论
《内经》曰∶诸风掉眩，皆属肝木。又曰∶岁木太过，风气流行，脾土受邪，民病飧泄食减，甚则忽忽善怒，眩冒
巅疾。虽为气化之所使然，未必不由气体之虚衰耳。其为气虚肥白之人，湿痰滞于上，阴火起于下，是以痰挟虚火，上
冲头目，正气不能胜敌，故忽然眼黑生花，若坐舟车而旋运也，甚而至于卒倒无所知者有之，丹溪所谓无痰不能作眩者，
正谓此也。若夫黑瘦之人，躯体薄弱，真水亏欠，或劳役过度，相火上炎，亦有时时眩运，何湿痰之有哉。大抵人肥白
而作眩者，治宜清痰降火为先，而兼补气之药。人黑瘦而作眩者，治宜滋阴降火为要，而带抑肝之剂。抑考《内经》有
曰∶风胜则地动。风木太过之岁，亦有因其气化而为外感风邪而眩者，治法宜祛风顺气，伐肝降火，为良策焉。外有因
呕血而眩冒者，胸中有死血迷闭心窍而然，是宜行血清心自安。医者宜各类推而治之，无有不痊者也。
脉法
左手脉数，热多。脉涩而芤，有死血。右手脉实，有痰积。脉虚大，必是久病。
左手人迎脉，缓而浮大者，属风。
方法
丹溪曰∶痰在上，火在下，火炎上而动其痰也。此证属痰者多，盖无痰不能作眩也。虽有因风者，亦必有痰。又曰∶
火动其痰，二陈汤加黄芩、苍术、羌活。挟气虚者，亦以治痰为主，兼补气降火药。
去血过多而眩运者，芎归汤。
眩运不可当者，以大黄酒炒为末，茶清调下。（急则治其标也）。
（以上丹溪方法凡三条）
防风通圣散（河间） 治风热眩运。（方见中风门。）
半夏白术天麻汤（东垣） 治风痰眩运。（方见头痛门。）
加味六君子汤（丹溪） 治气虚痰盛，兼挟风邪，眩运不休者。
陈皮（去白，一钱） 半夏（汤泡透，一钱五分） 茯苓（一钱） 甘草（炙，五分） 荆芥穗（五分）
上细切，作一服，加生姜三片，大枣二枚，水二盏，煎至一盏，去渣，入竹沥一大匙，温服。
六合汤（良方） 治风虚眩运。
四物汤加秦艽、羌活为佐，水煎服之。
玉液汤（严氏方）治七情感动，气郁生涎，随气上冲，头目眩运，心嘈忪悸，眉梭骨痛。
大半夏（汤泡七次，去皮脐）
上以一味薄切成片，每服四钱，加生姜十片煎，入沉香磨水一呷服，大效。
芎术汤（严氏方）治冒雨中湿，眩运呕逆，头痛不食等证。
川芎 半夏（泡透） 白术（各一钱二分） 甘草（炙，六分）
上细切，作一服，加生姜七片，水一盏半，煎至一盏，温服。
川芎散（本事方）治风眩运。
山茱萸（一两，去核） 山药 甘菊花 人参 茯神 小芎 （各五钱）
上为细末，每服二钱，温酒调下。
（丹溪活套）云∶眩运者，中风之渐也。如肥白人，气虚而挟痰者，四君子汤倍蜜炙黄 ，加半夏、橘红，或少加
川芎、荆芥穗，以清利头目也。如痰盛而挟气虚者，二陈汤加人参、白术、黄 ，或少加炮附子煎，入竹沥、姜汁服。
如体瘦血虚而痰火兼盛者，二陈汤合四物，加片芩、薄荷煎，入竹沥、姜汁、童便服。如诸般眩运，挟风则加防风、荆
芥、天麻、秦艽等药，挟热加片芩、黄连、栀子之类，挟寒加干姜、官桂、附子之属，无有不安者也。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All wind-induced tremors and dizziness belong to Liver Wood." It further states: "In years when the Wood Qi is excessive, Wind Qi prevails, pathogenic factors invade Spleen Earth, and the people suffer from undigested diarrhea in their stools and reduced appetite. In severe cases, they experience mental confusion, irritability, vertigo, and diseases of the vertex." Although this is caused by the movement of cosmic Qi, it is not necessarily unrelated to the deficiency and decline of the individual's constitution. For individuals who are Qi-deficient and have a fat, white complexion, damp-phlegm stagnates in the upper jiao, while Yin Fire arises in the lower jiao. Consequently, phlegm carries deficient fire upward to rush against the head and eyes. The righteous Qi cannot overcome the pathogen, resulting in sudden blackouts, visual hallucinations (seeing spots), and a sensation of spinning as if riding in a boat or carriage. In severe cases, there may be sudden collapse with loss of consciousness. This is precisely what Zhu Danxi meant by "without phlegm, there can be no vertigo." As for individuals who are dark-skinned and thin, with a frail physique and deficiency of True Water (Kidney Yin), or those who suffer from overwork causing Ministerial Fire (Minister Fire) to flare upward, they also occasionally experience vertigo. Where is the damp-phlegm in such cases? Generally, for those with a fat, white complexion suffering from vertigo, treatment should prioritize clearing phlegm and descending fire, while simultaneously using Qi-tonifying herbs. For those with a dark, thin complexion suffering from vertigo, treatment should focus on nourishing Yin and descending fire, combined with herbs that subdue the Liver. Furthermore, examining the *Neijing*, it says: "When Wind is excessive, the earth shakes." In years of excessive Wood/Wind Qi, there are cases where vertigo is caused by external Wind pathogen invasion due to cosmic influences; the appropriate treatment method is to dispel Wind, regulate Qi, and purge the Liver while descending fire, which is an excellent strategy. Additionally, there are cases of vertigo and dizziness caused by vomiting blood, resulting from dead blood (blood stasis) obstructing the Heart orifices in the chest; these should be treated by promoting blood circulation and clearing the Heart to restore tranquility. Physicians should deduce and treat according to each category, and there will be no case that does not heal.
Pulse Diagnosis
If the pulse at the Left hand is rapid (Shu), it indicates excess Heat. If the pulse is choppy (Se) and hollow (Kou), it indicates the presence of blood stasis. If the pulse at the Right hand is full/excess (Shi), it indicates phlegm accumulation. If the pulse is empty and large (Xu Da), it must be a chronic disease.
If the Renying pulse at the Left hand is slow (Huan) and floating and large (Fu Da), it belongs to Wind.
Methods
Zhu Danxi said: "Phlegm is in the upper part, Fire is in the lower part; the flaming Fire agitates the Phlegm." Most cases of this syndrome involve phlegm, essentially because without phlegm, vertigo cannot occur. Even if caused by Wind, there must be phlegm involved. He also stated: "When Fire agitates Phlegm, use Er Chen Tang (Two-Cured Decoction) added with Huang Qin (Scutellaria Root), Cang Zhu (Atractylodes Rhizome), and Qiang Huo (Notopterygium Rhizome)." If accompanied by Qi deficiency, the primary treatment remains resolving phlegm, supplemented by Qi-tonifying and Fire-descending herbs.
For vertigo caused by excessive blood loss, use Xiong Gui Tang (Ligusticum and Angelica Decoction).
For unbearable, severe vertigo, use Da Huang (Rhubarb Rhizome) stir-fried with wine, ground into powder, and taken with tea infusion. (This addresses the branch/symptom in acute situations).
(Above are three methods from Zhu Danxi)
Fang Feng Tong Sheng San (Wind-Dispersing Universal Relief Powder, Liu Hejian's formula) treats vertigo caused by Wind-Heat. (Formula see Stroke Section.)
Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes, and Gastrodia Decoction, Li Dongyuan's formula) treats vertigo caused by Wind-Phlegm. (Formula see Headache Section.)
Jia Wei Liu Jun Zi Tang (Modified Six Gentlemen Decoction, Zhu Danxi's formula) treats Qi deficiency with abundant phlegm, complicated by Wind pathogen, resulting in incessant vertigo.
Chen Pi (Tangerine Peel, white part removed, 1 qian) Ban Xia (Pinellia Tuber, soaked in boiling water until soft, 1.5 qian) Fu Ling (Poria, 1 qian) Gan Cao (Licorice Root, honey-fried, 0.5 qian) Jing Jie Sui (Schizonepeta Spike, 0.5 qian)
Cut finely, prepare as one dose. Add three slices of Sheng Jiang (Fresh Ginger) and two dates (Da Zao). Add two cups of water, decoct until one cup remains. Strain, add one large spoonful of Zhu Li (Bamboo Sap), and take warm.
Liu He Tang (Six-Harmony Decoction, from *Liang Fang*) treats vertigo caused by Wind-Deficiency.
Si Wu Tang (Four Substances Decoction) added with Qin Jiao (Gentiana Macrophylla Root) and Qiang Huo (Notopterygium Rhizome) as assistants, decocted in water and taken.
Yu Ye Tang (Jade Fluid Decoction, Yan Yonghe's formula) treats agitation of the Seven Emotions, Qi stagnation generating saliva/phlegm, rising with Qi to cause head/eye vertigo, heart palpitations with a gnawing sensation (Xin Cao Song Ji), and pain in the supraorbital ridge.
Ban Xia (Pinellia Tuber, soaked seven times in boiling water, skin and umbilicus removed)
Slice thinly. Each dose uses four qian. Add ten slices of Sheng Jiang (Fresh Ginger) and decoct. Take with a sip of water infused with Chen Xiang (Aquilaria Wood). Highly effective.
Xiong Shu Tang (Ligusticum and Atractylodes Decoction, Yan Yonghe's formula) treats vertigo, vomiting, and regurgitation, headache, and inability to eat due to exposure to rain and dampness.
Chuan Xiong (Sichuan Lovage Rhizome) Ban Xia (Pinellia Tuber, soaked thoroughly) Bai Zhu (Atractylodes Macrocephala Rhizome, 1.2 qian each) Gan Cao (Licorice Root, honey-fried, 0.6 qian)
Cut finely, prepare as one dose. Add seven slices of Sheng Jiang (Fresh Ginger) and one and a half cups of water. Decoct until one cup remains. Take warm.
Chuan Xiong San (Ligusticum Powder, from *Ben Shi Fang*) treats Wind-induced vertigo.
Shan Zhu Yu (Cornus Fruit, 1 liang, pitted) Shan Yao (Dioscorea Rhizome) Gan Ju Hua (Chrysanthemum Flower) Ren Shen (Ginseng Root) Fu Shen (Poria with Hostwood) Xiao Xiong (Minor Ligusticum Rhizome, 5 qian each)
Grind into fine powder. Each dose takes two qian, mixed with warm wine and taken.
(Zhu Danxi's Flexible Methods) states: "Vertigo is the precursor to stroke." For fat individuals with Qi deficiency and phlegm, use Si Jun Zi Tang (Four Gentlemen Decoction) with doubled Mi Zhi Huang Qi (Honey-fried Astragalus Root), added with Ban Xia (Pinellia Tuber) and Ju Hong (Tangerine Red Peel), or a small amount of Chuan Xiong (Sichuan Lovage Rhizome) and Jing Jie Sui (Schizonepeta Spike) to clear and benefit the head and eyes. For cases with abundant phlegm and Qi deficiency, use Er Chen Tang (Two-Cured Decoction) added with Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), and Huang Qi (Astragalus Root), or a small amount of Pao Fu Zi (Prepared Aconite Lateral Root) decocted, then added with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice) before taking. For thin individuals with Blood deficiency and concurrent excess Phlegm-Fire, combine Er Chen Tang (Two-Cured Decoction) with Si Wu Tang (Four Substances Decoction), add Pian Huang Qin (Scutellaria Root) and Bo He (Mint Leaf), decoct, and add Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice), and Tong Bian (Child's Urine) before taking. For various types of vertigo: if complicated by Wind, add Fang Feng (Siler Root), Jing Jie (Schizonepeta), Tian Ma (Gastrodia Rhizome), Qin Jiao (Gentiana Macrophylla Root); if complicated by Heat, add Pian Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Zhi Zi (Gardenia Fruit); if complicated by Cold, add Gan Jiang (Dried Ginger), Guan Gui (Cinnamon Bark), Fu Zi (Aconite Lateral Root). There will be no case that does not stabilize.