一、头眩虽属上虚，然不能无涉于下。盖上虚者，阳中之阳虚也；下虚者，阴中
之阳虚也。阳中之阳虚者，宜治其气，如四君子汤、五君子煎、归脾汤、补中益气汤。如兼
呕吐者，宜圣术煎大加人参之类是也。阴中之阳虚者，宜补其精，如五福饮、七福饮、左归
饮、右归饮、四物汤之类是也。然伐下者必枯其上，滋苗者必灌其根。所以，凡治上虚者，
犹当以兼补气血为最，如大补元煎、十全大补汤，及诸补阴补阳等剂，俱当酌宜用之。
一、眩运证，凡有如前论首条所载病源者，当各因其证求而治之。其或有火者宜兼清火
，有痰者宜兼清痰，有气者宜兼顺气，亦在乎因机应变。然无不当以治虚为先，而兼治为佐
也。
一、古法之治眩运，亦有当察者。丹溪曰∶湿痰者，多宜二陈汤。火者加酒芩。挟气虚
者，相火也，治痰为先，挟气药降火，如东垣半夏白术天麻汤之类。眩运不可当者，以大黄
酒炒为末，茶汤调下。火动其痰，用二陈加黄芩、苍术、羌活，散风行湿。附录曰∶有早起
眩运，须臾自定，日以为常者，正元散下黑锡丹。伤湿头运，肾着汤加川芎，名除湿汤。有
痰，青州白丸子。
愚谓古法之治眩运，如半夏白术天麻汤，治脾痰也；二陈汤加黄芩，治热痰也；青州白
丸子治风痰、寒痰也；肾着汤，治湿痰也。此外，如大黄末之治眩运不可当，惟痰火之壅者
宜之；黑锡丹之重坠，惟气实于上者宜之。第恐眩运一证，实痰实火者无几，而亦非上盛之
病，此古方之有宜否用者，不可不审。
一、头眩（头晕目眩）虽然属于上部的虚证，但也不能不涉及下部的虚损。所谓上部的虚，是指阳气中的阳虚；下部的虚，是指阴分中的阳虚。对于阳气中的阳虚，应当治疗其气虚，例如使用四君子汤、五君子煎、归脾汤、补中益气汤。如果兼有呕吐症状，适宜使用圣术煎并大量加入人参等药物。对于阴分中的阳虚，应当填补其精血，例如使用五福饮、七福饮、左归饮、右归饮、四物汤等方剂。然而，砍伐树根必然导致树冠枯萎，浇灌苗株必须灌溉其根部。因此，凡是治疗上部虚证时，仍然应当以同时补益气血为最佳原则，例如大补元煎、十全大补汤，以及各类补阴、补阳的方剂，都应当酌情适宜地选用。
二、眩晕证，凡是有如前文第一条所述病因病机的，应当根据各自的症状寻求治疗方法。如果有火邪的，应当兼清火邪；有痰湿的，应当兼化痰湿；有气滞的，应当兼顺气机，这也在于根据病情变化灵活应对。然而，没有不应当以治疗虚证为先导，而以兼治作为辅助的。
三、古代治疗眩晕的方法，也有需要考察之处。朱丹溪说：湿痰引起的眩晕，多适宜用二陈汤。若有火邪，加酒制黄芩。若挟杂气虚，属于相火妄动，治疗应以化痰为先，配合行气药以降火，例如李东垣的半夏白术天麻汤之类。眩晕剧烈难以忍受的，用大黄酒炒后研成粉末，用茶汤调服。若是火邪扰动痰湿，用二陈汤加黄芩、苍术、羌活，以疏散风邪、祛除湿气。附录记载：有清晨起床即感眩晕，片刻后自行缓解，每日如此者，服用正元散送服黑锡丹。伤湿导致的头部眩晕，用肾着汤加川芎，名为除湿汤。有痰湿者，用青州白丸子。
我认为古代治疗眩晕的方法，如半夏白术天麻汤，是治疗脾虚生痰的；二陈汤加黄芩，是治疗热痰的；青州白丸子治疗风痰、寒痰；肾着汤治疗湿痰。此外，如大黄末治疗剧烈眩晕，只适用于痰火壅盛的情况；黑锡丹的重镇坠逆之性，只适用于上部气实的患者。只是担心眩晕这一病症，真正由实痰、实火引起的极少，而且也不是上部实证疾病，这些古方是否适宜使用，不可不仔细审察。
1. Dizziness (Xuanxuan) although belonging to deficiency in the upper part, inevitably involves deficiency in the lower part. The "upper deficiency" refers to Yang deficiency within Yang; the "lower deficiency" refers to Yang deficiency within Yin. For Yang deficiency within Yang, treatment should focus on Qi, such as using Sijunzi Tang (Four Gentlemen Decoction), Wujunzi Jian (Five Gentemen Decoction), Guipi Tang (Restore the Spleen Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If accompanied by vomiting, Shengzhu Jian (Sage's Atractylodes Decoction) with a significant addition of Renshen (Ginseng Radix et Rhizoma) is appropriate. For Yang deficiency within Yin, treatment should tonify Essence, such as using Wufu Yin (Five Blessings Drink), Qifu Yin (Seven Blessings Drink), Zuogui Yin (Left Restoring Drink), Yougui Yin (Right Restoring Drink), or Siwu Tang (Four Substances Decoction). However, cutting the roots will inevitably cause the canopy to wither, and watering the shoots requires irrigating the roots. Therefore, when treating upper deficiency, it is best to simultaneously tonify Qi and Blood, such as using Dabu Yuanjian (Great Tonification of Origin Decoction), Shiquan Dabu Tang (Ten Complete Great Tonification Decoction), and various Yin- or Yang-tonifying formulas, which should be selected according to suitability.
2. Regarding the syndrome of dizziness and vertigo, if the etiology matches that described in the first article above, treatment should be sought based on specific symptoms. If there is Fire, clear the Fire concurrently; if there is Phlegm-Dampness, resolve the Phlegm-Dampness concurrently; if there is Qi stagnation, regulate the Qi concurrently. This depends on adapting to changes in the condition. However, no case should fail to prioritize treating deficiency, while using concurrent treatments as adjuncts.
3. Ancient methods for treating dizziness and vertigo also require scrutiny. Zhu Danxi stated: For Phlegm-Dampness, Erchen Tang (Two Old Decoction) is mostly suitable. Add Jiuhuangqin (Wine-processed Scutellariae Radix) if there is Fire. If complicated by Qi deficiency, involving hyperactive Ministerial Fire, treat Phlegm first, combining with Qi-regulating herbs to descend Fire, such as Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) from Li Dongyuan. For severe dizziness that is unbearable, use Dahuang (Rhei Radix et Rhizoma) wine-fried and powdered, taken with tea water. If Fire stirs Phlegm-Dampness, use Erchen Tang added with Huangqin (Scutellariae Radix), Cangzhu (Atractylodis Rhizoma), and Qianghuo (Notopterygii Rhizoma et Radix) to disperse Wind and dry Dampness. An appendix records: For those who experience dizziness upon waking in the morning, which resolves spontaneously after a moment and occurs daily, use Zhengyuan San (Upright Origin Powder) to administer Heixi Dan (Black Tin Pill). For head dizziness caused by injury to Dampness, use Shen Zhuo Tang (Kidney Fixing Decoction) added with Chuanxiong (Ligustici Chuanxiong Rhizoma), named Chushi Tang (Remove Dampness Decoction). For cases with Phlegm, use Qingzhou Bai Wanzi (Qingzhou White Pills).
I believe that ancient methods for treating dizziness, such as Banxia Baizhu Tianma Tang, treat Spleen-related Phlegm; Erchen Tang added with Huangqin treats Heat-Phlegm; Qingzhou Bai Wanzi treats Wind-Phlegm and Cold-Phlegm; Shen Zhuo Tang treats Damp-Phlegm. Furthermore, Dahuang powder for treating severe dizziness is only suitable for cases of Phlegm-Fire congestion; the heavy descending nature of Heixi Dan is only suitable for cases of excess Qi in the upper part. It is feared that in the syndrome of dizziness, true cases of excess Phlegm or excess Fire are rare, and it is not a disease of upper excess. Whether these ancient formulas are appropriate must be carefully examined.