Appreciation of a Case: Professor Yang Muxuan Treats Cerebral Arteriosclerosis with His Self-created Vertigo Formula

Professor Yang Muxuan formerly served as director of the TCM Diagnostics teaching and research section and doctoral supervisor at the TCM College of Hebei Medical University, and is a renowned TCM expert in Hebei Province. On April 8, 1997, Professor Yang saw a 52-year-old farmer patient. The patient had had persistent dizziness for 5 years, worsening over 7 days. Symptoms included headache, tinnitus, insomnia with many dreams, irritability, and sore/weak lower back and knees; dizziness worsened with fatigue or emotional agitation. He had taken Xuan-yun-ting (vertigo-stopping pills) and Liuwei Dihuang Wan with poor effect, and so came to Professor Yang.

Examination showed hypertension (175/100 mmHg); fundoscopy showed grade 2 arteriosclerosis with obvious arteriovenous nicking; cholesterol and triglycerides were elevated. The tongue was red with little fluid, and the pulse was wiry, thin, and slightly rapid.

Professor Yang differentiated the pattern as liver-kidney yin deficiency with liver-yang ascending and stasis obstructing the vessels and collaterals. He planned treatment to pacify the liver and subdue yang, plus activate blood and unblock the collaterals, using his empirical Vertigo Formula with modifications.

Initial prescription: Tianma (Gastrodiae Rhizoma), Cili (Tribuli Fructus), Hanliancao (Ecliptae Herba), Shichangpu (Acori Tatarinowii Rhizoma), and Yujin (Curcumae Radix), 10 g each; Gouteng (Uncariae Ramulus cum Uncis; added later), Xiakucao (Prunellae Spica), Yimucao (Leonuri Herba), Nuzhenzi (Ligustri Lucidi Fructus), Danshen (Salviae Miltiorrhizae Radix et Rhizoma), Huainiuxi (Achyranthis Bidentatae Radix), and Juemingzi (Cassiae Semen), 15 g each; Huzhang (Polygoni Cuspidati Rhizoma et Radix) and Sangjisheng (Taxilli Herba), 30 g each; Dilong (Pheretima), 6 g. Decoct in water; one dose daily, divided into two warm doses.

After 7 doses, dizziness and headache were greatly reduced, blood pressure fell to 140/83 mmHg, the tongue was pale red, and the pulse was slightly wiry and thin; but insomnia and many dreams remained. The initial prescription was therefore modified by adding Yuanzhi (Polygalae Radix), Suanzaoren (Ziziphi Spinosae Semen), raw Longgu (Mastodi Fossilia), and raw Muli (Ostreae Concha), 30 g each.

After the second visit, the patient took a total of 28 consecutive doses, and all symptoms resolved. Six weeks later, follow-up showed blood pressure 135/85 mmHg; fundoscopy showed arteriosclerosis had dropped to grade 1, with no obvious arteriovenous nicking. He was later maintained on finished medicines such as Qiju Dihuang Wan and Tianma Wan. Follow-up at one year showed no recurrence of dizziness or headache.

Professor Yang’s case is a typical example of TCM treating difficult neurological and cardiovascular/cerebrovascular disorders. The patient’s symptom cluster was caused by hypertension and cerebral arteriosclerosis. Western treatment uses antihypertensive drugs and symptomatic treatment for vertigo, but the effect is not pronounced.

Professor Yang instead used a combination and modification of Tianma Gouteng Yin (composed of Tianma, Gouteng, Shijueming, Zhizi, Huangqin, Duzhong, Niuxi, Sangjisheng, and Yimucao) and Erzhi Wan (composed of Hanliancao and Nuzhenzi). Tianma Gouteng Yin treats headache, dizziness, and insomnia due to liver-yang ascending and internal stirring of liver wind; Erzhi Wan treats dizziness, tinnitus, insomnia with many dreams, dry throat and nose, sore weak lower back and legs, and excessive menstrual bleeding due to liver-kidney yin deficiency.

Once this broad treatment framework was set, the patient’s symptoms were basically expected to improve. Herbs such as Shichangpu, Yujin, Cili, Xiakucao, Dilong, and Niuxi, which lower blood pressure and open the orifices, were added to strengthen efficacy; Yuanzhi and Suanzaoren, which calm the spirit and promote sleep, were added to improve sleep. The treatment was thus well targeted.

Diseases of the cardiovascular, cerebrovascular, and nervous systems, though stubborn and difficult to treat, are not incurable. With patient, careful regulation, it is still possible to markedly improve the patient’s quality of life.