TREATING TINNITUS

WITH CHINESE MEDICINE

8 CEUs / PDAs

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From a Western Perspective:

Tinnitus is noise or ringing in the ears. The word Tinnitus is Latin and
literally means ringing.
Tinnitus is not a disease, but rather a condition that can result from a
wide range of underlying causes. To give you an idea, these causes
could include:

nerve damage
ear injury
ear infections
foreign objects in the ear
nasal allergies
wax build-up
age-related hearing loss
Most common: abnormally loud sounds in the ear canal for even
the briefest period (but usually with some duration). In-ear
headphones, whose sound enters directly into the ear canal are a
common cause of tinnitus when the volume is set too high. It
would not be unusual for the ear to then produce wax to protect
itself.

Tinnitus is also a known symptom of withdrawal from a benzodiazepine

addiction (Valium).
The condition is often rated clinically on a simple scale from "slight" to
"catastrophic" depending on how much it imposes on daily life, such as;
interference with sleep, quiet activities, and normal daily activities. For
testing and research purposes, the Tinnitus Handicap Inventory (THI) is
often used. An example of this test is on the last page.

On general health questionnaires of people between the ages of 55 and

65, symptoms of tinnitus are reported 20% of the time. On more detailed
tinnitus-specific questionnaires, it is reported 11.8% of the time. As you
can see, it is pretty common.
Western Medicine recognizes two kinds of tinnitus.
Subjective tinnitus is tinnitus only the patient can hear and is the most
common type. It can be caused by ear problems in the outer, middle or
inner ear. It also can be caused by problems with the auditory nerves or
the part of the brain that interprets nerve signals as sound.
Objective tinnitus is tinnitus that a specialist can hear on examination
with equipment. This type of tinnitus is more rare and may be caused by
a blood vessel problem, an inner ear bone condition or muscle
contractions.
Tinnitus can be perceived in one or both ears -- or in the head. It can be
intermittent, or it can be continuous. In some individuals the intensity
can be changed by shoulder, head, tongue, jaw, or eye movements.
It is usually described as a ringing noise, but for some it can be very
different with explanations of high-pitched whining, electric buzzing,
hissing, humming, whistling sound, or as ticking, clicking, roaring,
"crickets" or "tree frogs", tunes, songs, beeping, sizzling, sounds
that slightly resemble human voices or even a pure steady tone. It has
also been described as a "whooshing" sound, like wind or breaking
waves.
Understandably, persistent tinnitus may cause irritability, fatigue,
clinical depression and musical hallucinations (described as a condition
very similar to having a song stuck in ones head; but the music is
considerably more true-to-life, it is heard almost non-stop, and it is
practically impossible to ignore)

Conventional treatments available for Tinnitis :

Conventional medical treatment of tinnitus involves the correction of
underlying conditions including: counseling, cognitive behavior therapy
(CBT), sound therapy (using a tinnitus masker) and relaxation
techniques.
Tinnitus Retraining Therapy (TRT) as proposed by Pavel Jastreboff.
This treatment is based directly on the Jastreboff model. It uses a precise
and individual combination of sound therapy and teaching . It
demystifies the disorder by learning about tinnitus and hyperacusis
mechanisms, with directions about how to return to normal life without
provoking symptoms. To find out more about this type of therapy you
can access this website: http://www.tinnitus.org/home/frame/THC1.htm
Possible medications include:
Tricyclic antidepressants, such as amitriptyline and nortriptyline,
have been used for only severe tinnitus, as they can cause
troublesome side effects, including dry mouth, blurred vision,
constipation and heart problems.
Alprazolam (Niravam, Xanax) may help reduce tinnitus symptoms,
but side effects can include drowsiness and nausea. It also can
become habit-forming.
Earwax removal
Treating an underlying blood vessel condition.
Noise suppression by using a white noise device.
These medications and treatments are listed so that you will be aware
of symptoms a patient may have that comes to you for help with tinnitus.
On the next page you can view the THI Tinnitus Handicap Inventory
Test. The questions will give you an idea of what a patient with this
disorder might be experiencing, thereby leading you to direct questions
that may help with a TCM diagnosis for them on an individual basis.

TINNITUS HANDICAP INVENTORY (THI)

POINTS
Because of your Tinnitus is it difficult for you to concentrate?

Ye N
s o
Does the loudness of your Tinnitus make it difficult for you to hear people?
Ye N
s
o
Does your Tinnitus make you angry?
Ye N
s
o
Does your Tinnitus make you confused?
Ye N
s
o
Because of your Tinnitus are you desperate?
Ye N
s
o
Do you complain a great deal about your Tinnitus?
Ye N
s
o
Because of your tinnitus do you have trouble falling asleep at night?
Ye N
s
o
Do you feel as though you cannot escape from your Tinnitus?
Ye N
s
o
Does your Tinnitus interfere with your ability to enjoy social activities (such Ye N
as going out to dinner, to the cinema)?
s
o
Because of your Tinnitus do you feel frustrated?
Ye N
s
o
Because of your Tinnitus do you feel that you have a terrible disease?
Ye N
s
o
Does your Tinnitus make it difficult to enjoy life?
Ye N
s
o
Does your Tinnitus interfere with your job or household responsibilities?
Ye N
s
o
Because of your Tinnitus do you find that you are often irritable?
Ye N
s
o
Because of your Tinnitus is it difficult for you to read?
Ye N
s
o
Does your Tinnitus make you upset?
Ye N
s
o
Do you feel that your Tinnitus has placed stress on your relationships with Ye N
members of your family and friends?
s
o
Do you find it difficult to focus your attention away from your Tinnitus and on Ye N
to other things?
s
o
Do you feel that you have no control over your Tinnitus?
Ye N
s
o
Because of your Tinnitus do you often feel tired?
Ye N
s
o

2
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es

Because of your Tinnitus do you feel depressed?

Does your Tinnitus make you feel anxious?
Do you feel you can no longer cope with your Tinnitus?
Does your Tinnitus get worse when you are under stress?
Does your Tinnitus make you feel insecure?

Ye
s
Ye
s
Ye
s
Ye
s
Ye
s

N
o
N
o
N
o
N
o
N
o

Sometim
es
Sometim
es
Sometim
es
Sometim
es
Sometim
es

TOTAL SCORE PER COLUMN

TOTAL POINTS grade levels below.

0 16 Slight (Only heard in quiet environments)
1836

Mild (Easily masked by environmental sounds and easily forgotten with

activities
3856 Moderate (Noticed in presence of background noise, although daily activities
can still be performed)
5876 Severe (Almost always heard, leads to disturbed sleep patterns and can
interfere with daily activities)
78100 Catastrophic (Always heard, disturbed sleep patterns, difficulty with any
activities)

GRADE
1
GRADE
2
GRADE
3
GRADE
4
GRADE
5

Treatment from a TCM perspective:

According to Dr. Kiasang Law, Auricular Therapy can offer some help
for tinnitus sufferers in relieving the intensity of both the tinnitus and the
psycho-emotional symptoms associated with this condition.
The Auricular approach will address stress and anxiety (Shen Men &
Sympathetic points), tinnitus symptoms (Occiput, External and Internal
Ear) and restore the homeostatic balance of the bodily function (Zero
point) & enhancing the primordial energy of
the body (Kidney and Zero points).

Auricular acupuncture is very effective in relaxing muscle tension

through the treatment of Muscle Relaxation Point on the auricle, and
hence it can have a profound effect in reducing stress and anxiety. It is
well known that depression, anxiety and stress aggravate the
perception to tinnitus of many sufferers. Auricular treatment is able to
offer a state of calmness and well being by treating or needling ear
points associated with these conditions.
THIS IS THE MUSCLE RELAXATION POINT LOCATION

Nervous exhaustion, stress and anxiety can exacerbate tinnitus, and

therefore auricular acupuncture treatments can help a person to bring
their tinnitus to a more manageable level.
Depending on the symptoms presented at the time of treatment, psychic
points such as depression, anxiety and aggression points as well as the
Omega points should be explored and treated if active.

Advanced Auricular Therapy will examine the Vestibular Cochlear

Nerve / Auditory Nerve (cranial nerve VIII) projections in 3 differences
phases, superior cervical ganglion, and cervical spine (to relax neck and
shoulder muscles).

According to the French School of auricular acupuncture, all

diseases progress through acute, chronic and degenerative phases.
Additional improvement can be gained through the treatment of auditory
line whereby both high and low pitch sound perception can be treated
and brought to a more tolerable level.
It is well known that dysfunction of the Tempro-Mandibular joint (TMJ)
sometimes is one of the main causes of tinnitus and is also a blockage to
healing of many bodily disorders. TMJ dysfunction can be effectively
treated using auricular therapy.

In order to enhance the treatment, the modern thinking is to include a

multi-modality approach.
Include body acupuncture points from the Gall Bladder and Large
Intestine meridians as well acupuncture points around the ear (GB20,
LI1, GB2, SJ17, SI 19 & 21).
Dr Kiasang Law can be contacted at: The Nonsuch Auricular Therapy
223, Church Hill Road,
Sutton Surrey SM3 8BL Telephone: 020 8644 8853 Mobile: 07710
270508 email:
nonsuchaa@btinternet.com

Herbal Formulas used to treat Tinnitus

If there is no problem with the physical ear and there is no actual
damage to the ear, tinnitus or ringing sounds in the ears can be related to
a function disorder. As the ear is considered the "gateway" or opening of
the Kidney, one could assume kidney qi xu, especially
if the patient is older. The louder and the longer the duration of the
sound, the more deficient.
Two classical patent herbal formulas are very helpful for this condition:
Er Long Zuo Ci Wan and Zi Bai Di Huang Wan. The ingredients are
listed to differentiate between them. In general, these tonic type of
formulas, both address a deficiency type in an aged person and
need to be used for several months and should be monitored.
Er Long Zuo Ci Wan or Pill for Deafness that is Kind to the Left
(Kidney) is indicated for nourishing the kidney and subduing liver-yang.
The formula is widely used for tinnitus, deafness or hearing loss due to
old age, dizziness / vertigo, and blurring of vision caused by deficiency
of both liver Yin and kidney Yin.

A thin and frail or thin and rapid pulse would be present. This formula is
not appropriate if the tinnitus occurred suddenly, and is only for
gradual loss of hearing and/or ringing in the ears due to Yin deficiency
of the liver and kidney.
It is also not appropriate for tinnitus caused by ear infection.
Lets take a look at the ingredients and their actions:
Magnetitum (Ci Shi)
Magnetite is a mineral, magnetic iron oxide. It is salty in taste, cold in
nature, and distributed to the Liver, Heart and Kidney Channels to
subdue hyperactivity of the liver, to improve hearing and eyesight,
to calm the nerves, and to alleviate dyspnea.
Radix Rehmanniae Preparata (Shu Di Huang)
Prepared Rehmanniae Root. It is sweet in taste and slightly warm in
nature, and is distributed to the Heart, Liver and Kidney Channels. Its
action is to nourish yin and replenish blood, reinforce kidney
essence and marrow.
Fructus Corni Officinalis (Shan Zhu Yu)
Asiatic Cornelian Cherry Fruit is ripe and gathered from October to
November. The fruit is baked or boiled and the pit is removed. The fruit
is then dried in the sun or baked again. It is sour and slightly warm,
enters the Kidney and Liver. It is classified as an astringent. This herb
both tonifies the essence and assists the yang.
Cortex Moutan Radicis (Paeonia Suffruticosa) (Mu Dan Pi)
Tree Peony Bark is acrid, bitter and cool. Enters the Heart, Liver and
Kidney channels. Its action is to Clear Heat and Cool the Blood thereby
clearing deficient heat and clearing ascending liver fire. Mildly
invigorates the blood.

Rhizoma Dioscoreae Oppositae (Shan Yao)

Wild Yam grown in tropical areas and collected in winter when the stem
and leaf are withered and fumigated with sulfur and then dried. Its is
neutral in nature and sweet. Enters the Kidney, Spleen and Lung
Channels. Tonifies and nourishes.
Sclerotium Poriae Cocos / Hoelen (Fu Ling)
is a type of fungus that grows mainly around pine trees and is found
under the surface, collected from July to September spread out and airdried on the surface until wrinkles appears and the inside water
evaporates, then dried in the shade. It is bland, sweet and neutral in
nature entering the heart, spleen, and kidney channels. Eliminates Water;
Strengthens the Spleen, Calms the Mind
Rhizoma Alismatis Orientalis (Ze Xie)
A rhizome from the Oriental Water Plantain. It is Bland, sweet and cold
in nature. Enters the Kidney and Urinary Bladder Channels. Its action is
to eliminate dampness and clear deficient Kidney heat.
Radix Bupleuri Chinensis (Chai Hu)
The root of the Bupleurum. Taste is bitter and acrid. It is cool in nature.
Entering the Liver and Gall Bladder, San Jiao channels. Harmonizes the
interior and exterior, spreads liver qi (in this case for vertigo and
dizziness) and reduces fever.
Zi Bai Di Huang Wan or Anemarrhena, Phellodendron and
Rehmannia Pill
Radix Rehmanniae Preparata (Shu di huang)
Fructus Corni Officinalis (Shan zhu yu)
Cortex Moutan Radicis (Paeonia Suffruticosa) (Mu dan pi)
Sclerotium Poriae Cocos / Hoelen (Fu ling)
Rhizoma Alismatis Orientalis (Ze xie)
Rhizoma Dioscoreae Oppositae (Shan yao)
see descriptions above for these six herbs.

Rhizome Anemarrhena (Zhi mu)

The rhizome is from the lily family of plants. Taste is Sweet, bitter. It is
cold in nature and enters the Lung, Stomach and Kidney channels.
Its action is to clear heat and fire, nourishing the Yin and moisturize
dryness
Cortex Phellondendri (Huang bo / bai)
Phellodendron/ Amur Cork Tree Bark.
It is bitter in taste and cold in nature. Enters the Kidney and
Urinary Bladder Channels. Its action is to remove damp-heat, quench
fire, counteract toxicity, and relieve consumptive fever.
So it would be easy to say one of these two patent formulas will work
and thats all there is to it. The patent herbs are sold over the counter to
anyone and could sometimes worsen a condition and that is why it is
important to know the function of the herbs and make a proper
diagnosis within the paradigm.
I add here a discourse on the treatment of tinnitus with chinese herbs
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional
Medicine, Portland,
Oregon http://www.itmonline.org/about.htm I find his writings to be
extremely beneficial in understanding the reasoning behind the treatment.
In the Neijing Suwen , written around 100 B.C., several potential causes
were mentioned for cause and treatment of tinnitus. For example, it is
stated: "Kidney qi communicates with the ears; when the kidneys are
functioning well, the five types of sound can be heard." The term
kidney (shen), as used by ancient Chinese doctors, refers to a functional
complex that is today
difficult to link to specific organs, but can be suggested to involve not
only the kidneys, but also the endocrine system. According to the
traditional ideas, kidney qi weakens with aging (especially after age 50)
and difficulty with hearing, as well as failings of the other senses,
particularly vision, arises as a result. We know from modern
investigations that tinnitus may arise in conjunction with the common

old age disorders of anemia, heart and blood vessel disorders (e.g.,
hypertension, hyperlipidemia, arteriosclerosis), and the accumulated
effect of numerous ear infections or exposures to very loud noise over
many years.
There are specific strategies for rectifying the kidney qi deficiencies
described by Chinese physicians, and these same strategies are also
applied (with only slight modifications) to a number of aging-related
problems, such as lowered immune function, reduced libido and
sexual responsiveness, achiness in the lower back and joints, fatigue and
sleep disorder, and impairment of memory.
What is specific about tinnitus is the spontaneous aural activity, which
the Chinese usually interpret as a type of movement, signifying an
agitation of the yang energy that ought to be more settled by presence of
adequate yin. Such yang agitation can also cause dizziness, insomnia,
and headaches.
It is also said in the Neijing that "When the yin fails to contain the yang,
the flow in the channels will become rapid, causing the yang qi to
become excessive and reckless. If the yang qi is deficient and unable to
counterbalance the yin, communication between the internal organs will
be disrupted, and the nine orifices will cease to function....When yin and
yang are balanced, the five visceral organs function appropriately
together....vision is clear and hearing is acute."
According to this concept, both yang agitation (from yin deficiency) and
yang deficiency can lead to disorders in hearing (the ears being two of
the nine orifices; the eyes also being two of the orifices). In cases of
yang deficiency, the body is overwhelmed by yin (substance) and the
communication becomes blocked; organs don't interact properly with
each other or with their external manifestations, such as eyes and ears.
Another cause is indicated in the Neijing for cases of acute loss of
hearing: "a case of sudden onset [of symptoms], where the patient may
pass out, lose hearing, or experience obstruction of the bowel or urine, is
usually induced by chaos of the qi and blood within." In such cases,

one must regulate the flow of qi and blood to restore normal functions.
As to the cause of this chaos, the text continues: "Headaches, ringing in
the ears, and obstruction of the nine orifices are usually caused by
imbalances in the stomach and intestines."
By improving dietary practices and by using harmonizing therapy to
improve and coordinate the stomach and intestine functions, these
problems may be alleviated.
According to the Advanced Textbook on Traditional Chinese Medicine
and Pharmacology, in approaching treatment of tinnitus, it is important
to distinguish between recently acquired disorders (acute, sudden onset)
and long-term disorders (displaying gradual development), between
continuous and intermittent tinnitus, and also between excess-type
(attributed to accumulation of pathogenic substances affecting the ear)
and deficiency-type (attributed to inadequate nutritional status).
Excess-syndrome tinnitus is often experienced in one ear only
(or begins distinctly in one ear and later develops in the second ear to a
lesser extent), while deficiency-syndrome tinnitus tends to develop in
both ears and intermittently may improve, being less severe during the
day and obviously worse at night. A combination of deficiency
and excess syndromes is possible, especially in persons with other
illnesses or with tinnitus that has persisted for several years.
The specific syndromes described in the textbook include four primary
types, the first two are in the excess category and the last two are in the
deficiency category. The disorders of the liver, gallbladder, kidney, and
spleen mentioned in these descriptions apply to the traditional
depictions of the organ systems and may not relate directly to the
modern structural and functional connotations of the named organs.

Type 1. An excess syndrome defined as being due to hyperactive

liver and gallbladder fire.
This manifests as sudden onset of tinnitus, usually continual sound,
which may be accompanied by symptoms of the excess syndrome, such
as headache, flushed face, restlessness, irritability, insomnia, and
constipation. Though there can be other causes, this syndrome is
believed to be due mainly to the experience of anger, violent rage, or
fright, and the tinnitus may arise soon after becoming embroiled in
situation that causes much anger.
Persons who frequently drink alcohol to excess are especially subject to
this syndrome. The traditional remedy for hyperactive liver and
gallbladder fire is Gentiana Combination (Longdan Xiegan Tang),
which can be modified to treat tinnitus by adding moutan, ligustrum,
and eclipta (these additions are intended to rectify the problem of
extreme or persistent liver fire weakening the kidney water).
Type 2. An excess syndrome defined as being due to retained hot
phlegm (phlegm-fire syndrome).
This typically manifests as intermittent ringing in the ears, like the
chirping of cicadas, sometimes accompanied by the sensation that the
ears are blocked, thus impairing hearing. Possible accompanying
symptoms may include stuffiness in the chest, excess sputum
production, dizziness, nausea, and difficulty in urination or defecation
(these symptoms reflect the blockage, retention, and accumulation). This
syndrome is believed to be due to improper diet, especially if there is
much fatty and/or spicy food that is consumed regularly. A standard
remedy for phlegm-fire syndrome is Bamboo and Hoelen Combination
(Wendan Tang), and this formula is modified for treating tinnitus by
adding pearl, haliotis, and uncaria in cases accompanied by hyperactive
liver; or by adding lapis, scute, rhubarb, and aquilaria (Lapis and
Scute Formula; Mengshi Guntan Wan) for cases of stuffiness in the
chest, excessive sputum, and difficulty defecating. If the fire is not a
major concern, but phlegm accumulation is evident, Pinellia and
Gastrodia Combination (Banxia Baizhu Tianma Tang) may be used
alone or with Bamboo and Hoelen Combination.

Type 3. A deficiency syndrome defined as being due to insufficient

kidney yin (essence).
This is a gradually worsening tinnitus (though it may reach a certain
constant level and get no worse after that) which is accompanied by
deficiency type symptoms such as dizziness, backache, and weakness of
the knees, sometimes accompanied by deficiency-heat symptoms, such
as hot sensation of the palms/soles and facial flushing. This syndrome is
often caused simply by the aging process (accumulated stress, lack of
adequate nourishment, insufficient exercise, chronic depression, etc.),
and may be worsened by experience of certain diseases (especially
chronic or debilitating diseases).
The standard remedy for kidney yin deficiency is the Rehmannia Six
Formula (Liuwei Dihuang Wan), which is modified to treat tinnitus by
adding magnetite and schizandra. In more severe cases, one may add
tortoise shell, gelatin, dragon bone, oyster shell, ligustrum, and morus
fruit to further nourish yin and settle agitated yang (that is not controlled
by the yin, blood, and essence).
Type 4. Deficiency syndrome defined as failure of clear qi to ascend.
This manifests as intermittently occurring tinnitus that is alleviated by
rest and aggravated by stress. Other possible symptoms of the
deficiency include lassitude, poor appetite, and loose stools. This
syndrome is caused by a yang deficiency affecting the spleen system,
which may result from stress and worry, inadequate nutrition, or poor
eating habits. The standard remedy for failure of clear qi to ascend to the
head is Ginseng, Astragalus, and Pueraria Combination (Yiqi
Chongming Tang), which was developed for treatment of auditory
difficulties, mainly deafness and tinnitus, and for treatment of reduced
visual acuity; it was first reported in the Yuan Ji Qi Wei (1370 A.D.).
In an article on treating sensorineural hearing loss , Sun Aihua gives the
following background information on tinnitus and hearing loss, taking a
somewhat different, but overlapping, perspective compared to the
textbook definitions:

According to TCM theory, deafness and tinnitus are related to

dysfunction of kidney, heart, liver, gallbladder, and spleen. Feebleness
of kidney qi, deficiency of kidney yin, vertigo or facial tic due to
dysfunction of the liver [i.e., liver yang agitation], stagnation of liver qi,
deficiency of heart qi, and diminished vitality of spleen are the causes of
deafness and tinnitus.
Ye Tianshi, a noted Qing Dynasty physician, pointed out that the ear
was connected with the kidney, heart, and gallbladder in various ways.
He stressed heart and kidney in treating deafness in the feeble, but in
deafness due to harmful environmental factors he stressed the
gallbladder channel in treatment, concluding that the main principles to
follow were "clearing the upper and suppressing the lower parts of the
body." The actual methods of treatment were "reinforcing kidney,
invigorating heart, purging gallbladder, etc."
Recent investigations on the pathophysiology of sensorineural hearing
loss have generally pointed to disorder of microcirculation of the inner
ear as a main disturbance. "Promoting blood circulation and
relieving stasis" is, therefore, a method of choice in correction.
In this depiction, there are two ideas mentioned beyond those listed in
the Advanced Textbook: an old concept of deficiency of heart qi (which
is not pursued in modern clinical practice) and the newer finding of
disruption of normal blood circulation (which several Chinese
physicians pursue in treatment of deafness and tinnitus, along with the
traditional methods).
SAMPLE CLINICAL TRIAL
In the Chinese Journal of Integrated Traditional and Chinese Medicine ,
a clinical trial for treatment of tinnitus was described. A basic formula
was designed, which would be modified for different types of tinnitus.
The basic formula contained:
polygonatum
(huangjing)
40 grams

epimedium (yinyanghuo) 10 grams

cynomorium (suoyang) 10 grams
hu-chang
Japaneseknotweed (huzhang) 30 grams
persica
Peach kernel (taoren) 10 grams
earthworm (dilong) 10 grams
This formula, which primarily treats the deficiency of spleen and kidney
with a heavy dose of polygonatum, differs from those described in the
Advanced Textbook by adding tonification for yang deficiency
(epimedium, cynomorium) as well as herbs for vitalizing circulation of
blood (persica and earthworm). Hu-chang helps treat heat and dampness,
as occurs in excess type disorders; it is also used to promote blood
circulation, and it has been recognized as a remedy for tinnitus since
ancient times, having been mentioned for that purpose in the 7th
century book Qianjin Yaofang.
These adjustments reflect the modern physician's view that tinnitus often
arises from a combination of yin and yang deficiency and that the
damage to the ear involves a blood stasis syndrome (a disorder
emphasized in Chinese clinical practice during the past century, and
mentioned by Sun Aihua).
For the tinnitus of type 1 described above, add to the basic formula:
chrysanthemum (juhua) 10 grams
prunella (kuxingcao) 15 grams
moutan (mudanpi) 10 grams
vitex (manjingzi) 10 grams
magnetite (cishi) 30 grams
These herbs quell the liver and gallbladder fire and settle the agitated
liver yang

For the tinnitus type 2 described above, add to the basic formula:
pueraria (gegen) 20 grams
morus leaf (sangye) 10 grams
forsythia (lianqiao) 15 grams
gardenia (zhizi) 10 grams
cimicifuga (shengma) 6 grams
These herbs clear heat and dry dampness (forsythia, gardenia), and open
up the congested circulation to the head (pueraria, cimicifuga, morus
leaf).
For the tinnitus type 3 described above, add to the basic formula:
rehmannia (dihuang) 15 grams
asparagus (tianmendong) 10 grams
ophiopogon (maimendong) 10 grams
magnetite (cishi) 30 grams
cimicifuga (shengma) 10 grams
cyathula (chuanniuxi) 15 grams
achyranthes (huainiuxi) 15 grams
These herbs nourish the yin (rehmannia, asparagus, ophiopogon), and
normalize the circulation of blood (cyathula, achyranthes) and the
upward/downward flow of yang qi (cimicifuga, magnetite).
The type 4 tinnitus was not mentioned in this article.
There were 38 persons treated, with tinnitus caused by infections, loud
sounds, or accompanying hypertension, mental disorders, extreme
fatigue, or drug side-effects. The herbs were decocted in the proportions
indicated above and served as a tea once per day. Lidocaine was also
administered to the patients by IV drip or by application to the
tympanum (middle ear). As a result of the treatment (one month), 9 of
the patients were then free of the tinnitus, 22 were free of tinnitus during
the day, but could still detect some during the quiet night time
with varying degrees of threshold sound, and 7 of the patients did not
respond.

In considering these results and the possible application of similar

therapies in the West, the following should be considered:
The "types" of tinnitus represent general categories; most individuals
will show a mixture of signs and symptoms that may seem to confuse
the situation. The practitioner must use the differentiation of types of
tinnitus merely as a guidepost to analysis and treatment. Note that
the formulas used in the clinical evaluation included a mixture of the
therapeutic principles.
The patients took a high dosage decoction daily. The herb combinations
contained from about 170 to 200 grams of herbs, an amount that far
exceeds what is often prescribed by Western practitioners. If the
treatment results are dosage dependent, as is expected to be the case,
then a lower dosage may yield a more modest result.
The lidocaine treatment is unlikely to be used here (especially its
application by IV drip); its contribution to the effectiveness of the
therapy is unknown.
Shao Nianfang, writing his personal experiences about treating tinnitus
in his book Treatment of Knotty Diseases with Chinese Acupuncture and
Chinese Herbal Medicine, has this to say about analysis of the disorder
and the results of treatments:
In general, acute tinnitus and deafness pertain to excess. In cases due to
wind-phlegm-fire invasion of the upper part, namely the sensitive
orifices of the ear, it is proper to treat with the clearing and purging
method of the liver and gallbladder, to extinguish wind, and resolve
phlegm. A prompt recovery will usually ensue.
Cases with gradual development of chronic tinnitus and deafness usually
pertain to deficiency of essence, blood, and qi; in such cases it is suitable
to replenish the essence and blood, reinforce the spleen and promote qi.
Slow recovery is usually the case, so the therapist has to be patient in
treating such cases. It is advisable to combine the use of acupuncture
therapy [with the herb therapy]. In difficult and knotty cases, herbs that

activate the circulation and meridians, such as cnidium, carthamus,

persica, red peony, pangolin scales, liquidambar, earthworm, and
silkworm, can be used to enhance the replenishing and stimulant action.
No matter whether the disease is of the excess or deficiency type, it is
important to add bupleurum, cimicifuga, acorus, curcuma, pueraria, or
others as guiding herbs to lead the other ingredients to the proper
channel to enhance the therapeutic effects.
In another clinical trial, 100 patients with type 1 tinnitus (persistent
ringing of the ear, in one ear only) were divided into two groups, one
receiving Chinese herbs and the other receiving Western medicine. The
basic Chinese herb formula was markedly different than the one
reported above:
rehmannia (shou dihuang) 15 grams
ho-shou-wu (heshouwu) 12 grams
salvia (danshen) 20 grams
magnetite (cishi) 30 grams
polygala (yuanzhi) 12 grams
acorus (shichangpu) 30 grams
cornus (shanzhuyu) 30 grams
lycium fruit (gouqizi) 12 grams
ligustrum (nuzhenzi) 12 grams
morus fruit (sangshen) 30 grams
This formula combines the principles of nourishing the kidney and liver
(lycium fruit, ligustrum, morus fruit, ho-shou-wu, rehmannia, cornus),
clearing phlegm-obstruction of the orifices (polygala and acorus),
promoting microcirculation of blood (salvia), and settling agitated yang
(magnetite). In addition, the traditional formula Suanzaoren Wan
(Zizyphus Formula), which nourishes the liver and settles fire agitation,
was given in pill form, 10 grams at a time, twice daily (at noon and
before going to sleep).
The treatment would be modified according to symptom presentation as
follows:

for kidney qi deficiency: add 12 g cuscuta and 30 g dioscorea;

for heart and spleen deficiency, add 15 g codonopsis, 12 g astragalus,
and 15 g longan, removing ligustrum, morus fruit, and lycium fruit from
the base formula;
for liver fire, add 9 g gentiana, 12 g gardenia, 12 g bupleurum and 10 g
peony, removing rehmannia, ho-shou-wu, and cornus from the base
formula.
The herbs were given daily for 5 weeks. The control group took
carbamazepine (Tegretol; this drug inhibits transmission of impulses at
certain nerve terminals and is used for excitability of nerve fibers in the
brain; it is more commonly applied in treatment of tic
douloureux/trigeminal neuralgia and epilepsy).
In the Chinese herb group, 14 of the 50 patients were improved and in
the Western drug group 12 of 50 improved, there being no statistically
significant difference between the results for the two groups. Analyzing
these modest results of high dosage herb treatment over a 5 week
period, the authors state that:
The cases in which there was a moderate tinnitus, with low frequency
ringing, loudness less than 3 decibels above threshold value, and
duration of the disorder being not more than one year, the results of
treatment were good; by contrast, the high frequency ringing, loudness
in excess of 8 decibels, and longer duration of the disorder did not show
response to this treatment.
It is possible that the results of treatment in this trial were not as good as
in the previous report because the doctors had failed to follow the
traditional principles indicated for the selection of patients with
persistent tinnitus in one ear: the decoction formula and the pill were
both fundamentally tonic in nature, rather than purging the fire and
clearing the phlegm-dampness, as would be indicated by the traditional
style analysis.

In a study of sensorineural hearing loss reported by Sun Aihua, the

following formula was used:
magnetite (cishi) 60 grams
pueraria (gegen) 45 grams
drynaria (gusuibu) 45-60 grams
dioscorea (shanyao) 30 grams
peony (baishao) 15 grams
cnidium (chuanxiong) 15 grams
rhubarb (dahuang) 1.5-6.0 grams
licorice (gancao) 12 grams
This basic formula was modified as follows:
for evident stasis of qi and blood, add salvia, red peony, sparganium,
and zedoaria
for vertigo and facial tic, add uncaria, chrysanthemum, and lumbricus
(earthworm)
for kidney yin deficiency, add ligustrum, eclipta, and lycium
for deficiency of qi and blood or spleen dampness, add codonopsis,
atractylodes, pinellia, and tang-kuei.
The decoction of the resulting formula was given once per day. In
addition, oral iron supplements were given three times daily, along with
vitamin C and vitamin B6 to enhance iron absorption. Lidocaine was
given intravenously 4 days a week in patients suffering from
dizziness and tinnitus.
As a result of therapy, which continued for as many days as needed to
get a steady result (minimum of 20 days), or was eventually terminated
after three months if no benefit was detected, it was reported that of 183
affected ears in 108 patients, 10 of the ears had full hearing recovery, 54
of the ears had marked improvement in hearing, and 46 ears had a slight
improvement.
In looking for factors that influenced ability to fully or partially recover
normal hearing, the authors noted:

Less satisfactory results were obtained when the deafness was due to
noise [i.e., repeated exposure to loud noise] or recurring attacks of
Meniere's disease. No improvement was observed in 12 ears with
ototoxic deafness [i.e., the result of drug side-effects that persisted].
The shorter the duration [of deafness], the better the result. 73.5% of the
ears affected for less than a year responded to treatment; 52.2% of the
ears deaf for over a year responded. It is generally believed that severe
or profound hearing loss was much more difficult to treat than
the mild, moderate, or moderately severe. However, our study revealed
no significant influence of severity of the disease on therapeutic results,
and we obtained satisfactory results in no few cases of severe or
profound hearing loss. Patients over 40 years of age showed less
satisfactory response than younger persons; we obtained few satisfactory
results in patients over 55.
Thus, younger age and early intervention should yield a good prognosis,
while older age and delayed intervention should yield a poor prognosis,
while severity of hearing loss is not an inherent factor. This latter claim
differs from that in a tinnitus study mentioned above, where
the severe cases responded less well than the mild cases. However, in
that report, the overall effects of treatment were not as good as in the
other studies and the severity of disease was linked, in the analysis, with
duration of disease, which most physicians consider an important
factor in outcome; thus, the authors may have simply observed improved
results with shorter duration of the disorder.
Dietary changes
According to the Tao of Nutrition, there are some steps you can take to
help ease tinnitus.
First, you should avoid the following:
loud noise
stress & tension
stimulating foods and drinks (ex. caffeine)
spicy foods
smoking
alcohol

Overworking or excessive physical strain can lead to a nerve disturbance,

causing tinnitus.
Furthermore, you can try the following simple recipes:
Drink one cup of juice made with celery and grapes 2-3 times a day.
Boil Chinese black dates, walnuts and lotus seeds with rice porridge and
eat some daily.
Rice porridge with black beans and azuki beans once daily.
Excessive greasy foods or irregular eating can lead to Phlegm which
prevents the rising of clear qi to the head (resulting in the "phantom
noise" associated with tinnitus).
If you use Homeopathy in your practice, here is a list of remedies
used for tinnitus:
This is not addressing the similimum.
Calcarea carbonica: When this remedy is indicated, tinnitus may be
experienced alone or with vertigo. You may have hearing problems, or
cracking and pulsing sensations in the ears.
Those who need this remedy are usually chilly, easily fatigued, crave
sweets, and feel overwhelmed and anxious when unwell.
Carbo vegetabilis: Useful if ringing in the ears occurs during flu or
other conditions involving vertigo and nausea. The symptoms may be
worst in the evening and at night. You may feel cold and faint. You may
have a craving for fresh and moving air.
China (also called Cinchona officinalis): Helpful if you feel touchy,
weak, and nervous with sensitivity to noise and tinnitus. This remedy is
often given after fluids have been lost through vomiting, diarrhea, heavy
sweating, and surgery or other conditions involving blood loss.
Chininum sulphuricum: Buzzing, ringing, and roaring sounds that are
loud enough to impair the person's hearing suggest a need for this
remedy. A tendency toward chills and vertigo, during which the tinnitus
is often worse is another indication for this remedy.

Cimicifuga: This remedy is useful for people who are very sensitive to
noise, along with tinnitus, and often have pain and muscle tension in the
neck and back. They are usually energetic, nervous, and talkative, but
become depressed or fearful when not feeling well.
Other indications for this remedy are: headaches and problems during
menstrual periods.
Coffea cruda: This remedy is indicated for an excitable, nervous person
with tinnitus accompanied by extremely sensitive hearing and a buzzing
feeling in the back of the head.
They often have insomnia from mental overstimulation.
Graphites: Beneficial to a person who has tinnitus with associated
deafness. Hissing and clicking sounds are often heard in the ears (or
even louder sounds like gunshots). The person may also have a tendency
toward constipation, poor concentration, and cracking skin eruptions.
Kali carbonicum: Useful for tinnitus with ringing or roaring,
accompanied by cracking noises and itching in the ears. Vertigo is
another indication. Persons who benefit most from this remedy are often
quite conservative, with a rigid code of ethics. They tend to feel anxiety
in the region of the stomach.
Lycopodium: This remedy is often prescribed when you have a
humming and roaring in the ears, along with impairment of hearing.
Sounds seem to echo in the ears. You have a tendency
toward ear infections with discharge, as well as chronic digestive
problems or urinary tract complaints.
Natrum salicylicum: Beneficial if ringing in the ears is like a low, dull
hum. Loss of hearing related to bone conduction, as well as nerve
interference and vertigo, may be involved. This is
a useful remedy when tinnitus and tiredness occur after influenza or
along with Meniere's disease.

Salicylicum acidum: This remedy is often indicated for tinnitus with

very loud roaring or ringing sounds, which may be accompanied by
deafness or vertigo. Flu and Meniere's disease are other indications. This
may also be helpful if tinnitus has been caused by too much aspirin.
ESSENTIAL OILS used in the treatment of Tinnitus
Take a drop of frankincense and a drop of basil, with your finger run it
from the top/back of the ear, down the jaw line to the middle of the chin.
Repeat this same procedure in front of the top of the ear and down the
jaw line to the middle of the chin. Repeat every hour for the first
day and then as needed. DO NOT PUT OIL DIRECTLY IN EAR.
Helichrysum oil can also be used alone or with frankincense and basil as
above.

Test Questions for Tinnitus:

1. Tinnitus is noise or ______________________________________
2. The word Tinnitus is Latin and literally means
___________________________.
3. Western Medicine recognizes two kinds of tinnitus. They are:
_______________________________________________________.
4. Two classical patent herbal formulas are very helpful for this
condition:
__________________________________________________________
__________________________________________________________.
5. Nervous exhaustion, stress and anxiety can exacerbate tinnitus, and
therefore ______________________________acupuncture treatments
can help a person to bring their tinnitus to a more manageable level.
6. According to the Advanced Textbook on Traditional Chinese
Medicine and Pharmacology, in approaching treatment of tinnitus, it is
important to distinguish
__________________________________________________________
__________________________________________________________

7. also between

answer is a continuation from

#6

__________________________________________________________
8. An excess syndrome defined as being due to hyperactive liver and
gallbladder fire. This manifests as ______________________________,
usually continual sound, which may be accompanied by symptoms of
the excess syndrome
9. An excess syndrome defined as being due to retained hot phlegm
(phlegm-fire syndrome). This typically manifests as
____________________________________________________
like the chirping of cicadas, sometimes accompanied by the sensation
that the ears are blocked, thus impairing hearing.
10. Possible accompanying symptoms may include
_________________________________________________________
__________________________________________________________
11. A deficiency syndrome defined as being due to insufficient kidney
yin (essence). This is a
__________________________________________________________
(though it may reach a certain constant level and get no worse after that)
which is accompanied by deficiency type symptoms such as dizziness,
back ache, and weakness of the knees, sometimes accompanied by
deficiency-heat symptoms.

12. This syndrome is often caused simply by the

_______________________________________________________
13. Deficiency syndrome defined as failure of clear qi to ascend. This
manifests as
__________________________________________________________
Other possible symptoms of the deficiency include lassitude, poor
appetite, and loose stools.
14. This syndrome is caused by a
_______________________________________________________
affecting the spleen system, which may result from stress and worry,
inadequate nutrition, or poor eating habits

Name _________________________________License # ____________

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