Chief Complaints: Paroxysmal vertigo with recurrent visual rotation for 2 months before treatment. 2 months before treatment, sudden vertigo occurred after the patient had a family dispute at home. Symptoms remained unchanged after resting. Dizziness and tinnitus appeared the next day and the patient came to the hospital. After being injected with Salviae via IV and taking Merislon Pills orally, the patient felt better. Since then, vertigo, tinnitus and dizziness recurred frequently. Symptoms were often aggravated by mood and irritability. During the onset of disease, the vertigo was accompanied by decreased hearing. The patient also frequently experienced a bitter taste in her mouth, a dry throat, a red face, red eyes, irritability and anger.Signs and Symptoms: Vertigo, dizziness along with a fear of rotating the head, nausea, decreased hearing and paroxysmal tinnitus along with a bitter taste in the mouth, a dry throat, red face and eyes, and bitterness and fullness in the hypochondriac region. The tongue body was red with spots and a yellow coating. The pulse was wiry and rapid.Past History: Unremarkable.Physical Examination: Blood pressure 130/80 mmHg, thin body type, in supine position, fearful of rotating the head.Special Examination: There was no blockage in the external ear canal. The tympanic membrane was intact with clear marking signs. Involuntary nystagmus one degree, which was faster on the left.Diagnostic AnalysisIn this case, the vertigo occurred after emotional distress, indicating that the binding of liver qi had transformed into fire, leading to wind-fire rising upward and disturbing the clear orifices. The liver prefers free flow rather than stagnation, and liver qi stagnation can cause irritability and anger. Liver qi stagnation transforms fire into wind, and wind-fire rising upward can disturb the clear orifices. All these factors resulted in vertigo, tinnitus, hearing loss, a red face and eyes. Qi depression caused fullness in the chest and hypochondriac region, and liver fire injured fluids, leading to the bitter taste in the mouth and dry throat. The red tongue body with spots and a yellow coating and the wiry, rapid pulse indicated heat. The wiry pulse is a sign that indicates liver disease.The location of this condition was the clear orifices. It was caused by liver yang rising and was an excessive pattern.DiagnosisWM Diagnosis: Vertigo due to auricular illnessTCM Diagnosis: Vertigo due to liver yang disturbing upward
The vertigo in this case was due to emotional distress causing liver qi stagnation, and liver yang ascending disturbing the clear orifices. The clinical manifestation of this case was in the liver, while the root cause lay in the kidneys. Liver and kidney deficiency resulted in liver yang rising. Treatment, therefore, should focus on calming yang, extinguishing the wind, nourishing yin and subduing yang. The patient should rest in bed during the acute onset and maintain quiet.
Treatment Principles: Calm the liver, extinguish the wind, nourish the yin and subdue the yang.
Formula: Modified Tiān Má Gōu Téng Yĭn (Gastrodia and Uncaria Decoction)
[天麻钩藤饮加减]
|
天麻 |
tiān má |
30g |
Rhizoma Gastrodiae |
|
钩藤（后下） |
gōu téng (add at the end) |
15g |
Ramulus Uncariae Cum Uncis |
|
石决明 |
shí jué míng |
30g |
Concha Haliotidis |
|
黄芩 |
huáng qín |
10g |
Radix Scutellariae |
|
栀子 |
zhī zĭ |
10g |
Fructus Gardeniae |
|
龙胆草 |
long dăn căo |
5g |
Radix et Rhizoma Gentianae |
|
丹皮 |
dān pí |
15g |
Cortex Moutan |
|
牛膝 |
niú xī |
15g |
Radix Achyranthis Bidentatae |
|
杜仲 |
dù zhòng |
10g |
Cortex Eucommiae |
|
桑寄生 |
sāng jì shēng |
10g |
Herba Taxilli |
|
益母草 |
yì mŭ cáo |
30g |
Herba Leonuri |
|
夜交藤 |
yè jiāo téng |
15g |
Caulis Polygoni Multiflori |
Formula Analysis
Tiān má, gōu téng and shí jué míng calm the liver, subdue yang and extinguish the wind.
Huáng qín and zhī zĭ clear liver heat.
Niú xī, dù zhòng, sāng jì shēng and yì mŭ căo nourish the liver and kidney.
Yè jiāo téng calms the spirit and stabilizes the mind.
Lóng dăn căo and dān pí clear the liver and sedate fire, which is indicated by the prickles on the side of the tongue, a sign of excessive liver fire.
Modifications: If there are obvious symptoms of photophobia and nystagmus, the condition belongs to the pattern of liver yin deficiency and deficient wind causing pathological eye movement. Add jú huā (Flos Chrysanthemi), jué míng zĭ (Semen Cassiae), qīng xiāng zĭ (Semen Celosiae), shā yuàn zĭ (Semen Astragali Complanati) and bái jí lí (Fructus Tribuli) to calm the liver and brighten the eyes.
If there is a stiff neck and aggravated vertigo while turning the head, these are symptoms of liver channel congestion and liver wind stirring internally. For these cases, add sī guā luò (Retinervus Luffae Fructus), luò shí téng (Caulis Trachelospermi) and rĕn dōng téng (Caulis Lonicerae Japonicae) to open the channels and invigorate the collaterals.
Acupuncture
Main Points: DU 20 (băi huì), ST 8 (tóu wĕi), GB 20 (fēng chí), DU 16 (fēng fŭ), HT 7 (shén mén), PC 6 (nèi guān).
Supplementary Points: LV 2 (xíng jiān), GB 43 (xiá xī), UB 18 (gān shū).
Method: Select three main points along with 1-2 supplementary points per treatment, alternating the points every day. Needles should be retained for 20 minutes after obtaining needle sensation, once per day.
Techniques: Sedating technique applied mainly.
Follow Up
After 3 days of treatment, the vertigo improved. The redness in the face, red eyes, the bitter taste and fullness in the chest area were eliminated, indicating that smoothing of liver qi stagnation and a reduction of liver fire had occurred. A dry throat, thirst, irritability, insomnia, and vexing heat in the heart accompanied by mild vertigo remained. The tongue body was red with little fluid and a yellow coating and the pulse was thin and rapid. This indicated that damaged yin remained despite bringing the liver yang under control.
Treatment Principles: Nourish the yin, enrich fluids, calm the liver and subdue the yang.
Formula: Modified Qí Jú Dì Huáng Wán (Lycium Berry, Chrysanthemum and Rehmannia Pill)
[杞菊地黄丸加减]
