Meniere's disease

Keywords: Chinese medicine, acupuncture, Meniere's disease, dizziness, vertigo

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Meniere's disease is a disorder characterized by recurrent prostrating vertigo, loss or diminution of auditory acuity, tinnitus, and a feeling of fullness in the ear. Its Western etiology is unknown and its pathophysiology is only poorly understood. Typically, paroxysmal attacks of vertigo occur suddenly. These attacks may last anywhere from a few to 24 hours, are commonly accompanied by nausea and vomiting, and subside gradually. Usually, only one ear is affected, and there may be a feeling of fullness or pressure in that ear. Hearing progressively deteriorates in the affected ear over the years. Tinnitus may be either intermittent or constant and may be worse before, during, or after an attack of dizziness.

The Western medical treatment of Meniere's disease is empirical. Symptomatic relief of dizziness and vertigo may be obtained by anticholinergic drugs, such as scopolamine and atropine in over the counter preparations. Antihistamines and barbituates are also used to provide general sedation. Valium (diazepam) is particularly effective in relieving the distress of severe vertigo, however it may be habit-forming. There are several different surgical procedures for patients who are disabled by frequent attacks of vertigo, but, since these may result in permanent hearing loss, procedures such as a labyrinthectomy are usually reserved for those who have already lost most or all of their hearing. Therefore, any effective alternative treatments would be welcome to many sufferers of this condition.

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In issue #9, 2002 of Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), Zhang Zhi-hua published an article titled, "The Treatment of 18 Cases of Meniere's Disease Mainly with the Points Bai Hui (GV 20) Joined to Hou Ding (GV 19)." This article appeared on page 48 of that issue. Since Meniere's disease is often a difficult condition to treat, a precis of that article appears below.

Cohort description

Among the 18 patients in this study, seven were male and 11 were female, 25-64 years of age. These patients had suffered from Meniere's disease from two days to six years.

Treatment method

The main points used in this protocol were Bai Hui (GV 20), Hou Ding (GV 19), and Ting Gong (SI 19). The first two of these were needled through from one to the other. Then, depending on each patient's pattern discrimination, certain auxiliary points were added. For ascendant liver yang hyperactivity, Tai Chong (Liv 3) and Xia Xi (GB 43) were added with draining technique. For phlegm turbidity harassing above, Nei Guan (Per 6) and Feng Long (St 40) were added with draining technique, and, for liver-kidney yin vacuity, Tai Xi (Ki 3) was added with supplementing technique. The points on the scalp were needled transversely from Bai Hui to Hou Ding with a 28 gauge needle to a depth of approximately two inches. Then large amplitude twisting was used to stimulate the point. Ting Gong was needled perpendicularly to a depth of 1.2-1.5 inches in order to propagate the needle sensation to the inner ear. Needles were left in place for 30 minutes each treatment and stimulated manually once every five minutes. Treatment was given once per day, and 10 treatments equaled one course of therapy. A two day rest was allowed between successive courses.

Treatment outcomes

Cure was defined as complete disappearance of clinical symptoms with no recurrence within two years. Marked effect was defined as disappearance of clinical symptoms but slight recurrence within one year. No effect was defined as no obvious or marked improvement in clinical symptoms. Based on these criteria, 13 cases were considered cured, another four experienced a marked effect, and only one patient got no effect. Therefore, the total effectiveness rate using this protocol on this group of patients was 94.4%.

Representative case history

The patient was a 35 year old female who was first seen in March 1991. The patient's major complaint was recurrent bouts of dizziness and vertigo for the previous two years. The woman said that she had had an attack in the last two days. This had been precipitated by family stress. In addition to vertigo, the patient complained of nausea and vomiting. Movement made her vertigo worse. There was also tinnitus, and she was easily agitated and easily angered. Based on these signs and symptoms, the patient was diagnosed as suffering from Meniere's disease, while her Chinese medical pattern was discriminated as liver yang mixed with phlegm turbidity harassing above. Therefore, Dr. Zhang needled Bai Hui through to Hou Ding and also needled Ting Gong, Tai Chong, Xia Xi, Nei Guan, and Feng Long. After one such treatment, the patient's symptoms were greatly reduced. After one course of treatment, all her symptoms had disappeared. Another course of therapy was given in order to secure the treatment effects. However, these treatments were given only every other day. On follow-up after two years, there had been no recurrence.

Discussion

According to Dr. Zhang, Meniere's disease falls under the traditional Chinese medical disease category of xuan yun or vertigo and dizziness. It is mostly due to either liver-kidney yin vacuity with ascendant liver yang hyperactivity or spleen-stomach loss of fortification with phlegm turbidity obstructing the center and confounding and misting the clear yang. Bai Hui (GV 20) is located on the midline at the vertex of the head. It is one of the five meetings of the three yang channels of the hands and feet. It is located on the governing vessel, and the governing vessel flows freely or connects with the sea of marrow, i.e., the brain. Ithis point also connects with a network vessel of the liver channel. Therefore, needling it is able to subdue and settle floating yang as well as revitalize the clear yang. Hence it is an effective point for the treatment of vertigo and dizziness. Hou Ding (GV 19) is also a point located on the governing vessel which treats vertigo and dizziness. The technique of joining these two points with a single needle frees the flow and abducts the governing vessel qi and blood. It also quiets the spirit and stabilizes the mind. From a Western medical point of view, it promotes the circulation of blood in the region of the brain and regulates the vegetative nervous system. Ting Gong (SI 19) frees the flow of the orifices and improves the hearing of the ears. Tai Chong (Liv 3) is the source point of the liver, while Xia Xi is the construction point of the gallbladder. Needling these two point can, therefore, level the liver and subdue yang. Nei Guan (Per 6) and Feng Long (St 40) are the network points respectively of the pericardium and stomach. Needling them is able to transform phlegm, harmonize the stomach, and stop vomiting. Tai Xi is the source point of the kidney which enriches water so that it may moisten or sprinkle wood. This point also fosters or helps fill yin essence. Thus this protocol uses a combination of local points with chosen points on the body based on the patient's pattern discrimination. Such a combination treats both the root and tip or branches of Meniere's disease and so it gets quite good therapeutic effects.

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abstracted & translated by Honora Lee Wolfe, Dipl. Ac., Lic. Ac., FNAAOM

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