Experience in Acupuncture Treatment of Dizziness and Vertigo——A Report of 3 Cases

Dizziness and vertigo is a commonly encountered disease in clinic. There has been the saying from ancient times that "there would be no dizziness if without wind", " there would be no dizziness if without phlegm", "there would be no dizziness if without deficiency", and " there would be no dizziness if without fire". However, in the author's view, the dizziness and vertigo caused by blood stasis blocking the collaterals is most commonly seen in clinic, which should deserve more attention. The following is an introduction about the author's experience in treating 3 cases of dizziness and vertigo with acupuncture.

ACUPUNCTURE TREATMENT OF DIZZINESS AND VERTIGO

Case HistoryName: Xia; Sex: male, Age: 62; Occu-Pation: worker (retired); Date of first visit:May 27, 1985.Chief ComplaintsDizziness and vertigo with nausea for20 days. Since the afternoon of May 8

Discussion on the Treatment of Ear Vertigo Based on the Theory of"All Winds and Dizziness Belong to the Liver"

The theory of"all winds and dizziness belong to the liver"provides a basis for 1ater plysicians to study the etiologic and pathogenesis of vertigo diseases.This theory of pathogenesis suggests that vertigo diseases are most closely related to the liver,so the mechanism can be simply understood as liver and spleen damage.Water dampness is unfavourable for transportation and transformation as dampness gathers phlegm,and liver‘wind’carries phlegm to the ear orifice,causing dizziness,or the ear orifice can be attacked due to the deficiency of yin and hyperactivity of yang in liver and kidney,resulting in sudden dizziness.Based on the pathogenesis theory of liver and spleen damage,the treatment principles should be based on strengthening the spleen and dispelling dampness,eliminating phlegm and extinguishing‘wind’.For‘yang-type'hyperactive liver,nourishing yin and suppressing yang,and the clearing of yang in the ears should always be the standard.

Electromagnetic Waves Collected by a Dental Amalgam Filling Induced Balance Dysregulation and Dizziness over a Period Exceeding 10 Years

This case report describes a woman aged approximately 50 years who has suffered from balance dysregulation and dizziness for more than 10 years. Although the subject underwent several examinations to confirm the etiology of her symptoms, the root cause remained unknown. The symptoms were thought to be caused by electromagnetic wave hypersensitivity because the subject experienced uneasiness and dizziness when a cell phone was held close to her body. A cell phone was used to diagnose the collection of harmful electromagnetic waves, and an amalgam filling was determined to be the cause. The amalgam filling was removed under strict protection, and the subject’s symptoms completely disappeared soon after the filling was removed.

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness.Anterior cervical surgery can eliminate not only chronic neck pain,cervical radiculopathy or myelopathy,but also dizziness.Immunohistochemical studies show that a large number of mechanoreceptors,especially Ruffini corpuscles,are present in degenerated cervical discs.The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease(i.e.cervical discogenic dizziness).Disc degeneration is characterized by an elevation of inflammatory cytokines,which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization.Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system,resulting in sensory mismatches with vestibular and visual information and leads to dizziness.In addition,neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles.Like cervical discogenic pain,the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out.Conservative treatment is effective for the majority of patients.Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

Post-stroke dizziness and psycholo gical disturbance

AIM:To study the relationship between post-stroke dizziness and psycho-logical factors.METHODS:To choose 82cases with dizziness after stroke.The patients whose medical treatmen t were invalid were divided into two groups randomly.The experimental g roup of 43cases was treated with an-tipsychotic and the controls group o f 39cases was treated with consola-tion.RESULTS:The total effective rate in experime ntal group was signifi-cantly higher than that in the contro l group(P<0.001).CONCLUSION:It is suggested that though the menta l scales scores might be normal,post-stroke dizziness should be tre ated for a long-term helplessly be ju st a sign of psychological matter.It ought to be discerned and given pertinen t treatments.

The Causes of Dizziness in Parkinson’s Disease

Patients with Parkinson’s disease complain dizziness frequently. Postural hypotension and postural instablity are suggested to be the reasons of dizziness in elderly people with Parkinson’s disease. The aim of this prospective surveillance study was to characterize the etiology of the dizziness in patients with PD. A total of 47 consecutive patients with idiopathic Parkinson’s disease were enrolled in the prospective surveillance study. Of the 47 patients, 32 (68.1%) had dizziness. All patients underwent neurological and otologic examination. Complete blood count, serum electrolytes, glucose, liver function tests, renal function tests and thyroid function tests, cranial computerized tomography, direct cervical region radiography and vertebral artery doppler ultrasonography were obtained from all patients. Patients were screened for blood pressure changes, drug use, cardiovascular diseases, hypertension and diabetes mellitus. The findings of loss of disk height, with subsequent loss of cervical lordosis were higher in patients with dizziness (p = 0.01). The results of this study show that cervical-vertebral degeneration may be a common cause of dizziness in Parkinson’s disease patients.

Isolated versus Drug Combined Vestibular Rehabilitation for the Treatment of Metabolic Dizziness

Introduction: Systemic processes and inappropriate use of medications may affect vestibular adaptation. Objectives: To assess the efficacy of isolated and combined drug therapy for treating metabolic dizziness and to determine the effect of multidrug treatment. Methodology: We analyzed 100 questionnaires of patients diagnosed with dizziness of metabolic origin. Results: The group treated with vestibular rehabilitation alone showed improvement with 9 months of therapy (p = 0.01). The group treated with vestibular rehabilitation and medication showed improvement with 45 days of therapy (p = 0.01). The group treated with a single type of drug did not show significant improvement. The group treated with several drugs showed improvement with 45 days of therapy (p = 0.03). Conclusion: Combined vestibular rehabilitation resulted in immediate improvement of symptoms without contributing to long-term compensation. Vestibular rehabilitation alone resulted in improve- ment of symptoms over time. Multidrug treatment was beneficial for immediate relief of dizziness.

Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness:A retrospective pilot study

BACKGROUND Persistent postural-perceptual dizziness(PPPD)is a functional disorder,typically preceded by acute vestibular disorders.It is characterized by a shift in processing spatial orientation information,to favor visual over vestibular and somatosensory inputs,and a failure of higher cortical mechanisms.To date,no therapies for PPPD have been approved.Kampo medicine hangebyakujutsutemmato(HBT)has been reported to alleviate disturbances of equilibrium.We hypothesized that HBT would be a beneficial treatment for PPPD.AIM To examine the efficacy of HBT for the treatment of PPPD.METHODS Patients with PPPD were enrolled and divided into two groups:The HBT group(n=24)and the non-HBT group(n=14).The participants completed questionnaire surveys[Niigata PPPD questionnaire(NPQ),dizziness handicap inventory,hospital anxiety and depression scale(HADS),orthostatic dysregulation questionnaire,pittsburg sleep quality index(PSQI),and motion sickness scores]before and after HBT treatment.Additionally,to identify HBT responders,multivariate regression analysis was performed using the results of the ques-tionnaire surveys and equilibrium tests;including stabilometry,and caloric,vestibular evoked myogenic response,and head-up tilt tests.RESULTS Thirty-eight outpatients were included in this study,of which 14 patients(3 men,11 women;mean age,63.5±15.9 years)received treatment without HBT,and 24(1 man,23 women;mean age,58.2±18.7 years)received combination treatment with HBT.Following HBT treatment,NPQ scores decreased significantly(baseline 40.1±10.0 vs 2 mo 24.6±17.7,P<0.001).No statistically significant changes were observed in the NPQ scores in the non-HBT group(baseline 38.6±12.2 vs 2 mo 39.4±14.4,P=0.92).Multivariable regression analysis revealed that the results of stabilometry(P=0.02)and the caloric(P=0.03),and head-up tilt tests(P<0.001),HADS(P=0.003),and PSQI(P=0.01)were associated with HBT responsiveness in PPPD patients.CONCLUSION HBT may be an effective adjunct therapy for PPPD.Patients with autonomic dysfunction,unstable balance,semicircular canal paresis,anxiety,and poor sleep quality may be high responders to HBT.

Dental Treatment for Dizziness and Joint Mobility Disorder Caused by Harmful Electromagnetic Waves

With the development of an IT (Information Technology) society, the opportunity to use electronic devices, such as cell phones and personal computers, has increased. These electronic devices pro-vide many benefits to society. However, there have been a number of reports of electromagnetic hypersensitivity (EHS) related to the use of electronic devices. The symptoms of EHS may include headaches, fatigue, tinnitus, dizziness, memory loss, irregular heartbeat, and skin trouble. Since the pathogenic mechanism of such conditions is not yet clear, further research is required. This report shows how a subject’s dizziness and joint mobility disorder, caused by electromagnetic waves emitted by electronic devices, were cured by removing an onlay from the patient’s mouth and replacing it with a gold alloy onlay. The result indicates that the subject’s symptoms were caused by EHS. Although the symptoms were improved after the dental treatment, the underlying mechanism of the symptoms and the reason why this treatment is successful remain unclear. Further research is required to clarify these issues.

Comparison of Survey Results on Subjective Dizziness,Hearing and Tinnitus and Stabilometry Test Results in Yakumo Inhabitant Examination Study (Comparison of 2005, 2007 and 2015, 2017)

Abstract: The Nagoya University Hospital otolaryngology department is doing the prospective cohort study in Yakumo-cho, Hokkaido, Japan from 2005, because this place is a little transfer of the population. Most of inhabitants of Yakumo-cho engage in fishery and agriculture as work mainly. We perform questionary survey using an interview vote. The item is “having feeling of dizziness or not”,“quality of hearing” and “having tinnitus or not”. Furthermore, we go for the examination of stabilometry, too. We compared 2015, 2017 with 2005, 2007 among Yakumo-cho inhabitant examination data this time. As a result, participant with a feeling of conscious dizziness got a bad reputation of the hearing consciously. In addition, participant with a feeling of conscious dizziness had tinnitus consciously. Furthermore, the participant with a feeling of conscious dizziness had bad stabilometry result. As a result of having compared ten years later, we understood that stabilometry result worsened if 60s became in 70s with or without a feeling of dizziness consciously. When there is a feeling of conscious dizziness, it is necessary to perform an examination of stabilometry as routine work. In addition, it is necessary to inspect stabilometry if participants have the bad hearing or tinnitus with a feeling of dizziness in particularly.

Transient ventricular arrhythmia as a rare cause of dizziness during exercise:A case report

BACKGROUND Dizziness is a common symptom in adults and usually due to peripheral causes affecting semicircular canal function or central causes affecting the pons,medulla,or cerebellum.Arrhythmia is a recognized cause of dizziness in people with structural or ischemic heart disease.We report a case of exercise-induced transient ventricular tachycardia and dizziness in a man with no evidence of organic heart disease.CASE SUMMARY A 42-year-old man presented with a 6 mo history of transient exercise-induced dizziness and prodromal palpitations.The patient was otherwise asymptomatic.Physical examination,otoscopy,vestibular tests,cerebellar tests,laboratory investigations,and imaging investigations were all unremarkable.Twenty-four hour Holter monitoring revealed four episodes of transient ventricular tachycardia during exercise.The patient was started on metoprolol and subsequently underwent radiofrequency catheter ablation.The patient reported a full recovery and no dizziness during daily activities.These results were maintained at the 6 mo follow-up.CONCLUSION Ventricular tachycardia is an uncommon but potentially serious cause of dizziness.The outcome of this case illustrates the benefits of careful clinical examination and communication with specialized centers.High clinical suspicion of arrhythmia in a patient with dizziness merits consultation with a cardiologist and referral to a specialized center to ensure timely diagnosis and treatment.

Treatment of Dizziness by Massotherapy and Traditional Chinese Drugs——A Report of 110 cases

Note: HLY = hyperactivity of the liver-yang, STPMJ = stagnation of turbid phlegm in middle-Jiao, DQB = deficiency of qi and blood, DKE = deficiency of the kidney-essence, OCBS = obstruction of collaterals by blood

Integrating cupping therapy in the management of tinnitus and dizziness:a pilot study

Background:Cupping therapy is one of integrative medicine modalities which is used by several nations.Its mechanism of action is not well known but there are several theories explained how it can play a rule in the treatment of diseases.In recent years,huge advances have taken place in understanding of inner ear pathophysiology causing sensorineural hearing loss,tinnitus,and vertigo.Research articles providing evidence of acupuncture treating dizziness and vertigo but no studies of cupping therapy.The aim of this pilot study was to evaluate the safety and efficacy of integrating wet cupping therapy in the management of tinnitus and dizziness associated with ear pathologies.Methods:This is a prospective interventional pilot study in which pre and post intervention outcomes(tinnitus handicap inventory and dizziness handicap inventory)were assessed and compared.27 patients diagnosed with Ménière's disease and idiopathic tinnitus or tinnitus secondary to inner ear pathology were included in this study and received usual medical treatment and wet cupping therapy.Results:There was a significant improvement after 6 sessions of cupping in tinnitus handicap inventory and dizziness handicap inventory but not in patient’s hearing.No adverse events were reported in this study.Conclusion:Wet cupping therapy demonstrates a promising effectiveness in reducing discomforts of both dizziness and tinnitus.A large scale randomized controlled trial is recommended.

Clinical evaluation of Xiaoyao Jieyu prescription in the treatment of persistent postural-perceptual dizziness

目的：评价中药逍遥解郁方（XJP）治疗持续性姿势-知觉性头晕（PPPD）的临床疗效.方法：纳入33例确诊为PPPD的患者,随机分为试验组和对照组.两组患者均给以心理治疗.试验组给予口服逍遥解郁方,对照组给予口服艾司西酞普兰,疗程为12周.分别于治疗前及治疗4周、8周、12周末,采用眩晕残障程度评定量表（DHI）、汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）评估疗效.结果：两组患者在治疗4周后,HAMA、HAMD、DHI总评分及各因子评分即较治疗前显著降低（P〈0.01）;与对照组相比,试验组第8、12周的DHI总评分及功能、生理评分,第4、8、12周的HAMA、HAMD积分均明显低于同期对照组（P〈0.05）;不良反应发生率试验组明显低于对照组（P〈0.05）.结论：逍遥解郁方可全面改善PPPD患者的临床症状,降低PPPD患者的功能、生理症状积分,降低患者的焦虑、抑郁及头晕残障程度;在治疗过程中不良反应少而轻;具有高效、安全、价廉、易取材等优点.

Systematic Review and Meta-analysis on the Efficacy and Safety of Tianma Gouteng Granules(天麻钩藤颗粒)in Treatment of Dizziness

Objective:The effectiveness and safety of Tianma Gouteng Granules(天麻钩藤颗粒)in the treatment of dizziness were systematically evaluated.Methods:A randomized controlled trial of Tianma Gouteng Granules for dizziness was screened out by searching CNKI,Wanfang Data,VIP,SinoMed,Cochrane Library,PubMed,Embase,Web of Science in a systematic way and was based on Handbook 5.1 evaluation criteria and tools and RevMan 5.3 software for meta-analysis of the final inclusion of the study.Results:A total of 7 studies were included,6 studies were included in meta-anlysis and 1 other study,with a total sample size of 568 cases,including 328 cases in the experiential group and 240 cases in the control group.The systolic pressure of Tianma Gouteng Granules alone or combined with conventional treatment in the treatment of dizziness is better than conventional treatment alone(MD=-3.38,95%CI[-4.90,-1.86],P<0.00001).The diastolic pressure of Tianma Gouteng Granules alone or combined with conventional treatment in the treatment of dizziness had no difference compared with conventional treatment alone(MD=-1.35,95%CI[-2.36,-0.34],P=0.72).The TCM syndromes score of Tianma Gouteng Granules alone or combined with conventional treatment in the treatment of dizziness was better than conventional treatment(MD=-5.18,95%CI[-6.89,-5.47],P<0.00001).The marked effective rate of Tianma Gouteng Granules combined with conventional treatment in the treatment of dizziness was better than conventional treatment(RR=2.09,95%CI[1.35,3.24],P=0.001).The marked effective rate of Tianma Gouteng Granules in the treatment of dizziness was better than conventional treatment(RR=1.85,95%CI[1.34,2.54],P=0.0002).Adverse actions included stomach discomfort,dry mouth,headache,dizziness,nausea,insomnia,rash,etc.The number of reported cases in both groups was small.Conclusion:The treatment of systolic pressure,TCM syndrome score and marked effective rate of Tianma Gouteng Granules alone or combined with conventional treatment for dizziness was better than conventional treatment.There was no difference between Tianma Gouteng Granules alone or combined with conventional treatment on diastolic pressure.No serial reverse actions were reported,and all reverse actions were reported after drug withdrawal or dose reduction,and the sample size was small,requiring large samples for further verification.However,the quality of the study is not high,and it is necessary to improve the level of evidence quality by using clinical trial schemes with large samples,rational design and compliance with international standards.

Acute isolated vertigo with vertical up-beating nystagmus: A rare case of nucleus intercalatus of Staderini ischemia

The role of intercalatus nucleus of Staderini(INS),the most caudal of the perihypoglossal nuclei,is much debated.Last research seems to suggest that this nucleus plays a role as a vertical eyes movements integrator.The few clinical reports present in the literature that describe isolated lesions of the INS have described patients presenting in acute with up-beating vertical spontaneous nystagmus.Isolated acute lesion of INS is,in fact,much rare,and,without other neurological signs,is exceptional.We present a case of acute isolated vertigo with no other neurological signs or symptoms,due to INS ischemia provoked by vertebral artery stenosis.The patient presented with spontaneous vertical up-beating nystagmus that showed at videonystagmographic recording,a clear exponential decay of angular slow-phase velocity,that is considered a typical sign of neural integrator impairment.This case seems to represent a further confirm that INS is part,as a vertical-to-position neural integrator,of the neural circuit controlling the vertical eyes movements.

APPLIED STUDY ON BRAIN ATLAS AFTER AND BEFORE TREATMENT BY SIBELIUM IN ISCHEMIC VASCULAR DIZZINESS

目的:探讨西比灵的临床疗效和脑电地形图的应用价值。方法:应用西比灵治疗300例缺血性血管性头晕患者,通过临床症征和脑电地形图观察其疗效。结果:西比灵治疗缺血性血管性头晕有效率为100％,脑电地形图在治疗前后有明显改变。结论:西比灵是治疗缺血性血管性头晕的较理想药物。脑电地形图是观察西比灵疗效和作用机理的有效指标。

眩晕相关评价量表研究进展及应用

眩晕是前庭功能障碍的主要症状,发生在中老年人群中十分常见。临床上可使用问卷或量表量化患者的严重程度,应用合适的量表有助于疾病的诊断及治疗方案的完善。本文介绍了目前常用的眩晕相关量表,并将其分成三类:症状评估量表、日常生活质量问卷和特异性筛查问卷,以为临床医生提供更多选择,促进眩晕量表在临床使用的标准化和科学化。

儿童良性阵发性位置性眩晕的临床分析

目的探讨儿童良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)的临床特征,并观察其复位效果。方法将就诊于郑州大学第一附属医院耳科门诊2018年1月—2022年6月确诊为BPPV且年龄<18岁的17例患儿为儿童组,同期就诊确诊为BPPV行复位治疗的成年患者5275例为成人组,比较两组临床发病特点,分析其发病率、复位治疗效果等临床特征。结果儿童患者BPPV发病率为3.4%低于成人患者发病率39.8%,差异有统计学意义(P<0.01)。儿童组继发性BPPV比例为70.6%,高于成人组的32.6%,差异有统计学意义(P<0.01)。儿童组BPPV治愈率为94.1%,成人组的治愈率为92.0%,两组治愈率比较,差异无统计学意义(χ^(2)=0.102,P=0.750)。结论儿童BPPV发病率虽低于成年人,但并不少见,且复位治疗效果与成人无差异,一旦确诊建议尽可能行复位治疗。儿童BPPV以继发性多见,对于主诉不清或者已诊断为其他眩晕疾病的患儿,可加强变位试验的应用,谨防漏诊,延误患儿康复。