Dizziness is a frequent clinical problem and has its related diagnosis in internal medicine. Clinically, the patient states that dizziness actually includes two aspects: 1. dizziness: the patient’s persistent mental unclearness, no sense of movement and rotation of oneself and the outside world, mostly accompanied by head weight, head stuffiness, head swelling, forgetfulness and weakness and other neurological and chronic somatic symptoms, aggravated by exertion and stress, caused by neurasthenia and chronic somatic diseases. 2. Vertigo: the illusion of feeling that the spatial position of oneself and surrounding objects has changed. Patients feel the illusion of rotation and bumps, oscillation, floating and sinking of themselves and external materials, which is aggravated when the head position is changed or when the eyes are opened. Imbalance, head heavy, syncope, this kind of vertigo patient expresses unstable standing and the whole room is rotating. It is mainly a dysfunction of the vestibular system and can have peripheral factors and factors of peripheral nerves. Causes of vertigo (a) Muscle provocation points: 1. Sternocleidomastoid muscle injury causes: vertigo: when the sternocleidomastoid muscle is tense during position change, it can be expressed as obvious vertigo, and the vertigo can be very intense, but it can also be not usually expressed, but in the case of seasickness when riding in a car, seasickness when riding in a boat. Vertigo is divided into vestibular peripheral vertigo and vestibular central vertigo. Imbalance: carrying a dumbbell and feeling very obvious weight discrepancy. 2. diastasis: leads to vertigo 3. posterior small rectus muscle of the head, semi-spinal muscle of the head, trapezius muscle tension: causes vertigo with pain and distension in the posterior occipital region because the occipital greater nerve passes from penetration or from the vicinity. Aggravated by tilting the head: change the light bulb in the house (b) Cervical vertigo: By treating the cervical spine, it can be a good intervention and treatment for vertigo. Definition of internal medicine: There are no clear diagnostic criteria so far, but most believe that there is stimulation of sympathetic nerves by osteophytes or occupying lesions in the cervical spine, resulting in compression or spasm of the vertebral and basilar arteries and temporary ischemia causing dizziness. Dizziness attacks when the head is in a specific position or changing position, but this is not common and should not be overdiagnosed clinically. However, the actual clinical cervical vertigo is a lot, mainly because the cervical spine is too fragile and easily damaged in many activities, leading to headache and vertigo. Therefore, full attention should be paid to the protection of the cervical spine and to the diagnosis with vertigo. We believe that the definition of cervical vertigo: various symptoms of vertigo appear due to chronic strain and acute injury of the cervical spine caused by tension in the posterior occipital muscles, cervical extensor muscles, sympathetic nerve disorder caused by misalignment, hyperplasia or even disc herniation of the cervical joints, compression or spasm of the vertebral artery, and proprioceptive disorder of the posterior cervical muscles. Among them, insufficient blood supply to the brain caused by irritation and compression of the vertebral artery is called vertebral artery type cervical spondylosis. The cervical spine will have many symptoms: neck pain, stiffness, limitation of movement with symptoms of insufficient blood supply to the vertebral artery, dizziness, migraine, tinnitus along with sympathetic symptoms: gastrointestinal and inspiratory, respiratory changes. This vertigo usually occurs with aggravation of cephalic and facial five sensory symptoms and postural vertigo, which can prompt imaging changes in severe cases. When the vertebral artery is irritated and compressed, it can lead to symptoms of inadequate blood supply to the brain. The vertebral artery emanates from the subclavian artery to the basilar artery of the intracranial nucleus, which is divided into 4 segments, including the primary segment, the intraforaminal segment, the atlanto-occipital segment, and the intracranial segment of the occipital bone. The origin segment, from the subclavian artery to the 6th transverse foramen, crosses the longissimus carotidus and anterior oblique muscles, so when the longissimus carotidus and anterior oblique muscles are tense, the vertebral artery is compressed. Anterior oblique syndrome causes pain and numbness in the upper extremities, but it also causes compression of the vertebral artery. Anterior oblique muscle: The anterior oblique muscle starts from the transverse process of the 3rd to 6th cervical vertebrae and ends downward and slightly anterolaterally above the 1st rib at the node of the anterior oblique muscle, which allows anterior or lateral cervical flexion and also lifts the rib to aid inspiration. The anterior trapezius muscle is sandwiched between the middle trapezius muscle and the 1st rib below it to form the trapezius gap, through which the brachial plexus nerve roots and the subclavian artery pass. The long cervical muscle: starts at the C3~T3 vertebrae and ends at the anterior atlantoaxial tuberosity and C2~4 vertebrae Intraforaminal segment: from the sixth cervical vertebra to the anteromedial end of the first cervical vertebra, as long as the vascular artery and nerve alignment, it must have a fibrous fat fascial layer to play a protective and cushioning role, but it can also cause compression and compression. The surface of the vertebral artery is very rich in sympathetic nerves, and often unknowing continuous and prolonged compression will cause stimulation of the vertebral artery as long as it causes sympathetic nerves, causing spasm of the vertebral artery, which manifests as intermittent dizziness. The atlanto-occipital segment is located within the inferior occipital triangle, penetrating vertically posteriorly from above the transverse foramen of the first cervical vertebra to the atlanto-axial vertebra around the vertebral artery sulcus inward and forward, then passing through the outer edge of the posterior atlanto-occipital membrane along the vertebral artery sulcus into the spinal canal and through the spinal membrane vertically upward into the skull. The vertebral artery is directed from behind the posterior atlanto-occipital membrane into the anterior and then into the supraoccipital triangle. Above it is the cephalic semispinalis muscle covering the triangle. The thick atlanto-occipital membrane rarely latches on to the nerves. Other cervical spine problems can also cause vertigo: problems with the atlantoaxial joint Transverse growth of the hook vertebral joint, leading to cervical instability. Changes in compression and irritation occur. The posterior atlanto-occipital membrane is an interstitial tissue and is not actively contracting. However, in practical terms: first, it is more difficult for the posterior atlanto-occipital membrane to compress the vertebral artery; second, even if the posterior atlanto-occipital membrane compresses the vertebral artery, it is difficult to treat it. Because the atlanto-occipital thick membrane is beneath the medulla oblongata, when touched, it is prone to injury and irreversible consequences. When the vertebral artery is compressed here, it may also be accompanied by functional symptoms of sympathetic nerves such as panic and chest tightness. And it is very similar to the vagus nerve, if the muscles are tense, accompanied by pain in the cervical-occipital region, and even difficulty in sleeping and insomnia, so its injury we consider neck pain, dizziness, nausea and other symptoms of the five senses of the head and face, but its consciousness remains awake all the time, such as: when crossing the street, hearing someone call behind you suddenly turn your head, then suddenly fall down, and will get up again, but conscious. How to clinically diagnose the dizziness complained by the patient: first determine dizziness or vertigo, then central or peripheral, whether it is related to the cervical spine (how it is connected), sternocleidomastoid muscle turning the head, getting up or sleeping dizziness. If the vertigo is due to sympathetic disorder: the episodes of vertigo are not related to the head and neck posture, but they will be manifested by a white face, a purple tongue and varying degrees of edema visible on the scalp and skin. In case of vertigo due to proprioceptive disturbances of the posterior cervical musculature: vertigo is aggravated in the low and extreme posterior extension positions and reduced in the neutral position. The resulting vertigo is rarely isolated and mostly occurs in conjunction with other injuries.