Probe into the treatment of tinnitus by acupuncture combined with medicine under the mechanism of pathophysiology: A review

This study presents a comprehensive review of tinnitus (ringing in the ears) treatment using acupuncture combined with traditional Chinese medicine, grounded in new understandings of the pathophysiologic mechanisms of this condition. Tinnitus is a phantom auditory perception that affects 10-15% of the adult population, classified as primary (idiopathic, related to the auditory system) or secondary (with an identifiable mechanical source). Current research suggests that, although tinnitus may originate from cochlear damage, its maintenance involves cascades of neural changes in the central auditory system, including neuronal hyperexcitability and alterations in synaptic plasticity. Neuroimaging mechanisms reveal involvement of both auditory and non-auditory areas of the brain, including the frontal cortex, limbic system, and memory areas.

In traditional Chinese medicine, tinnitus is understood through the theory of the five organs (Wu Zang 五臟), where imbalances in the kidneys, heart, liver, spleen, and lungs can contribute to its manifestation. Syndrome differentiation identifies patterns such as kidney essence deficiency, liver qi stagnation, heat-wind disturbance, and qi and blood deficiency. The integrated treatment combines acupuncture at specific points such as Shuigou, Yintang, Shenting, Baihui, Fengfu, Dazhui, Tinghui, and Yifeng with traditional herbal formulas such as Modified Sitenglongmu Decoction, Longdan Xiegan Decoction, and Erlong Zuoci Pill. The clinical trials reviewed demonstrated superior efficacy of combined treatment compared to isolated approaches.

Studies with 220 patients using Sitenglongmu Decoction combined with mecobalamin showed significant reduction in tinnitus severity, with mechanisms related to the regulation of central neurotransmitters such as serotonin (5-HT) and gamma-aminobutyric acid (GABA). Another study with 80 patients using Modified Longdan Xiegan Decoction for liver-gallbladder damp-heat type tinnitus demonstrated improvements in mood and reduction in serum platelet activating factor levels. 'Tongdu Tiaoshen' acupuncture showed efficacy in 92 patients with subjective tinnitus, with improvements related to the regulation of brain-derived neurotrophic factor. Specialized techniques such as temporal three-needle acupuncture combined with respiratory methods, and Linggui Bafa acupuncture also demonstrated promising results.

Identified limitations include the subjective nature of symptoms, lack of standardization in assessment criteria, small sample sizes in some studies, and the need for higher-quality multicenter research. Despite these limitations, the evidence suggests that the integrative approach offers advantages over isolated treatments, providing holistic regulation of organ and meridian functions, improvement in qi circulation, and reduction in both tinnitus intensity and the associated psychological impact.