芎 散 治风头眩，眼目昏痛眩晕，倦怠，心忪。
芎 前胡 白僵蚕（炒） 人参（各一两） 蔓荆子 天麻（酒浸焙） 防风（去叉，各半两）
上为末。每服二钱。食后温酒调下。
东垣羌活汤 治风热壅盛，上攻头目昏眩。
羌活 防风 黄芩（酒洗，各一两） 柴胡（七钱） 黄连（酒煮一两） 黄柏（酒炒） 栝蒌（
酒洗，各半两） 甘草（炙，七钱） 白茯苓（五钱） 泽泻（三钱）
上为粗末。每服五钱。水煎取清。食后或先卧，通口热服之。日二服。
凉膈散（见第十九）
防风通圣散（见第四十九）
上散。贾同知、崔宣武、刘庭瑞及河间者共四方。其中药品增减、分量多寡，
俱不相同。但河间适中，选用当从之也。
半夏白术天麻汤（见第二十二）
滚痰丸（见第十七）
玉液汤 治七情所伤。气郁生涎，随气上逆，头目眩晕，心嘈忪悸，眉棱骨痛。
半夏（肥大者六钱，汤泡七次，切作片）
上作一服。水一钟半，生姜十片，煎至八分。去滓，入沉香末少许，不拘时温服。
四物汤（见第二十一）
补中益气汤（见第三十九）
头痛多弦。浮风紧寒，热洪湿细，缓滑厥痰，
气虚弦软，血虚微涩，肾厥弦坚，真痛短涩。
弦为阴脉，敛直而无抑扬之势，乃阳虚不能张大，或致外邪所乘。况头乃六阳
所乘，邪束于外，阳郁于中，安得不痛？故头痛者多弦。多弦者，不皆弦也。亦有
脉浮而痛者，属风，风性飘荡虚浮也。（兼见恶寒、发热、自汗等证，宜仲景桂枝汤、玄珠茶调散之类。）
脉紧而痛者属寒，寒性收敛紧实也。（兼见恶寒、发热、无汗、体痛等证，宜仲景麻黄汤，九味羌活汤之类。）
脉洪而痛者属热，热性充盛洪大也。（兼见恶热、面赤、口干等证，其痛刺动不定。宜泻青丸、二仙散、对
金散、神芎丸、凉膈散之类。）脉细而痛者属湿，湿性渗衍濡细也。（兼见体痛、头重冒、鼻塞、目黄等证，
宜奇效芎术汤、半夏白术天麻汤，或瓜蒂散，或红豆散搐鼻。）脉缓滑而痛者属痰。痰乃凝水结液，停蓄
不流，故替替然缓滑也。（兼见呕逆、痞闷、肠鸣等证，宜局方玉壶丸、半夏白术天麻汤之类。）脉弦软而痛
者属气虚。气虚则弦敛软弱，而无鼓动之力。（兼见恶寒、痛而空晕、四肢多寒喜暖、气虚微、体倦等
证，宜补中益气汤、六君子汤之类。）脉微涩而痛者属血虚。血虚则微弱涩滞，而有干燥之象。
（兼见面白、口干、头两侧痛甚而兼晕、痛加于夜或夜热等证，宜四物汤、逍遥散之类。）脉弦坚而痛者属
肾。肾气厥逆，不能接引膀胱。膀胱经气壅遏，上实下虚，巅为之痛，脉亦弦直而坚实也。
即《灵枢》经脉篇所云∶膀胱是动，则病冲头痛。《难经》六十难所云厥头痛者
是也。（兼见头重晕、腰痛、少腹里急、上热下寒等证，宜六味丸、八味丸、羌活、川芎之类。）《难经》单言手
三阳而不及足三阳，恐未尽善。《素问》五藏生成篇云∶头痛巅疾，下虚上实，过
在足少阴、巨阳，甚则入肾。此正指膀胱厥痛不已，甚则入肾而为真头痛也。其痛
连脑尽痛，齿亦痛。盖肾主骨、主髓，髓以脑为海，而齿则骨之余也。其脉短涩者，
短则阳脱于上，涩则阴衰于下。若手足厥寒至节者，必死不治。（此等证若欲治之，非猛进乌
附之药不可。或灸百会穴，以望生于万一。）虽然，头痛又不止此数种。六腑之清阳固上升，而五
脏之精华亦上注。外有六淫之侵，内有经络之逆。使隧道壅遏，清阳混淆，而痛作于头巅者多矣。故
五脏六腑皆能病此，但宜细察其脉与兼见之证，以别其脏腑、阴阳、寒热、虚实而施治焉，则万举万当矣。
芎散：治疗头目眩晕，眼睛昏痛、视物旋转，身体疲倦乏力，心中悸动不安。
组成：川芎、前胡、白僵蚕（炒制）、人参（各一两）；蔓荆子、天麻（酒浸后焙干）、防风（去枝梗，各半两）。
制法与用法：将上述药物研为细末。每次服用二钱，饭后用温酒调服。
东垣羌活汤：治疗风热邪气壅盛，向上攻冲导致头目昏眩。
组成：羌活、防风、黄芩（酒洗，各一两）；柴胡（七钱）；黄连（酒煮，一两）；黄柏（酒炒）；栝蒌（酒洗，各半两）；甘草（炙，七钱）；白茯苓（五钱）；泽泻（三钱）。
制法与用法：将上述药物捣成粗末。每次服用五钱，加水煎煮取清汁。饭后或睡前，趁热通口服下。每日两次。
凉膈散（见第十九章）
防风通圣散（见第四十九章）
以上四种散剂，分别是贾同知、崔宣武、刘庭瑞以及刘河间所创制的方子。其中药物的增减、分量的多少，都不相同。但刘河间的方子药性适中，选用时应当遵循他的方法。
玉液汤：治疗因七情（喜、怒、忧、思、悲、恐、惊）内伤所致的气郁生涎，随气上逆，引起头目眩晕，心中嘈杂悸动，眉棱骨疼痛。
组成：半夏（选用肥大者六钱，用开水浸泡七次，切成片）。
制法与用法：作为一服的量。加水一钟半，生姜十片，煎至八分满。滤去药渣，加入少许沉香末，不拘时间温服。
头痛的脉象多表现为弦脉。浮脉主风，紧脉主寒，洪脉主热，细脉主湿，缓滑脉主厥证和痰饮，气虚则脉弦而软弱，血虚则脉微涩，肾气厥逆则脉弦而坚硬，真头痛则脉短而涩。
弦脉属于阴脉，脉形敛直而没有起伏抑扬的气势，这是阳气虚弱不能舒展张大，或者导致外邪乘虚而入。况且头部是六阳经汇聚之处，邪气束缚于外，阳气郁结于中，怎么能不疼痛呢？所以头痛的脉象多呈弦象。所谓“多弦”，并非全都是弦脉。也有脉浮而痛的，这属于风邪，因为风性飘荡虚浮。（如果兼见恶寒、发热、自汗等症状，适宜使用张仲景的桂枝汤、玄珠茶调散之类的方剂。）
脉紧而痛的，属于寒邪，因为寒性收敛紧实。（如果兼见恶寒、发热、无汗、身体疼痛等症状，适宜使用张仲景的麻黄汤、九味羌活汤之类的方剂。）
脉洪而痛的，属于热邪，因为热性充盛洪大。（如果兼见怕热、面红、口干等症状，且疼痛刺痛不定，适宜使用泻青丸、二仙散、对金散、神芎丸、凉膈散之类的方剂。）
脉细而痛的，属于湿邪，因为湿性渗衍濡细。（如果兼见身体疼痛、头重如裹、鼻塞、目黄等症状，适宜使用奇效芎术汤、半夏白术天麻汤，或者瓜蒂散，或用红豆散搐鼻。）
脉缓滑而痛的，属于痰饮。痰是水液凝结停蓄不流形成的，所以脉象显得替替然缓滑。（如果兼见呕吐逆气、痞闷、肠鸣等症状，适宜使用局方玉壶丸、半夏白术天麻汤之类的方剂。）
脉弦软而痛的，属于气虚。气虚则脉象弦敛软弱，没有鼓动的力量。（如果兼见恶寒、疼痛伴有空虚感眩晕、四肢多寒冷喜欢温暖、气虚脉微、身体疲倦等症状，适宜使用补中益气汤、六君子汤之类的方剂。）
脉微涩而痛的，属于血虚。血虚则脉象微弱涩滞，呈现干燥之象。（如果兼见面色苍白、口干、头两侧疼痛剧烈且伴有眩晕、夜间疼痛加重或夜热等症状，适宜使用四物汤、逍遥散之类的方剂。）
脉弦坚而痛的，属于肾脏病变。肾气厥逆，不能接续膀胱之气。膀胱经气壅遏不通，导致上实下虚，头顶发生疼痛，脉象也呈现弦直而坚实的状态。
这就是《灵枢·经脉篇》所说的：“膀胱经发生变动，就会引起冲头痛。”也是《难经·六十难》所说的厥头痛。（如果兼见头重眩晕、腰痛、少腹拘急、上热下寒等症状，适宜使用六味丸、八味丸、羌活、川芎之类的药物。）《难经》只提及手三阳经而未涉及足三阳经，恐怕不够全面。《素问·五脏生成篇》说：“头痛巅疾，是由于下虚上实，病位在足少阴肾经和足太阳膀胱经，严重时则传入肾脏。”这正是指膀胱厥痛不止，严重时传入肾脏成为真头痛。这种疼痛牵连脑部，全部疼痛，牙齿也会痛。因为肾主骨、主髓，髓以脑为海，而牙齿是骨骼的余气所化。其脉象短涩的，短脉表示阳气脱失于上，涩脉表示阴气衰败于下。如果手足冰冷达到关节部位，必定死亡，无法医治。（这类病症如果想要治疗，非猛烈进用乌头、附子等热药不可。或者灸百会穴，以期望在万分之一的情况下获救。）虽然如此，头痛也不止这几种情况。六腑的清阳之气固然上升，而五脏的精华也向上灌注。外有六淫邪气的侵袭，内有经络之气的逆乱。使得隧道壅塞遏阻，清阳之气混淆，从而导致头顶部疼痛的情况就很多了。所以五脏六腑都能导致这种病，只要仔细诊察其脉象和伴随症状，来辨别脏腑、阴阳、寒热、虚实从而施治，就能万无一失了。
Xiong San (Ligusticum Powder): Treats vertigo of the head and eyes, dimness and pain in the eyes with spinning sensation, fatigue, and palpitations.
Ingredients: Chuanxiong Rhizoma (Chuanxiong), Peucedani Radix (Qianhu), Bombyx Batryticatus (Bai Jiangcan, stir-fried), Ginseng Radix et Rhizoma (Renshen) (each 1 liang); Viticis Fructus (Manjingzi), Gastrodiae Rhizoma (Tianma) (soaked in wine and baked), Saposhnikoviae Radix (Fangfeng) (deprived of twigs, each 0.5 liang).
Preparation and Administration: Grind the above ingredients into a fine powder. Take 2 qian per dose, mixed with warm wine after meals.
Dongyuan Qianghuo Tang (Qianghuo Decoction by Dongyuan): Treats dizziness of the head and eyes caused by excessive wind-heat pathogen attacking upwards.
Ingredients: Notopterygii Rhizoma et Radix (Qianghuo), Saposhnikoviae Radix (Fangfeng), Scutellariae Radix (Huangqin) (washed with wine, each 1 liang); Bupleuri Radix (Chaihu) (7 qian); Coptidis Rhizoma (Huanglian) (boiled with wine, 1 liang); Phellodendri Cortex (Huangbai) (stir-fried with wine); Trichosanthis Fructus (Gualou) (washed with wine, each 0.5 liang); Glycyrrhizae Radix et Rhizoma (Zhigancao) (roasted, 7 qian); Poria (Baifuling) (5 qian); Alismatis Rhizoma (Zexie) (3 qian).
Preparation and Administration: Crush the above ingredients into coarse powder. Take 5 qian per dose, decocted in water to obtain clear liquid. Drink hot through the mouth after meals or before lying down. Twice daily.
Liangge San (Cool the Diaphragm Powder) (See Chapter 19)
Fangfeng Tongsheng San (Saposhnikovia Universal Salvation Powder) (See Chapter 49)
The above four powders were created by Jia Tongzhi, Cui Xuanwu, Liu Tingrui, and Liu Hejian respectively. The addition or reduction of herbs and the dosage vary among them. However, Liu Hejian's formula is balanced in nature; when selecting, one should follow his method.
Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) (See Chapter 22)
Gun Tan Wan (Rolling Phlegm Pill) (See Chapter 17)
Yuye Tang (Jade Fluid Decoction): Treats conditions caused by emotional injury (Seven Emotions). Qi stagnation generates phlegm-fluid, which reverses upward along with Qi, causing vertigo of the head and eyes, heart discomfort and palpitations, and pain in the supraorbital ridge.
Ingredients: Pinelliae Rhizoma Preparatum (Banxia) (select large tubers, 6 qian, soaked in boiling water seven times, sliced).
Preparation and Administration: Prepare as one dose. Add 1 zhong 1/2 of water and 10 slices of fresh ginger, decoct until 8/10 remains. Strain the dregs, add a small amount of Aquae Ligni Agaroschini (Chenxiang) powder, and take warm at any time.
Siwu Tang (Four Substances Decoction) (See Chapter 21)
Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) (See Chapter 39)
Headache pulses are mostly wiry (Xian). Floating pulse indicates Wind, tight pulse indicates Cold, surging pulse indicates Heat, fine pulse indicates Dampness, slow and slippery pulse indicates Jue syndrome and Phlegm. Qi deficiency presents as wiry and soft; Blood deficiency presents as faint and choppy; Kidney Jue presents as wiry and firm; True headache presents as short and choppy.
Wiry pulse belongs to Yin. It is straight and constricted without undulating momentum, indicating Yang deficiency failing to expand, or external pathogens taking advantage. Since the head is the meeting place of the Six Yang meridians, if pathogens bind externally and Yang is depressed internally, pain is inevitable. Thus, headache pulses are mostly wiry. "Mostly wiry" does not mean exclusively wiry. There are cases of floating pulse with pain, belonging to Wind, as Wind nature is drifting and floating. (If accompanied by aversion to cold, fever, spontaneous sweating, etc., Guizhi Tang [Cinnamon Twig Decoction] or Xuanzhu Chatiao San [Xuanzhu Tea-Powder for Regulating the Head] are suitable.)
Tight pulse with pain belongs to Cold, as Cold nature is constricting and solid. (If accompanied by aversion to cold, fever, anhidrosis, body ache, etc., Ma Huang Tang [Ephedra Decoction] or Jiwei Qianghuo Tang [Nine-Ingredient Qianghuo Decoction] are suitable.)
Surging pulse with pain belongs to Heat, as Heat nature is abundant and large. (If accompanied by aversion to heat, red face, dry mouth, etc., with stabbing and shifting pain, Xieqing Wan [Draining Green Pill], Erxian San [Two Immortals Powder], Duijin San [Metal-Matching Powder], Shenxiong Wan [Divine Ligusticum Pill], or Liangge San are suitable.)
Fine pulse with pain belongs to Dampness, as Dampness nature is permeating and moist. (If accompanied by body ache, heavy head like being wrapped, nasal congestion, yellow eyes, etc., Qixiao Xiongzhu Tang [Miraculous Effect Ligusticum and Atractylodes Decoction], Banxia Baizhu Tianma Tang, or Genti San [Gardenia Powder], or Hongdou San [Red Bean Powder for nasal insufflation] are suitable.)
Slow and slippery pulse with pain belongs to Phlegm. Phlegm is condensed fluid that stops and does not flow, hence the pulse feels slow and slippery. (If accompanied by vomiting/reversal, fullness/stuffiness, borborygmus, etc., Jufang Yuhu Wan [Official Pharmacy Jade Pot Pill] or Banxia Baizhu Tianma Tang are suitable.)
Wiry and soft pulse with pain belongs to Qi deficiency. Qi deficiency makes the pulse wiry, constricted, weak, and lacking driving force. (If accompanied by aversion to cold, empty/dizzy pain, cold limbs preferring warmth, faint Qi-deficiency pulse, fatigue, etc., Buzhong Yiqi Tang or Liujunzi Tang [Six Gentlemen Decoction] are suitable.)
Faint and choppy pulse with pain belongs to Blood deficiency. Blood deficiency makes the pulse faint, choppy, and dry. (If accompanied by pale face, dry mouth, severe pain on both sides of the head with dizziness, worsening pain at night or night fever, etc., Siwu Tang or Xiaoyao San [Free Wanderer Powder] are suitable.)
Wiry and firm pulse with pain belongs to the Kidney. Kidney Qi rebels and cannot connect with Bladder Qi. Bladder meridian Qi is obstructed, leading to excess above and deficiency below, causing vertex headache, with a wiry, straight, and firm pulse.
This corresponds to what is stated in *Ling Shu · Jing Mai Pian*: "When the Bladder meridian undergoes change, it causes rushing headache." This is also what is referred to as Jue Headache in *Nan Jing · Nan 60*. (If accompanied by heavy/dizzy head, lower back pain, hypogastric tension, upper heat/lower cold, Liuwei Wan [Six-Ingredient Pill], Bawei Wan [Eight-Ingredient Pill], Qianghuo, or Chuanxiong are suitable.) *Nan Jing* only mentions the Hand Three Yang meridians but omits the Foot Three Yang meridians, which may be incomplete. *Su Wen · Wu Zang Sheng Cheng Pian* states: "Headache and vertex disease are due to deficiency below and excess above, involving the Foot Shaoyin and Taiyang meridians; if severe, it enters the Kidney." This precisely refers to Bladder Jue pain persisting, entering the Kidney to become True Headache. The pain connects to the brain and is total, and the teeth also hurt. Because the Kidney governs bones and marrow, and marrow regards the brain as its sea, while teeth are the surplus of bone. If the pulse is short and choppy, short indicates Yang collapse above, and choppy indicates Yin decline below. If cold hands and feet reach the joints, death is certain and incurable. (To treat such conditions, aggressive use of Wutou [Aconiti Lateralis Radix Preparata] and Fuzi [Aconiti Radix Preparata] is necessary. Or moxa Baihui GV20, hoping for survival in one in ten thousand cases.) Although so, headache is not limited to these types. The clear Yang of the Six Fu organs naturally ascends, and the essence of the Five Zang organs also pours upward. External invasion by the Six Excesses and internal rebellion of meridian Qi cause obstruction in the tunnels, confusing clear Yang, leading to many cases of headache at the vertex. Therefore, all Five Zang and Six Fu organs can cause this disease. By carefully observing the pulse and accompanying symptoms to differentiate the Zang/Fu, Yin/Yang, Cold/Heat, and Deficiency/Excess, treatment can be applied accurately and effectively.