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[Naming] Xuan (dizziness) means hanging. The vision is turbulent and chaotic, like a suspended object, shaking and unstable. (*Shiming*)
"Xuan" refers to darkness/blackness before the eyes, "Yun" refers to rotation/spinning, and "Mao" refers to drowsiness/obscuration. Xuan-Yun (vertigo/dizziness) and Mao-Xuan share the same meaning. (*Zhizhi Fang*)
Someone asked about the difference between Xuan and Yun. The answer is: Xuan connects to Xuan (mysterious/dark), referring to suddenly seeing black flowers or chaos in vision, which settles after a short while. Yun connects to Yun (rotation), referring to the head and eyes feeling as if rotating while sitting in a boat or carriage; severe cases may even result in sudden collapse and loss of consciousness. (*Tongzhi*)

[Origins] Tou Feng Xuan (head wind vertigo) occurs due to deficiency of Qi and Blood, allowing Wind Pathogen to enter the brain and pull on the Eye System (meridians connecting eyes to brain). The essence and Qi of the five Zang and six Fu organs all ascend to the eyes. Qi, Blood, and meridians run together in the upper system, connect upward to the brain, and exit posteriorly at the neck. When encountering bodily deficiency, one is injured by Wind Pathogen. Entering the brain causes brain rotation and tension in the Eye System; tension in the Eye System leads to Xuan. If Wind-Xuan persists without healing, it transforms into Dian Ji (epilepsy/madness). (*Zhubing Yuanhou Lun*)
Head spinning is indeed caused by physical weakness, where Wind Pathogen attacks the Yang Meridians. All Yang meridians ascend to the head and face; Wind Pathogen follows into the brain, resulting in head spinning. It can also be caused by Phlegm-Fluids stagnating above the chest and diaphragm. Exposure to severe Cold prevents Yang Qi from functioning, causing Phlegm-Fluids to accumulate. Yin and Yang Qi rebel and ascend. Wind and Phlegm bind together, rushing upward to the head, causing head spinning. (*Taiping Shenghui Fang*)
Medical texts refer to Tou Mian Feng (head and face wind) as Xuan-Yun. However, since Xuan-Yun involves the Three Causes (Internal, External, Non-internal/External), it cannot be solely attributed to head wind. For example, injury by Wind, Cold, Summer-Heat, and Dampness in the Three Yang Meridians can cause dizziness with heavy head and stiff neck. Wind pathogen causes sweating; Cold causes pulling pain; Summer-Heat causes heat and stifling sensation; Dampness causes heaviness and sticking. With vomiting, rebellion, dizziness, and collapse, this belongs to the External Cause. Joy, anger, worry, and thought cause Zang-Fu Qi stagnation, leading to depression and generation of saliva, which condenses into Fluids. These rise with Qi, lodge in Yang meridians, and cause dizziness, vomiting, eyebrow and eye pain, and inability to open eyes (Jisheng Fang notes: eyebrow ridge pain and inability to open eyes often present with deep Cun pulse, a specific sign); this belongs to the Internal Cause. Dietary irregularities (hunger/fullness), damage from sweets and greasy foods, excessive sexual activity leading to lower deficiency and upper excess, dental extractions, traumatic wounds, hematemesis, epistaxis, excessive urination/defecation, excessive blood loss, and women's metrorrhagia or trauma can all cause dizziness, visual disturbances, room spinning, and collapse upon standing; this belongs to the Non-internal/External Cause. Treatments vary accordingly. (*Sanyin Jiyi Bingzheng Fanglun*)
Symptoms include closed eyes and dim vision, body rotation, deafness, feeling like standing on a boat, and wanting to fall when standing. This is generally due to extreme deficiency combined with Cold. Treatment should not follow a single rigid path. Wind causes sweating; Cold causes pulling pain; Summer-Heat causes heat/stifling; Dampness causes heaviness/stagnation. These four pathogens cause dizziness when attacking deficiency. Joy, anger, sorrow, fear, worry, and thought depress and generate Phlegm, rising with Qi; this is Seven Emotions attacking deficiency causing dizziness. Excessive lust prevents the Kidney from grasping Qi and returning it to its origin, causing Qi to rush upward; this clearly indicates dizziness arising from Qi deficiency. Hematemesis, epistaxis, leakage, and metrorrhagia prevent the Liver from securing Ying Qi, causing blood to flow recklessly out of channels; this clearly indicates dizziness arising from Blood deficiency. Postpartum deficiency of the Sea of Blood, or stasis preventing flow, can also cause dizziness. One must investigate the etiology. Treatment methods should adapt to the situation, utilizing ascending, descending, and settling techniques. One must absolutely avoid reckless sweating or purging. However, spontaneous sweating may occur as Xuan-Yun resolves. If violent sweating is used in cases of rebellious conditions, it leads to confused speech and dizziness. In Shaoyin disease, if diarrhea stops but dizziness and frequent self-obscuration occur, this is extreme deficiency and collapse; knowledgeable physicians will worry about the patient's inability to perform daily tasks (sign of critical condition). A surging and large Gan (Liver) pulse often presents with dizziness; all wind-induced tremors and dizziness belong to the Liver. (*Zhizhi Fang*)
Dizziness mostly belongs to various Winds, not just one type. Some are caused by Fire, some by Phlegm, some by Dead Blood (Blood Stasis), and some by Deficiency. Fire nature ascends and flares, rushing to the vertex, causing shaking and rotation, which is self-evident (possibly accompanied by vexation, dry mouth, red face, tinnitus, stomach discomfort, and acid regurgitation). Turbid Phlegm in the chest rises with Qi. The head and eyes are high, empty, and bright, where Clear Yang resides. Turbid Qi disturbs this area, making it impossible not to feel dizzy or spinning (possibly accompanied by vomiting phlegm/fluids, chest fullness, and bowel sounds; pulse should be slippery). All Yang meridians ascend to the head and eyes. If blood dies, vessels congeal and stagnate; the force of ascent weakens. Weakness at the top leads to deficiency and dizziness. The pulse must be choppy (Se); Se indicates stagnation, confirming non-flowing Dead Blood (possibly accompanied by hypochondriac pain, forgetfulness, yellow eyes, and difficult defecation). It may also indicate dryness/withering, confirming insufficient Blood, called Blood Deficiency Dizziness. The head models Heaven and is the head of all Yang. Clear Yang exits through the upper orifices, including the eyes. Clear Yang is Qi. Insufficient Qi cannot ascend, leading to emptiness in the head and eyes and frequent dizziness. The pulse must be large but forceless, appearing scattered and loose, called Qi Deficiency Dizziness. (*Xu Yan*) (Excerpt.)

When dizziness erupts suddenly, it is usually due to Wind, Summer-Heat, Cold, or Heat stagnating in the muscle layer, triggering internal Phlegm and Qi. This causes fullness in collaterals and deficiency in main meridians, resulting in excess externally and insufficiency internally, overflowing upper pulses and empty lower pulses. Hence, heavy head and light feet, with sudden spinning. If Qi and Blood are harmonious, recovery occurs once Wind, Cold, Summer-Heat, Phlegm, and Heat clear. If Spirit is chronically deficient, external pathogens transmit inward, causing persistent dizziness over time, risking sudden stroke. (*Baiwen Ji*)

[Pathology: Deficiency and Excess (Fat/Thin, Phlegm Obstruction)] Regarding the syndrome of dizziness, people attribute it to Upper Excess and Lower Deficiency without explaining why. "Deficiency" refers to Blood and Qi. "Excess" refers to Phlegm-Saliva, Wind, and Fire. Etiologically, Qi deficiency arises when Clear Qi fails to ascend or due to excessive sweating causing Yang collapse; treatment requires raising Yang and tonifying Qi. Blood deficiency arises from excessive blood loss, leaving Yang unattached; treatment requires nourishing Yin and tonifying Blood. These are deficiency syndromes. Phlegm-Saliva obstruction requires resolving Phlegm and guiding stagnation; severe cases use emesis or purgation. Wind-Fire agitation requires clearing the upper and descending Fire. If caused by external contraction, although Yan Shi distinguishes four pathogens, dispersing pathogens is primary. These are excess syndromes. (*Yixue Wei Yi*)

In Qi-deficient, fat/white individuals, Damp-Phlegm stagnates above, and Yin Fire rises below. Phlegm carries deficient Fire, rushing to head and eyes. Zheng Qi cannot resist, causing sudden blackness and flowers before eyes, spinning like in a boat, or even sudden collapse. Danxi said "No Phlegm, No Dizziness," referring to this. In thin/black individuals, physique is weak, True Water is deficient, or labor/exhaustion causes Minister Fire to flare up, causing occasional dizziness; where is the Damp-Phlegm? Generally, for fat/white persons with dizziness, treat by clearing Phlegm and descending Fire first, supplemented by Qi-tonifying herbs. For thin/black persons, treat by nourishing Yin and descending Fire primarily, supplemented by Liver-suppressing agents. Additionally, dizziness and obsuration due to hematemesis is caused by Dead Blood in the chest confusing the Heart orifices; treatment requires moving Blood and calming the Heart. (*Gezhi Yulun*) (Dead Blood Syndrome, Mutual Witnessing Treatment Examples.)

All head wind and eye dizziness are due to Phlegm obstruction and Upper Excess. (*Ju Fang - Zhinan Zonglun*)
Phlegm carrying Qi deficiency and Fire; this syndrome is mostly Phlegm-related. Without Phlegm, there is no dizziness. (*Danxi Xinfa*)

[Pathology: Mostly Deficiency (Liver Deficiency)] In dizziness, deficiency accounts for 80-90%, while combined Fire and Phlegm account for only 10-20%. Etiologies include: dizziness from excessive fatigue, irregular eating/drinking, vomiting injuring the upper, diarrhea injuring the lower, excessive sweating causing Yang collapse, fright/injury to the heart, obsessive thinking, beating/humiliation causing Qi loss, crying/screaming from grief/pain (all injuring Yang within Yang). Also, dizziness from hematemesis/epistaxis/melena, large abscess rupture, metal/stone wounds with blood loss/extreme pain, male excessive lust with Qi following Essence loss, female metrorrhagia/postpartum blood loss (all injuring Yang within Yin). Drunkenness causes damp-heat multiplication, injuring Yin. Great anger causes Wood hyperactivity, injuring Qi. Phlegm-Fluid retention in middle jiao obstructing regulation is Spleen weakness. This is also insufficiency within excess. In old age, essence declines, fatigue accumulates; sudden insomnia or dizziness results from dual deficiency of Ying and Wei. Thus, deficiency and excess can be distinguished. (*Jingyue Quanshu*)
Headache is an Upper Excess syndrome. Head dizziness is an Upper Deficiency syndrome. *Neijing* distinguishes them clearly: "Headache and crown diseases, Upper Excess Lower Deficiency." And "Upper Excess Lower Deficiency leads to Jue crown disease." Because pathogenic Qi is above, it causes pain, hence Upper Excess. For dizziness, it says "Insufficiency of Qi above" and "Upper Deficiency leads to dizziness," never mentioning Upper Excess. Later scholars like Yan Yonghe and Yang Renzhai spoke of fluid accumulation rising with Qi, or fatigue causing lower deficiency and upper excess, or Kidney failing to grasp Qi causing rebellion. Even Zhu Danxi said "Phlegm above, Fire below." All these speak of Upper Excess, contradicting *Neijing*. Alas! This is later ignorance. Dizziness symptoms include heavy head, black vision, or brain spinning/unsteadiness. Seeking reasons for "excess," they claim heavy head equals Upper Excess. But the head isn't inherently heavier than before; one simply cannot bear the weight, which is worse than before. Inability to bear weight is Yang deficiency, not Upper Excess. What of Qi failing to return to origin or Qi rushing up? Upper Excess requires descending and suppressing; Upper Deficiency must not be further depleted of Sheng Qi. The distinction between Upper Excess and Upper Deficiency is crucial; error brings harm. (Same source) (Note: Head dizziness is mostly deficiency, similar to *Zhizhi* and *Rumen*. However,经文 shows Shaoyang disease eye dizziness and Yangming disease dizziness/obsuration are excess. Also, fluid-retention and damp-stagnation dizziness are due to Clear Yang being blocked, not deficiency. All must be known.)

Gao Gufeng stated: Insufficient Kidney Yin allows Three Yang flames to blaze forward. Middle/Upper deficiency allows reverse Light from below to press against the vertex. Yin deficiency dizziness presents with flashes of firelight in eyes; Earth (Spleen) deficiency dizziness presents with nausea and vomiting. Middle Earth deficiency fails to cover below, so True Yang mounts the clear pathways, called "Light entering above." However, Middle deficiency with Liver Qi movement also causes dizziness, like thin soil causing wood to shake. Generally, dizziness originates from Liver, hence sayings of Liver Deficiency Dizziness and Kidney Deficiency Headache. Although Liver disease causes headache, there is no dizziness without involving Liver. (*Jinkui Yi*)

[Pulse Diagnosis] Pulse is surging, large, and long: Wind Xuan. If floating in Yang meridians: rising eye dizziness. (*Zhubing Yuanhou Lun*)
If Yuan Qi is not deficient, floating, wiry, slippery, or rapid pulses in six positions indicate no illness. If Yuan Qi is chronically deficient and unable to sustain, pulses are weak and pounding, or rapid, or choppy/debilitated: untreatable. (*Baiwen Ji*)

[Phlegm Dizziness] Head dizziness with desire to vomit, warmth in epigastrium, chest discomfort, only feeling rotation: caused by Phlegm-Fluids. Fluids gather and ascend to brain; Three Yang meridians cannot descend, stagnating above. Pulses at Guan positions on both hands are deep, wiry, rapid, or fine: called Phlegm Dizziness. (*Jifeng Puji Fang*) (Note: Yuanjin Wan was originally listed, omitted here.)
Wang Jingquan had dizziness and pain, collapsing upon standing, chest/diaphragm distension like rope binding, vomiting preventing food/drink intake, six pulses all choppy. This is Phlegm-Fluids combining with Water and Fire forces causing dizziness. First use Jisheng Zhuru Tang. Then, take 1 liang of Wuzhuyu powder, mix with egg white, apply to both sole centers to guide Fire downward. (*Chishui Xuanzhu*) (Note: For Phlegm-Fire dizziness/vomiting, Wendan Tang + Tianma should be considered.)

[Qi Movement/Dizziness] Only spinning without darkness, collapsing to ground unconscious, recovering after a meal time. Caused by Ying/Wei misdirection, turbid Qi/Blood, rebellious Yang Qi, separation of upper/lower. Recovery when Qi flows again. Pulse is deficient, large, and choppy: called Qi Yun. (*Jifeng Puji Fang*) (Note: Liqi Yinzi and Caowutou Tang were originally listed, omitted here.)

[Wind Dizziness] Head dizziness: body feels rotating, cannot look up (looking up causes falling sensation), heavy head cannot lift, distorted vision, or feeling like in a boat. Caused by Liver deficiency and weak Blood generating Wind. Wind Qi connects to Liver; all wind tremors/dizziness belong to Liver. Pulses at left/right Guan positions are deficient and wiry: called Wind Dizziness. (*Jifeng Puji Fang*) (Note: Xiangxiong San [derived from Shengji Toubing Tong removing Fangfeng] and Taohong San were originally listed, omitted here.)
For head wind dizziness, do not assume it is not wind because pain might be absent. Careful examination is needed; do not hastily treat as deficiency. If tonics worsen it, and there is no other blood loss or post-illness context, it is clearly Wind Dizziness. Use Xiao Xuming Tang + 3-4 Quanxie (Scorpion). (*Shiyi Dexiao Fang*)

[Deficiency Spinning (Mutual Witnessing Treatment Examples)] *Jiuyuan Fang* Vol 2: Treat Qi deficiency dizziness, constant tinnitus, numbness in limbs, heavy/stiff body. Use *Ju Fang* Sanwuqi San, grind with little Chenxiang water, add 3 slices ginger, decoct and drink. Also: Someone with dizziness and cicada-like tinnitus. Decoct *Ju Fang* Sizhu San, take with 100 Heixi Dan pills. Two doses cured instantly. (*Wan An Fang*) (Tinnitus syndrome also has mutual witnessing examples.)
Phlegm-fluids, head wind, Seven Qi, blood loss, alcohol intoxication can all cause dizziness. Here we list dizziness without other concurrent diseases, indicating deficiency. Some have intermittent dizziness; some have morning dizziness that settles quickly, becoming routine (Note: *Liuyao* attributes morning dizziness to old Phlegm in Stomach; *Shengmo* has comments, omitted as too detailed). Use Zhengyuan Yin with Heixi Dan (Note: *Yitong* suggests Qingmengshi Wan for settling, then Lizhong Wan for regulation). Due to deficiency causing dizziness, even when awake, face desires proximity to fire, wants warm hands pressing. Head/face is meeting of all Yang; insufficient Yang Qi (Note: *Liuyao* suggests large dose Renshen/Huangqi. *Yitong* suggests Fuzi Lizhong Tang). Severe dizziness: looking up causes room spinning, constant black flowers, seeing moving objects or double vision. Use Xiao Sanqi Wu San, or Xiongfu Tang, Shengliao Zhengyuan Yin + 1 qian Lurong (Deer Antler), take Lingsha Dan. Or Zhengyuan Yin + 15 fried Chuanjiao seeds, take Rongzhu Wan. If ineffective, use only Lurong, 0.5 liang per dose, decoct in 3 cups unfiltered wine to 1 cup, strain, add little Shexiang (Musk) and take. Since Lurong grows on the head, treating head dizziness with Lurong follows similarity principle. Once, persistent headache cured by Rongzhu Dan. (*Shiyi Dexiao Fang*, Rongzhu Dan seen in *Xulao*.)

[Fright and Gallbladder Cold] A woman with palpitations, greatly frightened by an event, experienced dizziness and unrest. I said: This is named Fright and Gallbladder Cold, disease in Heart/Gallbladder meridians. Pulse was large and moving like a bean, trembling without head or tail. Requires calming/settling. Used Huanglian Anshen Wan, and Wendan Tang + Fushen, Danggui, Shichangpu, Yuanzhi, Longyan Rou, decocted in water, taken warm. Cured in 10 days to a month. (*Shishan Yi'an*)

[Difference in Magnitude] Head dizziness has minor and major differences. Observing this reveals deficiency/excess. Why? People with weak constitution, young or old, after fatigue or sex/alcohol, often suddenly have ringing ears like a chime or dizziness/black vision, stopping quickly. This is common. After middle age, frequent fainting/collapse is also common. Sudden spinning stopping is called "head spinning eye black." Sudden collapse unconscious is called "Stroke" or "Phlegm Stroke." Those stopping quickly have undamaged Qi/Blood, so it appears and disappears; this is Minor Stroke. Severe collapse has damaged root, so illness is sudden and hard to recover; this is Major Head Dizziness. Seen mostly after middle age, compared to youth, it is clearer. Observing this, one understands if it is Wind or not, Phlegm or not, Deficiency or Excess. Why do moderns not understand pathology? Seeing dizziness/fainting/speechlessness, they all call it Wind-Phlegm, using dispersing/scattering methods. I fear the slight Qi cannot withstand further depletion; deeply sad. (*Jingyue Quanshu*)

[Treatment Examples] Head wind syndrome, constant tinnitus, buzzing sound in head like birds chirping. Do not entirely attribute tinnitus to deficiency; this is Brain/Head carrying Wind. (*Shiyi Dexiao Fang*)
World speaks of "Qi failing to return to origin," using mineral pills to settle or Chenxiang to descend Qi. Fragrant/dry herbs scatter Qi (Note: *Weiyi* adds "mineral pills assist Fire"). How can displaced Qi return thereby? Using settling is "treating branch in acute phase." Claiming it returns Qi to origin is illogical. If returned, why would it rebel again? If settling provides slight relief then dizziness returns, Qi has not returned to origin and root is untreated. To return Qi to origin, seek the root. (*Yitong Dafang*) (Note: Based on *Weiyi*.)
Middle-aged person, just recovered from major illness, Yuan Qi not restored, dizziness/collapse upon standing. Pulse slow/weak, or Right Cun/Guan large/forceless. Use Buzhong Yiqi, double Renshen/Astragali Radix (implied), add Tianma. Summer head dizziness, accidental summer-heat exposure/labor, pulse deficient/fine, vexation/thirst: Summer-heat injury. First Liuyi San, then large dose Shengmai San + Huangbai. Winter cold exposure, agitating Phlegm-Saliva causing dizziness: treat as Cold. Tianma, Jing sui (Schizonepeta), Bohe (Mint) are excellent for clearing Upper Jiao Wind-Heat, not root treatments. Treat Phlegm with Phlegm remedies, Fire with Fire remedies, or tonify Qi/Blood, or nourish Yin. Flexibility is key. (*Xue Yi An - Liuyao*)
Dizziness due to Qi deficiency sinking: Buzhong Yiqi Tang. Dizziness due to color/emotion injury, Qi rebelling not returning to origin: Ziyin Jianghuo Tang. Elderly Wind-Phlegm deficient Fire, confirmed Yang deficiency: Lizhong Tang + Chenxiang, Muxiang. Seven emotions Qi stagnation, Phlegm-Saliva obstructing upper: Qiqi Tang. (*Shilin Yuye*)
Blood stasis accumulating, rushing upward causing rebellion/dizziness: Taohong Siwu Tang. (*Yidu*)
Dead blood in chest, causing pain and dizziness: drinking leek juice with wine is good. (*Guyin Yitong Daquan*)