Dizziness is a common functional disorder of the brain, often manifested as a sensation of dizziness, head swelling, light-headedness, and blurred vision. If the patient feels that the peripheral environment or himself is rotating, moving or shaking, i.e., when dizziness is accompanied by balance perception disorder or spatial perception orientation disorder, it is called vertigo. In clinical practice, we find that dizziness is common in the following five types: 1. Cerebral dizziness. It is caused by cerebral arteriosclerosis (such as basilar arteriosclerosis) or cervical spine osteophytes stimulating or compressing the vertebral artery, or resulting in transient cerebral blood supply deficiency. The clinical characteristics are dizziness, sleep disturbance, memory loss, parieto-occipital headache, light palsy, speech disorder, emotional agitation, etc. The disease generally develops slowly, and such dizziness is characterized by easy appearance or aggravation during postural changes. 2, vasopressor dizziness. It is often precipitated by emotional stress, pain, fear, bleeding, sultry weather, fatigue, insomnia, etc. Patients often have dizziness, vertigo, nausea, epigastric discomfort, pallor, cold sweat and other plant nervous disorders. 3. Otoliths and Meniere’s syndrome. Otolithosis, also known as benign paroxysmal positional vertigo, is the flow of otoliths in the inner ear after they are dislodged, which stimulates the hair cells of the semicircular canal and causes vertigo in the body, and the duration of vertigo is usually short, often less than one minute. Meniere’s syndrome is caused by water accumulation in the membranous vagus, and its clinical manifestations are vertigo, deafness, tinnitus and a feeling of stuffiness in the ear. 4. Postural hypotensive dizziness. The diagnostic criterion is a 20 mmHg drop in systolic blood pressure or a 10 mmHg drop in diastolic blood pressure from the recumbent to the standing position, along with the symptoms of hypotension. It is mostly caused by the dysfunction of small upright arterial systolic function due to the disorder of plant nervous function. The main manifestation is low blood pressure when suddenly changing to upright position, which may also be accompanied by unsteadiness, blurred vision, dizziness, weakness, etc. 5. Cardiogenic dizziness. Commonly seen in acute cardiogenic cerebral hypoperfusion syndrome, which is acute cerebral ischemia caused by cardiac arrest, paroxysmal tachycardia, atrial fibrillation, ventricular fibrillation, which can manifest dizziness, blurred vision, stomach discomfort, syncope, etc. The etiology of this category is clear and the clinical symptoms are typical, so it is not easy to be confused. In clinical practice, people often come to us with various imaging data to see dizziness, often saying, “I have degeneration in my cervical spine, and I tend to get dizzy or aggravate dizziness when I turn my head and neck from side to side or flex and extend it. Or the patient may say, “Our doctor there said that my vertebral artery is thinning on one side. In fact, except for dizziness, the patient does not have any symptoms of nerve compression, and there is no obvious compression on the MRI, but perhaps a little bit of poor cervical physiological curvature. There are also some misconceptions in the clinical understanding. In fact, people over 35 years old basically start to develop cervical degenerative pathology (which is the so-called cervical spine osteophytes, which are often relatively mild and should have spinal cord compression symptoms in severe cases.) And many doctors do not recognize that the thickness of the left and right vertebral arch veins in the cervical spine is basically asymmetrical, and according to autopsy, angiography and ultrasound studies, the left vertebral artery is larger in diameter than the right. And most physicians do not know much about spinal disorders and push this category of patients to orthopedics. How do we diagnose and treat patients who encounter this type of dizziness: It has been reported that if a patient is older than 50 years of age, if dizziness occurs, cerebral insufficiency is the most common cause, while only a small percentage of patients under 50 years of age have cerebral insufficiency, and the age can be advanced if the patient has risk factors such as smoking, alcohol, hypertension, diabetes, and hyperlipidemia. Characteristics of cerebral insufficiency: Most of them are paroxysmal and transient, usually lasting for several days and relieved by themselves, or relieved by blood vessel dilation, blood circulation and blood stasis infusion or lying down for a period of time. This category accounts for the vast majority of patients. If the dizziness lasts for more than 3 months and is not relieved by cerebrovascular insufficiency infusion, other factors need to be considered. This group of patients is referred to neurology for treatment. Another part is vasodepressive dizziness, which is mostly seen in young women who are frail. It is often closely related to mood, poor sleep quality, and psychological factors. This type of patients can often improve after adjusting sleep, resting time and psychological counseling, but we often need to spend a long time doing mental work, which is called “talking therapy”. If a patient has vertigo symptoms, there is no doubt that we need to first consider the ENT diseases: otoliths and Meniere’s syndrome. It is customary to ask the patient if there is house spinning, tinnitus, hearing loss. If “yes”, highly suspect and refer to ENT, after all, this is not a specialty of orthopedics either. The rest of the patients are actually very low, and we need to differentiate them from postural hypotensive dizziness. In theory, according to this ratio, the number of patients who visit orthopedic clinics for dizziness should be very low, but in fact, the ratio is still very high, with a preliminary estimate of 15-20%, and the proportion of online consultations may be even higher. The main symptoms are dizziness with spinning sensation, occasional nausea and vomiting, while there is no obvious numbness and pain in both upper limbs, and walking is normal, and a significant proportion of patients feel tightness in the neck. In contrast, the cervical spine of middle-aged and elderly people often has degeneration, which makes it easy for clinicians and patients to first consider that it is caused by cervical spondylosis. The main reason for this phenomenon is that more and more people are now working in a sedentary position, repeating the same work posture almost every day, especially with the popularity of computers and smartphones, many people are keen on surfing the Internet, playing games, etc., sitting in front of the computer for a few hours, walking in the car and not forgetting to play with the phone. Forget to play with the phone, long-term head down to maintain the same posture, muscle stiffness, fatigue caused by cervical pain. For this type of patients, we first suggest that they adjust their work habits and living habits, avoid long-term low posture, appropriate outdoor activities, enhance physical fitness, and also do physical therapy. If the physiological curvature of the cervical spine has disappeared, we suggest that the patient sleep with a small round pillow or a memory pillow sold in the market to correct the physiological curvature of the cervical spine. If the patient complains of heavy symptoms, we can also give her symptomatic treatment such as blood vessel dilation, blood circulation and dehydration by infusion.