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Hearing various abnormal sounds in the ear that do not exist in real life is tinnitus. It may be continuous or intermittent. According to statistics, about 15% of the global population has tinnitus, with middle-aged and elderly people being more susceptible. Severe tinnitus can easily develop into hearing loss, or even deafness. According to statistics from Taiwan ⁽¹⁾, 40% of people over 65 years old have hearing loss, higher than the WHO's 33%; 47.9% for those over 75; 71.4% for those over 85; male:female ~38%:33%, with hearing loss in the eastern region slightly higher than other areas due to noise in marble quarries.

There are many causes of tinnitus, and below are some common ones:

• Aging and degeneration, degeneration of the brain's auditory center, degeneration of the auditory nerve, or degeneration of the vestibulocochlear nerve.
• Long-term exposure to noisy environments, such as military shooting, dance halls, quarries, or frequent use of headphones.
• Suffering from the three highs (hypertension, hyperlipidemia, hyperglycemia) or poor blood circulation, which may improve with treatment of the three highs or exercise.
• Long-term use of ototoxic drugs, such as certain antibiotics, chemotherapy drugs, diuretics, antipyretics, and analgesics.
• Trauma or bacterial infection of the external ear canal, damaging the inner ear.
• Acute or chronic sinusitis, with inflammation spreading to the middle and inner ear through the Eustachian tube.

This article will focus on tinnitus caused by aging and degeneration.

The sound of tinnitus due to aging is usually high-frequency, continuous, like the chirping of cicadas, and the more overworked, staying up late, or the later one sleeps, the louder the tinnitus. Loud tinnitus can affect sleep and quality of life, and poor sleep can make tinnitus louder and accelerate nerve degeneration, forming a vicious cycle.

Tinnitus is often accompanied by hearing loss. According to research, hearing loss can accelerate brain degeneration by 30-40%, and unclear hearing can also affect social activities, willingness to communicate, cognitive abilities, and increase the risk of depression and dementia. Long-term tinnitus accompanied by vertigo and hearing loss indicates severe degeneration of the inner ear nerves and may also be a precursor to dementia. Therefore, active treatment is necessary.

The ear is a consuming organ, and its nutrition and fuel come from the generation and delivery of the five zang and six fu-organs, through the distribution of the circulatory system, eventually reaching the ear for its use. Therefore, the aging of the five zang and six fu-organs or the blockage of the circulatory pathways will prevent the ear from receiving sufficient nourishment of qi and blood, leading to gradual functional decline and degeneration. In particular, Traditional Chinese Medicine (TCM) has found that the liver, kidneys, and ears are closely related, "Kidney Open Into Ear," and the gallbladder meridian passes through the inner ear. Once the function of the liver and kidneys declines, the aging of the ears accelerates more easily. Therefore, enhancing the function of the liver and kidneys has an immediate effect on the maintenance and treatment of the ears.

Therefore, the maintenance and treatment of the ears must start with enhancing the function of the five zang and six fu-organs and unblocking the qi and blood circulation pathways, so that the ears can always receive sufficient material supply, maintaining sharpness and delaying aging. The supplementary health products on the market do not consider the decline in function of the zang-fu organs and the blockage of the circulatory pathways. It's like an old factory machine with low efficiency and some blocked pipes, not very smooth. At this time, blindly throwing raw materials into the machine will result in uneven products and questionable quality.

Modern medicine treatments are almost all symptomatic, not as effective as the macro-control of TCM. TCM distinguishes tinnitus into several patterns based on different system imbalances. Below are some typical patterns common in aging:

• Liver blood deficiency: The liver normally stores various nutrients absorbed from the spleen for future use, which is the concept of Liver Storing Blood. If the body is overused, leading to the depletion of liver blood, the ears will not receive sufficient nourishment, making tinnitus more likely. This may also be accompanied by vertigo, excessive dreaming during sleep, dry eyes, blurred vision, and other symptoms. The treatment principle is to replenish liver blood.
• Kidney yin deficiency: Kidney yin, also known as kidney water, refers to the subtle nutrients used for growth, reproduction, and the construction of various tissues. The kidney has the ability to regulate kidney yin within the body, which is the concept of Kidney Storing Essence. If the body is excessively drained, leading to insufficient kidney water, the ears will not receive adequate logistical support, making tinnitus more likely. A lack of kidney water nourishment throughout the body may also be accompanied by vertigo, insomnia, nocturnal emission, night sweating, dry mouth and throat, soreness in the lower back and knees, fever in the palms and soles, and other symptoms. The treatment principle is to replenish kidney yin.
• Kidney qi deficiency: Kidney qi deficiency refers to the weakened function of the kidney, making it unable to regulate kidney water for daily use. The result is similar to kidney yin deficiency, with the difference being that in kidney yin deficiency, kidney qi is not deficient and can still manage to regulate, so the heart rate may be faster, the body's operational power may be increased, and heat production may be higher, leading to symptoms such as night sweating, dry mouth and throat, and fever in the palms and soles, which are "heat signs." However, in kidney qi deficiency, the function is low, so heat signs are not seen. The treatment principle is to boost kidney function, i.e., replenish kidney qi. When kidney qi deficiency reaches the level of kidney yang deficiency, "cold signs" such as aversion to cold, cold hands and feet, seminal emission, impotence, clear and copious urine, fatigue, poor appetite, loose stools, and pale complexion may be seen. In this case, kidney yang needs to be replenished.
• Ascendant hyperactivity of liver yang: This pattern arises because the kidney yin and liver blood that nourish the body are both depleted, while the liver and kidney functions are still barely able to regulate and strive to self-rescue, resulting in various signs. Kidney yin and liver blood are both subtle nutrients necessary for the normal functioning of human tissues. Severe depletion can lead to compensatory (deficient) hyperactivity of the body to self-rescue. The result of liver qi striving to self-rescue is ascendant hyperactivity of liver yang. Besides tinnitus, it is often accompanied by vertigo, headache, high blood pressure, red face and eyes, insomnia, soreness and weakness in the lower back and knees, dry mouth and throat, or dry eyes. The treatment principle is to use various nourishing herbs to replenish liver blood and kidney water, while also restraining the deficient hyperactivity of liver and kidney functions (known as subduing yang in TCM).
• Spleen-stomach weakness: The digestive system is the source of all nutrients in the body. If the spleen and stomach are weak, the body will not receive sufficient nutrients, naturally leading to various diseases. This is a systemic disease state. This type of tinnitus is often aggravated by labor and may also include fatigue, lack of appetite, abdominal distension and fullness, emaciation, sallow complexion, and loose stools. The treatment principle is to boost the function of the spleen and stomach and replenish spleen-stomach qi.
• Qi stagnation and blood stasis: The nutrients required by the ears need to be delivered through the circulatory channels. As one ages, or due to external injuries, chronic diseases, or emotional stagnation, liver qi becomes stagnant, leading to blockages in the channels of qi and blood circulation. As a result, the ears do not receive sufficient nourishment from qi and blood, leading to degeneration. This type of tinnitus often exhibits many signs of qi stagnation and blood stasis. The treatment principle is to regulate qi and resolve stasis, transforming blood stasis.

Aging-related tinnitus is almost always caused by the deficiency of zang-fu organs combined with blockages in the circulatory channels. It is a long-term chronic disease. Clinically, it often presents as a mixed pattern, with symptoms starting mildly and worsening rapidly due to overwork or staying up late. The ringing is often high-pitched, like the sound of cicadas, and is frequently accompanied by gradual hearing loss. It is easier to treat in the early stages but becomes more difficult to manage as the condition persists.

Acupoint massage and moxibustion

Local acupoints: Jiaosun (TE20), Ermen (TE21), Tinggong (SI19), Tinghui (GB2).
Different acupoints can be selected based on the specific pattern (pattern refers to systemic imbalances or pathological states in the body).

tinnitus pattern	Selected Acupoints
Liver blood deficiency	Taichong (LR3), Sanyinjiao (SP6), Zusanli (ST36)
Kidney yin deficiency	Taixi (KI3), Fuliu (KI7), Sanyinjiao (SP6)
Kidney qi deficiency	Taixi (KI3), Fuliu (KI7), Shenshu (BL23)
Ascendant hyperactivity of liver yang	Taichong (LR3), Fuliu (KI7), Sanyinjiao (SP6), Fengchi (GB20)
Spleen-stomach weakness	Zusanli (ST36), Hegu (LI4), Sanyinjiao (SP6)
Qi stagnation and blood stasis	Taichong (LR3), Jianshi (PC5), Sanyinjiao (SP6)

Each treatment session: Press each acupoint for 3-5 seconds, release for 3-5 seconds, repeat for 3-5 minutes before moving to the next acupoint. Perform one session in the morning, noon, and evening.

Acupoint massage method: Use a massage stick of moderate hardness or your own fingers to massage the relevant acupoints in sequence. Press until a slight soreness is felt, but do not use excessive force. If pain is felt upon light touch, it indicates the acupoint is injured, so avoid pressing it further.

Patients with yang deficiency can use moxibustion on the acupoints, one acupoint at a time. When a burning sensation is felt, move to the next acupoint. For mild cold deficiency, moxibustion for 10 minutes per session; for severe cold deficiency, moxibustion for 15-20 minutes per session. If dry mouth and tongue occur, it indicates excessive moxibustion and internal heat, so avoid further moxibustion.

Patients with yin deficiency and yang hyperactivity should not use moxibustion.

External application of Chinese medicinal paste

Tinnitus is a difficult condition to treat. Based on the characteristics of aging tinnitus, the author has developed a Chinese medicinal paste applied around the auricle, which can improve ear circulation, replenish inner ear nutrition, and aid in the recovery of the auditory nerve. The results are excellent, with rapid improvement even for tinnitus lasting decades. Combined with internal Chinese medicinal treatment, external acupuncture, and acupoint tuina, a multi-pronged approach is hoped to quickly cure the troublesome tinnitus.

Other recommendations

• Good sleep allows the body to fully recover.
• Avoid overly processed foods, mouth-melting spices, colorings, preservatives, and various chemical additives to reduce the burden on the liver and kidneys. Reduce consumption of grilled, fried, spicy, and dry foods to avoid "heatiness".
• Moderate exercise can improve the body's qi and blood circulation.
• Drink an adequate amount of water to meet the body's metabolic needs. The minimum daily water intake required per person = body weight (kg) × 30cc.
• Avoid excessive emotional fluctuations and relieve stress in a timely manner.
• Avoid taking ototoxic drugs.
• Avoid exposure to noisy environments.

bubble_chart Footnote

1. PSA Huake Charity Foundation 2019 statistics.