经曰。因于风。欲如运枢。起居如惊。神气乃浮。内经论眩。皆属于木。属上虚。仲景论眩。
以痰饮为先。丹溪论眩。兼于补
虚治痰降火。
戴复庵云。有头风证。耳内常鸣头。上如有鸟雀啾啾之声。切不可全谓耳鸣为虚。此头脑挟
风所致。有眩晕之甚。抬头则屋转。眼常黑花。观见常如有物飞动。或见物为两。宜三五七散。
或秘旨正元散加鹿茸。兼进养正丹。不效。一味鹿茸。每服半两。酒煎去滓。入麝少许。缘鹿茸
生于头。头晕而主以鹿茸。盖以类相从也。曾有服头痛药不愈。服茸朱丹而效。此为虚寒也。若
实者用之。殆矣。故丹溪曰。眩晕不可当者。大黄三次酒炒干为末。茶调下。每服一钱至二钱。
刘宗浓曰。眩晕乃上实下虚所致。所谓虚者。血与气也。所谓实者。痰涎风火也。经云。上虚则
眩。又云。徇蒙招尤。目瞑耳聋。下实上虚。则与刘氏所称。无乃冰炭乎。盖邪之所凑。其气必
虚。留而不去。其病为实。亦何冰炭之有。然当以脉法辨之。寸口大而按之即散者为上虚。以鹿
茸法治之。寸口滑而按之益坚者为上实。以酒大黄法治之。外感六淫。内伤七情。皆能眩晕。然
无不因痰火而作。谚云。无火不动痰。无痰不作晕。须以清火豁痰为主。而兼治六淫之邪。无不
愈者。风寒在脑。或感邪湿。头眩重痛欲倒。呕逆不定。三因芎辛汤。冒雨或中湿。眩晕呕逆。
头重不食。本方去细辛、芽茶加半夏、茯苓。恶风眩晕。头旋眼黑恶心。见风即复作者。半夏苍
术汤。风虚眩晕多痰。导痰汤加天麻。肾气素虚而逆者。沉香降气下养正丹。不应。八味丸。风
热眩晕眼掉。川芎茶调散。痰厥眩晕。半夏白术天麻汤。痰火眩晕者。二陈汤加白术、川芎、天
麻。有热。更加山栀、黄芩。七情郁而生痰。亦令头眩。但见于郁悒之人。及妇女辈。二陈加木
香、丁香、白术、砂仁。早起眩晕。须臾自定。乃胃中老痰使然。古方用黑锡丹劫之。不若青礞
石丸镇坠。后用理中丸调理。痰结胸中。眩晕恶心。牙皂末和盐汤探吐。吐定。服导痰汤。劳役
过度。眩晕发
热者。补中益气汤加天麻。兼呕逆。六君子汤。气虚而喘。加黄 。阴虚火炎痰盛。少加熟附子。
煎成加姜汁、竹沥。因虚致眩。虽定后。而常欲向火。欲得暖手按者。阳气不足故也。附子理中
汤。淫欲过度。肾与督脉皆虚。不能纳气归源。使诸逆奔上而眩晕。六味丸加沉香、鹿茸。名香
茸八味丸。肥白人眩晕。清火降痰为先。而兼补气药。黑瘦人眩晕。滋阴降火为要。而带抑肝之
剂。胸中有死血。作痛而眩。饮韭汁酒良。产后血晕。见妇人本门。
〔诊〕左手脉数热多。脉涩有死血。浮弦为肝风。右手滑实痰积。脉大是久病。虚大是气虚。
石预治司业董方南夫人。体虽不盛。而恒有眩晕之疾。诊其六脉皆带微弦。而气口尤甚。盖
缘性多郁怒。怒则饮食不思。恒服消导之味。则中土愈困。饮食皆化为痰。痰从火化而为眩晕矣。
岂平常肥盛多湿之痰可比例乎。为疏六君子方。水泛为丸。服之以培中土。中土健运。当无数化
不及。留结为痰而成眩晕之虑。所谓治病必求其本也。
朔客梁姓者。初至吴会。相邀石顽往诊。时当夏月。裸坐盘餐。倍于常人。而形伟气壮。热
汗淋漓于头项间。诊时不言所以。切其六脉沉实。不似有病之脉。惟两寸略显微数之象。但切其
左。则以右掌抵额。切其右。则易左掌抵额。知其肥盛多湿。而夏暑久在舟中。时火鼓激其痰。
而为眩晕也。询之果然。因与导痰汤加黄柏、泽泻、茅术、浓朴二服而安。
又治松陵贡士吴友良。年逾古稀。头目眩晕。乃弟周维。素擅岐黄。与补中益气数服。始用
人参一钱。加至三钱。遂痞满不食。坐不得卧。三昼夜。喃喃不休。仲君孝廉谦六。相延石顽往
候。见其面赤。进退不常。左颊聂聂 动。诊其
六脉皆促。或七八至一歇。或三四至一歇。询其平昔起居。云。是知命之年。便绝欲自保。饮啖
自强。此壮火烁阴而兼肝风上扰之兆。与生料六味除去茱萸。易入钩藤。大剂煎服。是夜即得酣
寝。其后或加鳖甲。或加龙齿。或加枣仁。有时妄动怒火。达旦不宁。连宵不已。则以秋石汤送
灵砂丹。应如桴鼓。盛夏酷暑。则以小剂生脉散代茶。后与六味全料调理。至秋而安。
《黄帝内经》说：感受风邪，头部感觉像门轴转动一样晕眩。起居突然受惊，神气就会浮越于上。《内经》论述眩晕，认为都归属于肝木（肝系统），属于上部虚损。张仲景论述眩晕，以痰饮为首要原因。朱丹溪论述眩晕，兼顾补虚、治痰和降火。
戴复庵说：有一种头风证，耳内经常鸣响，头上好像有鸟雀叽叽喳喳的声音。切不可完全认为耳鸣就是虚证，这是头脑夹带风邪所致。还有眩晕严重的，抬头时觉得房屋旋转，眼前经常出现黑花，看东西好像有物体在飞动，或者视物成双。适宜服用三五七散，或者秘旨正元散加鹿茸，同时进服养正丹。如果无效，单用一味鹿茸，每次服用半两，酒煎去渣，加入少许麝香。因为鹿茸生于头顶，头晕而主治用鹿茸，大概是取“同类相从”的道理。曾经有人服用头痛药不愈，服用茸朱丹却见效，这属于虚寒证。如果是实证使用此法，那就危险了。所以朱丹溪说：眩晕剧烈难以忍受的，用大黄三次酒炒干研为末，茶调服下，每次一钱至二钱。
刘宗浓说：眩晕是由于上实下虚造成的。所谓“虚”，是指血和气；所谓“实”，是指痰涎、风、火。经文说：“上虚则眩”，又说：“徇蒙招尤，目瞑耳聋”，这是下实上虚。这与刘氏所说的，岂不是冰炭不相容吗？大概邪气聚集的地方，正气必然虚弱；邪气停留不去，病势就表现为实。又有什么冰炭不相容的呢？然而应当通过脉法来辨别。寸口脉大而按之即散的，属于上虚，用鹿茸法治之；寸口脉滑而按之更坚硬的，属于上实，用酒大黄法治之。外感六淫，内伤七情，都能导致眩晕，但没有不是因痰火而发作的。谚语说：“无火不动痰，无痰不作晕”。必须以清火豁痰为主，兼治六淫之邪，没有不痊愈的。
风寒在脑，或感受邪湿，头眩重痛欲倒，呕吐逆乱不定，用三因芎辛汤。冒雨或中湿，眩晕呕逆，头重不食，本方去掉细辛、芽茶，加半夏、茯苓。恶风眩晕，头旋眼黑恶心，见风即复发者，用半夏苍术汤。风虚眩晕多痰，用导痰汤加天麻。肾气素来虚弱且气逆者，用沉香降气下配合养正丹；无效者，用八味丸。风热眩晕伴眼球颤动，用川芎茶调散。痰厥眩晕，用半夏白术天麻汤。痰火眩晕者，用二陈汤加白术、川芎、天麻；有热者，再加山栀、黄芩。七情郁结而生痰，也会引起头眩，但多见于忧郁之人及妇女，用二陈汤加木香、丁香、白术、砂仁。早起眩晕，片刻后自行缓解，这是胃中老痰所致。古方用黑锡丹攻伐，不如用青礞石丸镇坠，之后用理中丸调理。痰结胸中，眩晕恶心，用牙皂末和盐汤探吐。吐定后，服导痰汤。劳役过度，眩晕发热者，用补中益气汤加天麻；兼呕吐逆乱者，用六君子汤。气虚而喘，加黄芪。阴虚火炎痰盛，少加熟附子，煎成后加姜汁、竹沥。因虚致眩，虽然症状缓解后，仍常想靠近火源，想要暖手按压，这是因为阳气不足，用附子理中汤。淫欲过度，肾与督脉皆虚，不能纳气归源，使诸逆气奔上而眩晕，用六味丸加沉香、鹿茸，名为香茸八味丸。肥白人眩晕，以清火降痰为先，兼补气药。黑瘦人眩晕，以滋阴降火为要，兼抑肝之剂。胸中有死血，作痛而眩，饮韭汁酒良效。产后血晕，见妇人本门。
【诊法】左手脉数主热多，脉涩主有死血，浮弦主肝风。右手滑实主痰积，脉大是久病，虚大是气虚。
石顽治疗司业董方南夫人。体质虽不强盛，但常有眩晕之疾。诊其六脉皆带微弦，而气口尤为明显。大概是因为性情多郁怒，怒则饮食不思，常服消导之药，则脾胃中土更加困顿，饮食皆化为痰，痰从火化而为眩晕。这岂是平常肥盛多湿之痰可以相比的？于是开具六君子方，水泛为丸，服用以培补中土。中土健运，自然无数化不及、留结为痰而成眩晕的忧虑。这就是所谓治病必求其本。
北方客商梁姓者，初到吴会之地，邀请石顽前往诊治。当时正值夏季，裸坐盘餐，食量倍于常人，形体伟岸，气息壮盛，头项间热气淋漓。诊时不言病因，切其六脉沉实，不像有病之脉，只有两寸略显微数之象。但切左脉时，他用右掌抵住额头；切右脉时，换左掌抵住额头。可知其肥盛多湿，而夏暑久在舟中，时令之火鼓激其痰，从而引起眩晕。询问果然如此。于是给予导痰汤加黄柏、泽泻、茅术、浓朴，服两剂而安。
又治疗松陵贡士吴友良，年过七十，头目眩晕。其弟周维，素擅医道，给服补中益气汤数剂，开始用人参一钱，加至三钱，遂致痞满不食，坐卧不安，三昼夜喃喃不休。仲君孝廉谦六，邀请石顽前往问候。见其面赤，进退失常，左颊微微跳动。诊其六脉皆促，或七八至一歇止，或三四至一歇止。询问其平昔起居，回答说：到了知命之年，便绝欲自保，饮食自强。这是壮火烁阴而兼肝风上扰的征兆。给予生料六味地黄丸除去茱萸，易入钩藤，大剂煎服。当夜即得酣睡。其后有时加鳖甲，或加龙齿，或加枣仁。有时妄动怒火，达旦不宁，连宵不已，则以秋石汤送服灵砂丹，应验如桴鼓。盛夏酷暑，则以小剂生脉散代茶。后来用六味地黄丸全料调理，至秋季而安。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Affected by wind, the head feels as if rotating like a door pivot. Sudden fright in daily life causes the Shen Qi (Spiritual Energy) to float upward." In the *Neijing*, dizziness and vertigo are all attributed to Wood (Liver system), arising from deficiency in the upper part. Zhang Zhongjing attributes dizziness primarily to Phlegm-Fluids. Zhu Danxi addresses dizziness by simultaneously tonifying deficiency, treating phlegm, and descending fire.
Dai Fu'an stated: There is a condition of Head Wind where there is constant tinnitus in the ears, and a sensation on the head as if birds are chirping. One must not entirely attribute tinnitus to deficiency; this is caused by Wind clashing with the brain. In cases of severe vertigo, looking up causes the room to spin, black spots frequently appear before the eyes, objects seem to be flying or moving, or diplopia (double vision) occurs. The Sanwuqi Powder is suitable, or the Mizhi Zhengyuan Powder with Deer Antler, taken concurrently with Yangzheng Pill. If ineffective, use single-ingredient Deer Antler, half liang per dose, decocted in wine, strained, with a small amount of Musk added. Since Deer Antler grows on the head, using it for dizziness follows the principle of "similar things attract each other." There was a case where headache medicines failed, but Rongzhu Dan succeeded, indicating a Deficient-Cold pattern. Using this for an Excess pattern would be perilous. Thus, Zhu Danxi said: For unbearable severe vertigo, use Rhubarb (Da Huang) stir-fried three times with wine, dried and powdered, taken with tea, one to two qian per dose.
Liu Zongnong stated: Vertigo is caused by Excess in the upper and Deficiency in the lower. The "Deficiency" refers to Blood and Qi; the "Excess" refers to Phlegm-Saliva, Wind, and Fire. The Classics state: "Upper deficiency leads to vertigo," and also: "Blindness and deafness due to swaying and trembling indicate Lower Excess and Upper Deficiency." This seems contradictory to Liu's statement. However, where pathogenic factors gather, Qi must be deficient; if they remain, the disease manifests as Excess. So what contradiction is there? Differentiation must rely on pulse diagnosis. A Cun (inch) position pulse that is large but scatters upon pressure indicates Upper Deficiency, treated with Deer Antler methods. A Cun position pulse that is slippery and becomes harder upon pressure indicates Upper Excess, treated with Wine-Rhubarb methods. External contraction of the Six Evils and internal injury of the Seven Emotions can both cause vertigo, but none arise without Phlegm-Fire. As the proverb says: "Without Fire, Phlegm does not move; without Phlegm, Vertigo does not occur." Treatment must focus on clearing Fire and resolving Phlegm, while addressing the Six Evils, ensuring recovery.
When Cold-Wind is in the brain, or Evil-Dampness is contracted, causing heavy vertigo, pain, desire to fall, and irregular vomiting, use Sanyin Xiongxin Decoction. When exposed to rain or dampness, causing vertigo, vomiting, heaviness of head, and loss of appetite, remove Asarum (Xixin) and Bud Tea from the above formula, adding Pinellia (Banxia) and Poria (Fuling). For aversion to wind, vertigo, dizziness, blacking out, nausea, and recurrence upon exposure to wind, use Banxia Cangzhu Decoction. For Wind-Deficiency vertigo with much phlegm, use Daotan Tang plus Gastrodia (Tianma). For those with inherent Kidney Qi deficiency and rebellious Qi, use Chenxiang Jiangqi Xia combined with Yangzheng Dan; if ineffective, use Bawei Wan. For Wind-Heat vertigo with eye twitching, use Chuanxiong Chatiao San. For Phlegm-Juevertigo, use Banxia Baizhu Tianma Tang. For Phlegm-Fire vertigo, use Erchen Tang plus Baizhu, Chuanxiong, and Tianma; add Gardenia (Shanzhi) and Scutellaria (Huangqin) if heat is present. Emotional depression generating phlegm also causes vertigo, commonly seen in melancholic individuals and women; use Erchen Tang plus Mugua, Dingxiang, Baizhu, and Sharen. Morning vertigo that resolves spontaneously is caused by old phlegm in the stomach. Ancient formulas used Heixi Dan to purge, but Qingmengshi Wan for sedation is better, followed by Lizhong Wan for regulation. Phlegm knotting in the chest causing vertigo and nausea: probe vomiting with Ilex (Yazao) powder and salt water. After vomiting subsides, administer Daotan Tang. Overexertion causing vertigo and fever: use Buzhong Yiqi Tang plus Tianma; if accompanied by vomiting, use Liujunzi Tang. For Qi deficiency with wheezing, add Astragalus (Huangqi). For Yin deficiency with flaming fire and abundant phlegm, add small amounts of Prepared Aconite (Shu Fuzi); after decoction, add Ginger Juice and Bamboo Sap. Vertigo due to deficiency, even after resolution, often involves a desire for warmth or pressing hands against the body due to insufficient Yang Qi; use Fuzi Lizhong Tang. Excessive sexual activity depletes Kidney and Du Mai, failing to grasp Qi and return it to its source, causing rebellious Qi to rush upward leading to vertigo; use Liuwei Wan plus Chenxiang and Deer Antler, named Xiangrong Bawei Wan. For obese white-skinned individuals with vertigo, prioritize clearing fire and descending phlegm, supplemented by Qi-tonifying herbs. For thin dark-skinned individuals with vertigo, prioritize nourishing Yin and descending fire, supplemented by Liver-suppressing agents. Stagnant blood in the chest causing pain and vertigo: drinking leek juice with wine is beneficial. Postpartum blood fainting is discussed in the Women's Diseases section.
[Diagnosis] Left hand rapid pulse indicates excess heat; choppy pulse indicates stagnant blood; floating and wiry pulse indicates Liver Wind. Right hand slippery and solid pulse indicates phlegm accumulation; large pulse indicates chronic illness; empty and large pulse indicates Qi deficiency.
Shiwan treated Lady Dong Fangnan, Wife of Siye. Although her constitution was not robust, she suffered from frequent vertigo. Her six pulses were slightly wiry, especially at the Qikou (Radial Artery) position. This was likely due to a temperament prone to depression and anger. Anger led to poor appetite, and frequent use of digestive aids further weakened the Spleen-Stomach (Middle Jiao). Food transformed into phlegm, which converted to fire, causing vertigo. This differs from the damp-phlegm of obese individuals. He prescribed Liujunzi Formula, made into water pills, to strengthen the Middle Jiao. Once the Spleen-Stomach functions normally, there will be no fear of food transformation failure leading to phlegm accumulation and vertigo. This illustrates seeking the root cause in treatment.
A northern merchant surnamed Liang visited Wu-Hui region and invited Shiwan for consultation. It was summer. He sat naked during meals, eating twice as much as usual, with a sturdy physique and strong Qi, sweating profusely on the head and neck. He did not explain his condition during consultation. His six pulses were deep and solid, unlike a diseased pulse, except for a slight rapidity in the two Cun positions. When feeling the left pulse, he held his right palm to his forehead; when feeling the right pulse, he held his left palm to his forehead. This indicated obesity with dampness, and prolonged stay in a boat during summer heat stimulated phlegm with seasonal fire, causing vertigo. Inquiry confirmed this. He was given Daotan Tang plus Huangbai, Zexie, Maozhu, and Houpo. Two doses brought relief.
He also treated Wu Youliang, a Gongshi from Songling, over seventy years old, suffering from head and eye vertigo. His brother Zhou Wei, skilled in medicine, administered Buzhong Yiqi Decoction several times. Starting with one qian of Ginseng, increased to three qian, this caused fullness, loss of appetite, inability to sit or lie down, and muttering for three days and nights. Zhong Jun Xiao Lian Qianliu invited Shiwan to visit. The patient had a red face, erratic movements, and twitching of the left cheek. All six pulses were hurried (Cu), pausing every 7-8 beats or every 3-4 beats. Inquiry revealed that since reaching fifty, he abstained from sex to preserve health and ate strongly. This indicated Strong Fire consuming Yin and Liver Wind disturbing upward. Shiwan prescribed Sheng Liao Liuwei Dihuang Wan removing Cornus (Zhuyu), replacing it with Uncaria (Gouteng), in large doses. He slept soundly that night. Later, Turtle Shell (Biejia), Dragon Teeth (Longgu), or Ziziphus Seed (Suanzaoren) were added. When anger flared up, keeping him awake day and night, Ashi Tang was used to deliver Lingsha Dan, with immediate effect. During midsummer heat, a small dose of Shaoyao San was used as tea. Finally, Liuwei Dihuang Wan was used for conditioning, resulting in recovery by autumn.