Otitis Media, Labyrinthitis

General

Clinical Manifestations	A feeling of distention, fullness, and closure inside the ear Diminished hearing Ear pain May be tinnitus Slight reddening and inward sinking of the tympanic membrane Acute: Fluid or a bulging of the eardrum Chronic: The ear drum is greatly sunken The ear drum is dull or lusterless The ear drum is stuck together The ear drum is exhibits inhibited mobility An ear conduction test with a tuning fork is positive for hearing loss Purulent: Infection and pus formation in the middle ear It may be an acute or a chronic condition Chronic Purulent: There is a longstanding and repeated history of purulent discharge from the ear. Patients often complain of tinnitus and hearing loss. Essentials of diagnosis: There is intermittent or continuous purulent discharge from the ear accompanied by various degrees of tinnitus and hearing loss. The eardrum is perforated and pus is secreted into the ear canal and middle ear. Edematous swelling of the mucous membranes in the middle ear which may protrude in a granulometous appearance (fresh tissue or polyps) which may also fall down into the external auditory meatus. Appearance of cottage cheese like material is not uncommon. Examination for hearing loss reveals bone conduction deafness and, in severe cases, mixed deafness. X-ray studies may reveal bony erosion. If there are symptoms such as vertigo, facial paralysis, excruciating headache and chills with high fever, the condition has deteriorated to both an intra and extra cranial infection.
Treatment Principle
Herb Formulas
Points	Insert a needle slightly anterior to the SI-19 and needle inward, forward, and downward to a depth of 2 inches. This strengthens the functioning and tissues of the eustachian tubes. SI-19, GB-2, SJ-21, SJ-17, GB-3, GB-20, REN-6. Needle daily, selecting 2 - 3 points at a time, with even tonification and sedation. Retain the needles for 10 - 20 minutes. Seven treatments are considered a treatment course. GB-1, GB-2, GB-3, GB-20, GB-41, LI-4, SI-3, SI-15, SI-19, SJ-5, SJ-17, SJ-18, SJ-19, SJ-21, SJ-23, ST-36 GB-20. LI-4, LI-11, SJ-17, SJ-21 LI-4, SI-19, SJ-17 GB-2, GB-40, SJ-17, ST-36 With fever: + LI-11 Excess Type: + SJ-21 Deficiency Type: + KI-3

Wind-Pathogen Closes The Ear

Clinical Manifestations	Fullness and closure at the inside of the ear accompanied by decreased hearing, tinnitus, and a slight reddening of the ear drum Nasal congestion Rhinorrhea Fever Headache T: Normal C: Slightly white or Slightly yellow P: Floating and rapid
Treatment Principle	Disperse Wind Scatter the pathogen Dredge an opening through the cavities
Herb Formulas	Qing Shen San modified With neck and shoulder stiffness: Ge Gen Tang With vomiting but no diarrhea: Ge Gen Jia Ban Xia Tang
Points	Insert a needle slightly anterior to the SI-19 and needle inward, forward, and downward to a depth of 2 inches. This strengthens the functioning and tissues of the eustachian tubes. SI-19, GB-2, SJ-21, SJ-17, GB-3, GB-20, REN-6. Needle daily, selecting 2 - 3 points at a time, with even tonification and sedation. Retain the needles for 10 - 20 minutes. Seven treatments are considered a treatment course.

Wind-Cold Invasion With Damp Accumulation

Clinical Manifestations	Itching or tickling in the throat Wheezing Sneezing Gasping Cough with expectoration of thin, watery or frothy white sputum General body aches No thirst Dyspnea Headache Body aches A sensation of heaviness Chills with low grade fever Maybe asthma Intolerance of Cold Anhidrosis Blocked and/or runny nose with watery nasal discharge Chest discomfort Neck stiffness Irritability T: Pink C: Thin, white and moist P: Superficial and tight
Treatment Principle	Disperse Wind-Cold Induce diaphoresis Dispel Dampness
Herb Formulas	Ma Huang Jia Zhu Tang Ma Huang Tang Ge Gen Tang Jia Xin Yi Chuan Xiong
Points	DU-16, GB-20, UB-12, LI-4, SJ-5 (Sedating technique), UB-13, LU-7, REN-17, SP-6, SP-9, Moxa REN-4, REN-6, DU-4

Wind-Dampness (Acute Suppurative)

Clinical Manifestations	Suppuration Delicate constitution Polyps Ear pain
Treatment Principle	Disperse Wind Resolve Dampness
Herb Formulas	Qian Jin Nei Tuo San Shi Wei Bai Du San
Points	General points

Shao Yang Jing

Clinical Manifestations	Alternating chills and fever Restlessness Irritability Anorexia Sometimes fatigue Nausea/vomiting (occasional) Headaches (side of head) Hypochondriac pain Rib pain Achiness Ear infection Hearing difficulty Red eyes Stiff shoulders Throat pain Hip pain T:  Normal with bumps or dots on side C:  Thin white P:  Wiry.
Treatment Principle	Harmonize the Liver and Gall Bladder
Herb Formulas	Xiao Chai Hu Tang
Points	GB-2, GB-34, LIV-3, LIV-14, SJ-5, SJ-17, SJ-21

Shao Yang Fu With Congested Fluids

Clinical Manifestations	Alternating chills and fever (chills predominate) or Chills without fever Sensation of irritability in the chest Sweating from the head Fatigue Gastrointestinal weakness Heavy head Neuralgia Epigastric distension Lower abdominal pain Tension around pubic bone Periumbilical pain Urinary difficulty T: Moist C: White and slippery P: Superficial and wiry
Treatment Principle	Disperse Clumping Harmonize the Shao Yang Warm the Interior Dispel Cold
Herb Formulas	Chai Ling Tang
Points	GB-41, SJ-5, moxa or moxa needle REN-4, REN-6, REN-8, REN-12, SJ-6, ST-25, ST-36

Jue Yin Level - Cold And Heat

Clinical Manifestations	Intermittent attacks of abdominal pain Stifling sensation in the chest and epigastrium A sensation of warmth in the chest and epigastrium Irritability in the chest and epigastrium Vomiting after eating Extremely Cold extremities Vomiting of roundworms Incessant diarrhea Hunger with no desire to eat Vomiting immediately after eating Heat in the Stomach with Cold in the Intestines Bitter taste in the mouth Frequent urination Anxiety Abdominal pain (better with warmth and pressure) Pain beneath the Heart Borborygmus Unquenchable thirst Running piglet Qi Pain and Heat in the Stomach Discharge of small amounts of pus Irritability Recurrent nausea and vomiting Diarrhea Dry throat Turbid urine Polydipsia T: Red or geographic or pale C: White P: Hidden or Wiry and tight
Treatment Principle	Warm the Internal organs Warm the Middle Jiao Warms the Intestines Drains Heat Replenishes Qi Dispels parasites Calms roundworms Drains the Liver Calms the Stomach Promotes Blood circulation Relieves pain
Herb Formulas	Wu Mei Wan
Points

Wei Stage Wind Heat

Clinical Manifestations	Unilateral tinnitus or hearing loss that is sudden and generally mild Fullness, distention blockage and persistent itching of the ear Inflammation of throat and/or tongue May be ear pain or pain in the mastoid area sometimes radiating to the jaw Maybe purulent or bloody exudate from the ear Fever and chills with more fever than chills Sweating or Absence of sweating Cough with sticky yellow sputum Aversion to Wind and Heat Yellow nasal discharge Thirst with desire for cold drinks Headache General bodily soreness and malaise Throat is red The tonsils are swollen and engorged but without any particular pus spots Red bumps around mouth and lips (herpes simplex) Nasal obstruction Sore, swollen throat Dyspnea Chest pain Dry mouth Rapid breathing Maybe constipation Maybe scanty urine T: Red tip C: Thin and yellow P: Floating and rapid
Treatment Principle	Release the Exterior Clear Heat Open the ears
Herb Formulas	Yin Qiao San With exudate: Man Jing Zi San With pre-existing Internal Heat: Fang Feng Tong Sheng San Chinese patent medicines: Yin Qiao Jie Du Pian Gan Mao Dan Huang Lian Shang Qing Pian Niu Huang Jie Du Pian
Points	Two or three of the following: DU-23, GB-20, GB-39, LI-4, LI-5, LI-11, SI-4, SJ-5, SJ-17 + one or two of the following: GB-2, SI-17, SI-19, SJ-21 With Internal Heat: + LIV-2, SJ-2

Wei Stage Damp-Heat

Clinical Manifestations	Headache (wrapping) Fever and chills, fever more pronounced or Chills with afternoon fever Heavy extremities Heavy sensations in the body Stifling sensation in the chest Nausea Dizziness Gastric and abdominal distension Sticky mouth No thirst T: Normal C: Greasy white or yellow P: Soft and rapid or soft and slow or wiry thin and soft
Treatment Principle	Clear Damp-Heat.
Herb Formulas	San Ren Tang
Points	DU-14, DU-23, DU-24, GB-20, LI-4, or SJ-5, LI-11, REN-9, SP-6, SP-9, ST-8, ST-28, Taiyang, UB-12, UB-20, UB-40 (bleed).

Wind-Heat Toxin With Phlegm

Clinical Manifestations	Confused and disoriented half of head Lack of strength Abdominal distention Poor appetite T: Pale C: White P: Weak and relaxed
Treatment Principle	Raise the Yang Augment Qi Open the cavities
Herb Formulas	Bu Zhong Yi Qi Tang modified Pai Nong San Gan Mao Dan Qing Shang Fang Feng Tang
Points	Insert a needle slightly anterior to the SI-19 and needle inward, forward, and downward to a depth of 2 inches. This strengthens the functioning and tissues of the eustachian tubes. SI-19, GB-2, SJ-21, SJ-17, GB-3, GB-20, REN-6. Needle daily, selecting 2 - 3 points at a time, with even tonification and sedation. Retain the needles for 10 - 20 minutes. Seven treatments are considered a treatment course.

Qi Stage Gall Bladder Heat

Clinical Manifestations	Alternating chills and fever Bitter taste in mouth Thirst Dry throat Rib pain (doesn't like touch) Hypochondriac pain Nausea/vomiting Hypogastric pain and distension T:  Red C:  Yellow P:  Rapid and wiry
Treatment Principle	Relieve Gall Bladder Heat Pacify The Liver and Gall Bladder
Herb Formulas	With congestion in the chest and epigastrium: Zhi Zi Chi Tang With vomiting: Zhi Zi Sheng Jiang Chi Tang With short, rapid breathing: Zhi Zi Gan Cao Chi Tang With Food Stagnation: Zhi Shi Zhi Zi Chi Tang
Points	To Pacify the Liver and Gall Bladder: LIV-3, LIV-4, LIV-13, LIV-14. To Relieve Gall Bladder Heat: Lanweixue, LI-11, LIV-2, GB-34

Spleen Qi Deficiency - Chronic

Clinical Manifestations	Confused and disoriented half of head Lack of strength Abdominal distention Poor appetite T: Pale C: White P: Weak and relaxed
Treatment Principle	Raise the Yang Augment Qi Open the cavities
Herb Formulas	Bu Zhong Yi Qi Tang modified Huang Qi Jian Zhong Tang Yi Qi Cong Ming Tang With Liver Qi Stagnation and Dampness: Wan Dai Tang
Points	Insert a needle slightly anterior to the SI-19 and needle inward, forward, and downward to a depth of 2 inches. This strengthens the functioning and tissues of the eustachian tubes. SI-19, GB-2, SJ-21, SJ-17, GB-3, GB-20, REN-6. Needle daily, selecting 2 - 3 points at a time, with even tonification and sedation. Retain the needles for 10 - 20 minutes. Seven treatments are considered a treatment course.

Spleen Deficiency With Damp Accumulation (Chronic Purulent)

Clinical Manifestations	Intermittent discharge of pus from the ear which is viscous and thin in consistency. The ear drum is perforated Hearing is diminished Mental and physical fatigue Poor appetite Loose stools T: Pale C: Thin and white or Moist P: Thready and weak
Treatment Principle	Strengthen the Spleen Eliminate the Damp pathogen Tonify Qi Expel pus from within
Herb Formulas	Tuo Li Xiao Du San
Points

Spleen Qi Deficiency With Phlegm-Dampness

Clinical Manifestations	Tinnitus and/or loss of hearing which is worse with fatigue and exertion or on rising from sitting or lying The sound is likened to cicadas or the sound of rushing water The sound has a relatively low pitch. Occasionally the ear feels cold, empty or wet There may be persistent sinus or eustachean tube congestion Sallow complexion Pale lips Fatigue Weakness Anorexia Picky eating Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath T: Pale and flabby - may have teethmarks C: White P: Even, forceless and deficient or Thready and weak
Treatment Principle	Strengthen the Spleen Benefit Qi
Herb Formulas	Bu Zhong Yi Qi Tang modified Liu Jun Zi Tangmodified With Yang Deficiency: Fu Zi Li Zhong Tang
Points	LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

Stomach Yin Deficiency (Chronic Purulent)

Clinical Manifestations	Purulent otorrhea Bad odor Headaches No appetite or Famished but with no desire to eat Abdominal distention after meals Dry stools Irritability with low grade fever Tinnitus Maybe dry retching or Hiccups Children: postauricular eczema T: Red C: Little and dry P: Thready and rapid
Treatment Principle	Nourish Yin Nourish the Stomach
Herb Formulas	Sha Shen Mai Men Dong Tang Yi Wei Tang modified
Points	LI-4, SJ-17, SJ-21, ST-36 GB-20, LI-4, LI-11, SJ-17, SJ-21 With no otorrhea: KI-3 GB-2, LI-4, SJ-17, SJ-21, ST-36, UB-41

Liver Qi Stagnation Attacks The Stomach

Clinical Manifestations	Epigastric pain Belching with acid regurgitation Recurrent or chronic nausea Vomiting Vomiting immediately after meals Sour belching Acid reflux Heartburn Indigestion All symptoms are worse when emotionally upset Fullness of the chest Hypochondriac pain Continual belching Anorexia Epigastric distention Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Bitter taste in the mouth Dry mouth Irritability Inappropriate anger Frustration Anxiety Moodiness Irregular menses Dysmenorrhea Breast distention and pain before and during menses Head and nape painful or swollen T: Pink or Dark with slightly red edges C: Thin and white or Thin and sticky yellow P: Wiry or Thready and wiry or Wiry and slippery With Heat: Hot, foul vomit Aversion to Heat Thirst T: Normal C: Yellow P: Slippery and wiry With Cold: Vomiting large amounts of clear fluid No thirst Aversion to Cold Prefers warmth T: Normal C: White P: Thready
Treatment Principle	Soothe the Liver Harmonize the Stomach Descend Stomach Qi Stop nausea and vomiting
Herb Formulas	Yue Ju Wan modified Chai Hu Shu Gan Tang Xiao Yao San With Heat: Si Ni San Jia Wei Xiao Yao San With Stomach Heat: Zuo Jin Wan With persistent or severe vomiting: Xuan Fu Dai Zhe Tang Chinese Patent Medicines: Xiang Xia Yang Wei Wan Xia Yao Wan With pain: Shu Gan Wan For robust patients: Chai Hu Shu Gan Wan With constipation: Chen Xiang Hua Qi Wan With Stagnant Heat: Jia Wei Xiao Yao Wan With Spleen and Stomach Deficiency: Xiang Sha Yang Wei Wan With severe Damp-Heat in the Stomach: Huang Lian Jie Du Wan
Points	GB-34, LIV-3, PC-5, PC-6, REN-12, SP-3, ST-40 With Spleen Deficiency: + LIV-13, ST-36 With foggy-headedness: + GB-20, UB-62 With vomiting of bile: + Dannangxue, GB-24, GB-34 With Wind-Phlegm: + GB-40, ST-8, ST-41 With Cold Phlegm: + moxa UB-20, UB-23 With muscle aches and heaviness: + UB-21 With Fluid retention and edema: + SP-6, SP-9 With somnolence: + KI-6, UB-62 With severe abdominal distention : + SP-15, ST-25 Ear: Stomach, Spleen, Liver, Subcortex, Sympathetic, Shenmen

Liver Fire (Acute Purulent)

Clinical Manifestations	Alternating fever and chills Fullness in the chest and hypochondrium (with or without pain) Bitter taste in mouth Nausea Continuous vomiting Hard focal distension in the epigastrium Fullness and pain in the epigastrium Burning diarrhea or no bowel movement Despondency Slight fidgeting Slight irritability Headache Constipation or discharge of fluids rectally Tinnitus Diminished hearing Diminished vision Red eyes Manic behavior Asthma Mental instability T: Normal or red C: Yellow or Thick and yellow P: Wiry and forceful or Wiry tight and forceful
Treatment Principle	Harmonizes and Disperses the Shao Yang Drains Internal Heat Retention
Herb Formulas	Dang Gui Long Hui Wan Xie Qing Wan Long Dan Xie Gan Tang modified For chronic cases: Tian Ma Gou Teng Yin Zhen Gan Xi Feng Tang Chinese Patent Medicines: Long Dan Xie Gan Wan Ji Gu Cao Wan Niu Huang Jie Du Pian Ci Zhu Wan
Points	GB-12, GB-34, GB-37, LIV-2, UB-18, UB-19 GB-41, SJ-5 GB-2. LIV-14, SJ-5, SJ-17, SJ-21 For a painful mastoid: SP-2 GB-20. KI-1, LIV-2, bleed Taiyang, UB-2 GB-20, GB-34, GB-40, LI-5, LIV-2, LIV-3, SJ-3, SJ-5, SJ-17 With Yin Deficiency and Yang Rising: + KI-1, KI-3, UB-18, UB-23

Damp-Heat In The Liver And Gall Bladder (Acute)

Clinical Manifestations	Severe burning pain in the ear moving to the head Maybe a perforated eardrum Maybe sticky, yellow pus Maybe fever Severe, splitting headaches with dizziness Sudden tinnitus or deafness Flushed face Red, swollen, painful eyes Irascibility with violent angry outbursts Dry mouth Bitter taste in mouth Vomiting sour or bitter liquid Insomnia Restlessness Maybe rib pain Maybe Yang jaundice (sclera and skin bright yellow) Pain and fullness in ribs on both sides Maybe pain in the right hypochondrium Nausea Anorexia Maybe alternating chills and fever Concentrated, dark urine Abdominal distention T: Pink or Red C: Yellow and greasy or sticky. P: Wiry and rapid or Slippery and rapid
Treatment Principle	Drain Excess Fire from the Liver and Gallbladder Clear Damp-Heat from the San Jiao
Herb Formulas	Long Dan Xie Gan Tang Xiao Chai Hu Tang Da Chai Hu Tang Hao Qi Qing Dan Tang Chinese Patent Medicines: Li Dan Pian Long Dan Xie Gan Wan
Points	Dannangxue, DU-9, GB-24, GB-34, LIV-14, SI-4, SP-9, UB-18, UB-19, UB-48 + general points Sedate GB-4, GB-39, GB-40, LIV-1, LIV-2, SP-5, SP-9 GB-2, LI-4, SJ-17, SJ-21, SP-3 GB-41, SJ-5 GB-2. LIV-14, SJ-5, SJ-17, SJ-21 For a painful mastoid: SP-2

Phlegm-Heat In The Liver And Gallbladder

Clinical Manifestations	Palpitations Anxiety Insomnia Coughing and wheezing Thick, viscous, yellow sputum Distention of chest and epigastrium Stifling sensation of chest and epigastrium Dizziness Vertigo Tinnitus Stuffy nose with turbid, foul, thick, yellow nasal discharge Constipation Choking sensation Restlessness Agitation T: Red tip C: Thick, yellow and greasy P: Slippery, Excess and rapid or Wiry and rapid
Treatment Principle	Clear the Liver and Gall Bladder Clear Heat Resolve Phlegm
Herb Formulas	Gun Tan Wan Ling (Yang) Jiao Gou Teng Tang
Points

Liver Yin Deficiency With Liver Yang Rising (Chronic)

Clinical Manifestations	Burning pain in the ear Thinner discharge Dizziness Impaired vision Night blindness Tinnitus Maybe impaired hearing Irascibility Throbbing headache with distended feeling Flushed face Blurred vision Red, dry eyes with feeling of grit in eye Dry mouth and throat with bitter taste in mouth Palpitations Headache Nervousness Insomnia with much dreaming Dry throat Thirst Five sole Heat (palms, soles and center of chest) Night sweats Light or late menses or Amenorrhea T: Red and dry C: Little or None or Thin and yellow P: Thready and wiry or Wiry and rapid (when Yang is Rising and Excess, pulse is forceful) or Thready and rapid when Yang is not prominent
Treatment Principle	Nourish Yin Pacify the Liver Subdue Yang
Herb Formulas	Zi Shen Tong Qi Tang modified
Points	GB-2, GB-40, KI-3, SJ-17, ST-36 GB-41, SJ-5 DU-20, GB-20, GB-34, GB-43, KI-3, LIV-2, LIV-3, UB-18, UB-23

Heat In The Liver And Stomach

Clinical Manifestations	Morning sickness or Vomiting during pregnancy Nausea with sour regurgitation or Vomiting of sour material Hypochondriac discomfort Belching Sighing Moodiness Dizziness Depression Concentrated urine A tendency toward constipation T: Red edges C: Yellow P: Wiry and rapid
Treatment Principle	Clear Liver and Stomach Heat Descend Qi
Herb Formulas	Su Ye Huang Lian Tang
Points	General points

Kidney And Liver Yin And Blood Deficiency With Liver Fire

Clinical Manifestations	Deafness Tinnitus that worsen at night Dizziness Hypoacusis (elderly people) Blurred vision Fever Insomnia Irritability Hard of hearing Ocular pain Red eyes Thirst Auditory depression Poor hearing T: Red C: Yellow P: Weak, thready and rapid
Treatment Principle	Nourish Yin and Blood of the Liver and Kidneys Improve hearing Clear Heat
Herb Formulas	Zi Shen Tong Er Tang
Points

Yin Deficiency With Fire Flaring (Chronic Purulent)

Clinical Manifestations	A discharge of thick, foul smelling, sticky pus is exuded from the ear Diminished hearing Tinnitus The ear drum is loose or perforated at the rim Decreased mental clarity Vexation Sore, weak knees and lumbar region T: Red C: Thin P: Thready and rapid
Treatment Principle	Moisten the Yin Restrain the Fire Detoxify poison Eliminate pus
Herb Formulas	Zi Shen Tong Qi Tang modified Zhu Sheng Teng Er Tang Zhi Bai Di Huang Wan
Points	GB-2, GB-40, KI-3, SJ-17, ST-36 GB-41, SJ-5 DU-20, GB-20, GB-34, GB-43, KI-3, LIV-2, LIV-3, UB-18, UB-23

Qi And Blood Stagnation

Clinical Manifestations	This is a chronic disease that is recalcitrant to healing The inner ear feels full and distended Tinnitus Hearing loss The tympanic membrane is sunken, not transparent, and turbid T: Dark body or with petechiae C; Normal P: Moderate
Treatment Principle	Activate Qi flow Invigorate the Blood Open the cavities
Herb Formulas	Tong Qiao Huo Xue Tang + Tong Qi San modified
Points	Insert a needle slightly anterior to the SI-19 and needle inward, forward, and downward to a depth of 2 inches. This strengthens the functioning and tissues of the eustachian tubes. SI-19, GB-2, SJ-21, SJ-17, GB-3, GB-20, REN-6. Needle daily, selecting 2 - 3 points at a time, with even tonification and sedation. Retain the needles for 10 - 20 minutes. Seven treatments are considered a treatment course.

Qi And Blood Deficiency

Clinical Manifestations	Fatigue Loose stools Poor appetite Dizziness Pale face Weak voice Reluctance to speak Sweating with little or no exertion Palpitations Insomnia Dry skin Dry hair Poor memory Paleness Scanty periods T: Pale or Pale, thin and dry C: Thin and white P: Weak or Thin and choppy
Treatment Principle	Tonify Qi Nourish the Blood
Herb Formulas	Gui Qi Jian Zhong Tang
Points	KI-3, LIV-3, LU-9, SP-6, ST-36, UB-11, UB-17

Dampness Accumulating In The Ear

Clinical Manifestations	Closure inside the ear Hearing loss Tinnitus A distended ear drum Half of the head and body feels heavy and swollen T: Normal C: White and greasy P: Slippery
Treatment Principle	Promote urination Drain Dampness Strengthen the Spleen Disperse water accumulation Warm the Yang Promote the transforming functions of Qi
Herb Formulas	Wu Ling San modified Tuo Li Xiao Du San Si Ling San
Points	Insert a needle slightly anterior to the SI-19 and needle inward, forward, and downward to a depth of 2 inches. This strengthens the functioning and tissues of the eustachian tubes. SI-19, GB-2, SJ-21, SJ-17, GB-3, GB-20, REN-6. Needle daily, selecting 2 - 3 points at a time, with even tonification and sedation. Retain the needles for 10 - 20 minutes. Seven treatments are considered a treatment course.

Damp-Heat Accumulation (Chronic Purulent)

Clinical Manifestations	Discharge of yellow turbid, copious pus from the ear Reduced hearing Perforated eardrums Red and swollen membranes Bitter mouth taste Dry throat T: Red C: Thick yellow P: Rapid, wiry and slippery
Treatment Principle	Drain Excess Fire from the Liver and Gallbladder Clear Damp-Heat from the San Jiao
Herb Formulas	Long Dan Xie Gan Tang San Huang Xie Xin Tang
Points	Dannangxue, DU-9, GB-24, GB-34, LIV-14, SI-4, SP-9, UB-18, UB-19, UB-48 + general points Sedate GB-4, GB-39, GB-40, LIV-1, LIV-2, SP-5, SP-9 GB-2, LI-4, SJ-17, SJ-21, SP-3 GB-41, SJ-5 GB-2. LIV-14, SJ-5, SJ-17, SJ-21 For a painful mastoid: SP-2

Phlegm-Heat (Re Tan)

Clinical Manifestations	Tinnitus in both ears like the sound of cicadas There may be a feeling of blockage or pressure in the ears This condition often is long term with gradual loss of hearing Maybe yellow, purulent discharge from one ear associated with an earache Fullness and heaviness of the head Foggy-headedness Recurrent clearing of the throat Cough with sticky, yellow, difficult to expectorate sputum Rapid breathing with a harsh voice Maybe restless fever Sore throat Fullness in the chest and epigastrium Loose or sluggish stools or Constipation Dry stools Shortness of breath Anorexia A poor sense of taste or A bitter taste in the mouth Dyspnea Nausea Vomiting Pain in the ribs T: Scarlet C: Yellow or Yellow and greasy or Yellow and smooth P: Rapid and smooth or Slippery and rapid or Wiry and slippery
Treatment Principle	Clear Heat Resolve Phlegm
Herb Formulas	Wen Dan Tang modified For severe cases or cases with vertigo, a thick, yellow tongue coat, impairment of consciousness or constipation: Gun Tan Wan Following resolution of the Heat signs or between episodes: Er Chen Tang modified With dizziness and a headache of foggy-headedness: Ban Xia Bai Zhu Tian Ma Tang With Spleen Qi Deficiency: Liu Jun Zi Tang Chinese Patent Medicines: Qing Qi Hua Tan Wan Huang Lian Jie Du Tang Chuan Xin Lian Kang Yan Pian
Points	LI-11, LU-5, ST-40, UB-13 Choose one or two of the following: GB-2, SI-19, SJ-17, SJ-21 + two or three of the following: GB-20. LI-4, LU-7, PC-5, SJ-3, SP-4, SP-9, ST-40

Phlegm-Fire

Clinical Manifestations	Hot toxic sores Pimples Infection and pus formation in the middle ear It may be an acute or a chronic condition
Treatment Principle	Dispel Wind Transform Dampness Clear Heat Resolve toxicity
Herb Formulas	Shi Wei Bai Du San Jing Jie Lian Qiao Tang Huang Lian Jie Du Tang Bai Nung Tang Huang Lian Shang Qing Wan Liu Shen Wan
Points