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Headache is a syndrome (bing zheng), while Tou Feng (Head Wind) is a disease name; originally, there was no need to distinguish between them. Some argue that they differ in terms of new versus chronic duration and the retention or departure of pathogenic factors, but this view is far-fetched.

Pulse Diagnosis: A tight pulse at the Cun position indicates Wind Strike (Zhong Feng, illness caused by external wind pathogens); headache due to wind pathogens presents similarly (Qianjin Yi Fang states this may also be headache due to Shang Han [Cold Damage]). A wiry pulse at the Cun position indicates retained food stagnation; a deep pulse causes headache. If a patient presents with headache and eye pain, but the pulse is instead short and choppy, it indicates death (Mai Jing).
Headache with a short and choppy pulse indicates death; floating and slippery pulses indicate wind-phlegm, which is easy to eliminate (Mai Jue).
In headache, a wiry pulse in the Yang positions indicates wind; floating indicates wind; tight indicates cold; surging and rapid indicate wind-heat; fine and firm indicates dampness. Headache due to Qi deficiency, though wiry, must be choppy; headache due to Phlegm Jue (Phlegm-induced reversal) presents with a slippery pulse; headache due to Kidney Jue presents with a firm and solid pulse (Cui Shi Mai Jue).
The pulse of Phlegm Jue appears intermittently, sometimes hidden and sometimes visible (Yi Xue Da Cheng).
Brain pain with a slow and large pulse indicates death (Dan Xi Xin Fa).

General Discussion on Etiology, Symptoms, and Treatment:
Wind affecting the head and face occurs because the body's healthy Qi is deficient, allowing wind pathogens to invade the Yang meridians. All Yang meridians ascend to the head and face. When physical exertion causes Yang Qi to dissipate and the Cou Li (skin pores) open, wind invades; this is called Shou Feng (First Wind). (Original scriptures listed below are omitted.) Furthermore, one should not lie down with wet hair after washing, as this causes heavy head and hot body. If wind is contracted subsequently, it leads to irritability and oppression. Pulse diagnosis reveals mutual invasion of Yin-Yang and exterior-interior energies at the Cun position. If wind remains in the head and does not resolve for a long time, it enters the brain, transforming into Xuan Yun (Vertigo/Dizziness) (Bing Yuan Lun).

Regarding Wind Headache: Generally, when the body is deficient and externally invaded by wind pathogens, the wind flows into the Yang meridians and travels through the Six Fu organs. If the Cou Li are open, wind-toxin attacks the Fengfu acupoint, causing irritability and heat in the heart and diaphragm, empty sweating on the head and face, and upward congestion, resulting in heavy and painful head (Tai Ping Sheng Hui Fang).

The head is the gathering point of all Yang meridians. In cases of headache, it is primarily the Foot-Taiyang Bladder Meridian that is affected. Pain extending upward to connect with Fengfu and the eyebrow angle can be cured with medicine. However, if pain penetrates upward through Fengfu and hides in the Ni Wan Palace (deep brain region), it is called Zhen Tou Tong (True Headache), which cannot be cured by medicine; death occurs from evening to morning or morning to evening, because the root Qi has failed first. Investigating the causes, pain may result from contracting wind-cold-warmth-dampness, from Qi-Blood-Food-Drink Jue (reversal), or from Five Zang organ Qi depression Jue. The treatment method requires first examining these three categories of causes; once clear, treatment will hit the mark accurately (San Yin Ji Yi Bing Zheng Fang Lun).

Headache is not a single type; there are wind-cold headache, phlegm-Jue headache, kidney-Jue headache, accumulation-stagnation headache, Qi-deficiency headache, lateral-and-central headache, odor-toxin headache, Shang Han headache, diaphragm-phlegm wind-Jue headache, and additionally Jia Nao Feng (Brain-clasping Wind) and Xi Tou Feng (Washing-head Wind), each treated with specific formulas (Xu Yi Jian Fang).

The human head is where Yang Qi gathers. All Yin meridians reach the neck and return, whereas all Yang meridians ascend to the head and ears; thus, the head and face belong to the Yang portion. Normally, Yang Qi moves smoothly upward without rebellion, so there is no headache. When Yang Qi rebels upward and becomes obstructed, it congests the head, causing headache. Wind-cold in the brain, evil-heat attacking upward, phlegm-Jue, kidney-Jue, and Qi-deficiency with Qi attacking upward all cause headache. However, headache due to Qi-deficiency and Qi-attack often recurs after healing and drags on for years. Lateral and central Tou Feng often occur in women with abundant Qi and deficient Blood, or after postpartum excessive blood loss where Qi has no master, all leading to headache (Ji Sheng Xu Ji).

The Foot-Taiyang is the meridian of the head. Among the Six Meridians in Shang Han, the Taiyang is most frequently affected. Since the head is at the top, it faces the direct impact of wind and cold; any gap allows wind pathogens to enter the crown, brain, ears, or nose, especially given careless habits like bathing for coolness or lying supine after full meals. Tou Feng as a disease does not necessarily present with lateral or central headache symptoms; rather, any discomfort in the area from the neck upwards—including eyes, ears, mouth, nose, and brow ridge—indicates its progression. Symptoms include headache, dizziness, scalp numbness (unaware of sensation), oral/tongue insensitivity (loss of taste), deafness, head sweating, eye pain, pulling pain above and below the brow ridge, extreme sensitivity to smells (fragrant smells seem extremely fragrant, foul smells extremely foul), or merely yawning accompanied by vertigo. All these are Tou Feng syndromes. General treatment principles: For heat syndromes, use Xiao Feng San (Wind-Expelling Powder), taken with decoction of Fang Feng (Saposhnikovia Root) and Jing Jie (Schizonepeta Herb). For non-heat syndromes, use Zhui Feng San (containing Chuan Wu [Aconite Root] and Shi Gao [Gypsum], difficult to apply universally), taken with weak tea infusion. For those chronically suffering from Tou Feng who, after recovering from wind-cold-warmth-dampness, suffer a relapse, do not stick rigidly to previous prescriptions; instead, use a harmonizing formula for Tou Feng. If an elderly or weak patient, already suffering from Tou Feng, contracts cold pathogens and experiences continuous spontaneous sweating, Fuzi (Prepared Aconite Root) is indispensable. (Women who comb their hair during menstruation often develop Tou Feng with itching and pain, resembling water blisters on the head) (Zhi Zhi Fang).

Persistent headache involves the Three Yang meridians, each occupying specific regions. Pain in the head and nape belongs to the Foot-Taiyang Bladder Meridian. Pain at Cuanzhu acupoint, commonly called brow ridge pain, belongs to the Yangming Meridian. Pain at the upper temple, commonly called lateral headache, belongs to the Shaoyang Meridian. If pain persists for a long time, it can cause blindness. This is caused by old phlegm in the chest and diaphragm due to the Three Yang meridians being diseased. First induce vomiting with Cha Tiao San (Tea Regulating Powder), then treat with Xiang Ru San (Elsholtzia Powder) and Bai Hu Tang (White Tiger Decoction) for recovery. However, for persistent headache, one can decoct Cong Bai Xu (Scallion White Stalks) and Dou Chi (Fermented Soybean) to induce vomiting; after vomiting, administer Chuan Xiong (Ligusticum Rhizome) and Bo He (Mint Leaf), pungent-cool to clear the upper burner, along with Sou Feng Wan (Wind-Hunting Pill) or Xiang Xiong San (see San Fa Liu Men) (Zhi Bing Bai Fa).

Internal-cause headaches come and go; external-cause headaches are constant (Yong Lei Qian Fang).

There are six types of headache:
1. Wind-Cold: Headache or unilateral pain caused by cold wind exposure, triggered by cold; Cun pulse is floating.
2. Food Accumulation: Cold undigested food in the stomach rushes upward causing headache; Right hand pulse is floating, tight, and severe. (Note: Liu Yao states: Slippery and solid Right Guan/Cun pulses, with vomiting/nausea, epigastric fullness/pain, or alternating chills/fever, indicate Food-Stagnation Headache; treatment requires digestion-promoting methods.)
3. Qi Deficiency: Lower-body Qi deficiency rushing upward causes dull pain, distinct from toxin attack; Chi pulse is deficient and floating.
4. Shang Han: In the Taiyang meridian, pain feels like breaking; Guan-front pulse is rapid or tight-rapid.
5. Yangming Meridian Stomach Heat: Stomach heat rushes upward; Right Guan pulse is surging, large, and rapid. (Note: Jin Kui Yi states: Heat-Jue headache is due to excess Stomach Qi-Heat failing to descend. Symptoms include heat-pain in the head, preference for wind/cold even in winter, recurrence upon entering warmth or seeing fire/smoke; pulse is rapid or large.)
6. Diaphragm Wind-Saliva/Cold-Phlegm: Occasional vomiting; pulse is wiry and fine at the Cun position (Dan Xi Xin Fa).

Blood-Deficiency Headache: Pain attacking from the fish-tail (temple area) is treated with Xiong Gui Tang (Ligusticum and Angelica Decoction); ancient formulas use phlegm-expelling medicines (ibid.).

The head is the domain of Clear Yang. External invasion by Six Evils or internal rebellion of Zang-Fu/Meridian pathogens disrupts Clear Yang, causing conflict and pain. One must distinguish interior/exterior and deficiency/excess.
Excess: The person's Qi-Blood is fundamentally sound but invaded by external pathogens, obscuring clarity or blocking meridians, or internal Excess Fire flares up, causing Blood stasis and Phlegm stagnation preventing circulation, resulting in severe pain. This is Excess.
Deficiency: The person's Qi-Blood is fundamentally deficient. Invaded by external pathogens or internal Turbid Yin rising, although Blood stasis and Phlegm stagnation prevent circulation, the conflict lacks force, resulting in mild pain. This is Deficiency. (Zhun Sheng states: True Qi deficiency and cold, invaded by external cold-dampness, causes sluggish Blood and cold pulses, leading to contraction and tension of small collaterals and pain, relieved by warmth.) (Note: This text is adapted from Zhun Sheng, citing Ju Tong Lun.) In Excess, Evil is strong and Healthy Qi is not weak, so attack is tolerated. In Deficiency, Healthy Qi is weak and Evil is relatively strong; tonifying Healthy Qi still requires treating Evil. If Evil is not strong, tonifying Healthy Qi alone causes Evil to recede (Yi Que).

Headache due to Wind: Pulling pain, aversion to wind, sweating with pain.
Headache due to Summer-Heat: With or without sweating, always aversion to heat with pain.
Headache due to Dampness: Pain with heavy head, worse on cloudy days.
Headache due to Phlegm-Fluid: Dizzy, heavy, painful, with nausea/desire to vomit.
Headache due to Cold: Aversion to cold with constricted/tight pulse.
Headache due to Qi Deficiency: Worse with labor, large pulse.
Headache due to Blood Deficiency: Prone to fright/startle, knotted pulse (Jin Kui Yi). (Note: This is an excerpt from Zhun Sheng. Yi divides headache into eleven categories: Wind, Heat-Jue, Damp-Heat, Cold-Damp, Phlegm-Jue, Kidney Deficiency, Liver-Jue, Food Accumulation, Blood Deficiency, Qi Deficiency, Lateral.)

Blood-Deficiency Headache: Must have irritability, thirst, body heat; pulse is choppy and deficient. Common after childbirth or traumatic bleeding. Although blood tonification is needed, Qi must also be nourished, as Blood does not generate without Qi. If Yin deficiency with Water depletion causes Fire agitation and pain, use heavy, yin, tranquilizing herbs to nourish Water to control Fire; avoid overusing Chuan Xiong and Dang Gui to prevent ascending dispersion.
Qi-Deficiency Headache: Must have fatigue, poor appetite, aversion to cold, or photophobia; pulse is faint and fine, or large and empty. Common in chronic illness or elderly. Tonify Qi while using Jiang (Ginger) and Gui (Cinnamon Twig) to support Yang, and add small amounts of Chuan Xiong and Xi Xin to guide Qi.
Phlegm-Jue Headache: Must have nausea/vomiting, chest fullness, cough, rebellious Qi, excessive phlegm; pulse is wiry and slippery.
Fire-Evil Headache: Although all meridians can be involved, Yangming is most severe because Stomach Fire is abundant in the head/face, reaching directly to Toubwei acupoint. Pain is severe, pulse is surging, symptoms include thirst and restlessness. Use Zhi Mu (Anemarrhena Rhizome), Hua Fen (Tienchufan Root), Sheng Di Huang (Rehmannia Root), Mai Dong (Ophiopogon Tuber), Gan Cao (Licorice Root) to suppress Yang and generate Yin. Severe cases use Bai Hu Tang to counteract summer heat, yielding fastest results (Hui Lun).

Headache:
With Wind-Cold: Avoid tonifying/astringing; use Pungent-Warm dispersants.
With Evil-Heat: Do not treat like Wind-Cold; use Pungent-Cool/Bitter-Cool dispersants.
With Phlegm: Avoid lifting, tonifying, astringing, sour-sweet, or cloying herbs; use Phlegm-resolving/Qi-descending/Pungent-Dry herbs.
With Yin Deficiency: Avoid Pungent-Warm dispersants; use Blood-tonifying/Yin-nourishing/Sweet-Cool/Sour-Cool herbs (Ben Cao Jing Shu).

Etiology: Kidney Deficiency (Liver Deficiency Vertigo/Kidney Deficiency Syndrome Treatment):
Su Wen states: Headache and cranial diseases, lower deficiency and upper excess, involve Foot-Shaoyin (Kidney) and Foot-Taiyang (Bladder); severe cases enter the Kidney. "Xun Meng Zhao Yao" (blurred vision/swaying), closed eyes, deafness, upper deficiency and lower excess, involve Foot-Shaoyang (Gallbladder) and Foot-Jueyin (Liver); severe cases enter the Liver. Lower deficiency refers to Kidney Deficiency, hence Kidney Deficiency causes headache. Upper deficiency refers to Liver Deficiency, hence Liver Deficiency causes dizziness. "Xun Meng" means feeling as if covered by something. Swaying, dizziness, deafness are signs of vertigo. Thus, Liver-Jue dizziness and Kidney-Jue cranial pain are different (Ben Shi Fang).

Kidney Deficiency: Tinnitus, black complexion, frequent urination. Use Zhen Hei Xi Dan (True Black Tin Pill), taken with Su Zi Jiang Qi Tang (Perilla Seed Descending-Qi Decoction), Chen Fu Tang (Aucklandia and Aconite Decoction), or Zhu Fu Tang (Atractylodes and Aconite Decoction) plus Chuan Xiong and Xi Xin (Yong Lei Qian Fang).

Deficiency Headache (Kidney-Jue Headache): Use Zheng Yuan San (contains Wu Tou and Fu Zi), or Da San Wu Qi San with salt decocted, or Zheng Yuan San with 15 fried Sichuan peppercorns and Lai Fu Dan, alternating with Hei Xi Dan. If all medicines fail and pain worsens, use Rong Zhu Dan. The use of Rong (Deer Antler) is discussed in detail under Vertigo in the Deficiency category (Yao Jue).

Case: Jiang Tian'an, Vice Minister, suffered headache like breaking, heavy dizziness, unquiet. Wind, Blood, and Phlegm medicines failed for a long time. I said: Chi pulse is faint, Cun pulse is slippery; this is Kidney Deficiency with Water overflowing to create Phlegm. Use Di Huang 4 qian, Shan Yao, Dan Pi, Ze Xie 1 qian each, Fu Ling 3 qian, Chen Xiang 8 fen. Four doses daily. Reduced by 60-70% in two days. Then administered Qi Wei Wan (Seven-Ingredient Pill) with Ren Shen (Ginseng) soup. Pain disappeared in five days (Bi Du).

Case: Sister of Yang Shuzi suffered headache for months, untreatable by others. I diagnosed: Yang pulse large, Yin pulse choppy. I said: This is Yin decline below, Yang hyperactivity above, Excess above and Deficiency below. Method: Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Decoction) plus Qing Qian (Lead Oxide) 5 qian, to settle Clear and Turbid, thus stopping pain without directly treating it (Yin Ji Cao).

True Headache (See General Discussion and Descending-Qi Formulas): True pain, short/choppy pulse, Tianmen True Headache, pain radiating to Ni Wan Palace, untreatable; moxa Baihui acupoint, aggressively administer Ren Shen, Chen Xiang, Wu Tou, Fu Zi, possibly survival (Yong Lei Qian Fang).

If pain enters Ni Wan Palace, ascends to the vertex, unbearable pinpoint pain, six pulses vanish, this is due to fundamental Qi deficiency, called True Headache; morning onset evening death, evening onset morning death, must know this (Zhi Fa Mi Fang).

If True Headache, morning onset evening death, evening onset morning death (see Nan Jing Shu). No remedy exists. It stems from insecure root. If using moxibustion, must first moxa Baihui, Xinhui acupoints, and especially Dantian, Qihai acupoints to tonify, avoiding such extremity (Zi Sheng).

Phlegm-Jue Headache (See Fluids, Vomiting, and Phlegm-Resolving Formulas. Refer also.): Disordered Qi, stagnant Phlegm attacking head causing headache; regulating Qi is primary. Er Chen Tang, Dao Tan Tang, with modifications. Anger injuring Liver, Lung Qi disorder, stagnant Phlegm rushing to brain causing headache: use Chen Xiang Jiang Qi Tang and Su Zi Jiang Qi Tang, taken with Yang Zheng Dan (Yao Jue). (Note: Yi Wan She Cao records extreme Tou Feng with sour/bitter vomiting, treating with Yang Zheng Dan powder mixed with Ginger juice clarified pills, effective; text omitted for brevity, refer.)

Case: Wife of Cai Lechuan suffered headache, pain like breaking, slight movement of hair roots spread pain to whole head, fainted unconscious, recovered after half hour, body ache, chest/oppression, fluids stuck in diaphragm, vomited clear water several times prior, expelled 3 roundworms, started from anger, now aversion to wind/heat, thirst/no thirst, constipation, all six pulses slippery/large/powerful. I said: Phlegm-Jue Headache. First use Huo Xiang Zheng Qi San to stop vomiting, then Niu Huang Wan, Hei Hu Dan to clear spirit. Headache persisted. I said: Middle Jiao Phlegm excess, requires purging. Used Ban Xia 5 qian, Ba Shi (Croton Seed Paste) 1 fen, dough pills, 30 pills per dose, Ginger soup wash down. Three stools afternoon, thick sticky phlegm accumulation. Diet improved, other symptoms resolved (Excerpt). Note: Original book missing source citation.

Wind-Phlegm Headache: Often accompanied by vomiting/reversal and vertigo. Using Wind medicines makes Phlegm more rebellious and pain worse. He Ji Ju Fang's Yu Hu Wan is the correct medicine. Dong Yuan transformed it into Bai Zhu Ban Xia Tian Ma Tang, referring to Qi deficiency (Jin Kui Yi).

Brain Abscess: A woman suffered lateral headache, one side nasal congestion, loss of smell, clear discharge, occasional foul odor. All headache medicines plus Chuan Xiong and Quan Xie failed. No one recognized the disease; some said Brain Abscess. An expert physician said: Take Ju Fang Xiong Xi Wan (Long Nao Xiong Xi Wan: Long Nao [Borneol], Chuan Xiong, Xi Jiao [Rhinoceros Horn], Zhi Zi [Gardenia], E Jiao [Donkey-hide Gelatin], Shi Gao [Gypsum], Zhu Sha [Cinnabar], Mai Men Dong [Ophiopogon], Xi Xin [Asarum], Fu Ling [Poria], Ren Shen [Ginseng], Gan Cao [Licorice]). Within ten doses, suddenly sneezed/discharge, expelled a rod of thick pus, disease cured (Yi Shuo).

Sores-Toxin Headache: Wiry-rapid pulse, history of Syphilis, pain unceasing, or throat pain, or arm pain patch, belongs to Sores-Toxin. Take Yu Du Tang (Toxin-Resolving Decoction) frequently until stopped (Liu Yao).

Syphilis-Toxin Headache: Swelling below jaw moving like earthworm into ear, nodules on vertex, cold aggravates pain. Use Shan Niu Tang; if ineffective, treat as Knot-Toxin (Yi Tong).

Odor-Toxin Headache: Eat fried black beans (Xu Yi Jian Fang).

External Stench-Toxin Headache: Eat fried Xiang Fu (Cyperus Rhizome) alone to cure (Yao Jue).

Head and Abdomen Simultaneous Pain: Five types.
1. Stench-Toxin Headache with abdomen pain: Fried Xiang Fu decocted, cooled, taken.
2. Alcohol/Dampness injury with head/abdomen pain: Alcohol/Food injury adds vomiting/vertigo; Waitai Fu Ling Yin plus Wei Ge Gen (Kudzu Root). Dampness injury adds dull abdominal pain, heavy head unable to lift; Qiang Huo Sheng Shi Tang, external Gua Di San (Melon Spittle Powder) insufflated into nose.
3. Acclimatization pain: Huo Xiang Zheng Qi San.
4. Sores-Toxin entering abdomen: Huang Lian Jie Du Tang plus La Cha (Preserved Tea).
5. Headache stops then abdominal pain starts, vice versa: Spleen Yin/Blood deficiency, Stomach Fire. Qi moves up/down. Use Chuan Xiong, Dang Gui, Bai Shao, Huang Lian, Mu Xiang. If ineffective, add Tong Bian (Child Urine), Xiang Fu, Cong Bai (Scallion White) (Yi Tong).

Death Syndromes: Diagnosing headache and eye pain, unable to see after prolonged gazing indicates death (prolonged gazing alternatively sudden gazing) (Mai Jing).
Any headache with vertigo, frequent confusion/fainting, sudden severe head/eye pain, blindness, or after profuse diarrhea, are ominous signs (Yi Zong Jin Jian).

Treatment Distinction Between Tonifying and Purging:
Secular saying "No cold headache, no hot abdominal pain" is incorrect.
Yellow Emperor asked: Headache persisting for years, why?
Qibo answered: Likely contracted severe Cold, penetrating to Marrow. Bone houses Brain; Brain Qi rebellion causes headache and toothache.
I once treated Mrs. Yang, 50+, chronic headache. Wind/Phlegm treatments failed. Pulse: Left Cun deep, slow, knotted. I said: Qi and Blood both deficient. Used Dang Gui 2 liang, Fu Zi 3 qian. One dose reduced pain by half; two doses cured, no recurrence. Correct prescription matches effect instantly. (Note: Da Huan records Qi-deficient headache treated with large dose Bu Zhong Yi Qi Tang plus Shu Fu Zi, refer.)
A woman with chronic lateral headache cured by Da Cheng Qi Tang. Why? Yangming Dry-Metal overacts, suppressing Liver Qi stagnation; stagnation causes Blood obstruction; obstruction blocks upper/lower flow, causing dryness/constraint. Cheng Qi Tang unblocks, Qi-Blood circulates, Liver Qi opens. Shang Han Zhi Li states: Shaoyang lateral headache often with constipation, suitable for purging. This is for new illness; for chronic illness with insufficient Yuan Qi, treat differently (Xu Yi Shuo).

Treatment Requires Clearing Fire and Cooling Blood:
Chronic headache, triggered by slight wind-cold, requiring heavy cotton/warm wraps in winter, belongs to Depressed Heat, Root Heat with Branch Cold.