《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。
《本事方》记载：有一位亲属患项部筋脉疼痛，牵连至背部肩胛处，无法转动，服用各种祛风药物均无效。我曾回忆起《千金方》中有肾气攻背椒附丸，便勉强给他服用了两剂，顿时痊愈。此后给其他人使用也都有疗效。这是因为肾气从腰部夹脊上行，经过漕沟穴，然后进入泥丸宫（脑）。漕沟这一穴位，不是精通导引搬运之术的人不能通达，如今肾气逆行至此而不得通畅，使用花椒以引导其回归经脉，病情就能安定。
椒附丸
大附子（一枚，重量在六钱以上的，炮制后去皮和脐，研成粉末）
以上述药末两大钱，好川椒二十粒，用白面填满川椒，加水一盏半，生姜七片，共同煎煮至七分水量，去掉花椒，加入盐，空腹时通口服下。
回头散 治疗头项强直紧急、筋脉疼痛，或者因枕部不适导致颈部无法转动者，在乌药顺气散基础上加羌活、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，炒制）、天南星（炒制）、炮姜、炙甘草（五分）
加生姜、葱白煎煮。
臂痛有痰湿阻滞、气血虚弱、气血凝滞几种情况，应根据具体症状进行治疗。
《指迷方》茯苓丸 治疗中脘部位留伏的痰饮，导致手臂疼痛难以举起，手足不能随意移动，这是治疗痰湿的第一方。
半夏（二两） 茯苓（一两） 枳壳（去除瓤，麸皮炒，半两） 风化朴硝（二钱五分）
以上药物研为细末，用姜汁和面糊制成丸子，如梧桐子大小，每次服用三十丸，姜汤送下。
十味锉散（方剂见痹症门。） 治疗中风血虚引起的臂痛，举动困难支撑不住。
《鸡峰普济方》记载：所谓风眩病，起于心气不足，胸中蓄积热邪而充实，所以出现头风、面部发热等症状。痰热相互感应而动生内风，风与心火相扰乱则导致胸闷昏花，所以称为风眩闷瞀。又说：头风目眩，是由于血气虚弱，风邪侵入脑部，牵引目系所致。五脏六腑的精气，都上注于眼睛，血气与经脉并合上行成为目系，连接于脑，向后出于项中，如果血脉虚弱，就会被风邪所伤，风邪入脑则头部转动，且目系紧张，所以形成眩晕。诊察其脉象洪大而长的，是风眩病。
按语：眩晕虽然属于风病，但有内风和外风的区别。《鸡峰普济方》所说的痰热相感而动风，是风自内生。血气虚导致风邪入脑，是风从外入。内风多从热化，引发则更加旺盛；外风多乘虚而入，清利则反而加重。这两者不可不加以辨别。
《素问》记载：头痛巅疾，下部虚上部实，病变在于足少阴肾经和足太阳膀胱经，严重时波及肾脏，出现视物模糊、摇动不定、闭目耳聋等症状，这是下部实上部虚，病变在于足少阳胆经和足厥阴肝经，严重时波及肝脏。下部虚，是指肾虚，所以肾虚则头痛；上部虚，是指肝虚，所以肝虚则头晕。徇蒙，就像有东西蒙住头部，摇动不定，目瞑耳聋，都是眩晕的表现。
高鼓峰说：肾阴不足，三阳之火炽盛，照耀眼前；中土脾胃虚弱衰败，下逆之光上迫于头顶。阴虚而眩晕的，眼中时常见到火光；土虚而眩晕的，一定兼有恶心呕吐。
按语：中土脾胃虚弱衰败，不能下蔽真阳，则阳气上乘清道，这就是所谓的“上入之光”。然而也有中焦虚损、肝气妄动而导致眩晕的，就像土壤薄则树木摇晃一样。大抵眩晕多从肝发生，所以有肝虚头晕、肾虚头痛的说法，虽然有肝病引起头痛的，但未有眩晕而不兼涉肝脏的。
《圣济总录》记载：风头旋，是因为气虚怯弱，禀赋不充，阳气不能上达于脑，风邪容易侵入，与气相鼓动，导致头旋而晕。也有胸膈之上，痰水结聚，又遭受大寒侵袭，阴气逆上，风痰相聚而结，上冲于头，也会导致头旋，治疗应当用人参丸、祛痰丸之类的方剂。
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).