Tinnitus is a sound in the ear or in the skull that the patient perceives as loud, but there is no external source of sound. In general, 15-20% of the population has varying degrees of tinnitus. Tinnitus can be divided into subjective tinnitus and objective tinnitus. Subjective tinnitus is only heard by the patient but not by others and accounts for more than 95% of all tinnitus.
Tinnitus varies in loudness, and severe tinnitus accounts for 0.4 to 2.8%, which can disturb people and affect work and sleep, and there are no special drugs and special treatment methods, so tinnitus has become one of the three difficult diseases in otology (deafness, tinnitus and vertigo).
I. How does tinnitus occur?
Tinnitus and deafness often appear clinically at the same time or successively, and they are a common symptom of a variety of otologic diseases and even systemic diseases, or sometimes they can be a disease alone. The main mechanism of tinnitus is the abnormal rhythm of spontaneous firing of auditory nerve fibers and central neurons at all levels, and the higher auditory centers incorrectly perceive this abnormal neural activity in the auditory pathway as sound. Common etiologies are.
1. Otogenic tinnitus, caused by lesions of the auditory system, mostly sensorineural tinnitus.
2. Non-auricular tinnitus refers to tinnitus that originates from a part of the auditory system other than the auditory system, mostly referring to body sounds. It includes vasogenic tinnitus, myogenic tinnitus, abnormal opening of the eustachian tube, and temporomandibular joint lesions. In addition, cardiovascular diseases, metabolic diseases such as abnormal thyroid function, diabetes, neurological diseases, anemia, migraine, iodine or zinc deficiency, kidney disease, etc. can cause tinnitus.
Chinese medicine’s understanding of tinnitus
(I) Etiology and pathogenesis
Zhang Jinyue of the Ming Dynasty created the “five closures” theory, which says: “Deafness …… mostly has five evidences: it is fire closure; it is gas closure; it is evil closure; it is orifice closure; it is deficiency closure.”
1, “fire closed”, due to the evil of warmth or five will fire. Treatment is appropriate to clear the heat and fire method.
2, “Qi closed”, due to the loss of liver Qi, the spleen and stomach loss of health. Treatment is to regulate Qi and resolve phlegm.
3. “Evil closed”, i.e., caused by external invasion of wind. The treatment is to dredge the wind and relieve the symptoms.
4. “Closed orifices”, caused by excessive worry. Treatment is appropriate for the heart and kidney.
5, “deficiency closed”, due to old age, physical decline, long-term illness, injury to the kidneys, excessive room. The treatment is to tonify the kidneys and fill the essence.
6, “deficiency shutdown”, due to excessive fatigue or after a long illness. The treatment is to benefit the Qi and nourish the Blood, to raise the Yang and open the orifices.
There are many theories on the etiology and pathogenesis of tinnitus in the literature of Chinese medicine, but in summary, it can be divided into two categories: deficiency and reality.
Real.
1, Six perversions: wind-cold, wind-heat, and dampness evil invade the ear orifice.
2. Phlegm: Obscuring the clear orifices.
3. Fire and heat: The fire of the liver and gall bladder or the fire of the heart rushing up to the ear orifice.
4. Stasis: stagnation of the clear orifices.
Deficiency.
1. Kidney Yang deficiency.
2.Deficiency of kidney essence.
3. Deficiency of middle qi.
4, deficiency of Ying and Blood.
5.Deficiency of both Qi and Blood
The underlying pathogenesis of this disease is tinnitus due to stagnation of qi and blood in the ear, occlusion of the ear veins, and loss of nourishment of the ear orifices due to various causes.
(B) Principles of Chinese medicine treatment for tinnitus
1.Distinguish the priority and urgency.
Identifying the urgency of the onset of tinnitus can help determine the depth, location and condition of the disease evil. If tinnitus is violent, it is mostly caused by wind, fire, phlegm and stasis; while if tinnitus develops gradually, it is often caused by deficiency of internal organs.
2. Clear identification of deficiency and reality.
Discerning the evidence is the essence of Chinese medicine in treating diseases. Anyone who has tinnitus should first identify the deficiency, so as not to commit the precaution of deficiency. It is very harmful to mistakenly attack the real evidence and the false evidence. In clinical practice, the following methods can be used to identify the deficiency and reality of tinnitus.
(1) Discerning from the tone and volume of tinnitus: Zhang Jinyue believes that “those with loud tinnitus are more real, while those with thin tinnitus are more deficient.” Therefore, those with high pitch and high volume are real, while those with low pitch and low volume are deficient.
(2) From the onset of tinnitus, the onset of tinnitus is mostly real, and the onset of tinnitus is mostly deficient.
(3) Identification of local and general symptoms of the ear.
(4) Discerning from whether or not to accept external noise.
”Rejecting external noise” (i.e., hearing noise in the channel, tinnitus is also high-pitched and even harsh, and the heart is agitated) – is true. “Acceptance of external noise” (i.e., the tinnitus can be drowned out by noise, or reduced or even disappeared.) — belongs to deficiency.
(5) Identification of tinnitus from whether or not it likes to be pressed: The method of identifying tinnitus deficiency and reality in the Medical Guan is: “If tinnitus does not sound or decreases with a flat press, it is also deficiency. If the tinnitus is not tinnitus or decreases when pressed, it is also deficiency.
3.Comprehensive treatment.
In the treatment of tinnitus in Chinese medicine, internal treatment is important, but the combination of external treatment such as acupuncture and moxibustion, guidance and other comprehensive methods will be more effective.
4. Focus on the individual.
According to Chinese medicine, tinnitus has cold, hot and deficient symptoms, cold, hot, warm and cool medicines, and tapping and tonic methods, and patients differ in age, occupation, physique and personality.
(3) Characteristics of Chinese medicine treatment for tinnitus
1.Treatment by evidence
(1) External sensation of the six sexes.
(1) Six exogenous symptoms: (1) Influenza, mumps, herpes zoster and other acute infectious diseases. Tinnitus develops rapidly and the sound is booming and high-pitched. There is often a feeling of stuffiness and blockage in the ear. Or sudden deafness.
Examination: The eardrum is normal or slightly depressed. The eustachian tube is often blocked.
Electrical auscultation: Conductive deafness is common.
Treatment: The general principle of treatment is to disperse the external evil. It can be identified as wind-cold external sensation, wind-heat external sensation, and dampness external offense. For the treatment of wind-cold external sensation, we can use Xiang Su Drink or Jing Fang Defeat Poison San, for wind-heat external sensation, we can use Sang Ju Drink or Yin Qiao San, and for dampness and turbidity, we can use Ba Zheng San or Wu Ling San.
(2) Phlegm clouding evidence.
The onset of the disease may be acute or slow. Tinnitus is loud but not high in pitch, mostly persistent.
Examination: tympanic membrane is cloudy, and in severe cases, the light cone is often seen to disappear and the sign is unclear.
Electrical audiometry: mixed deafness.
Treatment: It can be identified as the evil of dampness and phlegm, and the evil of phlegm and fire. The treatment of dampness and phlegm is to remove dampness and eliminate phlegm, which can be done by using Er Chen Tang, Wenzhi Tang or Guiding Phlegm Tang. The treatment of phlegm and fire is to clear the fire and dissolve phlegm, which can be done by using Qing Qi and Phlegm Pill plus reduction.
(3) Evidence of liver and gallbladder fire.
Rapid onset. Tinnitus is high-pitched and piercing or sudden deafness.
Examination: normal tympanic membrane.
Electrical audiometry: sensorineural deafness.
Treatment: The general principle of treatment is to clear the fire in the liver and gallbladder. The bitter-cold method can be used to break the fire or to nourish Yin and submerge Yang.
The bitter cold method can be used as Gentian Diarrhea Liver Soup or Gardenia Qing Liver Soup, while the nourishing yin and subtle yang method can be used as Qiju Dihuang Wan or Danjian Yi Yao San plus or minus.
(4) Heart fire internal incandescence evidence.
Tinnitus and deafness.
Electrical audiometry: sensorineural deafness or mixed deafness.
Treatment: Clearing the heart and diarrhea of fire, can be used to add or subtract Guiding Chi San (light evidence) or Diarrhea Heart Tang (heavy evidence).
(5) Evidence of stasis and clearing of the orifices.
The tinnitus is low-pitched and small in volume, and the deafness is progressive.
Examination: normal or atrophied tympanic membrane.
Electrical audiometry: sensorineural deafness.
Treatment: activating blood circulation and resolving blood stasis, can use Tongkou and blood circulation soup (light evidence), plus and minus Sanjia San (heavy evidence) plus and minus.
(6) Kidney yang deficiency evidence.
Longer duration of disease.
Tinnitus is small and long.
Electrical audiometry: sensorineural deafness.
Treatment: Benefit the kidney and warm the yang.
(7) Evidence of deficiency of kidney essence.
Tinnitus is loud and low in pitch, especially obvious after fatigue or when hungry.
Treatment: Nourish Yin and benefit the kidneys, using Liu Wei Di Huang Wan, Zuo Gui Drink or Zuo Ci Wan for Deafness plus or minus.
(8) Deficiency of middle energy.
The sound of tinnitus is sometimes light and sometimes heavy, and the degree of deafness varies.
Treatment: Tonify the spleen and strengthen the earth, benefit the qi and promote clearing, using Yi Qi Smart Tang or Tonifying Zhong Yi Qi Tang plus or minus.
(9) Evidence of deficiency of Ying and Blood.
Low sound and low volume of tinnitus.
Examination: loss of luster of the tympanic membrane.
Treatment: Nourish Yin and Blood, using Siwu Tang or GuiShen Tang plus or minus.
(10) Evidence of double deficiency of qi and blood.
Treatment: Nourish both qi and blood, can use Eight Precious Soup or Ten Perfect Tonic Soup plus or minus.
2.Acupuncture.
(1) Body acupuncture points.
(1) Body acupuncture points: ear area points: mainly, such as ear gate, hearing palace, hearing session, cataract.
Hand and foot Shao Yang meridian points: Zhongzhu, Waiguan, Yanglingquan, Feosanli, Sanyinjiao, and other points.
External wind-heat plus Hegu and Quchi.
For liver and gall bladder fire, add Tai Chong and Qiu Xu, using the diarrheal method, or the flat tonic and flat diarrheal method.
for weakness of the spleen qi, add foot sanli and san yin jiao.
for deficiency of heart blood add Tongli and Shenmen
adding Tai Xi and Rangu for deficiency of kidney essence
For deficiency of kidney essence, add Kidney Yu and Guan Yuan. For deficiency of kidney essence, add Taixi and Rangu; for deficiency of kidney essence, add Kidney Yu and Guan Yuan.
(2) Ear acupuncture pressure beans.
The inner ear, kidney and liver points can be used for the purpose of opening and closing the orifices.
(3) Scalp acupuncture point taking: Halo hearing area.
(4) Acupoint injection to take points: hearing palace, hearing session, ear door, cataract, and complete bone.
According to the actual evidence or deficiency evidence, choose Dan Shen injection, Angelica injection, Ginseng injection, etc., each time choose 2 to 3 points, each point inject 0.5 to 1ml of liquid, every other day once, 10 times for a course of treatment.
(3) Tuina therapy
(1) “Yingzhi Chengkou” method: (“Internal Gong Tuoshuo? The method of “ying treatment of Chengkou”: (Internal gong Tuoshu? Ear Gong”): the two hands connected to the ear wheel, one up and one down friction, each time can be about 15 minutes, this method can not only treat tinnitus, but also as a preventive health care.
② in addition to tinnitus work: sitting flat stretch a leg flex a leg, horizontal extension of the two arms, straight vertical two palms, forward as if pushing the door shape. Twist your head around 7 times each.
③ “sounding heavenly drum” method: the palms of both hands close to both ears, both hands index finger, middle finger, ring finger, pinky symmetrically pressed across the occiput on both sides, the two middle fingers touching each other, and then the two index fingers cocked and folded on top of the middle finger, and then slide the index finger from the middle finger down hard and hit the occiput at the back of the head heavily, at this time heard a loud and clear sound like hitting a drum. The left hand first 24 times, then the right hand 24 times, and finally the two hands simultaneously knocking 48 times. This method also has the effect of unblocking the meridians and running qi and blood.
④Massage of the tympanic membrane: Use your fingers (or index fingers) to place the mouth of the external ear canal and press gently, 15-30 times on each side, 3 times a day. It has the effect of inducing the circulation of qi and blood.
⑤ Acupoint massage: press and knead the acupoints for —-0.5-1 minutes.
Pinch Hegu point: hand thumb fingertips placed on the other hand of the Hegu point. The remaining four fingers on the palm, appropriate force pinch and knead, there is a soreness and swelling to the degree that the hands alternate.
Effects: Relieve the wind, open the body
Press and knead the hearing acupuncture point: half-clenched fists with both hands, index finger straight, the index finger belly on the same side of the hearing acupuncture point, respectively, and press and knead with appropriate force.
Effect: To open the orifice and clear the ears.
Rub the hundred points: right palm on the top of the head on the hundred points, from light to heavy, clockwise, counterclockwise rubbing.
Effect: to wake up the brain and calm the mind, open the orifices and remove annoyance.
Fist knead kidney point: hands clenched fist, glass fist dare in the same sympathetic kidney point, appropriate pressure.
Effect: tonifying the kidney and benefitting the qi, ear and sunshine
(4) Other therapies.
Emotional and mental treatment: psychological counseling
Foot massage: deficiency tinnitus is more severe at night, which makes people upset, and patients often prevent sleep because of this, so before going to bed, you can use hot water to soak both feet, or use your hands to forcefully press the two feet on the bottom of the Yongquan point, so that it is extremely hot, which can lead the fire to return to the yuan, and guide its yin and yang intersection, thus changing the symptoms of tinnitus.
At present, tinnitus is a medically difficult disease. With the accelerated pace of life, increased work pressure, abuse of ototoxic drugs, increased physical and chemical stimuli, and the aging of the population, the incidence of this disease has increased significantly, which seriously affects people’s normal life and work. Foreign data show that about 35% to 45% of the population has had different types of tinnitus, and its incidence is gradually increasing.
Modern medical research on tinnitus is being intensified. The greatest advantage of Western medicine is that early treatment of the disease can restore or maintain hearing to the greatest extent possible. However, there are many shortcomings, such as the lack of effective methods for the early prevention of tinnitus, the poor treatment effect, and the side effects of western medicine.