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In cases of Shanghan (Cold Damage) presenting with dizziness, it is invariably caused by the deficiency of Yuan Qi (Primordial Qi) in the Upper Jiao (Upper Burner) resulting from improper sweating, vomiting, or purging. "Xuan" (Dizziness) refers to the eyes losing their normal focus; "Tou Xuan" (Head Dizziness) is commonly known as vertigo and blurred vision; "Xuan Mao" refers to a state of faintness and confusion. In Shaoyang disease, symptoms such as bitter taste in the mouth, dry throat, and visual dizziness occur because the Shaoyang channel resides between the exterior and interior. As pathogenic factors gradually move from the exterior to the interior, the Yang Qi of both the exterior and interior becomes deficient, leading to visual dizziness. When Taiyang and Shaoyang diseases occur simultaneously (Bing Bing) and present with dizziness, the root cause is deficiency. In Shanghan, dizziness upon rising or general faintness are all consequences of prior sweating, vomiting, or purging, indicating Yang Qi deficiency. Thus, the *Zhen Jing* (Classic of Acupuncture) states: "Deficiency in the upper part causes dizziness; deficiency in the lower part causes Jue (cold extremities/reversal)." Although dizziness is generally a sign of deficiency, in Yangming Wind Strike, if there is only head dizziness without aversion to cold, this is because Wind pathogens primarily cause dizziness. None of these conditions represent a critical or terminal prognosis. However, if various mis-treatments lead to forced sweating, resulting in disordered speech and dizziness, death ensues. Alas! If the disease process has already established itself, half recovery may still be sought; but if the condition is already extreme, even a divine physician cannot help.

In Taiyang Shanghan, if vomiting or purging is used first, followed by symptoms of fullness and rebellious Qi in the epigastrium (Xin Xia Ni Man), Qi rushing upward to the chest, dizziness upon rising, and a deep, tight pulse; if sweating is then incorrectly induced, it will disturb the collaterals, causing the body to tremble and shake. The formula Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) should be administered. (Note: After vomiting and purging, the interior is deficient, causing Qi rebellion and fullness in the epigastrium with upward rush to the chest; exterior deficiency and insufficient Yang Qi cause dizziness upon rising. A floating, tight pulse indicates pathogen in the exterior, warranting sweating; a deep, tight pulse indicates pathogen in the interior, forbidding sweating. Incorrect sweating moves the exterior collaterals, damages Yang Qi, preventing it from governing the vessels, leading to bodily trembling. This decoction harmonizes the collaterals and benefits Yang.) If sweating fails to stop after induction, Zhen Wu Tang (True Warrior Decoction) may be used to secure the interstices (Cou Li).

After Shanghan is treated with vomiting, purging, and then sweating, leading to empty irritability and a very faint pulse; after eight or nine days, if one experiences hardness and fullness in the epigastrium, pain under the ribs, Qi rushing to the throat, dizziness and faintness, and twitching of the meridians, prolonged duration will result in Wei syndrome (flaccidity/atrophy). (Note: Vomiting, purging, and subsequent sweating deplete both exterior and interior Qi. Empty irritability and faint pulse indicate internal deficiency of righteous Qi with sole presence of pathogenic Qi. By the seventh or eighth day, righteous Qi should recover and pathogenic Qi should dissipate. Persistent epigastric fullness, rib distension, Qi rushing to the throat, and dizziness indicate that righteous Qi has not recovered while pathogenic Qi remains. Twitching of meridians indicates extreme deficiency of Qi in the channels; over time, heat returns to the channels, inevitably forming flaccidity. Zhen Wu Tang or Fu Ling Gui Zhi Bai Zhu Gan Cao Tang may be used.)

When Taiyang and Shaoyang diseases occur simultaneously, presenting with hardness in the epigastrium, stiffness in the neck and occiput, and dizziness, acupuncture at Da Zhui (GV14) and Fei Shu (BL13) is indicated, and purgation is contraindicated.

When Taiyang and Shaoyang diseases occur simultaneously, presenting with stiffness and pain in the head and neck, dizziness and faintness, and sometimes epigastric fullness resembling Jie Xiong (Chest Binding), acupuncture at the first interspace of Da Zhui (GV14), Fei Shu (BL13), and Gan Shu (BL18) is indicated, and sweating is contraindicated. If sweating is incorrectly induced, delirium occurs with a wiry pulse; if delirium persists for five to six days, acupuncture at Qi Men (LR14) is required.

In Yangming disease, a slow pulse, inability to eat large meals (fullness leads to slight irritability and head dizziness), difficulty in urination, and impending Gu Dan (Grass Jaundice) indicate the need for purgation. However, if abdominal fullness persists, it is due to the slow pulse. (See previous Yangming disease section.) In Yangming disease, if there is only head dizziness without aversion to cold, the patient can eat and cough, and must have a sore throat; if there is no cough, the throat is not painful. (Note: Yangming disease without heavy body sensation, only head dizziness and no aversion to cold, indicates Yangming Wind Strike with internal attack by Wind. The classic states: "Yangming disease where the patient can eat is named Wind Strike." Wind pathogen attacks the Stomach, causing Stomach Qi to rebel upward, leading to cough. The throat is the connection of the Stomach; severe cough injures the throat, causing pain. If Stomach Qi does not rebel, there is no cough and no throat pain. Si Ni San (Frigid Extremities Powder) with Jie Geng (Platycodon Root) or Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be used. This is Wind Strike of this channel, not Shanghan. Xiao Cheng Qi Tang may also be used.)

Shaoyang disease presents with bitter taste in the mouth, dry throat, and visual dizziness. (Xiao Chai Hu Tang with Tian Ma and Chuan Xiong may be added.)

In Shaoyin disease, if diarrhea stops but dizziness occurs, accompanied by frequent episodes of self-induced faintness, the prognosis is fatal. (Note: Diarrhea exhausts water and grain essence; dizziness and faintness indicate depletion of Yang Qi, hence fatal.)

If Dong Qi (Pulsating Qi) is located on the left and sweating is incorrectly induced, dizziness and continuous sweating with muscle twitching occur. (For formula discussion, see Dong Qi section; *Huo Ren Shu* suggests Xiao Jian Zhong Tang.) For various mis-treatments where incorrect sweating leads to disordered speech and dizziness, death ensues. (Discussion seen in Delirium section.)

Wu's perspective: In Taiyang Wind Strike, dizziness and head shaking present with a floating, wiry, and rapid pulse. Qiang Huo Shen Shu Tang (Notopterygium and Atractylopsis Decoction) with Fang Feng and Tian Ma may be used. For blood deficiency causing dizziness, Si Wu Tang (Four Substances Decoction) with Ren Shen and Tian Ma may be used. For Phlegm-Fire attacking upward, Jiu Huang Qin (Wine-fried Scutellaria Root) and Zhu Li (Bamboo Sap) may be added. For internal injury from labor and fatigue causing Yin deficiency and dizziness, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Chuan Xiong, Tian Ma, Fang Feng, and Man Jing Zi may be used. For deficiency and collapse of Yuan Qi in the Lower Jiao, Ren Shen Yang Rong Tang (Ginseng Nourishing the Blood Decoction) or Da Jian Zhong Tang (Great Construct the Middle Decoction) with Tian Ma may be used. Once, a woman was treated with three doses of Huo Xiang Zheng Qi San (Patchouli Regulating the Qi Decoction), resulting in excessive sweating, dizziness, body shaking, fever, and a deficient, rapid pulse. Therefore, Ren Shen Yang Rong Tang was used with doubled Ren Shen as the main herb, plus Tian Ma, and a small amount of wine-fried Huang Bo (Phellodendron Bark); she recovered after two doses. Yi Lao (Li Dongyuan) stated: "Vertigo and blackening of the eyes cannot be cured without Tian Ma," so Tian Ma is added; a small amount of Huang Bo is added to nourish Kidney Water.