天津李氏妇，年过三旬，得脑充血头疼证。
病因 禀性褊急，家务劳心，常起暗火，因得斯证。
证候 其头疼或左或右，或左右皆疼，剧时至作呻吟。心中常常发热，时或烦躁，间有眩
晕之时，其大便燥结非服通下药不行。其脉左右皆弦硬而长，重诊甚实，经中西医延医二年，毫无功效。
诊断 其左脉弦硬而长者，肝胆之火上升也；其右脉弦硬而长者，胃气不降而逆行，又兼冲气上
冲也。究之，左右脉皆弦硬，实亦阴分有亏损也。因其脏腑之气化有升无降，则血随气升者
过多，遂至充塞于脑部，排挤其脑中之血管而作疼，此《内经》所谓血之与气，并走于上之厥证也。亦
即西人所谓脑充血之证也。其大便燥结不行者，因胃气不降，失其传送之职也。其心中发烦
躁者，因肝胃之火上升也。其头部间或眩晕者，因脑部充血过甚，有碍于神经也。此宜清其脏腑
之热，滋其脏腑之阴，更降其脏腑之气，以引脑部所充之血下行，方能治愈。
处方 生赭石（两半轧细） 怀牛膝（一两） 生怀山药（六钱） 生怀地黄（六钱）
天冬（六钱） 玄参（五钱） 生杭芍（五钱） 生龙齿（五钱捣碎） 生石决明（
五钱捣碎） 茵陈（钱半） 甘草（钱半）
共煎汤一大盅，温服。
方解 赭石能降胃平肝镇安冲气。其下行之力，又善通大便燥
结而毫无开破之弊。方中重用两半者，因此证大便燥结过甚，非服药不能通下也。盖大便不通，是
以胃气不下降，而肝火之上升冲气之上冲，又多因胃气不降而增剧。是治此证者，当以通其大便为
要务，迨服药至大便自然通顺时，则病愈过半矣。牛膝为治腿疾要药，以其能引气血下行也。而
《名医别录》及《千金翼方》，皆谓其除脑中痛，盖以其能引气血下行，即可轻减脑中之充血也。
愚生平治此等证必此二药并用，而又皆重用之。用玄参、天冬、芍药者，取其既善退热兼能滋阴也。
用龙齿、石决明者，以其皆为肝家之药，其性皆能敛戢肝火，镇熄肝风，以缓其上升之势也。用
山药、甘草者，以二药皆善和胃，能调和金石之药与胃相宜，犹白虎汤用甘草粳米之义，而山药且
善滋阴，甘草亦善缓肝也。用茵陈者，因肝为将军之官，其性刚果，且中寄相火，若但用药平之
镇之，恒至起反动之力，茵陈最能将顺肝木之性，且又善泻肝热，李氏《本草纲目》谓善治头痛，是
不但将顺肝木之性使不至反动，且又为清凉脑部之要药也。诸药汇集为方，久服之自有殊效。
复诊 将药连服二十余剂（其中随时略有加减），头已不疼，惟夜失眠时则仍疼，心中发热、
烦躁皆无，亦不复作眩晕，大便届时自行，无须再服通药，脉象较前和平而仍有弦硬之意，此宜注
意滋其真阴以除病根。
处方 生赭石（一两轧细） 怀牛膝（八钱） 生怀山药（八钱） 生怀地黄（八钱）
玄参（六钱） 大甘枸杞（六钱） 净萸肉（五钱） 生杭芍（四钱）
柏子仁（四钱） 生麦芽（三钱） 甘草（二钱）
共煎汤一大盅，温服。方中用麦芽者，借以宣通诸药之滞腻也。且麦芽生用原善调和肝气，
亦犹前方用茵陈之义也。
效果 将药又连服二十余剂（亦随时略有加减），病遂全愈，脉象亦和平如常矣。
A woman surnamed Li from Tianjin, over thirty years of age, suffered from a headache syndrome caused by cerebral congestion.
Etiology: Her disposition was narrow and irritable; she worried excessively over household affairs, often harboring latent internal heat (latent fire), which led to this condition.
Symptoms: Her headache occurred alternately on the left or right side, or on both sides simultaneously. During severe episodes, she would groan. She constantly felt heat in her heart/mind, occasionally experienced irritability, and had intermittent dizziness. Her stool was dry and constipated, requiring purgative herbs to evacuate. Both her left and right pulses were wiry, stiff, and long, feeling very solid upon heavy pressure. After two years of treatment by both Chinese and Western physicians, there was no effect.
Diagnosis: The wiry, stiff, and long pulse on the left indicates rising fire of the Liver and Gallbladder; the same pulse quality on the right indicates failing descent and counterflow of Stomach Qi, compounded by ascending Chong Qi. Ultimately, the wiry stiffness in both pulses signifies a deficiency in Yin. Because the Qi transformation of the Zang-Fu organs ascends without descending, blood rises with Qi excessively, leading to congestion in the brain. This congestion compresses the blood vessels in the brain, causing pain. This is the "Jue" syndrome described in the *Nei Jing* (Inner Canon) as "blood and Qi moving together upward." It corresponds to what Western medicine calls cerebral congestion. The dry constipation results from the failure of Stomach Qi to descend, losing its function of transportation and excretion. The irritability in the chest arises from the rising fire of the Liver and Stomach. The occasional dizziness in the head is due to excessive cerebral congestion affecting the nerves. Treatment should focus on clearing heat from the Zang-Fu, nourishing their Yin, and directing their Qi downward to guide the congested blood in the brain back down, thereby achieving a cure.
Prescription:
Sheng Zhe Shi (Ochre, half tael, finely crushed)
Huai Niu Xi (Achyranthes Bidentata Root, one tael)
Sheng Huai Shan Yao (Dioscorea Opposita Rhizome, six qian)
Sheng Huai Di Huang (Rehmannia Glutinosa Root, six qian)
Tian Dong (Asparagus Cochinchinensis Root, six qian)
Xuan Shen (Scrophularia Ningpoensis Root, five qian)
Sheng Hang Shao (Paeonia Lactiflora Root, five qian)
Sheng Long Chi (Dragon Teeth, five qian, crushed)
Sheng Shi Jue Ming (Haliotidis Shell, five qian, crushed)
Yin Chen (Artemisia Capillaris Herb, one and a half qian)
Gan Cao (Licorice Root, one and a half qian)
Decoct together in a large bowl of water, take warm.
Formula Analysis: Zhe Shi (Ochre) can direct Stomach Qi downward, calm Liver Yang, and stabilize Chong Qi. Its descending power also effectively relieves dry constipation without causing damaging breakthrough effects. Half a tael is used heavily here because the constipation is severe and requires medication to resolve. Generally, if stool is not evacuated, Stomach Qi cannot descend, and the rising Liver Fire and ascending Chong Qi are exacerbated by this failure. Therefore, the primary task in treating this syndrome is to unblock the bowels. Once the stool passes naturally after taking the medicine, more than half the illness will be cured. Niu Xi (Achyranthes Bidentata Root) is a key herb for treating leg ailments because it guides Qi and Blood downward. Both the *Mingyi Bielu* (Record of Famous Physicians) and *Qianjin Yifang* (Supplement to the Thousand Golden Formulas) state that it eliminates headaches in the brain, likely because guiding Qi and Blood downward reduces cerebral congestion. In my experience treating such cases, I always use these two herbs together, heavily dosed. Xuan Shen (Scrophularia Ningpoensis Root), Tian Dong (Asparagus Cochinchinensis Root), and Shao Yao (Paeonia Lactiflora Root) are used for their ability to clear heat and nourish Yin. Long Chi (Dragon Teeth) and Shi Jue Ming (Haliotidis Shell) are used because they enter the Liver channel; their nature can astringe and restrain Liver Fire, settle and extinguish Liver Wind, and slow their ascending momentum. Shan Yao (Dioscorea Opposita Rhizome) and Gan Cao (Licorice Root) are used because they harmonize the Stomach, making metallic/mineral herbs compatible with the Stomach, similar to the use of Gan Cao and Geng Mi (Rice) in Baihu Tang (White Tiger Decoction). Furthermore, Shan Yao nourishes Yin, and Gan Cao soothes Liver tension. Yin Chen (Artemisia Capillaris Herb) is used because the Liver is the "General," possessing a rigid and decisive nature, and harbors Ministerial Fire within. If only suppressed or pacified with medication, it often triggers a rebound effect. Yin Chen best conforms to the nature of Liver Wood and clears Liver Heat. Li Shizhen's *Bencao Gangmu* (Compendium of Materia Medica) states it treats headaches well; thus, it not only conforms to Liver Wood's nature to prevent rebellion but also serves as a crucial herb for cooling the brain. The combination of these herbs, taken over time, yields remarkable effects.
Follow-up Visit: After taking the prescription continuously for over twenty doses (with minor adjustments as needed), the headache ceased, except when insomnia occurred at night. The heat in the chest and irritability disappeared, and dizziness stopped. Bowel movements became regular without further need for purgatives. The pulse was milder than before but still retained some wiry and stiff qualities. At this stage, attention should be paid to nourishing True Yin to eliminate the root cause.
Prescription:
Sheng Zhe Shi (Ochre, one tael, finely crushed)
Huai Niu Xi (Achyranthes Bidentata Root, eight qian)
Sheng Huai Shan Yao (Dioscorea Opposita Rhizome, eight qian)
Sheng Huai Di Huang (Rehmannia Glutinosa Root, eight qian)
Xuan Shen (Scrophularia Ningpoensis Root, six qian)
Da Gan Gou Qi (Lycium Barbarum Fruit, six qian)
Jing Yu Rou (Cornus Officinalis Fruit, five qian)
Sheng Hang Shao (Paeonia Lactiflora Root, four qian)
Bai Zi Ren (Biota Seed, four qian)
Sheng Mai Ya (Barley Sprout, three qian)
Gan Cao (Licorice Root, two qian)
Decoct together in a large bowl of water, take warm. Mai Ya (Barley Sprout) is used to promote the circulation and prevent stagnation of the other herbs. Raw Mai Ya naturally harmonizes Liver Qi, serving a purpose similar to using Yin Chen in the previous formula.
Outcome: After taking the prescription continuously for another twenty-plus doses (with minor adjustments as needed), the patient recovered completely, and the pulse returned to a normal, peaceful state.