EARS AND EYES

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EARS AND EYES

Chapter contents

Feeling of distension of the eyes

EARS

The ears are the orifices of the Kidneys and for this reason tinnitus and deafness are often due to a Kidney deficiency. However, the ears are also influenced by many other organs including the Liver, Heart, Lungs and Gall-Bladder. In addition, although the Spleen is not directly related to the ears, Dampness or Phlegm (deriving from Spleen-Qi deficiency) may also affect the ears.

WHY WE ASK

I generally ask about any ear symptoms under three main circumstances: when there is a Kidney deficiency, Liver-Yang rising or Phlegm. In the last of these, Phlegm obstructs the orifices and may cause tinnitus or deafness.

WHEN WE ASK

I usually ask about any ear symptoms towards the end of the consultation, primarily to confirm a pattern of Kidney deficiency, Liver-Yang rising or Phlegm.

HOW WE ASK

When asking about tinnitus it is important to express this symptom in terms patients can understand. I generally ask them whether they experience any ‘ringing in the ears’. It is important to let the patient understand that even an occasional ringing in the ears has clinical significance.

In general terms, the ears may be affected by a pathology of Deficiency (usually of the Kidneys but also of Lung and Heart) causing tinnitus, hardness of hearing or deafness, or by one of Fullness, usually due to Heat or Phlegm.

The main deficiency patterns affecting the ear are:

• Kidney deficiency (or Yin or Yang) causing tinnitus or deafness, or both

• Lung-Qi deficiency causing tinnitus

• Heart-Blood deficiency causing tinnitus.

The main Full patterns affecting the ears are:

• Liver-Yang rising causing tinnitus and deafness

• Liver-Fire causing tinnitus and deafness

• Phlegm in the head causing tinnitus

• Damp-Heat in the Gall-Bladder causing earache.

Tinnitus

Symptoms and Signs, Chapter 57

Tinnitus is caused either by a failure of Qi to rise to the ears (Empty type) or by an excess of Qi in the ears (Full type). In order to differentiate between the Empty types and the Full types, we need to consider the onset, the pitch, the duration and the reaction to pressure of the tinnitus.

A sudden onset suggests a Full condition, which may be internal such as Liver-Fire or Liver-Wind, or external such as Heat in the Lesser Yang. A gradual onset suggests an Empty condition, which may be due to a deficiency of the Kidneys, Lung or Heart.

A loud, high-pitched, ringing noise like a whistle indicates Liver-Yang rising, Liver-Fire or Liver-Wind, whereas a low-pitched noise like rushing water indicates a Kidney deficiency.

Tinnitus of short duration is usually due to an external invasion of Wind-Heat affecting the Lesser Yang channels. Chronic tinnitus of long duration is due to either a Kidney deficiency or a Liver pathology (Liver-Yang rising, Liver-Fire, or Liver-Wind).

If the tinnitus is aggravated by pressing one’s hands on the ears, this suggests a Full condition; if it is alleviated it suggests an Empty condition.

Case history 42.1 illustrates a pattern of tinnitus caused by Yin deficiency.

Case history 42.1

A 56-year-old woman had been suffering from tinnitus for 3 years. The onset had been slow and gradual and the ear noise was low in pitch. She also suffered from poor memory, lack of concentration, blurred vision, dizziness and hot flushes (flashes). On asking her, it transpired that she also experience a dry mouth, anxiety and palpitations. Her urine was dark. She also said that she startled easily.

She also experienced occasionally a dull ache in the chest, with the pain sensation extending up to the neck like a ‘steel band’.

Her periods had stopped 2 years previously. Her tongue was Red, with a redder tip, entirely without coating and dry. Her pulse was Weak on both Rear positions and very slightly Wiry but Fine on the left.

This patient presents with very clear manifestations of Kidney-Yin deficiency (dark urine, tinnitus, dizziness, blurred vision, hot flushes) and Heart-Yin deficiency (poor memory and concentration, palpitations, anxiety and propensity to be startled). The condition of Yin deficiency is shown very clearly by the absence of coating, and the redness of the tongue (combined with the lack of coating) clearly indicates Empty-Heat. I interpreted the dull ache in the chest extending to the neck as a symptom of rebellious Qi of the Penetrating Vessel, a common complicating factor in menopausal problems. The Wiry quality of the pulse on the left supports this diagnosis.

Box 42.1 summarizes the patterns underlying tinnitus.

BOX 42.1 TINNITUS

• Lesser-Yang Heat pattern: tinnitus of sudden onset and alternation of chills and fever

• Liver-Fire or Liver-Yang rising: tinnitus of sudden onset with headache

• Liver-Fire, Liver-Wind or Liver-Yang rising: high-pitched tinnitus

• Kidney deficiency: low-pitched tinnitus

• Liver-Fire, Liver-Yang rising or Liver-Wind: chronic, severe tinnitus

• Kidney deficiency: chronic, mild, intermittent tinnitus

• Deficiency of Heart- and Lung-Qi: chronic, mild, intermittent tinnitus with palpitations and weak voice

Deafness

Symptoms and Signs, Chapter 57

The diagnostic criteria of deafness or hardness of hearing are similar to those of tinnitus: an acute onset points to Fullness, whereas a gradual onset points to Deficiency. The main Excess causes of deafness or hardness of hearing are Liver-Fire, Liver-Yang rising and Phlegm-Fire affecting the Liver channel.

The main Empty cause of deafness or hardness of hearing is a Kidney deficiency (the most common cause in the elderly). However, the Kidneys are not the only organ that influences the ears; hardness of hearing may also be caused by Heart-Blood, Heart-Yin, Lung- or Heart-Qi deficiency, or deficiency of the Gathering Qi (Zong-Qi) or Yang-Qi. In all these cases, hardness of hearing is due to Qi or Blood not flowing upwards to the ears.

Box 42.2 summarizes the patterns underlying deafness.

BOX 42.2 DEAFNESS

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