头为清阳之分，外而六淫之邪相侵，内而脏腑经脉之邪气上逆，皆能
乱其清气，相搏击致痛。须分内外虚实。实者，其人血气本不虚，为外邪所犯，或
蔽覆其清明，或壅塞其经络，或内之实火上炎，因而血瘀涎滞，不得通行而痛，其
痛必甚，此为实。虚者，其人气血本虚，为外邪所犯，或内之浊阴上干，虽亦血瘀
涎滞，不能通行，而搏击无力，其痛不甚，此为虚。（《准绳》谓真气虚寒，遇外之寒湿所侵，血
涩脉寒，卷缩紧急，引其小络而痛，得暖则痛止。）实者，邪气实而正气不虚，
可任攻。虚者，正
气自虚，而邪气自实，补正仍须治邪。若邪亦不实，但补正则邪自退。六淫外邪，
惟风寒湿三者，最能郁遏阳气。火暑燥三者皆属热，受其热则汗泄，非有风寒湿袭
之，不为患也。然热甚亦气壅脉满，而为痛矣。内邪不一，皆统于风，（风即气之飘 上
升者。）以高巅之上，惟风可到也。故不论内外邪，汤剂中必加风药以上引之。风药味
之薄者，阴中之阳，自地升天者也，升麻、薄荷之类。痛如破，不能忍，蔓荆子。
风在太阳，巅顶连颈强痛，脉浮紧，君羌活，加姜、葱。（葱白宜连须用。）风在少阳，
头角痛，口苦，脉弦细，君柴胡，加姜、葱。风在阳明，额痛连目，脉浮长，君
白芷，加姜、葱。少阴、太阴，脉至胸颈而还，故无头痛。惟厥阴脉会巅顶，故
巅痛，君 本，如脉沉足冷，干呕吐沫，加吴茱萸、附子。用风药者，由风木虚，
不能升散，土寡于畏，得以壅塞而痛。（犹言少阳清气不升，脾湿上壅不降耳。）故用风
药以散之。若疏散太过，服风药反甚，（发散太过，清阳之气愈虚，浊阴终不降，且表虚
易招外侮。）
宜补气实表，顺气和中汤。凡外感头痛，详《伤寒论》。头痛久不愈者，名头风。头
风，头面多汗，恶风，时止时发，先风一日则痛甚，至风日则少愈。（清阳之气被郁，故
喜通而恶塞。风者，天气之通者也。先郁后通，先风一日，正郁极欲通之候也，欲通不通，
故扰动而痛甚。至风日
则天气通，而人气应之亦通，故少愈也。）由内有郁热，或痰火，毛窍常疏，风易入，外寒束内
热，闭逆为痛。医用辛温之药散其标寒，虽暂效，以热济热，病益深。宜泻火凉血，
佐以辛散，南星、苍耳子、石菖蒲、天麻最当。头风久不愈，恐损目，（邪害空窍。）清
空膏主之。有痰加半夏，诸般头痛并治。惟血虚头痛（详下）不宜，正巅顶痛者亦勿用。
内伤头痛，气虚者耳鸣目眩，（清气不升，阴火上冲。）九窍不利，（气不能达于九窍也。）
自觉空虚，恶劳动，动则痛更甚，脉虚大，必包裹其头乃少宁，四君子汤（见气）加风药。血虚头痛，
鱼尾（眉尖后，近发际）终日星星如细筋抽引，痛不甚，脉芤或数，善惊惕，当归、川芎、
连翘、熟地各二钱，水煎，泡薄荷末二钱、鼻吸其气，候温服，安卧效。或四物汤
（见血）加风药。气血俱虚者，调中益气汤（见劳倦）加川芎、蔓荆子、细辛，神效。阴虚发
热，两太阳穴作痛，此相火自下冲上，六味九（见虚损）。产后血瘀头痛，膈热上干也。
热厥头痛，虽严寒犹喜风寒，在暖处或见烟火则甚，宜清上泻火汤，后用补气汤。
头目赤肿，胸膈烦闷，大便微秘，身半以下寒，足 尤甚，（此条详寒热篇上热下寒条。）既
济解毒汤（见寒热）。痰厥头痛，晕眩烦乱，恶心欲吐，半夏白术天麻汤（见眩晕）。虚风内作，
非天麻不治，痰非半夏不除，黄 实表止自汗，人参补气，二术、泽泻、茯苓除湿，
橘皮调中升阳，炒曲、麦芽消食荡胃，干姜除寒，黄柏（酒炒）治伏火发燥。湿热
作痛，必昏重欲吐，兼眉棱骨痛，二陈（见痰）加风药。伤食头痛，胸膈痞塞，咽酸，噫
败卵臭，恶食，治中汤加砂仁一钱，或红丸子，或平胃散（并见伤饮食）加枳实。伤酒头
痛，恶心，昏冒眩晕，葛花解酲汤。（见伤饮食。）头痛巅疾，下虚上实也。（寒湿上干。）过在
足少阴太阳，甚则入肾，寒湿自经而入脏也。肾主骨髓，髓通脑，寒入骨髓，逆上
至脑，阻碍清阳，故脑痛连齿，亦骨之余也。（此几几乎真头痛矣。）湿热上干者，必以苦吐
之，轻者透顶散，搐鼻取涎。头重如裹，由湿气在头，头者轻清象天，清故轻也。
湿者地之浊气，浊故重也。外湿蒙蔽故如裹，宜微汗，勿大汗，恐汗去湿留，红豆
搐鼻散。外有嗅毒头痛，吃炒香附一味愈。真头痛，手足寒至节，全脑连齿皆痛，
旦发夕死，不治。与黑锡丹，（见呃逆。）灸百会，猛进参、沉、乌、附或可生，然天
柱折者必死。（真头痛与真心痛皆寒证，阴灭阳也。）
偏头痛。旧分右属热与痰，（热用黄芩，痰用半夏、苍术。）以阳明胃腑居右，多热多痰也。
分左属风属血虚，以肝木主风居左，又左属血也。（风用荆芥、薄荷，血虚用川芎、当归、菊花。）
然不必泥定。生萝卜汁，仰卧注鼻中，左痛注右，（左痛则左壅塞，虽注之亦不通，右通故可注，
从右透左，则并通矣。）右痛注左。荜茇、（散热。）猪胆（清热）。搐鼻。川芎散、细辛散。川芎、
柴胡为主，佐以蔓荆子、苍耳叶、升麻、甘草、葱、姜。大便秘，大黄下之。外
用萆麻子五钱，大枣十五枚，捣成泥，涂绵纸上，箸卷成筒，去箸，纳鼻中，良久
下涕，痛止。又石膏二钱，牛蒡子二钱，为末酒下，饮大醉立愈。
雷头风。头痛而起核块，或头中如雷鸣，（风动作声，如籁之发。）清震汤。或不省人事，
地肤子、生姜捣烂，热酒冲服，取汗愈。子和用茶调散（见伤饮食）。吐之，后用神
芎丸（见肿胀）下之，再服乌荆丸（见血），及愈风饼子之类。弱者用凉膈散，（见发热。）消风散
热。痰热生风作响，半夏（牙皂、姜汁煮过，一两）、大黄（酒浸透，湿纸包煨，如是者三次，二两）、
白僵蚕、连翘、橘红、桔梗、天麻（各五钱）、片芩（酒炒，七钱）、薄荷叶（三钱）、白芷、青
礞石、粉草（各一钱），为末，水浸蒸饼丸，绿豆大，临卧茶吞二钱，以痰利为度，后服
清痰降火之药。气挟肝火作响，加味逍遥（见郁）最当。亦有如虫响者，名天白蚁，茶子
为细末吹鼻。
大头痛。头肿如斗，俗云大头瘟，天行疫气所发。头面赤肿，或发疙瘩。
先发鼻额属阳明，先发耳前后属少阳，先发脑后及项属太阳。若三阳俱受邪，则各
处并发，治戒急下。（恐遗高分之邪。）当先缓后急，退热、（芩、连等。）消毒，（连翘、鼠粘子、
板蓝
根之类。）缓缓治之。（细口呷，或食后服，或酒炒使上升不速下，皆缓之义。）候大便热结，
上焦之邪热
皆降聚于中州，乃下之，三承气（见大便不通）选用。此毒若结块不散，必成脓，外用柏
叶和蚯蚓粪泥捣敷。或井底泥调大黄、芒硝末亦可。赤肿结核， 针出血愈。
头摇掉眩属风热，风火主动也，羌活、川芎、白芷、 本、苍术、细辛、甘草、
天麻。若因肝肾二经血亏，致火炎生风，须养血。又凡人内有痛则头摇，心绝则头
摇，状如烟煤，直视者死。痉病亦头摇。
头风屑。罗谦甫谓肝风盛，金来克之，使头有雪皮。（难解。大抵风热上蒸，其液干，则
化为白屑耳。）大便实，泻青丸（见中风），虚者人参消风散。
眉棱骨痛。或外邪郁成风热，上攻于脑，从目系过眉骨，下注于目。（目系上属于
脑，过眉骨也。）或内之风热湿痰上攻，选奇汤主之。（风热者，清上散痰，二陈加酒芩、白芷。
风寒羌乌散。）肝虚者，才见光明，眼眶骨痛，生熟地黄丸。（肝血虚火旺也。）肝经停饮，发则
眉骨痛，眼不可开，昼静夜剧，（湿为阴邪，故夜病甚。）导痰汤（见痰），或小芎辛汤加半夏、
橘红、南星、茯苓。
头部是清阳之气汇聚的部位，外部受到六淫邪气的侵袭，内部脏腑经脉的邪气上逆，都会扰乱头部的清气，相互搏击而导致疼痛。必须区分内因和外因、虚证和实证。实证，是指患者气血原本不虚，被外邪侵犯，或者遮蔽覆盖其清明之气，或者壅塞经络，或者体内的实火上炎，导致血瘀痰滞，气血不能通行而疼痛，这种疼痛必然剧烈，这就是实证。虚证，是指患者气血本来虚弱，被外邪侵犯，或者体内的浊阴之气上犯，虽然也有血瘀痰滞，不能通行，但搏击的力量微弱，疼痛不剧烈，这就是虚证。（《医学准绳六要》认为真气虚寒，遇到外界的寒湿侵袭，血液涩滞、脉象寒冷，脉络收缩紧急，牵引细小的络脉而痛，得到温暖则疼痛停止。）实证，是邪气盛而正气不虚，可以承受攻伐治疗。虚证，是正气自身虚弱，而邪气相对显得实盛，补益正气的同时仍需治疗邪气。如果邪气也不实，只需补益正气，邪气自然消退。六淫外邪中，只有风、寒、湿三者，最能郁遏阳气。火、暑、燥三者都属热性，感受热邪会导致汗出泄气，如果没有风寒湿邪袭表，通常不会致病。然而热邪极盛也会导致气机壅滞、脉道充盈，从而引起疼痛。内伤邪气种类繁多，都统属于风（风就是气飘动上升的表现）。因为人体最高处（头顶），只有风能到达。所以无论内外邪气，在汤剂中都必须加入风药以向上引导。风药气味薄弱的，属于阴中之阳，是从地升天的药物，如升麻、薄荷之类。疼痛剧烈如破裂般无法忍受的，用蔓荆子。风邪在太阳经，表现为巅顶连及颈部强痛，脉浮紧，以羌活为君药，加生姜、葱白。（葱白宜带须使用）。风邪在少阳经，表现为头角痛，口苦，脉弦细，以柴胡为君药，加生姜、葱白。风邪在阳明经，表现为前额痛连及眼部，脉浮长，以白芷为君药，加生姜、葱白。少阴经、太阴经的脉气运行至胸颈部即止，所以没有头痛症状。只有厥阴经的脉气会合于巅顶，所以出现巅顶痛，以藁本为君药，如果脉沉且足冷，干呕吐沫，加吴茱萸、附子。使用风药的原因，是由于风木之气虚弱，不能升发疏散，脾土缺乏制约，得以壅塞而致痛。（这就好比少阳清气不升，脾湿上壅不降一样）。所以用风药来疏散它。如果疏散太过，服用风药后疼痛反而加重，（发散太过，清阳之气更加虚弱，浊阴终究不能下降，而且表虚容易招致外邪侵害），宜补气固表，顺气和中汤。凡是外感引起的头痛，详见《伤寒论》。头痛长久不愈的，称为头风。头风的症状是头面部多汗，怕风，疼痛时止时发，起风前一天疼痛加剧，到了有风的日子则稍微减轻。（清阳之气被郁遏，所以喜欢通畅而厌恶闭塞。风，是天气通畅的表现。先郁滞后通畅，起风前一天，正是郁积到极点想要通畅的时候，想通却不通，所以扰动而疼痛剧烈。到了有风的日子，天气通畅，人气随之也应和而通畅，所以疼痛稍减。）由于体内有郁热，或者有痰火，毛孔常处于疏松状态，风邪容易侵入，外寒束缚内热，闭阻逆乱而致痛。医生如果用辛温的药物发散表面的寒邪，虽然暂时有效，但以热助热，病情会更加深入。应该泻火凉血，佐以辛散药物，南星、苍耳子、石菖蒲、天麻最为适宜。头风长久不愈，恐怕损伤眼睛，（邪气伤害空窍），用清空膏主治。有痰的加半夏，各种头痛一并治疗。只有血虚头痛（详见下文）不宜用，真正是巅顶痛的也不要使用。内伤头痛，气虚的伴有耳鸣目眩，（清阳不升，阴火上冲），九窍不利，（气不能通达于九窍），自觉头部空虚，厌恶劳动，一动则疼痛更甚，脉虚大，必须包裹头部才能稍安宁，用四君子汤（见气虚篇）加风药。血虚头痛，眼角（眉梢后，近发际处）终日像星星一样如细筋抽引，疼痛不剧烈，脉芤或数，容易受惊惕，用当归、川芎、连翘、熟地黄各二钱，水煎，泡入薄荷末二钱，闻鼻吸气，待温服，安静卧床见效。或者用四物汤（见血虚篇）加风药。气血俱虚的，用调中益气汤（见劳倦篇）加川芎、蔓荆子、细辛，效果神奇。阴虚发热，两侧太阳穴作痛，这是相火自下向上冲逆，用六味地黄丸（见虚损篇）。产后血瘀头痛，是膈间热邪上犯所致。热厥头痛，虽然严寒却喜欢风寒，在暖和的地方或见到烟火则疼痛加重，宜用清上泻火汤，后用补气汤。头目红肿，胸膈烦闷，大便轻微秘结，身体下半部寒冷，足部尤其严重，（此条详见寒热篇上热下寒条），用既济解毒汤（见寒热篇）。痰厥头痛，头晕目眩烦乱，恶心欲吐，用半夏白术天麻汤（见眩晕篇）。虚风内动，非天麻不能治愈，痰非半夏不能消除，黄芪固表止自汗，人参补气，白术、泽泻、茯苓除湿，陈皮调中升阳，炒神曲、麦芽消食化胃，干姜除寒，黄柏（酒炒）治伏火发燥。湿热作痛，必定昏重欲吐，兼有眉棱骨痛，用二陈汤（见痰饮篇）加风药。伤食头痛，胸膈痞塞，咽酸，打嗝有腐败蛋臭味，厌恶食物，用治中汤加砂仁一钱，或者红丸子，或者平胃散（并见伤饮食篇）加枳实。伤酒头痛，恶心，昏冒眩晕，用葛花解酲汤。（见伤饮食篇）。头痛巅疾，是下虚上实的表现。（寒湿上犯）。病位在足少阴、太阳经，严重时传入肾脏，寒湿从经络传入脏腑。肾主骨髓，髓通于脑，寒邪进入骨髓，逆上至脑，阻碍清阳，所以脑痛连及牙齿，牙齿也是骨的余气。（这几乎就是真头痛了）。湿热上犯的，必须用苦味药催吐，轻的用透顶散，搐鼻取涎。头重如裹，是由湿气在头部所致。头是轻清之象，象天一样，清故轻。湿是地的浊气，浊故重。外湿蒙蔽头部所以感觉像被包裹，宜微汗，不可大汗，恐怕汗去湿留，用红豆搐鼻散。外有嗅毒引起的头痛，吃炒香附一味即可痊愈。真头痛，手足寒冷至关节，全脑连齿皆痛，早晨发病晚上死亡，不治。给予黑锡丹，（见呃逆篇），灸百会穴，猛进人参、沉香、乌梅、附子或许能生还，然而天柱骨折断者必死。（真头痛与真心痛都是寒证，阴灭阳也）。
偏头痛。旧说分为右边属热与痰，（热用黄芩，痰用半夏、苍术。）因为阳明胃腑居右，多热多痰。左边属风属血虚，因为肝木主风居左，又左边属血。（风用荆芥、薄荷，血虚用川芎、当归、菊花。）然而不必拘泥固定。生萝卜汁，仰卧滴入鼻中，左痛注右鼻，（左痛则左侧壅塞，即使滴入也不通，右侧通畅所以可滴入，从右侧透达左侧，则两侧皆通），右痛注左鼻。荜茇，（散热。）猪胆，（清热）。搐鼻。川芎散、细辛散。以川芎、柴胡为主，佐以蔓荆子、苍耳叶、升麻、甘草、葱、姜。大便秘结，用大黄攻下。外用蓖麻子五钱，大枣十五枚，捣成泥，涂在绵纸上，筷子卷成筒状，去掉筷子，纳入鼻中，很久之后流涕，疼痛停止。另外石膏二钱，牛蒡子二钱，研为末，酒送服，喝醉立愈。
雷头风。头痛且起核块，或者头中声音如雷鸣，（风动作有声，如乐器发声），用清震汤。如果不省人事，用地肤子、生姜捣烂，热酒冲服，取汗痊愈。张子和用茶调散（见伤饮食篇），吐法，后用神芎丸（见肿胀篇）下法，再服乌荆丸（见血证篇），以及愈风饼子之类。体质弱者用凉膈散，（见发热篇），消风散清热。痰热生风作响，用半夏（牙皂、姜汁煮过，一两）、大黄（酒浸透，湿纸包煨，如此三次，二两）、白僵蚕、连翘、橘红、桔梗、天麻（各五钱）、片芩（酒炒，七钱）、薄荷叶（三钱）、白芷、青礞石、粉草（各一钱），研为末，水浸蒸饼丸，绿豆大小，临睡前茶吞二钱，以痰利为度，后服清痰降火之药。气挟肝火作响，加味逍遥散（见郁证篇）最适宜。也有像虫鸣声的，名叫天白蚁，用茶子研为细末吹鼻。
大头痛。头肿如斗，俗云大头瘟，由天行疫气所发。头面赤肿，或者发疙瘩。先发鼻额属阳明经，先发耳前后属少阳经，先发脑后及项属太阳经。如果三阳经都受邪，则各处并发，治疗忌讳急下。（恐遗留高分部位的邪气）。应当先缓后急，退热，（黄芩、黄连等），消毒，（连翘、鼠粘子、板蓝根之类），缓缓治疗。（小口慢饮，或饭后服，或用酒炒使药力上升而不速下，都是缓的意思）。等到大便热结，上焦的邪热都降聚于中焦，才用下法，选用三承气汤（见大便不通篇）。此毒如果结块不散，必成脓，外用柏叶和蚯蚓粪泥捣敷。或者井底泥调大黄、芒硝末也可。赤肿结核，针刺出血痊愈。
头摇掉眩属风热，风火主动，用羌活、川芎、白芷、藁本、苍术、细辛、甘草、天麻。如果因肝肾二经血亏，导致火炎生风，须养血。另外凡人内有痛则头摇，心绝则头摇，状如烟煤，直视者死。痉病也会头摇。
头风屑。罗谦甫认为肝风盛，金来克之，使头有雪皮。（难以理解。大抵风热上蒸，津液干枯，则化为白屑罢了）。大便实，用泻青丸（见中风篇），虚者用人参消风散。
眉棱骨痛。或者外邪郁结成风热，上攻于脑，从目系经过眉骨，下注于目。（目系上属于脑，经过眉骨）。或者内的风热湿痰上攻，选奇汤主治。（风热者，清上散痰，二陈汤加酒芩、白芷。风寒用羌乌散）。肝虚者，刚见到光亮，眼眶骨痛，用生熟地黄丸。（肝血虚火旺也）。肝经停饮，发作时眉骨痛，眼不可开，白天安静夜晚加剧，（湿为阴邪，所以夜间病重），用导痰汤（见痰饮篇），或小芎辛汤加半夏、橘红、南星、茯苓。
The head is the region where clear yang qi gathers. External invasion by the six excess pathogens (Liu Yin, 六淫) or internal reversal of pathogenic qi from the zang-fu organs and meridians can all disturb the clear qi in the head, leading to pain through mutual combat. It is necessary to differentiate between internal and external causes, and deficiency and excess patterns. In an excess pattern, the patient's qi and blood are originally not deficient; they are invaded by external pathogens which either obscure their clarity or obstruct the meridians, or internal excess fire flares upward, causing blood stasis and phlegm stagnation that prevents free circulation, resulting in pain. This pain is necessarily severe, constituting an excess pattern. In a deficiency pattern, the patient's qi and blood are originally deficient; invaded by external pathogens or affected by internal turbid yin rising upward, although there may also be blood stasis and phlegm stagnation preventing circulation, the force of combat is weak, and the pain is not severe, constituting a deficiency pattern. (*Zhunsheng* states that when true qi is deficient and cold, and invaded by external cold-dampness, blood becomes sluggish and pulses cold, causing vessels to contract and tighten, pulling on small collaterals to cause pain, which stops with warmth.) In an excess pattern, pathogenic qi is excess while healthy qi is not deficient, so it can withstand attacking treatments. In a deficiency pattern, healthy qi is inherently deficient while pathogenic qi appears relatively excess; tonifying healthy qi still requires treating the pathogen. If the pathogen is also not excess, merely tonifying healthy qi will cause the pathogen to recede spontaneously. Among the six excess external pathogens, only wind, cold, and dampness can most effectively constrain yang qi. Fire, summer-heat, and dryness all belong to heat; contracting heat leads to sweating and qi leakage, and without wind, cold, or dampness attacking the exterior, it usually does not cause disease. However, extreme heat can also cause qi stagnation and full pulses, leading to pain. Internal pathogens vary but are all unified under wind (wind is essentially qi floating and rising). Because the highest point of the body (the vertex) is reachable only by wind, regardless of whether the pathogen is internal or external, wind herbs must be added to decoctions to guide them upward. Wind herbs with thin flavors belong to yang within yin, rising from earth to heaven, such as Shengma (Rhizoma Cimicifugae) and Bohe (Folium Menthae). For pain that feels like bursting and is unbearable, use Manjingzi (Fructus Viticis). When wind is in the Taiyang meridian, presenting as vertex pain extending to neck stiffness with a floating-tight pulse, use Qianghuo (Rhizoma et Radix Notopterygii) as the sovereign herb, adding Jiang (Zingiberis Rhizoma) and Congbai (Scleranthi Bulbus). (Congbai should be used with roots intact). When wind is in the Shaoyang meridian, presenting as temporal headache, bitter taste, and a string-taut-thin pulse, use Chaihu (Radix Bupleuri) as the sovereign herb, adding Jiang and Congbai. When wind is in the Yangming meridian, presenting as frontal headache extending to the eyes with a floating-long pulse, use Baizhi (Radix Angelicae Dahuricae) as the sovereign herb, adding Jiang and Congbai. The Shaoyin and Taiyin meridians' pulses return at the chest and neck, so they do not present with headache. Only the Jueyin meridian connects to the vertex, so vertex pain occurs, using Gaoben (Rhizoma Ligustici Chuanxiong) as the sovereign herb; if the pulse is deep and feet are cold with dry heaving and vomiting of foam, add Wuzhuyu (Fructus Evodiae) and Fuzi (Radix Aconiti Lateralis Preparata). Wind herbs are used because wind-wood qi is deficient and cannot ascend and disperse, allowing earth to become unconstrained and obstructed, causing pain (similar to saying Shaoyang clear qi fails to ascend and spleen dampness fails to descend). Thus, wind herbs are used to disperse it. If dispersion is excessive and pain worsens after taking wind herbs (excessive dispersion further depletes clear yang qi, turbid yin ultimately fails to descend, and exterior deficiency easily invites external aggression), one should tonify qi and secure the exterior with Shunqi Hezhong Tang. For all externally-contracted headaches, refer to *Shanghan Lun*. Headaches that persist for a long time are called Toufeng (Head Wind). Toufeng presents with sweating on the head and face, aversion to wind, intermittent pain that ceases and recurs; pain is severe the day before wind arises and lessens on windy days. (Clear yang qi is constrained, thus preferring openness and hating blockage. Wind represents the openness of weather. First constrained then open: the day before wind is exactly when constraint reaches its peak and seeks openness; wanting to open but unable to do so causes agitation and severe pain. On windy days, weather opens, human qi responds and opens, so pain lessens.) Due to internal constrained heat or phlegm-fire, pores are often loose, making wind entry easy; external cold binds internal heat, closing and reversing flow to cause pain. Physicians using acrid-warm herbs to disperse superficial cold may get temporary relief, but using heat to aid heat deepens the disease. One should purge fire and cool blood, assisted by acrid dispersants; Nanxing (Rhizoma Arisaematis), Can'erzi (Fructus Xanthii), Shichangpu (Rhizoma Acori Tatarinowii), and Tianma (Rhizoma Gastrodiae) are most appropriate. Prolonged Toufeng may damage the eyes (pathogens harm the orifices); Qingkong Gao is the main prescription. Add Banxia (Fructus Pinelliae Preparata) if there is phlegm; it treats various headaches. It is contraindicated for blood-deficiency headaches (see below) and true vertex pain. For internally-injured headaches, qi deficiency presents with tinnitus and vertigo (clear yang fails to ascend, yin fire rushes up), dysfunction of the nine orifices (qi cannot reach the nine orifices), a sensation of emptiness, aversion to labor, worsening pain upon movement, a large-deficient pulse, and relief only when the head is wrapped; use Sijunzi Tang (see Qi Deficiency) plus wind herbs. Blood-deficiency headache presents with twitching at the fish tail (posterior end of eyebrows near hairline) resembling fine tendon pulling, mild pain, a knotted or rapid pulse, and susceptibility to fright; use Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Lianqiao (Fructus Forsythiae), and Shudi (Radix Rehmanniae Preparata) each 2 qian, decocted in water, soaked with Bohe (Folium Menthae) powder 2 qian, inhale the vapor, take warm, rest quietly for effect. Or use Siwu Tang (see Blood Deficiency) plus wind herbs. For combined qi and blood deficiency, use Tiaozhong Yiqi Tang (see Fatigue/Labor Injury) plus Chuanxiong, Manjingzi, and Xixin (Herba Asari), yielding miraculous effects. Yin deficiency with fever causing pain in both temples indicates ministerial fire rushing up from below; use Liuwei Wan (see Deficiency Damage). Postpartum blood-stasis headache is due to diaphragmatic heat rushing up. Heat-jue headache prefers wind-cold even in severe cold, worsens in warmth or near smoke/fire; use Qingshang Xiehuo Tang, followed by Buqi Tang. Red swollen head and eyes, chest oppression, slight constipation, cold lower body especially feet (see Cold-Heat chapter Upper Heat Lower Cold section); use Jiji Jiedu Tang (see Cold-Heat). Phlegm-jue headache with dizziness, confusion, nausea; use Banxia Baizhu Tianma Tang (see Vertigo). Internal deficiency wind requires Tianma; phlegm requires Banxia. Huangqi (Astragali Radix) secures exterior and stops spontaneous sweating; Renshen (Ginseng Radix) tonifies qi; Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alismatis Rhizoma), Fuling (Poria) remove dampness; Chenpi (Citri Reticulatae Pericarpium) regulates middle and raises yang; Chaoqu (Massa Medicata Fermentata) and Maiya (Hordei Fructus Germinatus) digest food and cleanse stomach; Ganjiang (Zingiberis Rhizoma) removes cold; Huangbai (Phellodendri Cortex, wine-fried) treats latent fire causing dryness. Damp-heat pain presents with heaviness, nausea, and supraorbital pain; use Erchen Tang (see Phlegm) plus wind herbs. Food-stagnation headache presents with chest/epigastric fullness, sour throat, belching with rotten egg odor, food aversion; use Zhizhong Tang plus Sharen (Amomi Fructus) 1 qian, or Hongwanzi, or Pingwei San (see Food Injury) plus Zhishi (Fructus Aurantii Immaturus). Alcohol-injury headache with nausea, dizziness; use Gegua Jiexing Tang (see Food Injury). Headache at the vertex is lower deficiency and upper excess (cold-dampness rushing up). Pathology lies in Foot Shaoyin and Taiyang meridians, progressing to Kidney; cold-dampness enters from meridians to zang-fu. Kidney governs marrow, marrow connects to brain; cold entering marrow reverses up to brain, obstructing clear yang, causing brain pain connecting to teeth (teeth are surplus of bone). (This is almost True Headache). For damp-heat rushing up, bitter emetics are required; for mild cases, use Tou Ding San, insufflated into nose to extract phlegm-fluid. Heavy head like wrapping is due to dampness in the head; head is light/clear like heaven, hence light. Damp is heavy/turbid like earth, hence heavy. External damp obscuring feels like wrapping; induce slight sweat, not profuse, lest sweat leaves damp behind; use Hongdou Chubi San. External toxic inhalation headache cures with fried Xiangfu (Cyperi Rhizoma) alone. True Headache: hands and feet cold to joints, whole head and teeth pain, death morning to evening, untreatable. Give Heixi Dan (see Hiccups), moxa Baihui, aggressively administer Renshen, Chenxiang (Aquilariae Lignum Resinatum), Wu Mei (Fructus Mume), Fuzi; survival possible, but if Tianzhu (neck pillar) breaks, death is certain. (True Headache and True Heart Pain are both cold patterns, yin extinguishing yang).
Migraine. Old theory divides right side as heat and phlegm (heat uses Huangqin, phlegm uses Banxia, Cangzhu) because Yangming Stomach resides on right, prone to heat/phlegm. Left side as wind and blood deficiency (wind uses Jingjie, Bohe; blood deficiency uses Chuanxiong, Danggui, Juhua) because Liver Wood governs wind residing on left, and left belongs to blood. However, do not rigidly adhere. Raw radish juice, instilled supine into nose: left pain into right nostril (left pain implies left obstruction, instillation ineffective there; right is open, so instill right to penetrate left, opening both), right pain into left nostril. BiBo (Piperis Longi Fructus) disperses heat. Zhu Dan (Suis Fel) clears heat. Insufflate. Chuanxiong San, Xixin San. Use Chuanxiong, Chaihu as sovereign, assist with Manjingzi, Cang'er Ye, Shengma, Gancao, Cong, Jiang. Constipation: use Dahuang to purge. Externally: Bamazi (Ricini Semen) 5 qian, Dazao 15 pieces, mash into paste, spread on cotton paper, roll into tube with chopstick, insert into nose, wait for discharge of mucus, pain stops. Alternatively, Shigao 2 qian, Niubangzi 2 qian, powder, taken with wine until drunk, cures immediately.
Leifeng Feng (Thunderhead Wind). Headache with nodules or sound like thunder in head (wind action makes sound like reeds); use Qingzhen Tang. Unconsciousness: Difuzi, Ginger mashed, taken with hot wine to induce sweat and cure. Zhang Hezi uses Chatiao San (see Food Injury), emesis, then Shenxiong Wan (see Swelling) purgation, then Wu Jing Wan (see Blood), and Yufeng Bingzi. Weak patients use Liangge San (see Fever), Xiaofeng San to clear heat. Phlegm-heat generating wind noise: Banxia (Yazao, Ginger juice boiled, 1 liang), Dahuang (wine-soaked, wet-paper wrapped baked, thrice, 2 liang), Baijiangcan (Bombyx Batryticatus), Lianqiao, Juhong, Jiegeng, Tianma (each 5 qian), Pianqin (wine-fried, 7 qian), Bohe Ye (3 qian), Baizhi, Qingmengshi, Fencao (each 1 qian), powder, steamed pill with rice cake, mung-bean size, swallow 2 qian with tea before bed, stop when phlegm clears, then take phlegm-clearing fire-purging meds. Qi carrying liver fire making noise: Jiawei Xiaoyao San (see Depression) is best. Sound like insects named Tianbaiyi: Tea seed powder insufflated into nose.
Datou Feng (Great Headache). Head swollen like a bucket, commonly called Datou Wen (Big Head Plague), caused by epidemic qi. Red swollen head/face or pustules. Starting at nose/forehead belongs to Yangming; starting at ears/temples belongs to Shaoyang; starting at back of head/neck belongs to Taiyang. If all three yang meridians are affected, simultaneous onset occurs; treatment forbids urgent purgation (fear of leaving high-level pathogens). Should start slow then fast: reduce heat (Huangqin, Huanglian etc.), detoxify (Lianqiao, Niubangzi, Banlangen etc.), treat slowly (sip slowly, take after meals, or wine-fry to keep medicine ascending not descending quickly, all meaning "slow"). Wait until stool is heat-bound, upper jiao heat gathers in middle jiao, then purge, selecting among Three Chengqi Decoctions (see Constipation). If toxin forms induration not resolving, pus will form; externally apply Boye (Cupressi Cacumen) mixed with earthworm manure mud. Or well-bottom mud mixed with Dahuang, Mangxiao powder. Red swollen nodes: needle bleed to cure.
Head shaking/dizziness belongs to wind-heat; wind-fire moves. Use Qianghuo, Chuanxiong, Baizhi, Gaoben, Cangzhu, Xixin, Gancao, Tianma. If due to Liver/Kidney blood deficiency causing fire/wind, nourish blood. Also, internal pain causes head shaking; heart exhaustion causes head shaking, appearance like coal dust, staring straight ahead indicates death. Spasm disease also causes head shaking.
Toufeng Xie (Head Wind Dandruff). Luo Qianfu says Liver wind excess, Metal overcomes it, causing snow-like skin on head. (Hard to explain. Generally, wind-heat steams upward, fluids dry, turning into white scales). Constipation: Xieqing Wan (see Stroke), deficiency: Renshen Xiaofeng San.
Meilinggu Tong (Supraorbital Pain). External pathogens constrained into wind-heat, attacking brain, passing through eye system over brow bone to eyes (eye system connects to brain, passes brow bone). Or internal wind-heat/damp-phlegm attacking; use Xuanqi Tang. (Wind-heat: clear upper scatter phlegm, Erchen Tang plus wine-Huangqin, Baizhi. Wind-cold: Qiangwu San). Liver deficiency: pain in orbital bone upon seeing light, Shengshu Dihuang Wan (Liver blood deficiency, fire excess). Liver meridian fluid retention: brow bone pain, eyes cannot open, quiet day/worse night (damp is yin pathogen, worse at night); use Daotan Tang (see Phlegm), or Xiao Xiongxin Tang plus Banxia, Juhong, Nanxing, Fuling.