Vertigo is a common clinical symptom, and many diseases can cause vertigo, the most common causes are vestibular system diseases, including Meniere’s disease, benign paroxysmal positional vertigo, and vestibular neuritis. In addition, some other system diseases such as cervical spondylosis and central nervous system diseases can also cause vertigo. The following is a brief overview of the common clinical vertigo diseases.
1.Benign paroxysmal positional vertigo: Most of this disease is idiopathic, i.e. the cause is unknown, and some of them may be related to head trauma, purulent otitis media, sudden deafness and migraine, etc. The clinical manifestations are sudden sitting up, lying down, bending over and turning over or turning the head in a flat position, and the duration is usually less than 60 seconds, accompanied by nausea, vomiting and dizziness. Current CT, MRI and other examinations cannot diagnose the disease clearly. The postural test is the gold standard for diagnosing benign paroxysmal positional vertigo, and the treatment mainly adopts the method of otolith repositioning. Most of the patients can disappear immediately after treatment, and the symptoms are often relieved in a few days after supplemented with medication.
2.Ménière’s disease: The occurrence of this disease is related to the accumulation of water in the vagus of the inner ear membrane. Typical symptoms are episodic vertigo, fluctuating deafness and tinnitus, stuffy feeling in the ear, etc. The attacks may be accompanied by autonomic symptoms such as nausea, vomiting and balance disorders. However, some patients may only have vestibular system symptoms such as vertigo, which is called vestibular Ménière’s disease; some patients only have deafness and tinnitus, and a feeling of stuffiness in the ear, which is called cochlear Ménière’s disease. It occurs mostly in middle-aged people, and medication can reduce the symptoms and shorten the duration of attacks. For patients with persistent Ménière’s disease who do not respond well to medication, intra-vocal injection of gentamicin (also known as chemical vagotomy) can be given, which is simple, economical and effective, but complications of hearing loss may occur.
3. Vestibular neuritis: It occurs mostly in middle-aged people, and some patients have a history of cold before the onset. The main manifestation is sudden vertigo, and the vertigo lasts for a long time, up to several days. Anti-viral and symptomatic treatment should be given during the attack period, and vestibular function training can be given during the remission period.
4. Cervical vertigo: It is commonly caused by insufficient blood supply from the vertebrobasilar artery, and its vertigo attacks are sudden and short-lived, often lasting for a few minutes, and may be accompanied by nausea and vomiting. It is sometimes accompanied by symptoms related to ischemia in other blood supply areas of the posterior inferior cerebellar artery, such as limb weakness, falls, visual hallucinations and headache. The main treatment is the treatment of the primary cause and the drugs to improve microcirculation.
Western medicine considers the etiology of vertigo as.
(1) Otogenic vertigo: Meniere’s syndrome, vestibular neuronitis, blockage of internal auditory artery, paroxysmal positional vertigo, motion sickness.
(2) Cerebral vertigo: inadequate blood supply to the vertebrobasilar artery (the most common cause of vertigo in the elderly, mainly due to atherosclerosis and hypertension), cerebellopontocerebral lesions (hemorrhage in the cerebral bridge and cerebellum, brainstem, cerebellar and fourth ventricle masses), migraine, and vegetative disorders.
(3) Systemic vertigo: vascular diseases, hypertension, hypotension, anemia, metabolic diseases, hypoadrenocorticism, menopausal syndrome, hyperthyroidism, diabetes, uremia, etc., cause vertigo due to blood supply disorders, toxin effects, blood rheology changes, hyperlipidemia, nutritional deficiencies, micronutrient deficiencies and free radical damage.
(4) Cervicogenic vertigo: cervical spondylosis, cervical muscle imbalance, hypertrophic cervical arthritis.
(5) Ophthalmogenic vertigo: refractive error of the eye as in astigmatism, eye trauma or surgery resulting in absence of lens in one eye, etc., paralysis of eye muscles, visual impairment.
(6) Exogenous vertigo: drug vertigo (some patients after applying drugs such as chain, gentamicin, kana or vancomycin, polymyxin, quinine, salicylic acid, antimony potassium tartrate and phenytoin sodium), chemical poisoning (such as: carbon monoxide, drugs, alcohol, etc.), traumatic brain injury, concussion and sequelae.
(7) Psychogenic vertigo: neurosis, neurasthenia, insomnia, depression and other psychiatric diseases.
Causes according to TCM: According to TCM, vertigo is mostly caused by hyperactivity of liver yang, deficiency of qi and blood, deficiency of kidney essence, and obstruction of phlegm and turbidity.
(1) Hyperactivity of liver and yang (no wind, no vertigo)
Symptoms: Dizziness and tinnitus, headache and swelling. Dizziness due to irritability, aggravation of headache, anxiety and irritability, sleeplessness and dreaminess, bitterness of the mouth, red tongue, yellow fur, dizziness of the pulse.
Analysis of the symptoms: Liver Yang is hyperactive and rises up into the clear air, hence dizziness and headache. Liver fire disturbs the heart and mind, hence less sleep and more dreams. Bitter mouth, red tongue, yellow moss, and dizzy pulse are all symptoms of hyperactivity of liver-yang, while dizziness and fine count of pulse are signs of internal heat of liver-kidney yin deficiency.
(2) Deficiency of qi and blood: (no deficiency does not make vertigo)
Symptoms: Dizziness is aggravated by movement, immediately after exertion, with pale face, unpleasant lips and nails, poor hair color, palpitations and little sleep, fatigue and laziness, reduced diet, pale tongue and weak pulse.
Analysis of the symptoms: Qi deficiency is due to the non-expansion of clear yang, blood deficiency is due to the loss of brain nourishment, so dizziness is aggravated by exertion. The heart is the master of the blood vessels, and its flower is in the face. A deficiency of blood results in a pale face, non-flamboyant lips and nails, hair color, and restlessness of the heart and mind, resulting in palpitations and little sleep. Qi deficiency results in fatigue and lazy speech, and reduced diet. Pale tongue and weak pulse are signs of Qi and Blood deficiency.
(3) Kidney essence deficiency type: (no deficiency does not make vertigo)
Symptoms: Dizziness with mental depression, little sleep and dreams, forgetfulness, soreness and weakness of the waist and knees, seminal emission, tinnitus. In favor of Yin deficiency, the limbs are not warm, the form is cold and timid, the tongue is pale, and the pulse is sunken and weak.
Symptom analysis: Insufficient essence can’t fill the brain, so dizziness and mental depression. Kidney deficiency is because the heart and kidneys do not intersect, so there is little sleep, much dreaming and forgetfulness. The waist is the capital of the kidneys. Kidney deficiency results in soreness and weakness of the waist and knees. The kidney is open to the ears, so if the kidney is deficient, the ears will ring at times. Spermatorrhea is not fixed, so spermatorrhea. Yin deficiency leads to internal heat, so the five hearts are hot and bothered, the tongue is red, and the pulse is dizzyingly fine. Deficiency of Yin leads to external cold, so the limbs are not warm. Cold and timid form, pale tongue, sunken and weak pulse.
(4) Phlegm and turbidity blocking type.
Symptoms: Dizziness with head heaviness like a cloud, chest tightness and nausea, little food and much sleep, greasy moss and slow pulse.
Symptom analysis: If phlegm clouding obscures clear yang, then dizziness is as heavy as a cloud. If the spleen Yang is not invigorated, there is less food and more sleep, the moss is greasy and the pulse is moist and slow.