The clinician should distinguish acute situations versus chronic. In acute situations, chiropractic adjustment is the first therapy to consider, and can often relieve the situation immediately. In cases with a history of acute episodes, one should also consider the Eply maneuver. This treats cases of vertigo that are due to sand in the inner ear, and the maneuver tests for, and releases by gravity, this sand. It can be quite effective, and patients can learn to do it themselves. Acupuncture can also be effective, although success with acupuncture alone eludes many practitioners. Effective results can be obtained when using Chinese herbal formulas, however.

Vertigo and dizziness affect 20-30 percent of the general population, with the majority being older women. Modern medicine distinguishes three types of vertigo. In objective vertigo, the patient has the sensation that the environment is moving. In subjective vertigo, the patient feels as if he or she is moving, and in pseudo-vertigo, there is a sensation of rotation inside the patient’s head. Medical diagnoses include benign paroxysmal positional vertigo (BPPV), Ménière’s disease and vestibular neuritis. It may also be due to trauma, fever, migraine, and excessive alcohol consumption.

In Traditional Chinese Medicine, vertigo and dizziness are due to symptom-complexes of root deficiency and branch excess. There are a variety of etiological factors that can cause the condition. Emotional depression or anger can damage liver yin and result in the rise of liver yang or wind. Extended illness, stress, anxiety, over-pensiveness, or weak heart and spleen can cause deficiency of qi and blood. Overindulgent sexual activity, extended illness, or advancing years can lead to deficiency of kidney jing. Improper diet and eating habits, stress and overwork, can damage the spleen and stomach, allowing obstruction of the middle jiao by phlegm-dampness or phlegm-fire. The pathogenesis of vertigo and dizziness is complex, and basically all cases will involve wind, fire, phlegm, or deficiency.

In clinical practice, vertigo and dizziness are distinguished by degree, with vertigo as a more serious manifestation. In vertigo, the head feels as if wrapped in a wet towel, with symptoms of spinning and loss of balance. The etiological cause is an underlying deficiency of spleen qi with accumulation on heat in the middle jiao. This leads to food stagnation and phlegm, and if truth were told, phlegm is the key pathogenic factor in vertigo. Underlying deficiencies of kidney yin andjing can generate liver wind, driving phlegm upwards. In TCM, this can be referred to simply as endogenous wind-phlegm. Effective herbal formulas should address this complex of deficiency, wind, heat and phlegm.