累引起的耳聋和虚性耳闭，以及风邪侵入耳朵导致听力不灵敏。气与风邪相互搏结，耳中会有嘈杂的响声；热气乘虚而入，导致耳内流脓。
如何辨别风气、热气和虚证？通过脉象的浮、沉、数、涩即可穷尽其理。
【论述】耳朵属于足少阴肾经，是肾脏寄居窍穴所在。医经说：肾气通达于耳，肾气调和就能分辨五种声音。耳朵所主的是精气，精气调和，肾气充足，那么耳朵就能听觉灵敏。如果劳损伤及气血，风邪侵袭虚弱之处，致使精气脱失、肾气疲惫，那么耳朵就会丧失听力，这就是肾虚耳聋。十二经脉上行联络于耳，其中阴阳各经相通并有交汇，若脏气逆乱而厥逆，厥逆之气搏入耳中，这称为厥聋。耳朵是宗脉（众多经脉）附着之处，脉气虚弱而风邪乘虚而入，风邪进入耳部经脉，使经气痞塞而不宣通，这称为风聋，必然伴有头痛的症状。有人因过度劳累伤及血气，或因房事过度耗损精元，身体消瘦疲乏，精神昏沉迷糊，这称为劳聋，若能调养得当，血气平和，则耳聋逐渐减轻。又有因耳朵接触风邪，与气相搏结，发出嘈杂鸣响，眼中感觉如火灼烧，这称为虚聋。热气乘虚随经脉进入耳中，热邪聚集不散，流出脓汁，这称为脓耳。有的人耳间有津液，轻微时不会造成危害，若风热搏结，津液凝结成核，堵塞耳窍，也会导致突然耳聋，这称为耵聍栓塞（耵耳）。
大凡风邪致病，肾脉必然浮；热邪致病，肾脉必然数；虚证致病，肾脉涩弱；气郁致病，肾脉沉滞。风邪者用疏散法，热邪者用清利法，虚证者用补益法，气郁者用开导法，治疗的灵活方法，不过如此罢了。
【脉诊】耳病若属肾虚，脉象表现为迟或濡。脉浮大者为风邪，脉洪动者为火邪为害。脉沉涩者为气凝，脉数实者为热塞。若是久聋，专门责之于肾。突发疾病脉象浮洪，两尺脉相同。若两尺脉数，则是阴火上冲。
风耳
风邪触动导致耳鸣及耳聋，用防风通圣散。（方剂见中风章节。）风虚耳聋，用桂香散。风邪入耳致虚鸣，用芎芷散。（方剂见头痛章节。）风热搏结形成耵聍栓塞，用生猪脂、地龙、釜底墨（锅底灰）等分，细细研磨，用葱汁调和，捏成如枣子大小，用棉包裹塞入耳中数日，待变软后挑出。
桂香散
治疗风虚耳聋。
辣桂（二分） 川芎（五分） 当归（六分，酒洗） 细辛（三分） 石菖蒲（八分） 木香（三分） 木通（五分） 麻黄（去节，三分） 甘草（三分，生用） 南星（炮制，二分） 白蒺藜（炒，三分） 白芷（四分） 紫苏（五分）
锉碎一剂，加水二盏，加葱煎服。
热耳
耳聋者，多因少阳、厥阴经热盛，用通圣散。（方剂见中风章节。）因饮酒遏阻导致的耳鸣，加枳实、桔梗、柴胡、干葛、南星。阴虚火动导致的耳鸣，用四物汤（方剂见血证章节），加黄柏、知母。痰气导致的耳鸣，用滚痰丸。（方剂见痰证章节。）内热耳聋，用桃花散外塞，蔓荆子散内服。
桃花散
治疗耳中出脓。
枯矾（一钱） 干胭脂（一钱） 麝香（少许）
共研为末，吹入耳内。
蔓荆子散
甘草（炙，五分） 升麻（三分） 木通（三分） 赤芍药（五分） 桑白皮（五分） 生地黄（一钱） 麦门冬（去心，四分） 前胡（三分，去芦） 蔓荆子（七分） 赤茯苓（六分） 甘菊花（四分）
以上锉碎，一剂，加水二盏，生姜三片，大枣一枚，煎至八分，饭后服用。
虚耳
肾虚耳聋者，用益肾散或六味地黄丸、补阴丸。（方剂见虚损章节。）劳损耳聋者，用地黄丸、人参养荣汤。（方剂见虚损章节。）大病后元气损伤，精血虚耗，导致耳聋及耳鸣，用调中益气汤。（方剂见内伤章节。）
益肾散
治疗肾虚耳聋。
磁石（制，一两） 巴戟天（去心，一两） 沉香（一两） 石菖蒲（一两） 川椒（一两，去目）
研为末，每次二钱，用猪肾一枚，细切，加入葱白、食盐，连同药物用湿纸包裹煨熟，空腹时酒送下。
气耳
因气怒导致气机厥逆而耳聋，用和剂流气饮。气壅滞于上部而耳聋者，用清神散。气实证患者耳聋或耳鸣者，用槟榔丸、神芎丸。气闭导致耳聋，用甘遂制成丸剂，如枣子大小，塞入耳内，同时服用甘草汤。
和剂流气饮
陈皮（四两） 青皮（四两，炒） 甘草（炙，四两） 浓朴（姜炒，四两） 香附（醋炒，四两） 紫苏（四两） 木通（二两） 大腹皮（二两） 丁香（一两五钱） 槟榔（一两五钱） 木香（一两五钱） 草果（一两五钱） 莪术（炮，一两半） 藿香（一两五钱） 肉桂（一两五钱） 人参（去芦，一两） 白术（炒，一两） 木瓜（一两） 麦门冬（去心，一两） 赤茯苓（一两） 石菖蒲（一两） 白芷（一两） 半夏（一两） 枳壳（炒，一两）
每次服用三钱，生姜三片，大枣二枚，加葱煎服。
清神散
治疗气壅耳聋。
甘菊花（五钱） 羌活（去芦，五钱） 僵蚕（炒去嘴，五钱） 木通（四钱） 荆芥（四钱） 川芎（四钱） 防风（去芦，四钱） 木香（四钱） 甘草（炙，四钱） 石菖蒲（四钱）
研为末，每次服用三钱。
木香槟榔丸
郁李仁（一两） 半夏曲（一两） 皂荚（去皮，炙，一两） 槟榔（五钱） 枳壳（炒，五钱） 木香（五钱） 杏仁（去皮，炒，五钱） 青皮（五钱）
研为末，另外取皂荚三两，去皮、弦、子，用浆水半碗，搓揉，熬成膏，加入少许蜂蜜，制成梧桐子大小的丸剂，每次五十丸，饭后姜汤送下。
神芎丸
治疗气实证耳聋。
大黄（一两） 黄芩（一两） 牵牛（一两） 滑石（一两）
研为末，滴水泛丸如梧桐子大，每次服用六七十丸，白开水送下。
[Song]
Kidney deficiency leading to the loss of essence causes deafness; deafness due to Qi reversal has a different etiology. There is also deafness from overexertion and closure due to deficiency, as well as impaired hearing when wind pathogens invade the ears. When Qi and wind pathogen contend, a buzzing sound occurs in the ears; heat pathogens enter via deficiency, causing pus discharge from the ears.
How to distinguish between wind, heat, and deficiency? The pulse—floating, sunken, rapid, or choppy—reveals the truth.
[Discussion]
The ear belongs to the Foot-Shaoyin Kidney meridian and serves as the external opening for the Kidneys. The classics state: "Kidney Qi connects to the ears; when the Kidneys are harmonious, one can discern the five tones." The ear is governed by essence and blood. When essence and blood are harmonious and Kidney Qi is sufficient, hearing is acute. If labor damages Qi and blood, and wind pathogens attack the deficient areas, causing essence depletion and Kidney exhaustion, hearing will be lost; this is called Kidney-deficiency deafness. The twelve meridians connect to the ears; the Yin and Yang meridians intersect. If Zang organ Qi becomes rebellious and reverses, the reversing Qi enters the ear, known as Jue-deafness (deafness due to Qi reversal). The ear is the attachment site for the Zong-mai (major vessels); when vessel Qi is deficient and wind pathogens invade, the wind enters the ear meridians, causing Qi stagnation and obstruction, known as Wind-deafness, which must be accompanied by headache. Some suffer from overexertion damaging Qi and blood, or excessive sexual activity depleting Yuan-essence, resulting in emaciation, fatigue, and mental confusion; this is called Labor-deafness. With proper rest and regulation, if Qi and blood become balanced, the deafness gradually improves. Another type involves wind pathogens contacting the ear and contending with Qi, producing a buzzing noise and a sensation of fire in the eyes; this is called Deficient-deafness. Heat pathogens enter the ear via the meridians during deficiency, accumulating and not dispersing, leading to pus discharge; this is called Purulent-ear (Otorrhea). Some have fluid in the ear canal; if mild, it causes no harm. However, if wind and heat contend, the fluid condenses into a mass blocking the ear orifice, causing sudden deafness; this is called Cerumen impaction (Ding-ear).
Generally, wind pathogen involvement makes the Kidney pulse floating; heat pathogen involvement makes it rapid; deficiency makes it choppy and weak; Qi stagnation makes it sunken and sluggish. For wind, use dispersion; for heat, use clearing and draining; for deficiency, use tonification; for Qi stagnation, use guiding and unblocking. These are the flexible methods of treatment.
[Pulse Diagnosis]
For ear disease due to Kidney deficiency, the pulse is slow or soggy. Floating and large indicates wind; surging and moving indicates Fire damage. Sunken and choppy indicates Qi coagulation; rapid and excess indicates Heat obstruction. For chronic deafness, blame primarily the Kidneys. Acute onset with floating and surging pulses, identical in both Chi positions, suggests Yin Fire rushing upward if the Chi pulses are rapid.
Wind-Ear
Deafness and tinnitus triggered by wind: Fangfeng Tongsheng San (Saposhnikovia Decoction to Unblock the Toxin). [Formula see Stroke chapter.] Wind-deficiency deafness: Guixiang San (Cinnamon and Costus Powder). Wind entering the ear causing empty ringing: Xiongzi San (Ligusticum and Chrysanthemum Powder). [Formula see Headache chapter.] Wind-heat contending to form cerumen impaction: Equal parts fresh pig lard, Earthworm (Di Long), and soot from the pot bottom. Grind finely, mix with green onion juice, shape into dates, wrap in cotton, insert into the ear for several days, then remove when soft.
Guixiang San
Treats wind-deficiency deafness.
La Gui (Cinnamon Twig) (2 fen), Chuan Xiong (5 fen), Dang Gui (6 fen, washed with wine), Xi Xin (3 fen), Shi Chang Pu (Acorus Tatarinowii Rhizome) (8 fen), Mu Xiang (3 fen), Mu Tong (5 fen), Ma Huang (Ephedra Stem, nodes removed) (3 fen), Gan Cao (Licorice Root) (3 fen, raw), Nan Xing (Arisaema Cum Bile) (2 fen, processed), Bai Ji Li (Tribulus Fruit) (3 fen, stir-fried), Bai Zhi (Angelica Dahurica Root) (4 fen), Zi Su (Perilla Leaf) (5 fen).
Crush one dose, add two cups of water, decoct with green onions, and take orally.
Heat-Ear
Deafness often stems from excess heat in the Shaoyang and Jueyin meridians: Tongsheng San (Unblocking Toxin Decoction). [Formula see Stroke chapter.] Tinnitus caused by alcohol retention: Add Zhi Shi (Immature Bitter Orange), Jie Geng (Platycodon Root), Chai Hu (Bupleurum Root), Ge Gen (Kudzu Root), and Nan Xing. Tinnitus due to Yin deficiency with Fire hyperactivity: Siwu Tang (Four Substances Decoction). [Formula see Blood Disorders chapter], add Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome). Tinnitus due to Phlegm-Qi: Gun Tan Wan (Rolling Phlegm Pill). [Formula see Phlegm Disorders chapter.] Internal heat deafness: Use Taohua San (Peach Blossom Powder) externally, and Manjingzi San (Vitex Powder) internally.
Taohua San
Treats otorrhea (pus discharge from the ear).
Ku Fan (Alum) (1 qian), Gan Yan Zhi (Dry Carmine/Red Ochre) (1 qian), She Xiang (Musk) (a small amount).
Grind into powder and insufflate into the ear.
Manjingzi San
Gan Cao (Licorice Root, honey-fried) (5 fen), Sheng Ma (Cimicifuga Rhizome) (3 fen), Mu Tong (Akebia Stem) (3 fen), Chi Shao Yao (Red Peony Root) (5 fen), Sang Bai Pi (Mulberry Root Bark) (5 fen), Sheng Di Huang (Rehmannia Root) (1 qian), Mai Men Dong (Ophiopogon Tuber) (4 fen, heart removed), Qian Hu (Peucedanum Root) (3 fen, radix removed), Man Jing Zi (Chaste Fruit) (7 fen), Chi Fu Ling (Red Poria) (6 fen), Gan Ju Hua (Chrysanthemum Flower) (4 fen).
Crush all ingredients. One dose, add two cups of water, three slices of ginger, and one jujube. Decoct to eight-tenths volume, take after meals.
Deficiency-Ear
Kidney-deficiency deafness: Yishen San (Kidney-Tonifying Powder) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Buyin Wan (Nourishing Yin Pill). [Formulas see Deficiency and Damage chapter.] Deafness due to labor injury: Dihuang Wan (Rehmannia Pill), Renshen Yangrong Tang (Ginseng Nourishing the Spirit Decoction). [Formulas see Deficiency and Damage chapter.] Deafness and tinnitus following severe illness, where Yuan Qi is damaged and Essence-Blood are depleted: Tiaozhong Yiqi Tang (Regulate Middle and Boost Qi Decoction). [Formula see Internal Injury chapter.]
Yishen San
Treats Kidney-deficiency deafness.
Ci Shi (Magnetite, prepared) (1 liang), Ba Ji Tian (Morinda Officinalis Root) (1 liang, hearts removed), Chen Xiang (Aquilaria Wood) (1 liang), Shi Chang Pu (Acorus Tatarinowii Rhizome) (1 liang), Chuan Jiao (Sichuan Pepper) (1 liang, eyes removed).
Grind into powder. Take 2 qian per dose. Slice one pig kidney finely, mix with white part of green onion and salt, wrap the medicine and kidney in wet paper, and roast until cooked. Take on an empty stomach with wine.
Qi-Ear
Deafness due to anger causing Qi rebellion and reversal: Heji Liuqi Yin (Official Formulas Flowing Qi Decoction). Deafness due to Qi congestion in the upper body: Qingshen San (Spirit-Clearing Powder). Deafness or tinnitus in individuals with Qi excess: Binglang Wan (Areca Nut Pill), Shenxiong Wan (Divine Ligusticum Pill). Deafness due to Qi blockage: Use Kansui (Euphorbia Lathyris Root) pills, date-sized, inserted into the ear, while administering Gancao Tang (Licorice Decoction) orally.
Heji Liuqi Yin
Chen Pi (Aged Tangerine Peel) (4 liang), Qing Pi (Green Tangerine Peel) (4 liang, stir-fried), Gan Cao (Licorice Root, honey-fried) (4 liang), Hou Po (Magnolia Bark) (4 liang, stir-fried with ginger), Xiang Fu (Cyperus Rhizome) (4 liang, stir-fried with vinegar), Zi Su (Perilla Leaf) (4 liang), Mu Tong (Akebia Stem) (2 liang), Da Fu Pi (Areca Peel) (2 liang), Ding Xiang (Clove) (1.5 liang), Bing Lang (Areca Seed) (1.5 liang), Mu Xiang (Aucklandia Root) (1.5 liang), Cao Guo (Black Cardamom) (1.5 liang), E Zhu (Curcuma Rhizome) (1.5 liang, processed), Huo Xiang (Patchouli Herb) (1.5 liang), Rou Gui (Cinnamon Bark) (1.5 liang), Ren Shen (Ginseng Root) (1 liang, radix removed), Bai Zhu (Atractylodes Macrocephala Rhizome) (1 liang, stir-fried), Mu Gua (Chaenomeles Fruit) (1 liang), Mai Men Dong (Ophiopogon Tuber) (1 liang, heart removed), Chi Fu Ling (Red Poria) (1 liang), Shi Chang Pu (Acorus Tatarinowii Rhizome) (1 liang), Bai Zhi (Angelica Dahurica Root) (1 liang), Ban Xia (Pinellia Tuber) (1 liang), Zhi Ke (Aurantium Fruit, stir-fried) (1 liang).
Take 3 qian per dose, with three slices of ginger, two jujubes, and green onions decocted in water.
Qingshen San
Treats deafness due to Qi congestion.
Gan Ju Hua (Chrysanthemum Flower) (5 qian), Qiang Huo (Notopterygium Rhizome) (5 qian, radix removed), Jiang Can (Bombyx Batryticatus) (5 qian, stir-fried, heads removed), Mu Tong (Akebia Stem) (4 qian), Jing Jie (Schizonepeta Spike) (4 qian), Chuan Xiong (Ligusticum Rhizome) (4 qian), Fang Feng (Saposhnikovia Root) (4 qian, radix removed), Mu Xiang (Aucklandia Root) (4 qian), Gan Cao (Licorice Root, honey-fried) (4 qian), Shi Chang Pu (Acorus Tatarinowii Rhizome) (4 qian).
Grind into powder. Take 3 qian per dose.
Muxiang Binglang Wan
Yu Li Ren (Prunus Serrulata Seed) (1 liang), Ban Xia Qu (Pinellia Fermented Dough) (1 liang), Zao Jiao (Gleditsia Sinensis Fruit) (1 liang, skin removed, roasted), Bing Lang (Areca Seed) (5 qian), Zhi Ke (Aurantium Fruit, stir-fried) (5 qian), Mu Xiang (Aucklandia Root) (5 qian), Xing Ren (Apricot Seed) (5 qian, skin removed, stir-fried), Qing Pi (Green Tangerine Peel) (5 qian).
Grind into powder. Separately, take 3 liang of Zao Jiao, remove skin, strings, and seeds. Rub with half a bowl of sour rice water, boil into a paste, add a little honey, and form pills the size of sesame seeds. Take 50 pills per dose after meals with ginger tea.
Shenxiong Wan
Treats deafness in Qi-excess constitutions.
Da Huang (Rhubarb Root) (1 liang), Huang Qin (Scutellaria Root) (1 liang), Qian Niu (Morning Glory Seed) (1 liang), Hua Shi (Talcum) (1 liang).
Grind into powder. Form pills using water drop method, size of sesame seeds. Take 60-70 pills per dose with plain warm water.