Dizziness is a sensation of unsteadiness combined with a feeling of movement within the head. The symptoms in a mild case may be relived by closing the eyes, while the serious case may manifest itself as an illusion of bodily rotation and be accompanied by nausea, vomiting, sweating and even fainting. It is a common symptom occurring clinically as the result of exogenous pathogenic factors, the impairment of internal organs and trauma.

In modern medicine, some cases are considered auditory in origin, such as Meniere's syndrome, labyrinthitis, motion sickness, vestibular neuronitis, etc., and some as cerebral in origin, such as cerebral arteriosclerosis, hypertensive encephalopathy hypertension, vertebro basilar ischemia, intracranial space occupying lesion, etc. It may also seen in infective and allergic diseases, as well as other disorders such as epilepsy, hypertension, hypotension, anemia, arrhythmia, neurosis, head trauma, etc. In such cases whenever dizziness manifests itself as the major symptom, the differentiation and treatment mentioned in this section may be adopted as a reference.

Etiology and Pathogenesis

The cause of dizziness is either an exogenous pathogenic factor, impairment of an internal organ or trauma. Its mechanism may be summarized as wind, phlegm, asthenia, fire and blood stasis and the organ chiefly involved is the liver and also the spleen and kidneys.

A. Upward attack of liver-yang: Resulting from a yang-hyperactivity constitution; emotional distress, which causes qi stagnation with production of wind and fire; or insufficiency of kidney-yin, which fails to nourish the liver and causes irritation of liver-wind.

B. Insufficiency of kidney-essence: Due to a congenital deficiency, aging, chronic disease or sexual indulgence.

C. Deficiency of qi and blood: Accompanying the damage of spleen and stomach caused by overstrain or immoderate diet, the weakening of spleen and stomach resulting from a congenital defect or aging, or the consumption of qi and blood in the case of a long-term disease or hemorrhage. All these lead to deficiency of qi and blood, and qi-deficiency may cause failure of lucid-yang to ascend, while blood deficiency results in malnutrition of the brain and liver with internal agitation of asthenic wind.

D. Accumulation of phlegm-dampness in the middle jiao: Immoderate diet and drinking or overstrain may induce dysfunctioning of the spleen and stomach and production of phlegm-dampness. Accumulation of phlegm-dampness in the middle jiao may interfere with the ascending of lucid-yang and the descending of turbid-yin.

E. Retention of blood stasis: Trauma accompanied by blood stasis formation may obstruct the meridians and vessels, interfering with the function of upper orifices.

F. Affection of exogenous pathogenic factors: Particularly wind but also cold, heat, summer-heat and dampness. The head is a confluence of yang meridians and connects with the twelve meridians or the eight extra meridians. Whenever exogenous evils attack the body, they may readily disturb the upper orifice through the meridians.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between those due to exogenous pathogenic factors and those due to internal derangement. Dizziness of exogenous origin usually manifests itself as a superficies-syndrome of sudden onset cause by wind, cold, summer-heat, dampness, etc. When superficial evil attacks the interior, it appears as shaoyang syndrome or yangming hollow-organ syndrome. Dizziness of endogenous origin is identified by the impairment of liver-blood, spleen-qi or kidney-essence, which is associated with endogenous production of wind, fire, phlegm or blood stasis. Clinically the asthenia-syndrome or asthenia-syndrome complicated by sthenia-syndrome is frequently seen, and the sthenia-syndrome is relatively rare.

(b) Differentiation between asthenia and sthenia syndromes. The tongue picture and the pulse condition should be emphasized for this purpose.

(1) A pale and tender tongue and a thready and weak pulse are commonly seen in cases with deficiency of qi and blood.

(2) A red and tender tongue with little coating and a wiry, thready and rapid pulse are usually seen in the cases of kidney-essence insufficiency with predominant yin-deficiency; while a corpulent and dull, tender tongue and a deep and thready pulse with a weak chi pulse are seen in those with predominant yang-deficiency.

(3) A thick-smooth or turbid-greasy tongue coating and a smooth pulse indicate a serious phlegm-dampness syndrome.

(4) A dark purplish tongue with petechiae, dull lips and uneven pulse suggest the retention of blood stasis.

(c) Differentiation between the primary and secondary syndrome. Dizziness usually manifests itself as a primary asthenia-syndrome with a secondary sthenia-syndrome, in which the deficiency of liver-yin and kidney-yin and the insufficiency of qi and blood are the primary syndromes, and wind, fire, phlegm and blood stasis are the secondary.

B. Therapeutic principle

(a) For dizziness caused by invasion of exogenous pathogenic factors, the therapy of expelling evils is recommended, including that of expelling wind, cold, summer-heat and dampness. In addition, superficies-syndrome, interior-syndrome and half-superficies and half-interior syndrome should be differentiated and treated accordingly.

(b) For dizziness caused by impairment of internal organs, the therapy of nourishing the kidneys and liver, tonifying blood and qi, invigorating the spleen and eliminating phlegm should be adopted. The therapy of clearing, suppressing, descending and calming is advisable for hyperactivity of liver-yang; that of eliminating phlegm and dampness for obstruction caused by phlegm-dampness; and that of activating blood circulation and eliminating blood stasis for the rentention of blood stasis. However, a combined treatment is usually necessary, because most of the cases with dizziness manifest the coexistence of both asthenia and sthenia syndromes.

Classification and Treatment

A. Hyperactivity of liver-yang

Manifestations: Dizziness, tinnitus, pain and distention in the head which is aggravated by overstrain or anger, flushed face, irritability, sleeplessness, dreamfulness, bitter taste in the mouth, red tongue with yellow coating and wiry pulse.

Therapeutic principles: Calm the liver, suppress yang, nourish the kidneys and liver.

Prescription: The Modified Decoction of Gastrodiae and Ramulus Uncariae cum Uncis (Also see Traditions of Tao Vertigo / Migraine Formula - a modified Tian Ma Gou Teng Wan)

Rhizoma Gastrodiae 10 g
Ramulus Uncariae cum Uncis 12 g
Concha Haliotidis (decocted first) 30 g
Fructus Atriplex Sibiricae 10 g
Spica Prunellae 12 g
Radix Scutellariae 10 g
Radix Paeoniae Alba 12 g
Radix Achyranthis Bidentatae 12 g
Flos Chrysanthemi 10 g

Remarks: For cases with hyperactivity of liver-fire manifested as redness of eyes and face, yellow and harsh tongue coating and wiry and rapid pulse, add Radix Gentianae, Cortex Moutan Radicis and fructus Gardeniae to clear away liver-heat. For cases with hyperactivity of liver-wind manifested as severe dizziness, nausea, numbness of extremities or even muscular twitching and tremor of hands and feet add Os Draconis, Concha Ostreae and Choncha Margaritifera Usta to calm the liver and eliminate wind. For cases with deficiency of liver-yin with upward attack of liver-yang manifested as weakness of lumbus and knees, emission, fatigue, red tongue with little coating and thready, wiry and rapid pulse, use Bolus for Serious Endogenous Wind-Syndrome containing Radix Rehmanniae, Radix Paeoniae Alba, Plastrum Testudinis, Carapax Trionycis, Concha Ostreae and Radix Ophiopogonis to nourish yin and suppress yang.

B. Deficiency of qi and blood

Manifestations: Dizziness induced by fatigue and aggravated by movement, pale complexion, lusterless nails and lips, palpitations, insomnia, listlessness, poor appetite, pale tongue with thin coating, thready and weak pulse.

Therapeutic principles: Tonify qi and blood, invigorate the spleen and stomach.

Prescription: The Modified Decoction of Invigorating the Spleen and Nourishing the Heart

Radix Pseudostellariae 12 g
Radix Astragali 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Poria 10 g
Radix Angelicae Sinensis 10 g
Radix Paeoniae Alba 10 g
Radix Polygalae 10 g
Radix Glycyrrhizae Praeparata 10 g
Pericarpium Citri Reticulatae 10 g
Radix Aucklandiae Praeparata 6 g

Remarks: For cases with coldness of limbs and dull pain in the abdomen, add Rhizoma Zingiveris and Ramulus Cinnamomi to warm middle jiao and support yang. For cases with predominant blood-deficiency, add Radix Rehmanniae, Colla Corii Asini, Arillus Longan and increase the dose of radix astragali to nourish qi and blood. For cases with insufficiency of middle-jiao qi and failure of the ascending of lucid-yang manifested by listlessness, fatigue, diarrhea with a bearing-down sensation and a weak pulse, use the Decoction for Strengthening Middle Jiao and Benefiting Qi containing Radix Astragali, Rhizoma Atractylodis macrocephalae, Poria, Pericaripium Citri Reticulatae, Radix Codonopsis Pilosulae, Rhizoma Cimicifugae and Radix Puerariae to invigorate middle jiao, benefit qi, lift up the lucid-yang and lower turbidness.

C. Insufficiency of kidney-essence

Manifestations: Dizziness, soreness and weakness of lumbus and knees, listlessness, poor memory, emissions and tinnitus. In cases with a predomination of yin-deficiency, there are feverish sensations on the palms soles and chest, red tongue and wiry, thready and rapid pulse. In cases with a predomination of yang-deficiency, there appear coldness of limbs, aversion to cold, pale tongue and deep, thready and weak pulse.

Therapeutic principles: Tonify the kidneys and nourish yin for those with a predomination of yin-deficiency, and tonify the kidneys and support yang for those with a predomination of yang-deficiency.

Prescription:  The Modification of Zuogui Bolus for cases with predomination of yin-deficiency

Radix Rehmanniae Praeparata 12 g
Radix Rehmanniae 12 g
Fructus Corni 10 g
Fructus Lycii 12 g
Radix Paeoniae Alba 12 g
Radix Achyranthis Bidentatae 12 g
Os Draconic (decocted first) 30 g
Concha Ostreae (decocted first) 30 g

D. Obstruction of middle jiao by phlegm

Manifestations: Heaviness of head, dizziness, chest distress, nausea, poor appetite, somnolence, white greasy tongue coating and soft floating and smooth pulse.

Therapeutic principles: Dry dampness, eliminate phlegm, tonify the spleen and regulate the stomach.

Prescription: The Modified Decoction of Pinelliae, Gastrodiae, and Atractylodis Macrocephalae

Rhizoma Pinelliae 10 g
Rhizoma Gastrodiae 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Pericarpium Citri Reticulatae 10 g
Poria 12 g
Rhizoma Alismatis 15 g

Remarks: For cases with frequent vomiting, add Rhizoma Zingiveris (dried) and Flor Inulae to keep the adverse qi downward. For cases with epigastric upset and anorexia, add Fructus Amomi and Semen Alpiniae Katsumadai to regulate the stomach. For cases with stagnation of phlegm and production of fire manifested by distending pain over the head and eyes, vexation, bitter taste in the mouth, yellow greasy tongue coating and wiry and smooth pulse, use the Modified Decoction for Clearing Away Gallbladder-heat containing Radix Scutellariae, Rhizoma Coptidis, Poria, Pericarpium Citri Reticulatae, Fructus Aurantii Immaturus, Caulis Bambusae in Taeniam and Rhizoma Pinelliae to clear heat and eliminate phlegm.

E. Obstruction of collaterals by blood-stasis

Manifestations: Prolonged and intermittent dizziness, localized headache or stabbing headache pain, dark purplish face and lips, dull tongue with petechiae or ecchymosis and uneven and wiry or thready pulse.

Therapeutic principles: Activate blood circulation and eliminate blood stasis.

Prescription: The Modified Decoction for Removing Blood Stasis in the Chest

Radix Paeoniae Rubra 12 g
Radix Angelicae Sinensis 10 g
Rhizoma Chuanxiong 10 g
Radix Rehmanniae Praeparata 10 g
Flos Carthami 10 g
Radix Achyranthis Bidentatae 12 g
Radix Salviae Miltiorrhizae 30 g
Herba Schizonepetae 6 g
Ramulus Uncariae cum Uncis 12 g

Experiential Prescriptions

A. Flos Chrysanthemi (10 g), Flos Sophorae Immaturus (10 g), Ramulus Uncariae cum Uncis (10 g), infused in boiling water and taken daily; applicable to dizziness caused by hyperactivity of liver-yang.

B. Rhizoma Atractylodis Macrocephalae (30 g) and Rhizoma Alismatis (30 g), prepared as a decoction; one dose taken daily; applicable to auditory dizziness attributed to obstruction of the middle jiao by phlegm.

C. Spica Prunellae (18 g), Rhizoma Pinelliae Praeparata (12 g), Herba Plantaginis 918 g) and haematitum prepared as a decoction; one dose taken daily; applicable to auditory dizziness resulting from an upward attack of liver-yang and phlegm.

Copyright 1995 Hopkins Technology