凡头痛之候。感于六淫者。其发各以时。惟头风发不以时。或月计。或岁计。
虚则愈频。独可异者。素问云。当先风一日则痛甚。不可出内。至其风曰。则
少愈。夫痛既以风而作。何先风反甚。风日反愈乎。盖础润而雨。月晕而风。
凡气机之动。每先形于所感。在天为风者。在人为肝。肝者风木之脏。而血
藏焉。惟血虚则发热。热甚则生风。一经感召。而病机之跃跃欲动者。则从
少阳之火以上头角。故头风先患左半者以此。然木邪凌土。脾胃受克。头
痛甚者。必作呕。乃由少阳入阳明。则侵及于右半者以此。可见头风之疾。
乃本肝经而作。肾水不能生肝木。肝木来乘脾土。惟以补中益气。调中益
气。使清阳上升。入黄柏以降阴火。土生金。金平木。水制火。东垣先生深察
病机。立方神应。非后人所几及。于此见一班云。若漫作风治。去之不啻千
里。希其效也得乎。
一大寒犯脑。头痛齿亦痛。用补中益气汤加麻黄附子细辛。
一头痛耳鸣。九窍不利。肠胃之所生。用调中益气汤。
一挟热头痛。烦躁不宁。用茶调散。
一痰厥头痛。因误服疏风。脾胃虚损。头旋吐痰。身重肢冷。头苦痛如裂者。用半夏白术天麻汤。
一头痛巅疾。下虚上实。过在足少阴巨阳。用黑锡丹。
一眉棱骨痛。风热痰气上攻者。用选奇汤。
调中益气汤
升麻 柴胡 黄柏（酒炒） 川芎 甘草（各三分炙） 苍术（泔制） 人参 陈皮（各七分）
黄（蜜炙） 当归 蔓荆子（各一钱焙研）
水煎。畏寒甚。加细辛三分。
茶调散
黄芩（酒浸炒，二两） 川芎（一两） 白芷（五钱） 荆芥（四钱） 薄荷 细茶（各三钱）
为细未。每服三钱。茶送下。巅顶及脑痛。加细辛 本蔓荆子各三钱。
半夏白术天麻汤
半夏 麦芽（各钱半） 干姜（三分） 白术（土炒） 神曲（各一钱炒） 黄柏（二分酒炒） 人参 苍术（米
泔制） 天麻（煨） 黄 （蜜炙） 陈皮 泽泻 茯苓（各五分）
水煎
黑锡丹
沉香 附子（制） 葫芦巴 肉桂（各五分） 茴香（焙） 补骨脂 木香 金铃子 肉豆蔻 黑锡
硫黄（与黑锡结砂各一两）
为末。研匀酒煮。面和丸。梧子大。阴干。每服五钱。空心姜盐汤送下。一方有阳起石五钱。巴戟一两。
选奇汤
防风 羌活（各三钱） 黄芩（一钱酒炒） 甘草（三钱夏生冬炙）
每服三钱。水煎热服。
凡是头痛的症状，如果是感受六淫（风、寒、暑、湿、燥、火六种外感病邪）所致，其发作往往与季节时令有关。只有头风病的发作没有固定时间，有的按月计算，有的按年计算。
身体虚弱时，发作就会更加频繁。唯独值得探讨的是，《素问》中说：在风邪到来前一天，疼痛会加重，此时不宜外出或进入室内；等到风邪真正到来时，反而稍微减轻。既然疼痛是由风邪引起的，为什么在风来之前反而加重，而风来时反而减轻呢？这就像础石湿润预示下雨，月亮周围出现晕圈预示刮风一样。凡是气机的变动，往往先在外形上表现出受邪的迹象。在天为风，在人对应肝脏。肝是风木之脏，血液藏于其中。只有血虚才会产生内热，热势严重才会生风。一经感召，病机跃跃欲动，便顺着少阳之火上行至头角部位。所以头风病先发作在头部左侧的原因就在于此。然而，肝木邪气克制脾土，导致脾胃受损，当头痛剧烈时，必然伴随呕吐，这是因为病邪由少阳传入阳明经，从而侵犯到头部右侧的原因。由此可见，头风这一疾病，根本在于肝经病变。肾水不能滋养肝木，肝木反过来乘袭脾土。治疗应当采用补中益气汤和调中益气汤，使清阳之气上升，加入黄柏以降伏阴火。通过土生金、金平木、水制火的五行相生相克原理，李东垣先生深刻洞察了病机，创立的方剂神妙灵验，不是后人所能企及的。从这里可以窥见一斑。如果随意当作普通风邪来治疗，那就差之千里了，怎么能期望见效呢？
有一例因大寒侵袭脑部导致的头痛，牙齿也痛，使用补中益气汤加麻黄、附子、细辛。
有一例头痛伴耳鸣，九窍不通利，这是肠胃功能失调产生的，使用调中益气汤。
有一例痰厥头痛，因误服疏风药物，导致脾胃虚损，出现头晕吐痰、身体沉重、四肢发冷、头部痛苦如裂开的症状，使用半夏白术天麻汤。
有一例头痛且伴有巅顶疾患，属于下虚上实，病位在足少阴肾经和足太阳膀胱经，使用黑锡丹。
有一例眉棱骨疼痛，因风热痰气上攻所致，使用选奇汤。
调中益气汤
组成：升麻、柴胡、黄柏（酒炒）、川芎、甘草（各三分，炙）、苍术（泔水制）、人参、陈皮（各七分）、黄芪（蜜炙）、当归、蔓荆子（各一钱，焙干研碎）。
用法：水煎服。若畏寒严重，加细辛三分。
茶调散
组成：黄芩（酒浸炒，二两）、川芎（一两）、白芷（五钱）、荆芥（四钱）、薄荷、细茶（各三钱）。
用法：研成细末。每次服用三钱，用茶水送服。若巅顶及脑痛，加细辛、藁本、蔓荆子各三钱。
半夏白术天麻汤
组成：半夏、麦芽（各一钱半）、干姜（三分）、白术（土炒）、神曲（各一钱，炒）、黄柏（二分，酒炒）、人参、苍术（米泔水制）、天麻（煨）、黄芪（蜜炙）、陈皮、泽泻、茯苓（各五分）。
用法：水煎服。
黑锡丹
组成：沉香、附子（制）、葫芦巴、肉桂（各五分）、茴香（焙）、补骨脂、木香、金铃子、肉豆蔻、黑锡、硫黄（与黑锡结砂，各一两）。
用法：研成细末，混合均匀，用酒煮，面粉调和制成丸药，大小如梧桐子。阴干。每次服用五钱，空腹时用姜盐汤送服。另一版本方中有阳起石五钱、巴戟天一两。
For all cases of headache, if caused by the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), their onset is typically associated with specific seasons. Only Head Wind (Tou Feng) occurs without a fixed schedule, sometimes recurring monthly or annually.
When deficiency prevails, attacks become more frequent. What is particularly noteworthy is that *Su Wen* states: "One day before the wind arrives, pain intensifies, and one should not go out or enter; when the wind actually arrives, it becomes slightly better." Since the pain is caused by wind, why does it worsen before the wind arrives and improve when it comes? This is akin to dampness on stone foundations predicting rain, or halos around the moon predicting wind. Whenever Qi dynamics shift, signs of pathogenic invasion often manifest externally first. In nature, this corresponds to Wind; in the human body, it corresponds to the Liver. The Liver is the Zang organ of Wind and Wood, where Blood is stored. Only when Blood is deficient does internal Heat arise; when Heat is severe, it generates Wind. Once induced, the pathological mechanism stirs and moves upward along the Fire of Shaoyang (Lesser Yang) to the temples and head corners. This explains why Head Wind initially affects the left side of the head. However, Wood evil overacts on Earth, impairing the Spleen and Stomach. When headache is severe, vomiting inevitably occurs because the pathogen has moved from Shaoyang to Yangming (Greater Yang), affecting the right side of the head. Thus, it can be seen that Head Wind originates fundamentally from the Liver Meridian. If Kidney Water fails to nourish Liver Wood, Liver Wood overacts on Spleen Earth. Treatment should employ Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction) to raise Clear Yang, combined with Huangbai (Phellodendri Cortex) to descend Yin Fire. Through the principles of Earth generating Metal, Metal controlling Wood, and Water controlling Fire, Mr. Li Dongganc deeply comprehended the pathological mechanisms and formulated divine prescriptions, surpassing later generations. From this, we can glimpse the essence. If treated casually as ordinary Wind, the error would be vast, and efficacy could never be expected.
Case 1: Headache and toothache caused by severe Cold invading the brain. Prescribe Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Mahuang (Ephedrae Herba), Fuzi (Aconiti Lateralis Radix Praeparata), and Xixin (Asari Radix et Rhizoma).
Case 2: Headache accompanied by tinnitus and dysfunction of the nine orifices, originating from the intestines and stomach. Prescribe Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction).
Case 3: Headache with heat, restlessness, and agitation. Prescribe Chatiao San (Tea-Modifying Powder).
Case 4: Phlegm-Jue headache caused by misusing wind-dispelling herbs, leading to Spleen-Stomach deficiency damage, dizziness, phlegm expectoration, heavy body, cold limbs, and severe splitting headache. Prescribe Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction).
Case 5: Headache with cranial disorders, characterized by deficiency below and excess above, involving the Foot-Shaoyin (Kidney) and Foot-Taiyang (Bladder) meridians. Prescribe Heixi Dan (Black Tin Pill).
Case 6: Pain in the supraorbital ridge caused by Wind-Heat and Phlegm-Qi attacking upward. Prescribe Xuanqi Tang (Select Marvelous Decoction).
Tiaozhong Yiqi Tang (Regulate the Middle and Augment the Qi Decoction)
Ingredients: Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Huangbai (Phellodendri Cortex, wine-fried), Chuanxiong (Ligustici Chuanxiong Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma, each 3 fen, honey-roasted), Cangzhu (Atractylodis Rhizoma, rice-water processed), Renshen (Ginseng Radix), Chenpi (Citri Reticulatae Pericarpium, each 7 fen), Huangqi (Astragali Radix, honey-roasted), Danggui (Angelicae Sinensis Radix), Manjingzi (Viticis Fructus, each 1 qian, baked and ground).
Preparation: Decoct in water. If severe aversion to cold is present, add Xixin (Asari Radix et Rhizoma) 3 fen.
Chatiao San (Tea-Modifying Powder)
Ingredients: Huangqin (Scutellariae Radix, wine-soaked and fried, 2 liang), Chuanxiong (Ligustici Chuanxiong Rhizoma, 1 liang), Baizhi (Angelicae Dahuricae Radix, 5 qian), Jingjie (Schizonepetae Spica, 4 qian), Bohe (Menthae Haplocalycis Herba), Xiacha (Fine Tea, each 3 qian).
Preparation: Grind into fine powder. Take 3 qian per dose, washed down with tea. For pain at the vertex and brain, add Xixin (Asari Radix et Rhizoma), Gaoben (Ligustici Wallichii Rhizoma et Radix), and Manjingzi (Viticis Fructus), each 3 qian.
Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction)
Ingredients: Banxia (Pinelliae Rhizoma Preparatum), Maiya (Hordei Fructus Germinatus, each 1.5 qian), Ganjiang (Zingiberis Rhizoma, 3 fen), Baizhu (Atractylodis Macrocephalae Rhizoma, earth-fried), Shenqu (Massa Medicata Fermentata, each 1 qian, fried), Huangbai (Phellodendri Cortex, 2 fen, wine-fried), Renshen (Ginseng Radix), Cangzhu (Atractylodis Rhizoma, rice-water processed), Tianma (Gastrodiae Rhizoma, roasted), Huangqi (Astragali Radix, honey-roasted), Chenpi (Citri Reticulatae Pericarpium), Zexie (Alismatis Rhizoma), Fuling (Poria, each 5 fen).
Preparation: Decoct in water.
Heixi Dan (Black Tin Pill)
Ingredients: Chenxiang (Aquilariae Lignum Resinatum), Fuzi (Aconiti Lateralis Radix Praeparata), Huluba (Trigonellae Semen), Rougui (Cinnamomi Cortex, each 5 fen), Huixiang (Foeniculi Fructus, baked), Buguzhi (Psoraleae Fructus), Muxiang (Aucklandiae Radix), Jinlingzi (Meliosmae Fructus), Roudoukou (Myristicae Semen), Heixi (Black Tin), Liuhuang (Sulfur, forming cinnabar-like compound with Black Tin, each 1 liang).
Preparation: Grind into powder, mix evenly, boil with wine, bind with wheat flour paste to make pills the size of wu-tzu seeds. Air-dry in shade. Take 5 qian per dose, washed down with ginger-salt decoction on an empty stomach. Another variant includes Yangqishi (Pyrosilicum, 5 qian) and Bajitian (Morindae Officinalis Radix, 1 liang).
Xuanqi Tang (Select Marvelous Decoction)
Ingredients: Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix, each 3 qian), Huangqin (Scutellariae Radix, 1 qian, wine-fried), Gancao (Glycyrrhizae Radix et Rhizoma, 3 qian, raw in summer, honey-roasted in winter).
Preparation: Take 3 qian per dose, decoct in water and take hot.