头为天象，六腑清阳之气，五脏精华之血，皆会于此。故外感六淫之邪，与脏腑上逆之气，或蔽
复其清明，或瘀塞其经络，咸能作痛。昔人云∶头者身之元首，一有痛楚，无论标本，宜先治焉。但致
痛之因不一，宜各推类求之。如因外感六淫之邪而头痛者，当辩明何邪、何经，而从本门以施治；有阴
虚头痛者，必挟肾虚内热之症，六味汤加减，有血虚头痛者，痛在日晚，四物汤加减，有气虚头痛者，
痛在清晨，补中益气加减；有挟邪热头痛者，宜辛寒解散；有挟痰头痛者，宜豁痰降气；饮食自倍，胃
气不行壅逆头痛者，宜消食下气，怒气伤肝，肝气暴逆上冲头痛者，宜平肝降气；眉棱骨痛，多属阴虚血
亏，治宜补血益阴，然亦有挟外邪者，亦当审察。须知浅而暴者，但名头痛；深而远者，即为头风，作
止不常，愈后复发，昔人分偏左痛者为血虚，偏右痛为气热。仲淳则俱责之血虚肝家有热∶以养血清热为
主。若治之不急，必致损目。经谓东风生于春，病在肝。目者肝之窍，肝风动，则邪害空窍矣。察内
外之因，分虚实之症，胸中洞然，则手到病除矣。
疏邪利金汤〔见伤寒。〕
羌防香苏散
葛根汤
小柴胡汤
柴胡丹皮汤
柴胡骨皮汤
竹叶石膏汤〔俱见伤寒。〕
羌活胜湿汤
活人败毒散〔俱见湿。〕
此九方，外感六淫之邪而头痛者，须审察明系何邪、犯何经，而分别治之。
清上散〔自制。〕治风热、火热头痛，亦治偏头风痛，有实火者。
石膏〔辛能散邪，寒能清热。〕薄荷〔辛能发散，凉能清利。〕甘菊〔养血
清热。〕忍冬 黑豆〔祛风除热。〕枯黄芩〔酒炒。〕陈松萝〔降火清上。〕可用
土茯苓〔祛风、祛浊、厘清。二、三、四两。〕煎汤煎药。热极目昏便燥者，可加大黄。〔酒蒸。〕
此散邪清热降火之剂，功胜清宁膏。
二陈汤〔见中风。〕治肥人湿痰满中，气壅逆上，头痛眩晕。
宜加天麻〔痰厥头痛，非半夏不疗；风虚眩晕，非天麻不除。〕枳壳 木香 砂仁〔利
气。以气滞则不能运痰。〕黄芩〔泻火。以气积则有余为火。〕
此方果系肥人内有湿痰，以致头痛眩晕者，用之自效。若阴虚内热有痰者，此方不可与也。
保和丸〔见泄泻。〕治饮食自倍，胃气不行，壅逆头痛，主
此加减。
宜加香附 紫苏 淡豉。〔理气消食，倘兼感风寒，又能散邪。〕因伤酒，加葛根、甘菊、松
萝。〔以解酒毒。〕
此方总以消食为主，绝不用风药者，所谓治病必求其本也。
沉香降气散〔见喘。〕治怒气伤肝，肝气暴逆上冲头痛，主此加减。
宜加甘菊 钩藤 羚羊角〔平肝除热。羚角则兼下逆气。〕绿豆〔下气压热。〕松
萝〔下气降火。〕
此方总以降气为主，盖大怒则气血俱逆，切忌辛散升提之品。
六味地黄汤〔见虚劳。〕治阴虚火逆冲上头痛。〔必有肾虚诸症。〕
宜加甘菊 银花 二冬〔补阴益血清热。〕牛膝 枸杞〔补肾益精填髓。〕白芍或五
味，或乌梅，〔敛摄虚火下降。〕
此方肾水虚衰，火无所制，上炎头痛者，用以壮水滋阴清热，敛摄虚火下降，则痛自止。若用
辛散风药，是反耗肾中之水，助炎上之火矣。凡平素阴虚人患此者，当察果无外邪症候，酸收之品，不必
致疑。
四物汤 治血虚火炎头痛，〔如便血崩淋，产后多有患此者。〕自眉尖后近发际上攻而痛，痛在
日晚。〔血为阴，阴虚故交阴分而痛作，所谓内伤头痛，时作时止者是。〕亦治偏头风痛。
地黄〔生者凉血，熟者补血。〕白芍〔敛血凉血。〕当归〔活血和血。〕川
芎〔血中气药，辛散上升，故多功于头目，〕加葳蕤〔滋阴益精。〕枸杞〔益肝养荣。〕
宜参六味加用诸药。
此补血之剂，果属血虚无外邪者，用之自效。若兼挟外邪者，宜去敛摄之品，加荆、防、天麻之属。
补中益气汤〔见泄泻。〕治气虚头痛，痛在清晨。〔气为阳，阳虚故交阳分而痛作。〕
宜加葳蕤〔补中益气。〕甘菊、川芎。
此责脾胃阳虚衰弱，不能上升，故用升清阳，益中气，则痛自止。然世人之患气虚者甚少。必其人
面色黄白无神，四肢倦怠，嗜卧食少，体羸溏泄，并无阴虚内热症候者，方为对症。若误施阴虚火炎头
痛，为害不浅。此方嘉言论之甚阴，用者审之。
真头痛，头痛甚，脑尽痛，手足寒至节，死不治。〔一云火炎水灭，一云真阳败竭，阴邪真中脑
海。总之为火为寒，皆主死也。〕
The head is the highest part of the body, where the clear yang qi of the six fu organs and the essence blood of the five zang organs all converge. Therefore, pathogenic factors of the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) from external sources, as well as rebellious qi from the zang-fu organs, may either obscure their clarity or cause stasis and blockage in their meridians, all capable of producing headache. As the ancients said: "The head is the chief of the body." Once pain occurs, regardless of whether the etiology is root or branch, it should be treated first. However, the causes of pain vary, and one must investigate each category to determine treatment. If the headache is caused by external invasion of the Six Excesses, one must distinguish which pathogen and which meridian are involved, and treat accordingly from the perspective of that specific channel. For headache due to Yin Deficiency, there must be accompanying symptoms of Kidney Deficiency with internal heat; treat with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) modified. For headache due to Blood Deficiency, pain worsens in the evening; treat with Siwu Tang (Four-Substance Decoction) modified. For headache due to Qi Deficiency, pain occurs in the early morning; treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) modified. For headache accompanied by pathogenic heat, use acrid-cold methods to dissipate the heat. For headache accompanied by phlegm, use methods to resolve phlegm and direct qi downward. When food intake is excessive, causing Stomach qi stagnation and rebellious upward movement leading to headache, use methods to digest food and direct qi downward. When anger injures the Liver, causing sudden rebellious upward rushing of Liver qi leading to headache, use methods to calm the Liver and direct qi downward. Pain in the supraorbital ridge mostly belongs to Yin Deficiency and Blood Deficiency; treatment should nourish Blood and benefit Yin. However, there are cases complicated by external pathogens, which must also be carefully examined. It should be known that headaches that are superficial and acute are merely called "headache"; those that are deep-seated and chronic are called "Head Wind" (Toufeng), characterized by irregular onset and remission and recurrence after recovery. The ancients classified left-sided headache as Blood Deficiency and right-sided headache as Qi Heat. Zhongchun, however, attributed both to Blood Deficiency with Heat in the Liver family, prioritizing nourishing Blood and clearing Heat. If not treated promptly, this will inevitably damage the eyes. The Classics state: "East wind arises in Spring, disease affects the Liver." The eyes are the opening of the Liver; when Liver Wind moves, pathogens harm the orifices. By examining internal and external causes and distinguishing deficiency and excess syndromes, with clear understanding in mind, the disease can be cured effectively.
Shuxie Lijin Tang (Dispel Pathogens and Benefit Metal Decoction) [See Shanghan]
Qiangfang Xiangsu San (Notopterygium, Saposhnikovia, Litsea, and Perilla Powder)
Gegen Tang (Pueraria Decoction)
Xiao Chaihu Tang (Minor Bupleurum Decoction)
Chaihu Danpi Tang (Bupleurum and Moutan Decoction)
Chaihu Gupi Tang (Bupleurum and Cortex Lycii Decoction)
Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction) [All see Shanghan]
Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness)
Huoren Baidu San (Living Person's Toxin-Resolving Powder) [All see Shi Zheng]
For these nine formulas, they apply to headaches caused by external invasion of the Six Excesses. One must carefully examine which specific pathogen and meridian are involved, and treat separately.
Qingshang San (Clear Upper Powder) [Self-made] Treats headaches caused by Wind-Heat or Fire-Heat, and also treats lateral Head Wind pain in cases of Excess Fire.
Shigao (Gypsum Fibrosum) [Acrid nature disperses pathogens, cold nature clears heat.] Bohe (Menthae Haplocalycis Herba) [Acrid nature disperses, cool nature clears and benefits.] Ganju (Chrysanthemi Flos) [Nourishes Blood and clears heat.] Rendong (Lonicerae Japonicae Flos) Heidou (Sojae Semen Nigrum) [Dispel Wind and remove heat.] Ku Huangqin (Scutellariae Radix, dried) [Stir-fried with wine.] Chen Songluo (Ancient Pine Moss) [Directs fire downward and clears the upper jiao.] Tu Fuling (Smilax Glabrae Rhizoma) [2, 3, or 4 liang] can be decocted in water to cook the medicine. In cases of extreme heat causing blurred vision and dry stool, add Dahuang (Rhei Radix et Rhizoma) [Steamed with wine].
This powder has effects superior to Qingning Gao in dispelling pathogens, clearing heat, and reducing fire.
Erchen Tang (Two-Aged Decoction) [See Fengzhong] Treats obese individuals with damp-phlegm filling the middle jiao, qi stagnation and rebellion upward, leading to headache and vertigo.
It is advisable to add Tianma (Gastrodiae Rhizoma) [For headache due to Phlegm-Jue, Banxia is indispensable; for vertigo due to Wind-Deficiency, Tianma is indispensable.] Zhike (Aurantii Fructus Immaturus) Muxiang (Aucklandiae Radix) Sharen (Amomi Fructus) [Regulate qi. Because qi stagnation prevents the transformation of phlegm.] Huangqin (Scutellariae Radix) [Drain fire. Because qi accumulation leads to excess transforming into fire.]
If this formula is indeed used for obese individuals with internal damp-phlegm causing headache and vertigo, it will be effective. However, for those with Yin Deficiency, internal heat, and phlegm, this formula should not be used.
Baohe Wan (Preserve Harmony Pill) [See Xiexie] Treats headaches caused by excessive food intake, Stomach qi stagnation, and rebellious upward movement, using this formula as a base for modification.
It is advisable to add Xiangfu (Cyperi Rhizoma) Zisu (Perillae Folium) Danshi (Fermented Soybean) [Regulate qi and digest food; if complicated by Wind-Cold, it can also disperse pathogens.] Due to alcohol injury, add Gegen (Puerariae Lobatae Radix), Ganju (Chrysanthemi Flos), and Songluo (Ancient Pine Moss) [To resolve alcohol toxicity].
This formula primarily focuses on digesting food and absolutely avoids wind-dispersing herbs, which is what is meant by "treating disease requires seeking its root."
Chenxiang Jiangqi San (Aquilaria Directing Qi Downward Powder) [See Chuan] Treats headaches caused by anger injuring the Liver and sudden rebellious upward rushing of Liver qi, using this formula as a base for modification.
It is advisable to add Ganju (Chrysanthemi Flos), Gouteng (Uncariae Ramulus cum Uncis), Lingyangjiao (Saigae Tataricae Cornu) [Calm the Liver and remove heat. Lingyangjiao also directs rebellious qi downward.] Lvdou (Phaseoli Semen) [Directs qi downward and suppresses heat.] Songluo (Ancient Pine Moss) [Directs qi downward and reduces fire].
This formula primarily focuses on directing qi downward. Great anger causes both qi and blood to rebel; therefore, acrid-dispersing and ascending agents must be strictly avoided.
Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill/Decoction) [See Xulao] Treats headaches caused by Yin Deficiency with rebellious fire rushing upward [Must have various symptoms of Kidney Deficiency].
It is advisable to add Ganju (Chrysanthemi Flos), Yinhua (Lonicerae Japonicae Flos), Er Dong (Ophiopogonis Radix and Asparagi Rhizoma) [Nourish Yin, benefit Blood, and clear heat.] Niuxi (Achyranthis Bidentatae Radix) Gouqi (Lycii Fructus) [Tonify Kidney, benefit Essence, and fill Marrow.] Baishao (Paeoniae Radix Alba) or Wuweizi (Schisandrae Chinensis Fructus), or Wumei (Mume Fructus) [Astringe and gather deficient fire to descend].
For this formula, when Kidney Water is deficient and exhausted, Fire has no control and flares upward causing headache, it is used to strengthen Water, nourish Yin, clear heat, and gather deficient fire to descend, thereby stopping the pain. If acrid-dispersing wind herbs are used, it would instead deplete the Water in the Kidney and assist the flaming-upward Fire. For those who usually suffer from Yin Deficiency and develop this condition, one must examine whether there are truly no external pathogen symptoms; astringent agents need not be doubted.
Siwu Tang (Four-Substance Decoction) Treats headaches caused by Blood Deficiency with Fire Flaring Up [Common in cases such as hematochezia, metrorrhagia, postpartum conditions]. Pain attacks upward from behind the eyebrows near the hairline, occurring in the evening [Blood belongs to Yin; Yin Deficiency causes pain when entering the Yin portion of the day, which is referred to as Internal Injury Headache, characterized by intermittent onset and cessation]. Also treats lateral Head Wind pain.
Dihuang (Rehmanniae Radix) [Raw cools Blood, cooked tonifies Blood.] Baishao (Paeoniae Radix Alba) [Astringes and cools Blood.] Danggui (Angelicae Sinensis Radix) [Invigorates and harmonizes Blood.] Chuanxiong (Ligustici Chuanxiong Rhizoma) [Qi herb within Blood, acrid and dispersing, ascending, thus highly effective for head and eyes.] Add Weirui (Polygonati Odorati Rhizoma) [Nourish Yin and benefit Essence.] Gouqi (Lycii Fructus) [Benefit Liver and nourish Ying].
It is advisable to refer to Liuwei Dihuang Tang and add the aforementioned herbs.
This is a Blood-tonifying formula. If it truly belongs to Blood Deficiency without external pathogens, it will be effective. If complicated by external pathogens, remove astringent agents and add Jingjie (Schizonepetae Spica), Fangfeng (Saposhnikoviae Radix), Tianma (Gastrodiae Rhizoma), etc.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) [See Xiexie] Treats Qi Deficiency headache, occurring in the early morning [Qi belongs to Yang; Yang Deficiency causes pain when entering the Yang portion of the day].
It is advisable to add Weirui (Polygonati Odorati Rhizoma) [Tonify Middle and augment Qi], Ganju (Chrysanthemi Flos), Chuanxiong (Ligustici Chuanxiong Rhizoma).
This formula addresses Spleen-Stomach Yang Deficiency and weakness, unable to ascend; thus, it uses methods to raise Clear Yang and supplement Middle Qi, so the pain stops naturally. However, few people in the world suffer from Qi Deficiency. It must be someone with sallow or pale complexion lacking spirit, fatigue in limbs, lethargy, poor appetite, emaciation, and loose stools, without any symptoms of Yin Deficiency with internal heat, before it is symptomatic. If mistakenly applied to Yin Deficiency with Fire Flaring Up headache, the harm is significant. Jialun discussed this formula extensively; users must exercise caution.
Zhen Toutong (True Headache): Severe headache, pain throughout the brain, cold hands and feet extending to the joints, death is untreatable [One theory says Fire flares and Water extinguishes; another says True Yang fails and Exhaustion, with Yin Pathogen directly striking the Sea of Brain. In summary, whether Fire or Cold, it indicates death].