脉∶风寒暑湿，气郁生涎；下虚上实，皆头晕眩。风浮寒紧；湿细暑虚；痰弦而滑；瘀
芤而涩；数大火邪；虚大久极。先理气痰，次随症脉。
眩者，言其黑运旋转，其状目闭眼暗、身转耳聋，如立舟车之上，起则欲倒。盖虚极乘
寒得之，亦不可一途而取轨也。
大凡头眩者，痰也。
清晕化痰汤 治头目眩晕。
陈皮（去白） 半夏（姜汁炒） 茯苓（去皮，各一钱半） 甘草（三分） 川芎（八分） 白芷 羌活
（各七分） 枳实（麸炒，一钱） 南星（姜汁炒） 防风 细辛（各六分） 黄芩（酒炒，八分）气虚，加
人参七分，白术；有热，加黄连六分；血虚，加川芎、当归各一钱。上锉一剂。生姜三片，
水煎，温服。以此作丸，亦可。
肥人头眩者，属气虚湿痰也。
四君子汤 治气虚湿痰头眩。
人参（去芦） 白术（去芦） 茯苓（去皮） 黄 （蜜炒） 川芎 陈皮 半夏（姜制） 天麻
桔梗（去芦） 白芷 当归（各等分） 甘草（减半）
上锉一剂。生姜三片，枣一枚，水煎，温服。
瘦人头眩者，属血虚痰火也。
四物汤加减 治血虚痰火头眩。
当归 川芎 白芍（酒炒） 熟地 人参（减半） 陈皮 片芩 山栀 茯苓（去皮） 天麻（各
等分） 甘草（减半）
上锉一剂。生姜三片，枣一枚，水煎，温服。
忽时眩晕倒者，是风痰，脉浮滑也。
二陈汤加减
茯苓 陈皮 羌活 防风 人参 当归 白术（去芦） 枳实（麸炒） 南星（姜制） 川芎
桔梗 瓜蒌仁（各等分） 甘草（少许）
上锉一剂。水煎，入竹沥、姜汁同服。
劳役之人，饥寒眩晕者，脉虚弱也。补中益气汤加减（方见内伤）。根据本方加半夏、熟地
黄、白芍、天麻。
阴虚火动眩晕者，脉必数也。滋阴降火汤加减（方见虚劳）。根据本方加川芎、天麻、山栀
、竹沥少许。
虚极欲倒，如坐舟车，手足冷者，脉沉细也。
参附汤 治真阳不足，上气喘急、气短、自汗、眩晕。
人参（五钱） 大附子（炮，三钱）
上锉一剂。生姜十片，水煎，温服。
若泄泻多而眩晕，时时自冒者，难治也。头旋眼黑，如在风云中者，乃胃气虚停痰而致
也。半夏白术天麻汤（方见头痛）。
头目昏眩者，乃风热上攻也。防风通圣散，治风热上攻，头目昏眩闷痛、痰喘咳嗽。根据
本方去麻黄、芒硝，加菊花、人参、砂仁、寒水石（方见中风上治）。
临事不宁，眩晕嘈杂者，此心脾虚怯也。
滋阴健脾汤 此治气血虚损，有痰作眩晕之仙剂也。
当归（酒洗，一钱） 川芎（五分） 白芍 生地黄（酒洗，八分） 人参（七分） 白术（一钱五分） 白
茯苓（去皮，一钱） 陈皮（盐水洗，去白，一钱） 半夏（姜制） 白茯神（去皮木） 麦门冬（去心）
远志（去心，各七分） 甘草（炙，四分）
上锉一剂。姜、枣水煎，早晚服。
大学士中玄高公，患头目眩晕，耳鸣眼黑如在风云中，目中溜火，一医以清火化痰，一
医以滋补气血，俱罔效。余诊六脉洪数，此火动生痰。以酒蒸大黄末三钱，茶下。一服而愈
。盖火降则痰自消矣。
一熊槐二官，年六十余，身体胖大。余诊其脉，下手即得五至一止，余乃惊曰∶君休矣
!渠曰∶连日微觉头晕，别无恙也，何故出此，愿实教焉。予曰∶越十日用药，相哂而退。
少顷间中痰，求救于余。见其必不可治，令以香油灌之，即醒。逾十日，果卒。
Pulse: Wind, cold, summer-heat, and dampness pathogens, or qi stagnation generating phlegm-fluids; deficiency in the lower jiao with excess in the upper jiao, all can cause dizziness and vertigo. Wind presents as a floating pulse; cold presents as a tight pulse; dampness presents as a fine pulse; summer-heat presents as a deficient pulse; phlegm presents as a string-taut and slippery pulse; blood stasis presents as a knotted and choppy pulse; rapid pulse indicates intense fire pathogen; large and deficient pulse indicates extreme chronic depletion. Initially regulate qi and phlegm, then treat according to symptoms and pulse.
Vertigo refers to the sensation of darkness and rotation, manifesting as closed eyes with dim vision, body spinning, deafness, feeling as if standing on a boat or cart, and wanting to fall when rising. This is generally caused by extreme deficiency combined with cold invasion, but treatment should not be restricted to a single approach.
Generally speaking, head vertigo is due to phlegm.
Qingyun Huatan Decoction (Clear Dizziness and Resolve Phlegm Decoction): Treats head and eye vertigo.
Chenpi (Exocarpium Citri Reticulatae, white part removed), Banxia (Rhizoma Pinelliae Preparatum with ginger juice), Fuling (Poria, peel removed, each 1.5 qian), Gancao (Radix Glycyrrhizae, 0.3 qian), Chuanxiong (Rhizoma Chuanxiong, 0.8 qian), Baizhi (Radix Angelicae Dahuricae), Qianghuo (Rhizoma et Radix Notopterygii, each 0.7 qian), Zhishi (Fructus Aurantii Immaturus, bran-fried, 1 qian), Nanxing (Rhizoma Arisaematis Preparatum with ginger juice), Fangfeng (Radix Saposhnikoviae), Xixin (Herba Asari, each 0.6 qian), Huangqin (Radix Scutellariae Preparatum with wine, 0.8 qian). If qi deficiency, add Renshen (Radix Ginseng) 0.7 qian, Baizhu (Rhizoma Atractylodis Macrocephalae); if heat, add Huanglian (Rhizoma Coptidis) 0.6 qian; if blood deficiency, add Chuanxiong and Danggui (Radix Angelicae Sinensis) each 1 qian. Crush these herbs for one dose. Add three slices of Shengjiang (Rhizoma Zingiberis Recens), decoct in water, and take warm. Making this into pills is also acceptable.
Head vertigo in obese individuals belongs to qi deficiency with damp-phlegm.
Sijunzi Tang (Four Gentlemen Decoction) Modified: Treats head vertigo due to qi deficiency and damp-phlegm.
Renshen (Radix Ginseng, radix tip removed), Baizhu (Rhizoma Atractylodis Macrocephalae, radix tip removed), Fuling (Poria, peel removed), Huangqi (Radix Astragali Preparatum with honey), Chuanxiong (Rhizoma Chuanxiong), Chenpi (Exocarpium Citri Reticulatae), Banxia (Rhizoma Pinelliae Preparatum with ginger), Tianma (Rhizoma Gastrodiae), Jiegeng (Radix Platycodonis, radix tip removed), Baizhi (Radix Angelicae Dahuricae), Danggui (Radix Angelicae Sinensis, equal parts), Gancao (Radix Glycyrrhizae, half dose).
Crush these herbs for one dose. Add three slices of Shengjiang (Rhizoma Zingiberis Recens) and one date, decoct in water, and take warm.
Head vertigo in thin individuals belongs to blood deficiency with phlegm-fire.
Siwu Tang (Four Substances Decoction) Modified: Treats head vertigo due to blood deficiency and phlegm-fire.
Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Baishao (Radix Paeoniae Alba Preparatum with wine), Shudihuang (Radix Rehmanniae Preparata), Renshen (Radix Ginseng, half dose), Chenpi (Exocarpium Citri Reticulatae), Pianqing (Radix Scutellariae), Shanzhi (Fructus Gardeniae), Fuling (Poria, peel removed), Tianma (Rhizoma Gastrodiae, equal parts), Gancao (Radix Glycyrrhizae, half dose).
Crush these herbs for one dose. Add three slices of Shengjiang (Rhizoma Zingiberis Recens) and one date, decoct in water, and take warm.
Sudden onset of vertigo leading to collapse is due to wind-phlegm, with a floating and slippery pulse.
Erchen Tang (Two-Aged Decoction) Modified:
Fuling (Poria), Chenpi (Exocarpium Citri Reticulatae), Qianghuo (Rhizoma et Radix Notopterygii), Fangfeng (Radix Saposhnikoviae), Renshen (Radix Ginseng), Danggui (Radix Angelicae Sinensis), Baizhu (Rhizoma Atractylodis Macrocephalae, radix tip removed), Zhishi (Fructus Aurantii Immaturus, bran-fried), Nanxing (Rhizoma Arisaematis Preparatum with ginger), Chuanxiong (Rhizoma Chuanxiong), Jiegeng (Radix Platycodonis), Gualouren (Semen Benincasae, equal parts), Gancao (Radix Glycyrrhizae, small amount).
Crush these herbs for one dose. Decoct in water, add Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis汁), and take together.
Individuals engaged in physical labor who experience vertigo due to hunger and cold have a weak and deficient pulse. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) Modified (see Internal Injury chapter). Add Banxia (Rhizoma Pinelliae), Shudihuang (Radix Rehmanniae Preparata), Baishao (Radix Paeoniae Alba), and Tianma (Rhizoma Gastrodiae) to this formula.
Vertigo caused by yin deficiency with hyperactive fire presents with a rapid pulse. Use Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction) Modified (see Deficiency Consumption chapter). Add Chuanxiong (Rhizoma Chuanxiong), Tianma (Rhizoma Gastrodiae), Shanzhi (Fructus Gardeniae), and a small amount of Zhuli (Bambusae Caulis in Taenia) to this formula.
Extreme weakness with a desire to collapse, feeling like sitting on a boat or cart, with cold hands and feet, presents with a deep and fine pulse.
Shenfu Tang (Ginseng and Aconite Decoction): Treats true yang deficiency accompanied by panting, shortness of breath, spontaneous sweating, and vertigo.
Renshen (Radix Ginseng, 5 qian), Dafuzi (Radix Aconiti Lateralis Preparata, processed, 3 qian).
Crush these herbs for one dose. Add ten slices of Shengjiang (Rhizoma Zingiberis Recens), decoct in water, and take warm.
If severe diarrhea is accompanied by vertigo and frequent sensations of head blackout, it is difficult to treat. Head spinning and blackened vision, as if in wind and clouds, are caused by stomach qi deficiency and stagnant phlegm. Use Banxia Baizhu Tianma Tang (Pinellia, Atractylodes, and Gastrodia Decoction) (see Headache chapter).
Blurred vision and vertigo are caused by wind-heat attacking upward. Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) treats wind-heat attacking upward, causing blurred vision, vertigo, oppressive pain, phlegm, wheezing, and cough. Remove Mahuang (Herba Ephedrae) and Mangxiao (Natrii Sulfas) from this formula, and add Juhua (Flos Chrysanthemi), Renshen (Radix Ginseng), Sharen (Fructus Amomi Rotundus), and Hanshuishi (Halloysitum Rubrum) (see Stroke Upper Treatment chapter).
Mental unrest during activities, with vertigo and epigastric discomfort, indicates heart and spleen deficiency and timidity.
Ziyin Jianpi Tang (Nourish Yin and Strengthen Spleen Decoction): This is an excellent prescription for treating vertigo caused by qi and blood deficiency with phlegm.
Danggui (Radix Angelicae Sinensis, washed with wine, 1 qian), Chuanxiong (Rhizoma Chuanxiong, 0.5 qian), Baishao (Radix Paeoniae Alba), Shengdihuang (Radix Rehmanniae Fresh Preparata, washed with wine, 0.8 qian), Renshen (Radix Ginseng, 0.7 qian), Baizhu (Rhizoma Atractylodis Macrocephalae, 1.5 qian), Bai Fuling (Poria, peel removed, 1 qian), Chenpi (Exocarpium Citri Reticulatae, washed with salt water, white part removed, 1 qian), Banxia (Rhizoma Pinelliae Preparatum with ginger), Bai Fushen (Poria with Hostwood, wood removed), Maidong (Radix Ophiopogonis, heart removed), Yuanzhi (Radix Polygalae, heart removed, each 0.7 qian), Gancao (Radix Glycyrrhizae, roasted, 0.4 qian).
Crush these herbs for one dose. Decoct with ginger and dates in water, take morning and evening.
Grand Secretary Gao Gong (courtesy name Zhongxuan) suffered from head and eye vertigo, tinnitus, blackened vision as if in wind and clouds, and flowing fire in the eyes. One physician used clearing fire and resolving phlegm methods, another used nourishing qi and blood methods, both without effect. I palpated his six pulses as surging and rapid, diagnosing fire agitation generating phlegm. I administered three qian of Da Huang (Radix et Rhizoma Rhei) powder steamed with wine, taken with tea. He was cured after one dose. This is because when fire descends, phlegm naturally dissipates.
Official Xiong Huai'er, over sixty years old, had a large and fat body. I palpated his pulse and immediately felt a pause every five beats (intermittent pulse). I exclaimed in surprise, "Sir, you may perish!" He said, "I have only felt slightly dizzy these past few days, with no other discomfort. Why do you say this? Please teach me truthfully." I replied, "Use medicine for ten more days, and we shall smile at each other before parting." Shortly after, he suddenly suffered from wind-phlegm syncope and sought my help. Seeing that he was incurable, I ordered sesame oil to be poured into him, and he woke up. Over ten days later, he indeed passed away.