1. Ear disease

2. ZhangFu or Meridian theory related to Ear disease
1. Organs:
Kidney:
Kidney in charge of the ear ‘s function
Heart:
Heart also open on the ear
Liver & GB:
Liver & GB Qi connect with ear & easily goes up to ear
Spleen:
Spleen Qi nourish the ear
2. Meridians
Foot Shao Yang GB Meridian
Hand Shao Yang San Jiao Meridian
Foot Yang Ming Stomach meridian
Hand Tai Yang Small Intestine Meridian
Foot Tai yang Bladder Meridians
耳　与　脏　腑　经　络　的　关　系     　 　脏腑是人体生理功能、病理变化的活动基础，经络是人体气血运行、脏腑肢节的联系、上下表里沟通之通路。二者互相配合以行气血，调阴阳，把人体的五脏六 腑、四肢百骸、五官九窍、皮肉筋脉联结成为一个整体。由于脏腑不同的生理功能，经络循行不同的途径，使耳与不同脏腑发生不同程度的关系，在耳的生理功能和 病理变化中，与肾、心、胆、肝、脾等脏腑关系较为密切。 　　耳为肾之外窍，耳的 生理功能是由肾所主持，《素问阴阳应肾大论》说：“肾主耳……在窍为耳。”《灵枢·五阅五使篇》又说：“耳者肾之官也”，指出了耳与肾的关系。肾为藏精之 脏，受五脏六腑之精而藏之。精气充沛，上通于耳窍，则听力聪敏。正如《灵枢·五阅五使篇》指出：“肾气通于耳，肾和则能闻五音矣。”若肾脏失职，精气亏 损，则如《济生·耳门》所说：“肾气不平，则耳为受病也。”例如临床上所见，头晕、耳鸣，多因肾精亏损，脑髓不足所致。《灵枢·海论篇》指出：“髓海不 足，则脑转耳鸣。”某些耳的疾患，由于外邪所犯，引起肾脏发生病变所致，故《诸病源候论》卷二十九说：“凡耳中策策痛者，皆是风入于肾之经也。”往往通过 观察耳的色泽形态来诊察肾的病变，在《医学心悟》首卷说：“察耳之枯润，知肾之强弱。”可见肾与耳在生理和病理上是密切相互联系。 　　心 《素问·金匮真言论》说：“南方赤色，入通于心，开窍于耳。”《素问·缪刺论》指出：“手少阴之脉络于耳中。”在《医贯》卷五又有“心为耳窍之客。”《证 治准绳·杂病》第八册又说：“心在窍为舌，以舌非孔窍，因寄窍于耳，则是肾为耳窍之主，心为耳窍之客。”又谓：“耳属二脏之窍也。”二脏者心与肾也，心 火、肾水相互调和，则“清净精明之气上走空窍，耳受之而听斯聪矣。”这都说明心与耳的生理关系。若忧愁思虑则伤心，心虑血耗，必致耳聋耳鸣，心肾不交，皆 能使听闻之乱。 　　肝 肝气通于耳，故肝受损，气上逆而冲两耳，多种耳病，常由于肝脏失调所引起。《素问脏气法时论》说：“肝病者……虚则目无所见，耳无所闻。”又说：“气逆则头痛，耳聋不聪。”《素问·六元正纪大论》亦说：“木郁之发……甚则耳鸣眩转。”指出了肝与耳病理变化的关系。 　　胆 胆附于肝，互为表里，经脉相互络属，其生理、病理变化，关系非常紧密，胆足少阳之脉，其支者从耳后入耳中出走耳前。肝胆主升发，喜条达，若肝胆失调，胆经 有热，易上逆于耳而为病。在《医学心悟·伤寒六经见证法》说：“足少阳胆经，上络于耳，邪在少阳，则耳聋也。” 　　脾 主运化水谷精微及运化水湿，脾的功能正常，则耳得濡养而健旺，《素问·玉机真藏/论》说：“脾为孤脏其不及则令九窍不通。”说明了脾与耳的病理关系。若脾 气虚，不能化生气血上奉于耳，则耳的功能失常而易为病；若脾受伤，湿困于脾，则清阳不升，浊阴不降，蒙蔽耳窍，以致耳部发生病变。 此外耳与肺亦有一定关系，《温热经纬·外感温热篇》说：“温邪上受，首先犯肺。”在《素问·气交变大论》有“肺金受邪嗌　　燥，耳聋”的记述。在临床上耳病初起，往往出现邪在表的肺经症状。 耳为宗脉之所聚。在《灵枢邪气脏腑病形篇》说：“十二经脉，三百六十五络，其气血皆上于面而走空窍……其别气走于耳而为　　听。”其中直接循行于耳的经脉有： 　　足少阳胆经、手少阳三焦经，均从耳后入耳中，走耳前。 　　足阳明胃经，从颊车上耳前。 　　手太阳小肠经，由目锐眦入耳中。 　　足太阳膀胱经，从巅至耳上角。 　　耳通过经脉与脏腑和全身广泛地联系，因此有将耳壳分区分别隶属于人体各部，并以此作为诊断疾病和治疗疾病的依据。
Kidney
Physiologically, the kidney stores essence. When the renal essence reaches the ears upward, normal hearing will exist. Thus, the chapter of Jueqi in the book Miraculous Pivot says "depletion of essence gives rise to deafness". Sufficient essence ensures the generation of brain marrow. The human balance function is closely related to brain marrow. If the brain marrow is deficient, vertigo and tinnitus will occur.
 Liver and gallbladder Physiologically, the branches of gallbladder meridian of foot-shaoyang pass from the back of the ear through the ear to reach the area in front of the ear. It can be seen that the gallbladder meridian is connected with the ear; the liver and the gallbladder are exterior-interiorly connected. Accordingly, flaming-up of the liver fire may give rise to such diseases or symptoms like tinnitus, deafness, otalgia and ear suppuration.
Lung The Vol. 4 of Wenre Jingwei (Compendium on Epidemic Febrile Diseases) says "The lung meridian has an acupoint called Longcong in the ear which controls hearing." Clinically, deafness due to diseases like secretory otitis media results from the failure of Longcong to function normally in the case of invasion of the lung by pathogenic wind. So the book of Suwen Bingji Qiyi Baomingji says "Treating deafness aims at treating the lung."
Heart The chapter Jingui Zhenyanlun of Suwen (Plain Questions) says "The heart opens into the ear." Later the book of Shengji Zonglu ( General Collection for Holy Relief) changed it into "The heart has its orifice in the ear." This does not contradict the fact that the kidney has its orifice in the ear. At the same time, it also expresses the close ties between the heart and the ear. Pathologically, the two situations are commonly-seen: one is the physiological incoordination between the heart and the kidney which causes tinnitus and deafness; the other is the obstruction of blood vessels which may also give rise to deafness and obstruction of the ear.
Spleen The spleen raises lucid yang to nourish the ear. The seven facial orifices are called "the orifices of lucid yang".This means all the seven orifices depend on the nourishment of lucid yang to function normally. If the spleen qi is deficient, lucid yang will fail to be raised and turbid yang qi will rise, giving rise to prolonged purulent secretion inside the ear, hypoacusis, vertigo, etc.

3. Etiology & Pathology Exterior evil poison ( wind-heat ) attack ear
Liver & GB. Damp heat
Heart fire rising up
Kidney essence deficient
Dampness due to Spleen def.
Ear purulence or ear skin rankle
耳 病 的 病 理     　 　　　耳的疾病是由于致病邪毒侵犯，使机体正常生理功能失调，发生病理变化而致的。当机体正气旺盛，邪气便不易侵犯而发生病，故《素问·遗篇·刺法论》 说：“正气存内，邪不可干。”若正气虚，邪气乘虚而入，才会发生疾病，故《素问·评热病论》说：“邪之所凑，其气必虚。”因此，耳病的发生是正邪斗争的反 映，是五脏六腑功能失调的结果。在耳病中，致病之外邪多见于风、热、湿邪；脏腑功能失调，多为肝、肾、心、脾等。不同病邪，不同脏腑病变，就产生了不同病理变化和病证，兹归纳分述于下： 　　1．邪毒外犯 耳为清空之窍，外邪侵犯，易致滞留而为病。所犯外邪，多为风热之邪，常因肝胆二经失健，邪毒得以乘机直犯耳窍，结聚不散，遂致气血凝滞而成病。证见耳痒、耳内胀闷、堵塞感、耳微痛、耳鸣、耳聋等。 　　2．肝胆湿热 胆经经脉络于肝，胆附于肝，互为表里，二经病变相互影响。肝喜舒畅条达，若疏泄失常，郁而化热；胆性刚强，邪犯及胆，其病变多为火热上灼。当外邪侵犯耳 窍，湿热邪毒壅盛传里，犯及肝胆，肝胆湿热，循经搏结于耳窍。内外湿热熏蒸，以致气血凝滞，经络阻塞，肌膜内腐，证见憎寒壮热、耳红肿剧痛、流浓；若湿热 偏盛，则脓多色黄；若火毒炽盛，灼蚀耳后完骨，可有耳根红肿痛，甚则穿溃流浓。 　　3．邪犯心经 热毒壅盛，久困于里，内犯心经，心火炽热，上侵脑髓，火炼津液，结为痰火，痰火内扰，扰乱心神，证见耳脓增多、疼痛加剧、高热、烦躁、心悸、神昏谵语、昏睡等症。 　　4．肾脏亏损 肾藏精，主一身精气，若精气损耗，耳失滋养，功能不健，易为邪毒滞留引起耳病。可出现肾阴虚和肾阳虚的病理变化，肾阴虚，则阴精亏损，无以制火，虚火上炎 于耳窍；肾阳虚，则阳气虚弱，温煦生化功能不足。寒湿停聚，上泛耳窍，均可了现耳聋、耳鸣、眩晕、耳胀、耳痛、流脓等。 心气亦通于耳，心火肾水互为作用，相互制约，若心肾虚损，水火不济，则心肾不交，可致耳聋、耳鸣等。 肝与耳有一定关系，“肝肾同源”，肾精亏损，则肝血亦亏，故肾虚而致的耳病，往往亦兼有肝阴虚损肝阳上充。 　　5．脾虚湿困 脾为后天之本，脾气虚弱，气血生化之源不足，则耳功能虚弱，邪毒得以滞留。同时脾虚生湿，湿困于脾。阳气不升，湿浊邪毒停聚耳窍而为病。出现耳内流脓或耳部皮肤湿烂，或耳鸣耳聋，眩晕泛恶等症。 若脾肾二虚，邪毒滞留，聚而化火，脾虚生湿，火与湿结，久蒸耳窍，肾主骨，肾虚则骨质易为邪所侵蚀，出现邪毒上犯于脑的重证。

4. Diagnosis method Ear pus Ear ache Wind-heat
Liver & Kidney def. or spleen def.
Liver & GB. Fire
Excess
Tinnitus & deafness
Liver & GB. Fire attacking
Liver & kidney Yin def. or Qi & Blood def.
Wind, heat, or dampness accmulation
Dizziness
Liver Yang rising up
Phlegm-dampness accmulation
Qi & blood def.
Kidney essence def.
Dampness due to spleen def.
Ear pus
Damp-heat
如 何 辨 耳 病     　　耳病的辨证是以望、闻、问、切四诊，就全身和耳的局部症状结合起来，在八纲辨证和脏腑辨证的基础上进行综合分析。 　　1． 辨耳痛 　　⑴耳痛初起，痛势较轻，耳内堵塞感，耳膜微红，听力减退，多属风热，邪尚在表。 　　⑵耳病已久，耳内微痛不适或胀塞感，或兼耳鸣重听，无流脓病史者，多为肝肾不足或脾气虚弱，正不胜邪，邪留耳窍之证。若耳痛轻，有流脓，耳膜穿孔，听力下降，多为脾气虚，兼有湿浊停聚。 　　⑶耳内深部疼痛较剧，呈跳痛或钻痛，甚至影响患侧头面部，并有发热，多为肝胆火炽，湿热壅盛酿脓之证。 　　⑷耳痛加剧，耳脓骤然增多或减少，头痛剧烈，壮热，呕吐，甚或神昏谵语，此为火毒内攻，邪犯心包之重证。 　　⑸耳部疼痛，牵引耳壳或压迫耳屏时疼痛更甚，多为火热邪毒，上攻耳道作肿成脓。 　　2．辨耳脓 　　⑴新病耳脓稠黄，多为肝胆火热上蒸耳窍，灼腐肌膜。黄而量多者，多属湿热熏蒸。脓中夹血者，多为肝经火热，热伤血分。 　　⑵久病脓液清稀而量多，或牵丝如胶者，多为脾虚有湿。如脓液清稀而量不多者，多为肾虚，虚火上炎。 　　⑶脓液中有豆腐渣样物，带有臭味，多为肾元亏虚，湿热邪毒滞留，蒸灼肌膜，蚀及骨质，属正虚邪实之证。 　　3．辨耳鸣、耳聋 　　(1)耳鸣暴发，声音大，听力下降，多为肝胆之火上逆，或痰火郁结上扰清窍。 　　(2)耳鸣渐发，声音细，听力逐渐下降，多为肝肾阴虚，虚火上炎，或气血亏耗，耳失濡养。 　　(3)耳鸣如蝉鸣者，多属肝肾或心肾虚损，气血不足之证；耳鸣如潮声、风声者，多属肝胆热盛，邪气壅阻耳窍之证。 　　(4)暴聋多以风、热、湿邪壅塞耳窍或有盯聍、异物堵塞；渐聋多以肝、肾、脾等脏腑虚损为主。 　　(5)年老听力不灵，无流脓史，多为肝肾两亏，气血不足，不能上荣所致。 　　(6)因耳内流脓而致耳鸣、耳聋者，以脓液的辨证为主。 　　3.辨眩晕 　　眩晕的原因很多。耳病眩晕发作时，患者多首先一侧耳鸣或耳聋，继而感天旋地转，身体有向一侧倾倒的感觉，并有恶心呕吐、眼球震颤等症状。 　　⑴眩晕伴有头痛，耳痛胀闷感，口苦咽干，多属肝阳上亢之证。 　　⑵眩晕伴有头重、头胀、低音调耳鸣、胸闷、倦怠，多属痰湿壅阻之证。 　　⑶经常头晕耳鸣，听力差，遇劳或体位改变突发眩晕，或有心悸少气者，多属气血不足脾气虚损之证。 　　⑷时常眩晕，眼前黑花，并有高音调耳鸣，听力下降，记忆力差，腰疫膝软，属肾精亏损之证。 　　⑸眩晕伴有耳流脓，如为新病，多为肝胆火热蒸灼清窍；如为旧病，多为脾肾虚弱、湿邪内困。

5. Treatment method Internal medicine Expel wind & clear heat
Clear fire & toxin
Promote water & resolve dampness
Tonify kidney essence
Expel pus
Dispels & move the Qi
External medicine
Wash with clear heat & remove toxin herbs
Dripping drug into ear method
Blow powder into ear
Spread & apply with clear heat toxin, resolve swollen herbs
Acupuncture
Others
如　何　治　耳　病     　　耳病的治疗方法很多，有骨治、外治、针灸、导引等等。各种治法应从临床辨证的结果，有选择性地互相配合使用，才能取得较好疗效。 　　1．内治法 　　⑴疏风清热：用于风热之邪侵犯耳窍，或风寒化热而致耳病，证见耳微胀痛，堵塞感，听力减退，或有恶寒发热，头痛，舌苔薄白，脉浮等。病属初起，邪在肌表，宜用辛凉解表药物，使邪从表解。 　　⑵泻火解毒：用于邪毒传里，里热壅盛，耳部疼痛较剧，耳膜充血，或有流脓，兼有高热，头痛，口干，舌质红，脉数有力等症。宜用寒凉泻火药物，清泻内壅之热，若以肝胆火热为主者，宜清肝泻火。 　　⑶利水渗湿：用于湿浊内停，耳部流脓或耳膜后有渗出液之证。 　　⑷补肾填精：用于肾精亏损而致耳鸣、耳聋、眩晕、耳闭、脓耳日久等症。若为肾阴亏损，可用味甘微寒的滋阴药物以补肾养阴。若证见肾阳虚衰，耳鸣、耳聋、眩晕、形寒怕冷、腰膝疲软等，应以温补肾阳，散寒通窍。 　　⑸散排脓：用于瘀滞有脓之证。若热毒壅盛，瘀滞有脓者，宜散瘀排脓，清热解毒。 　　⑹行气通窍：：用于邪毒壅阻窍内，出现气血凝滞，耳窍闭塞等证，宜用行气通窍，辛散辟邪的方法。 　　2．外治法 　　⑴清洁法：用于流脓或糜烂的耳病，用清热解毒收敛的中草药，煎水洗涤患处，以清洁外耳或耳道的脓液和痂块。 　　⑵滴耳法：用于耳痛、耳内流脓者，可用清热解毒 ，收敛去湿，辟邪止前的药液滴入耳内。 　　⑶吹药法：用于脓耳、耳疮等，耳纸筒或喷粉器，将药散少许吹入耳内，以达到清热解毒，收敛干水目的。 　　⑷涂敷法：用于耳道、耳壳或其周围红肿流水者，用清热解毒，除湿消肿的药物，涂敷于患部。 　　3．针灸疗法 　　针刺可用以治疗很多耳病，如耳眩晕、耳鸣、耳聋等。通过循经取穴，针刺腧穴，促使气血和调，经络通畅，以达到扶正祛邪的目的。有体针、耳针、水针及艾灸法等方法，可根据病情分别选用。 　　4．其他疗法 　　按摩导引，是病者自行运动，按摩患处，静坐吐纳，以达到疏通经络，运行气血，舒畅筋骨，导邪外出的一种治病保健方法。 　　⑴咽鼓管自行吹张法：用于治疗耳闭的耳鸣、重听、耳膜内陷等。其法如《保生秘要》说：“定息以坐，塞兑，咬紧牙关，以脾肠二指捏紧鼻孔。睁二目，使气串耳通窍内，觉哄哄有声，行之二、三日，窍通为度。” 　　⑵耳膜按摩术：用于治疗耳闭、耳膜内陷。其法如《景岳全书》卷二十七说：“凡耳窍或损或塞，或震伤，以致暴聋，或鸣不止者，即宜以手中指于耳窍中轻轻按捺，随捺随放，随放随捺。或轻轻摇动，以引其气，捺之数次，其气必至，气至则窍自通矣。” 　　⑶“鸣天鼓”：用于预防耳聋、耳鸣。是将两手掌心紧贴两耳，两手食指、中指、无名指、小指对称横按在枕部，两中指相接触到，再将两食指翘起叠在中指上 面，然后把食指从中指上用力滑下，重重地叩击后枕部，此时可闻宏亮清晰之声如击鼓。先左手24次，再右手24次，最后两手同时叩击48次。每天可以多次施 行。

6. Main Sym: distention & blocked feeling
Pain Ears
1. Wind-heat type
Main Sym: distention & blocked feeling
Concurrent sym: tinntus, bad audition, reddish & swlloen eardrum, fever, aversion to cold, headache, blocked nose, sore thorat, dry mouth
Tongue: red body with thin white coating
Pulse: floating & rapid
Treatment principle: disperse wind-heat, open the ear
Formula
Yin Qiao San plus
Jing Yin Hua 12, Ju Hua 12, Lian Qiao 12, Xia Ku Cao 15, Jing Jie 10, Fang Fen 10, Chan Tui 6, Gan Cao 6
--distention: Shi Chang Pu 10, Bai Ji Li 15,
-- water secretion: Che qian Zi 10, Ze Xie 15, Sang Bai Pi 12

7. Concurrent sym: fever & headache, bitter mouth, dry thorat
2. Liver & GB fire
Main Sym: distent ear, inner ear ache radiated to the side of head, severe tinnitus, bad audience,
Concurrent sym: fever & headache, bitter mouth, dry thorat
tongue: red sides and tip of body with yellow coating
Pulse: wiry & rapid
Treatment: clear liver & GB. fire, open the ear
Formular: Long Dan Xie Gan Tang Plus
Long Dan Cao 12, Huang Qin 12, Zhi Zi 12, Ju Hua 12, Chai Hu 12, Mu tong 12, Che Qian Zi 10, Ge Gen 30, Chan Tui 10, Gan Cao 6
-- severe distention: Shi Chang Pu 12, Man Jing Zi 12;
-- eardrum water accmulation: Fu Ling 15, Ze Xie 15
耳胀痛的外治法
· 滴鼻 可用滴鼻灵、鼻炎滴剂、l％麻黄素液、呋喃西林麻黄素液等滴鼻。
· 滴耳 可选用黄连滴耳液、鱼腥草眼水、0．25％氯霉素眼药水等滴耳。
· 超短波理疗 做双耳前超短波理疗，每次15分钟，每日1次。
耳胀痛的其他疗法 1．针灸疗法 (1)针刺：以局部取穴与远端取穴相结合。局部取穴：听宫、听会、耳门、翳风等；远端取穴：合谷、内关。每次取穴2—3穴，中强度刺激(捻转泻法)，留针10—20分钟。 (2)耳针：取穴内耳、神门、肾上腺、肺、肝。可用针刺或贴耳珠方法，贴耳珠可贴2～3日，每日可按压3—4次。 2．按摩治疗 可作自行鼓膜按摩。方法：用手指按压耳屏，随压随放，或以掌心附外耳道口处间歇加压，每次做20—30下，早晚各1次。 3．预防调护
· 注意擤鼻方法，宜两侧鼻腔分别擤鼻，忌两侧鼻腔同时擤涕，并忌粗暴用力；也可先将涕液向后吸入口咽，将其吐出，以避免将涕液推入耳窍。
· 注意鼻腔通畅清洁。

8. Tinnitus Etiology & Pathology Excess type Liver fire Phlegm fire
Exterior wind heat
Deficient Type
- Liver & Kidney def.
- Spleen & St. def.
- Heart Blood def.
医认为耳鸣和肝胆心肾有关，人有12条经脉直接上通于耳，包括胆经、胃经、小肠经、膀胱经等。
　　在中医来看，耳朵是肾之窍，肾开窍于耳，心气直通于耳，胆经上通于耳，肝胆互有表里关系，故肝胆影响耳朵。
　　她说，耳鼻眼口七孔属清窍，有些身体壮实而脾气暴躁者，因肝火较旺，肝阳上亢而扰乱清窍。这类耳鸣者多也舌红及眼充血，他们多因生气而发病，或者冷静时耳鸣不严重，生气时就加重。
　　痰火，中医认为是导因之一，多喝酒，常吃煎炸辛辣食品者，肝火痰火就旺，痰火壅结在内，可能就产生耳鸣。
　　中医认为耳鸣在临床上分虚症实症两类，上述情况是属于实症，多发生在成年或壮年人身上；虚症耳鸣以肾虚为主，较多见于老人，中医理论说男性七七49岁，女性八八64岁，肾气开始虚弱。正因肾开窍于耳，耳得不到足够的肾气濡养，就产生耳鸣。
　　赵医师说，有些人耳鸣，听力没减退，有些两者兼有，也有些听力减退但没有耳鸣。
　　年轻人也可能因肾发育不全、脾胃虚弱，脾气虚，清气不可上升，以致清窍失养，造成耳鸣。
　　中医认为脾主管清气上升，胃主管浊气下降（排出），脾胃不好，清气不能升，浊气不能下，就可能引起耳鸣或失眠，而耳鸣者多也失眠。也有些人是因气血亏损，有些人因过度疲劳而体虚，都可能是耳鸣的诱因

9. Excess type :
1. Wind heat attacking
Main Sym: tinnitus with windy sound
Concurrent sym: exterior wind heat symptoms : headache, fever, sore throat,
Tongue: thin white or yellow coating
Pulse: floating & rapid
Treatment principle: disperse wind-heat , open the ear
Formula : Yin Qiao San Plus

10. Excess type
2. Liver Fire rising
Main Sym: suddent onset tinnitus, loud sound in the ear, severe sym. , worse in angry
Concurrent sym: emotional changing history, dizziness, headache, bitter mouth, dry throat & stools,
Tongue: red body
Pulse: wiry & rapid
Treatment principle: Clear liver fire, opent the ear
Formula : Long Dan Xie Gan Tang Plus

11. Excess Type
3. Phlegm Fire
Main Sym: tidal sound in the ear, blocked ear feeling
Concurrent sym: heavy head, distent & opressed feeling in the chest & abdomen, sticky stool, heavy body type
Tongue: red body with yellow geasy coating
Pulse: slippery & rapid
Treatment principle: resolve dampness, clear fire
Formula :

12. Main Sym: tinnitus sound like cicada singing
Deficient Type
4. Spleen Qi Def.
Main Sym: tinnitus sound like cicada singing
Concurrent sym: tiredness & weakness, bad appetite, worry during the whole day
Tongue: pale color with enlarged body & toothmark
Pulse: weak
Treatment principle: Tonify Spleen & open the ear
Formula : Yi Qi Chong Ming Tang
Huang Qi, Ren Shen, Ge Geng, Man Jing Zi, Bai Shao, Huang Bai, Sheng Ma, Gan Cao
脾气虚弱：过度思虑或疲劳，或饮食不节伤脾胃，清阳之气不能上升滋养耳窍。耳鸣如延绵蝉声，常感疲乏，胃口不佳，治疗在于健脾升阳，益气通窍，药用益气聪明汤

13. Concurrent sym: insominia, irrtability, nervious Tongue: pale body
Deficient Type
5. Heart Blood Def.
Main Sym: tinnitus after long term illness or hard working, repeatedly occured
Concurrent sym: insominia, irrtability, nervious
Tongue: pale body
Pulse: weak
Treatment principle: Nourish heart Blood, Open the ear
Formula : Gui Pi Tang
心血不足：大病后或操劳过度，耗伤心血，耳窍失去心血之养，引起耳鸣，听觉失灵。两耳蝉鸣，时轻时重，伴有失眠、心悸、焦虑比安，治疗以益气养血、宁心通窍为主，药用归脾汤；

14. Concurrent sym: dizziness & swimming, sore lower back Tongue:
Deficient Type
6 Liver & Kidney Def.
Main Sym: tinnitus & lack of sensitivity to sound, even deafness worse at night
Concurrent sym: dizziness & swimming, sore lower back
Tongue:
Pulse: weak
Treatment principle: Tonify Liver & Kidney, open the ear
Formula : Zuo Ci Wan or You Gui Wan
肝肾不足：忧郁肝肾虚，正气不足，以致外邪侵袭，或因急性耳病治疗不当，或病热迁延日久，内伤肝肾，外伤耳窍，引起耳鸣及听觉失灵。症状是两耳常闻蝉鸣声，昼轻夜重，头晕目眩，腰酸。治疗：若偏于肾精不足，药用耳聋左慈丸；若偏于肾亏虚者，可用右归丸。 ，胃口不佳，治疗在于健脾升阳，益气通窍，药用益气聪明汤
突发性耳鸣 服中药痊愈
　　今年5月，一名年纪40开外的壮年男子，因突发性耳鸣而到马光诊所，让赵戈医师诊病。所谓突发性，就是以前从来没有耳鸣，耳鸣情况不是逐渐从轻微到严重，而是突然间暴发的。
　　这位男士平时爱吃辛辣煎炸食品，性情急躁，耳鸣突然发作后，左耳也听不清楚，舌红苔黄，脉强，便秘，属典型肝阳化火，挟痰上扰清窍。
　　赵医师药开龙胆泻肝汤及导痰汤，3天后耳鸣渐减，又一星期后，突然又回复听觉，舌红渐退，舌苔转薄，后服加味逍遥散，又一星期后耳鸣消失，之后继续调理一个月，至今未再发。

15. Deafness Exterior wind or heat attacking
Liver Qi Stagnation or Liver Fire attacking
Improper dieting
Kidney essence def.
Others: old age, genetic, drugs,
Demographics
The global deaf population is roughly estimated to be 0.1% of the total population (1 in 1000) [3]. The figure is likely to be higher in developing countries than developed countries due to restricted access to health care, and, in some cultures, due to the high rate of intrafamilial marriages. The great majority of people with less than average hearing are elderly or developed hearing loss after leaving school[4]. According to the U.S. National Center for Health statistics, approximately three quarters of deaf and hard-of-hearing Americans experienced the onset of hearing loss after age 18[4].
病因病理     　中医学认为，风邪外袭，首先犯肺，肺失宣降，热结耳窍而失聪。情志不遂，忧郁过度，气机郁结，气郁化火，则肝火从内而生，上逆于耳所致。肝肾阴虚阴不制阳，以致肝阳上亢，上扰清窍而致病。或因饮食失调，思虑劳倦，脾胃受损，运化失职，以致水湿内停，聚而为痰，痰郁化火，痰火互结，上蒙耳窍而致。或因饮食不节，损伤脾胃，运化不健，气血生化无源，耳脉经气不足，耳窍失养所致。或因素来体虚，久病精亏，房劳过度等导致肾精不足，耳窍空虚而致病。或因耳部外伤，情志不遂，肝气不疏或久病气虚等引起脉络血瘀，耳脉闭塞，耳窍失养所致。    　 现代医学认为耳聋按照病变部位可分为传音性耳聋和感音性耳聋。    　 (1)传音性耳聋：可有先天性疾病，常见者如外耳道闭锁，中耳道畸形。后天性疾病，外耳道疾病，如外耳道异物、耵聍栓塞、炎症肿胀等。中耳疾病，如骨膜炎、分泌性中耳炎、化脓性中耳炎及后遗症等。     　 (2)感音性耳聋：病因可有：①先天因素：如常见的有遗传因素和非遗传因素，非遗传因素有自身免疫性疾病糖尿病、梅毒等；②老年性因素：机体衰老，听觉器 官常发生老年性退化，③耳毒性药物：如链霉素、卡那霉索、庆大霉素、新霉素等；④传染病源性聋：如流行性脊髓炎、猩红热、麻疹、梅毒等；⑤全身性病因素： 如高血压、动脉硬化、慢性肾炎等；⑥创伤性因素：脑外伤、颅底骨折，可导致迷路振荡、内耳出血等；⑦突发性耳聋：为突发重度感音神经性聋；⑧自身免疫性 聋：多发生于青壮年，为非对称性进行性感音神经性耳聋。    　 治疗

16. Main Sym: sudden onset of deafness
1 Wind-heat invasion
Main Sym: sudden onset of deafness
Concurrent sym: blocked nose, running nose, headache, distent ear, aversion to cold, fever
Tongue: thin white coating
Pulse: floating & rapid
Treatment principle: expel wind heat, open ear
Formula : Yin Qiao San Plus
Jing Yin hua 16, Lian Qiao 12, Lu Gen 12, Bo He 7, Niu Pang Zi 12, Jing Jie 7, Dan Dou Chi 12, Dan Zhu ye 12, Shi Chang Pu 16, Ge Geng 16
风邪上犯    　 突发耳聋，伴鼻塞，流涕，或有头痛，耳胀闷，或有恶寒，发热，身痛。舌苔薄白，脉浮。     　[治法]  疏风清热，散邪通窍。     　[方药]  银翘散加减：银花16克，连翘12克，芦根12克，薄荷7克，牛蒡子12克，荆芥穗7克，淡
豆豉12克，淡竹叶12克，石菖浦16克，葛根16克
气血逆乱，成痰成瘀阻塞经络，或六淫之邪上蒙清空而致的耳聋、耳鸣。临床多用于暴聋。即现代医学所说的突发性耳聋、美尼埃氏病等。
方中麝香可改善微循环，使脑部血液循环重新分布。
柴胡、生地、甘草具有激素样的作用，可减少内耳淋巴液的渗出；
僵蚕、蝉衣、浮萍等具有抗过敏、抗组胺的功能，可减少渗出，抗御眩晕。
当归、川芎、葛根扩血管。
赤芍、泽泻降血脂。
茯苓、泽泻减少内耳积液、降低脑压等。

17. 2. Liver Fire rising
Main Sym: suddent onset deafness after emotion changing
Concurrent sym: emotional changing history, dizziness, headache, bitter mouth, dry throat & stools,
Tongue: red body
Pulse: wiry & rapid
Treatment principle: Clear liver fire, opent the ear
Formula : Long Dan Xie Gan Tang Plus
Long Dan Cao 12, Huang Qin 12, Dang Gui12, Chai Hu 7, Ze Xie 12, Zhi Zi 12, Che Qian Zi 12, Shen Gan Cao 12, Mu Tong 12, Shi Chang Pu 16

18. 3. Phlegm fire accmulation
Main Sym: suddent onset deafness with heavy head & dizziness
Concurrent sym: distent ear, oppressed feeling in the chest and abdomen, bad appetite
Tongue: red body with yellow greasy coating
Pulse: slippery & rapid
Treatment principle: Clear fire & resolve phlegm, harmonize stomach & calm dwon the rebellion of Qi, opent the ear
Formula : Weng Dan Tang Plus
Ban Xia 12, Chen Pi 12, Gan Cao 12, Zhi Shi 12, Zu Ru 12, Fu Ling 16, Sheng Jiang 5pieces,
Greasy coating: Huo Xiang12 , Pei Lan 12, Cang Zhu 12, Hou Pu 12

19. 4. Qi & Blood Def.
Main Sym: tinnitus & deafness reaptedly occurred, worse after working
Concurrent sym: weak body, & pale face color, bad appetite
Tongue: thin white coating
Pulse: fine & Weak
Treatment principle: tonify Qi & Blood, open the ear
Formula : Ba Zheng Tang Plus
Dang Shen 16, Bai Zhu 12, Fu Ling 12, Zhi Gan Cao 12, Dang Gui 12, Shu Di 16, Bai Shao 12, Chuan Xiong 7, Chen Pi 12, Tai Zi Shen 16

20. Main Sym: long time deafness, tinnitus
5. Kidney essence Def.
Main Sym: long time deafness, tinnitus
Concurrent sym: dizziness & swimming, sore lower back, weak knees,
Tongue: red body with less coating
Pulse: fine & rapid
Treatment principle: Nourish kidney essence, open the ear
Formula : Qi Ju Di Huang Wan Plus
Gou Qi Zi 12, Ju Hua 12, Shu Di 12, Shan Zhu Yu 12, Shan yao 16, Fu Ling 12, Ze Xie 12, Dan Pi 16, Shi Chang Pu 12, Ci shi 16, He Shou Wu 16
Insomnia: Yuan Zhi 12, Suan Zhao Ren 12
def. fever: Di Gu pi 12
5．肾精亏损     　耳聋日久，耳鸣如闻蝉声，头晕眼花，腰膝酸软。舌红，苔少，脉细数。     　[治法]  益精补肾，滋阴降火。     　[方药]  杞菊地黄汤加减：枸杞12克，杭菊花12克，熟地1s克，山茱萸12克，淮山药16克，茯苓12克，泽泻12克，丹皮16克，石菖蒲12克，灵磁石16克，何首乌16克。失眠较甚者加远志12克，酸枣仁12克；五心烦热、口干咽燥者加地骨皮12克。

21. 6. Blood stasis due to Qi stag.
Main Sym: deafness sometime worse sometime better with tinnitus
Concurrent sym:
Tongue: purple color
Pulse:
Treatment principle: Move blood resolve blood stasis, moving qi to open the ear
Formula : Tong Qiao Huo Xue Tang Plus
Tao Ren 12, Hong Hua 12, Di Long 12, Chuan Xiong 12, Chi Shao 12, She Xiang 5, Cong Bai 5 Sheng Jiang 5 p, Da Zhao 5p; Xuan Hu Suo 12, Yu Jing 12
(三)单味药与经验方治法    　 (1)治双耳虚聋，白茯苓65克，炒山药100克，炒杏仁(去皮尖)50克，黄蜡35克，将三味为末研匀，熔蜡丸如弹子大，盐汤送下。    　 (2)对氨基甙类抗生素引起的耳聋可用：生地13克，女贞子12克，枸杞7克，五味子3克，珍珠母35克，磁石35克，生牡蛎35克，桑葚子16克，水煎服。    　 (四)针灸穴位疗法    　 (1)体针：可选听宫．听会、翳风、翳明、风池、液门、中褚、足三里、三阴交、复溜、太湲、太沖、行间、阴陵泉、阳陵泉等。    　 (2)耳针：取神门、肾、脾、肝、肺、内耳、中耳、大脑皮层、肾上腺等。    　 预防与护理    　 (1)广泛宣传杜绝近亲结婚，积极防治妊娠期疾病，对婴儿耳聋尽早治疗，利用残余听力进行听觉语音训练。

22. Meniere’s disease
Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, ringing in the ears (tinnitus), a feeling of fullness or pressure in the ear, and fluctuating hearing loss.
An acute attack of Meniere's disease is generally believed to result from fluctuating pressure of the fluid within the inner ear.
One way for this to happen is when the drainage system, called the endolymphatic duct or sac is blocked. In some cases, the endolymphatic duct may be obstructed by scar tissue, or may be narrow from birth. In some cases there may be too much fluid secreted by the stria vascularis. Recently, some have pointed out that this "central hypothesis" of Meniere's is questionable, as many normal people without Meniere's have evidence of increased pressure in the inner ear too.
Abnormally enlarged fluid pathways into the ear, such as the vestibular aqueduct or cochlear aqueduct, may also be associated with Meniere's-like symptoms, but recent evidence is against a relationship between the cochlear aqueduct and Meniere's disease (Yilmazer et al, 2001).
Recently, attention has been mainly focussed on the immunologic function of the endolymphatic sac; thus, immune disease may contribute to a substantial percentage of Meniere's disease.

23. TCM Pathology & Etiology
1.Phlegm block the ear orifices
Bad food digestion, fatigue, Over thinking or chronic disease -> damage the spleen function -> dampness accumulation -> Turn into phlegm -> Block the Yang Qi & orifice -> cause dizziness
2. Liver Yang rising
emotion changing-> Liver Qi stag. -> liver yang rising or liver fire attacking
3. Kidney essence deficiency

24. 1. Phlegm blocks the orifice.
Main Sym: severe dizziness, tinnitus, deafness,
Concurrent sym: heavy head, chest fullness & distention, vomiting & nausea, lots phlegm & saliva, poor digestion, fatigue, thirsty but no desire of drinking water
Tongue: thick greasy coating
Pulse: soft & slippery
Treatment principle: Strengthen the Spleen, Expel the phlegm, open the orifice
Formula : Ban Xia Bai Zhu Tian Ma Tang
Ban Xia 9g, Bai Zhu 9g, Tian Ma 9g, Fu Ling 15g, Ju Hong 9g, Gan Cao 6g, Sheng Jiang 3 slices, Da Zao 5 pieces

25. 2. Liver Yang rising.
Main Sym: suddenly occurred dizziness, tinnitus, deafness,
Concurrent sym: nausea & vomiting, worse with emotional changing, red eyes, dry throat, bitter mouth, pain rib area,
Tongue: red body with yellow coating
Pulse: rapid & wiry
Treatment principle: Nourish liver Yin, Calms the liver Yang or expel the liver wind
Formula : Tian Ma Gou Teng Yin
Tian Ma 9g, Gou Teng 9g, Shi Jue Ming 24g, Zhi Zi 9g, Huang Qin 9g, Chuan Niu Xi 9g, Du Zhong 9g, Sang Ji Sheng 9g, Fu Shen 12g, Ye Jiao Teng 12g, Chai Hu 9g

26. 3. Kidney essence deficiency.
Main Sym: Frequently occurred dizziness, tinnitus, Bad hearing
Concurrent sym: sore & weak lower back & knees, poor memory, hot sensation in five palms.
Tongue: red body with less coating
Pulse: rapid & fine
Treatment principle: Tonify Kidney essence
Formula : Qi Ju Di Huang Wan
Sheng Di Huang 12g, Shan Yao 15g, Shan Yu Rou 15g, Gou Qi Zi 9g, Ju Hua 9g, Shi Jue Ming 15g, Bai Shao 12g, Shou Wu 12g, Gui Ban Jiao 10g, Lu Jiao Jiao 10g, Mu Li 15g,

27. Case 1
Main complain: right ear ringing for one year
Continually ear ringing for one year, high pitch but low volume; Especially feel irritability when hear the noise from outside. Symptoms get worse after hard working. Right side ear ringing is worse than left side. With headache recently too.
Tongue: thin white coating & slightly red tongue body
Pulse: even
TCM diagnosis:
Excess heart fire attacking the ear orifice
Treatment: Clear heart fire
Sheng Di Huang 10g; Dan Zhu Ye 10g; Bai Mao Gen 10g; Deng Xing 3g;
Dang Gui 10g; Dan Shen 10g; Ju Hua 10g; Bai Zi Ren 10g; Yi Mu Cao 10g

28. Case 2
Female 48 y
Main complain: tinnitus & deafness
8 years ago, suddenly occurred tinnitus & deafness. After treated by hyperbaric oxygenation; tinnitus stopped, but deafness is still. And the deafness is getting even worse clearly in this year. Accompanied with distending feeling in the ear, dry throat. Also whole body very itching sometime, but with no any rashes or eczema; itching could be cured by drinking expel wind herb formula.
tongue: thin coating Pulse: fine
TCM diagnosis: Blood & Yin deficiency
Treatment: Nourish the blood & Yin
Shu Di Huang10g; Shan Yao 10g; Fu Ling 10g; Lu Dou Yi 10g;
Ze Lan 6g; Mu Dan Pi 6g; Dang Gui 10g; Xuan Shen 10g; Ge Gen 6g;

29. Case 3
Female 47 Y
Main complain: Acute deafness for 4 m
Suddenly occurred deafness in the middle of the June. After treatment, deafness is little better, but the ear ringing started, continually, high pitch and very loud volume, none stopping in the whole day & whole night. Couldn’t fall asleep due to its big noise. Dizziness, heavy head feeling but very light on the feet. Very sensitive to the noisy from outside.
Tongue: thin coating Pulse: slippery & wiry
TCM diagnosis: Phlegm fire block the ear orifice.
Treatment: Clear fire & resolve the phlegm
Long Dan Cao 3g; Dan Nan Xing 3g; Chen Pi 6g; BanXia 6g;
Tian Zhu Huang6g; Zhi Zi10g; Zhi Shi6g; Shi Chang Pu 3g;
Xia Ku Cao 10g; Ju Hua10g