The term referring to the condition dizziness in Chinese Medicine, Xuan Yun, has two major components. The first refers to visual acuities where the vision may become fuzzy, blurry, or completely black altogether; the second can be best summarized as a feeling that objects around the person or a person’s body may be spinning, commonly referred to as vertigo. These two conditions often present in unison, which is why the Chinese have chosen to use these terms collectively to define the condition of dizziness.
As we well know, our sense of balance is regulated by an interdependent network of sensory organs within the body. These include the sensory nerves, the eyes, and the inner ear. Any deviation in the normal function of these organs can have negative repercussions and lead to a loss of balance or dizziness. From a western medical perspective, dizziness can have many different causes: Meniere’s disease, irregular blood pressure, heart disease or heart arrhythmias, hardening of the cerebral arteries, tumors, stroke, migraines, insufficient volume of blood within the arteries, hypoxia, low blood sugar, dehydration, anemia, fatigue, stress, or neuropathy. In mild cases, simply closing the eyes and slowing down the respiratory rate can relieve these symptoms. In more severe cases, the symptoms can not be self-controlled, and the person may not be able to regain their balance or stand up. The condition may be further complicated in some cases by headaches, stiffness of the neck, nausea, vomiting, uncontrolled eye movements, tinnitus or hearing loss, profuse sweating, or in the worse cases, fainting. Due to the myriad of different factors that can attribute to dizziness, diagnosis and treatment of the condition can be a daunting task. Using medications or other therapies that are only directed at one organ system or one cause of dizziness often leads to unsatisfactory results, and a cure can remain elusive for many suffers.
Thankfully, practitioners of Chinese medicine are more inclined to take a holistic approach to treat their patients and have over 3,000 years of clinical observations at their disposal. Chinese clinicians first typified the condition in one of the earliest remaining Chinese Medical Text “The Yellow Emperor’s Internal Canon” (Huang Di Nei Jing). It is referred to multiple times within the text and is attributed to many different causes: irregular liver function, lack of marrow, blood deficiency, and obstruction of the blood vessels and circulatory system. By the Han dynasty, one physician Zhang Zhong Jing, promoted the theory that the major underlying cause of dizziness was actually phlegm or highly viscous fluids in the body that may inhibit or retard fluid or food metabolism. This later gave rise to the maxim attributed to Zhu Dan Xi from his text, “if there is no phlegm then there is no dizziness”. From henceforth, herbal formulas to treat the condition would focus on strengthing the spleen to improve fluid transportation and metabolism as well as resolving phlegm. By the time of the Jin and Yuan dynasties, there was a major revolution in how the condition was viewed. There was a shift in believes as to the causes of the disease, the pathology of the disease, and the herbal formulas that should be used to treat the disease. It was postulated that the internal stirring of both the body’s wind and fire elements was occurring simultaneously to produce the apparent dizzying effect. In response to this change in ideology herbal formulas used to treat dizziness at that time were altered to incorporate herbs that were more bitter, sour, and astringent in nature to combat the simultaneous attacks from both the internal wind and fire within the body. Nevertheless, the idea that phlegm was still the major cause was still upheld within the writings of certain physicians during this time period, and never completely lost popularity. In later years, during the Ming and Qing dynasties, after further investigation of the condition, a pattern of constitutional deficiencies was noted within patients suffering from dizziness. The old maxim was altered slightly by a physician named Zhang Jie Bin in his text, “if there is no deficiency then there is no dizziness”. It wasn’t until this time period that a complete synthesis of all these various theories took place, and that physicians would begin to recognize the need to treat all of the factors involved in producing dizziness. This meant that in treating the condition it was necessary to differentiate the underlying causes based on the patient’s body type. A good example of this comes from the text, “for those that are pale and obese and suffer from dizziness, the main principle in treating the disease is to resolve the phlegm and descend the fire while using herbs that will supplement the qi; for those with a dark complexion and thin that suffer from dizziness, the treatment principle is to use herbal formulas that increase the body’s fluids and descent the fire, while also inhibiting the liver”. It was also during this time period that Chinese physicians first noted the connection between dizziness and cerebral vascular disease, and that those who suffer from dizziness are more likely to incur a stroke. The numerous changes in the theories of the causes and pathology of dizziness may dishearten some and have led others to say that Chinese medicine is unscientific. While that may be one possible conclusion, I prefer to look at it as a 3,000-year process of development and refinement based on clinical findings and a better understanding of the condition.
There are some notable factors and precursors to the development of dizziness according to Chinese medicine. Often there is an element of emotional imbalance. Specifically, long-standing depression or being prone to bouts of over anger. These conditions if left unchecked, over time affect the liver’s normal physiological function. This in turn gives rise to the overactivity of both the body’s internal wind and fire, which as we mentioned above is the main pathology of dizziness. Age also plays a role in the development of dizziness. As we age our cognitive function slowly declines, due to the hardening of the cerebral arteries and a restriction of blood flow to the brain. In Chinese medicine, this is referred to as a loss of marrow. Normal brain function is dependent on a rich supply of marrow. The production of marrow is supported by the kidneys. The kidneys store essence, which comes in two different forms. One form is that which was supplied to us by our parents at birth, the original essence (xian tian Zhi jing). This is combined with nutrients that are filtered from the blood, commonly known as acquired essence (hou tian zhi jing). These are then put back into the circulatory system and transported throughout the body to support normal bone health, where marrow is produced. Excess marrow is transported to the brain where it is stored and used in cognitive function. When we can no longer provide enough marrow to support the brain, due to a decline in kidney function and the degradation of our bones, we become more susceptible to dizziness or other cerebral vascular diseases. A healthy immune and circulatory system is also critical in maintaining good brain health and staving off dizziness. If we suffer a serious prolonged disease or the immune system becomes compromised we can acquire a condition known in Chinese medicine as qi deficiency. If our circulatory and cardiovascular systems do not supply an ample volume of blood to the body a separate but complementary condition can insure known as blood deficiency. Over time the body weakens and normal metabolic processes can no longer be carried out which provides the platform for the development of dizziness. Poor nutrition and unhealthy habits such as smoking and drinking to excess can also stress the body and in time cause enough harm where dizziness can develop. Lastly, severe trauma to the head can cause bruising and swelling which may disrupt our sensory system and cause a loss of balance and dizziness. As mentioned previously in our discussion, it is often a combination of these factors which leads to dizziness. If all factors involved are not treated in a holistic and systematic fashion the dizziness may not abate. This is why Chinese medicine often produces good results when other modalities fail.
In addition to the normal battery of western medical tests that are used to diagnose the causes of dizziness practitioners of Chinese medicine also look for certain signs and symptoms the patient may be suffering from or suffered previously to guide their treatment principles. The first step is to recognize which organ systems are involved. Overactivity of the liver is suspected in patients with headaches accompanied by a feeling of distension within the temporal regions of the head, reddening of the face, easily irritated or angry, insomnia, and excess dreaming, with a bitter taste in the mouth and a wiry pulse. If the spleen, stomach, and digestive system are involved and the patient suffers from blood and qi deficiencies the patient will present with poor appetite, lassitude, fatigue, palpitations, and insomnia, and will have a pale complexion. If the metabolic transportation is insufficient, also a function of the spleen, due to internal dampness the patient will report a feeling of heaviness in the limbs with difficulty moving them, nausea, a headache which feels like the head is encapsulated by something with excessive pressure, chest tightness, overtired with excessive sleeping, and a greasy yellow tongue coating with a rolling or intermittent pulse. If there is a deficiency of kidney essence the patient will complain of weakness and pain in the knees and legs, forgetfulness, and tinnitus that sounds like crickets. In addition to knowing which organs are involved the practitioner should be able to determine if there is an underlying excess or deficiency in the patient’s constitution, or both occurring simultaneously. This can be determined by the use of several simple deductions based on the patient’s body type and symptoms. The quote mentioned above is still as true today as it was then and should always be considered when treating a dizzy patient. Furthermore, it is important to remember that for those suffering with dizziness there are normally multiple organ systems involved and deficiencies that have led to excess conditions and that all of these must be considered if a cure is to be effected.
Given the complicated nature of the condition and the number of causal factors involved it is of great importance that treatment is specialized to the individual and based on their constitutional deficiencies and imbalances. This is the greatest strength of Chinese medicine in treating dizziness. Treatment will most likely involve a combination of using herbal medicine and acupuncture. Commonly used herbal formulas in treating this condition include Tian Ma Gou Teng Yin, Gui Pi Tang, Zuo Gui Wan, and Ban Xia Bai Zhu Tian Ma Tang. Normally, one formula is chosen based on the organ system most adversely affected and then altered to include other essential herbs to match the individual needs of the patient For suffers from external trauma one very useful formula is Tong Qiao Huo Xue Tang, which helps to open the orifices and move stagnant blood and fluids which may cause swelling and can impair the function of the sensory organs. Herbs are taken two to three times a day for five to seven days. The patient is then reevaluated and any modifications in the prescription are then made and another course is begun. Acupuncture treatment is very much custom-tailored to deal with current symptoms and to treat the underlying conditions which led to the dizziness occurring. Most symptoms such as headaches, stiffness of the neck, nausea, vomiting, tinnitus, and profuse sweating will be alleviated within the first five to ten treatments. The normal course of treatment for acupuncture is two to three times a week, with 10-15 treatments being one course. Most patients will see significant improvement within the first course but may need up to three or more before a complete cure can be brought about. Treatment should be coupled with exercises that can help improve balance. In a typical treatment, the first step involves using scalp acupuncture and having the patient go through these exercises with the needles inserted to help recruit blood flow to these areas of the brain and improve neural function. In addition, emphasis should be placed on the patient trying to keep a calm demeanor, avoiding stimulants, any excess physical labor, and getting ample rest while undergoing treatment. Certain breathing and Tai Ji exercises can be immensely helpful in improving the patient’s sense of balance. Eating habits should also be changed to avoid certain foods and overeating and drinking at meals to help improve the immune system. Early treatment of these conditions is also important.
For those suffering from dizziness, even the simplest tasks can be incredibly arduous or uncomfortable. Many feel that there is no cure for their dizziness and it has become for many a fact of life.