头，象天，六腑清阳之气，五脏精华之血，皆会于此。然天气所发，六淫之邪，人气所
变，
五贼之逆，皆能相害。或蔽复其清明，或瘀塞其经络，因与真气相薄而为痛也。因风而痛者
，抽掣恶风，有汗而痛。因暑热而痛者，或有汗、或无汗，则皆恶热而痛。因湿而痛者，痛
而头重，遇天阴尤甚。因痰饮而痛者，亦头昏重而痛，愦愦欲吐。因寒而痛者。恶寒而脉绌
急。气虚而痛者，遇劳则痛甚，其脉大。血虚而痛者，善惊惕，其脉芤。
东垣治头痛，大率皆以酒芩、酒连、酒柏加风剂，如清空膏、安神散、清上泻火汤之类
，但
杂用羌、防、升、柴、 、蔓等药，殊欠纪律，学人师其意可也，《元珠》茶调散，简要可
用。
治头风久痛，须加芎、归、红花少许，非独治风，兼和血止痛也。细茶最能清上风热，
久痛以之作引弥佳。东垣、谦甫常用之。
许学士荆芥散，独用荆芥治风， 石膏治热，何等简要。东垣清空膏诸方，盖师其意而
扩充之。
风痰头痛，多兼呕逆眩晕，若用风药，其痰愈逆，其痛益甚。《和剂》玉壶丸，乃是的
药。东垣变为白术半夏天麻汤，则兼气虚而言之耳。
肾厥头痛、肝厥头痛，《本事方》论之最详。
玉真丸，硫黄、半夏，温降之力弥大，石膏、硝石，寒下之能甚长。夫阴气上逆，其来
最暴
，治以纯阳，必多格柜，故须膏、硝为之佐使，令其相入而不觉其相倾耳。黑锡丹亦见此意
。
茸珠丹有二方，一用朱砂、鹿茸二味为丸。盖亦补虚坠浮之意。一用朱砂同草乌、瞿麦
、黄
药子火 ，独取朱砂为末作丸。此不特朱砂经火有毒，即草乌之辛散，瞿麦、黄药子之苦降
，并已成灰，吹去不用，而顾需其相济，讵可得耶。
搐鼻诸方，《本事》独用辛温，东垣、河间并用辛凉。夫久畜之风，多化为热，而闭郁
之气，非温不通，随病斟酌，从少从多，则贤者之责也。
头痛饼子，有用五倍子、全蝎、土狗各七个，醋和作饼者。用南星、川芎等分同连须葱
白捣
烂作饼者。有用蓖麻子、乳香者。有用大黄、芒硝同井底泥捣贴者。然外治之药，无论邪之
寒热，并宜辛温开达，徒用苦寒，郁闭益甚，苟非热极，不可轻用。
头痛之因，非止一端，有风、有寒、有湿、有热、有兼气。兼气者，如火与湿合，《内
经》
所谓少阳司天之政，二之气，其热郁于上，头痛、呕吐、昏愦是也。有火胜水复者，《内经
》所云岁金不及，炎火乃行，复则阴厥，且格阳反上行，头脑户痛，延及脑顶，发热是也。
有胃实者，经所谓头痛耳鸣，九窍不利，肠胃之所生是也。有肾厥者，经所谓头痛巅疾，下
虚上实，过在足少阴巨阳，甚则入肾是也。有心热者，经所谓心烦头痛，病在膈中，过在手
巨阳少阴是也。有痰饮者，其病在脾，东垣所谓太阴痰厥，头痛眼黑，呕吐闷乱，亦湿胜也
。有内风者，风从火化，其病在肝，不特厥阴之脉与督脉上会于巅，盖即肝脏冲逆之气，亦
能上至巅顶也。又有真气不守，厥而上行，天门真痛，上引泥丸，名真头痛，多不可治。古
方云∶与黑锡丹，灸百会穴，猛进参、附、乌、沉，或有可生。然天柱折者，亦难为力矣。
头部，象征天空，六腑清阳之气与五脏精华之血，皆汇聚于此。然而，天气所引发的六淫邪气，人气所变化的五贼逆乱，都能相互侵害。它们或遮蔽复盖头部的清明，或瘀塞经络，因而与真气相搏结而产生疼痛。因风邪而致的头痛，表现为抽搐掣痛、恶风，有汗且疼痛；因暑热而致的头痛，或有汗、或无汗，都恶热且疼痛；因湿邪而致的头痛，疼痛且头部沉重，遇阴天尤为严重；因痰饮而致的头痛，也表现为头昏重且痛，心中烦闷欲吐；因寒邪而致的头痛，恶寒且脉象沉迟紧急；因气虚而致的头痛，劳累后疼痛加重，脉象大；因血虚而致的头痛，容易惊悸惕动，脉象芤。
李东垣治疗头痛，大体上都使用酒炒黄芩、酒炒黄连、酒炒黄柏，配合祛风药，如清空膏、安神散、清上泻火汤之类的方剂，但杂乱地使用了羌活、防风、升麻、柴胡、藁本、蔓荆子等药物，非常缺乏法度规矩，学习者借鉴其意即可。《元珠》中的茶调散，简要实用。
治疗头风久痛，必须加入川芎、当归、红花少许，不仅是为了治风，也是为了调和血液以止痛。细茶最能清除上部的风热，久痛用它作为引经药更佳。李东垣、张谦甫常用它。
许叔微的荆芥散，单独用荆芥治风，石膏治热，何等简要。李东垣的清空膏等方剂，大概是师承其意并加以扩充。
风痰头痛，多兼有呕吐逆气、眩晕，如果使用风药，会使痰浊更加上逆，疼痛更加严重。《和剂局方》中的玉壶丸，才是对症的药物。李东垣将其变为白术半夏天麻汤，则是兼论气虚的情况罢了。
玉真丸中，硫黄、半夏，温降的力量很大；石膏、硝石，寒下的功能很强。阴气上逆，发作最为暴急，如果只用纯阳药物治疗，必然会出现格拒现象，所以需要用石膏、硝石作为佐使药，让它们相互融入而不觉得相互倾轧排斥。黑锡丹也体现了这一意思。
茸珠丹有两个方子，一个用朱砂、鹿茸两味药制成丸剂。这也是补虚坠浮的意思。另一个用朱砂同草乌、瞿麦、黄药子一起火煅，只取朱砂为末制作丸剂。这不仅仅因为朱砂经过火烧有毒，即使草乌的辛散、瞿麦和黄药子的苦降，都已经烧成灰，吹去不用，反而还需要它们相互济助，怎么可能呢？
搐鼻的各种方剂，《本事方》单独使用辛温药，李东垣、刘河间同时使用辛凉药。长期蓄积的风邪，多化为热，而闭郁的气机，非温不能通开，根据病情斟酌，从少或从多，这是贤能者的责任。
头痛饼子，有用五倍子、全蝎、土狗各七个，用醋调和做成饼的。有用天南星、川芎等分，同带须的葱白捣烂做成饼的。有用蓖麻子、乳香的。有用大黄、芒硝同井底泥捣碎贴敷的。然而外治的药物，无论邪气的寒热，都适宜用辛温药开通达理，单纯使用苦寒药，会使郁闭更加严重，除非热极，不可轻易使用。
头痛的原因，不止一端，有风、有寒、有湿、有热、有兼夹气机失调。兼夹气机失调的，如火与湿结合，《内经》所谓少阳司天之政，二之气时，热气郁结于上部，出现头痛、呕吐、昏愦等症状。有火胜水复的，《内经》所说岁金不及，炎火乃行，报复则阴气厥逆，且格阳反向上行，头脑户痛，延及脑顶，发热，就是这种情况。有胃实证的，经文说头痛耳鸣，九窍不利，是由肠胃产生的。有肾厥的，经文说头痛巅疾，下虚上实，病在足少阴、足太阳经，严重时入肾。有心热的，经文说心烦头痛，病在膈中，病在手太阳、手少阴经。有痰饮的，病在脾，李东垣所谓太阴痰厥，头痛眼黑，呕吐闷乱，也是湿胜的表现。有内风的，风从火化，病在肝，不仅是厥阴经脉与督脉上会于头顶，也就是肝脏冲逆之气，也能上至巅顶。又有真气不守，厥逆而上行，天门真痛，上引泥丸宫，名叫真头痛，大多不可治。古方说：给予黑锡丹，灸百会穴，猛进人参、附子、乌头、沉香，或许还有生机。然而如果天柱骨折断，也难以施力了。
The head, symbolizing heaven, is the convergence point for the clear yang qi of the six fu-organs and the essence blood of the five zang-organs. However, the pathogenic factors of the Six Excesses (Liu Yin) arising from heavenly weather, and the rebellious Qi of the Five Thieves (Wu Zei) resulting from human constitution, can all mutually harm each other. They either obscure and cover the clarity of the head, or cause stasis and blockage in the meridians, thereby clashing with the true Qi to produce pain. Headache caused by Wind is characterized by twitching and pulling pain, aversion to wind, sweating, and pain. Headache caused by Summer-heat and Heat may present with or without sweating, but always involves aversion to heat and pain. Headache caused by Dampness presents with pain and a heavy sensation in the head, worsening on cloudy days. Headache caused by Phlegm-Fluids also presents with dizziness, heaviness, and pain, accompanied by a sense of mental cloudiness and nausea. Headache caused by Cold involves aversion to cold and a deep, slow, and tight pulse. Headache due to Qi Deficiency worsens with exertion and presents with a large pulse. Headache due to Blood Deficiency is associated with palpitations and fright, presenting with a knotted (Kou) pulse.
Li Dongyuan generally treated headaches using Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Phellodendri Cortex (Huangbai) processed with wine, combined with wind-dispelling agents, such as Qingkong Gao (Clear Sky Paste), Anshen San (Calm Spirit Powder), and Qingshang Xiehuo Tang (Clear Upper and Drain Fire Decoction). However, he indiscriminately used herbs like Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Gaoben (Ligustici Rhizoma et Radix), and Manjingzi (Vittagiae Fructus), which lacked strict discipline. Students may learn from his intent. The Chatiao San (Tea-Powder Powder) from *Yuanyu* is concise and practical.
For chronic headache due to Head Wind, it is necessary to add small amounts of Chuanxiong Rhizome (Chuanxiong), Angelicae Sinensis Radix (Danggui), and Carthami Flos (Honghua). This is not only to treat wind but also to harmonize blood and relieve pain. Fine tea is best at clearing upper wind-heat; using it as a guiding herb for chronic pain is excellent. Li Dongyuan and Zhang Qianfu often used it.
Xu Shuci's Jingjie San uses solely Jingjie (Schizonepetae Spica) to treat wind and Shigao (Gypsum Fibrosum) to treat heat, which is extremely concise. Li Dongyuan's Qingkong Gao and other formulas seem to have derived their intent from this and expanded upon it.
Headache due to Wind-Phlegm is often accompanied by vomiting, regurgitation, and vertigo. If wind-dispelling drugs are used, the phlegm will rise further, and the pain will intensify. Yuhu Wan (Jade Pot Pill) from *Heji Jufang* is the specific remedy. Li Dongyuan transformed it into Baizhu Banxia Tianma Tang (Atractylodis Macrocephalae, Pinellia, and Gastrodia Decoction), which addresses Qi Deficiency as well.
Kidney-Jue Headache and Liver-Jue Headache are discussed in greatest detail in *Ben Shi Fang*.
Yuzhen Wan contains Sulfur and Pinelliae Rhizoma (Banxia), possessing great warming and descending power; Shigao (Gypsum Fibrosum) and Xiaoshi (Natrii Sulfas) possess strong cold-draining capabilities. When Yin Qi rebels upward, its onset is most sudden. Treating it with purely Yang drugs will likely cause rejection (Ge Ju); therefore, Shigao and Xiaoshi must serve as assistants to ensure mutual integration without conflict. Heixi Dan (Black Pellet Pill) also reflects this principle.
Rongzhu Dan has two formulas: one uses Cinnabar (Zhusha) and Deer Antler Glue (Lurong) made into pills, reflecting the idea of tonifying deficiency and anchoring floating Yang. The other uses Cinnabar (Zhusha) together with Aconiti Lateralis Radix Preparata (Caowu), Impatiens Herba (Qumai), and Dioscoreae Hypoglaucae Rhizoma (Huangyaozi) roasted in fire, taking only the Cinnabar powder to make pills. Not only is Cinnabar toxic when roasted, but even the acrid dispersing nature of Caowu and the bitter-descending nature of Qumai and Huangyaozi become ash after roasting and are blown away and unused. How can they still be expected to assist each other?
Various nasal insufflation formulas for headache use solely acrid-warm herbs in *Ben Shi Fang*, while Li Dongyuan and Liu Hejian use both acrid-cool herbs. Long-standing accumulated wind tends to transform into heat, whereas obstructed Qi requires warmth to unblock. One must weigh the condition and adjust the dosage accordingly; this is the responsibility of the wise practitioner.
Toubing Bingzi (Headache Cake) includes recipes using Wubeizi (Galla Chinensis), Quanxie (Scorpio), and Tougou (Gecko) mixed with vinegar; or Tiantanxing (Arisaematis Rhizoma) and Chuanxiong Rhizome (Chuanxiong) mixed with scallion white and pounded into a cake; or Ricini Semen (Bimazi) and Frankincense (Ruxiang); or Rhei Radix et Rhizoma (Dahuang) and Mirabilite (Mangxiao) mixed with mud from the bottom of a well for external application. However, for external treatments, regardless of whether the pathogen is cold or heat, acrid-warm herbs should be used to open and unblock. Using purely bitter-cold herbs will exacerbate obstruction. Unless the heat is extreme, they should not be used lightly.
The causes of headache are manifold: Wind, Cold, Dampness, Heat, and combined Qi disharmony. Combined Qi disharmony, such as Fire combining with Dampness, is described in *Neijing*: "When Shaoyang governs the year... during the second Qi, heat stagnates in the upper part, causing headache, vomiting, and mental confusion." There is also Fire excess leading to Water retaliation: "When Metal of the year is insufficient,炎火 (blazing fire) prevails; retaliation brings Yin rebellion, and Yang is repelled and rises upward, causing pain in the head and extending to the vertex, with fever." There is Stomach Excess: "Headache and tinnitus, dysfunction of the nine orifices, arise from the stomach and intestines." There is Kidney Jue: "Headache and cephalic diseases, with deficiency below and excess above, involve the Foot Shaoyin and Foot Taiyang meridians; severe cases enter the Kidney." There is Heart Heat: "Mental restlessness and headache, the disease is in the diaphragm, involving the Hand Taiyang and Hand Shaoyin meridians." There is Phlegm-Fluids: The disease is in the Spleen; Li Dongyuan calls it Taiyin Phlegm-Jue, with headache, blurred vision, vomiting, and confusion, also due to Dampness excess. There is Internal Wind: Wind transforms from Fire, the disease is in the Liver; not only do the Jueyin meridian and Du meridian converge at the vertex, but the rebellious Qi of the Liver itself can also ascend to the vertex. Furthermore, if True Qi fails to remain secure and rebels upward, causing severe pain in the Tianmen (forehead) radiating to the Ninwan (brain), it is called True Headache (Zhen Toutong), which is mostly incurable. Ancient formulas state: Administer Heixi Dan, moxa Baihui (GV20), and vigorously administer Ginseng Radix et Rhizoma (Renshen), Aconiti Lateralis Radix Preparata (Fuzi), Aconitum carmichaelii Debx. (Wutou), and Aquilariae Lignum Resinatum (Chenxiang); there may be a chance of survival. However, if the Tianzhu (neck/spine) collapses, little can be done.