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Feng Luzhan stated: Tinnitus caused by Yin deficiency presents with symptoms such as heat in the palms and soles, thirst, dry intestines, a large pulse at both Chi positions (Kidney position), occasional ear itching, deafness, and tinnitus. Treatment should primarily focus on nourishing Yin and soothing the Liver. (From *Jin Nang*)

He further stated: Tinnitus caused by Phlegm presents with symptoms of Qi stagnation, dry mouth, non-painful but itchy ears, heavy body sensation, and a wiry pulse; tinnitus with internal roaring is characteristic. The primary treatment involves formulas such as Er Chen Tang (Two-Cured Decoction) and Zhu Li (Bamboo Juice).

Chen Shigong stated: When Heart and Kidney fail to interact, Heart labor causes Heart Fire to flare upward, and Qi stagnation prevents it from descending. Since the Kidney opens into the ears, when Heart Fire attacks the Kidney, it leads to disorders of tinnitus and ear obstruction. (From *Zheng Zong*)

Tian Shi (Master Qi) stated: Hearing sounds like ants fighting in the ears is not a manifestation of demonic influence, but rather results from the exhaustion of Kidney Water compounded by anger injuring the Liver. It is appropriate to use Zhi Xuan Dan (Stop Noise Powder) as the main treatment. The formula consists entirely of sacred herbs for tonifying the Kidney and calming the Liver. After drinking it for several days, the fighting sounds gradually recede, and after one month, recovery occurs. This is a rare disease treated successfully by Bo Dao's prescription. (From *Mi Lu*)

The Classics state: The Kidney opens into the ears. As an organ, the Kidney is the Water organ. "Heaven generates One, Water," so at the beginning of life, two Kidneys are formed first, hiding one Yin within. Additionally, Ministerial Fire resides within the Mingmen (Gate of Life), often accompanying the momentum of Sovereign Fire to insult what it cannot overcome, which is what the Classics refer to as "one water cannot conquer two fires." Moreover, if desires are unregulated and physical exertion excessive, or after middle age following a severe illness, Kidney Water becomes withered and dried up, causing Yin Fire to flare upward. Thus, ear itching and tinnitus occur daily. The Classics state: "Yang Qi promotes growth in all things, flourishing upward and leaping, therefore the ears make noise." Consequently, tinnitus may be severe like cicadas, occurring on either side or intermittently obstructed. However, why does treatment based on deficiency sometimes fail? This is due to Phlegm-Fire ascending and stagnating in the ears, causing ringing; severe stagnation leads to blockage. For such diseases, if the patient usually consumes alcohol and rich flavors, having pre-existing Phlegm-Fire in the Upper Jiao, treatment should only focus on clearing Phlegm and reducing Fire. This often arises because Phlegm-Fire was already present above, combined with emotional anger; anger causes Qi to rise, and Shaoyang Fire originates in the ears. If tinnitus is due to Kidney deficiency, it is also due to the ascent of Bladder Ministerial Fire; thus, the ringing is likely not severe, the person likely has excessive sexual activity, and symptoms of consumptive weakness should also be present.

Feng stated: The human body has nine orifices. There are seven Yang orifices: ears, eyes, mouth, and nose; and two Yin orifices: the anterior and posterior apertures. Yang Qi moves toward the upper orifices; if it descends into Yin positions, it causes diarrhea and abdominal borborygmus. Yin Qi moves toward the lower orifices; if it ascends into Yang positions, it causes obstruction and tinnitus. In elderly people, Kidney Water is exhausted, and True Fire is easily exposed. Therefore, Kidney Water Qi escapes easily but is hard to retain, floating upward to the upper orifices. Inside the orifice, sounds resemble frogs croaking, drums beating, or ants crawling. Thus, external sounds mix with internal sounds, leading to unclear hearing. In advanced age, without Qi, internal essence is depleted and cannot ascend, resulting in loss of hearing. This differs from young and strong individuals, where turbid Yin blocks the orifices, preventing external sounds from entering; hence, using Moschus (She Xiang) and Acorus (Shi Chang Pu) to open Qi and guide transmission is the method. Therefore, treating reversed Qi in the elderly relies primarily on Magnetite (Ci Shi), utilizing its heaviness to reach downward and its nature to absorb downward, assisted by Yuzhu (Rehmanniae Radix Preparata) and Testudinis Carapax et Plastrum (Gui Jiao) among other Yin-nourishing herbs. Furthermore, Schisandrae Fructus (Wu Wei Zi) and Corni Fructus (Shan Yu Rou) are added for their sour astringency, causing Yin Qi to flourish in its home palace without attacking the Yang orifices. Consequently, the space is empty and unobstructed, allowing the ear to receive sound like a valley receives echoes. Thus, the miraculous function of the ear lies in its emptiness and capacity to receive. The Classics state: "Black and dry ears indicate Kidney exhaustion." (From *Jin Nang*)

Chen Yuan Gong stated: Some patients have ear pain that resolves, but tinnitus persists. People assume it is Wind-Fire and continue using wind-dispelling and fire-clearing methods, yet the ringing worsens. Pressing the ear with the hand alleviates the ringing slightly, indicating Yang deficiency with Qi blockage. The method should prioritize tonifying Yang while regulating Liver and Kidney deficiency, using Fa Yang Tong Yin Tang (Decoction to Evoke Yang and Unblock Yin). Ingredients include Ginseng Radix (Ren Shen), Atractylodis Rhizoma (Bai Zhu), Angelicae Sinensis Radix (Dang Gui), and Brassicae Semen Album (Bai Jie Zi), each 2 qian; Poria (Fu Ling), Astragali Radix (Huang Qi), and Paeoniae Radix Alba (Bai Shao), each 3 qian; Rehmanniae Radix Preparata (Shu Di Huang) 5 qian; Bupleuri Radix (Chai Hu) 1 qian; Cinnamomi Cortex (Rou Gui) and Glycyrrhizae Radix et Rhizoma (Gan Cao), each 5 fen; and Viticis Fructus Niger (Hei Jing Jie) 1 qian. Decoct in water and take orally. Symptoms lighten after one dose and resolve after two. This is a comprehensive tonic. (From *Bing Jian*)

He further stated: Some people, while resting normally, suddenly hear sounds of wind, rain, war drums, or horns in their ears. People attribute this to excessive Kidney Fire, but who knows it is actually extreme Heart Fire? Only when Heart and Kidney interact can they maintain clarity above and below to govern hearing and vision. Heart-Kidney non-interaction causes auditory chaos. However, for Kidney to interact with Heart, Heart must accept; for Heart to interact with Kidney, Kidney must accept, ensuring harmony. If Kidney Fire is excessively vigorous, Heart fears the Kidney's inflammation and dares not descend to interact with the Kidney, causing bilateral tinnitus. When Heart does not interact with Kidney, tinnitus is mild; when Kidney does not interact with Heart, tinnitus is severe. Hearing wind, rain, drums, and horns indicates severe tinnitus. The treatment aims to return Kidney Qi to Heart and Heart Qi back to Kidney, using Liang Gui Tang (Two-Return Decoction). Ingredients include Ophiopogonis Radix (Mai Dong) and Rehmanniae Radix Preparata (Shu Di Huang), each 1 liang; Salviae Miltiorrhizae Radix (Dan Shen) and Polygalae Semen (Fu Shen), each 3 qian; Ziziphi Spinosae Semen (Sheng Suan Zao Ren) 5 qian; and Coptidis Rhizoma (Huang Lian) 2 qian. Decoct in water and take orally. Tinnitus stops after two doses and does not recur after four. (This is a formula to cool the Heart. When the Heart is cooled, the Kidney does not fear the Heart's heat. The medicines correspond to returning, without needing mutual attraction to combine. They are entirely herbs benefiting the Heart and nourishing the Kidney, avoiding excessive dryness of the Heart and providing great moistening for the Kidney. Like a husband and wife in harmony, enjoying the joy of fish and water, how could there be sorrow of separation?)

Shen Dou Yuan stated: Tinnitus sounding like cicadas is caused by Liver-Gallbladder Fire and should be treated primarily with Long Dan Xie Gan Tang (Gentian Decoction to Drain the Liver). (From *Qi Xuan*)