Dizziness

Dizziness and Vertigo/Xuàn Yùn
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.