Western medical diagnosis: vertigo; Chinese medical diagnosis: vertigo
Definition (including the scope of diagnosis in TCM): It is a subjective symptom, which is a disorder of orientation sensation or balance sensation of the body in relation to space, a kind of motion illusion, in which the patient feels that the external environment or himself is rotating, moving or swaying. It is often accompanied by balance disorders, unsteadiness, nystagmus, finger deflection, nausea, vomiting, pallor, sweating, and changes in heart rate and blood pressure. In Chinese medicine, dizziness refers to blurred vision or blackness in front of the eyes, and dizziness refers to dizziness or even the feeling of rotation of oneself or external scenery, with lighter symptoms such as closing the eyes and stopping, and heavier ones such as riding in a car or boat, or even fainting. It was first seen in “Nei Jing” and called “vertigo”.
Etiology and pathology
1. Western medical etiology
(1) Vestibular systemic vertigo (true vertigo): including true vertigo caused by various lesions of vestibular end receptors, vestibular nerve, vestibular nuclei, medial longitudinal bundle, cerebellum and vestibular cortex (such as otogenic, vestibular nerve lesions, brainstem lesions, cerebellar lesions, cervical spine lesions, etc.)
(2) Non-vestibular systemic vertigo (dizziness): including vertigo caused by ocular, cardiovascular lesions, systemic toxic, metabolic, infectious diseases, anemia caused by various reasons, neurosis, etc.
2.TCM etiology and pathogenesis.
The main causes of this disease are emotional and mental disorders, old age and kidney deficiency, post-illness deficiency, poor diet, and internal obstruction of blood stasis, etc. Although there are various causes, the basic pathological changes are no more than deficiency and reality. The deficiency is due to the deficiency of the medulla or the deficiency of qi and blood and the loss of nourishment of the clear orifices; the actual is due to the disturbance of the clear space by wind, fire, phlegm and stasis. This disease is located in the head orifice, and the internal organs are related to liver, spleen and kidney. The Su Wen says: “All winds and dizziness belong to the liver”. The liver is the organ of wind and wood, and its nature is active and ascending, which easily disturbs the head and eyes and causes dizziness; “Danxi Xinfa” says: “No phlegm does not make dizziness”. Spleen is the source of Qi and blood biochemistry, deficiency leads to deficiency of Qi and blood, loss of nourishment of clear orifices, and loss of transportation leads to phlegm and dampness in the blockage, and wind and yang with phlegm, which leads to dizziness; “Jing Yue Quan Shu” says: “The evidence of dizziness is eight or nine of the deficiency, but one or two of the ten is fire and phlegm”. The kidney is the master of bone marrow, and the brain is the sea of marrow. A deficiency of kidney essence and loss of filling of the sea of marrow will also lead to vertigo. It is also written in the book of “Medical Journal” that “vertigo is the gradual development of stroke”, and it is recognized that there is a certain internal connection between vertigo and stroke.
The evidence can be classified as follows
(1) Hyperactivity of liver yang: vertigo, tinnitus, head and eyes swelling and pain, insomnia and dreaminess, bitterness and irritability of the mouth, aggravated by irritability and anger, numbness and trembling of the limbs, vertigo, unfavorable speech, nausea and vomiting, red tongue with yellow fur and stringiness of the pulse.
(2) Phlegm obstruction: vertigo with head weight and dizziness, or with rotation of vision, chest tightness and weakness, dullness, spitting of phlegm and saliva, cloudy and greasy tongue coating, moist and smooth pulse.
(3) Deficiency of qi and blood: vertigo is aggravated by movement and occurs with exertion, fatigue and shortness of breath, less florid face, laziness, lack of lip and nail, palpitations and less sleep, poor appetite, light and fat tongue, thin white fur, thin or large pulse.
(4) Kidney essence deficiency: dizziness with tinnitus and forgetfulness, depression, little sleep and dreaminess, dry eyes, spermatorrhea, soreness and weakness of the waist and knees, tender red tongue with little or no moss, weak pulse and very weak ruler.
(5) Internal obstruction of blood stasis: dizziness with headache, pain with a fixed location, insomnia and forgetfulness, palpitation and boredom, fatigue and weakness, purple lips and tongue or bruises on the tongue, stringent or fine pulse.
IV. Clinical manifestations
1.Vestibular system vertigo: abnormal spatially oriented sensation, characterized by motion illusion or motion hallucination, or sensation of external environment or sensation of movement (rotation, swaying, moving to one side)
2.Non-vestibular systemic vertigo: no vestibular systemic vertigo symptoms, mostly manifested as dizziness, head swelling, light-headedness, turning within the mind, etc.
Among the clinical characteristics of patients with common vertigo.
(1) Meniere’s disease: It is an inner ear lesion and is the most common cause of paroxysmal vertigo in middle age and above. There is a typical triad of symptoms: episodic vertigo, fluctuating, progressive, sensorineural hearing loss and tinnitus. It often comes on suddenly and is accompanied by nausea and vomiting, sweating, pallor, and nystagmus.
(2) Vestibular neuronitis: sudden, severe vertigo with nausea and vomiting, but no cochlear symptoms, often with symptoms of infection (mostly upper respiratory tract) at onset. There is usually no tinnitus or hearing loss. It lasts for a long time, up to 6 weeks, and rarely recurs after healing.
(3) Labyrinthitis: Simple otitis media causes vertigo due to inflammatory stimulation of the labyrinth. It is mostly accompanied by symptoms and signs of middle ear infection such as ear pain, ear leakage, headache and fever.
(4) Drug-related vertigo: In the application of clinical drugs, some drugs cause vertigo due to improper use and toxic effects, such as streptomycin; some are unavoidable side effects, such as certain sedatives and sleeping pills; some are caused by allergy.
(5) Vascular vertigo (vertebrobasilar circulatory disorder): there is often acute and severe vertigo with nausea and vomiting that lasts for several minutes to several hours.
(6) Psychogenic vertigo: It is essentially a manifestation of neurological disorder, mostly feeling dizzy and swollen, without motion delusion, without spontaneous severe tremor or spontaneous tilting, mostly accompanied by insomnia, anxiety, tension, memory loss, etc.
V. Laboratory and other examinations
The main auxiliary examinations include cranial CT scan, cranial MRI, mammography, EEG, transcranial Doppler ultrasound (TCD); cervical CT scan or MRI for suspected cervical spondylosis; lumbar puncture for cerebrospinal fluid examination for suspected intracranial inflammation. In addition, there are electroacoustic examination, nystagmography, etc.
Sixth, the basis of diagnosis
1.Western medical diagnosis.
(1) Medical history: detailed information about the time of attack, causative factors, course of the disease, the presence of recurrent features; the presence of fever, tinnitus, hearing loss, nausea, vomiting, sweating, perioral and extremity numbness, vision changes, balance disorders and other related symptoms; the presence of acute infection, otitis media, cranio-cerebral disease and trauma, cardiovascular disease, severe liver and kidney disease, diabetes and other medical history; the presence of motion sickness, seasickness and history of medication.
(2) Physical examination: including neurological aspects (especially pay attention to spontaneous nystagmus, ataxia, intracranial pressure increase sign, etc.), internal medicine (pay attention to blood pressure, heart rate, cardiac insufficiency, infection, poisoning, anemia, metabolic disorders, etc.), and otology (pay attention to cerumen obstruction of external ear canal, cholesteatoma otitis media and otosclerosis).
(3) Auxiliary examinations: cranial CT scan, cranial MRI, mammography, EEG, transcranial Doppler ultrasonography (TCD); cervical CT scan or MRI for suspected cervical spondylosis; lumbar puncture to check cerebrospinal fluid for suspected intracranial inflammation.
2, Chinese medicine diagnosis points.
(1) Dizziness and dizziness, rotation of vision, light cases with eyes closed, heavy cases like riding in a car or boat, or even falling down.
(2) Severe cases may be accompanied by headache, strong neck, nausea and vomiting, nystagmus, tinnitus and deafness, sweating, pallor, etc.
(3) Most of them have a history of emotional and mental disorders, old age and frailty, poor diet, fall and injury, etc.
3. Identification of TCM class evidence.
Differentiation from syncope: Syncope is characterized by sudden fainting, unconsciousness, and cold extremities, and can be awakened within a short time after the attack. In severe cases, death can occur without resumption of syncope. Severe cases of vertigo also have the manifestation of wanting to fall down, but vertigo patients do not have the manifestation of coma and unconsciousness.
VII. Treatment
1.Western medical treatment.
(1) General treatment.
Patients with acute vertigo attack should rest in bed, and diet should be liquid. Those with obvious nausea and vomiting should be given intravenous fluids as appropriate to maintain nutrition and to pay attention to the balance of water and electrolytes. After the symptoms are relieved, the patient should be encouraged to adapt to daily life as soon as possible.
(2) Etiological treatment.
For acute purulent vaginitis caused by complications of otitis media, necessary surgery and anti-infection treatment should be performed by otology department; for those caused by intracranial occupying lesions, surgery is needed to remove the tumor; for those caused by Meniere’s disease, it is recommended to regulate autonomic function and low-salt diet is appropriate; for those caused by toxic drug damage, medication should be stopped in time and vitamin B drugs should be given; for vertigo caused by cervical vertebral osteophytes, disc bulge or If the vertigo is caused by cervical spine osteophytes, bulging or herniated discs, cervical traction or cervical brace can be done first; if the vertigo is caused by heart function and blood pressure, it should be treated by internal medicine accordingly. The treatment of all these causes is important and should not be ignored.
(3) Symptomatic treatment.
In addition to the treatment of etiology, medication should be given for vertigo symptoms to reduce vertigo symptoms and the accompanying nausea, vomiting, anxiety, tension and other symptoms. Commonly used drugs are.
①Sedatives: can reduce the symptoms of vertigo and eliminate the symptoms of tension, irritability, anxiety, etc.
②Antihistamines: they have antiemetic effect when applied in the period of vertigo attack.
③vasodilator drugs: applied to vertigo caused by vascular spasm and ischemic lesions.
④Anti-cholinergic drugs: they have antiemetic and vasospastic effects, and scopolamine has sedative effects.
⑤Increasing the partial pressure of arterial blood oxygen: it can increase the supply of blood oxygen to the vagus and brain tissue, which has good effect on the vertigo disease caused by ischemia and hypoxia.
2.TCM treatment
(1) Points of TCM dialectic.
(1) Identify the relevant internal organs The disease of vertigo lies in the clear orifices, but it is closely related to the dysfunction of liver, spleen and kidney. The symptoms of vertigo caused by hyperactivity of liver and yang include head swelling and pain, flushing, irritability, bitterness and stringiness of the mouth. Dizziness caused by weakness of the spleen and stomach and deficiency of qi and blood is accompanied by symptoms such as dullness, weakness and pallor. Dizziness due to loss of spleen function and phlegm-dampness obstruction, with symptoms of dullness, vomiting, headache, and greasy coating. Dizziness caused by deficiency of kidney essence is often accompanied by weakness of the back and legs and tinnitus like cicada.
②Define the deficiency of the specimen Where the disease lasts for a long period of time, with recurrent attacks and occurs with exertion, accompanied by dry eyes, soreness and weakness of the waist and knees, or pale face, fatigue and weak pulse, it is mostly a deficiency, caused by deficiency of menstrual blood or deficiency of qi and blood. Those with short duration of illness or sudden onset, heavy vertigo, rotating vision, with vomiting and vomiting of phlegm, headache, red face, and strong and solid body are mostly actual. In the case of phlegm-dampness, the head is heavy and dizzy, the chest is stuffy and vomiting, the coating is greasy and the pulse is slippery; in the case of blood stasis, the head is dizzy, the pain is fixed, the lips and tongue are purple and dark, and the tongue has petechiae; in the case of liver-yang wind and fire, the vertigo, face is red, irritability, mouth is bitter, limbs are numb and trembling, and even fainting, and the pulse is stringent and strong.
(2) Classification of evidence.
(1) Hyperactivity of liver yang
Symptoms: dizziness, tinnitus, swelling and pain in the head and eyes, insomnia and dreaminess, bitterness and irritability of the mouth, aggravated by irritability and anger, numbness and trembling of the limbs, dizziness and falling down, unfavorable speech, nausea and vomiting, red tongue with yellow fur and string pulse.
Treatment: Calming the liver and submerging Yang, nourishing the liver and kidney.
Tianma 10 grams, hooked vine 10 grams, stone cassia 30 grams, raw oyster 30 grams (first decoction), ochre 30 grams (first decoction), Chuan Niu Kne 10 grams, motherwort 10 grams, scutellaria 10 grams, mountain gardenia 10 grams, dulcimer 10 grams, mulberry 12 grams, Fu Shen 12 grams.
Proprietary Chinese medicine: Brain Liqing capsule can be used.
Intravenous medication: If the disease is prolonged and stasis is trapped, add Dengjianhua, Danhong, Chuanxiongzin and other medications for quiet drip.
②Deficiency of qi and blood
Symptoms: dizziness is aggravated by movement, and it occurs with exertion, fatigue, shortness of breath, less florid face, laziness and lazy speech, lip and nail not florid, palpitations and less sleep, poor appetite, light and fat tongue, thin white fur, thin or weak pulse.
Treatment: Tonifying Qi and Blood, tonifying the spleen and stomach.
Remedy: Ginseng and spleen soup with reduction.
Ginseng 15g (separately decocted), Astragalus membranaceus 25g, Radix Angelicae Sinensis 12g, Rhizoma Atractylodes Macrocephalae 12g, Poria 10g, Rhizoma Chuanxiong 12g, Radix Paeoniae Alba 12g, Rhizoma Dihuang 12g, Cinnamon 6g, Radix Achyranthes bidentatae 12g, Radix Glycyrrhizae 10g.
Chinese patent medicine: can be used to nourish blood and clear brain granules, qi and blood double tonic capsule, etc.
(3) Phlegm-dampness blockage
Symptoms: vertigo with head weight and dizziness, or with rotation of vision, chest tightness and weakness, dullness, spitting of phlegm, cloudy and greasy tongue coating, moist and smooth pulse.
Treatment: Eliminating dampness and phlegm, strengthening the spleen and harmonizing the stomach.
Remedy: Radix et Rhizoma Atractylodis Macrocephalae, plus reduction.
Radix Panax notoginseng 10g, Atractylodes macrocephala 10g, Rhizoma tenuifolia 10g, Poria 10g, Ginger 2g, Jujube 6g, Licorice 6g.
④Deficiency of kidney essence
Symptoms: dizziness with tinnitus and forgetfulness, depression, little sleep and dreams, dry eyes, spermatorrhea, soreness and weakness of the waist and knees, tender red tongue with little or no moss, weak pulse and very weak ruler.
Treatment: Nourishing the liver and kidney, benefiting the essence and filling the marrow.
Remedy: Zuo Gui Wan plus reduction.
Radix Codonopsis Pilosulae 15g, Radix Rehmanniae 12g, Poria Cocos 12g, Asparagus 12g, Radix Madonnas 12g, Radix Chaihecus 10g, Radix Tortoise 15g (first decoction), Radix Eucommiae 12g, Radix Achyranthes Bidentatae 12g, Radix Phellodendron Bidentatae 6g, Semen Cuscutae 10g, Fructus Lycii 10g, Cornu Cervi Pantotrichum 10g, Fructus Fructus Ligustrum 10g, Radix et Rhizoma Polygonati 10g.
⑤ Internal obstruction of blood stasis
Symptoms: Dizziness with headache, pain with a fixed location, palpitations and boredom, fatigue and weakness, purple lips and tongue or bruises on the tongue, stringent or fine astringent pulse.
Treatment: Invigorate blood circulation to remove stagnation, and clear the orifices and activate the channels.
Direction: Promoting blood circulation and activating blood circulation.
Radix Angelicae Sinensis 15g, Radix Rehmanniae 15g, Rhizoma Polygonatum 6g, Rhizoma Safflower 6g, Radix Paeoniae 6g, Citrus Aurantium 10g, Radix Bupleurum 6g, Radix Platycodon grandis 6g, Rhizoma Chuanxiong 6g, Radix Achyranthes bidentatae 6g, Radix Tianma 6g.
(3) Acupuncture and moxibustion therapy
(1) Body acupuncture: for acute attack of vertigo of liver-yang, acupuncture point Tai Chong with diarrhea method. For vertigo with qi and blood deficiency, choose Spleen Yu, Kidney Yu, Guan Yuan and Foot San Li acupoints, and take the tonic method or moxibustion. For hyperactivity of liver and yang, acupuncture points such as Fengchi, Xingma and Manxi can be used to take the laxative method. For those with liver and kidney yin deficiency, additional acupuncture points for liver and kidney yu should be used as a tonic. For those with phlegm obstruction, choose Nei Guan, Feng Long, Xie Xi and other points, using the laxative method. Acute attacks of vertigo with various kinds of deficiency can be treated with moxibustion at Baihui point.
②Auricular acupuncture: choose kidney, Shen Men, occipital, inner ear, and subcortical. Take 2. 3 points each time, medium or strong stimulation, leave the needle for 30 minutes, intermittent twisting. Once a day, 5-7 days for a course of treatment.
③Head acupuncture: select bilateral dizzy hearing area, once a day, 5-10 days for a course of treatment.
Prevention and conditioning
1. Diet: The diet of vertigo patients should be nutritious and fresh and light. Eat more eggs, lean meat, green vegetables and fruits. Avoid eating fatty, sweet and spicy things, such as fatty meat, fried things, alcohol, chili, etc. Nutritious food can replenish the body’s deficiency, so that the vitality of blood, brain marrow full. For vertigo caused by anemia, leukopenia or chronic wasting diseases, nutritional conditioning should be the main concern. Fatty, sweet, pungent and spicy products can produce phlegm and fire, which can aggravate vertigo. Therefore, people suffering from hypertension should be careful with fatty, sweet, spicy and pungent products. During the acute attack of vertigo, the intake of water and salt should be controlled properly. Modern medicine believes that this can reduce the edema of the inner ear vagus and vestibular nerve nucleus, thus relieving the vertigo symptoms or reducing the attacks.
2.Spiritual adjustment: The spiritual adjustment of vertigo patients should not be neglected. Mental stimulation such as depression and irritation can cause hyperactivity of liver yang or internal movement of liver wind, and induce vertigo. Therefore, vertigo patients should be broad-minded, optimistic, relaxed and emotionally stable, which is very important to prevent vertigo attacks and reduce the number of attacks.
3.Rest and living: Over fatigue or lack of sleep is one of the triggering factors of vertigo. You should pay attention to rest both during and after vertigo attacks. During the acute attack of vertigo, you should rest in bed. If the vertigo is caused by insufficient blood supply to the vertebral artery, the symptoms will be aggravated when standing, but can be reduced when lying in bed. Bed rest can also prevent physical injuries caused by fainting. It is very important for vertigo patients to get enough sleep. After sufficient sleep, their symptoms can be reduced or disappear.
Nine, vertigo dietary therapy formula
1, 15 grams of Chinese wolfberry, red dates 10 add water and boil for 30 minutes, 2 eggs will be broken and transferred to cook, take twice in the morning and evening. Can nourish the qi and blood, strengthen the body, anemia, chronic hepatitis, tuberculosis and other chronic diseases caused by dizziness, mental trance, vision loss, increased nocturia has a curative effect.
2, 250 grams of chicken, Shou Wu, angelica, Chinese wolfberry 20 grams each with water, eat meat and drink soup. It can nourish blood and liver, treat dizziness and blurred vision caused by liver blood deficiency.
3, 100 grams of beef liver cut into slices, and 30 grams of Chinese wolfberry cooked with water, eat beef liver and drink soup, a daily dose. It can nourish blood and liver, treat dizziness and dizziness caused by liver blood deficiency.
4, chamomile japonica rice porridge: take chamomile fresh shoots or seedlings 15-30 grams, wash, with 60 grams of japonica rice, ice sugar appropriate amount of porridge, morning and dinner, once a day, for 7 days. Suitable for hypertension, dizziness of hyperactive liver fire.
5, celery bitter gourd soup: celery 500 grams, bitter gourd 60 grams, cooked with soup to drink. Or 250 grams of celery, 30 grams of bitter gourd, boiling water for 2 minutes, chopped juice, add sugar, boiling water, 1 dose daily for several days. Applicable to hypertension, Yin deficiency Yang yuan of dizziness.
6, kudzu japonica rice porridge: fresh kudzu root appropriate amount of washed and sliced, saxifrage, maitake 20 grams each, clarified by water grinding to get starch, dried, each time with kudzu saxifrage maitake 30 grams of powder and japonica rice 60 grams of porridge to eat, a daily dose, can often eat. For hypertension yin and Yang deficiency of vertigo.
7, carpenter japonica rice porridge: carpenter 15 grams (cloth bag) decoction to remove slag, into the japonica rice 60 grams of porridge, corn flour appropriate amount of cold water dissolved and, mixed into the porridge cooked to eat, 1 dose daily, often eat. For hypertension phlegm and dampness congestion of dizziness.
8, black chicken and japonica rice porridge: black chicken 1 cut clean, thick decoction of chicken juice, astragalus 15 grams of decoction, and japonica rice 100 grams of porridge, morning and evening while hot. Used for dizziness patients with deficiency of both qi and blood.
9, lychee japonica rice porridge: 50 grams of lychee meat, 10 grams of yam, 10 grams of lotus seeds added to the appropriate amount of water with the decoction until soft, then put 250 grams of rice, cooked into porridge. It can be taken 2 times a day for those who suffer from vertigo due to spleen deficiency and blood deficiency.
10.Longan and chicken porridge: 50 grams of longan, 1 egg, 30 jujubes, add the right amount of round-grained rice and cook together.
11, ginseng japonica rice porridge: ginseng powder (tablets) 3 grams, with 100 grams of japonica rice with the appropriate amount of water cooked together into porridge, and then slowly add the boiled into juice of rock sugar into the porridge, stir well. It is used for dizziness patients with deficiency of middle energy and clear Yang not rising.