Disease and Condition Overview
Vertigo is characterized by subjective symptoms such as dizziness, perceiving objects spinning around. In Chinese medicine, the location of the disease is at the brain, closely associated with melancholy, anger, indulgence in rich, fatty foods，overwork, exhaustion and deficiency of qi and blood. Imbalance in emotions, anger or depression can lead to repressed qi transforming to fire and wind, liver yang uprising and cause vertigo. An imbalanced diet of indulging m rich fatty foods can lead to dysfunction of spleen and induce blockage consist of dampness and phlegm, stops clear yang from rising and in turn causes vertigo. Overwork, exhaustion can lead to the loss of kidney essence, or cause the essence unable to reach the brain, resulting in vertigo. In addition, weakened constitutions due to major illness, qi and blood deficiency can also induce the malnutrition of the brain, leading to vertigo.
Clinically, etiology of vertigo varies from inner ear disease, cervical spondylosis, acute vestibular neuronitis, anemia, and hypertension. It is important to obtain an accurate diagnosis before proceeding with treatments.

Pair-point Treatment Combinations

(1) Fengchi (GB20), Fengfu (DUI6)
Fengfu (DU16): on the neck, 1.0 cun superior to the midpoint of the posterior hairline, directly below the external occipital protuberance, in the depression between the trapezius muscle of both sides.
Fengchi (GB20): on the nape, at the same level as Fengfu (DU16), in the depression between the origins of the sternocleidomastoid and trapezius muscles.
Fengchi (GB20), Fengfu (DU16) are points vulnerable and susceptible to pathogenic wind attacking the brain. Used together, they treat all ailments caused by internal and external pathogenic wind, dispelling wind and extinguishing pathogenic factors, tranquilizing and calming the mind, and brightening eyes. Appropriate for all types of vertigo.

Needling techniques:
1. Fengchi (GB20) pointing towards throat perpendicular insertion l.5 cun.
2. Fengfu (DU16) from posterior to interior perpendicular insertion 0.5-1 cun.

(2) Baihui (DU20), Fengfu (DU16)
Baihui (DU20), Fengfu (DU 16) exit points where qi enters and exits from the brain. Baihui (DU20) elevates clear where as Fengfu (DU16) disperses pathogenic factors. When used in conjunction, they work to regulate original essence and qi, disperse wind, reviving the mind and opening orifices, tranquilizing and calming the mind. Appropriate for treating all types of acute vertigo.

Needling techniques:
1. Baihui (DU20) posterior oblique insertion 1 cun and moxa using moxa stick for 20 minutes.
2. Fengfu (DU 16) perpendicular insertion 1 cun.
(3) Zusanli (ST36), Ganshu (BL18)
Zusanli (ST36) strengthens spleen and stomach; Ganshu (BL18) pacifies liver, extinguishes wind, calms the mind and solidifies the will. One point tonifies and elevates while the other reduces and lowers. These two points work in synergy to regulate liver and stomach by strengthening spleen, tonifying qi, promoting blood and stabilizing kidney. Appropriate for treating vertigo caused by disharmony of liver and stomach, deficiency of qi and blood.

Needling techniques:
1. Zusanli (ST36) perpendicular insertion 2 cun, the needling sensation must traverse down and felt at the toes.
2. Ganshu (BL18) perpendicular insertion 1 cun, a using moxa stick for 10 minutes.

(4) Pishu (BL20), Weishu (BL21)
Spleen governs transportation and transformation, stomach is in charge of ascending and descending of food essence. Combining both points, one elevates while the other lowers, they work to strengthen spleen and stomach. Appropriate for vertigo caused by spleen and stomach weakness and qi and blood deficiency.

Needling techniques:
1. Perpendicular insertion 1 cun.
2. Use the dao-qi and "guiding qi" method, or warm needle, or apply moxibustion for 15 minutes after needling.

(5) Yingu (KI10), Xingjian (LR2)
Yingu (KI10) clears heat and tonifies yin. Xingjian (LR2) reduces liver and cools blood. The two points, one tonifies while the other reduces, work in synergy, to tonify kidney and clear liver. Appropriate for vertigo caused by liver and kidney yin deficiency.

Needling techniques:
1. Yingu (KI10) perpendicular insertion 1 cun.
2. Xingjian (LR2) perpendicular insertion 0.5 cun.

(6) Taixi (KI3), Taichong (LV3)
Taixi (KI3) tonifies kidney and strengthens congenital qi; Taichong (LV3) soothing the liver and regulate qi. Both points combined, they tonify kidney, pacify liver, clear above and stabilize below, subdue liver yang. Appropriate for treating vertigo caused by yin deficiency and liver yang uprising.

Needling techniques:
1. Taixi (KI3) perpendicular insertion 0.5 cun.
2. Taiehong (LV3) perpendicular insertion 1 cun.

(7) Guanyuan (RN4), Shenshu (BL23)
Guanyuan (RN4): on the lower abdomen, on the anterior midline, 3 cun inferior to the umbilicus.
Shenshu (BL23): on the lower back, below the spinous process of the second lumbar vertebra (L2), 5 cun lateral to the posterior midline.
Guanyuan (RN4) replenishes and nourishes original qi; Shenshu (BL23) strengthens kidney and drains dampness. When used in conjunction, the two points tonify congenital qi and nourishes acquired qi. Appropriate for treating vertigo caused by kidney yang and kidney yin deficiency.

Needling techniques:
1. Guanyuan (RN4) perpendicular insertion 1 cun.
2. Shenshu (BL23) perpendicular insertion l.5 cun.

(8) Yanglingquan (GB34), Taichong (LV3)
Yanglingquan (GB34): on the lateral side of the lower leg, in a depression anterior and inferior to the head of the fibula.
Taichong (LR3): on the dorsum of the foot, in the depression distal to the junction of the first and second metatarsal bones.
Yanglingquan (GB34) disperses and drains liver and gallbladder, clears damp heat. Taichong (LV3) soothes the liver and regulates qi, pacifies liver and extinguishes wind. These two points, one exterior, one interior; one zang organ, one fu organ, work in conjunction to regulate and harmonize liver and gallbladder by pacifying liver and subduing yang. Appropriate for treating vertigo caused by liver and gallbladder fire and liver yang uprising.

Needling techniques:
1. Yanglingquan (GB34) perpendicular insertion 1.5 cun.
2. Taiehong (LV3) perpendicular insertion 1 cun.

(9) Zhizheng (SI7), Feiyang (BI58)
Zhizheng (SI7): on the ulnar side of the posterior surface of the forearm, on the line connecting Yanggu (SI5) and Xiaohai (SI8), 5 cun proximal to the dorsal crease of the wrist.
Feiyang (BL58): on the posterior side of the leg, 7 cun superior to Kunlun (BL60), or a point posterior to the lateral malleolus, 1 cun lateral and inferior to Chengshan (BL57).
Zhizheng (SI7) connects to hand-taiyang and hand-shaoyin channels. Feiyang (BL58) connects foot-taiyang channel and foot- shaoyin channels. When combing both points, they sooth tendons and activate luo-connecting channels, clear heart and stabilize nerves, drain dampness and reduce swelling. Appropriate for treating vertigo related to qi stagnation at the taiyang channel.

Needling techniques:
1. Zhizheng (SI7) perpendicular insertion 1 cun.
2. Feiyang (BL58) perpendicular insertion 1 cun:

(10) Fenglong (ST36), Lieque (LU7)
Fenglong (ST40): on the anteriolateral side of the lower leg, 8 cun superior to the prominence of the lateral malleolus, lateral to Tiaokou ( ST38 ), two finger breadths ( middle finger) lateral to the anterior crest of the tibia.
Lieque (LU7): on the radial aspect of the forearm, above the styloid process of the radius, 1.5 cun proximal to the transverse crease of the wrist, between the tendons of brachioradialis and abductor pollicis longus.
Fenglong (ST36) resolves phlegm and lowers turbid, Lieque (LU7) elevates and regulates lung qi. Used in conjunction, one lowers while the other elevates, they work to regulate qi and harmonize the center, clear head and eyes. Appropriate for treating vertigo caused by excess of dampness and phlegm.

Needling techniques:
1. Fenglong (ST36) perpendicular insertion 2 cun.
2. Lieque (LU7) proximal oblique insertion 0.5-1 cun.

(11) Fengchi (GB20), Hegu (LI4)
Fengchi (GB20) dispels wind, while Hegu (LI4) clears heat. When used in conjunction, one clears and one disperses, one elevates while the other lowers, they work to regulate qi and blood, dispel wind and clear orifices. Appropriate for treating vertigo caused by wind heat misting clear orifices.

Needling techniques:
1. Fengchi (GB20) towards the throat, perpendicular insertion 1.5 cun, or moxa using moxa stick for 10 minutes.
2. Hegu (LI4) perpendicular insertion l cun, moxa using moxa stick 10 for minutes.

(12) Fengchi (GB20), Houxi (SI3)
Fengchi (GB20) dispels wind and extinguishes pathogenic factors, clears head and eyes while Houxi (SI3) connects to the Du channel and elevates yang, quiets the heart and calms the mind. These two points, one above and one below, work to dispel wind and to open channels and to clear orifices and to stabilize kidney. Appropriate for treating vertigo caused by wind yang misting clear orifices.

Needling techniques:
1. Fengchi (GB20) towards the tip of the nose, oblique insertion 1 cun.
2. Houxi (S13) perpendicular insertion 1 cun.

(13) Tianzhu (BL10), Dazhu (BLll)
Tianzhu (BL10): on the nape, in the depression of the lateral border of the trapezius muscle and 1.3 cun lateral to the midpoint of the posterior hairline.
Dazhu (BL11): on the back, below the spinous process of the first thoracic vertebra (T1), 1.5 cun lateral to the posterior midline.
Tianzhu (BL10) soothes tendons and activates luo-connecting channels, regulates qi and blood while Dazhu (BL11) disperses wind and strengthens bones. The two work in unison to regulate qi of the taiyang, to sooth tendons and activate luo-connecting channels, dispel wind and clear orifices. Appropriate for vertigo caused by stiff neck.

Needling techniques:
1. Tianzhu (BL10) perpendicular insertion 0.5-1 cun.
2. Dazhu (BL11) towards the spine, oblique insertion 1.5 cun.

(14) Tianzhu (BL10), Yanglao (SI6)
Tianzhu (BL10): on the nape, in the depression of the lateral border of the trapezius muscle and 1.3 cun lateral to the midpoint of the posterior hairline.
Yanglao (SI6): on the ulnar side of the posterior surface of the forearm, in the depression proximal to and on the radial side of the head of the ulna.
Tianzhu (BL10) soothes tendons and activates luo-connecting channels, regulates qi and blood. Yanglao (SI6) regulates and harmonizes qi of the channels. One above and one below, both are working in synchrony to open and regulate channels, to regulate qi and blood, to clear orifices and to stop dizziness. Appropriate for treating vertigo accompanied by stiff neck, having difficulty turning the head.

Needling techniques:
1. Tianzhu (BL10) perpendicular insertion 1 cun.
2. Yanglao (SI6) proximal oblique insertion 0.5 cun
3. Use even needling methods, manipulate for 10 minutes.

(15) Baihui (DU20), Yongquan (KI1)
Baihui (DU20) strengthens brain and kidney, pacifies liver and extinguishes wind. Yongquan (KI1) subdues yang, lowers fire, tranquilizes and calms the mind. The two points, one elevates while the other lowers, they tonify kidney, pacify liver, tranquilize and calm the mind. Appropriate for vertigo caused by disharmony of yin and yang ascending and descending.

Needling techniques:
1. Baihui (DU20) subcutaneously posterior needle 1 cun, if excess yang then prick to squeeze a few drops of blood, but in the case of elevated yang deficiency, apply moxa using moxa stick 10 minutes.
2. Yongquan (KI1) perpendicular insertion 1 cun.

Commentaries
Acupuncture treatment of vertigo yields great effects. In clinical treatment, it is important to differentiate between various syndromes such as excess or deficiency, acute or chronic. In serious cases, symptoms should be addressed first before treating the root cause. However, during the intermittent period, it is important to treat the root cause.

Fengchi (GB20), Fengfu (DUI6) and Baihui (DU20), Fengfu (DU16), these two pair combination are appropriate for treating all types and stages of vertigo. Depending on the patient's constitution, should be selected accordingly

Liver and stomach disharmony plus qi and blood deficiency -- select Zusanli, (ST36), Ganshu (BL18).
Spleen and stomach deficiency -- select Pishu (BL20), Weishu (BL21).
Yin deficiency and inner heat; liver and kidney yin deficiency -- select Yingu (KI10), Xingjian (LR2).
Kidney yin deficiency and liver yang excess --  select Taixi (KI3), Taichong (LV3).
Both kidney yang and kidney yin deficiency -- select Guanyuan (RN4), Shenshu (BL23).
Liver and gallbladder fire -- select Yanglingquan (GB34), Taichong (LV3),
Taiyang channel qi stagnation  -- select Zhizheng (SI7), Feiyang (BL58).
Excess of dampness and phlegm -- select Fenglong (ST36), Lieque (LU7).
Wind misting clear orifices, with indication of wind heat -- use Fengchi ( GB20), Hegu (LI4).
Closer to wind yang attack use Fengchi (GB20), Houxi (SI3).
Stiff neckandvertigo--select Tianzhu (BL10), Dazhu (BL11).
Accompanied by consistent pare and difficulty turning one's head -- select Tianzhu (BE10 ), Yanglao (SI6).
Yin yang descending and ascending disharmony -- select Baihui ( DU20 ), Yongquan (KI1).
Most deficiency syndromes use moxibustion, excess syndrome use needling method, mix of excess and deficiency, use even method when needling.