Tinnitus refers to a ringing or buzzing sound in the ears. In Traditional Chinese Medicine, the sounds of tinnitus are described as resembling the chirping of cicadas, the tolling of bells, or the sound of the wind, among others. Tinnitus is one of the symptoms of various ear disorders; it can also occur as a standalone condition that impairs hearing.
Hearing loss refers to a reduction in hearing ability of varying degrees; mild cases, where sounds are heard but not clearly, are termed “hearing impairment,” while severe cases, where external sounds cannot be heard at all, are termed “deafness.” Tinnitus and hearing loss are classified as either “deficiency” or “excess” conditions, and tinnitus often serves as a precursor to hearing loss.
I. Etiology and Pathogenesis
1. Invasion by Wind-Heat Pathogens: When wind-heat invades from the exterior and affects the ear orifices, the clear orifices are damaged, which can lead to tinnitus and deafness.
2. Liver Fire Disturbing the Clear Orifices: Sudden anger injures the liver; stagnant liver qi rises upward and obstructs the clear orifices; fire from the liver and gallbladder disturbs the clear orifices, triggering tinnitus and deafness.
3. Phlegm-Fire Obstructing the Ear Orifices: Excessive consumption of strong alcohol and rich, greasy foods damages the spleen and stomach, causing dampness to accumulate and form phlegm; stagnant phlegm transforms into fire, and the accumulation of phlegm-fire obstructs the airways.
4. Deficiency of Kidney Essence: The kidneys open into the ears; when kidney essence is depleted and the “Sea of Marrow” becomes empty, the ears lose their nourishment.
5. Weakness and Impaired Function of the Spleen and Stomach: Dietary indiscretion and overwork injure the spleen, leading to insufficient generation of qi and blood, and preventing clear qi from ascending to nourish the ears.
In addition, loud noises, explosions, and drug toxicity can also cause tinnitus and hearing loss.
II. Differential Diagnosis and Treatment in Traditional Chinese Medicine
1. Invasion by Wind-Heat: Onset is relatively acute, with a sensation of fullness and blockage in the ear, tinnitus, decreased hearing, heightened perception of one’s own voice, headache, aversion to cold, fever, and dry mouth. Treatment should focus on dispelling wind, clearing heat, and eliminating pathogenic factors; Yinqiao San or Manjingzi San may be prescribed. Externally, apply fresh Acorus calamus juice by crushing it and instilling the juice into the ear. Acupuncture points: Shangxing, Hegu, and Yingxiang.
2. Liver Fire Rising: Tinnitus sounds like the roar of waves or thunder, worsening after pent-up anger; accompanied by ear distension and pain, headache, dizziness, facial flushing, a bitter taste in the mouth, irritability and short temper, pain in the flanks, dry stools, and dark yellow urine; the tongue is red with a yellow coating, and the pulse is string-like, rapid, and forceful. Treatment should focus on clearing liver heat, resolving stagnation, and unblocking the orifices; use Modified Longdan Xiegan Decoction.
3. Stagnation of Phlegm-Fire: Persistent cicada-like ringing, a sensation of stuffiness in the ear with unclear hearing, heaviness in the head and chest tightness, excessive phlegm and a bitter taste in the mouth, and difficulty with bowel movements and urination; red tongue with a thick, yellow coating; and a string-like, slippery pulse. Treatment should focus on clearing fire, resolving phlegm, harmonizing the stomach, and descending turbidity; use Erchen Decoction or Qingqi Huatan Pills.
4. Deficiency of Kidney Essence: Persistent tinnitus, worse at night; restlessness and insomnia; gradual hearing loss; dizziness and blurred vision; soreness and weakness in the lower back and knees; in men, seminal emission; in women, leukorrhea; red tongue with little coating; fine and weak pulse. Treatment should focus on tonifying the Kidneys and nourishing essence, nourishing Yin and subduing Yang; use Modified Zuo Ci Pills for Deafness.
5. Spleen and Stomach Deficiency: Tinnitus and deafness, worsened by exertion; tinnitus becomes more pronounced when squatting or standing up; a sensation of emptiness and coolness in the ears; fatigue, poor appetite, abdominal distension, and loose stools; a sallow complexion; pale-red tongue and lips with a thin white coating; and a fine, weak pulse. Treatment should focus on strengthening the spleen, tonifying qi, and raising yang; use Bu Zhong Yi Qi Tang or Yi Qi Ming Qing Tang with the addition of Acorus tatarinowii.
Acupuncture Points: Tinggong, Tianchuang, Taixi, Tinghui, Yifeng, Wanzhu, and Zusanli.
Ear Acupoint Plaster Application: Inner Ear, Liver, Kidney, Endocrine, Subcortical, and Shenmen. The treatment course for this condition is relatively long and requires persistence.
III. Prevention of Tinnitus and Hearing Loss
1. Regulate emotions;
2. Limit consumption of rich and sweet foods to prevent the internal generation of phlegm-fire;
3. Practice moderation in sexual activity to preserve kidney essence;
4. Limit consumption of cold and cooling foods to protect the spleen and stomach;
5. Avoid stimulants such as strong tea, coffee, and alcohol;
6. In the early stages of tinnitus, adhere to Chinese herbal medicine treatment to prevent the condition from worsening.