Ears Ringing Like Cicadas That Won’t Stop? Here’s How Doctor Xue Lizhai Fixed It

Patient search terms: tinnitus / ears ringing / ears buzzing / like cicadas calling / cicada-sound tinnitus / nervous tinnitus / tinnitus louder at night / kidney deficiency / spleen deficiency

Medical terms for this condition: tinnitus · primordial qi depletion · spleen-stomach qi deficiency · kidney yin deficiency · sinking of middle qi · spleen-kidney dual deficiency

Opening: yesterday the eyes, today the ears — what is tinnitus, really?

Doctor Luo Dalun picks up where the last lecture left off and continues the stories of how Doctor Xue Lizhai treated his patients. Yesterday the topic was the eyes and diseases of the ear; today we’re going to talk specifically about tinnitus.

Tinnitus, friends, is actually a very common complaint — you could say most people have some ringing in their ears at one time or another; they just don’t pay attention to it and get used to it. Ask around carefully and you’ll find tinnitus patients everywhere — in fact, a great many people come to the clinic precisely because of tinnitus. So what is tinnitus, really? Today, using one small case of Doctor Xue Lizhai’s, let’s talk it through properly.

💬 Note from Doctor Luo: Doctor Xue Lizhai was the director of the Imperial Academy of Medicine in the Ming dynasty, and he left behind more than three thousand case records. The patients in his cases lived very much like people today — which is why Xue Lizhai’s approach fits modern people so well. Today’s tinnitus case is very short, but the reasoning behind it is explained thoroughly. It’s worth savoring.

Who was the patient: Li Puting, junior minister of justice, with cicadas in his ears

The patient was Li Puting, a shao si kou — the deputy head of the Ministry of Justice, roughly the equivalent of a vice minister of justice today. A classic high-ranking government official.

His illness is described in the case record very vividly: ear-inner cicada singing (er nei chan ming). That is, his ears buzzed and rang continuously — like what? Like cicadas in summer — the tree cicadas going ziiiii — woooooo — calling without a moment’s pause.

💬 Note from Doctor Luo: “Cicada singing” (chan ming) is the classic way Chinese medicine describes a certain quality of tinnitus. The old doctors were extremely attentive to the sound itself: high or low, loud or faint — these are all diagnostic clues. Patients often can’t describe it clearly, so the doctor has to find the pattern hidden in their description.

How bad was it? The blood-nourishing Si Wu Tang made the ringing louder

Presumably Li Puting had seen doctors before coming to Xue Lizhai. How was he treated? He was given Si Wu Tang — dang gui (Chinese angelica), chuan xiong (Ligusticum), bai shao (white peony) and shu di huang (prepared rehmannia) — the classic blood-nourishing formula. Everyone’s reasoning went: tinnitus is usually blood deficiency, so nourish the blood and enrich yin — surely that’s right?

The result? The tinnitus grew worse (er ming yi shen) — not only did it not improve, it got worse!

💬 Note from Doctor Luo: Notice this detail: blood-nourishing herbs made the ringing worse, which tells you the problem was never blood deficiency — or at least not simple blood deficiency. It’s like winding the spring on a car that’s out of gas: the direction is wrong, and the harder you push, the worse it gets. Doctor Xue’s brilliance was seeing at a glance that the direction was wrong.

Doctor Xue’s verdict: this is a case of primordial qi depletion

There was nothing for it but to consult Doctor Xue Lizhai. Xue looked at the patient and delivered his judgment in six characters: ci yuan qi kui sun zhi zheng — “This is a case of primordial qi depletion.”

Primordial qi depletion — not blood deficiency, not excess fire, but a loss of the root qi of the whole person. So how did Xue Lizhai treat it? His method is very distinctive:

💬 Note from Doctor Luo: “Primordial qi depletion” is the key phrase of this whole case. Doctor Xue Lizhai emphasized the spleen and kidneys, favored warming supplementation, and was best at recognizing that many of the “wealthy-class diseases” treated as “excess fire” or “blood deficiency” actually had their root in depleted primordial qi. Once this judgment was made, the treatment followed naturally.

The unusual dosing schedule: a pill before dawn, a decoction before breakfast — cured at once!

The prescription Doctor Xue gave Li Puting was two formulas taken alternately:

• At the fifth watch (wu geng tian) — that is, between 3 and 5 in the morning, before the sky is light — take Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill), the pill;
• Before breakfast — after dawn, before eating — take Bu Zhong Yi Qi Tang (Supplement the Middle and Boost Qi Decoction), the decoction.

Taking the two in alternation like this, what was the result? The case record gives two characters: dun yu — cured at once — it was immediately better!

💬 Note from Doctor Luo: You see, this case record is very short, but the effect was astonishingly fast. Some people say Xue Lizhai treated slowly — a case could drag on for a year. But in this case he used ready-made classic formulas, didn’t delay a single day, and the patient was cured instantly. The speed of a cure has nothing to do with whether a formula is new or old — it’s about whether it matches the condition and whether you know how to use it. Doctor Xue’s skill here is entirely in how he paired the two formulas and what time of day he had the patient take them.

Why this schedule (1): the decoction is the main force, riding the morning’s rising yang

In this case, Bu Zhong Yi Qi Tang is the core, and Liu Wei Di Huang Wan is the support. Why do I say that? Look: Bu Zhong Yi Qi is given as a decoction (tang), while Liu Wei Di Huang is given as a pill (wan) — the decoction is the primary treatment, the pill the slow, steady reinforcement.

Why take Bu Zhong Yi Qi Tang before breakfast? Because the morning is the time when clear yang qi rises. In the forenoon, yang qi ascends — drink the decoction at that moment and, riding the rising momentum of yang, you lift the spleen-stomach qi upward. And note the order: the medicine comes before the meal — when the grain arrives it assists the stomach qi, so the medicine is more easily transformed and carried.

💬 Note from Doctor Luo: This is Doctor Xue’s “hidden method” — timing matters. In the morning yang rises, so he uses qi-supplementing, qi-lifting medicine; borrowing the momentum of heaven, you get twice the result with half the effort. For ordinary people doing daily self-care, you really only need the big rhythm: take Bu Zhong Yi Qi Tang in the morning and Liu Wei Di Huang Wan in the evening — yang by day, yin by night. Follow that rhythm; there’s no need to copy the 3 a.m. rising.

Why this schedule (2): the pill guards the kidneys and keeps deficiency fire from rushing up

So why take Liu Wei Di Huang Wan at the fifth watch? Doctor Xue’s concern was subtle: this gentleman is certainly kidney-deficient. “I’m lifting yang qi upward — but if your kidney qi is insufficient and there’s deficiency fire below, what if that fire rides up together with the rising yang? And if kidney qi is weak, when I lift the qi, won’t the lower part go even more empty?”

So at the fifth watch — precisely when yang qi begins to stir — he first supplements the kidneys with Liu Wei Di Huang Wan. That formula is “three tonics, three drains”: shu di huang, shan zhu yu (cornus) and shan yao (Chinese yam) are the tonics; ze xie (alisma), mu dan pi (moutan bark) and fu ling (poria) are the drains — it both nourishes kidney yin and drains off deficiency fire. Once the kidney qi is a little replenished, the forenoon’s Bu Zhong Yi Qi Tang lifts the qi — both ends are looked after.

💬 Note from Doctor Luo: The pairing principle of “Bu Zhong Yi Qi Tang plus Liu Wei Di Huang Wan” comes right from Xue Lizhai. Doctor Luo says he himself learned this method from Xue Lizhai’s cases, then introduced it to patients, and ordinary people got genuinely good results with it. One formula tonifies the spleen and raises yang, the other tonifies the kidneys and nourishes yin — one lifts, one secures; the division of labor is crystal clear.

Doctor Xue’s systematic guide to tinnitus: blood deficiency, qi deficiency, anger, morning or afternoon — each has its own formula

Attached to this case, Doctor Xue Lizhai lays out his whole approach to treating tinnitus, clearly divided by pattern:

• Blood deficiency with fire: use Ba Zhen Tang (Eight Treasures Decoction — Si Jun Zi Tang combined with Si Wu Tang, tonifying both qi and blood) plus zhi zi (gardenia) and chai hu (bupleurum) — gardenia clears fire, bupleurum clears the lesser yang (shao yang) pathogen. The ears are connected to the liver-gallbladder and the gallbladder channel, and pathogenic fire of the lesser yang channel is something tinnitus treatment can address;
• Qi deficiency with fire: use Si Jun Zi Tang (Four Gentlemen Decoction — ren shen, bai zhu, fu ling, gan cao) plus gardenia and bupleurum;
• Sudden deafness or violent ringing triggered by anger: the ears go whump — suddenly you can’t hear, or the ringing is especially solid and loud — use Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus chuan xiong and dang gui (to regulate the blood) plus gardenia (to clear heat);
• Tinnitus worst in the forenoon: mainly qi deficiency — use Si Wu Tang plus bai zhu and fu ling;
• Tinnitus worst in the afternoon: mainly kidney yin deficiency — use Liu Wei Di Huang Wan;
• Long-standing, stubborn cases: use Bu Zhong Yi Qi Tang.

💬 Note from Doctor Luo: Look at the additions Doctor Xue made after the main case — he circles around the same bases: Bu Zhong Yi Qi, Si Jun Zi, Si Wu, Ba Zhen, Liu Wei Di Huang — with gardenia, bupleurum, chuan xiong and dang gui adjusted to the presentation. The core is two characters: support the upright (fu zheng). But please don’t turn this into a cookbook — “oh, forenoon use this, afternoon use that” and copy it mechanically. In Doctor Luo’s experience, patients rarely have pure, textbook patterns; diseases come mixed together, so you have to grasp the main contradiction.

Doctor Luo’s extension: “nervous tinnitus” is a headache for Western medicine too

Speaking of tinnitus, Doctor Luo raised a real-world problem: what Western medicine calls nervous (or neurogenic) tinnitus — the urgent advice is that you must treat it immediately; if it isn’t cured within the acute first dozen or so days, Western doctors believe some tinnitus can never be cured again. Treatment is a genuine headache — huge numbers of tinnitus patients shuttle from hospital to hospital and simply don’t get better.

But Chinese medicine does have a real advantage in regulating tinnitus. Doctor Luo gave a personal example: a relative of his had very severe tinnitus. All the big hospitals in Beijing had been consulted — including a top-level hospital like 301 Hospital — with little effect. Later she was treated with Chinese herbs and slowly got better. She went back to 301 and told the department head, “I’m cured.” The head was astonished: Chinese medicine can fix this disease? Then why are you here? — “I want to be examined, to see exactly how well it’s healed.” They examined her. She was indeed cured, and the department head was truly amazed.

💬 Note from Doctor Luo: Doctor Luo says his approach to tinnitus is learned from the predecessors — the ancient physicians and the modern masters alike. One is Professor Gan Zuwang, an elder of Nanjing University of Chinese Medicine, a generation-defining master of ear-nose-throat medicine, who lived to over a hundred. Professor Gan explained tinnitus with remarkable clarity, and Doctor Luo agrees with his discussion wholeheartedly.

Professor Gan Zuwang’s theory: subjective tinnitus and its long string of causes

What Professor Gan Zuwang discussed is subjective tinnitus — there is no real sound in the ear; it’s your own sensation of sound. That is subjective tinnitus. The causes vary widely. What can bring it on? Doctor Luo helped everyone sort through the list:

Residual pathogen from an external contraction (an external pathogen arrived and stayed); phlegm-dampness clouding the clear orifices (heavy phlegm-dampness inside obscuring the portals of the head); liver-gallbladder fire blazing (emotional problems and disordered qi movement; this tinnitus is an “explosion” — bam, it erupts suddenly); heart fire (both excess fire and the deficiency fire of yin deficiency); blood stasis; insufficient kidney qi (yang-deficient people can get tinnitus); kidney yin deficiency; insufficient middle qi, weak spleen and stomach; blood deficiency.

Basically, any deficiency of qi, blood, yin or yang can cause tinnitus — and so can phlegm-dampness, blood stasis and liver fire. Many different patterns can produce it.

💬 Note from Doctor Luo: Professor Gan held that tinnitus is mostly excess, rarely deficiency. But based on what Doctor Luo himself has seen — Professor Gan’s era was a bit earlier than ours — in modern society what he encounters is mostly deficiency. And the deficiency is never textbook-simple: either qi deficiency, or blood deficiency, or yin deficiency, or yang deficiency — one single cause. No such thing! Basically everyone who gets it has a compound pattern.

The root cause: exhaustion comes first

So what is the fundamental cause of tinnitus? Doctor Luo says it is exhaustion (lao lei). As Doctor Xue put it, overwork, excess in wine and sex — these are the causes — and exhaustion comes first.

Exhaustion constantly drains kidney essence; then the spleen and stomach weaken, middle qi becomes insufficient, and upright qi (zheng qi) is depleted — that’s the deficiency side. Then sometimes liver fire is added on top, together with some blood stasis: when upright qi is insufficient, it can’t push the blood along, so stasis forms; and when upright qi is insufficient, another person might shrug off a bit of anger, but you — your spleen and stomach collapse first. So all these causes are linked together.

💬 Note from Doctor Luo: Illness never arrives in textbook purity. That’s why we have to find the main contradiction. In Doctor Luo’s view, the two main ones here are: one, kidney deficiency; two, spleen deficiency. Grasp those two, add a little blood-invigorating, heart-fire-draining, liver-qi-regulating assistance, set the general direction of the treatment — and tinnitus is actually quite manageable.

Root cause number one: kidney yin deficiency — high-pitched sound, louder when you cover your ear, louder at night

Let’s talk about kidney deficiency first. What depletes kidney essence? Over-consumption — staying up late night after night, excess in wine and sex, overthinking and worrying too much. In people with depleted kidney essence, tinnitus leans mostly toward yin deficiency: once yin is deficient there is deficiency fire, and the fire travels along the channels — the kidneys open into the ears — reaches the ear, and problems start.

What are the characteristics of kidney-yin-deficient tinnitus? The sound is especially high and clear; it gets louder when you cover the ear with your hand; sometimes when you lie in bed at night it seems to grow as you listen — it sounds like a whole chorus of cicadas. Liver-fire tinnitus, by contrast, is a whump-whump — like a train rumbling through. So the description of the sound matters a lot; this is the tricky part of diagnosis.

What else marks kidney yin deficiency? Dizziness and poor memory; the cheekbones sometimes flush a little red; palms and soles tend to run hot; in men, seminal emission and premature ejaculation; in women, irregular periods, amenorrhea and infertility. The tongue coating is thin and especially dry, and the tongue body tends to be red or dark red; the pulse is thin and quick.

💬 Note from Doctor Luo: For this kind of kidney-yin-deficient tinnitus, what do you use? The familiar Liu Wei Di Huang Wan. There’s also a prepared medicine called Erlong Zuoci Wan (Deafness-Zuoci Pill) — Liu Wei Di Huang Wan plus ci shi (magnetite) and wu wei zi (schisandra) — specifically for tinnitus and the kind of hearing that’s fading and thin. If the person also has heart fire, add a touch of huang lian (coptis); the main line is still nourishing yin. That’s one big block.

Root cause number two: insufficiency of spleen-stomach middle qi — low, dull sound, like construction outside

The other big block is the slowly accumulated insufficiency of middle qi, weakness of the spleen and stomach.

What is the spleen-stomach? As was explained yesterday: the spleen-stomach is the central pivot that turns the qi mechanism. The spleen rises on the left and the stomach descends on the right, rotating the qi like the axle of a wheel: the liver follows the spleen upward, the gallbladder follows the stomach downward; lung qi moves down, heart fire moves down; kidney water rises to nourish heart fire — heart fire, restrained by kidney water, doesn’t overheat, and kidney water, warmed by heart fire, doesn’t over-chill. That is what’s called water and fire mutually assisting (shui huo ji ji). A person in this state is a “normal person” (ping ren).

If the spleen-stomach axle goes wrong, the whole qi mechanism falls into chaos: heart fire above can’t descend, and kidney water below, unwarmed by heart fire, runs especially cold — heat above, cold below (shang re xia han). The spleen-stomach also governs the separation of clear and turbid: if turbid qi stays up top and clear qi sinks below, then all the orifices of the head malfunction.

When qi is deficient it can no longer hold things up — qi holds the organs in place; when qi is deficient, the qi mechanism drifts downward. This is called sinking of middle qi (zhong qi xia xian). A great many people have sinking middle qi, but nobody pays attention to it these days.

💬 Note from Doctor Luo: After Doctor Luo talked about Doctor Zhang Xichun’s Sheng Xian Tang (Raise the Sunken Decoction), many patients said: “I’ve run around hospitals for years without a cure — how is it that a few doses of Zhang Xichun’s Sheng Xian Tang fixed me?” — It’s exactly this sinking of middle qi that nobody took seriously, so it never got treated. Its most important manifestation is malfunction of the orifices and features of the head: a hoarse voice — a teacher’s voice gives out; supplement the middle and it recovers; eye and ear problems — the ears especially; dizziness — the qi mechanism can’t rise, so nourishment can’t reach the head; and allergic rhinitis — why does it get better after supplementing qi? For this very reason. “Clear yang not rising” and “clear yang sinking” describe the same thing.

What if spleen deficiency and kidney deficiency are mixed? See which is worse

So here’s the question: if spleen deficiency with sinking and kidney yin deficiency are mixed together, is the tinnitus sound high or low?

Doctor Luo says anyone who can ask that question is clever — because these two really do mix. When they’re mixed, look at which pattern dominates: when spleen qi is insufficient and middle qi sinking is obvious, the sound is low and rumbling — hoooo, hooo — some patients describe lying in bed thinking there’s construction outside, or a train passing, that kind of boom. At that point you tonify the spleen; as you tonify and the sinking middle qi recovers, you’ll notice the sharp, high-pitched sound surface again — one problem healed, the other can no longer hide — and then it’s time to nourish yin.

💬 Note from Doctor Luo: An experienced doctor looks at the tongue and feels the pulse — kidney deficiency and spleen deficiency both present — and simply treats both at once; both get better together. This is another thing Doctor Luo learned from Professor Gan Zuwang: the old professor’s formulas were about tonifying the spleen, pure and simple, but he would often add a little channel-opening medicine at the end of the prescription — lu lu tong (sweetgum fruit) and the like. Doctor Luo does the same: add lu lu tong, add dan shen (salvia), a little blood-invigorating, stasis-resolving help — as long as there’s any hint of blood stasis, unblock the qi and blood of the ear; it does good.

Support the upright as the main line: phlegm-dampness is a result of spleen-stomach weakness; blood stasis is a result of insufficient upright qi

What about people with heavy phlegm-dampness? Doctor Luo says the root cause of heavy phlegm-dampness is insufficient upright qi. Sometimes you resolve phlegm-dampness and it doesn’t work — it comes back after two days. Why? Upright qi is insufficient. At that point you have to wake up: once you find phlegm-resolving isn’t working, you still need to support the upright — tonify the spleen, tonify the kidneys; where phlegm-dampness dominates, emphasize tonifying the spleen.

If there’s liver fire, add something to drain it as a complement. This is precisely Doctor Xue’s line of thinking — support the upright as the main line; deficiency of upright qi is the main contradiction.

💬 Note from Doctor Luo: Doctor Luo says that sometimes he uses Gui Pi Wan (Spleen-Restoring Pill) — for when both qi and blood are depleted and you want to nourish the blood — alternating it with Bu Zhong Yi Qi Tang: when the qi isn’t sinking that far, use Gui Pi to nourish heart blood; when upright qi deficiency is obvious, start with Bu Zhong Yi Qi Tang, then switch to Gui Pi to nourish after a stretch — the effect is excellent. In his personal experience, regulating tinnitus with this supporting-the-upright approach works eight or nine times out of ten; it will only keep improving.

The narrator’s closing advice: the earlier you treat, the better — and keep taking the medicine

Doctor Luo finished with two reminders.

First, the earlier you treat, the better — if tinnitus has already caused damage, the degeneration only gets worse; you can’t afford to delay.

Second, stick with the medicine — some people take it for a few days and stop; that won’t do. As long as you genuinely see deficiency and insufficiency of upright qi, keep at it for a stretch of time. The body’s self-repair capacity is very strong — give it the power, and it will slowly heal itself.

💬 Note from Doctor Luo: In relative terms, regulating tinnitus is really a matter of experience: once you’ve seen enough cases, you know. Liver fire is the trigger; blood stasis is a result of insufficient upright qi; phlegm-dampness is a result of spleen-stomach weakness — the truly deficient ones are the spleen and the kidneys. Many tinnitus cases don’t get better not because the disease is hard, but because the method was wrong: people assume liver fire or blood stasis dominates, when in fact supporting the upright should lead — the deficiency of upright qi is the main contradiction. Keep hold of the big direction of “tonify the spleen, tonify the kidneys” — Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan — and tinnitus is quite manageable.

What to take away

• Blood-nourishing formulas aren’t the automatic answer to tinnitus. In this case Si Wu Tang made the ringing worse — a sure sign the problem was never simple blood deficiency. Look deeper.
• Doctor Xue’s one-two punch: Liu Wei Di Huang Wan before dawn, Bu Zhong Yi Qi Tang before breakfast. The pill replenishes kidney yin and drains deficiency fire; the decoction rides the morning’s rising yang to lift spleen qi. One secures below, one lifts above.
• Diagnose by the sound. High-pitched, louder when you cover the ear, louder at night — kidney yin deficiency (Liu Wei Di Huang Wan, Erlong Zuoci Wan). Low and rumbling, like construction or a train — spleen-stomach middle qi deficiency with sinking (Bu Zhong Yi Qi Tang, and Zhang Xichun’s Sheng Xian Tang idea). Mixed cases: treat whichever dominates, and add lu lu tong or dan shen if there’s any sign of blood stasis.
• Exhaustion is the number one root cause. Overwork drains kidney essence, weakens the spleen-stomach, and leaves upright qi depleted — the soil in which liver fire, phlegm-dampness and blood stasis all grow.
• Treat early and persist. The acute window matters; and once you see real deficiency, keep the tonic going — the body will do the rest.

This article is based on Doctor Luo Dalun’s narrated explanation of a case from Doctor Xue Lizhai’s Medical Case Records (《薛氏医案》).