Dizzy and Blacking Out When You Stand Up from a Squat? TCM Reveals the Truth Behind "Orthostatic Dizziness"

I. Tracing the Origin: From "The Man of Qi Who Feared the Sky Would Fall" to "Qi and Blood Struggling to Rise"

The ancients often used the story of "the man of Qi who feared the sky would fall" as a metaphor for unnecessary worry. But if your vision goes black and you feel severely dizzy when you stand up after squatting, this is no groundless concern—it is a genuine signal from your body. Traditional Chinese Medicine classifies this "orthostatic" dizziness under the category of "vertigo." The Huangdi Neijing states: "When the upper qi is insufficient, the brain is not filled, the ears suffer from ringing, the head suffers from drooping, and the eyes suffer from dizziness." This describes precisely how, when qi and blood cannot rise to nourish the head and eyes, a person feels the world spinning and vision darkening. Seen this way, it is not "fearing the sky" but rather the affliction of "qi and blood struggling to rise."

II. Question One: Why Does Vision Suddenly Go Black When Moving Between Squatting and Standing?

Many people are puzzled: it is merely a change of posture, so why does the body react so dramatically? TCM theory points out that the movement of qi and blood in the human body requires the propulsion and containment of "qi." When a person squats, the lower limbs are compressed, and qi and blood relatively gather in the lower body. Upon standing suddenly, qi and blood must rapidly ascend to supply the brain. If the propelling force of qi is insufficient, or if blood deficiency makes it difficult to replenish quickly, then "upper qi becomes insufficient," causing the brain to be briefly deprived of nourishment. Dizziness and blacking out when standing up from a squat—feeling severely dizzy—is essentially a manifestation of qi and blood being "in short supply," just as when a water pipe is suddenly opened but the pump pressure is inadequate, the flow naturally becomes intermittent.

In TCM meridian theory, the Baihui acupoint on the crown of the head is closely related to "upper qi insufficiency." Baihui, also known as "Three Yang and Five Meetings," is located at the intersection of the midline of the head and the line connecting the tips of both ears. It belongs to the Governing Vessel (Du Mai) and is the meeting point of the Governing Vessel with the Foot Taiyang Bladder Meridian and the Hand and Foot Shaoyang Meridians, long known as the "meeting of all yang." The yang qi of the entire body tends to converge here. When qi and blood cannot rise to nourish the head and eyes, the area around Baihui often feels distended, heavy, and oppressive. The ancients regarded this acupoint as an important site for observing the state of qi and blood in the head. The Zhenjiu Dacheng records that it governs "head wind, dizziness, deafness, and visual dimness," reflecting its theoretical significance in the movement of qi and blood in the head.

III. Deeper Explanation: Qi and Blood Deficiency Is the Root, but the Primacy of "Qi" versus "Blood" Must Be Distinguished

Clinically, dizziness and blacking out when standing up from a squat—feeling severely dizzy—is commonly seen in two constitutional states. One is "qi deficiency predominant." These individuals tend to fatigue easily, speak with a weak voice, and sweat with slight activity. When they stand up, they feel dizzy, but the degree of vision darkening is relatively mild—more "dizziness" than "blacking out." The other is "blood deficiency predominant," commonly seen in people with pale complexion, pale lips and nails, palpitations, and insomnia. When they stand up, the vision darkening is more pronounced, sometimes accompanied by tinnitus. The TCM classic Jingui Yaolüe states: "For those who have lost essence, the lower abdomen feels tense and taut, the genitals are cold, the eyes are dizzy, and hair falls out." This reminds us that when qi and blood depletion reaches a certain degree, dizziness and visual disturbance will be accompanied by more manifestations.

IV. Question Two: Why Do Some People Need Warming Tonification While Others Need Clearing and Draining for the Same Problem?

Since the root cause is qi and blood insufficiency, should everyone tonify qi and nourish blood? This is precisely the key to TCM pattern differentiation. Dizziness and blacking out when standing up from a squat—feeling severely dizzy—may appear similar on the surface, but the underlying "pathomechanism" may be vastly different. Some people suffer because spleen deficiency prevents the transportation and transformation of water and grain essences, leading to insufficient production of qi and blood. Others have internal obstruction by phlegm-dampness, with sluggish movement of qi. They may appear to have qi and blood deficiency, but in reality, "the road is blocked." If one blindly applies warming tonification, it will instead promote dampness and generate phlegm, worsening the dizziness. As the Wenbing Tiaobian states: "Treating the upper burner is like feathering—without lightness, it cannot be raised; treating the middle burner is like balancing—without equilibrium, it cannot be settled." In regulating qi and blood, one must identify whether the problem is a "blockage point" or a "deficiency point"—the directions are entirely different.

V. Question Three: What Does It Mean When Dizziness Is Accompanied by Palpitations and Tinnitus?

Clinically, some individuals experience dizziness and blacking out when standing up from a squat—feeling severely dizzy—along with palpitations, tinnitus, and soreness and weakness of the lower back and knees. This often indicates "kidney essence insufficiency." The kidney stores essence; essence generates marrow; marrow fills the brain; and the brain is the sea of marrow. If kidney essence is depleted, the sea of marrow loses its filling. Not only does dizziness occur, but memory decline and hearing loss may also appear. In such cases, tonifying qi and nourishing blood alone has limited effect; one must start from "tonifying the kidney and replenishing essence." Traditional Chinese Medicine holds that these individuals often have a background of prolonged late nights, excessive overwork, or excessive sexual activity, with the body's "foundation" hollowed out, requiring even more patience in regulation.

Speaking of kidney essence, one cannot fail to mention the Taixi acupoint. Taixi, also known as Lüxi, is located on the medial side of the foot, in the depression between the posterior aspect of the medial malleolus and the Achilles tendon. It belongs to the Foot Shaoyin Kidney Meridian and is the Yuan-Source acupoint of the Kidney Meridian. Yuan-Source acupoints are where the original qi of the zang-fu organs passes through and remains. Taixi is closely related to the rise and fall of kidney essence. The Lingshu: Jiu Zhen Shi Er Yuan states: "As for the kidney, its source emerges from Taixi." In TCM theory, when kidney essence is abundant, the sea of marrow is nourished and the head and eyes are clear; when kidney essence is depleted, there is vertigo and tinnitus. Precisely because the Taixi acupoint can reflect the abundance or depletion of kidney essence, ancient physicians often assessed whether kidney qi was weak by observing the pulse and local condition at this site. This is also the manifestation of the TCM theory that "the kidney governs bone and generates marrow" in the meridian system.

VI. Comprehensive Understanding: Viewing Orthostatic Dizziness Through the Holistic Lens of "Ascending, Descending, Exiting, and Entering"

In TCM, dizziness and blacking out when standing up from a squat—feeling severely dizzy—is never viewed in isolation as a single symptom of "dizziness." The movement of qi and blood in the human body follows the principle of "ascending, descending, exiting, and entering." When standing up, qi and blood need to rapidly "ascend" to the head. If the force of "ascending" is insufficient, or if there is excessive "descending" (such as yang qi sinking), problems will arise. Clinically, one must also distinguish whether it is "yang qi failing to ascend" or "yin blood failing to fill." The former is often accompanied by aversion to cold and cold limbs; the latter by dry mouth and irritability. As the Huangdi Neijing states: "Yang qi is like the sky and the sun; when it loses its place, life is cut short and does not flourish." Only when yang qi ascends normally can qi and blood naturally rise to nourish the head and eyes like the sun rising in the east.

VII. Daily Care: How to Help Qi and Blood "Rise" Without Going "Too Far"?

For those who frequently experience dizziness and blacking out when standing up from a squat—feeling severely dizzy—daily care should begin with the two principles of "slowness" and "regulation." In terms of movement, when rising, one should first slowly transition to a half-squat, pause briefly, and then stand fully upright, giving qi and blood a "buffer" period. In terms of diet, those with qi deficiency may appropriately consume Chinese yam, red dates, millet, and other items that strengthen the spleen and boost qi. Those with blood deficiency may choose longan, goji berries, black sesame, and other blood-nourishing foods. However, note that if there are simultaneously signs of "dampness" such as dry mouth, thick greasy tongue coating, or sticky stools, one should not blindly tonify. The direction of regulation must be determined by a licensed TCM practitioner after pattern differentiation. Additionally, those who spend long hours in air-conditioned rooms or sit for extended periods already have sluggish qi and blood movement, making them more prone to this problem. Appropriate movement of the lower limbs and stretching of the lower back can help activate the "qi mechanism."

In classical meridian theory, Zusanli is the representative acupoint for regulating spleen and stomach function. Zusanli, also known as Xialing or Sanli, is located on the anterior-lateral aspect of the lower leg, 3 cun below Dubi, one finger-breadth from the anterior crest of the tibia. It belongs to the Foot Yangming Stomach Meridian and is the He-Sea acupoint of the Stomach Meridian and the Lower He-Sea acupoint of the Stomach. The spleen and stomach are the foundation of the acquired constitution and the source of qi and blood production. Whether qi and blood are sufficient is closely related to the transportation and transformation function of the spleen and stomach. The Lingshu states: "When pathogenic factors are in the spleen and stomach, there is muscle pain... all are regulated at Zusanli." The state of the spleen and stomach reflected at Zusanli is an important reference in TCM pattern differentiation for determining whether qi and blood production is sufficient. This also suggests that the regulation of orthostatic dizziness cannot be separated from attention to the spleen and stomach—the "qi and blood factory."

Frequently Asked Questions