OBSERVATION OF THE EARS

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OBSERVATION OF THE EARS

Chapter contents

INTRODUCTION

The ears are related to the Kidneys. Chapter 17 of the ‘Spiritual Axis’ says: ‘Kidney-Qi opens into the ears, when the Kidneys are harmonized the ears can detect the five sounds.’¹ Chapter 5 of the ‘Simple Questions’ says: ‘The Kidneys govern the ears.’² Chapter 37 of the ‘Spiritual Axis’ says: ‘The ears are the sense organ of the Kidneys.’³ Although the relationship between the ears and the Kidneys is very strong, other organs also influence the ears. For example, the Heart has an influence on the physiology and pathology of the ear. Chapter 4 of the ‘Simple Questions’ says: ‘The South corresponds to the colour red and to the Heart which opens into the ear.’⁴

CHANNELS INFLUENCING THE EARS

All the Yang channels reach or enter the ears. Both Lesser Yang channels, that is the Gall-Bladder and Triple Burner, have a strong influence on the ear also, the former circling around the ear and the latter entering the ear. These two channels are particularly involved in acute ear pathologies characterized by either Wind-Heat or Damp-Heat affecting the ears. The Small Intestine channel intersects with the Gall-Bladder channel in the region of the ear and enters the ear at SI-19 Tinggong. The Bladder channel also intersects with the Gall-Bladder channel in the region of the ear. The internal pathway of the Stomach channel also reaches the ear, while the Muscle channel of the Large Intestine travels to the front of the ear.

The pathways of the channels flowing to the ears are summarized in Box 9.1 and illustrated in Figure 9.1.

BOX 9.1 CHANNELS INFLUENCING THE EAR

• Gall-Bladder

• Triple Burner

• Small Intestine

• Large Intestine Muscle channel

Fig. 9.1 Channels flowing to the ears

The normal ear should be first of all proportionate in size to the head, it should be relatively moist, its flesh should be full but supple and the helix should be pale red and moist.

For a more detailed description of the patterns appearing in symptoms and signs related to the ears, see Chapter 57.

The following ear signs will be discussed:

Although the ear may present pathological signs like any other part of the face, the clinical significance of the observation of the ears is that they can give us an indication also of the constitution of the person; for example, large ears with long ear-lobes indicate a good constitution.

EAR SIZE

Large ears

The ears should be proportionate to the size of the head and therefore what is a ‘large’ ear for one person might be ‘normal’ for another. A large ear generally indicates a good hereditary constitution, a constitutional tendency to abundance of Qi and Blood and a propensity to Full conditions. However, it does so only if it is proportionate to the size of the head, well shaped and does not stick out, and if the lobe is long and well formed.

Small ears

Small ears generally indicate a poor hereditary constitution (especially if the lobe is very small), a constitutional tendency to deficiency of Qi and Blood and a propensity to Deficiency conditions.

Swollen ears

Symptoms and Signs, Chapter 57

Swollen ears are generally due to Heat or Damp-Heat, which may derive from various organs but particularly from the Gall-Bladder. (See Plate 9.1 on p. P8.) Another possible cause of swollen ears is invasion of Wind-Water in the Lungs.

Contracted ears

Symptoms and signs, Chapter 57

Contracted ears look somewhat ‘crumpled’ and ‘squashed’. Contracted ears are generally due to deficiency of Body Fluids, which may derive either from Heat injuring the Body Fluids or from Yin deficiency. A less common cause of contracted ears is a severe stasis of Blood in the abdomen with abdominal masses: the severely stagnant Qi and Blood fail to nourish the muscles and flesh so that the person loses weight and the ears become contracted. This situation could, for example, occur with carcinomas of the abdomen.

DRY AND CONTRACTED HELIX

Symptoms and Signs, Chapter 57

The most common cause of a contracted, dry helix with a rough and scaly texture is Blood stasis, sometimes combined with Damp-Heat. A dry and dark helix may also be due to Kidney-Yin deficiency. A jagged helix indicates chronic Blood stasis.

SORES ON THE EAR

Symptoms and Signs, Chapter 57

Sores on the ear are always due to Heat. They may derive from various organs but are particularly related to the Liver and Gall-Bladder. Another cause of acute sores on the ear is invasion of Wind-Heat in the Lesser Yang channels.

WARTS ON THE EAR

Symptoms and Signs, Chapter 57

Warts on the ear are generally due to Heat in the Liver and Gall-Bladder but they may also be due to Heat in the Stomach channel (as the deep pathway of the Stomach channel goes to the ear).

ABNORMAL COLOUR

Yellow helix

Symptoms and Signs, Chapter 57

Damp-Heat is the most common cause of a yellow helix, in which case it would be bright yellow if Heat predominates and dull yellow if Dampness predominates. Another possible cause of a yellow helix is Blood stasis deriving from Heat, in which case the helix will be dull, dark yellow.

Pale helix

Symptoms and Signs, Chapter 57

A pale helix is due either to Yang deficiency (when it will be bright pale) or to Blood deficiency (when it will be dull pale). A less common cause of a pale helix is invasion of Wind-Water in the Lungs. A ‘thick’, deep, white colour indicates Qi deficiency with Phlegm.

Bluish-greenish (qing) helix

Symptoms and Signs, Chapter 57

Blood stasis is the main cause of a bluish-greenish helix. The helix is greenish if the Blood stasis derives from Heat and bluish if it derives from Cold. A particular case of bluish-greenish helix is that seen in children suffering from acute convulsions from internal Wind.

Dark helix

Symptoms and Signs, Chapter 57

The helix may become dark either from Blood stasis or from chronic Heat. A greenish-dark helix indicates Kidney-Yin deficiency.

Red helix

Symptoms and Signs, Chapter 57

A red helix generally indicates Heat, especially of the Heart or Lungs, or both; it may also indicate Heat in the Lesser-Yang channels or Damp-Heat in the Liver and Gall-Bladder. A floating, red colour of the helix is due to Kidney-Yin deficiency with Empty-Heat. (See Plate 9.2 on p. P8.)

Red back of the ear

Symptoms and Signs, Chapter 57

The usual cause of redness at the back of the ear is invasion of Wind-Heat. It is also seen in the beginning stages of measles.

Swelling and redness of the concha

Symptoms and Signs, Chapter 57

Damp-Heat in the Liver and Gall-Bladder is the most common cause of redness and swelling of the concha. In chronic conditions, Kidney-Yin deficiency with Empty-Heat may also cause a redness and swelling of the concha, while in acute conditions Toxic Heat may cause it.

DISTENDED BLOOD VESSELS ON THE EAR

Symptoms and Signs, Chapter 57

The two main causes of visible distended blood vessels in the ear are Lung-Qi deficiency with retention of Phlegm, and Blood stasis.

EXCESSIVE WAX PRODUCTION

Symptoms and Signs, Chapter 57

Excessive wax production is usually caused by Phlegm, which may affect various organs. Another common cause of excessive wax production is Damp-Heat in the Liver and Gall-Bladder. Deficiency conditions causing excessive wax production include Spleen- and Kidney-Yang deficiency and Kidney-Yin deficiency with Empty-Heat.

DISCHARGE FROM THE EARS

Symptoms and Signs, Chapter 57

In acute cases, discharge from the ear can be due to invasion of Wind-Heat affecting the Lesser-Yang channels or to Damp-Heat in the Liver and Gall-Bladder; the latter may also cause ear discharge in chronic conditions. Both Kidney-Yin deficiency with Empty-Heat and Spleen-Qi deficiency with Dampness may cause an intermittent, thin discharge from the ear.

Box 9.2 summarizes the patterns underlying ear discharge.

BOX 9.2 EAR DISCHARGE

• Acute: invasion of Wind-Heat affecting the Lesser-Yang channels, Damp-Heat in the Liver and Gall-Bladder

• Chronic: Damp-Heat in the Liver and Gall-Bladder

• Intermittent, thin discharge: Kidney-Yin deficiency with Empty-Heat, Spleen-Qi deficiency with Dampness

NOTES

1. The Yellow Emperor’s Classic of Internal Medicine – Spiritual Axis (Ling Shu Jing ). People’s Health Publishing House: Beijing, 1981:50 First published c. 100BC

2. The Yellow Emperor’s Classic of Internal Medicine – Simple Questions (Huang Di Nei Jing Su Wen ). People’s Health Publishing House: Beijing, 1979:41 First published c. 100BC

3. Spiritual Axis, p. 78

4. Simple Questions, p. 26.

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