论
《内经》曰∶诸风掉眩，皆属肝木。又曰∶岁木太过，风气流行，脾土受邪，民病飧泄食减，甚则忽忽善怒，眩冒
巅疾。虽为气化之所使然，未必不由气体之虚衰耳。其为气虚肥白之人，湿痰滞于上，阴火起于下，是以痰挟虚火，上
冲头目，正气不能胜敌，故忽然眼黑生花，若坐舟车而旋运也，甚而至于卒倒无所知者有之，丹溪所谓无痰不能作眩者，
正谓此也。若夫黑瘦之人，躯体薄弱，真水亏欠，或劳役过度，相火上炎，亦有时时眩运，何湿痰之有哉。大抵人肥白
而作眩者，治宜清痰降火为先，而兼补气之药。人黑瘦而作眩者，治宜滋阴降火为要，而带抑肝之剂。抑考《内经》有
曰∶风胜则地动。风木太过之岁，亦有因其气化而为外感风邪而眩者，治法宜祛风顺气，伐肝降火，为良策焉。外有因
呕血而眩冒者，胸中有死血迷闭心窍而然，是宜行血清心自安。医者宜各类推而治之，无有不痊者也。
脉法
左手脉数，热多。脉涩而芤，有死血。右手脉实，有痰积。脉虚大，必是久病。
左手人迎脉，缓而浮大者，属风。
方法
丹溪曰∶痰在上，火在下，火炎上而动其痰也。此证属痰者多，盖无痰不能作眩也。虽有因风者，亦必有痰。又曰∶
火动其痰，二陈汤加黄芩、苍术、羌活。挟气虚者，亦以治痰为主，兼补气降火药。
去血过多而眩运者，芎归汤。
眩运不可当者，以大黄酒炒为末，茶清调下。（急则治其标也）。
（以上丹溪方法凡三条）
防风通圣散（河间） 治风热眩运。（方见中风门。）
半夏白术天麻汤（东垣） 治风痰眩运。（方见头痛门。）
加味六君子汤（丹溪） 治气虚痰盛，兼挟风邪，眩运不休者。
陈皮（去白，一钱） 半夏（汤泡透，一钱五分） 茯苓（一钱） 甘草（炙，五分） 荆芥穗（五分）
上细切，作一服，加生姜三片，大枣二枚，水二盏，煎至一盏，去渣，入竹沥一大匙，温服。
六合汤（良方） 治风虚眩运。
四物汤加秦艽、羌活为佐，水煎服之。
玉液汤（严氏方）治七情感动，气郁生涎，随气上冲，头目眩运，心嘈忪悸，眉梭骨痛。
大半夏（汤泡七次，去皮脐）
上以一味薄切成片，每服四钱，加生姜十片煎，入沉香磨水一呷服，大效。
芎术汤（严氏方）治冒雨中湿，眩运呕逆，头痛不食等证。
川芎 半夏（泡透） 白术（各一钱二分） 甘草（炙，六分）
上细切，作一服，加生姜七片，水一盏半，煎至一盏，温服。
川芎散（本事方）治风眩运。
山茱萸（一两，去核） 山药 甘菊花 人参 茯神 小芎 （各五钱）
上为细末，每服二钱，温酒调下。
（丹溪活套）云∶眩运者，中风之渐也。如肥白人，气虚而挟痰者，四君子汤倍蜜炙黄 ，加半夏、橘红，或少加
川芎、荆芥穗，以清利头目也。如痰盛而挟气虚者，二陈汤加人参、白术、黄 ，或少加炮附子煎，入竹沥、姜汁服。
如体瘦血虚而痰火兼盛者，二陈汤合四物，加片芩、薄荷煎，入竹沥、姜汁、童便服。如诸般眩运，挟风则加防风、荆
芥、天麻、秦艽等药，挟热加片芩、黄连、栀子之类，挟寒加干姜、官桂、附子之属，无有不安者也。
论
《黄帝内经》说：各种风邪引起的肢体震颤、头晕目眩，都归属于肝木。又说：如果岁运中木气太过，风气就会流行，导致脾土受到邪气侵袭，百姓会出现完谷不化的泄泻、食欲减退等症状，严重时会出现神情恍惚、容易发怒、头目昏晕甚至头顶疾病的症状。这虽然是由天地气化运行所致，但未必不是由于人体体质虚弱衰退造成的。如果是气虚且形体肥胖面白的人，湿痰停滞在上部，阴火兴起于下部，因此痰挟带虚火，向上冲撞头目，正气不能战胜邪气，所以突然眼前发黑、视物生花，感觉像坐在车船中一样旋转眩晕，严重的甚至有突然昏倒、不知人事的情况，朱丹溪所说的“无痰不能作眩”，正是指这种情况。至于那些形体黑瘦的人，躯体薄弱，真水（肾阴）亏欠，或者因过度劳累，相火（命门之火）上炎，也时常出现眩晕，这哪里有湿痰呢？大抵形体肥胖面白而发作眩晕的，治疗应当以清化痰热、降火为先，同时兼用补气的药物。形体黑瘦而发作眩晕的，治疗应当以滋阴降火为关键，并配合平抑肝火的药剂。另外考察《黄帝内经》有说：风邪偏胜则大地震动。在风木之气太过的年份，也有因为感受外界风邪而导致眩晕的，治疗方法应当以祛风顺气、伐肝降火为良策。此外还有因呕血而导致眩晕昏冒的，这是因为胸中有瘀血阻滞心窍所致，适宜使用行血清心的方法使心神安宁。医生应当根据各类情况进行推演治疗，没有不痊愈的。
脉法
左手脉象数，说明热邪较多。脉象涩且芤（浮大中空），说明有死血（瘀血）。右手脉象实，说明有痰积滞。脉象虚大，必定是久病。
左手人迎脉，脉象缓而浮大的，属于风邪。
方法
朱丹溪说：痰在上部，火在下部，火热炎上而动摇了痰浊。这种病症属于痰的多见，大概是因为无痰就不能发生眩晕。虽然有因风邪引起的，但也一定伴有痰。又说：火热动摇痰浊，可用二陈汤加入黄芩、苍术、羌活。如果夹杂气虚的，也以治痰为主，兼用补气降火的药物。
眩晕剧烈无法忍受的，用大黄经酒炒后研成粉末，用茶汁调服。（这是急则治其标的办法）。
（以上朱丹溪的方法共三条）
防风通圣散（刘河间方） 治疗风热引起的眩晕。（方剂见中风门。）
半夏白术天麻汤（李东垣方） 治疗风痰引起的眩晕。（方剂见头痛门。）
加味六君子汤（朱丹溪方） 治疗气虚痰盛，兼夹风邪，眩晕不止的患者。
陈皮（去白，一钱） 半夏（汤泡透，一钱五分） 茯苓（一钱） 甘草（炙，五分） 荆芥穗（五分）
以上药材细切，作为一服的量，加入生姜三片，大枣二枚，水两盏，煎煮至一盏，去渣，加入竹沥一大匙，温服。
玉液汤（严用和方） 治疗七情触动，气郁生涎，随气上冲，导致头目眩晕，心中嘈杂悸动，眉棱骨疼痛。
大半夏（汤泡七次，去皮脐）
以上一味药薄切成片，每服四钱，加入生姜十片煎煮，加入沉香磨成的水一杯服用，效果显著。
芎术汤（严用和方） 治疗冒雨受湿，眩晕呕吐逆气，头痛不能进食等证候。
以上药材细切，作为一服的量，加入生姜七片，水一盏半，煎煮至一盏，温服。
山茱萸（一两，去核） 山药 甘菊花 人参 茯神 小芎（各五钱）
以上研成细末，每服二钱，用温酒调服。
（朱丹溪的灵活变通之法）说：眩晕，是中风的前兆。如果是肥胖的人，气虚而挟痰的，用四君子汤加倍蜜炙黄芪，加入半夏、橘红，或少加川芎、荆芥穗，以清利头目。如果痰盛而挟气虚的，用二陈汤加入人参、白术、黄芪，或少加炮附子煎煮，加入竹沥、姜汁服用。如果身体瘦弱血虚而痰火兼盛的，用二陈汤合四物汤，加入黄芩、薄荷煎煮，加入竹沥、姜汁、童便服用。如果各种类型的眩晕，挟风则加防风、荆芥、天麻、秦艽等药，挟热加黄芩、黄连、栀子之类，挟寒加干姜、官桂、附子之属，没有不安定的。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "All wind-induced tremors and dizziness belong to Liver Wood." It further states: "In years when the Wood Qi is excessive, Wind Qi prevails, pathogenic factors invade Spleen Earth, and the people suffer from undigested diarrhea in their stools and reduced appetite. In severe cases, they experience mental confusion, irritability, vertigo, and diseases of the vertex." Although this is caused by the movement of cosmic Qi, it is not necessarily unrelated to the deficiency and decline of the individual's constitution. For individuals who are Qi-deficient and have a fat, white complexion, damp-phlegm stagnates in the upper jiao, while Yin Fire arises in the lower jiao. Consequently, phlegm carries deficient fire upward to rush against the head and eyes. The righteous Qi cannot overcome the pathogen, resulting in sudden blackouts, visual hallucinations (seeing spots), and a sensation of spinning as if riding in a boat or carriage. In severe cases, there may be sudden collapse with loss of consciousness. This is precisely what Zhu Danxi meant by "without phlegm, there can be no vertigo." As for individuals who are dark-skinned and thin, with a frail physique and deficiency of True Water (Kidney Yin), or those who suffer from overwork causing Ministerial Fire (Minister Fire) to flare upward, they also occasionally experience vertigo. Where is the damp-phlegm in such cases? Generally, for those with a fat, white complexion suffering from vertigo, treatment should prioritize clearing phlegm and descending fire, while simultaneously using Qi-tonifying herbs. For those with a dark, thin complexion suffering from vertigo, treatment should focus on nourishing Yin and descending fire, combined with herbs that subdue the Liver. Furthermore, examining the *Neijing*, it says: "When Wind is excessive, the earth shakes." In years of excessive Wood/Wind Qi, there are cases where vertigo is caused by external Wind pathogen invasion due to cosmic influences; the appropriate treatment method is to dispel Wind, regulate Qi, and purge the Liver while descending fire, which is an excellent strategy. Additionally, there are cases of vertigo and dizziness caused by vomiting blood, resulting from dead blood (blood stasis) obstructing the Heart orifices in the chest; these should be treated by promoting blood circulation and clearing the Heart to restore tranquility. Physicians should deduce and treat according to each category, and there will be no case that does not heal.
Pulse Diagnosis
If the pulse at the Left hand is rapid (Shu), it indicates excess Heat. If the pulse is choppy (Se) and hollow (Kou), it indicates the presence of blood stasis. If the pulse at the Right hand is full/excess (Shi), it indicates phlegm accumulation. If the pulse is empty and large (Xu Da), it must be a chronic disease.
If the Renying pulse at the Left hand is slow (Huan) and floating and large (Fu Da), it belongs to Wind.
Methods
Zhu Danxi said: "Phlegm is in the upper part, Fire is in the lower part; the flaming Fire agitates the Phlegm." Most cases of this syndrome involve phlegm, essentially because without phlegm, vertigo cannot occur. Even if caused by Wind, there must be phlegm involved. He also stated: "When Fire agitates Phlegm, use Er Chen Tang (Two-Cured Decoction) added with Huang Qin (Scutellaria Root), Cang Zhu (Atractylodes Rhizome), and Qiang Huo (Notopterygium Rhizome)." If accompanied by Qi deficiency, the primary treatment remains resolving phlegm, supplemented by Qi-tonifying and Fire-descending herbs.
For vertigo caused by excessive blood loss, use Xiong Gui Tang (Ligusticum and Angelica Decoction).
For unbearable, severe vertigo, use Da Huang (Rhubarb Rhizome) stir-fried with wine, ground into powder, and taken with tea infusion. (This addresses the branch/symptom in acute situations).
(Above are three methods from Zhu Danxi)
Fang Feng Tong Sheng San (Wind-Dispersing Universal Relief Powder, Liu Hejian's formula) treats vertigo caused by Wind-Heat. (Formula see Stroke Section.)
Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes, and Gastrodia Decoction, Li Dongyuan's formula) treats vertigo caused by Wind-Phlegm. (Formula see Headache Section.)
Jia Wei Liu Jun Zi Tang (Modified Six Gentlemen Decoction, Zhu Danxi's formula) treats Qi deficiency with abundant phlegm, complicated by Wind pathogen, resulting in incessant vertigo.
Chen Pi (Tangerine Peel, white part removed, 1 qian) Ban Xia (Pinellia Tuber, soaked in boiling water until soft, 1.5 qian) Fu Ling (Poria, 1 qian) Gan Cao (Licorice Root, honey-fried, 0.5 qian) Jing Jie Sui (Schizonepeta Spike, 0.5 qian)
Cut finely, prepare as one dose. Add three slices of Sheng Jiang (Fresh Ginger) and two dates (Da Zao). Add two cups of water, decoct until one cup remains. Strain, add one large spoonful of Zhu Li (Bamboo Sap), and take warm.
Liu He Tang (Six-Harmony Decoction, from *Liang Fang*) treats vertigo caused by Wind-Deficiency.
Si Wu Tang (Four Substances Decoction) added with Qin Jiao (Gentiana Macrophylla Root) and Qiang Huo (Notopterygium Rhizome) as assistants, decocted in water and taken.
Yu Ye Tang (Jade Fluid Decoction, Yan Yonghe's formula) treats agitation of the Seven Emotions, Qi stagnation generating saliva/phlegm, rising with Qi to cause head/eye vertigo, heart palpitations with a gnawing sensation (Xin Cao Song Ji), and pain in the supraorbital ridge.
Ban Xia (Pinellia Tuber, soaked seven times in boiling water, skin and umbilicus removed)
Slice thinly. Each dose uses four qian. Add ten slices of Sheng Jiang (Fresh Ginger) and decoct. Take with a sip of water infused with Chen Xiang (Aquilaria Wood). Highly effective.
Xiong Shu Tang (Ligusticum and Atractylodes Decoction, Yan Yonghe's formula) treats vertigo, vomiting, and regurgitation, headache, and inability to eat due to exposure to rain and dampness.
Chuan Xiong (Sichuan Lovage Rhizome) Ban Xia (Pinellia Tuber, soaked thoroughly) Bai Zhu (Atractylodes Macrocephala Rhizome, 1.2 qian each) Gan Cao (Licorice Root, honey-fried, 0.6 qian)
Cut finely, prepare as one dose. Add seven slices of Sheng Jiang (Fresh Ginger) and one and a half cups of water. Decoct until one cup remains. Take warm.
Chuan Xiong San (Ligusticum Powder, from *Ben Shi Fang*) treats Wind-induced vertigo.
Shan Zhu Yu (Cornus Fruit, 1 liang, pitted) Shan Yao (Dioscorea Rhizome) Gan Ju Hua (Chrysanthemum Flower) Ren Shen (Ginseng Root) Fu Shen (Poria with Hostwood) Xiao Xiong (Minor Ligusticum Rhizome, 5 qian each)
Grind into fine powder. Each dose takes two qian, mixed with warm wine and taken.
(Zhu Danxi's Flexible Methods) states: "Vertigo is the precursor to stroke." For fat individuals with Qi deficiency and phlegm, use Si Jun Zi Tang (Four Gentlemen Decoction) with doubled Mi Zhi Huang Qi (Honey-fried Astragalus Root), added with Ban Xia (Pinellia Tuber) and Ju Hong (Tangerine Red Peel), or a small amount of Chuan Xiong (Sichuan Lovage Rhizome) and Jing Jie Sui (Schizonepeta Spike) to clear and benefit the head and eyes. For cases with abundant phlegm and Qi deficiency, use Er Chen Tang (Two-Cured Decoction) added with Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), and Huang Qi (Astragalus Root), or a small amount of Pao Fu Zi (Prepared Aconite Lateral Root) decocted, then added with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice) before taking. For thin individuals with Blood deficiency and concurrent excess Phlegm-Fire, combine Er Chen Tang (Two-Cured Decoction) with Si Wu Tang (Four Substances Decoction), add Pian Huang Qin (Scutellaria Root) and Bo He (Mint Leaf), decoct, and add Zhu Li (Bamboo Sap), Jiang Zhi (Ginger Juice), and Tong Bian (Child's Urine) before taking. For various types of vertigo: if complicated by Wind, add Fang Feng (Siler Root), Jing Jie (Schizonepeta), Tian Ma (Gastrodia Rhizome), Qin Jiao (Gentiana Macrophylla Root); if complicated by Heat, add Pian Huang Qin (Scutellaria Root), Huang Lian (Coptis Rhizome), Zhi Zi (Gardenia Fruit); if complicated by Cold, add Gan Jiang (Dried Ginger), Guan Gui (Cinnamon Bark), Fu Zi (Aconite Lateral Root). There will be no case that does not stabilize.