徐 脉左浮弦数。痰多。脘中不爽。烦则火升眩晕。静坐神识稍安。议少阳阳明同治法。（痰火）
羚羊角 连翘 香豆豉 广皮白 半夏曲 黑山栀
某 痰火风在上。舌干头眩。
天麻 钩藤 菊花 橘红 半夏曲 茯苓 山栀 花粉
某 酒客中虚。痰晕。二陈加术白蒺藜钩藤天麻。
江（五十）脉弦动。眩晕痰多。胸痹窒塞。此清阳少旋。内风日沸。当春地气上升。最虑风痱。（内风挟痰）
明天麻 白蒺藜 桂枝木 半夏 橘红 茯苓 苡仁 炙草
又 头额闷胀。痰多作眩。外台茯苓饮加羚羊角桂枝竹沥姜汁法丸。
吴（四五）诊脉芤弱。痰多眩晕。心神过劳。阳升风动。不可过饮助升。治痰须健中。熄风可缓晕。
九蒸白术 炒杞子 白蒺藜 茯苓 菊花炭
周 内风挟痰眩晕。吐出清水。
半夏 茯苓 广皮 天麻 钩藤 菊花
张 肝风内沸。劫烁津液。头晕。喉舌干涸。（肝风）
大生地 天冬 麦冬 萸肉 阿胶 生白芍
陈 肝风动逆不熄。头晕。
九制首乌（四两） 甘菊炭（一两） 杞子（二两） 桑椹子（二两） 黑芝麻（二两） 巨胜子
（一两半） 牛膝（一两半） 茯神（二两） 青果汁法丸。
洪（四十）内风逆。头晕。
经霜桑叶（一钱） 炒黄甘菊花炭（一钱） 生左牡蛎（三钱） 黑 豆皮（三钱）
徽州黑芝麻（二钱） 茯神（一钱半）
某 两寸脉浮大。气火上升。头眩。甚则欲呕吐。厥阴上干。久则阳明失降。土被木克。脾胃俱伤。
先当镇肝阳。
制首乌 豆皮 炒杞子 柏子仁 紫石英 茯神 天冬 南枣
某 操持惊恐。相火肝风上窜。目跳头晕。阴弱欲遗。脉左弦劲。右小平。
生地 白芍 丹皮 钩藤 天麻 白蒺藜 黄菊花 橘红
王（六三）辛甘寒。眩晕已缓。此络脉中热。阳气变现。内风上冒。是根本虚在下。热化内风在上。上实
下虚。先清标恙。（络热）
羚羊角 元参心 鲜生地 连翘心 郁金 石菖蒲
又 照前方去菖蒲郁金加川贝花粉。
某（二四）晕厥。烦劳即发。此水亏不能涵木。厥阳化风鼓动。烦劳阳升。病斯发矣。据述幼年即然。药
饵恐难杜绝。（阴虚阳升）
熟地（四两） 龟版（三两） 牡蛎（三两） 天冬（一两半） 萸肉（二两） 五味（一两）
茯神（二两） 牛膝（一两半） 远志（七钱） 灵磁石（一两）
田（二七）烦劳。阳气大动。变化内风。直冒清空。遂为眩晕。能食肤充。病不在乎中上。以介类沉潜真
阳。咸酸之味为宜。
淡菜胶 龟版胶 阿胶 熟地 萸肉 茯苓 川斛 建莲 山药浆丸。
严（四五）营虚。内风逆。心悸头晕。（营血虚）
炒杞子 柏子仁 三角胡麻 川斛 生左牡蛎 冬桑叶
李（七三）高年颇得纳谷安寝。春夏以来。头晕。跗肿。不能健步。此上实下虚。肾气衰。不主摄纳。肝风
动。清窍渐蒙。大凡肾宜温。肝宜凉。温纳佐凉。乃复方之剂。（下虚）
附都气加车前淡天冬建莲丸。
经云。诸风掉眩。皆属于肝。头为六阳之首。耳目口鼻。皆系清空之窍。所患眩晕者。非外来
之邪。乃肝胆之风阳上冒耳。甚则有昏厥跌仆之虞。其症有夹痰。夹火。中虚。下虚。治胆。治
胃。治肝之分。火盛者。先生用羚羊山栀连翘花粉元参鲜生地丹皮桑叶。以清泄上焦窍
络之热。此先从胆治也。痰多者必理阳明。消痰如竹沥姜汁。菖蒲橘红。二陈汤之类。中虚
则兼用人参。外台茯苓饮是也。下虚者。必从肝治。补肾滋肝。育阴潜阳。镇摄之治是也。至
于天麻钩藤菊花之属。皆系熄风之品。可随症加入。此症之原。本之肝风。当与肝风中风
头风门合而参之。（华岫云）
徐评 眩晕清火养肝。固为正治。但阳气上升。至于身体不能自主。此非浮火之比。古人必用
金石镇坠之品。此则先生所未及知也。忆余初至郡中治病。是时喜用唐人方。先生见之。谓人
曰。有吴江秀才徐某。在外治病。颇有心思。但药味甚杂。此乃无师传授之故。以后先生得宋板
外台秘要读之。复谓人曰。我前谓徐生立方无本。谁知俱出外台。可知学问无穷。读书不可轻
量也。先生之服善如此。犹见古风。所谓药味杂。即指金石品也。因附记于此。
徐先生：脉象左侧浮、弦、数。痰多。胃脘部感觉不舒畅。烦躁时火气上升导致眩晕，静坐时神识稍微安定。建议采用少阳经与阳明经同治的方法。（病机为痰火）
羚羊角 连翘 香豆豉 广陈皮白 半夏曲 黑山栀
某患者：痰火风邪在上焦。舌干头眩。
天麻 钩藤 菊花 橘红 半夏曲 茯苓 山栀 花粉
某患者：长期饮酒者中气虚弱。痰湿导致的眩晕。在二陈汤基础上加白术、白蒺藜、钩藤、天麻。
江先生（五十岁）：脉象弦而动。眩晕痰多。胸痹窒塞感。这是清阳之气不能正常旋转，内风日益沸腾。正值春季地气上升之时，最担心发生风痱（中风偏瘫或失语）。（病机为内风挟痰）
明天麻 白蒺藜 桂枝木 半夏 橘红 茯苓 苡仁 炙甘草
又诊：头额闷胀。痰多引起眩晕。使用《外台秘要》中的茯苓饮，加入羚羊角、桂枝、竹沥、姜汁制成丸药服用。
吴先生（四十五岁）：诊脉芤而弱。痰多眩晕。心神过度劳累。阳气上升风动。不可过量饮用助长阳气升发的饮品。治疗痰湿必须健运中焦。熄风可以缓解眩晕。
九蒸白术 炒枸杞子 白蒺藜 茯苓 菊花炭
周先生：内风挟痰导致眩晕。吐出清水。
半夏 茯苓 广陈皮 天麻 钩藤 菊花
张先生：肝风在内沸腾。劫灼耗伤津液。头晕。喉舌干燥枯竭。（病机为肝风）
大生地 天冬 麦冬 山茱萸 阿胶 生白芍
陈先生：肝风动逆未能平息。头晕。
九制何首乌（四两） 甘菊炭（一两） 枸杞子（二两） 桑椹子（二两） 黑芝麻（二两） 巨胜子（一两半） 牛膝（一两半） 茯神（二两） 用青果汁法制丸。
洪先生（四十岁）：内风上逆。头晕。
经霜桑叶（一钱） 炒黄甘菊花炭（一钱） 生左牡蛎（三钱） 黑豆皮（三钱） 徽州黑芝麻（二钱） 茯神（一钱半）
某患者：两手寸脉浮大。气火上升。头眩。严重时想呕吐。厥阴肝经之气上犯。日久则阳明胃气失于下降。脾土被肝木克制。脾胃俱伤。
应当先平镇肝阳。
制首乌 豆皮 炒枸杞子 柏子仁 紫石英 茯神 天冬 南枣
某患者：操持劳碌且受惊恐。相火与肝风上窜。眼睑跳动头晕。阴液虚弱欲遗精。脉象左侧弦劲。右侧稍平小。
生地 白芍 丹皮 钩藤 天麻 白蒺藜 黄菊花 橘红
王先生（六十三岁）：辛甘寒法。眩晕已缓解。这是络脉中有热。阳气显现病变。内风上冒。这是根本虚弱在下焦。热化生内风在上焦。上实下虚。先清除标症。（病机为络热）
羚羊角 元参心 鲜生地 连翘心 郁金 石菖蒲
又诊：照前方去掉菖蒲、郁金，加入川贝母、花粉。
某患者（二十四岁）：晕厥。烦劳即发作。这是肾水亏虚不能涵养肝木。厥阳化风鼓动。烦劳时阳气上升，病症因此发作。据述幼年即如此。药物恐怕难以彻底杜绝。（病机为阴虚阳升）
熟地黄（四两） 龟版（三两） 牡蛎（三两） 天冬（一两半） 山茱萸（二两） 五味子（一两） 茯神（二两） 牛膝（一两半） 远志（七钱） 灵磁石（一两）
田先生（二十七岁）：烦劳。阳气大动。变化为内风。直冲头部清空之处。遂成眩晕。能进食，肌肤丰满。病不在中上焦。应用介类药材沉潜真阳，咸酸之味为宜。
淡菜胶 龟版胶 阿胶 熟地黄 山茱萸 茯苓 川石斛 建莲 山药浆制丸。
严先生（四十五岁）：营血虚弱。内风上逆。心悸头晕。（病机为营血虚）
炒枸杞子 柏子仁 三角胡麻 川石斛 生左牡蛎 冬桑叶
李先生（七十三岁）：高龄但颇能纳食安睡。自春夏以来，头晕。足背浮肿。不能健步。这是上实下虚。肾气衰弱，不能主司摄纳。肝风动，清窍逐渐蒙蔽。大凡肾脏宜温，肝脏宜凉。温补摄纳佐以清凉，才是复方之剂。（病机为下虚）
附都气丸加车前子、淡天冬、建莲制丸。
经文说：各种风病引起的掉摇眩晕，都属于肝。头为六阳之首，耳目口鼻，都是清空的窍道。所患的眩晕，不是外来的邪气，而是肝胆的风阳上冒罢了。严重的甚至有昏厥跌仆的危险。其症状有夹痰、夹火、中虚、下虚之分。治疗胆、治疗胃、治疗肝各有侧重。火盛者，先生先用羚羊角、山栀、连翘、花粉、元参、鲜生地、丹皮、桑叶，以清泄上焦窍络的热邪。这是先从胆经治疗。痰多者必须调理阳明经，消痰如用竹沥、姜汁、菖蒲、橘红、二陈汤之类。中虚则兼用人参，《外台秘要》中的茯苓饮就是此类。下虚者，必须从肝经治疗，补肾滋肝，育阴潜阳，镇摄的治疗方法是这类。至于天麻、钩藤、菊花之类的，都是熄风的药物，可根据症状加入。此症的根源，本于肝风，应当与《中风门》、《头风门》合参。（华岫云评注）
徐评：眩晕清火养肝，固然是正治之法。但阳气上升，以至于身体不能自主，这不同于一般的浮火。古人必定使用金石重镇坠降的药物。这是先生当时所未及知晓的。回忆我初到郡中治病时，那时喜欢用唐代方的方剂。先生见到后，对人说：“有位吴江秀才徐某，在外治病，颇有心思。但药味很杂。这是因为没有老师传授的缘故。”后来先生得到宋版《外台秘要》阅读后，又对人说：“我之前说徐先生立方的方剂没有本源，谁知都出自《外台》。可知学问无穷，读书不可轻视啊。”先生这种善于听取意见的态度如此，犹见古风。所谓“药味杂”，指的就是金石类药物。因此附记于此。
Mr. Xu: The pulse on the left is floating, wiry, and rapid. There is excessive phlegm. A sensation of discomfort in the epigastrium. When irritable, fire rises causing vertigo; sitting quietly brings slight relief to the spirit and mind. It is proposed to treat the Shaoyang and Yangming meridians simultaneously. (Pathogenesis: Phlegm-Fire)
Antelope Horn (Lingyangjiao), Forsythia Fruit (Lianqiao), Fermented Soybean (Xiangdouchi), White Peel of Tangerine Fruit (Guangpi Bai), Fermented Pinellia Rhizome (Banxia Qu), Gardenia Fruit (Heishanzhi).
Certain patient: Phlegm-fire and wind are above. The tongue is dry with vertigo.
Gastrodia Tuber (Tianma), Uncaria Ramulus cum Uncis (Gouteng), Chrysanthemum Flower (Juhua), Orange Peel (Juhong), Fermented Pinellia Rhizome (Banxia Qu), Poria (Fuling), Gardenia Fruit (Shanzhi), Trichosanthes Root (Huafen).
Certain patient: A chronic drinker has deficiency in the Middle Jiao. Vertigo caused by phlegm. Erchen Decoction (Two-Chen Decoction) added with Atractylodes Macrocephala Rhizome (Baizhu), Tribulus Fructus (Bajili), Uncaria Ramulus cum Uncis (Gouteng), and Gastrodia Tuber (Tianma).
Mr. Jiang (50 years old): The pulse is wiry and moving. Vertigo with excessive phlegm. Chest bi syndrome with a feeling of obstruction. This indicates that Clear Yang Qi fails to rotate properly, and internal wind is boiling day by day. During spring when earth qi rises, one should most fear Fengfei (stroke with hemiplegia or aphasia). (Pathogenesis: Internal Wind carrying Phlegm)
Premium Gastrodia Tuber (Tianma), Tribulus Fructus (Bajili), Cinnamon Twig Wood (Guizhi Mu), Pinellia Rhizome (Banxia), Orange Peel (Juhong), Poria (Fuling), Coix Seed (Yiren), Honey-fried Licorice Root (Zhigancao).
Second consultation: Stuffy and distended head and forehead. Excessive phlegm causing vertigo. Use Fuling Yin (Poria Drink) from *Waitai Mi Yao* (*Secrets of the Outer Palace*), adding Antelope Horn (Lingyangjiao), Cinnamon Twig (Guizhi), Bamboo Sap (Zhuli), and Ginger Juice (Jiangzhi), processed into pills.
Mr. Wu (45 years old): The pulse is knotted (Kou) and weak. Excessive phlegm and vertigo. The heart spirit is overworked. Yang rises and wind moves. One must not drink excessively to aid the rising of Yang. Treating phlegm requires strengthening the Middle Jiao. Extinguishing wind can relieve vertigo.
Nine-steamed Atractylodes Macrocephala Rhizome (Baizhu), Stir-fried Lycium Fruit (Qizi), Tribulus Fructus (Bajili), Poria (Fuling), Charred Chrysanthemum Flower (Juhua Tan).
Mr. Zhou: Internal wind carrying phlegm causes vertigo. Vomiting clear water.
Pinellia Rhizome (Banxia), Poria (Fuling), Broad-leafed Citrus Peel (Guangpi), Gastrodia Tuber (Tianma), Uncaria Ramulus cum Uncis (Gouteng), Chrysanthemum Flower (Juhua).
Mr. Zhang: Liver wind boils internally, consuming and drying up body fluids. Dizziness. Dryness of the throat and tongue. (Pathogenesis: Liver Wind)
Large Rehmannia Root (Dishengdi), Asparagus Tuber (Tiandong), Ophiopogon Tuber (Maidong), Cornus Fruit (Yurou), Donkey-hide Gelatin (Ejiao), Raw White Peony Root (Baishao).
Mr. Chen: Liver wind moves and rebels but is not extinguished. Dizziness.
Nine-processed Polygonum Multiflorum Root (He Shouwu, 4 liang), Charred Sweet Chrysanthemum (Ganju Tan, 1 liang), Lycium Fruit (Qizi, 2 liang), Mulberry Fruit (Sangshenzi, 2 liang), Black Sesame Seed (Heimazhi, 2 liang), Giant Sesame (Jushengzi, 1.5 liang), Achyranthes Bidentata Root (Niuxi, 1.5 liang), Poria with Hostwood (Fushen, 2 liang). Processed into pills using Green Plum Juice.
Mr. Hong (40 years old): Internal wind rebels. Dizziness.
Frost-exposed Mulberry Leaf (Sangye, 1 qian), Stir-fried Yellow Sweet Chrysanthemum Char (Huangju Tan, 1 qian), Raw Left-side Oyster Shell (Muli, 3 qian), Black Bean Skin (Doupi, 3 qian), Huizhou Black Sesame Seed (Heimazhi, 2 qian), Poria with Hostwood (Fushen, 1.5 qian).
Certain patient: Both Cun positions of the pulse are floating and large. Qi and fire rise upward. Vertigo. Severe cases lead to nausea/vomiting. Jueyin (Liver) channel interferes upwards. Over time, Yangming (Stomach) loses its descending function. Earth is overcome by Wood. Spleen and Stomach are both injured.
One should first suppress Liver Yang.
Processed Polygonum Multiflorum Root (Zhi Shouwu), Bean Skin (Doupi), Stir-fried Lycium Fruit (Chao Qizi), Biota Seed (Baiziren), Purple Quartz (Zishi), Poria with Hostwood (Fushen), Asparagus Tuber (Tiandong), Southern Date (Nanzao).
Certain patient: Mental exertion and fright cause Ministerial Fire and Liver wind to rush upward. Eye twitching and dizziness. Yin is weak with desire for emission. The pulse is wiry and forceful on the left, slightly flat and small on the right.
Rehmannia Root (Shengdi), White Peony Root (Baishao), Moutan Bark (Danpi), Uncaria Ramulus cum Uncis (Gouteng), Gastrodia Tuber (Tianma), Tribulus Fructus (Bajili), Yellow Chrysanthemum (Huangjuhua), Orange Peel (Juhong).
Mr. Wang (63 years old): Using Acrid-Sweet-Cold method. Vertigo has eased. This is heat in the collaterals. Yang Qi manifests pathology. Internal wind rushes upward. The root deficiency is in the Lower Jiao. Heat transforms into internal wind in the Upper Jiao. Upper excess and Lower deficiency. First clear the branch symptoms. (Pathogenesis: Collateral Heat)
Antelope Horn (Lingyangjiao), Scrophularia Root (Yuanshenxin), Fresh Rehmannia Root (Xianshengdi), Forsythia Heart (Lianqiaoxin), Curcuma Tuber (Yujin), Acorus Tuber (Shichangpu).
Second consultation: Follow the previous prescription, remove Acorus (Shichangpu) and Curcuma (Yujin), add Fritillaria Bulb (Chuanbei) and Trichosanthes Root (Huafen).
Certain patient (24 years old): Syncope. Triggered by mental fatigue. This is Kidney Water deficiency failing to nourish Liver Wood. Jueyang transforms into wind and agitates. Mental fatigue causes Yang to rise, and the disease arises. According to history, this has been present since youth. Medication may be difficult to completely prevent recurrence. (Pathogenesis: Yin Deficiency with Yang Rising)
Prepared Rehmannia Root (Shudi, 4 liang), Tortoise Plastron (Guiban, 3 liang), Oyster Shell (Muli, 3 liang), Asparagus Tuber (Tiandong, 1.5 liang), Cornus Fruit (Yurou, 2 liang), Schisandra Berry (Wuweizi, 1 liang), Poria with Hostwood (Fushen, 2 liang), Achyranthes Bidentata Root (Niuxi, 1.5 liang), Polygala Root (Yuanzhi, 7 qian), Spirit Magnetite (Lingcishi, 1 liang).
Mr. Tian (27 years old): Mental fatigue. Yang Qi moves greatly, transforming into internal wind. Rushing directly to the clear cavities of the head, resulting in vertigo. Appetite is good, skin and flesh are full. The disease is not in the Middle or Upper Jiao. Use shellfish-type materials to sink and submerge True Yang. Salty and sour flavors are appropriate.
Edible Mussel Gel (Dancaijiao), Tortoise Plastron Gel (Guibanjiao), Donkey-hide Gelatin (Ejiao), Prepared Rehmannia Root (Shudi), Cornus Fruit (Yurou), Poria (Fuling), Dendrobium Stem (Chuanhu), Jian Lotus Seed (Jianlian), Yam Paste (Shanyao) processed into pills.
Mr. Yan (45 years old): Ying Blood deficiency. Internal wind rebels. Palpitations and dizziness. (Pathogenesis: Ying Blood Deficiency)
Stir-fried Lycium Fruit (Qizi), Biota Seed (Baiziren), Triangular Sesame (Sanjiao Huma), Dendrobium Stem (Chuanhu), Raw Left-side Oyster Shell (Muli), Winter Mulberry Leaf (Dongsangye).
Mr. Li (73 years old): Advanced age but able to eat well and sleep peacefully. Since spring and summer, dizziness. Edema of the dorsum of the foot. Unable to walk steadily. This is Upper excess and Lower deficiency. Kidney Qi is declining, failing to govern reception. Liver wind moves, clouding the clear orifices gradually. Generally, the Kidney should be warmed, and the Liver cooled. Warming and receiving assisted by cooling constitutes a compound formula. (Pathogenesis: Lower Deficiency)
Formula based on Duqi Wan (Six-Ingredient Pill with Rehmannia) added with Alisma Rhizome (Cheqianzi), Light Asparagus Tuber (Dan Tiandong), and Jian Lotus Seed (Jianlian) processed into pills.
The Classic states: "All wind diseases causing tremors and vertigo belong to the Liver." The head is the summit of the Six Yang channels. The eyes, ears, mouth, and nose are all clear orifices. The vertigo suffered from is not due to external pathogens, but rather the uprising of Liver-Gallbladder Wind-Yang. In severe cases, there is danger of syncope and falling. Symptoms may involve carrying Phlegm, carrying Fire, Middle Deficiency, or Lower Deficiency. Treatment targets the Gallbladder, Stomach, or Liver respectively. For excessive Fire, Mr. Ye first uses Antelope Horn, Gardenia, Forsythia, Trichosanthes Root, Scrophularia, Fresh Rehmannia, Moutan Bark, and Mulberry Leaf to clear and drain heat from the upper jiao orifices and collaterals. This treats from the Gallbladder perspective. For excessive phlegm, one must regulate the Yangming, eliminating phlegm using Bamboo Sap, Ginger Juice, Acorus, Orange Peel, Erchen Decoction, etc. For Middle Deficiency, Ginseng is added; Fuling Yin from *Waitai Mi Yao* is an example. For Lower Deficiency, treatment must target the Liver, tonifying the Kidney and nourishing the Liver, nurturing Yin to submerge Yang, using sedative and stabilizing treatments. As for Gastrodia, Uncaria, and Chrysanthemum, these are wind-extinguishing herbs that can be added according to symptoms. The origin of this condition lies in Liver Wind; it should be studied together with the chapters on Wind Stroke and Headache. (Commentary by Hua Xiuyun)
Mr. Xu's Commentary: Clearing fire and nourishing the Liver for vertigo is indeed the correct treatment. However, when Yang Qi rises to the point where the body cannot control itself, this is not comparable to floating fire. Ancients would definitely use heavy mineral and stone sedatives. This was something Mr. Ye had not yet realized at that time. I recall when I first went to the prefecture to practice medicine, I liked using Tang dynasty formulas. Mr. Ye saw this and said to others, "There is a scholar named Xu from Wujiang practicing outside. He has considerable thought, but his prescriptions contain too many mixed herbs. This is because he lacks formal transmission." Later, after Mr. Ye read the Song edition of *Waitai Mi Yao*, he said to others, "I previously said Mr. Xu's prescriptions lacked a foundation, who knew they all came from *Waitai*? This shows learning is infinite; one must not underestimate reading." Mr. Ye's willingness to accept advice is so commendable, reflecting ancient virtues. By "mixed herbs," he referred to mineral and stone preparations. Therefore, I record this here.