耳为肾，之外候，以肾开窍于耳也。经曰∶肾气通于耳，肾和则耳能闻五音矣。又曰∶液脱者，脑
髓消，胫酸耳数鸣。又曰∶精脱者，耳聋。故治耳者，当以补肾为主。然有因外感而耳聋者，如经言∶手
少阳三焦，是动则病耳聋，浑浑沌沌，盖热邪感入少阳，热气拂郁故也。仲景言∶少阳中风，两耳无所
闻，目赤。盖言肝经之风热上壅故也。宜从本门以施治。有因气逆而耳聋者，如恼怒则气上逆，肝胆之火，
客于耳也。宜平肝降气清火。有痰火上升，郁于耳而为鸣，甚则闭塞者，多缘饮酒浓味所致，宜消痰降火。
有因气虚、因血虚而聋者，以补气补血为主，各加降火之品。丹溪言∶耳聋皆属于热，诚哉是言。若人瘦
面黑，筋强骨劲而聋者，此精气俱足，乃寿考之征，不须治之。赵氏云∶耳鸣以手按之而不鸣，或少减
者虚也。手按之而愈鸣者实也，不可不察。又嘉言云∶人当五十以外，肾水渐衰，真火易露，故肾中之气，
易出难收，况有肝木之子，疏泄母气，而散于外，是为谋虑郁怒之火一动，肾气从之上逆，耳窍室塞不
清，较之聋病天渊。聋病因窍中另有一膜，遮蔽外气，不得内入，故以菖蒲、麝香等药开窍为治。不知肾
气至上窍亦隔一膜，不能越出窍外，止于窍中，汨汨有声，如蛙鼓蚊锣，鼓吹不己。故外入之声，为其
内声所混，听之不清，若气不上逆，则听清矣。故余悟此理，凡治高年逆上之气，屡有奇效。立方施治，大
意全以磁石为主，以其黑色入肾，重能达下，又能制肝木，复以地黄、龟胶群阴之药补之，更用五味、山
萸之酸以收之，令肾气归元，听自清矣。夫收摄肾气，乃为治老人之先务，不可不知。又有耳疮、耳肿、
耳痛、耳痒。薛氏云∶皆属肝经风热，血虚火盛，或肾经虚火等因，宜审施治。
八仙丸 左归丸饮 保阴煎〔俱见虚劳〕肾虚，耳中潮声、蝉声，无休止时，妨害听闻者，选而
用之。耳疮。耳肿、耳痛、耳痒、属肾经虚火者，亦并选用。耳鸣加磁石、〔堕气补肾。〕猪
肾〔虚热耳聋甚易。〕如耳中脓血，不闻人声，属肾热者，八仙去萸肉五味，加花粉〔清
肃肺气。〕磁石〔引肺金清肃之气，下降于肾，则热自除。〕石菖蒲〔开听户而收脓血，少
许。〕外用青黛、黄柏。为末吹之。〔耳脓多属湿热，〕
此皆壮水之剂。
龙胆泻肝汤〔见胁痛〕治恼怒气逆，肝火上冲而聋者。
宜加羚羊角〔平肝火，下逆气。〕代储石〔性寒，质重
降火镇逆。〕
此泻肝火之要剂，其平肝降气镇逆之品，在所必加。
清痰降火汤〔自制。〕治痰火上升而聋者。
贝母、栝蒌霜、花粉、茯苓〔消痰。〕苏子、橘红、枳壳〔利气。〕连翘、黄芩〔降
火。〕加竹沥、梨汁。甚者加黄连，如醇酒浓味过度，壮实者可用礞石滚痰丸。
耳是肾之外候，因为肾开窍于耳。医经说：肾气通于耳，肾气调和则耳能听见五音。又说：津液脱失的人，脑髓消减，小腿酸软，耳朵经常鸣响。又说：精气脱失的人，会耳聋。所以治疗耳病，应当以补肾为主。然而有因外感邪气导致耳聋的，如医经所言：手少阳三焦经发生病变，会出现耳聋，听力模糊不清，这是因为热邪侵入少阳经，热气拂郁所致。张仲景说：少阳中风，两耳听不见声音，眼睛发红。这是说肝经的风热上壅所致。应当从本门（少阳/肝胆）进行治疗。有因气逆导致耳聋的，如恼怒时气机上逆，肝胆之火客居于耳。适宜平肝、降气、清火。有痰火上升，郁结于耳而致鸣响，甚至闭塞的，多因饮酒过多、饮食厚味所致，适宜消痰降火。有因气虚、血虚导致耳聋的，以补气补血为主，各加入降火的药物。朱丹溪说：耳聋都属于热证，这话说得确实正确。如果人形体消瘦、面色黑、筋脉强硬、骨骼强劲而耳聋的，这是精气充足的表现，是长寿的征兆，不需要治疗。赵氏说：耳鸣用手按压后不响，或减轻的是虚证；用手按压后反而更响的是实证，不可不仔细辨别。又嘉言说：人在五十岁以后，肾水逐渐衰退，真火容易显露，所以肾中的气，容易外出难以收回，何况有肝木之子（心），疏泄母气（肝），而散于外，这是谋虑郁怒之火一动，肾气随之上逆，耳窍室塞不清，这与聋病的区别如同天壤之别。聋病是因为耳窍中另有一层膜，遮蔽了外界之气，使其不能内入，所以用石菖蒲、麝香等药物来开窍治疗。不知道肾气到达上窍也隔着一层膜，不能越出窍外，只停留在窍中，汩汩有声，像蛙鼓蚊锣一样，鼓吹不停。所以外界进入的声音，被内部的声音所混杂，听起来就不清楚，如果气不上逆，听觉就清晰了。所以我领悟到这个道理，凡是治疗老年人气机上逆的病证，屡次取得奇效。创立方剂施治，大意全以磁石为主药，因为它色黑入肾，质重能达下焦，又能制约肝木，再用地黄、龟胶等滋阴药物补益它，更用五味子、山茱萸的酸味来收敛它，使肾气归元，听觉自然清晰。收摄肾气，是治疗老年人的首要任务，不可不知道。又有耳疮、耳肿、耳痛、耳痒。薛氏说：都属于肝经风热、血虚火盛，或肾经虚火等原因，应当审察病因进行治疗。
八仙丸、左归丸饮、保阴煎〔均见于虚劳章节〕肾虚，耳中有如潮声、蝉鸣声，无休止时，妨害听闻的，选择使用这些方剂。耳疮、耳肿、耳痛、耳痒，属于肾经虚火的，也一并选用。耳鸣加磁石，〔用于堕气补肾〕猪肾，〔虚热耳聋甚易出现〕如果耳中有脓血，听不见人声，属于肾热的，八仙丸去掉山茱萸肉和五味子，加天花粉，〔清肃肺气〕磁石，〔引肺金清肃之气，下降于肾，则热自除〕石菖蒲，〔开通听户而收束脓血，用量少许〕外用青黛、黄柏，研为末吹入耳中。〔耳脓多属湿热〕这些都是壮水制火的方剂。
龙胆泻肝汤〔见于胁痛章节〕治疗因恼怒气逆，肝火上冲而导致耳聋的。宜加羚羊角，〔平肝火，下逆气〕代赭石，〔性寒，质重，降火镇逆〕这是泻肝火的要剂，其中平肝、降气、镇逆的药物，在所必须添加。
清痰降火汤〔自制〕治疗痰火上上升而导致耳聋的。贝母、栝蒌霜、天花粉、茯苓，〔消痰〕苏子、橘红、枳壳，〔利气〕连翘、黄芩，〔降火〕加竹沥、梨汁。严重的加黄连，如果是饮酒厚味过度，体质壮实者，可用礞石滚痰丸。
The ear is the external manifestation of the Kidney, as the Kidney opens into the ear. The Classics state: "Kidney Qi connects with the ear; when Kidney Qi is harmonious, the ear can hear the five tones." It also states: "When body fluids are depleted, brain marrow diminishes, calves ache, and the ears ring frequently." And again: "When essence is depleted, deafness occurs." Therefore, in treating ear diseases, one should primarily tonify the Kidney. However, there are cases of deafness caused by exogenous pathogens, as stated in the Classics: "When the Hand-Shaoyang Sanjiao (Triple Burner) channel undergoes change, it causes deafness and muffled hearing, due to heat pathogen invading the Shaoyang and heat qi stagnating." Zhang Zhongjing said: "In Shaoyang wind-stroke, both ears cannot hear, and eyes are red." This refers to wind-heat of the Liver channel obstructing upwards. Treatment should be applied according to the primary channel involved. There are cases of deafness caused by rebellious Qi, such as when anger causes Qi to rebel upward, with fire of the Liver and Gallbladder lodging in the ear. One should soothe the Liver, direct Qi downward, and clear heat. There are cases where phlegm-fire rises and stagnates in the ear causing tinnitus or even blockage, often resulting from excessive alcohol consumption and rich foods. One should resolve phlegm and descend fire. There are cases of deafness due to Qi deficiency or Blood deficiency; treatment should focus on tonifying Qi and Blood, adding herbs that clear heat. Zhu Danxi said: "Deafness all belongs to heat," which is indeed true. If a person is thin, has a dark complexion, stiff sinews, and strong bones yet suffers from deafness, this indicates abundant essence and Qi, a sign of longevity, requiring no treatment. Zhao Shi said: "If tinnitus ceases or lessens when pressed with the hand, it is deficiency; if it worsens when pressed, it is excess. This must not be overlooked." Jiayan stated: "After age fifty, Kidney Water gradually declines, and True Fire easily emerges. Thus, Qi within the Kidney easily escapes but is hard to retain. Moreover, the Son of Wood (Fire/Heart) disperses the Mother's Qi (Wood/Liver), scattering it outward. When fire from planning and depression arises, Kidney Qi rebels upward, blocking the ear orifice unclearly. This differs from deafness as heaven differs from earth." Deafness occurs because another membrane within the ear orifice blocks external Qi from entering, so treatment uses herbs like Shichangpu (Acorus Tatarinowii Rhizome) and Muxiang (Musk) to open the orifice. However, one does not realize that Qi reaching the upper orifices is also separated by a membrane and cannot exit the orifice, remaining inside, producing gurgling sounds like frog drums or mosquito gongs, ceaselessly drumming. Thus, external sounds are mixed with internal sounds, making hearing unclear. If Qi does not rebel, hearing becomes clear. I have realized this principle; whenever treating elderly patients with rebellious Qi, I have achieved remarkable effects. In formulating prescriptions, the main strategy relies on Cishi (Magnetitum), as its black color enters the Kidney, its heaviness reaches the lower jiao, and it controls Liver Wood. It is combined with Dihuang (Rehmanniae Radix Preparata) and Guijiao (Colla Corii Asini) among other Yin-nourishing herbs to tonify it, and further uses Wuweizi (Schisandrae Fructus) and Shanzhuyu (Corni Fructus) for their sour taste to astringe it, causing Kidney Qi to return to its origin, thereby restoring clear hearing. Astringing Kidney Qi is the primary task in treating the elderly and must not be ignored. There are also ear sores, ear swelling, ear pain, and ear itching. Xue Yi said: "These all belong to Wind-Heat of the Liver channel, Blood deficiency with flourishing fire, or Deficient Fire of the Kidney channel," etc. Treatment should be tailored after careful examination.
Baxian Wan (Eight Immortals Pill), Zuogui Yin (Left Restoring Decoction), Baoyin Jian (Yin-Preserving Decoction) [all see Consumption] For Kidney deficiency with continuous tidal or cicada-like sounds in the ear, interfering with hearing, select and use these. For ear sores, swelling, pain, and itching belonging to Deficient Fire of the Kidney channel, they may also be selected. For tinnitus, add Cishi (Magnetitum) [to descend Qi and tonify Kidney], Zhushen (Porcine Kidney) [for severe empty-heat deafness]. If there is pus and blood in the ear, with inability to hear human voices, belonging to Kidney Heat, remove Shanzhuyu (Corni Fructus) and Wuweizi (Schisandrae Fructus) from Baxian Wan, add Huafen (Trichosanthis Radix) [to clear and purify Lung Qi], Cishi (Magnetitum) [to guide the clear and purifying Qi of Metal/Lung downward to the Kidney, thus eliminating heat], and Shichangpu (Acorus Tatarinowii Rhizome) [to open the auditory orifice and absorb pus/blood, use sparingly]. Externally, apply Qingdai (Indigo Naturalis) and Huangbai (Phellodendri Cortex) powdered and insufflated into the ear. [Ear pus mostly belongs to Damp-Heat.] These are all formulas that strengthen Water to control Fire.
Longdan Xiegan Tang (Gentian Liver-Draining Decoction) [see Hypochondriac Pain] Treats deafness caused by anger-induced Qi rebellion and Liver Fire rushing upward. Add Lingyangjiao (Saigae Tataricae Cornu) [to pacify Liver Fire and direct rebellious Qi downward], Daizheshi (Haematitum) [cold in nature, heavy in texture, descends fire and suppresses rebellion]. This is an essential formula for draining Liver Fire; herbs that pacify the Liver, direct Qi downward, and suppress rebellion must necessarily be added.
Qingtan Jianghuo Tang (Phlegm-Clearing Fire-Descending Decoction) [self-formulated] Treats deafness caused by rising Phlegm-Fire. Beimu (Fritillariae Bulbus), Gualou Shuang (Benincasae Semen Exsiccatum), Huafen (Trichosanthis Radix), Fuling (Poria) [resolve phlegm]; Suzi (Perillae Fructus), Juhong (Citri Reticulatae Pericarpium Rubrum), Zhiqiao (Aurantii Fructus Immaturus) [promote Qi movement]; Lianqiao (Forsythiae Fructus), Huangqin (Scutellariae Radix) [descend fire]; add Zhuli (Bambusae Caulis in Taenia Succus) and Lizhi (Pyrus Sinkiangensis Fruit Juice). For severe cases, add Huanglian (Coptidis Rhizoma). For those with excessive indulgence in alcohol and rich foods who are robust, Mengshi Guntan Wan (Magneti Ocreatum Phlegm-Rolling Pill) may be used.