[Characteristics of acupoint selection of acupuncture-moxibustion for vertigo in history: a data mining research]

The data mining technique is adopted to analyze characteristics and rules of acupoint and meridian selection of acupuncture-moxibustion for treatment of vertigo at different time periods in the ancient. The data is collected from literature regarding acupuncture-moxibustion from the pre-Qin period to the end of Qing Dynasty, so as to establish a clinical literature database of ancient acupuncture-moxibustion for treatment of vertigo. Data mining method is applied to analyze the commonly used meridians, acupoints and special acupoints in different dynasties, also possible rules are explored. Totally 82 pieces of prescription of acupuncture-moxibustion for treatment of vertigo are included. In the history the leading selection of acupoitns are Fengchi (GB 20), Hegu (LI 4), Shangxing (GV 23) and Jiexi (ST 41) while that of meridians are mainly three yang meridians of foot and the Governor Vessel, especially the acupoints on the Bladder Meridian of foot yangming had the highest utilization rate, accounting for 23.04%. The acupoint selection is characterized by special acupoint, accounting for 80.6%, among which the crossing points are the most common choice. Distal-proximal acupoints combination is the most frequent method. The results indicate that the ancient acupuncture-moxibustion for treatment of vertigo focused on acupoints in the yang meridians, and the specific acupoints play an essential role in prescription; also the principle of syndrome differentiation and selecting acupoints along the meridians could be seen.

[Study on rules of acupoints selection for vertigo in ancient acupuncture]

The characteristics of selection and matching acupoint and application rules of meridians in ancient acupuncture literature for vertigo were explored. The data were collected from literature regarding acupuncture for vertigo from the pre-Qin period to Qing dynasty and then database was established. Frequency statistics method and comparison of support degree were applied to analyze and explore application rules of acupoints and meridians, while association rules in data mining was used to extract combinations of acupoints. As a result, for treatment of vertigo, according to frequency of use and support degree, generally the most selected acupoints, in turn, were Fengchi (GB 20), Shangxing (GV 23), Yanggu (SI 5), Jiexi (ST 41), Zulinqi (GB 41) and Shenting (GV 24), etc.; the most methods for matching acupoint were combination of adjacent acupoints, combination of same-meridian acupoints, combination of the superior-inferior acupoints, combination of yang-meridian and yang-meridian acupoints and combination of child-mother meridians acupoints; the most selected meridians were bladder meridian of foot-taiyang, gallbladder meridian of foot-shaoyang and governor vessel. Compared between the ancient and modern literature, it was found out that the ancient and modern clinic has same points in selection of acupoint-meridian and matching acupoints methods. However, the use of Yanggu (SI 5), Jiexi (ST 41) and Feiyang (BL 58) as well as combination of child-mother meridians acupoints were less seen in modern clinic, which could provide new reference.

A curiosity in the history of sciences: the words "megrim" and "migraine"

Vertigo has been described by medical doctors since Antiquity, but the condition is not limited to human medicine. It is also interesting to note that vertigo-related disorders were long only mentioned in the descriptions of migraine: however, in the Corpus Hippocraticum, a pain with vertigo (odunê kai skotodiniê) was not considered as hemicrania; in Aretaeus medical text, scotoma was clearly another disease than heterocraniê; although there could be metastases between them (pain could be followed by vertigo, as Boerhaave translated from Greek to Latin); Caelius Aurelianus, Ibn Zuhr of Seville, Īsmā'īl Jurjānī considered vertigo as a separate entity from "migraine" as well. One had to wait until 1831 for "ophthalmic migraine" (Piorry) to take systematically this disorder into account (to more or less causally relate it to migraine), and 1988 for the International Headache Society to acknowledge vertigo as a symptom of aura in "basilar migraine," which was given the better name of basilar-type migraine in 2004. From this point of view, veterinary medicine presents a particular interest because, for centuries, diseases mainly affecting horses - called in French "migraine," "mal de tête" (headache), "douleur de tête" (head pain), or in English "megrim(s)," "head-ach," "pain," and for which it is not self-evident that they are in any way related with the conditions that bear these names in humans - have been connected with vestibular impairments. Whatever is the relationship between the human and animal pathologies and, although it is impossible to interpret animal signs (abnormal behavior) with human symptoms (complaints), some impressive descriptions, written by Anglo-Saxon authors for the most part, seem to have played a significant role in the history of migraine. The purpose is to examine how a word in its English veterinary medical sense could have influenced French medical descriptions.

[Medical history of Martin Luther]

Martin Luther achieved great success in religious reformation, though he was said to have suffered from many kinds of diseases during his lifetime. Unfortunately, however, his medical history has never been reported in Japan. Since the second half of his thirties, he was suffering from severe constipation, causing hemorrhoids and anal prolapse. At the beginning of his forties he had vertigo, tinnitis and headaches, which were the signs of chronic purlent otitis media and ended in left otorrhea and pyorrhea of the left mastoiditis. Nearly at the same time, he started to suffer from anginal pain, colic and dysuria due to urinary uric acid stones, gout and left leg ulcer, which were all caused by metabolic syndromes. The last 1/3 of his life was affected by the shadow of diseases, and his religious activities were frequently disturbed. He died from myocardial infarction at the age 63, in February 1546.

The Darwins and Wells: from revolution to evolution

In the biography of his grandfather (Erasmus Darwin), Charles Darwin hinted that his father (Robert Darwin) had received parental assistance in conducting and writing his medical thesis (which concerned afterimages). The experiments also involved visual vertigo, and they were elaborated by the senior Darwin in his Zoonomia, published in 1794. Erasmus Darwin's interpretation was in terms of trying to pursue peripheral afterimages formed during rotation; it was at variance with one published two years earlier by William Charles Wells, who had investigated the visual consequences of body rotation when the body is subsequently still. Wells penned two retorts to the Darwins' theory; although they were not accepted by Erasmus, he did devise a human centrifuge, models of which were employed in later studies of vertigo. Wells's ideas on evolution were expressed in a paper delivered to the Royal Society (in 1813) but not published in its Transactions. Commenting on the case of a white woman, part of whose skin was black, he proposed a process of change that was akin to natural selection. His ideas were acknowledged by Charles Darwin in the fourth edition of On the Origin of Species.

Hallaran's circulating swing

William Saunders Hallaran (c.1765-1825) was physician superintendent at the County and City of Cork Lunatic Asylum for 40 years, where he distinguished between mental insanity and organic (systemic) delirium. In treatment he used emetics and purgatives, digitalis and opium, the shower bath and exercise, and argued that patients should be saved from 'unavoidable sloth' by mental as well as manual occupation. However, it is as an exponent of the circulating swing, proposed by Erasmus Darwin and used by Joseph Cox, that he is remembered. His best results were achieved, as he recorded in An Enquiry in 1810, by inducing sleep in mania of recent onset, but perhaps his most enduring observation was that some of his patients enjoyed the rotatory experience, and he had enough sense to allow the use of the swing as a mode of amusement.

La Mettrie's soul: vertigo, fever, massacre, and The Natural History

La Mettrie's materialist and monistic philosophy is that of a military doctor, knowing what dysentery did to his own mind, watching his regiment destroyed at Fontenoy, running French field hospitals in Flanders. He learned brain science in the injuries of his fellows. He knew pain and that man's main positive drive was sex. He despised the prudish hypocrisies of feeble materialists like Diderot and Voltaire. His brutal military life and his hedonism made him the most coherent monist against Cartesian dualism. His study of vertigo is sound clinical medicine, which well accords with one trend in today's medical practice.

Benign paroxysmal vertigo, and Bárány's caloric reactions

The Nobel Prize winner Robert Bárány described benign positional vertigo and related it to the otoliths in 1921. Dix and Hallpike further elucidated this clinically distinctive, common disorder in 1952. The displacement of otoliths from the utricle or saccule into one of the semicircular canals later proved to be the underlying mechanism, described by Schuknecht and utilised therapeutically by Semont and Epley.

The history of neuro-otology. A personal perspective

I realize I practiced otology and neuro-otology during a golden era, but I have to admit that I didn't appreciate how important it was until I sat down to outline this article. How fortunate I was to have lived and practiced during these developing years of neuro-otology. How fortunate to have worked with the likes of Howard and William House, James Sheehy, James Crabtree, David Austin, and John Shea. How fortunate to have had the opportunity to teach residents and fellows in association with my private practice. So I envy the young otologist-neuro-otologist and the future you have. You stand on the brink of great discoveries. And like my generation, you stand on the shoulders of giants. Good luck.

Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo has been recognized as the most common vestibular disorder. The evolution of its pathophysiological concepts has led to current therapeutic strategies that have made it the most successfully treatable cause of vertigo.

Betahistine in the treatment of vertigo. History and clinical implications of recent pharmacological researches

A short profile of betahistine and its activity in treatment of Menière's disease and other forms of peripheral vertigo is presented. The clinical efficacy of betahistine is documented by a series of more than twenty controlled clinical studies, performed in the years 1966-2000. Basic researches initially proved that bethaistine acts trough a vasodilating action on inner ear and cerebral blood flow (Suga and Snow, 1969; Martinez, 1972). In the following years this activity was confirmed using the modern laser doppler flowmetry technique (Laurikainen et al, 1998). Further recent studies proved that betahistine acts on the central vestibular histaminergic system as a weak H1 agonist and a strong H3 antagonist (Arrang et al., 1985), improving the process of vestibular compensation (Tighilet et al., 1995) as well as on peripheral labyrinthine receptors, reducing the spontaneous firing rate but not the activity induced by thermal or mechanical stimulation (Botta et al., 1998). More than forty years after its discovery, this series of studies carried out in the second half of the 90s leads to the conclusion that betahistine is a drug which maintains its scientific interest and its pharmacological potential in the treatment of vertigo.

A Century of Eighth Nerve Surgery

STUDY DESIGN

A scholarly review of over 70 original papers from the late 19th and early 20th centuries.

RESULTS

Although many neurotologists consider vestibular nerve section to be a recent innovation, eighth nerve division dates back to the dawn of intracranial surgery. Although surgery of peripheral nerves (e.g., repair after injury) is ancient, intracranial nerve surgery began in the latter part of the 19th century with fifth nerve division for tic douloureux. By analogy, it was reasoned that hyperactivity of the eighth nerve (initially tinnitus and later vertigo) could be relieved by dividing this nerve. In 1898, Fedor Krause (1856-1937) of Berlin attempted the first eighth nerve section. This patient, as did many during this era, died shortly after the operation. Most of the survivors had facial palsy. These innovative early surgeons used a variety of approaches, including the suboccipital, middle fossa, and transtemporal routes. After an initial burst of excitement during the first decade of the century, poor results led to few procedures being performed through the second and third decades. Throughout this era, there was much debate about the relative merits of labyrinthectomy (introduced by Milligan and Lake in 1904) as opposed to eighth nerve division. In the late 1920s, the prolific Walter E. Dandy (1886-1946) of Baltimore repopularized eighth nerve section and ultimately performed 607 procedures between 1927 and 1946. Although Dandy achieved a high vertigo control rate and reduced the mortality rate to <1%, he had a high rate of facial nerve weakness (9.1% transient, 4.2% permanent). Remarkably, the latter outcome was never published in his numerous papers on the subject, but was first revealed in a 1951 retrospective survey, which appeared some 5 years after his death. Selective division of the vestibular fibers was introduced by Kenneth G. McKenzie (1892-1963) of Toronto in 1931. At least 11 sizable series appeared in the literature before the introduction of microsurgical vestibular nerve section by William F. House (b. 1923) of Los Angeles in 1960.

CONCLUSIONS

The introduction and progressive refinement of eighth nerve section played a central role in the evolution of operative neurotology. Many of the most vigorous debates of recent years (e.g., the choice of operative route, the optimal site of division, and the relative role of inner ear surgery vs. nerve surgery) have antecedents in the controversies of the distant past.

William Charles Wells (1757-1817) and vestibular research before Purkinje and Flourens

Vestibular research before Flourens typically involved vertigo and eye movements. In 1820 Purkinje integrated these in studies of postrotary vertigo and he is linked with Flourens as a founder of vestibular research. In the late eighteenth century Erasmus Darwin described vertigo in detail, but he did not accept that it involved an oculomotor component. Darwin reached this conclusion despite detailed experiments by William Charles Wells (1757-1817), who described the pattern of postrotary nystagmus and its dependence on head orientation during rotation. Wells generated afterimages prior to rotation and subsequently compared their motions with those of real images. He was able to distinguish between the slow and fast phases of nystagmus, its reducing amplitude following cessation of rotation, its suppression with fixation, and its torsional dimension. In many ways, Wells's experiments were more sophisticated than those of Purkinje, and he should be recognised as a founder of vestibular research. Possible reasons for the neglect of Wells's work are discussed.

Harold Schuknecht and pathology of the ear

BACKGROUND

Like Joseph Toynbee and Karl Wittmaack before him, Harold Schuknecht understood that studying pathology was the key to advancing the scientific basis of neurotology. His work elucidated the pathophysiology of the most common neurotologic disorders, including benign paroxysmal positional vertigo, Meniere's disease, and viral neurolabyrinthitis. Schuknecht was a tireless crusader against medical and surgical treatments that he considered to have little scientific foundation. His textbook Pathology of the Ear remains the definitive work in the field.

["Agoraphobia--place anxiety/place fear--place-related vertigo". The classical description of place anxiety by Carl Westphal and Emil Cordes and its significance for the history of the concept and current discussion of anxiety disorders]

We discuss the history of "agoraphobia" and related descriptions as the "Platzangst" from M. Benedikt and the artile of E. Cordes, who used the same title "agoraphobia" as Westphals original paper. It is remarkable that Westphal and Cordes recognized the psychological character of the phenomenon, whereas Benedikt in 1870 suspected a neuroophthalmological origin for his "Platzschwindel". Regarding the details of these first three descriptions one can show that the primary authorities set up a discussion, which is still going on: The relation between agoraphobia, dizziness, fear and panic is until now object of many controversies, as shown in the final chapter.

Background and history of the interface between anxiety and vertigo

The comorbidity of vertigo and anxiety has been an integral component of the medical literature since antiquity. In the works of Plato, the same terms were used in the context of vertigo, inebriation, height vertigo, disorientation, and mental confusion. In classical medicine, vertigo had the ambiguous status of being both a disease per se and a symptom of other diseases such as hypochondriacal melancholy. Further, two etiologies were described for vertigo: an origin in the head (brain) and an origin in the hypochondria (abdominal viscera). In the course of the development of a detailed neurologic taxonomy of vertigo in the latter half of the nineteenth century, a debate ensued whether agoraphobia was a form of vertigo or a distinct psychiatric condition. Elucidation of this forgotten debate, within its historical context, provides insights into the recent rediscovery of the balance-anxiety interface.

Charles Skinner Hallpike and the beginnings of neurotology

Although the symptom of vertigo had been well-recognized for several thousand years, it was not until the pioneering work of Prosper Ménière in the mid-19th century that it was appreciated that vertigo could originate from damage to the inner ear. Before that time, patients with vertigo (regardless of the cause) were said to have "cerebral congestion," a condition resulting from excessive blood filling the brain. Bloodletting and leeches to relieve the congestion were the treatment of choice. The discovery of endolymphatic hydrops in temporal bone specimens from patients with Ménière's disease by Hallpike and Cairns in 1938 marked the beginning of modern neurotology. For the first time, vertigo was correlated with specific pathophysiology. Propelled by his temporal bone work, Charles Hallpike received an appointment at the National Hospital at Queen Square, where he developed an internationally renowned neurotology clinic. His bithermal caloric test and positional tests are still routinely used in evaluation of the vertiginous patient.

[Height-induced vertigo and its medical interpretation: Goethe and the Strassburger Münster]

An analysis combining medicine and literature challenges the methodology of both disciplines. This essay on the vertigo Goethe suffered on the tower of the Strasbourg Minster attempts to trace the vicissitudes of interpreting an emblem, like vertigo, burdened by cultural meaning and implications. Thus, Goethe's own report of this event 40 years after the fact, in his "Dichtung und Wahrheit", has to be related to another, hidden chronology of vertigo and fear in his account which, at first glance, conveys quite different implications. The first part of this paper refers to a medical interpretation of Goethe's dread of high places and his way of coping with it which, today, could be defined as a typical example of a behaviourist approach. In the second part, Goethe's vertigo is linked to psychoanalytic, literary, and historical reflections on the meanings of symptoms we connect today with medical terms like anxiety, phobia, and vertigo. Goethe's vertigo is shown as a complex problem--not only for himself but also for its interpreters: on the one hand, it tells its own story-within-a-story; on the other, it depends on the tools it was written with. Traditional approaches of medical history try to find symptoms and traces of diseases known to us today in literary texts, an approach which is as dubious as taking today's tools of medical analysis, such as psychoanalytic terms and concepts, to explain specific phenomena in literature without first carefully analysing these methods themselves, and only then subjecting the text to an analysis based on them. Nevertheless, this essay does not contest the justification of interpreting literary texts in the light of today's medical knowledge, but postulates that it should be clear which type of medical knowledge is applied. It is quite possible to read Goethe's account only as an old tale of acrophobia, but how will this help us? It seems more interesting to look at the link between the feeling of dizziness he experienced on top of the tower and the "cultural feeling" of the Sturm and Drang period, and then to trace the perception of this feeling at that time within its cultural context and in the light of prevalent medical theory.

History of "epileptic vertigo": its medical, social, and forensic problems

We traced the history of the association of vertigo with the condition of epilepsy through the ages. In ancient times, vertigo was closely linked with epilepsy; indeed, it was believed to be the harbinger of chronic seizures. With the advent of modern scientific study of epilepsy initiated by the French in the 18th and 19th centuries, vertigo, not yet associated with disease of the inner ear or vestibular connections, assumed a specific role in the clinical gradation of seizure entities. It was believed to be the mildest form of epilepsy. Later, with the establishment of the conceptual linkage of "larval" or "masked" epilepsy with outbursts of violence, "epileptic vertigo" was considered the trigger for potentially lethal behavior and thus assumed a much-feared reputation. Evidence for this abounds in the medical, legal, and even the popular literature at the end of the 19th century. The role of vertigo and its epileptic associations occupied the attention of most of the pioneer workers in epileptology of that era, and it was finally agreed that as a symptom the inner ear rather than epilepsy underlay its causation. Even today, epilepsy and vertigo are conceptually associated, sometimes erroneously.

Benign paroxysmal positioning vertigo: classic descriptions, origins of the provocative positioning technique, and conceptual developments

The original description of benign paroxysmal positioning vertigo (BPPV) has been variously attributed to Bárány, Adler, and others. In addition, the proper eponymic designation for the provocative positioning test used to diagnose BPPV has been unclear, because authors use a variety of different terms, including Bárány, Nylén-Bárány, Nylén, Hallpike, Hallpike-Dix, and Dix-Hallpike to refer to the procedure in current use. Based on a review of the extant medical literature, Bárány was the first to describe the condition in detail, and Dix and Hallpike were the first to clearly describe both the currently used provocative positioning technique and the essential clinical manifestations of benign paroxysmal positioning vertigo elicited by that technique. Nevertheless, despite their important contributions, neither Bárány nor Dix and Hallpike understood the pathophysiology of BPPV nor did they appreciate that the positioning techniques they used actually demonstrated pathology in the semicircular canals rather than the utricle. The modern understanding of the pathophysiology of BPPV began with Schuknecht's proposal that the dysfunction resulted from the gravity-dependent movement of loose or fixed dense material within the posterior semicircular canal ("cupulolithiasis"). Although Schuknecht's formulations were not consistent with all clinical features of the disease, they led to the modern "canalolithiasis theory" and highly effective canalith repositioning or "liberatory" maneuvers for BPPV.

[Preliminary exploration on knockout drops (Meng Han Agents)]

This author points out, based on relevant materials, that knockout drops were vertigo powder. Due to homophonic reasons in Chinese language, the term "mingxuan" was transliterated into the former Chinese term (menghan). Knockout drops for medicinal use were merely made up of compound recipes containing stramonium flowers. The knockout drops in old fictions and opera books were powder of stramonium flower. The ingredients and application of such recipes are discussed here, the anti-remedies for such recipes are also mentioned.

Vincent's violent vertigo. An analysis of the original diagnosis of epilepsy vs. the current diagnosis of Meniére's disease

The authors propose to correct the historical misimpression that Vincent van Gogh's medical problems resulted from epilepsy. Rather, the authors propose his main medical problem was Meniére's disease. The authors have reviewed the 796 personal letters written by van Gogh. The symptoms of his Vertigo attacks, their presentation and duration as described in these letters, taken as a whole, are consistent with the clinical picture of Meniére's disease, not epilepsy. They point out that Prosper Meniére's description of his syndrome was not well known at the time of van Gogh's death, and was often misdiagnosed as epilepsy. During the last years of his life, van Gogh was labeled epileptic, although no rigid criteria for this diagnosis are evident. This diagnosis is still prevalent in the art history literature today. His symptoms included episodic vertigo and dizziness, physical imbalance, hearing symptoms, ear noises (tinnitus) as well as a presumed secondary psychological reaction to his physical symptomatology. van Gogh's diagnosis of epilepsy is based on written diagnosis in his medical records in 1889 when he was interred (voluntarily) in St. Remy at an asylum for epileptics and lunatics.