Dizziness & Vertigo

WESTERN MEDICINE: Vertigo is a disturbance in which the individual has a subjective impression of movement in space, or of objects moving around him, with a tendency to lose equilibrium. True vertigo, as distinguished from faintness, lightheadedness, and other forms of "dizziness", results invariably from a disturbance of the equilibratory apparatus. The balancing mechanism (vestibule, semicircular canals, eighth nerve, vestibular nuclei and connections, eyes, and the sensory nerve of the muscles, joints and tendons) may be affected by any of a large variety of disorders: 

(1).Otogenic: myringitis, otitis media, middle ear tumors, labyrinthitis, petrositis, otosclerosis, obstruction of the external auditory canal or the eustachian tube, meniere's disease. 

(2).Toxic: disturbances due to alcohol, salicylates, streptomycin, opiates, nicotine, caffeine, and various sedatives. 

(3).Environmental: motion sickness, sunstroke, abrupt changes in atmospheric pressure. 

(4). Ocular: glaucoma, ocular imbalance. 

(5). Cerebrovascular: hypertension, transient ischemic attacks (especially in vertebrobasilar distribution), postural hypotension, overactive carotid sinus reflex, cardiac failure. 

(6).Blood dyscraias: anemia, leukemia, polycythemia. 

(7). Infectious diseases: influenza, diphtheria, typhoid fever, streptococcosis, epidemic encephalitis, syphilis, measles, mumps, herpes zoster. 

(8). Neoplastic: tumors of the cerebrum, cerebellum, cerebellopontine angle, eight nerve, and labyrinth.

(9).Miscellaneous: hemorrhage, psychogenic disorders, temporal lobe seizures, multiple sclerosis.

SYMPTOMS AND SIGNS: Main symptoms are giddiness, and blurring vision with a subjective impression of movement in space, or of objects moving around oneself, or with a tendency to lose equilibrium. In light cases, all symptoms disappear with closed eyes; in serious cases, the continuous whirling sensation and of things turning makes a person feel like falling, accompanied with nausea, vomiting, sweating, or faintness. 

ETIOLOGY AND PATHOLOGY: The causative factors of vertigo and dizziness can be categorized as following: 

(1). The hyperactive liver Yang goes flaming upward and attacks the head: due to the Yang excessive body type; or prolonged strong unhealthy emotions cause the stagnation of Qi which gradually change into the liver fire to consume the liver Yin and produce the internal wind, the excessive Yang and internal wind combined and attack head creating vertigo; or due to the kidney Yin deficiency, yin loses its function to nourish the liver, causing deficient liver fire and wind.

(2). The deficiency of Qi and blood: chronic diseases; or after major hemorrhage; or deficient of Qi and blood due to the dysfunctions of spleen and stomach. Qi deficiency will lose its function of ascending pure Yang to head, the deficiency of blood losses its ability to nourish the head (brain). 

(3). The deficiency of kidney- essence: due to the deficiency of body type, or elderly, or excessive sexual· activities. Kidney essence is the source of morrow. Brain is the sea of marrow. Kidney essence deficiency will cause the brain insufficient nourishment so to cause dizziness, or vertigo. 

(4). Turbid phlegm obstructs spleen and stomach which is supposed to separate the pure from the impure and ascend the pure Yang to nourish the head. The dysfunction of spleen and stomach lead the disorders of ascending of pure Yang an descending of turbid Yin. Also, phlegm is easy to combine with other pathogenic factors, such as wind. damp, fire and Qi, so as to produce the substantial pathogenic factors and cause dizziness and vertigo. 

DIFFERENTIATIONS: 

1. The Excessive Liver Yang Type: 

Indications: Vertigo, dizziness, headache, or extended feeling of head, symptoms show up or become worse when strong angry emotions come or after over working, flushed face, restlessness, insomnia, drea-sleep, bitter taste, red tongue, yellow coating, wiry pulse. 
Treatment & Formulas: Sedates the excessive live Yang, clears the internal heat and wind.
Products:
    • Go Teng San (Gambir Formula, Item No. 2238): This is a very good formula to treat headaches vertigo, or dizziness due to the excessive liver Yang, internal heat and wind. Liver excess easily attacks the spleen according to the relationship of the five elements, so this formula has Ginseng to strengthen the function of the spleen, which make this a perfect formula to treat the liver problem without worrying about the functions of the spleen and stomach. 
    • Jia Wei Xiao Yao San (Bupleurum and Paeoni Formula, Item No. 2068): It treats the mild case of vertigo and dizziness due to the disharmony of liver and spleen. 
    • Long Dan Xie Gan Tang (Gentian Combination, Item No. 2267): This is a strong formula for excessive Hver fire combined with damp factor. Except for vertigo of strong liver fire type, it is often used for cystitis, urethritis, vaginitis, leukorrha, endometritis, genital pruritus, gonorrhea, acute cholecystitis, herpes, acute pyelitis, acute prostatitis. 
    • Ji Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia Six Formula, Item No. 2290): It treats the excessive liver Yang due to the kidney Yin deficiency. It is especially good to take at the late stage of vertigo after the symptoms become mild or weaker by the use of other formulas. 

2. The Qi and Blood Deficiency Type:

Indications: Vertigo and dizziness occur after any activity, or after exhaustion, pale complexion, fingernails and lips, insomnia, palpitation, lassitude, listlessness, reluctant speech, poor or no appetite, pale tongue, thin coating, thready and weak pulse. 

Treatment & Formulas: Tonify the Qi and blood by promoting the function of spleen and stomach. 

Products:

    • Gui Pi tang (Ginseng and Longan Combination, Item No. 2261): It treats vertigo due to both Qi and blood deficiency.
    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item no. 2225): It treats vertigo due to the middle Qi (spleen and stomach) deficiency. 

3. The Kidney Essence Deficiency Type:

Indications: Vertigo, dizziness, forgetfulness, sore and weak sensation at lumbar regions, emission, tinnitus. If it is more kidney Yin deficiency, symptoms show hot sensation of the souls and palms, red tongue, wiry and thready pulse; if it is more kidney Yang deficiency, symptoms show cold limbs and body, pale tongue, deep and thready pulse. 

Treatment & Formulas: Strengthen the kidney essence by tonifying the kidney Yin or Yang.

Products:

    • Liu Wei Di Huang Wan (Rehmannia Six Formula, Item No. 2051): This is a tonic formula for kidney Yin. 
    • Zi Shen Tong Er Wan (Scute Formula, Item No. 2207): It tonifies the kidney, at the same time it clears the liver fire. Therefore it is often used for tinnitus, hearing loss, otitis media of elderly. 
    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron, and Rehmannia Formula, Item No. 2123): This is a tonic for kidney Yin and it clears the deficiency fire at the same time. 
    • Zhen Wu Tang (Vitality Combination, Item No. 2170): It tonifies the kidney Yang, as well as having diuretic function. So it is very suitable for vertigo, dizziness due to the kidney Yang deficiency, and with water retention. 
    • Ba Wei Di Huang Wan (Rehmannia Eight Formula, Item No. 2011): This is a tonic formula for both kidney Yin and Yang.
    • Jia Wei Chang Chun (Ginseng & Condonopsis Combination, Item No. D3041): This is a very good formula to tonify both kidney Yin and Yang. 

4. The Obstruction due to Turbid Phlegm Type:

Indications: Vertigo, heavy head, suffocating and fullness of chest, poor appetite, nausea, vomiting, somnolence, white and greasy tongue coating, slippery and deep pulse. 

Treatment & Formulas: Eliminate the damp phlegm by dry and pungent herbs, promote the functions of spleen and stomach. 

Products:

    • Ban Xia Bai Zhu Tian Ma Tang (Pinellia and Gastrodia Combination, Item No. 2066): This is a very effective formula to treat vertigo and dizziness due to the damp phlegm. 
    • Wen Dan Tang (Bamboo and Hoelen Combination, Item No. 2228): It is used for stagnant fire of liver and gallbladder due to the stagnation of damp phlegm. 
    • Ling Gui Zhu Gan tang (Hoelen and Atractylodes Combination, Item No. 2130): lt treats vertigo and dizziness due to attacks by water retention of the stomach. 
    • Er Chen Tang (Citrus & Pinellia Combination, Item No. 2003): It resolves phlegm by drying internal dampness.
    • Ban Xia Hou Po Tang (Pinellia and Magnolia Combination, Item No. 2064)

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