Library

Headache caused by epidemic pestilence differs from that of wind-cold: Wind-cold involves cold binding the upper part of the body, with no pathogenic factors in the middle or lower jiao reversing upward; thus, although the headache is severe, it is not accompanied by dizziness or stuffiness. Epidemic pestilence involves heat steaming the upper part, with pathogens from the middle jiao invading the upper jiao; the headache is not severe but is always accompanied by a sensation of stuffiness, which is referred to as "Zhuo Ran Er Tong" (distinct and fixed pain). By examining Qi, complexion, spirit, pulse, and tongue coating, one can identify epidemic headache and distinguish between exterior and interior syndromes.

In the initial stage, if headache is slightly more severe at the back of the head, vertex, and eyeballs, with a white tongue coating and fever, it is Taiyang headache. The main herbs are Qiang Huo (Notopterygii Rhizoma et Radix) and Chuan Xiong (Ligustici Chuanxiong Rhizoma), assisted by Dou Chi (Sojae Semen Praeparatum), Jiu Qin (Scutellariae Radix prepared with wine), Zhi Mu (Anemarrhenae Rhizoma), and Sheng Di Huang (Rehmanniae Radix). If there is distending pain in the forehead and skull, eye pain, dry nostrils, a white tongue coating turning slightly yellow, irritability, fever, and thirst, it is Yangming headache. The main herb is Ge Gen (Puerariae Lobatae Radix), assisted by Dou Chi and Shi Gao (Gypsum Fibrosum). If there is pain at both temples, pain in the supraorbital ridge, alternating chills and fever, bitter taste in the mouth, dry throat, and a tongue coating that is yellow in the center with white edges, or yellow in the middle section and white at the tip, it is Shaoyang headache. The main herbs are Chai Hu (Bupleuri Radix), Jing Jie (Schizonepetae Herba), and Chuan Xiong, assisted by Jiu Qin and Shi Gao. For headache where symptoms of all three Yang meridians are present, Wu's San Xiao Yin (Three-Draining Decoction) is the main formula. In epidemic headaches, cases showing symptoms of only one meridian are rare, while those mixing symptoms of two or three meridians are common; this formula is particularly effective. For severe headache, add Dou Chi, Xiong (Chuan Xiong), and Fang Feng (Saposhnikoviae Radix) to clear the head and eyes.

If there is headache, a yellow tongue coating, fullness below the heart (epigastric region), and steaming fever, it is a Yangming interior syndrome. Selectively use San Huang Shi Gao Tang (Three-Yellow Gypsum Decoction), Xiao Cheng Qi Tang (Minor Order the Qi Decoction), Da Chai Hu Tang (Major Bupleurum Decoction), or Fang Feng Tong Sheng San (Saposhnikovia Releasing the Exterior Powder). If the tongue coating is yellow, or has a patch of white on half or the side, with chest fullness, vomiting, headache, and dizziness, it is Phlegm-Jue headache. The main herb is Qian Hu (Peucedani Radix), assisted by Ban Xia (Pinelliae Rhizoma), Lai Fu Zi (Raphani Fructus), Zhi (Zhi Ke - Aurantii Fructus), Jie Geng (Platycodonis Radix), Shan Zha (Crataegi Fructus), and Mai Ya (Hordei Fructus Germinatus). If accompanied by irritability and fever, add Da Huang (Rhei Radix et Rhizoma) and Zhi Shi (Aurantii Fructus Immaturus). After sweating, purging, or clearing and resolving treatments, if headache and palpitations persist, use Si Wu Tang (Four Substances Decoction) removing Chuan Xiong, adding Dan Pi (Moutan Cortex), Zhi Mu, and Huang Bo (Phellodendri Cortex); or use Gui Pi Tang (Restore the Spleen Decoction) or Xiao Yao San (Free Wanderer Powder) added with Sheng Di Huang and Zao Ren (Ziziphi Spinosae Semen). Whenever headache symptoms are mixed and difficult to distinguish between exterior and interior, rely primarily on the tongue coating for differentiation.