bubble_chart Concept

Ear pain, which refers to pain in the ear, can occur in the auricle, external auditory canal, and tympanic membrane. It is often accompanied by pus discharge from the ear. Suwen. Zhizhenyao Da Lun states: "Excessive heat in the Shaoyang meridian causes ear pain and reddish urine," clearly indicating that ear pain is caused by excessive heat in the liver meridian. Waike Zhengzong refers to it as "pain in the ear orifice," while Waike Dacheng calls it "pain in the ear base." From the analysis of symptoms and treatments, both refer to disorders of the ear canal.

Cases where ear pain is accompanied by pus discharge from the ear are not the main focus of this discussion and can be referred to in the entry on pus discharge from the ear.

bubble_chart Pattern Analysis

1. Wind-heat Toxin︰The pathological changes can occur in the auricle, external auditory canal, and middle ear, as described below:
   1. Auricle pain: The pain is severe, and in severe cases, the skin becomes red and swollen, the auricle thickens, and fluctuation can be felt upon palpation.
   2. External auditory canal pain is commonly seen in furuncle of external auditory meatus. At the onset of ear sore, there is burning pain in the ear, which worsens with chewing or yawning. The skin of the ear canal becomes red and swollen. In severe cases of ear canal furuncle, hearing may be impaired.
   3. In cases related to middle ear diseases, the condition often arises during the initial stage of external contraction of wind-heat. Symptoms include ear pain, hearing loss, redness of the tympanic membrane, or the formation of blisters, accompanied by nasal congestion and discharge.
   In addition to the localized pain mentioned above, systemic symptoms such as fever, headache, aversion to wind, fatigue, etc., may occur. The tongue is red with a thin yellow coating, and the pulse is floating and rapid. This is often caused by skin trauma, such as abrasions of the auricle or injury to the ear canal from ear digging, followed by exposure to wind-pathogenic heat toxins. Alternatively, as Waike Zhengzong states: "Water entering the ear canal during bathing can also cause ear pain and pus formation." Due to skin injury, meridian obstruction, and stagnation of qi and blood, ear pain is accompanied by swelling. Treatment should focus on dispersing wind and clearing heat, removing toxins, and dispersing swelling. The recommended prescription is Universal Relief Decoction for Eliminating Toxin .
2. Liver-Gallbladder Heat Toxicity︰The pathological changes can still be divided into the three aforementioned areas. There is severe ear pain, unbearable in intensity, with red, swollen, and elevated skin, a red tympanic membrane, and significantly reduced hearing. Systemic symptoms include fever, bitter taste in the mouth, dry throat, dry stools, yellow urine, a red tongue with a yellow and greasy coating, and a wiry and rapid pulse. This is mostly caused by liver depression transforming into fire, internal generation of dampness-heat, and heat toxin ascending along the meridians to steam and scorch the ear orifices. Hence, there is intense ear pain, red and swollen skin with elevation, accompanied by symptoms such as bitter taste in the mouth, dry throat, constipation, and yellow urine. The treatment should focus on clearing the liver and draining fire, and the recommended formula is Gentian Liver-Draining Decoction.
3. Qi Stagnation and Blood Stasis︰Ear pain with unbearable twitching, dizziness, tinnitus, thin tongue coating, dark tongue texture, and thin and choppy pulse. Mostly caused by liver-gallbladder heat evil ascending along the channels, blocking the collaterals and affecting qi-blood circulation, or external ear trauma leading to qi-blood stagnation in the ear orifice. Local skin may not show redness and swelling, or may be slightly red, or develop small blisters. Treatment should focus on clearing the liver and draining fire, harmonizing collaterals to relieve stuffy orifices. Prescription selection: Gentian Liver-Draining Decoction combined with Four Ingredients Decoction.

Ear pain is often an excess pattern, frequently accompanied by swelling. It can be differentiated into qi, blood, exterior, and interior aspects. The Yixue Rumen states: "Pain followed by swelling indicates injury to the blood, while swelling followed by pain indicates injury to the qi." When the disease is in the superficial muscles, it belongs to the qi aspect and is considered an exterior syndrome; when the disease is in the bones and tendons, it belongs to the blood aspect and is considered an interior syndrome.