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Whenever a patient with Shanghan (Cold Damage) presents with dizziness (Xuan, vertigo/dizziness), it is invariably caused by the deficiency of Yuan Qi (Original Qi) in the Upper Jiao (Upper Burner) resulting from sweating, vomiting, or purging. "Xuan" refers to the eyes losing their normal focus; "Tou Xuan" (head dizziness) is commonly known as spinning sensation and blurred vision; "Xuan Mao" refers to a state of drowsy confusion. In Shaoyang disease, bitter taste in the mouth, dry throat, and dizziness occur because the Shaoyang channel resides between the exterior and interior; as pathogenic factors gradually move from the exterior into the interior, the Yang Qi between the exterior and interior becomes deficient, leading to visual dizziness. When Taiyang and Shaoyang diseases occur simultaneously (Bing Bing) and present with dizziness, the cause is attributed to deficiency. In Shanghan, dizziness upon rising or drowsy confusion are all consequences of prior sweating, vomiting, or purging, indicating Yang Qi deficiency. Thus, the *Zhen Jing* (Classic of Acupuncture) states: Deficiency in the upper part causes dizziness; deficiency in the lower part causes Jue (cold extremities/reversal). Although dizziness is generally a sign of deficiency, in Yangming wind-strike, if there is only head dizziness without aversion to cold, this is because Wind pathogens primarily cause dizziness. These conditions are not adverse prognostic signs. However, when various mis-treatments lead to forced sweating, resulting in confused speech and dizziness, death ensues. Alas! Once the disease process has established itself, half recovery may still be possible; but if the condition is already critical, even a divine physician cannot help.

In Taiyang Shanghan, if vomiting or purging is used first, followed by symptoms of fullness and rebellious Qi in the epigastrium (Xin Xia Ni Man), Qi rushing up to the chest, dizziness upon rising, and a deep, tight pulse; if sweating is then induced, it disturbs the collaterals, causing the body to tremble and shake. This should be treated with Fuling Guizhi Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractodes Macrocephala, and Licorice Decoction). (Note: After vomiting and purging, the interior is deficient, causing rebellious Qi and fullness in the epigastrium, with Qi rushing to the chest. Exterior deficiency and insufficient Yang Qi cause dizziness upon rising. A floating, tight pulse indicates exterior pathogen, warranting sweating; a deep, tight pulse indicates interior pathogen, contraindicating sweating. Misguided sweating moves the exterior collaterals, damaging Yang Qi, which fails to govern the vessels, causing bodily tremors. This decoction harmonizes the collaterals and benefits Yang.) If Zhenwu Tang (True Warrior Decoction) is used. (Note: After sweating, if sweating does not stop, this formula is used to consolidate the Cou Li (pores/skin texture), though it failed to stop the sweating.)

After Shanghan is treated with vomiting, purging, and then sweating, leading to empty irritability (Xu Fan) and a very faint pulse; after eight or nine days, symptoms include hardness and fullness in the epigastrium, pain under the ribs, Qi rushing up to the throat, dizziness and confusion, and twitching of the meridians. If prolonged, this develops into Wei syndrome (flaccidity/atrophy). (Note: Vomiting, purging, and subsequent sweating deplete both exterior and interior Qi. Empty irritability and faint pulse indicate internal deficiency of righteous Qi, leaving pathogenic Qi alone. By the seventh or eighth day, righteous Qi should recover and pathogenic Qi should dissipate. Persistent epigastric fullness, rib-side distension, Qi rushing to the throat, and dizziness indicate that righteous Qi has not recovered while pathogenic Qi remains. Twitching of meridians indicates extreme deficiency of Qi in the channels; over time, heat returns to the channels, inevitably forming flaccidity. Zhenwu Tang or Fuling Guizhi Baizhu Gancao Tang may be used.)

When Taiyang and Shaoyang diseases occur simultaneously, presenting with hardness in the epigastrium, stiffness in the neck and occiput, and dizziness, acupuncture at Dazhui (GV14) and Feishu (BL13) is indicated, and purgation is forbidden.

When Taiyang and Shaoyang diseases occur simultaneously, presenting with stiffness and pain in the head and neck, dizziness and confusion, and sometimes epigastric fullness resembling Jie Xiong (Chest Binding), acupuncture at the first interspace of Dazhui (GV14), Feishu (BL13), and Ganshu (BL18) is indicated, and sweating is forbidden. If sweating is induced, it leads to delirium (Chan Yu) and a wiry pulse. If delirium persists for five or six days, Qimen (LR14) should be needled.

In Yangming disease, a slow pulse, inability to eat until full, mild irritability and dizziness after eating, difficulty urinating, and impending Gu Dan (Grass Jaundice) require purgation. However, if abdominal fullness persists, it is due to the slow pulse. (See previous Yangming disease section.) In Yangming disease, if there is only head dizziness without aversion to cold, the patient can eat and cough, and will necessarily have a sore throat; if there is no cough, the throat will not hurt. (Note: Yangming disease with body heaviness absent, only head dizziness and no aversion to cold, indicates Yangming wind-strike with internal attack by Wind. The classic states: In Yangming disease, if the patient can eat, it is called wind-strike. Wind pathogen attacks the Stomach, causing rebellious Stomach Qi and cough. The throat is connected to the Stomach; severe cough damages the throat, causing pain. If Stomach Qi does not rebel, there is no cough and no throat pain.) Si Ni San (Frigid Extremities Powder) with Jiegeng (Platycodon) or Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be used. This is wind-strike of this channel, not Shanghan; Xiao Cheng Qi Tang (Minor Order the Qi Decoction) is also an option.

Shaoyang disease manifests as bitter taste in the mouth, dry throat, and dizziness. (Xiao Chai Hu Tang with Tianma and Chuanxiong may be added.)

In Shaoyin disease, if diarrhea stops but dizziness occurs, accompanied by periodic fainting/confusion, death ensues. (Note: Diarrhea exhausts water and grain essence; dizziness and confusion indicate the depletion of Yang Qi, hence death.)

If Dong Qi (Pulsatile Qi) is on the left, mistaken sweating causes dizziness and incessant sweating, with muscle twitching. (For formula discussion, see Dong Qi section; *Huo Ren Shu* suggests Xiao Jian Zhong Tang.) For various mis-treatments where mistaken sweating leads to confused speech and dizziness, death ensues. (Discussion seen in Delirium section.)

Wu's perspective: In Taiyang wind-strike, if dizziness and head shaking occur with a floating, wiry, and rapid pulse, use Qiang Huo Shen Shu Tang with Fangfeng and Tianma. If dizziness is due to Blood deficiency, use Si Wu Tang with Renshen and Tianma. If Phlegm-Fire attacks upward, add Jiuhuang Qin (Alcohol-fried Scutellaria) and Zhuli (Bamboo Sap). If dizziness is due to internal injury from labor and fatigue with Yin deficiency, Bu Zhong Yi Qi Tang with Chuanxiong, Tianma, Fangfeng, and Manjingzi is appropriate. If Yuan Qi of the Lower Jiao is depleted, Renshen Yang Rong Tang or Da Jian Zhong Tang with Tianma is suitable. I once treated a woman who took three doses of Huoxiang Zhengqi San, causing excessive sweating, leading to dizziness, body shaking, fever, and a deficient-rapid pulse. I used Renshen Yang Rong Tang, doubling Renshen as the main herb, adding Tianma, and a small amount of Jiuhuang Bo (Alcohol-fried Phellodendron). Two doses resulted in recovery. Yilao (Zhang Yuansu) stated: For spinning head and blackened vision, only Tianma can remove it, so it is added; a small amount of Huangbo is added to nourish Kidney Water.