Years of the room spinning: pattern differentiation and holding the formula in Meniere's disease

History and prior work-up

Recurrent episodic vertigo for 3 years, each attack lasting 20 minutes to several hours, with tinnitus, ear fullness, and fluctuating hearing; nausea and vomiting during attacks, with tinnitus and mild unsteadiness persisting between attacks.

At ENT, pure-tone audiometry, vestibular function testing, and inner-ear MRI were performed; BPPV and central vertigo were excluded and Meniere's disease diagnosed. Betahistine and diuretics had been tried with inconsistent effect; no intratympanic injection or surgical evaluation.

Examination and pattern differentiation

The main pattern is phlegm-dampness obstructing the middle, with ascendant liver yang — the nausea and vomiting of attacks lean toward phlegm-dampness, the head heaviness and bitter taste toward liver yang. Classical internal medicine divides vertigo into five patterns — ascendant liver yang, phlegm-dampness obstructing the middle, blood stasis obstructing the orifices, qi-blood insufficiency, and kidney essence deficiency — and in this case phlegm-dampness obstructing the middle is the guiding pattern.

• Rotational vertigo, provoked by changes of position and fatigue; head heaviness and tinnitus.
• Tongue pale with a white greasy coat; pulse wiry and slippery; chest and epigastric oppression, average appetite, stool tending to looseness; poor sleep.

Treatment pathway

• External treatment first: Baihui GV20, Fengchi GB20, Wangu (mastoid process), Tinggong, Yifeng TE17, Neiguan PC6, Zusanli ST36, Fenglong ST40, Taixi KI3, Taichong LR3; for severe vertigo add Yintang and Taiyang. Mostly oblique needling with gentle technique; in remission, moxibustion at Baihui and Zusanli. Twice weekly.
• Herbal decoction as support: for phlegm-dampness obstructing the middle, Banxia Baizhu Tianma Decoction; for ascendant liver yang, Tianma Gouteng Decoction; for qi-blood insufficiency, the intent of Guipi Decoction or Buzhong Yiqi Decoction; for kidney essence deficiency, Zuogui Pill. Dosage is set at the in-person consultation.
• Classical references: Li Dongyuan's Pi Wei Lun and Banxia Baizhu Tianma Decoction; Zhu Danxi's saying that 'without phlegm there is no vertigo'. The modern physician Lu Zhizheng treated dampness through the spleen and stomach with light, dispersing methods.
• Concurrent management: low-salt diet (per the ENT plan); keep an attack diary (timing, duration, triggers, accompanying symptoms) for pattern differentiation and judging response.

Re-evaluation

Follow-up and advice

Hearing in Meniere's disease requires periodic audiometric review; Chinese medicine aims to reduce attack frequency and accompanying symptoms — we do not promise hearing recovery. During attacks safety comes first (fall prevention), with acute symptoms managed by ENT when necessary.