徐志华-经行头晕 – Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle

徐志华 - 经行头晕

Xu Zhi-hua’s Treatment Of Dizziness During The Menstrual Cycle
Translated by XU Zhi-jun & J. Heaverlo

经行前后或经期,出现头目眩晕,并伴随月经周期发作者,称 “经行头晕”。徐老着重于”无痰不作眩”,施用半夏天麻自术汤而获效.

Dizziness may develop before, during or after the menstrual period.  When this occurs it is called “dizziness during menstrual cycle”.   Xu Zhi-hua emphasizes the concept “Without phlegm, there can be no dizziness”.  He achieves excellent results with the formulation ban xia tian ma bai zhu tang.

经行头晕责痰障  施用半夏天麻汤
Menstrual cycle dizziness due to phlegm – use ban xia tian ma tang

组成:天麻 10g   姜夏 10g    白术10g  神曲lOg   麦芽 lOg    泽泻lOg   党参 10g   夜苓 10g   黄柏 10g   陈皮lOg 于姜 10g   生姜 3 片

Ban Xia Bai Zhu Tian Ma Tang
Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces



Functions:  Strengthens the Spleen and dries damp.  Expels phlegm and descends turbidity

Primary Treatment: dizziness during the menstrual cycle


Explanation:  Tian ma is acrid and slightly warming.  It can expel wind and transform phlegm.  It serves as the chief herb when there is liver wind and phlegm damp causing dizziness.  This formula also contains er chen tang with ze xie and huang bai.  Together these herbs can transform damp and expel phlegm, descend counterflow and stop vomiting.  Dang shen and bai zhu strengthen the spleen and benefit the qi.  Shen qu and mai ya strengthen the stomach and harmonize the center.  Sheng jiang disperses water dampness.

例一:女,42岁。初诊日期: 1987 年 5 月5 日。患者近年来每至经行之时即觉头晕,后脑作胀微痛,不能见行驶车辆。发作严重时恶心呕吐,不能起坐。头重如蒙,胸闷纳少,整日昏昏欲睡。月经初潮 15 岁,3 - 5 / 2 6 - 3 0天,量中色红无块,末次月经:  1987 年 4 月 11  日,舌质淡,苔白腻,脉濡。

Case Study 1:
A 42 year old female patient reports, in the past few years, at the time of her menstrual period, she has  dizziness and occipital distention with slight pain.   She cannot even bear to see moving vehicles. When the dizziness worsens she also experiences nausea and vomiting, and cannot sit up.   The head feels heavy and foggy.  She has chest oppression and is unable to eat much.  She feels tired all day and only desires sleep.  Her menstrual cycle began when she was 15 years old.   The cycle lasts 26-30 days and the period is 3-5 days.  It is medium in amount, red in color and without clotting.   Her last menstrual period was 3 weeks prior to the time of diagnosis.   The tongue body is pale-red and the coating is white and greasy.  The pulse is soggy.


This condition is due to phlegm turbidity obstructing the clear yang, causing dizziness and a sensation of fogginess and heaviness in the head.  When phlegm turbidity obstructs the center, the turbid yin cannot descend causing the Qi mechanism to become obstructed.  Therefore, there will be chest oppression and nausea.  The spleen yang is unable to ascend, causing diminished appetite and excessive sleepiness.   In addition, during the menstrual cycle, the Qi and blood pour downward, causing the Qi to be even more vacuous.  The clear yang is unable to ascend causing phlegm-damp to harass the upper body. Administer ban xia tian ma bai zhu tang.

天麻 10g,姜夏  10g,臼术 1 g,泽泻  10g,党参 10g夜苓lOg ,干姜 10g,陈皮 10g,黄柏 10g,麦芽10g,神曲10g,生姜 3 片。4 剂。水煎服。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, ze xie 10g, dang shen 10g, fu ling 10g, gan jiang 10g, chen pi 10g, huang bai 10g, mai ya 10g, shen qu 10g, sheng jiang 3 pieces.  4 formulas were administered for decoction.

二诊: 1987 年 5 月 10 日。此次经行已 3 天,精神明显好转,仅觉轻度头晕,尚能坚持正常教学。舌质淡,苔白微腻,脉濡滑。嘱下次经前 5天按上方再服 4 剂。3 月后随访,头晕己愈。

Follow up:  At the time of the second visit (5 days later) the patient was on day 3 of her period.  Her vitality had clearly improved.  Not only was the dizziness less intense but she was able to return to work.  The tongue body was pale-red.  The tongue coating was white and slightly greasy.  The pulse was moist and slippery.  The patient was urged, next time to start taking the herbal formulation 5 days before her menstrual cycle begins.  She was instructed to take 4 formulations at that time.  After 3 months, follow up showed that her dizziness had already recovered.

例二:付某,女,37 岁,干部,已婚。1990 年 11 月 7日初诊。患者经前头晕反复发作 2 年,头晕多在月经前 1 周发作。头晕头重如裹,胸院痞塞,恶心欲呕,纳呆,肢重乏力。末次月经,1990 年 10 月 12 日。舌质淡红,苔白腻而厚,脉滑。证属痰湿中阻,风痰上扰。方用半夏臼术天麻汤:

Case Study 2:
A 37 year old female patient reports dizziness occurring one week before her menstrual cycle begins.  This has been repeatedly occurring for 2 years.  The head feels heavy as if wrapped.  There is a sensation of chest and stomach glomus and blockage, nausea with a desire to vomit, torpid intake, and heavy limbs without strength.  Her last menstrual cycle was 3 1/2 weeks prior.  The tongue is pale-red.  The tongue coating is white, greasy and thick.  The pulse is slippery.  The diagnosis is phlegm-damp obstructing the center with wind-phlegm harassing the upper body.  Administer ban xia bai zhu tian ma tang.

天麻lOg ,姜夏 10g,自术 10g,神曲 10g,麦芽 10g,浑海  10g,党参 10g,夜苓 10g,黄柏 10g,陈皮 10g,干姜10g,生姜 3 片。5 剂。

Ingredients:  tian ma 10g, jiang ban xia 10g, bai zhu 10g, shen qu 10g, mai ya 10g, ze xie 10g, dang shen 10g, fu ling 10g, huang bai 10g, chen pi 10g, gan jiang 10g, sheng jiang 3 pieces.  5 formulas were administered.

二诊: 1990 年 11 月 13 日。头晕减轻,纳可。现月经将至,舌脉同前,原方加泽兰叶lO g,再进 7 剂,经净晕止,一切正常,以后每临经前,继续宗方调治半年,痊愈。

Follow up:  After one month, the dizziness was mitigated and the appetite returned.  At the time of the follow up, the menstrual period was about to begin.  The pulse and the tongue were unchanged.  The same formulation was administered with the addition of ze lan ye 10g.  Seven formulations were prescribed.   After the period, the dizziness stopped and the symptoms were no longer present.  At each follow up visit, prior to the beginning of the menstrual cycle, the same formulation was prescribed.  After 6 months the patient recovered completely.

按1 经行头晕是妇科临床常见症候之一。轻者闭目即止,重者如坐舟车,旋转不定。加之经行之时,营血趋向于下,髓海空虚,肝阳偏亢,阳扰于上,则头目为之昏眩。正如《内经》云:”诸风掉眩,皆属于肝”、”上虚则眩”、”髓海不足则脑旋耳鸣”,     <金匮要略》云:”心下有痰饮,胸胁支满目眩,”刘河间认为眩晕由风火所致;朱丹溪认为”无痰不作眩”,张景岳认为”无虚不作眩”等。因此,眩晕之由,不外风、火、痰、虚。而以风阳上扰及气血亏虚者最为多见。治疗中必须首先审证求因,分清虚实,然后再确立治法。本类患者脾虚水湿失运,聚而成痰,经行痰浊上扰,蒙闭清窍,清阳被遏,故经行头晕。

Discussion:  Clinically, in gynecological medicine, dizziness during the menstrual cycle is a commonly seen condition.  In less severe cases, if the patient closes their eyes the dizziness will stop.  In more severe cases, however, it may feel as if one is riding on a boat, causing a continuous spinning sensation.  In addition, during the menstrual period, the construction blood are moving downward leaving the sea of marrow empty and depleted.  The inclination is for the  liver yang  then to ascend and harass the upper body causing dizziness.  The Nei Jing states “All wind with shaking and dizzy vision is ascribed to the liver.”“when the upper body is vacuous there will be dizziness”, “when the sea of marrow is insufficient there will be dizziness and tinnitus.”.   The Jin Gui Yao Lue states, ” when there is phlegm-rheum below the heart there will be distention in the chest and rib-side, and dizziness.”  Liu He-jian  believes dizziness is caused by wind-fire.  Zhu Dan-xi states ” without phlegm there cannot be dizziness.”  Zhang Jing-yue states “without vacuity there cannot be dizziness”.  Therefore, the causes of dizziness are nothing more than external wind, fire, phlegm and vacuity.  Among these causes the  most commonly seen are due to  the liver yang rising to harrass the upper body and qi and blood depletion and vacuity.  Treatment first must be determined by seeking the root cause and distinguishing between vacuity and repletion.  After this, the correct treatment method can be established.  Typically, these are patients with spleen vacuity and water damp causing loss of transportation.  This allows for the accumulation of phlegm.  At the time of the menstrual cycle, this phlegm turbidity will ascend and harass the upper causing fogginess and obstruction of the clear orifices.  The clear yang will be blocked leading to “dizziness during the menstrual cycle”.

徐老几十年的临床实践中,对东垣指出的”足太阴痰厥头晕非半夏不能疗,眼黑头旋,虚风内作,非天麻不除”体会尤深。遵其所论,以半夏天麻臼术汤加减屡用皆效。《本草从新》称:”天麻入肝经,通血脉,疏痰气,治诸风掉眩, 头眩眼黑”、”半夏体滑性燥,能走能散,治咳逆头眩,痰厥头痛”,浑泻利水行饮下走水道,小便一行,水湿有其出路,三焦阳气通达,表里通畅,故头晕病解。
Xu Zhi-hua has numerous years of clinical practice that has brought about a deep understanding of this condition.  As Li Dong-yuan points out ” ban xia is capable of treating foot tai-yin  phlegm-rheum causing dizziness.  When the eyes are black and the head is spinning, and there is vacuity wind internally occurring, tian ma is indispensable”.  Following this theory, the usage of modified ban xia tian ma bai zhu tang will bring results.   The Ben Cao Cong Xin states, ” tian ma enters the liver channel, opens the blood vessels, dredges the phlegm-qi and thereby treats all wind with shaking and dizzy vision, as well as, dizzy head and dim eyes.  Ban xia is slippery in body and dry in nature.  It is capable of moving and dispersing and can treat cough, counterflow, dizziness, and phlegm reversal  headaches.”  Ze xie opens waterways, moves fluids downward and promotes urination.   Once urination is unblocked,  water-damp finds a passage out and the Yang Qi of the Triple Burner becomes open and free. Thus, both the exterior and interior are open and unblocked and the dizziness can be relieved.

施今墨的降血压十法 - SHI Jin-mo’s 10 methods for reducing blood pressure

Translated by XU Zhi-jun & J. Heaverlo


The chief manifestation of high blood pressure is a continued elevation of arterial blood pressure.  Over time, this can lead to damage of the heart, brain, and kidneys, as well as other vital organs.  Its clinical symptoms belong to the Chinese medicine category of “dizziness” and “headache”.  The disease etiology is complex, especially when psychological factors (such as anxiety and anger) are intimately related.  In addition, natural endowment insufficiency, zàng fǔ organ vacuity and damage, exhaustion of food and drink, plus many other factors can lead to yīn yáng imbalance, qì and blood disorder, and blood stasis of the luò pathways.
In order to enhance the quality of life, health and longevity, it is necessary to lower the blood pressure and important to maintain a certain level.  Below is a summary of  SHĪ Jīnmò’s ten methods for reducing (blood) pressure.

肝胆火旺,炎至于上,气血沸腾,并走于脑,遂有头疼如裂,青筋怒张,面红耳赤,烦热易怒,大便硬结,小便短赤,舌红,苔黄腻。治宜清肝泻火,苦寒折逆。方用三黄石膏汤,龙胆泻肝汤。药用黄芩,黄连,知母,生石膏,槐花, 蔚子,夏枯草,知母,黄柏等。

(1) Method of using bitter and cold medicinals to reduce pressure

Use bitter and cold medicinals when there is liver and gall bladder effulgent fire, upward flaring fire, qì and blood seething upward towards the brain.  Hence, there will be splitting headaches, sudden distention of veins, red complexion and ears, easy to anger, heat vexation, bowels which are hard and bound, urination that is short and dark colored, tongue that is red with a thin, yellow coating.
The appropriate treatment is to the drain liver and gall bladder with bitter and cold medicinals.  The exemplar formulas are sān huáng shí gāo tāng, and lóng dǎn xiè gān tāng.  The medicinals used are huáng qín, huáng lián, zhī mǔ, shēng shí gāo, huái huā, wèi zi, xià kū cǎo, zhī mǔ, huáng bǎi.


(2)  Regulate the qì to reduce blood pressure

It is said that “qì is the commander of the blood, when qì moves blood moves, when qì stops  blood stops”.  To regulate the qì is an effective method for treatment.  Medicinals used are xuán fù huā, dài zhě shí, jié gěng, zhǐ ké, xìng rén, xiè bái, fó shǒu, xiāng yuán.


(3)     Extinquish wind to reduce blood pressure

This method is appropriate for use with liver wind internally stirring, with dizziness and a red complexion, vexation and agitation, restlessness, and inability to rest in the evening.
The appropriate treatment is to extinguish wind to reduce the blood pressure.  The exemplar formula is tiān má gòu téng yǐn.  Medicinals used include gòu téng, tiān má, huái huā, jú huā, líng yáng jiǎo, shuǐ niú jiǎo.


(4) Settle counterflow to reduce blood pressure

This method is appropriate to use when there is liver yáng exuberance.  The blood pressure will be exceedingly high and the blood vessels of the head are excessively full.  The correct method of treatment is to select stones and heavy substances to settle, thereby, leading the blood downward.
The exemplar formula is zhèn gān xí fēng tāng.  Medicinals used are zǐ bèi chǐ, zǐ shí yīng, qīng lóng chǐ, shí jué míng, cí shí, tiě luò, zhēn zhū mǔ, cí zhū wán.


(5)    Transform phlegm to reduce blood pressure

Transform phlegm to reduce blood pressure when there is turbidity obstructing the center causing abnormal upbearing and downbearing, dizziness, headaches, distention headaches as if bound, chest and diaphragm fullness and oppression, numbness of the limbs, inhibited speech, and vomiting of phlegm.  The tongue coating will be white and greasy.  The pulse will be bowstring and slippery.
The appropriate treatment is to harmonize the stomach, descend turbidity, and transform phlegm to reduce the blood pressure.  The exemplar formulas are bàn xià bái zhú tiān má tāng, and shí wèi wēn dǎn tāng.  Medicinals used are bàn xià, zhú rú, fú líng, bái zhú, jú pí, yuǎn zhì, chāng pú, zhǐ shí, dǎn nán xīng.


(6) Enrich the yīn to lower blood pressure

When there is liver and kidney yīn vacuity, water will not be able to moisten wood and liver yáng will rise to harass the upper body.  The blood will follow the ascension of the qì thereby causing the blood pressure to increase.  The appropriate treatment is to enrich the yīn to decrease the blood pressure.  The exemplar formulas are zhī bǎi dì huáng tāng and qǐ jú dì huáng tāng.  Medicinals used would be gǒu qǐ zi, jú huā, bái jí lí, shā yuàn zi, nǚ zhēn zi, hàn lián cǎo, zhī mǔ, huáng bǎi, shēng shú dì, shā rén, dù zhòng, huái niú xī.


(7) Open the bowels to reduce blood pressure

This method is appropriate for replete heat internally accumulating with abnormal upbearing and downbearing (the clear yáng will be unable to ascend while the turbid yīn will not be able to descend)  the bowels, therefore, will become blocked.
The appropriate treatment would be to open and regulate the bowel qì, drain heat to descend the blood pressure.  The exemplar formula would be chéng qì tāng.  Medicinals used are shēng chuān jūn, máng xiāo, guā lóu, fēng huà xiāo, zhǐ shí, hòu pǔ, wǎn cán shā, chǎo zào jiǎo zi.


(8) Disinhibit water to reduce blood pressure

This method is appropriate when the qì and blood have become chaotic with prolonged recovery.  Therefore, the water and fluids will become obstructed.  There will be concurrent lower limb swelling.  It is appropriate to disinhibit water to reduce blood pressure.  The exemplar formula is zhēn wǔ tāng, wǔ líng sàn, or èr cǎo dān.  Medicinals used are zhū líng, dōng guā pí, dōng guā zì, chē qián zi, chē qián cǎo, hàn lián cǎo, chì fú líng, and chì xiǎo dòu.


(9) Open the luò vessels to decrease blood pressure

The luò vessels can flow smoothly when they are unobstrcuted .  Among high blood pressure patients, many have improper circulation of the luò vessels.  It is said: “chronic disease enters the luò vessels”, (here) this is evident.  The appropriate treatment is to open the luò vessels to descend the (blood) pressure.  The exemplar formula is Six Vine Decoction (liù téng jiān).  The medicinals used are gòu téng, rěn dōng téng, hǎi fēng téng, luò shí téng, qīng fēng téng, jī xuè téng, sāng jì shēng, sāng zhī, sī guā luò, and pào jiǎ zhū.


(10) Quicken the blood and expel stasis to decrease blood pressure

In the later stages of high blood pressure many (patients) will exhibit signs of stasis in the blood vessels.  The appropriate treatment is to quicken the blood and expel stasis to reduce the blood pressure.  The exemplar formula is xuè fǔ zhú yū tāng.  The medicinals used are táo rén, hóng huā, dāng guī, chuān xiōng, dān shēn, gé gēn, chōng wèi zi, and xià kū cǎo.


Methods for additions and subtractions:  If there is dizziness add bái wēi tāng (dāng guī, dǎng shēn, bái wēi, gān cǎo); if treating wind stroke add tiān má, gōu téng, jú huā, dì lóng; if there is insomnia and the pattern belongs to heart and kidney not communicating add yuǎn zhì, chāng pú, suān zǎo rén, yè jiāo téng; if there is palpitations or tachycardia, add zhū shā, hǔ pò, zhēn zhū mǔ, zǐ shí yīng, xiān hè cǎo, wò dàn cǎo; if there is precordial pain add tán xiāng, jiàng xiāng, dān shēn, sān qī, pú huáng, wǔ líng zhī, wú gōng, quán xiē, rǔ xiāng, mò yào.