By Dr. Jin-duo Wang, Jian-hua Huang, & Jian-kui Hui

This woman's condition was a case of dizziness due to internal causes, and was diagnosed as spleen and kidney Yang depletion.  In her case, because spleen Yang was deficient, it was unable to control water.  Consequently, water-rheum flooded upwards, and causing dizziness.  On her first visit, the patient was given Vitality Combination (Zhen Wu Tang, Wen Fu Tang) plus Atractylodes & Hoelen Combination (Ling Gui Zhu Gan Tang) to greatly supplement spleen and kidney Yang Qi, as well as fortify the spleen and release dampness.  Her condition improved slightly.  On her second visit, she complained of having low appetite, so the formula was changed to Pinellia & Gastrodia Combination (Ban Xia Bai Zhu Tian Ma Tang) plus Vitality Combination (Zhen Wu Tang, Wen Fu Tang) to increase the functions of fortifying the spleen, promoting digestion, and transforming phlegm.  As a result, her symptoms of dizziness and low appetite greatly improved.

Dizziness is the primary complaint of many patients who come to seek TCM treatment.  Clinically, it is important to differentiate whether the patient is suffering from vertigo or faintness.  In vertigo, the patients feel as if the world around them is spinning, and the problem lies in the semicircular canal of the inner ear and the cerebral vestibular nerve.  Faintness, on the other hand, feel light-headed.  In severe cases, a person may faint suddenly.  The cause is usually deficiency of blood or oxygen to the brain.

The “Su Wen: Zhi Zhen Yao Da Lun” says, “All cases of wind, swaying and dizziness are related to the liver.”  This clarifies that dizziness is related to the nervous system.  The “Ling Shu: Kou Wen Pian” points out, “When Qi in the upper body is insufficient, the brain won't be full, the ears will suffer from ringing and the vision will spin.”  Here, “Qi in the upper body is insufficient” means insufficient blood supply to the brain.

Zhong-jing Zhang of the Eastern Han Dynasty thought that external contraction and phlegm-rheum were major causes of dizziness.  In the “Shang Han Lun: Shao Yang Bing Pian”, it is written, “When Shao Yang is diseased, the mouth will be bitter, the throat will be dry, and the vision will spin.”  This paragraph clarifies that dizziness due to external contraction can be treated with Minor Bupleurum Combination (Xiao Chai Hu Tang).  In the “Shang Han Lun: Tai Yang Bing Pian”, it says, “If cold damage is treated with emesis or purging, then there will be reversal and fullness in the area below the heart, Qi will surge upwards into the chest, the person will feel dizzy upon standing, and their pulse will be deep and tight.  If sweating is induced, this will disturb the channels, and the person's body will shake and sway, Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria, Cinnamon Twig, White Atractylodes, & Licorice Combination) governs.” In the “Jin Kui Yao Lue: Tan Yin Ke Sou Bing Mo Zheng Bing Zhi Pian”, it is written, “When there is propping rheum below the heart, and the person suffers from dizziness, Ze Xie Tang (Alisma Combination) governs.”  It also says, “In cases of sudden vomiting with focal distention below the heart, water in the diaphragm, and dizziness with palpitations, Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia & Hoelen Combination) governs.”  These excerpts regarding the relationship between phlegm-rheum and dizziness as well as the formulas used to treat them were the original sources for how to treat “dizziness caused by phlegm” and “dizziness caused by spleen depletion with pooling water.”

        Yong-he Yan of the Song Dynasty wrote in the “Zhong Ding Yan Shi Ji Sheng Fang: Xuan Yun Men”, “Contraction of the six pathogenic factors, and injury to seven emotions can all cause dizziness and should be differentiated by external signs and the pulse.”  “The influence of the seven emotions can cause the Zang Qi to become unbalanced, leading to constraint and the production of saliva, which becomes bound and turns into rheum.  The rheum follows rebellious Qi upwards and causes a person to feel dizzy¡K Extreme exhaustion, depletion below and repletion above, incised wounds, vomiting, diarrhea, as well as uterine flooding with blood loss, all these conditions can cause a person to feel dizzy.”  Yong-he Yan's theory of the seven emotions and how they lead to dizziness was an important addition to medical literature.  The other symptoms of vomiting, diarrhea, and severe uterine bleeding can cause the quantity of blood in the blood vessels to become depleted and lead to orthostatic hypotension and dizziness.

Jing-yue Zhang of the Ming Dynasty wrote in the “Jing Yue Quan Shu: Xuan Yun”, “Although dizziness is an issue of depletion in the upper aspect of the body, it also involves the lower aspect.  The upper depletion is depletion of the Yang within Yang, and lower depletion is depletion of the Yang within Yin. For depletion of Yang within Yang treat its Qi, for depletion of Yang within Yin supplement its essence.  Cutting down below will cause the upper to wither.  In order to enrich the leaves of a tree, it is necessary to irrigate its roots.”  Jing-yue Zhang put forth that in order to treat dizziness, one must supplement kidney Yin and Yang.

general information media press gallery illustration