《本事方》云∶一亲患项筋痛，连及背胛不可转，服诸风药皆不效。余尝忆及《千金》
有肾气攻背椒附丸，予强与之两服，顿瘥。自后与人皆有验。盖肾气自腰夹脊，上至漕 ，然后
入泥丸宫，漕 一穴，非精于搬运者不能透，今逆行至此不得通，用椒以引归经则安矣。
椒附丸
大附（一枚，六钱以上者，炮去皮脐，末之）
上每末二大钱，好川椒二十粒，用白面填满，水一盏半，生姜七片，同煎至七分，去椒
，入盐通口空心服。
回头散 治头项强急筋痛，或锉枕转项不得者，乌药顺气散加羌活、独活、木瓜
。
顺气散
乌药 橘红（各二钱） 麻黄 川芎 白芷 桔梗 枳壳（各一钱，炒） 天虫（炒） 炮姜
炙草（五分）
加姜葱煎。
臂痛有痰、有虚、有气血凝滞，各随症治之。
《指迷》茯苓丸 治中腕留伏痰饮，臂痛难举，手足不得转移，此治痰之第一方
也。
半夏（二两） 茯苓（一两） 枳壳（去穣，麸炒，半两） 风化朴硝（二钱五分）
上为末，姜汁面糊丸，如梧子大，每服三十丸，姜汤下。
十味锉散（方见痹症门。） 治中风血虚臂痛，举动难支。
《鸡峰》云∶夫风眩之病，起于心气不足，胸中蓄热而实，故有头风面热之所为也。痰
热相
感而动风，风与心火相乱则闷瞀，故谓之风眩闷瞀也。又云∶头风目眩者，由血气虚，风邪
入脑，而牵引目系故也。五脏六腑之精，皆上注于目，血气与脉并上为目系属于脑，后出于
项中，血脉若虚，则为风邪所伤，入脑则转，而目系急，故成眩也。诊其脉洪大而长者，风
眩也。
按∶眩晕虽为风病，而有内外之分。鸡峰所谓痰热相感而动风者，风自内生者也。血气
虚风
邪入脑者，风从外入者也。内风多从热化，引之则弥盛。外风多从虚入，清之则转加。二者
不可不辨也。
《素问》云∶头痛巅疾，下虚上实，过在足少阴巨阳，甚则入肾，徇蒙招尤，目瞑耳聋
，下
实上虚，过在足少阳厥阴，甚则入肝。下虚者，肾虚也，故肾虚则头痛；上虚者，肝虚也，
故肝虚则头晕。徇蒙者，如以物蒙其首，招摇不定，目瞑耳聋，皆晕之状也。
高鼓峰云∶肾阴不足，三阳之焰，震耀于当前，中土虚衰，下逆之光，上薄于巅顶，阴
虚而眩者，目中时见火光，土虚而眩者，必兼恶心呕吐也。
按∶中土虚衰，不能下蔽真阳，则上乘清道，所谓上入之光也。然亦有中虚肝气动而晕
者，
如土薄则木摇也。大抵眩晕多从肝出，故有肝虚头晕，肾虚头痛之说，虽亦有肝病头痛者，
要未有眩晕而不兼肝者也。
《圣济总录》云∶风头旋者，以气虚怯，所禀不充，阳气不能上至于脑，风邪易入，与
气相
鼓，致头旋而晕也。亦有胸膈之上，痰水结聚，复犯大寒，阴气逆上，风痰相聚而结，上冲
于头，亦令头旋，治当用人参丸、祛痰丸之类者也。
The *Ben Shi Fang* records: A relative suffered from pain in the tendons of the neck, extending to the scapula, making rotation impossible. Various wind-dispelling medicines were ineffective. I recalled that the *Qian Jin Fang* contained a formula called Jiaofu Wan (Pepper and Aconite Pill) for kidney qi attacking the back, so I reluctantly administered two doses, resulting in immediate recovery. Subsequent use on others also proved effective. This is because kidney qi ascends from the waist along the spine, passes through the Caogou acupoint, and then enters the Newan Palace (brain). The Caogou point cannot be penetrated by those not skilled in Dao Yin (guiding and pulling exercises). Now, with kidney qi reversing and failing to pass through here, using pepper to guide it back to its meridian brings peace.
Jiaofu Wan (Pepper and Aconite Pill)
Da Fuzi (Aconiti Lateralis Radix Praeparata, one piece, weighing over six qian, processed, skin and umbilicus removed, powdered)
Take two large qian of the above powder, twenty grains of good Sichuan pepper (Zanthoxyli Pericarpium), fill the pepper with white flour, add one and a half cups of water, seven slices of fresh ginger, decoct together until three-sevenths of the liquid remains, remove the pepper, add salt, and take orally on an empty stomach.
Huitou San (Turning Head Powder) Treats stiffness and acute pain in the head and neck tendons, or inability to turn the neck due to pillow discomfort. It consists of Wuyao Shunqi San (Wu Yao Smooth Qi Powder) plus Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix), and Mugua (Chaenomelis Fructus).
Shunqi San (Smooth Qi Powder)
Wuyao (Linderae Radix), Juhong (Citri Reticulatae Pericarpium Rubrum) (each two qian)
Mahuang (Ephedrae Herba), Chuanxiong (Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Jiegeng (Platycodonis Radix), Zhike (Aurantii Fructus Immaturus) (each one qian, stir-fried)
Tianchong (Arisaematis Tuber, stir-fried), Paojiang (Zingiberis Rhizoma Preparatum), Zhi Cao (Glycyrrhizae Radix et Rhizoma Preparata cum Melle) (five fen)
Decoct with fresh ginger and green onion.
Arm pain may be caused by phlegm, deficiency, or stagnation of qi and blood; treatment should follow the specific symptoms.
Fuling Wan (Poria Pill) from *Zhi Mi* treats retained fluid-phlegm in the middle jiao (epigastrium), causing arm pain difficult to lift, and inability to move hands and feet freely. This is the primary formula for treating phlegm.
Banxia (Pinelliae Rhizoma) (two liang)
Fuling (Poria) (one liang)
Zhike (Aurantii Fructus Immaturus) (remove pith, bran-fried, half liang)
Fenghua Ponxiao (Natrii Sulfas Exsiccatus) (two qian five fen)
Grind all into powder, make pills with ginger juice and wheat paste, size of wutong seeds. Take thirty pills per dose, washed down with ginger soup.
Shiwei Cusan (Ten-Ingredient Decoction Powder) (See Bi Syndrome section for formula.) Treats arm pain due to blood deficiency in wind-stroke, where movement is difficult to support.
The *Jifeng Puji Fang* states: The disease of wind-dizziness originates from insufficiency of heart qi, with heat accumulating and filling the chest, thus causing head wind and facial heat. Phlegm-heat interacts to generate internal wind; when wind disturbs heart fire, it causes oppression and dizziness, hence termed "wind-dizziness with oppression and blurred vision." It further states: Head wind and dizzy eyes result from deficiency of qi and blood, allowing wind pathogen to enter the brain and pull on the eye system. The essence of the five zang and six fu organs all ascend to the eyes. Qi and blood, merging with the meridians, ascend to form the eye system connected to the brain, emerging posteriorly at the neck. If the blood vessels are deficient, they are injured by wind pathogen; entering the brain, it causes head turning and tension in the eye system, resulting in vertigo. Palpating a pulse that is surging, large, and long indicates wind-dizziness.
Commentary: Although vertigo is considered a wind disease, there is a distinction between internal and external wind. The "phlegm-heat generating internal wind" mentioned in *Jifeng* refers to wind arising from within. Wind entering the brain due to qi and blood deficiency refers to wind entering from outside. Internal wind tends to transform into heat, becoming more intense when provoked. External wind tends to enter via deficiency, and clearing it may exacerbate the condition. These two must be distinguished.
The *Su Wen* states: Headache and disorders of the vertex involve deficiency below and excess above, affecting the Foot Shaoyin (Kidney) and Foot Taiyang (Bladder) meridians; if severe, it enters the Kidney. Symptoms include visual obscuration, swaying instability, closed eyes, and deafness. This involves excess below and deficiency above, affecting the Foot Shaoyang (Gallbladder) and Foot Jueyin (Liver) meridians; if severe, it enters the Liver. Deficiency below refers to Kidney deficiency, hence Kidney deficiency causes headache. Deficiency above refers to Liver deficiency, hence Liver deficiency causes dizziness. "Xunmeng" describes a sensation as if covered by something, with swaying instability; closed eyes and deafness are all manifestations of vertigo.
Gao Gufeng stated: Insufficiency of Kidney yin allows the flames of the Three Yang meridians to blaze before the eyes. Deficiency and decline of the Central Earth (Spleen/Stomach) allow inverted light to press upward against the vertex. Vertigo due to yin deficiency presents with seeing firelight in the eyes; vertigo due to earth deficiency is accompanied by nausea and vomiting.
Commentary: When the Central Earth (Spleen/Stomach) is deficient and declining, it cannot obscure the True Yang below, allowing it to ascend to the clear pathways, which is referred to as "light entering from above." However, there are also cases of vertigo caused by middle jiao deficiency and stirring of Liver qi, similar to how thin soil causes trees to sway. Generally, vertigo largely originates from the Liver, hence the theories of Liver deficiency causing dizziness and Kidney deficiency causing headache. Although Liver disease can cause headache, there is no case of vertigo that does not involve the Liver.
The *Sheng Ji Zong Lu* states: Dizziness of the head results from qi deficiency and timidity, insufficient endowment, where yang qi cannot reach the brain, allowing wind pathogen to easily enter. It beats against the qi, causing head spinning and vertigo. There are also cases where phlegm and water accumulate in the upper chest and diaphragm, combined with exposure to severe cold, causing yin qi to reverse upward. Wind and phlegm gather and knot, rushing upward to the head, also causing dizziness. Treatment should employ formulas such as Renshen Wan (Ginseng Pill) or Qutan Wan (Phlegm-Expelling Pill).