典藏书目

The *Kouwen Pian* (Chapter on Questions Concerning the Mouth) states: When Qi in the upper jiao is insufficient, the brain feels empty and unsatisfied, the ears suffer from tinnitus, the head feels heavy and difficult to support, and the eyes feel dizzy.

The *Weiqi Pian* (Chapter on Wei Qi) states: Deficiency in the lower jiao leads to jue syndrome (cold extremities/fainting), while excess in the lower jiao leads to heat; deficiency in the upper jiao leads to dizziness, while excess in the upper jiao leads to heat and pain.

The *Hailun* (Discourse on the Sea) states: If the Sea of Marrow is in excess, the body becomes light and vigorous with excessive strength, exceeding normal limits; if the Sea of Marrow is deficient, there is a sensation of the brain rotating, tinnitus, soreness of the shins, vertigo and faintness, inability to see clearly, lethargy, and a desire to lie down.

The *Wuzang Shengcheng Pian* (Chapter on the Generation of the Five Zang Organs) states: Blurred vision, head shaking, deafness, and blindness are conditions of lower excess and upper deficiency, located in the Foot Shaoyang Gallbladder and Foot Jueyin Liver meridians; in severe cases, the pathogen enters the Liver.

The *Maiyao Jingwei Lun* (Discourse on the Essentials of Pulse Diagnosis) states: A pulse that is floating and scattered indicates sudden collapse (fainting).

The *Jueqi Pian* (Chapter on Essence and Qi) states: Loss of Jing (Essence) causes deafness; loss of Qi causes blurred vision.

The *Juelun* (Discourse on Jue Syndrome) states: Jue syndrome of the Taiyang (Greater Yang) meridian presents with swelling of the head, heaviness of the head, inability to walk with the feet, leading to sudden collapse.

The *Jingmai Pian* (Chapter on the Meridians) states: Excess in the Du Mai (Governing Vessel) causes spinal stiffness; deficiency causes heaviness of the head, worsened by shaking the head. If the Yin Qi of all five Zang organs is exhausted, the eye system twists, causing rotation of the eyeballs and vertigo; those with vertigo have their Shen (Spirit) dying first; if the Shen dies first, death will occur within one and a half days.

The *Zhihen Yao Da Lun* (Great Discourse on the Most Essential Truths) states: All wind-induced tremors and dizziness belong to the Liver. During years when Taiyang governs the climate, people suffer from sadness and frequent dizziness and collapse. In cases of Taiyang retaliatory qi, symptoms include headache, sadness, frequent dizziness and collapse, and reduced appetite.

The *Qijiao Bian Da Lun* (Great Discourse on Changes in the Interaction of Qi) states: When the annual Wood Qi is excessive, Wind Qi spreads, and Spleen Earth is attacked. People suffer from undigested diarrhea (unsan digestion) and reduced appetite; in severe cases, they feel uneasy, irritable, experience vertigo and faintness, and suffer from diseases at the vertex of the head.

The *Liuyuan Zhengji Da Lun* (Great Discourse on the Correct Records of the Six Origins) states: When Wood Qi is depressed and erupts, severe cases present with tinnitus, vertigo and rotation, inability to recognize people, and sudden stiff collapse.

Vertigo and dizziness are predominantly due to deficiency (accounting for 80-90%), while cases complicated by Fire or Phlegm account for only 10-20%. Investigating the causes: there is vertigo due to excessive labor and fatigue; due to irregular eating and drinking; due to vomiting damaging the upper jiao; due to diarrhea damaging the lower jiao; due to profuse sweating causing Yang collapse; due to fright disturbing the Heart; due to excessive worry and rumination; due to assault or humiliation causing Qi depletion; due to grief and pain accompanied by loud crying and shouting. These all damage the "Yang within Yin" (or Yang of the Upper Jiao). There is also vertigo due to hematemesis, epistaxis, or hematochezia; due to large-scale ulceration of abscesses and pus; due to metal wounds, blood loss, and extreme pain; due to men's sexual excess where Qi follows the loss of Jing; due to women's metrorrhagia or postpartum blood loss. These all damage the "Yang within Yin" (or Yang rooted in Yin). Furthermore, vertigo after heavy drunkenness is caused by damp-heat clashing, damaging Yin; vertigo after great anger is caused by Liver Wood acting recklessly, damaging Qi; vertigo caused by Phlegm-fluid retention in the middle jiao obstructing regulatory functions is due to Spleen weakness, which is also a case of "deficiency amidst excess" (root deficiency with branch excess). For the elderly whose Jing and Blood decline, with accumulated fatigue, suddenly suffering from insomnia and vertigo, this is due to dual deficiency of Ying (Nutritive) and Wei (Defensive) Qi. From this, deficiency and excess can be distinguished. The statements in the *Neijing* (*Inner Canon*) all refer to deficiency, yet later generations often propose various speculative theories. Do these align with the disease conditions and canonical principles? It is like pointing south when the compass points north; how can students avoid errors? Therefore, I extract the most significant points and state them as follows.

First, Liu Hejian’s theory on vertigo relies solely on one sentence from the *Zhihen Yao Da Lun*: "All wind-induced tremors and dizziness belong to Liver Wood," because Wind is active. He argues that severe Wind causing head and eye vertigo results from exuberant Liver Wood, implying Metal is weak and cannot control Wood, leading Wood to generate Fire. Since both Wind and Fire are Yang, and Yang governs movement, the interaction of two movements causes rotation; thus, fire is inherently moving, and flames rotate naturally when fanned by wind. While this explanation of Wind and Wood seems plausible, it fails to recognize that the *Zhihen Yao Da Lun* discusses climatic cycles and organ associations, not the specific pathology of vertigo. Theories from the *Kouwen Pian*, *Weiqi Pian*, *Jueqi Pian*, *Jingmai Pian*, and *Hailun* are much more pertinent. Why did Liu Hejian cite none of these, relying only on "Wind" and "Fire" to cover all vertigo? Is this not an error? Zhu Danxi argued: "Phlegm is above, Fire is below; Fire flares upward and agitates the Phlegm." He believed most vertigo cases involve Phlegm, stating "No Phlegm, no vertigo"; even wind-induced vertigo must involve Phlegm. For cases with Qi deficiency, he advocated treating Phlegm primarily, supplemented by Qi-tonifying and Fire-reducing herbs. If this theory holds, all vertigo would be Phlegm-related. However, why does Qibo (the Yellow Emperor) never mention Phlegm-fluids, but instead says "Upper Qi insufficiency causes head heaviness and eye vertigo," "Upper deficiency causes vertigo," "Du Mai deficiency causes head heaviness worsened by shaking," and "Sea of Marrow deficiency causes brain rotation, tinnitus, and vertigo"? Are all these Phlegm syndromes? As listed in my previous chapter, these are causes of vertigo, yet are they all Phlegm? Thus, Danxi said, "No Phlegm, no vertigo; treat Phlegm primarily." I say, "No deficiency, no vertigo; treat deficiency primarily, while酌情 (discretionarily) addressing branch symptoms." Who is right or wrong, I cannot determine; I merely cite canonical principles to express the general idea, awaiting correction by experts.

Second, Headache is an Upper Excess syndrome; Vertigo is an Upper Deficiency syndrome. The *Neijing* distinguishes them clearly: "Headache and vertex diseases are Upper Excess and Lower Deficiency." And again: "Upper Excess and Lower Deficiency lead to Jue and vertex diseases." This is because pathogenic factors are in the Upper, causing pain, hence Upper Excess. Regarding vertigo, it states "Upper Qi insufficiency" and "Upper deficiency causes vertigo," never mentioning Upper Excess. Yet later physicians like Yan Yonghe and Yang Renzhai claimed: "Fluids condense and rise with Qi"; "Excessive fatigue leads to Lower Deficiency and Upper Excess"; "Kidney fails to grasp Qi, causing Qi to rush upward." Even Zhu Danxi stated "Phlegm above, Fire below," all describing Upper Excess. How does this contradict the *Neijing* so greatly? Alas, this is due to later ignorance. Vertigo may present as head heaviness, blackouts, or a spinning sensation in the brain. Seeking reasons for "Excess," some claim head heaviness indicates Upper Excess, failing to realize that the head is not actually heavier than usual, but rather the patient cannot bear the weight. This is weakness in the Upper, a deficiency of Yang, not Excess. What about Qi failing to return to its source or Qi rushing upward? Upper Excess requires descending and suppressing methods; Upper Deficiency must not be further damaged by attacking the vital Qi. The principle of Upper Excess and Lower Deficiency must be distinguished; misjudgment leads to harm.

Third, Vertigo has minor and major forms. Observing this reveals the nature of deficiency and excess. Why? People with weak constitutions, regardless of age, may experience vertigo after fatigue or sexual activity/alcohol, such as sudden tinnitus like ringing bells, or brief dizziness and blackouts that stop quickly. This is common. After middle age, sudden collapse and fainting are also common. Brief dizziness stopping quickly is called "dizzy head and blurry eyes"; sudden collapse without consciousness is called "Wind-stroke or Phlegm-obstruction." The former stops quickly because Qi and Blood are not yet exhausted, so symptoms appear and vanish rapidly; this is minor Wind-stroke. The latter is severe because the root is depleted, making recovery difficult; this is major vertigo, typically seen after middle age, distinguishable from youth. Observing this clarifies whether it is Wind or not, Phlegm or not, and reveals deficiency/excess. Why do modern practitioners ignore pathogenesis, labeling any vertigo, collapse, or muteness as "Wind-Phlegm" and using dispersing methods? I fear the subtle Qi cannot withstand further destruction. This is truly pitiable.