Acupuncture and Vertigo

One of the most frequent questions I am asked is why would a Western trained medical doctor practice acupuncture? This newsletter will attempt to answer that question by examining a medical case history from both the Western and Traditional Chinese Medical (TCM) perspectives. In the telling I hope to show why I find Chinese Medicine, with a tradition of thousands of years of practice and refinement, to be a more nuanced and flexible modality for the practitioner while providing empowering tools for the patient.

1. One man's story: Vertigo?
2.  The Western Diagnosis
3.  The Chinese Medical Diagnosis
4.  Outcome
5.  Reflections

1. Case History: Vertigo?

Recently I got a call from a friend of mine: we'll call him Tony (not his real name). Tony, now in his late 40’s, works in a very stressful corporate environment. Lately he has seen a lot of his co-workers laid off as their jobs were outsourced overseas. To deal with the stress Tony drinks alcohol daily, sometimes in large quantities. He is not a smoker and takes no medications.

He called to say that he had spent 2 ½ days on his bathroom floor vomiting and that he got dizzy every time he tried to get up. He reported having had two drinks that day, which was not a lot for him, and he had eaten out. He assumed at first that he had food poisoning but became alarmed when the dizziness and nausea did not abate. By the fourth day he was improved enough to go to work, but the nausea persisted and he was dizzy when he changed position.  Still symptomatic, a few days later he saw his internist.

2. The Western Medical Diagnosis:

Tony's doctor, a renowned internist at NYU, examined him and diagnosed “viral” vertigo.

In Western Medicine vertigo is thought to be a disorder of the vestibular system of unknown cause, hence the "viral" assignation. Located in the bony labyrinth of the inner ear, the vestibular system contains the sensors that control balance. This is the same system that is affected when one gets sea sick. Tony's doctor prescribed Antivert, an antihistamine medication to treat the symptoms of nausea and dizziness. Since the doctor thought the ear canal might be a little red he also prescribed an antibiotic. Finally he said that the vertigo would resolve on its own. However, three days after his appointment Tony was still symptomatic, and possibly worse, so he stopped  taking the medications. Frankly concerned, he called me for advice.

3. The Chinese Medical Diagnosis:

Wearing my Western Medical hat I would have given Tony the same diagnosis and treatment, but since I am trained in Traditional Chinese Medicine (TCM), I had some other suggestions. Immediately I e-mailed him pictures of acupressure points he could press at home to start to correct the underlying energy imbalances that might be causing his symptoms. I suggested that he not drink alcohol, try to nourish himself with warm, cooked food and rest. I told him to come for a treatment at Turning Point as soon as he could.

Why did I make these recommendations? In TCM, as opposed to Western medicine where the cause of vertigo is unknown, there are several reasons why a person would have Tony's symptoms of dizziness and nausea. The acupressure points I suggested he press relate to each of the categories. (They can be seen here.)

The differential diagnosis in Chinese medicine, grossly simplified, is as follows:

 (Remember when we use the name of an organ in Chinese Medicine, i.e., liver, kidney, etc., we mean an organ system, not the body part we would reference in Western Medicine)

Internal liver wind

Many of the disturbances of the liver Qi (energy) are poetically referred to being like wind in the trees; that is, a symptom that comes on suddenly, that comes and goes, or that is moving. The dizziness Tony describes when he changes position is a classic example. Other examples would include some tremors, seizures and migraine headaches, especially the ones with visual aura as the liver rules the eyes. The liver is the organ system that deals with stress and is also responsible for detoxification of toxins. Tony, as we know, is in a very stressful work situation and uses alcohol daily. So I suggested that he not drink to rest the liver.

Phlegm and dampness

Phlegm is the product of incomplete digestion in TCM. Most of the job of processing falls to the spleen organ system. When the spleen is damp a condition known as Turbid Mucous Disturbing The Head can develop which is associated with severe dizziness and nausea. To make the digestive processing more efficient I recommended that Tony eat food that is easier to assimilate, i.e., closer to body temperature and slightly broken down already by cooking.

Kidney deficiency

A stressed individual is someone who has a lot of adrenaline output. This in many cases is augmented by high caffeine intake like my friend Tony who is known to consume large quantities of Diet Coke. In TCM the kidneys and the adrenals form the kidney organ system. Prolonged anxiety states and caffeine deplete the adrenals and lead to kidney deficiency. A weakened individual with kidney deficiency can be dizzy and needs rest.

Blood deficiency

A final consideration would be blood deficiency such as we see in undernourished people and women with menstrual disorders.

So what do I think of my friend's symptoms from the TCM perspective?

When he came to Turning Point for treatment we took his history, examined his pulse and tongue and his body for signs of disharmony. Our finding confirmed that the liver organ system was definitely affected, probably from stress and alcohol. His kidney energy was depleted, again from stress, and aggravated by caffeine abuse. His phlegm was not significant but we felt that he would get more value from his food if we tonified (strengthened) his digestive organs, i.e., the spleen and stomach. He was not blood deficient.

The treatment consisted of acupuncture to balance the Qi in the meridians and to harmonize and strengthen the internal organs. Calming points were added to address the stress. He was advised not to drink alcohol for now and to taper off the caffeinated soda. The dietary precautions of warmed cooked food should be continued along with rest and low key activities. A Chinese herbal formula was prescribed that addressed his fundamental liver disharmony and therefore his stress level.

4.  Outcome

Tony left the office calmer and with less dizziness. Two days later he reported that he was no longer dizzy and that he had enjoyed the deepest sleep he had in years.

5. Reflections

I often reflect on the value of my training in both Western and Eastern medicine. I am glad to have both perspectives. My Western training comes into play in a number of ways:  First, in recognizing and diagnosing the patient's condition according to Western criteria, i.e., assessing physical signs and interpreting lab work.  Secondly, my training helps when coordinating the Turning Point TCM treatment with a patient's Western treatment, as in the case of drug/herb interactions, or when preparing a patient for Western procedures like surgery, or even when complementing Western therapies such as chemotherapy or radiation.  Lastly, my expertise as a Western trained physician guides me when I deem that a recommendation to other specialists is indicated including to gynecologists, chiropractors, nutritionists, orthopedists, physical therapists, dermatologists or even internists, in the case of a person who needs a general work up with blood tests, etc. Under my guidance this melding of West and East is the guiding philosophy of the Turning Point staff and all the practitioners here are trained to view the patient's condition from both points of view.  This enables our practice to maintain a flexibility and adaptability to each individual's needs.

But when people ask me why as a Western trained physician I would practice Chinese medicine, the answer seems obvious: The subtle array of diagnoses and the easy availability of treatment make TCM attractive. Moreover, especially for the 21st century urbanite population we treat at Turning Point, I appreciate that much of the TCM treatment involves lifestyle adjustments that the individual can make to take charge of, and to promote, his or her own health. Thus in this case presentation we as practitioners were able to give Tony acupuncture and herbs, but he was able to look at his job, his caffeine and alcohol use, his recreational outlets for stress, and his diet to make informed decisions about how he wants to live. For me as a physician it is this aspect, empowering the individual towards health, which is the most compelling.