The Gathering Place of the Ancestral Vessels
On Treating Ear Diseases
Water season is upon us. The sensory orifice associated with water is the ear, as Sù Wèn 5 tells us (these days I usually refer to Unschuld & Tessenow, 2011). There have been a few recent cases in the clinic with a primary or secondary complaint of ear problems. In addition, I have had tinnitus for many years, probably from too much rock and roll (for example, my ears were never the same after being in the second row in front of the stacks for Stevie Ray Vaughan’s Texas Flood tour – it was both rewarding and punishing at the same time).
Ear problems in general can be challenging to treat, especially if they are chronic. Acute symptoms of recent onset are usually less so and I’ve had some luck in helping them resolve. As I’m always digging around in one text or another these days, I thought I would post a couple of entries from Zhēn Jiǔ Féng Yuán (針灸逢源, Encountering the Origins of Acumoxa) by Lǐ Xuéchuān, written in 1815, and then maybe do a followup discussion later on.
Here are the relevant passages. The punctuation was a little funky in spots; this is my working version of the text:
耳病（有補遺）
Ear Diseases (with addendum)
耳聾 亦名重聽有從外不能達者。其病在經。有從內不能通者。其病在臟。
新聾多熱。取少陽陽明 久聾多虛。補足少陰。
液門 中渚 外關 翳風 耳門 後谿 聽宮 聽會 合谷 俠谿
Deafness: also called hardness of hearing, in cases where there is an inability to outthrust from the exterior, the disease is located in the channels. In cases where there is an inability to unblock from the interior, the disease lies in the viscera.
New-onset deafness with copious heat: select shǎoyáng and yángmíng [channels].
Chronic deafness with extensive vacuity: supplement foot shǎoyīn.
Yè Mén [TB2], Zhōng Zhǔ [TB3], Wài Guān [TB5], Yì Fēng [TB17], Ěr Mén [TB21], Hòu Xī [SI3], Tīng Gōng [SI19], Tīng Huì [GB2], Hé Gǔ [LI4], Xiá Xī [GB43].
耳鳴 此乃痰火上升。壅閉聽戶。或因腦怒而得者。少陽之火客於耳也。鳴不甚。其脈細者多虛。
耳門 聽會 聽宮 前谷 腕骨 陽谷 絡郄 腎俞
Tinnitus: This is upbearing of phlegm fire, which blocks off and closes the door of hearing. Or its cause is from the brain as a result of one’s rage, as the shǎoyáng fire travels to the ears. In cases where the ringing is not excessive and the pulse is thin, there is more vacuity.
Ěr Mén [TB21], Tīng Huì [GB2], Tīng Gōng [SI19], Qián Gǔ [SI2], Wàn Gǔ [SI4], Yáng Gǔ [SI5], Luò Xī [UB8], Shèn Shū [UB23]
聤耳 生瘡形似赤肉。又耳出惡水曰聤。
聽宮 翳風 耳門 合谷 下關
Purulent ear: gives rise to ulcers that look like red meat. Moreover there is foul water coming out of the ear, which is called purulence [tíng].
Tīng Gōng [SI19], Yì Fēng [TB17], Ěr Mén [TB21], Hé Gǔ [LI4], Xià Guān [ST7]
Later in the text is the addendum:
耳病
Ear Diseases
腎開竅於耳。而能聽聲者肺也。因肺主氣。一身之氣貫於耳也。凡治耳聾。必先調氣開鬱
The kidney opens at the orifice of the ears. Also [making one] capable of hearing sound is the lung. This is because the lung masters qì and the qì of the whole body passes through the ears. The general idea for treating deafness is that one must first regulate qì and open depression.
[Mulch comments: Another connection of the lung to the ears is found in a footnote commentary in Unschuld & Tessenow (2011, p. 504), “The network vessel of the lung moves upwards and meets with the center of the ear.” ]
宗脈虛。而風邪乘之。氣否不宣。是為風聾。內必作癢。或兼頭痛。
[When there is] vacuity in the gathering place of the ancestral vessels [eyes and ears*] and wind evil exploits it, the qì becomes blocked and cannot diffuse. This is wind deafness. There will be itching inside [the ear] and perhaps a concurrent headache.
[Mulch comments: *This recalls a line from Líng Shū 28, rendered by Unschuld & Tessenow (2011, p. 659), as “目者宗脈之所聚, ‘the eye is where all vessels gather,’ and耳者宗脈之所聚, ‘the ear is where all vessel [sic] gather.’”]
厥氣搏於耳。是為厥聾。否塞不通。必兼眩暈。
Reversal qì throbs in the ears. This is reversal deafness. [There is] blockage and stoppage. There will be concurrent dizziness.
[Mulch comments: In TCM this would likely fall under a pattern of ascendant hyperactivity of liver yáng.]
勞傷血氣。淫欲斫喪。憔悴昏憒。是為勞聾。有能將息得宜。其聾自輕。如日就疲勞。則為久聾。厚味動胃火。左右俱聾。忿怒動膽火。則左聾。色欲動相火。則右聾。
Taxation damages the blood and qì, devastates the libido, and leaves one withered, haggard, clouded and confused. This is taxation deafness. If one is able to rest and recuperate appropriately, the deafness will naturally ease. If one [continues] to exhaust oneself daily, it will become chronic deafness. Richly flavored [foods] stir stomach fire, causing deafness in both left and right [ears]. Anger and wrath stir gallbladder fire, causing deafness on the left [ear]. Lustful urges stir minister fire, causing deafness on the right [ear].
[Mulch comments: I think in cases where there is no structural damage to the inner ear, or nerves and so forth – and likely even in some of those cases - taxation damage plays a big role. From the cases that I have seen, loss of acuity and ringing can both improve with increased ability to rest, decreased emotional stress, and changes in diet.]
耳瘡屬三焦經。若發熱炊痛。風熱所致。若內熱癢痛。兼肝經血。熱也。
Ear ulcers pertain to the triple burner channel. If it effuses heat as if it were cooking and there is pain, it is the result of wind heat. If there is heat inside with itching and pain, there is concurrent liver channel blood heat.
耵耳者風熱搏之。津液結塞成核。能令暴聾。宜四物加羌活防風柴胡黃芩。連翹玄參。
Cases of impacted earwax are due to contending wind and heat. Jīnyè binds into a plug and forms a hard kernel, which can cause sudden deafness. It’s appropriate to use Sì Wù [Four Substance Decoction] adding Qiāng Huó [Rx Notopterygii], Fáng Fēng [Rx Saposhnikoviae], Chái Hú [Rx Bupleuri], Huáng Qín [Rx Scutellariae Baicalensis], Lián Qiáo [Fr Forsythiae], Xuán Shēn [Rx Scrophulariae].
[Mulch comments: Salty medicinals that soften hardness can be used in cases like this as well, such as Wēi Líng Xiān (Rx Clematidis), and some of the phlegm-heat resolving substances like Hǎi Zǎo (Hb Sargassii) and Fú Hǎi Shí (Pumice).]
聤耳由氣鬱生痰。內火攻衝。生瘡形似赤肉。或出膿水。宜二陳加玄參花粉黃芩山梔連翹蔓荊子柴胡。
Purulent ear is caused by qì depression engendering phlegm. Internal fire attacks and surges, engendering sores that look like red meat. There may be discharge of purulent water. It is appropriate to use Èr Chén [Two Aged Decoction] adding Xuán Shēn, Huā Fěn [Rx Trichosanthis], Huáng Qín, Shān Zhī [Fr Gardeniae], Lián Qiáo, Màn Jīng Zi [Fructus Viticis], Chái Hú.
耳衄。耳中出血也。左關脈弦數者。為少陽經火。宜柴胡清肝散尺脈或躁或弱者。少陰經虛。宜六味地黃丸。
Spontaneous bleeding of the ear: This is blood coming out from inside the ear. In cases where the left guān pulse is wiry and rapid, it is due to shǎoyáng channel fire. It is appropriate to use Chái Hú Qīng Gān Sàn (Bupleurum Liver-Clearing Powder). In cases where the chǐ pulse may be agitated or weak, it is due to shǎoyīn channel vacuity. It is appropriate to use Liù Wèi Dì Huáng Wán [Six Flavor Rehmannia Pill].
That’s it for now. As always, thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Lǐ, X. (1815). Zhēn jiǔ féng yuán. https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E9%80%A2%E6%BA%90/index.html
Unschuld, P.U., & Tessenow, H. (2011). Huang Di Nei Jing Su Wen : An annotated translation of Huang Di's Inner Classic - Basic Questions: 2 Volumes. University of California Press.