Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Two ingredients, and the indication is 苦冒眩 - three characters meaning distressing veiling dizziness, a dizziness that darkens and dims. No cause is offered beyond 心下有支饮, retained fluid below the heart. A reader who wants to understand this formula has to accept that the classical text made a particular choice about dizziness and then follow where it leads, which in this case is directly away from the ears and toward the brain.
Dizziness today is first divided not by hot and cold but by where it comes from, and the division is worth learning because the two halves are handled by different people in different time frames. The peripheral causes are the common ones and mostly the survivable ones: benign paroxysmal positional vertigo, which is triggered by a change in head position, lasts seconds to a minute, has a characteristic nystagmus on a positional test and can often be cured in the clinic by a repositioning manoeuvre; vestibular neuritis, which comes on once and lasts days with no change in hearing; Meniere disease, whose four features are episodic vertigo, fluctuating hearing loss, tinnitus and aural fullness; labyrinthitis; superior canal dehiscence; and vestibular schwannoma, which usually declares itself through progressive one-sided hearing loss rather than through dizziness. Sudden hearing loss with vertigo is an ear, nose and throat emergency with a treatment window measured in days.
The central causes are fewer and far more urgent: posterior circulation stroke, cerebellar haemorrhage, vertebrobasilar dissection, and posterior fossa masses. What separates them is a short list of features that anyone can ask about, and every one of them moves dizziness out of the ear clinic: double vision, difficulty swallowing, slurred speech, facial or limb weakness or numbness, incoordination, inability to stand or walk unaided, a new severe headache or neck pain, and altered consciousness. The head impulse, nystagmus and test of skew examination, performed by a clinician trained in it, distinguishes central from peripheral vertigo in the acute setting better than an early MRI scan does, because diffusion imaging can be negative in the first day or two after a posterior circulation infarct. That last point is the reason a normal early scan does not close the question.
Outside that split, the list continues: orthostatic hypotension, arrhythmia, hypoglycaemia, anaemia, vestibular migraine, panic attacks, persistent postural-perceptual dizziness, visual vertigo, and drugs - aminoglycosides, loop diuretics, antihypertensives, antiepileptics, benzodiazepines, alcohol and sedatives among them. In an older person, a fall that was really an episode of dizziness is a common and under-recognised presentation, and the consequence of the next fall is what makes it worth asking about.
The two materials are unremarkable by comparison, and that is itself the interesting part. 泽泻, Alisma, has been reported to produce nephrotoxicity in animal work at high intakes over prolonged periods; this has not been established in humans, and an unquantified renal hazard is a reason for caution rather than reassurance in anyone who also takes diuretics, NSAIDs or has existing kidney disease. 白术 is an Asteraceae rhizome, and Asteraceae contact dermatitis is common. Neither ingredient is a reason for anyone to delay the assessment described above. There are no adequate safety data for pregnancy or breastfeeding, and pregnancy is an absolute exclusion. Chinese clinical reports on 泽泻汤 exist, mostly for dizziness and for conditions now understood as inner-ear disorders, small in scale and methodologically limited; this library records that the research exists, not that benefit has been established.
两味药，主治是「苦冒眩」三个字 —— 冒是昏蒙、眩是旋转，一种让人难受的、发黑发蒙的眩晕。除「心下有支饮」外，原文没有给出别的病因。要读懂这首方，得先接受古典文献对眩晕做了某一个选择，然后顺着它走 —— 而这次它指向的方向，恰好是从耳朵直接走向脑。
眩晕今天的第一个分界不是寒热，是来源；这个分界值得学会，因为两半边由不同的人、在不同的时间尺度上处理。外周性原因最常见，也大多不致命：良性阵发性位置性眩晕 —— 由头位改变诱发、持续数秒到一分钟、位置试验有特征性眼震，往往在诊室里靠手法复位就能解决；前庭神经元炎 —— 发作一次、持续数天、听力不变；梅尼埃病 —— 发作性眩晕、波动性听力下降、耳鸣、耳闷四联；迷路炎；上半规管裂；以及前庭神经鞘瘤，它通常靠进行性单侧听力下降宣告自己，而不是靠眩晕。**突发听力下降伴眩晕是耳鼻喉急症，治疗窗以天计。**
中枢性原因更少，也急得多：后循环卒中、小脑出血、椎基底动脉夹层、后颅窝占位。把它们分开的是一份任何人都能问的短清单，而其中任何一项都把眩晕从耳科挪走：复视、吞咽困难、构音不清、面或肢体无力或麻木、共济失调、不能独立站立或行走、新发的剧烈头痛或颈痛、意识改变。由受过训练的临床医生完成的「头脉冲—眼震—扭转偏斜」检查（HINTS），在急性期区分中枢与外周，比早期 MRI 更可靠 —— 因为后循环梗死最初一两天内弥散成像可以是阴性的。正因如此，早期一张正常片子并不能把问题关掉。
在这个分界之外，清单还在继续：体位性低血压、心律失常、低血糖、贫血、前庭性偏头痛、惊恐发作、持续性姿势-知觉性头晕、视觉性眩晕，以及药物 —— 氨基糖苷类、髓袢利尿剂、降压药、抗癫痫药、苯二氮䓬类、酒精与镇静剂都在其中。在老年人身上，「一次跌倒」其实是一次眩晕发作，这是常见又被低估的表现形式，而「下一次跌倒」的后果正是值得追问它的理由。
相比之下两味药本身都不起眼，而不起眼这件事恰恰是看点。泽泻（Alisma）在动物实验中有大剂量长期摄入造成肾毒性的报道；**人体证据未建立**，而一味含量不明的肾脏风险，在同时服用利尿剂、非甾体抗炎药或已有肾病的人身上，是谨慎的理由而不是放心的理由。白术是菊科根茎，菊科接触性皮炎常见。这两味药都不是任何人推迟上述评估的理由。孕期与哺乳期没有充分的人体安全性数据，孕期为绝对排除项。中文文献里这方多用于眩晕、以及今天被理解为内耳疾病的那些情况，规模小、方法学质量有限；本库如实记「研究存在」，不记「疗效已被确立」。