HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 8, NUMBER 1

2021

Acupuncture and Moxibustion Treatment for Tinnitus
Nobuyuki Otsuka†, ††† Hotal Ancient Medicine Research Institute (HARI), †† Otsuka Clinic

3-8-14 Hotarugaike-nakamachi, Toyonaka, Osaka, 560-0033 Japan
E-mail: hari@otsuka.holding.jp
Keywords: Tinnitus, Tinnitus reaction point, Pressure, Retaining needle, Press needle,
Body condition sensor, Oriental medicine, Acupuncture and moxibustion

According to the 2013 Comprehensive Survey of Living Conditions, there
were 26 males and 34 females per onethousand population with tinnitus, an increase from the 2010 survey. Tinnitus increases dramatically with age. The prevalence rate of tinnitus among the elderly
was 67 males and 66 females per one
thousand people.
Tinnitus is often subjective and thecause is often unknown. Tinnitus is thesensation of sound in the absence of any
apparent sound source other than inside
the body. Tinnitus is clearly distinguishedfrom auditory hallucinations in which thecontent of the sound heard has meaning,such as words or music. Tinnitus is thesensation of sound without meaning [1].
Tinnitus may be accompanied by thesound of muscular contractions or vascular noise [2].
The mechanism by which tinnitus occurs is explained to be that when thebrain perceives a lack of sound signals,
the brain increases its activity in an attempt to compensate for the missing portion [3]. Stress is also said to ravage cerebral function and affect the cochlea. Tinnitus can be classified into subjective tinnitus and objective tinnitus. Subjective tin-nitus is heard only by the patient and accounts for the majority of tinnitus. Objective tinnitus is a sound that can be heard
by others, too. The cause of subjective
tinnitus is often unknown, but it isthought to be due to a lesion in the inner
ear or cochlear nerve. High-pitched tinnitus is suspected to be a sensorineural disorder due to inner ear or central nervous
system disease. Low-pitched tinnitus issuspected to be a conductive disordersuch as middle ear disease [4]. Because of
the wide variety of diseases that cause
tinnitus, fundamental treatment of tinnitus is difficult. Antianxiety medications
etc. may be prescribed, and psychotherapy may be carried out.
Tinnitus can be classified into twotypes, otic tinnitus and somatic tinnitus.
Tinnitus is associated with disorders of
the inner ear or cochlear nerve. There areseveral pathways by which ear or nerve
damage can be associated with tinnitus.
Somatic tinnitus is generated resulting
from that the somatosensory system affects the auditory system by the interaction between the somatosensory systemand the central nervous system which includes the auditory system [5,6,7]. Somatic tinnitus is a non-auditory tinnitus.

Hotal Traditional Oriental Medicine Letters, Vol.8, No.1, pp.1-6, 2021

(C) 2021 HARI1

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 8, NUMBER 1
The treatment of tinnitus in modern
medicine involves surgery on the cochlearnerve. Electrical stimulation can be effective in suppressing the cochlear nerve.
Acupuncture and moxibustion has the potential to suppress tinnitus by activating
pathways to the somatic nerve nuclei inthe medulla oblongata. The influence ofsomatosensory stimulation is also important because subjective tinnitus is influenced by the emotional and autonomic
nervous systems [8]. Objective assessment of tinnitus is difficult because tinnitus is subjective. Evaluation methods include the Standard Tinnitus Test Method
1993, the Tinnitus Visual Analog Scale(VAS), and the Tinnitus Handicap Inventory (THI). The methods can quantify thedegree of improvement of tinnitus.
In Oriental medicine, tinnitus isbroadly classified into Liver and Gall bladder heat and Kidney essence deficiency.
There is also tinnitus caused by phlegmdampness and weakness of the spleenand stomach [9]. Tinnitus can be classified
into exterior pattern, interior pattern, andintermediate pattern [10]. The Yellow Emperor's Classic of Internal Medicine also
describes tinnitus. Since then, it has beenvariously identified and effective acupuncture points have been indicated. Recently,anxiety, depression, insomnia, and irritability are said to adversely affect thelimbic system, which in turn affects theautonomic nervous system via thecochlear nerve. Since hearing is located in
the temporal lobe of the cerebrum, it canbe treated with head acupuncture, which
was progressed as scalp acupuncture in
1984. In eight trigrams scalp acupuncture
on TE20, eight points are used, centeringon the upper two inches of TE20 and up

2021

and down, left and right, and slant directions [11].
In acupuncture treatment of tinnitus,tinnitus reaction points are used wheretinnitus improves with pressure[12]. Tinnitus was reduced or eliminated even inreports of the automatic movements ofthe facial and neck area as well as thepressure or electro-acupuncture stimulation on the acupuncture points [13]. In areport of the pressure stimulation ofacupuncture points in the neck and hand,acupuncture stimulation at the site of thetinnitus changed by the pressure stimulation also reduced tinnitus [14]. At the tinnitus reaction point, tinnitus was reduced
not only by retaining needle but also by
weak acupuncture stimulation with press
needle or noninvasive acupuncture instruments. Tinnitus reaction points are not
only located in the head and neck areaaround the ear, but also in the upper andlower extremities, so careful explorationis necessary. In a report of the vertigo andtinnitus outpatient for acupuncture andmoxibustion, tinnitus VAS decreased [15].
Tinnitus and dysacousis often coexisted[16,17]. In the clinical treatment of tinnitus, not only the tinnitus reaction point,
but also a multiple treatments are usedsuch as pattern identification and treatment, acupuncture point location determination based on meridian, exacerbating
factors, and accompanying symptoms.
Acupuncture and moxibustion treatment not only reduces tinnitus, but also
has beneficial effects throughout thewhole body. Whole body effects include
improved visual acuity, reduction of eyestrain, improvement of ocular circulation,
lowering of intraocular pressure, relax-Hotal Traditional Oriental Medicine Letters, Vol.8, No.1, pp.1-6, 2021

(C) 2021 HARI2

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 8, NUMBER 1
ation of ciliary muscle tone, adjustment ofautonomic nervous system functions, andrelaxation of the mind and body. Othereffects include analgesia, improvement ofblood flow in organs and nerves, relaxation of muscle tone, improvement andpromotion of intestinal peristalsis, immune regulation, and anti-inflammatory
and anti-allergic effects. The mechanismof tinnitus reduction is subject to the interaction and mutual influence of various
parts of the human body, such as the relationship between hearing and the wholebody. Therefore, the whole body effects
by acupuncture and moxibustion treatment influence the reduction of tinnitus.
Thus, there is not only a direct effect on
tinnitus, but also an indirect effect due towhole body effects. The effects in thewhole body by acupuncture and moxibustion treatment, such as autonomic nerve
regulation and relaxation, are also important. There are individual differences in
the manifestation of effects. Therefore, itis necessary to consider the reduction oftinnitus as the culmination of various
acupuncture and moxibustion effects.
In discussion, the effect of acupuncture and moxibustion treatment for tinnitus is examined. Tinnitus signals passthrough the cochlear nerve to the cerebral cortex. Mental stress can affect theautonomic nervous system and worsen
tinnitus [3]. There, excessive feelings ofanxiety, anger, or depression worsen tinnitus. Since acupuncture and moxibustion
treatment has the effects of autonomic
nerve regulation and relaxation, acupuncture and moxibustion treatment for tinnitus is expected to be effective. There arealso modern medicine approaches to tinnitus retraining therapy and reducing irri-2021

tability [8]. The improvement of tinnitus
with acupuncture and moxibustion treatment may be due to such an indirect effect on the stagnation of liver qi. The purpose of acupuncture and moxibustion
treatment for tinnitus is to reduce themagnitude of tinnitus after the treatmentcompared to before the treatment. Because tinnitus rarely disappears completely, the ultimate goal of treatment is
to make the patient not worry about ringing. Not only the disappearance of tinnitus but also realizing the patient whodoesn’t worry about ringing is an important effect. To clarify the effect ofacupuncture and moxibustion treatment
on tinnitus, it is necessary to ask the patient whether tinnitus bothers him or her.
If the tinnitus does not bother them, it is
the same as if there is no tinnitus. In
acupuncture and moxibustion treatment,
it is necessary to evaluate the presence orabsence of treatment effect on tinnitus byasking whether the number of times inwhich tinnitus bothers the patient on adaily basis has decreased. In acupuncture
and moxibustion treatment for tinnitus, it
should be noted that there are individual
differences in the onset of the suppression effect of tinnitus. Tinnitus may be affected by diseases other than the patient's complaint. Patients who hasearnest wish to their tinnitus may haveexcessive expectations. It is also important to inform such kind of patients thatthey may not feel the effect of tinnitus reduction even after receiving acupuncture
and moxibustion treatment.
Tinnitus was reduced even with nonpenetrating acupuncture needles such aspress needles or with very slight stimulation. Therefore, it is important to investi-Hotal Traditional Oriental Medicine Letters, Vol.8, No.1, pp.1-6, 2021

(C) 2021 HARI3

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 8, NUMBER 1
gate the reduction of tinnitus using press
needles with various stimulation intensities. Although weekly treatment is sufficient for tinnitus treatment, it is also important to establish self-care treatment
through pedestal moxa and auricularacupuncture, since self-care is necessary
for those who cannot come once a week.
It is also important to examine the effectiveness of treatment for tinnitus withdysacousis. The acupuncture and moxibustion treatment is expected to reducetinnitus even in the presence ofdysacousis. There are cases in which
dysacousis is improved by acupunctureand moxibustion treatment. However ingeneral, the treatment of dysacousis isdifficult. The results of hearing tests as afunction of the cerebrum may have little
relationship to the ease of hearing. Even if
the hearing test does not show anychange, the patient may be able to hearbetter. The judgment of the effect ofacupuncture treatment should include
not only the result of the hearing test but
also the ease of listening. Examination of
the mechanism of tinnitus reduction on
acupuncture and moxibustion treatment
is also necessary. Since there are direct,indirect, and interactive effects, it is necessary to consider their combined effects
and long-term effects. It is important not
only to elucidate the mechanism of individual effect, but also to gain knowledgeof the mechanism of the effect expected
for long-term. Tinnitus is thought to be asituation in which the brain is hypersensitive and picks up signals that would normally be excluded. Acupuncture and moxibustion treatment is thought to suppress
tinnitus as a result of inhibition of the somatosensory center. Under normal situation, the inhibitory effect on the so-2021

matosensory center disappears when
acupuncture stimulation ceases. However,reduction of tinnitus sometimes continue
over the long term even after acupuncture treatment is discontinued. This isprobably because the patient was released from the stress of despair of tinnitus. Since the presence of tinnitus is a major stress, the experience that tinnitus canbe reduced, even if only slightly, free thepatient from despair. It is considered thatthe stress-induced tinnitus was suppressed by the acupuncture and moxibustion treatment. Therefore, reducing tinnitus, even if only slightly, will have a positive feedback on the patient's stress relief
and lead to a long-term reduction of tinnitus.
Tinnitus can be viewed as a disease
sensor output rather than a disease. Tinnitus often becomes louder when fatigue
builds up or the patient's physical condition takes a turn for the worse. This canbe thought of as the tinnitus sounding asiren that signals that one's physical condition is deteriorating. Changes in the intensity of the tinnitus can be used to determine whether the patient is in good or
bad physical condition. Therefore, patients should not think of tinnitus as a disease and focus on eliminating tinnitus,
but rather would be better to consider touse the tinnitus to ascertain their physicalcondition. Patients should be taught to allow and utilize tinnitus as a valuable sensor of their physical condition. In this way,
negative feelings will disappear and tinnitus will not bother them, even if they
have tinnitus. Thus, when a state in which
tinnitus does not bother them is realized,
the tinnitus is positioned as if it were notpresent. It is important to educate pa-Hotal Traditional Oriental Medicine Letters, Vol.8, No.1, pp.1-6, 2021

(C) 2021 HARI4

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 8, NUMBER 1tients to view tinnitus in a positive manner.
In summary, tinnitus is often subjective and the cause is often unknown. Because of the wide variety of diseases thatcause tinnitus, fundamental treatment oftinnitus is difficult. Antianxiety medications etc. may be prescribed, and psychotherapy may be carried out. In Oriental medicine, tinnitus is broadly classified
into Liver and Gall bladder heat and Kidney essence deficiency. There is also tinnitus caused by phlegm-dampness andweakness of the spleen and stomach. In
acupuncture treatment of tinnitus, tinnitus reaction points are used where tinnitus improves with pressure. At the tinnitus reaction point, tinnitus was reduced
not only by retaining needle but also by
weak acupuncture stimulation with press
needle or noninvasive acupuncture instruments. Tinnitus reaction points are not
only located in the head and neck areaaround the ear, but also in the upper andlower extremities, so careful explorationis necessary. In the clinical treatment oftinnitus, not only the tinnitus reaction
point, but also a multiple treatments areused such as pattern identification andtreatment, acupuncture point location determination based on meridian, exacerbating factors, and accompanying symptoms. The mechanism of tinnitus reduction is subject to the interaction and mutual influence of various parts of the human body, such as the relationship between hearing and the whole body.
Therefore, the whole body effects byacupuncture and moxibustion treatment
influence the reduction of tinnitus. Theeffects in the whole body by acupuncture
and moxibustion treatment, such as auto-

2021

nomic nerve regulation and relaxation,
are also important. Because tinnitus
rarely disappears completely, the ultimate
goal of treatment is to make the patient
not worry about ringing. Reduction of tinnitus sometimes continue over the longterm even after acupuncture treatment isdiscontinued. This is probably because
the patient was released from the stressof despair of tinnitus. Since the presenceof tinnitus is a major stress, the experience that tinnitus can be reduced, even if
only slightly, free the patient from despair.
Reducing tinnitus, even if only slightly, will
have a positive feedback on the patient'sstress relief and lead to a long-term reduction of tinnitus. Patients should notthink of tinnitus as a disease and focus on
eliminating tinnitus, but rather would bebetter to consider to use the tinnitus toascertain their physical condition. In thisway, negative feelings will disappear andtinnitus will not bother them, even if they
have tinnitus. It is important to educate
patients to view tinnitus in a positive
manner.

[1] Nanzando's Medical Dictionary, 20th edition, Nanzando, 2015.
[2] Japan College Association of Oriental Medicine edited Clinical
Medicine Detailed Exposition, 2nd ed., Ishiyaku Pub., 2009.
[3] Seiichi Nitta, “90% of Tinnitus can be Cured - Suppressing theExcitement of the Brain will stop the Sound”, Makino Shuppan, 2014.
[4] Shutaro Mori, “Diagnosis and Treatment for Acupuncture 7th ed.”,Idononippon, pp.123, 1992.
[5] Levine, R. A.: Somatic (Craniocervical) Tinnitus and the Dorsal
Cochlear Nucleus Hypothesis, Am J Otolaryngol. 1999; 20: 351-362.
https://pubmed.ncbi.nlm.nih.gov/10609479/[6] Levine, R. A. et al. Evidence for a Tinnitus Subgroup responsive toSomatosensory based Treatment Modalities. Prog. Brain Res. 2007;
166: 195-207.
https://pubmed.ncbi.nlm.nih.gov/17956783/Hotal Traditional Oriental Medicine Letters, Vol.8, No.1, pp.1-6, 2021

(C) 2021 HARI5

HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 8, NUMBER 1[7] Ougi Sato et al., A Hypotheses about Mechanism of Tinnitus without
Hearing

LossinTemporomandibular

Disorder”,

Jpn.

Soc.

Stomatognath. Funct., vol. 13(2), pp. 103-114, 2007.
https://doi.org/10.7144/sgf.13.1032021[15] Hiroyuki Tsuru, “Acupuncture Treatment for Tinnitus”, Japan Societyof Acupuncture and Moxibustion Kinki branch training B course,
2016.
[16] Guanhao Li,”Acupuncture on GB31 for Neuropathic Tinnitus and[8] P.J. Jastreboff et al. Tinnitus Retraining Therapy (TRT) as a Method forTreatment of Tinnitus and Hyperacusis Patients. J. Am. Acad. Audiol.
2000; 11(3): 162-177.

Deafness”, Journal of Clinical Acupuncture and Moxibustion, Zhenjiu
Linchuang Zazhi, vol. 22(5), pp. 36, 2006.
[17] Zaigen Oh, “Traditional Chinese Medicine Culture and Tinnitus”,

https://pubmed.ncbi.nlm.nih.gov/10755812/[9] Katsutoshi Kitade, “New Acupuncture and Moxibustion Treatment”,

Japan Society of Acupuncture and Moxibustion Kinki branch training
B course, 2016.

Ishiyaku Pub., pp. 63, 2006.
[10] Tianjin University of Traditional Chinese Medicine, “Acupuncture(Received 2 October 2021)

and Moxibustion Clinical Edition”, Oriental Academic Press, pp. 482,
1993.
[11] Katsutoshi Kitade et al., “Special Acupuncture and Moxibustion
Textbook”, Ishiyaku Pub., pp. 15, 2014.
[12] Fuminori Ando, “Effects of Acupuncture on Tinnitus: A case series”,
Journal of the Japan Society of Acupuncture and Moxibustion, vol.
65(2), pp. 99-106, 2015.
https://doi.org/10.3777/jjsam.65.99[13] Hiroyuki Tsuru, “Basic Research on the Effect of Muscle Contraction

Dr. Nobuyuki Otsuka

and Somatosensory Stimulation on Subjective Tinnitus”, Grants-in-He graduated from Tohoku University in 1985 and completed the first

Aid for Scientific Research 24500840, 2012.

half term of doctoral course of Tohoku University graduate school in

https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-24500840/

1987. He was awarded doctor degree in 1997 from Tohoku University.

[14] Hiroyuki Tsuru, “Fundamental Research for Therapeutic Application

He established Hotal Ancient medicine Research Institute (HARI) inof Oriental Medicine Somatosensory Stimulation to relieve

1999. He established Otsuka Clinic for acupuncture and moxibustion af-

Subjective Tinnitus”, Grants-in-Aid for Scientific Research 16K01780,

ter graduated from Meiji school of oriental medicine in 2017. He is en-2016.

gaged in research on oriental medicine such as traditional Chinese

https://kaken.nii.ac.jp/ja/grant/KAKENHI-PROJECT-16K01780/

medicine, acupuncture and moxibustion, qigong etc.

Hotal Traditional Oriental Medicine Letters, Vol.8, No.1, pp.1-6, 2021

(C) 2021 HARI6