Er Long Zuo Ci Wan and Tinnitus

Source material by Xu Weichao, attending physician at Hebei Provincial Hospital of Traditional Chinese Medicine

Content edited by Janet Borges, L.Ac.

photo of a woman holding her ears like she is in pain from a loud sound

Here at Mayway, we have been reviewing some of our favorite formulas. These are formulas that were taught in acupuncture school, but perhaps have been forgotten over time, or maybe there hasn’t been a patient encounter for whom the formula is appropriate. For this edition of our newsletter, we are highlighting Er Long Zuo Zi Wan, also known as Er Ming Zuo Ci Wan, or Tinnitus Left Supporting Pills. Here is an account from within the source material as an example of a patient for whom this formula fits the diagnostic pattern.

Mr. Wang, who had just gone through the official retirement procedures, didn't know what was wrong. Recently, he had been experiencing “ringing” in his ears which sounded like cicadas, especially in the dead of night while lying in bed. This was disruptive to his sleep and causing him to be irritable and short tempered during the daytime. He went to the otolaryngology department for several examinations, and no substantial disease was found. But the annoying sounds persisted, so he sought diagnosis and treatment from traditional Chinese medicine. After examination and diagnosis, the TCM doctor told Mr. Wang that his hearing difficulty was due to "insufficient Kidney and Liver Yin with Deficiency Heat and Liver Yang Rising” and prescribed Er Long Zuo Ci Wan. Mr. Wang was also informed that he may need to remain on the formula for at least several weeks, and that it would be safe for him to take on a long-term basis if needed.

Tinnitus, commonly called “ringing in the ears”, refers to a patient's conscious hearing of sounds that are not present in the surrounding environment. It often brings a series of disruptive effects to the patient's life and can also lead to negative psychological symptoms such as depression, anxiety, and irritability. In terms of biomedical causes for tinnitus, it can be ascribed to many things; inclusive of long or short term exposure to loud noise, as a side effect from certain prescription medications (e.g. some antibiotics, NSAIDS, anti-depressants, anti-cancer, or malaria drugs), head or neck injuries, or sometimes the lingering effects of an ear infection that has caused blockage to the ear canal.

According to the principles of traditional Chinese medicine, it is said that after middle age, physical stamina begins to decline, and Kidney essence gradually becomes “insufficient to fill the ears”, leading to decline of the hearing organs and a decrease in hearing acuity. Mild cases may manifest as tinnitus, sometimes sounding like cicadas (higher pitched), sometimes sounding like tides (lower pitched, rising and falling like ocean waves), and in severe cases may lead to significant hearing loss if the condition lingers or worsens. As stated in "Miscellaneous Diseases Sources Xi Zhu" zá bìng yuánliú xī zhú《杂病源流犀烛》: "Those with tinnitus will gradually become deaf."

Deafness does not always occur of course, and in many cases the origins of tinnitus can be sudden and acute; possibly arising from a singular stressful situation that has caused the Liver Fire to rise. This would be more of an excess pattern, as compared to Mr. Wang’s case above, which was attributed to Liver and Kidney Yin deficiency (seemingly presumed because of his age) leading to an uprising of Liver Yang.

For a case study comparing Kidney Yang deficiency with Liver Yang Rising, please see our article Kidney Yang Deficiency or Liver Yang Rising: A Case Study.

Er Long Zuo Ci Wan comes from the "Feihe Pavilion Collection of Prescriptions" sì hè tíng jí fān《饲鹤亭集方》written by Ling Huan, a physician in the Qing Dynasty. It is a modification of the classical formula Liu Wei Di Huang Tang, with the addition of Chai hu and Ci shi, or magnetite. Some variations of the prepared pill formula include Shi chang pu and Wu wei zi, but Mayway’s Plum Flower product does not. Historically, Er Long Zuo Ci Wan was refined into a honey pill and administered with lightly salted water to assist with leading the herbs into the Kidney meridian.

For a refresher on Liu Wei Di Huang Tang/Six Flavor Rehmannia, please see our write up breaking down the formula. Liu Wei Di Huang Tang / Wan nourishes Liver and Kidney Yin and with the assistance of Chai hu raises the pure Yang Qi to the ears, while Ci shi suppresses deficiency Fire by anchoring the Yang, nourishing the True Yin, and assisting the Kidneys to grasp Qi. Er Long Zuo Ci Wan treats symptoms as well as the underlying condition, as it both tonifies and purges, and can help clear the ears and apertures. It is most suitable for patients who may present with tinnitus and possible hearing impairment from a deficiency pattern, but not suitable for those who may present with a more excess pattern and tinnitus that sounds like tides.

Other modern clinical applications for Er Long Zuo Ci Wan include some types of headaches, poor memory or unclear thinking, dim or unclear vision, inflammation of the inner ear labyrinth, and high blood pressure. The tongue may present as red with scanty or no coat, and the pulse may be thin, rapid, and possibly wiry. While taking this medicine, patients should be monitored for signs of weak digestion with a propensity toward dampness or phlegm congestion and pay careful attention to diet, avoiding spicy and greasy food, as well as an excess of simple carbohydrates. It is contraindicated during the early stages of an acute illness or acute infection and may be used over the course of several years.

References and Source Material

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