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Qin Zi said: Da Tou Zheng (Disease of Large Head, characterized by swelling and redness of the head and face) is not recorded in ancient texts but is very common in recent times. The head and face swell and become red, large as a dou (a unit of volume); if the swelling occurs only in the parotid regions (cheeks/jaw) without swelling on the head, it is called Fa Yi (Mumps/Parotitis), which does not belong to Da Tou Zheng. Da Tou Zheng is caused by external contraction and has no internal injury etiology.

[Symptoms of Severe Headache] The body presents with aversion to cold and fever, swelling of the head and face, reddish skin discoloration, pharyngeal congestion causing difficulty in speech; this is caused by damp-heat pathogenic factors affecting the Three Yang meridians. The condition is contagious, spreading from house to house with similar symptoms, which is known as Tian Xing Shi Du Bing (Epidemic Damp-Toxin Disease). If there is no contagion and only one person falls ill independently, it arises from careless daily living, accidentally encountering damp-heat qi, leading to personal external contraction. This corresponds to what the *Nei Jing* (Inner Canon) states: "Dampness above becomes severe heat," referring precisely to this syndrome.

[Etiology of Severe Headache] In years when Tai Yin (Too-Yin) governs the heaven, dampness prevails excessively; in years when Shao Yang (Lesser-Yang) governs the heaven, fire prevails excessively; when Yang Ming (Bright-Yang) is victorious, pathogens ascend to the head and eyes. Excessive dampness leads to swelling, excessive heat leads to pain. When damp-heat ascends severely, the head and face swell, and the disease of Da Tou Zheng manifests.

[Pulse Diagnosis of Severe Headache] The pulse must appear Floating and Surging (Fu Hong). Excessive dampness results in a Floating pulse; excessive heat results in a Rapid pulse. A Floating-Rapid pulse indicates suitability for sweating therapy; a Deep-Rapid pulse indicates suitability for clearing heat. A Floating-Large pulse suggests the disease is easy to cure.

[Treatment of Severe Headache] One should use Qiang Huo Bai Du San (Notopterygium Decoction to Overcome Toxins) to disperse weather-related pathogens; subsequently, use Pu Ji Xiao Du Yin (Universal Benefit Decoction to Eliminate Toxins) with Rhubarb boiled in wine added, to clear and dissipate heat-toxin.

Qiang Huo Bai Du San
Herbs: Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Chai Hu (Bupleuri Radix), Qian Hu (Peucedani Radix), Jie Geng (Platycodonis Radix), Zhi Ke (Aurantii Fructus Immaturus), Chuan Xiong (Ligustici Chuanxiong Rhizoma).
If dampness is excessive causing swelling, add Cang Zhu (Atractylodis Rhizoma) and Bai Zhi (Angelicae Dahuricae Radix); if there is dry mouth and a large pulse, add Ge Gen (Puerariae Lobatae Radix) and Sheng Ma (Cimicifugae Rhizoma) to simultaneously disperse Yang Ming pathogens.

Pu Ji Xiao Du Yin
Herbs: Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Jie Geng (Platycodonis Radix), Xuan Shen (Scrophulariae Radix), Lian Qiao (Forsythiae Fructus), Ma Bo (Toxicarium Flos), Niu Bang Zi (Arctii Fructus), Jiang Can (Bombyx Batryticatus).
If stool is constipated, add Rhubarb soaked in wine. If thirsty, add Shi Gao (Gypsum Fibrosum) and Tian Hua Fen (Trichosanthis Radix).

Although headaches can be caused by deficiency of Qi and Blood, ultimately there is no pure tonification method for headache, because if there were only deficiency without pathogenic factors, pain would certainly not occur; even if the headache is due to Qi deficiency, it must be that deficiency allows invasion of cold pathogens, after which pain occurs; if the headache is due to Blood deficiency, it must be that blood deficiency is accompanied by fire, after which attacking and throbbing pain occurs. In treating any disease, one must first address the pain. If it is Qi deficiency with invasion of wind-cold, use Jing Fang Xiong Su Yin (Schizonepeta and Saposhnikovia Decoction with Ligusticum and Perilla), taken internally and used for external fumigation; after pain subsides, administer Si Jun Zi Tang (Four Gentlemen Decoction) to tonify Qi. If it is Blood deficiency with fire, use Zhi Bai Si Wu Tang (Anemarrhena, Phellodendron, and Four Substances Decoction); after pain stops, take Dang Gui Bu Xue Tang (Angelica Sinensis Decoction to Tonify Blood). However, the primary requirement in treating headache is to carefully examine whether there is stagnation in the Stomach. If there is no stagnation, the aforementioned two methods can be used; if the chest area feels uncomfortable, it indicates stagnation of phlegm-fluids, requiring Ping Wei San (Powder to Calm the Stomach) to resolve stagnation. This is because headaches all arise from stagnation in the chest; when the chest is stagnant, Stomach Yang cannot distribute upward, making one susceptible to pathogens. Therefore, Ping Wei Bao He San (Powder to Calm the Stomach and Preserve Harmony) is a key formula for treating headaches, applicable to both internal injury headaches and those caused by external contraction. Because external contracted exterior pathogens require the unblocking of Stomach Yang to induce sweating and release pathogens from the exterior, dispersing Stomach stagnation is the excellent secret for inducing sweat and scattering pathogens. Everyone knows that sweating scatters pathogens, but few know that to scatter exterior pathogens, one must first disperse Stomach stagnation, allowing Stomach Yang to distribute and generate sweat.