凡诊头痛者，当先审久暂，次辨表里。盖暂痛者，必因邪气；久病者，必兼元气。以暂
病言之，则有表邪者，此风寒外袭于经也，治宜疏散，最忌清降；有里邪者，此三阳之火炽
于内也，治宜清降，最忌升散，此治邪之法也。其有久病者，则或发或愈，或以表虚者，微
感则发，或以阳胜者，微热则发，或以水亏于下，而虚火乘之则发，或以阳虚于上，而阴寒
胜之则发。所以暂病者当重邪气，久病者当重元气，此固其太纲也。然亦有暂病而虚者，久
病而实者，又当因脉、因证而详辨之，不可执也。
一、头痛有各经之辨。凡外感头痛，当察三阳、厥阴。盖三阳之脉俱上头，厥阴之脉亦
会于巅，故仲景《伤寒论》则惟三阳有头痛，厥阴亦有头痛，而太阴、少阴则无之。其于辨
之之法，则头脑、额颅虽三阳俱有所会，无不可痛，然太阳在后，阳明在前，少阳在侧，此
又各有所主，亦外感之所当辨也。至若内伤头痛，则不得以三阳为拘矣。如本经所言，下虚
上实，过在足少阴、巨阳；若《厥病篇》所论，则足六经及手少阴、少阳皆有之矣。《奇病
论》曰∶脑者阴也，髓者骨之充也。凡痛在脑者，岂非少阴之病乎？此内证外证之异，所不
可不察也。（厥病篇义详《类经》）
一、外感头痛，自有表证可察，盖其身必寒热，脉必紧数，或多清涕，或兼咳嗽，或兼
脊背酸痛，或兼项强不可以左右顾，是皆寒邪在经而然，散去寒邪，其痛自止，如川芎
、细辛、蔓荆子、柴胡之类，皆最宜也。若寒之甚者，宜麻黄、桂枝、生姜、葱白、紫苏、
白芷之类，随其虚实而加减用之。
一、火邪头痛者，虽各经皆有火证，而独惟阳明为最。正以阳明胃火，盛于头面而直达
头维，故其痛必甚，其脉必洪，其证必多内热，其或头脑振振，痛而兼胀，而绝无表邪者，
必火邪也。欲治阳明之火，无如白虎汤加泽泻、木通、生地、麦冬之类，以抑其至高之势，
其效最速。至若他经之火，则芍药、天花、芩、连、知、柏、龙胆、栀子之类，无不可择而
用之。但治火之法，不宜佐以升散，盖外邪之火，可散而去，内郁之火，得升而愈炽矣，此
为忌也。
一、阴虚头痛，即血虚之属也，凡久病者多有之。其证多因水亏，所以虚火易动，火动
则痛，必兼烦热、内热等证，治宜壮水为主，当用滋阴八味煎、加减一阴煎、玉女煎之类主
之。火微者，宜六味地黄丸、四物汤、三阴煎、左归饮之类主之。
一、阳虚头痛，即气虚之属也，亦久病者有之。其证必戚戚悠悠，或羞明，或畏寒，或
倦怠，或食饮不甘，脉必微细，头必沉沉，遇阴则痛，逢寒亦痛，是皆阳虚阴胜而然。治宜
扶阳为主，如理阴煎、理中汤、十全大补汤、补中益气汤之类，皆可择用，或以五福饮，五
君子煎加川芎、细辛、蔓荆子之类，以升达阳气，则最善之治也。
一、痰厥头痛，诸古方书皆有此名目，然以余论之，则必别有所因，但以头痛而兼痰者
有之，未必因痰头痛也。故兼痰者必见呕恶、胸满、胁胀，或咳嗽气粗多痰，此则不得不兼
痰治之，宜二陈汤、六安煎、和胃饮、平胃散加川芎、细辛、蔓荆子之类主之。如多痰兼火
者，宜用清膈煎，或二陈汤、六安煎加黄芩、天花粉之类主之，火甚者加石膏亦可。如多痰
兼虚而头痛者，宜金水六君煎，或六君子汤加芎、辛之类，酌而用之。东垣治痰厥头痛，恶
心烦闷，头旋眼黑，气短促，上喘无力，懒言，心神颠倒，目不能开，如在风云中，头苦痛
如裂，身重如山，四肢厥冷，不得安卧，如范天FS 之妻，因两次下之而致头痛者，用
半夏白术天麻汤。
Whenever diagnosing headache, one must first examine the duration of the illness and then distinguish between exterior (Biao) and interior (Li) patterns. Generally, acute pain is caused by pathogenic factors, while chronic disease involves a deficiency of Yuan Qi (Primordial Qi). Regarding acute conditions: if there are exterior pathogens, this is due to Wind-Cold invading the meridians externally; treatment should focus on dispersing and releasing, strictly avoiding cooling and descending methods. If there are interior pathogens, this is due to excessive Fire in the Three Yang meridians blazing internally; treatment should focus on clearing and descending, strictly avoiding ascending and dispersing methods. These are methods for eliminating pathogens. In cases of chronic headache, symptoms may wax and wane. Some flare up due to exterior deficiency with slight exposure to external pathogens; some flare up due to Yang excess with slight heat; some flare up due to Kidney Water deficiency below, allowing Deficient Fire to ascend; some flare up due to Yang deficiency above, allowing Yin-Cold to prevail. Therefore, in acute conditions, emphasis should be placed on eliminating pathogens; in chronic conditions, emphasis should be placed on supporting Yuan Qi. This is indeed the general principle. However, there are acute conditions presenting as deficiency and chronic conditions presenting as excess; these must be carefully distinguished based on pulse and symptoms, and one must not adhere rigidly to rules.
1. Differentiation of Headache by Meridians. For all exogenous headaches, one must observe the Taiyang, Yangming, Shaoyang, and Jueyin meridians. The meridians of the Three Yang all ascend to the head, and the Jueyin meridian also converges at the vertex. Thus, in Zhang Zhongjing's *Treatise on Cold Damage* (*Shanghan Lun*), only the Three Yang and Jueyin are mentioned as having headaches, while the Taiyin and Shaoyin do not. Regarding differentiation: although the brain and forehead are convergence points for the Three Yang and can all experience pain, the Taiyang governs the back of the head, Yangming the front, and Shaoyang the sides; these have specific dominions and must be distinguished in exogenous headaches. As for endogenous headaches, one cannot be confined to the Three Yang. As stated in this text, "deficiency below and excess above" relates to the Foot-Shaoyin and Foot-Taiyang meridians. If referring to the discussion in the *Jue Bing Pian* (Chapter on Jue Diseases), then all six Foot meridians, as well as the Hand-Shaoyin and Hand-Shaoyang meridians, can present with headaches. The *Qi Bing Lun* (Treatise on Rare Diseases) states: "The brain is Yin; marrow fills the bones." Is pain in the brain not a disease of the Shaoyin? This distinction between internal and external syndromes must not be overlooked. (The meaning of the *Jue Bing Pian* is detailed in *Lei Jing*).
1. Exogenous Headache naturally presents with exterior signs. Typically, the patient has aversion to cold and fever, the pulse is tight or rapid, accompanied by clear nasal discharge, cough, soreness and pain in the spine and back, or stiffness in the neck preventing turning the head left or right. These are all caused by Cold pathogens in the meridians. Dispersing the Cold will stop the pain spontaneously. Herbs such as Chuanxiong Rhizome (Chuanxiong), Asarum Root (Xixin), Vitex Fruit (Manjingzi), and Bupleurum Root (Chaihu) are most suitable. If the Cold is severe, Ephedra Stem (Mahuang), Cinnamon Twig (Guizhi), Fresh Ginger (Shengjiang), Scallion White (Congbai), Perilla Leaf (Zisu), and Angelica Dahurica Root (Baizhi) should be used, added or subtracted according to the patient's deficiency or excess.
1. Headache caused by Fire Pathogens: Although Fire syndromes can occur in any meridian, they are most prominent in the Yangming. This is because Stomach Fire in the Yangming flares up in the head and face, reaching directly to the Touwei point (ST8). Consequently, the pain is severe, the pulse is surging (Hong), and symptoms include internal heat, trembling of the head, pain with distension, and an absolute absence of exterior pathogens; this indicates Fire Pathogen. To treat Yangming Fire, nothing is better than Baihu Tang (White Tiger Decoction) added with Alisma Rhizome (Zexie), Akebia Stem (Mutong), Rehmannia Root (Shengdi), and Ophiopogon Tuber (Maidong) to suppress its high-reaching intensity, yielding the fastest effect. For Fire in other meridians, Paeonia Root (Shaoyao), Trichosanthes Root (Tianhua), Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Anemarrhena Rhizome (Zhimu), Phellodendron Bark (Huangbai), Gentian Root (Longdan), and Gardenia Fruit (Zhizi) can all be selected and used. However, when treating Fire, one should not assist with ascending and dispersing herbs. External Fire can be dispersed away, but Internal Stagnant Fire becomes more intense with ascending agents; this is a contraindication.
1. Headache due to Yin Deficiency belongs to Blood Deficiency and is common in chronic diseases. Symptoms often arise from Kidney Water deficiency, causing Deficient Fire to move easily; when Fire moves, pain occurs, accompanied by vexation, heat, and internal heat. Treatment should primarily nourish Water (Kidney Yin), using Ziyin Bawei Jian (Nourishing Yin Eight-Flavor Decoction), Jiayi Yiyin Jian (Modified One-Yin Decoction), or Yinvu Jian (Jade Woman Decoction). If the Fire is mild, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Siwu Tang (Four-Substance Decoction), Sanyin Jian (Three-Yin Decoction), or Zuogui Yin (Left Restoring Drink) may be used.
1. Headache due to Yang Deficiency belongs to Qi Deficiency and is also seen in chronic diseases. Symptoms include a sense of gloom or lingering discomfort, photophobia, aversion to cold, fatigue, lack of appetite, a fine and weak pulse, a heavy sensation in the head, pain worsening on cloudy days or in cold weather. These are all due to Yang deficiency and Yin excess. Treatment should primarily support Yang. Formulas such as Liyin Jian (Supporting Yin Decoction), Lizhong Tang (Regulate the Middle Decoction), Shiquan Dabu Tang (Ten Significant Tonifying Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can be selected. Alternatively, Wufu Yin (Five Blessings Drink) or Wu Junzi Jian (Five Gentlemen Decoction) added with Chuanxiong, Xixin, and Manjingzi can be used to ascend and diffuse Yang Qi; this is the optimal treatment.
1. Headache due to Phlegm-Jue (Phlegm Obstruction): Ancient formularies list this term, but in my view, there must be other causes. While headache may be accompanied by Phlegm, it is not necessarily caused by Phlegm. When accompanied by Phlegm, symptoms must include nausea, vomiting, chest fullness, hypochondriac distension, or cough with coarse breathing and abundant sputum. In such cases, treatment must address Phlegm simultaneously. Suitable formulas include Erchen Tang (Two-Aged Decoction), Liu'an Jian (Liu'an Decoction), Hewei Yin (Harmonize the Stomach Drink), or Pingwei San (Calm the Stomach Powder) added with Chuanxiong, Xixin, and Manjingzi. If there is abundant Phlegm accompanied by Fire, Qingge Jian (Clear the Diaphragm Decoction) or Erchen Tang/Liu'an Jian added with Huangqin and Tianhuafen should be used; if Fire is severe, Gypsum (Shigao) may be added. If there is abundant Phlegm accompanied by Deficiency leading to headache, Jinshui Liujun Jian (Metal-Water Six-Gentlemen Decoction) or Liujunzi Tang (Six-Gentlemen Decoction) added with Chuanxiong and Xixin should be used judiciously. Li Dongyuan treated Phlegm-Jue headache characterized by aversion to heat, vexation, dizziness, blurred vision, shortness of breath, labored breathing, reluctance to speak, mental confusion, inability to open the eyes, feeling as if amidst wind and clouds, severe splitting headache, heaviness of the body like a mountain, cold limbs, and inability to lie down. For example, the wife of Fan Tian FS developed headache after two instances of inappropriate purgative treatment; she was treated with Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction).