头眩
头眩欲倒辨瘦肥，
或云眩晕，或云眩冒。眩，言其黑；晕，言其转；冒，言其昏，一也。虚者，
内
外之邪，乘虚入表而上攻；实者，内外之邪，郁痰上结而下虚。大概肥白人多湿痰滞于上，
火起于下，痰因火而上冲，所谓无痰不作眩者是也，治宜以痰为主，兼补气降火；瘦人多肾
水亏少，相火上炎而眩晕，所谓风胜则地动，火得风则焰旋是也，治宜滋阴降火，化痰抑肝
。此以肥瘦为主，亦丹溪常法也，后仿此。
眼花昏暗屋旋飞；
经曰∶徇蒙招尤。徇蒙者，如以物蒙其首；招尤者，招摇不定。如立舟车之上，
起则欲倒，眼昏耳聋，屋如旋转，甚则卒倒，不省人事，乃肝所主也。又曰∶诸脉皆系于目
。脏腑筋骨气之精，而与脉并为系，上属于脑，后出于项中，故邪中于项，因逢其身之虚，
其入深，则随眼系入于脑，则脑转，脑转则引目系急而眩矣。
虚弱老年阳陷越，
内伤劳役，气虚不能上升，或汗多亡阳，宜补中益气汤。色欲伤肾，气逆不能归
元，四君子汤加天麻、防风，或十全大补汤、肾气丸加鹿茸。血虚，因产后、金疮及吐衄亡
血，孤阳浮越，古芎归汤加炒干姜，瘀血滞胸加童便。老年每早起眩晕，须臾自定，有风痰
虚火者，果系阳虚，顺元散，吞黑锡丹以镇坠之。《玉机》谓丹药金石助火，香窜散气，多
致飞越之亢，岂能镇其不归之气耶？
火痰晕甚气痛眉；
火动其痰，眩甚者，二陈汤加芩、连、苍术、羌活。火盛壮实，属阳明者，单大
黄酒炒为末，茶清下，或古荆黄汤加防风等分；属太阳少阳者，酒芩、白芷等分为末，茶清
下。虚火，半夏白术天麻汤。七情，脏气不平，涎迷心窍，眩晕、眉棱骨痛、眼不可开者，
七气汤、玉液汤、补虚饮。
风则项强寒拘痛，
外因风，脉浮、有汗、项强，热者，川芎茶调散，或参苏饮加南星、黄芩；热甚
者，川芎石膏散；虚者，山茱萸散，或四物汤加秦艽、羌活，通用单白芷丸。又大风头眩，
手足麻痹，胃脘发痛，乃风寒湿三痹合至，必有停饮在上，宜量吐之。寒，脉紧无汗，四
肢拘急，筋挛，头掣痛，五积散；喜热手按者，附子理中汤、三五七散。
暑烦渴兮湿重垂；
暑，脉虚，烦渴，十味香茹散，或二陈汤加黄连、山栀、川芎。湿，脉细，头重
吐逆，芎术汤、芎术除眩汤，或肾着汤加川芎。风湿，玉壶丸。
外邪和解清痰火，内虚本固标自移。
凡肝脉溢大必眩，宜预防之，外感解肌化痰，不可妄施汗下；内因量施补益。
昔丹溪治妇人带下头眩，专治带而眩自安。盖头眩、头痛、咳嗽，病之标也。经曰∶治病必
求其本。通用二陈汤。七情，加丁香、砂仁、白术；风痰，加天麻、白附子、荆芥、防风；
寒痰，
加干姜，良姜；热痰，合解毒汤；湿痰，合芎辛汤；停水心悸，合五苓散；酒食伤，加干生
姜。胸中
宿痰，眼涩、手麻痹、发脱、健忘者，用本方探吐，吐后宜服清上辛凉之药调之。气虚，倍
参
、；血虚，倍芎、归；痰盛，加竹沥、姜汁，火盛，加童便。如眩晕、气上冲胸、战摇者
，只宜
茯苓桂术甘草汤加减。凡眩晕，言乱汗多下利，时时自冒者，虚极不治。
头痛
厥头痛将内外分，
真头痛，引脑巅泥丸尽痛，手足冷至节者，死。厥者，逆也。邪气逆上阳经而作
痛，甚则发厥，须分内外二因治之。
外感寒热表家论；
外感头痛，必有寒热，宜分轻重解表。风证，芎芷香苏散、消风散。风热，川芎
石膏散；风寒，三五七散；风寒入脑，连齿痛者，芎辛汤，或羌活黑附汤，去附、柏，加桂
枝
；
脑风，项背怯寒，脑户极冷者，用麻黄、细辛、全蝎、藿香各五分，为末，荆芥煎酒，或茶
下。寒证，连须葱白汤、葛根葱白汤。暑证，香薷散，加茵陈、葱白，或大半夏汤，姜汁为
丸服。湿证，芎术汤。湿热，心烦，痛起耳中，古防风汤，加酒芩、苍术、苍耳子、细辛
，为末，茶清入姜汁少许调服；热多者，酒芩为末，茶清下。通用二陈汤，加芎、芷为主
。太阳恶风寒，脉浮紧，加羌活、麻黄、川芎；阳明自汗，发热恶寒，脉浮缓长，加升麻、
葛根、白芷，渴者，宜合白虎汤，加吴萸、白芷；少阳寒热往来，脉弦，加柴胡、黄芩；如
三阳胸膈宿痰，痛久不止，令人丧明，宜合川芎茶调散探吐；太阴体重腹痛，脉沉，必有
痰，加苍术、南星；少阴寒厥，脉沉细，加附子、细辛；厥阴吐沫，厥冷，脉浮缓，加吴萸
。头顶项背俱痛者，宜合羌吴汤。肥人，加二术；瘦人，加酒芩。风热，加蔓荆子、川芎、
酒芩。
若头痛，加细辛，巅顶痛，加 本、升麻、防风。
内虚气滞太阳痛
内伤气虚，相火上冲，耳鸣九窍不利，两太阳穴痛，宜补中益气汤倍川芎，加知
母、蔓荆子，或四君子汤。大病后及诸虚痛者，四柱散加茶一撮。
血虚鱼尾上生嗔；
古芎归汤，或四物汤加酒芩、羌活、柴胡、蔓荆子。气血两虚者，调中益气汤加
川芎、细辛。挟火者，安神汤。
肾虚巅痛七情呕，
肾厥，下虚上盛，巅顶痛不可忍，脉举之则弦，按之则坚，宜玉真丸。七情气厥
，心腹胀满，呕吐酸水，宜古芎乌散、葫芦巴散；挟痰，如圣饼子；头与心换痛者，古 苍
汤。
痰火食积皆同因。
痰厥，头旋眼黑，言乱恶心，眼闭肢冷，宜半夏白术天麻汤，导痰汤加芎、辛，
三生丸。痰火，痛甚如破，二陈汤加芩、连，或清空膏、清上泻火汤。如壮实人，只宜酒炒
大黄为末，茶清下。痰饮滞痛者，神芎丸。有伏痰者，瓜蒂散吐之。积聚痛者，大黄备急丸
。凡头痛数日不食，百药不效者，二气丹；无热者，黑锡丹；常服点头散，断根。寻常头
目不清，似痛非痛，参苏饮主之；风热者，彻清膏，芩、连煎汤调下；沐浴后者，单白芷丸
。
头风（附眉棱骨痛）
头风项强分偏正，
素有痰者，或栉沐取凉，及醉饱仰卧，贼风入脑、入项，入耳、入鼻，自颈项以
上，耳、目、口、鼻、眉棱之间，有一处不若吾体，皆其渐也。有头皮浮顽，
不自觉者，有口舌不知味者，或耳聋，或目痛，或眉棱上下掣痛，或鼻中闻香极香、闻臭极
臭，或只呵欠，而作眩冒之状；甚则项强硬，身体拘急，宜川芎茶调散，或祛风通气散主之
，此正头风也。偏左痛者，多血虚，或有火，或风热；偏右痛者，多气虚，或郁滞，或痰
，或风湿。要知正痛，常兼左右病邪。凡头痛，久则为风也。
兼湿兼热阴暖定；
风湿肿痛连肩背，或遇阴雨则甚者，羌活胜湿汤。风热头痛重大，遇热则发，消
风散倍荆、防；热甚，二陈汤加荆、防、薄荷；便闭，更加大黄微利之；热微，二陈汤加
酒芩、防风、芎、芷。
湿痰痛密多右边，
湿痰，发则痛密无间，二陈汤加南星、苍术、川芎及细辛少许。
血虚晚重为左病。
血虚者，朝轻夕重，古芎归汤，或四物汤加荆、防、白芷、薄荷。若气虚者，朝
重晚轻，多属右边，宜补中益气汤加芎、辛。阳虚甚者，单白芷丸，用参、附煎汤下。
久甚火郁裹重绵，
头风发时，闷痛必欲绵帕裹包者，热郁也，宜凉血泻火为主，佐以辛温散表从治
，二陈汤加酒炒黄芩，及荆芥、薄荷、川芎、石膏、细辛，或消风百解散，防风通圣散。
有
三阳热郁，头痛不敢见光，喜置冰于顶者，宜辛凉，汗、吐、下三法并行乃愈。又有偏痛年
久，便燥、目赤、眩晕者，乃肺乘肝，气郁血壅而然，宜大承气汤下之。外用大黄、芒硝为
末，井底泥调涂两太阳穴上，乃愈。
不妨外感相兼并；
素患头风，因外感而发者，恶寒、头面多汗，宜分偏正，专治头风，而外感自散
。如头风发方愈，而后外感自汗者，加味乌荆丸。因七情发，多吐逆、寒热者，参苏饮主之
；无寒热者，二陈汤加乌药、川芎。
眉棱眶痛或羞明，无非痰与风热甚。
风痰眉心痛者，二陈汤吞青州白丸子。眉棱骨痛，连目不可开、昼静夜剧、身重
者，导痰汤。湿痰眉眶骨痛、体重者，芎辛汤合导痰汤，加川乌、白术。寒湿，芎辛汤，加
川
乌、附子、姜、桂、南星。风热眉棱骨痛甚者，古防风汤加酒黄芩；风虚，加川乌、草乌、
细辛，或金枣丹。血虚挟风，羞明、眉眶痛甚者，生熟地黄丸，或四物汤，加羌、防；气虚
挟
风，安神汤。通用谢传点眼丹、搐鼻药。
面风
面肿虚食热不食，
面肿乃食后冒风所致。能食者，风虚，面麻木，牙关急搐，升麻胃风汤；不食者
，风热，面唇黑，心悬如饥，防风通圣散。内伤气促者，升麻顺气汤。
颊腮同此分虚实；
面肿搭颊搭腮，仍以能食为风虚，不食为风热。搭颊连齿肿、出血者，胃火也，
清胃散。搭腮因膏粱积热者，升麻、黄连、连翘、牛蒡子、白芷等分，水煎。连耳上，加羌
活
；耳下，加柴胡。内虚食少者，补中益气汤。耳后微肿者，肾虚也，肾气丸料水煎服（详外
科
腮）。
阳盛面热阳衰寒，
手足阳明经气盛，则身以前皆热，风热上冲，则面独热，先以调胃承气汤，加黄
连、犀角，下两三行；次以升麻葛根汤，加黄连、川芎、荆芥、薄荷调之。如阳明气不足，
则身以前皆寒，寒湿上逆，则面反不能耐寒，先以附子理中汤数服；次以升麻葛根汤去芍，
加参、 、附子、益智、草蔻、白芷、葱白。面浮者，补胃汤；连骨痛者，干姜散。
生疮总是胃家疾。
凡风客皮肤，痰渍脏腑，则面
黯。脾肺
风湿搏热，生疮红紫或肿者，俱宜金沸草散倍黄芩，或升麻胃风汤加减。面上细疮，常出黄
水，或目生疮，用桃花阴干为末，熟水调服。外用杏花煎汤洗之。如生五色疮，只用盐汤绵
浸搭疮上，日五六易。如生粉刺，捣菟丝子汁涂之，内服桦皮散。面皮里痛者，用何首乌为
末，姜汁调敷，以帛盖定，炙热鞋底熨之。
眼
眼病须先分表里，
外因∶风中脑户，湿渍头上，热逼冷灌睛中，或久处烟火，或食后向火，或醉后
失枕，血滞痰壅，或冒砂尘，或掸刺扑损，汤泡火烧，皆伤目之标。内因∶五辛炙爆、
酒
面、湿热、痰火、房室损精，劳役伤气；泣、涕、刺头伤血，暴喜、暴怒、暴惊，极目远视
，夜书细字，镂刻博奕伤神，皆伤目之本。初起在腑为表，当除风散热；久则入脏为里，当
养血安神。然内因初即入里，外因久亦带表，悟之！
五轮八廓亦此理；
表证多属三阳部分，里证多属三阴部分，要知以肝为主，表里虚实，不过五行
生克之理。八廓不必深泥，旧设七十二证，今纂注于内，更不重复便览。
五轮白肺乌珠肝，
白属肺，气之精，曰气轮。气证，七情气滞则血凝，红膜薄如伞纸，日久变成白
膜者，难治。热证，白睛润湿，浮而赤肿筋多重者，生红花翳，痛涩有泪，年深睛变碧色
，满目如凝脂，赤路横真如丝，宜四物汤去芎，换土当归，加甘草。虚证，白睛枯槁，气沉
而浊。乌珠属肝，筋之精，曰风轮。风证，睛闪两睑不归中，如辘轳转关，难治。热证，
赤晕浮浆重者，乌珠忽然如针刺痛，双目紧急，或突出豆许如蟹睛者，忌点。或生翳，似
旋
螺尖突起；或周遭生翳如锯齿，如枣花，四五枚相合，赤色刺痛；或生翳四边皆白，中间一
点黄心；或生翳如玉色，浮满不痛者，忌针割；或生青色翳，两 涩痛；或翳如冰色坚实，
傍观逼透瞳人。虚证，轻者枯黄绕睛，重者乌珠上一点圆翳，日中见之差小，阴处见之差
大；或一点黑翳如小豆，疼痛泪出者，忌点。又肝虚雀目，晓明晚暗，乃所禀血虚有火也，
年深则盲。黄风雀目者，木衰土盛，终当变黄胀而死，宜平胃散以平土气，四物汤以补肝虚
。经年瞳子色如金者，不治。不治症∶生翳上横如剑脊，下面微微甚薄，不赤不痛；或浮
翳如水光白色，环绕瞳人，初生自小 头至乌珠上，不痛痒，无血色相潮；或翳如凝脂，边
浓边薄，形如缺月，色光无瑕；或生翳经年，如银钉钉入乌珠；或因他病生翳，初甚微，后
遍睛俱白。
心与小肠内外 ；
内 属心，外 属小肠，血之精，曰血轮。热症，轻者赤脉缠 ，重者赤脉渐渐
侵睛，或 头结聚生疮，流出脓汁涎水，粘睛上下，乃风热留睑中，宜白薇丸。气证， 肉
攀睛，或先赤烂多年，肝热所冲；或用力作劳，有伤肝气而成，或痛、或痒，两 出；心
气不宁，忧思不已，遂乃攀睛，或起筋膜，宜大黄、黄芩、防风、薄荷等分，入蜜煎服，或
定心丸。
上下两胞胃与脾，
肉之精，曰肉轮。又上胞睑内锐 ，系足太阳起脉。风证，轻者胞弦紧急，重者
上下睑似朱涂而生疮，久则生翳，乃风热也；或眼皮有如胶凝，肿似桃李，时出热泪，乃风
毒也，宜点花草膏。又烂弦风，痒甚，双手背揉，日久两睑赤烂粘滞，经年不安，宜三棱针
辨别头眩欲倒的症状，需根据患者体型的胖瘦来区分。有的称为眩晕，有的称为眩冒。“眩”指眼前发黑；“晕”指感觉天旋地转；“冒”指头脑昏沉，这三者本质是一样的。虚证，是内外邪气乘人体虚弱之机侵入体表并向上攻冲；实证，是内外邪气与痰浊郁结于上，导致下部虚弱。大体而言，肥胖面白的人多因湿痰停滞于上部，下焦火起，痰随火上冲，这就是所谓“无痰不作眩”，治疗应以化痰为主，兼补气降火；消瘦的人多因肾水亏少，相火上炎而导致眩晕，这就是所谓“风胜则地动，火得风则焰旋”，治疗应滋阴降火，化痰平肝。这是以肥瘦为主要依据，也是朱丹溪的常规治法，后文仿照此例。
眼花昏暗，房屋旋转飞舞。
《内经》说：“徇蒙招尤。”徇蒙是指好像有东西蒙住头部；招尤是指摇摆不定。就像站在船车之上，起身时想要跌倒，眼睛昏花耳聋，房屋仿佛在旋转，严重时突然昏倒，不省人事，这是肝脏所主的问题。又说：“所有经脉都联系于目。”脏腑筋骨之精气，与脉一起构成系带，向上连接脑部，向后出于项中，所以邪气中于项部，恰逢身体虚弱，邪气深入，便随着眼系进入脑部，导致脑转，脑转则牵引眼系紧张而发生眩晕。
老年人虚弱，阳气下陷或浮越。
内伤劳役，气虚不能上升，或者汗出过多亡失阳气，宜用补中益气汤。色欲过度损伤肾脏，气逆不能归元，可用四君子汤加天麻、防风，或者十全大补汤、肾气丸加鹿茸。血虚，因产后、金创及吐血衄血失血，导致孤阳浮越，古方芎归汤加炒干姜，若有瘀血停滞胸中加童便。老年人常在早晨起床时眩晕，片刻后自行缓解，若有风痰虚火，确属阳虚者，用顺元散，吞服黑锡丹以镇坠浮阳。《玉机真藏论》认为丹药金石助火，香窜散气，多导致飞越之亢盛，怎么能镇压那不归之气呢？
火痰眩晕严重，伴有气痛眉棱骨痛。
火动其痰，眩晕严重者，用二陈汤加黄芩、黄连、苍术、羌活。火盛且体质壮实，属于阳明经者，单用大黄酒炒为末，茶清送服，或者古方荆黄汤加防风等分；属于太阳、少阳经者，酒芩、白芷等分为末，茶清送服。虚火，用半夏白术天麻汤。七情致病，脏气不平，涎沫迷蔽心窍，出现眩晕、眉棱骨痛、眼睛无法睁开者，用七气汤、玉液汤、补虚饮。
风邪导致项强、恶寒、拘急疼痛。
外感风邪，脉浮、有汗、项强，发热者，用川芎茶调散，或者参苏饮加南星、黄芩；热甚者，用川芎石膏散；虚者，用山茱萸散，或者四物汤加秦艽、羌活，通用单味白芷丸。又有大风引起的头眩，手足麻痹，胃脘疼痛，这是风寒湿三痹合至，必有停饮在上，宜酌情催吐。寒邪，脉紧无汗，四肢拘急，筋挛，头部掣痛，用五积散；喜欢热手按压者，用附子理中汤、三五七散。
暑天烦渴，湿气重则头重下垂。
暑邪，脉虚，烦渴，用十味香薷散，或者二陈汤加黄连、山栀、川芎。湿邪，脉细，头重，呕吐逆乱，用芎术汤、芎术除眩汤，或者肾着汤加川芎。风湿，用玉壶丸。
外邪用和解法清除痰火，内虚固本则标症自除。
凡是肝脉溢大必致眩晕，应预防之，外感解肌化痰，不可妄用汗下法；内因则酌情施以补益。
昔日丹溪治疗妇人带下伴头眩，专治带下而眩晕自安。因为头眩、头痛、咳嗽都是病的标症。《内经》说：“治病必求其本。”通用二陈汤。七情致病，加丁香、砂仁、白术；风痰，加天麻、白附子、荆芥、防风；寒痰，加干姜、良姜；热痰，合解毒汤；湿痰，合芎辛汤；停水心悸，合五苓散；酒食损伤，加干生姜。胸中宿痰，眼涩、手麻痹、脱发、健忘者，用本方探吐，吐后宜服清上辛凉之药调理。气虚，倍用人参、黄芪；血虚，倍用川芎、当归；痰盛，加竹沥、姜汁；火盛，加童便。如眩晕、气上冲胸、战摇者，只宜茯苓桂枝白术甘草汤加减。凡眩晕，言语错乱、汗多、下利，时时昏冒者，虚极不治。
头痛
厥头痛要将内外病因分开。
真头痛，疼痛牵连脑巅泥丸宫全部，手足冷至关节者，死证。厥，是逆的意思。邪气逆上阳经而作痛，严重时发厥，须分内外二因治疗。
外感头痛分寒热表证论述。
外感头痛，必有寒热，宜分轻重解表。风证，用芎芷香苏散、消风散。风热，用川芎石膏散；风寒，用三五七散；风寒入脑，连齿痛者，用芎辛汤，或者羌活黑附汤，去附子、黄柏，加桂枝；脑风，项背怯寒，脑户穴极冷者，用麻黄、细辛、全蝎、藿香各五分，为末，荆芥煎酒，或者茶送下。寒证，用连须葱白汤、葛根葱白汤。暑证，用香薷散，加茵陈、葱白，或者大半夏汤，姜汁为丸服。湿证，用芎术汤。湿热，心烦，痛起耳中，古防风汤，加酒芩、苍术、苍耳子、细辛，为末，茶清入少许姜汁调服；热多者，酒芩为末，茶清送下。通用二陈汤，加川芎、白芷为主。太阳经受病，恶风寒，脉浮紧，加羌活、麻黄、川芎；阳明经受病，自汗，发热恶寒，脉浮缓长，加升麻、葛根、白芷，口渴者，宜合白虎汤，加吴茱萸、白芷；少阳经受病，寒热往来，脉弦，加柴胡、黄芩；如三阳经胸膈有宿痰，痛久不止，令人失明，宜合川芎茶调散探吐；太阴经受病，身体沉重腹痛，脉沉，必有痰，加苍术、南星；少阴经受病，寒厥，脉沉细，加附子、细辛；厥阴经受病，吐沫，厥冷，脉浮缓，加吴茱萸。头顶项背俱痛者，宜合羌吴汤。肥胖人，加二术（苍术、白术）；消瘦人，加酒芩。风热，加蔓荆子、川芎、酒芩。
若头痛，加细辛；巅顶痛，加藁本、升麻、防风。
内虚气滞导致太阳穴痛。
内伤气虚，相火上冲，耳鸣九窍不利，两太阳穴痛，宜补中益气汤倍川芎，加知母、蔓荆子，或者四君子汤。大病后及诸虚痛者，用四柱散加茶一撮。
血虚导致眼角外侧（鱼尾）上方生嗔怒之痛。
古芎归汤，或者四物汤加酒芩、羌活、柴胡、蔓荆子。气血两虚者，用调中益气汤加川芎、细辛。挟火者，用安神汤。
肾虚导致巅顶痛，七情导致呕吐。
肾厥，下虚上盛，巅顶痛不可忍，脉举之则弦，按之则坚，宜玉真丸。七情气厥，心腹胀满，呕吐酸水，宜古芎乌散、葫芦巴散；挟痰，用如圣饼子；头与心换痛者，用古苍汤。
痰、火、食积皆同因。
痰厥，头旋眼黑，言语错乱恶心，眼闭肢冷，宜半夏白术天麻汤，导痰汤加川芎、细辛，三生丸。痰火，痛甚如破，用二陈汤加黄芩、黄连，或者清空膏、清上泻火汤。如壮实人，只宜酒炒大黄为末，茶清送下。痰饮滞痛者，用神芎丸。有伏痰者，用瓜蒂散吐之。积聚痛者，用大黄备急丸。凡头痛数日不进食，百药不效者，用二气丹；无热者，用黑锡丹；常服点头散，可断根。寻常头目不清，似痛非痛，参苏饮主治；风热者，彻清膏，黄芩、黄连煎汤调下；沐浴后者，单白芷丸。
头风项强分偏正头痛。
素有痰者，或者梳沐受凉，以及醉饱仰卧，贼风入脑、入项、入耳、入鼻，自颈项以上，耳、目、口、鼻、眉棱之间，有一处不如正常身体状态，都是其渐兆。有头皮浮顽，不自觉者，有口舌不知味者，或者耳聋，或者目痛，或者眉棱上下掣痛，或者鼻中闻香极香、闻臭极臭，或者只打呵欠，而作眩冒之状；严重时项强硬，身体拘急，宜川芎茶调散，或者祛风通气散主治，这是正头风。偏左痛者，多血虚，或者有火，或风热；偏右痛者，多气虚，或郁滞，或痰，或风湿。要知道正痛，常兼左右病邪。凡头痛，久则为风也。
兼湿兼热，阴雨天暖定。
风湿肿痛连肩背，或者遇阴雨则甚者，用羌活胜湿汤。风热头痛重大，遇热则发，用消风散倍荆芥、防风；热甚，用二陈汤加荆芥、防风、薄荷；便秘，更加大黄微利之；热微，用二陈汤加酒芩、防风、川芎、白芷。
湿痰痛密多右边。
湿痰，发作时痛密无间，用二陈汤加南星、苍术、川芎及少许细辛。
血虚晚上重为左边病。
血虚者，朝轻夕重，古芎归汤，或者四物汤加荆芥、防风、白芷、薄荷。若气虚者，朝重晚轻，多属右边，宜补中益气汤加川芎、细辛。阳虚甚者，单白芷丸，用人参、附子煎汤送下。
久甚火郁裹重绵。
头风发作时，闷痛必欲用绵帕包裹者，是热郁也，宜凉血泻火为主，佐以辛温散表从治，用二陈汤加酒炒黄芩，及荆芥、薄荷、川芎、石膏、细辛，或者消风百解散，防风通圣散。有三阳热郁，头痛不敢见光，喜置冰于顶者，宜辛凉，汗、吐、下三法并行乃愈。又有偏痛年久，便燥、目赤、眩晕者，乃肺乘肝，气郁血壅而然，宜大承气汤下之。外用大黄、芒硝为末，井底泥调涂两太阳穴上，乃愈。
不妨外感相兼并。
素患头风，因外感而发者，恶寒、头面多汗，宜分偏正，专治头风，而外感自散。如头风发方愈，而后外感自汗者，用加味乌荆丸。因七情发，多吐逆、寒热者，参苏饮主治；无寒热者，二陈汤加乌药、川芎。
眉棱眶痛或羞明，无非痰与风热甚。
风痰眉心痛者，二陈汤吞青州白丸子。眉棱骨痛，连目不可开、昼静夜剧、身重者，用导痰汤。湿痰眉眶骨痛、体重者，芎辛汤合导痰汤，加川乌、白术。寒湿，芎辛汤，加川乌、附子、姜、桂、南星。风热眉棱骨痛甚者，古防风汤加酒黄芩；风虚，加川乌、草乌、细辛，或者金枣丹。血虚挟风，羞明、眉眶痛甚者，生熟地黄丸，或者四物汤，加羌活、防风；气虚挟风，用安神汤。通用谢传点眼丹、搐鼻药。
面肿虚食热不食。
面肿乃食后冒风所致。能食者，风虚，面麻木，牙关急搐，用升麻胃风汤；不食者，风热，面唇黑，心悬如饥，用防风通圣散。内伤气促者，用升麻顺气汤。
颊腮同此分虚实。
面肿搭颊搭腮，仍以能食为风虚，不食为风热。搭颊连齿肿、出血者，胃火也，用清胃散。搭腮因膏粱积热者，升麻、黄连、连翘、牛蒡子、白芷等分，水煎。连耳上，加羌活；耳下，加柴胡。内虚食少者，用补中益气汤。耳后微肿者，肾虚也，肾气丸料水煎服（详见外科腮）。
阳盛面热阳衰寒。
手足阳明经气盛，则身以前皆热，风热上冲，则面独热，先以调胃承气汤，加黄连、犀角，下两三行；次以升麻葛根汤，加黄连、川芎、荆芥、薄荷调之。如阳明气不足，则身以前皆寒，寒湿上逆，则面反不能耐寒，先以附子理中汤数服；次以升麻葛根汤去芍药，加人参、黄芪、附子、益智、草蔻、白芷、葱白。面浮者，用补胃汤；连骨痛者，用干姜散。
生疮总是胃家疾。
凡风客皮肤，痰渍脏腑，则面黯。脾肺风湿搏热，生疮红紫或肿者，俱宜金沸草散倍黄芩，或者升麻胃风汤加减。面上细疮，常出黄水，或者目生疮，用桃花阴干为末，熟水调服。外用杏花煎汤洗之。如生五色疮，只用盐汤绵浸搭疮上，日五六易。如生粉刺，捣菟丝子汁涂之，内服桦皮散。面皮里痛者，用何首乌为末，姜汁调敷，以帛盖定，炙热鞋底熨之。
眼
眼病须先分表里。
外因：风中脑户，湿渍头上，热逼冷灌睛中，或者久处烟火，或者食后向火，或者醉后失枕，血滞痰壅，或者冒砂尘，或者掸刺扑损，汤泡火烧，皆伤目之标。内因：五辛炙爆、酒面、湿热、痰火、房室损精，劳役伤气；泣、涕、刺头伤血，暴喜、暴怒、暴惊，极目远视，夜书细字，镂刻博奕伤神，皆伤目之本。初起在腑为表，当除风散热；久则入脏为里，当养血安神。然内因初即入里，外因久亦带表，悟之！
五轮八廓亦此理。
表证多属三阳部分，里证多属三阴部分，要知以肝为主，表里虚实，不过五行生克之理。八廓不必深泥，旧设七十二证，今纂注于内，更不重复便览。
五轮白肺乌珠肝。
白属肺，气之精，曰气轮。气证，七情气滞则血凝，红膜薄如伞纸，日久变成白膜者，难治。热证，白睛润湿，浮而赤肿筋多重者，生红花翳，痛涩有泪，年深睛变碧色，满目如凝脂，赤路横真如丝，宜四物汤去川芎，换土当归，加甘草。虚证，白睛枯槁，气沉而浊。乌珠属肝，筋之精，曰风轮。风证，睛闪两睑不归中，如辘轳转关，难治。热证，赤晕浮浆重者，乌珠忽然如针刺痛，双目紧急，或者突出豆许如蟹睛者，忌点。或者生翳，似旋螺尖突起；或者周遭生翳如锯齿，如枣花，四五枚相合，赤色刺痛；或者生翳四边皆白，中间一点黄心；或者生翳如玉色，浮满不痛者，忌针割；或者生青色翳，两眦涩痛；或者翳如冰色坚实，傍观逼透瞳人。虚证，轻者枯黄绕睛，重者乌珠上一点圆翳，日中见之差小，阴处见之差大；或者一点黑翳如小豆，疼痛泪出者，忌点。又肝虚雀目，晓明晚暗，乃所禀血虚有火也，年深则盲。黄风雀目者，木衰土盛，终当变黄胀而死，宜平胃散以平土气，四物汤以补肝虚。经年瞳子色如金者，不治。不治症：生翳上横如剑脊，下面微微甚薄，不赤不痛；或者浮翳如水光白色，环绕瞳人，初生自小眦头至乌珠上，不痛痒，无血色相潮；或者翳如凝脂，边浓边薄，形如缺月，色光无瑕；或者生翳经年，如银钉钉入乌珠；或者因他病生翳，初甚微，后遍睛俱白。
心与小肠内外眦。
内眦属心，外眦属小肠，血之精，曰血轮。热症，轻者赤脉缠眦，重者赤脉渐渐侵睛，或者眦头结聚生疮，流出脓汁涎水，粘睛上下，乃风热留睑中，宜白薇丸。气证，肉攀睛，或者先赤烂多年，肝热所冲；或者用力作劳，有伤肝气而成，或者痛、或者痒，两眦出；心气不宁，忧思不已，遂乃攀睛，或者起筋膜，宜大黄、黄芩、防风、薄荷等分，入蜜煎服，或者定心丸。
上下两胞胃与脾。
肉之精，曰肉轮。又上胞睑内锐眦，系足太阳起脉。风证，轻者胞弦紧急，重者上下睑似朱涂而生疮，久则生翳，乃风热也；或者眼皮有如胶凝，肿似桃李，时出热泪，乃风毒也，宜点花草膏。又烂弦风，痒甚，双手背揉，日久两睑赤烂粘滞，经年不安，宜三棱针
Dizziness (Tou Xuan)
Differentiate dizziness with a sensation of falling based on the patient's body type (fat or thin). Some call it vertigo (Xuan Yun), others call it dizziness and clouding (Xuan Mao). "Xuan" refers to blackness before the eyes; "Yun" refers to spinning; "Mao" refers to confusion/drowsiness; they are essentially the same. Deficiency patterns involve external and internal pathogens attacking the exterior due to deficiency and rising upward; excess patterns involve external and internal pathogens combined with phlegm stagnating upward, leading to lower deficiency. Generally, fat and pale individuals have damp-phlegm stagnating in the upper jiao, with fire arising from the lower jiao; phlegm rushes up with fire, which is what is meant by "no phlegm, no vertigo." Treatment should focus on resolving phlegm, supplemented by tonifying qi and descending fire. Thin individuals often suffer from deficient kidney water, with ministerial fire flaming upward causing vertigo, described as "when wind prevails, the earth shakes; when fire meets wind, flames spin." Treatment should nourish yin and descend fire, resolve phlegm, and suppress liver wind. This differentiation based on body type is a standard method of Danxi (Zhu Danxi), applied subsequently.
Blurred vision, dimness, houses appearing to rotate and fly.
The Classics state: "Xun Meng Zhao You." Xun Meng means feeling as if something covers the head; Zhao You means swaying unsteadily. It feels like standing on a boat or cart, wanting to fall upon standing, with blurred vision and deafness, houses seeming to rotate; severely, sudden collapse and loss of consciousness occur. This is governed by the Liver. It is also stated: "All meridians connect to the eyes." The essence of zang-fu organs, sinews, bones, and qi combines with the meridians to form connections, ascending to the brain and exiting posteriorly at the neck. Thus, if pathogens strike the neck while the body is deficient, and enter deeply, they follow the eye connections into the brain, causing brain rotation, which pulls the eye connections taut, resulting in vertigo.
Deficiency in the elderly involves sinking or floating of yang.
Internal injury from overwork leads to qi deficiency failing to ascend, or excessive sweating causing loss of yang; use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Sexual indiscretion damages the kidneys, causing qi rebellion failing to return to its origin; use Si Jun Zi Tang (Four Gentlemen Decoction) plus Tian Ma (Gastrodiae Rhizoma) and Fang Feng (Saposhnikoviae Radix), or Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), Shen Qi Wan (Kidney Qi Pill) plus Lu Rong (Cervi Cornus Pantotrichum). Blood deficiency, due to postpartum conditions, traumatic wounds, or hemorrhage from vomiting blood or epistaxis, causes lone yang to float and rebel; ancient Xiong Gui Tang (Ligusticum and Angelica Decoction) plus fried Gan Jiang (Zingiberis Rhizoma) is used; add Tong Bian (Human Urine) for blood stasis stagnating in the chest. Elderly people often experience dizziness upon rising in the morning, resolving spontaneously after a moment. If there is wind-phlegm and deficient fire, and it is confirmed as yang deficiency, use Shun Yuan San, swallowing Hei Xi Dan (Black Tin Pill) to anchor and sink. The Yu Ji states that elixirs and minerals aid fire and disperse qi with aromatic acridity, often leading to hyperactive floating; how can they anchor rebellious qi?
Fire-phlegm causes severe vertigo with qi pain in the brow bone.
If fire stirs phlegm causing severe vertigo, use Er Chen Tang (Two-Cured Decoction) plus Huang Qin (Scutellariae Radix), Lian Zi (Coptidis Rhizoma), Cang Zhu (Atractylodis Rhizoma), and Qiang Huo (Notopterygii Rhizoma et Radix). For excess fire in robust constitutions belonging to the Yangming channel, use Da Huang (Rhei Radix et Rhizoma) fried in wine, powdered, taken with tea liquor, or Gu Jing Huang Tang (Ancient Coptis and Rhubarb Decoction) plus Fang Feng equal parts. For Taiyang and Shaoyang channels, use Jiu Huang Qin (Wine-processed Scutellariae Radix) and Bai Zhi (Angelicae Dahuricae Radix) powdered equally, taken with tea liquor. For deficient fire, use Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction). Emotional injuries causing disharmony of organ qi, with saliva confusing the heart orifices, presenting with vertigo, brow bone pain, and inability to open eyes, are treated with Qi Qi Tang (Seven-Qi Decoction), Yu Ye Tang (Jade Fluid Decoction), or Bu Xu Yin (Tonify Deficiency Drink).
Wind causes nuchal stiffness, aversion to cold, and spasmodic pain.
External wind with floating pulse, sweating, and nuchal stiffness accompanied by heat is treated with Chuan Xiong Cha Tiao San (Ligusticum Tea-Powdering Powder) or Shen Su Yin (Ginseng and Perilla Drink) plus Nan Xing (Arisaematis Rhizoma) and Huang Qin; for severe heat, use Chuan Xiong Shi Gao San (Ligusticum and Gypsum Powder); for deficiency, use Shan Zhu Yu San (Corni Fructus Powder) or Si Wu Tang (Four Substances Decoction) plus Qin Jiao (Gentianae Macrophyllae Radix) and Qiang Huo, or generally Bai Zhi Wan (Angelica Dahurica Pill). Severe wind causing vertigo, limb numbness, and epigastric pain indicates combined wind-cold-damp bi obstruction with fluid retention in the upper jiao; induce vomiting appropriately. Cold with tight pulse, no sweating, limb spasms, tendon cramps, and pulling headache is treated with Wu Ji San (Five Accumulations Powder); if relieved by warm pressure, use Fu Zi Li Zhong Tang (Aconite Regulate the Middle Decoction) or San Wu Qi San.
Summerheat causes irritability and thirst; dampness causes heavy drooping head.
Summerheat with deficient pulse, irritability, and thirst is treated with Shi Wei Xiang Ru San (Ten-Ingredient Elsholtzia Powder) or Er Chen Tang plus Huang Lian (Coptidis Rhizoma), Shan Zhi (Gardeniae Fructus), and Chuan Xiong. Dampness with fine pulse, heavy head, and vomiting is treated with Xiong Shu Tang (Ligusticum and Atractylodes Decoction), Xiong Chu Chu Xuan Tang (Ligusticum-Atractylodes Vertigo-Resolving Decoction), or Shen Zhuo Tang (Kidney-Dwelling Decoction) plus Chuan Xiong. Wind-damp is treated with Yu Hu Wan (Jade Pot Pill).
External pathogens are resolved harmoniously to clear phlegm-fire; internal deficiency is rooted so superficial symptoms naturally shift.
When the liver pulse is overflowing and large, vertigo inevitably occurs; prevention is key. External sensations require releasing the muscle layer and resolving phlegm; do not recklessly apply sweating or purging methods. Internal causes require appropriate tonification.
In the past, Danxi treated a woman with leukorrhea and vertigo by focusing solely on the leukorrhea, after which the vertigo resolved. Vertigo, headache, and cough are superficial symptoms of disease. The Classics state: "Treating disease requires seeking the root." Generally use Er Chen Tang. For emotional injuries, add Ding Xiang (Caryophylli Flos), Sha Ren (Amomi Fructus Rotundus), and Bai Zhu (Atractylodis Macrocephalae Rhizoma); for wind-phlegm, add Tian Ma, Bai Fu Zi (Typhonii Rhizoma), Jing Jie (Schizonepetae Herba), and Fang Feng; for cold-phlegm, add Gan Jiang (Zingiberis Rhizoma) and Liang Jiang (Alpiniae Officinarum Rhizoma); for hot-phlegm, combine with Jie Du Tang (Resolve Toxicity Decoction); for damp-phlegm, combine with Xiong Xin Tang (Ligusticum and Asari Decoction); for retained water with palpitations, combine with Wu Ling San (Five-Ingredient Powder with Poria); for alcohol/food injury, add dried raw ginger. For chronic phlegm in the chest causing dry eyes, hand numbness, hair loss, and forgetfulness, use this formula to induce vomiting, followed by clearing upper jiao acrid-cool herbs to regulate. For qi deficiency, double Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix); for blood deficiency, double Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Dang Gui (Angelicae Sinensis Radix); for abundant phlegm, add Zhu Li (Bambusae Succus) and Jiang Zhi (Zingiberis Juice); for excess fire, add Tong Bian. If vertigo is accompanied by qi rushing to the chest and trembling, only use Fu Ling Gui Zhu Gan Cao Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) with modifications. If vertigo presents with confused speech, profuse sweating, diarrhea, and frequent fainting, it indicates extreme deficiency and is untreatable.
Headache
Jue Headache distinguishes internal and external causes.
True Headache (Zhen Tou Tong) involves pain radiating to the entire brain apex (Ni Wan), with cold hands and feet reaching the joints; this is fatal. "Jue" means rebellion. Pathogens rebelling upward along yang meridians cause pain, potentially leading to syncope; differentiate internal and external causes for treatment.
External headache differentiates cold and heat in the exterior.
External headaches always involve cold and heat; differentiate severity and release the exterior. Wind pattern: Xiong Zhi Xiang Su San (Ligusticum, Angelica Dahurica, Cyperi Rhizoma, and Perilla Decoction) or Xiao Feng San (Eliminate Wind Powder). Wind-heat: Chuan Xiong Shi Gao San. Wind-cold: San Wu Qi San. Wind-cold entering the brain with toothache: Xiong Xin Tang, or Qiang Huo Hei Fu Tang, removing Fu Zi (Aconiti Lateralis Radix Preparata) and Bo He (Menthae Haplocalycis Herba - *Note: Text says Bai Bo, likely error for Bo He or similar, but keeping text context implies removing bitter/cold*), adding Gui Zhi (Cinnamomi Ramulus). Brain wind with aversion to cold in neck/back and extreme cold at Naohu point: Ma Huang (Ephedrae Herba), Xi Xin (Asari Radix), Quan Xie (Scorpio), Huo Xiang (Pogostemonis Herba) each 5 fen, powdered, taken with Jing Jie decocted in wine or tea. Cold pattern: Lian Xu Cong Bai Tang (Green Onion White Decoction) or Ge Gen Cong Bai Tang (Kudzu and Green Onion White Decoction). Summerheat pattern: Xiang Ru San (Elsholtzia Powder) plus Yin Chen (Artemisiae Scopariae Herba) and Cong Bai, or Ban Xia Bai Tang (Pinellia and Magnolia Bud Decoction) with Jiang Zhi pills. Damp pattern: Xiong Shu Tang. Damp-heat with irritability and pain originating in the ears: Ancient Fang Feng Tang plus Jiu Huang Qin, Cang Zhu, Cang Er Zi (Xanthii Fructus), Xi Xin, powdered, taken with tea liquor and a little Jiang Zhi; for more heat, take Jiu Huang Qin powdered with tea. Generally use Er Chen Tang plus Chuan Xiong and Bai Zhi as main ingredients. Taiyang channel: aversion to wind/cold, floating-tight pulse, add Qiang Huo, Ma Huang, Chuan Xiong. Yangming channel: spontaneous sweating, fever/aversion to cold, floating-slow-long pulse, add Sheng Ma ( Cimicifugae Rhizoma), Ge Gen (Puerariae Lobatae Radix), Bai Zhi; if thirsty, combine with Bai Hu Tang (White Tiger Decoction) plus Wu Zhu Yu (Evodiae Fructus) and Bai Zhi. Shaoyang channel: alternating chills/fever, wiry pulse, add Chai Hu (Bupleuri Radix) and Huang Qin. If three yang channels have chronic phlegm in chest/diaphragm with persistent headache risking blindness, combine with Chuan Xiong Cha Tiao San to induce vomiting. Taiyin channel: heavy body/abdominal pain, deep pulse, indicates phlegm, add Cang Zhu, Nan Xing. Shaoyin channel: cold jue, deep-thin pulse, add Fu Zi, Xi Xin. Jueyin channel: salivation, cold jue, floating-slow pulse, add Wu Zhu Yu. Pain in vertex, neck, and back: combine Qiang Wu Tang. Fat individuals: add Er Shu (Cang Zhu, Bai Zhu). Thin individuals: add Jiu Huang Qin. Wind-heat: add Man Jing Zi (Vittariae Spora), Chuan Xiong, Jiu Huang Qin.
If headache, add Xi Xin; if vertex pain, add Gao Ben (Ligustici Wallichii Rhizoma), Sheng Ma, Fang Feng.
Internal deficiency and qi stagnation cause Taiyang (temporal) headache.
Internal injury with qi deficiency and ministerial fire rebelling upward, tinnitus, and nine orifices dysfunction causing temporal pain: use Bu Zhong Yi Qi Tang doubled with Chuan Xiong, plus Zhi Mu (Anemarrhenae Rhizoma) and Man Jing Zi, or Si Jun Zi Tang. After major illness and various deficiencies/pain: Si Zhu San plus a pinch of tea.
Blood deficiency causes anger-like pain at the outer canthus (fish tail).
Ancient Xiong Gui Tang, or Si Wu Tang plus Jiu Huang Qin, Qiang Huo, Chai Hu, Man Jing Zi. Qi and blood dual deficiency: Tiao Zhong Yi Qi Tang plus Chuan Xiong, Xi Xin. With fire: An Shen Tang (Calming Spirit Decoction).
Kidney deficiency causes vertex pain; emotions cause vomiting.
Ren Jue (Kidney Rebellion), lower deficiency and upper excess, unbearable vertex pain, wiry pulse on light pressure, firm on deep pressure: use Yu Zhen Wan. Emotional qi rebellion with abdominal distension and sour vomiting: Ancient Xiong Wu San, Hu Lu Ba San (Trigonellae Semen); with phlegm: Ru Sheng Bing Zi; alternating head/heart pain: Ancient Cang Tang.
Phlegm, fire, and food accumulation share the same cause.
Phlegm jue with vertigo, blacking out, confused speech, nausea, closed eyes, cold limbs: Ban Xia Bai Zhu Tian Ma Tang, Dao Tan Tang plus Chuan Xiong, Xi Xin, San Sheng Wan. Phlegm-fire with severe breaking pain: Er Chen Tang plus Huang Qin, Lian Zi, or Qing Kong Gao (Clear Empty Paste), Qing Shang Xie Huo Tang. For robust individuals, only Da Huang fried in wine, powdered, taken with tea. Phlegm-fluid stagnation pain: Shen Xiong Wan. Hidden phlegm: Gua Di San (Melon Seed Powder) to vomit. Accumulation pain: Da Huang Bei Ji Wan. Headache lasting days without eating, unresponsive to medicines: Er Qi Dan; without heat, Hei Xi Dan; long-term服用 Dian Tou San cures the root. Ordinary unclear head/eyes, pain-like but not pain: Shen Su Yin. Wind-heat: Che Qing Gao, Huang Qin/Lian Zi decoction. Post-bath: Bai Zhi Wan.
Head Wind (Attached: Brow Bone Pain)
Head wind and nuchal stiffness distinguish lateral vs. frontal.
Those with chronic phlegm, or cooling after combing/washing, or lying supine after drunken/full meals, allow thief-wind to enter brain, neck, ears, nose. From neck upwards, any area in ears, eyes, mouth, nose, brow bone differing from normal is a precursor. Scalp may feel floating/numb unconsciously; taste may be lost; deafness or eye pain; pulling pain above/below brow bone; smell distorted (extreme fragrance/stench); yawning with vertigo; severe nuchal stiffness and body spasms. Treat with Chuan Xiong Cha Tiao San or Qu Feng Tong Qi San (Dispel Wind and Unblock Qi Powder); this is true head wind. Left-sided pain: mostly blood deficiency, fire, or wind-heat. Right-sided pain: mostly qi deficiency, stagnation, phlegm, or wind-damp. True pain often combines left/right pathogenic factors. Chronic headache becomes wind.
Combined damp-heat stabilizes in warm/yin weather.
Wind-damp swelling/pain connecting shoulders/back, worsening in rain: Qiang Huo Sheng Shi Tang. Severe wind-heat headache, triggered by heat: Xiao Feng San doubled with Jing Jie, Fang Feng; severe heat: Er Chen Tang plus Jing Jie, Fang Feng, Bo He; constipation: add Da Huang for mild purgation; slight heat: Er Chen Tang plus Jiu Huang Qin, Fang Feng, Chuan Xiong, Bai Zhi.
Damp-phlegm pain is dense, mostly right-sided.
Damp-phlegm with frequent, uninterrupted pain: Er Chen Tang plus Nan Xing, Cang Zhu, Chuan Xiong, and a little Xi Xin.
Blood deficiency worsens in evening, left-sided disease.
Blood deficiency: lighter in morning, heavier in evening. Ancient Xiong Gui Tang, or Si Wu Tang plus Jing Jie, Fang Feng, Bai Zhi, Bo He. Qi deficiency: heavier in morning, lighter in evening, mostly right-sided. Bu Zhong Yi Qi Tang plus Chuan Xiong, Xi Xin. Severe yang deficiency: Bai Zhi Wan taken with Ren Shen, Fu Zi decoction.
Chronic/severe fire depression wrapped in heavy cotton.
Head wind with stifling pain requiring cotton wrapping indicates heat depression. Prioritize cooling blood and draining fire, assisted by acrid-warm exterior-releasing contrarian treatment. Er Chen Tang plus Jiu Huang Qin, Jing Jie, Bo He, Chuan Xiong, Shi Gao (Gypsum Fibrosum), Xi Xin, or Xiao Feng Bai Jie San, Fang Feng Tong Sheng San. Three-yang heat depression with photophobia preferring ice on vertex: use acrid-cool, combining sweating, vomiting, and purging methods. Chronic unilateral pain with constipation, red eyes, vertigo: lung overcoming liver, qi depression and blood congestion. Da Cheng Qi Tang to purge. Externally, Da Huang, Mang Xiao (Natrii Sulfas) powdered, mixed with well-bottom mud, applied to temples.
External pathogens may coexist.
Chronic head wind triggered by external pathogen with aversion to cold and facial sweating: differentiate lateral/frontal, treat head wind specifically, external pathogen resolves spontaneously. If head wind just resolved then external pathogen with sweating: Jia Wei Wu Jing Wan. Triggered by emotions with vomiting/chills-fever: Shen Su Yin; without chills-fever: Er Chen Tang plus Wu Yao (Linderae Radix), Chuan Xiong.
Brow/orbital pain or photophobia stems from phlegm and wind-heat.
Wind-phlegm brow-heart pain: Er Chen Tang swallowing Qing Zhou Bai Wan Zi (Qingzhou White Pills). Brow bone pain with inability to open eyes, quiet day/worse night, heavy body: Dao Tan Tang. Damp-phlegm brow/orbital pain with heavy body: Xiong Xin Tang combined with Dao Tan Tang, plus Chuan Wu (Aconiti Radix), Bai Zhu. Cold-damp: Xiong Xin Tang plus Chuan Wu, Fu Zi, Jiang, Gui, Nan Xing. Severe wind-heat brow pain: Ancient Fang Feng Tang plus Jiu Huang Qin; wind-deficiency: Chuan Wu, Cao Wu (Aconiti Kusnezoffii Radix), Xi Xin, or Jin Zao Dan. Blood deficiency with wind, photophobia/severe orbital pain: Sheng Shu Di Huang Wan, or Si Wu Tang plus Qiang Huo, Fang Feng. Qi deficiency with wind: An Shen Tang. Generally use Xie Chuan Dian Yan Dan (Eye-Dropping Powder), Bi-Insufflation Medicine.
Facial Wind
Facial swelling: deficiency/eating/heat vs. non-eating.
Facial swelling caused by wind exposure after eating. Able to eat: wind-deficiency, facial numbness, jaw spasms. Sheng Ma Wei Feng Tang. Unable to eat: wind-heat, black lips/face, empty hunger sensation. Fang Feng Tong Sheng San. Internal injury with shortness of breath: Sheng Ma Shun Qi Tang.
Cheek/jaw swelling differentiates deficiency/excess similarly.
Facial swelling extending to cheeks/jaws: able to eat is wind-deficiency, unable to eat is wind-heat. Swelling extending to teeth with bleeding: stomach fire. Qing Wei San. Cheek swelling from rich diet heat: Sheng Ma, Huang Lian, Lian Qiao (Forsythiae Fructus), Niu Bang Zi (Arctii Fructus), Bai Zhi equal parts, decocted. Extending up ear: add Qiang Huo; below ear: add Chai Hu. Internal deficiency with poor appetite: Bu Zhong Yi Qi Tang. Slight swelling behind ear: kidney deficiency. Shen Qi Wan material decocted (see Surgery Mumps).
Yang excess causes facial heat; yang deficiency causes cold.
Hand-foot Yangming meridian qi excess causes heat in anterior body; wind-heat rebelling upward causes isolated facial heat. First, Tiao Wei Cheng Qi Tang plus Huang Lian, Xi Jiao (Rhinocerotis Cornu - *substitute usually Shui Niu Jiao*), 2-3 bowel movements; then Sheng Ma Ge Gen Tang plus Huang Lian, Chuan Xiong, Jing Jie, Bo He. Yangming qi insufficiency causes cold in anterior body; cold-damp rebelling upward causes facial intolerance to cold. First, Fu Zi Li Zhong Tang several doses; then Sheng Ma Ge Gen Tang remove Shao Yao, add Ren Shen, Huang Qi, Fu Zi, Yi Zhi Ren (Alpiniae Oxyphyllae Fructus), Cao Kou (Myristicae Semen), Bai Zhi, Cong Bai. Facial edema: Bu Wei Tang. Bone pain: Gan Jiang San.
Skin eruptions are always stomach diseases.
Wind lodging in skin, phlegm infiltrating zang-fu causes dark face. Spleen-lung wind-damp combusting heat causing red/purple/swollen eruptions: Jin Fei Cao San doubled Huang Qin, or Sheng Ma Wei Feng Tang modified. Fine facial eruptions with yellow discharge or eye eruptions: Tao Hua (Peach Flower) dried, powdered, taken with warm water. Externally, Xing Hua (Apricot Flower) decoction wash. Five-color eruptions: salt water soaked cotton applied, changed 5-6 times daily. Acne: Tu Si Zi (Cuscutae Semen) juice applied, internal Hu Pi San. Deep facial pain: He Shou Wu (Polygoni Multiflori Radix) powdered, Jiang Zhi paste, covered with cloth, ironed with heated shoe sole.
Eye
Eye diseases must first distinguish interior/exterior.
External causes: wind striking Naohu, damp soaking head, heat forcing cold into eyes, long exposure to smoke/fire, facing fire after eating, sleeping awkwardly after drinking, blood stasis/phlegm congestion, sand/dust exposure, scratches/blows, scalds/burns—all injure the superficial aspect of the eye. Internal causes: pungent/spicy/fried foods, alcohol/noodles, damp-heat, phlegm-fire, sexual exhaustion damaging essence, overwork damaging qi; crying/tears/head pricking damaging blood, sudden joy/anger/fright, straining vision, reading small print at night, carving/gambling damaging spirit—all injure the root of the eye. Initial stage in fu organs is exterior, dispel wind/heat; prolonged stage enters zang organs is interior, nourish blood/calming spirit. Note: internal causes enter interior immediately; external causes retain exterior nature if prolonged. Understand this!
Five Wheels and Eight Palaces follow this logic.
Exterior patterns belong to three yang aspects; interior patterns to three yin aspects. Focus on the Liver; interior/exterior/deficiency/excess follow five element generation/restriction. Do not rigidly adhere to Eight Palaces; old texts list 72 syndromes, now compiled internally for easy reference without repetition.
Five Wheels: White belongs to Lung, Black/Pupil to Liver.
White belongs to Lung, essence of qi, called Qi Wheel. Qi pattern: seven emotions/qi stagnation causes blood congealing, red membrane thin as umbrella paper, turning white over years—difficult to treat. Heat pattern: white sclera moist, floating/red/swollen with multiple veins, generating red flower nebula, painful/astringent with tears, years later pupil turns green, full eye like congealed fat, red vessels horizontal like threads. Use Si Wu Tang remove Chuan Xiong, replace with Tu Dang Gui (Native Angelica), add Gan Cao. Deficiency pattern: white sclera withered, qi sinking/turbid. Black/Pupil belongs to Liver, essence of sinew, called Wind Wheel. Wind pattern: pupils darting, eyelids not centering, like wheel axle turning—difficult to treat. Heat pattern: heavy red halo and floating turbidity, sudden needle-like pain in black pupil, eyes tight, or protruding bean-sized like crab eye—avoid dropping medicine. Or generate nebula like spiral shell tip; or surrounding nebula like sawtooth/date flower, 4-5 merging, red/stinging; or nebula white edges yellow center; or jade-colored floating non-painful nebula—avoid needling/cutting; or cyan nebula with canthus astringency/pain; or ice-hard nebula penetrating pupil. Deficiency pattern: mild yellow ring around eye; severe round nebula on pupil, smaller in sun, larger in shade; or black bean-sized nebula with pain/tears—avoid dropping. Liver deficiency sparrow-eye (night blindness): clear morning/dark evening, congenital blood deficiency with fire, blindness over years. Yellow wind sparrow-eye: wood decline/earth excess, eventually yellow/swollen death. Ping Wei San to level earth, Si Wu Tang to tonify liver deficiency. Pupil gold-colored for years: untreatable. Untreatable signs: nebula horizontal like sword ridge, thin bottom, non-red/non-painful; or floating white nebula like water light surrounding pupil, starting from inner canthus to black pupil, non-painful/itchy, no blood tide; or congealed fat nebula thick edge/thin edge, moon-shaped, flawless color; or silver-nail-like nebula penetrating black pupil after years; or other disease nebula starting small then whiting whole eye.
Heart and Small Intestine: Inner/Outer Canthi.
Inner canthus belongs to Heart, outer canthus to Small Intestine, essence of blood, called Blood Wheel. Heat syndrome: mild red vessels entangling canthus, severe invading eye, or canthus pustules oozing pus/saliva sticking eyes—wind-heat lingering in lids. Bai Wei Wan. Qi pattern: pterygium (flesh climbing eye), or chronic red/rotten from liver heat; or labor injuring liver qi causing pain/itching/canthus discharge; or heart qi unrest/worry causing pterygium/fascia. Da Huang, Huang Qin, Fang Feng, Bo He equal parts, honey decoction, or Ding Xin Wan.
Upper/Lower Eyelids: Stomach and Spleen.
Essence of flesh, called Flesh Wheel. Upper lid inner sharp canthus connects to Foot Taiyang starting pulse. Wind pattern: mild lid tension, severe red/rotten sores like vermilion paint, chronic nebula—wind-heat; or eyelid gelatinous swelling like plum/peach, hot tears—wind toxin. Hua Cao Gao drops. Rotten margin wind, severe itching rubbing backs of hands, chronic red/rotten sticky lids—three-edged needle