Zhang Ruo Liu Qi Dongfang

This paper reviews the etiology and pathogenesis of vertigo, treatment of traditional Chinese medicine, acupuncture and catgut embedding therapy at acupoints. It is considered that there are various methods of treating vertigo in traditional Chinese medicine, and the curative effect is remarkable, which is worthy of clinical promotion.

1 etiology and pathogenesis

Vertigo has been discussed in ancient Chinese medicine books. In Su Wen Zhi Zhen Da Lun, "wind dizziness belongs to the liver", and it is considered that dizziness is closely related to the liver. "On Shu Hai's Spirit" says: "Deficiency of marrow sea leads to tinnitus in the brain and dizziness in the tibia", pointing out that dizziness is caused by deficiency. Physicians in past dynasties have different opinions on the etiology and pathogenesis of vertigo. Zhu Danxi advocated "no phlegm and no dizziness", while Wang Qingren believed that dizziness was caused by blood stasis. Villi Chaodeng [1] thinks that vertigo is the most common disease, and wind, phlegm and blood stasis are intertwined. Its main etiology and pathogenesis are liver wind moving internally, phlegm blocking blood stasis, qi disorder, rushing up and clearing the orifices, leading to dizziness. Professor Guo Zhihua summarized the etiology and pathogenesis of vertigo, and thought that the disease was mostly related to improper diet, excessive strain, emotional exhaustion and sexual fatigue, or deficiency of liver yin could not restrict yang, or deficiency of spleen and stomach led to deficiency of qi and blood, or deficiency of kidney and marrow [2]. Professor Zhang Huailiang argues that dizziness is caused by wind, which can be either external or internal. At the same time, wind is the length of all diseases, and wind pathogens often cause dizziness together with other pathogens. Wind evil is the most common cause of disease, and it is the forerunner of exogenous evil [3]. On the other hand, Professor Fang Xianming thinks that dizziness is closely related to "liver wind". The imbalance of yin and yang in the liver can lead to blood deficiency, phlegm-dampness, blood stasis, obstruction of clearing orifices or blood stasis, and blood deficiency can nourish clearing orifices. Therefore, it advocates the treatment of calming the liver and calming the wind, and skillfully uses "wind" drugs [4]. Hua Rong summed up clinical experience, and thought that the etiology and pathogenesis of vertigo was abnormal ascending and descending of qi due to imbalance of liver and spleen and stomach, or failure of clearing yang and lowering turbid yin due to exogenous pathogenic factors, and regulating qi was the key to treatment [5]. If the spleen and stomach are qi-deficient, the qi and blood can't be biochemical, and the brain will also lead to dizziness [6]. Li believes that phlegm-dampness is the main cause of dizziness. When the spleen loses transport, the yang will not rise, the turbid yin will not fall, and the phlegm will be dizzy [7].

2 Chinese medicine treatment

2. 1 Traditional Chinese Medicine Decoction Many prescriptions about vertigo were recorded in medical monographs of past dynasties, which accumulated valuable experience for later generations. He Qingyong followed the proportion of the original prescription and used Alisma Decoction to treat vertigo, with remarkable curative effect [8]. Duan Haichen advocated treating vertigo based on syndrome differentiation, and treated dizziness with Banxia Baizhu Tianma Decoction, Qingzhen Decoction and Alisma Decoction. Deficiency vertigo was treated with Tianma Gouteng Decoction. For those with deficiency of spleen and stomach and deficiency of qi and blood, Shengmai Decoction and Guipi Decoction can be modified; Qijudihuang Pill is effective in treating kidney essence deficiency [9]. Li et al [10] used Shugan decoction combined with Zhenwu decoction to treat inner ear vertigo, and achieved good results. Liu Chaoyan [1 1] selected 74 patients with vertigo for clinical study, among which 37 patients with vertigo were treated with Huanglian Wendan decoction, with a total effective rate of 97. 30%, which shows that Huanglian Wendan decoction is effective in treating vertigo and can improve the quality of life of patients. In clinical treatment based on syndrome differentiation, not only classic prescriptions are widely used, but also self-made prescriptions play an important role in treatment. Han Tiansheng et al. [12] self-made Wenyang Lishui Shujing recipe to treat vertigo. Compared with the control group treated with conventional western medicine, the total effective rate is 96. 67%. The results show that this prescription has remarkable curative effect on vertigo and can be popularized and applied in clinic. Deng Zhenxing et al [13] observed the clinical effect of Yiqi Dingxuan recipe on vertigo. The control group was given nicergoline tablets, 65438±05mg each time, orally three times a day. The treatment group was given Yiqi Dingxuan recipe. The effective rates of the treatment group and the control group were 92. 98% and 73. The LDL-C and average blood flow velocity in the treatment group were significantly improved compared with those before treatment, indicating that Yiqi Dingxuan recipe has a good effect on vertigo and can reduce the occurrence of arteriosclerosis and cerebrovascular diseases. Yuan Bing et al. [14] treated 64 cases of vertigo caused by vertebrobasilar insufficiency with the prescription of replenishing essence and qi. After treatment, the blood flow velocity of bilateral vertebral artery and basilar artery was improved, vertigo symptoms were relieved, and good clinical results were achieved.

2.2 Chinese medicine injection Chinese medicine injection is an extract of single Chinese medicine or compound Chinese medicine, with high concentration of effective components and wide clinical application, which provides a new idea for the treatment of vertigo. Most traditional Chinese medicine injections for treating vertigo have the functions of dilating blood vessels, resisting oxidation, reducing blood viscosity and resisting atherosclerosis. Chen Jing et al [15] conducted a multicenter randomized single-blind controlled trial to evaluate the efficacy and safety of gastrodin injection in treating vertigo. Treatment group 120 cases, control group 65438 cases. The treatment group was treated with gastrodin injection, while the control group was treated with betahistine hydrochloride injection. After the course of treatment, the clinical control rate and effective rate of vertigo symptoms in the treatment group were higher than those in the control group. Astragalus membranaceus can tonify middle energizer and treat qi deficiency and blood deficiency. Astragalus membranaceus can reduce platelet adhesion, repair vascular elasticity, dilate blood vessels and improve blood flow velocity [16]. Ge Jun et al [17] randomly divided 60 patients with cervical vertigo into treatment group and control group. The control group was treated with Shenmai injection, while the treatment group was treated with Huangqi injection. It was observed that the total effective rate of the treatment group was 96. 67%, and no recurrence. The symptoms of vertigo basically disappeared, and the accompanying symptoms such as nausea and vomiting were effectively alleviated. Zheng [18] safflower yellow injection has a definite clinical effect on vertigo caused by vertebrobasilar insufficiency. There are no abnormalities in blood routine, urine routine and liver function test before and after treatment, and there are no other serious adverse reactions, which shows that this medicine has a good effect on vertigo. Modern pharmacological studies have found that Xingnaojing has a direct impact on the apoptosis of nerve cells, can scavenge free radicals, play an antioxidant role and achieve therapeutic effects [19]. Dong et al. [20] observed the clinical efficacy of Xingnaojing injection and vinpocetine in treating vertigo caused by vertebrobasilar insufficiency, and found that the total effective rate of Xingnaojing group was 95. 56%, the quality of life score was significantly improved, the vertigo symptom score was significantly reduced, and no adverse reactions occurred. Therefore, Xingnaojing injection has a good clinical effect and high safety in treating vertigo caused by vertebrobasilar insufficiency, which is worthy of clinical promotion. Zhang et al [2 1] combined with Xuesaitong injection to treat 72 cases of vertigo on the basis of routine western medicine treatment. The total effective rate in the treatment group was 88. 9%) was higher than that of the control group (73. There were no adverse reactions in both groups. Wang Xinlin and others [22] in order to systematically evaluate the efficacy and safety of Danhong injection in treating vertebrobasilar insufficiency vertigo, they searched the literature in CNKI, PubMed, Wanfang and other databases, and found that Danhong injection improved the clinical total effective rate in treating vertebrobasilar insufficiency vertigo compared with the western medicine group, and improved the blood flow velocity of vertebrobasilar artery better than the western medicine group. Xuesaitong injection is composed of panax notoginseng saponins, which can improve hemorheology, microcirculation and reduce blood lipid, thus improving cerebral blood flow [23]. The drug can also inhibit the release of cellular calcium and avoid its inflow, thus improving the circulation effect of patients' cerebral blood. Qin Xing [24] randomly divided 104 patients into control group (52 cases) and study group (52 cases). The control group was treated with routine betahistine hydrochloride injection by intravenous drip, while the study group was treated with Xuesaitong injection on the basis of routine treatment. The results showed that the vertigo score and the total effective rate of clinical treatment in the study group were better than those in the control group.

2.3 Compared with traditional Chinese medicine decoction and traditional Chinese medicine injection, traditional Chinese medicine has the advantages of convenient administration and easy storage, and is suitable for patients with mild symptoms or needing long-term treatment. Tianshu capsule is mainly composed of Chuanxiong and Gastrodia elata, which has a good effect on dizziness caused by hyperactivity of liver yang. Wang Qi et al. [25] treated 30 patients with migraine vertigo with Tianshu capsule, while the control group was treated with flunarizine. After 3 months of treatment, the total number of vertigo attacks, the total time of vertigo and the severity of vertigo in the two groups decreased, especially in the treatment group, and no serious adverse reactions occurred in the two groups. Vertigo due to phlegm-dampness and blood stasis is a common syndrome of vertigo. Xuanyunning is a traditional Chinese medicine preparation, which is composed of Alisma orientale, Atractylodes macrocephala, Poria, Pinellia ternata, Ligustrum lucidum, Eclipta prostrata, Chrysanthemum, Achyranthes bidentata, Pericarpium Citri Tangerinae and Glycyrrhiza uralensis. Has the effects of invigorating spleen, promoting diuresis, nourishing kidney and calming liver. Liu Jing et al. [26] discussed the therapeutic effect of Xuanyunning on posterior circulation transient ischemic attack. The control group was given routine treatment of western medicine, and the treatment group was given oral treatment of Xuanyunning tablets on this basis. After treatment 10 d, the total effective rate in the treatment group was 98%, the blood flow in the posterior circulation was accelerated, the blood supply was improved, and the vertigo symptoms of the patients were obviously alleviated. Traditional Chinese medicine believes that the pathogenesis of vertigo is mixed with excess and deficiency, and the syndrome is mixed with excess and deficiency, so it is often difficult to achieve ideal curative effect from a single pathogenesis. Xie [27] chose Yangxue Qingnao Granule in the observation group to treat vertigo caused by cerebral blood supply insufficiency. Compared with the control group (sibelium treatment), the total effective rate of the observation group (97%) was higher than that of the control group (68%), and the difference was statistically significant. With the increase of blood flow velocity, the vertigo symptoms of patients were obviously improved.

3 Acupuncture treatment

Acupuncture is a part of traditional Chinese medicine therapy, which has the advantages of quick onset, simple operation and small side effects, and is more easily accepted by patients. Li Jing et al [28] discussed the clinical effect of acupuncture on vertigo. The control group was treated with routine western medicine, and the experimental group was treated with acupuncture on this basis. According to syndrome differentiation and treatment, different acupoints are selected for vertigo of qi deficiency and yang deficiency. After treatment, the symptoms of vertigo in the experimental group were alleviated and the quality of life of patients was improved. To Jing Yi et al. [29], cervical vertigo was treated by tonifying kidney and activating blood acupuncture. The total effective rate of 40 patients with vertigo was 97. 5%, and no adverse reactions occurred. Qu Liang et al. [30] treated vertigo from deficiency, mainly by needling Guhui point, repeatedly needling Baihui point, combining Gugu, Yanglao and Zheng Zhi points to reach the triple energizer of liver and gallbladder, nourishing spleen and stomach at Zhongwan and Zusanli points, and nourishing liver and kidney at Taichong and Taixi points, and achieved good clinical effects. Xiao [3 1] used acupuncture to treat cervical vertigo with deficiency of both qi and blood. 45 patients in the study group were treated with acupuncture at Dazhui, cervical vertebra, Baihui and Fengchi points, with a total effective rate of 95. It shows that acupuncture is effective in treating vertigo, and the operation is simple and safe. Lu et al. [32] used the acupuncture method of "waking up the brain and inducing resuscitation" to treat mental vertigo, and selected head acupuncture points to make Yang qi accessible, and cooperated with body acupuncture points to achieve the purpose of balancing Yin and Yang. The DHI score and HADS score of the patients in the treatment group were improved, which were better than those in the control group. Therefore, acupuncture can improve the symptoms of patients with mental vertigo and improve their quality of life.

4 Other therapies

In addition to traditional Chinese medicine, acupuncture and other treatments, auricular point pressing and acupoint application are widely used in clinic because of their advantages of non-invasive, convenient and remarkable curative effect. Yao et al. [33] observed the curative effect of pressing beans at auricular points on vertebrobasilar insufficiency vertigo (blood stasis type). The control group was treated with routine western medicine, and the research group was treated with auricular point pressing beans on the basis of the control group. After treatment, the total effective rate of the study group was 97. 06%(P 0 . 05)。 The hospitalization days of patients were shorter than those of the control group. It can be seen that pressing beans at auricular points can relieve vertigo symptoms, which has the advantages of quick recovery and remarkable effect, and is worthy of clinical promotion. Jian Luo et al [34] studied the treatment of atlantoaxial joint disorder vertigo with electroacupuncture. The treatment group was treated with electroacupuncture, while the control group was treated with oral flunarizine hydrochloride capsules. The total effective rate in the treatment group was 87. 8% (P 0。 05). It reflects that electroacupuncture is superior to western medicine in treating vertigo. Deng et al. [35] used self-made Chinese medicine prescription to apply Fengchi point and Yifeng point to treat vertigo. After treatment, the total effective rate of patients in the experimental group was 9 1. 89. 0% higher than that of the control group. The decrease of DHI in experimental group was more obvious than that in control group. Hu Xuguang et al [36] discussed the clinical efficacy of massage and betahistine tablets in the treatment of cervical vertigo. The total effective rate of the observation group was 94. 29%, significantly higher than the control group. Massage therapy can improve the score of vertigo scale, which is beneficial to the recovery of patients and the curative effect is better than that of western medicine group. Zhang Shuai [37] used acupoint injection to treat cervical vertigo, and its effective rate was higher than that of acupuncture treatment group. Acupoint injection is simple and effective, and can be popularized in clinic. Li Zhen et al. [38] applied the method of embedding catgut in acupoints to introduce medical catgut into the needle tube, and determined the actual needle insertion point according to different acupoints and needle insertion angles. After getting angry, pull out the needle and push the core, so that the thread body reaches the muscle layer in the center of the acupoint, and then arrange the needle quickly. The total effective rate in the treatment group is 93. It has obvious curative effect on cervical vertigo, and the curative effect is lasting. Lu Caifeng [39] used small needle knife therapy to treat cervical vertigo. After treatment, the effective rate is higher than that of the control group, and the vertigo score is reduced, and the curative effect is better. Clinically, small needle knife combined with chiropractic manipulation is also widely used to treat vertigo. Nie Jianjun and others [40] used chiropractic manipulation combined with small needle knife to treat cervical vertigo, and its curative effect was better than that of simple chiropractic treatment group, with statistical significance, which effectively improved dizziness, headache, blurred vision and other symptoms.

5 abstract

The etiology of vertigo is complex, the syndromes are often mixed with excess and deficiency, and the clinical manifestations are complex and diverse. Based on the whole, TCM treats vertigo according to syndrome differentiation, and often uses Chinese medicine combined with acupuncture, pressing beans at ear points and catgut embedding at points, which has remarkable effects. Clinically, some patients with vertigo are not effective after being treated by western medicine, but TCM can give full play to their advantages. However, in clinical observation, most of them are small sample experiments or case examples, and there are problems such as lack of unified evaluation criteria for curative effect and no control group. Therefore, in the future scientific research, we should pay attention to the establishment of scientific experimental design, find feasible observation indicators and determine the evaluation criteria of curative effect.