Vertigo and Dizziness in TCM (眩晕): 'No Phlegm, No Dizziness; No Wind, No Dizziness'

An Old Complaint, an Old Distinction

Dizziness and vertigo (眩晕, xuànyùn — xuán meaning spinning, yùn meaning clouded) are among the conditions TCM has thought hardest about. Two thousand years ago the Huangdi Neijing attributed dizziness to the Liver: “all wind and dizziness belongs to the Liver” (诸风掉眩，皆属于肝). Later physicians, watching patients whose heads swam with nausea and a heavy feeling, added phlegm to the picture and produced the famous teaching that still anchors the subject today:

“No phlegm, no dizziness; no wind, no dizziness.” (无痰不作眩，无风不作眩)

In other words, most dizziness traces back to internal wind rising upward (usually from the Liver) or phlegm clouding the head (usually from a weak Spleen) — and very often to a combination of the two. Deficiency — of Qi and blood, or of Kidney essence — is the third thread, especially in chronic and elderly cases. The practical task is to figure out which mechanism is in play, because the treatments point in opposite directions.

The Four Main Patterns

1. Liver Yang Rising / Internal Wind (肝阳上亢)

The classic spinning, sudden, “acute” dizziness.

• Quality: a feeling of spinning or swaying, often sudden; head feels heavy or the brain “shakes”
• Triggers: brought on or worsened by anger, stress, or emotional upset
• Accompanying signs: headache (often at the temples or behind the eyes), tinnitus, a red face, bitter taste, irritability, high blood pressure
• Mechanism: when Liver Yin can no longer anchor Liver Yang, the Yang rises and “stirs” upward as internal wind, shaking the head

This is the “wind” of the classical saying. The signature is dizziness that flares with emotion and rides along with heat signs and a tense, irritable state.

2. Phlegm-Damp Clouding the Head (痰浊中阻)

The heavy, muddled, “swimming” kind of dizziness.

• Quality: dizziness with a sensation of heaviness, as if the head were wrapped in cloth; not necessarily spinning
• Triggers: worse after eating heavy or greasy food; associated with fatigue and damp weather
• Accompanying signs: nausea, vomiting of phlegm, a stuffed or chest-oppressed feeling, poor appetite
• Mechanism: a weak Spleen fails to transform fluids, dampness congeals into phlegm, and the phlegm clouds the clear Yang so it cannot rise to the head

This is the “phlegm” of the classical saying. The signature is the heaviness, the nausea, and the gastrointestinal company it keeps.

3. Qi and Blood Deficiency (气血亏虚)

The tired, post-exertional dizziness.

• Quality: mild dizziness, lightheadedness, “blacking out” on standing up; worse with exertion
• Triggers: worse when tired, hungry, or after blood loss; better with rest
• Accompanying signs: pale complexion, palpitations, poor sleep, fatigue, a pale tongue
• Mechanism: there is not enough Qi and blood to nourish and lift the brain; the clear Yang fails to rise because it is simply insufficient

4. Kidney Essence Deficiency (肾精不足)

The chronic, age-related, slowly progressive dizziness.

• Quality: persistent, low-grade dizziness with a hollow, unsteady feeling; memory and concentration decline
• Triggers: longstanding, gradually worsening; common in older adults or after chronic overwork
• Accompanying signs: tinnitus (often low and chronic), weak knees and lower back, hair greying, scanty memory
• Mechanism: the Kidney stores essence, which generates marrow and fills the brain (脑为髓海, “the brain is the sea of marrow”); when essence runs low, the brain is under-nourished

The contrast between patterns is striking: wind-type dizziness is sudden, spinning, and hot; phlegm-type is heavy, nauseous, and damp; deficiency-type is tired, pale, and chronic. Telling them apart is most of the work.

The Points That Matter

Point	Location	What it does
Fengchi (GB20)	Base of the skull, in the hollow behind the ear	Primary point for wind-type dizziness; settles rising Yang
Baihui (GV20)	Crown of the head	Lifts clear Yang; helps the muddled, heavy type
Taichong (LR3)	Top of the foot, between 1st and 2nd toes	Drains Liver Yang; pairs with Fengchi for the irritable type
Fenglong (ST40)	Below the knee, outside the shin	Transforms phlegm; used for phlegm-type dizziness
Neiguan (PC6)	Inner wrist, two finger-widths up	Calms nausea and the chest; useful with phlegm-type
Zusanli (ST36)	Below the knee, outside the shin	Tonifies Qi and blood; for deficiency-type dizziness

A note of caution: dizziness raises the risk of falls. Sit or lie down before applying acupressure, and never drive or climb until the episode has clearly passed.

Herbal Strategies

The patterns map to specific classical formulas:

• Liver Yang rising → Tian Ma Gou Teng Yin (天麻钩藤饮), which calms the Liver, extinguishes wind, and clears heat; Gastrodia (Tian Ma) is the signature herb for dizziness.
• Phlegm-damp → Ban Xia Bai Zhu Tian Ma Tang (半夏白术天麻汤), literally “Pinellia, Atractylodes, and Gastrodia Decoction” — the representative formula for phlegm-type dizziness, combining phlegm-transforming herbs with Tian Ma.
• Qi and blood deficiency → Gui Pi Tang (归脾汤) or Ba Zhen Tang (八珍汤) to tonify both Qi and blood.
• Kidney essence deficiency → Zuo Gui Wan (左归丸) or You Gui Wan (右归丸) depending on whether the deficiency leans toward Yin or Yang.

Tian Ma (天麻, Gastrodia) deserves special mention: it is the single herb most strongly associated with dizziness in TCM, used both to extinguish internal wind and to treat vertigo of almost any pattern, which is why it appears in so many dizziness formulas.

Self-Care That Aligns with TCM

• For wind-type: manage stress and anger — the trigger is often emotional. Cooling teas (chrysanthemum, 菊花) fit the hot, rising-Yang picture.
• For phlegm-type: eat lighter, avoid greasy and cold food, and don’t overeat — a tired Spleen is the root.
• For deficiency-type: prioritize sleep, warm and nourishing food, and slow rises from sitting.
• Press Fengchi daily: firm pressure for 1–2 minutes is the single most accessible intervention for the common, stress-related type.

Key Takeaways

• Dizziness in TCM follows the teaching “no phlegm, no dizziness; no wind, no dizziness” — Liver wind and Spleen phlegm are the two great causes, with deficiency a close third.
• Liver-Yang dizziness is sudden, spinning, and hot; phlegm-dizziness is heavy, muddled, and nauseous; deficiency-dizziness is tired and chronic.
• Fengchi (GB20) is the primary acupoint; Tian Ma (Gastrodia) is the signature herb.
• Ban Xia Bai Zhu Tian Ma Tang treats phlegm-type dizziness; Tian Ma Gou Teng Yin treats Liver-Yang dizziness.
• Sudden, severe, or new dizziness needs urgent medical evaluation — this article is educational, not a substitute for care.

Related Articles

• Tian Ma Gou Teng Yin
• Ban Xia Bai Zhu Tian Ma Tang
• Fengchi (GB20): Wind Pool Point
• TCM Liver Health
• TCM Tinnitus Guide