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Wang Jiezhai stated: In cases of tinnitus (ringing in the ears), the sound may be loud like cicadas, occur on one side or the other, or be accompanied by a sensation of blockage. People generally treat this as Kidney deficiency (Shen Xu), but it is often ineffective. They fail to realize that this is caused by Phlegm-Fire rising and stagnating in the ear, causing ringing; when the stagnation is severe, it leads to obstruction. When encountering such cases, one should examine whether the patient has a history of excessive alcohol consumption and rich foods, and whether there is pre-existing Phlegm-Fire in the Upper Jiao. Treatment should focus solely on clearing Phlegm and descending Fire. Generally, this condition often arises from pre-existing Phlegm-Fire in the upper body, combined with anger. Anger causes Qi to ascend, and the Fire of the Shaoyang channel invades the ear. If tinnitus is due to Kidney deficiency, the ringing is not severe, the person is likely prone to anger, and signs of consumptive disease (Lao Qie) must be present.

In general, deafness occurring after a serious illness is mostly due to Qi deficiency. For the elderly whose hearing gradually declines, this is also due to Qi deficiency. If hearing loss is accompanied by tinnitus, Phlegm may also be involved, and drastic tonification should not be used.

A surging and large pulse at both Cun positions indicates Phlegm-Fire tinnitus. A surging and full pulse at the Shen position (Chi pulse) indicates Kidney Fire. A slightly choppy pulse at the Xin position indicates epilepsy of the ear with Phlegm. A soggy and choppy pulse at the Shen position indicates Deficiency; a short and faint pulse indicates Yin Deficiency. A surging and rapid pulse at the left Cun position indicates Heart Fire flaming upward. Surging and rapid pulses at both Chi positions indicate Ministerial Fire flaming upward; the patient will likely experience nocturnal emissions, tinnitus, or deafness. Deafness with a slow, large, and choppy pulse indicates a fatal prognosis.

The syndrome of deafness results from the obstruction of the Qi pathway, where Phlegm-Fire stagnates and blocks the ear. When using herbs to clear Phlegm and descend Fire, it is essential to include herbs with pungent flavors that move Qi and open orifices; this is the key to treatment. Ancient formulas used needle sand soaked in wine for one day. At night, the needle sand was removed, and the wine was held in the mouth. A piece of lodestone (Cishi) tightly wrapped in cotton was then inserted into the ear—left ear for left-sided deafness, right ear for right-sided deafness. This method aims to guide Qi flow and unblock obstruction. Using drastic Phlegm-clearing and Fire-descending herbs may instead damage the Spleen and Stomach and fail to open the obstruction. Urgently tonifying Qi deficiency may cause Fire to ascend further, also failing to open the obstruction. Only by using the aforementioned method—supplementing Phlegm-clearing and Fire-descending herbs with acrid-warm agents—and treating gently and steadily, can recovery naturally occur. I have seen cases where excessive attacking methods damaged healthy Qi, leading to other diseases; this requires careful consideration.

Worry and overthinking damage the Heart. Heart deficiency and blood depletion inevitably lead to deafness and tinnitus. Excessive sexual activity damages the Kidney. Kidney deficiency and essence exhaustion inevitably lead to deafness and tinnitus. Medication should follow the principle of "draining the South (Heart/Fire) and tonifying the North (Kidney/Water)," focusing primarily on nourishing Yin and descending Fire. For Heart deficiency, calm the Mind and regulate Qi; select Chen Sha Miao Xiang San (Cinnabar Wonderful Fragrance Powder) or Ping Bu Zhen Xin Dan (Peaceful Tonification Heart-Calming Pill). For Kidney deficiency, benefit essence and tonify the Kidney; use Rou Cong Rong Wan (Cistanche Pill).