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Dou Cai treated a patient whose head wind (headache disorder) caused rotational vertigo and vomiting, preventing food intake for several days. Dou Cai punctured the Fengfu (GV16) acupoint, inserting the needle three cun towards the left ear, retaining it for thirteen breaths. The patient felt numbness and heat inside the head. Only then was the needle withdrawn while the patient inhaled. After taking Fuzi Banxia Tang (Aconite and Pinellia Decoction), the condition never recurred. Hua Tuo also treated Cao Cao's head wind by puncturing this same acupoint, resulting in immediate recovery. However, puncturing this acupoint usually causes fainting. If the needle is inserted horizontally towards the right ear, it will not damage the major tendons nor cause dizziness; this is a wonderful method from Qianjin Fang. (This acupuncture technique is miraculous and must be discussed with expert acupuncturists to ensure accuracy.)

Gong Zicai diagnosed Guan Xiong Huai, aged over sixty, who was obese. Upon palpating the pulse, he found a intermittent pulse (Dai Mai, characterized by regular pauses). He exclaimed in surprise, "You are likely to perish." The patient replied, "I have only felt slightly dizzy these past few days, with no other discomfort. Why do you say this? Please teach me honestly." Gong said, "Medication will be administered in ten days." The patient laughed and left. Soon after, the patient suddenly experienced excessive phlegm and sought help from Gong. Knowing the condition was incurable, Gong instructed someone to pour sesame oil into the patient's mouth, which revived him temporarily, but he died exactly ten days later.

Zhang Luyu treated the wife of Director Dong, who was not particularly stout but suffered from chronic vertigo. Her six pulses were all slightly wiry (Xian Mai), especially at the Qi Kou (radial artery position corresponding to the Lung meridian). This was due to her prone to depression and anger; anger led to loss of appetite, causing vertigo. How could this be compared to ordinary cases of obesity with damp-phlegm? He prescribed Liujunzi Tang (Six Gentlemen Decoction), formed into pills with water paste, to tonify the Middle Jiao (Spleen and Stomach). With robust Spleen function, transformation would proceed normally, preventing phlegm accumulation that causes vertigo. This embodies the principle that treating disease requires seeking its root.

A merchant surnamed Shuo invited Zhang Luyu for consultation. It was summer, and unlike others, he ate meals naked while sitting, appearing robust and vigorous, with sweat dripping from his head. During consultation, he did not explain the cause. His six pulses were deep and solid (Chen Shi Mai), not resembling illness, except the two Cun positions were slightly rapid (Shu Mai). When feeling the left pulse, he held his right palm against his forehead; when feeling the right pulse, he held his left palm against his forehead. Zhang deduced he had excess dampness due to obesity, and prolonged exposure to boat travel in summer heat stirred up phlegm, causing vertigo. Inquiry confirmed this. He prescribed Daotan Tang (Phlegm-Expelling Decoction) modified with Huangbai (Phellodendron Bark), Zexie (Alisma Rhizome), Maoyu Zhu (Atractylodes Lancea), and Houpo (Magnolia Bark). Two doses brought relief.

Wu Youliang, over seventy years old, suffered from head and eye vertigo. His brother Zhou Wei, proficient in medicine, initially gave Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). Starting with one qian of Renshen (Ginseng Root) and increasing to three qian, the patient developed abdominal fullness, anorexia, inability to sit or lie down comfortably, and muttering day and night. (For symptoms of Upper Excess and Lower Deficiency, using Buzhong Yiqi Tang causes such harm.) Upon examination, his face was red, movements erratic, and left cheek twitched. His pulses were hurried (Cu Mai), pausing every 7-8 beats or every 3-4 beats. Inquiry revealed he had abstained from sexual activity since age fifty to preserve health and forced himself to eat. This indicated vigorous fire consuming Yin, accompanied by Liver Wind disturbing upwards. He was given Shengliao Liuwei Wan (Raw Six-Ingredient Pill) modified by removing Cornus Fruit and adding Gouteng (Uncaria Ramulus), in large doses. He slept soundly that night. Later, Chizhejia (Burned Turtle Shell), Longchi (Dragon Bone), or Zaoren (Ziziphus Seed) were added as needed. For episodes of anger and insomnia lasting all night, Qiushi Tang (Ash Decoction) was used to deliver Lingsha Dan (Cinnabar Pill), yielding immediate results. In midsummer heat, Shengmai San (Generate the Pulse Powder) was taken as tea instead. Finally, complete Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) was used for conditioning, leading to recovery by autumn.

Lu Yangyu treated the wife of Chen Xunyuan, who previously had occasional vertigo that resolved without medication. In mid-August, after labor and mental distress, she drank several cups of wine, sat under the moon until late at night, and then slept, feeling slight heat and unease. The next morning, she suddenly experienced blackouts, spinning vertigo, and mild pain, feeling as if in a storm, worse than usual. A physician diagnosed floating and rapid pulses as extreme heat generating wind, prescribing Qingre (Clear Heat) herbs like Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Zhizi (Gardenia Fruit). After two doses, vertigo persisted, headache worsened to splitting sensation, upper body felt hot, yet she desired heavy coverings. Another diagnosis suggested "no vertigo without phlegm," prescribing Qinghuo (Clear Fire) herbs combined with Erchen Tang (Two-Aged Decoction). Two doses failed. Pulse diagnosis showed left hand floating, wiry, and tight; right hand floating, rapid, and weak, with strong Cun and weak Chi positions. Right pulse indicates deficiency of righteous Qi; left pulse indicates excess of pathogenic factors. Strong Cun and weak Chi indicate pathology in the Upper Jiao. This was contraction of pathogens due to deficiency in the Upper Jiao. The Classic states: Essence of sinews, bones, blood, and qi form the Eye System, connecting to the brain and emerging from the neck. Thus, pathogens strike the neck. If the body is deficient, pathogens penetrate deeply, entering via the Eye System into the brain. Brain rotation pulls the Eye System taut, causing vertigo. Labor caused distress (deficiency); sitting under the moon exposed the neck to cold-damp mist. Treatment should expel Upper Jiao pathogens, tonify Middle Jiao Qi, and slowly resolve phlegm and clear heat. Shen Su Yin (Ginseng and Perilla Decoction) modified with Gaoben (Ligusticum Chuanxiong Rhizome) was given first. Two doses stopped the headache and reduced vertigo. Then, Buzhong Yiqi Tang was used with Erchen Tang, Huangqin, and Huanglian for several doses, achieving stability.

Zhang Luyu treated Miao Fengjun, who developed vertigo and chest fullness after minor anger. For three days, phlegm-resolving and Qi-moving medicines failed, causing fatigue and reduced intake, with weakness in the Lower Yuan. Pulses seemed abundant but lacked harmony; Qi Kou was stagnant and irregular, varying in size. Both Chi pulses were soggy, large, and weak. This indicated inherent damp-phlegm infiltrating the Earth (Spleen) and Water (Kidney) meridians, exacerbated by repeated use of draining agents damaging Middle Qi. Treatment应先调中气 (first regulate Middle Qi) to transport essence, then gradually tonify Lower Yuan. Liujunzi Tang (Six Gentlemen Decoction) plus Danggui (Angelica Sinensis Root) was prescribed to nourish Ying and Blood, avoiding issues of "Yang cannot transform without Yin."

Gong Zicai treated Grand Secretary Gao Zhongxuan, suffering from head/eye vertigo, tinnitus, visual obscurity, feeling like being in a storm, with fire flashing in eyes. Clearing heat/phlegm or tonifying Qi/blood were ineffective. Pulses were flooding and rapid. This was fire stirring phlegm. Jiuzheng Dahuang (Wine-processed Rhubarb) 3 qian was powdered and taken with tea. One dose cured it; lowering fire cleared phlegm naturally.

Xue Lizhai treated a woman with vertigo and expectoration. Phlegm-resolving/Qi-regulating meds caused limb soreness/numbness; wind-dispelling/phlegm-resolving meds caused constant numbness and alternating cold/hot extremities. This was Spleen Earth deficiency failing to generate Lung Metal. Buzhong Yiqi Tang plus Fuling (Poria), Banxia (Pinellia Tuber), and Paojiang (Prepared Ginger) cured her in 20+ doses. Later, anger-induced vomiting of phlegm occurred after self-medicating with Qingqi Huatan Wan. Anorexia, copious phlegm, and hypochondriac distension resulted. She was taught to use Liujunzi Tang with doubled Renshen and Baizhu, plus small amounts of Muxiang (Aucklandia Root), curing her in a few doses.

Tao Tianjue's concubine often suffered severe vertigo and pain, with limb flaccidity and bone/joint pain upon exertion, resembling wind disorders. Diagnosed as Kidney deficiency failing to grasp Qi, Jiajian Bawei Wan (Modified Eight-Ingredient Pill) cured her. Later, sexual exhaustion and anger caused vertigo, stiff neck, and ear pain. This was Liver Fire. Previous pills were reused to nourish Kidney Water, generate Liver Blood, and subdue wind-fire, leading to recovery.

Zhang Feichou treated a woman with chest fullness, body heat, wiry-rapid-weak pulses, fatigue, and slight thirst. She reported晕船 (seasickness) and vomiting after visiting Tiger Hill, followed by sweating, fever, and headache. Four doses of dispersing herbs worsened chest distension; smelling grain induced vomiting/vertigo; fever persisted. Doctors forbade porridge for half a month; she drank only weak tea. Now, whole-body pain, turning-induced vertigo/vomiting occurred. Zhang said: Wind-exposure with sweating/vomiting suggests exterior pathogen, already dispersed. Vomiting depleted food; purging damaged Spleen. Spleen deficiency causes distension; Spleen failure causes vomiting; Wood overcoming Earth causes vertigo. Stop medication; give only rice porridge to support Spleen Earth. Following this, she recovered without drugs.

Xue Lizhai recounted: Gu Tongshi asked why Meng Youya survived vertigo/phlegm treated with Suhexiang Wan (Styrax Pill) while Chen Donggu did not, despite similar presentations. Xue explained both had Kidney deficiency failing to grasp Qi (causing vertigo) and control Water (causing phlegm). Chen took phlegm-draining/Qi-moving drugs; Meng took Fire-tonifying/Qi-supplementing drugs. Later, Gu Tongshi overindulged sexually, developed similar symptoms, and worsened with Qingqi Huatan Wan. He realized his issue was Kidney deficiency failing to grasp Qi. The physician failed to understand, and Gu died. Regrettable!

Wang Tiancheng, Prefect of Changping, had vertigo, aversion to cold, fatigue, improvement after eating, worsening with labor, and floating pulses at Cun/Guan. Spleen/Lung deficiency. Buzhong Yiqi Tang plus Manjingzi (Vitex Fruit) cured him. Later, labor-induced fever/cold, delirium, insomnia, improved with food. Buzhong Yiqi Tang cured him again.

Zhu Zhishan, County Magistrate, had vertigo from anger, muscle spasms, alternating chills/fever, worse in afternoon. Liver Fire causing spasms, Qi deficiency causing vertigo. Bazhen Tang (Eight-Treasure Decoction) plus Chaihu (Bupleurum Root), Zhizi, and Danpi (Moutan Cortex) cured him in 20+ doses.

Commentary: Liver Fire can cause vertigo, not just Qi deficiency. The Classic says: All wind, tremors, and vertigo belong to the Liver. Liver meridian connects to the vertex. I once cured such cases with Yi Qi Tang plus Wuyu (Evodia Fruit) and fried Huanglian in 2-3 doses.

Zhu Danxi treated a 79-year-old man with heavy vertigo, weak limbs, continuous expectoration. Left pulse scattered-large-slow; right pulse slow-large, smaller than left, powerless on deep pressure. Reduced diet, slight thirst, bowel movement every 3-4 days. Others used wind-dispersing herbs. Zhu said: Taking these will lead to death by late spring. This is severe deficiency. Large doses of tonics are needed. Others left angrily. Zhu prescribed Renshen, Huangqi (Astragalus Root), Danggui, Baishao (White Peony Root), Baizhu, and Chenpi (Tangerine Peel) decocted strongly, with Lianbai Wan (Coptis and Phellodendron Pill) 30 pills. Taken for 1.5 years, energy returned to youth. In winter, add dried ginger to Lianbai Wan; other seasons follow base method. Coptis and Phellodendron are stir-fried with ginger juice into powder, then pillified with ginger juice paste.

Commentary: Tonifying heavily while assisting with Coptis and Phellodendron is exquisite. Targeting Liver and Kidney meridians, Coptis clears Liver Fire, Phellodendron clears Kidney Fire. Ginger juice mitigates cold nature. Perfect. However, using Shudihuang (Rehmannia Root) and Gouqi (Goji Berry), like Zuogui Wan (Left Restoring Pill) modifications, would be even better.

Chen Ziming treated a woman suffering from head wind and vertigo for years. One pill of Taiyi Dan caused her to vomit a bowl of phlegm, and the condition never recurred. (Formula see Worm Section.)

Feng Chuzhan treated Elderly Jin Shao, who collapsed with sudden vertigo, unconsciousness, hallucinations, and incoherent speech after accumulated labor. Pulse was fine, rapid, and chaotic, indicating extreme depletion of True Yin and True Yang. At this early stage, it could be reversed; delay leads to further depletion and collapse. Quan Zhen Yi Qi Tang (Complete True One Qi Decoction) was given, two doses daily, each containing 8 qian of Renshen. Full recovery in less than ten days.

Qian Guobin treated Chen Shuming, a scholar living in poverty, clean-living. After thirty, he became dizzy upon seeing sunlight, eventually needing to stay in curtains avoiding light for 20 years. Tried many medicines. Friends helped financially. Qian diagnosed Yang deficiency and Yin extremity. Required return-to-root remedies. Shoujing (Platycodon Root), human milk, umbilical cord, fetal hair, and Qiushi (Mineral Ash) were honey-pilled, coated with Cinnabar. One pill taken at midnight. Improved significantly in a month. Coincidentally, someone else had this formula and provided it.

Xu Lingtai stated: Clearing fire and nourishing Liver is correct treatment for vertigo. But when Yang Qi rises uncontrollably, affecting bodily autonomy, it is not merely floating fire. Ancients used mineral sedatives. Early in my career, I favored Tang dynasty formulas. Ye Tianshi remarked: Scholar Xu from Wujiang treats well but mixes too many herbs due to lack of formal instruction. Later, Ye read Song edition of Waitai Miyao and admitted Xu's formulas derived from it. Learning is endless; do not underestimate reading. Ye's openness reflects ancient virtue. "Mixed herbs" referred to mineral sedatives.