脉∶风寒暑湿，气郁生涎；下虚上实，皆头晕眩。风浮寒紧；湿细暑虚；痰弦而滑；瘀
芤而涩；数大火邪；虚大久极。先理气痰，次随症脉。
眩者，言其黑运旋转，其状目闭眼暗、身转耳聋，如立舟车之上，起则欲倒。盖虚极乘
寒得之，亦不可一途而取轨也。
大凡头眩者，痰也。
清晕化痰汤 治头目眩晕。
陈皮（去白） 半夏（姜汁炒） 茯苓（去皮，各一钱半） 甘草（三分） 川芎（八分） 白芷 羌活
（各七分） 枳实（麸炒，一钱） 南星（姜汁炒） 防风 细辛（各六分） 黄芩（酒炒，八分）气虚，加
人参七分，白术；有热，加黄连六分；血虚，加川芎、当归各一钱。上锉一剂。生姜三片，
水煎，温服。以此作丸，亦可。
肥人头眩者，属气虚湿痰也。
四君子汤 治气虚湿痰头眩。
人参（去芦） 白术（去芦） 茯苓（去皮） 黄 （蜜炒） 川芎 陈皮 半夏（姜制） 天麻
桔梗（去芦） 白芷 当归（各等分） 甘草（减半）
上锉一剂。生姜三片，枣一枚，水煎，温服。
瘦人头眩者，属血虚痰火也。
四物汤加减 治血虚痰火头眩。
当归 川芎 白芍（酒炒） 熟地 人参（减半） 陈皮 片芩 山栀 茯苓（去皮） 天麻（各
等分） 甘草（减半）
上锉一剂。生姜三片，枣一枚，水煎，温服。
忽时眩晕倒者，是风痰，脉浮滑也。
二陈汤加减
茯苓 陈皮 羌活 防风 人参 当归 白术（去芦） 枳实（麸炒） 南星（姜制） 川芎
桔梗 瓜蒌仁（各等分） 甘草（少许）
上锉一剂。水煎，入竹沥、姜汁同服。
劳役之人，饥寒眩晕者，脉虚弱也。补中益气汤加减（方见内伤）。根据本方加半夏、熟地
黄、白芍、天麻。
阴虚火动眩晕者，脉必数也。滋阴降火汤加减（方见虚劳）。根据本方加川芎、天麻、山栀
、竹沥少许。
虚极欲倒，如坐舟车，手足冷者，脉沉细也。
参附汤 治真阳不足，上气喘急、气短、自汗、眩晕。
人参（五钱） 大附子（炮，三钱）
上锉一剂。生姜十片，水煎，温服。
若泄泻多而眩晕，时时自冒者，难治也。头旋眼黑，如在风云中者，乃胃气虚停痰而致
也。半夏白术天麻汤（方见头痛）。
头目昏眩者，乃风热上攻也。防风通圣散，治风热上攻，头目昏眩闷痛、痰喘咳嗽。根据
本方去麻黄、芒硝，加菊花、人参、砂仁、寒水石（方见中风上治）。
临事不宁，眩晕嘈杂者，此心脾虚怯也。
滋阴健脾汤 此治气血虚损，有痰作眩晕之仙剂也。
当归（酒洗，一钱） 川芎（五分） 白芍 生地黄（酒洗，八分） 人参（七分） 白术（一钱五分） 白
茯苓（去皮，一钱） 陈皮（盐水洗，去白，一钱） 半夏（姜制） 白茯神（去皮木） 麦门冬（去心）
远志（去心，各七分） 甘草（炙，四分）
上锉一剂。姜、枣水煎，早晚服。
大学士中玄高公，患头目眩晕，耳鸣眼黑如在风云中，目中溜火，一医以清火化痰，一
医以滋补气血，俱罔效。余诊六脉洪数，此火动生痰。以酒蒸大黄末三钱，茶下。一服而愈
。盖火降则痰自消矣。
一熊槐二官，年六十余，身体胖大。余诊其脉，下手即得五至一止，余乃惊曰∶君休矣
!渠曰∶连日微觉头晕，别无恙也，何故出此，愿实教焉。予曰∶越十日用药，相哂而退。
少顷间中痰，求救于余。见其必不可治，令以香油灌之，即醒。逾十日，果卒。
脉象：风寒暑湿邪气侵袭，或气机郁滞生痰涎；下元虚损而上部实邪壅盛，都会导致头晕目眩。风邪致脉浮，寒邪致脉紧；湿邪致脉细，暑邪致脉虚；痰饮致脉弦而滑；瘀血致脉芤而涩；数脉主火热邪盛；虚大之脉多见于久病至极。治疗时，应先调理气机和痰湿，随后根据症状和脉象进行辨证施治。
眩晕，是指眼前发黑、天旋地转的感觉，其表现为闭眼视物昏暗、身体旋转、耳聋，如同站在船车之上，起身时想要跌倒。这大多是因为极度虚弱又感受寒邪所致，但也不可拘泥于一种治疗方法。
清晕化痰汤：治疗头目眩晕。
陈皮（去白）、半夏（姜汁炒）、茯苓（去皮，各一钱半）、甘草（三分）、川芎（八分）、白芷、羌活（各七分）、枳实（麸炒，一钱）、南星（姜汁炒）、防风、细辛（各六分）、黄芩（酒炒，八分）。若气虚，加人参七分、白术；若有热，加黄连六分；若血虚，加川芎、当归各一钱。以上药材锉碎为一剂，加生姜三片，水煎，温服。将此方制成丸药服用亦可。
四君子汤加减：治疗气虚湿痰引起的头眩。
人参（去芦）、白术（去芦）、茯苓（去皮）、黄芪（蜜炒）、川芎、陈皮、半夏（姜制）、天麻、桔梗（去芦）、白芷、当归（各等分）、甘草（减半）。
以上药材锉碎为一剂，加生姜三片、大枣一枚，水煎，温服。
四物汤加减：治疗血虚痰火引起的头眩。
当归、川芎、白芍（酒炒）、熟地黄、人参（减半）、陈皮、黄芩、山栀、茯苓（去皮）、天麻（各等分）、甘草（减半）。
以上药材锉碎为一剂，加生姜三片、大枣一枚，水煎，温服。
二陈汤加减：
茯苓、陈皮、羌活、防风、人参、当归、白术（去芦）、枳实（麸炒）、南星（姜制）、川芎、桔梗、瓜蒌仁（各等分）、甘草（少许）。
以上药材锉碎为一剂，水煎，加入竹沥、姜汁同服。
从事体力劳动的人，因饥寒导致的眩晕，脉象虚弱。可用补中益气汤加减（方剂见内伤篇）。在本方基础上加半夏、熟地黄、白芍、天麻。
阴虚火旺动扰引起的眩晕，脉象必然数急。可用滋阴降火汤加减（方剂见虚劳篇）。在本方基础上加川芎、天麻、山栀及少许竹沥。
极度虚弱想要跌倒，如同坐在船车上，手足冰冷的，脉象沉细。
参附汤：治疗真阳不足，伴有上气喘急、气短、自汗、眩晕。
人参（五钱）、大附子（炮制，三钱）。
以上药材锉碎为一剂，加生姜十片，水煎，温服。
如果腹泻严重且伴有眩晕，时常感到头目昏蒙不清的，难以治疗。头旋眼黑，如同在风云之中，这是胃气虚衰、痰湿停滞所致。可用半夏白术天麻汤（方剂见头痛篇）。
头目昏花眩晕，是风热上攻所致。防风通圣散，治疗风热上攻引起的头目昏眩闷痛、痰喘咳嗽。根据本方去掉麻黄、芒硝，加入菊花、人参、砂仁、寒水石（方剂见中风上治篇）。
滋阴健脾汤：这是治疗气血虚损、有痰引发眩晕的良方。
当归（酒洗，一钱）、川芎（五分）、白芍、生地黄（酒洗，八分）、人参（七分）、白术（一钱五分）、白茯苓（去皮，一钱）、陈皮（盐水洗，去白，一钱）、半夏（姜制）、白茯神（去皮木）、麦门冬（去心）、远志（去心，各七分）、甘草（炙，四分）。
以上药材锉碎为一剂，用姜、枣水煎，早晚服用。
大学士高拱（字中玄），患有头目眩晕，耳鸣眼黑如同在风云之中，眼中似有火光流动。一位医生用清火化痰法，另一位医生用滋补气血法，都无效。我诊察其六脉洪数，判断为火动生痰。用酒蒸大黄末三钱，茶水送服。服药一次即痊愈。这是因为火降则痰自消。
有一位熊槐二官，六十多岁，身体肥胖。我诊察他的脉象，手下即感到五至一止（代脉），我惊讶地说：“您恐怕不行了！”他说：“这几天只是微微觉得头晕，没有其他不适，为什么这么说？请如实告诉我。”我说：“再过十天用药，到时候我们相视一笑告别吧。”不久后他突然发作中风痰厥，向我求救。我看他已不可救治，便让人灌入香油，他随即苏醒。过了十天，果然去世。
Pulse: Wind, cold, summer-heat, and dampness pathogens, or qi stagnation generating phlegm-fluids; deficiency in the lower jiao with excess in the upper jiao, all can cause dizziness and vertigo. Wind presents as a floating pulse; cold presents as a tight pulse; dampness presents as a fine pulse; summer-heat presents as a deficient pulse; phlegm presents as a string-taut and slippery pulse; blood stasis presents as a knotted and choppy pulse; rapid pulse indicates intense fire pathogen; large and deficient pulse indicates extreme chronic depletion. Initially regulate qi and phlegm, then treat according to symptoms and pulse.
Vertigo refers to the sensation of darkness and rotation, manifesting as closed eyes with dim vision, body spinning, deafness, feeling as if standing on a boat or cart, and wanting to fall when rising. This is generally caused by extreme deficiency combined with cold invasion, but treatment should not be restricted to a single approach.
Generally speaking, head vertigo is due to phlegm.
Qingyun Huatan Decoction (Clear Dizziness and Resolve Phlegm Decoction): Treats head and eye vertigo.
Chenpi (Exocarpium Citri Reticulatae, white part removed), Banxia (Rhizoma Pinelliae Preparatum with ginger juice), Fuling (Poria, peel removed, each 1.5 qian), Gancao (Radix Glycyrrhizae, 0.3 qian), Chuanxiong (Rhizoma Chuanxiong, 0.8 qian), Baizhi (Radix Angelicae Dahuricae), Qianghuo (Rhizoma et Radix Notopterygii, each 0.7 qian), Zhishi (Fructus Aurantii Immaturus, bran-fried, 1 qian), Nanxing (Rhizoma Arisaematis Preparatum with ginger juice), Fangfeng (Radix Saposhnikoviae), Xixin (Herba Asari, each 0.6 qian), Huangqin (Radix Scutellariae Preparatum with wine, 0.8 qian). If qi deficiency, add Renshen (Radix Ginseng) 0.7 qian, Baizhu (Rhizoma Atractylodis Macrocephalae); if heat, add Huanglian (Rhizoma Coptidis) 0.6 qian; if blood deficiency, add Chuanxiong and Danggui (Radix Angelicae Sinensis) each 1 qian. Crush these herbs for one dose. Add three slices of Shengjiang (Rhizoma Zingiberis Recens), decoct in water, and take warm. Making this into pills is also acceptable.
Head vertigo in obese individuals belongs to qi deficiency with damp-phlegm.
Sijunzi Tang (Four Gentlemen Decoction) Modified: Treats head vertigo due to qi deficiency and damp-phlegm.
Renshen (Radix Ginseng, radix tip removed), Baizhu (Rhizoma Atractylodis Macrocephalae, radix tip removed), Fuling (Poria, peel removed), Huangqi (Radix Astragali Preparatum with honey), Chuanxiong (Rhizoma Chuanxiong), Chenpi (Exocarpium Citri Reticulatae), Banxia (Rhizoma Pinelliae Preparatum with ginger), Tianma (Rhizoma Gastrodiae), Jiegeng (Radix Platycodonis, radix tip removed), Baizhi (Radix Angelicae Dahuricae), Danggui (Radix Angelicae Sinensis, equal parts), Gancao (Radix Glycyrrhizae, half dose).
Crush these herbs for one dose. Add three slices of Shengjiang (Rhizoma Zingiberis Recens) and one date, decoct in water, and take warm.
Head vertigo in thin individuals belongs to blood deficiency with phlegm-fire.
Siwu Tang (Four Substances Decoction) Modified: Treats head vertigo due to blood deficiency and phlegm-fire.
Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Baishao (Radix Paeoniae Alba Preparatum with wine), Shudihuang (Radix Rehmanniae Preparata), Renshen (Radix Ginseng, half dose), Chenpi (Exocarpium Citri Reticulatae), Pianqing (Radix Scutellariae), Shanzhi (Fructus Gardeniae), Fuling (Poria, peel removed), Tianma (Rhizoma Gastrodiae, equal parts), Gancao (Radix Glycyrrhizae, half dose).
Crush these herbs for one dose. Add three slices of Shengjiang (Rhizoma Zingiberis Recens) and one date, decoct in water, and take warm.
Sudden onset of vertigo leading to collapse is due to wind-phlegm, with a floating and slippery pulse.
Erchen Tang (Two-Aged Decoction) Modified:
Fuling (Poria), Chenpi (Exocarpium Citri Reticulatae), Qianghuo (Rhizoma et Radix Notopterygii), Fangfeng (Radix Saposhnikoviae), Renshen (Radix Ginseng), Danggui (Radix Angelicae Sinensis), Baizhu (Rhizoma Atractylodis Macrocephalae, radix tip removed), Zhishi (Fructus Aurantii Immaturus, bran-fried), Nanxing (Rhizoma Arisaematis Preparatum with ginger), Chuanxiong (Rhizoma Chuanxiong), Jiegeng (Radix Platycodonis), Gualouren (Semen Benincasae, equal parts), Gancao (Radix Glycyrrhizae, small amount).
Crush these herbs for one dose. Decoct in water, add Zhuli (Bambusae Caulis in Taenia) and Jiangzhi (Zingiberis汁), and take together.
Individuals engaged in physical labor who experience vertigo due to hunger and cold have a weak and deficient pulse. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) Modified (see Internal Injury chapter). Add Banxia (Rhizoma Pinelliae), Shudihuang (Radix Rehmanniae Preparata), Baishao (Radix Paeoniae Alba), and Tianma (Rhizoma Gastrodiae) to this formula.
Vertigo caused by yin deficiency with hyperactive fire presents with a rapid pulse. Use Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction) Modified (see Deficiency Consumption chapter). Add Chuanxiong (Rhizoma Chuanxiong), Tianma (Rhizoma Gastrodiae), Shanzhi (Fructus Gardeniae), and a small amount of Zhuli (Bambusae Caulis in Taenia) to this formula.
Extreme weakness with a desire to collapse, feeling like sitting on a boat or cart, with cold hands and feet, presents with a deep and fine pulse.
Shenfu Tang (Ginseng and Aconite Decoction): Treats true yang deficiency accompanied by panting, shortness of breath, spontaneous sweating, and vertigo.
Renshen (Radix Ginseng, 5 qian), Dafuzi (Radix Aconiti Lateralis Preparata, processed, 3 qian).
Crush these herbs for one dose. Add ten slices of Shengjiang (Rhizoma Zingiberis Recens), decoct in water, and take warm.
If severe diarrhea is accompanied by vertigo and frequent sensations of head blackout, it is difficult to treat. Head spinning and blackened vision, as if in wind and clouds, are caused by stomach qi deficiency and stagnant phlegm. Use Banxia Baizhu Tianma Tang (Pinellia, Atractylodes, and Gastrodia Decoction) (see Headache chapter).
Blurred vision and vertigo are caused by wind-heat attacking upward. Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) treats wind-heat attacking upward, causing blurred vision, vertigo, oppressive pain, phlegm, wheezing, and cough. Remove Mahuang (Herba Ephedrae) and Mangxiao (Natrii Sulfas) from this formula, and add Juhua (Flos Chrysanthemi), Renshen (Radix Ginseng), Sharen (Fructus Amomi Rotundus), and Hanshuishi (Halloysitum Rubrum) (see Stroke Upper Treatment chapter).
Mental unrest during activities, with vertigo and epigastric discomfort, indicates heart and spleen deficiency and timidity.
Ziyin Jianpi Tang (Nourish Yin and Strengthen Spleen Decoction): This is an excellent prescription for treating vertigo caused by qi and blood deficiency with phlegm.
Danggui (Radix Angelicae Sinensis, washed with wine, 1 qian), Chuanxiong (Rhizoma Chuanxiong, 0.5 qian), Baishao (Radix Paeoniae Alba), Shengdihuang (Radix Rehmanniae Fresh Preparata, washed with wine, 0.8 qian), Renshen (Radix Ginseng, 0.7 qian), Baizhu (Rhizoma Atractylodis Macrocephalae, 1.5 qian), Bai Fuling (Poria, peel removed, 1 qian), Chenpi (Exocarpium Citri Reticulatae, washed with salt water, white part removed, 1 qian), Banxia (Rhizoma Pinelliae Preparatum with ginger), Bai Fushen (Poria with Hostwood, wood removed), Maidong (Radix Ophiopogonis, heart removed), Yuanzhi (Radix Polygalae, heart removed, each 0.7 qian), Gancao (Radix Glycyrrhizae, roasted, 0.4 qian).
Crush these herbs for one dose. Decoct with ginger and dates in water, take morning and evening.
Grand Secretary Gao Gong (courtesy name Zhongxuan) suffered from head and eye vertigo, tinnitus, blackened vision as if in wind and clouds, and flowing fire in the eyes. One physician used clearing fire and resolving phlegm methods, another used nourishing qi and blood methods, both without effect. I palpated his six pulses as surging and rapid, diagnosing fire agitation generating phlegm. I administered three qian of Da Huang (Radix et Rhizoma Rhei) powder steamed with wine, taken with tea. He was cured after one dose. This is because when fire descends, phlegm naturally dissipates.
Official Xiong Huai'er, over sixty years old, had a large and fat body. I palpated his pulse and immediately felt a pause every five beats (intermittent pulse). I exclaimed in surprise, "Sir, you may perish!" He said, "I have only felt slightly dizzy these past few days, with no other discomfort. Why do you say this? Please teach me truthfully." I replied, "Use medicine for ten more days, and we shall smile at each other before parting." Shortly after, he suddenly suffered from wind-phlegm syncope and sought my help. Seeing that he was incurable, I ordered sesame oil to be poured into him, and he woke up. Over ten days later, he indeed passed away.