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Tinnitus syndrome, in some cases, the ringing is severe like cicadas, occurring on either the left or right side, or sometimes accompanied by a sensation of blockage. People generally treat it as Kidney deficiency, but with little effect. They fail to realize that this is caused by Phlegm-Fire ascending and stagnating in the ear, leading to tinnitus; when the stagnation is severe, it causes obstruction and blockage. When encountering this syndrome, one should examine whether the patient usually consumes alcohol and rich, greasy foods, and whether there has been pre-existing Phlegm-Fire in the Upper Jiao (Upper Burner). Treatment should focus solely on clearing Phlegm and descending Fire. Generally, this syndrome often arises from pre-existing Phlegm-Fire in the upper body, triggered by anger. Anger causes Qi to ascend, and the Shaoyang (Lesser Yang) Fire lodges in the ear. If tinnitus is due to Kidney deficiency, the ringing is not severe, and the patient typically exhibits excessive sexual desire and symptoms of consumptive deficiency.

My commentary: For the aforementioned syndromes, if it is Blood deficiency with Fire, use Siwu Tang (Four Substances Decoction) with Zhizi (Gardeniae Fructus) and Chaihu (Bupleuri Radix); if it is Middle Qi deficiency, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if both Qi and Blood are deficient, use Bazhen Tang (Eight Treasures Decoction) with Chaihu; if deafness or tinnitus occurs after anger, it belongs to Excess of Qi in the Liver and Gallbladder meridians, use Xiaochaihu Tang (Minor Bupleurum Decoction) with Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), and Zhizi; for deficiency patterns, use Bazhen Tang with Zhizi; if symptoms worsen before noon, it indicates Excess Heat of Yang, use Xiaochaihu Tang with Huanglian (Coptidis Rhizoma) and Zhizi; if it is Yang deficiency, use Buzhong Yiqi Tang with Chaihu and Zhizi; if symptoms worsen after noon, it indicates Yin-Blood deficiency, use Siwu Tang with Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria); if it is Kidney deficiency with moving Fire, or Phlegm excess causing thirst, Dihuang Wan (Rehmannia Pill, specifically Liuwei Dihuang Wan) must be used. The Classic states: "Headache and tinnitus, and dysfunction of the nine orifices, arise from the intestines and stomach." Once the Spleen and Stomach are deficient, the ears, eyes, and all nine orifices will suffer.

Li Puting, Vice Minister of Personnel, had tinnitus like cicadas. After taking Siwu Tang, his tinnitus worsened. I diagnosed it as deficiency of the three Yin meridities of the foot. He took Liwei Dihuang Wan (Six-Ingredient Rehmannia Pill) at the fifth watch (early morning) and Buzhong Yiqi Tang before meals, resulting in immediate recovery.

Li Yangzhi, Vice Minister of War, suffered from anger-induced tinnitus, expectoration, vomiting, anorexia, alternating chills and fever, and hypochondriac pain. He was treated with Xiaochaihu Tang combined with Siwu Tang, plus Zhizi, Fushen (Poria cum Radix), and Chenpi (Citri Reticulatae Pericarpium), and recovered.

Nasal congestion with loss of smell, or congestion mainly during cold months, or congestion upon slight exposure to wind-cold, recurring frequently, is commonly regarded by laypeople as Lung Cold. However, using acrid-warm herbs to release the exterior and unblock the orifices is ineffective. This is actually due to pre-existing Fire pathogen in the Lung meridian. When Fire stagnates severely, the patient prefers warmth and dislikes cold, hence congestion occurs in cold weather and upon exposure. The treatment principle is primarily to clear the Lung and descend Fire, assisted by agents that promote ventilation. For chronic nasal congestion with loss of smell, treating it as Lung Heat based on the patient's constitution is appropriate. Clear Metal (Lung), purge Fire, and resolve Phlegm. This can be administered as pills to be held in the mouth for gradual absorption, or as powders taken lightly. Slow, long-term administration yields effective results. This is based on my personal clinical experience. For those without a history of nasal congestion who suddenly develop stuffiness, heavy voice, or clear rhinorrhea due to acute wind-cold exposure, it should naturally be treated as Wind-Cold.

My commentary: For the aforementioned syndromes, if caused by damage to the Spleen and Stomach from irregular diet or overwork, leading to an inability of the generated Qi to ascend, allowing pathogenic factors to harm the empty orifices, resulting in dysfunction and loss of smell, it is advisable to nourish the Spleen and Stomach so that Yang Qi can ascend, thereby clearing the nose. According to Dongyuan: "When Gallbladder heat transfers to the brain, it causes Xin'e Biyuan (nasal sinusitis with foul discharge), treated with Fangfeng Tang." Generally, these cases are mostly caused by disharmony of Stomach Qi.

A man, suffering from kidney damage due to sexual exhaustion and liver injury due to anger, experienced distension and stuffiness at the Fengfu point (GV16) and distending pain in both hypochondria. I diagnosed it as kidney damage from lust and liver damage from anger, and prescribed the ingredients of Liwei Dihuang Wan with added Chaihu and Danggui (Angelicae Sinensis Radix). One dose brought relief.

Another man, pale in complexion, with clear rhinorrhea and loss of smell for three years, was diagnosed with Lung Qi deficiency. He was cured using Buzhong Yiqi Tang with added Maimendong (Ophiopogonis Radix) and Zhizi.