内经云徇蒙招尤目瞑耳聋下实上虚过在足少阳厥阴甚则入肝
按许学士云上虚者肝虚也攻肝虚则头晕徇蒙者如以物蒙其首招摇不定目眩耳聋皆晕之状
也故肝厥头晕治宜钩藤散(方见后)
原病式曰诸风掉眩皆属肝木风主动故也所谓风气甚而头目眩晕者由风木旺必是金衰不能
制木而木复生火风皆属阳阳主乎动两动相搏则为之旋转故火本动也焰得风则自然旋转也
成无己云伤寒头眩责其虚也起则头眩与眩冒者皆发汗吐下后所致是知阳虚也故针经曰上
虚则眩然风家亦多有眩者风主动故尔
严用和云眩晕之证经虽云皆属于肝风上攻所致然体虚之人外感六淫内伤七情皆能眩晕当
以脉
证别之风则脉浮有汗项强不仁寒则脉紧无汗筋挛掣痛暑则脉虚烦闷湿则脉细沉重吐逆及其七
情所感遂使脏气不平郁而生涎结而为饮随气上逆令人眩晕眉棱骨痛眼不可开寸脉多沉此为
异耳若疲劳过度下虚上实金疮吐衄便利及妇人崩伤产后去血过多皆令人眩晕当随其所因而治
之
按此所分四气痰饮亡血等证可谓亲切但其所集之方则欠发明学人当自求之
子和云大风头风眩晕手足麻痹胃脘发痛皆风寒湿三气杂至合而为痹也在上谓之停饮可用
独圣散吐之吐讫后服清上辛凉之药
按此法施于胸膈痰涎闭塞多年眩晕不已血气充实之人其效甚捷
谨按眩晕一证人皆称为上盛下虚所致而不明言其所以然之故盖所谓虚者血与气也所谓实
者痰
涎风火也原病之由有气虚者乃清气不能上升或汗多亡阳而致当升阳补气有血虚者乃因亡血过
多阳无所附而然当益阴补血此皆不足之证也有因痰涎郁遏者宜开痰导郁重则吐下有因风火所
动者宜清上降火若因外感而得者严氏虽分四气之异皆当散邪为主此皆有余之证也世有所谓气
不归元而用丹药镇坠沉香降气之法盖香窜散气丹药助火其不归之气岂能因此而复耶内经所谓
治病必求其本气之不归求其本而用药则善矣
《黄帝内经》说：“徇蒙招尤，目瞑耳聋”，这是下实上虚的病症，病位在足少阳胆经和足厥阴肝经，严重时邪气会传入肝脏。
按许叔微（许学士）的解释：所谓的“上虚”就是肝虚。治疗肝虚引起的头晕，“徇蒙”的感觉就像有东西蒙住头部，感到摇晃不定；目眩、耳聋都是眩晕的表现。因此，对于肝厥引起的头晕，治疗适宜用钩藤散（方剂见后文）。
《原病式》说：“诸风掉眩，皆属肝木”，因为风性主动的缘故。所谓风气旺盛导致头目眩晕，是因为风木之气过旺，必然是金气衰弱不能制约木气，而木气又生火。风和火都属于阳，阳主运动，两动相互搏结，就会产生旋转感。所以火本性是动的，火焰遇到风就会自然旋转。
成无己说：伤寒病中的头眩，要责之于虚证。“起则头眩”与“眩冒”等症状，都是在发汗、催吐、泻下之后导致的，由此可知这是阳气虚弱。所以《针经》说：“上虚则眩”。然而患风病的人也多有眩晕，这是因为风性主动的缘故。
严用和说：眩晕的病症，虽然经典说多属于肝风上攻所致，但身体虚弱的人，外感六淫、内伤七情都能引起眩晕，应当通过脉象和证候来辨别。如果是风邪，脉象浮，有汗出，项部僵硬不仁；如果是寒邪，脉象紧，无汗，筋脉拘挛掣痛；如果是暑邪，脉象虚，烦闷；如果是湿邪，脉象细，沉重，呕吐逆乱。至于因七情所感，致使脏气不平，郁结而生涎，凝结而成饮，随着气机上逆，令人眩晕，眉棱骨疼痛，眼睛难以睁开，寸脉多沉，这是另一种情况。如果是疲劳过度、下虚上实、金疮出血、鼻衄、大小便失血以及妇人崩漏、产后失血过多，都会导致眩晕，应当根据病因进行治疗。
按语：这里所区分的四气、痰饮、亡血等证候，可以说分析得很贴切，但其所收集的方剂则不够明确，学习者应当自行探求。
张子和（张从正）说：大风、头风引起的眩晕，手足麻痹，胃脘疼痛，都是风寒湿三气杂至，合而为痹证。病邪在上焦称为停饮，可以用独圣散催吐。吐完后服用清上焦辛凉的药物。
按语：此法适用于胸膈痰涎闭塞、多年眩晕不止且气血充实之人，效果非常迅速。
谨按：眩晕一症，人们都称之为上盛下虚所致，却不明白其所以然的原因。所谓的“虚”，是指血和气；所谓的“实”，是指痰、涎、风、火。导致疾病的缘由，有气虚者，乃清气不能上升，或者因汗多亡阳而导致，应当升阳补气；有血虚者，乃因失血过多，阳气无所依附所致，应当益阴补血。这些都属于不足之证。也有因痰涎郁遏者，宜开痰导郁，病情重的可用吐法或下法；有因风火所动者，宜清上降火。若因外感而得病，严氏虽区分了四种气候的不同，但都应以发散邪气为主。这些都属于有余之证。世间有所谓“气不归元”，而使用丹药镇坠、沉香降气的方法，殊不知沉香辛窜耗散正气，丹药助长火势，那不归的气岂能因此恢复？《内经》说：“治病必求其本。”气不归元，应探究其根本而用药，这样就好了。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Xunmeng zhaoyou, ming meng er long" (dizziness with visual blurring and head shaking, closed eyes, deafness), which is a condition of excess below and deficiency above, located in the Foot Shaoyang Gallbladder Channel and Foot Jueyin Liver Channel. When severe, the pathogenic factor enters the Liver.
According to Xu Shumi (Xu Xueshi): The so-called "deficiency above" refers to Liver Deficiency. Treating Liver Deficiency addresses dizziness. The sensation of "Xunmeng" feels as if something is covering the head, causing unsteadiness; vertigo and deafness are all manifestations of dizziness. Therefore, for dizziness caused by Liver-Jueyin, the appropriate treatment is Gouteng San (Uncaria Decoction, see formula later).
The *Yuanbing Shi* (Treatise on Original Causes of Diseases) states: "All wind-induced tremors and dizziness belong to Liver Wood," because Wind has the nature of movement. The so-called dizziness and vertigo caused by excessive Wind-Qi occur because Wood Qi is hyperactive, implying that Metal Qi is weak and fails to control Wood, while Wood generates Fire. Both Wind and Fire belong to Yang, and Yang governs movement. When two movements clash, rotation occurs. Thus, Fire inherently moves; when flames encounter wind, they naturally rotate.
Cheng Wuji states: In Shanghan diseases, dizziness is attributed to deficiency. Dizziness upon rising and dizzy spells are all caused after sweating, vomiting, or purging. This indicates Yang Deficiency. Therefore, the *Zhenjing* (Classic of Acupuncture) states: "Deficiency above causes dizziness." However, patients with Wind disorders often experience dizziness because Wind has the nature of movement.
Yan Yonghe states: Although classics state that dizziness mostly results from Liver-Wind attacking upward, individuals with weak constitutions can also experience dizziness due to external contraction of the Six Excesses or internal injury from the Seven Emotions. One must differentiate based on pulse and symptoms. For Wind, the pulse is floating, there is sweating, and stiffness/numbness in the neck. For Cold, the pulse is tight, there is no sweating, and muscle spasms/pain. For Summerheat, the pulse is deficient with irritability. For Dampness, the pulse is fine and heavy, with nausea/vomiting. Regarding injuries from the Seven Emotions, uneven Zang-Qi leads to stagnation, generating phlegm-fluids that congeal into retained fluids. Rising with the Qi, these cause dizziness, pain in the supraorbital ridge, and inability to open the eyes; the Cun pulse is often sunken. This is an exception. Fatigue, lower deficiency with upper excess, traumatic bleeding, epistaxis, bowel/bladder blood loss, menorrhagia, and postpartum blood loss also cause dizziness; treatment should follow the specific cause.
Commentary: The differentiation of Four Qi, Phlegm-Fluids, and Blood Loss conditions described here is insightful, but the collected formulas lack clarity; students should seek them out independently.
Zhang Hezi (Zhang Congzheng) states: Dizziness from Great Wind or Head Wind, along with numbness of hands and feet and epigastric pain, results from the mixture of Wind, Cold, and Dampness forming Bi syndrome. When pathogenic factors reside in the Upper Jiao, it is called Retained Fluids, treatable with Dusheng San (Single Sovereign Powder) to induce vomiting. After vomiting, administer cooling and acrid-clearing herbs for the Upper Jiao.
Commentary: This method is effective and rapid for individuals with robust Qi and Blood who suffer from chronic dizziness due to phlegm-fluid obstruction in the chest and diaphragm.
Careful Analysis: The condition of dizziness is commonly attributed to "Excess Above and Deficiency Below," yet the underlying mechanism is rarely explained. The "Deficiency" refers to Blood and Qi; the "Excess" refers to Phlegm, Saliva, Wind, and Fire. Etiologies include Qi Deficiency, where Clear Yang fails to ascend or excessive sweating leads to Yang collapse; treatment requires raising Yang and tonifying Qi. Blood Deficiency, caused by excessive blood loss leaving Yang without attachment, requires nourishing Yin and tonifying Blood. These are Deficiency patterns. Patterns due to Phlegm-Saliva stagnation require resolving phlegm and guiding stagnation; severe cases may use emesis or purgation. Patterns driven by Wind-Fire require clearing the Upper Jiao and descending Fire. If caused by external pathogens, although Yan differentiated four climatic factors, dispersing pathogens is primary. These are Excess patterns. Some claim "Qi failing to return to its source" and use mineral pills to suppress or Chenxiang (Aquilaria Lignum) to descend Qi. However, Chenxiang is pungent and scatters Qi, while mineral pills assist Fire; thus, displaced Qi cannot be restored this way. The *Neijing* states: "In treating disease, one must seek the root." To address Qi failing to return to its source, one must find the root and medicate accordingly.