Many people assume that a persistent cicada-like ringing in the ears, especially noticeable when it is quiet at night, is simply a sign of "excess internal heat" (shanghuo) and that they should promptly consume cooling foods or medications. In fact, this is not the case. This seemingly simple tinnitus has causes far more complex than "excess internal heat." In traditional Chinese medicine (TCM) clinical practice, it often signals an internal imbalance within the body that requires careful differentiation.
Why Is the Cicada-Like Ringing Clearer in the Stillness of Night?
During the day, the surrounding environment is noisy, our attention is drawn outward, and the body's qi and blood flow more toward the limbs and sensory organs. At night, when all is quiet, qi and blood return inward, and subtle internal changes within the body become easier to perceive. The cicada-like ringing in the ears is like a signal sent by the body, reminding us that it is time to pay attention.
Kidney Essence Depletion Pattern: Like an Old Radio—Faint but Persistent
In clinical practice, this type of tinnitus is commonly seen in middle-aged and elderly individuals or in young people who have been overworked for a long time. The sound typically resembles a cicada's chirp—thin, high-pitched, and continuous. These individuals often also experience soreness and weakness of the lower back and knees, dizziness, blurred vision, and reduced memory. TCM holds that the kidney opens into the ears; when kidney essence is abundant, the ear orifices are clear and sharp, but when kidney essence is depleted, the ears lose their nourishment, deficient fire flares upward, and ringing arises. In TCM meridian theory, the pathway of the Foot Shaoyin Kidney Meridian is closely related to the ear orifices, and Taixi (KI3) is frequently mentioned in this context. Taixi, also known as Lüxi, is located in the depression between the tip of the medial malleolus and the Achilles tendon. It belongs to the Foot Shaoyin Kidney Meridian and serves as both the Shu-Stream point and the Yuan-Source point of the Kidney Meridian—a site where kidney qi gathers. The Lingshu records that "the kidney emerges from Yongquan, and Yongquan is at the center of the sole of the foot." As the Yuan-Source point of the Kidney Meridian, Taixi is commonly used to reflect the sufficiency or depletion of kidney essence and is one of the representative acupoints in patterns of kidney deficiency.
For care and maintenance, individuals with this constitution need to prioritize rest and avoid staying up late and excessive depletion. They may appropriately increase their intake of black-colored foods, such as black sesame seeds and black beans, which can help nourish kidney essence. However, it should be noted that if cold intolerance and cold hands and feet are also present, this may indicate kidney yang deficiency, and cooling foods should not be used indiscriminately.
Liver Fire Flaring Upward Pattern: Like a Summer Cicada—Loud and Agitating
The sound of this type of tinnitus is usually relatively loud, to the point of causing restlessness, irritability, and an inability to sit or lie still. In the quiet of night, the sound becomes even more prominent. These individuals tend to have a quick temper, are easily angered, and often experience bitter taste in the mouth, dry throat, red eyes, insomnia, and frequent dreams. TCM theory indicates that the liver governs free coursing and discharge; when emotions are not smooth, liver qi becomes constrained, and constraint transforms into fire. Fire tends to flame upward, following the meridian to disturb the ear orifices. In the Foot Jueyin Liver Meridian, Taichong (LR3) is closely related to this pattern. Taichong, also known as Dachong, is located on the dorsum of the foot, between the first and second metatarsal bones, in the depression anterior to the junction of the metatarsal bases. It belongs to the Foot Jueyin Liver Meridian and serves as both the Shu-Stream point and the Yuan-Source point of the Liver Meridian. Taichong is the site where liver meridian qi and blood converge and has an intrinsic connection to pathological changes such as liver qi constraint and liver fire flaring upward. It is an important acupoint in TCM theory for reflecting the free coursing and discharge function of liver qi.
Clinically, this pattern is relatively common in people who experience long-term mental stress and are emotionally volatile. For care and maintenance, maintaining a cheerful mood is of utmost importance. One may try practicing deep breathing or taking walks to soothe emotions. In terms of diet, light and bland foods are advisable, while spicy and stimulating foods should be avoided. If dizziness, headache, or elevated blood pressure also occur, it is even more important to promptly seek the help of a licensed TCM practitioner and not to clear fire on one's own.
Phlegm-Fire Binding Pattern: Like Cotton Stuffed in the Ears—Muffled and Mixed Sounds
The sensation of this type of tinnitus is somewhat distinctive—the sound is not so crisp but rather muffled, as if something is blocking the ears, sometimes accompanied by a feeling of ear fullness and hearing decline. These individuals tend to be overweight, habitually consume greasy and sweet foods, and are prone to chest tightness, excessive phlegm, and sticky, unformed stools. TCM holds that the spleen governs transportation and transformation; improper diet damages the spleen, spleen deficiency generates dampness, dampness accumulates into phlegm, phlegm constraint transforms into fire, phlegm and fire bind together, and the clear orifices are obscured. Among acupoints related to transforming phlegm, Fenglong (ST40) is a rather representative point in TCM theory. Fenglong is located on the lateral aspect of the lower leg, 8 cun above the tip of the lateral malleolus, on the outer edge of the tibialis anterior muscle. It belongs to the Foot Yangming Stomach Meridian and serves as the Luo-Connecting point of the Stomach Meridian. Luo-Connecting points have the function of connecting the interior and exterior meridians, and Fenglong occupies an important position in the theory of the spleen and stomach's transportation and transformation of water and dampness and the transformation of phlegm and descent of turbidity. It has historically been regarded as the "essential acupoint for transforming phlegm," and the Yulong Ge states, "For excessive phlegm, one should seek Fenglong."
Clinically, this condition is more commonly seen in people with long-term irregular eating habits and lack of exercise. For care and maintenance, adjusting dietary structure is the first step—reducing the intake of greasy, sweet, and cold foods and eating more light and easily digestible foods. Appropriately increasing exercise to promote the circulation of qi and blood also helps transform phlegm and reduce fire. If there is also a sensation of heaviness in the head as if wrapped in something, and bodily fatigue, this may indicate a phlegm-dampness constitution, and the focus of care should be on strengthening the spleen and eliminating dampness.
These General Recommendations May Be Helpful to You
Regardless of which type one belongs to, a persistent cicada-like ringing in the ears that is especially noticeable in the quiet of night signals the need to pay attention to the body's overall state. Regular daily routines, a balanced diet, and a calm mindset are the foundations for maintaining ear orifice health. Try to avoid prolonged exposure to noisy environments, and before bedtime, one may try soaking the feet in warm water to help qi and blood descend.
It should be noted that the above are only several commonly seen types in clinical practice. For any given individual, the situation may be more complex. Sometimes several patterns may appear simultaneously, or other factors may be involved. Therefore, if tinnitus persists without relief, it is recommended to consult a licensed medical institution and have a licensed TCM practitioner conduct a detailed pattern differentiation to formulate a personalized conditioning plan. Do not make judgments on your own or use medications indiscriminately.
Frequently Asked Questions
Q: Why is it that for the same tinnitus, some people need warming supplementation while others need clearing and draining?
A: This reflects the TCM principle of "treating the same disease with different methods." Tinnitus is only a surface phenomenon; the underlying pathogenesis differs from person to person. Those with kidney deficiency need supplementation, those with liver fire need clearing, and those with phlegm-fire need transformation—the treatment principles are naturally different. If one does not distinguish between deficiency and excess and blindly follows trends, the problem may actually worsen.
Q: Are tinnitus and hearing loss the same thing?
A: No. Tinnitus is a phantom sound produced by the auditory system in the absence of an external sound source, whereas hearing loss is a diminished ability to perceive sound. The two may occur simultaneously, or only one may be present. However, long-term tinnitus can sometimes affect concentration, indirectly leading to reduced efficiency in receiving sounds.
Q: Why does tinnitus worsen under high stress?
A: High stress easily leads to liver qi constraint or liver fire flaring upward, both of which can trigger or aggravate tinnitus. At the same time, stress also affects sleep quality, and insufficient sleep further depletes kidney essence, creating a vicious cycle. Therefore, regulating emotions and improving sleep are crucial for alleviating tinnitus.