大意
诸脉皆系于目。脏腑筋骨之精。与脉并为系。上属于脑。后出于项中。故邪气中于项。因逢其身之虚。其入
深者。随目系而入于脑。则脑转。脑转则引目系急而眩矣。（经文）
内因
诸风掉眩。皆属肝木。（内经）以肝上连目系而应于风。故眩为肝风。然亦有因火。因痰。因虚。因暑。因湿者。（汇
补）
外候
其状目暗耳鸣。如立舟车之上。起则欲倒。不省人事。盖眩者。言视物皆黑。晕者。言视物皆转。二者兼有。方
曰眩晕。若甚而良久方醒者。又名郁冒。谓如以物冒其首。不知人事也。（汇补）
眩分虚实
虚者。内外之邪。乘虚入表而上攻。实者。内外之邪。郁痰上结而下虚。（入门）
湿痰眩晕
肥白人湿痰滞于上。阴火起于下。痰挟虚火。上冲头目。邪正相煽。故忽然眼黑生花。所谓无痰不作眩也。（丹溪）
肝火眩晕
黑瘦人肾水亏少。肝枯木动。复挟相火。上踞高巅而眩晕。谓风胜则地动。火得风而旋焰也。（丹溪）
肾虚眩晕
人身阴阳。相抱而不离。故阳欲上脱。阴下吸之。若淫梦过度。肾家不能纳气归原。使诸气逆奔而上。此眩
晕出于肾虚也。（直指）
血虚眩晕
血为气配。气之所丽。以血为荣。凡吐衄崩漏产后亡阴。肝家不能收摄荣气。使诸血失道妄行。此眩晕生
于血虚也。（直指）
脾虚眩晕
脾为中州。升腾心肺之阳。堤防肾肝之阴。若劳役过度。汗多亡阳。元气下陷。清阳不升者。此眩晕出于中
气不足也。（刘纯）
气郁眩晕
七情所感。脏气不平。郁而生涎。结而为饮。随气上逆。令人眩晕。必寸口脉沉。眉棱骨痛为异。若火动其痰。
必兼眩晕嘈杂。欲作吐状。（汇补）
停饮眩晕
中气不运。水停心下。心火畏水。不敢下行。扰乱于上。头目眩晕。怔忡心悸。或吐涎沫。宜泻水利便。使心火
下交。其眩自已。（汇补）
外感眩晕
外邪所感者。风则项强自汗。寒则拘挛掣痛。暑则烦闷口渴。湿则重着吐逆。此四气乘虚而眩晕也。（心法）
晨昏眩晕
有早起眩晕。须臾自定。日以为常。谓之晨晕。此阳虚也。有日晡眩晕。得卧少可。谓之昏晕。此阴虚也。（绳墨）
死症
凡眩晕言乱。汗多下利。时时自冒。卧亦旋转者。虚极不治。（入门）
脉法
肝脉溢大必眩。若风浮寒紧。湿细暑虚。痰弦而滑。瘀芤而涩。数大火邪。濡大虚极。
治法
先理痰气。次随症治。（举要）外邪和解清痰火。内虚本固标自移。（入门）
用药
外邪痰火。主以二陈汤。加天麻、蔓荆等。挟风。加荆、防。挟寒。加 本、细辛。挟暑。加香薷、藿香。挟湿。
加苍术、浓朴。挟火。加山栀、黄芩。气虚。主以四君子汤。气陷。主以补中益气汤。血虚。主以人参养荣汤。肾虚。
主以鹿茸肾气丸。阳气久虚。遇寒必冒者。桂附八味丸。相火妄动。遇劳必眩者。加减逍遥散。
丹药禁用
世有所谓气不归源。而用丹药镇坠。沉香降气。误人极矣。盖金石助火。香窜散气。多致飞越之祸。岂能镇
其不归之气耶。
【附郁冒症】
郁冒者。由肾气大亏。每遇风寒。即发眩冒。不仁不省。冷汗时流。宜十全大补汤主之。
【附肝厥症】
肝厥之症。状如痫疾。僵仆不醒。醒则呕吐。头眩发热。宜二陈汤。加柴胡、枳壳、甘菊、钩藤、干葛、山栀、生
姜。
【附头重症】
湿气在上。头重如山。有似眩状。宜红豆散搐鼻内。
眩晕选方
二陈汤 统治头眩。属风寒湿痰。诸有余之疾。（方见痰症）
四君子汤 治头眩。属脾弱气虚。诸不足之症。
补中益气汤 治头眩。属脾气下陷。清汤不朝于巅顶。（二方俱见中风）
人参养荣汤 治头眩。属脾肝血虚。荣气不充于三阴。
即十全大补汤。去川芎。加陈皮、远志、五味子。
鹿茸肾气丸 治眩晕。属肾气衰弱。不能纳气归原。
即六味丸加鹿茸、菟丝子、石斛、巴戟、龟板。
桂附八味丸 治眩晕。属阳气孤浮。引火归原。（方见中风）
加减逍遥散 治头眩。属气血不足。肝肾相火兼郁者。
当归 白术 白芍 茯苓 柴胡 丹皮 熟地 黄柏 炙甘草
或加山栀、薄荷。舒郁尤捷。
[General Principle]
All meridians connect to the eyes. The essence of the Zang-Fu organs, tendons, and bones, along with the meridians, forms the optic nerve system (Muxi), which connects upward to the brain and emerges posteriorly from the nape. Therefore, when pathogenic factors attack the nape, and coincide with the body's deficiency, if the invasion is deep, it follows the optic nerve system into the brain. This causes the brain to rotate; the rotation of the brain pulls the optic nerve system tight, resulting in vertigo (Xuanyun). (From the Classic Text)
[Internal Causes]
All wind diseases causing tremors and vertigo belong to Liver Wood. (Neijing) Because the Liver channel connects upward to the optic nerve system and corresponds to Wind, vertigo is considered Liver Wind. However, there are also cases caused by Fire, Phlegm, Deficiency, Summerheat, and Dampness. (Zhengzhi Huibu)
[External Manifestations]
The condition presents as dim vision and tinnitus, feeling as if standing on a boat or cart, wanting to fall upon rising, and even loss of consciousness. "Xuan" refers to seeing darkness; "Yun" refers to seeing things spinning. When both occur together, it is called vertigo (Xuanyun). If severe and lasting long before recovery, it is also called Yu Mao (Depression and Overwhelm), meaning something seems to cover the head, causing loss of consciousness. (Zhengzhi Huibu)
[Differentiation of Deficiency and Excess in Vertigo]
Deficiency: Internal and external pathogenic factors invade the exterior due to deficiency and attack upward. Excess: Internal and external pathogenic factors combine with stagnant Phlegm to bind upward, while the lower part becomes deficient. (Yizong Rumen)
[Vertigo due to Damp-Phlegm]
In obese individuals, Damp-Phlegm stagnates in the upper body, while Yin Fire arises from below. The Phlegm carries deficient Fire upward to rush to the head and eyes, where evil and righteous Qi stir each other, causing sudden blackouts and visual spots. This is what is meant by "No Phlegm, No Vertigo." (Zhu Danxi)
[Vertigo due to Liver Fire]
In thin, dark-skinned individuals, Kidney Water is deficient, causing Liver Wood to wither and move, carrying Ministerial Fire to occupy the high peak of the head, leading to vertigo. This is like "Wind prevails, earth shakes; Fire meets wind, flames spin." (Zhu Danxi)
[Vertigo due to Kidney Deficiency]
Human Yin and Yang embrace each other and do not separate. Thus, if Yang Qi desires to escape upward, Yin Qi attracts it downward. If sexual excess occurs, the Kidneys fail to grasp Qi and return it to its source, causing all Qi to rush upward in rebellion. This vertigo stems from Kidney Deficiency. (Zhizhi Fang)
[Vertigo due to Blood Deficiency]
Blood is the companion of Qi; Qi attaches to Blood, and Blood provides nourishment. In cases of vomiting blood, epistaxis, metrorrhagia, or postpartum Yin loss, the Liver fails to secure Ying Qi, causing Blood to flow recklessly out of its channels. This vertigo arises from Blood Deficiency. (Zhizhi Fang)
[Vertigo due to Spleen Deficiency]
The Spleen resides in the central region, ascending the Yang of the Heart and Lungs, and damming the Yin of the Kidneys and Liver. If overwork leads to excessive sweating and Yang loss, Yuan Qi sinks, and Clear Yang fails to ascend. This vertigo stems from insufficient Middle Qi. (Liu Chun)
[Vertigo due to Qi Stagnation]
Emotional stimuli cause organ Qi imbalance, leading to stagnation that generates saliva, condenses into fluid retention, and rebels upward with Qi, causing vertigo. The Cun Kou pulse must be deep, and pain in the supraorbital ridge is characteristic. If Fire stirs Phlegm, it must be accompanied by vertigo, gastric discomfort, and a desire to vomit. (Zhengzhi Huibu)
[Vertigo due to Fluid Retention]
Middle Qi fails to transport, causing water to stagnate under the Heart. Heart Fire fears the Water and dares not descend, disturbing the upper body, causing head and eye vertigo, palpitations, or expectoration of frothy saliva. It is appropriate to drain water and promote urination so that Heart Fire descends, and the vertigo will resolve itself. (Zhengzhi Huibu)
[Vertigo due to External Contraction]
Caused by external pathogens: Wind causes stiff neck and spontaneous sweating; Cold causes spasms and pulling pain; Summerheat causes irritability, stuffiness, thirst, and dry mouth; Dampness causes heaviness and vomiting. These four climatic factors cause vertigo by taking advantage of deficiency. (Zhongyi Xinfa)
[Morning and Evening Vertigo]
Morning vertigo occurs upon rising, resolves quickly, and happens daily; this is Yang Deficiency. Evening vertigo occurs at dusk, improves slightly with lying down; this is Yin Deficiency. (Yizong Shengmo)
[Fatal Signs]
If vertigo is accompanied by confused speech, profuse sweating, diarrhea, frequent fainting, and a sensation of rotation even when lying down, it indicates extreme deficiency and is untreatable. (Yizong Rumen)
[Pulse Diagnosis]
An overflowing and large Liver pulse indicates vertigo. A floating pulse indicates Wind; tight indicates Cold; fine indicates Dampness; weak indicates Summerheat; wiry and slippery indicate Phlegm; hollow and choppy indicate Blood Stasis; rapid indicates intense Fire; soft and large indicates extreme deficiency.
[Treatment Principles]
First regulate Phlegm and Qi, then treat according to symptoms. (Yimen Juyao) For external pathogens, harmonize and clear Phlegm-Fire; for internal deficiency, strengthen the root so the branch resolves spontaneously. (Yizong Rumen)
[Medication]
For external pathogens and Phlegm-Fire, primarily use Er Chen Tang, adding Tianma (Gastrodiae Rhizoma) and Manjingzi (Vittariae Spora). If complicated by Wind, add Jingjie (Schizonepetae Herba) and Fangfeng (Saposhnikoviae Radix). If complicated by Cold, add Gaoben (Ligustici Rhizoma et Radix) and Xixin (Asari Radix et Rhizoma). If complicated by Summerheat, add Xiangru (Elsholtziae Herba) and Huoxiang (Pogostemonis Herba). If complicated by Dampness, add Cangzhu (Atractylodis Rhizoma) and Houpo (Magnoliae Officinalis Cortex). If complicated by Fire, add Zhizi (Gardeniae Fructus) and Huangqin (Scutellariae Radix). For Qi Deficiency, primarily use Sijunzi Tang. For Qi Sinking, primarily use Buzhong Yiqi Tang. For Blood Deficiency, primarily use Renshen Yangrong Tang. For Kidney Deficiency, primarily use Lurong Shenqi Wan. For chronic Yang Deficiency with fainting upon cold exposure, use Guifu Bawei Wan. For reckless movement of Ministerial Fire with vertigo upon exertion, use Jiawei Xiaoyao San.
[Contraindication of Elixirs]
The world uses elixirs to suppress Qi that does not return to its source, using Chenxiang (Aquilaria Lignum) to descend Qi, which is extremely misleading. Minerals and stones assist Fire, and aromatic substances scatter Qi, often leading to disastrous dispersion. How can they suppress Qi that does not return?
[Appendix: Yu Mao Syndrome]
Yu Mao results from severe Kidney Qi deficiency. Upon exposure to Wind-Cold, vertigo and overwhelm occur, with numbness, loss of consciousness, and cold sweat. It should be treated primarily with Shiquan Dabu Tang.
[Appendix: Liver Jue Syndrome]
Liver Jue resembles epilepsy, with sudden collapse and unconsciousness. Upon waking, vomiting, head vertigo, and fever occur. Treat with Er Chen Tang, adding Chaihu (Bupleuri Radix), Zhike (Aurantii Fructus), Ganju (Chrysanthemi Flos), Gouteng (Uncariae Ramulus cum Uncis), Ge Gen (Puerariae Lobatae Radix), Zhizi (Gardeniae Fructus), and Shengjiang (Zingiberis Rhizoma Recens).
[Appendix: Heavy Head Syndrome]
Dampness in the upper body causes the head to feel heavy as if weighted down, resembling vertigo. Use Hongdou San (Red Bean Powder) insufflated into the nose.
[Selected Formulas for Vertigo]
Er Chen Tang (Two-Aged Decoction): Universally treats head vertigo due to Wind-Cold-Damp-Phlegm and other Excess conditions. (Formula see Phlegm Syndrome)
Sijunzi Tang (Four Gentlemen Decoction): Treats head vertigo due to Spleen weakness and Qi Deficiency, representing various Deficiency conditions.
Buzhong Yiqi Tang (Decoction to Tonify the Middle and Augment the Qi): Treats head vertigo due to Spleen Qi sinking and Clear Yang failing to rise to the vertex. (Both formulas see Stroke Syndrome)
Renshen Yangrong Tang (Ginseng Nourishing Nutritive Qi Decoction): Treats head vertigo due to Spleen and Liver Blood Deficiency, where Ying Qi fails to fill the Three Yin channels.
It is Shiquan Dabu Tang minus Chuanxiong (Ligustici Chuanxiong Rhizoma), plus Chenpi (Citri Reticulatae Pericarpium), Yuanzhi (Polygalae Radix), and Wuweizi (Schisandrae Chinensis Fructus).
Lurong Shenqi Wan (Deer Antler Kidney Qi Pill): Treats vertigo due to Kidney Qi decline, unable to grasp Qi and return it to its source.
It is Liuwei Wan (Six-Ingredient Pill with Rehmannia) plus Lurong (Cervi Cornu Degelatinatum), Tusizi (Cuscutae Semen), Shihu (Dendrobii Caulis), Bajitian (Morindae Officinalis Radix), and Guiban (Testudinis Carapax et Plastrum).
Guifu Bawei Wan (Cinnamon Twig and Aconite Eight-Ingredient Pill): Treats vertigo due to isolated floating Yang, guiding Fire back to its source. (Formula see Stroke Syndrome)
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Plus Decoction): Treats head vertigo due to Qi and Blood insufficiency, with concurrent Ministerial Fire and stagnation in Liver and Kidney.
Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Baishao (Paeoniae Radix Alba), Fuling (Poria), Chaihu (Bupleuri Radix), Danpi (Moutan Cortex), Shudi (Rehmanniae Radix Preparata), Huangbai (Phellodendri Cortex), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata).
Or add Zhizi (Gardeniae Fructus) and Bohe (Menthae Haplocalycis Herba). This is particularly effective for relieving stagnation.