bubble_chart Concept

Dizziness refers to a condition where one feels as if the surroundings are spinning or swaying, akin to being on a boat or in a moving vehicle. In severe cases, opening the eyes can cause an immediate sensation of the sky and earth spinning, making it impossible to stand, accompanied by nausea and vomiting, and even leading to collapse.

This symptom has been referred to by various names in ancient medical texts. The *Suwen* mentions terms such as "head dizziness," "shaking dizziness," and "confused vision and unsteady movement"; the *Lingshu* refers to it as "dizzy vision," "dizzy vision," and "fainting collapse"; the *Jingui Yaolue* records terms like "vertigo" and "epileptic dizziness"; the *Zhubing Yuanhou Lun* calls it "wind dizziness"; the *Shenghui Fang* refers to it as "head spinning"; the *Sanyin Fang* uses the term "vertigo"; the *Jisheng Fang* calls it "dizzy movement," and from the Qing Dynasty onwards, it is mostly referred to as "vertigo" or "dizziness."

Some differentiate between cases where blurred vision leads to dizziness, calling it "dizzy vision," and cases where dizziness leads to blurred vision, calling it "epileptic dizziness." When dizziness is severe and accompanied by blackouts, it is referred to as "dizzy vision." These naming conventions do not differ in essence and are therefore all discussed in this section.

bubble_chart Modern Research

Wind phlegm headache and vertigo are roughly equivalent to Meniere's disease in Western medicine, which is caused by the accumulation of fluid and edema in the labyrinth of the inner ear. This may be due to excessive secretion of endolymph or dysfunction in absorption, leading to increased pressure in the endolymphatic system, resulting in the expansion of the endolymphatic space and hypoxia-induced degeneration of the inner ear. This disease commonly occurs in middle-aged individuals, characterized by sudden, rotational vertigo attacks, tinnitus, and fluctuating deafness as the main clinical manifestations. Treatment may include antihistamines such as diphenhydramine, anticholinergic drugs like atropine, and vasodilators such as cinnarizine. Sedatives and tranquilizers can also be used to alleviate the patient's anxiety.

bubble_chart Pattern Analysis

1. Wind-fire Disturbing Upward︰Dizziness, distending pain, dysphoria, irritability—aggravation of dizziness and pain when angry, flushed face, tinnitus, insomnia, dreamfulness, dry mouth, bitter taste in the mouth, red tongue with yellow coating, and wiry-rapid pulse. Suwen. Zhizhenyao Da Lun: "All wind with vertigo and shaking is ascribed to the liver." This syndrome is often caused by habitual yang exuberance and fire excess, leading to ascendant hyperactivity of liver yang; or frequent anger and depression, transforming qi stagnation into fire, which consumes liver yin, resulting in internal stirring of wind-yang and upward disturbance of wind-fire. Suwen Xuanji Yuanbingshi. The Five Evolutive Phases and Primary Diseases states: "Wind and fire both belong to yang, often manifesting together. Yang governs movement, and when two movements clash, it leads to spinning." When wind-fire disturbs the upper body, it causes dizziness, blurred vision, and distending pain; anger further intensifies liver fire, thus worsening dizziness and headache; disturbance of wind-fire to the heart-mind results in dysphoria, irritability, insomnia, and dreamfulness. A bitter taste in the mouth, red tongue with yellow coating, and wiry-rapid pulse are all signs of exuberant wind-fire. Treatment should focus on clearing fire, extinguishing wind, pacifying the liver, and subduing yang. The recommended formula is Gastrodia and Uncaria Drink. If liver-gallbladder heat is severe, with oral or nasal sores and scanty dark urine, it is advisable to clear and purge liver-gallbladder fire, using Gentian Liver-Draining Decoction. For middle-aged and older individuals with wind-fire dizziness, vigilance is needed to determine whether it is a precursor to apoplexy, and timely prevention and treatment should be implemented.
2. Yin Deficiency with Yang Hyperactivity︰Dizziness, dry eyes, irritability, insomnia, dreamfulness, or night sweats, feverish feeling in the palms and soles, dry mouth, red tongue with scant or no coating, thin and rapid or thin and wiry pulse. Yin deficiency with yang hyperactivity is due to chronic insufficiency of kidney yin or Rebing prolonged illness damaging yin, leading to insufficient yin fluids and water failing to nourish wood, resulting in ascendant hyperactivity of liver yang, primarily characterized by yin deficiency. Insufficient yin fluids fail to nourish the eyes, hence dizziness and dry eyes; kidney yin deficiency and non-interaction between the heart and kidney cause irritability, insomnia, and dreamfulness during sleep; yin deficiency leading to internal heat results in feverish feeling in the palms and soles, as well as night sweats. A red tongue and thin, rapid pulse are signs of yin deficiency with internal heat. This syndrome is characterized by vertigo, dry eyes, feverish feeling in the palms and soles, and a red tongue with scant or no coating. Treatment should focus on enriching yin and pacifying the liver to relieve dizziness, using Chrysanthemum Flower Peony Decoction or Wolfberry and Chrysanthemum Rehmannia Pill.
3. Heart-Spleen Blood Deficiency︰Dizziness and blurred vision, excessive mental exertion aggravates the condition, palpitation and mental fatigue, shortness of breath and lack of strength, insomnia, poor appetite, dull complexion, pale lips and tongue color, weak and thin pulse. The heart stores the spirit and governs the blood vessels, while the spleen controls blood and houses the mind. Excessive mental exertion and endless contemplation can damage the heart and spleen, depleting qi and blood; or after severe illness or significant blood loss, qi and blood become insufficient. As stated: "Blood is the companion of qi, and where qi resides, it flourishes with blood. Conditions such as hematemesis, epistaxis, menorrhagia and metrostaxis, postpartum yin exhaustion... this vertigo arises from blood deficiency." When qi and blood are depleted and cannot nourish the head and eyes, dizziness and blurred vision occur; blood deficiency leads to palpitation, mental fatigue, difficulty sleeping, dull complexion, pale lips and tongue color, and weak, thin pulse. Dizziness worsens with excessive mental exertion. Treatment should focus on tonifying qi and blood, and benefiting the heart and spleen. The formula used is Returning to Spleen Decoction.
4. Spleen Qi Deficiency︰Dizziness, prefers lying down, worsens upon standing, excessive labor can induce onset, fatigue and reluctance to speak, shortage of qi and weakness, spontaneous sweating, reduced appetite and loose stool, pale tongue and thin pulse. Middle qi deficiency dizziness, often without loss of blood, usually caused by excessive labor, original qi injury; or habitual spleen-stomach weakness, middle qi deficiency. As stated in Lingshu.Kouwen: "Abnormal rising of qi deficiency, the brain becomes insufficient, the ears suffer from tinnitus, the head inclines painfully, and the eyes experience dizziness." Qi deficiency fails to raise clear yang, leading to dizziness, tinnitus, head inclination and preference for lying down, fatigue and reluctance to speak, shortage of qi and weakness, reduced appetite and loose stool. Treatment should focus on tonifying middle and replenishing qi, with the main prescription being Middle-Tonifying Qi-Replenishing Decoction.
5. Kidney Essence Insufficiency︰Dizziness, tinnitus, mental fatigue, forgetfulness, blurred vision, soreness and weakness in the lower back and knees, seminal emission, impotence, a thin and pale-red tongue, and a deep, thin pulse that is especially weak at the chi position. The kidney stores essence and generates marrow, serving as the foundation of innate constitution. Innate deficiency, aging with weakened kidney qi, or excessive sexual activity can deplete kidney essence. The brain is the sea of marrow; when kidney essence is depleted, the sea of marrow becomes insufficient, leading to dizziness. Lingshu. Hai Lun: "When the sea of marrow is insufficient, it causes dizziness, tinnitus, soreness in the legs, vertigo, blurred vision, and a tendency to lie down due to fatigue." Persistent dizziness accompanied by mental fatigue, forgetfulness, tinnitus, blurred vision, soreness and weakness in the lower back and legs, seminal emission, impotence, and a weak chi pulse are all signs of kidney deficiency. This condition differs from dizziness caused by yin deficiency with effulgent fire, as the latter typically presents with feverish sensations in the palms and soles, restlessness, insomnia, and other signs of yin deficiency with effulgent fire, which are less prominent here. It also differs from dizziness due to middle qi deficiency, as this condition is marked by soreness in the lower back, weakness in the legs, seminal emission, impotence, and other signs of kidney deficiency. Treatment should focus on tonifying the kidney and replenishing essence, using Left-Restoring Pill as the primary prescription. If there is a deficiency of kidney yang, accompanied by fear of cold, cold limbs, a pale tongue, and a deep, faint pulse, the treatment should warm and tonify kidney yang, using Right-Restoring Pill as the primary prescription.
6. Phlegm-Dampness Obstructing the Middle Jiao︰Dizziness (heaviness of head), fullness and oppression in the chest and diaphragm, nausea (vomiting), poor appetite, heavy limbs, or somnolence, white and greasy tongue coating, soggy and slippery or wiry and slippery pulse manifestation. Due to improper diet, injury to the spleen and stomach, dysfunction of the spleen in transportation, and abnormal transformation of water and grain essence, dampness accumulates and produces phlegm; phlegm-dampness obstructing the middle, clear yang fails to ascend, and turbid yin fails to descend, hence dizziness and somnolence, along with a heavy sensation. As stated in Danxi Xinfa, "Dizziness Treatise": "Without phlegm, there would be no dizziness." Phlegm-dampness stagnating in the chest and epigastrium, disturbance of qi movement, leads to fullness, oppression, nausea, and poor appetite; heavy body, greasy tongue coating, and slippery pulse are all signs of phlegm-dampness. Treatment should focus on dispelling phlegm and resolving dampness, with the main formula being Pinellia, White Atractylodes and Gastrodia Decoction. If accompanied by distending pain in the head and eyes, bitter taste in the mouth, irritability, yellow and greasy tongue coating, and slippery and rapid pulse, it indicates phlegm stagnation transforming into heat, and treatment should involve clearing heat and resolving phlegm, using Gallbladder-Warming Decoction with the addition of Coptis Rhizome and Skullcap Root.

Dizziness is mostly attributed to deficiency patterns and less frequently to excess patterns. For instance, dizziness caused by wind-fire disturbing the head, although it is an excess pattern, is often accompanied by yin damage. In such cases, while clearing heat and extinguishing wind, nourishing yin should also be incorporated, and one should not indiscriminately use bitter-cold herbs to clear and purge. Dizziness due to phlegm-turbidity obstructing the middle burner belongs to an excess pattern, with more severe vertigo accompanied by nausea and vomiting, making it easier to differentiate from other patterns.

Additionally, dizziness as a sequela often occurs after head trauma that injures the brain marrow, even after treatment. Clinically, based on the above pattern differentiation, herbs that invigorate blood and resolve stasis can be added. As for dizziness and vomiting experienced while traveling by car or boat, known as "motion sickness" or "seasickness," it may resolve without treatment or be alleviated by taking anti-dizziness medication.

bubble_chart Documentation

1. Suwen-Zhizhenyao Da Lun: "The predominance of Jueyin, tinnitus and dizziness, a feeling of confusion and desire to vomit, the stomach and diaphragm feel cold, and strong winds frequently arise."
2. Lingshu-Dahuo Lun: "When evil invades the neck, it encounters the body's deficiency. If it penetrates deeply, it reaches the marrow and eye connector to enter the brain. Entering the brain causes brain rotation, which leads to tension in the eye connector, and tension in the eye connector results in dizzy vision and rotation."
3. Jingui Yaolue．Phlegm-fluid retention cough disease, pulse and symptom treatment: "Suppose a thin person has palpitations below the navel, spits frothy saliva, and experiences dizziness and vertigo, this is due to water, Five Ingredients with Poria Powder is the main treatment."
4. Jingyue Quanshu．Dizziness: "Without deficiency, dizziness cannot occur. The treatment should focus on addressing deficiency, while also considering the symptoms."
5. Linzheng Zhinan Yi'an．Vertigo: "Liver wind boils internally, depleting body fluids, causing dizziness, and dryness in the throat and tongue."