或问∶耳根结核何如？曰∶是名耳根毒。状如痰核，按之不动而微痛，属足少阳胆经，
兼三焦经风热所致。用活命饮加升麻、柴胡，水酒煎服，或乌金散汗之。壮实者，一粒金
丹下之；老弱者，黄 内托散、十宣散托之。一人劳倦，耳下 肿，恶寒发热，头疼作
渴，右脉大而软，当服补中益气汤。彼自用药发散，遂致呕吐，始信。予用六君子汤，更
服补中益气汤而愈。大抵内伤荣卫失守，皮肤间无气滋养，则不任风寒，胃气下陷，则
阳火上冲，气喘发热头痛，脉大，此不足证也，误作外感表实而反泻之，宁免虚虚之祸。
东垣云∶内伤右脉大。外感左脉大。当以此别之。按∶左脉大属外感，此亦难凭，必须
察形观色审证，参之以脉，乃得不误。丹溪治一老人，饥寒作劳，患头疼发热，恶寒骨
节疼，无汗妄语，脉洪数而左甚，治以参、 、归、术、陈皮、甘草，每帖加附子一片，五
帖而愈。又一少年，九月间发热头痛，妄语大渴，形肥脉数大左甚，以参、术君，茯、芍
臣， 佐，附一片使，盖人肥而脉左大于右事急矣，非附则参、 无捷效，五十帖大汗
而愈。此皆左脉大，丹溪悉以内伤治之。若根据东垣认作外感，宁不杀人。 一妇耳下肿
痛，发寒热，与荆防败毒散四剂，表证悉退，以散肿溃坚汤数剂，肿消大半，再以神效栝
蒌散四剂而平。 一人肝经风热，耳下肿痛发热，脉浮数，以薄荷丹治之而消。 一妇
因怒，耳下肿痛，以荆防败毒散加连翘、黄芩，四剂而愈。尝治此旬日不消者，以益气
血药及饮远志酒井效，无脓自消，有脓自溃。一妇因怒，耳下 痛，头痛寒热，以荆防
败毒加黄芩，表证悉退。但饮食少思，日晡发热。东垣云∶虽有虚热不可大攻，热去则
寒起，遂以小柴胡加地骨皮、芎、归、苓、术、陈皮十余帖而愈。次年春复肿坚不溃，用八
珍汤加香附、柴胡、地骨皮、桔梗，服至六七帖，以为延缓，仍服人参败毒散，热愈盛，
又服流气饮则盗汗发热，口干食少，至秋复求诊视，气血虚极，辞之果殁。一人每怒
耳下肿，或胁作痛，以小柴胡汤加青皮、红花、桃仁四剂而愈。 一女性急好怒，耳下
常肿痛，发寒热，肝脉弦急，投小柴胡加青皮、牛蒡子、荆芥、防风而寒热退，更以小
柴胡汤对四物数剂而肿消。其父欲除病根，予谓∶肝内主藏血，外主荣筋。若恚怒气逆则
伤肝，肝主筋，故筋蓄结而肿，须要自加调摄，庶可免患。否则肝迭受伤，不能藏血，血
虚则难瘥矣。后不戒，果结三核，屡用追蚀，不敛而殁。 一人远途劳倦，发热，脉大无
力，耳下患肿，此劳损也，宜补中益气、养荣汤，自然热退肿消。彼不听，服降火药及
必效散，果吐泻不食而死。夫劳倦损气，气衰则火旺，火乘脾土，故倦怠而热，此元气
伤也。丹溪曰∶宜补形气，调经脉，其疮自消，不可汗下。若不详脉症。经络受病之异。
而辄用峻厉之剂，鲜不危矣。
有人问：耳根部的结核是什么情况？回答说：这叫做耳根毒。形状像痰核，按压时推不动且微痛，属于足少阳胆经，兼由三焦经的风热所致。使用活命饮加升麻、柴胡，用水和酒煎服，或者用乌金散使其发汗。体质壮实的人，用一粒金丹攻下；年老体弱的人，用黄芪内托散、十宣散来托毒外出。有一人因劳累倦怠，耳下肿胀，恶寒发热，头痛口渴，右脉大而软，应当服用补中益气汤。他自己用药发散，导致呕吐，这才相信我的说法。我用六君子汤，再让他服用补中益气汤而痊愈。大抵内伤导致营卫失守，皮肤间没有气滋养，就不能抵御风寒，胃气下陷，则阳火上冲，出现气喘、发热、头痛，脉大，这是不足之证，如果误作外感表实证反而泻下，怎能避免虚上加虚的祸害？李东垣说：内伤右脉大。外感左脉大。应当以此区别它们。按：左脉大属于外感，这也难以凭信，必须观察形体神色、审察证候，参合脉象，才能不犯错。朱丹溪治疗一位老人，因饥寒劳累，患头痛发热，恶寒骨节疼痛，无汗谵语，脉洪数且左侧更甚，用人参、白术、当归、白术、陈皮、甘草，每帖加附子一片，五帖后痊愈。又有一位少年，九月间发热头痛，谵语大渴，形体肥胖脉数大且左侧更甚，以人参、白术为君药，茯苓、芍药为臣药，陈皮为佐药，附子一片为使药，因为人肥而脉左大于右，病情紧急了，不用附子则人参、白术没有快速疗效，五十帖大汗后痊愈。这些都是左脉大，朱丹溪都用内伤法治疗。如果根据李东垣认为是外感，岂不是要杀人。
一位妇女耳下肿痛，发寒热，给予荆防败毒散四剂，表证全部消退，再用散肿溃坚汤数剂，肿块消去大半，接着用神效栝楼散四剂而平复。一人肝经风热，耳下肿痛发热，脉浮数，用薄荷丹治疗而消散。一位妇女因愤怒，耳下肿痛，用荆防败毒散加连翘、黄芩，四剂而愈。曾经治疗此病十天不消退的，用补益气血的药及饮用远志酒，均有效，无脓自消，有脓自溃。一位妇女因愤怒，耳下肿痛，头痛寒热，用荆防败毒散加黄芩，表证全部消退。但饮食减少思食，傍晚发热。李东垣说：虽有虚热不可大力攻伐，热去则寒起，于是用小柴胡汤加地骨皮、川芎、当归、茯苓、白术、陈皮十余帖而愈。次年春天再次肿胀坚硬不溃破，用八珍汤加香附、柴胡、地骨皮、桔梗，服用至六七帖，认为进展缓慢，仍服人参败毒散，热势更盛，又服流气饮则盗汗发热，口干食少，到秋天再次求诊，气血极度虚弱，我推辞不治，果然死亡。一人每次发怒耳下就肿，或胁部作痛，用小柴胡汤加青皮、红花、桃仁四剂而愈。一位女性急躁易怒，耳下常肿痛，发寒热，肝脉弦急，投小柴胡汤加青皮、牛蒡子、荆芥、防风而寒热退，再用小柴胡汤对四物汤数剂而肿消。她的父亲想除病根，我说：肝内主藏血，外主荣养筋脉。如果恚怒气逆则伤肝，肝主筋，所以筋蓄结而肿，必须自己加以调摄，才可以避免患病。否则肝屡次受伤，不能藏血，血虚就很难痊愈了。后来不加戒慎，果然结成三个核，屡次用追蚀之法，伤口不愈合而死亡。
一人长途劳累倦怠，发热，脉大无力，耳下患肿，这是劳损，适宜用补中益气汤、养荣汤，自然热退肿消。他不听，服降火药及必效散，果然吐泻不食而死。夫劳累倦怠损伤气，气衰则火旺，火乘脾土，所以倦怠而热，这是元气受伤。朱丹溪说：宜补形气，调经脉，其疮自消，不可汗下。如果不详察脉症、经络受病的差异，而轻易使用峻厉的药物，很少有不危险的。
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."