治产后大便不通。(许叔微曰∶妇人产后有三种
疾,郁胃则多汗,多汗则大便秘,故难于用药。)及老人风秘,俱宜此粥。
大麻仁 紫苏子(等分) 共研,再用水研取汁煮粥。
此手阳明药也。麻仁阳明正药,滑肠润燥,利便除风;苏子兼走太阴,润肺通肠,和血下气,行
而不峻缓而能通。故老人产妇气血不足者,所宜用也。
治大小便不通。
用连根葱一二茎,带土生姜一块,淡豆豉二十一粒,盐二匙同研烂,捏作饼子烘热
掩脐中,以帛札定,良久气透自通,否则再换一饼。
蜜导法
方见伤寒门。
猪胆汁导法
方见伤寒门。
《经》曰∶风气循风府而上,则为脑风。新沐中风,则为首风。又曰∶头痛耳鸣,九
窍不利,肠胃之所生。总之,头为诸阳之首,以象天,六腑清阳之气,五脏精华之
血,皆会于头,为至清至高之处,故为天象,谓之元首,言其至尊,不可犯也。凡手
之三阳,从手走头。足之三阳,从头走足,以为常度,则无头痛之患。若外因风寒雾露
之触,内因痰火湿热之熏,痛由起矣。至于真头痛者,其脑尽痛,而手足寒,且青至
节,旦发夕死,夕发旦死,盖四肢为诸阳之本,痛尽脑而寒至节,则元阳亏败,气血虚
极,阴邪真中髓海于泥丸宫中,非药所能愈,盖其根先绝也。书又曰∶脑为髓海,受
邪则死,灸百会穴,猛迸大剂参附,亦有生者焉。
头痛头风,非二证也,在新久去留之分耳。浅而近者,名头痛,其痛卒然而至,易
于解散速安也;深而远者,名头风,其痛作止不常愈后遇触复发也。手足三阳之脉,皆
上循于头,为诸阳之会,六阴脉至颈而还,惟厥阴上入吭嗓,连目系出额,故当于七经
辨之,属痰者,居多,然有风寒湿热火痰,及气虚血虚,食郁疮毒之别,皆能伤于脉道
而为病也。伤于太阳则在后,阳明在额,挟鼻与齿,少阳两角,厥阳属巅顶,而多吐
涎,须寻风寻火,在气在血,晰其虚实表里,而便得病情矣。
《经》之论头痛,风也、寒也、虚也。皆六气相侵,与真气相搏,经气逆上,干于
清道,不得营运,壅遏而痛也。天气六淫之邪,人气五贼之变,皆能相害,或蔽覆其清
明,或瘀塞其经络,与气相搏,郁而成热,脉满而痛。若邪气稽留,脉满而气血乱,则
痛乃甚,此实痛也。寒湿所侵,真气虚弱,虽不相搏成热,然邪客于脉外,则血泣脉
寒,卷缩紧急,外引小络而痛,得温则止,此虚痛也。因风痛者,抽掣恶风;因热痛
者,烦心恶热;因湿痛者,头重而天阴转甚;因痰痛者,昏重而欲吐不休;因寒痛
者,绌急而恶寒战栗;气虚痛者,恶劳动其脉大;血虚痛者,善惊惕,其脉芤。头痛自
有多因,古方必兼风药者,以高巅之上,惟风可到。味之薄者,阴中之阳,自地升上者
也。在风寒湿者,固为正用,即虚与热者,亦假引经,且散其抑遏也。若疏散太过而
痛,及服辛散而反甚者,不防用酸收以降之。若年衰气弱,清气不能上升,而浊阴犯
之,以作痛者,宜升阳补气而自愈。若血虚之头痛,必处眉尖后,近发际而上攻头目,
宜用芎归养血而自愈。然新而暴者,但名头痛,深而久者,名为头风。头风必害眼者。
《经》所谓东风生于春,病在肝。目者,肝之窍,肝风动,则邪害空窍,且由精髓脑之
不足,而外邪易于以深入也。
厥头痛者,手三阳之脉,受风寒而伏留不去,上干于头,其气不循经隧而逆行,故
名曰厥。
久头痛病,略感风寒便发,而至塞目重
绵浓帕包裹者,此属郁热。本热而标寒,世人不识,率用辛温解散之药,临时得效,误
认为寒,殊不知因其本有郁热,毛窍常疏,故风寒易入,外寒束其内热,闭逆而为痛,
辛热之药,虽能开通闭逆,散其标之寒邪、然以热济热,病本益深,恶寒愈甚矣。惟当
泻火凉血为主,佐以辛温散表之剂,以从治法治之,则病可愈,而根可除也。
头痛多主于痰。痛甚者,火多,盖火性炎上,其痛发劈,有可吐者,有可下者,东
垣曰∶湿热在头而痛者,当以苦吐之,如瓜蒂散、浓茶之类是也。痰厥头痛,非半夏不
能除,有属于风者,有属于寒者,有属于半寒为偏头痛者,有属于湿者,有属于火郁
者,有属于外感有余,有属于内伤不足,伤食伤酒,种种症候,皆以头痛,总由清阳不
升,浊阴上犯也。
感冒头痛,宜防风、羌活、 本、白芷,即所谓新沐中风为首风。风热在上头
痛,宜天麻、蔓荆子、台芎、酒制黄芩。肥白人头痛,是气虚,宜黄 酒洗生地、南
星。形瘦苍黑之人头痛,是血虚,宜当归、川芎、酒黄芩之类。太阳头痛,恶风寒,脉
浮紧,其痛在巅顶,与两额角,川芎、羌活、独活、麻黄之类为主,为冲头痛。少阳
头痛,脉弦细,往来寒热,其痛连耳根,柴胡黄芩为主。阳明头涌,自汗,发热恶寒,
脉浮缓长实,其痛连目 ,鼻干齿颊目疼,升麻、葛根、石膏、白芷为主。太阴头痛,
必有痰,体重或腹痛,或痰癖,脉沉缓,以苍术、半夏、南星为主。少阴头痛,足寒气
逆,为寒厥,其脉沉细,麻黄、细辛、附子汤主之。厥阴头项痛,或吐痰沫厥冷,其脉
浮缓,以吴茱萸汤主之。然太阴、少阴,有身热而无头痛,厥阴有头痛而无身热,若身
热又头痛,属阳经也。血虚头痛,连鱼尾相连者,当归、川芎为主,以润风燥经。所谓
头痛耳鸣,九窍不利,肠胃之所生也。气虚头痛,人参、黄 为主,以升清阳,《经》
所谓上气不足,脑为之不满,头为之苦倾是也。偏头痛者少,少阳相火也。有痰者多,
在左属风属火,多血虚,宜薄荷、荆齐、川芎、当归,在右属痰,属热,多气虚,宜苍
术、半夏、酒芩为主。若属湿痰,川芎、南星、苍术为主。气血俱虚头痛,调中益气
汤,内加川芎三分,蔓荆子二分,细辛二分,其效如神。厥逆头痛者,所犯大寒,内
至骨髓,髓者,以脑为主,脑逆故令头痛,齿亦痛,以羌活附子汤主之。肾虚头痛,即
《经》所谓下虚上实,由相火上冲,气逆上行,痛不可忍,用补中汤加芎归,或姜附理
中汤。太阴头痛,必有痰也。少阴头痛,足寒而气逆也。太阴、少阴二经,虽不上头,
然痰与气壅于隔中,头上气不得畅而为痛也。痰厥头痛,所感不一,发时恶心,呕吐
痰水,甚则手足厥冷,吐去痰涎,其痛见减,虽由乎痰,然痰之始也,必有本,是知
方者,体也,法者,用也。徒知体而不知用者弊。若体用不失,可谓上工矣,宜以白
术、半夏、天麻汤主之。痰厥头痛,非半夏不能除;眼黑头旋,风虚内作,非天麻不能
解。平人头痛属火与痰者多,若肥人多是湿痰,二陈加苍术;人瘦多是血虚与火,酒炒
芩连荆防薄荷芎归之类。巅顶痛甚,加 本酒炒升柴。东垣曰∶顶巅痛,须用 本去川芎。
头痛不可专泥风药愈虚其虚,使风入于脑,永不可拔。亦不可偏于逐火,使风火上
乘空窍而从眼出,如腐之风火相煽,而成衣焉。谚云∶医得头风瞎了眼,此之谓也。
总之,头痛、头风,皆因清阳之气有亏,精华之血有损,不能交会卫护于首,以
致浊阴外邪犯之。若从标疏散清理,不过徒取近功。然益虚其虚,旋踵愈甚,(张)每
重用八味汤,加牛膝、五味子,食前早晚服之,浊阴降,真阴生,雷火熄,真火藏,上
下整肃,不惟头病既痊,精神亦可倍长矣
Treats postpartum constipation. (Xu Shuwei said: Women after childbirth have three types of diseases; if the Stomach Qi is stagnant, there is excessive sweating; excessive sweating leads to dry stool constipation, so it is difficult to use medication.) It is also suitable for elderly people with wind-type constipation. Use equal parts of Hemp Seed (Cannabis Fructus) and Perilla Seed (Perillae Fructus), grind them together, then add water, grind again to extract the juice, and cook into a porridge.
This involves the Hand Yangming channel. Hemp Seed is the primary herb for the Yangming channel, capable of lubricating the intestines, moistening dryness, promoting bowel movements, and dispelling wind; Perilla Seed also travels to the Taiyin channel, moistens the Lungs, unblocks the intestines, harmonizes Blood, directs Qi downward, acts gently without being harsh, and promotes flow smoothly. Therefore, it is suitable for the elderly and postpartum women who lack Qi and Blood.
Treats obstruction of both urination and defecation.
Take one or two stalks of green onion with roots, a piece of fresh ginger with soil attached, twenty-one grains of prepared Soybean (Fermented Glycine Max Semen), and two spoonfuls of salt. Grind them into a paste, shape into cakes, warm them, and apply to the umbilicus. Secure with a cloth bandage. After a while, Qi will penetrate and passage will naturally open; otherwise, replace with another cake.
Honey Suppository Method
See the Treatise on Cold Damage section.
Pig Bile Suppository Method
See the Treatise on Cold Damage section.
The Classic states: When Wind Qi follows the Fengfu point upward, it becomes Brain Wind. If one catches a cold immediately after washing hair, it becomes Head Wind. It also states: Headache, tinnitus, and dysfunction of the nine orifices are generated from the Intestines and Stomach. In summary, the head is the leader of all Yang channels, symbolizing Heaven. The Clear Yang Qi of the Six Fu organs and the Essence Blood of the Five Zang organs all converge in the head, which is the most pure and exalted place, thus called the Heavenly Image, or "Head Chief," implying supreme dignity that must not be offended. All three Hand Yang channels run from the hands to the head; all three Foot Yang channels run from the head to the feet. This is the normal pattern, under which there would be no headache. However, if externally invaded by Wind, Cold, Fog, and Dew, or internally harassed by Phlegm-Fire, Damp-Heat, pain arises. As for True Headache, the entire brain hurts, accompanied by cold limbs where cyanosis extends to the joints. Death occurs in the evening if onset is in the morning, and in the morning if onset is in the evening. This is because the four limbs are the root of all Yang; when pain pervades the brain and cold reaches the joints, it indicates depletion of Primordial Yang and extreme deficiency of Qi and Blood. Yin pathogenic factors truly invade the Sea of Marrow (Niwang Palace). It cannot be cured by medicine because the root is already severed. Medical texts also state: The Brain is the Sea of Marrow; if affected by pathogens, death ensues. Moxibustion at Baihui (GV20) and vigorous administration of large doses of Ginseng (Ren Shen) and Aconite (Fu Zi) may result in survival.
Headache and Head Wind are not two different conditions, but differ only in their newness/oldness and retention/resolution. Superficial and recent cases are named Headache; the pain comes suddenly and resolves quickly. Deep and chronic cases are named Head Wind; the pain comes and goes irregularly and recurs upon triggering after recovery. The meridians of the Hand and Foot Yang all ascend to the head, making it the meeting point of all Yang. The six Yin meridians return at the neck; only the Jueyin meridian ascends to the throat, connects to the eye system, and emerges at the forehead. Therefore, differentiation should be made among these seven channels. Cases involving Phlegm are common, but distinctions must be made between Wind-Cold-Damp, Fire, Phlegm-Fire, Qi deficiency, Blood deficiency, Food stagnation, and Carbuncle toxins, all of which can damage the meridians and cause disease. Invasion of the Taiyang channel causes pain at the back; Yangming channel affects the forehead, nose, and teeth; Shaoyang channel affects the temples; Jueyin channel affects the vertex and often involves salivation. One must identify Wind and Fire, determine involvement of Qi or Blood, and clarify Deficiency/Excess and Interior/Exterior to grasp the pathology.
The Classics discuss headache as caused by Wind, Cold, and Deficiency. These involve the invasion of the Six Qi clashing with True Qi, causing meridian Qi to reverse upward, disturbing the clear pathways, failing to circulate normally, leading to congestion and pain. Atmospheric Six Excesses and Human Five Thieves can harm each other, either obscuring clarity or blocking meridians. Clashing with Qi, they stagnate and generate Heat, causing full pulses and pain. If pathogens linger, pulses become full, Qi and Blood chaotic, and pain intensifies; this is Excess Pain. Invasion by Cold-Damp with weak True Qi, even without generating Heat, causes pathogens to lodge outside the vessels, leading to sluggish blood and cold vessels, contraction, tension, and traction on collateral vessels causing pain, which stops with warmth; this is Deficiency Pain. Pain due to Wind involves twitching and aversion to wind; due to Heat involves irritability and aversion to heat; due to Dampness involves heavy head worsening on cloudy days; due to Phlegm involves dizziness, heaviness, and persistent nausea; due to Cold involves cramping, aversion to cold, and shivering; Qi deficiency pain involves aversion to exertion and a large pulse; Blood deficiency pain involves palpitations and a hollow pulse. Headaches have many causes. Ancient formulas always include Wind-dispelling herbs because only Wind can reach the high summit. Herbs with thin flavors are Yang within Yin, rising from the earth. For Wind-Cold-Damp, they are primary; for Deficiency and Heat, they serve as guiding herbs to disperse stagnation. If over-dispersal worsens pain, or if acrid-dispersing herbs aggravate it, sour-astringent herbs may be used to descend. In elderly people with weak Qi, if Clear Yang fails to rise and Turbid Yin invades, tonifying Yang and boosting Qi will lead to self-recovery. For Blood deficiency headache, pain attacks near the hairline above the eyebrows; Angelica Sinensis (Dang Gui) and Ligusticum Chuanxiong (Chuan Xiong) nourish Blood. Acute cases are called Headache; chronic deep cases are called Head Wind. Head Wind inevitably damages the eyes. The Classic says: East Wind born in Spring harms the Liver. The Eye is the opening of the Liver; Liver Wind moves, harming the orifices. Insufficiency of Essence and Brain Marrow allows external pathogens to penetrate deeply.
Jue Headache occurs when Hand Yang meridians are invaded by Wind-Cold, which lingers and ascends to disturb the head. Qi reverses against the meridians, hence named Jue.
Chronic headache triggered by slight Wind-Cold exposure, requiring heavy wrapping, belongs to Stagnant Heat. The root is Heat, the branch is Cold. People mistakenly use acrid-warm dispersing herbs, gaining temporary relief and misdiagnosing it as Cold. In reality, underlying Stagnant Heat keeps pores loose, allowing Wind-Cold entry. External Cold binds internal Heat, causing blockage and pain. Acrid-hot herbs open blockages and scatter superficial Cold, but adding Heat to Heat deepens the root and worsens aversion to cold. Treatment should focus on purging Fire and cooling Blood, assisted by acrid-warm exterior-dispersing agents, treating according to the contrary method to cure the disease and remove its root.
Headache is mostly dominated by Phlegm. Severe pain often involves Fire, as Fire flares upward. Pain may be treated with emesis or purgation. Li Dongyuan stated: Headache due to Damp-Heat in the head should be treated with bitter emetics like Momordica Seed Powder (Gua Di San) or strong tea. Phlegm-Jue headache requires Pinellia (Ban Xia) to resolve. Causes include Wind, Cold, Half-Cold (hemicrania), Dampness, Fire Stagnation, Exterior Excess, and Interior Deficiency (food/wine injury). All stem from failure of Clear Yang to ascend and invasion of Turbid Yin.
For Cold-Damage headache, use Saposhnikovia (Fang Feng), Notopterygium (Qiang Huo), Ligusticum Wallichii (Gao Ben), and Angelica Dahurica (Bai Zhi); this is Head Wind from washing hair. Upper Headache due to Wind-Heat uses Gastrodia (Tian Ma), Vitex (Man Jing Zi), Ligusticum (Tai Xiong), and Scutellaria (Huang Qin) processed with wine. Headache in fat, pale people indicates Qi deficiency; use Astragalus (Huang Qi), Rehmannia (Sheng Di) processed with wine, and Pinellia (Nan Xing). Headache in thin, dark people indicates Blood deficiency; use Angelica Sinensis (Dang Gui), Ligusticum (Chuan Xiong), and Scutellaria (Huang Qin) processed with wine. Taiyang headache, with aversion to Wind-Cold and floating-tight pulse, pain at vertex and temples, uses Ligusticum (Chuan Xiong), Notopterygium (Qiang Huo), Angelica Pubescens (Du Huo), and Ephedra (Ma Huang). Shaoyang headache, with wiry-thin pulse and alternating chills/fever, pain radiating to ears, uses Bupleurum (Chai Hu) and Scutellaria (Huang Qin). Yangming headache, with spontaneous sweating, fever, aversion to cold, floating-slow-long-full pulse, pain radiating to eyes, dry nose, tooth/jaw/eye pain, uses Cimicifuga (Sheng Ma), Pueraria (Ge Gen), Gypsum (Shi Gao), and Angelica Dahurica (Bai Zhi). Taiyin headache involves Phlegm, body weight, abdominal pain, or phlegm-rheum, sinking-slow pulse; uses Atractylodes (Cang Zhu), Pinellia (Ban Xia), and Pinellia Tuber (Nan Xing). Shaoyin headache, with cold feet and reversing Qi (Cold Jue), sinking-thin pulse, uses Ephedra (Ma Huang), Asarum (Xi Xin), and Aconite Decoction (Fu Zi Tang). Jueyin head/neck pain, with vomiting phlegm/saliva and cold limbs, floating-slow pulse, uses Evodia Decoction (Wu Zhu Yu Tang). Note: Taiyin and Shaoyin may have fever but no headache; Jueyin has headache but no fever. Fever plus headache indicates Yang channels. Blood deficiency headache extending to the temporal corners uses Angelica Sinensis (Dang Gui) and Ligusticum (Chuan Xiong) to moisten Wind-dry meridians. "Headache and tinnitus, dysfunction of nine orifices" arise from Intestines/Stomach. Qi deficiency headache uses Ginseng (Ren Shen) and Astragalus (Huang Qi) to raise Clear Yang ("Insufficient Upper Qi leads to empty Brain and painful tilting"). Hemicrania is rare, related to Ministerial Fire. Phlegm cases are common: Left side relates to Wind/Fire/Blood deficiency (Mint, Schizonepeta, Ligusticum, Angelica); Right side relates to Phlegm/Heat/Qi deficiency (Atractylodes, Pinellia, Scutellaria). Wet-Phlegm uses Ligusticum, Pinellia, Atractylodes. Qi-Blood dual deficiency uses Modulating Middle and Boosting Qi Decoction (Tiao Zhong Yi Qi Tang) plus Ligusticum, Vitex, Asarum. Jue Ni headache from severe Cold penetrating marrow to Brain uses Notopterygium and Aconite Decoction (Qiang Huo Fu Zi Tang). Kidney deficiency headache ("Lower Deficiency, Upper Excess") from Ministerial Fire rushing up uses Tonifying Middle Decoction plus Ligusticum/Angelica, or Ginger-Aconite Lizhong Decoction. Taiyin headache involves Phlegm; Shaoyin involves cold feet/reversing Qi. Though Taiyin/Shaoyin don't ascend to the head, Phlegm/Qi congestion in the diaphragm blocks Head Qi, causing pain. Phlegm-Jue headache varies; symptoms include nausea, vomiting phlegm-water, cold limbs. Vomiting phlegm reduces pain. Although caused by Phlegm, there is an original root. Formulas represent Substance (Ti); Methods represent Function (Yong). Knowing Substance without Function is flawed. Balancing both makes one a master physician. Use Atractylodes, Pinellia, Gastrodia Decoction. Phlegm-Jue requires Pinellia; Blackout/dizziness from Internal Wind-Deficiency requires Gastrodia. Common people's headache is often Fire/Phlegm. Fat people: Wet-Phlegm (Er Chen Tang + Atractylodes). Thin people: Blood deficiency/Fire (Scutellaria, Coptis, Schizonepeta, Saposhnikovia, Mint, Ligusticum, Angelica). Vertex pain adds Ligusticum Wallichii (Gao Ben) processed with wine, Bupleurum, Cyperus. Li Dongyuan said: Vertex pain requires Gao Ben, excluding Ligusticum. Do not rely solely on Wind herbs, which further deplete and allow Wind into the Brain. Do not focus only on purging Fire, allowing Wind-Fire to exit through eyes, causing blindness. As the saying goes: "Treating Head Wind blinds the eyes."
In summary, Headache and Head Wind result from deficiency of Clear Yang and Essence Blood, failing to protect the head, allowing Turbid Yin and external pathogens to invade. Treating only the branch with dispersing/clearing methods yields only short-term benefit, further depleting the patient and worsening the condition. Zhang frequently used Ba Wei Wan (Eight-Ingredient Pill) plus Achyranthes (Niu Xi) and Schisandra (Wu Wei Zi), taken before meals morning and night. This lowers Turbid Yin, generates True Yin, extinguishes Thunder Fire, stores True Fire, and restores order, curing head disease and doubling spirit.