脉
风寒暑湿，气郁生涎，上实下虚，皆晕而眩。风浮寒紧，湿细暑虚，涎弦而滑，虚脉则无。治眩晕法，尤
当审谛。先理痰气，次随症治。又曰∶左手脉数热多，脉涩有死血；右手脉实有痰积，脉大是久病。
证
夫眩者言其黑，晕者言其转。其状目闭眼暗，身转耳聋，如立舟车之上，起则欲倒，皆属于肝风邪上
攻所致。然体虚之人，外感六淫，内伤七情，皆能眩晕，当以脉症别之。风则脉浮有汗，项强不仁；寒则脉
紧无汗，筋挛制痛；暑则脉虚烦闷；湿则脉沉细重吐逆。及七情所感，遂使脏气不和，郁而生涎，结而为饮，
随气上逆，令人眩晕，眉棱骨痛，眼不可开，寸脉多沉，此为异耳。若疲劳过度，下虚上实，金枪吐衄，
及妇人崩伤产后，去血过多，皆令人眩晕，当随其所因而治之。
眩晕之症，人皆称为上盛下虚所致，而不明言其所以然之故。盖所谓虚者，血与气也；所谓实者，痰
涎风火也。原病之由，有气虚者，乃清气不能上升，或汗多亡阳而致，当升阳补气；有血虚者，乃因亡血过
多，阳无所附而然，当益阴补血。此皆不足之症也。有因痰涎郁遏者，宜开痰道郁，重则吐下；有因风火所动
者，宜清上降火；若因外感而得者，前论须分四气之异，皆当散邪为主。此
皆有余之症也。世有所谓气不归元，而为丹药镇坠，沉香降气之法。盖香窜之气，丹药助火，其不归元之气，
岂能因此而复？即《内经》所谓治病必求其本。气之不归，求其本，用药则善矣。
治
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。
人因忧思劳苦，发作眩晕，眼暗耳鸣，面赤口干，发热气喘，
有汗不食，六脉洪数，用十全大补汤，去桂，加生地黄、姜炒黄连麦门冬、五味子、陈皮，酒炒黄柏、知母。
方
清晕化痰汤（云林制）
橘红（一钱五分） 半复（制，一钱半） 白茯苓（一钱） 甘草（三分） 川芎（八分）
白芷（七分） 羌活（七分） 枳实（麸炒，一钱） 南星（制，六分） 防风（六分） 细辛（六
分） 黄芩（酒炒，八分） 气虚加人参（七分） 白术（一钱） 有热加黄连（六分） 血
虚倍川芎加当归（一钱五分）
上锉一剂，生姜三片，水煎。以此作丸亦可。
黑将军散（秘方）〔批〕（按此方治痰火眩晕之剂） 治因痰火太盛，眩晕难当。
用大黄酒炒为末，清茶调下。或用大黄酒浸，九蒸九晒为末，水丸如绿豆大。每服百丸，食后临卧清茶送下，神效。
仙术通神散 治风热上壅，头旋目眩，起则欲倒，即防风通圣散去麻黄、芒硝，加藿香、砂仁、
甘菊花、苍术。如风热上攻，头目昏眩闷痛，痰喘咳嗽，根据本方去麻黄、芒硝，加甘菊花、人参、砂仁、寒水石。
半夏白术天麻汤〔批〕（按此方治气虚痰厥眩晕之剂） 治头旋眼黑，恶心烦闷，气促上喘，心神
颠倒，目不敢开，头痛如裂，身重如山，四肢厥冷，不能安睡。此乃胃气虚损停痰所致。
半夏（制，一钱半） 白术（炒，二钱） 天麻（一钱半）
上锉一剂，生姜三片，水二钟，煎八分，食后温服。
芎归汤〔批〕（按此方治血虚眩晕之剂） 治血虚眩晕，或去血过多之后眩冒。
川芎（二钱五分） 当归（二钱五分）
上锉一剂，水二盏，煎至八分，空心温服。
Pulse Diagnosis:
Wind, cold, summerheat, and dampness; qi stagnation generating phlegm-fluids; excess in the upper and deficiency in the lower—these all cause dizziness and vertigo. Wind presents with a floating pulse, cold with a tight pulse, dampness with a fine pulse, summerheat with a deficient pulse, phlegm-fluids with a wiry and slippery pulse, while deficiency presents with a forceless pulse. The method for treating vertigo requires careful examination. First regulate phlegm and qi, then treat according to symptoms. It is also said: A rapid pulse on the left hand indicates excessive heat; a choppy pulse indicates fixed blood (blood stasis); an excess pulse on the right hand indicates phlegm accumulation; a large pulse indicates chronic disease.
Symptoms:
"Xuan" (vertigo/dazzling) refers to darkness before the eyes, while "Yun" (dizziness/whirling) refers to a sensation of rotation. The condition manifests as closed eyes with dim vision, a sensation of body rotation, deafness, feeling as if standing on a moving boat or carriage, and a desire to fall when rising. All these belong to attacks by Liver wind pathogen ascending. However, individuals with weak constitutions can experience vertigo due to external contraction of the Six Excesses (wind, cold, summerheat, dampness, dryness, fire) or internal injury from the Seven Emotions (joy, anger, worry, thought, sadness, fear, fright). One must distinguish them by pulse and symptoms. Contraction of wind leads to a floating pulse with sweating and stiffness/numbness in the nape; contraction of cold leads to a tight pulse without sweating and muscle spasms with pain; contraction of summerheat leads to a deficient pulse with vexation and stuffiness; contraction of dampness leads to a deep, fine pulse with heaviness, vomiting, and regurgitation. As for influences from the Seven Emotions causing disharmony of Zang-Fu Qi, leading to stagnation and generation of phlegm-fluids, which congeal into fluid retention and ascend with Qi, causing vertigo, pain in the supraorbital ridge, and inability to open the eyes, the Cun position pulse is often deep; this is a special case. Overfatigue, resulting in deficiency below and excess above; injuries from metal weapons with bleeding; epistaxis or hematemesis; and women suffering from metrorrhagia, trauma, or postpartum conditions with excessive blood loss—all cause vertigo. Treatment should follow the specific etiology.
Regarding vertigo, people generally attribute it to excess in the upper and deficiency in the lower but fail to explain the underlying reasons. What is referred to as "deficiency" involves Blood and Qi; what is referred to as "excess" involves phlegm-fluids, wind, and fire. Investigating the origin of the disease: In cases of Qi deficiency, clear Yang fails to ascend, or excessive sweating causes loss of Yang, requiring raising Yang and tonifying Qi. In cases of Blood deficiency, excessive blood loss leaves Yang without attachment, requiring nourishing Yin and tonifying Blood. These are all Deficiency syndromes. In cases of phlegm-fluid stagnation, one should open the obstruction of phlegm; in severe cases, use emesis or purgation. In cases stirred by wind and fire, clear the Upper Jiao and descend fire. If caused by external pathogens, as discussed previously, differentiate among the four Qi (wind, cold, summerheat, dampness), primarily focusing on dispersing pathogens. These are all Excess syndromes. There is a worldly notion of "Qi failing to return to its root," treated with mineral pills to suppress and aromatic herbs like Aquilaria wood to direct Qi downward. However, the penetrating nature of aromatics and the heating nature of mineral pills cannot restore Qi that has failed to return to its root. This aligns with the *Neijing* principle: "In treating disease, one must seek the root." For Qi failing to return, seeking the root and using appropriate medication is effective.
Treatment Methods:
Zhu Danxi stated: Phlegm is in the Upper, Fire is in the Lower; Fire flares upward and agitates the phlegm. Most cases of this syndrome involve phlegm, for without phlegm, vertigo cannot occur. Even if caused by wind, there must be phlegm present. He further stated that when fire agitates phlegm, use Erchen Tang (Two-Aged Decoction) added with Huangqin (Scutellaria Root), Cangzhu (Atractylodes Rhizome), and Qianghuo (Notopterygium Rhizome). If accompanied by Qi deficiency, treat phlegm as the primary focus, adding herbs to tonify Qi and descend fire.
For individuals experiencing vertigo due to worry, thought, and overwork, manifesting as dim vision, tinnitus, red face, dry mouth, fever, panting, sweating, anorexia, and a flooding and rapid pulse in all six positions, use Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction), removing Guizhi (Cinnamon Twig), and adding Shengdi Huang (Rehmannia Root), Huanglian (Coptis Rhizome) stir-fried with ginger, Maimendong (Ophiopogon Tuber), Wuweizi (Schisandra Fruit), Chenpi (Tangerine Peel), Huangbai (Phellodendron Bark) wine-fried, and Zhimu (Anemarrhena Rhizome).
Formulas:
Qingyun Huatan Tang (Cloud Forest Formula for Clearing Vertigo and Resolving Phlegm) [Prepared by Yunlin]
Juhong (Citrus Reticulatae Pericarpium, 1.5 qian) Banxia (Pinelliae Rhizoma, processed, 1.5 qian) Baifuling (Poria, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 0.3 qian) Chuanxiong (Ligustici Chuanxiong Rhizoma, 0.8 qian)
Baizhi (Angelicae Dahuricae Radix, 0.7 qian) Qianghuo (Notopterygii Rhizoma et Radix, 0.7 qian) Zhishi (Aurantii Fructus Immaturus, bran-fried, 1 qian) Nanting (Arisaematis Rhizoma, processed, 0.6 qian) Fangfeng (Saposhnikoviae Radix, 0.6 qian) Xixin (Asari Radix et Rhizoma, 0.6 qian) Huangqin (Scutellariae Radix, wine-fried, 0.8 qian)
For Qi deficiency, add Renshen (Ginseng Radix et Rhizoma, 0.7 qian) and Baizhu (Atractylodis Macrocephalae Rhizoma, 1 qian). For Heat, add Huanglian (Coptidis Rhizoma, 0.6 qian). For Blood deficiency, double Chuanxiong and add Danggui (Angelicae Sinensis Radix, 1.5 qian).
Decoct one dose with three slices of fresh ginger in water. This may also be made into pills.
Hei Jiangjun San (Black General Powder) [Secret Recipe] [Commentary: This formula treats vertigo caused by phlegm-fire.]
Treats vertigo that is unbearable due to excessive phlegm-fire.
Use Dahuang (Rhei Radix et Rhizoma) fried with wine, ground into powder, taken with clear tea. Alternatively, soak Dahuang in yellow wine, steam and sun-dry nine times, grind into powder, and form water pills the size of mung beans. Take 100 pills after meals and before bed, delivered with clear tea. Miraculous effect.
Xianshu Tongshen San (Immortal Efficacy Spirit-Connecting Powder)
Treats wind-heat congestion in the upper body, causing head spinning and visual vertigo, with a desire to fall upon rising. This is Fangfeng Tongsheng San (Wind-Protecting Universal Rescue Powder) minus Mahuang (Ephedrae Herba) and Mangxiao (Natrii Sulfas), plus Huoxiang (Agastaches Herba), Sharen (Amomi Fructus), Ganjuhua (Chrysanthemi Flos), and Cangzhu (Atractylodis Rhizoma). If wind-heat attacks the upper body causing dizziness, visual vertigo, stifling pain, phlegm-panting, and cough, follow this base formula minus Mahuang and Mangxiao, adding Ganjuhua (Chrysanthemi Flos), Renshen (Ginseng Radix et Rhizoma), Sharen (Amomi Fructus), and Hanshuishi (Halloysit Rubra).
Banxia Baizhu Tianma Tang [Commentary: This formula treats vertigo caused by Qi deficiency and phlegm-jue.]
Treats head spinning and blackening of vision, nausea, vexation, shortness of breath and panting, mental confusion, inability to open eyes, headache as if splitting, heaviness of the body as if weighted down, cold limbs, and insomnia. This is caused by deficiency and damage of Stomach Qi leading to retained phlegm.
Banxia (Pinelliae Rhizoma, processed, 1.5 qian) Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried, 2 qian) Tianma (Gastrodiae Rhizoma, 1.5 qian)
Decoct one dose with three slices of fresh ginger and two zhong of water, reduce to eight fen, and take warm after meals.
Xionggui Tang [Commentary: This formula treats vertigo caused by Blood deficiency.]
Treats vertigo due to Blood deficiency, or dizziness and faintness following excessive blood loss.
Chuanxiong (Ligustici Chuanxiong Rhizoma, 2.5 qian) Danggui (Angelicae Sinensis Radix, 2.5 qian)
Decoct one dose with two zhan of water, reduce to eight fen, and take warm on an empty stomach.