This paper introduces Professor WANG Haidong\'s approach to treat cervical vertigo with needle knife based on the holism of body-qi-spirit. Professor WANG Haidong, considering the etiology and pathogenesis of cervical vertigo, starting from the holism of body-qi-spirit, based on the anatomical structure, employs the \"seven-neck points\" technique to improve local blood supply and address the physical issue; guided by the Jingjin theory, he utilizes the \"knot releasing technique\" to disperse knots and relax sinews, thereby regulating qi. In addition, he uses the \"bone puncturing technique at governor vessel\" to uplift yang-qi and nourish the brain, thereby nurturing the spirit.
介绍王海东教授基于形气神一体观应用针刀治疗颈性眩晕的思路。王海东教授基于颈性眩晕的病因病机，从形气神一体观出发，以解剖结构为基础，采用“颈七刀”技术以改善局部血供而治形；以经筋理论为指导，采用“舒筋解结术”以散结缓筋、濡润筋肉而调气；以督脉为总纲，采用“督脉刺骨术”以升举清阳、滋养脑窍而养神。.

OBJECTIVE: To investigate the clinical effect of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylosis of vertebral artery type(CSA).
METHODS: The clinical data of 42 patients with CSA from January 2020 to January 2022 were retrospectively analyzed. There were 25 males and 17 females, aged from 30 to 74 years old with an average of (53.9±11.0) years old. There were 18 cases with single-segment lesions, 17 cases with two-segment lesions, and 7 cases with three-segment lesions. The American Academy of Otolaryngology-Head and Neck Surgery\'s Hearing and Balance Committee score (CHE), the Neck Disability Index (NDI) and the cervical curvature Cobb angle were recorded before surgery and after surgery at 6 months.
RESULTS: All 42 ACDF patients were followed up for 6 to 30 months with an average of (14.0±5.2) months. The operative time ranged from 95 to 220 min with an average of (160.38±36.77) min, the intraoperative blood loss ranged from 30 to 85 ml with an average of (53.60±18.98) ml. Tow patients had mild postoperative dysphagia, which improved with symptomatic treatment such as nebulized inhalation. CHE score decreased from (4.05±0.96) preoperatively to (2.40±0.70) at 6 months postoperatively (t=12.97, P<0.05). The number of improved vertigo at 6 months postoperatively was 38, with an improvement rate of 90.5%. NDI score was reduced from (34.43±8.04) preoperatively to (20.76±3.91) at 6 months postoperatively (t=11.83, P<0.05). The cervical curvature Cobb angle improved from (8.04±6.70)° preoperatively to (12.42±5.23)° at 6 months postoperatively (t=-15.96, P<0.05).
CONCLUSIONS: The ACDF procedure has outstanding clinical efficacy in treating CSA. The operation can rapidly relieve patients\' episodic vertigo symptoms by relieving bony compression and reconstructing cervical curvature. However, it is necessary to strictly grasp the indications for surgery and clarify the causes of vertigo in patients, and ACDF surgery is recommended for CSA patients for whom conservative treatment is ineffective.

OBJECTIVE: To observe the clinical effect of nape seven needles combined with pressing moxibustion for cervical vertigo (CV).
METHODS: A total of 70 patients with CV were randomized into an observation group and a control group, 35 cases in each group. In the observation group, nape seven needles combined with pressing moxibustion was delivered, once a day, 6 times a week, for consecutive 2 weeks. In the control group, betahistine hydrochloride tablet and aceclofenac dispersible tablet were given orally, for 2 weeks and 3 days respectively. Before and after treatment, the evaluation scale for cervical vertigo (ESCV) score was observed, the plasma levels of neuropeptide Y (NPY), endothelin-1 (ET-1) and calcitonin gene related peptide (CGRP) were detected, the hemorheologic and hemodynamic indexes were measured, and the clinical efficacy was evaluated after treatment in the two groups.
RESULTS: After treatment, the scores of dizziness, daily life and work ability, psychological and social adaptability, and headache, as well as the total scores of ESCV were increased compared with those before treatment (P<0.01, P<0.05) in the two groups, and the score and total score of neck and shoulder pain of ESCV was increased compared with that before treatment (P<0.01) in the observation group; each sub-item score and total score of ESCV in the observation group were higher than those in the control group (P<0.01, P<0.05). After treatment, the plasma levels of NPY and ET-1 were decreased compared with those before treatment (P<0.01), while the plasma levels of CGRP were increased compared with those before treatment (P<0.01, P<0.05) in the two groups; the plasma levels of NPY and ET-1 in the observation group were lower than those in the control group (P<0.01), the plasma level of CGRP in the observation group was higher than that in the control group (P<0.01). After treatment, the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity were decreased compared with those before treatment (P<0.01, P<0.05), the mean velocity of basilar artery (BA), left vertebral artery (LVA) and right vertebral artery (RVA) were increased compared with those before treatment (P<0.05) in the two groups; the whole blood high shear viscosity, plasma viscosity and whole blood low shear viscosity in the observation group were lower than those in the control group (P<0.01), and the mean velocity of BA, LVA and RVA in the observation group were higher than those in the control group (P<0.05). The total effective rate in the observation group was 91.4% (32/35), which was superior to 71.4% (25/35) in the control group (P<0.05).
CONCLUSIONS: Nape seven needles combined with pressing moxibustion can effectively alleviate the clinical symptoms, and improve the hemorheology and hemodynamics in CV patients.
目的：观察项七针联合压灸治疗颈性眩晕（CV）的临床疗效。方法：将70例CV患者随机分为观察组和对照组，每组35例。观察组采用项七针联合压灸治疗，每日1次，每周6次，连续治疗2周。对照组予口服盐酸倍他司汀片（2周）和醋氯芬酸分散片（3 d）。分别于治疗前后观察两组患者颈性眩晕症状与功能评估量表（ESCV）评分，检测血浆神经肽Y（NPY）、内皮素-1（ET-1）、降钙素基因相关肽（CGRP）含量及血液流变学、血流动力学指标，并于治疗后评定两组临床疗效。结果：治疗后，两组患者ESCV眩晕、日常生活及工作能力、心理及社会适应能力、头痛评分及总分较治疗前升高（P<0.01，P<0.05），观察组患者颈肩痛评分较治疗前升高（P<0.01）；观察组患者ESCV各项评分及总分均高于对照组（P<0.01，P<0.05）。治疗后，两组患者血浆NPY和ET-1含量较治疗前降低（P<0.01），血浆CGRP含量较治疗前升高(P<0.01，P<0.05)；观察组患者血浆NPY、ET-1含量低于对照组（P<0.01），血浆CGRP含量高于对照组（P<0.01）。治疗后，两组患者全血高切黏度、血浆黏度、全血低切黏度均较治疗前降低（P<0.01，P<0.05），基底动脉（BA）、左侧椎动脉（LVA）、右侧椎动脉（RVA）平均血流速度均较治疗前升高（P<0.05）；观察组患者全血高切黏度、血浆黏度及全血低切黏度均低于对照组（P<0.01），BA、LVA、RVA平均血流速度均高于对照组（P<0.05）。观察组总有效率为91.4%（32/35），高于对照组的71.4%（25/35，P<0.05）。结论：项七针联合压灸可有效减轻CV患者临床症状，改善血液流变学及血流动力学。.

OBJECTIVE: To evaluate the efficacy and safety of moxibustion at Baihui (CV20) combined with acupuncture in treatment of cervical vertigo.
METHODS: From the databases, such as CNKI, VIP, WanFang, CBM, PubMed, Cochrane Library and Embase, the studies of randomized controlled trials (RCTs) on moxibustion at CV20 combined with acupuncture for cervical vertigo were searched from inception to September 15th, 2021. The Cochrane risk of bias assessment tool was utilized to evaluate the quality of the included literature. Using RevMan5.3, Stata12.0 and TSA0.9.5.0 10 Beta software, the Meta-analysis and trial sequential analysis (TSA) were performed.
RESULTS: Seventeen RCTs with 1 232 patients were included. Meta-analysis showed that in the trial group (moxibustion at CV20 combined with acupuncture), the total effective rate (RR=1.17, 95%CI［1.12, 1.22］, P<0.000 1), the curative and remarkably-effective rate (RR＝1.28，95%CI［1.20，1.36］，P<0.000 1) and the score of cervical vertigo (WMD=2.88, 95%CI［1.87, 3.89］, P<0.000 1) were all better when compared with the control group (simple acupuncture or electroacupuncture group). The results of trial sequential analysis indicated that for the cumulative Z-score of each RCT, the Z-curve crossed the conventional test boundary and TSA boundary, which further confirmed the clinical efficacy of moxibustion at CV20 combined with acupuncture on cervical vertigo.
CONCLUSIONS: The clinical efficacy of moxibustion at CV20 combined with acupuncture is determined in treatment of cervical vertigo.
目的：系统评价艾灸百会联合针刺治疗颈性眩晕(CV)的疗效及安全性。方法：计算机检索中国知网、维普、万方、中国生物医学文献数据库、PubMed、Cochrane Library、Embase数据库，检索日期为从建库至2021年9月15日，搜集以艾灸百会联合针刺治疗CV的随机对照试验，利用Cochrane 偏倚风险评估工具评价纳入文献的质量。采用RevMan5.3、Stata12.0、TSA0.9.5.10 Beta软件进行Meta分析和试验序贯分析(TSA)。结果：共纳入17篇文献，包括1 232例患者。Meta分析结果显示：试验组(艾灸百会联合针刺治疗)在临床总有效率［RR＝1.17，95% CI(1.12，1.22)，P<0.000 1］、愈显率 ［RR＝1.28，95%CI(1.20，1.36)，P<0.000 1］，改善眩晕症状与功能评分［WMD＝2.88，95% CI(1.87，3.89)，P<0.000 1］方面均优于对照组(单纯针刺或电针治疗)。TSA结果显示，临床总有效率累计纳入的研究穿过了传统界值和 TSA 界值，进一步肯定了艾灸百会联合针刺治疗CV的临床疗效。结论：艾灸百会联合针刺治疗CV的临床疗效明确。.

The prevalence of cervical dizziness, still not recognized by the entire medical community, not only does not become less frequent, but even increases today. This phenomenon is facilitated by the widespread computerization of our lives and, in particular, the strain on the neck when working with portable electronic equipment. Despite the fact that criteria that reliably confirming the association of dizziness with cervical pathology have not yet been defined, experimental and clinical evidence of such an association continues to accumulate. This review presents data from studies of the last few years on cervical pathology as a causative factor in some types of dizziness and vertigo. To date, the following variants of cervical vertigo are distinguished: Barre-Lieu syndrome, rotational vertebral artery syndrome, proprioceptive cervical vertigo, migraine-associated cervical vertigo. The paper considers the features of all four cervical vertigo types, as well as methods for diagnosing and the first randomized trials on the treatment of dizziness associated with the pathology of neck structures. The results of own observations of similar cases (diagnosis and treatment) are described; as well as principles of differential diagnosis of some conditions manifested by headache and dizziness in patients with various types of disorders of cervico-cranial region. The similarities of clinical presentation and pathogenetic mechanisms characteristic of skull base and neck anomalies, Meniere\'s syndrome and cervical vertigo are discussed. In conclusion, an assumption was made about the common origin of a whole group of the diseases associated with the cranio-cervical region.
Распространенность цервикогенного головокружения, по-прежнему признаваемого не всем медицинским сообществом, не только не уменьшается, но даже увеличивается в наши дни. Этому способствует все более широкая компьютеризация, особенно нагрузка на шею при работе с портативной электронной техникой. Несмотря на то что все еще не определены критерии, достоверно подтверждающие связь головокружения с шейной патологией, экспериментальные и клинические доказательства такой связи продолжают накапливаться. В настоящем обзоре представлены данные исследований последних нескольких лет, посвященных шейной патологии как причинного фактора некоторых видов головокружения. На сегодняшний день выделяют следующие варианты цервикогенного головокружения: синдром Барре—Льеу, ротационный синдром позвоночной артерии, проприоцептивное цервикогенное головокружение, ассоциированное с мигренью цервикогенное головокружение. В статье рассмотрены особенности всех 4 типов цервикогенного головокружения, а также способы диагностики и первые рандомизированные исследования, посвященные лечению головокружения, связанного с патологией структур шеи. Описаны результаты собственных наблюдений подобных случаев (диагностика и лечение); принципы дифференциальной диагностики состояний, проявляющихся головными болями и головокружением у пациентов с различными вариантами нарушений шейно-черепной области. Обсуждается сходство клинической картины и патогенетических механизмов, характерных для аномалий основания черепа и шеи, для синдрома Меньера и цервикогенного головокружения. В заключение выдвинуто предположение об общности происхождения целой группы заболеваний, связанных с краниоцервикальным регионом.

Dizziness is one of the most common symptoms encountered by physicians daily. It is divided into four categories: vertigo, disequilibrium, presyncope, and psychogenic dizziness. It is essential to distinguish these four symptoms because the causes, prognosis, and treatment differ. Vertigo constitutes a disease of the central or peripheral nervous system. Central origin vertigo may be a life-threatening situation and must be detected as soon as possible because it includes diseases such as stroke, hemorrhage, tumors, and multiple sclerosis. Peripheral origin vertigo includes benign diseases, which may be fully treatable such as vestibular migraine, benign paroxysmal positional vertigo, vestibular neuritis, Ménière\'s disease, and cervical vertigo. The HINTS (head impulse, nystagmus, test of skew) examination is essential to distinguish central from peripheral causes. A detailed history including the duration of vertigo (episodic or continuous), its trigger, and a clinical examination step by step following the appropriate protocol could help to make a definite and accurate diagnosis and treatment. Due to a lack of expertise in dizziness and inappropriate treatment, many patients are admitted to dizziness clinics with long-standing dizziness. A holistic treatment combining medications, vestibular rehabilitation, physiotherapy, and psychotherapy should be initiated to improve the quality of life of these patients. So, this review aims to recommend a clinical protocol for approaching a dizzy patient with vertigo and to present in detail the epidemiology, pathophysiology, symptoms, diagnosis, and contemporary treatments of all causes of vertigo.

OBJECTIVE: To compare the effect of micro-needle knife therapy and betahistine mesilate tablets in the treatment of cervical vertigo (CV) and the influence on the mean blood flow velocity (Vm) of vertebral artery.
METHODS: A total of 200 patients with CV were randomly divided into a micro-needle knife group (100 cases, 5 cases dropped off) and a medication group (100 cases, 3 cases dropped off). In the micro-needle knife group, micro-needle knife was performed on the suboccipital triangle of the atlantoaxial segment of the posterior neck, once every other day, for a total of 7-time treatment. The medication group received oral betahistine mesilate tablets, 6 mg each time, three times a day, for 14 consecutive days. The dizziness handicap inventory (DHI) scores of the two groups were observed before treatment, after treatment and during follow-up 3 months after treatment; the Vm of vertebral artery was compared between the two groups before and after treatment, and the clinical effect was evaluated during follow-up.
RESULTS: After treatment and during follow-up, the DHI scores of the two groups were lower than those before treatment (P<0.001), and those in the micro-needle knife group were lower than the medication group (P<0.001). After treatment, the Vm of bilateral vertebral arteries in both groups was higher than that before treatment (P<0.05), and that in the micro-needle knife group was higher than the medication group (P<0.05). The total effective rate of the micro-needle knife group was 96.8% (92/95), which was higher than 67.0% (65/97) of the medication group (P<0.001).
CONCLUSIONS: Micro-needle knife therapy can improve vertigo symptoms and balance dysfunction, increase the mean blood flow velocity of vertebral artery in CV patients, and its clinical efficacy is better than oral betahistine mesilate tablets.
目的：比较微针刀疗法与口服甲磺酸倍他司汀片治疗颈源性眩晕（CV）的疗效及对椎动脉平均血流速度（Vm）的影响。方法：将200例CV患者随机分为微针刀组（100例，脱落5例）和药物组（100例，脱落 3例）。微针刀组于后颈项部寰枢段枕下三角区域行微针刀治疗，隔日治疗1次，共治疗7次；药物组予口服甲磺酸倍他司汀片，每次6 mg，每天3次，连续口服14 d。分别于治疗前、治疗后和3个月随访时比较两组眩晕障碍量表（DHI）评分；比较治疗前后两组椎动脉Vm，并随访评定两组临床疗效。结果：治疗后及随访时，两组DHI评分均较治疗前降低（P<0.001），且微针刀组低于药物组(P<0.001）；治疗后，两组双侧椎动脉Vm均较治疗前升高（P<0.05），且微针刀组高于药物组（P<0.05)；微针刀组总有效率为96.8%(92/95)，高于药物组的67.0%（65/97，P<0.001）。结论：微针刀疗法可改善CV患者眩晕症状和平衡功能障碍，提高椎动脉平均血流速度，临床疗效优于口服甲磺酸倍他司汀片。.

OBJECTIVE: To analyze the relationship between cervical vertigo and vestibular function evaluated by vestibular evoked myogenic potentials(VEMPs) and analyze the correlations between cervical vertigo and vestibular dysfunction, discuss the related factors of cervical vertigo and guide the clinical treatment of patients with cervical vertigo.
METHODS: A total of 75 patients with cervical vertigo as the main complaint in the outpatient clinic of the Second Hospital of Shanxi Medical University from August 2019 to July 2020 were set as the diseased group, and 60 patients without cervical and vestibular related diseases in the hospital were selected to set as non-diseased group. The age of diseased group was 12 to 70 years with an average of (46.40±10.91) years, including 25 males and 50 females;and the age of non-diseased group was 22 to 60 years with an average of(43.78±7.75) years, including 19 males and 51 females. VEMPs were performed in the two groups. The data of VEMPs were collected and the results were compared and analyzed. The patients with abnormal cervical myogenic vestibular evoked myogenic potential (cVEMP) were divided into light, moderate and severe groups. The correlation between VEMPs and cervical vertigo and its severity were analyzed by statistical method.
RESULTS: (1)The severity of cervical vertigo in diseased group:33 cases of mild, 34 cases of moderate, 8 cases of severe; cVEMP examination:62 cases were positive and 13 cases were negative, including 13 cases of mild, 33 cases of moderate, 16 cases of severe. The cVEMP of non-diseased group:4 cases were positive and 56 cases were negative.(2) The level of cVEMP in diseased group was higher than that in non-diseased group (P<0.001). It can be considered that there was a correlation between cervical vertigo and vestibular function.(3)The correlation between the level of cVEMP and the level of cervical vertigo in diseased group was analyzed. The Spearman rank sum test was used, and the correlation coefficient was 0.687, which was statistically significant (P<0.05). And it can be considered that the two indicators have a high degree of correlation.
CONCLUSIONS: It is feasible to evaluate the relationship between cervical vertigo and vestibular function by VEMPs. For patients with cervical vertigo, the higher the severity, the greater the positive rate of VEMPs, which indicates that it has a greater impact on vestibular function. The treatment of patients with cervical vertigo should be the combination of cervical rehabilitation and vestibular function.

Positional vertigo is a complex symptom that may arise from several disorders. In this chapter, we define positional vertigo and provide a comprehensive review of the disorders in the differential diagnosis, including benign paroxysmal positional vertigo, central paroxysmal positional vertigo, cervical vertigo and vertebrobasilar insufficiency, and persistent postural perceptual dizziness.

(1) Background: Cervical vertigo (CV) represents a controversial entity, with a prevalence ranging from reported high frequency to negation of CV existence. (2) Objectives: To assess the prevalence and cause of vertigo in patients with a manifest form of severe cervical spondylosis-degenerative cervical myelopathy (DCM) with special focus on CV. (3) Methods: The study included 38 DCM patients. The presence and character of vertigo were explored with a dedicated questionnaire. The cervical torsion test was used to verify the role of neck proprioceptors, and ultrasound examinations of vertebral arteries to assess the role of arteriosclerotic stenotic changes as hypothetical mechanisms of CV. All patients with vertigo underwent a detailed diagnostic work-up to investigate the cause of vertigo. (4) Results: Symptoms of vertigo were described by 18 patients (47%). Causes of vertigo included: orthostatic dizziness in eight (22%), hypertension in five (14%), benign paroxysmal positional vertigo in four (11%) and psychogenic dizziness in one patient (3%). No patient responded positively to the cervical torsion test or showed significant stenosis of vertebral arteries. (5) Conclusions: Despite the high prevalence of vertigo in patients with DCM, the aetiology in all cases could be attributed to causes outside cervical spine and related nerve structures, thus confirming the assumption that CV is over-diagnosed.