伤寒杂病。头晕痛者。风寒也。血家晕痛。则多是痰火。误用发散药。鲜不增剧。
痰气上攻。头目沉重昏花。兀兀欲吐。首如裹物。右手脉实。阴雨增痛。是痰候也。二陈汤。加防风川芎黄芩
薄荷细辛石膏治之。病重者。消化丹治之。
火逆晕痛者。烦渴引饮。见火增剧。掉头更痛。口苦嗌干。溺赤便闭。左手脉数。是火症也。大柴胡汤治之。当
归芦荟丸亦治之。轻则小柴胡汤加菊花。
以上所论。皆晕痛之实证。又有晕痛之虚证。须分晕与痛之两门。而后施治有别也。肝虚则头晕。内经云。
诸风掉眩。皆属于肝。肝血不足。则生风。风主动。故掉眩。失血之人。血虚生风者多。逍遥散。加川芎青葙子
夏枯草治之。或但滋肝脏。以为息风之本。左归饮。加牛膝巴戟天杭菊花细辛枸杞。肾虚则头痛。内经所
谓头痛巅疾。下虚上实。过在少阴是也。六味地黄丸。加细辛葱白麝香治之。若是肾厥头痛。乃肾中浊阴
上逆于头。上实下虚。手足厥冷。宜肾气丸。加细辛葱白。此证之痛。连齿入脑。与寻常微痛者不同。血家头
痛。似此者少。宜用六味丸者多。
又曰。头晕痛虽是两病。失血之人。往往兼见二证。由于血虚。则风动而眩。火动而晕。吾谓不分晕痛。亦不
分治肝治肾。总以四物汤。加元参枸杞肉苁蓉玉竹天麻细辛知母黄柏山茱萸牛膝。
In cold damage (Shanghan) and miscellaneous diseases, dizziness and headache are mostly caused by wind-cold. However, in patients with blood disorders, dizziness and headache are mostly due to phlegm-fire. If dispersing herbs are mistakenly used, the condition is rarely not aggravated.
When phlegm-qi attacks upward, it causes heaviness and dimness of the head and eyes, vertigo with a desire to vomit, a sensation as if the head were wrapped in cloth, and a full pulse on the right hand. Pain increases during cloudy or rainy weather; this is the sign of a phlegm syndrome. It can be treated with Erchen Tang (Two-Cured Decoction), adding Fangfeng (Saposhnikovia Root), Chuanxiong (Ligusticum Rhizome), Huangqin (Scutellaria Root), Bohe (Mint Herb), Xixin (Asarum Root), and Shigao (Gypsum Fibrosum). For severe cases, Xiaohua Dan (Digestive Pill) is used.
For dizziness and headache caused by fire rebellion, symptoms include irritability, thirst with excessive drinking, aggravation upon seeing fire, worsening pain when shaking the head, bitter taste in the mouth, dry throat, dark urine, and constipation. The pulse on the left hand is rapid; this is a fire syndrome. It should be treated with Da Chaihu Tang (Major Bupleurum Decoction). Danggui Lvhui Wan (Angelica and Aloe Pill) is also effective. For mild cases, Xiao Chaihu Tang (Minor Bupleurum Decoction) with Juhua (Chrysanthemum Flower) is used.
The above discussions all refer to excess syndromes of dizziness and headache. There are also deficiency syndromes of dizziness and headache. One must distinguish between "dizziness" and "headache" as two separate categories so that treatment differs accordingly. Liver deficiency leads to dizziness. The *Neijing* states: "All wind diseases causing tremors and vertigo belong to the Liver." When Liver blood is insufficient, internal wind is generated. Wind is active by nature, thus causing tremors and vertigo. Patients who have lost blood often suffer from internal wind due to blood deficiency. This can be treated with Xiaoyao San (Free and Easy Wanderer Powder), adding Chuanxiong (Ligusticum Rhizome), Qingxiangzi (Celosia Seed), and Xiakucao (Prunella Spike). Alternatively, one may simply nourish the Liver to address the root of calming wind. Zuogui Yin (Left Restoring Decoction) with Niuxi (Achyranthes Root), Bajitian (Morinda Root), Hang Juhua (Hangzhou Chrysanthemum), Xixin (Asarum Root), and Gouqi (Goji Berry) can be used. Kidney deficiency leads to headache. This corresponds to what the *Neijing* describes as "headache and cranial disease, lower deficiency and upper excess, involving the Shaoyin." Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with Xixin (Asarum Root), Congbai (Green Onion White), and Shexiang (Musk) is used. If it is Renjue headache (Kidney-Jue headache), it is due to turbid yin from the Kidney rebelling upward to the head, presenting with upper excess and lower deficiency, and cold extremities. Shenqi Wan (Kidney Qi Pill) with Xixin (Asarum Root) and Congbai (Green Onion White) is appropriate. The pain in this syndrome extends to the teeth and penetrates into the brain, differing from ordinary mild headaches. Such cases are rare in patients with blood disorders; using Liuwei Wan is more common.
It is further stated: Although dizziness and headache are two distinct conditions, patients with blood loss often present with both simultaneously. Due to blood deficiency, wind moves causing vertigo, and fire moves causing dizziness. I propose that there is no need to distinguish between dizziness and headache, nor to treat the Liver or Kidney separately. Instead, one should generally use Siwu Tang (Four Substances Decoction), adding Xuanshen (Scrophularia Root), Gouqi (Goji Berry), Rongzong (Cistanche Stem), Yuzhu (Polygonatum Rhizome), Tianma (Gastrodia Tuber), Xixin (Asarum Root), Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Shanzhuyu (Cornus Fruit), and Niuxi (Achyranthes Root).