【歌】痰火令人头转旋，气虚血失每头眩。风寒暑湿乘
虚致，识得其机可望痊。
【论】眩者，目花黑暗旋倒也。其状头旋目闭，身转耳聋，如立舟车之上，起则欲倒。虚极乘寒得之，故
风则有汗；寒则掣痛；暑则燠闷；湿则重滞，此四气乘虚而眩晕也。或七情郁而生痰、动火，随气上厥，此七
情致虚而眩晕也。酒色过度，肾虚不能纳气归元，使气逆奔而上，气虚而眩晕也。吐衄、崩漏或产后失血，脾
虚不能收摄营气，使诸血失道妄行，此血虚眩晕也。丹溪云∶头眩多挟痰，气虚并火及湿痰、火痰，盖无痰不
能作眩，痰因火动也。凡此之证，要参以脉症治之，随机应变，不可以一途而取轨也。
谨按∶经曰∶诸风掉眩，皆属肝木。肝木为风所撼，必鼓动其肺，肺金不能制木，风卷痰而上升，故目无
定视，上下反复，甚则呕吐，饮食罕御。大法，平其风、降其痰而已。妇人患崩淋头眩，以血虚治，为少血不
能养肝，肝木根虚，不能不动摇，故眩治崩淋则眩自止，所以培其根也。
【脉】风寒暑湿，气郁生涎。下虚上实，皆头眩晕。风浮寒紧，湿细暑虚。痰则滑弦，瘀芤而涩。数大火
邪，虚大久极。先理气痰，次随症脉。
外感眩晕
风热虚眩，川芎茶调散。（方见头痛证。）风寒上厥眩晕，芎术除眩散。暑火眩晕，二陈汤（方见痰证。）
加人参、白术、山栀、黄连、川芎。伤湿，肾着汤。（方见腰痛证。）
芎术除眩散
治风寒上厥眩晕。
附子（生，半两） 白术（半两） 川芎（半两） 桂（二钱半） 甘草（炙二钱半）
每服三钱，姜三片，水二盏，煎一盏服。
虚眩
气虚眩晕，因相火盛，治痰为先，半夏白术天麻汤，（方见头眩证。）或用香橘饮。气虚眩晕，四君子
汤（方见脾胃。）加天麻、防风。血虚眩晕，芎归汤。（方见头痛。）失血眩晕，四物汤（方见血证。）
加焦姜。产后血虚眩晕，清魂散。（方见女科。）
香橘饮
治气虚眩晕。如治血虚者，加芎、归、肉桂。
木香（七分） 白术（一钱，炒） 半夏曲（一钱） 橘皮（一钱） 茯苓（一钱） 砂仁（七分）
丁香（十四粒） 甘草（炙，八分）
上锉，一帖，生姜三片，水二盏，煎一盏，食远热服。
痰火眩晕
湿痰眩晕，二陈汤加酒芩、白术、南星、天麻、苍术，（方见痰证。）或青州白丸子，（方见头痛。）或
白术半夏天麻汤。（方见头痛。）火动其痰者，二陈汤加黄芩、黄连、苍术、羌活。（方见痰证。）火盛者，
酒炒大黄末，茶调下。
方用大黄酒浸，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。
方用半夏、白茯苓、川芎、甘草、羌活、白芷、枳实、南星、防风、细辛、酒黄芩，气虚加参、术；血虚
加芎、归；热加黄连各等分，姜三片，水煎服。以此作丸，每日下二、三，极效。
[Verse] Phlegm-fire causes the sensation of head spinning; Qi deficiency and blood loss often lead to dizziness. Wind, cold, summerheat, and dampness invade due to deficiency; recognizing the mechanism offers hope for recovery.
[Discussion] Dizziness (Xuan) refers to blurred vision, darkness, and a sensation of rotation or falling. The presentation includes vertigo, closed eyes, body rotation, deafness, feeling as if standing on a moving boat or carriage, and a desire to fall when rising. When caused by extreme deficiency combined with cold, wind leads to sweating; cold causes pulling pain; summerheat causes stifling heat; dampness causes heaviness and stagnation. These are four pathogenic factors invading due to deficiency that cause dizziness. Alternatively, emotional depression generates phlegm and stirs fire, which ascends with rebellious Qi; this is dizziness caused by deficiency from seven emotions. Excessive alcohol and sexual activity damage Kidney Yin, preventing it from grasping Qi and returning it to its source, causing Qi to rebel and rush upward, leading to dizziness due to Qi deficiency. Hematemesis, epistaxis, metrorrhagia, or postpartum blood loss result in Spleen deficiency failing to control Ying Qi, causing blood to wander recklessly outside its vessels; this is dizziness due to Blood deficiency. Zhu Danxi stated: Head dizziness often involves phlegm, Qi deficiency combined with fire, damp-phlegm, and fire-phlegm. Generally, without phlegm, there is no dizziness; phlegm moves due to fire. For all such conditions, treatment must be based on pulse and symptoms, adapting flexibly, not adhering to a single method.
Note: The Classics state: "All wind-induced tremors and dizziness belong to Liver Wood." When Liver Wood is shaken by wind, it agitates Lung Metal. If Lung Metal cannot restrain Liver Wood, wind rolls up phlegm and ascends, causing unstable vision, repeated up-and-down movements, and in severe cases, vomiting and inability to eat. The general principle is to calm wind and descend phlegm. Women suffering from metrorrhagia with dizziness should be treated for Blood deficiency, as insufficient blood fails to nourish the Liver, causing Liver Wood roots to be weak and unstable, thus causing dizziness. Treating metrorrhagia stops the dizziness, thereby nourishing the root.
[Pulse Diagnosis] Wind, cold, summerheat, and dampness, or Qi stagnation generating saliva/phlegm. Deficiency below and excess above both present with head dizziness. Wind pulses are floating; cold pulses are tight; dampness pulses are fine; summerheat pulses are deficient. Phlegm pulses are slippery and wiry; blood stasis pulses are knotted and choppy. Rapid pulses indicate strong fire pathogens; deficient and large pulses indicate extreme chronic deficiency. First regulate Qi and phlegm, then treat according to symptoms and pulse.
Exogenous Dizziness
Wind-heat and deficient dizziness: Chuanxiong Chatiao San (Ligusticum Tea-Pausing Powder). [Formula seen under Headache Syndrome.] Wind-cold rebelling upward causing dizziness: Xiongzhu Chuxuan San. Summerheat-fire dizziness: Erchen Tang (Two-Cured Decoction) [Formula seen under Phlegm Syndrome] plus Renshen (Ginseng), Baizhu (Atractylodes Macrocephala Rhizome), Shanzhi (Gardeniae Fructus), Huanglian (Coptidis Rhizoma), and Chuanxiong (Ligusticum Chuanxiong Rhizome). Injury from dampness: Shen Zhuo Tang (Kidney-Dampness Decoction). [Formula seen under Lower Back Pain Syndrome.]
Xiongzhu Chuxuan San
Treats wind-cold rebelling upward causing dizziness.
Fuzi (Raw, half liang) Baizhu (half liang) Chuanxiong (half liang) Guizhi (two qian half) Gancao (Honey-fried, two qian half)
Take three qian per dose, with three slices of fresh ginger, two cups of water, decocted to one cup.
Deficient Dizziness
Qi-deficient dizziness, due to flourishing ministerial fire, prioritizes treating phlegm: Banxia Baizhu Tianma Tang (Pinellia, Atractylodes, and Gastrodia Decoction). [Formula seen under Dizziness Syndrome.] Or use Xiangju Yin (Aromatic Citrus Drink). Qi-deficient dizziness: Sijunzi Tang (Four Gentlemen Decoction) [Formula seen under Spleen-Stomach] plus Tianma (Gastrodiae Rhizoma) and Fangfeng (Saposhnikoviae Radix). Blood-deficient dizziness: Xionggui Tang (Ligusticum and Angelica Decoction). [Formula seen under Headache.] Blood-loss dizziness: Siwu Tang (Four Substances Decoction) [Formula seen under Blood Syndromes] plus Jiaojang (Charred Ginger). Postpartum blood-deficient dizziness: Qinghun San (Clear Soul Powder). [Formula seen under Gynecology.]
Xiangju Yin
Treats Qi-deficient dizziness. For blood-deficient cases, add Chuanxiong, Danggui, and Rougui.
Muxiang (seven fen) Baizhu (one qian, stir-fried) Banxiaqu (Pinellia Fermented Paste) one qian) Pechen (Citri Reticulatae Pericarpium) one qian) Fuling (Poria) one qian) Sharen (Amomi Fructus) seven fen) Dingxiang (Caryophylli Flos) fourteen grains) Gancao (Honey-fried, eight fen)
Crush the above ingredients. One dose, with three slices of fresh ginger and two cups of water, decocted to one cup. Take warm, well after meals.
Phlegm-Fire Dizziness
Damp-phlegm dizziness: Erchen Tang plus Jiuhuangqin (Wine-fried Scutellariae Radix), Baizhu, Nanxing (Arisaematis Rhizoma prepared with alum), Tianma, and Cangzhu (Atractylodis Lanceae Rhizoma). [Formula seen under Phlegm Syndrome.] Or Qingzhou Baiwanzi (Qingzhou White Pills). [Formula seen under Headache.] Or Baizhu Banxia Tianma Tang. [Formula seen under Headache.] Fire stirring phlegm: Erchen Tang plus Huangqin, Huanglian, Cangzhu, and Qianghuo (Notopterygii Rhizoma et Radix). [Formula seen under Phlegm Syndrome.] For excessive fire: Use Da Huang (Rhei Radix et Rhizoma) end powder fried in wine, taken with tea.
Formula: Soak Da Huang in wine, steam nine times and sun-dry nine times, grind into powder, make water pills the size of mung beans. Take 100 pills per dose, washed down with clear tea after meals and before bed. Miraculous effect.
Formula: Banxia, Baifuling (Poria), Chuanxiong, Gancao, Qianghuo, Baizhi (Angelicae Dahuricae Radix), Zhishi (Aurantii Fructus Immaturus), Nanxing, Fangfeng, Xixin (Asari Radix et Rhizoma), Jiu Huangqin. Add Renshen and Baizhu for Qi deficiency; add Chuanxiong and Danggui for Blood deficiency; add Huanglian for heat. Equal parts, with three slices of fresh ginger, decocted in water. Make into pills. Take two or three pills daily. Extremely effective.