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(Head Wind. Appendix: Pain of the Brow Bone)

The *Nan Jing* (Classic of Difficult Issues) states: When the meridians of the three Yang channels of the hand are invaded by wind and cold pathogens that linger and remain, Jue Headache occurs. "Jue" means reversal or counterflow. When Qi reverses and obstructs, rushing upward to the head, pain ensues. If the pain radiates to the brain and teeth, penetrating into the Niwan Palace (referring to the brain), it is called True Headache. In this condition, the hands and feet become cold up to the joints; if onset occurs in the morning, death follows in the evening, and it cannot be treated with medicine.

Generally speaking, regarding headache syndromes, internal causes arise from stagnation of Qi, Blood, Phlegm, and Fluids, or depression of the Seven Emotions; external causes result from invasion by wind, cold, summer-heat, and dampness pathogens. However, most cases belong to Wind and Fire. This is because the vertex of the head is a site where Wind and Fire Qi easily ascend. Moreover, the face is the gathering place of the essence of the five Zang organs, and the head is the meeting point of the six Yang meridians. Treatment should focus on dispersing Wind and expelling pathogens, combined with clearing Fire and nourishing Blood; this is the general principle. It is particularly important to differentiate according to the Six Meridians, as well as the nature of Qi and Blood, Cold and Heat, and the duration of Dampness and Phlegm. For Taiyang meridian headache, pain at the vertex radiating to the forehead and neck, with aversion to wind; for Yangming meridian headache, pain in the head and eyes radiating to the teeth and cheeks, with body heat; for Shaoyang meridian headache, pain on one side of the temples radiating to the ears, with alternating chills and fever; for Taiyin meridian headache, heavy body with phlegm, abdominal fullness; for Shaoyin meridian headache, cold feet with counterflow Qi leading to Jue Headache; for Jueyin meridian headache, vertex pain with cold limbs, or vomiting of frothy saliva.

Headache accompanied by tinnitus and dysfunction of the nine orifices indicates Qi Deficiency. Blurred vision, relieved during the day but worsened at night, indicates Blood Deficiency. Headache with excessive phlegm and dizziness indicates Phlegm Jue. Headache with irritability, numbness of the body, and hot feet indicates Damp-Heat. Invasion by severe cold, reaching the bone marrow internally, affects the brain (as marrow governs the brain); counterflow of Brain Qi causes pain, indicating Cold. Swelling of the cheeks, restlessness, heat, and severe pain indicate Heat. Newly onset headaches are Excess patterns; chronic headaches lasting years are Deficiency patterns. If headache with aversion to cold and body heat belongs to Shang Han (Cold Damage), treat according to the Shang Han chapter.

Furthermore, Head Wind syndromes, whether lateral or central, belong to lingering Wind-Heat. Men who sleep exposed to wind and dew, and women whose heads are not covered, often suffer from this. If prolonged and unresolved, pathogens invade the empty orifices, potentially leading to blindness. Lateral headache on the left indicates Wind and Blood Deficiency; lateral headache on the right indicates Phlegm and Qi Deficiency. Treatment methods refer to similar headache categories. The classics state: A short pulse at the Cun Kou (radial artery) indicates headache. The *Mai Jing* (Pulse Classic) states: A wiry Yang pulse indicates headache. Any tight, short, floating, or wiry pulse at the Cun Kou indicates headache. A floating and slippery pulse suggests Wind-Phlegm headache, which is easy to treat; a short and choppy pulse indicates difficulty in recovery.

Main Formula: Chuanxiong Rhizome (Qianxiong) (1.5 qian), Notopterygium Root (Qianghuo), Angelica Dahurica (Baizhi), Saposhnikovia Root (Fangfeng), Ligusticum Rhizome (Gaben) (each 1 qian), Cimicifuga Rhizome (Shengma), Asarum Root (Xixin), Licorice Root (Gancao) (each 3 fen). Add a pinch of fine tea and three green onion bulbs. Use two zhong of water. During decoction, cover the patient's head with a thick quilt, seal the mouth of the decoction pot, and allow the steam to fumigate the painful area until sweating occurs. Decoct until eight parts remain, then take warm. Repeat decoction and fumigation. After finishing the medicine, wrap the head tightly with cloth and lie down; sweating will stop the pain. For vertex pain, double Gaben, add wine-fried Shengma and Bupleurum Root (Chaihu). For Fire excess, add wine-fried Scutellaria Root (Huangqin); for Phlegm excess, add Tangerine Peel (Chenpi) and Pinellia Tuber (Banxia). In winter, add Ephedra Stem (Mahuang); in summer, add Gypsum (Shigao). For Taiyang headache, double Qianghuo, add Atractylodes Macrocephala Rhizome (Cangzhu); for aversion to wind and cold, add Mahuang and Angelica Pubescens Root (Duhuo). For Yangming headache, double Baizhi and Shengma; for spontaneous sweating, fever, and aversion to cold, add Pueraria Root (Gegen) and Shigao. For Shaoyang headache, add Chaihu and wine-fried Huangqin. For Taiyin headache, add Banxia, Cangzhu, and Arisaema Rhizome (Nanxing); if the pulse is deep, use Lizhong Decoction (see Cold chapter). For Shaoyin headache, double Xixin; for cold limbs and deep, thin pulse, use Mahuang Fuzi Xixin Decoction as the main formula (see Shang Han chapter). For Jueyin headache, pain extending to the neck suggesting transition to Taiyin, also double Qianghuo and Cangzhu; for cold limbs and slow, deep pulse, use Evodia Fruit Decoction (Wuyu Tang) as the primary treatment. For Qi Deficiency, use Ginseng Radix (Renshen) and Astragalus Membranaceus Root (Huangqi); for Blood Deficiency, use Angelica Sinensis Root (Danggui) and Chuanxiong Rhizome; for dual deficiency, use Tiaozhong Yiqi Decoction (see Deficiency chapter) plus Chuanxiong, Vitex Fruit (Manjingzi), and Xixin, which is highly effective. For Phlegm Jue, use Banxia Baizhu Tianma Decoction. For Dampness, use emesis to clear Damp-Heat, using Kongqing Paste. For retained Phlegm, first induce vomiting with Chuanxiong Chatiao Powder, then administer acrid-cool medicines like Chuanxiong and Mint Leaf (Bohe). For Jue Headache caused by severe cold, use Qianghuo Fuzi Decoction. For extreme Fire toxicity with severe pain and constipation, use Dachengqi Decoction to purge (Rhizoma Rhei Prepared with Wine, see Shang Han chapter). For obese individuals, use Erchen Decoction plus Cangzhu and Atractylodis Rhizoma (Baizhu); for thin individuals, use Siwu Decoction plus wine-fried Huangqin and Fangfeng. For severe pain due to labor and lower Yuan deficiency, where Ministerial Fire rushes upward from below, use Buzhong Yiqi Decoction (see Deficiency chapter) plus Chuanxiong and Danggui; for severe cases, add Anemarrhena Rhizome (Zhimu), Phellodendron Bark (Huangbai), Manjingzi, and Xixin. For head and facial swelling with heat, use Liangge San (see Fire chapter), removing Mangxiao and Dahuang, adding Platycodon Root (Jiegeng), Schizonepeta Spike (Jingjie), and Bohe. For Wind-Heat attacking upward, use Tianma, Manjingzi, Taichuanxiong, wine-fried Huangqin, and Xixin.

**Qianghuo Fuzi Decoction**: Treats cold invasion in winter and wind pathogen entering the brain, causing severe pain radiating to the teeth, also known as Brain Wind.
Ephedra Stem (Mahuang), Prepared Aconite Root (Fuzi), Fangfeng, Baizhi, Bombyx Batryticatus (Jiangcan), Qianghuo, Cangzhu (each 7 fen), Petasites Flower (Foercao) (omit if no cough), Huangqi (each 5 fen), Gancao, Shengma (each 3 fen). Decoct in water and take.

**Chuanxiong Chatiao Powder**: Treats various Wind pathogens attacking upward, lateral and central Head Wind, headache, nasal congestion, and heavy voice.
Mint Leaf (Bohe Ye) (2 liang), Chuanxiong, Jingjie, Fangfeng (each 1 liang), Baizhi, Qianghuo, Gancao (each 1.5 liang), Xixin (2.5 qian).
Grind into fine powder. Take 2 qian per dose. Mix with tea soup and take after meals.

**Rusheng Bing**: Treats headache caused by wind-cold lingering in Yang meridians and counterflow of Phlegm-Fluids and Qi.
Fangfeng, Banxia, Tianma (each 5 qian), Nanxing, Prepared Sichuan Aconite Root (Chuanwu), Chuanxiong, Dried Ginger (Ganjiang), Gancao (each 1 liang).
Grind into powder. Mix with steamed cake paste to form cakes the size of coins. Chew 5 cakes finely with Jingjie powder and swallow with tea soup.

**Jiuxian Dan**: Treats eight types of Head Wind in men and women, and all kinds of headaches.
Prepared Chuanwu, Water-washed Gypsum (Shigao), Baizhi, Chuanxiong, Grass Aconite (Caowu), Nanxing, Banxia (each 5 qian), Xixin, Scorpion (Quanxie) (each 2.5 qian).
Grind into powder. Make pills the size of tung tree seeds with leek juice. Take 50 pills with tea.

**Kongqing Gao**: Treats persistent lateral and central headaches, as well as Wind-Heat eye pain and brain pain.
Qianghuo, Fangfeng, Coptis Rhizome (Huanglian), Gancao (each 1.5 liang), Chaihu (7 qian), Chuanxiong (5 qian), Scutellaria Root (Kuangqin) (1.5 liang, half wine-fried).
Grind into powder. Take 3 qian per dose, mix with clear tea to form a paste, apply inside the mouth, and swallow with warm water before bed. For severe headache, add 3 qian Xixin; for Phlegm Jue pain, add Banxia; for lateral headache, double Qianghuo, Fangfeng, and Chuanxiong.

**Shangqing San**: Headache radiating to the brow bone, unbearable eye pain.
Chuanxiong, Curcuma Zedoina Rhizome (Yujin), Peony Root (Shaoyao), Jingjie, Mirabilite (Mangxiao) (each 5 qian), Frankincense (Ruxiang), Myrrh (Moyao) (both separately ground), Bohe (each 1 qian), Borneolum Syntheticum (Bingpian) (5 fen).
Grind into fine powder. Use 3 fen per application, insufflate into the nose.

**Banxia Baizhu Tianma Decoction**: Treats Phlegm Jue headache feeling like splitting, blackouts, dizziness, nausea, sensation of being in wind and clouds, heavy body, aversion to cold, and inability to rest.
Citrus Peel (Juhong), Banxia, Malt (Maiya) (each 7.5 fen), Atractylodis Macrocephala Rhizome (Baizhu), Medicated Leaven (Shenqu) (each 5 fen), Cangzhu, Renshen, Huangqi, Tianma, Poria (Fuling), Alisma Rhizome (Zexie), Ganjiang, Phellodendron Bark (Huangbai) (each 3 fen).
Add three slices of fresh ginger. Decoct in water. One dose brings relief.

**Simple Prescription**: Sophora Flower Bud (Juemingzi) ground into powder, mixed with water and applied to the Taiyang acupoint, or used as a pillow. For Blood Deficiency headache, decoct 2 liang of Danggui in good wine and take.

**Newly Washed Hair Exposed to Wind**: Chuanxiong (4 qian), Tianma (1 qian) ground into powder, mixed with honey, chewed with tea and swallowed. For chronic pain, insufflate Trichosanthes Fruit Stalk (Guadi) powder into the nose; discharge of clear fluid brings relief.

**Wind Blowing on Neck, Back, and Brain Pain; Headache in Women during Pregnancy and Postpartum**: Soak Baizhi, grind into powder, mix with honey, chew finely, and swallow with tea.

**Wind-Heat Headache**: Chuanxiong, Baizhi, Shigao in equal parts, ground into powder. Take 4 qian with tea. For head and neck pain, sleep on one sheng of steamed soybeans; repeat steaming when healed.

**Stop Pain (Taiyang Dan)**: Large Nanxing and Chuanxiong in equal parts, ground into powder. Mash scallion whites (with roots) into a cake and apply to the painful Taiyang area.

**Phlegm Jue Pain**: Ten Smoked Plums (Wumei) and 2 qian salt, decoct in water and take. Vomiting phlegm leads to cure.

**Sudden Severe Pain**: 2 qian of Jiangcan powder, taken with water.

**Various Headaches**: Cocklebur Fruit (Canger), Chuanxiong, Danggui in equal parts, ground into powder. Take 3 qian before bed with tea.

**Cold Pain**: Rub Mugwort Leaf (Aiye) until soft, wrap the painful area in cloth, and warm with a heated iron (ironing tool); pain stops.

**Heat Pain**: Equal parts of Dahuang powder and Glauber's Salt (Puxiao), ground uniformly, mixed with mud from the bottom of a well to form a cake, applied to the Taiyang acupoint and painful area.

**Unbearable Pain**: Seven Corydalis Tuber (Yanyhusuo), two tooth-like soap pods (Zhuya Zaojiao), 2 qian Indigo Naturalis (Qingdai), ground into powder. Mix with water to make a small amount. Have the patient lie down. Insert into the nostril (left for men, right for women) using a bamboo tube. When the medicine reaches the throat and causes slight sourness, sit up. Bite one qian of front teeth; profuse salivation filling a basin brings relief.