bubble_chart Concept

Ear bleeding, also known as ear orifice bleeding, is mentioned in Zhangshi YitongYizong Jinjian and others. This entry refers to bleeding from the external and middle ear, excluding bleeding from the auricle due to trauma and bleeding from the inner ear.

bubble_chart Pattern Analysis

1. Up-flaming of Liver Fire︰Blood suddenly flows from the ear in large amounts, accompanied by ear pain, irritability, or fullness in the chest and hypochondrium, bitter taste in mouth, red eyes, headache, concentrated urine, a wiry and rapid pulse with strong force, and a red tongue texture. This syndrome belongs to "excess heat," often caused by excessive stimulation of the seven emotions, liver failing to act freely, qi depression transforming into fire, which ascends along the meridians to disturb the ear orifice, forcing blood to recklessly flow out, resulting in sudden and profuse bleeding. When liver-gallbladder fire-heat binds and stagnates, it often leads to qi and blood congestion, hence ear pain. Xiezheng Lun Volume 2 states: "For those with blood flowing from the ear, it is due to...ministerial fire flourishing and carrying liver qi upward." Additional symptoms include irritability, fullness in the chest and hypochondrium, bitter taste in mouth, red eyes, headache, and dark urine, which are signs of excess fire in the liver meridian. A wiry pulse indicates liver involvement, while a rapid pulse signifies excessive fire. The treatment principle should focus on clearing the liver and draining fire, cooling blood and stopping bleeding. The recommended formula is Rhinoceros Horn and Rehmannia Decoction supplemented with Gentian and Yerbadetajo Herb, among others, and externally applied with calcined Fossil Bone powder.
2. Yin Deficiency︰Blood slowly flows from the ear, intermittently, with a small amount, and there is no swelling or pain in the ear. Symptoms include dizziness, dizzy vision, palpitation, tinnitus, soreness and weakness in the lower back and knees, mental fatigue, lack of strength, a thin and rapid pulse, and a red tongue texture. This is mostly caused by kidney yin deficiency, where water fails to control fire, leading to ministerial fire flaring upward and forcing blood to recklessly flow. It manifests as a chronic condition with intermittent episodes. Kidney yin deficiency results in insufficient essence and water, causing the zang-fu organs, meridians, and orifices to lack nourishment, leading to symptoms such as palpitation, dizziness, dizzy vision, tinnitus, lower back soreness, and lack of strength—all manifestations of kidney deficiency. Since the kidney meridian does not pass through the ear, it is said that "the small intestine meridian, the palace of the heart, ascends to the ear" (Xiezheng Lun, Vol. 2), hence there is no swelling or pain in the ear due to Jingmai qi and blood stagnation. A thin and rapid pulse and a red tongue texture are signs of yin deficiency with effulgent fire. The treatment should focus on nourishing yin and reducing fire, using a modified Anemarrhena and Phellodendron Rehmannia Decoction with Ophiopogon Tuber and Scrophularia Root.

Both of the above syndromes are caused by excessive fire disturbing the upper body and forcing blood to flow recklessly. However, liver fire causing nosebleeds is due to excess fire, while yin deficiency with effulgent fire causing nosebleeds is due to deficient fire. The key points for differentiation and identification lie in the severity of symptom onset, systemic manifestations, the presence or absence of swelling and pain in the ear, and the amount of bleeding.

bubble_chart Documentation

1. Xiezheng LunVolume 2: "Bleeding from the ear is called ear bleeding... or due to pestilence and irritability, the fire energy runs rampant, recklessly moving through the empty orifices."