普明子曰。瘰 者。肝病也。肝主筋。肝经血燥有火。则筋急而生瘰 。多生于耳前后
者。胆之部位。胆与肝相表里。其初起。即宜消瘰丸消散之。不可用刀针。及敷溃烂之药。
若病久已经溃烂者。外贴普救万全膏。内服消瘰丸。并逍遥散。自无不愈。更宜戒恼怒。断
煎炒及发气闭气诸物。免致脓水淋漓。渐成虚损。患此者可毋戒欤。
（新采）消瘰丸。
此方奇效。治愈者不可胜计。予亦刻方普送矣。
元参（蒸。）牡蛎（ 醋淬。）贝母（去心蒸。各四两。）
共为末。炼蜜为丸。每服三钱。开水下。日一服。
愚按普明着医学心悟一书。逐未亡本。用之鲜效。唯此方平淡而神奇。当共宝之。但耳
前后为少阳部位。（渠云肝之部位者误也。故改正之。）
内经云。上虚则眩。又云。肾虚则高摇髓海。不足则脑转耳鸣。皆指不足而言仲景论眩。
以痰饮为先。丹溪宗河间之说。亦谓无痰不眩。无火不晕。皆指有余而言。前圣后贤。何其
相反至此。不知此症不离于肝。经云。诸风掉眩。皆属于肝。此风非外来之风。指厥阴风木
而言。厥阴风木。与少阳相火同居。厥阴气逆。则风生而火发。故河间以风火立论也。风生
必挟木势而克土。土病则聚液而成痰。故仲景以痰饮立论。丹溪以痰火立论也。然一身聚邪
之处。即为偏虚之处。头为诸阳之会相火得以逆行上 者。非上焦之虚而何。肾为肝母。
肾主藏精。精虚则髓海空而头重。故内经以上虚及肾虚髓海不足立论也。言虚者。言其病根。
言
脉数热多 脉涩血少。 弦为肝风。 滑实痰责。 虚小气虚。 大为病进。
一眩晕脉弦发热。或寒热往来。宜
逍遥散。加半夏天麻钩藤主之。（四十八）
一眩晕脉数或滑实。大小便闭。胸胁作痛。耳聋耳鸣多怒。凡属肝经实火。宜
当归芦荟丸○此法。从喻嘉言寓意草医吴添宫之母一案得来。
一眩晕脉涩。乃精气不足。欲荣其上。必灌耳根。宜
六味地黄汤。倍地黄。去丹皮泽泻。加细辛炙甘草各一钱。川芎二钱。枸杞子三
钱。肉苁蓉
一脉虚细弱小。是气虚。宜
补中益气汤。加天麻半夏钩藤。（五）
一脉弦而滑。眩晕而呕逆。为痰饮。宜泽泻四钱白术二钱水煎服。或用二承汤。加天麻
合此二味。
一实火眩晕不可当。宜大黄酒炒三遍研末。茶调下二三钱。
一虚眩诸药不效。宜鹿茸五钱。酒煎去滓。入麝香少许服。缘鹿茸生于头。以类相从也。
一眩晕大虚。诸药不效。及虚人愈后调理。俱宜正元丹。（二十）
桂附八味丸。（十五）
普明子说：瘰疬（颈部淋巴结结核）是肝脏的疾病。肝主司筋脉，若肝经血燥且有内火，就会导致筋脉拘急从而产生瘰疬。瘰疬多生于耳前耳后，这是因为该部位属于胆经循行区域，而胆与肝互为表里关系。在疾病初起阶段，就应当使用消瘰丸来消散结节，不可使用刀针切割，也不宜敷贴导致溃烂的药物。如果病程日久已经溃烂，则外贴普救万全膏，内服消瘰丸和逍遥散，没有不痊愈的。此外，更应戒除恼怒情绪，断绝煎炒及容易引发气机闭塞的食物，以免导致脓水淋漓不尽，逐渐演变成虚损劳伤。患此病的人怎能不引以为戒呢？
（新采录）消瘰丸。
此方疗效奇特，治愈者不计其数。我也曾刻印此方广泛赠送。
玄参（蒸制）、牡蛎（醋淬）、贝母（去心、蒸制），各四两。
共研为细末，用炼蜜制成丸药。每次服用三钱，开水送服，每日一次。
我按语：普明子撰写了《医学心悟》一书，但该书未收录此方底本，使用其他方剂鲜有见效。唯有此方看似平淡却神奇有效，应当共同珍视。只是耳前后部位实为少阳经所主。（普明子说是肝的部位是错误的，故在此改正。）
《黄帝内经》说：上部虚弱就会发生眩晕。又说：肾虚则头部摇晃，髓海不足则头晕耳鸣，这些都是指正气不足而言。张仲景论述眩晕，以痰饮为首要因素；朱丹溪遵循刘河间的学说，也认为无痰不作眩，无火不作晕，这些都是指邪气有余而言。前代圣贤与后代贤人，为何观点如此相反？不知道此症离不开肝脏，《内经》云：“诸风掉眩，皆属于肝。”这里的风并非外感之风，而是指厥阴风木之气。厥阴风木与少阳相火同居一体，厥阴之气上逆，则生风而火发，所以刘河间以风火立论。风生必然挟带木势克制脾土，脾土病变则聚液而成痰，所以张仲景以痰饮立论，朱丹溪以痰火立论。然而全身聚集邪气的地方，就是偏于虚弱的地方。头为诸阳之会，相火得以逆行向上，难道不是上焦虚弱吗？肾为肝之母，肾主藏精，精虚则髓海空虚而导致头重，所以《内经》以上虚及肾虚、髓海不足立论。所谓言“虚”，是指疾病的根本原因。
脉数且热多，脉涩且血少，脉弦主肝风，脉滑实主痰浊，脉虚小主气虚，脉大主病情进展。
若眩晕伴有脉弦、发热，或寒热往来，适宜用逍遥散，加半夏、天麻、钩藤为主治。（第四十八条）
若眩晕伴有脉数或滑实，大小便闭结，胸胁疼痛，耳聋耳鸣，易怒，凡属肝经实火者，适宜用当归芦荟丸。此法是从喻嘉言《寓意草》中治疗吴添宫母亲一案得来的。
若眩晕伴有脉涩，乃精气不足，欲荣养上部，必须灌溉耳根，适宜用六味地黄汤，加倍地黄用量，去掉丹皮、泽泻，加细辛、炙甘草各一钱，川芎二钱，枸杞子三钱，肉苁蓉适量。
若脉虚细弱小，是气虚所致，适宜用补中益气汤，加天麻、半夏、钩藤。（第五条）
若脉弦而滑，眩晕且呕吐逆气，为痰饮所致，适宜用泽泻四钱、白术二钱，水煎服。或用二陈汤，加天麻、半夏这两味药。
若实火引起的眩晕剧烈难以忍受，适宜用大黄酒炒三次后研末，茶调下二三钱。
若虚证眩晕，诸药无效，适宜用鹿茸五钱，酒煎去渣，加入少许麝香服用。因为鹿茸生于头顶，取以类相从之意。
若眩晕属大虚证，诸药无效，以及体虚之人病愈后的调理，都适宜用正元丹。（第二十条）
桂附八味丸。（第十五条）
Pu Mingzi stated: Luoli (scrofula, cervical lymph node tuberculosis) is a disease of the Liver. The Liver governs the sinews. If there is blood dryness and internal fire in the Liver meridian, it leads to sinew tension and the formation of Luoli. Luoli often occurs around the ears because this area belongs to the Gallbladder region, and the Gallbladder and Liver are exterior-interiorly related. In the initial stage, Xiaoluo Wan should be used to dissipate the nodules; one must not use knives or needles, nor apply medications that cause ulceration. If the disease has been prolonged and already ulcerated, one should apply Puji Wanquan Gao externally and take Xiaoluo Wan and Xiaoyao San internally, which will invariably lead to recovery. Furthermore, one must abstain from anger and avoid fried foods and items that obstruct Qi flow, to prevent continuous discharge of pus and gradual progression into deficiency consumptive disease. How can those suffering from this illness fail to take heed?
(Newly collected) Xiaoluo Wan.
This formula yields miraculous results, with countless cures. I have also had it printed and distributed widely.
Shenxuan (Prepared Scrophulariae Radix), Muli (Calcined Oyster Shell), Beimu (Prepared Fritillariae Bulbus), each four liang.
Grind into fine powder, form pills with refined honey. Take three qian per dose, washed down with boiled water, once daily.
My commentary: Pu Mingzi authored "Yixue Xinwu" (Heart Mirror of Medicine), but did not include this formula's base version, and other prescriptions rarely yield efficacy. Only this formula, though seemingly plain, is miraculously effective and should be cherished by all. However, the area around the ears and back of the head is actually governed by the Shaoyang meridian. (Pu Mingzi claimed it was the Liver's domain, which is incorrect; thus, I correct it here.)
The *Neijing* states: "Deficiency in the upper part causes vertigo." It also says: "Kidney deficiency leads to swaying of the head; insufficiency of the Marrow Sea causes dizziness and tinnitus." All these refer to deficiency. Zhang Zhongjing discusses vertigo primarily in terms of Phlegm-Fluid retention. Zhu Danxi followed Liu Hejian's theory, stating that without Phlegm there is no vertigo, and without Fire there is no dizziness; these refer to excess conditions. Why are the views of ancient sages and later worthies so contradictory? One must understand that this condition is inseparable from the Liver. As the *Jing* says: "All wind-induced tremors and vertigo belong to the Liver." This "wind" does not refer to external pathogenic wind, but rather to Jueyin Wind-Wood qi. Jueyin Wind-Wood resides together with Shaoyang Ministerial Fire. When Jueyin Qi rebels upward, wind generates and fire erupts; hence, Liu Hejian established his theory on Wind-Fire. When wind generates, it inevitably carries Wood energy to overcome Earth (Spleen/Stomach). Spleen pathology leads to fluid accumulation forming Phlegm; thus, Zhang Zhongjing established his theory on Phlegm-Fluid, and Zhu Danxi on Phlegm-Fire. However, where pathogens gather in the body, that is precisely where deficiency exists. The head is the meeting point of all Yang meridians; for Ministerial Fire to reverse and ascend, it must be due to Upper Jiao deficiency. The Kidney is the Mother of the Liver; the Kidney stores Essence. Insufficient Essence leads to an empty Marrow Sea and heavy head. Thus, the *Neijing* establishes its theory on Upper Deficiency, Kidney Deficiency, and Marrow Sea insufficiency. Speaking of "deficiency" refers to the root cause of the disease.
Rapid pulse indicates heat excess; choppy pulse indicates blood deficiency. Wiry pulse indicates Liver Wind; slippery and solid pulse indicates Phlegm-Turbidity. Deficient and small pulse indicates Qi deficiency; large pulse indicates disease progression.
For vertigo with wiry pulse, fever, or alternating chills and fever, Xiaoyao San is appropriate, added with Banxia, Tianma, and Gouteng as the main treatment. (48)
For vertigo with rapid or slippery-solid pulse, constipation, chest and hypochondriac pain, deafness, tinnitus, and irritability, indicating Liver Meridian Excess Fire, Danggui Lurve Wan is appropriate. This method was derived from Yu Jiayan's case study in *Yuyi Cao* regarding the mother of Wu Tiangong.
For vertigo with choppy pulse, indicating insufficiency of Essence and Qi, aiming to nourish the upper part and irrigate the ear roots, Liujun Dihuang Tang is appropriate. Double the dosage of Dihuang, remove Danpi and Zexie, add Xixin and Zhigancao (each 1 qian), Chuanxiong (2 qian), Gouqizi (3 qian), and Roushouling.
For deficient, thin, small, and weak pulse, indicating Qi deficiency, Buzhong Yiqi Tang is appropriate, added with Tianma, Banxia, and Gouteng. (5)
For wiry and slippery pulse with vertigo and vomiting, indicating Phlegm-Fluid, Zexie (4 qian) and Baizhu (2 qian) decocted in water is appropriate. Or use Erchen Tang, added with Tianma and Banxia.
For unbearable severe excess Fire vertigo, Dahuang stir-fried three times in wine and ground into powder, taken with tea (2-3 qian), is appropriate.
For deficiency-type vertigo unresponsive to other medicines, Lurong (Deer Antler) 5 qian, decocted in wine, filtered, with a small amount of Shexiang (Musk) added, is appropriate. This is based on the principle of similarity, as Deer Antler grows on the head.
For severe deficiency vertigo unresponsive to various medicines, and for post-illness conditioning in deficient individuals, Zhengyuan Dan is appropriate. (20)
Guifu Bawei Wan. (15)