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The head is the region where clear yang qi gathers. External invasion by the six excess pathogens (Liu Yin, 六淫) or internal reversal of pathogenic qi from the zang-fu organs and meridians can all disturb the clear qi in the head, leading to pain through mutual combat. It is necessary to differentiate between internal and external causes, and deficiency and excess patterns. In an excess pattern, the patient's qi and blood are originally not deficient; they are invaded by external pathogens which either obscure their clarity or obstruct the meridians, or internal excess fire flares upward, causing blood stasis and phlegm stagnation that prevents free circulation, resulting in pain. This pain is necessarily severe, constituting an excess pattern. In a deficiency pattern, the patient's qi and blood are originally deficient; invaded by external pathogens or affected by internal turbid yin rising upward, although there may also be blood stasis and phlegm stagnation preventing circulation, the force of combat is weak, and the pain is not severe, constituting a deficiency pattern. (*Zhunsheng* states that when true qi is deficient and cold, and invaded by external cold-dampness, blood becomes sluggish and pulses cold, causing vessels to contract and tighten, pulling on small collaterals to cause pain, which stops with warmth.) In an excess pattern, pathogenic qi is excess while healthy qi is not deficient, so it can withstand attacking treatments. In a deficiency pattern, healthy qi is inherently deficient while pathogenic qi appears relatively excess; tonifying healthy qi still requires treating the pathogen. If the pathogen is also not excess, merely tonifying healthy qi will cause the pathogen to recede spontaneously. Among the six excess external pathogens, only wind, cold, and dampness can most effectively constrain yang qi. Fire, summer-heat, and dryness all belong to heat; contracting heat leads to sweating and qi leakage, and without wind, cold, or dampness attacking the exterior, it usually does not cause disease. However, extreme heat can also cause qi stagnation and full pulses, leading to pain. Internal pathogens vary but are all unified under wind (wind is essentially qi floating and rising). Because the highest point of the body (the vertex) is reachable only by wind, regardless of whether the pathogen is internal or external, wind herbs must be added to decoctions to guide them upward. Wind herbs with thin flavors belong to yang within yin, rising from earth to heaven, such as Shengma (Rhizoma Cimicifugae) and Bohe (Folium Menthae). For pain that feels like bursting and is unbearable, use Manjingzi (Fructus Viticis). When wind is in the Taiyang meridian, presenting as vertex pain extending to neck stiffness with a floating-tight pulse, use Qianghuo (Rhizoma et Radix Notopterygii) as the sovereign herb, adding Jiang (Zingiberis Rhizoma) and Congbai (Scleranthi Bulbus). (Congbai should be used with roots intact). When wind is in the Shaoyang meridian, presenting as temporal headache, bitter taste, and a string-taut-thin pulse, use Chaihu (Radix Bupleuri) as the sovereign herb, adding Jiang and Congbai. When wind is in the Yangming meridian, presenting as frontal headache extending to the eyes with a floating-long pulse, use Baizhi (Radix Angelicae Dahuricae) as the sovereign herb, adding Jiang and Congbai. The Shaoyin and Taiyin meridians' pulses return at the chest and neck, so they do not present with headache. Only the Jueyin meridian connects to the vertex, so vertex pain occurs, using Gaoben (Rhizoma Ligustici Chuanxiong) as the sovereign herb; if the pulse is deep and feet are cold with dry heaving and vomiting of foam, add Wuzhuyu (Fructus Evodiae) and Fuzi (Radix Aconiti Lateralis Preparata). Wind herbs are used because wind-wood qi is deficient and cannot ascend and disperse, allowing earth to become unconstrained and obstructed, causing pain (similar to saying Shaoyang clear qi fails to ascend and spleen dampness fails to descend). Thus, wind herbs are used to disperse it. If dispersion is excessive and pain worsens after taking wind herbs (excessive dispersion further depletes clear yang qi, turbid yin ultimately fails to descend, and exterior deficiency easily invites external aggression), one should tonify qi and secure the exterior with Shunqi Hezhong Tang. For all externally-contracted headaches, refer to *Shanghan Lun*. Headaches that persist for a long time are called Toufeng (Head Wind). Toufeng presents with sweating on the head and face, aversion to wind, intermittent pain that ceases and recurs; pain is severe the day before wind arises and lessens on windy days. (Clear yang qi is constrained, thus preferring openness and hating blockage. Wind represents the openness of weather. First constrained then open: the day before wind is exactly when constraint reaches its peak and seeks openness; wanting to open but unable to do so causes agitation and severe pain. On windy days, weather opens, human qi responds and opens, so pain lessens.) Due to internal constrained heat or phlegm-fire, pores are often loose, making wind entry easy; external cold binds internal heat, closing and reversing flow to cause pain. Physicians using acrid-warm herbs to disperse superficial cold may get temporary relief, but using heat to aid heat deepens the disease. One should purge fire and cool blood, assisted by acrid dispersants; Nanxing (Rhizoma Arisaematis), Can'erzi (Fructus Xanthii), Shichangpu (Rhizoma Acori Tatarinowii), and Tianma (Rhizoma Gastrodiae) are most appropriate. Prolonged Toufeng may damage the eyes (pathogens harm the orifices); Qingkong Gao is the main prescription. Add Banxia (Fructus Pinelliae Preparata) if there is phlegm; it treats various headaches. It is contraindicated for blood-deficiency headaches (see below) and true vertex pain. For internally-injured headaches, qi deficiency presents with tinnitus and vertigo (clear yang fails to ascend, yin fire rushes up), dysfunction of the nine orifices (qi cannot reach the nine orifices), a sensation of emptiness, aversion to labor, worsening pain upon movement, a large-deficient pulse, and relief only when the head is wrapped; use Sijunzi Tang (see Qi Deficiency) plus wind herbs. Blood-deficiency headache presents with twitching at the fish tail (posterior end of eyebrows near hairline) resembling fine tendon pulling, mild pain, a knotted or rapid pulse, and susceptibility to fright; use Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Lianqiao (Fructus Forsythiae), and Shudi (Radix Rehmanniae Preparata) each 2 qian, decocted in water, soaked with Bohe (Folium Menthae) powder 2 qian, inhale the vapor, take warm, rest quietly for effect. Or use Siwu Tang (see Blood Deficiency) plus wind herbs. For combined qi and blood deficiency, use Tiaozhong Yiqi Tang (see Fatigue/Labor Injury) plus Chuanxiong, Manjingzi, and Xixin (Herba Asari), yielding miraculous effects. Yin deficiency with fever causing pain in both temples indicates ministerial fire rushing up from below; use Liuwei Wan (see Deficiency Damage). Postpartum blood-stasis headache is due to diaphragmatic heat rushing up. Heat-jue headache prefers wind-cold even in severe cold, worsens in warmth or near smoke/fire; use Qingshang Xiehuo Tang, followed by Buqi Tang. Red swollen head and eyes, chest oppression, slight constipation, cold lower body especially feet (see Cold-Heat chapter Upper Heat Lower Cold section); use Jiji Jiedu Tang (see Cold-Heat). Phlegm-jue headache with dizziness, confusion, nausea; use Banxia Baizhu Tianma Tang (see Vertigo). Internal deficiency wind requires Tianma; phlegm requires Banxia. Huangqi (Astragali Radix) secures exterior and stops spontaneous sweating; Renshen (Ginseng Radix) tonifies qi; Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alismatis Rhizoma), Fuling (Poria) remove dampness; Chenpi (Citri Reticulatae Pericarpium) regulates middle and raises yang; Chaoqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus) digest food and cleanse stomach; Ganjiang (Zingiberis Rhizoma) removes cold; Huangbai (Phellodendri Cortex, wine-fried) treats latent fire causing dryness. Damp-heat pain presents with heaviness, nausea, and supraorbital pain; use Erchen Tang (see Phlegm) plus wind herbs. Food-stagnation headache presents with chest/epigastric fullness, sour throat, belching with rotten egg odor, food aversion; use Zhizhong Tang plus Sharen (Amomi Fructus) 1 qian, or Hongwanzi, or Pingwei San (see Food Injury) plus Zhishi (Fructus Aurantii Immaturus). Alcohol-injury headache with nausea, dizziness; use Gegua Jiexing Tang (see Food Injury). Headache at the vertex is lower deficiency and upper excess (cold-dampness rushing up). Pathology lies in Foot Shaoyin and Taiyang meridians, progressing to Kidney; cold-dampness enters from meridians to zang-fu. Kidney governs marrow, marrow connects to brain; cold entering marrow reverses up to brain, obstructing clear yang, causing brain pain connecting to teeth (teeth are surplus of bone). (This is almost True Headache). For damp-heat rushing up, bitter emetics are required; for mild cases, use Tou Ding San, insufflated into nose to extract phlegm-fluid. Heavy head like wrapping is due to dampness in the head; head is light/clear like heaven, hence light. Damp is heavy/turbid like earth, hence heavy. External damp obscuring feels like wrapping; induce slight sweat, not profuse, lest sweat leaves damp behind; use Hongdou Chubi San. External toxic inhalation headache cures with fried Xiangfu (Cyperi Rhizoma) alone. True Headache: hands and feet cold to joints, whole head and teeth pain, death morning to evening, untreatable. Give Heixi Dan (see Hiccups), moxa Baihui, aggressively administer Renshen, Chenxiang (Aquilariae Lignum Resinatum), Wu Mei (Fructus Mume), Fuzi; survival possible, but if Tianzhu (neck pillar) breaks, death is certain. (True Headache and True Heart Pain are both cold patterns, yin extinguishing yang).

Migraine. Old theory divides right side as heat and phlegm (heat uses Huangqin, phlegm uses Banxia, Cangzhu) because Yangming Stomach resides on right, prone to heat/phlegm. Left side as wind and blood deficiency (wind uses Jingjie, Bohe; blood deficiency uses Chuanxiong, Danggui, Juhua) because Liver Wood governs wind residing on left, and left belongs to blood. However, do not rigidly adhere. Raw radish juice, instilled supine into nose: left pain into right nostril (left pain implies left obstruction, instillation ineffective there; right is open, so instill right to penetrate left, opening both), right pain into left nostril. BiBo (Piperis Longi Fructus) disperses heat. Zhu Dan (Suis Fel) clears heat. Insufflate. Chuanxiong San, Xixin San. Use Chuanxiong, Chaihu as sovereign, assist with Manjingzi, Cang'er Ye, Shengma, Gancao, Cong, Jiang. Constipation: use Dahuang to purge. Externally: Bamazi (Ricini Semen) 5 qian, Dazao 15 pieces, mash into paste, spread on cotton paper, roll into tube with chopstick, insert into nose, wait for discharge of mucus, pain stops. Alternatively, Shigao 2 qian, Niubangzi 2 qian, powder, taken with wine until drunk, cures immediately.

Leifeng Feng (Thunderhead Wind). Headache with nodules or sound like thunder in head (wind action makes sound like reeds); use Qingzhen Tang. Unconsciousness: Difuzi, Ginger mashed, taken with hot wine to induce sweat and cure. Zhang Hezi uses Chatiao San (see Food Injury), emesis, then Shenxiong Wan (see Swelling) purgation, then Wu Jing Wan (see Blood), and Yufeng Bingzi. Weak patients use Liangge San (see Fever), Xiaofeng San to clear heat. Phlegm-heat generating wind noise: Banxia (Yazao, Ginger juice boiled, 1 liang), Dahuang (wine-soaked, wet-paper wrapped baked, thrice, 2 liang), Baijiangcan (Bombyx Batryticatus), Lianqiao, Juhong, Jiegeng, Tianma (each 5 qian), Pianqin (wine-fried, 7 qian), Bohe Ye (3 qian), Baizhi, Qingmengshi, Fencao (each 1 qian), powder, steamed pill with rice cake, mung-bean size, swallow 2 qian with tea before bed, stop when phlegm clears, then take phlegm-clearing fire-purging meds. Qi carrying liver fire making noise: Jiawei Xiaoyao San (see Depression) is best. Sound like insects named Tianbaiyi: Tea seed powder insufflated into nose.

Datou Feng (Great Headache). Head swollen like a bucket, commonly called Datou Wen (Big Head Plague), caused by epidemic qi. Red swollen head/face or pustules. Starting at nose/forehead belongs to Yangming; starting at ears/temples belongs to Shaoyang; starting at back of head/neck belongs to Taiyang. If all three yang meridians are affected, simultaneous onset occurs; treatment forbids urgent purgation (fear of leaving high-level pathogens). Should start slow then fast: reduce heat (Huangqin, Huanglian etc.), detoxify (Lianqiao, Niubangzi, Banlangen etc.), treat slowly (sip slowly, take after meals, or wine-fry to keep medicine ascending not descending quickly, all meaning "slow"). Wait until stool is heat-bound, upper jiao heat gathers in middle jiao, then purge, selecting among Three Chengqi Decoctions (see Constipation). If toxin forms induration not resolving, pus will form; externally apply Boye (Cupressi Cacumen) mixed with earthworm manure mud. Or well-bottom mud mixed with Dahuang, Mangxiao powder. Red swollen nodes: needle bleed to cure.

Head shaking/dizziness belongs to wind-heat; wind-fire moves. Use Qianghuo, Chuanxiong, Baizhi, Gaoben, Cangzhu, Xixin, Gancao, Tianma. If due to Liver/Kidney blood deficiency causing fire/wind, nourish blood. Also, internal pain causes head shaking; heart exhaustion causes head shaking, appearance like coal dust, staring straight ahead indicates death. Spasm disease also causes head shaking.

Toufeng Xie (Head Wind Dandruff). Luo Qianfu says Liver wind excess, Metal overcomes it, causing snow-like skin on head. (Hard to explain. Generally, wind-heat steams upward, fluids dry, turning into white scales). Constipation: Xieqing Wan (see Stroke), deficiency: Renshen Xiaofeng San.

Meilinggu Tong (Supraorbital Pain). External pathogens constrained into wind-heat, attacking brain, passing through eye system over brow bone to eyes (eye system connects to brain, passes brow bone). Or internal wind-heat/damp-phlegm attacking; use Xuanqi Tang. (Wind-heat: clear upper scatter phlegm, Erchen Tang plus wine-Huangqin, Baizhi. Wind-cold: Qiangwu San). Liver deficiency: pain in orbital bone upon seeing light, Shengshu Dihuang Wan (Liver blood deficiency, fire excess). Liver meridian fluid retention: brow bone pain, eyes cannot open, quiet day/worse night (damp is yin pathogen, worse at night); use Daotan Tang (see Phlegm), or Xiao Xiongxin Tang plus Banxia, Juhong, Nanxing, Fuling.