bubble_chart Concept

Ear discharge refers to the flow of pus from the ear, which may be yellow or green in color, and thick or thin in consistency.

This condition was first mentioned in "Zhu Bing Yuan Hou Lun" and is referred to as "otopyorrhea (suppurative otitis media)". Throughout history, physicians have named it differently based on the color of the pus. For example, Wang Ken-tang in the Ming Dynasty Zabing Zhunsheng, Volume 8 states: "It is called 'ting ear' or 'ear dampness', often discharging yellow pus; there is 'wind ear toxin', often discharging red pus; there is otopyorrhea (suppurative otitis media), often discharging white pus; there is ear gan, with sores and foul odor; there is 'shock ear', with internal ringing and often discharging clear pus." Yizong Jinjian also refers to red pus as "wind ear". Feng's Jinnang Milu refers to clear pus as "sack ear".

Any case of pus discharge due to "furuncle of external auditory meatus" is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Wind-heat Disturbing Upward︰Ear pain with distension and stuffiness, throbbing or stabbing pain. After severe pain, pus discharge from the ear alleviates the pain, accompanied by hearing impairment, headache, fever, aversion to wind, nasal congestion, runny nose, dry and sore throat, dry mouth, ruptured ear membrane with yellow pus discharge, thin yellow tongue coating, and floating rapid pulse. This is caused by wind-heat toxin invasion, transmitting heat inward and steaming the ear orifice, leading to fire-heat conflict and suppuration. There are also wind-heat exterior symptoms such as aversion to cold, nasal congestion, dry throat, thirst, thin yellow tongue coating, and floating rapid pulse. Treatment should focus on dispelling wind and clearing heat, releasing the exterior with pungent-cool herbs. Prescriptions include Lonicera and Forsythia Powder or Mulberry Leaf and Chrysanthemum Decoction, supplemented with heat-clearing and toxin-removing herbs such as Dandelion, Tokyo Violet Herb, and wild chrysanthemum flower. In severe cases, with ruptured ear membrane, intensified distending pain, thick yellow pus, and symptoms of liver-gallbladder dampness-heat such as fullness and discomfort in the chest and hypochondrium, red eyes, bitter taste in the mouth, and dry throat, along with constipation, yellow urine, and yellow greasy tongue coating indicating internal dampness-heat excess, and wiry rapid pulse indicating liver heat, treatment should focus on clearing liver-gallbladder dampness-heat. The prescription Gentian Liver-Draining Decoction is recommended. For both syndromes, locally, Qingchui Kou San ointment can be applied with a cotton swab inserted into the ear canal, or Coptis Rhizome ear drops can be used, three times a day.
2. Liver-gallbladder Dampness-heat︰The onset is sudden, with severe ear pain that lessens upon pus discharge. Accompanied by fever, bitter taste in the mouth, dry throat, headache, dry stool, and dark urine. The ear pus is yellow and thick, with a large amount, yellow and greasy tongue coating, and wiry and rapid pulse. It is caused by the accumulation of dampness-heat evils, ascending along the foot Shaoyang gallbladder channel, and the binding of dampness-heat resolving into putridity to produce pus. Generally, there is no exterior pattern, only interior excess heat syndrome, with a relatively intense heat condition.
3. Kidney Yin Deficiency︰Pus discharge from the ear persists for a long time, occurring intermittently. The pus is thin and odorless, accompanied by dizziness, tinnitus, deafness, soreness and weakness in the lower back and knees, dry mouth, restlessness, flushed complexion, low-grade fever, a red tongue texture, and a thin, rapid pulse. This is due to kidney essence deficiency, which fails to restrain yang, leading to deficiency fire flaming upward. The fire ascends along the meridians to steam the ears, leaving the kidney orifice empty and vulnerable to external pathogens. The pathogens and deficiency fire interact, resolving putridity into pus. Besides the characteristics of thin, persistent ear discharge, poor hearing, tinnitus, and dizziness, this condition also presents symptoms of kidney yin deficiency, such as soreness and weakness in the lower back and knees, dry mouth, and restlessness with heat. Treatment should focus on nourishing yin and reducing fire, and the recommended formula is Anemarrhena, Phellodendron, and Rehmannia Pill.

The condition of pus discharge from the ear involves the liver, gallbladder, and kidney meridians, but it essentially boils down to two aspects: excess and deficiency. Excess pattern is more commonly seen in children, while deficiency pattern is more frequently observed in adults.

bubble_chart Documentation

1. Gujin Yian An．Ermen: "Another woman, due to anger and fever, had pus discharge from both ears during menstruation, with pain in the taiyang channels. Pressing the area slightly alleviated the pain. When angry, she experienced distending pain in the chest, ribs, and breasts, or alternating chills and fever, frequent urination, or slight abdominal distension and fullness with discomfort. All these symptoms were attributed to liver fire and blood deficiency. She was treated with modified Peripatetic Powder, and all symptoms subsided. She was then treated with a decoction to tonify the middle and replenish qi, combined with five flavors, and recovered."