反复发作性剧烈头痛呕吐40年。医诊血管性头痛。先以西药久治不效，后又以中药补气养血、和胃降逆、平肝潜阳、疏风散寒等剂，以及针灸、按摩、气功等亦无功。细询其证，结婚以后，性欲要求比较旺盛，但不久即发现每次性交之后，即感头胀隐痛，至30多岁时，每次性交之后，即头痛纳呆，甚至几天头痛的不能坚持工作，头痛停止后，又有性欲要求迫切的感觉，但一性交又头痛几天不能工作。至40岁左右时，性欲要求不如以前那样迫切，头痛也渐减少。但头痛的剧烈程度和时间却较前更加严重，每次同房发生快感时，即突然感到头顶灼热，迅即剧痛，恶心呕吐，滴水不入，接着连续头痛、呕吐，烦躁不安，难于入睡十几天。最近数年以来，以上症状持续的时间更加延长。近两年来，由于忙碌，经常出差不在，夫妇未曾同居，所以一直没有发生头痛。在两个多月前，由于工作已告一段落，而性交一次，在此次性交达于兴奋高潮时，突然感到头顶灼热，迅即转为头痛呕吐不止，立即请本单位医生救治，不效，又转至某院进行治疗。先以西药、支持疗法治疗一个多月不效，又请中医以川芎茶调散、二陈汤等加减治疗20多天仍不效。再邀余前往会诊治疗。察其除头顶灼痛，频繁的呕吐外，并见其烦躁不安，舌苔薄白，脉弦紧。综合脉证，思之：巅顶头痛者，肝也；弦紧之脉者寒也。合而论之，乃肝寒厥逆头痛之疾。治宜温肝降逆。处方：吴茱萸10克，人参10克，当归10克，白芍10克，生姜4片，大枣7个。
服药4剂后，头痛大减，呕吐停止，食欲增进，又服上药6剂，痛减八九，食欲，睡眠恢复正常。3个月后，又因再次性交，头痛又发，但较上次头痛明显为轻，且未发现呕吐，复与上方10剂服之，诸证不减。再察其证，除头痛、失眠之外，并见两脉尺弱寸盛而弦细。因思尺脉者，肾脉也，且见足冷，必肾阳亏损，厥气上逆所为耳。因拟温肾纳气。处方：沉香10克，补骨脂10克，骨碎补10克，硫黄1克，肉苁蓉15克，吴茱萸10克，当归10克。
服药10剂，头痛消失。继以上方为丸，每次3克，每日2次，服药3个月，果愈。
某医云：余亦曾用温胃降逆，然其不效者何也?答曰：本证之始确为肝胃之证俱见证，故以肝胃之方治之而取效，然其用温胃降逆何其反不效也?经络不同耳。喻嘉言云：不明脏腑经络，开口动手便错，意即此耳。仲景《金匮要略》云：“干呕，吐涎沫，头痛者，茱萸汤主之。”在《伤寒论》一书中列于厥阴篇，即指能治厥阴头痛也。然本病病程甚长，且肾气亦衰，故寒厥上逆而头痛，因此改用温肾降逆治之。
6．治病宗法，而不可泥方，此中医之大法也
邵××，女，48岁。
头痛头闷时或剧痛难忍3年多。医诊血管性头痛。先用西药治疗年余不效，继又以中药补气养血、活血通络、清肝泻火、虫药止痛，针灸、按摩等亦不功。细审其除头闷头痛，时见剧痛外，并见面色虚浮皓白，神疲乏力，白带增多，月经失调，舌苔薄白，脉濡缓。综合脉证，诊为脾虚湿盛，肝木失达，清阳失升。治拟健脾除湿，理肝升阳。处方：白术50克，山药50克，党参10克，白芍10克，车前子10克，苍术9克，甘草10克，陈皮10克，柴胡4克，荆芥4克。
某医云：此乃傅氏女科第一方完带汤也。完带汤乃治白带之方，何先生用其治头痛之证?答曰：傅青主《女科》云：“夫白带乃湿盛而火衰，肝郁而气弱，则脾土受伤，湿土之气下陷，是以脾精不守，不能化荣血以为经水，反变成白滑之物，由阴门直下，欲自禁而不可得也。治法宜大补脾胃之气，稍佐以疏肝之品，使风木不闭塞于地中，则地气自升腾于天上，脾气健而湿气消，自无白带之患矣。”完带汤者，“脾胃肝三经同治之法，寓补于散之中，寄消于升之内，升提肝木之气，则肝血不燥，何至下克脾土，补益脾土之元，则脾气不湿，何难分消水气，至于补脾而兼以补胃者，由里以及表也。脾非胃气之强，则脾之弱不能旺，是补胃正所以补脾耳。”本证虽非白带之病，而其病机亦与完带汤所治之证相同，故仍可以完带汤治之。此即所谓重法而不重方也。
眼药6剂，精神、食欲好转，头闷头痛消减六七。继服4剂，诸证不减。再审其脉虚弦而滑，舌苔薄白。因思脉虚者，气血俱虚也；弦滑者，痰热郁于肝胆也。治宜补气养血，理气化痰。处方：黄芪15克，当归6克，党参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克，生地10克。
服药10剂，诸证消失，后果愈。
某医云：完带汤、加减十味温胆汤两方均能除湿，然用完带汤不效，用加减十味温胆汤有效，其故何也?答曰：痰与湿虽属同类，然有其不同耳，故改用祛痰而取功耳。
7．久用气药，阴液因伤，不知变化，病必延宕
续××，男，12岁。
头阳白穴附近约指头大一片疼痛，痛则恶心呕吐，视物昏花6年多。医诊神经血管性头痛。先用西药治疗1年多无明显效果，继又配中药祛风散寒，活血止痛之剂治疗2年多亦不见好转。最近半个多月以来，又以针灸治之，其痛更甚，特别是近1周来，几乎每天都剧痛3～4次，每次少则几秒，多则3分钟，且见一痛即剧烈呕吐，视物昏花，疼痛一止即昏昏欲睡。细审其证，除头痛外，并时见心烦不安，舌苔白，脉弦紧。综合脉证，诊为肝郁气结，痰湿内蕴。治拟疏肝理气化痰。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草6克，生姜3片，大枣5个，桂枝10克，茯苓10克，熟军3克，龙骨15克，牡蛎15克。
服药6剂，头痛大减，由每日头痛3—4次，减为每周仅发2次，而且发作的时间亦明显减少，但继服至第10剂时疼痛不但不再继续减轻，而且反有加重之势，仅近2天即头痛发作3次。再审其证，舌苔薄白，舌尖稍红，脉弦小数。综合脉证，思之：此乃少年稚阴稚阳之躯，久久必然阴津亏损，风邪乘虚而入。治宜养阴益血，佐以散风止痛。处方：JII芎6克．防风4克，元参30克，当归10克，白芍12克。
服药10剂，头痛消失，继服10剂，果愈。
某医云：川芎、防风均止痛之品，今头痛甚剧，反以微量治之，吾甚不解也?答曰：本证阴血不足，若以大剂风药以耗血散血则病必剧，故只可以量少之风药内服，因恐其伤血也。
8．郁火当散，实火当泻，泻散不当，其病难瘳
钱××，女，58岁。
左侧头部、上牙、耳、颧、鼻孔疼痛15年多。医诊三叉神经痛、血管性头痛。先用西药与酒精封闭，曾经有一度有所减轻，但不久疼痛更加严重，后又配合针灸、散寒止痛之剂，亦是开始减轻，其后更剧，特别是近3个月来，疼痛一直持续不止。细审其证，疼痛如绞，上下牙不敢闭合咀嚼，亦不敢用鼻大吸气，心烦不安，食欲不振，大便干，口干舌燥，舌苔黄白，脉弦紧而数。综合脉证，思之：此乃肝胆相火内郁而外受风寒也。治宜拟清泻肝火，外散风寒。处方：防风10克，细辛3克，龙胆草10克，栀子10克，黄芩10克，柴胡10克，生地10克，车前子10克(布包)，泽泻10克，木通10克，甘草10克，当归10克。
服药1剂，疼痛大减，但当服至第7剂时疼痛不再继续改善。综合脉证，反复思考：此乃久病由气及血，当在散寒、泻火的同时，酌加养血泻火之品。处方：川芎15克，生石膏40克，元参60克，龙胆草10克，当归15克，细辛3克。服药6剂，其痛大减，继服50剂，愈。
9．元参养阴，善清浮火，量少力微，亦难奏效
吴××，女，成。左偏头痛十几年。医诊血管性头痛。始用西药稍有缓解，继续用药则无效果，后配中药祛风散寒、补气养血、益血安神，亦只开始有效，继而无功。细审其证，头痛头闷，时而钝痛，时如锥刺，时或吐泻，痛止后则嗜睡乏力数天，其后又见失眠心烦，胸满心悸，月经失调，舌苔薄白，脉弦细。综合脉证，思之：此肝郁血虚为本，肝火为标也。治宜疏肝养血泻火。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，生姜3片，薄荷3克，龙胆草10克，元参40克。
服药6剂，头痛头闷大减，继服30剂，愈。
某医云：本病余曾用丹栀逍遥散治之，然其不效者何也?答曰：本病脉弦细，治宜养血泻火，丹栀逍遥散者，养血泻火之方也，临证用之尚称合拍，然用之何故不效?此因肝阴不足，养阴不足所致也。又日：余亦曾加生地、元参以益阴，然用之亦不效，其故何也?答曰：阴虚火炎于上者，当滋阴降火，元参者，不但滋阴，且善清上焦浮游之火，尤宜用之，然用元参何故不效?药量不足所致也。今火浮于上当滋阴降火，而柴胡者，不但疏肝，且能升阳以助火邪之上浮，故需大剂元参以佐制之，否则难于凑效也。
10．气机郁滞，不予调气，反予止痛，寒气伤胃，其痛更剧
柳××，男，64岁。
持续性头痛，时轻时重30多年。医诊血管神经性头痛。胃脘满胀，隐隐作痛，频繁嗳气40多年。医诊慢性胃炎。胸痛心悸消瘦5年多。医诊冠状动脉硬化性心脏病、心房纤颤、糖尿病。医先用西药治此害彼，治彼害此，而病情日渐加重，后又请中医或治头而胃伤，或治胃而头痛加剧，或治心而诸证更甚。细审诸证，胃脘满胀，隐隐作痛，不断嗳气，按压之则痛胀更甚，头痛头胀，口苦口干，疲乏思睡．阳痿。腰困腰酸，目视昏花，舌苔白，脉沉弦缓。综合脉证，思之：此气阴两虚为本，脾湿不化，食滞中焦，肝木失达为标。治拟补气养阴，燥湿健脾，理气活血，消积导滞。处方：党参30克，麦冬10克，生地30克，苍术10克，白术10克，青皮10克。陈皮10克，三棱10克，莪术10克，薄荷4克，神曲12克。
服药6剂，头痛、胸满、脘腹胀痛，嗳气均大减，继服12剂，诸证大部消失。
某医云：本病证情极杂，诸方用之均无效果，且其止痛仅用蜈蚣即达干条，全蝎亦达10斤，然其微效俱不得见，今用此方未见一味止痛之药，然其效甚佳，其故何也?答曰：东垣《脾胃论》云：“《阴阳应象大论》云：谷气通于脾，六经为川，肠胃为海，九窍为水注之气。九窍者，五脏主之。五脏皆得胃气乃能通利。《通评虚实论》云：头痛耳鸣，九窍不利，肠胃之所生也，胃气一虚，耳目口鼻，俱为之病……谓人以胃土为本……胆者，少阳春升之气，春气升则万化安，故胆气春升则余脏从之。”今之以加味一贯煎治愈者，一者调脾胃也，二者调肝胆也，故一方而诸证俱愈。至于蜈蚣、全蝎者，一熄风也，二活络也，然其均无调肝脾之效，故用之无功也。
外伤性头痛
1．胶执瘀阻，不辨脉证，气滞活血，疗效不明
郜××，女，成。
头部被木棒击伤后3个多月来，一直头痛头晕，心烦失眠。医诊外伤性头痛。先用西药治疗1个多月不效，继用中药活血化瘀之剂近2个月仍无功。细审其证，除头痛头晕之外，并见心烦失眠，舌苔薄白，脉沉弦而涩。综合脉证，诊为气滞血瘀，治拟理气活血。处方：柴胡15克，赤芍10克，枳实10克，炮甲珠10克，桃仁10克，红花10克，熟军10克，甘草10克。
服药3剂，头痛稍减，继服15剂，头痛消失，愈。
某医云：为何余久用活血逐瘀而不效，而老师应用活血逐瘀之剂反效耶?答曰：外伤后头痛大部是与瘀血有关，因此多用活血逐瘀法进行治疗，但是本病脉沉弦而涩，不但有瘀血而且有气滞。气滞血瘀者，治当理气活血，而你的治法中恰恰缺少理气这一项，故而不愈。
2．泥于瘀血，频施逐瘀，虚证已具，反予攻邪，久久不愈
郝××，男，43岁。
车祸外伤昏迷经过抢救虽然已经恢复，但其后4个多月来，一直头晕头痛，失眠健忘，疲乏无力。为此先用西药治疗2个多月不见好转，继又用中药活血逐瘀之剂仍不见效。细审其证，除头晕头痛，失眠健忘，疲乏无力之外，并见舌苔薄白，脉虚大而弦。综合脉证，诊为气阴两虚证，拟用补气养阴之剂治之。处方：黄芪15克，白术10克，人参10克，当归10克，升麻10克，柴胡10克，陈皮10克，甘草10克，生地15克，山药10克，山茱萸10克，五昧子10克，茯苓10克，泽泻10克，丹皮10克。
服药3剂，头晕头痛，失眠健忘等证好转；继服30剂，愈。
某医云：脑震荡诸医均云瘀血所致，而本证反用活血不效，其故何也?答曰：瘀血者，脉见沉涩也，今脉反见虚大而弦，虚大而弦者，乃气阴俱虚之脉也。仲景在《伤寒论》中，当论及到误治坏证的治法时，曾谆谆告诫说：“观其脉证，知犯何逆，随证治之。”即知何逆，当首观脉，次观症，而不是首观症，后观脉。本证既属久治不效者，必有误治在中也，怎么辨证?怎么论治?宗脉可也。今脉既为虚大而弦，其证自当以气阴两虚为主，所以治以补阴益气煎以补气养阴也。
3．脑髓不足，气阴两虚者，当益气养阴，填精补髓
葛××，男，成。
反复发作性剧烈头痛伴呕吐40年。医生诊断为血管性头痛。先用西药长期治疗无效，后又用中药补气养血、和胃降逆、平肝潜阳（平息肝阳上亢）、疏风散寒等方剂，以及针灸、按摩、气功等方法，也都没有效果。详细询问病情后得知，结婚以后性欲比较旺盛，但不久发现每次性交之后，就会感到头部胀痛隐痛；到了30多岁时，每次性交之后，不仅头痛，还食欲不振，甚至头痛几天导致无法坚持工作；头痛停止后，又会有迫切的性欲要求，但一旦性交又会头痛几天不能工作。到40岁左右时，性欲要求不如以前迫切，头痛也逐渐减少。但是头痛的剧烈程度和时间却比以前更加严重，每次同房达到快感高潮时，突然感到头顶灼热，随即转为剧烈疼痛，恶心呕吐，滴水不进，接着连续头痛、呕吐，烦躁不安，难以入睡长达十几天。最近几年来，上述症状持续的时间更加延长。近两年来，由于工作忙碌经常出差，夫妇未曾同居，所以一直没有发生头痛。两个多月前，由于工作告一段落，进行一次性交，在此次性交达到兴奋高潮时，突然感到头顶灼热，随即转为头痛呕吐不止，立即请本单位医生救治，无效，又转至某医院进行治疗。先以西药和支持疗法治疗一个多月无效，又请中医用川芎茶调散（Chuanxiong Chatiao San, Cinnamon Twig and Ligusticum Decoction）和二陈汤（Erchen Tang, Two-Cured Decoction）等加减治疗20多天仍然无效。再邀请我前往会诊治疗。观察其除了头顶灼痛、频繁呕吐外，还见到烦躁不安，舌苔薄白，脉象弦紧（Wiry and tight pulse）。综合脉象和症状思考：巅顶头痛属于肝脏病变；弦紧之脉属于寒证。合起来分析，这是肝寒厥逆（Liver cold with counterflow of Jueyin Qi）引起的头痛疾病。治疗应当温肝降逆。处方：吴茱萸10克，人参10克，当归10克，白芍10克，生姜4片，大枣7个。
服药4剂后，头痛大幅减轻，呕吐停止，食欲增进，又服用上方6剂，疼痛减轻八九成，食欲和睡眠恢复正常。3个月后，又因再次性交，头痛复发，但比上次头痛明显为轻，且未发现呕吐，再次给予上方10剂服用，诸症未见减退。再观察其症状，除头痛、失眠之外，还见到两脉尺部弱、寸部盛而弦细。因此想到尺脉属于肾脉，且见足冷，必定是肾阳亏损，厥气上逆所致。于是拟定温肾纳气的方法。处方：沉香10克，补骨脂10克，骨碎补10克，硫黄1克，肉苁蓉15克，吴茱萸10克，当归10克。
服药10剂，头痛消失。继以上方制成丸药，每次3克，每日2次，服药3个月，果然痊愈。
某医生说：我也曾用温胃降逆法，为什么没有效果？回答说：本病开始时确实有肝胃同病的见证，所以用治肝胃的方剂取得了效果，然而为什么用温胃降逆反而无效呢？这是因为经络不同。喻嘉言说：不明脏腑经络，开口动手便错，意思就是如此。张仲景《金匮要略》说：“干呕，吐涎沫，头痛者，茱萸汤主之。”在《伤寒论》一书中列于厥阴篇，即指能治厥阴头痛。然而本病病程很长，且肾气也已衰退，所以是寒厥上逆而头痛，因此改用温肾降逆法治疗。
6．治病遵循法则，而不可拘泥于方剂，这是中医的大法。
邵××，女，48岁。
头痛头闷，有时剧痛难忍3年多。医生诊断为血管性头痛。先用西药治疗一年多无效，继而又用中药补气养血、活血通络、清肝泻火、虫药止痛，以及针灸、按摩等方法也没有效果。仔细审查其症状，除头闷头痛，时而剧痛外，还见面色虚浮皓白，神疲乏力，白带增多，月经失调，舌苔薄白，脉象濡缓（Soggy and slow pulse）。综合脉象和症状，诊断为脾虚湿盛（Spleen deficiency with dampness abundance），肝木失达（Liver wood failing to spread），清阳失升（Clear yang failing to ascend）。治疗拟健脾除湿，理肝升阳。处方：白术50克，山药50克，党参10克，白芍10克，车前子10克，苍术9克，甘草10克，陈皮10克，柴胡4克，荆芥4克。
某医生说：这是傅氏女科第一方完带汤（Wandai Tang, Complete Belt Decoction）啊。完带汤是治疗白带的方子，为什么先生用它来治疗头痛？回答说：傅青主《女科》说：“夫白带乃湿盛而火衰，肝郁而气弱，则脾土受伤，湿土之气下陷，是以脾精不守，不能化荣血以为经水，反变成白滑之物，由阴门直下，欲自禁而不可得也。治法宜大补脾胃之气，稍佐以疏肝之品，使风木不闭塞于地中，则地气自升腾于天上，脾气健而湿气消，自无白带之患矣。”完带汤是“脾胃肝三经同治之法，寓补于散之中，寄消于升之内，升提肝木之气，则肝血不燥，何至下克脾土，补益脾土之元，则脾气不湿，何难分消水气，至于补脾而兼以补胃者，由里以及表也。脾非胃气之强，则脾之弱不能旺，是补胃正所以补脾耳。”本证虽然不是白带病，但其病机与完带汤所治疗的病症相同，所以仍可以用完带汤治疗。这就是所谓重视法则而不重视方剂。
服用眼药（此处原文疑误，应为上方）6剂，精神、食欲好转，头闷头痛消减六七成。继服4剂，诸症未见减退。再审其脉虚弦而滑，舌苔薄白。因此想到脉虚是气血俱虚；弦滑是痰热郁于肝胆。治疗宜补气养血，理气化痰。处方：黄芪15克，当归6克，党参10克，麦冬10克，五味子10克，竹茹10克，枳实10克，半夏10克，陈皮10克，茯苓10克，甘草10克，菖蒲10克，远志10克，生地10克。
服药10剂，诸症消失，后果痊愈。
某医生说：完带汤、加减十味温胆汤（Jiajian Shiwei Wendan Tang, Modified Ten-Ingredient Gallbladder-Warming Decoction）两方均能除湿，然而用完带汤无效，用加减十味温胆汤有效，这是什么原因？回答说：痰与湿虽然属同类，但有不同之处，所以改用祛痰而取得功效。
7．久用气药，阴液因伤，不知变化，病必延宕
续××，男，12岁。
头阳白穴附近约指头大一片疼痛，痛则恶心呕吐，视物昏花6年多。医生诊断为神经血管性头痛。先用西药治疗1年多无明显效果，继又配中药祛风散寒，活血止痛之剂治疗2年多也不见好转。最近半个多月以来，又以针灸治疗，其痛更甚，特别是近1周来，几乎每天都剧痛3～4次，每次少则几秒，多则3分钟，且见一痛即剧烈呕吐，视物昏花，疼痛一止即昏昏欲睡。仔细审查其症状，除头痛外，还时见心烦不安，舌苔白，脉弦紧。综合脉象和症状，诊断为肝郁气结（Liver depression with qi stagnation），痰湿内蕴（Phlegm-dampness accumulating internally）。治疗拟疏肝理气化痰。处方：柴胡10克，半夏10克，黄芩10克，党参10克，甘草6克，生姜3片，大枣5个，桂枝10克，茯苓10克，熟军3克，龙骨15克，牡蛎15克。
服药6剂，头痛大幅减轻，由每日头痛3—4次，减为每周仅发2次，而且发作的时间亦明显减少，但继服至第10剂时疼痛不但不再继续减轻，而且反有加重之势，仅近2天即头痛发作3次。再审其症状，舌苔薄白，舌尖稍红，脉弦小数（Wiry, fine and rapid pulse）。综合脉象和症状思考：这是少年稚阴稚阳之躯，久久必然阴津亏损，风邪乘虚而入。治疗宜养阴益血，佐以散风止痛。处方：川芎6克，防风4克，元参30克，当归10克，白芍12克。
服药10剂，头痛消失，继服10剂，果然痊愈。
某医生说：川芎、防风均是止痛之品，如今头痛甚剧，反而用微量治疗，我很不理解？回答说：本证阴血不足，若以大剂风药耗血散血则病必加剧，所以只可以量少之风药内服，因为恐怕其伤血。
8．郁火当散，实火当泻，泻散不当，其病难瘳
钱××，女，58岁。
左侧头部、上牙、耳、颧、鼻孔疼痛15年多。医生诊断为三叉神经痛、血管性头痛。先用西药与酒精封闭，曾经有一度有所减轻，但不久疼痛更加严重，后又配合针灸、散寒止痛之剂，亦是开始减轻，其后更剧，特别是近3个月来，疼痛一直持续不止。仔细审查其症状，疼痛如绞，上下牙不敢闭合咀嚼，亦不敢用鼻大吸气，心烦不安，食欲不振，大便干，口干舌燥，舌苔黄白，脉弦紧而数（Wiry, tight and rapid pulse）。综合脉象和症状思考：这是肝胆相火内郁而外受风寒。治疗拟清泻肝火，外散风寒。处方：防风10克，细辛3克，龙胆草10克，栀子10克，黄芩10克，柴胡10克，生地10克，车前子10克(布包)，泽泻10克，木通10克，甘草10克，当归10克。
服药1剂，疼痛大减，但当服至第7剂时疼痛不再继续改善。综合脉象和症状，反复思考：这是久病由气及血，应当在散寒、泻火的同时，酌加养血泻火之品。处方：川芎15克，生石膏40克，元参60克，龙胆草10克，当归15克，细辛3克。服药6剂，其痛大减，继服50剂，痊愈。
吴××，女，成年。左偏头痛十几年。医生诊断为血管性头痛。始用西药稍有缓解，继续用药则无效果，后配中药祛风散寒、补气养血、益血安神，也只开始有效，继而无功。仔细审查其症状，头痛头闷，时而钝痛，时如锥刺，时或吐泻，痛止后则嗜睡乏力数天，其后又见失眠心烦，胸满心悸，月经失调，舌苔薄白，脉弦细。综合脉象和症状思考：此肝郁血虚为本，肝火为标。治疗宜疏肝养血泻火。处方：柴胡10克，当归10克，白芍10克，白术10克，茯苓10克，生姜3片，薄荷3克，龙胆草10克，元参40克。
某医生说：本病我曾用过丹栀逍遥散（Danzi Xiaoyao San, Moutan and Gardenia Bupleurum Powder）治疗，然而没有效果，为什么呢？回答说：本病脉弦细，治疗宜养血泻火，丹栀逍遥散是养血泻火的方子，临证使用尚称合拍，然而为何无效？这是因为肝阴不足，养阴力度不够所致。又说：我也曾加生地、元参以益阴，然而使用也无效，这是什么原因？回答说：阴虚火炎于上者，应当滋阴降火，元参不但滋阴，且善于清上焦浮游之火，尤其适宜使用，然而用元参为何无效？是因为药量不足所致。如今火浮于上，应当滋阴降火，而柴胡不但疏肝，且能升阳以助火邪之上浮，所以需要大剂元参以佐制之，否则难于凑效。
10．气机郁滞，不予调气，反予止痛，寒气伤胃，其痛更剧
柳××，男，64岁。
持续性头痛，时轻时重30多年。医生诊断为血管神经性头痛。胃脘满胀，隐隐作痛，频繁嗳气40多年。医生诊断为慢性胃炎。胸痛心悸消瘦5年多。医生诊断为冠状动脉硬化性心脏病、心房纤颤、糖尿病。医生先用西药治此害彼，治彼害此，而病情日渐加重，后又请中医或治头而胃伤，或治胃而头痛加剧，或治心而诸证更甚。仔细审查诸证，胃脘满胀，隐隐作痛，不断嗳气，按压之则痛胀更甚，头痛头胀，口苦口干，疲乏思睡，阳痿。腰困腰酸，目视昏花，舌苔白，脉沉弦缓。综合脉象和症状思考：此气阴两虚为本，脾湿不化，食滞中焦，肝木失达为标。治疗拟补气养阴，燥湿健脾，理气活血，消积导滞。处方：党参30克，麦冬10克，生地30克，苍术10克，白术10克，青皮10克，陈皮10克，三棱10克，莪术10克，薄荷4克，神曲12克。
服药6剂，头痛、胸满、脘腹胀痛，嗳气均大减，继服12剂，诸证大部消失。
某医生说：本病证情极杂，诸方用之均无效果，且其止痛仅用蜈蚣即达千条，全蝎亦达10斤，然而其微效俱不得见，今用此方未见一味止痛之药，然而其效甚佳，这是什么原因？回答说：李东垣《脾胃论》说：“《阴阳应象大论》云：谷气通于脾，六经为川，肠胃为海，九窍为水注之气。九窍者，五脏主之。五脏皆得胃气乃能通利。《通评虚实论》云：头痛耳鸣，九窍不利，肠胃之所生也，胃气一虚，耳目口鼻，俱为之病……谓人以胃土为本……胆者，少阳春升之气，春气升则万化安，故胆气春升则余脏从之。”如今以加味一贯煎（Jiawei Yiguan Jian, Modified One-Glance Decoction）治愈者，一是调脾胃也，二是调肝胆也，故一方而诸证俱愈。至于蜈蚣、全蝎，一是熄风，二是活络，然而它们均无调肝脾之效，所以用之无功。
1．胶执瘀阻，不辨脉证，气滞活血，疗效不明
郜××，女，成年。
头部被木棒击伤后3个多月来，一直头痛头晕，心烦失眠。医生诊断为外伤性头痛。先用西药治疗1个多月无效，继用中药活血化瘀之剂近2个月仍无功。仔细审查其症状，除头痛头晕之外，还见心烦失眠，舌苔薄白，脉沉弦而涩（Deep, wiry and choppy pulse）。综合脉象和症状，诊断为气滞血瘀（Qi stagnation and blood stasis），治疗拟理气活血。处方：柴胡15克，赤芍10克，枳实10克，炮甲珠10克，桃仁10克，红花10克，熟军10克，甘草10克。
某医生说：为什么我久用活血逐瘀而不效，而老师应用活血逐瘀之剂反而有效呢？回答说：外伤后头痛大部分是与瘀血有关，因此多用活血逐瘀法进行治疗，但是本病脉沉弦而涩，不但有瘀血而且有气滞。气滞血瘀者，治疗应当理气活血，而你的治法中恰恰缺少理气这一项，所以不愈。
2．泥于瘀血，频施逐瘀，虚证已具，反予攻邪，久久不愈
郝××，男，43岁。
车祸外伤昏迷经过抢救虽然已经恢复，但其后4个多月来，一直头晕头痛，失眠健忘，疲乏无力。为此先用西药治疗2个多月不见好转，继又用中药活血逐瘀之剂仍不见效。仔细审查其症状，除头晕头痛，失眠健忘，疲乏无力之外，还见舌苔薄白，脉虚大而弦（Deficient, large and wiry pulse）。综合脉象和症状，诊断为气阴两虚证，拟用补气养阴之剂治疗。处方：黄芪15克，白术10克，人参10克，当归10克，升麻10克，柴胡10克，陈皮10克，甘草10克，生地15克，山药10克，山茱萸10克，五味子10克，茯苓10克，泽泻10克，丹皮10克。
某医生说：脑震荡诸医均云瘀血所致，而本证反用活血不效，这是什么原因？回答说：瘀血者，脉见沉涩也，如今脉反见虚大而弦，虚大而弦者，乃是气阴俱虚之脉也。张仲景在《伤寒论》中，当论及到误治坏证的治法时，曾谆谆告诫说：“观其脉证，知犯何逆，随证治之。”即知何逆，应当首观脉，次观症，而不是首观症，后观脉。本证既属久治不效者，必有误治在中也，怎么辨证？怎么论治？宗脉可也。如今脉既为虚大而弦，其证自当以气阴两虚为主，所以治以补阴益气煎（Buyin Yiqi Jian, Yin-Nourishing and Qi-Replenishing Decoction）以补气养阴。
3．脑髓不足，气阴两虚者，当益气养阴，填精补髓
葛××，男，成年。
Recurrent severe headache accompanied by vomiting for 40 years. The physician diagnosed vasogenic headache. Initially treated with Western medicine for a long time without effect, subsequently treated with Chinese herbal formulas for tonifying Qi and nourishing Blood, harmonizing the Stomach and descending rebellious Qi, pacifying Liver Yang (calming hyperactive Liver Yang), dispersing Wind and scattering Cold, as well as acupuncture, massage, and Qigong, all without efficacy. Upon detailed inquiry, it was found that after marriage, sexual desire was relatively strong, but soon it was discovered that after each intercourse, a distending and dull pain in the head would occur; by the age of thirty-something, after each intercourse, not only headache but also poor appetite occurred, sometimes preventing work for several days due to headache; after the headache subsided, there would be an urgent feeling of sexual desire, but once intercourse occurred, headache would persist for several days making work impossible. By around age forty, sexual desire was not as urgent as before, and headaches gradually decreased. However, the severity and duration of the headaches became more serious than before. During coitus, upon reaching the peak of pleasure, a sudden burning sensation in the vertex of the head would occur, rapidly turning into severe pain, nausea, vomiting, inability to take even a drop of water, followed by continuous headache and vomiting, restlessness, and insomnia lasting for over ten days. In recent years, the duration of these symptoms has become longer. For the past two years, due to busy work and frequent business trips, the couple had not lived together, so no headaches occurred. More than two months ago, after work concluded, one instance of intercourse led to a sudden burning sensation in the vertex upon reaching the climax, immediately followed by incessant headache and vomiting. The unit doctor was consulted immediately but ineffective; transferred to a certain hospital for treatment. Treated with Western medicine and supportive therapy for over a month without effect, then consulted a Chinese medicine practitioner who prescribed modified Chuanxiong Chatiao San (Cinnamomi Ramulus et Ligustici Chuanxiong Pulvis) and Erchen Tang (Two-Cured Decoction) for over 20 days, still without effect. I was invited for consultation. Observation revealed vertex burning pain, frequent vomiting, restlessness, thin white tongue coating, and wiry-tight pulse. Synthesizing the pulse and symptoms: Vertex headache belongs to the Liver; wiry-tight pulse indicates Cold. Combined, this is a disease of Liver Cold with Jueyin Qi counterflow causing headache. Treatment should warm the Liver and descend rebellious Qi. Prescription: Evodiae Fructus 10g, Ginseng Radix 10g, Angelicae Sinensis Radix 10g, Paeoniae Radix Alba 10g, Zingiberis Rhizoma Recens 4 slices, Jujubae Fructus 7 pieces.
After taking 4 doses, headache significantly reduced, vomiting stopped, appetite improved. Taking the same prescription for another 6 doses, pain reduced by 80-90%, appetite and sleep returned to normal. Three months later, following another intercourse, headache recurred but was significantly milder than before, without vomiting. Prescribed the same formula for 10 doses, but symptoms did not subside. Re-examination showed headache, insomnia, weak Chi (Kidney) pulse positions, full and wiry-fine Cun (Lung) pulse positions. Thinking further: Chi pulse corresponds to the Kidney; coupled with cold feet, this must be due to Kidney Yang deficiency causing Jueyin Qi counterflow. Thus, the method of warming the Kidney and grasping Qi was adopted. Prescription: Aquilariae Lignum Resinatum 10g, Psoraleae Fructus 10g, Drynariae Rhizoma 10g, Sulfur 1g, Cynomorii Herba 15g, Evodiae Fructus 10g, Angelicae Sinensis Radix 10g.
After 10 doses, headache disappeared. Continued with the above formula made into pills, 3g per dose, twice daily. After 3 months of medication, it was indeed cured.
A certain doctor asked: I also used the method of warming the Stomach and descending rebellious Qi, why was it ineffective? Answer: The onset of this case indeed presented signs of both Liver and Stomach involvement, so treating Liver and Stomach yielded results. However, why did warming the Stomach and descending rebellious Qi fail? It is because the meridians differ. Yu Jiayan said: "Not understanding the Zang-Fu organs and meridians leads to errors from the outset," which implies this point. Zhang Zhongjing's *Jingui Yaolue* states: "For dry retching, spitting saliva, and headache, Zhuyu Tang is the primary treatment." Listed in the Jueyin chapter of *Shanghan Lun*, it refers to treating Jueyin headache. However, this disease has a long course and Kidney Qi is also declining, so it is Cold-Jue counterflow causing headache; thus, the method was changed to warming the Kidney and descending rebellious Qi.
6. Treating diseases should follow principles, not be rigidly attached to specific formulas; this is a major principle of Traditional Chinese Medicine.
Shao XX, Female, 48 years old.
Headache and head heaviness, occasionally unbearable severe pain for over 3 years. Diagnosed as vasogenic headache. Treated with Western medicine for over a year without effect, then with Chinese herbs for tonifying Qi and nourishing Blood, invigorating Blood and unblocking collaterals, clearing Liver fire and purging heat, using insect drugs for pain relief, as well as acupuncture and massage, all without success. Detailed examination revealed besides head heaviness and occasional severe pain, pale and puffy complexion, mental fatigue and weakness, increased leukorrhea, menstrual irregularities, thin white tongue coating, and soggy-slow pulse. Synthesizing pulse and symptoms, diagnosed as Spleen Deficiency with Dampness Abundance, Liver Wood failing to spread, Clear Yang failing to ascend. Treatment plan: Strengthen Spleen and eliminate dampness, regulate Liver and raise Yang. Prescription: Atractylodis Macrocephalae Rhizoma 50g, Dioscoreae Rhizoma 50g, Codonopsis Radix 10g, Paeoniae Radix Alba 10g, Plantaginis Semen 10g, Atractylodis Rhizoma 9g, Glycyrrhizae Radix et Rhizoma 10g, Citri Reticulatae Pericarpium 10g, Bupleuri Radix 4g, Schizonepetae Spica 4g.
A certain doctor asked: This is Fu Qingzhu's Gynecology First Formula Wandai Tang. Wandai Tang treats leukorrhea, why use it for headache? Answer: Fu Qingzhu's *Gynecology* states: "Leukorrhea is caused by excess dampness and deficient fire, Liver depression and weak Qi, damaging Spleen Earth. Damp-Earth Qi sinks, causing Spleen Essence to fail to guard, unable to transform into nutritious Blood for menstruation, instead turning into white slippery substance flowing down from the vagina... Treatment should greatly tonify Spleen and Stomach Qi, slightly assist with Liver-soothing agents, so that Wind-Wood does not block in the earth, allowing Earth Qi to rise to heaven. When Spleen Qi is strong and dampness eliminated, leukorrhea will cease." Wandai Tang is a method treating Spleen, Stomach, and Liver meridians simultaneously, embedding tonification within dispersion, and elimination within ascending. Ascending Liver Wood Qi prevents Liver Blood from drying and attacking Spleen Earth; tonifying Spleen Earth Yuan prevents Spleen Qi from being damp. As for tonifying Spleen while also tonifying Stomach, it is extending from interior to exterior. Without strong Stomach Qi, weak Spleen cannot flourish; thus tonifying Stomach is indeed tonifying Spleen. Although this case is not leukorrhea, its pathogenesis is identical to what Wandai Tang treats, so it can still be treated with Wandai Tang. This is what is meant by valuing principles over formulas.
After 6 doses, spirit and appetite improved, head heaviness and pain reduced by 60-70%. Continuing for 4 more doses, symptoms did not subside. Re-examining pulse: deficient-wiry and slippery; tongue coating thin white. Thinking further: Deficient pulse indicates both Qi and Blood deficiency; wiry-slippery indicates Phlegm-Heat郁 (stagnating) in Liver and Gallbladder. Treatment should tonify Qi and nourish Blood, regulate Qi and resolve Phlegm. Prescription: Astragali Radix 15g, Angelicae Sinensis Radix 6g, Codonopsis Radix 10g, Ophiopogonis Radix 10g, Schisandrae Fructus 10g, Bambusae Caulis in Taeniam 10g, Aurantii Fructus Immaturus 10g, Pinelliae Rhizoma Preparatum 10g, Citri Reticulatae Pericarpium 10g, Poria 10g, Glycyrrhizae Radix et Rhizoma 10g, Acori Tatarinowii Rhizoma 10g, Polygalae Radix 10g, Rehmanniae Radix Preparata 10g.
After 10 doses, all symptoms disappeared, eventually cured.
A certain doctor asked: Both Wandai Tang and Modified Shiwei Wendan Tang can eliminate dampness, yet Wandai Tang failed while Modified Shiwei Wendan Tang succeeded. Why? Answer: Phlegm and Dampness are similar but different; thus changing to resolving Phlegm achieved success.
7. Long-term use of Qi-moving drugs damages Yin fluids; failure to adapt leads to prolonged illness.
Xu XX, Male, 12 years old.
Pain in a finger-tip-sized area near the Yangbai acupoint on the head, with nausea and vomiting upon pain, blurred vision for over 6 years. Diagnosed as neurovascular headache. Treated with Western medicine for over a year with no obvious effect, then with Chinese herbs for dispersing Wind and scattering Cold, invigorating Blood and relieving pain for over 2 years without improvement. For the past half-month, treated with acupuncture, pain worsened. Especially in the last week, severe pain occurred 3-4 times daily, lasting seconds to 3 minutes, accompanied by severe vomiting and blurred vision upon onset, and drowsiness upon cessation. Detailed examination revealed besides headache, occasional restlessness, white tongue coating, and wiry-tight pulse. Synthesizing pulse and symptoms, diagnosed as Liver Depression with Qi Stagnation, internal accumulation of Phlegm-Dampness. Treatment plan: Soothe Liver, regulate Qi, and resolve Phlegm. Prescription: Bupleuri Radix 10g, Pinelliae Rhizoma Preparatum 10g, Scutellariae Radix 10g, Codonopsis Radix 10g, Glycyrrhizae Radix et Rhizoma 6g, Zingiberis Rhizoma Recens 3 slices, Jujubae Fructus 5 pieces, Cinnamomi Ramulus 10g, Poria 10g, Prepared Rheum Palmatum Radix et Rhizoma 3g, Dragon Bone 15g, Oyster Shell 15g.
After 6 doses, headache significantly reduced, frequency dropped from 3-4 times daily to 2 times weekly, duration shortened. However, continuing to the 10th dose, pain did not continue to decrease but worsened, occurring 3 times in the last 2 days. Re-examining symptoms: thin white tongue coating, slightly red tongue tip, wiry-fine-rapid pulse. Synthesizing pulse and symptoms: This is a young body with immature Yin and Yang; long-term usage inevitably depletes Yin fluids, allowing Wind Pathogen to enter via deficiency. Treatment should nourish Yin and benefit Blood, assisted by dispersing Wind and relieving pain. Prescription: Ligustici Chuanxiong Rhizoma 6g, Saposhnikoviae Radix 4g, Scrophulariae Radix 30g, Angelicae Sinensis Radix 10g, Paeoniae Radix Alba 12g.
After 10 doses, headache disappeared; continuing for another 10 doses, indeed cured.
A certain doctor asked: Chuanxiong and Fangfeng are pain-relieving herbs. Given the severe headache, why use such small doses? I do not understand. Answer: This case has insufficient Yin and Blood. Using large doses of Wind-dispersing drugs would consume and scatter Blood, worsening the disease. Therefore, only small doses of Wind drugs can be taken internally to avoid damaging Blood.
8. Depressed Fire should be dispersed, Excess Fire should be purged; improper purging or dispersal makes cure difficult.
Qian XX, Female, 58 years old.
Pain in left side of head, upper teeth, ear, cheekbone, nostril for over 15 years. Diagnosed as trigeminal neuralgia, vasogenic headache. Initially treated with Western medicine and alcohol block, temporarily relieved, but pain soon worsened. Later combined with acupuncture and Cold-scattering pain-relieving herbs, initially relieved but subsequently worse. Especially in the last 3 months, pain persisted continuously. Detailed examination revealed pain like twisting, unwillingness to close teeth for chewing or inhale deeply through nose, restlessness, poor appetite, dry stool, dry mouth and throat, yellow-white tongue coating, wiry-tight-rapid pulse. Synthesizing pulse and symptoms: This is Internal Depression of Ministerial Fire of Liver and Gallbladder combined with external Wind-Cold. Treatment plan: Clear and purge Liver Fire, externally disperse Wind-Cold. Prescription: Saposhnikoviae Radix 10g, Asari Radix et Rhizoma 3g, Gentianae Radix 10g, Gardeniae Fructus 10g, Scutellariae Radix 10g, Bupleuri Radix 10g, Rehmanniae Radix Preparata 10g, Plantaginis Semen 10g (wrapped), Alismatis Rhizoma 10g, Akebiae Caulis 10g, Glycyrrhizae Radix et Rhizoma 10g, Angelicae Sinensis Radix 10g.
After 1 dose, pain significantly reduced. By the 7th dose, pain no longer improved. Synthesizing pulse and symptoms, reflecting repeatedly: Long-standing disease moves from Qi to Blood; while dispersing Cold and purging Fire, Blood-nourishing and Fire-purging agents should be added. Prescription: Ligustici Chuanxiong Rhizoma 15g, Gypsum Fibrosum 40g, Scrophulariae Radix 60g, Gentianae Radix 10g, Angelicae Sinensis Radix 15g, Asari Radix et Rhizoma 3g. After 6 doses, pain significantly reduced; continuing for 50 doses, cured.
9. Xuanshen nourishes Yin and clears floating Fire well; if dose is too small, efficacy is weak.
Wu XX, Female, Adult. Left-sided migraine for over 10 years. Diagnosed as vasogenic headache. Initially Western medicine provided slight relief, continued use ineffective. Later Chinese herbs for dispersing Wind and scattering Cold, tonifying Qi and nourishing Blood, benefiting Blood and calming Spirit were effective only initially, then ineffective. Detailed examination revealed headache and head heaviness, dull pain at times, stabbing pain at others, occasional vomiting and diarrhea, lethargy and weakness for days after pain stops, followed by insomnia and irritability, chest fullness, palpitations, menstrual irregularities, thin white tongue coating, wiry-fine pulse. Synthesizing pulse and symptoms: Liver Depression and Blood Deficiency as root, Liver Fire as branch. Treatment plan: Soothe Liver, nourish Blood, and purge Fire. Prescription: Bupleuri Radix 10g, Angelicae Sinensis Radix 10g, Paeoniae Radix Alba 10g, Atractylodis Macrocephalae Rhizoma 10g, Poria 10g, Zingiberis Rhizoma Recens 3 slices, Menthae Haplocalycis Herba 3g, Gentianae Radix 10g, Scrophulariae Radix 40g.
After 6 doses, headache and head heaviness significantly reduced; continuing for 30 doses, cured.
A certain doctor asked: I used Danzhi Xiaoyao San for this disease, but it was ineffective. Why? Answer: The pulse is wiry-fine, requiring Blood-nourishing and Fire-purging. Danzhi Xiaoyao San is a Blood-nourishing and Fire-purging formula, clinically appropriate. Yet why ineffective? Because Liver Yin is insufficient, and the Yin-nourishing power was inadequate. Furthermore, I added Shengdi and Xuanshen to benefit Yin, but it was still ineffective. Why? Answer: For Yin Deficiency with Fire flaming upward, one must nourish Yin and descend Fire. Xuanshen not only nourishes Yin but excels at clearing floating Fire in the Upper Jiao, making it highly suitable. Yet why ineffective with Xuanshen? Insufficient dosage. Now Fire floats upward, requiring Yin-nourishing and Fire-descending. Chaihu not only soothes Liver but raises Yang, assisting the upward float of Fire Pathogen. Therefore, a large dose of Xuanshen is needed to counteract it, otherwise efficacy is hard to achieve.
10. Qi mechanism stagnation, failing to regulate Qi but instead using pain relief, Cold damages Stomach, pain worsens.
Liu XX, Male, 64 years old.
Continuous headache, varying severity for over 30 years. Diagnosed as vascular-neurogenic headache. Epigastric fullness, dull pain, frequent belching for over 40 years. Diagnosed as chronic gastritis. Chest pain, palpitations, emaciation for over 5 years. Diagnosed as coronary atherosclerotic heart disease, atrial fibrillation, diabetes. Western medicine treatment harmed one system while treating another, condition worsening. Chinese medicine treatment either injured Stomach while treating Head, or worsened Headache while treating Stomach, or aggravated all symptoms while treating Heart. Detailed examination revealed epigastric fullness, dull pain, constant belching, pain/worsening upon pressure, headache/head distension, bitter taste, dry mouth, fatigue, somnolence, impotence. Lower back soreness and ache, blurred vision, white tongue coating, deep-wiry-slow pulse. Synthesizing pulse and symptoms: Qi and Yin Dual Deficiency as root, Spleen Dampness failing to transform, Food Stagnation in Middle Jiao, Liver Wood failing to spread as branch. Treatment plan: Tonify Qi and nourish Yin, dry Dampness and strengthen Spleen, regulate Qi and invigorate Blood, eliminate accumulation and guide out stagnation. Prescription: Codonopsis Radix 30g, Ophiopogonis Radix 10g, Rehmanniae Radix Preparata 30g, Atractylodis Rhizoma 10g, Atractylodis Macrocephalae Rhizoma 10g, Citri Reticulatae Pericarpium Viride 10g, Citri Reticulatae Pericarpium 10g, Samadi 10g, Curcumae Rhizoma 10g, Menthae Haplocalycis Herba 4g, Massae Fermentatae Medicinatae 12g.
After 6 doses, headache, chest fullness, epigastric abdominal distension/pain, belching significantly reduced. Continuing for 12 doses, most symptoms disappeared.
A certain doctor asked: This case is extremely complex, all previous formulas failed. Pain relief used thousands of centipedes and 10 jin of scorpions, yet no slight effect was seen. Now this formula contains no single pain-relieving herb, yet efficacy is excellent. Why? Answer: Li Dongyuan's *Pi Wei Lun* states: "*Yin Yang Ying Xiang Da Lun* says: Grain Qi connects to Spleen, Six Meridians are rivers, Intestines and Stomach are seas, Nine Orifices are where Water Qi pours. Nine Orifices are governed by Five Zang. All Five Zang need Stomach Qi to function smoothly. *Tong Ping Xu Shi Lun* says: Headache, tinnitus, obstruction of Nine Orifices arise from Intestines and Stomach. Once Stomach Qi is deficient, ears, eyes, mouth, nose all suffer... Man is based on Stomach Earth... Gallbladder is Shaoyang Spring-Rising Qi. When Spring Qi rises, all transformations are peaceful. Thus when Gallbladder Qi rises in Spring, other Zang follow." Cured here by Jiawei Yiguan Jian: first regulating Spleen and Stomach, second regulating Liver and Gallbladder. Hence one formula cures all symptoms. As for centipede and scorpion: one extinguishes Wind, the other unblocks collaterals, but neither regulates Liver and Spleen, hence ineffective.
Traumatic Headache
1. Stubborn Blood Stasis, failing to differentiate pulse and symptoms, moving Qi and invigorating Blood yields unclear efficacy.
Gao XX, Female, Adult.
Over 3 months since head struck by wooden stick, continuous headache, dizziness, restlessness, insomnia. Diagnosed as traumatic headache. Treated with Western medicine for over a month ineffective, then Chinese herbs for invigorating Blood and resolving stasis for nearly 2 months still ineffective. Detailed examination revealed besides headache and dizziness, restlessness, insomnia, thin white tongue coating, deep-wiry-choppy pulse. Synthesizing pulse and symptoms, diagnosed as Qi Stagnation and Blood Stasis. Treatment plan: Regulate Qi and invigorate Blood. Prescription: Bupleuri Radix 15g, Paeoniae Radix Rubra 10g, Aurantii Fructus Immaturus 10g, Prepared Pangolin Scale 10g, Persicae Semen 10g, Carthami Flos 10g, Prepared Rheum Palmatum Radix et Rhizoma 10g, Glycyrrhizae Radix et Rhizoma 10g.
After 3 doses, headache slightly reduced. Continuing for 15 doses, headache disappeared, cured.
A certain doctor asked: Why did my long-term use of Blood-invigorating and Stasis-resolving methods fail, while the teacher's application of such agents succeeded? Answer: Post-traumatic headache is mostly related to Blood Stasis, so Blood-invigorating and Stasis-resolving methods are commonly used. However, this case's pulse is deep-wiry-choppy, indicating not only Blood Stasis but also Qi Stagnation. For Qi Stagnation and Blood Stasis, treatment must regulate Qi and invigorate Blood. Your method lacked the Qi-regulating component, hence failure.
2. Clinging to Blood Stasis, frequently applying Stasis-resolving, Deficiency patterns present, attacking Evil instead, prolonged non-healing.
Hao XX, Male, 43 years old.
Recovered from coma after car accident trauma, but for over 4 months thereafter, continuous dizziness, headache, insomnia, forgetfulness, fatigue. Treated with Western medicine for over 2 months no improvement, then Chinese herbs for invigorating Blood and resolving stasis still ineffective. Detailed examination revealed besides dizziness, headache, insomnia, forgetfulness, fatigue, thin white tongue coating, deficient-large-wiry pulse. Synthesizing pulse and symptoms, diagnosed as Qi and Yin Dual Deficiency. Treatment plan: Tonify Qi and nourish Yin. Prescription: Astragali Radix 15g, Atractylodis Macrocephalae Rhizoma 10g, Ginseng Radix 10g, Angelicae Sinensis Radix 10g, Cimicifugae Rhizoma 10g, Bupleuri Radix 10g, Citri Reticulatae Pericarpium 10g, Glycyrrhizae Radix et Rhizoma 10g, Rehmanniae Radix Preparata 15g, Dioscoreae Rhizoma 10g, Corni Fructus 10g, Schisandrae Fructus 10g, Poria 10g, Alismatis Rhizoma 10g, Moutan Cortex 10g.
After 3 doses, dizziness, headache, insomnia, forgetfulness improved. Continuing for 30 doses, cured.
A certain doctor asked: Physicians all say concussion is caused by Blood Stasis, yet this case fails with Blood-invigorating methods. Why? Answer: Blood Stasis presents with deep-choppy pulse. Here pulse is deficient-large-wiry, which indicates Qi and Yin dual deficiency. Zhang Zhongjing in *Shanghan Lun*, discussing treatment of mishandled adverse conditions, earnestly warned: "Observe their pulse and symptoms, know what deviation occurred, treat according to the syndrome." Knowing the deviation, one must first observe pulse, then symptoms, not vice versa. Since this case has been refractory to long-term treatment, there must have been mishandling. How to differentiate? How to treat? Follow the pulse. Since pulse is deficient-large-wiry, the syndrome is primarily Qi and Yin Dual Deficiency, hence treated with Buyin Yiqi Decoction to tonify Qi and nourish Yin.
3. Brain Marrow insufficiency, Qi and Yin Dual Deficiency, should tonify Qi and nourish Yin, fill essence and supplement marrow.
Ge XX, Male, Adult.