（附∶颈项强痛）
总括 头痛先须辨六经，湿痰风火夹邪侵；气虚血少兼寒湿，识者尤当审厥真。
脉法 《脉经》云∶阳热则头疼。又曰∶寸口脉浮，中风发热头痛，脉紧头痛是伤寒，脉紧上寸口者风头痛。《脉诀》
云∶头痛短涩应须死，浮滑风痰皆易除。
《内经》曰∶寸口脉中短者曰头痛。
子和曰∶头痛不止，夫三阳受病，皆胸膈有痰之致，盖指病之壅郁于上而言也。
《内经》曰∶春气者病在头，盖天气在上，知病气亦升于上也，其法当吐，谓吐之所以宣达在上之邪。
仲景云∶大法春宜吐是也，此特治头痛之一法耳。按头痛之症有自外而生者，如风寒暑湿之邪；有自内而生者，如
气血痰饮之动。然人有三阳三阴之异，而又皆以风药治之者，总其大体而言之，高巅之上，惟风可到耳。故太阳头痛者，
恶风寒，脉浮紧，痛在巅顶两额角；少阳头痛者往来寒热，脉弦，痛连耳根；阳明头痛者，发热自汗，脉浮长大，痛连
目颊齿；太阴头痛者，必有痰，体重或腹痛，脉沉，头重；少阴头痛者，足冷气逆为寒厥，脉沉细；厥阴头痛者吐痰
沫厥冷，脉浮缓，痛引目系，此六经头痛多挟外邪者也。血虚头痛者，自鱼尾上攻头痛也；气虚头痛者，耳鸣九窍不利
也；真头痛者，痛甚入连于脑，手足寒至节，旦发夕死、夕发旦死也。
有厥逆头痛者，所犯大寒内至骨髓，髓者以脑为主，脑逆故令头痛齿亦痛也。
痰厥头痛者，头苦痛如裂，眼黑头旋恶心，烦闷，目不敢开，如在风云中，此足太阴痰厥头痛也。凡此之类，种种
不同，更 大方，究其所因，斯无一偏之弊矣。
丹溪云，头痛大率属痰，甚者火多，有可吐者可下者。肾虚则头痛，肝虚则头晕。
〔附方〕
太阴经头痛方 本 川芎 羌活 独活 麻黄
少阳经头痛方 柴胡 半夏 黄芩 人参 甘草
阳明经头痛方 升麻 芍药 干葛 甘草 加石膏、白芷煎服。
太阴经头痛方 苍术 半夏 南星 川芎 蔓荆子
少阴经头痛方 麻黄 附子 细辛
厥阴经头痛方 麻黄 羌活 吴茱萸 本 升麻 黄 黄连 黄芩 当归 黄柏 川芎 细辛 柴胡
半夏 红花 苍术 蔓荆子
芎归汤 即四物汤去地黄、芍药，一方加柴胡、羌活、酒芩、蔓荆子
四君子汤 人参 白术 茯苓 甘草
羌活黑附汤 麻黄 僵蚕 黄柏 羌活 苍术 防风 甘草 升麻 白芷 黄 黑附子
痰厥二陈汤 加减 陈皮 半夏 蔓荆子 苍术 南星 防风 茯苓 甘草
（附注：颈项强直疼痛）
总括
头痛首先必须辨别属于哪一经，常见病因包括湿痰、风邪、火邪夹杂外邪侵袭；也有因气虚、血少兼夹寒湿所致，有识见的人尤其应当审慎辨别厥阴病的真象。
脉法
《脉经》说：阳热亢盛会导致头痛。又说：寸口脉浮，是中风发热头痛；脉紧的头痛属于伤寒；脉紧且出现在寸口部位的，是风邪引起的头痛。《脉诀》说：头痛若脉象短涩，预后不良甚至致死；脉象浮滑的，多为风痰所致，容易治愈。
《内经》说：寸口脉中呈现短象的，称为头痛。
张子和说：头痛不止，是因为三阳经受病，都是胸膈有痰浊导致的，这指的是病邪壅滞郁结于上部的情况。
《内经》说：春季的病气往往表现在头部，因为天气位于上部，可知病气也升发于上部，治疗方法应当采用吐法，所谓吐法是为了宣通发散在上部的邪气。
仲景说：大法则是春季适宜用吐法，这只是治疗头痛的一种方法罢了。按头痛的症状，有从外部产生的，如风寒暑湿之邪；有从内部产生的，如气血痰饮的变动。然而人有三阳三阴经络的差异，而又都用风药来治疗，这是从大体上来说的，因为高处的头顶，只有风药能够到达。所以太阳经头痛者，恶风寒，脉浮紧，疼痛在巅顶和两额角；少阳经头痛者，往来寒热，脉弦，疼痛牵连耳根；阳明经头痛者，发热自汗，脉浮大长，疼痛牵连目颊和牙齿；太阴经头痛者，必定有痰，身体沉重或腹痛，脉沉，头重；少阴经头痛者，足部冷、气逆为寒厥，脉沉细；厥阴经头痛者，呕吐痰沫、四肢厥冷，脉浮缓，疼痛牵引目系，这六经头痛大多夹杂外邪。血虚头痛者，疼痛从鱼尾处向上攻冲头部；气虚头痛者，耳鸣、九窍不通利；真头痛者，疼痛剧烈深入连及脑部，手足寒冷至关节，早晨发病晚上死亡，晚上发病早晨死亡。
有厥逆头痛者，是由于遭受大寒，寒气内入骨髓，髓以脑为主，脑气逆乱故导致头痛，牙齿也痛。
痰厥头痛者，头部痛苦如裂开，眼前发黑、头晕恶心，烦闷，眼睛不敢睁开，如同处在风云之中，这是足太阴经的痰厥头痛。像这样种种不同，更应参考大方剂，探究其病因，这样就没有偏颇的弊病了。
丹溪说，头痛大体上属于痰，严重的多属火，有的可以用吐法，有的可以用下法。肾虚则头痛，肝虚则头晕。
〔附方〕
太阴经头痛方：藁本、川芎、羌活、独活、麻黄。
少阳经头痛方：柴胡、半夏、黄芩、人参、甘草。
阳明经头痛方：升麻、芍药、干葛、甘草，加石膏、白芷煎服。
太阴经头痛方（另一首）：苍术、半夏、南星、川芎、蔓荆子。
少阴经头痛方：麻黄、附子、细辛。
厥阴经头痛方：麻黄、羌活、吴茱萸、藁本、升麻、黄芪、黄连、黄芩、当归、黄柏、川芎、细辛、柴胡、半夏、红花、苍术、蔓荆子。
芎归汤：即四物汤去掉地黄、芍药，另一方加柴胡、羌活、酒炒黄芩、蔓荆子。
四君子汤：人参、白术、茯苓、甘草。
羌活黑附汤：麻黄、僵蚕、黄柏、羌活、苍术、防风、甘草、升麻、白芷、黄芪、黑附子。
痰厥二陈汤加减：陈皮、半夏、蔓荆子、苍术、南星、防风、茯苓、甘草。
(Attachment: Stiffness and pain in the neck and nape)
General Principles
Headache must first be differentiated by the Six Channels (Liu Jing). Common etiologies include damp-phlegm, wind-pathogen, fire-pathogen, or mixed pathogens invading; it may also result from Qi deficiency, Blood deficiency, combined with cold-dampness. Those with insight must carefully examine for true Jueyin patterns.
Pulse Diagnosis
The *Mai Jing* (Classic of Pulses) states: Yang-heat causes headache. It further states: A floating pulse at the Cun Kou indicates wind-strike with fever and headache; a tight pulse indicates headache due to Cold Damage (Shang Han); a tight pulse appearing at the Cun Kou indicates wind-headache. The *Mai Jue* (Pulse Rhymes) states: Headache with a short and choppy pulse portends death; a floating and slippery pulse indicates wind-phlegm, which is easy to eliminate.
The *Nei Jing* (Inner Canon) states: A short pulse at the Cun Kou is termed headache.
Zihehe stated: Persistent headache arises from disease in the Three Yang channels, caused by phlegm accumulation in the chest and diaphragm, referring to the obstruction and stagnation of pathogenic factors in the upper body.
The *Nei Jing* states: Pathogenic qi in spring manifests in the head, as heavenly qi resides above, implying pathogenic qi also ascends. The treatment method should employ emesis to vent and disperse pathogenic factors located superiorly.
Zhongjing stated: The general principle is that spring is suitable for emesis. This is merely one method for treating headache. Regarding headache symptoms, some arise externally, such as wind, cold, summer-heat, and dampness; others arise internally, such as disturbances of Qi, Blood, phlegm, and fluid retention. Although there are differences among the Three Yang and Three Yin channels, wind herbs are generally used because, broadly speaking, only wind herbs can reach the high summit of the head. Therefore:
Taiyang headache presents with aversion to wind and cold, a floating-tight pulse, and pain at the vertex and lateral forehead angles.
Shaoyang headache presents with alternating chills and fever, a wiry pulse, and pain radiating to the root of the ear.
Yangming headache presents with fever and spontaneous sweating, a floating-large-long pulse, and pain radiating to the eyes, cheeks, and teeth.
Taiyin headache is characterized by the presence of phlegm, heavy body or abdominal pain, a deep pulse, and a heavy sensation in the head.
Shaoyin headache presents with cold feet and reversed Qi constituting cold-Jue, with a deep-thin pulse.
Jueyin headache presents with vomiting of phlegm-saliva, cold limbs, a floating-slow pulse, and pain drawing into the eye system. These six-channel headaches mostly involve external pathogens.
Blood-deficiency headache involves pain attacking upward from the outer canthus area.
Qi-deficiency headache involves tinnitus and dysfunction of the nine orifices.
True headache involves severe pain penetrating into the brain, with cold limbs extending to the joints; morning onset leads to evening death, and evening onset leads to morning death.
There is also Jue-ni headache, caused by severe cold invading inward to the bone marrow. Since marrow governs the brain, brain Qi reversal causes headache and toothache.
Phlegm-Jue headache involves severe splitting pain in the head, blackouts, dizziness, nausea, restlessness, inability to open the eyes, feeling as if amidst wind and clouds; this is Phlegm-Jue headache of the Foot-Taiyin channel. For such varied cases, one should refer to major formulas and investigate the underlying causes to avoid bias.
Danxi stated that headache largely belongs to phlegm, with severe cases involving much fire; some can be treated with emesis, others with purgation. Kidney deficiency causes headache; Liver deficiency causes dizziness.
[Attached Formulas]
Taiyin Channel Headache Formula: Ligustici Rhizoma (Gaoben), Chuanxiong Rhizome (Chuanxiong), Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Pubescentis Radix (Duhuo), Ephedrae Herba (Mahuang).
Shaoyang Channel Headache Formula: Bupleuri Radix (Chaihu), Pinelliae Tuber (Banxia), Scutellariae Radix (Huangqin), Ginseng Radix et Rhizoma (Renshen), Glycyrrhizae Radix et Rhizoma (Gancao).
Yangming Channel Headache Formula: Cimicifugae Rhizoma (Shengma), Paeoniae Radix Alba (Shaoyao), Puerariae Radix (Gegen), Glycyrrhizae Radix et Rhizoma (Gancao), added with Gypsum Fibrosum (Shigao) and Angelicae Dahuricae Radix (Baizhi), decocted and taken.
Taiyin Channel Headache Formula (Second): Atractylodis Rhizoma (Cangzhu), Pinelliae Tuber (Banxia), Pinelliae Tuber Preparatum (Nanxing), Chuanxiong Rhizome (Chuanxiong), Viticis Fructus (Manjingzi).
Shaoyin Channel Headache Formula: Ephedrae Herba (Mahuang), Aconiti Lateralis Radix Praeparata (Fuzi), Asari Radix et Rhizoma (Xixin).
Jueyin Channel Headache Formula: Ephedrae Herba (Mahuang), Notopterygii Rhizoma et Radix (Qianghuo), Evodiae Fructus (Wuzhuyu), Ligustici Rhizoma (Gaoben), Cimicifugae Rhizoma (Shengma), Astragali Radix (Huangqi), Coptidis Rhizoma (Huanglian), Scutellariae Radix (Huangqin), Angelicae Sinensis Radix (Danggui), Phellodendri Cortex (Huangbai), Chuanxiong Rhizome (Chuanxiong), Asari Radix et Rhizoma (Xixin), Bupleuri Radix (Chaihu), Pinelliae Tuber (Banxia), Carthami Flos (Honghua), Atractylodis Rhizoma (Cangzhu), Viticis Fructus (Manjingzi).
Xiongui Tang: Siwu Decoction minus Rehmanniae Radix (Dihuang) and Paeoniae Radix Alba (Shaoyao); another variation adds Bupleuri Radix (Chaihu), Notopterygii Rhizoma et Radix (Qianghuo), Scutellariae Radix prepared with wine (Jiu Huangqin), and Viticis Fructus (Manjingzi).
Sijunzi Tang: Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao).
Qianghuo Heifu Tang: Ephedrae Herba (Mahuang), Bombyx Batryticatus (Jiangcan), Phellodendri Cortex (Huangbai), Notopterygii Rhizoma et Radix (Qianghuo), Atractylodis Rhizoma (Cangzhu), Saposhnikoviae Radix (Fangfeng), Glycyrrhizae Radix et Rhizoma (Gancao), Cimicifugae Rhizoma (Shengma), Angelicae Dahuricae Radix (Baizhi), Astragali Radix (Huangqi), Aconiti Lateralis Radix Praeparata (Hei Fuzi).
Tan Jue Erchen Tang Modified: Citri Reticulatae Pericarpium (Chenpi), Pinelliae Tuber (Banxia), Viticis Fructus (Manjingzi), Atractylodis Rhizoma (Cangzhu), Pinelliae Tuber Preparatum (Nanxing), Saposhnikoviae Radix (Fangfeng), Poria (Fuling), Glycyrrhizae Radix et Rhizoma (Gancao).