Dizziness refers to a sensation of mental fogginess or lack of clarity, typically without a feeling of the world spinning; it is often associated with insufficient blood flow to the brain, sleep disorders, or chronic fatigue.
The Difference Between Dizziness and Vertigo
Dullness in the Head: A sensation of heaviness and dullness in the head, as if wrapped in cloth, accompanied by sluggish thinking and no illusion of movement.
Dizziness/Vertigo: A sensation that one’s body or surroundings are spinning or swaying, often accompanied by nausea, vomiting, and sweating.
Key Distinction: The presence or absence of a sensation of “the world spinning” is the key to distinguishing between the two.
A Story About Unclogging a Drain
For a while, there was a foul odor coming from the bathroom at home that would spread throughout the entire house, making everyone feel quite uncomfortable. Later, we called in a professional plumber. After taking a look, the plumber said the drain was clogged. So he used tools to remove a clump of hair, plastic, and other debris from the drainpipe. Since then, the bathroom hasn’t smelled bad at all, and the problem was solved.
So it turned out that the sewer pipe was partially blocked, causing waste to accumulate—that’s why the bathroom smelled so bad!
My mood improved significantly once the odor was gone. This small incident left a deep impression on me, but what I never expected was that this little incident would later provide me with insights into clinical treatment.
I. Pure Yang Emerges Through the Upper Orifices; Turbid Yin Emerges Through the Lower Orifices
One day, several months later, a patient came in for a consultation. I noticed that whenever she spoke, she would intentionally or unintentionally cover her mouth with her hand, but I didn’t pay much attention to it at the time. My usual practice is to first take the pulse, analyze the condition based on the pulse pattern, and then, after the patient provides a brief supplement, write a prescription.
Observing this patient’s pulse, I noticed a “rising beyond” pattern at the Cun and Guan positions of her right wrist. This indicated that her stomach qi was rebelling upward, turbid qi was surging upward, and lung fire was excessive. She should be experiencing symptoms such as indigestion, frequent belching, a dry and uncomfortable throat, nausea when brushing her teeth, and constipation. As I carefully assessed the pulse, I explained this analysis to her.
She nodded in agreement repeatedly, but finally added: “Lately, my bad breath has been particularly strong—sometimes even with a fecal odor. I feel constantly drowsy and foggy-headed. It’s uncomfortable to talk to people around me, and even my husband doesn’t want to speak to me up close anymore. This condition has left me feeling very depressed.”
I never expected that something as minor as bad breath could cause such major problems—even affecting the harmony of family relationships.
In the past, when treating bad breath, I mostly relied on aromatic deodorizing methods—prescribing herbs like Agastache and Elsholtzia to patients. The results varied from very effective to somewhat less so. Had I not fully grasped the underlying pathogenesis? I asked the patient to hold her hands out flat and speak a few words to me at close range so I could smell her breath.
Sure enough, the odor was very strong! As I inhaled that smell, I immediately thought of the problem with the toilet at home a few months ago—it was a real epiphany!
“Pure yang emerges through the upper orifices; turbid yin emerges through the lower orifices.” This is a direct quote from the *Huangdi Neijing* (The Yellow Emperor’s Inner Canon). Here, “turbid” can be understood as referring to murky or filthy substances, including human excrement, urine, and flatulence. Foul odors inherently belong to turbid qi, and their natural outlet should be the lower orifices. Now that turbid qi is surging upward, halitosis naturally occurs.
The brain is the extraordinary and constant organ where clear yang energy converges; hence, it is also called the “clear and empty organ.” “Clear” here refers to a state of clarity and vitality. When turbid qi rebels upward, clear yang fails to rise, and turbid pathogens invade the clear and empty organ—this is why the patient experiences dizziness and a heavy, foggy sensation in the head.
Having grasped these principles and considered the patient’s pulse pattern, I prescribed the following formula: loquat leaves, daizhashi, forsythia, kudzu root, bitter apricot kernels, chuanxiong, and peppermint.
After taking three doses, the patient experienced frequent flatulence, their breath became fresh, and their dizziness, hiccups, and dry, uncomfortable throat improved significantly. The patient repeatedly marveled at the results.
Let me analyze this prescription.
Loquat leaves serve as the sovereign herb, entering the Lung and Stomach meridians. The *Compendium of Materia Medica* states regarding loquat leaves: “In treating diseases of the Lung and Stomach, their efficacy largely lies in their ability to descend qi. When qi descends, fire subsides and phlegm flows smoothly; thus, what was rebellious ceases to be rebellious, vomiting ceases, thirst subsides, and coughing stops.” In this formula, we specifically harness its ability to descend the qi of the Lung and Stomach meridians; when the qi of the Lung and Stomach descends, turbid qi naturally follows.
Daizhashi and Bitter Apricot Kernel serve as the minister herbs. Daizhashi is heavy in nature and rapidly descends the qi of the Stomach; Bitter Apricot Kernel consolidates the Lung qi, enhancing the Lung’s ability to consolidate and descend. One addresses the Stomach, the other the Lung, thereby enhancing the qi-descending power of Loquat Leaf.
Forsythia, Sophora flavescens, Ligusticum chuanxiong, and Peppermint serve as auxiliary herbs. Forsythia is included for its ability to disperse nodules; once the stagnation of turbid qi is resolved, the channels of circulation naturally become unobstructed, allowing qi to descend much more rapidly. Sophora flavescens, with its bitter taste and cold nature, clears heat, dries dampness, and detoxifies, thereby neutralizing the toxins resulting from the long-term stagnation of turbid qi.
Chuanxiong has the power to lift the clear. Zhang Xichun wrote in *Integrating Chinese and Western Medicine*: “Chuanxiong has a fragrant, penetrating aroma and a warm nature; when warmth and penetration combine, its power ascends, descends, reaches outward, and penetrates inward, leaving no corner untouched. Its particular strength lies in its ability to guide the body’s light and clear qi up to the brain. ” The purpose of using Chuanxiong is to lift the clear; the purpose of lifting the clear is to lower the turbid. This addresses the pathogenesis of turbid qi rebelling upward and the failure of clear yang to rise from another perspective.
Peppermint has an ascending nature, which may seem inconsistent with the pathogenesis; however, it actually enters the Liver meridian and acts on the Liver, also serving to generate the body’s yang qi.
The formulation’s approach fully embodies the principle from the *Huangdi Neijing*: “Clear yang emerges through the upper orifices, while turbid yin exits through the lower orifices.” As a result, the patient’s internal balance of yin and yang—their ascending and descending functions—is restored; the clear and the turbid each return to their proper paths, and the disease is naturally cured.
With this treatment experience, my understanding of the *Inner Canon*’s principle—“Pure yang emerges through the upper orifices, while turbid yin emerges through the lower orifices”—has reached a new level. The simplest theories often guide the most complex matters.
II. Failure of Clear Yang to Rise Leads to Dizziness
Clinically, many patients experience dizziness, constantly feeling as though their minds are foggy and heavy—much like a summer day with persistent drizzle. Tapping their heads provides some relief. Hospital examinations, such as intracranial color Doppler ultrasound, often reveal insufficient blood supply to the vertebrobasilar arteries. Western medicine typically employs methods to dilate cerebral blood vessels, but these not only yield slow results but are also prone to recurrence.
In reality, this is simply a matter of the Clear Yang failing to rise.
For the Clear Yang to rise, it requires both energy and a smooth pathway. Without sufficient energy, the Clear Yang cannot ascend; insufficient upward Qi not only causes dizziness but also leads to palpitations and shortness of breath, because the heart and lungs reside in the Upper Jiao alongside the brain. If the pathway for the Clear Yang to rise is obstructed, dizziness will naturally occur.
The strength of the ascending Clear Yang is related to the Liver and Spleen. The Spleen governs the ascension of the Clear, while the Liver governs regulation and distribution. Located on the left and right sides of the body, respectively, these two organs are responsible for propelling the body’s Clear Yang upward. If the functions of these two organs are impaired, the ascending force will naturally be insufficient.
A patient suffering from severe dizziness once came to see me. He reported that despite extensive testing at the hospital, no underlying cause had been identified, and he was seeking an effective remedy. Upon taking his pulse, I detected severe stagnation and obstruction in the Liver pulse. I asked him if his medical reports indicated moderate to severe fatty liver disease. He nodded in acknowledgment.
I explained to the patient, “Your dizziness is caused by fatty liver disease; there is no other underlying condition.”
The patient was skeptical, so I said, “If you don’t believe me, try taking liver protection tablets for a week. Although this medicine cannot cure your fatty liver, it is very beneficial for repairing liver damage.”
After taking the liver-protecting tablets for a week, the patient’s dizziness was greatly relieved. Deeply surprised, the patient immediately asked me, “It doesn’t say on the label that these tablets can treat dizziness—so why did they work?”
I smiled and said, “Can’t the money spent on salt also be used to buy oil? These liver-protecting tablets target the liver; once the liver is regulated properly, these related symptoms will naturally be resolved!”
Patients with a weak spleen are also prone to dizziness. This is because the spleen’s function of “raising the pure” is inhibited, preventing the body’s clear yang qi from rising. The spleen thrives on dryness and abhors dampness; dampness is the pathogen most likely to damage the spleen. Once dampness impedes the spleen, a person will feel dizzy. For such patients, regulating the spleen is key.
Clinically, there are many such patients. Most of them experience irregular bowel movements and abdominal distension; women often suffer from leukorrhea, while men frequently have chronic prostatitis. In the previous chapter, “The Story of the Wet Clothes,” I discussed the issue of dampness obstructing the flow of qi. In fact, the qi that is obstructed is the body’s clear yang; when clear yang fails to rise, it is the root cause of dizziness.
For such patients, in addition to prescribing medication based on pattern differentiation, I often recommend brewing a tea made from Atractylodes macrocephala and Atractylodes lancea, using equal amounts of each—10 grams. After taking this for a period of time, these patients all report significant improvement.
This remedy is not only effective for dizziness caused by spleen deficiency with excessive dampness and the failure of clear yang to rise; as long as this pathological mechanism is present, it can also serve as an adjunctive treatment for gynecological and urological conditions, yielding positive results in both cases.
In addition to the “ascension” issue discussed above, patients with dizziness actually face another “channel” problem—namely, an obstruction in the channel through which yang qi ascends. Since the head is the convergence point of all yang, an obstruction in the channel for yang qi to rise is also a cause of dizziness. Clinically, the most common cause is insufficient blood supply; when blood cannot reach the head, it leads to dizziness. For such patients, intravenous infusion of Danshen Injection or Xuesaitong can resolve the issue—but is it really that simple?
III. Dizziness Is More Often Caused by a Lack of Qi in the Brain
Clinically, some patients with dizziness are indeed found to have insufficient cerebral blood supply upon examination. However, the use of vasodilators or blood-activating medications fails to resolve the issue, and the patients’ symptoms do not improve. In these cases, aside from issues with the blood vessels, there is actually another underlying problem: a blockage in the meridians. When the meridians are obstructed, the patient experiences an insufficiency of qi supply to the head—not merely an insufficiency of blood supply.
Qi and blood are two distinct systems: blood flows through the blood vessels, while qi flows through the meridians. Pathological byproducts in the body can obstruct the blood vessels, impairing blood flow to the head; similarly, they can stagnate in the meridians, hindering the flow of qi to the head. While vasodilators can improve blood circulation and restore vascular patency, they cannot resolve meridian stagnation or promote the flow of qi.
Therefore, to address the issue of obstructed channels, a differential diagnosis is necessary. Pathological byproducts within the body must be promptly cleared, and both qi regulation and blood activation must be applied simultaneously to fundamentally cure the condition of dizziness.
IV. Dizziness Caused by the Failure of Turbid Yin to Descend
Earlier, we discussed the issue of “failure of clear yang to rise.” In fact, dizziness can also result from “failure of turbid yin to descend.” A patient’s head is like a room filled with suffocating, foul air. Simply opening a window to let in fresh air is useless; if the foul air is not expelled through another window, the air inside the room cannot flow in one direction and out another. Without this passage, convection cannot occur. As the saying goes, “To invite the south wind, one must open the north window.” Similarly, as stated in the *Huangdi Neijing*: “Pure yang emerges from the upper orifices, while turbid yin emerges from the lower orifices.” Through this interplay of ascension and descent, the flow of qi can circulate, allowing a person to maintain a clear mind, sharp hearing, and keen vision.
The human body is a highly sophisticated organism; it can ingeniously accomplish all of the above on its own. The liver and gallbladder are paired as exterior and interior organs; the liver governs ascension, while the gallbladder governs descent. The spleen and stomach are also paired as exterior and interior organs; the spleen governs ascension, while the stomach governs descent. Through the ascending and descending actions of these two pairs of organs, the body’s qi mechanism functions with remarkable precision. Therefore, while investigating the cause of “failure of clear yang to rise,” we must also examine the cause of “failure of turbid yin to descend”; while considering the failure of the liver and spleen to rise, we must also consider the failure of the gallbladder and stomach to descend; and while investigating the cause of obstruction in the channels through which clear yang is released, we must also consider the cause of obstruction in the channels through which turbid yin descends. For patients with chronic constipation, a thorough bowel movement may immediately relieve dizziness. This is because the pathway for the descent of turbid yin has been opened; once turbid yin descends, the clear yang within the patient’s body can then rise smoothly.
A patient once came to me complaining of dizziness. After taking his pulse, I discovered that his Gallbladder Meridian was obstructed—that is, the gallbladder qi was failing to descend, causing it to rise upward and enter the Stomach, which in turn affected the downward flow of Stomach qi. The ascending function of the Liver and Spleen to transport clear substances was still functioning reasonably well. I therefore advised the patient to regularly apply finger pressure to the Yanglingquan and Zusanli acupoints to facilitate the descent of gallbladder and stomach qi. Three days later, the patient reported that the treatment had worked wonders; moreover, after pressing these two acupoints, his bitter taste in the mouth had significantly improved. During the treatment period, he frequently passed gas—a sign that turbid qi was descending. Only after turbid qi descends can clear yang rise.
Through the “story of unclogging the drain,” we have gained insight into the treatment of bad breath and, in doing so, have gained a deeper understanding of the meaning behind the saying, “Clear yang emerges through the upper orifices, while turbid yin emerges through the lower orifices.” At the same time, this illustrates the treatment approach for dizziness. In fact, “pure yang emerges through the upper orifices, while turbid yin exits through the lower orifices” refers not only to bad breath and dizziness; it speaks to the Dao—the laws governing the circulation of pure yang and turbid yin within the human body. When we align with these laws, we are healthy; when we go against them, we fall ill. Countless diseases stem from violating this fundamental principle. By applying this principle to regulate the body, we can achieve twice the result with half the effort.
The principle may seem simple, but its clinical significance is profound!
Among theory, methodology, formula, and medication, theory comes first. But does understanding the theory guarantee a cure? Not necessarily, because every subsequent step is crucial. Let’s now consider the importance of medication through another story: the story of scratching glass.
