Journal of Acuherb in Medicine


Ménière’s Disease

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By Dr. Ken. Y. Wang

 
Picture of ear anatomy
Eardrum, malleus, incus and stapes are hearing organs.
Semicircular canal (labyrinth), vestibular nerve and cochlea are balancing organs.
(Stedmans’s Medical Dictionary 27th edition copyright 1999)


Ménière’s disease
 is a disease of the inner ear. Build-up of fluid in the inner ear creates excess pressure and causes damage to the sense organs that are responsible for balance and hearing. A patient with Ménière’s disease typically presents with varying levels of hearing loss, a sense of fullness in the ears, tinnitus and episodes of vertigo.

The disorder is also known as endolymphatic hydrops. The cause is unknown, but it is a common ear, nose and throat (ENT) disease. The major clinical symptoms are frequent attacks of vertigotinnitus, degrees of hearing loss and a sensation of fullness in the inner ear. Symptoms will resolve with or without treatment. The disease is usually seen in the young and middle-aged adults, and approximately 75 per cent of cases occur in those aged 30 to 60 years. The incidence between the sexes is equal. A recent increase in the number of cases is probably related to the increasing risk of air pollution and chemical toxicity.

 

Ménière’s disease is a disorder of the fluid-filled semicircular canals of the inner ear (labyrinth).

Traditional Chinese medicine (TCM) practitioners focus on the dizziness that results from the disease and consider it to be ear related. The disorder is therefore categorized as “aural dizziness.” Dizziness is a sensation of unsteadiness with a feeling of movement within the head. It is also referred to as giddiness or vertigo and there is often blurring of vision. In mild cases, the symptoms disappear when the eyes are closed. In serious cases, patients experience a whirling sensation and the feeling that things about them are turning. There is also then a tendency to loose balance and fall; this is commonly accompanied by nausea, vomiting and sweating. 

Different TCM schools through the ages have varied in their theories on the etiology of this disease. The famous classic Huang Di Nei Jing (The Yellow Emperor’s Medicine Classic) held that “Dizziness with trembling extremities is a syndrome caused by the stirring of liver-wind inside the body. It is also related to qi deficiency and deficit in the sea of marrow, etc.” 

Causes

The understanding in TCM is that the disease mainly stems from internal injuries to the liver,  spleen and kidneys. This leads to loss of nourishment of the orifices and a deficit in the sea of marrow, resulting in dizziness. The causative factors of the organ damage include wind evil, fire evil and phlegm.

Excess of liver yang
The liver dominates the conduction and dispersal of qi movement. Liver-yang has the property of upward motion and causes qi or other things to ascend. Liver-yin, conversely, has the property of static motion and causes things to descend. Yin and yang mutually restrict and promote each other in order to maintain balance in the body. Hyperactivity of liver-yang or deficiency of liver-yin triggers the qi and blood to ascend to the brain. Moreover, the acceleration of qi movement also produces wind evil and leads to symptoms of dizziness or sudden blackouts.

Hyperactivity of liver-yang occurs in these situations:

In individuals who are prone to a natural excess of yang, the excess yang periodically triggers the generation of wind evil.
Emotional instability, especially long-term anger and depression, causes stagnation of the liver-qi. This results in the accumulation of fire evil in the body and the exhaustion of liver-yin. In turn, this activates the liver-yang and generates wind evil.
Damage to the kidneys, for example as a result of indulgence, results in a depletion of kidney essence and affects the liver-yang. According to the theory of the five elements, the kidneys (representing water) nourish and promote the liver (representing wood).


Obstruction of orifices by phlegm and dampness

Orifices are the openings on the body’s surface to the five internal organs. Phlegm and dampness evil are heavy and turbid (viscous) in nature. They tend to cause obstructions in the places where they accumulate. When these evils are brought up by qi and reach the head, they lodge easily in the orifices and cause dizziness. 

In TCM, it is believed that phlegm and dampness evil accumulate under the following conditions:

Consumption of an improper diet, such as an excess of fat and alcohol, irregular meal times, and excessive concentration and stress lead to malfunction of the spleen and stomach. The organ damage facilitates accumulation of dampness evil, which can then turn into phlegm.
Impaired functioning of the lungs, resulting in a failure to regulate and distribute fluid throughout the body, leads to a build-up of dampness evil.
When the kidneys fail to perform their vaporization function (removal of metabolic waste), excessive fluid will remain in the body.

Deficiency of the kidneys
The kidneys are responsible for storing essence  and producing the marrow of which the brain is composed. The kidneys therefore nourish the brain. In kidney deficiency, the brain loses this supporting nourishment and dizziness results.

TCM holds that impaired functioning of the kidneys or loss of kidney essence happens in the following conditions:

in individuals with congenital (inherited) weakness who do not care for themselves properly
aging
chronic disease
indulgence.

Symptoms

TCM practitioners will examine a sufferer and categorize symptoms under special syndrome groups known as “disharmony patterns.” Certain disharmony patterns are present at different stages of a disorder. In Ménière’s disease these can be classified into the following types:

Deficit in the sea of marrow 
Individuals present with frequent attacks of dizziness accompanied by severe ringing in the ears and obvious hearing loss. Other symptoms include listlessness, soreness and weakness in the back and knees, insomnia and irritability, nightmares,  spermatorrhea, poor memory, and a hot sensation in the chest, palms of the hands and the feet. 

Deficiency in qi and blood

During the dizziness attacks, individuals look pallid, are fatigued or sleepy, lack emotion and are reluctant to speak. Other symptoms include loss of appetite, diarrhea, shortness of breath, and wheezing and palpitation on exertion.

Flood of cold-dampness 
Individuals experience forceful palpitations during attacks, accompanied by an aversion to cold, a low body temperature and the spitting-up of large amounts of thin, clear sputum. Other symptoms include pain and a sensation of cold in the loin area, listlessness and lack of affect (emotion), frequent nocturnal urination, and production of large volumes of clear urine.

Disturbance of liver-yang 

These episodes usually happen after an emotional disturbance and are accompanied by impetuosity and irritability, headache, a flushed face and blood-shot eyes. Other symptoms include a bitter taste in the mouth, a dry throat, and a feeling of fullness and discomfort in the chest and below the ribs. Insomnia and nightmares may occur.

Obstruction by viscous phlegm 

Individuals experience heaviness and distension in the forehead during dizzy spells. Chest discomfort, nausea and sometimes severe vomiting can accompany these symptoms. Other symptoms include the production of large amounts of saliva and sputum, palpitation, poor appetite and fatigue.

Diagnosis

Diagnosis in TCM places importance on determining the circumstances and manifestations of a disease through inquiry and symptom observation. Diagnosis is based on the traditional four examination techniques:

1. Questioning The TCM practitioner will establish the medical history of both the patient and his family.
2. Observation Examination of the physical features of the body, such as the face, tongue, hair, nails, sputum (mucus that is coughed up), and location of pain, all offer clues to the problem. The tongue is a particularly useful indicator of the functioning of the internal organs.
3. Listening and smelling The smelling of sputum and breath and listening to the sounds produced by the chest offer additional clues to the patient’s health.
4. Touching Feeling the pulse is a cornerstone of TCM diagnosis and gives the practitioner much information about any bodily imbalance.

In Ménière’s disease, the procedures used in TCM to differentiate between disharmony patterns can be explained as follows:


Deficit in the sea of marrow

This syndrome group is the result of  kidney deficiency. When kidney essence becomes depleted, production of brain marrow declines. The brain loses nourishment and the result is dizziness. Furthermore, the ear is the surface opening of the kidney and as the kidneys also produce marrow for bones, ringing in the ears and soreness of the back and knees develop concomitantly. 

On examination, the tongue is red with scanty fur. The pulse is thready, fine and rapid. 

Deficiency in qi and blood
As defective qi circulation causes a disturbance to the function of the brain and insufficiency of blood leads to a lack of nourishment, the result to the brain is dizziness. Exertion consumes more qi and so triggers an attack. Other presentations of qi deficiency include fatigue, a reluctance to speak, sleepiness and lack of appetite.

 

On examination, the tongue is pale. The pulse is fine and rapid. 

Flood of cold-dampness 

The syndrome results from the retention of coldness and dampness evils, and damage to the kidneys. The evils not only obstruct the orifices in the head, leading to dizziness, they also bring manifestations of patterns of cold, such as a low body temperature, fatigue and lack of affect (emotion). Kidney damage is usually involved in this condition, so the individual may experience pain and a cold sensation in loin area, or frequent urination at night.

 

On examination, the tongue is pale, and coated with white and moist fur. The pulse is deep, weak and fine.

 

Disturbance of liver-yang 
This pattern is usually triggered by an emotional disturbance, which gives rise to hyperactivity of liver-yang and generates wind evil. The symptoms that result include dizziness, headache, insomnia and nightmares. Moreover, due to yang excess, individuals can also experience heat symptoms, such as a flushed face, blood-shot eyes, a bitter taste in the mouth and a dry throat. 

On examination, the tongue is red and coated with yellow fur. The pulse is taut and rapid.

Obstruction by viscous phlegm 

When phlegm remains in the head and causes obstruction of orifices, normal qi flow will be affected. The individual experiences dizziness, fatigue, and heaviness and throbbing in the forehead. When phlegm stays inside the organs, symptoms such as chest discomfort, nausea, vomiting and poor appetite develop. 

On examination, the tongue is pink, and coated by white and greasy fur. The pulse is uneven and slippery, or may be taut. 

Note: If a TCM practitioner suspects a serious problem that Chinese medicine alone cannot treat, he or she will recommend the individual to see a Western doctor for further follow-up. 

Treatment

TCM treatment of Ménière’s disease is based on two principles: 

Elimination in conditions of excess; and tonifying in conditions of deficiency.
Dealing with symptoms in the acute stage; and dealing with the origin of the disorder when it is chronic.

Chinese Medicine 

Deficit in the sea of marrow


Therapeutic aim: 
To nourish yin, tonify kidneys, replenish essence and benefit marrow.

Prescription:

shu di huang processed rehmannia root
shan zhu yu Asiatic cornelian cherry fruit
shan yao common yam root
mu dan pi tree peony bark
ze xie oriental water-plantain root
fu ling Indian bread
gou qi chi Chinese wolfberry fruit
ju hua chrysanthemum
shi jue ming sea-ear shell
duan mu li processed oyster shell
bai shao white peony root
he shou wu fleece flower root

A Chinese patent medicine such as Qiju Dihuang bolus is recommended as it can nourish yin and tonify the kidneys. 

Deficiency in qi and blood

Therapeutic aim: To replenish qi and blood, reinforce the spleen and calm the mind.

Prescription: 

huang qi milk-vetch root
dang shen pilose asiabell root
dang gui Chinese angelica
long yan rou longan aril
suan zao ren spine date seed
bai shu large head atractylodes root
fu ling Indian bread
mu xiang costus root
yuan zhi thin-leaf milkwort root
zhi gan cao liquorice root (processed with honey)

A Chinese patent medicines such asGuipi bolus is recommended to reinforce the spleen, benefit qi and promote blood production.

 

Flood of cold-dampness

Therapeutic aim: To warm the kidney yang, eliminate coldness evil and promote diuresis (elimination of fluid from the body by urination).

Prescription:
 

fu zi monkshood
fu ling Indian bread
bai shu large head atractylodes root
sheng jiang fresh ginger
bai shao white peony root
zhi gan cao liquorice root (processed with honey)

A Chinese patent medicine such asFugui Bawei bolus is recommended. This warms the kidneys and reinforces the yang part of body.

Disturbance of liver-yang

Therapeutic aim: To smooth the liver, expel wind evil, nourish the yin and depress the yang component.

Prescription:
 Tianma Gouteng drink

tian ma tall gastrodia tuber
gou teng gambir plant
sheng shi jue ming fresh abalone shell
niu xi achyranthes root
du zhong eucommia bark
sang ji sheng Chinese taxillus herb
huang qin baical skullcap root
zhi zi Cape jasmine fruit
ye jiao teng fleece flower stem
fu shen foria with hostwood
gan cao liquorice root

A Chinese patent medicine such asLongdan Xiegan bolus is recommended. This clears heat and fire evils, promotes liver function and detoxifies.

Viscous phlegm obstruction

Therapeutic aim: To reinforce the spleen and liver, expel dampness evil and phlegm

Prescription:
 

fa ban xia pinellia tuber (processed with liquorice root and lime)
tian ma tall gastrodia tuber
bai shu large head atractylodes root
fu ling Indian bread
ju hong dried tangerine peel
sheng jiang fresh ginger
da zao Chinese date
gan cao liquorice root

Acupuncture and moxibustion

The use of acupuncture and moxibustion can be helpful, for alleviating symptoms like vertigo and tinnitus. Treatment is conducted as follows:

When applying general methods, the usual acupuncture points are:
Bai-hui, shen-ting, shen-men, er-men, nei-guan, shen-mai, he-gu, zu-shan-li, feng-long, pi-shu, shen-shu, guan-yuan, feng-chi, xing-jian and zhong-wan. 
Three or four acupoints are stimulated each time.
When applying otopuncture therapy, the acupuncture points are: 
Forehead, heart, shen-men, kidney, occipital and inner ear. 
Two to three acupoints are stimulated each time.
When applying acupoint injection, the recommended acupuncture points are: 
He-gu, zu-shan-li, tai-chong, yi-ming or nei-guan, feng-chi and si-du.
Two to three acupoints are stimulated each time. Injections can include danshen, ginseng and Chinese angelica.

 


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