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Luo Qianfu treated Advisor Bo. The patient was sixty-one years old. Initially, he suffered from dizziness, stuffiness, and slight headache. The physician treated it as Taiyang disease (disease of the Taiyang channel), and after inducing sweating, the pain became more severe. After inducing sweating again,
the patient could no longer bear the pain. A different physician prescribed medication, but the formulas were mostly similar. The pain became so severe that he could not lie down, accompanied by aversion to wind and cold, and loss of appetite. Luo Qianfu examined him and found the pulse in all six positions wiry, thin, and faint. He had shortness of breath and was reluctant to speak. The *Neijing* states: "In spring, diseases manifest in the head." This year, the clear Qi of heaven is weak, and the Clear Yang cannot ascend to the head and face, causing dizziness and stuffiness. Moreover, this syndrome originally lacked exterior pathogenic factors. Excessive sweating further depleted the Clear Yang Qi, preventing it from nourishing the upper body and securing the exterior. Thus, the headache and aversion to wind and cold occurred, along with shortness of breath, weakness, and anorexia. He prescribed Huangqi (Astragali Radix) 1.5 qian, Renshen (Ginseng Radix) 1 qian, Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) 0.7 qian, Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix), and Baishao (Paeoniae Radix Alba) each 0.5 qian, Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) each 0.3 qian, Xixin (Asari Radix et Rhizoma), Chuanxiong (Chuanxiong Rhizoma), and Manjingzi (Vittariae Spora) each 0.2 qian. It was named Shunqi Hezhong Tang (Regulating Qi and Harmonizing Middle Decoction). Taken after meals, the symptoms alleviated after one dose and resolved after a second dose.

Dairen treated a woman who had suffered from unilateral headache for five to seven years. She had dry stool constipation, red and swollen eyes, and vertigo. She had tried every medicine for treating Head Wind without success, and her head had undergone countless acupuncture treatments. Dairen examined her and found the pulse rapid, forceful, and strong, indicating severe Wind-Heat. The pain at the temporal region belongs to the Sanjiao Ministerial Fire channel, caused by the excess of Yangming Dry Metal. When Dry Metal overacts on Liver Wood, Liver Qi becomes stagnant. Stagnant Liver Qi leads to Qi and Blood congestion. Congestion blocks the upper and lower flow, causing dryness and accumulation in the middle jiao, eventually leading to blindness. He prescribed Dachengqi Tang (Major Order the Qi Decoction) with doubled Mangxiao (Natrii Sulfas), resulting in more than twenty purgative stools. Subsequently, she took Qixuan Wan (Seven-Ventilation Pill) and Shengong Wan (Divine Merit Pill) to moisten the intestines. Her vision cleared, her head felt light, and the dryness and accumulation resolved, leading to recovery.

Xue Lizhai treated Liu Shangbao. When angry, his Taiyang area (vertex/supraorbital) would hurt. He prescribed Xiaochaihu Tang (Minor Bupleurum Decoction) plus Fuling (Poria) and Zhizi (Gardeniae Fructus) to clear Liver Fire, followed by Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish Kidney Water. The condition did not recur.

Li Shicai treated Jiang Tian'an, Shaozai. He suffered from splitting headaches, heavy dizziness, and restlessness. Treatments with Wind-dispelling, Blood-invigorating, and Phlegm-resolving medicines had failed for a long time. Li said, "The Chi position pulse is faint, and the Cun position pulse is slippery. This indicates Kidney deficiency with water flooding transforming into Phlegm." He prescribed Dihuang (Rehmanniae Radix) 4 qian, Shanyao (Dioscoreae Rhizoma), Danpi (Moutan Cortex), and Zexie (Alismatis Rhizoma) each 1 qian, Fuling (Poria) 3 qian, and Chenxiang (Aquilariae Lignum) 0.8 fen. Four doses were taken daily. Within two days, the symptoms reduced by six or seven tenths. He then used Qiwu Wan (Seven-Ingredient Pill) delivered with Renshen Tang (Ginseng Decoction). After five days, the pain disappeared completely.

Sun Dongsu treated the wife of Magistrate Cai Leming. She suffered from splitting headaches; slight movement of the hair roots caused pain to spread over the entire head. She fainted and lost consciousness, recovering after half an hour. Her whole body ached. She felt fullness and oppression in the chest and diaphragm, and drinking water stopped in the diaphragm without going down. The day before, she vomited clear fluid several times and expelled three roundworms. The condition originated from anger. Now, she sometimes had aversion to wind, sometimes aversion to heat, sometimes thirst, sometimes no thirst. Her stool was constipated. The pulse in all six positions was slippery, large, and forceful. Sun said, "This is Phlegm-Jue Headache." First, he used Huoxiang Zhengqi San (Agaricus Rectifying Qi Powder) to stop vomiting. Then, he used Niuhuang Wan (Calculus Bovis Pill) and Heihu Dan (Black Tiger Elixir) to clear the mind and open the orifices. The headache remained severe. He then used Tianma (Gastrodiae Rhizoma) and Gaoben (Ligustici Chuanxiong-Rhizoma et Radix) each 3 qian, Banxia (Pinelliae Rhizoma) 2 qian, Mahuang (Ephedrae Herba), Bohe (Menthae Haplocalycis Herba), Baizhi (Angelicae Dahuricae Radix), Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens), and Congbai (Allii Fistulosi Bulbus) decocted and administered. After obtaining slight sweating, the headache subsided slightly. Taking it again at night, by Wu Geng (3-5 AM), the pain reduced by more than half, but mental clarity was not fully restored. Sun stated, "There is excessive Phlegm in the Middle Jiao; purgation is necessary." He used Banxia (Pinelliae Rhizoma) 5 qian and Bashuang (Crotonis Seminis Extract) 1 fen, made into pills with flour paste. Each dose consisted of thirty pills, taken with Ginger Decoction. In the afternoon, she had three bowel movements consisting of thick, sticky phlegmatic accumulation. Consequently, her appetite improved, and other symptoms were manageable. However, her whole body still ached slightly. He switched to Erchen Tang (Two-Aged Decoction) plus Qianhu (Peucedani Radix), Gaoben (Ligustici Chuanxiong-Rhizoma et Radix), Bohe (Menthae Haplocalycis Herba), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Zhike (Aurantii Fructus Immaturus), and Shichangpu (Acori Tatarinowii Rhizoma) for regulation, leading to stability.

Monk Shenrou treated a noble youth, aged thirty. Previously, due to toothache, he took Shigao (Gypsum Fibrosum) 3 qian decocted. Soon after, his entire head became swollen and painful, with severe gingival ulceration and swelling. The swelling subsided slightly at dawn because Yang Qi had arrived. Examination revealed the Right Guan pulse was fine and choppy, the Left Guan pulse was surging, and the Left Chi pulse was also choppy. Shenrou said, "Qi must be guided downward to harmonize the pulse." He formulated Qianghuo Sanhuo Tang (Notopterygium Dispersing Fire Decoction): Qianghuo (Notopterygii Rhizoma et Radix) wine-fried 0.5 fen, Fangfeng (Saposhnikoviae Radix) 0.3 fen, Jiulianlian (Wine-processed Coptidis Rhizoma) 0.1 fen, Jiuqingqin (Wine-processed Scutellariae Radix) 0.2 fen, Bai Fuling (Poria) 1 qian, Renshen (Ginseng Radix) 2 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 0.5 fen, Banxia (Pinelliae Rhizoma) 1 qian, Pogu Zhi (Evodiae Fructus) 1 qian, and Gouqizi (Lycii Fructus) 1 qian. After two doses, the fine and choppy pulse became coarse and large, indicating Yang Qi descending. The headache subsided slightly. This shows that anterior headache was due to lack of Yang in the Lower Jiao with Yin Fire rushing upward. After eight doses, the headache ceased completely. Gingival swelling persisted, but the pulse became more harmonious. Shenrou said, "It is nearly cured. Yang Qi has reached the site of illness." Indeed, after four or five days, a small amount of pus discharged, and he recovered.

Yu Zhen commented: Luo's case is Qi-deficiency headache. Zhang's case (Note: Text says "Zhang An", likely referring to a specific case not fully detailed here or a typo for another name, translated literally) is Accumulated-Heat headache. Xue's case is Liver-Fire headache. Li's case is Kidney-Deficiency headache. Sun's case is Phlegm-Jue headache. Monk's case is Ascending-Yang-not-Descending headache. Beyond these six types, there are Wind-pain cases: pulling sensations, aversion to wind, nasal congestion, and eye distension. There are Cold-pain cases: aversion to cold, shivering, pale face, and cold limbs. There are Damp-pain cases: heavy headache worsening on cloudy days, or limb swelling and edema of face and eyes. These are all external causes. Internal causes include, besides Qi deficiency, more frequently Blood deficiency. Besides accumulated Phlegm, there is also accumulated Food stagnation. Zhu Danxi said, "Headaches in fat people are mostly due to Damp-Phlegm. Headaches in thin people are mostly due to Blood deficiency with Fire." This is indeed essential wisdom. However, although etiologies vary, they all involve Wind. Without Wind, there is only vertigo, not pain. Therefore, ancient formulas like Chuanxiong Chatiao San (Chuanxiong Tea-Tonifying Powder) and Da Zhuifeng San (Great Wind-Chasing Powder) are quite effective. Chronic pain becomes Head Wind, with even more complex formulas, which cannot be listed here. True Headache (Zhen Tou Tong) is a fatal syndrome. External moxibustion at Baihui (GV20) and internal administration of Shenfu Tang (Ginseng and Aconite Decoction) or Heixi Dan (Black Tin Elixir) might hope for reversal, though untested. Ordinary headaches can also be fatal. Gao Yangsheng said, "Headache with short and choppy pulse indicates death." I have seen this in my life. Simultaneous headache and abdominal pain have five syndromes: Odor-Toxin, Alcohol Injury, Dampness Injury, Acclimatization Failure, and Toxin from Sores entering the abdomen. There is a pattern where headache stops then abdominal pain starts, and vice versa. This belongs to Spleen Yin Deficiency, with Stomach Fire moving up and down with Qi. Use Chuanxiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Muxiang (Aucklandiae Radix), Xiangfu (Cyperi Rhizoma), Huanglian (Coptidis Rhizoma), and Congbai (Allii Fistulosi Bulbus). For headaches unresponsive to various medicines, with worsening pain, it may be due to Du Mai (Governing Vessel) pathology, suitable for Rongzhu Dan (Velvet Antler and Cinnabar Elixir), followed by Xiangrong Bawei Wan (Fragrant Velvet Eight-Ingredient Pill). There is also Lei Tou Feng (Thunder Head Wind), a separate category, caused by internally constrained Phlegm-Fire and externally bound Wind-Heat. Da Tou Feng (Big Head Wind) is equivalent to Da Tou Wen (Big Head Plague). It may or may not hurt, may ulcerate or resolve spontaneously, with life and death hanging in the balance. Pain in the supraorbital ridge is due to Foot-Shaoyang Wind-Heat and Phlegm, most damaging to the eyes. Suppuration in both ears is critical. One should induce vomiting with a bowl of strong tea, followed by Upper-Clearing medicines such as Xuanqi Tang (Select Extraordinary Decoction) or Qingkong Gao (Clear Sky Ointment). Women focusing on needlework often suffer sore and aching supraorbital ridges, requiring nourishment of Yin and Blood.

[Appendix] Dairen treated a monk with hot and painful head, and photophobia. He wrapped cloth around the top of his head, placed ice inside, and changed it multiple times daily. This was Heat accumulation in the Three Yang channels. He then burned charcoal in a warm room to induce sweating and performed emesis. The three methods were applied simultaneously, and he recovered in seven days.

A person with weak Qi in childhood was frequently moxa-burned at Qihai (CV6) and Zusanli (ST36). As an adult, he developed Heat-Jue Headache. Even in severe winter, he preferred north winds to stop the pain. If he stayed in warm places or near fire/smoke, the pain would start. This was due to moxibustion. Li Dongyuan treated him with Qing Shang Xie Huo Tang (Clear Upper and Drain Fire Decoction), and he recovered soon.

A young unmarried woman working near a window suddenly suffered severe headache, unresponsive to medicines. A physician observed carefully and saw geese outside the window. He deduced that goose lice flew into her ear and bit her, causing pain. He poured concentrated rice straw decoction into her ear. The lice died and came out, and the pain ceased.

A person suffered from Head Wind. From the jawline left and right, it felt like two earthworms slowly crawling into the ears, then branching up to the vertex from both ears, crossing left to right and right to left. Two lumps rose on the vertex, resembling pig kidneys. The front and back of the head sounded like drumbeats when tapped, with severe cold pain. Thick cotton pads were needed for wrapping. Severe pain rendered the limbs useless. Medical efforts failed. Later, a formula was obtained: Siwu Tang ingredients each 1 qian, Zaogelaci (Gleditsiae Sinensis Spina) 1 qian, Bibo (Dioscoreae Hypoglaucae Rhizoma) 4 liang, and Pork Meat 4 liang. Decocted in water, filtered, and eaten with the juice. After twenty doses, symptoms reduced by three-tenths. After forty doses, by six-tenths. After one hundred doses, stability was achieved. Jiang said, "This is not Head Wind. The person previously suffered from Syphilis (Mei Chuang). The raised lumps on the head are toxins condensed from Calomel (Qingfen). Therefore, Bibo is the chief herb. Siwu Tang nourishes Blood. Zaogelaci acts as a guide. The toxin is deep, hence prolonged administration yields results."

Yu Zhen commented: Bibo should be Tuberosum Dioscorea Spongiosa Rhizoma (Tu Fuling). Guangji Biji has a better formula for Syphilis headache. However, treatment must rely on the pulse. Alchemical formulas have varying efficacy, and recording them all is impossible. Although the above four cases do not record pulses, the syndromes are difficult, and the methods are rigorous. They deserve selection. Others, such as Jiang Huangnan treating his aunt with Buzhong Yiqi Tang plus Chuanxiong, Xixin, and Manjingzi, and Zhai Wenbing treating Mother Lu with first Yiqing Wan then Buzhong Yiqi Tang, only describe symptoms and should not be imitated. Mother Lu's case was very complex; Yiqing Wan cured her in one dose. Is this really so?

Furthermore, the History of Southern Tang records that Chancellor Feng Yanji suffered from persistent brain pain for days. Imperial Physician Wu Tingshao secretly asked the kitchen staff, "What does the Chancellor usually crave?" They replied, "He eats much pheasant and partridge." Tingshao said, "I know the cause." He administered Gandou Tang (Sweet Bean Decoction), and he recovered. This is because pheasants and partridges eat black beans and Pinellia, so this formula resolves the toxicity.

Yu Zhen commented: This is similar to the case in Mingyi Lu where Lady Wang suddenly developed black spots on her face, spreading over time. Experts said the cause was daily eating turtle doves, which eat Pinellia seedlings, leading to poisoning. They used ginger slice crushed for juice, dried the residue, and made pills with ginger juice paste. One month of服用 cured her. The ingested object was the same, but the medicinal properties (acrid, sweet, warm, neutral) differed.