Vertigo

Dizziness & Vertigo/Xuàn Yùn
//Western Diagnosis:// the subjective impression of the movement in space (subjective vertigo) or of objects moving around (objective) -often accompanied by loss of equilibrium

Etiology
1. dysfunction of equilibratory apparatus: vestibule, semi-circular canals, 8th cranial nerve, brainstem, cortex, eyes 2. otogenic: Meniere’s, otitis, labyrinthitis 3. toxic: alcohol 4. environmental: motion sickness 5. psychogenic 6. ocular: diplopia 7. circulatory 8. neurologic: MS, seizures 9. neoplastic: tumors

Peripheral vs. central
1. peri - labyrinth, 8th nerve 2. cen - brainstem, cortex

Signs & Symptoms:
1. paroxysmal, severe - peripheral 2. unilateral deafness and tinnitus - peripheral 3. persistent with gait disturbances and nystagmus - central 4. HA, diplopia, slurred speech, discoordination of an extremity - central 5. peripheral usually more severe sx 6. postural or peripheral vertigo on rising or rolling over in bed with no change in BP - labyrinth 7. if on sudden turning or extension of head - vertebral artery insufficiency, 4th ventricle tumors

Diagnosis
1. vestibular function tests 2. x-ray, CT scan, MRI 3. CSF, EEG

Treatment
1. find cause

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======================================================================== //TCM Pathology:// In Chinese, dizziness and vertigo are known as Xuàn Yùn. Xuàn means blurred vision or blackouts, while Yùn means the subjective sensation that the body or the environment is spinning. Xuàn Yùn can range from mild lightheadedness, sometimes only with changes in posture, to severe vertigo with loss of balance, nausea and vomiting, perspiration, and even fainting.

Relevant Biomedical Conditions
-Hypertension -Hypotension -Hypoglycemia -Anemia -Labyrinthitis -Meniere’s disease -Traumatic head injury

Etiology and Pathogenesis
-Liver: depression, anger, frustration or irritability can result in Qi stagnation which, in turn, can generate Heat. Pathological Heat can damage Liver and Kidney Yin, resulting in failure to nourish the Liver and dysregulation between Yin and Yang. This will cause Liver Yang to rise hyperactively, disturbing the clear orifices and causing dizziness and vertigo. “All manifestations of Wind, such as dizziness, tremors and twitching, pertain to Liver pathology.” -Spleen: excessive pensiveness can weaken the Spleen, causing failure to generate Qi and Blood and lack of nourishment to the Brain, resulting in dizziness and vertigo.
 * Emotional stress:**


 * Improper diet, overwork, hemmorhage:** improper diet and overwork can weaken the Spleen and Stomach, causing failure to generate Qi and Blood and lack of nourishment to the Brain, resulting in dizziness and vertigo. Spleen and Stomach vacuity also can result in accumulation of Phlegm-Dampness. Turbid Phlegm prevents clear Yang Qi from rising to the Brain. “Dizziness will not occur if there is no Phlegm.”


 * Chronic illness, aging, congenital vacuity, excessive sexual activity:** the preceding factors result in Kidney Essence vacuity with inability to generate Marrow in failure to nourish the Brain. “Insufficient Sea of Marrow manifests as dizziness, vertigo, blurred vision, tinnitus…”

Liver Yang Rising
[Tian Ma (Gastrodia Root) 9g, Gou Teng (Uncaria Stem and Thorn) 12g, Shi Jue Ming (Abalone Shell) 12g, Shan Zhi Zi (Gardenia Fruit) 9g, Huang Qin (Scutellaria Root) 9g, Chuan Niu Xi (Cyathula Root) 12g, Du Zhong (Eucommia Bark) 9g, Yi Mu Cao (Leonurus) 9g, Sang Ji Sheng (Mistletoe) 9g, Ye Jiao Teng (Flowery Knotweed Stem) 9g, Fu Shen (Poria Root) 9g]
 * Main Symptoms:** Dizziness and vertigo often accompanied by a pounding or distending headache, symptoms worse with emotional stress/anger
 * Additional Symptoms:** Irritability, tinnitus, blurred vision, dream-disturbed sleep, insomnia, flushed face, red eyes, bitter taste in the mouth
 * Tongue:** Red, scanty, yellow coating
 * Pulse:** Wiry, rapid
 * Treatment Principles:** Settle the Liver, subdue Yang, nourish and supplement the Liver and Kidney, relieve dizziness and vertigo
 * Acupuncture Treatment:** LR2/LR3, BL18, BL23, KI3, SP6, GB20
 * Herbal Treatment:** Tian Ma Gou Teng Yin (Gastrodia and Uncaria Beverage)

Phlegm-Damp in the Middle Jiao
Herbal Treatment: Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Ovate Atractylodes and Gastrodia Decoction) [Fa Ban Xia (Processed Pinellia Tuber) 9g, Tian Ma (Gastrodia Root) 6g, Fu Ling (Poria) 6g, Ju Hong (Red Tangerine Peel) 6g, Bai Zhu (Ovate Atractylodes Root) 15g, Gan Cao (Licorice Root) 4g, Sheng Jiang (Fresh Ginger) 3g, Da Zao (Jujube Fruit) 2 pc]
 * Main Symptoms:** Dizziness and vertigo, heaviness of the head, cloudy thinking and poor concentration
 * Additional Symptoms:** Nausea, poor appetite, sleepiness, oppressive feeling in the chest, obesity
 * Tongue:** White, greasy coating
 * Pulse:** Soggy, slippery, soft
 * Treatment Principles:** Strengthen the Spleen, harmonize the Stomach, dry dampness, resolve phlegm, relieve dizziness and vertigo
 * Acupuncture Treatment:** ST8, ST36, ST40, CV12, PC6, GB20, BL20

Phlegm-Fire in the Middle Jiao
[Fa Ban Xia (Pinellia Tuber) 6g, Zhu Ru (Bamboo Shavings) 6g, Zhi Shi (Unripe Bitter Orange) 6g, Chen Pi (Tangerine Peel) 6g, Gan Cao (Licorice Root) 6g, Fu Ling (Poria) 9g, Sheng Jiang (Fresh Ginger) 2 pc, Da Zao (Jujube Fruit) 3 pc] Plus: Huang Lian (Coptis Root) 9g, Huang Qin (Scutellaria Root) 9g
 * Main Symptoms:** Dizziness and vertigo, heaviness of the head
 * Additional Symptoms:** Nausea, headache, irritability, red eyes that feel distended, bitter taste in the mouth, thirst without desire to drink, oppressive sensation in the chest
 * Tongue:** Yellow, greasy coating
 * Pulse:** Slippery, wiry
 * Treatment Principles:** Transform phlegm, drain heat, relieve dizziness and vertigo
 * Acupuncture Treatment:** ST8, ST40, LR2, GB20, PC6, CV12
 * Herbal Treatment:** Wen Dan Tang (Gallbladder-Warming Decoction)

Vacuity of Qi and Blood
[Huang Qi (Astragalus Root) 9g, Ren Shen (Ginseng) 9g, Bai Zhu (Ovate Atractylodes Root) 9g, Fu Shen (Poria Root) 9g, Long Yan Rou (Longan Fruit) 9g, Suan Zao Ren (Spiny Jujube Kernel) 9g, Mu Xiang (Saussurea Root) 6g, Dang Gui (Tangkuei) 6g, Yuan Zhi (Polygala Root) 3g, Zhi Gan Cao (Honey-fried Licorice Root) 6g, Shang Jiang (Fresh Ginger) 3g, Da Zao (Jujube Fruit) 5 pc]
 * Main Symptoms:** Positional dizziness and vertigo in mild cases. In severe cases fainting is possible.
 * Additional Symptoms:** Pale complexion, nails and lips, fatigue, shortness of breath, disinclination to speak, palpitations, poor memory, insomnia, loss of appetite, often occurs during recovery from severe illness or severe blood loss
 * Tongue:** Pale
 * Pulse:** Weak, thready
 * Treatment Principles**: Strengthen Spleen and Stomach, supplement qi and blood, relieve dizziness and vertigo
 * Acupuncture Treatment:** BL17, BL18, CV6, CV4, DU20, SP6, ST36, GB39, LR8
 * Herbal Treatment:** Gui Pi Tang (Spleen-Returning Decoction)

Vacuity of Kidney Essence and Yin
[Shu Di Huang (Cooked Rehmannia Root) 24g, Shan Yao (Dioscorea Root) 12g, Shan Zhu Yu (Cornus Fruit) 12g, Gou Qi Zi (Lycium Berry) 12g, Chuan Niu (Cyathula Root) 9g, Tu Si Zi (Cuscata Seed) 12g, Lu Jiao Jiao (Deerhorn Glue) 12g, Gui Ban Jiao (Tortoise Plastron) 12g]
 * Main Symptoms:** Dizziness and vertigo that does not abate
 * Additional Symptoms:** Listlessness, insomnia and/or dream-disturbed sleep, poor memory, achy and weak low back and knees, seminal emission, tinnitus, five-centers heat, night sweating
 * Tongue:** Red, scanty coating
 * Pulse:** Thready, rapid, wiry
 * Treatment Principles:** Supplement the Kidney, nourish Yin, relieve dizziness and vertigo
 * Acupuncture Treatment:** KI3, BL18, BL23, DU20, ST36, SP6
 * Herbal Treatment:** Zuo Gui Wan (Left-Restoring Kidney Yin Pill)

Vacuity of Kidney Essence and Yang
[Shu Di Huang (Cooked Rehmannia Root) 24g, Shan Yao (Dioscorea Root) 12g, Shan Zhu Yu (Cornus Fruit) 9g, Gou Qi Zi (Lycium Berry) 12g, Lu Jiao Jiao (Deerhorn Glue) 12g, Tu Si Zi (Cuscata Seed) 12g, Du Zhong (Eucommia Bark) 12g, Dang Gui (Tangkuei) 9g, Rou Gui (Cinnamon Bark) 6g, Zhi Fu Zi (Processed Aconite) 6g]
 * Main Symptoms:** Dizziness and vertigo that does not abate
 * Additional Symptoms:** Cold body and extremities, listlessness, poor memory, weak and aching low back and knees, impotence, tinnitus, seminal emissions, insomnia
 * Tongue:** Pale, scanty, white coating
 * Pulse:** Deep, weak
 * Treatment Principles:** Supplement the Kidneys, tonify Kidney Yang, relieve dizziness and vertigo
 * Acupuncture Treatment:** BL17, BL23, KI6, DU20, CV4, DU4
 * Herbal Treatment:** You Gui Wan (Right-Restoring Kidney Yang Pill)

Tx of Dizziness and Vertigo with Acupuncture and Moxibustion

 * Liver Yang Rising:** LR2/LR3, BL18, BL23, KI3, SP6, GB20
 * Vacuity of Qi & Blood:** BL17, BL18, CV6, CV4, DU20, SP6, ST36, GB39, LR8
 * Vacuity of Kidney Yin:** KI3, BL18, BL23, DU20, ST36, SP6
 * Vacuity of Kidney Yang:** BL17, BL23, KI6, DU20, CV4, DU4
 * Phlegm-Damp in the Middle Jiao:** ST8, ST36, ST40, CV12, PC6, GB20, BL20
 * Phlegm-Fire in the Middle Jiao:** ST8, ST40, LR2, GB20, PC6, CV12

Ear Points: Shen Men, Kidney, Occiput, Inner Ear, Subcortex Scalp Points: Yun Ting Qu (vertigo & hearing region)

Clinical Tips
In middle-aged and older patients there is a distinct possibility that more severe cases of dizziness and vertigo, particularly crossed by Liver Yang rising, may result in Wind-Stroke. Hence, prevention and prompt treatment of dizziness and vertigo in older patients is very important.

Preventive measures include decreasing consumption of rich foods and alcohol, abstaining from hot, spicy foods, controlling the emotions, engaging in appropriate physical exercise.

[|dizzness & vertigo.pdf]

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Dietary Recommendations
The dietary principles are that coffee, tea, tobacco, wine, chocolate, and salty foods should be avoided.
 * 1) The main focus should be to maintain an equilibrium between blood and body fluid volumes, so as to avoid the impact of fluctuations in fluid volume of the inner ear lymph edema, which will consequently increase symptoms of inner ear imbalance.
 * 2) The daily diet and water intake must be regulated carefully, so that the body fluid volume will not have significant fluctuations due to food and drink.
 * 3) One should always drink enough water and fluids. Try to limit the fluids to water, milk, and low sugar fruit juices. Avoid drinking coffee, caffeinated teas, and soda. If it is a hot day or if there is much physical activity where loss of body fluid is anticipated, fluid intake should increase beforehand.
 * 4) Avoid eating salty or sugary food, as it will cause fluctuations in the inner ear fluid pressure. Also avoid eating canned, frozen, or processed foods, because they also have a tendency to be too salty. Foods containing monosodium glutamate (MSG) should also be avoided, as MSG is also a salt. Try to eat more fresh vegetables, fruits, and whole grains.
 * 5) Avoid eating food containing caffeine (e.g. coffee, tea, chocolate).
 * 6) Alcohol consumption should be moderated because alcohol will also change the inner ear fluid pressure fluctuations.

Low liquid and salt diet to reduce the production of liquid in the labyrinth.

TCM Pattern Differentiation
__Liver Wind Moving the Fire__ This pattern is most commonly seen in thinner patients, or patients who are overly sensitive. This pattern may be divided into the following three TCM diagnoses: __//Taiyin// Phlegm Accumulation__ This pattern is an excess condition. The pulse sign for this condition is deep, soft, and sinking on the left //guan//. The pulse is forceful upon pressure. The herbal treatment is as follows: //Ban Xia Bai Zhu Tian Ma Tang// (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction), //Tian Ma Gou Teng Yin// (Gastrodia and Uncaria Decoction), //Long Dan Xie Gan Tang// (Gentiana Decoction to Drain the Liver), and //Gou Teng// (Ramulus Uncariae cum Uncis). If the patient complains more of dizziness, add //Tian Ma// (Rhizoma Gastrodiae); if more tinnitus, add //Shi Chang Pu// (Rhizoma Acori Tatarinowii).
 * 1) **Excess Heat**
 * Pulse Dx – (L) //guan//: Floating and convex; Forceful at both superficial and deep levels
 * BP / HR: Blood pressure slightly high; Heart rate slightly rapid.
 * Herbal Tx: //Long Dan Xie Gan Tang// (Gentiana Decoction to Drain the Liver)
 * //Tian Ma Gou Teng Yin// (Gastrodia and Uncaria Decoction)
 * //Yi Gan San// (Restrain the Liver Powder)
 * //Gou Teng// (Ramulus Uncariae cum Uncis)
 * 1) **Yin Deficiency**
 * Pulse Dx – (L) //guan//: Floating, thin, and convex; Forceful at the superficial level but disappears at the deeper levels
 * BP / HR: Blood pressure slightly high; Heart rate slightly rapid.
 * Herbal Tx: //Yi Gan San// (Restrain the Liver Powder)
 * //Jia Wei Xiao Yao San// (Augmented Rambling Powder)
 * //Long Dan Xie Gan Tang// (Gentiana Decoction to Drain the Liver)
 * //Gou Teng// (Ramulus Uncariae cum Uncis)
 * 1) **Qi and Blood Deficiency**
 * Pulse Dx – (L) //guan//: Thin, floating, convex; Weak on both superficial and deep levels
 * BP / HR: Blood pressure slightly low; Heart rate slightly slow
 * Herbal Tx: //Tian Ma Gou Teng Yin// (Gastrodia and Uncaria Decoction)
 * //Ban Xia Bai Zhu Tian Ma Tang// (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction)
 * //Gou Teng// (Ramulus Uncariae cum Uncis)
 * //Xia Ku Cao// (Spica Prunellae)
 * //Tian Zhu Huang// (Concretio Silicea Bambusae)

Orthomolecular Treatment
-Vinpocetine

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Definition:
A disturbance in which the individual has a subjective impression of movement in space (subjective vertigo) or of objects moving around him/her (objective vertigo) usually with a loss of equilibrium.

Etiology:
From a disturbance in the equilibratory apparatus: vestibule, semicircular canals, 8th cranial nerve, vestibular nuclei in the brainstem, and eyes. May be from effects of several disorders: • otogenic: Meniere's syndrome, myringitis, otitis media, acute vestibular neuronitis, herpes zoster oticus, labyrinthitis, petrositis, otosclerosis, obstructed eustachian tube • toxic: alcohol, streptomycin, opiates • psychogenic: hysteria • environmental: motion sickness • ocular: diplopia • circulatory: transient vestibular ischemic attack • neurologic: MS, skull fracture, temporal lobe seizures, encephalitis • neoplastic: tumors of the pons; cerebellopontine angle or 8th nerve • hematogenic: leukemia involving the labyrinth

Nutrition:
therapeutic foods: • foods that dispel Damp • increase foods rich in Calcium, Phosphorus, Manganese, Sulfur, Iodine, tryptophan (Jensen, p. 63) • egg yolk, kale, celery, fish, raw goat's milk, veal joint broth, cod roe, rice polishings, brewer's yeast, nutritional yeast (Jensen, p. 63)

therapeutic foods: » Xue Xu (Blood Deficiency) or Stagnant Liver Qi or Stagnancy in the Liver channel type: • foods that nourish the Xue (Blood), soothe the Liver, tonify the Kidney • sesame seeds, honey, tahini

therapeutic foods: » Liver Fire: • foods that clear Heat, Cooling foods, soothe the Liver

fresh juices: • celery, carrot, prune (Jensen, p. 63) • prune and rice polishings (Jensen, p. 63) • raw goat's milk and 1 tsp. sesame, sunflower or almond butter, 1 tsp. honey and sliver of avocado (Jensen, p. 63) • black cherry and egg yolk (Jensen, p. 63) • carrot, celery, spinach, and parsley (Walker, p. 134) • carrot, beet, and cucumber (Walker, p. 134) • carrot (Walker, p. 134) • for Liver Fire: celery juice mixed with honey (Lu, p. 87)

specific remedies: • take 15 g fresh longan fruit, 30 g lean meat, 2 slices of fresh ginger and splash of rice wine or sake, Steam and serve per day Or, eat 250 g of fresh longan fruit per day (Yin-fang and Cheng-jun, p. 27) • for vertigo from orthostatic hypotension, low blood pressure: take 250 g of peeled pineapple and stir-fry with 60 g of chicken, oil, salt and pepper (Yin-fang and Cheng-jun, p. 79)

avoid: • meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar, cow's milk and other dairy products, white bread, refined foods, processed foods, catarrh-forming foods: tofu, ice cream

Botanicals
• Anemone pulsatilla (toxic): dizziness (Harper-Shove, p. 34) • Betonica officinalis: vertigo (British Herbal Pharmacopoeia, p. 42) • Cimicifuga racemosa: vertigo associated with auditory tinnitus (NCNM Botanicals) • Claviceps purpurea (toxic): vertigo with noises in the ears; with intracranial hemorrhage or obstruction (Harper-Shove, p. 39; Felter, p. 360) • Crataegus oxyacantha: vertigo (Harper-Shove, p. 39) • Mentha piperita: despondency and dizziness (Harper-Shove, p. 26) • Podophyllum peltatum (toxic): dizziness (Felter, p. 555) • Ginkgo biloba (standardized extract): vertigo associated with vestibular dysfunction (NCNM Botanicals) • Veronicastrum virginicum: vertigo with liver enlargement, dizziness and depression with liver pains (Harper-Shove, p. 27, Sherman)

see: Meniere's disease

Chinese Formulae
• Tian Ma Gou Teng Yin; Tian Ma Mi Huang Jun Pian (patent): Liver Wind Arising from Liver Yang Rising: sensation of heat rushing to the head, insomnia with dream-disturbed sleep, red tongue, wiry rapid pulse. (Tian Ma Gou Teng Yin: Yeung, p. 229; Bensky and Barolet, p. 405; Tian Ma Mi Huang Jun Pian: Zhu, p. 319) • Lycium, Chrysanthemum and Rehmannia F. (Qi Ju Di Huang Wan) (available as patent): Liver Yin Xu (Deficiency) (Lycium: Hsu, 1980, p. 598; Yeung, p. 164; Dharmananda, 1986, p. 173; Bensky and Barolet, p. 264; patent: Zhu, p. 294) • Dang Gui Long Hui Wan: Liver and Gall Bladder Invaded by Damp-Heat: restlessness, constipation, dark urination. (Yeung, p. 76; Bensky and Barolet, p. 98) • Ginseng and Longan C. (Gui Pi Tang) (available as patent as Kwei Bi Wan); Dang Gui Yang Xue Gao (Tankwe Gin for Tea) (patent): Heart Xue Xu (Blood Deficiency) with Spleen Qi Xu (Deficiency): forgetfulness, palpitations, dream-disturbed sleep, anxiety, reduced appetite, pale complexion, pale tongue and thin pulse. (Ginseng: Hsu, 1980, p. 425; Yeung, p. 112; Dharmananda, 1986, p. 244; Bensky and Barolet, p. 255; Dang Gui Yang Xue Gao: Zhu, p. 283) • Zuo Gui Yin; Er Ming Zuo Ci Wan (Tso-Tzu Otic Pills) (patent): Kidney Yin Xu (Deficiency) (Zuo Gui: Yeung, p. 300; Dharmananda, 1986, p. 264; Bensky and Barolet, p. 267; Er Ming: Zhu, p. 304) • You Gui Wan; Gui Ling Ji (Kwei Ling Chi Super Tonic) (patent): Kidney Yang Xu (Deficiency) (You Gui Wan: Yeung, p. 276; Dharmananda, 1986, p. 263; Bensky and Barolet, p. 278; Gui Ling Ji: Zhu, p. 297) • Gentiana C. (Long Dan Xie Gan Wan) (available as patent); Gentiana 12 (patent): Liver and Gall Bladder Invaded by Damp-Heat (Gentiana: Hsu, 1980, p. 181; Yeung, p. 154; Dharmananda, 1986, p. 229; Bensky and Barolet, p. 96; patent: Zhu, p. 172; Fratkin, p. 82; Gentiana 12: Dharmananda, 1990, p. 69) • Bamboo and Hoelen C. (Wen Dan Tang); Pinellia and Gastrodia C. (Ban Xia Bai Zhu Tian Ma Tang); Er Chen Wan (Pinellia-Pachyma Compound Pills) (patent): Gall Bladder Xu (Deficiency) with Phlegm Heat: nausea or vomiting, insomnia, palpitations, anxiety, indeterminate gnawing hunger, bitter taste. (Bamboo and Hoelen: Hsu, 1980, p. 114; Yeung, p. 241; Dharmananda, 1986, p. 305; Bensky and Barolet, p. 435; Ban Xia: Yeung, p. 41; Bensky and Barolet, p. 447; Er Chen Wan: Zhu, p. 83 • Morus Fruit Tablets (patent): Xue Xu (Blood Deficiency) with Xue (Blood) Heat (Dharmananda, 1990, p. 86)

Acupuncture
after assessing the person and palpating, consider these patterns: » vertigo: Xue Xu (Blood Deficiency); Liver Yin Xu (Deficiency); Liver Yang Rising; Liver Fire Blazing; Liver Wind Arising from Liver Yang Rising; Heart Xue Xu (Blood Deficiency) with Spleen Qi Xu (Deficiency); Stomach Phlegm Fire; Kidney Yin and/or Yang Xu (Deficiency); Interior Retention of Phlegm-Damp

» illustrative combinations: • St-41 (D) and Ht-5 (D): for dizziness (Shanghai, p. 686; Lee and Cheung, p. 352) • an mian, GB-20, TW-20, LI-11 and St-40 to treat dizziness • LI-2, Lv-3 and yi ming alternating with PC-6, GB-20 and TW-9 (strong stimulation with both sets) for vertigo (Lee and Cheung, p. 352) • GV-24, GV-23, GV-22, GV-21, GV-19, GB-19, GB-20, SI-5, Sp-2, UB-67, UB-63, UB-62 and St-36 for dizziness (Shanghai, p. 686; Lee and Cheung, p. 352) • LI-4, St-40 and GB-20; UB-16, GV-20, UB-62, UB-67 and UB-8; GV-23, GB-20, PC-1 and GV-19; SI-3, UB-62 and SI-7; UB-66 for vertigo (Mann, p. 121) • GB-20, Lv-3, TW-17, SI-19, PC-6, St-36, CV-12, Kd-3 and an mian for vertigo with internal ear disease, esp. Meniere's (Lee and Cheung, p. 351) • GB-20, yin tang, PC-6, St-36, St-40, Sp-9 and LI-11 for vertigo due to Phlegm-Dampness with Heat (Jirui and Wang, p. 142) • Lv-3, Kd-3, PC-7 and Lv-8 (also consider LI-11 and St-40): for dizziness due to Liver Yang Rising (Jirui and Wang, p. 40) • yi ming, GV-15, PC-6 and Lv-3 for aural vertigo (Shanghai, p. 162) • GB-20, GB-41 and St-40 for headache and vertigo (Shanghai, p. 279) • SI-7 and UB-22 for vertigo and headache (Lee and Cheung, p. 352) • an mian, Ht-7 and St-40: for insomnia and vertigo (Shanghai, p. 274) • UB-21, CV-12, St-40 (-): cool Stomach Fire to make Phlegm Fire descend (Finkelstein) • UB-23 and Kd-3 (+): nourish Water to submerge excess Fire • UB-20 and Lv-13 (+): tonify Earth to transform Damp

Homeopathy
Aconitum napellus: on rising up from lying; from congestion as in the sun, on stooping; anxiety and restlessness Agaricus muscarius: vertigo and confusion of mind are mixed up; walking in open air; > quickly turning the head Ailanthus glandulosa: dizzy, face hot, cannot sit up; drowsy but restless and anxious; in malignant scarlet fever, diphtheria Apis mellifica: on closing eyes; < sitting, lying Argentum metallicum: giddiness looking at running water Argentum nitricum: looking at high buildings Baptisia: rapid septic state; swimming sensation; confusion as drunk; vertigo with paralysis of eyelids; feels scattered Belladonna: suddenness and violence; with pulsations in the head, dilated pupils, nausea; as if bed bounced him up and down; as if sinking with or through a bed Bryonia: rising from a seat or from lying; < least motion; sinking with or through a bed Camphora bromata: feels is journeying in one direction when actually moving in the opposite direction Cannabis indica: on rising, with stunning pain back of head; exalted sensation with exaggeration of time and distance Chelidonium: with bilious vomiting; on closing eyes; as if everything turned in a circle; typical pain under right scapula; desires hot milk Cinchona: after loss of blood; head tends to sink backwards, < moving and walking, > lying down Cocculus indicus: things go round; whirl from right to left with confusion, nausea; < rising from lying; general sensation of empty and hollow; extreme aversion to food Conium maculatum: turning or moving head, turning eyes, as if turning in a circle; if in bed, as if bed turned in a circle; when rising from a seat, watching moving objects; sweats day and night on closing eyes Cyclamen: transparent vertigo on waking or on riding, e.g. lamp seen whirling unsteadily and flickering away to the side while all the time, through the whirl, the lamp is seen standing solid and immovable; sensation as if brain moving within cranium Digitalis: from cardiac weakness; severe vertigo with very slow pulse; constant dizziness with ringing in the ears Dulcamara: momentary vertigo with darkness before eyes; at noon, before eating, while walking, giddy as if all objects remained standing before him Ferrum metallicum: face fiery red; vertigo < rising from lying or sitting Gelsemium: head feels light and large with vertigo; dizziness with blurring of vision, < smoking; feels intoxicated when trying to move; sensation of falling Lycopodium: everything turning around with nausea; vertigo while driving, in hot room Natrum carbonicum: quick onset, with "weak and sickly feeling" and headache due to sunstroke; in susceptible persons exposure to sunlight is adequate cause for vertigo Natrum muriaticum: with flickering before the eyes; tends to fall forward Natrum sulphuricum: sudden onset due to any blow to the head or coccyx; or, slow onset with "congested feeling in the head" due to malaria or malaria-like response to an epidemic infection Nux vomica: rising from seat or bed or raising head, vanishing of sight and hearing; objects seem to move around; from digestive disturbance Onosmodium virginianum: fears to look down; headache < dark Opium: compelled to lie down, as if all went round in a circle with him; from injury to head after fright; as if flying or hovering in the air Petroleum: in occiput; obliges him to stoop; more violent when standing than sitting Phosphorus: from looking upwards, downwards; chair seems to rise with him; sensation as if would fall forwards, < lying on left side Pulsatilla: violent vertigo-like intoxication; as if one had turned around in a circle for a long time, with nausea; < sitting, > walking in open air Salicylicum acidum: auditory nerve vertigo (Meniere's disease); tends to fall to left while surrounding objects seem falling to right Sanguinaria canadensis: cannot turn quickly without fear of falling; nausea and headache then vomiting as if heavy substance in stomach; looking up, lying down, during sleep; rush of blood to the head, feels sick and faint, < cold weather Secale cornutum: constantly increasing; inability to stand upright; head, esp. occiput feels light Silicea: creeping up spine into head; tends to fall forward; < closing eyes; vertigo during sleep Sulphur: dizziness when going into open air or when standing; < sleep, standing Tabacum: excessive heaviness of head; deathlike paleness of face; weakness to loss of consciousness, > open air and vomiting

Complex Homeopathy: Vertigoheel: complex remedy containing Cocculus 4X, Conium 3X, Ambra grisea 6X, Petroleum 8X. Specific for vertigo, dizziness and nausea. Studies have found that Vertigoheel activates the vestibular regulatory systems located in the brainstem area. Computer-processed brain mapping recordings indicate an increase in activity in the neuropathways which connect the vestibulo-pathways with the corpora quadrigemina. (Clause, C.F. Biological Therapy, 5(1)1-24, 1987 and 5(2)25-49, 1987; Claussen, C.F., et al. Arzneimittel-Forschung (Drug Research), 34(II), 12, 1791-1798, 1984.) A more recent double-blind clinical trial found Vertigoheel at least as effective as Betahistine. (Weiser, M., Stroesser, W, Klein, P, et al. Arch Otolaryngol Head Neck Surg 1998:124:879-885)

• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

Mind/Body
• Flight; scattered thinking; a refusal to look. (Hay, 1984, p. 162)

Chinese psychophysiology: • Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; nourishes the brain to sustain concentration, clear thinking, and memory; manifests through the ears and equilibrium; and displays the effects of sexual dissipation, overwork, aging, chronic debilitation, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat rising. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); opens into the eyes; and expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc. » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems. Wind can also be internalized after exposure to inclement, especially windy, weather and any concomitant influences of Damp, Cold, and/or Heat.

• Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; maintains upbearing; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; muscular weakness; and eventually obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Dampness and Phlegm Shi (Excess) usually derive from Spleen Yang and/or Qi Xu (Deficiency). » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.