Like the Chirping of Cicadas
More Formulas for Ear Diseases
Hearing difficulties are notoriously vexing to treat. We’ve looked at couple of different sources for discussions on treating the ears, both in terms of acupuncture and herbal medicine, but the literature is quite extensive and more treatment options may be found if we keep digging. Here is an abridged section of Lèi Zhèng Zhì Cái [Differentiation and Classification of Patterns and Treatments, 類證治裁, 1839] by Lín Pèiqín. The chapter is fairly long and includes infectious diseases that we seldom treat and insufflation methods that we rarely use, so I have edited those out for length. If you are curious about these edited bits [about 1300 words], let me know.
耳症論治
足少陰腎竅於耳，腎氣充則耳聽聰，故經言精脫者耳聾也。又言肝病氣逆，則頭痛耳聾，以膽附於肝，而膽脈上貫耳中也。精脫失聰，治在腎。氣逆閉竅，治在膽。凡耳聾以及耳鳴，治法悉准乎此。
Discussion and Treatment of Ear Diseases
The orifice of foot shàoyīn kidney is at the ear. If kidney qì fills the ears, they will hear clearly, therefore the classic says that in cases of essence desertion, there will be deafness. It also says that in liver disease, qì will counterflow, resulting in headache and deafness; this is because the gallbladder is attached to the liver, and the gallbladder vessel ascends to penetrate into the ear. In essence desertion hearing loss, treat the kidney. For qì counterflow blocking the orifices, treat the gallbladder. For all deafness as well as tinnitus, these are the standard treatment methods to know.
Comment: This is similar to other sources we’ve looked at, and indeed what I was taught in school, which is that if tinnitus is acute, it is due to pathogenic factors in the shàoyáng, and if chronic, it is due to depletion of kidney essence.
But then, Lín breaks it down still further:
第就中條析之，有因勞力傷氣者，補中湯加鹽水炒黃柏、知母、茯苓、菖蒲。有因房勞傷腎者，滋陰地黃湯、益腎散，加鹽炒知、柏。有因陰虛火動者，磁石六味丸加減。有因病後虛鳴者，四物湯加鹽炒知、柏。腎氣丸加磁石、龜板。
However, to analyze separately among them:
If the cause is physical taxation injuring the qì, [use] Bǔ Zhōng Tāng [Supplement the Center Decoction] plus brine-fried Huáng Bǎi [Cx Phellodendri], Zhī Mǔ [Rx Anemarrhenae], Fú Líng [Poria], Chāng Pú [Rz Acori Graminei].
If the cause is bedroom taxation injuring the kidney, Zī Yīn Dì Huáng Tāng [Enrich Yīn Rehmannia Decoction], Yì Shèn Sàn [Boost the Kidney Decoction], plus salt-fried Zhī Mǔ, and Huáng Bǎi.
If caused by yīn vacuity fire stirring, Cí Shí Liù Wèi Wán Jiā Jiǎn [Modified Magnetite Six Flavor Pill].
If the ringing caused by vacuity after an illness, Sì Wù Tāng [Four Substance Decoction] plus salt-fried Zhī Mǔ and Huáng Bǎi [or] Shèn Qì Wán [Kidney Qì Pill] plus Cí Shí [Magnetitum] and Guī Bǎn [Plastron Testudinis].
Comment: Lín lists the formula constituents at the end of the chapter, so they will appear below. Interestingly, contrary to what we saw when examining Xuē Jǐ’s text, the Bǔ Zhōng prescription is augmented by both Huáng Bǎi and Zhī Mǔ, sort of splitting the different approaches between the Lǐ and Zhū schools. The brine- and salt-frying enhances a given medicinal’s ability to enrich water.
有因心腎虧，肝陽逆，虛風上旋蒙竅者，用填陰鎮逆，佐以酸味入陰，咸以和陽。如山萸、地黃、磁石、龜板、天冬、麥冬、白芍、五味、牛膝、秋石。
If caused by heart and kidney depletion and counterflow liver yáng, with vacuity wind whirling upward to cloud the orifices, use replenishing yīn to settle counterflow, and assist using the sour taste to enter the yīn and salty to harmonize yáng. [Use medicinals] such as Shān Yú [Fr Corni], Dì Huáng [Rx Rehmanniae], Cí Shí, Guī Bǎn, Tiān Dōng [Rx Asparagi], Mài Dōng [Rx Ophiopogonis], Bái Sháo, Wǔ Wèi [Fr Schisandrae], Niú Xī [Rx Achyranthis Bidentatae], Qiū Shí [Depositus Hominis Urinae Praeparatum].
Comment: We saw a very similar passage in Zōu Shíchéng’s comments on Yè Tiānshì’s Lín Zhèng Zhǐ Nán Yī Àn (Clinical Guidelines and Medical Cases, 1746).
有臟氣逆為厥聾者，流氣散、當歸龍薈丸。有風入絡為風聾者，必兼頭痛，防風通聖散。有因怒氣壅者，流氣散、清神散。有因驚火鬱者，清膽湯。有氣閉猝聾者，芎芷散。有年久耳聾者，勝金透關散。有小兒耳聾者，通鳴散。
In cases where there is viscera qì counterflow turning into reversal deafness, [use] Liú Qì Sàn [Six Qì Powder], [or] Dāng Guī Lóng Huì Wán [Chinese Angelica, Gentian and Aloe Pill].
In cases where there is wind entering the network vessels turning into wind deafness, there will be simultaneous headache, [use] Fáng Fēng Tōng Shèng Sàn [Saposhnikovia Sage-Inspired Powder].
If the cause is anger congesting the qì, [use] Liú Qì Sàn, [or] Qīng Shén Sàn [Clear Spirit Powder].
If the cause is fright depressing fire, Qīng Dǎn Tāng [Gallbladder Clearing Decoction].
In cases where there is qì blockage [causing] sudden deafness, Xiōng Zhǐ Sàn [Chuanxiong and Angelica Dahurica Powder].
In cases of chronic deafness for years, Shèng Jīn Tòu Guān Sàn [Victorious Metal Barrier-Penetrating Powder].
For deafness in young children, Tōng Míng Sàn [Sound-Freeing Powder].
Comment: I will save the formula comments for the appended formulas section below.
有腎經熱，右耳重聽，兼苦鳴者，地黃湯。有肝膽火升，常聞蟬鳴者，龍膽瀉肝湯、清膽湯。有因痰火升而鳴者，加減龍薈丸。總之，由痰火者其鳴甚，由腎虛者其鳴微。
In cases where there is kidney channel heat, the right ear [will be] hard of hearing with concurrent pain and ringing, [use] Dì Huáng Tāng [Rehmannia Decoction].
If there is liver and gallbladder fire ascending, [one] constantly hears ringing like the chirping of cicadas, [use] Lóng Dǎn Xiè Gān Tāng [Gentian Liver-Draining Decoction], [or] Qīng Dǎn Tāng [Gallbladder-Clearing Decoction].
In cases caused by phlegm fire ascending with ringing, Jiā Jiǎn Lóng Huì Wán [Modified Gentian and Aloe Pill].
In general, if the cause is phlegm fire the ringing will be severe, if the cause is kidney vacuity the ringing will be slight.
耳症脈候
尺脈浮而盛為風，洪而實為熱，細而澀為虛，兩尺數為陰火上衝。
Ear disease pulse signs
Chǐ [proximal] pulse will be floating and exuberant if the cause is wind, flooding and repl ete if the cause is heat, thin and choppy if the cause is cold, and both chǐ will be rapid if the cause is yīn fire surging upward.
附方
Appended Formulas
〔補氣〕 補中湯
〔Supplement qì〕 Bǔ Zhōng Tāng
Comment: This another name for Bǔ Zhōng Yì Qì (Center-Supplementing Qi-Boosting Decoction) which we discussed in the Xuē Jǐ post linked above.
〔房勞〕 滋陰地黃湯 六味地黃 加 歸 芍 芎 菖蒲 遠志 知母 黃柏
〔Bedroom taxation〕 Zī Yīn Dì Huáng Tāng: Liù Wèi Dì Huáng plus Dāng Guī [Rx Angelicae Sinensis), Bai Sháo [Rx Paeoniae Alba], Chuān Xiōng [Rz Ligusticum Chuanxiong], Chāng Pú, Yuǎn Zhì [Rx Polygalae], Zhī Mǔ, Huáng Bǎi.
Comment: This is a large formula made up of a combination of Sì Wù Tāng plus Zhī Bǎi Dì Huáng Wán, plus the Chāng Pú/Yuǎn Zhì duì yào pair.
〔傷腎〕 益腎散 磁石 巴戟 沉香 菖蒲 川椒 各研末二錢，用豬腰子一個切開，和蔥白、食鹽，紙包煨，空心酒下。
〔Injury to the kidney〕 Yì Shèn Sàn: Cí Shí, Bā Jǐ [Rx Morindae], Chén Xiāng [Lignum Aquilariae], Chāng Pú, Chuān Jiāo [Pc Zanthoxyli], each ground to powder, 2 qián; use one pork kidney, cut open, mix with Cōng Bái [Blb Allii Fistulosi], Shí Yán [Sal, table salt], wrap in paper and roast, down with wine on an empty stomach.
Comment: A short formula which targets particularly the yáng aspect of the kidney while opening the orifices with aromatic and turbidity-transforming medicinals. Cí Shí is especially useful to treat problems of hearing, and thus pops up frequently in this chapter.
〔陰虛〕 磁石六味丸 六味地黃加磁石。
〔Yīn vacuity〕 Cí Shí Liù Wèi Wán: Liù Wèi Dì Huáng plus Cí Shí.
Comment: This is similar to Ěr Lóng Zuǒ Cí Wán [耳聾左磁丸, Deafness Left-Benefitting Lodestone Pill, which is probably the most commonly cited formula for hearing loss today.
〔病後〕 四物湯 地 芍 歸 芎
〔After illness〕Sì Wù Tāng: Dì Huáng, Bai Sháo, Dāng Guī, Chuān Xiōng
〔病虛〕 腎氣丸。(八味丸，此再加牛膝、車前。) (八味地黃丸 六味地黃丸加桂心一兩，名七味地黃丸，此再加附子一兩。)
〔Vacuity (after) illness〕 Shèn Qì Wán : Bā Wèi Wán plus Niú Xī, Chē Qián [Sm Plantaginis]. (Bā Wèi Dì Huáng Wán [Eight Flavor Rehmannia Pill] is Liù Wèi Dì Huáng Wán plus Guì Xīn [Cx Cinnamomi] 1 liǎng, known as Qī Wèi Dì Huáng Wán [Seven Flavor Rehmannia Pill], plus Fù Zǐ [Rx Aconiti Lateralis Praeparata] 1 liǎng.)
Comment: This formula is also known as 濟生腎氣丸 Jì Shēng Shèn Qì Wán. In both of these cases, the principle is to supplement either blood or kidney yáng / essence, rather than attacking the tinnitus directly.
〔氣逆〕 流氣散 參 苓 術 草 青 陳 芷 枳 檳 樸 藿 夏 桂 麥冬 香附 丁香 木香 木瓜 木通 腹皮 草果 蓬朮 菖蒲 蘇葉
〔Qì counterflow〕 Liú Qì Sàn: Rén Shēn [Rx Ginseng], Fú Líng [Poria], Bái Zhú [Rz Atractylodis Macrocephalae], Gān Cǎo [Rx Glycyrrhizae], Qīng Pí [Pc Citri Reticulatae Viride], Chén Pí [Pc Citri Reticulatae], Bái Zhǐ [Rx Angelicae Dahuricae], Zhǐ Shí [Fr Aurantii Immaturus], Bīng Láng [Sm Arecae], Hòu Pò [Cx Magnoliae], Huò Xiāng [Hb Pogostemonis] Bàn Xià [Rz Pinelliae], Guì Zhī [Rm Cinnamomi], Mài Dōng, Xiāng Fù [Rz Cyperi], Dīng Xiāng [Fl Caryophylatae], Mù Xiāng [Rx Aucklandiae]. Mù Guā [Fr Chaenomelis], Mù Tōng [Caulis Akebiae], Dà Fù Pí [Pc Arecae], Cǎo Guǒ [Fr Tsaoko], Péng Zhú [Rz Curcumae], Chāng Pú, Sū Yè [Fm Perillae].
Comment: This prescription incorporates elements of various formulas such as Xiāng Shā Liù Jūn Zǐ Tāng (Aucklandia and Amomum Six Gentlemen Decoction), Bàn Xià Hòu Pò Tāng (Pinellia and Magnolia Bark Decoction), Huò Xiāng Zhèng Qì Sǎn (Pogostemon Correct Qì Powder), and Dá Yuan Yǐn (Membrane-Source-Opening Beverage). In this case, the viscera qì counterflow stems from obstruction by cold-dampness with underlying spleen qì vacuity.
〔氣逆〕 當歸龍薈丸。
〔Qì counterflow〕 Dāng Guī Lóng Huì Wán.
Comment: Ingredients are not given in the source text. Formula composition in the Chinese Medicine Database (http://cm-db.com/) is Dāng Guī, Lóng Dǎn Cӑo [Rx Gentianae], Zhī Zĭ, Huáng Lián [Rz Coptidis], Huáng Bǎi, Huáng Qín [Rx Scutellariae Baicalensis], Lú Huì [Hb Aloes], Qīng Dài [Pulverata Indigo], Dà Huáng [Rx et Rz Rhei], Mù Xiāng, Shè Xiāng. In this case, the viscera qì counterflow stems from fire in the liver and gallbladder.
〔風聾〕 防風通聖散 荊 防 歸 芍 芎 術 苓 梔 桔草 連翹 麻黃 薄荷 大黃 芒硝 石膏 滑石 蔥。
〔Wind deafness〕 Fáng Fēng Tōng Shèng Sàn: Jīng Jiè [Hb Schizonepetae], Fáng Fēng [Rx Saposhnikoviae], Dāng Guī, Bai Sháo, Chuān Xiōng, Bái Zhú, Fú Líng, Zhī Zĭ, Jié Gěng, Gān Cǎo, Lián Qiáo, Má Huáng [Hb Ephedrae], Bò Hé [Hb Menthae], Dà Huáng, Máng Xiāo [Mirabilitum], Shí Gāo [Gypsum], Huá Shí, Cōng Bái.
Comment: For a relatively robust presentation which includes heat in the interior as well as wind invading the exterior.
〔怒氣〕 清神散 羌 防 荊 芎 菊 草 殭蠶 木通 木香 菖蒲。
〔Anger qì〕 Qīng Shén Sàn: Qiāng Huó [Rx Notopterygii], Fáng Fēng, Jīng Jiè, Chuān Xiōng, Jú Huā [Flos Chrysanthemi], Gān Cǎo, Jiāng Cán [Bombyx Batryticatus], Mù Tōng, Mù Xiāng, Chāng Pú.
Comment: Interesting that anger is treated here primarily by acrid exterior-releasing. Jú Huā also clears liver heat, Mù Tōng can clear fire from the heart, Mù Xiāng is a ghost herb and Chāng Pú opens the orifices. The alternative formula given for this etiology is Liú Qì Sàn, discussed above.
〔火鬱〕 清膽湯 青蒿 菊葉 薄荷 連翹 苦丁茶 荷葉。
〔Fire depression〕 Qīng Dǎn Tāng: Qīng Hāo [Herba Artemisiae Annuae], Jú Yè, Bò Hé, Lián Qiáo, Kǔ Dīng Chá, Hé Yè [Fm Nelumbinis].
Comment: An interesting choice for treating fright-induced fire depression in that it is by all appearances a warm disease formula. Its mechanism of action is to clear deep-lying heat with Qīng Hāo and vent it outward through the more superficial levels with cool acrid qì- and wèi-level clearing herbs. Lián Qiáo enters the heart, clears ying-level heat from the pericardium, and disperses binds. Contrast the actions of Lóng Dǎn Xiè Gān Tāng, which is the alternative given in one of the examples above, this time for ascending liver-gallbladder fire.
〔氣閉〕 芎芷散 川芎（錢半） 芷 辛 樸 夏 陳 蘇 桂 草 蒼朮 木通（各七分） 姜（三片） 蔥白（二莖）。
〔Qì blockage〕 Xiōng Zhǐ Sàn: Chuān Xiōng (1.5 qián); Bái Zhǐ, Xì Xīn [Hb Asari], Hòu Pò, Bàn Xià, Chén Pí, Sū Yè, Guì Zhī, Gān Cǎo, Cāng Zhú [Rz Atractylodis], Mù Tōng (each 7 fēn); Shēng Jiāng [Rz Zingiberis Recens], (3 slices); Cōng Bái (2 stalks) .
Comment: This formula combines elements of Chuān Xiōng Chá Tiáo Sǎn (Ligusticum Chuanxiong Powder to Be Taken with Green Tea) with Bàn Xià Hòu Pò Tāng and Píng Wèi Sǎn (Stomach-Balancing Powder). Releases the exterior and opens shàoyáng, yángmíng, and shàoyīn channels reaching the head, but also opens the chest and mobilizes qì throughout the upper burner.
〔久聾〕 勝金透關散 鼠膽 川烏 細辛 膽礬 麝香
〔Chronic deafness〕 Shèng Jīn Tòu Guān Sàn: Shǔ Dǎn [Vesica Fellae Ratti, rat’s gallbladder], Chuān Wū [Rx Aconiti Praeparata], Xì Xīn, Dǎn Fán [Chalcanthitum], Shè Xiāng.
Comment: Shǔ Dǎn [Vesica Fellae Ratti, rat’s gallbladder] is bitter and cold, and enters the heart, gallbladder, and liver channels. It treats clear-eye blindness, sparrow's-eye [i.e. night] blindness, and purulent ear (Wiseman & Brand, 2020). Obviously a formula for historical interest only.
〔小兒〕 通嗚散 菖蒲 遠志 防風 柴胡 麥冬 細辛 杏仁 磁石 葶藶 蔥白湯下。
〔Pediatric〕 Tōng Wū Sàn: Chāng Pú, Yuǎn Zhì, Fáng Fēng, Chái Hú [Rx Bupleuri], Mài Dōng, Xì Xīn, Xìng Rén [Sm Armeniacae], Cí Shí, Tíng Lì [Sm Lepidii], decoct with Cōng Bái and drink.
Comment: This is given as Tōng Míng Sàn (通鳴散) above. The prescription opens the orifices, opens the surface, clears the heart, downbears lung qi, and transforms rheum. Cí Shí sharpens the hearing, anchors and settles. Personally I would be inclined to substitute for both Xì Xīn and Tíng Lì, the former because of toxicity while the latter seems a bit strong for little spleens.
〔腎虛〕 六味湯 熟地黃（酒蒸曬）萸肉 山藥 茯苓 丹皮 澤瀉。
〔Kidney vacuity〕 Liù Wèi Tāng: Shú Dì Huáng (wine-steamed, sun-dried); Yú Ròu [Fr Corni], Shān Yào [Rz Dioscoreae], Fú Líng, Dān Pí [Cx Moutan], Zé Xiè [Rz Alismatis].
〔肝火〕 龍膽瀉肝湯 龍膽草 黃芩 梔子 澤瀉 生地 木通 車前 當歸 柴胡 甘草。
〔Liver fire〕 Lóng Dǎn Xiè Gān Tāng: Lóng Dǎn Cǎo, Huáng Qín, Zhī Zĭ, Zé Xiè, Shēng Dì, Mù Tōng, Chē Qián, Dāng Guī, Chái Hú, Gān Cǎo.
〔痰火〕 加減龍薈丸 芩 梔 歸 柴 龍膽 大黃 青皮 青黛 蘆薈 膽星 木香 麝香 神麯糊丸。
Comment: Two formulas that need no introduction. But in case you want to read more about Lóng Dǎn Xiè Gān Tāng, here’s a link.
〔Phlegm fire〕 Jiā Jiǎn Lóng Huì Wán: Huáng Qín, Zhī Zĭ, Dāng Guī, Chái Hú, Lóng Dǎn Cǎo , Dà Huáng, Qīng Pí, Qīng Dài, Lú Huì, Dǎn Xīng [Rz Arisaematis Praeparata], Mù Xiāng, Shè Xiāng; make a paste with Shén Qū [Massa Medica Fermentata] and form into pills.
Comment: Compare with Dāng Guī Lóng Huì Wán above. This version contains Chái Hú, Qīng Pí and Dǎn Xīng to course the liver, rectify qì and transform phlegm-fire.
Okay, that’s more than enough for now.
A Quick Note
Substack is telling me that this is my 100th post. I suppose I never thought I would make it this far, as the material I post is typically pretty abstruse (this post being a good example). So I want to thank everyone who has taken the time to read the mulch, especially those of you who have hung in there for a year or two. I appreciate you.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Lìn, P. (1839). Lèi Zhèng Zhì Cái. Retrieved January 14, 2024, from https://jicheng.tw/tcm/book/%E9%A1%9E%E8%AD%89%E6%B2%BB%E8%A3%81/index.html.
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.