经曰∶诸风掉眩皆属于肝。头为六阳之首,耳目口鼻皆系清空之窍,所患眩晕非外来
之邪,乃肝胆风阳上冒耳。内风乃身中阳气疲动。
头眩昏晕气血虚,风寒暑湿痰火居。《内经》头眩责肝木(风木主动),丹溪痰火原相
居。元气挟火动痰致,虚火上炎痰则无。化痰清晕二陈用,菊 (本)荆桔羌防抚(芎)。劳役
气虚补中妙,产后血虚四物须。冒暑薷香麦薷味,寒而无汗麻黄苏。
火重头眩(宜清泄上焦窍络之热)
山栀 天花粉 桑叶 元参 连翘 湖丹皮 生地
肝风头眩(肾宜温肝宜凉)
阿胶 麦冬 白芍 牡蛎 生地 萸肉 甘菊
络热眩晕
羚羊角 元参 生地 石菖蒲 连翘 郁金
营血虚头眩
西枸杞 胡麻 左牡蛎 川石斛 桑叶 柏子仁
内风挟痰头眩
煨天麻 法半夏 云茯苓 甘菊花 白蒺藜 广橘皮 西杞子 鲜竹沥
阴虚阳升头眩(补肾滋肝,育阴潜阳,兼镇摄治)
大熟地 山萸肉 五味子 牡蛎 淮牛膝 龟版心 麦门冬 灵磁石 茯神 炒远志
属下虚头眩
都气丸加车前、淡天冬。
动怒郁勃(痰火风火并炽,头眩)
二陈汤、龙荟丸加减治之。
何书田曰∶精液有亏,肝阴不足,血燥生热,热则风阳上升,窍络阻塞,头目不清,眩晕
跌仆。治宜缓肝之急以熄风,滋肾之液以驱热。如虎潜丸、侯氏黑散、地黄饮子、滋肾丸、
复脉饮汤等方。介以潜之,酸以收之,浓味以填之,或清上实下之法。风木过动,必犯阳明,
呕吐不食,法当泄肝安胃,或填补阳明。又法辛甘化阴,清金平木,治痰须健中,熄风可缓晕。
陈参曰∶肝肾虚则多惊恐,阳动莫制,皆脏阴少藏耳。
《黄帝内经》说:各种风病引起的肢体震颤、头晕目眩,都归属于肝脏。头部是六条阳经汇聚的最高处,耳、目、口、鼻都是清虚通畅的孔窍,所患的眩晕症并非由外来的邪气引起,而是肝胆的风阳之气上冲侵犯所致。内风是由于身体内部的阳气躁动不安而产生的。
头眩昏晕多因气血虚弱,或是风寒暑湿痰火等邪气停留体内所致。《黄帝内经》将头眩归责于肝木(风木主司运动),朱丹溪认为痰与火原本就相互伴随。元气挟带火热扰动痰浊导致发病,若是虚火上炎则痰浊自消。治疗化痰清晕可用二陈汤;若兼有外感风邪,可用菊花、白芷、荆芥、桔梗、羌活、防风、川芎等药物安抚疏解。因劳累过度导致的气虚,用补中益气汤效果奇妙;产后血虚引起的眩晕,需用四物汤调理。中暑引起的眩晕,可用香薷、藿香、麦冬、五味子等药;受寒且无汗者,可用麻黄、紫苏发散风寒。
火盛引起的头眩(适宜清泄上焦窍络的热邪):
山栀、天花粉、桑叶、玄参、连翘、牡丹皮、生地黄。
肝风引起的头眩(肾脏宜温养,肝脏宜凉润):
阿胶、麦冬、白芍、牡蛎、生地黄、山茱萸、甘菊。
经络热盛引起的眩晕:
羚羊角、玄参、生地黄、石菖蒲、连翘、郁金。
营血虚弱引起的头眩:
西枸杞、胡麻、左牡蛎、川石斛、桑叶、柏子仁。
内风挟带痰浊引起的头眩:
煨天麻、法半夏、云茯苓、甘菊花、白蒺藜、广橘皮、西杞子、鲜竹沥。
阴虚阳升引起的头眩(补肾滋肝,育阴潜阳,兼用镇摄之法治疗):
大熟地、山茱萸、五味子、牡蛎、淮牛膝、龟版心、麦门冬、灵磁石、茯神、炒远志。
因愤怒抑郁导致(痰火与风火同时炽盛,引发头眩):
用二陈汤、龙胆泻肝丸加减治疗。
何书田说:精液亏损,肝阴不足,血液干燥而生热,热盛则风阳上升,阻塞窍络,导致头目不清,出现眩晕甚至跌仆。治疗应当舒缓肝之急迫以熄风,滋润肾之津液以驱热。如使用虎潜丸、侯氏黑散、地黄饮子、滋肾丸、复脉饮汤等方剂。用介类药材潜降浮阳,用酸味药收敛耗散之气,用浓厚滋腻的药物填补真阴,或者采用清上实下的治法。风木之气过动,必然侵犯阳明胃经,出现呕吐、不能进食的症状,治法当泄肝安胃,或者填补阳明经气。又有辛甘化阴、清金平木的方法,治疗痰浊须健运中焦,熄风则可缓解眩晕。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All wind diseases characterized by tremors and dizziness belong to the Liver." The head is the summit of the six Yang meridians, and the ears, eyes, mouth, and nose are clear and hollow orifices. The dizziness suffered here is not caused by external pathogenic factors, but rather by the upward invasion of Wind-Yang from the Liver and Gallbladder. Internal Wind arises from the restless movement of the body's Yang Qi.
Dizziness and vertigo often result from deficiency of Qi and Blood, or the accumulation of Cold, Wind, Summerheat, Dampness, Phlegm, and Fire within the body. The *Neijing* attributes dizziness to Liver Wood (Wind-Wood governs movement), while Zhu Danxi posits that Phlegm and Fire originally coexist. When Yuan Qi (Original Qi) moves with Fire to disturb Phlegm, pathology ensues; however, if Deficient Fire flares upward, Phlegm dissipates. To resolve Phlegm and clear dizziness, Er Chen Tang (Two-Cured Decoction) is used; for external Wind pathogens, Chrysanthemum, Angelicae Dahuricae Radix (Bai Zhi), Schizonepetae Herba (Jing Jie), Platycodonis Radix (Jie Geng), Notopterygii Rhizoma et Radix (Qiang Huo), Saposhnikoviae Radix (Fang Feng), and Ligustici Chuanxiong Rhizoma (Chuan Xiong) are employed to soothe and disperse. For Qi deficiency due to overwork, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is excellent; for Blood deficiency postpartum, Si Wu Tang (Four-Substance Decoction) is required. For heatstroke-induced dizziness, Elsholtziae Herba (Xiang Ru), Houttuyniae Herba (Huo Xiang), Ophiopogonis Tuber (Mai Dong), and Schisandrae Fructus (Wu Wei Zi) are used; for cold retention without sweating, Ephedrae Herba (Ma Huang) and Perillae Folium (Zi Su Ye) are indicated to release the exterior.
**Head Dizziness due to Excess Fire** (Suitable for clearing Heat from the upper Jiao orifices and collaterals):
Gardenia Fruit (Shan Zhi), Trichosanthis Radix (Tian Hua Fen), Mulberry Leaf (Sang Ye), Scrophulariae Radix (Yuan Shen), Forsythiae Fructus (Lian Qiao), Moutan Cortex (Hu Dan Pi), Rehmanniae Radix (Sheng Di).
**Head Dizziness due to Liver Wind** (Kidney should be warmed, Liver should be cooled):
Donkey-hide Gelatin (E Jiao), Ophiopogonis Tuber (Mai Dong), Paeoniae Radix Alba (Bai Shao), Ostrea Concha (Mu Li), Rehmanniae Radix (Sheng Di), Corni Fructus (Yu Rou), Chrysanthemum Morifolium (Gan Ju).
**Vertigo due to Collateral Heat**:
Antelope Horn (Ling Yang Jiao), Scrophulariae Radix (Yuan Shen), Rehmanniae Radix (Sheng Di), Acori Tatarinowii Rhizoma (Shi Chang Pu), Forsythiae Fructus (Lian Qiao), Curcumae Radix (Yu Jin).
**Head Dizziness due to Ying-Blood Deficiency**:
Lycium Fruit (Xi Gou Qi), Sesame Seed (Hu Ma), Ostrea Concha (Zuo Mu Li), Dendrobii Caulis (Chuan Shi Hu), Mulberry Leaf (Sang Ye), Biota Seed (Bai Zi Ren).
**Head Dizziness due to Internal Wind with Phlegm**:
Prepared Gastrodia Rhizome (Wei Tian Ma), Processed Pinellia Tuber (Fa Ban Xia), Poria (Yun Fu Ling), Chrysanthemum Morifolium (Gan Ju Hua), Tribuli Fructus (Bai Ji Li), Tangerine Peel (Guang Ju Pi), Lycium Fruit (Xi Qi Zi), Fresh Bamboo Juice (Xian Zhu Li).
**Head Dizziness due to Yin Deficiency with Yang Rising** (Tonify Kidney and nourish Liver, nurture Yin to subdue Yang, combined with sedative treatment):
Prepared Rehmanniae Radix (Da Shu Di), Corni Fructus (Shan Yu Rou), Schisandrae Fructus (Wu Wei Zi), Ostrea Concha (Mu Li), Achyranthes Bidentatae Radix (Huai Niu Xi), Tortoise Plastron Heart (Gui Ban Xin), Ophiopogonis Tuber (Mai Men Dong), Magnetitum (Ling Ci Shi), Poria with Hostwood (Fu Shen), Polygala Root (Chao Yuan Zhi).
**Head Dizziness due to Lower Jiao Deficiency**:
Du Qi Wan (Duqi Pill) added with Alisma Rhizome (Che Qian) and Asparagus Tuber (Dan Tian Dong).
**Anger and Depression** (Phlegm-Fire and Wind-Fire blazing simultaneously, causing head dizziness):
Treat with modifications of Er Chen Tang (Two-Cured Decoction) and Long Dan Xie Gan Wan (Gentian Liver-Draining Pill).
He Shutian stated: "Deficiency of essence and fluids leads to insufficient Liver Yin, dry blood generating Heat. Heat causes Wind-Yang to rise, blocking the orifices and collaterals, resulting in unclear vision and hearing, dizziness, and falls. Treatment should soothe the Liver's urgency to extinguish Wind, and nourish Kidney fluids to drive out Heat. Formulas such as Hu Qian Wan (Tiger Crouching Pill), Hou Shi Hei San (Master Hou's Black Powder), Di Huang Yin Zi (Rehmannia Drink), Zi Shen Wan (Nourish Kidney Pill), and Mai Mai Jing Tong Tang (Pulse-Nourishing Decoction) may be used. Use shell/stone minerals to anchor floating Yang, sour flavors to astringe scattered Qi, and rich/nourishing substances to fill true Yin, or employ methods to clear the Upper and solidify the Lower. Overactive Wind-Wood must invade the Yangming Stomach channel, causing vomiting and anorexia; the method should drain the Liver and harmonize the Stomach, or tonify the Yangming channel. Another method involves transforming Yin through pungent-sweet combinations, clearing Metal to pacify Wood. Treating Phlegm requires strengthening the Middle Jiao; extinguishing Wind alleviates dizziness."
Chen Can stated: "Deficiency of Liver and Kidney leads to frequent fright and fear; unrestrained Yang movement occurs because there is insufficient Zang Yin to store and anchor it."