Vertigo is a collective term for two symptoms: “xuan” and “yun.” “Xuan” refers to dizziness, blurred vision, and a sensation of confusion or disorientation; “yun” refers to lightheadedness, which is a sensation of the head spinning or moving unsteadily, similar to the sensation of riding in a car or on a boat. These two symptoms may occur separately or simultaneously; when they occur together, the condition is referred to as “vertigo.”
In modern medicine, this condition includes vertigo caused by cerebral arteriosclerosis, hypertension, anemia, neurasthenia, certain brain disorders, and otogenic vertigo. Otogenic vertigo is also known as Meniere’s disease or endolymphatic hydrops.
I. Etiology and Pathogenesis of Vertigo
The primary cause of vertigo lies in internal pathological factors. The *Su Wen: Treatise on the Essentials of the True Principle* states: “All wind-induced dizziness and vertigo belong to the liver,” indicating that liver wind can cause vertigo; Zhang Zhongjing, however, often treated it from the perspective of phlegm and fluid retention; Zhu Danxi believed that “there is no vertigo without phlegm”; Zhang Jingyue emphasized that “there is no vertigo without deficiency,” noting that “in cases of vertigo, eight or nine out of ten are due to deficiency, while those complicated by fire or phlegm account for no more than one or two out of ten”; Chen Xiuyuan, in *Medical Records for the Masses: Vertigo*, synthesized the theories of various medical scholars, concluding that the root of this condition lies in deficiency, while its clinical manifestations are of excess—a principle that remains consistent throughout, meaning that the root of the condition is deficiency, while its clinical manifestations are of excess.
The specific causes can be summarized as follows:
1. Excessive Liver Yang Rising: The liver is the organ of the Foot Jueyin, associated with wind and wood; its nature is vigorous, governing ascension and preferring free flow. If one experiences chronic emotional distress, Liver Qi becomes stagnant, transforming into fire and generating wind, with wind and fire disturbing the upper body; or if sudden rage injures the Liver—as anger causes Qi to rise excessively, disturbing the clear orifices; or if there is an inherent deficiency of Kidney Yin, which fails to nourish the Liver, leading to insufficiency of Liver Yin and hyperactivity of Liver Yang—all of these can manifest as vertigo.
2. Deficiency of Qi and Blood: This may result from a chronic illness that has not healed, depleting Qi and blood; from blood loss that has not been adequately replenished; or from weakness of the spleen and stomach, which fails to properly transform and transport food and drink to generate Qi and blood. This leads to a deficiency of both Qi and blood; when Qi is deficient, the clear Yang cannot expand, and when blood is deficient, the brain lacks nourishment—both of which can cause dizziness.
3. Obstruction by Phlegm-Dampness: Excessive consumption of rich and sweet foods, or overwork and excessive worry, can damage the spleen and stomach, impairing their ability to transport and transform. Consequently, fluids fail to be transformed into essential nutrients, and dampness cannot be properly metabolized, leading to the retention of dampness. Accumulated dampness generates phlegm; when phlegm and dampness obstruct the channels, clear yang fails to rise and turbid yin fails to descend, resulting in dizziness.
4. Deficiency of Kidney Essence (or Deficiency of the Sea of Marrow): The Kidneys govern the storage of essence and the production of marrow. Marrow fills the bones and converges in the brain; thus, the brain is known as the “Sea of Marrow,” from which essence and qi permeate to nourish the auditory orifices. Whether due to congenital deficiency or excessive physical exertion, both can lead to depletion of Kidney essence and insufficient production of marrow, preventing it from ascending to nourish the brain, thereby causing dizziness.
II. Differential Diagnosis and Treatment in Traditional Chinese Medicine
1. Liver Yang Rising Type: The patient’s dizziness often worsens with emotional fluctuations, distress, or anxiety. It may be accompanied by tinnitus, headache with a sensation of fullness, a bitter taste in the mouth, a dry throat, red eyes, facial flushing, irritability, restlessness, chest and rib discomfort, insomnia with frequent dreaming, a red tongue with a yellow coating, and a string-like, rapid pulse. The treatment principle is to calm the liver and subdue wind, as well as nourish yin and subdue yang. The Gastrodia elata Gou Teng Decoction, modified according to the specific symptoms, may be used.
2. Qi and Blood Deficiency Type: Due to insufficiency of qi and blood, the brain is inadequately nourished, resulting in dizziness and blurred vision that worsen with movement, a pale complexion, lackluster lips and nails, palpitations, insomnia or excessive sleepiness, reduced appetite, loose stools, mental fatigue and reluctance to speak, shortness of breath with insufficient breath to sustain breathing, and a pale tongue with a fine, weak, and feeble pulse. The treatment principle should focus on tonifying qi and nourishing blood, as well as strengthening the spleen and calming the mind. Gui Pi Decoction or Bu Zhong Yi Qi Decoction, modified as appropriate, may be used for treatment.
3. Phlegm-Dampness Obstructing the Middle Jiao Pattern: Because phlegm-dampness obscures the clear yang and obstructs the middle jiao, the patient presents with dizziness, a sensation of head distension and heaviness, chest oppression and discomfort, a vague sensation of nausea, palpitations and excessive sleepiness, excessive phlegm and saliva, poor appetite, and fatigue. The tongue coating is white and greasy, and the pulse is soft and slippery. The treatment principle should focus on drying dampness, eliminating phlegm, strengthening the spleen, and harmonizing the stomach. The Banxia Baizhu Gastrodia elata Decoction with modifications may be used.
4. Kidney Essence Deficiency (or Marrow Sea Deficiency) Pattern: Due to insufficient kidney essence and marrow, which fails to nourish the brain, patients present with dizziness, mental fatigue, forgetfulness, listlessness, soreness and weakness in the lower back and knees, nocturnal emissions, tinnitus, restlessness, insomnia, and frequent dreaming.
In cases with a predominance of Yang deficiency, patients may experience cold extremities, frequent nocturnal urination, a pale tongue, and a deep, fine pulse;
in cases with a predominance of Yin deficiency, patients may experience heat in the palms and soles, a red tongue, a thin coating, and a string-like, fine pulse. The treatment principle for cases with a predominance of Yang deficiency is to tonify the Kidney and assist Yang; Yougui Pills may be used with modifications based on the specific symptoms;
for cases with a predominance of Yin deficiency, the treatment principle is to tonify the Kidney and nourish Yin; Zhibai Dihuang Pills may be used.
III. Acupuncture Therapy
Acupuncture therapy can be used in conjunction with the treatment of all the above types of vertigo. The principles for selecting acupoints are generally the same, but the techniques—tonification and dispersion—as well as the use of needles and moxibustion differ.
1. Acupuncture: Points such as Baihui, Shenting, Shenmen, Ermen, Neiguan, Shenmai, Hegu, Zusanli, and Fenglong may be selected. Select 3–4 points per session, apply moderate stimulation, once daily, with a 10-day course of treatment. For cases involving deficiency-cold, moxibustion is primarily used.
2. Auricular Acupuncture or Auricular Acupoint Application: Acupoints such as E (Forehead), Xin (Heart), Shenmen, Wei (Stomach), and Zhen (Occipital) may be selected. Use 2–3 acupoints per session with strong stimulation.
IV. Other Therapies
1. During an episode of this condition, mild cases may see the dizziness subside by lying still with eyes closed; if the dizziness is otogenic, opening the eyes causes surrounding objects to appear to spin around the patient, while closing the eyes creates a sensation of spinning. Physical activity may lead to nausea and vomiting. Lying still with eyes closed is beneficial for all types of dizziness.
2. For more severe episodes of this condition, sedatives should be administered;
3. During an episode, a low-salt, low-fluid diet should be followed;
4. Treat the underlying conditions, such as hypertension or anemia.
V. Preventing the Recurrence of Dizziness
1. Patients with hypertension, anemia, or atherosclerosis should seek timely treatment;
2. Avoid excessive fatigue in daily life, maintain a positive outlook, and follow a regular routine;
3. Limit consumption of excessively salty and rich, sweet foods;
4. Follow a low-fat diet;
5. Quitting smoking and alcohol consumption is effective in preventing recurrence of this condition;
6. Patients with kidney essence deficiency should practice moderation in sexual activity;
7. Taking Chinese herbal medicines that lower blood pressure and blood lipids, as well as replenish blood and qi, plays an important role in preventing recurrence of this condition.