TINNITUS ER MING

Wind Heat invading the Lungs

Liver Qi stagnation
Liver Fire
Liver Blood Xu/Qi & Blood Xu
Kidney Yin Deficiency
Kidney Qi Deficiency
Miscommunication: Heart & Kidney
Spleen Qi deficiency (Phlegm Damp)
Phlegm Fire
Qi & Blood stasis

TINNITUS CM OVERVIEW
Tinnitus is often due to a Kidney & Liver Yin deficiency where there is decreased nourishment
of the ear. Other causes include trauma resulting in stagnation of Blood & the excess
conditions of Liver Qi stagnation, Liver Fire & exogenous Wind Heat.
Auricular acupuncture is very important for the treatment of Tinnitus.

BIOMEDICAL EXPLANATION OF TINNITUS

Current Epidemiology: Incidence of tinnitus falls between 17 to 20 percent for Australians
with the prevalence of severe tinnitus being considerably low.
(Betterheath.vic.gov.au)
Factors associated with tinnitus & main CM patterns associated:

Exposure to loud sounds (Qi & Blood stagnation)

Extreme stress or trauma (Liver Qi stagnation, Liver Fire, HT & KD Miscommunication

Degeneration of the hair cells in the cochlear (Deficiency patterns with reduced
nourishment)

Meniere's (Damp Turbidity/Phlegm Fire)

Otosclerosis (Liver Qi stagnation, Phlegm/Damp, Liver Fire, KD Qi & Yin Xu)

Some medications such as salicylates which affect nerve conductivity

Depression (Liver Qi stagnation)

Anxiety (Heart & Kidney Miscommunication,

Hypertension (Liver Qi stagnation, Liver Yang rising)

Insomnia (Heart & Kidney miscommunication, Kidney Yang deficiency)

BIOMEDICAL PATHOMECHANISM FOR TINNITUS

Tinnitus is defined as Pathological increases in spontaneous activity within the processing
centers of the central auditory pathway causing hyper-responsiveness and phantom sound
perception.
Officially the exact Pathomechanism for the development of Tinnitus remains unknown,
however stress is seen as a major associated factor clinically.
Many people who suffer from tinnitus also experience hypertension. This increases the
pressure within the blood vessels which supply the auditory apparatus. Malfunction & loss of
auditory hair cells (Stereocilia) found within the cochlea

TINNITUS DUE TO W/H INVADING LUNG

Aetiology: W/H invading Lungs & Tai Yang or W/C which has transformed into Heat,
usually equates to otitis media in biomedicine & may be purulent.
Associated Symptoms: Fever, thirst, muscle aches, headache, aversion to Wind, cough.
Pulse: Floating & rapid or Deep
Tongue: Unremarkable (Due to acute nature) or white or yellow thin coat
Treatment Principle: Release the exterior W/H, clear Heat & open the orifice of the ear.
Herbal Prescription: Yin Qiao San Jia Wei (Honeysuckle & Forsythia Powder) + Shi
Chang Pu to open the ear orifice, dislodge Phlegm, promotes Blood flow to ear, reduces
swelling, encourages healing & remove turbid Damp + Ge Gen to release exterior & directs
formula towards the ears.
Acupuncture Prescription:
DU14- Release the exterior W/H
LI4- Command point of the head, Disperses Wind, resolves the exterior & regulates surface
SJ21- Opens the ear, unblocks the vessels & Disperses Heat
SJ17- Disperses W/H, resolves the exterior & is specific for excess conditions
SJ5- Dissipates W/H, resolves the exterior & regulates the Shao Yang
SJ3- Dissipates W/H & clears the ears
SI19- Dissipates W/H & unblocks the channel
(Littleton, 2008, pp. 510-512) (Gang, 2014, p. 119) (Ross, 2009, pp. 424-425)

TINNITUS DUE TO LIVER QI STAGNATION

Aetiology: Impeded Liver Qi can traverses the Gallbladder channel to disrupt ear function.
This is more likely to manifest as Tinnitus than as hearing loss.
Associated Symptoms: Mild Tinnitus, aggravated by emotional state, better for relaxation.
Tongue: Normal or dark
Pulse: Wiry & thready or Wiry & strong
Treatment Principle: Promote the movement of Liver Qi
Herbal Prescription: Xiao Yao San or with Heat signs Jia We Xiao Yao San
Acupuncture Prescription:
SJ21- Benefits the ears, promotes Qi movement & clears Heat
SJ17- Benefits the ears, Activates the channel & clears Heat
GB2- Opens the ear, moves Qi within GB channel & Clears LV & GB channel
GB9- Clears GB Channel
LV3- Disperses & corrects LV Qi flow & draws Qi back downward
LI4- Command point for face, promotes Qi movement
SJ6- Promotes Qi movement
GB41- Disperses LV Qi, clears the head & draws Qi back down
(Littleton, 2008, pp. 515-517) (Ross, 2009, p. 425)

TINNITUS DUE TO LIVER FIRE

Aetiology: Anger triggers upbearing of Liver Fire or restrained Liver Qi manifests as Fire due
to the Internal/External relationship with the GB, Liver Fire can ascend the GB channel &
disturb the ear portals to manifest as tinnitus.
Associated Symptoms: High pitches roaring tinnitus, hypertension, headache, dizziness, ear
blockage, bitter taste, dry throat, restless sleep, red face, red eyes, constipation & dark urine
Pulse: Wiry, rapid, forceful
Tongue: Red body with yellow coat
Treatment Principle: Clear Liver Heat, restrain Fire & unblock the portals of the ear
Herbal Prescription: Long Dan Xie Gan tang Jie Wei + Shi Chang Pu to open the
orifices, dislodge Phlegm & transform turbid Dampness & Yu Jin to clear Heat, promote the
movement of Qi & open the orifices.
Acupuncture Prescription:
GB2- Benefits the ears, clears Heat & activates the channel
SJ17- Benefits the ear & clears excess Heat
SJ3- Shu Stream: Clears pathogenic Heat from ears & activates the channel
LV2- Ying Spring: Clears pathogenic Heat, spreads Liver Qi & subdues Fire
GB43- Ying Spring: Clears pathogenic Heat from ears
LI4- Regulates head & ears
(Littleton, 2008, pp. 515-517) (Gang, 2014, pp. 120-121)

TINNITUS DUE TO LIVER BLOOD DEFICIENCY

Aetiology: Proper function of the ears relies on nourishment from Blood & due to the Liver s
role in storing the Blood, a Liver Blood deficiency can result in Tinnitus & hearing loss.
Associated Signs & Symptoms: Low pitched transient Tinnitus, like Cicadas, worse as day
progresses as Blood is consumed, dizziness, white complexion, lustreless nails, dream
disturbed sleep, Blurred vision, dry eyes & skin.
Pulse: Fine or thready
Tongue: Pale body
Treatment principle: Nourish LV Blood & direct Blood towards the ears
Herbal Prescription:
Acupuncture Prescription: Si Wu Tang Jie Wei + Shi Shang Pu & Sang Shen
SJ17- Unblocks the network vessels of the ear & encourage Blood flow to the ear
GB2- Unblocks & encourages the flow of Blood to the ear
SP6+ Promotes the generation of Blood via the Spleen
ST36+ Promotes the generation of Blood via tonification of the middle Jiao
BL17+ Promotes the generation of Blood
ST8+ Nourishes Liver Yin & therefore Blood
(Gang, 2014, p. 122)

TINNITUS DUE TO KIDNEY YIN XU

Aetiology: The Kidneys open into the ears, Kidney Yin is required to properly nourish the ear & to
protect from eternal & internal pathological factors. Deficiency Heat can rise to affect the ears also.
Associated Signs & Symptoms: Chronic low pitches Tinnitus, dizziness, insomnia, vertigo,
seminal emissions, dry mouth & throat, 5 palm Heat, night sweats, back & knee ache.
Treatment Principle: Nourish Kidney Yin
Herbal prescription: Er Long Zuo Ci Wan Jie Wei (Pill For Deafness That is Kind To The Left
Kidney) + Shi Chang Pu open the orifices & direct Yin nourishment towards the ears
Acupuncture Prescription:
BL23+ Nourishes Kidney Yin
KD3+ Nourishes Kidney Yin
KD7+ Nourishes Kidney Yin
SI19 Encourages Qi flow within the ear & directs Yin towards the ear
SI3- To bring down deficiency Heat
Yin Wei Mai
Auricular: KD, LV
(Littleton, 2008, pp. 506,523) (Gang, 2014, pp. 117,123)
(Littleton, 2008, p.523) (Gang, 2014, pp. 124-5)

TINNITUS DUE TO KIDNEY QI XU

Aetiology: Kidney Qi deficiency results in a loss of Kidney essence which is required to nourish the
ears: as the Kidneys open to the ears. Kidney essence nourishes the marrow & in turn the sea of
marrow (the brain), nerves are under the category of the brain & governed by the Kidneys, so tinnitus
deriving from nervous system pathologies can be due to Kidney Qi deficiency.
Associated Signs & Symptoms: Low pitched chronic tinnitus, worse as day progresses & at night,
lower back & knee pain, clear urine, fatigue, lack of strength, loose stools & white facial complexion
Pulse: Fine & weak
Tongue: Thick or medium white tongue coat
Treatment Principle: Warm & tonify Kidney Qi & direct Qi towards the ear
Herbal Prescription: Cong

Rong Wan or Bu Gu Zhi Wan (Psoraleae Pills)

BL23+Tonifies Kidney Qi
REN4+Tonifies Kidney Qi
DU4+Tonifies Kidney Qi
KD3+ Tonifies Kidney Qi
* SI19 to promote Qi flow within the ear & to direct the KD nourishment towards the ear
GB2 Encourages Qi flow within the ear & directs Qi nourishment towards the ear
BL62 Activates the Yang Qiao Mai (Yang Heel Vessel) ending with SI3 (Littleton, 2008, p.523)
(Gang, 2014, p.117)

TINNITUS DUE TO HT & KD MISCOMMUNICATION

Aetiology: Heart Fire via Liver Fire or Kidney Yin deficiency. Kidney Yin should normally restrain Heart
Fire. If this does not occur then Heart Fire can flare upward & disturb the portals of the ear via the Heart
Shao Yin internal channel pathway. Or exuberant Heart Fire can consume KD Yin. In addition an emotional
shock can promote the separation of Heart & Kidney.
Accompanying Signs & Symptoms: Possibly high pitched tinnitus but likely low pitch, reduced hearing,
insomnia, palpitations, anxiety, lower back & knee pain, dark urine, tidal fever, night sweats, & memory
issues & possible hypertension.
Tongue: Red with slight coat
Pulse: Fine & rapid
Treatment Principle: Nourish KD Yin, subdue Heart Fire or restrain ministerial Fire & re establish
Heart/Kidney communication
Herbal Prescription: Huang

Lian E Jiao Tang Jia Wei + Shi Chang Pu or Tian Wang Bu

Xin Dan
Acupuncture Prescription:
SJ17- Dissipates excess Heat
* SI19 Directs Yin towards the ear
PC7- Drains & subdues Heart Fire

KD3+ Nourishes Kidney Yin

REN7 Encourages communication between Yin & Yang
(Gang, 2014, p.125)

TINNITUS DUE TO SP QI DEFICIENCY

Aetiology: Normal function of the ears are reliant on adequate warming & nourishment from Qi &
Blood. Damp may be created via Spleen Qi Xu with combined reduction in ascent of clear Yang &
reduced transformation of fluids resulting in the ascent of turbidly/Damp which slows Qi & Blood
movement within the ear while also blocking the ear portals, resulting in tinnitus.
Associated Signs & symptoms: Tinnitus worse for taxing activity, transient acute sensation of
Cold within the ears, fatigue, lack of strength, low appetite, abdominal distension after eating,
sallow facial complexion, Possible frontal headache & ear blockage due to Phlegm accumulation,
loose stools & pale lips.
Tongue: White coat
Pulse: Empty & weak
Treatment Principle: Tonify middle Jiao/Spleen & encourage the generation of Qi & Blood &
upward movement of Qi
Herbal Prescription: Bu Zhong Yi Qi Tang
Acupuncture Prescription:
SJ17 Directs & encourages Qi & Blood flow to & around the ears
GB2 Directs & encourages Qi & Blood flow around the ears
ST36+ Tonifies the middle/Spleen to promote transformation & generation of Qi & Blood
BL20+ Tonifies the Spleen to encourage the generation of Qi Blood
SP3+ Tonifies the Spleen to generate Qi Blood & promotes transformation to prevent Damp
(Gang, 2014, pp. 118,126) (Littleton, 2008, pp.526-8) (Ross, 2009, p. 424)

TINNITUS DUE TO PHLEGM FIRE

Aeteology: Usually an acute exacerbation of an underlying Phlegm/Damp accumulation of th ear. Here
Phlegm damp results in stasis & the generation of Heat. Liver Fire can also exacerbate this condition via
Fire traversing the Gallbladder channel.
Associated Signs & Symptoms: Bi or unilateral tinnitus, often high pitched, sensation of blockage or
pressure, possible purulent yellow discharge, Holly headedness, Fullness in chest with nausea, poor
appetitive, bitter taste & presence of yellow mucous in the throat.
Tongue: Red with thick yellow greasy coat
Pulse: Wiry, slippery or slippery & rapid
Treatment Principle: Clears Heat & transform Phlegm, redirect turbidity downwards
Herbal Prescription: Wen Dan Tang Jie Wei + Huang Qin, Chai Hu, Huang Lian to clear Heat &
dampness & subdue Fire. For Phlegm Within the ear between episodes Er Chen Tang
Acupuncture Prescription:
SJ21- Opens the ear & dissipates Heat
SI19- Promotes Qi movement within the ear
GB2- Clears Liver & Gallbladder channels & Heat
SP4 Regulates Spleen & Stomach
ST40- Transforms Phlegm & Damp
(Littleton, 2008, p.518-10)

TINNITUS DUE TO QI & BLOOD STAGNATION

Aeteology: Usually follows trauma to the ear, including exposure to loud noise or sudden pressure
changes. Can also be the sequelae of unresolved patterns manifesting as tinnitus.
Accompanying Signs & symptoms: Persistent & unresponsive tinnitus, possible dark ear discharge,
possible sharp pains or ear ache, dark complexion, dark eye rings, spider naive, chronic headaches &
hair loss.
Tongue: Possible purple body, with brown or purple stasis spots & none or little coat
Pulse: Wiry, choppy, thready
Treatment Principle: Invigorate the Blood while clearing & opening the ear
Herbal Prescription: Tong
Decoction) or Xue

Qiao Hou Xue Tang (Unblock the Orifices & Invigorate the Blood

Fu Zhu Yu Tang if more systemic signs of Blood stasis are present

Acupuncture Prescription:
SJ21- Promotes the flow of Qi & Blood within the ear
GB2- Promotes Qi & Blood flow within the ear
SI19- Promotes Qi & Blood flow & reduces stagnation
SP10- Transforms Blood stasis
BL17- Transforms Blood stasis
(Littleton, 2008, p.521-2)