脉
头痛阳强，浮风紧寒，风热洪数，湿细而坚。气虚头痛，虽弦必涩。痰厥头
痛，肾厥坚实。又曰∶头痛短涩应须死，浮滑风痰必易除。寸口紧急，或短，或浮，或弦，皆主头痛。
病
东垣曰∶东风生于春，病在肝俞、在项颈，故春气者，病在头。又诸阳会于头面，如足太阳膀胱之脉，
起于目内 ，上额交巅之上，入络、脑，还出别下项，病冲头痛；又足少阳胆之脉，起于目锐 ，上抵头角，
病则头角额痛。夫风从上受之，风寒伤上，邪从外入，客于经络，令人振寒头痛，身重恶寒，治在风池、
风府，调其阴阳，不足则补，有余则泻，汗之则愈，此伤寒头痛也。头痛耳鸣，九窍不利者，肠胃之所生，
乃气虚头痛也。心烦头痛者，病在耳中，过在手巨阳、少阴，乃湿热头痛也。如气上不下，头痛癫疾者，下
虚上实也，过在足少阴巨阳，甚则入肾，寒湿头痛也。如头半寒痛者，先取手少阳、阳明，后取足少阳、阳
明，偏头痛也。有真头痛者，甚则脑尽痛，手足寒至节，死，不治。有厥逆头痛者，所犯大寒，内至骨髓，髓
者头脑为主，脑逆故令头痛，齿亦痛。凡头痛者，皆以为风，治之者总其大体而言之也，高巅之上，
惟风可到。故味之薄者，阴中之阳，乃自地升天者也。然亦有三阴、三阳之异。
治
故太阳头痛，恶风脉紧，川芎、羌活、独活、麻黄之类为主；少阳经头痛，脉弦细，往来寒热，柴胡
为主；阳明头痛，自汗，发热恶寒，脉浮缓长实者，升麻、干葛、白芷、石膏为主；太阴头痛，必有痰，
体重，或腹痛，为痰癖，其脉沉缓，苍术、半夏、南星为主；少阴头痛，三阴、三阳经不流行，而足寒气逆，
为寒厥，其脉细，麻黄、细辛、附子为主；厥阴头痛，或吐痰沫厥冷，其脉浮缓，吴茱萸汤主之。血虚头痛，
当归、川芎为主；气虚头痛，黄 、人参为主；气血俱虚头痛，调中益气汤，少加川芎、细辛、蔓
荆子，其效如神。白术半夏天麻汤，治痰厥头痛药也；羌活附子汤，治厥阴头痛药也。如湿气在头者，以苦
吐之，不可执方而治。先师尝病头痛，发时两颊青黄，眩晕眼不欲开，懒言，身体沉重，兀兀欲吐。洁古曰∶此
厥阴、太阴合病，名曰风痰，以《局方》玉壶丸治之，更灸侠溪穴，即愈。
丹溪云∶多主于痰，其痛甚者火多，诸经气滞，亦能头痛。劳役下虚之人，似伤寒发热汗出，两太
阳作痛，此相火自下冲上，宜补中益气，多加川芎、当归，甚者加知母、蔓荆子。又曰∶自鱼尾上
攻而痛，属血虚，川芎、当归、酒黄柏。
偏头风，在右属痰，属热。痰用苍术、半夏，热用酒片芩。在
左属风，属血虚。风用荆芥、薄荷，血虚用芎、归、芍药、酒黄柏。
节斋云∶久病头痛，略感风寒便发，寒月须重绵浓帕包裹
者，此属郁热而标寒。世人不识，悉用温辛散之药，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，散其标之寒热，然以热济热，病本益深，恶寒愈甚矣。惟当泻火凉血，而佐以辛温
散表之剂，以从法治之，则病可愈，而根可除也。
方
春用香苏散，加川芎、白芷、羌活（胡恒斋传）
夏用五苓散，加香薷、浓朴、扁豆、羌活；
秋用金佛草散，加桔梗、石膏、防风、羌活；
冬用十神汤，加羌活（随时倍真羚羊角，服之如神）
川芎茶调散〔批〕（按此方治风气头痛之剂） 治诸风上攻，头目昏沉，
偏正头痛，鼻塞声重，憎寒壮热，肢体烦，肌肉蠕动，膈热痰盛，妇人血攻注太阳穴痛，但感风气皆然。
南薄荷（四钱） 香附米（四钱，炒） 荆芥穗 川芎（各二钱） 羌活 白
芷甘草（炙，各一钱） 防风（七钱半）
上为细末，每服二钱，食后茶清调下，姜、葱煎服亦可。一方加菊花一钱，细辛五分，僵蚕三分，
蝉蜕三分，名菊花茶调散。
白术半夏天麻汤〔批〕（按此方治痰厥头痛之剂） 治痰厥头痛，其证眼黑头眩，恶心烦闷，气短促
上喘，无力以言，心神颠倒，目不敢开，如在风云中，头苦痛如裂，身重如山，四肢厥冷，不得安卧，
此乃胃气虚损停痰而致也。
黄 （三分半） 人参（三分半） 白茯苓（三分半） 白术（五分） 陈皮（七分半）
半夏（汤泡，姜汁炒，三分半） 神曲（炒，五分） 麦芽（炒，七分半） 苍术（米泔浸
炒，三分半） 干姜（炒黑，二分） 黄柏（一分半，酒洗） 泽泻（二分半） 天麻（三分半）
上锉一剂，生姜三片，水煎，食前热服，可一剂而愈。
当归补血汤〔批〕（按此方治血虚头痛之剂） 治血虚头痛。
当归 生地黄 川芎 白芍（各一钱） 防风（五分） 荆芥（四分） 本
（四分） 黄芩（一钱，酒炒） 柴胡（五分） 蔓荆子（五分）
上锉一剂，水煎服。
补中益气汤〔批〕（按此方治气虚头痛之剂） 治气虚头痛。
方见内伤门，根据本方加川芎、白芷、细辛、蔓荆子。
调中益气汤〔批〕（按此方治气血两虚头痛之剂） 治气血俱虚头痛，其效如神。
陈皮（三分） 黄柏（酒炒，三分） 升麻 柴胡（去芦，各四分） 人参 甘草
（炙，各六分） 细辛（二分） 黄 （一钱） 川芎（六分） 蔓荆子（三分）
上锉作一服，水二钟，煎至一钟，去渣温服。一方有木香二分，无黄柏。如大便虚，坐不得，或了
而不了，腹中逼迫，此血虚、血涩也，加当归身五分。
芎芷散 治远年近日偏正头风，疼痛难忍，诸药不效，收功如神。
川芎（三钱） 白芷（三钱）
上为末，黄牛脑子一个，擦药在上，瓷器内加酒顿熟，乘热和酒食之，尽量一醉，睡后酒醒，其疾如失。
都梁丸 治偏正头风，一切头痛。
香白芷（二两，切碎晒干）
上为细末，炼蜜为丸，如龙眼大。每服二三丸，食后细嚼，茶清下。
补血祛风汤（秘方） 治妇人头风，十居其半，每发必掉眩，如立
舟车之上，盖因肝血虚损，风邪乘虚而袭之耳。
当归 川芎 生地黄 防风 荆芥 细辛 本 蔓荆子 半夏 石膏 甘草 旋复花
上锉，姜、枣煎，食后服。一方加羌活
加减芎辛汤（秘方） 治头风攻目。
川芎 白芷 石膏 本 细辛 皂角 羌活 防风 荆芥 桔梗 薄荷 甘草 菊花 蔓荆子
上锉，水煎，食后服。
选奇方 治眉棱骨痛，属风热与痰，痛不可忍者。
羌活 防风（各二钱） 甘草（一钱，夏生、冬炙用） 酒片芩（一钱半，冬不用，甚者冬亦可用）
上锉，水煎，食后服。一方加姜制半夏二钱。
回首散 治头项强急，筋痛，或挫枕转项不得者，用乌药顺气
散，方见中风门，加羌活、独活、木瓜。
Pulse Diagnosis
Headache with a strong yang pulse indicates excess; a floating pulse indicates wind, a tight pulse indicates cold; a surging and rapid pulse indicates wind-heat, while a thin and firm pulse indicates dampness. For headache due to Qi deficiency, the pulse may be wiry but must be choppy. For headache due to Phlegm-Jue (reversal), the pulse is firm and forceful. It is also said: Headache with a short and choppy pulse indicates a fatal prognosis; headache with a floating and slippery pulse indicates wind-phlegm, which is easy to cure. An urgent pulse at the Cun Kou (radial artery), or one that is short, floating, or wiry, all indicate headache.
Pathogenesis
Li Dongyuan stated: East wind arises in spring, affecting the Liver Shu point and the neck, so spring pathogens often affect the head. Furthermore, all Yang meridians converge on the face and head. For instance, the Foot-Taiyang Bladder Meridian originates from the inner canthus, ascends to the forehead, intersects at the vertex, enters to connect with the brain, emerges again to descend separately along the neck; when diseased, it causes rushing headache pain. Similarly, the Foot-Shaoyang Gallbladder Meridian originates from the outer canthus, ascends to reach the temporal angle; when diseased, it causes pain in the temporal angle and forehead. Wind pathogens are acquired from above; wind-cold damages the upper body, pathogenic factors enter from the exterior and lodge in the collaterals, causing chills, headache, heavy body, and aversion to cold. Treatment should focus on Fengchi (GB20) and Fengfu (GV16) points, regulating Yin and Yang: tonify if deficient, sedate if excessive, and sweating will lead to recovery. This is headache due to Cold Damage (Shanghan). Headache accompanied by tinnitus and dysfunction of the nine orifices arises from the stomach and intestines, constituting headache due to Qi deficiency. Heart irritability with headache indicates pathology in the ears, involving the Hand-Taiyang Small Intestine and Hand-Shaoyin Heart meridians, constituting headache due to damp-heat. If Qi rises but does not descend, causing headache and epilepsy, this is deficiency below and excess above, involving the Foot-Shaoyin Kidney and Foot-Taiyang Bladder meridians; if severe, it affects the Kidneys, constituting headache due to cold-dampness. If there is cold pain on one side of the head, first treat the Hand-Shaoyang Sanjiao and Hand-Yangming Large Intestine meridians, then the Foot-Shaoyang Gallbladder and Foot-Yangming Stomach meridians; this is hemicephalic headache (pian tou tong). True headache (Zhen Tou Tong) involves severe pain throughout the brain, with cold limbs extending to the joints; this is a death syndrome and is untreatable. Jue-ni headache results from exposure to severe cold, which penetrates to the bone marrow. Since the brain is the master of the marrow, rebellious brain Qi causes headache, and the teeth also hurt. Generally, headaches are attributed to wind, as only wind can reach the high summit of the head. Therefore, herbs with thin flavors belong to "Yang within Yin" and ascend from earth to heaven. However, there are distinctions among the Three Yin and Three Yang meridians.
Treatment Principles
Therefore, for Taiyang headache with aversion to wind and a tight pulse, use Chuanxiong, Qianghuo, Duhuo, Mahuang, etc., as main agents; for Shaoyang headache with a wiry-thin pulse and alternating chills and fever, use Chaihu as the main agent; for Yangming headache with spontaneous sweating, fever, aversion to cold, and a floating-slow-long-excess pulse, use Shengma, Gan Ge (Gegen), Baizhi, and Shigao as main agents; for Taiyin headache with phlegm, heavy body, or abdominal pain (phlegm-stagnation), and a deep-slow pulse, use Cangzhu, Banxia, and Nanting as main agents; for Shaoyin headache where Qi and Blood do not circulate through the Three Yin and Three Yang meridians, with cold feet and rebellious Qi (Cold Jue), and a thin pulse, use Mahuang, Xixin, and Fuzi as main agents; for Jueyin headache with vomiting of frothy saliva and cold limbs, and a floating-slow pulse, use Wuzhuyu Tang. For blood-deficiency headache, use Danggui and Chuanxiong as main agents; for Qi-deficiency headache, use Huangqi and Renshen as main agents; for combined Qi and blood-deficiency headache, use Tiaozhong Yiqi Tang with small amounts of Chuanxiong, Xixin, and Manjingzi, yielding miraculous effects. Baizhu Banxia Tianma Tang treats phlegm-Jue headache; Qianghuo Fuzi Tang treats Jueyin headache. If dampness resides in the head, use bitter herbs to induce vomiting; do not adhere rigidly to fixed formulas. My predecessor once suffered from headache; upon onset, his cheeks were blue-yellow, he experienced vertigo, reluctance to open his eyes, lethargy, heavy body, and a sensation of impending vomiting. Jiegu said: This is a combined disease of Jueyin and Taiyin, named Wind-Phlegm. Treat with Yu Hu Wan from the *Ju Fang*, and moxa Xiashi (GB43); he recovered immediately.
Zhu Danxi said: Headaches are mostly due to phlegm; severe pain often involves fire. Qi stagnation in any meridian can also cause headache. In individuals weakened by labor and lower deficiency, resembling Cold Damage with fever and sweating, pain in both Taiyang regions occurs due to Minister Fire rushing upward from below. Tonify Middle and boost Qi with Bu Zhong Yi Qi Tang, adding Chuanxiong and Danggui; if severe, add Zhimu and Manjingzi. He also said: Pain attacking upward from the fish tail (outer canthus) belongs to blood deficiency, treated with Chuanxiong, Danggui, and wine-processed Huangbai.
Hemicephalic wind (Pian Tou Feng) on the right belongs to phlegm and heat. Use Cangzhu and Banxia for phlegm; wine-processed Huangqin for heat. On the left, it belongs to wind and blood deficiency. Use Jingjie and Bohe for wind; Chuanxiong, Danggui, Shaoyao, and wine-processed Huangbai for blood deficiency.
Jiezhang said: Chronic headache triggered by slight wind-cold exposure, requiring thick wrapping in winter, belongs to internal constrained heat with external cold. People fail to recognize this, using warm-acrid dispersants which provide temporary relief, mistakenly identifying it as cold. They do not realize that due to underlying constrained heat and open pores, wind enters easily; external cold binds internal heat, causing obstruction and pain. Acrid-hot herbs can open obstructions and disperse superficial cold/heat, but adding heat to heat deepens the root disease and worsens aversion to cold. One should purge fire and cool blood, assisted by acrid-warm exterior-dispersing agents, following correct treatment principles, to cure the disease and eradicate its root.
Formulas
In Spring, use Xiang Su San, adding Chuanxiong, Baizhi, Qianghuo (transmitted by Hu Hengzhai).
In Summer, use Wu Ling San, adding Xiangru, Houpo, Bian Dou, Qianghuo;
In Autumn, use Jin Fo Cao San, adding Jiegeng, Shigao, Fangfeng, Qianghuo;
In Winter, use Shi Shen Tang, adding Qianghuo (add real Lingyangjiao proportionally for divine effect).
Chuanxiong Chatiao San [Commentary] (According to this commentary, this formula treats headache due to wind-pathogens.) Treats various wind pathogens attacking upward, causing dizziness and heaviness of head and eyes, hemicephalic or frontal headache, nasal congestion, heavy voice, aversion to cold with high fever, limb restlessness, muscle twitching, chest heat with abundant phlegm, and women's blood qi attacking the Taiyang acupoints causing pain. Applicable to any condition caused by wind pathogens.
Nan Bohe (4 qian) Xiangfumii (4 qian, stir-fried) Jingjisui Chuanxiong (each 2 qian) Qianghuo Baizhi Gancao (stir-baked, each 1 qian) Fangfeng (7.5 qian)
Grind into fine powder. Take 2 qian per dose, mixed with clear tea after meals. Decocting with Jiang (Ginger) and Cong (Scallion) is also acceptable. Another prescription adds Julhua (1 qian), Xixin (0.5 qian), Jiangcan (0.3 qian), Chantui (0.3 qian), named Julhua Chatiao San.
Baizhu Banxia Tianma Tang [Commentary] (According to this commentary, this formula treats headache due to Phlegm-Jue.) Treats Phlegm-Jue headache, characterized by blackouts and vertigo, nausea and stifling sensation, shortness of breath and wheezing, inability to speak, mental confusion, inability to open eyes, feeling as if in wind and clouds, severe splitting headache, heavy body like a mountain, cold limbs, and inability to lie down comfortably. This is caused by deficiency of Stomach Qi and retention of phlegm.
Huangqi (0.35 fen) Renshen (0.35 fen) Bai Fuling (0.35 fen) Baizhu (0.5 fen) Chenpi (0.75 fen)
Banxia (soaked in water, fried with ginger juice, 0.35 fen) Shenqu (stir-fried, 0.5 fen) Maiya (stir-fried, 0.75 fen) Cangzhu (soaked in rice wash water, stir-fried, 0.35 fen) Ganjiang (stir-fried until black, 0.2 fen) Huangbai (0.15 fen, washed with wine) Zexie (0.25 fen) Tianma (0.35 fen)
Cut into pieces for one dose. Decoct with three slices of fresh ginger. Drink hot before meals. One dose can bring recovery.
Danggui Buxue Tang [Commentary] (According to this commentary, this formula treats headache due to blood deficiency.) Treats headache due to blood deficiency.
Danggui Sheng Dihuang Chuanxiong Baishao (each 1 qian) Fangfeng (0.5 qian) Jingjie (0.4 qian) Gaoben (0.4 qian) Huangqin (1 qian, wine-fried) Chaihu (0.5 qian) Manjingzi (0.5 qian)
Cut into pieces for one dose. Decoct in water and take.
Bu Zhong Yi Qi Tang [Commentary] (According to this commentary, this formula treats headache due to Qi deficiency.) Treats headache due to Qi deficiency.
See the Internal Injury section. Add Chuanxiong, Baizhi, Xixin, and Manjingzi to the base formula.
Tiaozhong Yiqi Tang [Commentary] (According to this commentary, this formula treats headache due to combined Qi and blood deficiency.) Treats headache due to combined Qi and blood deficiency, with miraculous effects.
Chenpi (0.3 fen) Huangbai (wine-fried, 0.3 fen) Shengma Chaihu (remove radicles, each 0.4 fen) Renshen Gancao (stir-baked, each 0.6 fen) Xixin (0.2 fen) Huangqi (1 qian) Chuanxiong (0.6 fen) Manjingzi (0.3 fen)
Cut into pieces for one dose. Decoct in two zhong of water until one zhong remains. Remove dregs and take warm. Another prescription includes Muxiang (0.2 fen) and excludes Huangbai. If stool is loose, difficult to sit still, or incomplete defecation with abdominal pressure, indicating blood deficiency and blood stasis, add Danggui shen (0.5 fen).
Xiong Zhi San Treats chronic or recent hemicephalic or frontal wind, unbearable pain, unresponsive to other drugs, with miraculous results.
Chuanxiong (3 qian) Baizhi (3 qian)
Grind into powder. Apply to one ox brain. Steam in a porcelain vessel with wine. Eat hot with wine. Get drunk. After sleeping and waking from the wine, the disease disappears.
Duliang Wan Treats hemicephalic or frontal wind, and all types of headache.
Xiang Baizhi (2 liang, chopped and sun-dried)
Grind into fine powder. Make pills with refined honey, size of longan seeds. Take 2-3 pills per dose, chew slowly after meals, swallow with clear tea.
Buxue Qufeng Tang (Secret Recipe) Treats women's wind headache, accounting for half of cases. Each attack involves dizziness and vertigo, as if standing on a boat or cart, due to Liver blood deficiency allowing wind pathogens to invade.
Danggui Chuanxiong Sheng Dihuang Fangfeng Jingjie Xixin Gaoben Manjingzi Banxia Shigao Gancao Xuanfuhua
Cut into pieces. Decoct with Ginger and Jujube. Take after meals. Another prescription adds Qianghuo.
Jiajian Xiong Xin Tang (Secret Recipe) Treats wind headache attacking the eyes.
Chuanxiong Baizhi Shigao Gaoben Xixin Zaorao Qianghuo Fangfeng Jingjie Jiegeng Bohe Gancao Julhua Manjingzi
Cut into pieces. Decoct in water. Take after meals.
Xuanqi Fang Treats pain in the supraorbital ridge, due to wind-heat and phlegm, unbearable pain.
Qianghuo Fangfeng (each 2 qian) Gancao (1 qian, raw in summer, stir-baked in winter) Wine-processed Huangqin (1.5 qian, not used in winter, but can be used if severe)
Cut into pieces. Decoct in water. Take after meals. Another prescription adds Jiang-zhi Banxia (2 qian).
Huishou San Treats stiffness and tension of the head and neck, tendon pain, or difficulty turning the neck due to pillow position. Use Wuyao Shunqi San (see Stroke section), adding Qianghuo, Duhuo, Mugua.