{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T07:22:59Z","timestamp":1787642579818,"version":"build-2736575974"},"reference-count":69,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>\n                    Posterior circulation ischemic vertigo (PCIV) denotes vertigo attributable to ischemia in the vertebrobasilar territory. It overlaps with the vascular vertigo categories of the B\u00e1r\u00e1ny Society diagnostic criteria and may indicate posterior circulation stroke or transient ischemic attack, so timely vascular evaluation is essential. In traditional Chinese medicine (TCM) theory, phlegm-dampness is regarded as a principal pathological product in vertigo, and pattern-based prescribing frequently targets it; whether phlegm-dampness pattern in PCIV corresponds to a biologically defined patient subgroup is unknown. This narrative review critically appraises the evidence behind that possibility. We searched PubMed, Embase, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang from inception to June 30, 2026. Direct clinical evidence in PCIV is limited to trials and meta-analyses of low certainty indicating that acupuncture, alone or as an adjunct, increases vertebrobasilar blood-flow velocity and improves symptom scores; transcranial Doppler velocity is not equivalent to tissue perfusion, and the composite \u201cclinical effective rate\u201d is a non-standardized outcome. Biomarker studies link phlegm-dampness constitution\u2014assessed in non-PCIV cohorts\u2014to dyslipidemia, low-grade inflammation, and gut microbiome alterations including depletion of\n                    <jats:italic>Flavonifractor plautii<\/jats:italic>\n                    and its product phytosphingosine. Mechanistic studies, conducted almost entirely in healthy volunteers or animal models, suggest that acupuncture can modulate cerebrovascular hemodynamics, inflammatory and oxidative-stress signaling, and gut\u2013brain communication. Integrating these strands, we propose a candidate metabolic\u2013microbial endotype framework as a hypothesis-generating model rather than an established entity: the proposed abnormalities have not been shown to coexist in pattern-defined PCIV patients, nor to predict differential response to acupuncture. Pattern-stratified trials with pre-specified biomarker panels are needed to test the framework.\n                  <\/jats:p>","DOI":"10.3389\/fneur.2026.1876704","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T07:02:57Z","timestamp":1787641377000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Toward precision acupuncture: phlegm-dampness pattern as a candidate metabolic\u2013microbial endotype in posterior circulation ischemic vertigo: a narrative review"],"prefix":"10.3389","volume":"17","author":[{"given":"Yike","family":"Han","sequence":"first","affiliation":[{"name":"School of Acupuncture-Moxibustion and Orthopedics, Hubei University of Chinese Medicine","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruili","family":"Wang","sequence":"additional","affiliation":[{"name":"Acupuncture and Moxibustion Center, Hubei Provincial Hospital of Traditional Chinese Medicine","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Acupuncture and Moxibustion in Obesity Treatment","place":["Wuhan, Hubei, China"]},{"name":"Acupuncture and Moxibustion Center, Affiliated Hospital of Hubei University of Chinese Medicine","place":["Wuhan, Hubei, China"]},{"name":"Hubei Shizhen Laboratory","place":["Wuhan, Hubei, China"]},{"name":"Hubei Key Laboratory of Theory and Application Research of Liver and Kidney in Traditional Chinese Medicine","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichen","family":"Ma","sequence":"additional","affiliation":[{"name":"School of Acupuncture-Moxibustion and Orthopedics, Hubei University of Chinese Medicine","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijin","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Acupuncture-Moxibustion and Orthopedics, Hubei University of Chinese Medicine","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Acupuncture and Moxibustion Center, Hubei Provincial Hospital of Traditional Chinese Medicine","place":["Wuhan, Hubei, China"]},{"name":"Hubei Provincial Clinical Research Center for Acupuncture and Moxibustion in Obesity Treatment","place":["Wuhan, Hubei, China"]},{"name":"Acupuncture and Moxibustion Center, Affiliated Hospital of Hubei University of Chinese Medicine","place":["Wuhan, Hubei, China"]},{"name":"Hubei Shizhen Laboratory","place":["Wuhan, Hubei, China"]},{"name":"Hubei Key Laboratory of Theory and Application Research of Liver and Kidney in Traditional Chinese Medicine","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1007\/s10072-019-03977-2","article-title":"Posterior circulation ischaemic stroke\u2014a review part I: anatomy, aetiology and clinical presentations","volume":"40","author":"Sparaco","year":"2019","journal-title":"Neurol Sci"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"30","DOI":"10.3389\/fneur.2014.00030","article-title":"Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management","volume":"5","author":"Nouh","year":"2014","journal-title":"Front Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1001\/archneurol.2011.2083","article-title":"Symptoms and signs of posterior circulation ischemia in the new England Medical Center posterior circulation 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