Looking at tinnitus from TCM point of view Anna van der Vlies

Tinnitus, Western Medicine Tinnitus is noise in the ear. Subjective tinnitus is perception of sound in the absence of an acoustic stimulus and is heard only by the patient. Most tinnitus is subjective. Objective tinnitus is uncommon and results from noise generated by structures near the ear. Sometimes the tinnitus is loud enough to be heard by the examiner.

Tinnitus may be described as buzzing, ringing, roaring, whistling, or hissing and is sometimes variable and complex. Objective tinnitus typically is pulsatile (synchronous with the heartbeat) or intermittent. Tinnitus is most noticeable in quiet environments and in the absence of distracting stimuli and, thus, frequently seems worse at bedtime. Tinnitus may be intermittent or continuous. Continuous tinnitus is at best annoying and is often quite distressing. Some patients adapt to its presence better than others; depression occasionally results. Stress generally exacerbates tinnitus. The sound is a manifestation of neural activities, which generates the tinnitus in the central auditive system.

Causes Tinnitus . Acoustic trauma Aging Reaction to medicine Meniere disease Infections and tumor and a stroke that affect auditory pathways also may be responsible Sudden deafness As a symptom of other diseases, e.g. anemia A blocked vertebra

Infections in teeth or Lyme. Problems with the jaw Hypertension

Western solutions Hearing aid Filtered music therapy Anti depressant Psychotherapy Niacin : Vit B3: vasodilation Prevention / protect ears

Small intestine,

Galbladder

San Jiao

Luo vessel Large intestine

TCM, Classics The Jing qi from the kidneys communicates with 2 ears. If the kidneys are balanced, one can hear 5 tones. (condition of kidneys) Heart, being the emperor, is in charge of the extrasensory openings.

The ear is te place where many meridians meet The ear is te place where many meridians meet. Deficiency of stomach qi causes emptiness from vessels and meridians who meet in the ear. Prick GB 3. And: Everywhere, where an EPF can go, there is emptiness. There is not enough nourishment in the upper jiao to feed the brain. And: When Jing is empty, one is deaf And: If the sea of marrow is empty, one is dizzy and you will have tinnitus

First step Deficiency: Slow start, low tone, all the time, less when you press the ear, volume may be lower Excess: Sudden onset, loud, intervals, worse with pressure, caused by loud noise.

Key questions to ask Is the tone high or low? Do you hear the sound all the time? Can you give an indication to how loud the tone is? Did the tinnitus start at once or slowly? Other signs, like: bitter taste (liver), headache or dizziness or skin problems (possibly internal wind), neck problems (examine), trauma (yu) or signs of phlegm

Because of the deficiency, qi and blood cannot rise to clear and nourish the marrow and the openings. This can lead to tinnitus. Damp heat or phlegm can obstruct the openings of the head, which can lead to tinnitus. Phlegm can also combine easily with fire and so can Gan fire rise to the brain. Combination: Kidney def. Liver yang rising: Loud with high tone and slow beginning.

Due to Kidney Yang def: Du 4, Kid 3, Kid 7, Ren 4 (moxa), Ren 6 (moxa) , BL 23. Kidney Yin Xu: Kid 3, Sp 6. Kidney Jing: Du 4, Ren 4 Blood deficiency: Sp 6, Sp 10, Ren 4, St 36, Ht 5, PC 6 Deficiency upper jiao: Ren 17, Lu 9, Ub: 13 , Ren 6 , Du 20, SJ 16, Si 19.

Excess type Liver yang rising: Liv.2 (Liv. 3) To calm liver yang rising, sooth ear : SJ 5, SJ3 GB 20: calm liver yang rising and internal wind GB 43 : to clear liver fire and to influence the ears GB 8, SJ3/SJ5 : To ease the ear Li 4: regulates clear rising yang and descending cloudy yin

Phlegm and Fire rising St 40 Du 12, Du 9 Sp 9 GB 20 SJ 3, SJ 5: To clear the area (if possible or necessary , include dietary advise)

Tinnitus points GB 2 Du 20, Du 19 Sj 2, SJ 17, SJ 21 Si 16, Si 17, Si 18, SI 19 Tai Yang, Sishencong, Yintang

Tinnitus, moxa and ginger To unblock the channels and improve circulation. SJ 17, GB 2, SJ 21, SI 19, Lu7, GB 43, Sj3, Liv 3,Gb40 (combi of needles and electro acu) Large pieces of ginger with a smal needle hole with pagoda shaped ginger on top, on the auricle, move the pieces of ginger Once a day, for 10 days

Treatment Often Combine distal and local points Life style advice if necessary Treat what you diagnose

Sources A manual of acupuncture, Deadman Foundations of Chines Medicine, Maciocia Chinese acupuncture and moxibustion Verloren stilte , M.C. Duijvestijn Syllabus Shenzhou