Dr Win Huang’s Clinical Reflections | Before Treating Dizziness, We Must First Recognise What Kind of Dizziness It Is

By Dr Win Huang, PhD (Chinese Medicine & Acupuncture)

A patient came to my clinic today because of recurring dizziness.

He had been experiencing this problem for more than six months. At the beginning, certain movements would easily trigger dizziness. Sometimes he experienced a strong spinning sensation, accompanied by nausea and vomiting.

He had previously received Chinese medicine and acupuncture treatment, including acupuncture, moxibustion and other traditional treatments. For a period of time, he felt much better. The obvious dizziness had stopped, and he believed the problem had been resolved.

However, three days ago, the symptoms returned.

He again experienced episodes of spinning dizziness, sometimes accompanied by nausea and vomiting. Between these episodes, he described a different feeling: heaviness in his head, light-headedness, and unsteadiness when walking.

This time, a friend recommended that he come to see me.

What Kind of Dizziness Was He Experiencing?

I did not begin with acupuncture. Instead, I first asked him to describe exactly how his dizziness occurred.

He explained that the true spinning sensation was usually triggered by movement or changes in head position. Each episode lasted from several seconds to around one or two minutes. When he stopped moving and remained still, the spinning gradually settled.

This pattern immediately made me consider benign paroxysmal positional vertigo (BPPV), commonly known as positional vertigo caused by displaced inner-ear crystals.

As for the lingering light-headedness, head pressure and unsteadiness between attacks, I considered whether these symptoms might be related to the balance system still adjusting after the vertigo episodes. They did not necessarily mean that he was experiencing continuous spinning vertigo.

Therefore, rather than focusing on acupuncture, I assessed him in the direction of possible BPPV and performed repositioning treatment. I then asked him to observe how his symptoms changed over the following days.

This case brought me back to an important question:

As acupuncturists, is our main responsibility simply to know how to insert needles, or should we first understand what condition the patient may actually have?

We Need to Understand Both TCM Pattern Differentiation and Medical Diagnosis

In Chinese medicine and acupuncture, pattern differentiation is an essential part of clinical practice.

But dizziness is a symptom, not a diagnosis.

Several different conditions may cause dizziness or vertigo, including BPPV, Ménière’s disease, vestibular neuritis, persistent postural-perceptual dizziness (PPPD), and other neurological or inner-ear disorders.

I am not suggesting that every acupuncturist should become an ENT specialist or be able to perform every complex vestibular examination.

However, I believe we should understand the basic clinical characteristics of these common conditions.

For example, when a patient describes brief episodes of spinning vertigo triggered by changes in head position, lasting seconds to around one or two minutes and then settling, BPPV should be considered. Appropriate positional testing can help confirm the diagnosis.

If we do not recognise this possibility, we may hear the word “dizziness” and immediately begin our familiar Chinese medicine assessment, select acupuncture points and choose our usual treatment methods.

In doing so, we may overlook the problem that needs attention first.

Learning Repositioning Techniques Is Helpful, but Knowing When to Refer Is Equally Important

When BPPV is correctly identified, an appropriate canalith repositioning manoeuvre can often improve the characteristic spinning vertigo quite quickly.

For this reason, I think acupuncturists who regularly see patients with dizziness would benefit from learning basic positional assessment and repositioning techniques, provided they have the appropriate training and clinical competence.

But what if they do not know how to perform these procedures?

That is not necessarily a problem.

The important thing is to recognise when the patient may have BPPV.

The patient can then be referred to an ENT specialist, a vestibular physiotherapist or another appropriately trained clinician who can assess and manage the condition.

Making a referral does not mean that a practitioner lacks ability.

On the contrary, I believe it demonstrates an understanding of professional boundaries.

What the Patient Needs Matters More Than What I Know How to Do

When a patient comes to an acupuncture clinic, it does not mean that every problem must be treated with acupuncture.

If a patient has BPPV and the most appropriate treatment is a repositioning manoeuvre, then that should come first.

If the patient later continues to experience other symptoms, such as residual light-headedness or general discomfort, we can reassess whether acupuncture, Chinese medicine or other treatment may have a role.

That is a separate clinical decision.

We should not turn every condition into an acupuncture problem simply because we are acupuncturists.

Today’s case reminded me once again:

A good acupuncturist should not only know when to use a needle, but also when not to rush into needling.

Knowing how to treat is a clinical skill.

Knowing how to recognise a disease is also a clinical skill.

Knowing when to refer is equally important.

Ultimately, we are not treating a method or a theory. We are treating an individual patient. What that patient actually needs at that moment should always come first.

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