伤寒头眩，言睡在床褥，亦觉头眩眼花，非言坐起而觉也。夫外感风寒之症，坐起时，皆头
眩也。方书头眩，皆以阳虚立论，愚以为久病后、汗下吐后，方可言阳虚。若暴病及未曾汗
下吐者，则风寒邪热，痰火积饮，皆能眩晕。吴氏书以太阳中风头眩，头摇。脉浮弦而急
者，羌活神术汤，加防风、天麻，此治太阳阳明外感风寒也。又云寒热呕而口苦，头眩，脉
弦数，小柴胡汤，加川芎、天麻，此治少阳头眩也。余今酌定初起暴病，有表症而头眩，无
汗脉浮者，发散表邪为主，在太阳用羌活汤，在阳明用干葛防风汤，在少阳用柴胡汤。以上
恶寒者，多加羌活，有风者，多加防风；有火者，加酒炒黄芩连。若表症已解，里有结热，
又宜清里热，如桔梗汤、凉膈散。大凡眩晕之症，一见呕吐，即为痰饮食滞，急用保和平胃
二陈汤。里有积热者，加山栀、黄连，最忌凝滞补剂。惟汗吐下及久病后见头眩者，当用温
中扶元，如建中汤、真武汤、苓桂白术甘草汤。若气虚者，四君子汤加天麻；气虚有火，加
栀连；虚而有痰者，六君子汤，血虚者，四物汤加天麻；血虚而有火者，加山栀、黄连；若
阴火上冲，知柏四物汤。
太阳病发汗，汗出不解，其人仍发热，心下悸，头眩身 动振振欲擗地者，真武汤主之。
太阳病，误用麻黄以发汗，是以头眩身 动，一派阳虚之症，故用真武汤。伤寒若吐若下
后，心下逆满，气上冲胸，起则头眩，脉沉紧，发汗则动经，身为振振摇者，茯苓桂枝白
术甘草汤主之。
言若吐若下后，久病胃虚，不能运化，虚邪搏饮上冲，故头眩。脉沉紧，非汗脉，强发汗
则振振身动，故用苓术甘桂汤，助中州化水饮。
伤寒吐下后，发汗虚烦，脉甚微，八九日心下痞硬，胁下痛，气上冲咽喉，眩冒经脉动惕
者，久而成痿。
此与上条同是吐下后，因此症心下痞硬，胁下痛，气上冲咽喉，似火似实，又见眩冒经脉
动惕之虚候，攻补两难，故曰久则成痿。
太阳与少阳并病，头项强痛，或眩冒，时如结胸，心下痞硬者，当刺大椎第一间肺俞、肝俞，
慎不可发汗，发汗则谵语，脉弦五六日，谵语不止，当刺期门。
此条详注项强。
阳明病，脉迟，食难用饱，饱则微烦头眩，必小便难，欲作谷疸。虽下之，腹满如故。所以
然者，脉迟故也。
阳明病，脉迟，胃寒也，饱则微烦头眩。胃寒不能消水，谷停留肠胃，则小便难。而作谷
疽。虽下之，腹满如故。何以知其然者？以脉迟。
阳明病，但头眩不恶寒，故能食而咳，其人必咽痛。若不咳者，不痛。
阳明病，不恶寒，又能食，胃热也。咳主于肺，胃热上冲，则肺热而咳，咽喉痛。设不
咳，则肺无火咽亦不痛。
少阳之病，口苦咽干目眩。
目眩口苦，胆经所主，故名少阳之病。
羌活神术汤
羌活 苍术 石膏 防风 天麻
此治太阳风湿发热眩晕之症。若兼阳明，加干葛，白芷；兼少阳，加柴胡、川芎；兼饱闷
恶心，加半夏、神曲。
小柴胡汤
柴胡 黄芩 广皮 甘草 川芎 天麻 半夏
此治少阳寒热眩晕症。若恶寒，加羌活防风，有火，加栀连。
羌活汤 见恶寒。
此治太阳恶寒发热眩晕者。若胸前饱闷，合平胃保和散。呕吐，加半夏、天麻。
干葛汤 见似疟。
此治阳明表邪眩晕者。若呕吐饱满，加半夏、浓朴；恶寒无汗，加羌活、防风。
桔梗汤
桔梗 半夏 陈皮 枳实
此治痰结饱闷眩晕者。若恶寒发热，加羌活、防风；里有积热，加栀连；阳明见症，加白
芷、天麻；少阳见症，加柴胡、川芎。
凉膈散 见发狂。
平胃二陈汤 即苍朴二陈汤。
此治痰饮食积眩晕之症。胸前饱闷，合保和散，加砂仁、豆蔻、胃寒，加干姜，胃热，加栀连。
建中汤
白芍药 桂枝 甘草
此治阳虚眩晕之症。气虚，加人参、白术；血虚，加当归、黄 。
真武汤
伤寒引起的头眩，是指躺在床上时也觉得头晕眼花，而不是指坐起来时才感觉到的。外感风寒的病症，在坐起时都会出现头眩。医书中关于头眩的论述，大多从阳虚立论，但我认为只有在久病之后、或者经过发汗、攻下、催吐治疗后，才可以说是阳虚。如果是突发疾病以及未曾进行过发汗、攻下、催吐治疗的，那么风寒邪热、痰火、积饮都能导致眩晕。吴氏的书里提到太阳中风引起的头眩伴有头摇，脉象浮弦而急的，用羌活神术汤，加防风、天麻，这是治疗太阳阳明两经外感风寒的方法。又说寒热往来、呕吐且口苦、头眩、脉弦数的，用小柴胡汤，加川芎、天麻，这是治疗少阳经头眩的方法。我现在斟酌确定：初起突发疾病，有表证而头眩，无汗且脉浮的，以发散表邪为主，在太阳经用羌活汤，在阳明经用干葛防风汤，在少阳经用柴胡汤。以上这些情况中，如果有恶寒症状的，多加羌活；有风邪的，多加防风；有火的，加酒炒的黄芩和黄连。如果表证已经解除，里有结聚的热邪，又应当清泄里热，比如桔梗汤、凉膈散。大凡眩晕的病症，一见到呕吐，就是痰饮食滞造成的，急忙使用保和汤和平胃二陈汤。里有积热的，加山栀、黄连，最忌讳使用凝滞的补益药剂。只有经过发汗、催吐、攻下以及久病后出现头眩的，才应当用温中扶元的方法，比如建中汤、真武汤、苓桂白术甘草汤。如果是气虚的，用四君子汤加天麻；气虚而有火的，加山栀、黄连；虚而有痰的，用六君子汤；血虚的，用四物汤加天麻；血虚而有火的，加山栀、黄连；如果是阴火上冲，用知柏四物汤。
太阳病发汗后，汗出后病不解，病人仍然发热，心下悸动，头眩，身体动摇震颤，想要扑倒在地，用真武汤主治。
太阳病，误用麻黄来发汗，因此出现头眩、身体动摇，这是一派阳虚的症状，所以用真武汤。
伤寒如果经过催吐或攻下后，心下逆满，气上冲胸，站起来就头眩，脉象沉紧，如果发汗就会扰动经脉，身体震颤摇摆，用茯苓桂枝白术甘草汤主治。
这里说的是如果经过催吐或攻下后，久病导致胃虚，不能运化水湿，虚邪搏结饮邪上冲，所以头眩。脉象沉紧，不是发汗的脉象，强行发汗就会导致身体震颤动摇，所以用苓术甘桂汤，帮助中焦运化水饮。
伤寒经过催吐或攻下后，发汗导致虚烦，脉象非常微弱，到了第八九天心下痞硬，胁下痛，气上冲咽喉，眩晕昏冒，经脉跳动惕惧的，时间久了会形成痿证。
这一条与上一条相同，都是经过催吐或攻下后，但因为症状中心下痞硬、胁下痛、气上冲咽喉，看起来像火像实证，却又出现眩晕昏冒、经脉跳动惕惧的虚候，攻补两难，所以说时间久了会形成痿证。
太阳与少阳并病，头项强痛，有时眩晕昏冒，有时像结胸证，心下痞硬的，应当针刺大椎第一间、肺俞、肝俞，千万不要发汗，发汗就会谵语，脉弦，过了五六天，谵语不止，应当刺期门穴。
这一条详细注释了项强的症状。
阳明病，脉迟，吃饭难以吃饱，饱了就轻微心烦、头眩，一定小便困难，将要发生谷疸。即使用了下法，腹满依然如故。之所以这样，是因为脉迟的缘故。
阳明病，脉迟，是胃寒的表现，吃饱了就轻微心烦、头眩。胃寒不能消化水谷，食物停留肠胃，就会导致小便困难，从而产生谷疸。即使用了下法，腹满依然如故。怎么知道是这样呢？因为脉迟。
阳明病，只是头眩而不恶寒，所以能吃东西并且咳嗽，病人一定咽痛。如果不咳嗽，就不痛。
阳明病，不恶寒，又能吃东西，这是胃热。咳嗽主责于肺，胃热上冲，则肺热而咳，咽喉痛。假设不咳嗽，那么肺没有火，咽喉也不会痛。
少阳的病，口苦、咽干、目眩。
羌活神术汤
羌活 苍术 石膏 防风 天麻
这是治疗太阳经风湿发热眩晕的病症。如果兼有阳明经症状，加干葛、白芷；兼有少阳经症状，加柴胡、川芎；兼有饱闷恶心，加半夏、神曲。
小柴胡汤
柴胡 黄芩 广皮 甘草 川芎 天麻 半夏
这是治疗少阳经寒热眩晕的病症。如果恶寒，加羌活、防风；有火，加山栀、黄连。
羌活汤 见恶寒条目。
这是治疗太阳经恶寒发热眩晕的病症。如果胸前饱闷，合用平胃保和散。呕吐，加半夏、天麻。
干葛汤 见似疟条目。
这是治疗阳明经表邪眩晕的病症。如果呕吐饱满，加半夏、浓朴；恶寒无汗，加羌活、防风。
桔梗汤
桔梗 半夏 陈皮 枳实
这是治疗痰结饱闷眩晕的病症。如果恶寒发热，加羌活、防风；里有积热，加山栀、黄连；阳明经见症，加白芷、天麻；少阳经见症，加柴胡、川芎。
凉膈散 见发狂条目。
平胃二陈汤 即苍术厚朴二陈汤。
这是治疗痰饮食积眩晕的病症。胸前饱闷，合用保和散，加砂仁、豆蔻；胃寒，加干姜；胃热，加山栀、黄连。
Dizziness (Touxuan) caused by Cold Damage refers to feeling dizzy and having blurred vision while lying in bed, rather than dizziness felt only upon sitting up. In cases of external contraction of Wind-Cold, dizziness is always experienced when sitting up. Medical texts generally discuss dizziness based on the theory of Yang Deficiency; however, I believe that Yang Deficiency can only be claimed after prolonged illness or following treatments such as sweating, purging, or vomiting. If it is an acute onset disease and no sweating, purging, or vomiting has been performed, then Wind-Cold pathogenic heat, Phlegm-Fire, and accumulated fluid retention can all cause dizziness. In Mr. Wu's book, regarding dizziness accompanied by head tremor due to Wind Strike at Taiyang with a floating, wiry, and rapid pulse, Qianghuo Shenzhu Tang (Notopterygium and Atractylodes Decoction) is used with added Fangfeng (Saposhnikovia Root) and Tianma (Gastrodia Rhizome); this treats external Wind-Cold affecting both Taiyang and Yangming meridians. It also states that for alternating chills and fever, vomiting, bitter taste in the mouth, dizziness, and a wiry, rapid pulse, Xiaochaihu Tang (Minor Bupleurum Decoction) is used with added Chuanxiong (Ligusticum Rhizome) and Tianma (Gastrodia Rhizome); this treats dizziness of Shaoyang origin. I have now determined: for acute onset diseases at the beginning, presenting with exterior syndrome and dizziness, without sweat and with a floating pulse, the primary treatment should be to disperse exterior pathogens. For Taiyang, use Qianghuo Tang; for Yangming, use Gange Fangfeng Tang (Pueraria and Saposhnikovia Decoction); for Shaoyang, use Chaihu Tang (Bupleurum Decoction). Among these, if there are chills, add more Qianghuo (Notopterygium Rhizome); if there is wind, add more Fangfeng (Saposhnikovia Root); if there is fire, add Jiuhuang Qinlian (Jiao-fried Scutellaria and Coptis). If the exterior syndrome has resolved but interior constrained heat exists, one should clear interior heat, such as using Jiegeng Tang (Platycodon Decoction) or Liangge San (Cooling the Diaphragm Powder). Generally, in cases of vertigo/dizziness, if vomiting is seen immediately, it indicates Phlegm, Food, and Stagnation; urgently use Baohe Tang (Harmonizing the Stomach Decoction) combined with Pingwei Erchen Tang (Calm the Stomach and Two-Chen Decoction). If there is accumulated interior heat, add Zhizi (Gardenia Fruit) and Huanglian (Coptis Rhizome); one must strictly avoid cloying tonifying agents. Only when dizziness appears after sweating, vomiting, purging, or in prolonged illness, should one use methods to warm the middle and support Yuan Qi, such as Jianzhong Tang (Establish the Middle Decoction), Zhenwu Tang (True Warrior Decoction), or Linggui Baizhu Gancao Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction). If Qi Deficient, use Sijunzi Tang (Four Gentlemen Decoction) with Tianma (Gastrodia Rhizome); if Qi Deficient with Fire, add Zhizi (Gardenia Fruit) and Huanglian (Coptis Rhizome); if Deficient with Phlegm, use Liujunzi Tang (Six Gentlemen Decoction); if Blood Deficient, use Siwu Tang (Four Substances Decoction) with Tianma (Gastrodia Rhizome); if Blood Deficient with Fire, add Zhizi (Gardenia Fruit) and Huanglian (Coptis Rhizome); if Yin Fire rushes upward, use Zhibo Siwu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction).
In Taiyang Disease, after inducing sweating, if the condition does not resolve, the patient still has fever, palpitations in the epigastrium, dizziness, and body trembling/shaking as if wanting to fall to the ground, Zhenwu Tang (True Warrior Decoction) is the principal treatment.
In Taiyang Disease, if Ephedra Decoction (Mahuang Tang) was mistakenly used to induce sweating, resulting in dizziness and body trembling, this presents a picture of Yang Deficiency, hence Zhenwu Tang (True Warrior Decoction) is used.
After Cold Damage is treated with emesis or purging, if there is fullness and rebellion in the epigastrium, Qi rushing up to the chest, dizziness upon standing, and a deep, tight pulse, inducing sweating will disturb the channels, causing the body to tremble and sway; Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction (Ling Gui Zhu Gan Tang) is the principal treatment.
This explains that after emesis or purging, prolonged illness leads to Stomach deficiency, inability to transform and transport, allowing deficient pathogens to contend with fluid retention which rushes upward, thus causing dizziness. A deep, tight pulse is not a pulse for sweating; forcing sweating causes trembling and body movement, hence Ling Gui Zhu Gan Tang is used to assist the Middle Jiao in transforming water and fluids.
After Cold Damage is treated with emesis or purging, followed by sweating leading to empty irritability, with a very faint pulse, on the eighth or ninth day, there is hardness and stuffiness in the epigastrium, pain under the ribs, Qi rushing up to the throat, dizziness, vertigo, and twitching/trembling of the channels; if prolonged, this becomes Wei Syndrome (Flaccidity Syndrome).
This case is similar to the previous one, occurring after emesis or purging. However, because of epigastric hardness/stuffiness, rib-side pain, and Qi rushing to the throat, it resembles Fire or Excess patterns, yet presents with deficient signs like dizziness, vertigo, and channel twitching. Since both attacking and tonifying are difficult, it is said that if prolonged, it becomes Wei Syndrome (Flaccidity Syndrome).
When Taiyang and Shaoyang diseases combine, there is stiffness and pain in the head and neck, sometimes dizziness and vertigo, sometimes resembling Jie Xiong Syndrome (Chest Binding Syndrome), and hardness/stuffiness in the epigastrium. One should needle the first interspace of the Dazhui (GV14) point, Feishu (BL13), and Ganshu (BL18). Sweating must be strictly avoided; if sweating is induced, delirium will occur. If the pulse is wiry and after five or six days the delirium persists, one should needle Qimen (LR14).
This clause details the annotation of neck stiffness.
In Yangming Disease, with a slow pulse, food intake cannot reach satiety; upon eating until full, there is slight irritability and dizziness, and urination will necessarily be difficult, indicating impending Gu Dan Jaundice (Grain Jaundice). Even if purgatives are used, abdominal fullness remains unchanged. The reason for this is the slow pulse.
Yangming Disease with a slow pulse indicates Stomach Cold. Upon eating until full, there is slight irritability and dizziness. Stomach Cold cannot digest water and grain; food stagnates in the intestines and stomach, leading to difficult urination and the production of Grain Jaundice. Even if purgatives are used, abdominal fullness remains unchanged. How do we know this? Because of the slow pulse.
In Yangming Disease, if there is only dizziness without aversion to cold, the patient can eat and may cough; such a person will certainly have a sore throat. If there is no cough, there is no pain.
Yangming Disease without aversion to cold, where the patient can eat, indicates Stomach Heat. Cough is primarily governed by the Lung; Stomach Heat rushing upward causes Lung Heat and cough, leading to sore throat. If there is no cough, the Lung has no Fire, and the throat will not hurt.
Shaoyang Disease presents with bitter taste in the mouth, dryness in the throat, and dizziness of the eyes.
Dizziness of the eyes and bitter taste in the mouth are governed by the Gallbladder Meridian, hence it is named Shaoyang Disease.
Qianghuo Shenzhu Tang (Notopterygium and Atractylodes Decoction)
Qianghuo (Notopterygium Rhizome), Cangzhu (Atractylodes Lancea Rhizome), Shigao (Gypsum Fibrosum), Fangfeng (Saposhnikovia Root), Tianma (Gastrodia Rhizome).
This treats dizziness/vertigo due to Wind-Dampness and fever in Taiyang. If combined with Yangming, add Gange (Pueraria Lobata Root) and Baizhi (Angelica Dahurica Root); if combined with Shaoyang, add Chaihu (Bupleurum Root) and Chuanxiong (Ligusticum Rhizome); if combined with fullness/bloating and nausea, add Banxia (Pinellia Tuber) and Shenqu (Massamedica Fermentata).
Xiaochaihu Tang (Minor Bupleurum Decoction)
Chaihu (Bupleurum Root), Huangqin (Scutellaria Root), Guangpi (Citrus Reticulata Pericarpium), Gancao (Licorice Root), Chuanxiong (Ligusticum Rhizome), Tianma (Gastrodia Rhizome), Banxia (Pinellia Tuber).
This treats alternating chills and fever with dizziness/vertigo in Shaoyang. If there are chills, add Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root); if there is Fire, add Zhizi (Gardenia Fruit) and Huanglian (Coptis Rhizome).
Qianghuo Tang (Notopterygium Decoction) - See "Aversion to Cold".
This treats Taiyang aversion to cold, fever, and dizziness/vertigo. If there is chest fullness/bloating, combine with Pingwei Baohe San (Calm the Stomach and Harmonize the Stomach Powder). If vomiting, add Banxia (Pinellia Tuber) and Tianma (Gastrodia Rhizome).
Gange Tang (Pueraria Decoction) - See "Resembling Malaria".
This treats exterior pathogen-induced dizziness/vertigo in Yangming. If vomiting and fullness, add Banxia (Pinellia Tuber) and Houpo (Magnolia Bark); if aversion to cold and no sweat, add Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root).
Jiegeng Tang (Platycodon Decoction)
Jiegeng (Platycodon Root), Banxia (Pinellia Tuber), Chenpi (Citrus Reticulata Pericarpium), Zhishi (Immature Bitter Orange).
This treats dizziness/vertigo due to Phlegm binding and fullness/bloating. If aversion to cold and fever, add Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root); if interior accumulated heat, add Zhizi (Gardenia Fruit) and Huanglian (Coptis Rhizome); if Yangming symptoms appear, add Baizhi (Angelica Dahurica Root) and Tianma (Gastrodia Rhizome); if Shaoyang symptoms appear, add Chaihu (Bupleurum Root) and Chuanxiong (Ligusticum Rhizome).
Liangge San (Cooling the Diaphragm Powder) - See "Delirium/Frenzy".
Pingwei Erchen Tang (Calm the Stomach and Two-Chen Decoction) is identical to Cang Po Erchen Tang (Atractylodes and Magnolia Bark and Two-Chen Decoction).
This treats dizziness/vertigo due to Phlegm, Food, and Accumulation. If chest fullness/bloating, combine with Baohe San (Harmonizing the Stomach Powder), add Sharen (Amomum Fruit) and Doukou (Black Cardamom); if Stomach Cold, add Ganjiang (Dried Ginger); if Stomach Heat, add Zhizi (Gardenia Fruit) and Huanglian (Coptis Rhizome).
Jianzhong Tang (Establish the Middle Decoction)
Baishao (White Peony Root), Guizhi (Cinnamon Twig), Gancao (Licorice Root).
This treats dizziness/vertigo due to Yang Deficiency. If Qi Deficient, add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodes Macrocephala Rhizome); if Blood Deficient, add Danggui (Angelica Sinensis Radix) and Huangqi (Astragalus Membranaceus Root).
Zhenwu Tang (True Warrior Decoction)