bubble_chart Concept

Deafness refers to the loss of hearing in the ears, rendering one unable to hear external sounds. In mild cases, where hearing is not clear, it is called hearing impairment; in severe cases, where no external sounds are heard, it is complete deafness. Zabing Yuanliu Xizhu states: "Deafness is when sound is completely blocked, and one hears nothing at all. There are also cases where one does not become completely deaf but hears indistinctly, which is called hearing impairment."

Tinnitus refers to the sensation of ringing in the ears, hence the name. Waike Zhengzhi Quanshu says: "Tinnitus is when there is a sound in the ears, like the chirping of cicadas, the ringing of a bell, the crackling of fire, the sound of water from a river, the sound of winnowing rice, or when sleeping, like the beating of war drums or the sound of wind entering the ears."

In classical medical texts, deafness has many names. For example, Neijing provides a rough classification of deafness, referring to it as "deafness" and "sudden deafness," while Suwen．Shengqi Tongtian Lun also mentions "deafness that cannot hear." Later generations, based on different disease causes and mechanisms, divided it into prolonged deafness, sudden deafness, fatigue-induced deafness, wind-induced deafness, deficiency-induced deafness, toxin-induced deafness, syncope-induced deafness, qi-induced deafness, dampness-induced deafness, wind-heat deafness, liver fire deafness, phlegm-fire deafness, qi deficiency deafness, blood deficiency deafness, kidney deficiency deafness, etc. Jingyue Quanshu．Miscellaneous Diseases summarizes it into five categories: "fire blockage, qi blockage, evil blockage, orifice blockage, and deficiency blockage."

Tinnitus and deafness are closely related, as tinnitus is the early stage of deafness, and deafness is the severe stage of tinnitus. The two cannot be strictly separated, so this article discusses them together.

Tinnitus and deafness caused by "alcohol ear," "ear pain," or "earwax" are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Wind-heat Invading the Lung︰The main clinical manifestations include unilateral or bilateral {|###|}deafness{|###|}, {|###|}tinnitus{|###|} resembling the sound of wind, along with a sense of fullness and pressure in the ears. Accompanied by {|###|}nasal congestion{|###|}, excessive nasal discharge, {|###|}headache{|###|}, {|###|}fever{|###|}, a red {|###|}tongue texture{|###|} with thin coating, and a floating, rapid pulse. It is caused by external contraction of wind-heat or prolonged stagnation of {|###|}wind-cold{|###|} transforming into heat. The lung's collaterals connect to the ears, and when the lungs are affected by wind-heat, prolonged stagnation transforms into fire that ascends and attacks, leading to obstruction of both the orifices and collaterals. Obstruction of the orifices results in {|###|}nasal congestion{|###|}, while obstruction of the collaterals causes {|###|}deafness{|###|} and inability to hear. In the early stages, symptoms often include {|###|}nasal congestion{|###|}, excessive nasal discharge, ear pain, a sense of ear blockage, along with {|###|}fever{|###|} and {|###|}headache{|###|} as superficial symptoms. The characteristic feature of {|###|}deafness{|###|} is poor low-frequency hearing, with the patient perceiving their own voice as loud, and the {|###|}tinnitus{|###|} resembling the sound of wind. The tympanic membrane is often red, or there may be fluid accumulation in the middle ear. Treatment should focus on dispersing lung qi, supplemented by clearing and resolving methods. The recommended formula is Mulberry Leaf and Chrysanthemum Decoction.
2. Up-flaming of Liver Fire︰deafness tinnitus, sudden onset, even complete deafness, tinnitus like a bell, or like wind and thunder, or like tidal sounds, accompanied by ear distending pain, deafness, bitter taste in mouth, dry throat, flushed face, red eyes, dry stools, yellow urine, red tongue with yellow coating, wiry and rapid pulse. liver fire deafness is caused by the upward rebellion of liver-gallbladder qi along the meridians, invading the clear orifices, mostly belonging to excess pattern. Characterized by severe deafness, complete inability to hear, rapid progression, and loud ringing sounds. Treatment should focus on clearing the liver and draining fire, with the formula selection Angelica, Gentian and Aloe Pill.
3. Ascendant Hyperactivity of Liver Yang︰tinnitus deafness, vertigo distending pain, accompanied by flushed face, red eyes, insomnia forgetfulness, dry throat and mouth, soreness and weakness of the waist and knees, red tongue with scant fluid, wiry-thin and rapid pulse. Ascendant hyperactivity of liver yang deafness is caused by liver-kidney yin deficiency and ascendant hyperactivity of liver yang, characterized by root deficiency and branch excess, with a slow onset. The degree of deafness and tinnitus fluctuates between mild and severe, accompanied by symptoms such as dry eyes, dry mouth and throat, distending and dizzy head. Treatment should focus on nourishing yin and subduing yang, and the prescription selected is Gastrodia and Uncaria Drink.
4. Liver Blood Deficiency︰Tinnitus like cicadas, sometimes light and sometimes heavy, hearing loss, accompanied by vertigo, dreamful sleep at night, dry eyes, blurred vision, tongue texture pale, pulse thin. Due to insufficient blood generation and transformation, or excessive loss of blood, or prolonged illness damaging yin and blood, leading to the liver's failure to store blood. Symptoms include tinnitus like cicadas, impaired hearing, worsening with fatigue or in the afternoon. Treatment should focus on nourishing liver blood, with prescriptions such as Liver-Tonifying Decoction, or Four Ingredients Decoction added with Moutan and Gardenia.
5. Kidney Yin Deficiency︰Deafness gradually worsens, with a prolonged course, tinnitus resembling the sound of cicadas, low and faint, accompanied by dizziness, blurred vision, insomnia, seminal emission, dry mouth and throat, vexing heat in the chest, palms, and soles, night sweats, aching pain in the lower back and knees, a red tongue with thin coating, and a thready rapid pulse. Deafness progressively worsens, tinnitus like cicadas, especially severe at night, along with vexing heat in the chest, palms, and soles, dry mouth, and restlessness. The treatment should focus on nourishing kidney yin, promoting qi absorption, and subduing yang, using Zuoci's Deafness Pill.
6. Kidney Qi Deficiency︰Deafness and tinnitus, persistent and unhealed, accompanied by fear of cold, cold limbs, soreness and weakness in the lower back and knees, seminal emission, impotence, clear and profuse urine, fatigue, lack of strength, poor appetite, loose stools, pale complexion, pale tongue with thin white coating, and weak fine pulse. The deafness gradually worsens, the tinnitus sounds like cicadas, especially severe at night, accompanied by fear of cold, cold limbs, impotence, and other symptoms. The treatment should focus on warming and tonifying kidney yang, and the recommended prescription is Cong Rong Wan.
7. Non-interaction between Heart and Kidney︰Tinnitus, hearing impairment, restlessness, insomnia, palpitation, forgetfulness, soreness and weakness of the waist and knees, tidal fever, night sweats, scanty dark urine, red tongue with little coating, thready and rapid pulse. The heart and kidney are zang organs of water and fire, with mutual interaction between water and fire. Imbalance of water and fire leads to non-interaction between the heart and kidney. Its clinical features include faint tinnitus, worsening tinnitus with poor sleep, and significant deafness. Treatment should focus on nourishing yin and reducing fire, restoring coordination between the heart and kidney, and returning fire to its origin. Recommended formulas are Bu Xin Dan or Harmonic Interacting Pill.
8. Spleen-stomach Weakness︰deafness tinnitus, overstrain worsens, accompanied by fatigue lack of strength, poor appetite, abdominal distension and fullness after eating, complexion shallow yellow, loose stool, tongue coating thin white, pulse weak. The spleen and stomach being the origin of producing qi and blood, spleen-stomach weakness or spleen yang deficiency leads to the inability of clear qi to ascend, resulting in turbid yin obstructing the ear meridians. Its clinical characteristics are: deafness tinnitus, worsening with overexertion, accompanied by fatigue lack of strength, abdominal distension and fullness, loose stool, and other symptoms. Treatment should focus on tonifying the middle and replenishing qi, with the prescription selected being Middle-Tonifying Qi-Replenishing Decoction.
9. Phlegm-Fire︰The ears are ringing, hearing is unclear, deafness with a blocked and stuffy sensation, dizziness and heaviness in the head, fullness and oppression in the chest and epigastrium, cough with copious phlegm, difficulty in urination and defecation, red tongue with yellow and greasy coating, and wiry-slippery pulse. The *Ancient and Modern Medical Compendium* states: "The syndrome of deafness is caused by the obstruction of the qi pathway, stagnation of phlegm-fire, and congestion leading to deafness." Its clinical characteristics are: deafness often accompanied by a sense of blockage, along with symptoms such as fullness and oppression in the chest and epigastrium, dizziness, and heaviness of the head. The treatment should focus on purging fire and sweeping phlegm, harmonizing the stomach, and descending turbidity. The recommended formula is Two Old Ingredients Decoction with modifications.
10. Qi Stagnation and Blood Stasis︰Mostly caused by liver fire flaring upward or external injury, deafness tinnitus occurs suddenly, accompanied by dizziness headache, irritability, and distension in the chest and hypochondrium. The tongue coating is thin, and the pulse is wiry and thin. Due to emotional distress or trauma, qi and blood stasis stagnate, leading to liver qi depression and impaired dispersion, where qi stagnation results in blood coagulation. Its clinical characteristics often include systemic symptoms of blood stasis and qi stagnation. Treatment should focus on {|###|}regulating qi and resolving stasis{|###|} to transform stasis, with the prescription selected being Orifice-Openning Blood-Activating Decoction.

Liver fire and ascendant hyperactivity of liver yang deafness, although both belong to liver and gallbladder disorders, differ in deficiency and excess. Kidney yin deficiency and kidney qi deficiency deafness both fall under kidney deficiency, but differ in yin deficiency and yang deficiency.

The differentiation of deafness and tinnitus can be summarized as follows: first, it is essential to distinguish between deficiency and excess. In excess pattern, deafness occurs suddenly, and tinnitus is loud, often with a low pitch. In deficiency pattern, hearing gradually declines, and tinnitus is high-pitched, resembling the sound of cicadas. Sudden deafness in excess patterns is mostly caused by wind, heat, or dampness pathogens, while progressive deafness in deficiency patterns is often due to zang-fu organ deficiencies. Generally, deficiency pattern are more common than excess pattern, and acute conditions are easier to treat, while chronic conditions are more difficult to cure.