景岳云∶头痛一证，暂痛者必因邪气，久痛者必因元气。但暂病者，有外感头痛，有火
邪头痛。久病者，有阴虚头痛，有阳虚头痛。然亦有暂病而虚者，久病而实者，又当因脉因
证而详察之，不可执也。或寒热，脉紧，清涕，咳嗽，脊背疼痛者，此寒邪在表而然，治宜
疏散，九味羌活汤及茶调散、清空膏主之。或内热脉洪，头脑振振，痛而兼胀者，此火邪在里
而然，治宜清降，玉女煎及一味大黄散主之。或因水亏而火动，蒸热脉弦，痛兼烦躁者，此
阴虚血虚而然，治宜补阴，以六味汤、左归饮，加肉苁蓉、细辛、川芎主之。或因遇阴则痛，遇
寒亦痛，倦怠脉微者，此阳虚气虚而然，治宜扶阳，以补中益气汤加蔓荆子、川芎、八味汤
、右归丸主之。或外感头痛，当察三阳厥阴。盖三阳之脉俱上头，厥阴之脉亦会巅，太阳在
后，阳明在前，少阳在侧，此又当有所主，亦外感所当辨也。但内伤头痛，则不得以三阳为
拘耳。至真头痛者，头痛甚，脑尽痛，手足寒至节，死不治，或灸百壮，吞黑锡丹，可救十中之一。
宜浮滑，忌短涩。
九味羌活汤（方见《时方》）
治太阳轻症。
葛根汤（方见《伤寒》）
治阳明。
小柴胡汤（方见《伤寒》）
治少阳。
麻黄附子细辛汤（方见《伤寒》）
治少阴。
当归四逆汤（方见《伤寒》）
治厥阴。
川芎茶调散（《局方》）
治久风化火，头痛及偏正头风。
川芎 白芷 羌活 防风 荆芥 薄荷 甘草（炙，各一两） 香附（童便浸，炒，二两）为末，
食后清茶调服二两，日三服，妇人产后，黑豆淋酒服，轻者三服，重者五七服效。一本无
香附，有细辛五钱。
清空膏
治头风湿热上盛，遇风即发。
羌活 黄芩（各一钱，酒炒） 甘草（炙，七分） 防风（一钱） 黄连（五分，酒炒） 柴胡（四分） 川
芎（三分）
水煎，入清茶一匙服。
玉液汤（《济生》）
治眉棱骨痛。
半夏（六钱，汤泡七次，切片，作一服） 生姜（十片）
水煎，去渣。纳沉香末少许服。
玉女煎（《景岳》）
治水亏火盛，六脉浮洪大，头痛，牙疼，失血等症。
生石膏（三五钱） 熟地（三五钱或一两） 麦冬（二钱） 知母 牛膝（各一钱五分）水煎服
玉真丸（《本事》）
治肾气不足，气逆上行，头痛不可忍，调之肾厥。其脉举之则弦，按之石坚。
硫黄（二两） 石膏（ ） 半夏（汤洗） 硝石（各一钱五分）
为末，生姜汁糊丸，如梧子大，阴干。每服二十丸。或姜汤或米饮下，更灸关元穴百壮。
补中益气汤（方见《时方》）
当归补血汤（方见《时方》）
治血虚头痛。
按∶加鹿茸三钱，沙参五钱，黄酒半杯煎，更效。
又方，只用当归二两，黄酒四杯，煎一杯半，分两服效。
加味左归饮（方见《时方》）
治肾虚头痛如神，此余乡前辈胡先生新定方也。
清震汤（《保命》）
治雷头风，头面疙瘩，憎寒拘急发热，状如伤寒。疙瘩宜刺出血。
升麻（二钱） 苍术（四钱） 荷叶（一个）
水煎，食后服。
头风摩散（方见《金匮》）
治大寒犯脑头痛。
止痛太阳丹（《奇效》）
天南星 川芎（等分）
为末，同莲须、葱白作饼，贴太阳痛处。
秘方贴头痛风热病大黄
朴硝（等分）
为末，用井底泥捏饼，贴两太阳穴。
气攻头痛方（《奇效》）
蓖麻子、乳香各等分，捣成饼，贴太阳穴。如痛止，急于顶上解开头发出气，即去药。
透顶散（《本事》）
治偏正头风，远年近日皆效。并治鼻塞，不闻香臭。
细辛（三茎） 瓜蒂（七枚） 丁香（七粒） 粳米（七粒，一作赤小豆） 龙脑（半分） 麝香（一分）
研末。置小口罐中，紧塞罐口，令患人口含清水，随左右，搐一豆大于鼻中，良久涎出，即安。不愈，三日后再搐。
按∶此本《金匮》纳药鼻中取黄涎之法。酒客多湿头重者宜之。
又法治偏正头风，以生莱菔捣汁，令患者仰卧，以汁灌鼻中。左痛灌右，右痛灌左，左右俱痛，俱灌之。
又头风有偏正之殊，其病皆在少阳阳明之络，以毫针刺痛处数穴，立效。
张石顽云∶外用法不若蒸法最效，方用川芎半两，晚蚕砂二两，僵蚕如患年岁之数。以
水五碗，煎至三碗，就砂锅中以浓纸糊满，中间开钱大一孔，取药气熏蒸痛处，每日一次。虽
年久者，三五次永不再发。
平时置新鲜木瓜于枕边，取香气透达，引散肝风，亦良法也。
张景岳说：头痛这一证候，暂时发作的疼痛必定是因为邪气，长久持续的疼痛必定是因为元气（正气）不足。但是，暂时患病的人，有外感引起的头痛，有火邪引起的头痛。长久患病的人，有阴虚引起的头痛，有阳虚引起的头痛。然而也有暂时患病却表现为虚证的，有长久患病却表现为实证的，这应当根据脉象和症状详细考察，不可固执己见。如果出现恶寒发热、脉象紧、流清鼻涕、咳嗽、脊背疼痛等症状，这是寒邪在体表所致，治疗宜疏散解表，以九味羌活汤及川芎茶调散、清空膏为主方。如果出现内热、脉象洪大、头脑震动、疼痛兼有胀感等症状，这是火邪在体内所致，治疗宜清热降火，以玉女煎及一味大黄散为主方。如果是因肾水亏虚导致虚火妄动，出现蒸蒸发热、脉象弦细、疼痛兼有烦躁等症状，这是阴虚血虚所致，治疗宜滋补阴液，以六味地黄丸、左归饮，加肉苁蓉、细辛、川芎为主方。如果是遇到阴天则痛，遇冷也痛，倦怠无力、脉象微弱，这是阳虚气虚所致，治疗宜扶持阳气，以补中益气汤加蔓荆子、川芎、八味丸、右归丸为主方。如果是外感引起的头痛，应当辨别三阳经与厥阴经。因为三阳经的经脉都上行至头部，厥阴经的经脉也会合于头顶，太阳经在后头，阳明经在前额，少阳经在两侧，这又应当有所侧重，这也是外感头痛所必须辨别的。但是内伤引起的头痛，就不必拘泥于三阳经了。至于真头痛，头痛非常剧烈，整个脑部都痛，手脚寒冷直到关节，属于死证无法救治，或者艾灸百壮，服用黑锡丹，或许能救活十分之一的人。
川芎茶调散（出自《太平惠民和剂局方》）
治疗久患风邪化火，以及偏头痛或正头痛的头风病。
药材：川芎、白芷、羌活、防风、荆芥、薄荷、甘草（炙，各一两）、香附（用童子小便浸泡，炒制，二两）。研为细末，饭后用清茶调服二钱，每日三次。妇女产后，用黑豆淋酒送服，轻者服三次，重者服五到七次见效。另一版本没有香附，有细辛五钱。
清空膏
治疗头风湿热上盛，遇风即发。
药材：羌活、黄芩（各一钱，酒炒）、甘草（炙，七分）、防风（一钱）、黄连（五分，酒炒）、柴胡（四分）、川芎（三分）。
用水煎煮，加入一匙清茶服用。
玉液汤（出自《济生方》）
治疗眉棱骨痛。
药材：半夏（六钱，开水泡七次，切片，作一次服用量）、生姜（十片）。
用水煎煮，去渣。加入少许沉香末服用。
玉女煎（出自《景岳全书》）
治疗肾水亏虚而火势旺盛，六脉浮洪大，头痛，牙疼，失血等症。
药材：生石膏（三到五钱）、熟地黄（三到五钱或一两）、麦冬（二钱）、知母、牛膝（各一钱五分）。
用水煎煮服用。
玉真丸（出自《本事方》）
治疗肾气不足，气逆上行，头痛剧烈难以忍受，调理肾厥。其脉象举之则弦，按之如石般坚硬。
药材：硫黄（二两）、石膏（缺具体剂量，原文留空）、半夏（开水洗）、硝石（各一钱五分）。
研为细末，用生姜汁调和做成药丸，如梧桐子大小，阴干。每次服用二十丸。或用姜汤或米饮送下，另外艾灸关元穴百壮。
补中益气汤（方剂见《时方》）
当归补血汤（方剂见《时方》）
治疗血虚引起的头痛。
按语：加入鹿茸三钱、沙参五钱、黄酒半杯煎煮，效果更好。
另一个方子，只用当归二两，黄酒四杯，煎取一杯半，分两次服用见效。
加味左归饮（方剂见《时方》）
治疗肾虚头痛效果如神，这是我家乡前辈胡先生新制定的方子。
清震汤（出自《保命集》）
治疗雷头风，头面起疙瘩，憎寒战栗、拘急发热，症状像伤寒。疙瘩宜刺破出血。
药材：升麻（二钱）、苍术（四钱）、荷叶（一个）。
用水煎煮，饭后服用。
止痛太阳丹（出自《奇效良方》）
药材：天南星、川芎（等分）。
研为细末，同莲须、葱白做成饼状，贴在太阳穴疼痛处。
秘方贴头痛风热病大黄
药材：朴硝（等分）。
研为细末，用井底泥捏成饼状，贴在两个太阳穴。
气攻头痛方（出自《奇效良方》）
药材：蓖麻子、乳香各等分，捣成饼状，贴在太阳穴。如果疼痛停止，急于在头顶解开头发以散发气机，随即去掉药物。
透顶散（出自《本事方》）
治疗偏头痛和正头痛，无论新旧皆有效。并治疗鼻塞，闻不到香味和臭味。
药材：细辛（三茎）、瓜蒂（七枚）、丁香（七粒）、粳米（七粒，一作赤小豆）、龙脑（半分）、麝香（一分）。
研为细末。放入小口罐中，紧紧塞住罐口，让病人含一口清水，根据疼痛部位左右，将药粉搐入鼻中约一粒豆子大小，良久后涎液流出，疼痛即安。如果不愈，三天后再搐。
按语：这原本是《金匮要略》中将药纳入鼻中取出黄涎的方法。嗜酒多湿、头重的人适宜使用。
另一种治疗方法治疗偏正头风，用新鲜莱菔（萝卜）捣汁，让患者仰卧，将汁液灌入鼻中。左边痛灌右边，右边痛灌左边，左右都痛，两边都灌。
另外头风有偏侧和正中之分，病位都在少阳经和阳明经的络脉，用毫针刺破疼痛处的几个穴位，立即见效。
张石顽说：外用方法不如熏蒸法最有效，方子用川芎半两，晚蚕砂二两，僵蚕的数量如同患者的年龄岁数。用水五碗，煎至三碗，就在砂锅中用厚纸糊满，中间开一个铜钱大一孔，取药气熏蒸疼痛处，每天一次。即使是多年的老病，三五次后永远不再复发。
平时在枕边放置新鲜木瓜，利用香气透达，引散肝风，也是好方法。
Zhang Jingyue stated: Regarding the syndrome of headache, acute pain is necessarily caused by pathogenic factors (Xieqi), while chronic pain is necessarily due to a deficiency of Yuanqi (Original Qi). However, among those with acute illness, there are headaches caused by external contraction and those caused by Fire pathogen. Among those with chronic illness, there are headaches caused by Yin deficiency and those caused by Yang deficiency. Nevertheless, there are cases of acute illness presenting as deficiency and chronic illness presenting as excess; these must be carefully examined based on pulse and symptoms, and one should not adhere rigidly to fixed rules. If there are aversion to cold and fever, tight pulse, clear nasal discharge, cough, and pain in the spine and back, this is due to Cold pathogen at the exterior; treatment should focus on dispersing and releasing, primarily using Jiuwei Qianghuo Tang (Nine-Ingredient Notopterygia Decoction) or Chuantiao San (Chuanxiong Tea Powder) and Qingkong Gao (Clearing the Vault Ointment). If there is internal heat, surging pulse, throbbing head, and pain accompanied by distension, this is due to Fire pathogen within; treatment should focus on clearing and descending, primarily using Yuniu Jian (Jade Woman Decoction) or Yiwei Dahuang San (Single-Ingredient Rhubarb Powder). If it is due to depletion of Kidney Water causing stirring of deficient fire, presenting with steaming heat, wiry pulse, and pain accompanied by irritability, this is due to Yin and Blood deficiency; treatment should focus on nourishing Yin, primarily using Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Zuogui Yin (Left Restoring Decoction), added with Rongrong (Cistanche), Xixin (Asarum), and Chuanxiong. If pain occurs when encountering yin days or cold, accompanied by fatigue and faint pulse, this is due to Yang and Qi deficiency; treatment should focus on supporting Yang, primarily using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Manjingzi (Vittex Seed), Chuanxiong, Bawei Wan (Eight-Ingredient Pill), and Yougui Wan (Right Restoring Pill). For headaches caused by external contraction, one must examine the Taiyang, Yangming, Shaoyang, and Jueyin meridians. The pulses of the three Yang meridians all ascend to the head, and the Jueyin meridian also converges at the vertex. Taiyang is at the back, Yangming at the front, and Shaoyang at the sides; this requires specific emphasis and is also what must be differentiated in external contraction. However, for headaches caused by internal injury, one should not be restricted to the three Yang meridians. As for Zhen Toutong (True Headache), the pain is severe, extending through the entire brain, with cold hands and feet reaching the joints; this is a death syndrome that cannot be treated. Alternatively, moxibustion of 100 cones or swallowing Heixi Dan (Black Tin Pill) might save one in ten.
The pulse should be floating and slippery; short and choppy pulses are contraindicated.
Jiuwei Qianghuo Tang (Formula seen in *Shifang*)
Treats mild syndromes of the Taiyang meridian.
Gegen Tang (Pueraria Decoction) (Formula seen in *Shanghan*)
Treats Yangming meridian syndromes.
Xiaochaihu Tang (Minor Bupleurum Decoction) (Formula seen in *Shanghan*)
Treats Shaoyang meridian syndromes.
Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) (Formula seen in *Shanghan*)
Treats Shaoyin meridian syndromes.
Danggui Sini Tang (Angelica Sinensis Decoction for Cold Extremities) (Formula seen in *Shanghan*)
Treats Jueyin meridian syndromes.
Chuanxiong Chatiao San (Chuanxiong Tea Powder) (*Ju Fang*)
Treats long-standing wind transforming into fire, as well as lateral and central headaches (Toufeng).
Ingredients: Chuanxiong, Baizhi, Qianghuo, Fangfeng, Jingjie, Bohe, Gancao (roasted, each 1 liang), Xiangfu (soaked in urine of a young boy, roasted, 2 liang). Grind into powder. Take 2 qian after meals mixed with clear tea, three times daily. For postpartum women, take with wine made from black beans. Mild cases resolve in three doses; severe cases in five to seven doses. Another version lacks Xiangfu but includes Xixin 5 qian.
Qingkong Gao (Clearing the Vault Ointment)
Treats upper excess of Wind-Damp-Heat in the head, triggered by wind.
Ingredients: Qianghuo, Huangqin (each 1 qian, fried with wine), Gancao (roasted, 7 fen), Fangfeng (1 qian), Huanglian (5 fen, fried with wine), Chaihu (4 fen), Chuanxiong (3 fen).
Decoct in water, add one spoonful of clear tea, and take.
Yuye Tang (Jade Liquid Decoction) (*Jisheng Fang*)
Treats pain in the supraorbital ridge.
Ingredients: Banxia (6 qian, soaked in boiling water seven times, sliced, for one dose), Shengjiang (10 slices).
Decoct in water, remove dregs. Add a small amount of Chenxiang powder and take.
Yuniu Jian (Jade Woman Decoction) (*Jingyue*)
Treats conditions of Kidney Water deficiency with excessive Fire, surging-large pulse at six positions, headache, toothache, and hemorrhage.
Ingredients: Sheng Shigao (3–5 qian), Shudi (3–5 qian or 1 liang), Maidong (2 qian), Zhimu, Niuxi (each 1.5 qian).
Decoct in water and take.
Yuzhen Wan (Jade True Pill) (*Benshi Fang*)
Treats insufficiency of Kidney Qi with rebellious Qi ascending, unbearable headache, regulating Ren Jue (Kidney Reversal). The pulse is wiry upon lifting and stone-hard upon pressing.
Ingredients: Liuhuang (2 liang), Shigao (dose missing in text), Banxia (washed in boiling water), Xiaoshi (each 1.5 qian).
Grind into powder, mix with ginger juice to form pills the size of wetapostle seeds, dry in shade. Take 20 pills per dose. Swallow with ginger soup or rice drink. Additionally, moxa Guanyuan point 100 cones.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (Formula seen in *Shifang*)
Danggui Buxue Tang (Angelica Sinensis Decoction for Tonifying Blood) (Formula seen in *Shifang*)
Treats headache due to Blood deficiency.
Note: Adding Lurong (Deer Antler) 3 qian, Shashen (Glehnia) 5 qian, and half cup of yellow wine during decoction yields better results.
Another prescription uses only Danggui 2 liang and four cups of yellow wine, decocted to one and a half cups, divided into two doses.
Jiawei Zuogui Yin (Modified Left Restoring Decoction) (Formula seen in *Shifang*)
Treats headache due to Kidney deficiency with miraculous effect. This is a new formula formulated by Mr. Hu, a senior scholar from my hometown.
Qingzhen Tang (Clearing and Shaking Decoction) (*Baoming Ji*)
Treats Leitoufeng (Thunderhead Wind), lumps on the head and face, aversion to cold, rigidity, fever resembling Shanghan. The lumps should be pricked to bleed.
Ingredients: Shengma (2 qian), Cangzhu (4 qian), Heye (Lotus Leaf, one piece).
Decoct in water, take after meals.
Toufeng Mo San (Headwind Rubbing Powder) (Formula seen in *Jingui*)
Treats headache caused by severe Cold invading the brain.
Zhitong Taiyang Dan (Pain-Relieving Taiyang Pill) (*Qixiao*)
Ingredients: Tiannanxing, Chuanxiong (equal parts).
Grind into powder, mix with Lianxu (Lotus Stamen) and Congbai (White Part of Scallion) to make cakes, apply to the painful Taiyang acupoint.
Secret Formula Paste for Headache, Wind-Heat, and Rhubarb
Ingredients: Puxiao (Mirabilite, equal parts).
Grind into powder, mix with mud from the bottom of a well to form cakes, apply to both Taiyang acupoints.
Qi Gong Tou Tong Fang (Formula for Qi-Attacking Headache) (*Qixiao*)
Ingredients: Bamazi (Castor Seed), Ruxiang (Frankincense) in equal parts. Pound into cakes, apply to the Taiyang acupoint. Once pain stops, urgently untie hair at the vertex to release Qi, then remove the medicine.
Touding San (Top-Penetrating Powder) (*Benshi Fang*)
Treats lateral and central headaches, effective for both old and recent cases. Also treats nasal congestion and loss of smell/taste.
Ingredients: Xixin (3 stems), Gudia (Melon Seeds, 7 pieces), Dingxiang (Cloves, 7 grains), Jingmi (Rice, 7 grains, alternatively Red Bean), Longnao (Borneol, 0.5 fen), Shexiang (Musk, 1 fen).
Grind into powder. Place in a narrow-mouthed jar, seal tightly. Have the patient hold clear water in their mouth. Depending on the side, insufflate a bean-sized amount into the nose. After a while, saliva will flow out, and relief will occur. If not cured, repeat after three days.
Note: This originates from the method in *Jingui* of inserting medicine into the nose to extract yellow phlegm. It is suitable for alcohol drinkers with dampness-induced heavy head.
Another method for treating lateral/central headaches: crush fresh Lufu (Radish) to extract juice. Have the patient lie supine and instill the juice into the nose. If left-sided pain, instill right nostril; if right-sided, instill left. If both sides hurt, instill both.
Additionally, although lateral and central headaches differ, the pathology lies in the collaterals of the Shaoyang and Yangming meridians. Pricking several points at the painful area with a filiform needle yields immediate results.
Zhang Shiwan said: External application methods are less effective than fumigation. The formula uses Chuanxiong 0.5 liang, Wancansha (Mulberry Silkworm Feces) 2 liang, and Jiangcan (Silkworm) quantity corresponding to the patient's age in years. Decoct five bowls of water down to three bowls. Cover a clay pot thickly with paper, leaving a coin-sized hole in the center. Use the medicinal vapor to fumigate the painful area once daily. Even for long-standing cases, recurrence will cease permanently after three to five treatments.
Placing fresh Mugua (Chaenomeles) by the pillow during daily life allows its aroma to penetrate, guiding and dispersing Liver Wind; this is also an excellent method.