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Headache in Cold Damage. How shall this be elucidated? Headache refers to the condition caused by pathogenic factors on the exterior meridians attacking upwards to the head. The *Nan Jing* (Classic of Difficult Issues) states: When the Three Yang Meridians are affected by Wind-Cold, which remain latent and do not depart, it is called Jue Headache (Jue Tou Tong). This indicates that the meridians of the Three Yang ascend to the head. However, in Cold Damage, headache is primarily governed by the Taiyang (Greater Yang) Meridian. Why? Because the Taiyang Meridian originates at the inner canthus of the eye, ascends to the forehead, intersects at the vertex, and enters to connect with the brain. The classics state that when the Taiyang Meridian is diseased, there is pain in the head and nape, and stiffness in the lower back and spine. It is also stated that after seven days, as the disease declines, the headache subsides slightly. Although both the Yangming (Yang Brightness) and Shaoyang (Lesser Yang) meridians present with headache, they do not govern it exclusively as the Taiyang does. Generally, Taiyang disease belongs to the Exterior syndrome, and headache serves specifically as a marker for Exterior syndromes. Regardless of whether the pathogen is Wind or Cold, resolution requires dispersing methods (diaphoresis).

In Taiyang disease, if there is headache, fever, body ache, low back pain, bone and joint pain, aversion to wind, absence of sweating, and wheezing, it is Cold Damage, treated with Mahuang Tang (Ephedra Decoction). In Taiyang disease, if there is headache, fever, sweating, and aversion to wind, it is Wind Strike, treated with Guizhi Tang (Cinnamon Twig Decoction). There are cases where, despite six or seven days of constipation in Cold Damage, headache and fever persist; in such instances, Tiaowei Chengqi Tang (Regulate the Stomach and Purge Decoction) may be used to purge. It is also said that if urination is clear, one knows the heat is not in the Interior but remains in the Exterior, and thus Guizhi Tang should be administered. Since the headache has not resolved, even with several days of constipation, if urination is clear, it still indicates an Exterior pattern. Thus, it is clear that headache belongs to the Exterior.

Is all headache attributed to the Three Yang Meridians? Can Yin meridians present with headache? The meridians of the Taiyin (Greater Yin) and Shaoyin (Lesser Yin) ascend to the neck and chest and then return; they do not ascend along the head. Therefore, these meridians rarely present with headache. Only the Jueyin (Terminal Yin) meridian follows the posterior aspect of the throat, ascends into the pharynx (hangsang), connects with the eye system, ascends out of the forehead, and meets the Du Mai (Governing Vessel) at the vertex. Disease of the Jueyin meridian can also cause headache. The classics state that for dry vomiting and spitting of saliva, Wuzhuyu Tang (Evodia Decoction) is indicated; this refers to such cases.

The head is the mansion of the spirit and clarity, where the Shen (Spirit) resides. For minor pathogenic factors causing headache, dispersing methods are appropriate. However, if the pain is severe, radiating to the brain, accompanied by cold hands and feet, it constitutes a critical disease involving the True Qi. Can it be treated merely by dispersing methods? Alas, although headache is an external ailment, there are incurable cases; how much more so for diseases of the Zang-Fu organs!