TREATMENT OF TINNITUS, VERTIGO,
AND MENIERE'S DISEASE WITH CHINESE HERBS

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

TINNITUS

Chinese medical ideas about the cause and treatment of tinnitus and other hearing disorders were developed many centuries ago. In the Neijing Suwen (1), written around 100 B.C., several potential causes were mentioned. For example, it is stated: "Kidney qi communicates with the ears; when the kidneys are functioning well, the five types of sound can be heard." The term kidney (shen), as used by ancient Chinese doctors, refers to a functional complex that is today difficult to link to specific organs, but can be suggested to involve not only the kidneys, but also the endocrine system. According to the traditional ideas, kidney qi weakens with aging (especially after age 50) and difficulty with hearing, as well as failings of the other senses, particularly vision, arises as a result. We know from modern investigations that tinnitus may arise in conjunction with the common old age disorders of anemia, heart and blood vessel disorders (e.g., hypertension, hyperlipidemia, arteriosclerosis), and the accumulated effect of numerous ear infections or exposures to very loud noise over many years.

There are specific strategies for rectifying the kidney qi deficiencies described by Chinese physicians, and these same strategies are also applied (with only slight modifications) to a number of aging-related problems, such as lowered immune function, reduced libido and sexual responsiveness, achiness in the lower back and joints, fatigue and sleep disorder, and impairment of memory. What is specific about tinnitus is the spontaneous aural activity, which the Chinese usually interpret as a type of movement, signifying an agitation of the yang energy that ought to be more settled by presence of adequate yin. Such yang agitation can also cause dizziness, insomnia, and headaches.

It is also said in the Neijing that "When the yin fails to contain the yang, the flow in the channels will become rapid, causing the yang qi to become excessive and reckless. If the yang qi is deficient and unable to counterbalance the yin, communication between the internal organs will be disrupted, and the nine orifices will cease to function....When yin and yang are balanced, the five visceral organs function appropriately together....vision is clear and hearing is acute." According to this concept, both yang agitation (from yin deficiency) and yang deficiency can lead to disorders in hearing (the ears being two of the nine orifices; the eyes also being two of the orifices). In cases of yang deficiency, the body is overwhelmed by yin (substance) and the communication becomes blocked; organs don't interact properly with each other or with their external manifestations, such as eyes and ears.

Another cause is indicated in the Neijing for cases of acute loss of hearing: "a case of sudden onset [of symptoms], where the patient may pass out, lose hearing, or experience obstruction of the bowel or urine, is usually induced by chaos of the qi and blood within." In such cases, one must regulate the flow of qi and blood to restore normal functions. As to the cause of this chaos, the text continues: "Headaches, ringing in the ears, and obstruction of the nine orifices are usually caused by imbalances in the stomach and intestines." By improving dietary practices and by using harmonizing therapy to improve and coordinate the stomach and intestine functions, these problems may be alleviated.

According to the Advanced Textbook on Traditional Chinese Medicine and Pharmacology (2), in approaching treatment of tinnitus, it is important to distinguish between recently acquired disorders (acute, sudden onset) and long-term disorders (displaying gradual development), between continuous and intermittent tinnitus, and also between excess-type (attributed to accumulation of pathogenic substances affecting the ear) and deficiency-type (attributed to inadequate nutritional status). Excess-syndrome tinnitus is often experienced in one ear only (or begins distinctly in one ear and later develops in the second ear to a lesser extent), while deficiency-syndrome tinnitus tends to develop in both ears and intermittently may improve, being less severe during the day and obviously worse at night. A combination of deficiency and excess syndromes is possible, especially in persons with other illnesses or with tinnitus that has persisted for several years.

The specific syndromes described in the textbook include four primary types, the first two are in the excess category and the last two are in the deficiency category. The disorders of the liver, gallbladder, kidney, and spleen mentioned in these descriptions apply to the traditional depictions of the organ systems and may not relate directly to the modern structural and functional connotations of the named organs.

Type 1. An excess syndrome defined as being due to hyperactive liver and gallbladder fire. This manifests as sudden onset of tinnitus, usually continual sound, which may be accompanied by symptoms of the excess syndrome, such as headache, flushed face, restlessness, irritability, insomnia, and constipation. Though there can be other causes, this syndrome is believed to be due mainly to the experience of anger, violent rage, or fright, and the tinnitus may arise soon after becoming embroiled in situation that causes much anger. Persons who frequently drink alcohol to excess are especially subject to this syndrome. The traditional remedy for hyperactive liver and gallbladder fire is Gentiana Combination (Longdan Xiegan Tang), which can be modified to treat tinnitus by adding moutan, ligustrum, and eclipta (these additions are intended to rectify the problem of extreme or persistent liver fire weakening the kidney water).

Type 2. An excess syndrome defined as being due to retained hot phlegm (phlegm-fire syndrome). This typically manifests as intermittent ringing in the ears, like the chirping of cicadas, sometimes accompanied by the sensation that the ears are blocked, thus impairing hearing. Possible accompanying symptoms may include stuffiness in the chest, excess sputum production, dizziness, nausea, and difficulty in urination or defecation (these symptoms reflect the blockage, retention, and accumulation). This syndrome is believed to be due to improper diet, especially if there is much fatty and/or spicy food that is consumed regularly. A standard remedy for phlegm-fire syndrome is Bamboo and Hoelen Combination (Wendan Tang), and this formula is modified for treating tinnitus by adding pearl, haliotis, and uncaria in cases accompanied by hyperactive liver; or by adding lapis, scute, rhubarb, and aquilaria (Lapis and Scute Formula; Mengshi Guntan Wan) for cases of stuffiness in the chest, excessive sputum, and difficulty defecating. If the fire is not a major concern, but phlegm accumulation is evident, Pinellia and Gastrodia Combination (Banxia Baizhu Tianma Tang) may be used alone or with Bamboo and Hoelen Combination.

Type 3. A deficiency syndrome defined as being due to insufficient kidney yin (essence). This is a gradually worsening tinnitus (though it may reach a certain constant level and get no worse after that) which is accompanied by deficiency type symptoms such as dizziness, back ache, and weakness of the knees, sometimes accompanied by deficiency-heat symptoms, such as hot sensation of the palms/soles and facial flushing. This syndrome is often caused simply by the aging process (accumulated stress, lack of adequate nourishment, insufficient exercise, chronic depression, etc.), and may be worsened by experience of certain diseases (especially chronic or debilitating diseases). The standard remedy for kidney yin deficiency is the Rehmannia Six Formula (Liuwei Dihuang Wan), which is modified to treat tinnitus by adding magnetite and schizandra. In more severe cases, one may add tortoise shell, gelatin, dragon bone, oyster shell, ligustrum, and morus fruit to further nourish yin and settle agitated yang (that is not controlled by the yin, blood, and essence).

Type 4. Deficiency syndrome defined as failure of clear qi to ascend. This manifests as intermittently occurring tinnitus that is alleviated by rest and aggravated by stress. Other possible symptoms of the deficiency include lassitude, poor appetite, and loose stools. This syndrome is caused by a yang deficiency affecting the spleen system, which may result from stress and worry, inadequate nutrition, or poor eating habits. The standard remedy for failure of clear qi to ascend to the head is Ginseng, Astragalus, and Pueraria Combination (Yiqi Chongming Tang), which was developed for treatment of auditory difficulties, mainly deafness and tinnitus, and for treatment of reduced visual acuity; it was first reported in the Yuan Ji Qi Wei (1370 A.D.).

In an article on treating sensorineural hearing loss (3), Sun Aihua gives the following background information on tinnitus and hearing loss, taking a somewhat different, but overlapping, perspective compared to the textbook definitions:

According to TCM theory, deafness and tinnitus are related to dysfunction of kidney, heart, liver, gallbladder, and spleen. Feebleness of kidney qi, deficiency of kidney yin, vertigo or facial tic due to dysfunction of the liver [i.e., liver yang agitation], stagnation of liver qi, deficiency of heart qi, and diminished vitality of spleen are the causes of deafness and tinnitus. Ye Tianshi, a noted Qing Dynasty physician, pointed out that the ear was connected with the kidney, heart, and gallbladder in various ways. He stressed heart and kidney in treating deafness in the feeble, but in deafness due to harmful environmental factors he stressed the gallbladder channel in treatment, concluding that the main principles to follow were "clearing the upper and suppressing the lower parts of the body." The actual methods of treatment were "reinforcing kidney, invigorating heart, purging gallbladder, etc." Recent investigations on the pathophysiology of sensorineural hearing loss have generally pointed to disorder of microcirculation of the inner ear as a main disturbance. "Promoting blood circulation and relieving stasis" is, therefore, a method of choice in correction.

In this depiction, there are two ideas mentioned beyond those listed in the Advanced Textbook: an old concept of deficiency of heart qi (which is not pursued in modern clinical practice) and the newer finding of disruption of normal blood circulation (which several Chinese physicians pursue in treatment of deafness and tinnitus, along with the traditional methods).

SAMPLE CLINICAL TRIAL

In the Chinese Journal of Integrated Traditional and Chinese Medicine (4), a clinical trial for treatment of tinnitus was described. A basic formula was designed, which would be modified for different types of tinnitus. The basic formula contained:

This formula, which primarily treats the deficiency of spleen and kidney with a heavy dose of polygonatum, differs from those described in the Advanced Textbook by adding tonification for yang deficiency (epimedium, cynomorium) as well as herbs for vitalizing circulation of blood (persica and earthworm). Hu-chang helps treat heat and dampness, as occurs in excess-type disorders; it is also used to promote blood circulation, and it has been recognized as a remedy for tinnitus since ancient times, having been mentioned for that purpose in the 7th century book Qianjin Yaofang. These adjustments reflect the modern physician's view that tinnitus often arises from a combination of yin and yang deficiency and that the damage to the ear involves a blood stasis syndrome (a disorder emphasized in Chinese clinical practice during the past century, and mentioned by Sun Aihua).

For the tinnitus of type 1 described above, add to the basic formula:

These herbs quell the liver and gallbladder fire and settle the agitated liver yang.

For the tinnitus type 2 described above, add to the basic formula:

These herbs clear heat and dry dampness (forsythia, gardenia), and open up the congested circulation to the head (pueraria, cimicifuga, morus leaf).

For the tinnitus type 3 described above, add to the basic formula:

These herbs nourish the yin (rehmannia, asparagus, ophiopogon), and normalize the circulation of blood (cyathula, achyranthes) and the upward/downward flow of yang qi (cimicifuga, magnetite). The type 4 tinnitus was not mentioned in this article.

There were 38 persons treated, with tinnitus caused by infections, loud sounds, or accompanying hypertension, mental disorders, extreme fatigue, or drug side-effects. The herbs were decocted in the proportions indicated above and served as a tea once per day. Lidocaine was also administered to the patients by IV drip or by application to the tympanum. As a result of the treatment (one month), 9 of the patients were then free of the tinnitus, 22 were free of tinnitus during the day, but could still detect some during the quiet night time with varying degrees of threshold sound, and 7 of the patients did not respond.

In considering these results and the possible application of similar therapies in the West, the following should be considered:

1. The "types" of tinnitus represent general categories; most individuals will show a mixture of signs and symptoms that may seem to confuse the situation. The practitioner must use the differentiation of types of tinnitus merely as a guidepost to analysis and treatment. Note that the formulas used in the clinical evaluation included a mixture of the therapeutic principles.
2. The patients took a high dosage decoction daily. The herb combinations contained from about 170 to 200 grams of herbs, an amount that far exceeds what is often prescribed by Western practitioners. If the treatment results are dosage dependent, as is expected to be the case, then a lower dosage may yield a more modest result.
3. The lidocaine treatment is unlikely to be used here (especially its application by IV drip); its contribution to the effectiveness of the therapy is unknown.

Shao Nianfang, writing his personal experiences about treating tinnitus in his book Treatment of Knotty Diseases with Chinese Acupuncture and Chinese Herbal Medicine (5), has this to say about analysis of the disorder and the results of treatments:

In general, acute tinnitus and deafness pertain to excess. In cases due to wind-phlegm-fire invasion of the upper part, namely the sensitive orifices of the ear, it is proper to treat with the clearing and purging method of the liver and gallbladder, to extinguish wind, and resolve phlegm. A prompt recovery will usually ensue. Cases with gradual development of chronic tinnitus and deafness usually pertain to deficiency of essence, blood, and qi; in such cases it is suitable to replenish the essence and blood, reinforce the spleen and promote qi. Slow recovery is usually the case, so the therapist has to be patient in treating such cases. It is advisable to combine the use of acupuncture therapy [with the herb therapy]. In difficult and knotty cases, herbs that activate the circulation and meridians, such as cnidium, carthamus, persica, red peony, pangolin scales, liquidambar, earthworm, and silkworm, can be used to enhance the replenishing and stimulant action. No matter whether the disease is of the excess or deficiency type, it is important to add bupleurum, cimicifuga, acorus, curcuma, pueraria, or others as guiding herbs to lead the other ingredients to the proper channel to enhance the therapeutic effects.

In another clinical trial (6), 100 patients with type 1 tinnitus (persistent ringing of the ear, in one ear only) were divided into two groups, one receiving Chinese herbs and the other receiving Western medicine. The basic Chinese herb formula was markedly different than the one reported above:

This formula combines the principles of nourishing the kidney and liver (lycium fruit, ligustrum, morus fruit, ho-shou-wu, rehmannia, cornus), clearing phlegm-obstruction of the orifices (polygala and acorus), promoting microcirculation of blood (salvia), and settling agitated yang (magnetite). In addition, the traditional formula Suanzaoren Wan (Zizyphus Formula), which nourishes the liver and settles fire agitation, was given in pill form, 10 grams at a time, twice daily (at noon and before going to sleep). The treatment would be modified according to symptom presentation as follows:

for kidney qi deficiency: add 12 g cuscuta and 30 g dioscorea;

for heart and spleen deficiency, add 15 g codonopsis, 12 g astragalus, and 15 g longan, removing ligustrum, morus fruit, and lycium fruit from the base formula;

for liver fire, add 9 g gentiana, 12 g gardenia, 12 g bupleurum and 10 g peony, removing rehmannia, ho-shou-wu, and cornus from the base formula.

The herbs were given daily for 5 weeks. The control group took carbamazepine (Tegretol; this drug inhibits transmission of impulses at certain nerve terminals and is used for excitability of nerve fibers in the brain; it is more commonly applied in treatment of tic douloureux and epilepsy). In the Chinese herb group, 14 of the 50 patients were improved and in the Western drug group 12 of 50 improved, there being no statistically significant difference between the results for the two groups. Analyzing these modest results of high dosage herb treatment over a 5 week period, the authors state that:

The cases in which there was a moderate tinnitus, with low frequency ringing, loudness less than 3 decibels above threshold value, and duration of the disorder being not more than one year, the results of treatment were good; by contrast, the high frequency ringing, loudness in excess of 8 decibels, and longer duration of the disorder did not show response to this treatment.

It is possible that the results of treatment in this trial were not as good as in the previous report because the doctors had failed to follow the traditional principles indicated for the selection of patients with persistent tinnitus in one ear: the decoction formula and the pill were both fundamentally tonic in nature, rather than purging the fire and clearing the phlegm-dampness, as would be indicated by the traditional style analysis.

In a study of sensorineural hearing loss (3) reported by Sun Aihua, the following formula was used:

This basic formula was modified as follows:

for evident stasis of qi and blood, add salvia, red peony, sparganium, and zedoaria

for vertigo and facial tic, add uncaria, chrysanthemum, and lumbricus (earthworm)

for kidney yin deficiency, add ligustrum, eclipta, and lycium

for deficiency of qi and blood or spleen dampness, add codonopsis, atractylodes, pinellia, and tang-kuei.

The decoction of the resulting formula was given once per day. In addition, oral iron supplements were given three times daily, along with vitamin C and vitamin B₆ to enhance iron absorption. Lidocaine was given intravenously 4 days a week in patients suffering from dizziness and tinnitus.

As a result of therapy, which continued for as many days as needed to get a steady result (minimum of 20 days), or was eventually terminated after three months if no benefit was detected, it was reported that of 183 affected ears in 108 patients, 10 of the ears had full hearing recovery, 54 of the ears had marked improvement in hearing, and 46 ears had a slight improvement. In looking for factors that influenced ability to fully or partially recover normal hearing, the authors noted:

Less satisfactory results were obtained when the deafness was due to noise [i.e., repeated exposure to loud noise] or recurring attacks of Meniere's disease. No improvement was observed in 12 ears with ototoxic deafness [i.e., the result of drug side-effects that persisted]. The shorter the duration [of deafness], the better the result. 73.5% of the ears affected for less than a year responded to treatment; 52.2% of the ears deaf for over a year responded....It is generally believed that severe or profound hearing loss was much more difficult to treat than the mild, moderate, or moderately severe. However, our study revealed no significant influence of severity of the disease on therapeutic results, and we obtained satisfactory results in no few cases of severe or profound hearing loss....Patients over 40 years of age showed less satisfactory response than younger persons; we obtained few satisfactory results in patients over 55.

Thus, younger age and early intervention should yield a good prognosis, while older age and delayed intervention should yield a poor prognosis, while severity of hearing loss is not an inherent factor. This latter claim differs from that in a tinnitus study mentioned above, where the severe cases responded less well than the mild cases. However, in that report, the overall effects of treatment were not as good as in the other studies and the severity of disease was linked, in the analysis, with duration of disease, which most physicians consider an important factor in outcome; thus, the authors may have simply observed improved results with shorter duration of the disorder.

VERTIGO AND MENIERE'S DISEASE

Vertigo refers to a type of dizziness, and Meniere's disease refers to aural vertigo, or recurrent vertigo that is accompanied by hearing loss and/or tinnitus. Meniere's disease usually occurs in "attacks" that last 3-24 hours and then gradually remit. The disease involves the inner ear; in those with persisting Meniere's disease, hearing loss gradually develops and there may be tinnitus which worsens in association with an attack (the worsening may slightly precede or antedate the attack or it may occur during the attack). In severe cases, modern physicians may perform a surgical procedure (vestibular neurectomy) to halt the nerve impulses associated with the symptom of vertigo.

Traditional Chinese physicians divide vertigo into four major categories, two associated with excess type conditions and two associated with deficiency type conditions, as outlined in the Advanced Textbook on Traditional Chinese Medicine and Pharmacology:

1. Hyperactivity of kidney yang, secondary to a syndrome of liver qi stagnation, development of liver fire, and damage to the liver yin. The standard treatment for this type of problem is Gastrodia and Uncaria Combination (Tianma Gouteng Tang), which may be modified to treat vertigo by adding chyrsanthemum, tribulus, and prunella (or other modifications as appropriate to the specific presentation of symptoms).
2. Retention of turbid phlegm in the middle burner, which results from eating too much greasy and/or sweet foods, working too much, and, as a result, impairing the ability of spleen and stomach to transport and transform. The standard treatment for this type of problem is Pinellia and Gastrodia Combination (Banxia Baizhu Tianma Tang), though sometimes Hoelen Five Herb Formula (Wuling San) is given in mild cases to drain the excess dampness; when the dampness-phlegm syndrome is severe, hoelen and alisma (ingredients of Wuling San) are added to the Pinellia and Gastrodia Combination. If the phlegm combines with a fire syndrome, then Bamboo and Hoelen Combination (Wendan Tang) may be used instead or along with Pinellia and Gastrodia Combination.
3. Deficiency of kidney essence (yin), which may be the result of congenital deficiency, aging, or excessive stress on the kidney system. The standard remedy for this problem is either Rehmannia Six Formula (Liuwei Dihuang Wan) or Zuogui Wan (Left Returning Pill, referring to restoration of yin to the left kidney); this formula may be modified, if necessary, to address symptoms such as deficiency heat, or to address accompanying kidney yang deficiency.
4. Deficiency of qi and blood, which may result from prolonged illness, massive blood loss, or chronic deficiencies of spleen and stomach function. The standard remedy for this type of problem is Ginseng and Longan Combination (Guipi Tang); in cases of weakened stomach function, shen-chu, hoelen, and dioscorea can be added.

In general, the treatment of Meniere's disease parallels that of tinnitus and deafness. However, the symptom of dizziness connotes, to most physicians, an accumulation of dampness in the head, so that there is greater emphasis on treating the type 2 vertigo described above, while simple tinnitus or loss of hearing (not accompanied by significant dizziness) is more frequently treated by tonifying the deficiency of qi , blood, and yin (the strategies involved in type 3 and type 4 vertigo).

Combination syndromes are likely. For example, a person with chronic poor diet may accumulate phlegm and dampness, but not adequately nourish qi and blood; with aging, the lack of nourishment can lead to kidney yin deficiency, which results in liver yin deficiency; the combination of liver yin and blood deficiency contributes to liver fire and liver yang rising, carrying with it the pathological fluids that have accumulated. Thus, an elderly person may suffer from Meniere's disease simply as a consequence of long-term dietary indiscretion along with aging. These combination syndromes can also arise via other pathways; for example, emotional distress may cause liver qi stagnation which will lead, over the long run, to the problem of liver fire and liver yang rising; in the meantime, this problem yields disturbance of the spleen and stomach (liver qi adversely affecting these organs) and weakening of kidney yin under the influence of liver fire. In the case of such combination syndromes, it is important to evaluate the extent of excess and deficiency that exists and treat accordingly. In some cases, one can first clear some of the excess (relatively quickly) and then treat the deficiency (over an extended period of time); in other cases, the deficiency may be so severe that it needs to be treated in order to help alleviate the excess. A survey of the Chinese literature indicates that Meniere's disease is usually more easily treated than persistent tinnitus and deafness.

SAMPLE CLINICAL TRIAL

In a report by Wang Jian (7), the following formulations were said to be effective for Meniere's disease patients:

Base Formula, Wuling San (made as decoction):

Modifications: in patients with nausea and vomiting, add 10 grams fresh ginger and 12 grams pinellia; in patients who additionally have palpitation, fidgetiness, and anxiety, add 15 grams curcuma and 15 grams uncaria.

The decoction is prepared and consumed in three divided doses per day. All the patients were reported to have had their symptoms alleviated; the duration of treatment was 2 to 45 days of taking the herbs. In some cases, the herbs might not have been taken consecutively for all days; for example, if one week of therapy resulted in improvement, the herb use may have stopped, but if the symptoms relapsed a little later, then the herb therapy would be taken again. A follow-up was done seeking long-term evidence of relapse. Among the 30 patients that had a prior history of several attacks of Meniere's symptoms, there were 8 patients who had one relapse during the year, which could be alleviated by again taking the herbs; there were 18 cases that did not have a relapse during the first year after therapy, and there were 4 cases that had no relapse for at least five years. Of the 30 patients that were treated after their first Meniere's attack, there were no further attacks during a follow-up of more than one year.

Wuling San and its modifications are relatively easily administered by Western physicians using dried decoctions. The daily dosage of decoction, about 80-110 grams, used in the study reported here corresponds, roughly, to about 20 grams of the dried decoctions. If administered three times daily, the dosage of dried decoctions would be about two heaping teaspoons each time. Because the treatment time is not particularly long, the level of compliance may be high. In a review of Meniere's disease clinical research published in Modern Clinical Necessities for Traditional Chinese Medicine (8) the reported treatment times included a mean duration of 5.4 days for a formula similar to those used for treating tinnitus, and, in another study, it was stated that 7-8 days treatment was sufficient to resolve most cases.

REFERENCES

1. Maoshing Ni, The Yellow Emperor's Classic of Medicine: A New Translation of the Neijing Suwen with Commentary, 1995 Shambhala, Boston, MA.
2. State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, (4 vol.) 1995-6 New World Press, Beijing.
3. Sun Aihua, A preliminary report on combined traditional Chinese and Western medicine in sensorineural hearing loss, Journal of Traditional Chinese Medicine 1982; 2(3); 215-222.
4. Jiang Shuren and Tao Lubing, Audioawakening formula plus lidocaine applied to treat 38 cases of tinnitus and deafness, Chinese Journal of Integrated Traditional and Chinese Medicine, 1992; 12(8): 506-507.
5. Shao Nian-fang, The Treatment of Knotty Diseases with Chinese Acupuncture and Chinese Herbal Medicine, 1990 Shandong Science and Technology Press, Jinan.
6. Zhang Qing and Zheng Ronghua, Subjective tinnitus treated by a traditional Chinese medicine comparative analysis on 100 cases, Journal of the Shanghai College of Traditional Chinese Medicine 1992 [incomplete reference information].
7. Wang Jian, Observation of 60 cases of Meniere's disease treated with modified Wuling San, Chinese Journal of Integrated Traditional and Western Medicine 1986; 6(5): 303.
8. Wang Qi and Dong Zhilin, Modern Clinical Necessities for Traditional Chinese Medicine, 1990 China Ocean Press, Beijing.
9. Hong-Yen Hsu, et al., Oriental Materia Medica: A Concise Guide, 1986 Oriental Healing Arts Institute, Long Beach, CA.
10. Werbach M, Nutritional Influences on Illness, 1993 Third Line Press, Tarzana, CA.

APPENDIX 1. MAGNETITE

Magnetite (cishi) is prominently mentioned in the Chinese literature for treatment of tinnitus, deafness, blurred vision, and dizziness. Its composition, according to Oriental Materia Medica (9), is 69% ferric oxide and 31% ferrous oxide. It is said that the best quality material is magnetized and is dark black. Magnetite is usually prepared in a decoction. When making a decoction and consuming the resulting fluid, the magnetic field is lost and one can imagine that the end result is nothing more than absorbing some iron, though one cannot know the extent of the natural product's influences. There are other iron compounds used in Chinese medicine. However, they are usually not said to treat the ear and eye disorders, at least in the Materia Medica references For example, hematite, which, like magnetite, is said to subdue the hyperfunction of the liver (exuberant yang), is comprised mainly of ferric oxide and silicon dioxide; is reputed to treat vomiting, regurgitation, asthmatic breathing, and hematemesis or epistaxis, among other signs of uprushing qi and blood, and to treat anemia; it is indicated for dizziness, but not mentioned for tinnitus and blurry vision. Pyritum (zirandong), is comprised mainly of ferrous sulfide, and it is primarily used for the treatment of damaged tendons and bones, and other injuries. The difference between the oxide and sulfide of iron may influence gastro-intestinal absorption, but should not otherwise alter what is ultimately provided, at least from a biochemical viewpoint: the body will absorb some iron.

The reason for these differences in reported effects between the mineral substances is not made evident in the medical texts, but there are some clues. Magnetite may be preferred for some cases of tinnitus and blurred vision because of its black color: it is often used in prescriptions that tonify the kidney, which is associated (in the Five Elements scheme) with the color black. The magnetic quality, which draws together, may be associated with a stabilizing property useful for vertigo, ringing in the ears, and blurring of vision. Hematite, by contrast, is red in color and may be associated with the heart (which is, in turn, associated with the bleeding and anemia conditions); it has a heavy quality, but not the unique magnetic aspect or black color. Pyritum has a color like that of copper or bronze and it has a crystalline appearance. Its reputation for healing injuries may be traced back to the early martial artists; pyrite is included in the "hit medicines," usually along with a few dozen other ingredients; these tend to be applied topically. An example of an internal pill for injuries is Shujin Zhuangli Wan, the pill for soothing and strengthening the tendons.

There is some evidence that iron deficiency contributes to tinnitus and that iron supplementation may alleviate tinnitus and deafness in some individuals (see below for nutrition and diet information). Worldwide, iron deficiency remains a nutrition and health problem, and it is particularly noted among infants and the elderly.

Despite the absence of Materia Medica references to it, the fact is that many modern treatments for visual and auditory disorders utilize hematite rather than magnetite: the two probably have the same actions on the disease. For example, under Meniere's Disease, the book Modern Clinical Necessities for Traditional Chinese Medicine (8) mentions a decoction made with 45 grams hematite, 8 grams pinellia, 18 grams plantago leaf, and 18 grams prunella; it was reported that 58 out of 86 cases were cured by this treatment and most other patients improved. A similar approach using magnetite was a decoction with 25 grams magnetite, 15 grams each of atractylodes, mother of pearl, and uncaria, 20 grams alisma, and 10 grams each chrysanthemum and cyathula. It was reported that 90 of 102 cases were cured.

A traditional prescription for vertigo, dizziness, and tinnitus is Zhengan Xifeng Tang (Decoction To Subdue Liver Wind), it contains: hematite and achyranthes (each 30 grams), dragon bone, oyster shell, tortoise shell, peony, scrophularia, and asparagus (each 15 grams), melia, malt, and capillaris (each 6 grams), and a small dose of licorice. This formula is frequently cited for its interesting design concept. Achyranthes helps the upward rushing blood to flow downward; the heavy sedating materials and the yin and blood nourishing agents settle the uprising yang of the liver. However, it is said that the liver is like a fierce general: if constrained, it will lash out. Therefore, the formula includes melia, malt, and capillaris to assure that flowing of qi from the liver. In other words, these herbs prevent a backlash from overcontrol of the liver by the other agents (see Treatment of post-stroke syndrome with Chinese herbs).

Another example of a traditional formula for vertigo and tinnitus is Jian Ling Tang (the name is difficult to translate properly); it contains 24 grams hematite, with 30 grams each dioscorea and achyranthes, and 18 grams each of dragon bone, oyster shell, and rehmannia; this is supported with 12 grams each peony and biota.

Magnetite is included in a traditional formula indicated for darkening of vision (rather than blurring vision), in Bushen Cishi Wan (Tonify Kidney Magnetite Pill) comprised of equal parts haliotis (the Chinese name of this shell means vision clarifying stone), chrysanthemum, magnetite, cistanche, and cuscuta. A traditional formula for dizziness, dim vision, deafness, and tinnitus is Erlong Zuoci Wan (Left Kidney Ear Improving Pill), made of Rehmannia Six Formula (Liuwei Dihuang Wan) with magnetite, acorus, and schizandra added. A modern patent medicine version of this is Erming Zuoci Wan, which is made of Rehmannia Six Formula with magnetite and bupleurum added.

In sum, though magnetite is the specified ingredient for treating tinnitus, dizziness, hearing loss and visual disturbance, hematite appears to be used equally.

APPENDIX 2. NUTRITIONAL APPROACHES

A review of nutritional effects on inner ear disorders, including tinnitus and Meniere's disease, is presented by Melvyn Werbach in his book Nutritional Influences on Illness (10). The following are tentative conclusions from the medical literature:

1. Hyperlipidemia, obesity, and low tolerance to glucose appear to correlate with higher risk of hearing loss, dizziness, and Meniere's disease. Reducing fat intake reduces the hearing and vertigo problems in some; reducing sugar intake and total caloric intake is helpful for the disorders in those with sugar intolerance and obesity.
2. Vitamins A and D, and the minerals fluoride, iron, and zinc tend to be low in persons with hearing disorders, and supplementation alleviates the problem in some patients.
3. There is some indication that bioflavonoids and omega-3 fatty acids (fatty acids) can yield improvements in persons with hearing disorders and Meniere's diseases.

It is interesting to note that from the Chinese perspective, the condition of hyperlipidemia and obesity is considered to be a phlegm-accumulation syndrome (see Obesity and hyperlipidemia) and that excess-type tinnitus and Meniere's (especially type 2 as depicted in this article) is attributed to phlegm accumulation (see A study guide to phlegm-resolving herbs). Nutritional deficiencies often occur in the elderly and have been associated with general deficiency syndromes as defined by Chinese physicians; some of the kidney tonic herbs provide fluoride, iron, and zinc; atractylodes, used in spleen-tonifying and dampness-resolving formulas, is a good source of vitamin A, and was traditionally recommended for the vitamin-A deficiency condition called night blindness. Bioflavonoids are active constituents of some of the herbs used to treat tinnitus and Meniere's disease, and they generally have the property of enhancing blood circulation. In Chinese diet therapy, fish (a source of omega-3 fatty acids) is recommended when there is an accumulation of fluids.

The role of iron needs further investigation. According to Sun Aihua (3):

Many references in ancient Chinese medicine literature indicates that deafness and tinnitus were treated with magnetitum, which has high iron content. Our basic prescription for deafness contained a large amount of magnetitum, though certain other compounds, such as ferric sulfate were added. Our experience indicated that the few cases treated with ferric sulfate alone also showed satisfactory results....Our series showed that patients with improved hearing after treatment usually had increased serum iron level, while there was no change in iron level in patients with no improvement. This would suggest that therapeutic effect correlates with serum iron level. We are scarcely prepared, however, to draw the conclusion that sensorineural hearing loss is related to disturbance of iron metabolism.

He goes on to point out that there can be tissue deficiency of iron even when there is no iron deficiency anemia (low plasma iron). Thus, the issue of the contribution of iron compounds administered as part of Chinese herb formulas, and the use of iron supplements is not yet resolved, but there are some grounds for suggesting certain nutritional supplements, including iron, for cases of tinnitus and deafness. Since iron is an oxidizing agent, many modern nutritionists caution against excessive iron administration; therefore, high iron doses should be limited to the standard treatment time (a few days for Meniere's disease, a few weeks for tinnitus), and then should be maintained at levels that support normal nutritional needs.

June 1998

Early Chinese depiction (1249 A.D.) of magnetite, showing its ability to attract little pieces of metal to it. Its magnetic action looks like the loving mother (cimu) reuniting with all the children, which accounts for its name (cishi; shi = stone; the character for ci has been changed slightly and now means magnetic).