Treating Tinnitus 2014

8/21/2019 Treating Tinnitus 2014

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TREATING TINNITUS

WITH CHINESE MEDICINE8 CEU’s / PDA’s

OPTIONS FOR WELLNESS, INC.

7059 SW 53 LN

MIAMI, FL 33155

mailto:[email protected]

305-665-0615

305-675-0117 FAX

http://www.myacupunctureceus.comFLA CEU PROVIDER – 50-2489-1

NCCAOM 038

CALIFORNIA CEP 722


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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 protectitself.

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) isoften used. An example of this test is on the last page.


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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 bya 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 verydifferent 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 conditionvery similar to having a song stuck in one’s head; but the music is

considerably more true-to-life, it is heard almost non-stop, and it is

practically impossible to ignore)


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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 awareof 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.


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POINTS 4 0 2 Because of your Tinnitus is it difficult for you to concentrate? Ye

sNo

Someties

Does the loudness of your Tinnitus make it difficult for you to hear people? Yes

No

Someties

Does your Tinnitus make you angry? Yes

No

Someties

Does your Tinnitus make you confused? Yes

No

Someties

Because of your Tinnitus are you desperate? Yes

No

Someties

Do you complain a great deal about your Tinnitus? Yes

No

Someties

Because of your tinnitus do you have trouble falling asleep at night? Yes

No

Someties

Do you feel as though you cannot escape from your Tinnitus? Yes

No

Someties

Does your Tinnitus interfere with your ability to enjoy social activities (suchas going out to dinner, to the cinema)?

Yes

No

Someties

Because of your Tinnitus do you feel frustrated? Yes

No

Someties

Because of your Tinnitus do you feel that you have a terrible disease? Yes

No

Someties

Does your Tinnitus make it difficult to enjoy life? Yes

No

Someties

Does your Tinnitus interfere with your job or household responsibilities? Yes

No

Someties

Because of your Tinnitus do you find that you are often irritable? Yes

No

Someties

Because of your Tinnitus is it difficult for you to read? Yes

No

Someties

Does your Tinnitus make you upset? Yes

No

Someties

Do you feel that your Tinnitus has placed stress on your relationships withmembers of your family and friends?

Yes

No

Someties

Do you find it difficult to focus your attention away from your Tinnitus and onto other things?

Yes

No

Someties

Do you feel that you have no control over your Tinnitus? Yes

No

Someties

Because of your Tinnitus do you often feel tired? Yes

No

Someties

TINNITUS HANDICAP INVENTORY (THI)


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Because of your Tinnitus do you feel depressed? Yes

No

Someties

Does your Tinnitus make you feel anxious? Yes

No

Someties

Do you feel you can no longer cope with your Tinnitus? Yes

No

Someties

Does your Tinnitus get worse when you are under stress? Yes

No

Someties

Does your Tinnitus make you feel insecure? Yes

No

Someties

TOTAL SCORE PER COLUMN

TOTAL POINTS grade levels below.

0 – 16 Slight (Only heard in quiet environments) GRA1

18–36 Mild (Easily masked by environmental sounds and easily forgotten with

activities

GRA

238–56 Moderate (Noticed in presence of background noise, although daily activitiescan still be performed)

GRA3

58–76 Severe (Almost always heard, leads to disturbed sleep patterns and caninterfere with daily activities)

GRA4

78–100 Catastrophic (Always heard, disturbed sleep patterns, difficulty with anyactivities)

GRA5


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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).


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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


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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.


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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).


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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.


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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:

[email protected]

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 thesound, 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.


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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 therebyclearing deficient heat and clearing ascending liver fire. Mildly

invigorates the blood.


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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 air-

dried 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 theinterior 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.


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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 that’s all there is to it. The patent herbs are sold over the counter toanyone 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 beextremely 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 notonly 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


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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 alsoapplied (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 ofadequate 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 andyang 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,


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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 toimprove 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 deficiencyand 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.


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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 ofextreme 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 thechest, 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.


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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, suchas 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 byadding 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 thedeficiency 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:


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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 (whichis 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 formulawas designed, which would be modified for different types of tinnitus.

The basic formula contained:

polygonatum

(huangjing )

40 grams


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epimedium ( yinyanghuo) 10 grams

cynomorium ( suoyang ) 10 grams

hu-chang

Japaneseknotweed (huzhang ) 30 grams

persica

Peach kernel (taoren) 10 gramsearthworm (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 sinceancient 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


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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 gramsThese 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 gramsmagnetite (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 duringthe 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.


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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 oftinnitus 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 andChinese 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


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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, orothers 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


polygala ( yuanzhi) 12 grams

acorus ( shichangpu) 30 grams

cornus ( shanzhuyu) 30 grams

lycium fruit ( gouqizi) 12 gramsligustrum (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:


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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, andduration 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.


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

following formula was used:


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 zedoariafor 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 withvitamin 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 slightimprovement.

In looking for factors that influenced ability to fully or partially recover

normal hearing, the authors noted:


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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 theears 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, withduration 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 noisestress & tension

stimulating foods and drinks (ex. caffeine)

spicy foods

smoking

alcohol


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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.


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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 (oreven 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 nerveinterference and vertigo, may be involved. This is

a useful remedy when tinnitus and tiredness occur after influenza or

along with Meniere's disease.


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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 asabove.


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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

__________________________________________________________

__________________________________________________________


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7. also between

__________________________________________________________

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.

answer is a continuation from

#6


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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 # ____________

Address ___________________________________________________

City _______________________State ___________Zip ____________

Telephone ___________________E-Mail _______________________

Signature ________________________________________________My signature confirms that I have read and answered the questions on

my own to receive Continuing education units. If returning these

answers electronically, my typed name confirms this statement.

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Treating Tinnitus 2014