42 :Hepatophilic virus disease – TCM classification as “Wetness-heat vaporization form” Common symptoms (9):Hepatogenic vertigo (II) – (auriculogenic vertigo, imbalance of auricular fluid, Meniere’s syndrome)

   Internal auricular vertigo attacks are often paroxysmal in character and each time it is associated with nausea, vomiting, tinnitus and gradual weakening of hearing ability.  The severity, duration and interval between attacks are not the same in each time.  The onset of disease usually occurs in middle age and the disease is slightly more in male.  The vertigo usually occurs suddenly.  During attack, the patient is conscious and feels himself or things around him spinning and if severe, there may be pallor of face, nausea, vomiting sweating and sense of defecation.  The patient, afraid of aggravating the vertigo, dares not to turn his head but is willing to sleep in bed with his eyes shut.  If the eyes are examined at this time, one may find tremor of the eyeballs.

The duration of attack is variable and generally it subsides by itself.  Internal auricular vertigo attacks complicating chronic hepatitis are usually caused by hepatic edema and internal retention of wetness-heat; these may lead to dysfunction of the autonomic nervous system and further, result in edema of the internal auricular labyrinth.  In statistical analysis of cases, it is not difficult to find that most of the patients have signs of abdominal distention, tympanites, decrease in the area of liver dullness. (It is, in fact, the enlargement of liver, because the tympanites covers the hepatic surface and causes retraction of the margin of liver dulness; the actual enlarged liver area is demonstrated after taking TCM drugs to drive out the wind) rapid pulse and edema of lower extremities (pitting edema over the pretibial region).

           It is not difficult to prevent the occurrence of symptoms of hepatogenic internal auricular vertigo.  The methods of preventing relapse of internal auricular vertigo include the following:

1.         Effective systemic TCM therapy, promoting clinical cure of “chronic hepatitis” and abolishing hepatic edema.

2.         Correct the anemia, low albumin level, hypotension, hypoglycemia constitution due to chronic hepatitis.  Adequate and balanced nutrition and plenty of sleep are the only way to improve the body constitution.  One should not disregard this point.

3.         Adapt to the habit of taking water “in separate intervals” and “in small amounts”: do not drink too much water in a short time because of thirst.  A small number of individuals think that large amount of water intake can promote the discharge of waste products in the body and attain the object of keeping fit.  This is a very erroneous conception.

4.         One should be cautious of taking too much “cold” soup, fruits, drugs and food.  If the cause of inducing vertigo is found in time, the chance of another relapse can often be avoided.

Introduction of cases

     Case 3

 

Leung (code number 119) female, age 33 years.  Her first visit was on September 1997.  She complained that she had a weak body constitution and suffered from repeated nasal obstruction and discharge, sore throat and sensation of foreign body in the throat.  She had a history of dysmenorrheal.  Ten years ago, she received tonsil and nasal sinusitis operations.  In the recent years, she had repeated stomache ache, gastroenteritis and in September last year, she experienced severe vertigo for more than one month because of imbalance of auricular fluid.

Physical examination: thin build up, face pale looking, slight edema of lower extremities, blood pressure 50/60 mmHg, abdomen distended, hypochondriac anomaly, hepatomegaly of 3 cm.  She was suspected to have early pregnancy since her menses had been absent for 37 days.  The diagnosis was therefore affirmed as chronic hepatitis complicated with imbalance of auricular fluid, early pregnancy and anemia.

The basic formula for hepatitis together with 3 parcels of TCM drugs for fetal stabilization were given.  Pregnancy was confirmed by laboratory examination after TCM administration.  Thereafter, TCM drugs for fetal stabilization and chronic hepatitis were not given to the patient and during early pregnancy period repeated vaginal bleeding occurred, and she had to be hospitalized for treatment of threatened abortion.

Her second visit was on September 1998 when she complained of paroxysmal vertigo after delivery of a male infant by cesarean section four months ago.  She also had insomnia, headache, abundant loss of hair, repeated nasal discharge, sore throat and soreness of back and shoulders.  She was in doubt that the liver disease was not cured and so asked for TCM treatment.  Physical examination: lean appearance, abdominal wall relaxed, abdomen soft but distended, a persistent hepatomegaly of 3 cm, percussion tenderness over hepatic region and blood pressure of 82/60 mmHg.

After taking 7 parcels of TCM drugs, sleeping improved but she still felt tired and slight degree of vertigo; the liver returned to normal.  With the continuation of TCM treatment, the patient felt better, the vertigo subsided, the sensation of illusion disappeared; sleeping was good and the bowel movements were normal.  Systemic TCM therapy lasted for 6 weeks and medication was stopped at the attainment of clinical cure.  The follow-up continued for almost 3 years.  Hepatomegaly relapsed for 5 times but was cured by TCM drugs each time. Vertigo did not happen anymore.

 

Case 4

        Lee (code number 1289) male, age 37 years.  About one month ago, he suffered from peptic ulcer complicated with hemorrhage.  Afterwards, he had imbalance of auricular fluid with repeated tinnitus and vertigo.  He felt weak and also had palpitation, yellowish urine, gastric distention, loose stools of brownish color, 1-2 times a day.  Physical examination: tongue enlarged with teeth prints, abdomen soft and distended, lower margin of liver 3 cm above costal margin, showing decrease of hepatic area, lower extremities (+) pitting edema.  The impression was virus hepatitis (wetness-heat vaporization, deficiency of blood and energy) complicated with imbalance of auricular fluid.

After taking 6 parcels of TCM drugs, the liver became normal and after 9 parcels, tinnitus decreased and vertigo disappeared.  His facial appearance and the color of his lips improved.  Systemic TCM drugs were given for 4 weeks at the end of which clinical cure was attained.  TCM therapy was then stopped for observation.

Case 5

 

Leung (code number 660) female, age 46 years.  Two years ago, she had blood examinations and found to have position type A and type B hepatitis antibodies.  Her menopause occurred at the age of 43.  Her first visit was on May, 1999, complaining of paroxysmal vertigo with sensation of spinning of the heaven and earth and also nausea and vomiting for about one month.  In the past, she also had occasional episodes of vertigo and dizziness but of a milder degree.  She had no history of hypertension.  The impression was chronic hepatitis complicated with auriculogenic vertigo.  Physical examination abdomen distended with tympanites, percussion tenderness over hepatic region and significant shrinkage of liver on percussion, the lower margin of liver being 4.5 cm above costal margin, (+) pitting edema of lower extremities.

After taking 6 parcels of TCM drugs, she felt abdominal pain and increase of flatus.  Tympanites decreased significantly and percussion showed a hepatomegaly of 1.5 cm.  Pitting edema was still (+) in the lower extremities.  Another 3 parcels of TCM drugs were taken and the liver returned to normal.  During the course of TCM treatment, no attack of vertigo was seen.  The patient stopped the TCM drugs by herself after 3 weeks of medication.

 

By WONG  Kwok Hung

published on  17th July 2001

(translated by Professor ZHENG Hua En in March 2003)