Treatment of Meniere's disease

Author

Patient

Symptoms

This particular patient was referred by another acupuncturist who didn't use herbs and had not obtained any results using acupuncture alone. Technically she did not have Meniere's syndrome but certainly wind phlegm was active.

She presented to me with the biomedical diagnosis of stibulitis (inner ear infection ) .There was a history of dizziness with her mother .She suddenly gets severe dizziness and inside her head feels like it is "sloshing around" .She must keep her head perfectly still and must lie down and says it feels that there is not enough blood going to the head .Gynecological history reveals that she had a hysterectomy 4 and half years ago (but still has her ovaries) and believes her dizziness started after that. Before she went on HRT she had flushes, mild sweats, felt irritable alternating with emotional weeping. When she went on HRT the dizziness stopped and at one stage voluntarily went off HRT and took Dang Gui tablets and was still fine but the effect of the herbal supplement wore off .The first severe dizziness attack occurred 2 years ago with disorientation ,vomiting and she couldn't stand up .She described the dizziness as like being on a ship.

Stematol was prescribed to her which made her excessively hungry .The day before she gets an attack she is forgetful and has "strange ears". Some of her friends say that she has a hearing weakness and she feels like she has a tight band around her head .Recently she has had a weak low back, weak vision, tinnitus ad her hair has become lifeless .She gets dizzy spells sometimes but has the tight band feeling constantly.

The TONGUE was pale with severe spleen deficiency cracks at the edge ,with a thin crack down the centre extending to the lung area .The rear had a stripped patchy section (probably) due to a recent course of antibiotics.

The signs and symptoms indicate a bit of a mixed bag of pathologies, but certainly kidney Xu is apparent. The necessity for the hysterectomy and resulted damage to kidney and chong vessels coupled with hearing weakness, weak vision and low back ache exemplify this. The kidney weakness would cause the Yang to rise. The spleen was also clearly xu and probably caused the heavy bleeding of her menstrual cycle (due to spleen not governing blood) that led to the hysterectomy in the first place. And as Kevin has stated "but the spleen is always the primary factor responsible for the formation of phlegm".

However, having treated this patient before having read Kevin Lu's article, my prescriptions didn't use any diuretic herbs to drain fluids. Perhaps this is why results with my case were slower and Kevin was able to stop vertigo after 1 to 2 weeks in the case histories he presented. (Or perhaps it is due to the fact that he has had 25 years more experience than me!).

1st treatment:

PULSE reflected a full liver (due to Yang rising).

• Han lian cao 6g (Ecliptae Prostratae, Herba)
• Nu zhen zi 6g (Ligustri Lucidi, Fructus)
• Dang gui 9g ( Angelica Polymorpha, Radix
• Bai shao 9g (Paeoniae Lactiflora, Radix
• Gan cao 6g (Glycyrrhizae Uralensis, Radix)
• Mai ya 9g (Horder Vulgaris Germinantus, Fructus)
• Bai zhu 6g (Actractylodis Macrocephalae, Rhizoma)
• Dang shen 9g (Codonopsis Pilosulae, Radix)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Yuan zhi 3g ((Polygalae Tenuifoliae, Radix)
• Shi chuan pu 3g (Acori Graminei, Rhizoma)
• He huan pi 6g (Albizziae Julibrissin, Cortex)

3 packets

Though her pulse had a liver yang rising feel about it I prescribed herbs more on her spleen deficient tongue and hence a resulting blood deficiency .The first 4 herbs will treat blood deficiency and Han Lian Cao and Nu Zhen Zi will benefit yin and thus treat the root of the yang rising. Then we have Si Jun Zi Tang plus Mai Ya to further tonify spleen .Yuan Zhi and Shi Chuan Pu treat phlegm and dampness and can treat some of her mental symptoms such as forgetfulness and her stress associated with having the dizziness. He Huan Pi was added to further relax her.

2nd Treatment: 1 week later

Her dizziness had improved and was now just light headed. She was worse for moving her head up and down and worse to lie flat on the bed and she still had the tight band feeling around her head. This time I noticed a slight deviation of the tongue to the right and she commented that she had more varicose veins on her right leg. Her pulse was still a tense Yang rising type but her tongue had a bit of phlegm heat in the central stomach area. The nature of her dizziness indicated phlegm dampness because it was described as like being on a ship .She also wanted some acupuncture and I used:

• Sp 6 San Yin Jiao
• St 40 Feng Long
• Pc 6 Nei Guan

The points are self explanatory treating yin and phlegm and stuck liver Qi .

• Zhu ru 9g (Bambusae In Taeniis, Caulis)
• Zhi shi 6g (Citri seu Ponciri Immaturis, Fructus)
• Ban xia 6g (Pinelliae Ternata, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Gan cao 6g (Glycyrrhizae Uralensis, Radix)
• Sheng jiang 2 slices (Zingiberis Officinalis Recens, Rhizoma)
• Shi chuan pu 3g (Acori Graminei, Rhizoma)
• Han lian cao 6g (Ecliptae Prostratae, Herba)
• Nu zhen zi 6g (Ligustri Lucidi, Fructus)
• Bai shao 9g (Paeoniae Lactiflora, Radix)
• Dang gui 6g (Angelica Polymorpha, Radix)
• Bai Zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Gou teng 3g (Uncariae Cum Uncis, Ramulus)

3 packets

Here we have basically er chen tang and si jun zi tang with blood tonics and yin tonics. I added zhu ru because I wanted to clear some heat from the stomach as the tongue showed some yellow coat in the centre. This time I used zhi shi to help her stress and the stasis that this will cause.

3rd Treatment: 4 days later

The colour in her tongue had changed and was no longer as pale and now the pulse was more thready. There was now no more tight band feeling around her head and only she felt a bit dizzy when lying down and turning her head.

• St 36 Zhu San Li
• St 40 Feng Long
• Ki 3 Tai Xi
• Si 6 Yang Lao was added to help strengthen her vision

• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Gan cao 6g (Glycyrrhizae Uralensis, Radix)
• Dang shen 9g (Codonopsis Pilosulae, Radix)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Shi chuan pu 6g (Acori Graminei, Rhizoma)
• Zhu ru 6g (Bambusae In Taeniis, Caulis)Ban xia 3g (Pinelliae Ternata, Rhizoma)
• Sheng jiang 2 slices (Zingiberis Officinalis Recens, Rhizoma)
• Bai Shao 9g (Paeoniae Lactiflora, Radix)
• Dang gui 6g (Angelica Polymorpha, Radix)
• Chuan xiong 3g (Ligustici Wallichii, Radix)
• Shan yao 9g (Dioscoreae Oppositae, Radix)
• Shan yu rou 6g (Corni Officimalis, Fructus)

Now I focused the treatment on building up kidney energy by adding shan yao and shan yu rou .In particular the latter to help the dizziness .Also I added tian ma because previously I didn't have it in stock but kept the dose low because of its expense .

4th Treatment: 4 days later

She sometimes had a mild dizzy attack and had mild nausea one day .Overall she felt better for exercise and felt better at the end of the day. Also the tinnitus had lessened. The pulse reflected a thinness and softness in the liver and I was still noticing that the tongue was deviating to the left .She also commented that she felt worse , that is more nauseous if exposed to any petrol fumes .Thus confirming dampness as well .
She only had herbs today and the prescription was

• Bai dou kou 9g (Amomi Cardamomi, Fructus)
• Sha ren 6g (Amomi, Fructus et Semen)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Gan cao 6g (Glycyrrhizae Uralensis, Radix)
• Da zao 1 piece (Zizyphi Jujubae, Fructus)
• Dai zhe shi 9g (Haematitum)
• Zhu ru 9g (Bambusae In Taeniis, Caulis)
• Ban xia 6g (Pinelliae Ternata, Rhizoma)
• Dang gui 9g (Angelica Polymorpha, Radix)
• Bai shao 9g (Paeoniae Lactiflora, Radix)
• Chuan xiong 3g (Ligustici Wallichii, Radix)

3 packets

5th Treatment: 7 days later

The last 2 days she had mild dizziness but only if she looked up and if she lied down and turned her head .She had half a glass wine and the next day there was a headache for the whole day .Even though there was only a mild head band feeling around her head. She felt that there was no progress .Further more her vision had weakened and believed it was just old age.

I needled st 40 feng long and she felt a reaction in sj 7 so I needled that as well .I also did sp 6 san yin jiao and yin tang .The last herbs were very disagreeable to her so I changed the strategy away from the dampness concept and used si jun zi tang ( four gentleman ) as the basis.

• Dang shen 12 g (Codonopsis Pikosulae, Radix)
• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Zhi gan cao 6g (Glycyrrhizae Uralensis, Radix)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Mu xiang 3g (Saussureae seu Vladimiriae, Radix)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Ban xia 6g (Pinelliae Ternata, Rhizoma)
• Gou qi zi 9g (Lycii Chinensis, Fructus)
• Dang gui 9g (Gastrodiae Elatae, Rhizoma)
• Bai shao 9g (Paeoniae Lactiflora, Radix)
• Shen qu 6g (Massa Fermentata)
• Mai ya 9g (Horder Vulgaris Germinantus, Fructus)
• Dai zhe shi 12g (Haematitum)
• Han lian cao 9g (Ecliptae Prostratae, Herba)
• Nu zhen zi 9g (Ligustri Lucidi, Fructus)
• Shan you rou 9g (Corni Officinalis, Fructus)

3 packets

Here the formula tonifies the spleen, resolves phlegm and damp, helps food stasis, tonifies blood, tonifies liver and kidney yin and calms ascendant liver yang.

6th Treatment: 3 days later

She had come back for treatment sooner because she had such a good reaction to yin tang which made her feel "almost normal". I applied acupuncture points :

• Yin tang
• Sp 6 san yin jiao
• St 40 feng long
• Sj 7 hui zong

7th treatment: 4 days later

Now there has been a major improvement and there is no more pressure in the front of the head and can move her head more freely and had more energy .There was also improvement in her vision .
T: no patchy coat, no furry coat in the center (St.)
P: spleen deficient and slippery

• Yin tang
• St 40 fenglong
• R sp 4 gong sung
• L pc 6 neiguan
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Ban xia 6g (Pinelliae Ternata, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Zhi gan cao 3g (Glycyrrhizae Uralensis, Radix)
• Gou qi zi 9g (Lycii Chinensis, Fructus)
• Dang gui 12g (Gastrodiae Elatae, Rhizoma)
• Bai shao 9g (Paeoniae Lactiflora, Radix)
• Ye jiao teng 9g (Polygoni Multiflori, Caulis)
• Shen qu 9g (Massa Fermentata)
• Han lian cao 9g (Ecliptae Prostratae, Herba)
• Nu zhen zi 9g (Ligustri Lucidi, Fructus)
• Dang shen 9g (Codonopsis Pikosulae, Radix)
• Sha shen 9g (Glehniae Littoralis, Radix)
• Shan yu rou 4g (Corni Officinalis, Fructus)
• Shi chang pu 6g (Acori Graminei, Rhizoma)
• Dai zhi shi 9g (Haematitum)
• Tu si zi 12 g (Cuscutae, Semen)

3 packets

8th Treatment:

She had been to see her neurologist who had confirmed that there was no Menier's disease , no tumor and a stroke had not taken place. He also told her that nothing else could be done. Today she was mildly dizzy and had hurt her back playing golf .There was less tinnitus but was still adamant that exercise helped her condition because of increased blood flow. It was the first day of Autumn and she was starting to get sinus trouble.

T: showing improvement because of less spleen cracks at the edge .
P: slippery and liver (blood ) weak

• Yintang
• L st 36 Zusanli
• R st 40 Fenglong
• Sp 6 Sanyinjiao
• L co 11 Quchi
• Bl 25 Dachangshu and moxa
• Gv 3 Yaoyangguan and moxa
• Ban xia 9g (Pinelliae Ternata, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Zhi gan cao 3g (Glycyrrhizae Uralensis, Radix)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Dang gui 9g (Gastrodiae Elatae, Rhizoma)
• Han lian cao 9g (Ecliptae Prostratae, Herba)
• Nu zhen zi 9g (Ligustri Lucidi, Fructus)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Shen qu 3g (Massa Fermentata)
• Hong hua 3g (Carthami Tinctorii, Flos)
• Shi chang pu 3g (Acori Graminei, Rhizoma)
• Mu xiang 3g (Saussureae seu Cocculi, Radix)
• Cang er zi 9g (Xanthii, Fructus)
• Bai zhi 3g (Angelicae, Radix)

3 packages

There was no special reason why points were chosen on left and right except that they felt more empty and hence I needled them .

9th Treatment: 1 week later

She had been feeling really good all week and then had a severe attack after doing some gardening.
It was a hot day and was feeling a bit dizzy as she was bending over and getting up. But there was no vomiting and still no headband feeling. Her eyes were looking droopy.

P: kidney yin thready ,lung full and spleen damp.
T: not much change

• St 40 feng long
• Ki 3 tai xi
• Th5 wei guan
• Yintang

• Jie geng 3g (Platycodi Grandiflori, Radix)
• Ban xia 3g (Pinelliae Ternata, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Dang shen 9g (Codonopsis Pilosulae, Radix)
• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Zhi gan cao 6g (Glycyrrhizae Uralensis, Radix)
• Zhu ru 9g (Bambusae in Taeniis, Caulis)
• Pi pa ye 9g (Eriobotryae Japonicae, Folium)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Dang gui 9g (Gastrodiae Elatae, Rhizoma)
• Bai shao 12g (Paeoniae Lactiflora, Radix)
• Chuan xiong 6g (Ligustici Wallichii, Radix)
• Shen qu 9g (Massa Fermentata)
• Dai zhe shi 12g (Haematitum)
• Mai ya 9g (Hordei Vulgaris Germinantus, Fructus)

3 packets

The treatment stayed the same by continuing to tonify the blood and spleen ,resolve damp with pi pa ye and dai zhe shi to treat nausea and dizziness .

10th Treatment: 1 week later

After the last acupuncture treatment she felt much relief, I presume from yintang .She had played golf on the weekend and did much bending of her neck without problems. Though the next day it was hot and felt that this aggravated her.

P: spleen wiry ,lung damp and kidney yin weak .
T: the spleen deficiency cracks were still showing an improvement

• St 40 fenglong
• Pc6 neiguan
• Gv 20 bai wei

• Jie geng 3g (Platycodi Grandiflori, Radix)
• Pi pa ye 6g (Eriobotryae Japonicae, Folium)
• Ban xia 6g (Pinelliae Ternata, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Zhi gan cao 3g (Glycyrrhizae Uralensis, Radix)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Dang gui 9g (Gastrodiae Elatae, Rhizoma)
• Dang shen 9g (Codonopsis Pilosulae, Radix)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Shi chang pu 3g (Acori Graminei, Rhizoma)
• Chuan xiong 3g (Ligustici Wallichii, Radix)
• Hong hua 3g (Carthami Tinctorii, Flos)
• Han lian cao 9g (Ecliptae Prostratae, Herba)
• Shan yu rou 9g (Corni Officinalis, Fructus)
• Nu zhen zi 9g (Ligustri Lucidi, Fructus)
• Sheng jiang 3 slices (Zingiberis Officinalis Recens, Rhizoma)
• Da zao 2 dates (Zizyphi Jujubae, Fructus)

3 packets

11th Treatment: 1 week later

At this stage she is the best she has felt for a long time. There has been no nausea and can even look up and down without dizziness .Previously she always had dizziness when she lied down and even this was better and even her tinnitus had disappeared .

• Pc 6 neiguan
• St 40 fenglong
• Yintang

• Ban xia 9g (Pinelliae Ternata, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Zhi gan cao 3g (Glycyrrhizae Uralensis, Radix)
• Fu ling 9g (Poriae Cocos, Sclerotium)
• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)
• Dang gui 9g (Gastrodiae Elatae, Rhizoma)
• Tai zi shen 9g (Paeudostellariae Heterophyllae, Radix)
• Chuan xiong 3g (Ligustici Wallichii, Radix)
• Shi chang pu 3g (Acori Graminei, Rhizoma)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Shan yu rou 9g (Corni Officinalis, Fructus)
• Han lian cao 9g (Ecliptae Prostratae, Herba)
• Nu zhen zi 9g (Ligustri Lucidi, Fructus)
• Sheng jiang 3g (Zingiberis Officinalis Recens, Rhizoma)
• Hong zao 3 dates (Zizyphi Jujubae, Fructus)

6 packages

Here the formula addresses the spleen, blood, liver and kidney deficiency as well as resolving phlegm. I am hoping that herbs to address the dizziness such as tian ma and dai zhe shi can be omitted and the treatment can be more focused on treating the root ,ie the over all deficiency.

12th Treatment: 1 week later

She is feeling very well and only had a slight wave of dizziness a few times. I repeated 3 packets of the same prescription.

13th Treatment: 3 weeks later

She now reports that she hasn't felt so good for a long time and only noticed a bit of tinnitus once. The energy is good and can play golf really well. Even her finger nail has changed where she used to have cracks in the thumb nail corresponding to dizziness is now clear! (Refer to Chinese medical palmistry by Xiao-Fan Zong and Gary Liscum). There was now another problem that she wanted to fix which had been bothering her for some months as well. Her nose is always blocked first thing in the morning and she must sneeze 2 times, the tip of the nose tickles and it runs a bit. I only gave herbs and I administered 9 packets to be taken 3 packets per week for 3 weeks.

• Han lian cao 9g (Ecliptae Prostratae, Herba)
• Nu zhen zi 9g (Ligustri Lucidi, Fructus)
• Ban xia 6g (Pinelliae Ternata, Rhizoma)
• Chen pi 3g (Citri Reticulatae, Pericarpium)
• Fu ling 12g (Poriae Cocos, Sclerotium)
• Gan cao 6g (Glycyrrhizae Uralensis, Radix)
• Shan yu rou 9g (Corni Officinalis, Fructus)
• Shan yao 9g (Dioscoreae Oppositae, Radix)
• Cang er zi 9g (Xanthii, Fructus)
• Xin yi hua 9g (Magnoliae Liliflorae, Flos)
• Shi chang pu 3g (Acori Graminei, Rhizoma)
• Tian ma 3g (Gastrodiae Elatae, Rhizoma)
• Dang gui 9g (Gastrodiae Elatae, Rhizoma)
• Bai zhu 9g (Actractylodis Macrocephalae, Rhizoma)

This finishing off prescription is er zhi wan (two ultimate pill) plus er chen tang (two cured decoction). Plus cang er zi san and plus tian ma & shi chuan pu, shan yu rou & shan yao. At this point I referred her back to the original acupuncturist to continue treatment as I was leaving town.

It would be interesting for the readers to know what Kevin Lu (or anyone for that matter) would of prescribed and if a different combination of herbs may have given a speedier recovery.