Background: Vertigo, a presumptive diagnosis, is a symptom of diseases in the internal ear and is especially common in labyrinthic disease or inflammation. Several other etiologies may induce vertigo.
Objective: To determine if medical acupuncture would alleviate vertigo.
Design, Setting, and Patient: A retrospective case review of 1 adult female patient.
Intervention: Five treatment sessions: every other day for 4 treatments, and 1 week later for the last treatment. Treatment consisted of needling 16 acupuncture points, based on the specific alteration according to Chinese syndromes. Needles were placed bilaterally and De Qi was obtained. The most frequently used points were LR 3, GB 43, and GB 34 for dispersing the Liver; SP 6, SP 9, and ST 36 for tonifying the Spleen and Stomach; GB 2, SI 19, and TH 17 as local points for helping to release the stagnation in the Meridians.
Main Outcome Measure: Subjective symptom improvement and objective assessment of existence of nystagmus and vertigo after head movement.
Results: The patient reported significant symptom improvement after the first session. After the second session, she reported complete cessation of vertigo. At 6-month follow-up, the patient was still symptom-free.
Conclusions: This case report suggests that acupuncture could be an initial alternative therapy for vertigo. Further clinical and laboratory research should be performed to confirm this finding and to determine the physiologic basis of the harmonizing effect on the labyrinthic system.
Key Words: Acupuncture, Vertigo, Yang, Yin, Liver Fire
VERTIGO IS A SYMPTOM OF a variety of diseases. When accompanied by nystagmus and if the symptom can be induced or aggravated by head movement, vertigo is related to labyrinthic inflammation and diseases. This symptom is sometimes refractory to conservative treatment or drug therapy. With the patient reported herein, the only other remaining option was surgical ablation of the vestibular system, which the patient was not willing to undergo.
In Traditional Chinese Medicine (TCM), vertigo is a syndrome produced by: (1) insufficiency of Qi and Blood, (2) hyperactivity of Liver Yang, (3) consumption of Kidney essence, and (4) retention of Dampness and Phlegm in the Middle Energizer. (1)
The patient was a 45-year-old woman who presented with vertigo and nystagmus completely resistant to conventional treatment. She had previously seen several physicians. Computed tomographic scan of her brain, audiometry, and biochemical examination results were normal. Traditional Chinese Medicine was chosen for the patient after consent was given for treatment. The tongue and pulse diagnosis of TCM is one base of diagnosis. Her TCM pulse was floating, middle, and taut, and her tongue had teeth marks with a white, greasy coating. (2)
Based on the TCM diagnosis, this patient's symptoms were induced by chronic anger and depression that consumed Liver Yin and Liver Yang, becoming active and attacking the head. (1) Chronic emotional problems were consuming Liver Yin.
Therapy was planned according to TCM diagnosis. I performed acupuncture treatment every other day for the first 4 sessions, and the last treatment was a week later. Acupuncture points were selected to nourish Liver Yin and subdue Liver Fire or Liver Yang. Points used were ST 36, GB 34, SI 3, SI 19, GB 2, TH 17, LI 4, SP 6, and GB 43. Gallbladder points were needled with reducing maneuver, and Spleen and Stomach points were needled with reinforcement maneuver. Needles were left in place for 30 minutes (single-use, 25 x 0.25, stainless steel; HuanQiu).
The patient reported significant improvement of symptoms after the first session of acupuncture with complete removal of vertigo after the second session. Follow-up for 6 months revealed no further symptoms.
During the early 1970s, attitudes among the global medical community regarding medical acupuncture began changing and now, acupuncture is more accepted as a viable modality. In the book Medical Acupuncture: A Western Scientific Approach, Filshie and White write, "It is hoped that this textbook celebrates the emergence of acupuncture from its mystical alternative roots and hasten its complete integration into conventional medicine over the next decade." (3)
However, there are still restrictions toward acceptance of acupuncture in the medical community as in this case; and as in the beginning of TCM onward that embodies the treatment of many such cases treated by acupuncture. Rotchford discusses the safety and advantage of referral to an acupuncturist when standard medicine could not help patients, and its acceptance by many as an effective approach to treatment in the cases where conventional medicine was lacking. (4) As in this case of vertigo, conventional medicine was ineffective and referring to an acupuncturist resulted in successfully treating the patient.
The results of this case suggest that if findings could be reproduced with a larger population and longer follow-up, acupuncture may be a safe therapy for vertigo. Certainly, additional investigation of the physiologic effects of acupuncture in the labyrinthic system is warranted.
(1.) Jingsheng Z. Chinese Acupuncture and Moxibustion. Shanghai: Shanghai University of Traditional Chinese Medicine; 2002:335-337.
(2.) Zhixian L. Diagnosis of Traditional Chinese Medicine. Beijing, People's Republic of China: Academy Press (Xue Yuan); 1998.
(3.) Filshie J, White A. Medical Acupuncture: A Western Scientific Approach. New York, NY: Churchill Livingstone; 2006.
(4.) Rotchford J. Incorporating medical acupuncture into standard medical practice. Med Acupuncture. 2000;12(2):33-35.
Syros Soltanian, MD
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Syros Soltanian, MD
Sagafie Physician Building