典藏书目

Zihe (Zhang Congzheng) stated that persistent headache is caused by pathogenic invasion of the Three Yang meridians. The foot-Taiyang meridian governs the head and nape; thus, pain in the head and nape belongs to the foot-Taiyang meridian. Pain at the Cuanzhu acupoint (BL2, commonly referred to as "eyebrow tiger bone pain") also belongs to the foot-Taiyang meridian. Pain above the temple corners, commonly known as hemianalgesia (migraine), belongs to the foot-Shaoyang meridian. If the headache persists for a long time, it may lead to visual impairment, as the invasion of the Three Yang meridians is often caused by chronic disorders in the chest and diaphragm. Initially, Cha Tiao San (Tea Regulation Powder) should be administered to induce vomiting. After vomiting ceases, one may take herbs such as Chuanxiong Rhizoma (Chuanxiong) and Bohe Herba (Menthae Haplocalycis Herba) with acrid-cool properties to clear the upper jiao. Shuhe (Wang Shuhe) stated: "A rapid pulse at the cun position indicates headache."

Note: The statement here that headache results from the invasion of the Three Yang meridians due to phlegm in the chest and diaphragm refers to the stagnation and oppression of pathogenic qi in the upper body. The *Neijing* states: "In spring, diseases manifest in the head," because heavenly qi resides above, so pathogenic qi also ascends to the upper part. The use of emesis aims to vent and release pathogens located in the upper region. Zhang Zhongjing stated: "The general principle is that spring is suitable for emesis." This is indeed one method for treating headaches, but it should not be rigidly applied exclusively.

Zihe said that a monk from Danyang suffered from heat-pain in the head that did not subside and worsened upon exposure to light. He would wrap cloth around his crown and place ice in the center, changing it several times a day. Zihe said, "This is due to accumulated heat in the Three Yang meridians." Therefore, he placed charcoal fires in a warm room and simultaneously employed sweating and emesis methods. The patient recovered after seven days.

A woman suffered from hemianalgesia for five or seven years, accompanied by dry and hard stools, red and swollen eyes, and vertigo. She had taken all kinds of medicines for wind-stroke of the head available in the world, and had undergone thousands of acupuncture and moxibustion treatments on her head. One day, Zihe palpated her pulse, which was rapid, frequent, and forceful, indicating severe wind-heat. This pain in the temple corners belongs to the Sanjiao (Triple Burner) ministerial fire meridian, caused by the dominance of Yangming Dryness Metal over Liver Wood. When Dryness Metal dominates, it attacks the Liver, causing Liver Qi stagnation; Liver Qi stagnation leads to Qi and Blood obstruction; Qi and Blood obstruction prevents smooth flow between the upper and lower parts, resulting in internal dryness accumulation, which can even progress to blindness. The treatment used Da Cheng Qi Tang (Major Order the Qi Decoction). It was decocted with river water, using two liang of the powder, plus one liang of Mangxiao (Natrii Sulfas). After decoction, it was taken in two doses. The patient experienced diarrhea like liquid more than twenty times. Subsequently, Qi Xuan Wan (Seven Circulation Pill) and Shen Gong Wan (Divine Efficacy Pill) were administered to moisten the intestines, while Spinacia Oleracea (Bo Leng Cai) and pig/sheep blood were consumed to lubricate the bowels. After three doses, vision cleared, the head felt light, and the dryness and accumulation were resolved, leading to recovery.

Note: Since the disease treated here had persisted for many years without resolution, could it not be attributed to the stubborn stagnation of wind, dampness, and heat? Thus, although the methods employed were harsh, they were appropriate for the condition. Furthermore, regarding severe wind-stroke of the head, prolonged duration leads to dim vision. Hemianalgesia involves Shaoyang ministerial fire; prolonged duration leads to constricted pupils and constipation. In such cases, bloodletting and vigorous purgation are suitable. The meaning of bloodletting lies in resolving stagnation and releasing the exterior.

Respectfully noted: The etiology of headache is diverse. Li Dongyuan's discussion is quite detailed. However, those caused by external factors differ in wind, cold, summer-heat, and dampness, such as Zhang Zhongjing's Cold Damage (Shanghan) and Li Dongyuan's classification of the Six Meridians. Those caused by internal factors differ in Qi deficiency, Blood deficiency, Phlegm, Fluid retention, and stagnation of the Five Zang organs' Qi, such as Li Dongyuan's discussions on Qi-deficiency headache, Blood-deficiency headache, and Phlegm-jue headache. Generally speaking, the four exogenous pathogens (wind, cold, summer-heat, dampness) are external evils and should be treated externally according to the degree of wind, cold, dampness, and heat. Conditions involving Qi, Blood, Phlegm, and Fluid retention, as well as the Five Zang organs, are internal evils and should be regulated internally based on the excess/deficiency and cold/heat of Qi, Blood, Phlegm, Fluid retention, and Seven Emotions/Internal Fire, thereby treating the external manifestations. However, when tonifying Qi and Blood deficiency, one should follow Li Dongyuan's theories. For instance, using Fuzi (Aconiti Lateralis Radix Praeparata) to treat Qi deficiency in formulas like San Yin Fang is based on the concept of Yang deficiency, which does not reflect the balanced state of normal Qi and Blood. As for chronic hemianalgesia or frontal headache, these are mostly due to internal retention of phlegm-saliva, depression of wind-fire obstructing the collaterals, and stagnation of Qi and Blood. However, there are also cases of Blood deficiency, which must be distinguished and treated accordingly.