眩谓眼黑眩也，运如运转之运，世谓之头旋是也。《内经》论眩，皆属肝木，属上虚。丹溪论眩，
主于补虚治痰降火。仲景治眩，亦以痰饮为先也。赵以德曰∶丹溪先生主火而言者，道也。然道无所
之而不在，道之谓何？阴阳水火是也。其顺净清谧者水之化，动扰挠乱者火之用也。脑者，地气之所
生，故藏于阴，目之瞳子，亦肾水至阴所主，所以二者皆喜静谧而恶动扰，静谧则清明内持，动扰则
掉扰散乱，是故脑转目眩者，皆由火也。《灵枢》曰∶五脏六腑之精气，皆上注目而为之精，筋骨血
气之精与脉并为目系，上属于脑，后出于项中，故邪中于项，因逢其身之虚，其入深，则随眼系以入
于脑，入于脑则脑转，脑转则引目系急，目系急则目眩以转矣。所谓邪者。风寒湿热内外之诸邪也。
然诸邪昼谓以火之所成眩者何？《内经》谓
诸风掉眩，皆属肝木者，是专言风邪矣。《原病式》释之曰∶风火皆属阳，多为兼化，阳主乎动，两
动相搏，则头目为之眩晕而旋转，火本动也，焰得风则自然旋转，于是乎掉眩掉摇也，眩昏乱旋运也，
此非风邪之因火所成者欤。然风有内外，外入者、兼火化者、则如是。若内发者，尤是因火所生之风
也。及诸篇中考之，有谓厥阴司天，客胜，耳鸣掉眩。厥阴之胜者亦然。此司天之气，从上受者，外
入者也。又谓发生之纪，与岁木运太过，皆掉眩巅疾，善怒。肝脉太过，善忘，忽忽冒眩巅疾。又徇
蒙招尤，过在足少阳、厥阴者，言目 动蒙暗也。巢氏亦谓胁下痛头眩者，肝实也。此或得于肝脏，
应天气者所动，或因本脏虚实之气自动，皆名之为风，非火之烈焰，何能上于巅也。至于木郁之发，
甚则耳鸣眩转，目不识人，善暴僵仆者，尤是肝木中火发之甚也。此天气内应于脏，与肝虚实之气动
者，是皆名内发之风者也。又谓太阳之胜，热反上行，头项顶脑中痛，目如脱。注文谓寒气凌逼，阳
不胜之，太阳之气，标在于巅，入络于脑，故病如是。谓太阳司天，善悲，时眩仆。《灵枢》谓邪在
心者病亦同。二者皆是邪逼于心下，致神志不安则悲，心火不行则
妄动上炎。谓太阴之复，阴气上厥，饮发于中，头项胸痛而掉螈尤甚。注文谓湿气内逆，寒气不行，
太阳上留，故为是病。谓太阴在泉，病冲头痛，目似脱。注文云亦是足太阳病也。谓太阴司天，头项
痛，善眩。《灵枢》谓邪在肾，颈项时眩。此皆湿邪害肾，逼太阳之气留于上而然也。至于《金匮要
略》谓心下有支饮，其人苦冒眩者，亦是格其心火不行而上冲也。谓尺脉浮为伤肾，趺阳脉紧为伤脾，
风寒相搏，食谷即眩。谓阳明脉迟，食难用饱，饱则发烦头眩。二者因脾胃虚而阳气不足，所以外见
迟紧之脉，内受湿饮之郁，不足之微阳者，始与所郁之热，并而冲上于胸目也。用此比类言之，则眩
运之病，非一邪而可终。若夫太乙天真元气，皆得胃脘之阳以行于周身，分三阴三阳之经脉。六气应
天之阴阳，营运于表者，谓之六化。布五行于五脏，属之气，应地之阴阳营运于里者，谓之五阳。虽
然表里固分为二，及乎一经合一脏相通气而行，则表里必似二而一，一而二者也。悉如其天之有德、
有化、有用、有变于气交者，备在身形之中。经曰∶成败倚伏，皆生于动，动之清静则生化治，动之
躁乱则苛疾起。自此言之，掉眩由人气所动者，岂止如《金匮》所云湿饮而已。若此五阳六化妄动而
病者，又可胜数哉。且夫，凡有过节，即随其所
动，经脏之气而妄起，因名曰厥阳之火。厥阳之火有五，谓之五邪。五邪之变，遂胜克之病作。又或
肾水不足，或精血伤败，不能制其五阳之火独光，或中土虚衰，不能堤防下气之逆，则龙雷之火得以
震动于巅，诸火上至于头，重则搏击为痛，轻则旋转为眩晕矣。夫如是比类之，道在经有之，诸治病
循法守度，援物比类，化之冥冥，循上及下，何必守经，不引比类，是知不明也，其此之谓欤。或曰
治诸邪当何如？曰∶夫火因动而起，但各从其所动之因而治之。因实热而动者，治其热。因邪搏击而
动者，治其邪。因厥逆逼上者，下治所厥之邪。因阴虚而起者，补其阴，抑其阳，按而收之。因阳虚
而气浮上者，则补其阳，敛其浮游之气。因五志而动者，各安其脏气以平之。因郁而发者，治其所郁
之邪，开之、发之。因精血不足者补之，不已则求其属以衰之。因胜克而动者，从盛衰之气而补泻之。
中气虚衰而动者，补其土以安之。上焦清明之气虚，不能主持而动者，亦当补中焦之谷气，推而扬之。
因五脏六腑上注之精气不足而动者，察其何者之虚而补之。如是虽不专治其火，而火自息矣。凡治百
病之由火而生者皆然，非唯掉眩而已。严氏云∶外感六淫，内伤七情，皆能眩晕，当以脉证辨之。风
则脉浮有汗，项强不仁，《局方》消风散、《本
事》川芎散、羚羊角散、都梁丸、青州白丸子。寒则脉紧无汗，筋挛掣痛，不换金正气散加芎、芷、
白芍药，甚则姜附汤、《济生》三五七散。暑则脉洪大而虚，自汗烦闷，黄连香薷饮、十味香薷饮、
消暑丸。湿则脉细沉重，吐逆涎沫，肾着汤加川芎名除湿汤、渗湿汤、《济生》芎术散。风热，羌活
汤、钩藤散。寒湿，芎术除眩汤、理中汤，仍吞来复丹，甚者养正丹。七情相干，眩晕欲倒，用十四
友丸、安肾丸二药夹和，以《和剂》七气汤送下，仍间用乳香泡汤下。有气虚者，乃清气不能上升，
或汗多亡阳所致。当升阳补气，黄 、人参、白术、川芎、当归、甘菊花、柴胡、升麻之类。《直指
方》云∶淫欲过度，肾家不能纳气归元，使诸气逆奔而上，此眩晕出于气虚也，宜益气补肾汤。有血
虚者，乃因亡血过多，阳无所附而然，当益气补血芎归汤之类。《直指方》云∶吐衄崩漏，肝家不能
收摄荣气，使诸血失道妄行，此眩晕生于血虚也，宜补肝养荣汤。有因虚致晕，虽晕醒时面常欲近火，
欲得暖手按之，盖头面乃诸阳之会，阳气不足故耳。丹溪云∶一男子年七十九岁，头目昏眩而重，手
足无力，吐痰口口相续，左手脉散大而缓，右手缓而脉大不及于左，
重按皆无力，饮食略减而微渴，大便三四日一行。众人皆与风药，至春深必死。予曰此大虚证，当以
补药作大剂服之，众怒而去。予教用人参、当归身、黄 、芍药、白术，浓煎作汤使，下连柏丸三十
粒，如此者服一年半，而精力如少壮时。连柏丸，冬加干姜少许，余三时皆根据本法。连柏皆姜汁炒为
细末，又以姜汁煮糊为丸。东垣云；范天 之内，素有脾胃之病，时显烦躁，胸中不利，大便不通，
初冬出外晚归，为寒气怫郁，闷乱大作，火不得伸故也。医疑有热，治以疏风丸，大便行而病不减。
又疑药力少，复加七八十丸，下两行，前证仍不减，复添吐逆，食不能停，痰吐稠粘，涌出不止，眼
黑头旋，恶心烦闷，气短促，上喘无力，不欲言，心神颠倒，兀兀不止，目不敢开，如在风云中，头
苦痛如裂，身重如山，四肢厥冷，不得安卧。予谓前证乃胃气已损，复下两次，则重损其胃，而痰厥
头痛作矣。制半夏白术天麻汤治之而愈。中脘伏痰，呕逆眩晕，旋复花汤主之。《金匮》方，卒呕吐，
心下痞，膈间有水，眩悸者，半夏加茯苓汤主之。假令瘦人脐下有悸，吐涎沫而头眩，此水也，五苓
散主之。又云∶心下有支饮，（短气倚息，形如肿，为支饮）。其人苦冒眩，泽泻白术汤主之。泽泻
五两，白术二两，水二升，煮一升，分温再服。痰闭不出者，吐之。青
黛散搐鼻取涎，治眩神效。头风眩晕，可用独圣散吐之，吐讫可用清上辛凉之药，防风通圣散加半夏
等味。仲景云∶此痰结胸中而致也。大小便结滞者，微利之，河间搜风丸。体虚有寒者，温之。仲景
云∶风虚头重眩，苦极，不知食味，暖肌补中益精气，白术附子汤主之。肝厥，状如痫疾，不醒呕吐，
醒后头虚运发热，用麻黄、钩藤皮、石膏、干葛、半夏曲、柴胡、甘草、枳壳、甘菊为粗末。每服四
钱，水一钟半，生姜三片，枣一枚，同煎至八分，去渣温服。钩藤散，钩藤、陈皮、半夏、麦门冬、
茯苓、石膏、人参、甘菊、防风各等分，甘草减半为粗末。每服四钱，水一钟半，生姜七片，煎八分
温服。戴复庵云∶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，宜小三五
七散。或芎附汤、生料正元饮加鹿茸一钱，下灵砂丹。或用正元饮加炒川椒一十五粒，下茸朱丸。若
不效则独用鹿茸一味，每服半两，用无灰酒一盏半，煎至一盏，去滓，入麝香少许服。缘鹿茸生于头，
头晕而治以鹿茸，盖以类相从也。曾有头痛不愈，服茸朱丹而效。右上一条，为虚寒者设也。若实热
者用之殆矣。故丹溪云∶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
以眩晕为上实下虚所致，而又明之曰，所谓虚者，血与气也。所谓实者，痰涎风火也。是固然矣。然
《针经》胃风篇云∶上虚则眩。
又五脏生成篇云∶徇蒙招尤，目瞑耳聋，下实上虚。蒙、昏冒也，招、摇掉也，瞑、黑眩也，即眩晕
之证。则刘氏所称，无乃与之冰炭乎？盖知虚者正气虚，实者邪气实，邪之所凑，其气必虚，留而不去，
其病为实。则虚即实，实即虚，何冰炭之有。然亦当从寸部以定虚实。上虚者，以鹿茸法治之。上实
者，以酒大黄法治之。《本事方》治虚风头旋，吐痰涎不已，以养正丹主之，称其升降阴阳，补接真
气，非止头旋而已。严氏云∶世所谓气不归元，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》云∶治病必求其本。气之归，求其本，而用药则善矣。
【诊】左手脉数热多。脉涩有死血。右手脉实痰积。脉大是久病。
眩晕，是指眼前发黑、视物昏花；“运”如同物体运转之状，世人称之为头晕目眩。《黄帝内经》论述眩晕，多归属于肝木病变或上焦虚损。朱丹溪论述眩晕，主张以补虚、治痰、降火为主。张仲景治疗眩晕，也以痰饮为首要因素。赵以德说：朱丹溪先生强调“火”的作用，这是阐述了医理。然而，“道”无处不在，所谓“道”，指的就是阴阳水火。水的气化表现为顺从、清净、安宁；火的作用表现为躁动、扰乱。脑是由地气所生，故藏于阴；眼睛的瞳孔，也是由肾中至阴之水所主宰，所以这两者都喜欢静谧而厌恶躁动。静谧则内部清明持守，躁动则导致摇荡散乱，因此头脑旋转、眼睛昏花，都是由火引起的。《灵枢经》说：五脏六腑的精气，都向上注于眼睛而形成视觉，筋骨血气的精华与脉管结合成为目系，向上连接于脑，向后出于项部中间，所以邪气侵袭项部，恰逢身体虚弱，邪气深入，便随着目系进入脑部，进入脑部则头脑旋转，头脑旋转则牵引目系紧张，目系紧张则眼睛昏花并伴有旋转感。所谓的“邪”，是指风、寒、湿、热等内外各种邪气。然而各种邪气白天发作，为何说是由火造成的眩晕呢？《黄帝内经》说“所有风病引起的摇动眩晕，都归属于肝木”，这是专门谈论风邪。《原病式》解释它说：风和火都属于阳，多为兼夹变化，阳主运动，两动相互搏击，就会使头目眩晕旋转，火本性就是动的，火焰遇到风就自然旋转，于是出现摇动眩晕，眩晕就是昏乱旋转，这难道不是风邪因火而形成的吗？然而风有内风和外风之分，外入的、兼夹火化的，就是这样。如果是内发的，更是因火所生的风。查阅各篇章，有说厥阴司天，客气胜，会出现耳鸣、摇动眩晕。厥阴之气偏胜也是如此。这是司天的气候，从上受邪，属于外入的。又说发生之纪，以及岁木运太过，都会出现摇动眩晕和头顶疾病，容易发怒。肝脉太过，容易健忘，忽忽冒眩头顶疾病。还有徇蒙招尤，病在足少阳、厥阴经的，说的是眼睛动摇、视物昏暗。巢元方也说胁下疼痛、头晕，是肝实。这些或者是肝脏受到天气影响而动，或者是因为本脏虚实之气自动，都称为风，如果不是火的猛烈炎上，怎么能到达头顶呢？至于木郁发作时，严重时耳鸣眩晕，看不清人，容易突然僵倒，这更是肝木中火爆发严重的表现。这是天气内应于脏腑，与肝虚实之气相动的，都称为内发的风。又说太阳之气偏胜，热气反而上行，头项顶脑中疼痛，眼睛像要脱出一样。注文说寒气凌逼，阳气不能胜任，太阳之气标在于头顶，入络于脑，所以生病如此。说太阳司天，容易悲伤，时常眩晕仆倒。《灵枢》说邪在心，病症也相同。这两者都是邪气逼迫于心下，导致神志不安所以悲伤，心火不通所以妄动上炎。说太阴之复，阴气上逆，饮水发于中焦，头项胸痛且摇动抽搐特别严重。注文说湿气内逆，寒气不行，太阳之气停留于上，所以产生这种病。说太阴在泉，病见冲头痛，眼睛像要脱出。注文说这也是足太阳经的病。说太阴司天，头项痛，容易眩晕。《灵枢》说邪在肾，颈项时常眩晕。这都是湿邪伤害肾脏，逼迫太阳之气停留于上所致。至于《金匮要略》说心下有支饮，病人苦于冒眩，也是格拒心火不通而上冲。说尺脉浮为伤肾，趺阳脉紧为伤脾，风寒相搏，进食即眩晕。说阳明脉迟，难以吃饱，饱则发烦头眩。这两者因为脾胃虚弱而阳气不足，所以外见迟紧之脉，内受湿饮之郁，不足的微阳，开始与所郁之热，一起冲上于胸目。用此类比来说，眩晕的病，不是一种邪气就能终结的。如果太乙天真元气，都能得到胃脘之阳而在周身运行，分属于三阴三阳经脉。六气应天之阴阳，营运于表，称为六化。布五行于五脏，属于气，应地之阴阳营运于里，称为五阳。虽然表里固分为二，但一经合一脏相通气而行，则表里必似二而一，一而二。完全像天有德、有化、有用、有变于气交之中，备在身形之中。经书说：成败倚伏，都生于动，动之清静则生化治理，动之躁乱则苛疾兴起。由此而言，摇动眩晕由人气所动，岂止像《金匮》所说的湿饮而已。如果这五阳六化妄动而生病，又怎能数得过来呢？况且每逢过节，就随其所动，经脏之气妄起，因而名为厥阳之火。厥阳之火有五种，称为五邪。五邪的变化，遂引起胜克之病发作。又或者肾水不足，或精血伤败，不能制约其五阳之火独光，或中土虚衰，不能堤防下气之逆，则龙雷之火得以震动于巅顶，诸火上至于头，重则搏击为痛，轻则旋转为眩晕了。像这样类比，道在经典中有记载，各种治病遵循法则，援引事物进行类比，在冥冥之中变化，循上及下，何必死守经文，不引类比，就是知识不明，说的就是这个道理。有人问：治疗各种邪气应当如何？回答说：火因动而起，只要各自从其动的因因而治疗。因实热而动者，治其热。因邪气搏击而动者，治其邪。因厥逆逼上者，下治所厥之邪。因阴虚而起者，补其阴，抑其阳，按而收之。因阳虚而气浮上者，则补其阳，敛其浮游之气。因五志而动者，各安其脏气以平之。因郁而发者，治其所郁之邪，开之、发之。因精血不足者补之，不已则求其属以衰之。因胜克而动者，从盛衰之气而补泻之。中气虚衰而动者，补其土以安之。上焦清明之气虚，不能主持而动者，亦当补中焦之谷气，推而扬之。因五脏六腑上注之精气不足而动者，察其何者之虚而补之。像这样虽然不专门治火，而火自息矣。凡治疗百病由火而生者皆如此，不仅限于摇动眩晕。严氏说：外感六淫，内伤七情，都能导致眩晕，应当以脉证辨别。风邪则脉浮有汗，项强不仁，《局方》消风散、《本事方》川芎散、羚羊角散、都梁丸、青州白丸子。寒邪则脉紧无汗，筋挛掣痛，不换金正气散加川芎、白芷、白芍药，甚则姜附汤、《济生方》三五七散。暑邪则脉洪大而虚，自汗烦闷，黄连香薷饮、十味香薷饮、消暑丸。湿邪则脉细沉重，吐逆涎沫，肾着汤加川芎名除湿汤、渗湿汤、《济生方》芎术散。风热，羌活汤、钩藤散。寒湿，芎术除眩汤、理中汤，仍吞来复丹，甚者养正丹。七情相干，眩晕欲倒，用十四友丸、安肾丸二药夹和，以《和剂局方》七气汤送下，仍间用乳香泡汤下。有气虚者，乃清气不能上升，或汗多亡阳所致。当升阳补气，黄芪、人参、白术、川芎、当归、甘菊花、柴胡、升麻之类。《直指方》说：淫欲过度，肾家不能纳气归元，使诸气逆奔而上，此眩晕出于气虚也，宜益气补肾汤。有血虚者，乃因亡血过多，阳无所附而然，当益气补血芎归汤之类。《直指方》说：吐衄崩漏，肝家不能收摄荣气，使诸血失道妄行，此眩晕生于血虚也，宜补肝养荣汤。有因虚致晕，虽晕醒时面常欲近火，欲得暖手按之，盖头面乃诸阳之会，阳气不足故耳。丹溪说：一男子年七十九岁，头目昏眩而重，手足无力，吐痰口口相续，左手脉散大而缓，右手缓而脉大不及于左，重按皆无力，饮食略减而微渴，大便三四日一行。众人皆与风药，至春深必死。我说这是大虚证，当以补药作大剂服之，众怒而去。我教用人参、当归身、黄芪、芍药、白术，浓煎作汤使，下连柏丸三十粒，如此者服一年半，而精力如少壮时。连柏丸，冬加干姜少许，余三时皆根据本法。连柏皆姜汁炒为细末，又以姜汁煮糊为丸。东垣说：范天之内，素有脾胃之病，时显烦躁，胸中不利，大便不通，初冬出外晚归，为寒气怫郁，闷乱大作，火不得伸故也。医疑有热，治以疏风丸，大便行而病不减。又疑药力少，复加七八十丸，下两行，前证仍不减，复添吐逆，食不能停，痰吐稠粘，涌出不止，眼黑头旋，恶心烦闷，气短促，上喘无力，不欲言，心神颠倒，兀兀不止，目不敢开，如在风云中，头苦痛如裂，身重如山，四肢厥冷，不得安卧。我说前证乃胃气已损，复下两次，则重损其胃，而痰厥头痛作矣。制半夏白术天麻汤治之而愈。中脘伏痰，呕逆眩晕，旋复花汤主之。《金匮要略》方，卒呕吐，心下痞，膈间有水，眩悸者，半夏加茯苓汤主之。假令瘦人脐下有悸，吐涎沫而头眩，此水也，五苓散主之。又说：心下有支饮，（短气倚息，形如肿，为支饮）。其人苦冒眩，泽泻白术汤主之。泽泻五两，白术二两，水二升，煮一升，分温再服。痰闭不出者，吐之。青黛散搐鼻取涎，治眩神效。头风眩晕，可用独圣散吐之，吐讫可用清上辛凉之药，防风通圣散加半夏等味。仲景说：此痰结胸中而致也。大小便结滞者，微利之，河间搜风丸。体虚有寒者，温之。仲景说：风虚头重眩，苦极，不知食味，暖肌补中益精气，白术附子汤主之。肝厥，状如痫疾，不醒呕吐，醒后头虚运发热，用麻黄、钩藤皮、石膏、干葛、半夏曲、柴胡、甘草、枳壳、甘菊为粗末。每服四钱，水一钟半，生姜三片，枣一枚，同煎至八分，去渣温服。钩藤散，钩藤、陈皮、半夏、麦门冬、茯苓、石膏、人参、甘菊、防风各等分，甘草减半为粗末。每服四钱，水一钟半，生姜七片，煎八分温服。戴复庵说：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，宜小三五七散。或芎附汤、生料正元饮加鹿茸一钱，下灵砂丹。或用正元饮加炒川椒一十五粒，下茸朱丸。若不效则独用鹿茸一味，每服半两，用无灰酒一盏半，煎至一盏，去滓，入麝香少许服。缘鹿茸生于头，头晕而治以鹿茸，盖以类相从也。曾有头痛不愈，服茸朱丹而效。右上一条，为虚寒者设也。若实热者用之殆矣。故丹溪说：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。刘宗浓以眩晕为上实下虚所致，而又明之曰，所谓虚者，血与气也。所谓实者，痰涎风火也。是固然矣。然《针经》胃风篇云：上虚则眩。又五脏生成篇云：徇蒙招尤，目瞑耳聋，下实上虚。蒙、昏冒也，招、摇掉也，瞑、黑眩也，即眩晕之证。则刘氏所称，无乃与之冰炭乎？盖知虚者正气虚，实者邪气实，邪之所凑，其气必虚，留而不去，其病为实。则虚即实，实即虚，何冰炭之有。然亦当从寸部以定虚实。上虚者，以鹿茸法治之。上实者，以酒大黄法治之。《本事方》治虚风头旋，吐痰涎不已，以养正丹主之，称其升降阴阳，补接真气，非止头旋而已。严氏说：世所谓气不归元，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》说：治病必求其本。气之归，求其本，而用药则善矣。
Dizziness (Xuan) refers to blacking out of the eyes and blurred vision; "Yun" is like the rotation of an object, commonly known in the world as vertigo or dizziness. The *Neijing* discusses dizziness, attributing it all to Liver Wood (Liver system pathology) or deficiency at the upper jiao. Danxi's discussion on dizziness emphasizes tonifying deficiency, treating phlegm, and descending fire. Zhang Zhongjing treats dizziness, prioritizing phlegm-fluids (Tan Yin). Zhao Yi-de said: Master Danxi emphasized "Fire," which is discussing the Dao (principle). However, the Dao is everywhere; what is this Dao? It is Yin and Yang, Water and Fire. The transformation of Water manifests as compliance, purity, clarity, and tranquility; the function of Fire manifests as agitation, disturbance, and chaos. The brain is generated by Earth Qi, thus stored in Yin; the pupil of the eye is also governed by the extreme Yin of Kidney Water. Therefore, both prefer tranquility and dislike agitation. Tranquility maintains internal clarity; agitation leads to shaking and scattering. Thus, brain rotation and eye dizziness are all caused by Fire. The *Lingshu* states: The essence of the five Zang and six Fu organs all ascend to the eyes to form vision. The essence of sinews, bones, blood, and Qi combines with the vessels to become the Eye System (Muxi), ascending to connect with the brain, exiting posteriorly from the middle of the neck. Therefore, when pathogenic factors invade the neck, coinciding with bodily deficiency, if they enter deeply, they follow the Eye System into the brain. Entering the brain causes brain rotation; brain rotation pulls the Eye System tight; the tight Eye System causes eye dizziness and rotation. The so-called "pathogenic factors" refer to wind, cold, dampness, heat, and various other external and internal pathogens. But why do these various pathogens cause dizziness during the day, attributed to Fire? The *Neijing* states, "All wind diseases causing shaking and dizziness belong to Liver Wood," which specifically discusses Wind Pathogen. The *Yuan Bing Shi* explains: Wind and Fire both belong to Yang, often occurring as combined transformations. Yang governs movement; two movements clashing together cause the head and eyes to become dizzy and rotating. Fire is inherently moving; flames naturally rotate when encountering wind, thus causing shaking and dizziness. Dizziness is confusion and rotation. Is this not Wind Pathogen formed due to Fire? However, Wind has internal and external aspects. External entry combined with Fire transformation is as described. If internally generated, it is even more Wind born of Fire. Examining various chapters, there is mention of Jueyin ruling the year, with guest excess causing tinnitus and shaking dizziness. Excess of Jueyin Qi is similar. This is atmospheric Qi received from above, belonging to external entry. It is also stated that in the Ji of Generation, and when the annual Wood transport is excessive, shaking dizziness and vertex diseases occur, with irritability. Excessive Liver pulse leads to forgetfulness, sudden dizziness, and vertex disease. Also, Xunmeng Zhaoyou (visual obscuration and head shaking), involving the Foot Shaoyang and Jueyin meridians, refers to eye movement and visual darkness. Chao Shi also stated that hypochondriac pain and dizziness indicate Liver Excess. These may arise from the Liver organ reacting to heavenly changes, or from the internal movement of the organ's own deficiency/excess Qi. All are named "Wind." Without the fierce upward flare of Fire, how could it reach the vertex? When Wood Depression occurs, severe cases involve tinnitus, vertigo, inability to recognize people, and sudden stiffness/collapse. This is especially severe Liver Wood Fire eruption. This is heavenly Qi internalizing to the Zang, moving with Liver deficiency/excess Qi, all named internally generated Wind. It is also stated that when Taiyang wins, heat reverses upward, causing headache in the head, neck, vertex, and brain, with eyes feeling like they will fall out. The annotation says cold Qi presses down, Yang cannot withstand it. Taiyang Qi marks the vertex and enters the network vessels of the brain, hence such illness. When Taiyang rules the year, sadness and frequent dizziness/collapse occur. The *Lingshu* states that pathogenic factors in the Heart cause similar symptoms. Both are due to pathogenic factors pressing below the Heart, causing Shen (Spirit) unrest leading to sadness, and Heart Fire stagnation leading to wild upward flaming. When Taiyin returns, Yin Qi rebels upward, fluid retention arises in the middle, causing head/neck/chest pain with severe shaking/spasms. The annotation says dampness rebels internally, cold Qi fails to move, Taiyang Qi remains above, causing this disease. When Taiyin is in the泉 (subterranean/source), illness involves rushing headache and eyes feeling like falling out. The annotation says this is also a Foot Taiyang disease. When Taiyin rules the year, head/neck pain and frequent dizziness occur. The *Lingshu* states pathogenic factors in the Kidney cause periodic neck/head dizziness. All these are due to Dampness harming the Kidney, forcing Taiyang Qi to remain above. As for the *Jingui Yaolue*, it states that subphrenic Branch Fluids (Zhi Yin) cause patients to suffer from heavy dizziness/blurred vision, due to blocking Heart Fire from flowing and causing upward rush. Floating Chi pulse indicates Kidney injury; tight Fuyang pulse indicates Spleen injury. Wind-Cold clashing causes dizziness upon eating. Slow Yangming pulse means difficulty eating until full; fullness causes irritability and dizziness. These are due to Spleen/Stomach deficiency and insufficient Yang, manifesting externally as slow/tight pulses, internally constrained by Damp-Fluids. The deficient slight Yang, combined with constrained Heat, rushes upward to the chest and eyes. By analogy, dizziness is not caused by a single pathogen. If the Taiyi True Primal Qi, supported by Stomach-Warmth, circulates through the body via the Three Yin and Three Yang meridians: Six Qi responding to Heaven's Yin/Yang circulating outward is called Six Transformations (Liu Hua); Five Elements distributed among Five Zang, associated with Qi, responding to Earth's Yin/Yang circulating inward is called Five Yang (Wu Yang - *Note: likely a textual variant or specific theoretical term here, often referring to the functional aspect of Zang Qi*). Although exterior and interior are divided, when one meridian connects with one Zang to circulate Qi, exterior and interior are like two becoming one, one becoming two. This mirrors Heaven having Virtue, Transformation, Function, and Change at the Qi intersection, all prepared within the body. The Classics state: Success and failure, support and obstruction, all arise from movement. Movement in tranquility leads to healthy generation/transformation; movement in agitation leads to severe disease. From this perspective, shaking/dizziness caused by human Qi movement is not limited to the Damp-Fluids mentioned in the *Jingui*. If these Five Yang and Six Transformations move recklessly and cause disease, how can they be counted? Moreover, whenever there is a festival or change, Qi moves according to its nature, causing meridian/Zang Qi to rise recklessly, named Jueyang Fire. Jueyang Fire has five types, called Five Evils. Changes in Five Evils lead to diseases of overcoming/overcoming-by. If Kidney Water is insufficient, or Essence/Blood is damaged, failing to restrain the solitary brilliance of Five Yang Fire, or Middle Earth is weak, failing to dam the rebellion of lower Qi, then Dragon-Lei Fire shakes at the vertex. Various Fires ascend to the head; severely they clash causing pain, lightly they rotate causing dizziness. By such analogy, the Dao exists in the classics. Treating diseases follows laws, draws analogies, transforms in the unseen, follows up and down. Why stick strictly to classics without drawing analogies? This is ignorance. Someone asks: How to treat various pathogens? Answer: Fire rises due to movement; treat each according to its cause of movement. Due to Excess-Heat? Treat the Heat. Due to pathogenic clash? Treat the pathogen. Due to Jue-Rebellion pressing up? Treat the rebellious pathogen downward. Due to Yin Deficiency? Tonify Yin, suppress Yang, press and gather. Due to Yang Deficiency with floating Qi? Tonify Yang, gather floating Qi. Due to Five Emotions? Calm the respective Zang Qi to balance. Due to Constraint? Treat the constrained pathogen, open and release. Due to Essence/Blood deficiency? Tonify; if ineffective, seek its root to diminish. Due to Overcoming cycles? Tonify/Drain based on excess/deficiency Qi. Due to Middle Qi weakness? Tonify Earth to stabilize. Due to Upper Jiao Clear Qi deficiency failing to govern? Tonify Middle Jiao Grain Qi, push and elevate. Due to insufficient Essence/Qi from Five Zang/Six Fu ascending? Observe which is deficient and tonify. In this way, although not specifically treating Fire, Fire extinguishes itself. This applies to all diseases born of Fire, not just dizziness. Yan Shi said: External contraction of Six Evils, internal injury of Seven Emotions, can all cause dizziness; differentiate by pulse and signs. Wind: floating pulse, sweating, stiff neck/numbness. Ju Fang Xiao Feng San, Ben Shi Fang Chuanxiong San, Lingyangjiao San, Duliang Wan, Qingzhou Baiwanzi. Cold: tight pulse, no sweating, muscle spasms/pain. Buhuanjin Zhengqi San plus Chuanxiong, Baizhi, Baishao; severe cases Jiangfu Tang, Jisheng Fang Sanwuqisan. Summerheat: surging-large-empty pulse, spontaneous sweating, vexation/stuffiness. Huanglian Xiangru Yin, Shiwei Xiangru Yin, Xiaoshu Wan. Dampness: fine-heavy pulse, vomiting/regurgitation of saliva/phlegm. Shen Zhuo Tang plus Chuanxiong (named Chushi Tang), Shenshi Tang, Jisheng Fang Xiongsan. Wind-Heat: Qianghuo Tang, Gouteng San. Cold-Damp: Xiongsu Chuxuan Tang, Lizhong Tang, swallow Laifu Dan; severe cases Yangzheng Dan. Seven Emotions interfering, dizziness near collapse: use Shisiyou Wan and Anshen Wan mixed, delivered with Heji Ju Fang Qi Qi Tang, occasionally using Ruxiang soaked in water. Qi Deficiency: clear Yang cannot ascend, or excessive sweating destroys Yang. Raise Yang and tonify Qi: Huangqi, Renshen, Baizhu, Chuanxiong, Danggui, Ganjuhua, Chaihu, Shengma. Zhizhi Fang said: Excessive sexual activity, Kidney fails to grasp Qi to return to origin, causing Qi to rebel upward; this dizziness is due to Qi deficiency, suitable for Yiqi Bushen Tang. Blood Deficiency: due to excessive blood loss, Yang has no attachment. Tonify Qi and Blood with Xionggui Tang. Zhizhi Fang said: Vomiting blood, epistaxis, metrorrhagia, Liver fails to secure Ying Qi, causing blood to wander; this dizziness is due to Blood deficiency, suitable for Bugan Yangrong Tang. Dizziness due to deficiency: even when awake, face desires warmth/fire, wants warm hands pressing it. Head/Face is the meeting of all Yang Yang; insufficient Yang causes this. Danxi said: A 79-year-old man, heavy dizziness/blurred vision, weak limbs, continuous expectoration of phlegm. Left hand pulse scattered-large-slow; Right hand pulse slow-large but weaker than left; deep pressure powerless. Slight decrease in appetite, mild thirst, bowel movement every 3-4 days. Everyone gave Wind medicines, predicting death by late spring. I said this is severe deficiency, must take large doses of tonics. Others were angry and left. I instructed using Renshen, Danggui Shen, Huangqi, Shaoyao, Baizhu, decocted strongly, taken with Lianbai Wan 30 pills. Taken for 1.5 years, energy returned to youth. Lianbai Wan: add small amount of Ganjiang in winter, otherwise follow method. Lianbai stir-fried in Jiangzhi powder, made into pills with Jiangzhi paste. Dongyuan said: Fan Tiannei had chronic Spleen/Stomach disease, occasional irritability, chest discomfort, constipation. Early winter, went out late, cold Qi constrained, severe mental confusion, Fire unable to extend. Doctor suspected Heat, treated with Shufeng Wan. Bowels moved but illness didn't improve. Suspected dose too low, added 70-80 pills, two loose stools, previous symptoms unchanged, added vomiting, inability to keep food, thick sticky phlegm spurting continuously, blackening eyes/head spinning, nausea/vexation, shortness of breath, weak panting, unwilling to speak, chaotic Shen, constant dizziness, eyes dare not open, like in wind/clouds, splitting headache, heavy body, cold limbs, unable to sleep. I said previous symptoms indicated damaged Stomach Qi; two purgations further damaged Stomach, causing Phlegm-Jue Headache. Prepared Banxia Baizhu Tianma Tang, cured. Subepigastric latent phlegm, vomiting/dizziness: Xuanfuhua Tang. Jingui Fang: sudden vomiting, epigastric stuffiness, fluid between diaphragm, dizziness/palpitations: Banxia plus Fuling Tang. Suppose thin person has palpitations below umbilicus, spitting saliva/phlegm, head dizziness: this is Water, Wuling San. Also: Subphrenic Branch Fluids (shortness of breath leaning, swollen appearance) cause suffering from heavy dizziness: Zexie Baizhu Tang. Zexie 5 liang, Baizhu 2 liang, water 2 sheng, boil to 1 sheng, divide into two warm doses. Phlegm blocked not coming out: induce vomiting. Qingdai San snorted into nose to extract phlegm, effective for dizziness. Headwind dizziness: use Dusheng San to vomit, after vomiting use clearing-upper acrid-cool medicines, Fangfeng Tongsheng San plus Banxia etc. Zhongjing said: This is Phlegm knotting in chest. Constipation of stool/urine: mild purgation, Hejian Soufeng Wan. Body deficiency with Cold: warm it. Zhongjing said: Wind-Deficiency heavy head dizziness, severe suffering, loss of taste: warm muscles, tonify middle, benefit essence/Qi, Baizhu Fuzi Tang. Liver Jue, resembling epilepsy, unconscious/vomiting, waking with empty dizziness/fever: Mahuang, Gouteng Pi, Shigao, Gange, Banxia Qu, Chaihu, Gancao, Zhike, Ganju coarse powder. Take 4 qian, water 1.5 zhong, 3 slices ginger, 1 date, decoct to 0.8, strain, warm drink. Gouteng San: Gouteng, Chenpi, Banxia, Maimendong, Fuling, Shigao, Renshen, Ganju, Fangfeng equal parts, Gancao half, coarse powder. Take 4 qian, water 1.5 zhong, 7 slices ginger, decoct to 0.8, warm drink. Dai Funan said: Severe dizziness, looking up makes room spin, seeing black spots constantly, feeling things flying, double vision. Suitable for Xiao Sanwuqisan. Or Xiongtang Tang, Shengliao Zhengyuan Yin plus 1 qian Lurong, take Lingsha Dan. Or Zhengyuan Yin plus 15 fried Chuanjiao, take Rongzhu Wan. If ineffective, use only Lurong, 0.5 liang per dose, non-ash wine 1.5 zhong, decoct to 1 zhong, strain, add少许 Mosiang. Since Lurong grows on the head, treating dizziness with Lurong follows similarity. Previously had persistent headache, cured by Rongzhu Dan. The above items are for Deficiency-Cold. Using them for Excess-Heat is dangerous. Thus Danxi said: Unbearable dizziness: Dahuang wine-fried 3 times, dried powder, taken with tea, 1-2 qian per dose. Liu Zongnong attributes dizziness to Upper Excess/Lower Deficiency, clarifying: Deficiency is Blood/Qi; Excess is Phlegm-Saliva/Wind-Fire. True enough. But *Zhenjing* Weifeng Pian says: Upper deficiency causes dizziness. Wuzang Shengcheng Pian says: Xunmeng Zhaoyou, eye closing/deafness, Lower Excess/Upper Deficiency. Meng is dim/confusion, Zhao is shaking, Ming is black dizziness, i.e., dizziness. Then Liu's claim contradicts this? Knowing Deficiency is Zheng Qi deficiency, Excess is Xie Qi excess. Where Xie gathers, Qi must be deficient; staying without leaving, disease becomes Excess. So Deficiency is Excess, Excess is Deficiency, why contradiction? Determine deficiency/excess from Cun position. Upper Deficiency: treat with Lurong method. Upper Excess: treat with Wine Dahuang method. Ben Shi Fang treats deficiency-headwind vertigo, endless phlegm-saliva, with Yangzheng Dan, claiming it regulates Yin/Yang, supplements true Qi, not just stopping vertigo. Yan Shi said: World speaks of Qi not returning to origin, using mineral pills to suppress, Chenxiang to descend Qi. Fragrant substances scatter Qi, mineral pills aid Fire, how can displaced Qi return? Neijing says: Treat disease seeking the root. For Qi return, seek the root, then medication is good.
[Diagnosis] Left hand pulse rapid indicates much Heat. Pulse choppy indicates fixed blood stasis. Right hand pulse excess indicates Phlegm accumulation. Pulse large indicates chronic disease.