大意
头为天象。六腑清阳之气。五脏精华之血。皆会于此。惟经气上逆。干犯清道。不得营运。则壅遏为痛。（微论）
内因
自外入者。风寒暑湿之邪。自内发者。气血痰郁之异。（玉机）或蔽覆其清明。或瘀塞其经络。与气相搏。脉满
而痛。（汇补）
外候
头脑痛连两额属太阳。头额痛连目齿属阳明。头角痛连耳根属少阳。太阳穴痛属脾虚。巅顶痛属肾。目
系痛属肝。（汇补）
痛分内外
外感头痛。如破如裂。无有休歇。内伤头痛。其势稍缓。时作时止。（入门）
痛分诸因
因风痛者。抽掣恶风。因热痛者。烦心恶热。因湿痛者。头重而天阴转甚。因寒痛者。绌急而恶寒战栗。因痰
痛者。昏重而眩晕欲吐。因食痛者。噫酸发热而恶食。气虚痛者。九窍不利。恶劳动。其脉大。血虚痛者。鱼尾
上攻。恶惊惕。其脉芤。肾厥痛者。下虚上实。其脉举之则弦。按之则坚。气逆痛者。心头换痛。其症胸腹胀满。
呕吐酸水。（汇补）
厥头痛症
厥头痛者。所犯大寒。内至骨髓。髓以脑为主。胸中寒邪。故厥逆而头齿皆痛。
真头痛症
真头痛者。引脑及巅。陷入泥丸大痛。手足青冷至节者。旦发夕死。夕发旦死。（用和）外灸百会穴。内进参附
汤。亦有生者。
脉法
寸口紧盛。或短或弦或浮。皆主头痛。又浮弦为风。浮洪为火。细濡为湿。滑大为痰。短涩为虚。
治法
高巅之上。惟风可到。（东垣）古方治头痛。每用风药者。取其味轻。阴中之阳。自地升天者也。在风寒湿者。固
为正用。即虚与热者。亦可假此引经。（必读）
郁热当清
头痛多主于痰。甚必兼火。（丹溪）有久痛而感寒便发。外用重绵包裹者。此属郁热。盖本热而标寒也。因其
本有郁热。毛窍常开。风寒易入。束其内火。闭逆为痛。惟泻火凉血。佐以辛凉散表。（玉纶）
寒湿当取
湿热头痛。心烦重滞。病在隔中。过在手太阳少阴。寒湿头痛。气上而不下。头痛巅疾。下虚上实。过在手少
阴巨阳。甚则入肾。偏头痛者。先取手少阳阳明。后取足少阳阳明。（准绳）
用药
头痛。若属外邪痰火诸有余者。主以二陈汤。风。加羌活、防风。寒。加细辛、 本。湿。加苍术、白芷。火。加
山栀、酒芩。郁热。加酒浸大黄、细辛、芽茶。风热。加天麻、蔓荆。又太阳加 本。阳明加白芷。少阳加柴胡。太阴
加苍术。少阴加细辛。厥阴加吴萸。此六经引经药也。若属气虚者。顺气和中汤。加天麻、川芎。血虚者。四物汤。加
薄荷、甘菊。风热。用清空膏。风痰。用玉壶丸。痰火。用石膏散。寒湿。用芎辛汤。痰厥。用白术半夏天麻汤。肾厥。
用玉真来复丹。肝虚。用生熟地黄丸。肝火。用逍遥散。
快捷方式法
治风虚半边头痛者。用白芷二钱。黄牛脑一个。川芎三钱。入瓷器内。酒煮食之。任量一醉。睡后即愈。 治
寒湿头痛。用白凤仙一株捣烂。火酒浸。露七夕。去渣。饮酒效。 治血气虚而头痛。憎风恶寒。用盐披草纸
上。于痛处以热熨斗熨之。冷即再熨。以平为度。 热郁脑中而痛者。以硝石为末。吹入鼻中。即止。 气郁
偏头痛。用蓖麻同乳香、食盐捣。贴太阳穴。即止。凡外感头目闷痛甚者。用葱叶插入鼻内一二寸。觉气
通。即减。
【附眉棱痛】
眉棱者。目系之所过。上属于脑。外挟风寒。内成郁热。上攻头脑。下注目睛。则眉骨作痛。又有肝火壅热者。
有风痰上攻者。有湿气内郁者。（必读）有肝经血虚。见光则痛者。有肝经伤饮。昼静夜剧身重者。若妇人经
行将尽。不能安养。或以针指劳神。致令眉骨酸痛者。专以益阴养血。（汇补）
【附脑痛】
头脑作痛。犹如刀劈。动辄眩晕。脑后抽掣跳动。举发无时。此肝经痰火。名曰厥疾。厥者。逆也。恚怒太过。气
与血俱逆于高巅。而胆穴又络于脑。宜清痰降火。以芩、连、花粉、胆草、大黄、芦荟、丹皮、赤芍之类。调猪胆汁
服之。若虚弱人患此。宜逍遥散加川芎、生地主之。
用药
肝虚。主以生熟地黄丸。血虚。主以加味逍遥散。湿痰。主以导痰汤。风热。主以上清散。此症失治。多致伤目。
或两耳出脓。则危矣。
头痛选方
二陈汤 统治头痛（方见痰症）
顺气和中汤 治气虚头痛。
即补中益气汤加芍药、川芎、蔓荆、细辛。
加味四物汤 治血虚头痛。
即四物汤加甘菊、蔓荆。
清空膏 治风热头痛。
羌活 防风（各一两） 柴胡（七钱） 川芎（五钱） 甘草（五钱） 黄芩（酒炒三两） 黄连（炒二两）
末之。每服二钱。清茶下。
玉壶丸（和剂） 治风痰头痛。胸膈满。食不下。咳嗽呕吐痰涎。
南星 半夏（各一两） 天麻（半两） 白面（三两）
水滴丸。每服三十丸。姜汤下。
石膏散 治痰火头痛。
川芎（下） 石膏（上） 黄芩（中） 白芷（下）
水煎。
芎辛散 治寒湿头痛。
川芎 细辛（各一钱半） 苍术 甘草 干姜（各一钱）
半夏白术天麻汤 治痰厥头痛。
天麻 白术 半夏（各一钱） 人参 苍术 陈皮 黄 泽泻 茯苓（各五分） 神曲 麦芽（各七分） 干姜
（三分） 黄柏（二分）
水煎。
玉真丸（本事） 治肾厥头痛。
硫黄（二两） 石膏（ ） 半夏 硝石（研各一两）
虚甚者。去石膏。加钟乳粉一两。生姜糊丸。姜汤下。外灸关元百壮。
来复丹（和剂） 治上盛下虚。
硝石（同硫黄研） 玄精石 硫黄（各一两） 五灵脂（水澄去砂） 青皮 陈皮（各二两）
为末。醋糊丸。米饮下。
生熟地黄丸 治肝虚头痛。
生地 熟地（上） 天麻 川芎 茯苓（下） 当归 白芍 黑豆 石斛 玄参 地骨皮（中）
蜜丸。
祛风清上散（统旨） 治风热上攻。
酒芩（二钱） 白芷（一钱半） 防风 柴胡 川芎 荆芥 羌活（各一钱） 甘草（五分）
水煎。
黑锡丹（和剂） 治真头痛。
沉香 附子 葫芦巴 肉桂（各五钱） 茴香 破故纸 金铃子 肉果 木香（各一两） 黑锡 硫黄（炒成珠各
三两）
一方。有阳起石半两。巴戟天一两。酒煮。面糊丸。姜汤下。
羌活黑附汤（东垣） 治寒厥头痛。
麻黄 羌活 防风 苍术（各一钱） 升麻（二分） 甘草（二分） 附子（一分） 白芷（三分）
水煎。
彻清膏
蔓荆 细辛 薄荷 川芎 本 甘草
川芎茶调散（玄珠）
薄荷（三钱） 川芎（一两） 荆芥（四钱） 白芷（五钱） 细芽茶（三钱） 黄芩（二两酒炒）
头顶痛及脑痛。加细辛、 本、蔓荆子各一钱。每服二三钱。清茶下。
[General Principle]
The head is regarded as the celestial aspect (the upper part of the human body). The clear yang qi of the six fu organs, and the essence blood of the five zang organs, all converge here. Only when the qi of the meridians rebels upward, invading the clear orifices, causing the qi and blood to fail in normal circulation, will stagnation and obstruction occur, leading to pain. (From *Wei Lun*)
[Etiology: Internal Factors]
Pathogenic factors entering from the exterior are wind, cold, summer-heat, and dampness; those arising from within are abnormalities of qi, blood, phlegm, and depression. (From *Yu Ji Zhen Cang Lun*) These pathogenic factors either obscure and cover the clarity of the head, or obstruct and block the meridians, contending with healthy qi, resulting in fullness and distension of the vessels and pain. (From *Zheng Zhi Hui Bu*)
[External Manifestations]
Headache radiating to both foreheads belongs to the Taiyang channel. Headache involving the forehead, eyes, and teeth belongs to the Yangming channel. Headache at the temples radiating to the root of the ears belongs to the Shaoyang channel. Pain at the temporal region belongs to Spleen deficiency. Pain at the vertex belongs to Kidney deficiency. Pain in the ocular system belongs to Liver pathology. (From *Zheng Zhi Hui Bu*)
[Differentiation: External vs. Internal]
Headache due to external contraction feels like breaking or tearing, without cessation. Headache due to internal injury is relatively milder in intensity, occurring intermittently. (From *Yi Zong Bi Du*)
[Differentiation by Etiology]
Headache due to wind presents with twitching, pulling pain, and aversion to wind. Headache due to heat presents with vexation and aversion to heat. Headache due to dampness presents with heaviness in the head, worsening on cloudy days. Headache due to cold presents with contraction, tightness, aversion to cold, and shivering. Headache due to phlegm presents with dizziness, heaviness, and a desire to vomit. Headache due to food retention presents with sour belching, fever, and anorexia. Headache due to qi deficiency presents with dysfunction of the nine orifices, aversion to exertion, and a large pulse. Headache due to blood deficiency presents with pain attacking upwards from the outer canthus (fish tail), fearfulness, and a knifelike (Kou) pulse. Headache due to Jue (rebellious) Kidney presents with deficiency below and excess above, with a pulse that is wiry on light palpation and firm on deep palpation. Headache due to qi rebellion presents with alternating pain in the heart region, accompanied by chest and abdominal fullness, and vomiting of sour fluid. (From *Zheng Zhi Hui Bu*)
[Jue Tou Tong Syndrome]
"Jue Tou Tong" (Rebellious Headache) occurs due to severe cold invasion penetrating to the bone marrow. Since marrow governs the brain, combined with cold evil in the chest, it causes rebellious qi flow, resulting in pain in both the head and teeth.
[Zhen Tou Tong Syndrome]
"Zhen Tou Tong" (True Headache) involves pain radiating to the brain and vertex, sinking into the "Ni Wan" (deep brain) with severe pain. If the hands and feet turn blue and cold up to the joints, death occurs on the same day (morning onset leads to evening death; evening onset leads to morning death). (From *Yong He Yi An*) In such cases, external moxibustion at Baihui (GV20) and internal administration of Shen Fu Tang (Ginseng and Aconite Decoction) may result in survival.
[Pulse Diagnosis]
A tight, excessive, short, wiry, or floating pulse at the Cun Kou (radial artery) indicates headache. Specifically, a floating-wiry pulse indicates wind; floating-hong indicates fire; fine-and-soggy indicates dampness; slippery-and-large indicates phlegm; short-and-choppy indicates deficiency.
[Therapeutic Principles]
At the highest point of the head, only wind herbs can reach. (From Li Dongyuan) Ancient formulas for treating headache often use wind herbs because their flavors are light, representing "yang within yin," rising from earth to heaven. For wind-cold-dampness, this is the direct treatment; even for deficiency and heat patterns, these herbs can be used as guiding agents. (From *Yi Zong Bi Du*)
[Clearing Depressed Heat]
Headache is mostly governed by phlegm, and in severe cases, accompanied by fire. (From Zhu Danxi) Some long-term headaches triggered by cold exposure, treated externally with thick cotton wrapping, belong to depressed heat. The root is heat, but the branch is cold. Because there is inherent depressed heat, the pores are often open, allowing wind-cold to enter easily, binding the internal fire and causing obstruction and rebellion, leading to pain. Treatment should involve purging fire and cooling blood, assisted by acrid-cool herbs to dissipate the exterior. (From *Zhang Shi Yi Tong*)
[Addressing Cold-Dampness]
Damp-heat headache presents with vexation and heavy stagnation, located in the diaphragm, passing through the Hand Taiyang Small Intestine and Hand Shaoyin Heart channels. Cold-damp headache involves qi rebelling upward without descending, causing headache and vertigo, with deficiency below and excess above, passing through the Hand Shaoyin Heart and Foot Taiyang Bladder channels, potentially entering the Kidneys. For migraines, first select points from the Hand Shaoyang Sanjiao and Hand Yangming Large Intestine channels, then select points from the Foot Shaoyang Gallbladder and Foot Yangming Stomach channels. (From *Yi Xue Zhun Sheng Liu Yao*)
[Medication]
For headache caused by external pathogens, phlegm, or fire (excess patterns), Er Chen Tang (Two-Cured Decoction) is the primary formula. For wind, add Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix); for cold, add Xi Xin (Asari Radix) and Gao Ben (Ligustici Chuanxiong Rhizoma); for dampness, add Cang Zhu (Atractylodis Rhizoma) and Bai Zhi (Angelicae Dahuricae Radix); for fire, add Shan Zhi (Gardeniae Fructus) and Jiu Qin (Scutellariae Radix fried with wine); for depressed heat, add Jiu Da Huang (Rhei Radix et Rhizoma soaked in wine), Xi Xin, and Ya Cha (Sprouted Tea); for wind-heat, add Tian Ma (Gastrodiae Rhizoma) and Man Jing Zi (Viticis Semen). Additionally, Taiyang headaches add Gao Ben; Yangming headaches add Bai Zhi; Shaoyang headaches add Chai Hu (Bupleuri Radix); Taiyin headaches add Cang Zhu; Shaoyin headaches add Xi Xin; Jueyin headaches add Wu Yu (Evodiae Fructus). These are the guiding herbs for the Six Channels. For qi deficiency, Shun Qi He Zhong Tang (Regulating Qi and Harmonizing Middle Decoction) is used, adding Tian Ma and Chuan Xiong (Chuanxiong Rhizoma). For blood deficiency, Si Wu Tang (Four Substances Decoction) is used, adding Bo He (Menthae Haplocalycis Herba) and Gan Ju (Chrysanthemi Flos). For wind-heat headache, Qing Kong Gao (Clearing Empty Paste) is used. For wind-phlegm headache, Yu Hu Wan (Jade Pot Pill) is used. For phlegm-fire headache, Shi Gao San (Gypsum Powder) is used. For cold-damp headache, Xiong Xin San (Ligusticum and Asari Powder) is used. For phlegm-Jue headache, Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) is used. For Kidney-Jue headache, Yu Zhen Lai Fu Dan (Jade True Returning Pellet) is used. For Liver deficiency headache, Sheng Shu Di Huang Wan (Raw and Prepared Rehmannia Pill) is used. For Liver fire headache, Xiao Yao San (Free and Easy Wanderer Powder) is used.
[Rapid Methods]
To treat half-headache due to wind-deficiency, use 2 qian of Bai Zhi, one yellow ox brain, and 3 qian of Chuan Xiong. Place in a porcelain vessel, boil in wine, and consume. Drink until intoxicated; upon waking, the pain will cease. To treat cold-damp headache, take one plant of Bai Feng Xian (Impatiens balsamina), mash it, soak in liquor, expose to dew on the seventh day of the seventh lunar month, strain, and drink the liquid. To treat headache due to qi-blood deficiency with aversion to wind and cold, sprinkle salt on grass paper, apply a hot iron to the painful area, reapply when cool, until resolved. For heat depression in the brain causing pain, blow powdered Xiao Shi (Niter) into the nose to stop pain immediately. For qi-depression migraines, mash Bi Ma (Ricini Semen) with Ru Xiang (Olibanum) and salt, and apply to the Taiyang acupoint to stop pain. For severe stuffy pain in the head and eyes due to external contraction, insert scallion leaves 1-2 cun into the nose; once qi flow is felt, pain decreases.
[Appendix: Meiling Pain]
Meiling (supraorbital ridge) is where the ocular system passes, connecting upward to the brain. Externally affected by wind-cold and internally forming depressed heat, it attacks upward to the head and downward to the eyes, causing pain in the brow bone. Other causes include Liver fire congestion, wind-phlegm attacking upward, and internal dampness depression. (From *Yi Zong Bi Du*) There are cases of Liver channel blood deficiency causing pain upon exposure to light, and Liver channel injury from fluids causing quietness by day and aggravation with heaviness by night. In women nearing the end of menstruation, if nourishment is insufficient, or due to mental labor from needlework, causing sore ache in the brow bone, the treatment focuses specifically on nourishing yin and blood. (From *Zheng Zhi Hui Bu*)
[Appendix: Naotong (Brain Pain)]
Head pain resembling a chop, accompanied by frequent dizziness, twitching and throbbing at the back of the head, occurring at any time. This is Liver channel phlegm-fire, named Jue Ji (Rebellious Disease). "Jue" means rebellion. Excessive anger causes qi and blood to rebel together to the highest peak, and since the Gallbladder channel connects to the brain, treatment should clear phlegm and descend fire using Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Hua Fen (Trichosanthis Radix), Dan Cao (Gentianae Radix), Da Huang (Rhei Radix et Rhizoma), Lu Hui (Aloe), Mu Dan Pi (Moutan Cortex), and Chi Shao (Paeoniae Radix Rubra), mixed with pig bile for administration. For weak individuals suffering from this, Xiao Yao San plus Chuan Xiong and Sheng Di Huang (Rehmanniae Radix) should be used.
[Medication]
For Liver deficiency, primarily use Sheng Shu Di Huang Wan. For blood deficiency, primarily use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). For damp-phlegm, primarily use Dao Tan Tang (Guiding Phlegm Decoction). For wind-heat, primarily use Shang Qing San (Upper Clearing Powder). If this condition is neglected, it often damages the eyes or causes pus discharge from both ears, which is critical.
[Selected Formulas for Headache]
Er Chen Tang: Universally treats headache (Formula see Phlegm Syndrome section).
Shun Qi He Zhong Tang: Treats qi-deficiency headache.
It is Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shao Yao (Paeoniae Radix), Chuan Xiong, Man Jing Zi, and Xi Xin.
Jia Wei Si Wu Tang: Treats blood-deficiency headache.
It is Si Wu Tang added with Gan Ju (Chrysanthemi Indici Flos) and Man Jing Zi.
Qing Kong Gao: Treats wind-heat headache.
Qiang Huo, Fang Feng (each 1 liang), Chai Hu (7 qian), Chuan Xiong (5 qian), Gan Cao (Licorice Root, 5 qian), Huang Qin (3 liang fried with wine), Huang Lian (2 liang stir-fried).
Grind into powder. Take 2 qian each time, washed down with clear tea.
Yu Hu Wan (from *He Ji Ju Fang*): Treats wind-phlegm headache, chest and diaphragm fullness, inability to eat, cough, and vomiting of phlegm-saliva.
Tian Nan Xing (Arisaematis Rhizoma), Ban Xia (Pinelliae Rhizoma) (each 1 liang), Tian Ma (0.5 liang), Bai Mian (Wheat Flour, 3 liang).
Make pills with water drops. Take 30 pills each time, washed down with ginger soup.
Shi Gao San: Treats phlegm-fire headache.
Chuan Xiong (lower layer), Shi Gao (Gypsum, upper layer), Huang Qin (middle layer), Bai Zhi (lower layer).
Decoct in water.
Xiong Xin San: Treats cold-damp headache.
Chuan Xiong, Xi Xin (each 1.5 qian), Cang Zhu, Gan Cao, Gan Jiang (Dried Ginger) (each 1 qian).
Ban Xia Bai Zhu Tian Ma Tang: Treats phlegm-Jue headache.
Tian Ma, Bai Zhu, Ban Xia (each 1 qian), Ren Shen (Ginseng Radix et Rhizoma), Cang Zhu, Chen Pi (Citri Reticulatae Pericarpium), Huang Qi (Astragali Radix), Ze Xie (Alismatis Rhizoma), Fu Ling (Poria) (each 0.5 qian), Shen Qu (Massa Medicata Fermentata), Mai Ya (Hordei Fructus Germinatus) (each 0.7 qian), Gan Jiang (0.3 qian), Huang Bo (Phellodendri Cortex) (0.2 qian).
Decoct in water.
Yu Zhen Wan (from *Ben Shi Fang*): Treats Kidney-Jue headache.
Liu Huang (Sulfur, 2 liang), Shi Gao, Ban Xia, Xiao Shi (Natrii Sulfas) (ground, each 1 liang).
For severe deficiency, remove Shi Gao and add Zhong Ru Fen (Stalactitum Powder, 1 liang). Make pills with ginger paste, washed down with ginger soup. External moxibustion at Guan Yuan (CV4) for 100 moxa cones.
Lai Fu Dan (from *He Ji Ju Fang*): Treats excess above and deficiency below.
Xiao Shi (ground with Liu Huang), Xuan Jing Shi (Mirabilite), Liu Huang (each 1 liang), Wu Ling Zhi (Trogopterori Faeces) (water-cleaned to remove sand), Qing Pi (Citri Reticulatae Pericarpium Viride), Chen Pi (each 2 liang).
Grind into powder, make pills with vinegar paste, washed down with rice drink.
Sheng Shu Di Huang Wan: Treats Liver-deficiency headache.
Sheng Di Huang (Prepared Rehmannia Root), Shu Di Huang (upper layer), Tian Ma, Chuan Xiong, Fu Ling (lower layer), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Hei Dou (Black Soybean), Shi Hu (Dendrobii Caulis), Xuan Shen (Scrophulariae Radix), Di Gu Pi (Lycii Cortex) (middle layer).
Make pills with honey.
Qu Feng Qing Shang San (from *Tong Zhi Fang*): Treats wind-heat attacking upward.
Jiu Qin (2 qian), Bai Zhi (1.5 qian), Fang Feng, Chai Hu, Chuan Xiong, Jing Jie (Schizonepetae Spica), Qiang Huo (each 1 qian), Gan Cao (0.5 qian).
Decoct in water.
Hei Xi Dan (from *He Ji Ju Fang*): Treats True Headache.
Chen Xiang (Aquilariae Lignum Resinatum), Fu Zi (Aconiti Lateralis Radix Praeparata), Hu Lu Ba (Trigonellae Semen), Rou Gui (Cinnamomi Cortex) (each 5 qian), Hui Xiang (Foeniculi Fructus), Po Gu Zhi (Psoraleae Fructus), Jin Ling Zi (Meliae Fructus), Rou Guo (Myristicae Semen), Mu Xiang (Aucklandiae Radix) (each 1 liang), Hei Xi (Lead), Liu Huang (fried into beads, each 3 liang).
Another prescription includes Yang Qi Shi (Pyritum, 0.5 liang) and Ba Ji Tian (Morindae Officinalis Radix, 1 liang). Decoct in wine, make pills with wheat paste, washed down with ginger soup.
Qiang Huo Hei Fu Tang (from Li Dongyuan): Treats cold-Jue headache.
Ma Huang (Ephedrae Herba), Qiang Huo, Fang Feng, Cang Zhu (each 1 qian), Sheng Ma (Cimicifugae Rhizoma, 2 fen), Gan Cao (2 fen), Fu Zi (1 fen), Bai Zhi (3 fen).
Decoct in water.
Che Qing Gao
Man Jing Zi, Xi Xin, Bo He (Menthae Haplocalycis Herba), Chuan Xiong, Gao Ben, Gan Cao
Chuan Xiong Cha Tiao San (from *Xuan Zhu*)
Bo He (3 qian), Chuan Xiong (1 liang), Jing Jie (4 qian), Bai Zhi (5 qian), Xi Ya Cha (Fine Sprouted Tea, 3 qian), Huang Qin (2 liang fried with wine).
For vertex headache and brain pain, add Xi Xin, Gao Ben, and Man Jing Zi (each 1 qian). Take 2-3 qian each time, washed down with clear tea.