Abstract： This article introduces Professor WANG Bangcai's clinical experience in treating refractory cranial tinnitus by syndrome differentiation. Professor WANG holds that the core pathogenesis of refractory cranial tinnitus is insufficiency of qi in the upper region caused by depletion and deficiency of viscera and bowels，and pathological factors of wind，phlegm and blood stasis are important links disturbing the restless of brain and spirit. The brain and spirit can be nourished， and the cranial tinnitus will resolve spontaneously after the qi in the upper region is nourished and pathogens are eliminated. This is achived through five mechanisms， including boosting kidney and supplementing essential qi to tonify marrow，calming heart and spirit to fortify brain，supplementing spleen and upbearing the clear to tonify qi， soothing the liver and regulating emotions to restore orifice patency， and dispelling wind and resolving phlegm to disperse blood stasis.