Differentiation

Symptoms

Formula

E x c e s s

Liver fire blazing

sudden onset, ear ringing sounds like ocean waves or a storm, sound of tinnitus is loud; or hearing loss, may have ear pain or swelling; anger can induce the ringing or make symptoms worse; red face and eyes, irritability, insomnia, bitter taste in the mouth, red tongue, rapid and wiry pulse

Long Dan Xie Gan Tang Xiao Yao San modified Si Ni San modified

Liver Yang raising

subacute onset, sometimes better and sometimes worse, headache, dizziness and vertigo, tremors or shaking of the limbs or even hemiplegia, wiry pulse

Tian Ma Gou Teng Yin

Wind-heat attacking the Lungs

difficulty in hearing low frequency pitches, but patient perceives one’s own voice as louder, tinnitus which sounds like wind, symptoms usually manifest after nasal congestion, headache, chills and fever, throat, ear infection, distention or stifling sensation in the ear, floating and rapid pulse

Sang Ju Yin

Heat-phlegm accumulation

tinnitus that sounds like cicadas or crickets, a feeling of blockage in the ear, decrease in hearing but not total deafness; heavy feeling in the head, dizziness, oppressive sensation in the chest, expectoration of sputum, red tongue with thick yellow greasy coating, slippery and rapid pulse

Wen Dan Tang modified

Deficiency type: protracted deafness, intermittent tinnitus that is high pitch and low volume, aggravated by stress, eliminated by pressing the ear canal.

D e f i c i e n c y

Liver Blood deficiency

ear ringing that sounds like cicadas, sometime better and sometime worse, hearing loss, dizziness, dream disturbed sleep, dry eyes, blurred vision, pale tongue, thready and wiry pulse

Suan Zao Ren Tang, Si Wu Tang

Kidney essence deficiency

Yin

gradual onset, low volume sound that sometimes sounds like rushing water and sometimes like cicadas; tinnitus worse at night time, hearing loss or even deafness, a feeling of emptiness in the head, poor memory, sore
back and knees

insomnia, dizziness, five center heat, red dry cracked tongue with scanty coating; thready, weak and rapid pulse

Liu Wei Di Huang Wan

Yang

aversion to cold, desire to lie down, pale face, pale flabby tongue with white moist coating, a weak and slow pulse

Jin Gui Shen Qi Wan

Middle Jiao Qi deficiency

gradual onset, tinnitus and deafness worse after exertion with some relief after rest, empty and cold sensation in the ear, low energy, shortness of breath, fatigue, loose stools, pink tongue, weak pulse

low volume tinnitus which is worse in the evening, insomnia, palpitations, memory loss, night sweats, mental restlessness, dry throat, sore back and knees; scanty yellow urine, red tongue with