Professor Fan Yalan 's Clinical Experience In Treating Vertigo

This paper aims to delve into the knowledge, diagnosis and treatment of vertigo in the theories of traditional Chinese medicine and Western medicine, and sums up Professor Fan Yalan’s experience in clinic treatment of vertigo.Pertinent ancient and modern literatures are sorted out to review vertigo theoretically from the perspective of traditional Chinese medicine and Western medicine. In addition, I also make an analysis on the clinical cases of emergency department and comprehensive internal medicine department where I have sought instruction from the master for a year, to observe the clinical manifestation of vertigo, and summarize Professor Fan Yalan’s thought and feature in treatment of vertigo. This paper falls into two parts. The first part presents literature review, in which all the past dynasties of medical literatures on vertigo are searched and consulted, the cause, pathogenesis and differentiation of vertigo as well as the common medicines and recipes are sorted out, and emergency medicine’s diagnostic procedure for vertigo under the guidance of Western medicine as well as the knowledge and treatment of the common diseases are collated. The second part focuses on summing up Professor Fan Yalan’s experience in clinic treatment of vertigo in the emergency department and comprehensive internal medicine department, concluding clinical therapeutic principles and differentiation types, recipes and medicines, with an analysis and discussion on cases. The final part presents a conclusion, in which I, based on the first two parts, summarize the full paper according to my experience as an apprentice.In modern Western medicine, vertigo falls into systemic vertigo and non-systematic vertigo in accordance with whether the anatomic site of lesion is the vestibular system. Systemic vertigo manifests as rotatory vertigo, subdivided into vestibular central vertigo and vestibular peripheral vertigo; non-systematic vertigo manifests as dizziness, no sense of rotation, or mild astasia, falling under the category of dizziness. However, vertigo is defined in today’s Internal Medicine of Traditional Chinese Medicine as:"vertigo means the combined symptom of giddiness and dizziness or a feeling of rotation. Both symptoms often appear simultaneously, so they are called vertigo by a joint name. Mild patients will feel well when closing their eyes; critical patients will feel carsick and rotate unsteadily, unable to stand, or with the symptom of nausea, emesis, sweating and even faint. Traditional Chinese medicine focuses on researching the syndromes in which giddiness or dizziness dominates or giddiness and dizziness attack simultaneously. Its content covers the systematic vertigo and non-systematic vertigo in which giddiness serves as the primary symptom in Western medicine. Since modern times, many physicians have sorted out the previous experience and theories, concluding that wind, internal heat, phlegm, deficiency and stasis lead to vertigo, among which wind, internal heat, phlegm and stasis are the symptom of vertigo, and deficiency is the root cause of vertigo. Common clinical symptoms include intermingled deficiency and excess, so attention should be paid to the synthesis of the four diagnostic methods and treatment of both symptoms and root causes. In addition, the ancient TCM held that both exogenous pathogenic factor and internal injury could cause vertigo. Moreover, due to the huge social pressure, developed information and much consumed spirit in the 21st century, those psychopaths, who are panic-stricken and melancholy occasionally, often have the symptoms of vertigo and palpitation, so the vertigo caused by exogenous pathogenic factor and spiritual awareness will be expounded in the review.Professor Fan Yalan works in the emergency department and comprehensive internal medicine department, and her treatment means is featured by the combination of Chinese traditional and Western medicine. About the diagnosis and treatment of vertigo, my tutor has divided vertigo into stage of acute attack and period of remission through patients’ induced pathogenesis, past medical history, associated symptoms, point-of-care test (Dix-Hallpike positional test, spontaneous nystagmus, vestibular-ocular reflex examination and eye movement) according to whether "visual rotation" could simply distinguish systematic vertigo from non-systematic vertigo. In the stage of acute attack, the procedure of emergency treatment under the guidance of Western medicine is of important significance, because there are obvious neurological signs and severe hearing losses, and older patients or the ones with vascular disease need auxiliary examinations (electrocardiogram, magnetic resonance imaging) and computed tomography). The infected need biochemical tests (blood routine test and routine urine test, etc.) if they have a fever, so that diagnosis should be correct and patients should have no worries about death. About treatment, for emergency cases, symptoms need to be first cured, because the primary task is to save their life and relieve the symptoms. For emergency cases, Chinese and Western medicines are often combined, to relieve the acute and serious disease. Such traditional Chinese medicines as gastrodin, tanshinone and Shuxuening, as well as some Chinese patent medicines, are mainly adopted. Looking, listening, questioning and feeling the pulse, four ways of TCM diagnosis, is primarily used in the period of remission. My tutor often cures vertigo by "nourishing the central parts to have them rise and fall again, and unblocking the liver and gall to eliminate stagnation"; this is her characteristic. When the disease is diagnosed and treated, she calms the liver, subsides yang, clears heat, reduces phlegm and disperses blood stasis to cure the symptoms in accordance with the urgency of the symptoms and root causes. Besides, she often soothes the nerves and regulates yin and yang when curing the patients with vertigo who also have a mental disease. Clinic differentiation mainly falls into seven types:(1) stagnation of liver qi and spleen deficiency; (2) syndrome of phlegm-dampness blocking collaterals; (3) hyperactivity of liver-yang; (4) deficiency of liver and kidney; (5) deficiency of qi and blood; (6) qi-stagnation and blood stasis; (7) yin-yang disharmony. The syndrome types are often mixed with each other, accompanied by a syndrome of intermingled deficiency and excess, so they need to be discriminated clearly. My tutor regulates the internal organs and enhances the physique with traditional Chinese medicine. Instead of rigidly adhering to a certain syndrome type in clinical practice, she often increases or decreases drug dosage according to the basic prescription, to achieve a better curative effect. Generally speaking, she does nothing but "let wind and heat extinguish each other, dryness and dampness mediate each other, water and heat benefit each other", to achieve a global balance, so that vertigo should naturally take a turn for the better.