头为诸阳之会，清阳不升，则邪气乘之，致令头痛。然有内伤、外感之异，外感风寒者
宜散之。热邪传入胃腑，热气上攻者，宜清之。直中证，寒气上逼者，宜温之。治法详见
伤寒门，兹不赘。然除正风寒外，复有偏头风，雷头风，客寒犯脑，胃火上冲，痰厥头痛，
大头天行，破脑伤风，眉棱骨痛，眼眶痛等证。更有真头痛，朝不保暮，势更危急。皆宜细
辨。
偏头风者，半边头痛，有风热，有血虚。风热者，筋脉抽搐，或鼻塞，常流浊涕，清空
膏主之；血虚者，昼轻夜重，痛连眼角，逍遥散主之。雷头风者，头痛而起核块，或头中雷
鸣，多属痰火，清震汤主之。客寒犯脑者，脑痛连齿，手足厥冷，口鼻气冷，羌活附子汤主
之。胃火上冲者，脉洪大，口渴饮冷，头筋扛起者，加味升麻汤主之。痰厥头痛者，胸膈多
痰，动则眩晕，半夏白术天麻汤主之。肾厥头痛者，头重足浮，腰膝酸软，经所谓下虚上实
是也。肾气衰，则下虚，浮火上泛，故上实也，然肾经有真水虚者，脉必数而无力；有真火
虚者，脉必大而无力。水虚，六味丸，火虚，八味丸。大头天行者，头肿大，甚如斗，时疫
之证也，轻者名发颐，肿在耳前后，皆火郁也，普济消毒饮主之，更加针砭以佐之。破脑伤
风者，风从破处而入，其症多发搐搦，防风散主之。眉棱骨痛，或眼眶痛，俱属肝经，见光
则头痛者，属血虚，逍遥散。痛不可开者，属风热，清空膏。真头痛者，多属阳衰。头统诸阳
而脑为髓海，不任受邪，若阳气大虚，脑受邪侵，则发为真头痛，手足青至节，势难为矣
速用补中益气汤，加蔓荆子、川芎、附子、并进八味丸，间有得生者，不可忽也。
头是诸阳经汇聚的地方，如果清阳之气不能上升，邪气就会趁虚而入，导致头痛。然而，头痛有内伤和外感的不同：外感风寒的，适宜用发散的方法治疗；热邪传入胃腑，热气向上攻冲的，适宜用清热的方法治疗；直中阴经的寒证，寒气向上逼迫的，适宜用温里的方法治疗。具体的治法详见《伤寒论》相关章节，这里不再赘述。除了正性的风寒头痛外，还有偏头风、雷头风、客寒犯脑、胃火上冲、痰厥头痛、大头天行、破脑伤风、眉棱骨痛、眼眶痛等证候。更有真头痛这一危重证候，早晨发病晚上就可能死亡，病情更加危急。这些都应当仔细辨别。
偏头风，表现为半边头痛，分为风热型和血虚型。风热型的，伴有筋脉抽搐，或者鼻塞，经常流出浑浊鼻涕，以清空膏为主方治疗；血虚型的，白天轻晚上重，疼痛牵连眼角，以逍遥散为主方治疗。雷头风，表现为头痛且头部出现核块，或者感觉头中有雷鸣声，多属于痰火所致，以清震汤为主方治疗。客寒犯脑，表现为脑痛牵连牙齿，手足冰冷，口鼻呼出气体寒冷，以羌活附子汤为主方治疗。胃火上冲，表现为脉象洪大，口渴想喝冷水，头部筋脉隆起强硬，以加味升麻汤为主方治疗。痰厥头痛，表现为胸膈部多痰，活动后头晕目眩，以半夏白术天麻汤为主方治疗。肾厥头痛，表现为头重脚轻，腰膝酸软，这就是中医经典所说的“下虚上实”。肾气衰弱，则下部虚弱，浮火向上泛溢，所以上部实证。但是肾经有真水（肾阴）虚的，脉象必然数而无力；有真火（肾阳）虚的，脉象必然大而无力。真水虚的，用六味丸治疗；真火虚的，用八味丸治疗。大头天行，表现为头部肿大，甚至像斗一样大，这是时疫（流行性传染病）的证候，轻的称为发颐，肿胀在耳朵前后，都属于火郁所致，以普济消毒饮为主方治疗，并配合针刺或砭石放血来辅助治疗。破脑伤风，表现为风邪从伤口处侵入，症状多发为抽搐，以防风散为主方治疗。眉棱骨痛或眼眶痛，都属于肝经病变，见到光线就头痛的，属于血虚，用逍遥散；疼痛剧烈无法睁眼的，属于风热，用清空膏。真头痛，多属于阳气衰微。头统摄诸阳，脑为髓海，不能承受邪气侵袭，如果阳气极度虚弱，脑受邪气侵犯，就会发生真头痛，手足青紫直到关节，病情难以救治。此时应迅速使用补中益气汤，加入蔓荆子、川芎、附子，并同时服用八味丸，偶尔有救活的，不可轻视。
The head is the convergence point of all Yang meridians. When clear Yang fails to ascend, pathogenic factors take advantage of this deficiency, leading to headache. However, there are distinctions between internal injury and external contraction: for external contraction of wind-cold, dispersing methods are appropriate; when heat pathogens transmit to the stomach fu-organ and heat qi attacks upward, clearing methods are appropriate; for cold pathogens directly striking the yin meridians with cold qi forcing upward, warming methods are appropriate. Detailed treatment methods are described in the Shanghan (Cold Damage) section, so they are not repeated here. Besides standard wind-cold headaches, there are also conditions such as hemi-cephalgia (Pian Tou Feng), thunder-headache (Lei Tou Feng), guest-cold invading the brain, stomach fire rushing upward, phlegm-jue headache, epidemic big-head disease (Da Tou Tian Xing), traumatic wind-stroke (Po Nao Shang Feng), pain in the supraorbital ridge, and orbital pain. Furthermore, there is true headache (Zhen Tou Tong), which can be fatal from morning to evening, representing an even more critical condition. All these must be carefully differentiated.
Hemi-cephalgia presents as pain on one side of the head and is divided into wind-heat and blood-deficiency types. In the wind-heat type, there may be twitching of tendons and vessels, nasal congestion, or frequent discharge of turbid nasal mucus; it is treated primarily with Kongqing Gao (Clearing Empty Paste). In the blood-deficiency type, pain is lighter during the day and heavier at night, radiating to the corner of the eye; it is treated primarily with Xiaoyao San (Free and Easy Wanderer Powder). Thunder-headache presents with headache accompanied by nodules on the scalp or a sensation of thunder rumbling within the head; it mostly belongs to phlegm-fire and is treated primarily with Qingzhen Tang (Clearing and Shaking Decoction). Guest-cold invading the brain presents with brain pain radiating to the teeth, coldness of the hands and feet, and cold breath from the mouth and nose; it is treated primarily with Qianghuo Fuzi Tang (Notopterygium and Aconite Decoction). Stomach fire rushing upward presents with a surging-large pulse, thirst with desire for cold drinks, and distended, rigid temporal arteries; it is treated primarily with Jiawei Shengma Tang (Modified Cimicifuga Decoction). Phlegm-jue headache presents with excessive phlegm in the chest and diaphragm, and dizziness upon movement; it is treated primarily with Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction). Kidney-jue headache presents with heaviness of the head and floating sensation of the feet, along with soreness and weakness of the waist and knees; this corresponds to the classic description of "deficiency below and excess above." When kidney qi declines, the lower part becomes deficient, and floating fire rises upward, causing upper excess. Specifically, if there is deficiency of true water (Kidney Yin), the pulse will be rapid and forceless; if there is deficiency of true fire (Kidney Yang), the pulse will be large and forceless. For true water deficiency, Liuwei Wan (Six-Ingredient Pill with Rehmannia) is used; for true fire deficiency, Bawei Wan (Eight-Ingredient Pill with Rehmannia) is used. Epidemic big-head disease presents with massive swelling of the head, sometimes as large as a measuring cup; it is a type of epidemic disease. The mild form is called Fayi (Jaw Swelling), with swelling around the ears, caused by stagnant fire; it is treated primarily with Puji Xiaodu Yin (Universal Benefit Decoction to Eliminate Toxins), supplemented by acupuncture or bian stone therapy. Traumatic wind-stroke occurs when wind pathogen enters through a wound, presenting mainly with convulsions; it is treated primarily with Fangfeng San (Saposhnikovia Powder). Pain in the supraorbital ridge or orbital region belongs to the Liver meridian. Headache triggered by light exposure belongs to blood deficiency and is treated with Xiaoyao San. Severe pain preventing eye opening belongs to wind-heat and is treated with Kongqing Gao. True headache mostly belongs to yang decline. The head governs all Yang meridians, and the brain is the sea of marrow, unable to withstand pathogenic invasion. If yang qi is severely deficient and the brain is invaded by pathogens, true headache occurs, characterized by cyanosis of the hands and feet extending to the joints, a condition difficult to save. At this stage, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) should be administered rapidly, added with Chuanminzhizi (Vitex Fruit), Chuanxiong (Ligusticum Rhizome), and Fuzi (Aconite Root), while simultaneously administering Bawei Wan. Occasionally, survival is possible; this must not be neglected.