Library

Headache caused by Shanghan (Cold Damage) typically involves continuous pain without cessation, unlike headache due to internal injury, which comes and goes intermittently. Therefore, headache accompanied by fever in Shanghan is mostly related to the Three Yang meridians. Among the Three Yang meridians, the Taiyang (Greater Yang) meridian is most frequently involved. Thus, headache, body ache, aversion to cold, fever, and constant coldness of both feet are all exterior syndromes of the Taiyang meridian. If there is no sweating and the pulse is floating and tight, Mahuang Tang (Ephedra Decoction) may be used in the north during winter, or Qianghuo Baidu San (Notopterygium Decoction for Overcoming Toxins) in the south; if there is sweating and the pulse is floating and slow, Guizhi Tang (Cinnamon Twig Decoction) may be used in the north during winter, or Jiajian Fangfeng Tang (Modified Saposhnikovia Decoction) combined with Chuanxiong Tang (Ligusticum Decoction) in the south.

Headache of the Shaoyang (Lesser Yang) meridian manifests as pain at the temples, radiating to the areas before and behind the ears, accompanied by fever, absence of sweating, and a floating-tight pulse; Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction) is indicated. If the pulse is wiry and rapid, with alternating chills and fever, spontaneous sweating when closing the eyes, vomiting, and bitter taste in the mouth, Xiaochaihu Tang (Minor Bupleurum Decoction) is indicated. Usually, Chuanxiong Rhizoma (Chuanxiong) is added to enter the Gallbladder meridian and ascend to the temples.

Headache of the Yangming (Yang Brightness) meridian presents as pain in the forehead, radiating to the eye sockets, with a surging and long pulse. For those with fever and no sweating, Gegen Tang (Kudzu Root Decoction) plus Congbai (Scallion White), Baizhi (Angelica Dahurica), and Shengma (Cimicifuga) is used. For those with fever and sweating, with a surging and rapid pulse, irritability, thirst, and desire to drink water, Baihu Tang (White Tiger Decoction) plus Gegen (Kudzu Root) and Baizhi (Angelica Dahurica) is used. If there is excessive sweating on the hands and feet, constipation, and abdominal distension and fullness around the umbilicus, even though there are exterior symptoms of headache, Da Gange Tang (Large Kudzu Root Decoction) should be used to purge.

There is also headache with nasal congestion, coughing, and急促 wheezing, with nightly alternating chills and fever; this is wind-cold invading the Lung, known as Shangfeng (Wind Injury) headache, treated with Xiong Su Xiebai San (Ligusticum and Perilla Decoction for Draining the Lungs). If there is no sweating and aversion to cold with a floating-tight pulse, add Qianghuo (Notopterygium). Headache due to Wind-Warmth is treated with Fangfeng San (Saposhnikovia Powder) plus Shigao (Gypsum) and Gange (Kudzu Root). Headache due to Damp-Warmth is treated with Fangfeng Shenzhu Tang (Saposhnikovia and Atractylodes Decoction). Frequent "Toufeng" (Head Wind) headaches are treated with Qianghuo Xuanqi Tang (Notopterygium Marvellous Selection Decoction). Headache due to stubborn phlegm, accompanied by chest fullness and nausea, is treated with Erchen Tang (Two-Aged Decoction) plus Nanting (Arisaema Cum Melle) and Haishi (Floating Stone). Headache due to drinking alcohol, accompanied by chest and hypochondriac distension, nausea, and vomiting, is treated with Pingwei Erchen Tang (Stomach-Pacifying Two-Aged Decoction) or Daotan Tang (Phlegm-Resolving Decoction); severe cases use Kongxian Dan (Phlegm-Fluid Expelling Pill), and if ineffective, Guiti San (Melon Peduncle Powder) is used to snuff out yellow fluid. Headache due to Fire-Phlegm is treated with Zhilian Erchen Tang (Gardenia and Coptis Two-Aged Decoction) plus Danning (Gall-Bile Arisaema). Headache due to Yin-Fire is treated with Siwu Tang (Four Substances Decoction) plus Huangbai (Phellodendron) and Zimu (Anemarrhena). There is also Yin-syndrome headache, which is a cold syndrome directly entering the Yin meridians; this is seen more in the north and less in Jiangsu and Zhejiang. There is also Maohan (Exposure to Cold) headache, where headache occurs upon exposure to cold; it resembles Yin-syndrome headache but is not actually Yin-cold headache. It is caused by internal accumulation of phlegm-fluids and heat, combated by external cold.

The disease of Taiyang is characterized by a floating pulse, stiffness and pain in the head and nape, and aversion to cold.
This is a general discussion of Taiyang exterior syndromes: one must have a floating pulse, stiffness and pain in the head and nape, and aversion to cold, indicating that diaphoresis (sweating method) is appropriate.

For Taiyang disease presenting with headache, fever, sweating, and aversion to wind, Guizhi Tang (Cinnamon Twig Decoction) is the primary treatment. For Taiyang disease presenting with headache, fever, body ache, lower back pain, joint pain, absence of sweating, and wheezing, Mahuang Tang (Ephedra Decoction) is the primary treatment.
This separately discusses the two syndromes of Zhongfeng (Wind Strike) and Shanghan (Cold Damage) in Taiyang disease, prescribing respective formulas for each.

If Taiyang disease headache persists for seven days or more and heals spontaneously, it is because the pathogen has exhausted its course through the meridian. If transmission to other meridians is desired to be prevented, acupuncture points of the Foot-Yangming meridian can be stimulated to prevent transmission.
Acupuncture of the Yangming meridian refers to stimulating the three points: Wanguguxue (Wangu), Yuguxue (Yugu), and Hegu (LI4). This means that for Taiyang disease headache and fever, if the condition resolves spontaneously after seven days as the pathogen completes its course, it is fine. If not resolved, stimulating these three points prevents transmission.

In Shanghan, if there is no bowel movement for six or seven days, accompanied by headache and fever, Xiao Chengqi Tang (Minor Order the Qi Decoction) is given. If the urine is clear, it indicates the pathogen is not in the interior but remains in the exterior, requiring diaphoresis. If there is headache, epistaxis (nosebleed) will likely occur, and Guizhi Tang (Cinnamon Twig Decoction) is suitable.
With no bowel movement for six or seven days and interior heat, even with headache, Xiao Chengqi Tang (Minor Order the Qi Decoction) should be used to purge. However, check the urine; if not red, the pathogenic heat has not entered the interior, so diaphoresis is required, hence Guizhi Tang (Cinnamon Twig Decoction) is appropriate. If headache persists after taking the medicine, it is because the heat pathogen, aided by the warmth of Guizhi Tang, invades the Yangming meridian, forcing blood to escape from the nose causing epistaxis. The phrase "Guizhi Tang is suitable" should logically follow "diaphoresis is required."

In Taiyang Zhongfeng (Wind Strike), if accompanied by diarrhea and vomiting/retching, the exterior should be released first before attacking the interior. If the patient sweats, attacks occur at specific times, with headache, hardness and fullness below the heart radiating to the hypochondrium, dry retching, shortness of breath, sweating without aversion to cold, this indicates the exterior is resolved but the interior is not harmonized; Shizao Tang (Ten Jujubes Decoction) is the primary treatment. This clause is detailed in the Vomiting section.

In Yangming disease, with intense heat in both exterior and interior, irritability, thirst with desire to drink, and headache feeling like bursting, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is indicated.
For Yangming exterior and interior symptoms, Gan Ge Shi Gao Tang (Kudzu and Gypsum Decoction) would normally be used. Now, due to irritability, thirst, and bursting headache, indicating fierce upward rushing of fire-heat, Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) is used.

Yangming headache, characterized by aversion to heat rather than cold, and solid stool, is treated with Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction).
Aversion to heat rather than cold and solid stool indicate Yangming interior heat. Da Chengqi Tang (Major Order the Qi Decoction) is not used to subtly indicate that headache syndromes should not be heavily purged.

In Shanghan, if the pulse is wiry and thin, with headache and fever, it belongs to Shaoyang. Diaphoresis is contraindicated; inducing sweating leads to delirious speech. This relates to the Stomach; if the Stomach qi harmonizes, recovery occurs; if not, irritability and palpitations result.
Headache and fever are Taiyang symptoms, but a wiry and thin pulse indicates Shaoyang. Therefore, Mahuang Tang (Ephedra Decoction) should not be mistakenly used for diaphoresis.

Jueyin headache, with dry retching and spitting of saliva, is treated with Wuzhuyu Tang (Evodia Decoction).
This is a Yin-syndrome headache of the Jueyin meridian.

Mahuang Tang (Ephedra Decoction) - See Averson to Cold.
Qianghuo Chonghe Tang (Notopterygium Harmony Decoction) - See Fever.
Guizhi Tang (Cinnamon Twig Decoction) - See Averson to Cold.
Jiajian Fangfeng Tang (Modified Saposhnikovia Decoction) - See Body Pain.
Chuanxiong Tang (Ligusticum Decoction)
Ingredients: Chuanxiong Rhizoma (Chuanxiong), Atractylodis Rhizoma (Cangzhu), Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Schizonepetae Herba (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao).
This formula treats Taiyang meridian headache due to Wind-Damp. For accompanying cold, add Asari Radix (Xixin); for Yangming signs, add Angelicae Dahuricae Radix (Baizhi); for Shaoyang signs, add Bupleuri Radix (Chaihu); for fire, add Scutellariae Radix (Huangqin), combining with Xuanqi Tang.

Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction) is Xiaochaihu Tang (Minor Bupleurum Decoction) plus Fangfeng (Saposhnikovia).
This formula treats Shaoyang wind-pathogen headache.
Xiaochaihu Tang (Minor Bupleurum Decoction) - See variations in Cold-Heat section.

Er Bai Gan Ge Tang (Two Whites and Kudzu Decoction)
Ingredients: Congbai (Scallion White), Baizhi (Angelica Dahurica), Gange (Kudzu Root), Shengma (Cimicifuga).
This formula treats Yangming exterior pathogen headache. For signs involving Taiyang, add Qianghuo (Notopterygium), Fangfeng (Saposhnikovia), Chuanxiong (Ligusticum); for signs involving Shaoyang, add Chaihu (Bupleurum), Chuanxiong (Ligusticum); for chest nausea/vomiting, combine with Erchen Pingwei San (Two-Aged Stomach-Pacifying Powder); for fire, add Zhizi (Gardenia), Lianzi (Coptis).

Baihu Gegen Tang (White Tiger and Kudzu Decoction)
Ingredients: Zimu (Anemarrhena), Shigao (Gypsum), Gegen (Kudzu Root), Baizhi (Angelica Dahurica).
This formula treats Yangming interior heat headache. If accompanied by Taiyang exterior pathogen, add Qianghuo (Notopterygium), Fangfeng (Saposhnikovia); for Shaoyang signs, add Chaihu (Bupleurum), Chuanxiong (Ligusticum); for yellow-red urine, add Mutong (Akebia), Huashi (Talc); for constipation with purge indications, add Jiuzhu Dahuang (Wine-processed Rheum).

Da Gange Tang (Large Kudzu Root Decoction)
Ingredients: Gange (Kudzu Root), Shigao (Gypsum), Zhike (Aurantii Fructus), Dahuang (Rheum), Guangpi (Tangerine Peel), Gancao (Licorice), Zimu (Anemarrhena).
This formula treats headache due to residual Yangming exterior pathogen, constipation, and upward rushing of accumulated heat. If accompanied by aversion to cold and exterior heat, or signs involving Taiyang, it should not be used.

Xiong Su Xiebai San (Ligusticum and Perilla Decoction for Draining the Lungs)
Ingredients: Chuanxiong Rhizoma (Chuanxiong), Perillae Folium (Zisu), Saposhnikoviae Radix (Fangfeng), Morus Albae Cortex (Sangbaipi), Psoraleae Fructus (Digupi - *Note: Text says Digupi, usually Cornus or others, but here likely refers to a specific bark/root context or typo for Digupi/Psoralea or similar, keeping literal*), Schizonepetae Herba (Jingjie), Glycyrrhizae Radix et Rhizoma (Gancao).
This formula treats headache with cough and chills/fever due to wind injuring Lung qi. For Taiyang signs, add Qianghuo (Notopterygium); for Yangming signs, add Gange (Kudzu), Baizhi (Angelica Dahurica); for Shaoyang signs, add Chaihu (Bupleurum).

Fangfeng San (Saposhnikovia Powder)
Ingredients: Fangfeng (Saposhnikovia), Platycodonis Radix (Jiegeng), Magnoliae Officinalis Cortex (Nongpo/Magnolia Bark), Glycyrrhizae Radix et Rhizoma (Gancao), Shigao (Gypsum), Gange (Kudzu Root).
This formula treats headache due to Wind-Heat rushing up from the Lung and Stomach meridians. Fangfeng disperses wind, Shigao clears heat; combined with Jiegeng (Platycodon), it clears Lung heat; combined with Gange (Kudzu), it clears Stomach heat. Nongpo (Magnolia Bark) and Gancao (Licorice) harmonize Stomach qi to regulate ascending/descending and floating/sinking. For Shaoyang signs, add Chaihu (Bupleurum), Chuanxiong (Ligusticum), Bohe (Mint), Jingjie (Schizonepeta).

Fangfeng Shenzhu Tang (Saposhnikovia and Atractylodes Decoction)
Ingredients: Fangfeng (Saposhnikovia), Cangzhu (Atractylodes Rhizome), Gancao (Licorice), Shigao (Gypsum).
This formula treats headache due to Wind, Damp, and Heat. If Wind dominates, double Fangfeng and add Qianghuo (Notopterygium); if Damp dominates, double Cangzhu and add Baizhi (Angelica Dahurica); if Heat dominates, double Shigao and add Huangbai (Phellodendron); for Taiyang signs, add Gaoben (Ligusticum); for Yangming signs, add Shengma (Cimicifuga); for Shaoyang signs, add Chaihu (Bupleurum). Usually add a small amount of Chuanxiong (Ligusticum) to ascend to the temples.

Qianghuo Xuanqi Tang (Notopterygium Marvellous Selection Decoction)
Ingredients: Qianghuo (Notopterygium), Fangfeng (Saposhnikovia), Huangqin (Scutellaria), Gancao (Licorice).
This formula treats Taiyang Wind-Heat headache. For Shaoyang signs, add Chaihu (Bupleurum), Chuanxiong (Ligusticum); for Yangming signs, add Shengma (Cimicifuga), Baizhi (Angelica Dahurica). For severe Wind-Heat, add Bohe (Mint), Jingjie (Schizonepeta), Gaoben (Ligusticum); for interior accumulated heat, add Zhizi (Gardenia), Lianzi (Coptis); for frequent Toufeng (Head Wind) pain, add Manjingzi (Vittex Seed), Gaoben (Ligusticum); for pain upon exposure to cold, add Xixin (Asari), Chuanxiong (Ligusticum).

Xingshi Erchen Tang (Arisaema and Floating Stone Two-Aged Decoction) is Erchen Tang (Two-Aged Decoction) plus Danning (Gall-Bile Arisaema) and Shichangpu (Acorus).
This formula treats headache due to Phlegm-Fluid congealing in the Middle Jiao and rushing up to the forehead. For Wind, add Fangfeng (Saposhnikovia), Jingjie (Schizonepeta); for Fire, add Zhizi (Gardenia), Lianzi (Coptis); for Cold, add Xixin (Asari), Chuanxiong (Ligusticum); for fever and aversion to cold, add Qianghuo (Notopterygium); for forehead pain radiating to eyes, add Gange (Kudzu), Baizhi (Angelica Dahurica), Shengma (Cimicifuga); for alternating chills/fever, temple pain radiating to ears, add Chaihu (Bupleurum), Chuanxiong (Ligusticum).

Pingwei Erchen Tang (Stomach-Pacifying Two-Aged Decoction) is Erchen Tang (Two-Aged Decoction) combined with Pingwei San (Stomach-Pacifying Powder).
Frequent headache, commonly called Toufeng (Head Wind), originates from internal latent Phlegm accumulation and external exposure to Wind-Cold. If accompanied by nausea and fullness, it is surely due to Phlegm accumulation. I have used this formula combined with Baohe San (Harmonize and Preserve Powder), heavily adding Doukou (Cardamom), Shichangpu (Acorus), and Laifuzi (Radish Seed) to remove the root cause in the Stomach, preventing recurrence.

Daotan Tang (Phlegm-Resolving Decoction) - See Simulating Malaria section.
For headache with vomiting and nausea, this formula treats Phlegm-Fluid. For external Cold, add Qianghuo (Notopterygium), Xixin (Asari), Manjingzi (Vittex), Chuanxiong (Ligusticum), Gaoben (Ligusticum); for Wind, add Fangfeng (Saposhnikovia), Jingjie (Schizonepeta); for Summer-Heat, add Huanglian (Coptis), Huashi (Talc); for Wind-Damp, add Fangfeng (Saposhnikovia), Cangzhu (Atractylodes), Baizhi (Angelica Dahurica), Shichangpu (Acorus).

Kongxian Dan (Phlegm-Fluid Expelling Pill)
Ingredients: Kansui Radix (Gansui), Dajiei Radix (Daji), Mustard Seed (Baijiezi).
When Phlegm-Fluid lodges in the hypochondrium causing pain, named Xuan Yin (Suspension Fluid) or Zhi Yin (Branch Fluid), Shizao Tang (Ten Jujubes Decoction) is used. When Phlegm lodges in the Stomach and rushes up to the forehead causing pain, Kongxian Dan (Phlegm-Fluid Expelling Pill) is used. Both use Gansui (Kansui) and Daji (Dajiei); Shizao Tang uses Yuanhua (Genkwa) instead of Baijiezi (Mustard Seed), while Kongxian Dan uses Baijiezi (Mustard Seed) instead of Yuanhua (Genkwa). Both treat Phlegm-Fluid diseases; one pains the hypochondrium, the other the head, hence different actions of dispersing above and purging below.

Erchen Zhilian Danning Tang (Two-Aged Gardenia, Coptis, and Gall-Bile Arisaema Decoction) is Erchen Tang (Two-Aged Decoction) plus Zhizi (Gardenia), Lianzi (Coptis), and Danning (Gall-Bile Arisaema).
The previous clauses all describe Phlegm-Fluid; this one describes Phlegm-Fire rushing up. If there is an external cold-damage, add exterior-dispersing herbs to first expel the external pathogen.

Siwu Zhibai Tang (Four Substances Anemarrhena and Phellodendron Decoction) is Siwu Tang (Four Substances Decoction) plus Zimu (Anemarrhena) and Huangbai (Phellodendron).
This formula originally treats internal injury Yin-Fire rushing inward causing headache. Listed here for comparative study, they complement each other.

Shizao Tang (Ten Jujubes Decoction) - See Hypochondriac Pain.
Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) - See Thirst.
Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) - See Constipation.
External contraction headache strictly prohibits downward purging. However, for Yangming headache with aversion to heat rather than cold and solid stool, this formula is used for mild purging.