What should I do if I have dizziness that cannot be cured for a long time? - This kind of consultation is very "TCM!"

Introduction: How can we consider the long-lasting "vertigo"? What do you think? Follow in the footsteps of the sages and take a look at the consultation records of this vertigo case!

This case has been suffering from vertigo for six years, and multiple treatments have failed.

Before the onset of the syndrome, there is heat rushing from the abdomen to the top of the head, followed by dizziness, tinnitus, nausea and vomiting, accompanied by yellow constipation, red tongue, yellow and greasy coating, and a slow, slippery pulse. What is the pathogenesis?

It seems that various opinions can be considered.

"If there is no deficiency, there will be no dizziness." If the kidneys are empty and the marrow is empty, the upper and lower parts will be deficient;

Deficiency is the root of the disease, but water does not contain wood, and liver yang is disturbed, so deficiency is the disease. symptoms.

However, the attending doctor is discerning and believes that the disease is neither a simple disease of wind, fire, phlegm, and deficiency, nor is it a syndrome of yin deficiency and yang hyperactivity, but "yin deficiency and blood stasis leading to phlegm and fluid retention" "Evidence. Therefore, the method should be to nourish yin, relieve depression and clear away heat, resolve phlegm and reduce fire, add warming gallbladder decoction, white peony root, zhi licorice and bitter almond to eliminate yin, prunella vulgaris to clear less yang and stagnation of heat, mother of pearl to relieve yin, and Glauber's salt.

The dizziness stopped after three doses. The effect is like a bifurcation drum, which can solve this chronic disease. This method is difficult for a famous doctor with extensive knowledge to determine.

A

Case Introduction

Patient Liu xx, male, 33 years old, worker, clinic number 67461, came to the clinic on January 14, 1964.

Question:

This patient has suffered from paroxysmal and rotational vertigo for more than six years. The condition has changed dramatically over the past two years. The number of vertigo attacks has increased from a few times a month to 3-4 times a week now. Before each attack, I feel a rush of hot air from my abdomen to my head, and then the surrounding scenery shakes, my body rotates, my vision goes black, or I fall down, but I am conscious.

I was diagnosed with Meniere's syndrome at Peking Union Medical College Hospital. I took a variety of Western medicines, which were effective at first, but gradually became ineffective after taking them, so I came to our hospital for treatment.

Inscription:

Dizziness, tinnitus, deafness (mild), significant memory loss, nausea and vomiting, restlessness, palpitation and shortness of breath, bitter mouth and dry tongue, constipation or yellow urine , morning sickness, sometimes hot palms, backache. I smoke and drink a lot, but I don't drink much. I suffered from typhoid fever and deafness 10 years ago, nothing special.

Visit:

The tongue is slightly fat and red, the coating is thin, yellow and slightly greasy, the body is thick, the complexion is gray, and the nutrition is moderate.

Odor diagnosis:

The voice is normal and breathing is slow and even.

Pulse diagnosis:

Pulse is heavy and steady.

Examination:

Pigment 11.9g, red blood cells 3.96 million, white blood cells 6700, blood pressure 120/80mmHg. Heart and lungs (-), liver and spleen (-).

Otolaryngology examination: The tympanic membranes of both ears were slightly congested, and the light cones disappeared. Otolith reaction: The patient sweated, tilted at 90°, almost fell, had a mildly pale face, and felt nauseated, which was consistent with the reaction and suggested moderate vestibular hypersensitivity. Electrical audiometry revealed mild neurological deafness (bilateral).

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Course of treatment

Based on the above pulse conditions, we diagnosed dizziness, which was caused by liver and kidney yin deficiency and liver yin hyperactivity. We adopt the method of nourishing yin and calming the liver. First, Qiju Dihuang Pills failed, and then we changed to the method of calming the liver and calming the wind.

Medicinal uses: Uncaria, chrysanthemum, Cassia, mint, skullcap, dog spine, Achyranthes bidentata, Aphrodisiac root, raw and cooked rehmannia root, white peony root, amomum villosum, tangerine peel, etc. If there is no improvement after taking multiple doses, it is a product that aggravates liver stagnation, suppresses yang, and reduces wind. It is also a product that can be used to purge the liver and stomach.

Medicinal uses: Gastrodia elata, Uncaria, chrysanthemum, Tribulus terrestris, Poria, Anemarrhena, Ziziphus seed, Dendrobium, Ligustrum lucidum, tangerine peel, Cassia, magnet, mother-of-pearl, licorice

The patient is strong and young, and the condition is paroxysmal, often caused by changes in body position, anger, anxiety or hot weather.

Na Gujia often has dry stools, yellow urine, and dry mouth. During the attack, hot air surges up, causing dizziness and nausea. The pulse on the right side is thin and the mouth is wide on the left side. This indicates that the syndrome of liver and kidney yin deficiency is not obvious and it is not suitable to take supplements.

Liver fire is different from liver yang, it is liver and gallbladder excess fire. Although I have tried Longdan Xiegan Pills, they are not decoctions. It is advisable to treat the disease first, taking Longdan Xiegan Decoction, and then proceed to nourish liver and kidney yin deficiency, such as Bai Dihuang Pills and Qiju Dihuang Pills.

The characteristics of vertigo are virtuality and reality, as well as the principles of treatment. Generally, methods are used to nourish kidney yin and calm liver yang. Poria cocos and red peony root have certain effects on reducing labyrinth edema and can be used.

According to the syndrome differentiation of deficiency, excess, cold and heat in the Eight Cardinal Guidelines, the symptoms of spleen and kidney deficiency include: rising heat before onset, dizziness, nausea and vomiting, variable onset time, fear of cold, and bitter mouth , hot or not fond of drinking, backache, moist scrotum, hard stool at the beginning, turbid and yellow urine, dull complexion, cold feet, and hot palms.

Kidney deficiency leads to imbalance of liver yang, so it is a deficiency syndrome. To distinguish between cold and heat, there is more cold and less heat; what is said on the outside is the evidence on the inside. The tongue is not red, and the coating is thin and white; four to one pulse or more, five to one pulse or less, plus the tongue and pulse, are often deficient and cold.

Vertigo is more deficient than actual. The deficiency syndrome of vertigo is not serious, but this patient is very serious.

According to the symptoms of internal heat, bitter mouth, dry tongue, irritability, etc. before the onset of the disease, it is related to liver-fire; urine is yellow as fire; abdominal distension, hard stool will become soft at first.

Judging from the abnormal pulse, neither red nor light tongue, and less tongue coating, the pathogenesis is liver heat. When clearing the liver and stomach, Sini Powder should be added to regulate stomach qi.

Agree with the diagnosis of vertigo. The Jueyin liver pulse is on the upper side, and the symptoms of the liver meridian are obvious, but it is not caused by yin deficiency and liver yang hyperactivity.

Phlegm stasis in the liver results in liver depression. There is an ancient saying that "no phlegm, no dizziness". Judging from the symptoms, most patients have phlegm and blood stasis, so treatment can be based on phlegm. Banxia Atractylodes and Tianma Decoction should be used in conjunction with medicines for calming liver yang hyperactivity.

For vertigo syndrome with a long duration, treatment generally starts with the liver and kidneys.

The patient is strong, rosy, irritable, thirsty and nauseated. During the attack, there are internal heat, constipation, yellow urine, red tongue tip, thin white coating, and thready pulse. There are no obvious symptoms of kidney deficiency. They are all caused by excess fire in the liver and gallbladder, and also manifest as liver yin deficiency. Longdan Xiegan Decoction is used to relieve excess heat, and the prescription also contains yin-nourishing medicine. Gentian can be reused.

The Chinese medicine diagnosis of vertigo is correct. There are two symptoms of vertigo: dizziness when the eyes turn black, and vertigo when spinning. Although the disease is in the head, the pathogenesis of the triple burner can be clearly seen.

Mostly phlegm due to upper wind is caused by clear yang, turbid yin and stagnation. Followed by liver and kidney deficiency.

Based on this case, the pathogenesis is in the middle and upper Jiao, not the lower Jiao. Those who are really weak often feel dizzy and sometimes have difficulty with attacks.

Therefore, this case should be dizziness caused by phlegm and turbidity, and its pathogenesis lies in dizziness caused by spleen-yang deficiency, stagnation of clear yang, and stagnation of turbid yin.

The spleen governs the four ends, and spleen yang cannot reach the four ends, so the patient's limbs are cold. The chest is clear and the Yang can not rise, the chest is tight and the Qi is rising.

Furthermore, patients spit more in the morning, the spleen is the source of phlegm, and the lungs are the reservoir of phlegm. Personally, I think "no phlegm and no dizziness" makes sense.

Sometimes, patients with phlegm are earthy, prone to moisture, and have a gloomy complexion.

It is also said: "The source of this disease is liver wind, which should be combined with liver wind and stroke." , Scalp valve."

Xu Lingtaiyun said: "The main indications are dizziness, clearing fire, and nourishing the liver, but as for the inability of the body to become independent, this is not the ratio of floating fire. The product of Jinshi Zhenjiang."

In this case, the symptoms seem to be yin deficiency and fire exuberance, wind, such as irritability, bitter mouth, dry tongue, constipation, yellow urine, etc. However, if there is phlegm and turbidity in the stomach, such as nausea and vomiting, thin yellow greasy coating, and hard stool before vomiting, it belongs to the so-called liver wind catching phlegm syndrome in the above leaf case. If used together with warming and tonic, it will hinder phlegm and turbidity; if used together with warming and dryness, it will damage liver yin and make it difficult to take the medicine.

It is recommended to use Waitai Fuling Decoction to remove ginseng and Atractylodes, add pinellia, amomum villosum, and coix seed to treat the stomach, and use Qiju Dihuang Pills to nourish the liver and kidneys.

In February 1963, I suffered from Meniere's disease. Symptoms are deafness and tinnitus. I use yin-filling therapies to help clear phlegm fire, such as rehmannia glutinosa, yam, dogwood, lodestone, tortoise shell, achyranthes, calamus, fritillary, poria and tangerine peel.

After taking a few doses, let me tell you about it for your reference.

There are many reasons for dizziness, but this patient’s water does not contain wood, and Yang deficiency is the main factor.

The disease is located in the kidneys, dizziness caused by rising deficiency heat is the standard, and kidney yin deficiency is the root cause, and both symptoms and symptoms should be treated.

Vomiting and internal heat are caused by the overflow of kidney qi.

Danxi Dabuyin Pills are suitable for treatment, consisting of 15g of turtle shell, 15g of turtle shell, 31g of dogwood, 6g of Phellodendron (decocted in salt water), 6g of Anemarrhena (decocted in salt water), 15g of keel bone, and 15g of oyster.

With enough water, wood can be contained, and liver yang will not be disturbed. This prescription focuses on nourishing water and containing wood, calming the liver and subduing yang. In the future, you can take Dabuyin Pills, Qiju Dihuang Pills, and Baidihuang Pills for a long time to relieve dizziness with fire.

Generally speaking, dizziness never leaves the liver and kidneys. The disease is in the liver and its source is in the kidneys.

It says: "Everything caused by the wind will return to the liver." The so-called wind, the liver is the organ of Jueyin Fengmu, the liver is used by yin and yang, and yang is driven by wind. Although there are dizziness caused by external wind, there are many internal causes.

In addition, wind, phlegm, qi, and fire can all cause dizziness, and each has its own deficiency and excess of phlegm.

In clinical practice, we must grasp the pathogenesis, use the three causes, four diagnosis and eight principles to conduct detailed analysis, and apply the principles of syndrome differentiation and treatment.

In this case, the pulse is deep and smooth on the right side, stringy and thin on the left side, the tongue is red, and there is a slightly yellow and greasy coating in the center of the tongue. Combined with the pulse, tongue and symptoms, the disease is Yin deficiency, heat stagnation, and phlegm retention. Treatment should nourish yin, relieve stagnation, clear away heat and reduce phlegm-fire, that is, clear Shaoyang, relieve Jueyin and purge Yangming, and add Zongwendan Decoction.

Prescription: 6 grams of Poria, 9 grams of faxia, 6 grams of tangerine peel, 4.5 grams of fried tangerine, 3 grams of calamus, 6 grams of bamboo root, 12 grams of mother of pearl (pre-fried), 9 grams of prunella vulgaris , 3 grams of Cyperus rotunda, 6 grams of white peony root, 1.5 grams of licorice, and 6 grams of Glauber's salt (taken in two times).

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Postscript

After consultation and discussion, we followed the advice of Teacher Pu Fuzhou and adopted the method of nourishing yin, relieving stagnation, clearing away heat, resolving phlegm and reducing fire. After taking three doses of the medicine proposed by Teacher Zong Pu, the dizziness stopped and the symptoms were significantly relieved.

Add a penny of coptis in front and take 19 doses to relieve the symptoms. During follow-up until June 8, the vertigo did not recur.

In order to consolidate its curative effect, the dosage is still 10 times higher than the original prescription and ground into coarse powder and homogeneous powder, resulting in a small dose of 18 grams. Take one sachet (18g) decoction in water, twice in the morning and evening.

Currently, there is no effective way to prevent the recurrence of this disease