头痛逍遥（散）芎芷良，血虚（当归）补血（汤）入茸尝（血虚头痛，诸药不效者，用当归补血汤加鹿
茸治之，以鹿茸生于头为同气也。）肾经亏损左归饮，真痛吴萸（汤）挽绝阳（可救十中之一、二。
（此证百药不效者，时医只守方书相沿之说，及时下常用之方，必不能救此大病。今录高
士宗石破天惊之说，壮同志之胆，而为破釜沉舟之计。
头痛之证有三∶一，太阳头痛；一，少阳头痛；一，厥阴头痛。太阳之脉，上额交巅络
脑，而太阳之上，寒气主之，太阳头痛，寒痛也。少阳之脉，上抵头角，而少阳之上，相火
主之，少阳头痛，火痛也。厥阴之脉，上出额与督脉会于巅，而厥阴之上，风气主之，厥阴
头痛，风痛也。头痛虽有寒、火、风三者之异，尤当观其微剧，察其阴阳。身有他病而兼头
痛，痛之微者也。独患头痛，其痛欲死，痛之剧者也。凡阴血虚而阳热盛，则痛微；若阳气
虚而阴寒盛，则痛剧。风火头痛，有余则清散之，不足则滋补之。阴寒头痛乃阴盛阳虚，所
谓阳虚头痛者是也，非桂附参 不能治之。世遇头痛之证，便谓外受风寒，即与发散。发散
不愈，渐加寒凉，非芎、防、荆、羌即芩、连、栀、膏，风火头痛而遇此不致伤身，若阳虚
头痛而遇，必致此殒命矣。可不慎哉!
世有三阴无头痛之说，岂知阳虚头痛，纯属阴寒，阳几绝灭，病此者十无一生。所以然
者，一如日不丽天，下沉于海，万方崩陷也。盖人与天地相合，天有日，人亦有日，君火之
阳日也，地有四海，人亦有四海，头为髓海，胸为气海，胃为谷海，胞中为血海。在天之日
，昼行于天，夜行于海，在人之日，既行于天，亦行于海。自头项至尾闾，如日之行乎天也
，自血海至髓海，如日之行于海也。今阳虚头痛，乃阴寒蔽日，逆于髓海，不能上巅至项，
以行于背，反从阳入阴，以行于腹，是以头痛不已则心烦，心烦者，阳光逆于气海也。心烦
不已则呕吐，呕吐者，阳光逆于谷海也，呕吐不已则神昏，神昏者，阳光逆于血海也。头痛
至神昏，则入阴之尽，如日沉海底矣。此症治之得法，百中仅能救其二、三，而浅学之医，
妄投汤药，至治之不效。有云肝风入脑者，有云客气犯脑者，有云真头痛者，其言如是，而
散风散寒之药，终以不免。岂知散之之法。非所以治之，适所以害之旨哉。《灵柩·四海论
》云∶“得顺者生，得逆者败，知调者利，不知调者害。”其即日逆于海之头痛，而医者倒
行逆施，不善治而致死之谓欤。
愚按∶高士宗此论，发前人所未发，但恨有论无方，所云“非桂附参 不能治之”。肤
浅之语，不足尚也。余拟白通汤，倍加附子为的剂。盖阳气起于下焦，妙在重用附子之辛热
，在下以启之，干姜从中以接之，葱白自上以通之，可以救十中之一。
眩晕者，眩冒而旋转不定也。《至要大论》曰∶“诸风掉眩，皆属于肝。”此言实证
也，宜以二陈汤加防风、玉竹、川芎、天麻、白术、钩藤主之。属痰饮者，倍半夏，再倍加泽
泻。火盛者加黄芩、元参。《卫气篇》曰∶“上虚则眩。”此言虚证也，宜加参、 ，虚甚
者加附子。《海论》曰∶“髓海不足，则脑转耳鸣，胫酸眩冒，目无所见，懈怠安卧。”此
言病在上，而根起于下，宜加肉苁蓉、附子、巴戟天。如大虚诸药不效者，宜鹿茸一两，酒
煎，入麝香一厘服之，此即《经脉篇》所谓∶“督脉实则脊强，虚则头重高摇之之义也。”此
外，又有火亢眩晕不可当者，大黄酒炒三遍，研末，茶清调下。此证与头痛，不专为表病，
以头为诸阳之会，阳主外，故列于表证。
（经解）《脉要精微论》曰∶“浮而散者为 仆。”盖 与瞬同。项藉传云∶“ 目
视之。
”谓目动使之也。仰面曰僵，覆面曰仆，即风虚眩晕卒倒是也。《口开篇》曰∶上气不足，
脑为之不满，耳为之苦鸣，头为之苦倾，目为之眩。”《经脉篇》曰∶“五阴气俱绝，则目
系转，转则目运，目运者，为志先死，志先死，则远一日半死矣。”
头痛逍遥散配合川芎、白芷疗效良好；对于血虚引起的头痛，若常规药物无效，可使用当归补血汤加入鹿茸治疗（因为鹿茸生于头部，与人体头部同气相求）。肾经亏损导致的头痛用左归饮；若是剧烈疼痛且阳气将绝，可用吴茱萸汤挽回（此法仅能挽救十分之一二的患者。
（这种病症各种药物都无效时，当时的医生只拘泥于医书沿袭的说法和时下常用的方剂，必定不能救治这种大病。现在记录高士宗石破天惊的见解，以壮同行之胆，作为破釜沉舟的治疗策略。
头痛的证候有三种：一是太阳头痛；二是少阳头痛；三是厥阴头痛。太阳经脉，上行至额部，交会于巅顶，联络脑部，而太阳之上由寒气主令，所以太阳头痛是寒痛。少阳经脉，上行抵住头角，而少阳之上由相火主令，所以少阳头痛是火痛。厥阴经脉，上行出于额部，与督脉会合于巅顶，而厥阴之上由风气主令，所以厥阴头痛是风痛。头痛虽然分为寒、火、风三种不同情况，但更应当观察其轻重，辨别其阴阳。身体有其他疾病兼见头痛，这是疼痛轻微的。单独患头痛，疼痛欲死，这是疼痛剧烈的。凡是阴血虚而阳热盛，则疼痛轻微；如果阳气虚而阴寒盛，则疼痛剧烈。风火头痛，属于有余之证则用清散法，属于不足之证则用滋补法。阴寒头痛乃是阴盛阳虚，也就是所谓的阳虚头痛，非用人参、肉桂、附子不能治疗。世间遇到头痛的证候，就认为是外受风寒，立即给予发散药物治疗。发散治疗后不愈，逐渐加上寒凉药物，不是用川芎、防风、荆芥、羌活，就是黄芩、黄连、栀子、石膏。如果是风火头痛遇到这些药不至于伤害身体，若是阳虚头痛遇到这些药，必定导致死亡。能不谨慎吗！
世上有“三阴经没有头痛”的说法，哪里知道阳虚头痛，纯属阴寒，阳气几乎灭绝，患此病的人十人中没有一人能活。之所以这样，就像太阳不依附于天空，下沉到海里，万方崩陷一样。大概人与天地相合，天有太阳，人也有太阳，君火之阳就是太阳；地有四海，人也有四海，头为髓海，胸为气海，胃为谷海，胞中为血海。在天的太阳，白天行于天，晚上行于海；在人身的太阳，既行于天，也行于海。从头项到尾闾，如同太阳行于天；从血海到髓海，如同太阳行于海。现在阳虚头痛，是阴寒遮蔽了太阳，逆乱于髓海，不能上达巅顶至项部，从而行于背部，反而从阳入阴，行于腹部，因此头痛不止会导致心烦，心烦，是阳光逆乱于气海；心烦不止会导致呕吐，呕吐，是阳光逆乱于谷海；呕吐不止会导致神志昏迷，神志昏迷，是阳光逆乱于血海。头痛发展到神志昏迷，就进入了阴证的极致，如同太阳沉入海底。此症治疗得法，百人中仅能救活二三人，而浅薄无学的医生，妄投汤药，导致治疗无效。有人说肝风入脑，有人说客气犯脑，有人说真头痛，言论如此，但散风散寒的药物终究不免使用。哪里知道散法并不是治疗此症的方法，恰恰是害人的宗旨啊。《灵枢·四海论》说：“得顺者生，得逆者败，知调者利，不知调者害。”说的就是这种日逆于海的头痛，而医生倒行逆施，不善治疗而导致死亡的例子吧。
我按语：高士宗的这篇论述，阐发了前人未曾发现的问题，但遗憾只有论述没有方剂，所说的“非人参、肉桂、附子不能治疗”，是肤浅的话，不值得推崇。我拟定白通汤，加倍增加附子的用量作为确切的方剂。因为阳气起于下焦，妙在重用附子的辛热，在下焦以激发它，干姜在中焦以接续它，葱白在上焦以通达它，可以挽救十分之一二的患者。
眩晕，是指头晕目眩且旋转不定。《素问·至要大论》说：“诸风掉眩，皆属于肝。”这是指实证，适宜用二陈汤加防风、玉竹、川芎、天麻、白术、钩藤为主方。属于痰饮的，加倍半夏，再加倍加泽泻。火盛的加黄芩、玄参。《灵枢·卫气篇》说：“上虚则眩。”这是指虚证，适宜加人参、[甘草]，虚甚的加附子。《灵枢·海论》说：“髓海不足，则脑转耳鸣，胫酸眩冒，目无所见，懈怠安卧。”这是指病位在上，而根源起于下，适宜加肉苁蓉、附子、巴戟天。如大虚且各种药物无效者，宜用鹿茸一两，酒煎，加入麝香一厘服用，这就是《灵枢·经脉篇》所说的：“督脉实则脊强，虚则头重高摇”的意思。此外，又有火亢盛导致眩晕不可抵挡的，用大黄酒炒三次，研末，茶清调服。此证与头痛，不专门属于表证，因为头为诸阳之会，阳主外，所以列于表证。
（经文解释）《素问·脉要精微论》说：“浮而散者为仆。”盖“仆”与“瞬”同义。《史记·项羽本纪》引文：“瞋目视之。”谓使目动。仰面跌倒叫僵，覆面跌倒叫仆，即风虚眩晕突然倒地。《灵枢·口问篇》说：“上气不足，脑为之不满，耳为之苦鸣，头为之苦倾，目为之眩。”《灵枢·经脉篇》说：“五阴气俱绝，则目系转，转则目运，目运者，为志先死，志先死，则远一日半死矣。”
Xiaoyao San (Free and Easy Wanderer Powder) combined with Chuanxiong Rhizome (Rhizoma Chuanxiong) and Baizhu Flower (Flos Chrysanthemi Indici) yields good results for headache. For blood deficiency headache, if various medicines are ineffective, Danggui Buxue Tang (Decoction for Tonifying Blood) with Deer Antler (Cornu Cervi Pantotrichum) can be used (because deer antler grows on the head, it shares the same qi with the human head). For kidney meridian depletion headache, Zuogui Yin (Left Restoration Decoction) is used; for severe pain where yang qi is about to collapse, Wuzhuyu Tang (Evodia Decoction) can be used to salvage the dying yang (this method can only save one or two out of ten patients.
(When this condition proves unresponsive to all medicines, contemporary physicians merely adhere to the inherited theories in medical texts and commonly used formulas of the time, which certainly cannot cure such a serious illness. Herein is recorded Gao Shizong's groundbreaking insight, to bolster the courage of colleagues, as a plan of burning one's bridges.
There are three types of headache syndromes: one is Taiyang headache; one is Shaoyang headache; and one is Jueyin headache. The Taiyang meridian ascends to the forehead, intersects at the vertex, and connects with the brain. Above Taiyang, cold qi governs; thus, Taiyang headache is caused by cold. The Shaoyang meridian ascends to reach the temporal angle. Above Shaoyang, ministerial fire governs; thus, Shaoyang headache is caused by fire. The Jueyin meridian emerges from the forehead and meets the Du meridian at the vertex. Above Jueyin, wind qi governs; thus, Jueyin headache is caused by wind. Although headaches differ in being cold, fire, or wind, one must observe their severity and distinguish yin and yang. When headache occurs alongside other bodily diseases, the pain is mild. When headache occurs alone, causing pain so severe as to feel like death, the pain is severe. Whenever yin blood is deficient and yang heat is excessive, the pain is mild; conversely, when yang qi is deficient and yin cold is excessive, the pain is severe. For wind-fire headache, if it is an excess condition, clear and disperse it; if it is a deficiency condition, tonify and nourish it. Yin-cold headache is due to yin excess and yang deficiency, known as yang-deficient headache, which cannot be treated without Ginseng Radix et Rhizoma (Ren Shen), Cinnamon Bark (Rou Gui), and Aconite Lateralis Radix Praeparata (Fu Zi). In the world, upon encountering headache, people often assume it is due to external wind-cold and immediately administer dispersing treatments. If dispersing fails, cooling herbs are gradually added: either Chuanxiong Rhizome (Chuan Xiong), Saposhnikovia Root (Fang Feng), Schizonepeta Spike (Jing Jie), or Notopterygium Rhizome et Radix (Qiang Huo); or Scutellaria Root (Huang Qin), Coptis Rhizome (Huang Lian), Gardenia Fruit (Zhi Zi), or Gypsum Fibrosum (Shi Gao). If wind-fire headache encounters these, the body may not be harmed; but if yang-deficient headache encounters them, death is certain. Can one not be cautious!
The world holds the theory that "the three yin meridians do not suffer headache," but how could they know that yang-deficient headache is purely yin-cold, with yang nearly extinguished? Those suffering from this have less than one survivor in ten. The reason is akin to the sun not clinging to the sky but sinking into the sea, causing all directions to collapse. Man corresponds to heaven and earth: Heaven has the sun, and man also has the sun; the Yang of Ministerial Fire is the sun. Earth has the four seas, and man also has the four seas: the head is the Sea of Marrow, the chest is the Sea of Qi, the stomach is the Sea of Grain, and the uterus/abdomen is the Sea of Blood. The sun in heaven travels through the sky by day and the sea by night; the sun in man travels through the sky and also through the sea. From the neck to the tailbone is like the sun traveling through the sky; from the Sea of Blood to the Sea of Marrow is like the sun traveling through the sea. Now, yang-deficient headache is caused by yin-cold obscuring the sun, rebelling within the Sea of Marrow, unable to ascend to the vertex and neck to travel along the back. Instead, it enters yin from yang and travels through the abdomen. Therefore, unremitting headache leads to vexation; vexation indicates sunlight rebelling in the Sea of Qi. Unremitting vexation leads to vomiting; vomiting indicates sunlight rebelling in the Sea of Grain. Unremitting vomiting leads to coma; coma indicates sunlight rebelling in the Sea of Blood. Headache progressing to coma signifies entering the extreme of yin, like the sun sinking to the bottom of the sea. If treated correctly, this condition might save two or three out of a hundred, but shallow physicians, recklessly prescribing decoctions, fail in treatment. Some claim liver wind enters the brain, some claim hostile qi invades the brain, some call it true headache. Despite such statements, dispersing wind and cold herbs are inevitably used. How could they know that dispersing methods are not for treating this, but rather harm the patient? The *Lingshu · Si Hai Lun* states: "Those who obtain harmony live; those who obtain rebellion perish; those who know how to regulate benefit; those who do not know how to regulate are harmed." This refers precisely to headache where the sun rebels in the sea, yet physicians act contrary to nature, failing to treat properly and causing death.
My commentary: Gao Shizong's discussion reveals what predecessors had not yet expounded, but I regret that there is discussion without formula. The statement "non-Ginseng, Cinnamon, and Aconitate cannot treat it" is superficial and not worthy of esteem. I propose using Bitong Tang (White Pass Decoction) with doubled Aconite Lateralis Radix Praeparata (Fu Zi) as the precise formula. Since yang qi originates in the lower jiao, the妙 (wonder) lies in heavily using the pungent and hot nature of Fu Zi to stimulate it from below, Ganjiang (Dried Ginger) to connect it from the middle, and Congbai (Scallion White) to open it from above. This can save one or two out of ten.
Vertigo (Xuan Yun) refers to dizziness and spinning instability. The *Suwen · Zhi Da Yao Lun* says: "All wind-induced tremors and vertigo belong to the Liver." This refers to excess conditions, suitable for Erchen Tang (Two-Cured Decoction) plus Saposhnikovia Root (Fang Feng), Polygonatum Odoratum Rhizome (Yuzhu), Chuanxiong Rhizome (Chuan Xiong), Gastrodia Tuber (Tian Ma), Atractylodes Macrocephala Rhizome (Baizhu), and Uncaria Ramulus cum Uncis (Gouteng). If due to phlegm-fluid retention, double the Pinellia Tuber (Banxia) and add Alisma Rhizome (Zexie) in double amount. If fire is excessive, add Scutellaria Root (Huang Qin) and Scrophularia Root (Yuanshen). The *Lingshu · Wei Qi Pian* says: "Upper deficiency causes vertigo." This refers to deficiency conditions, suitable for adding Ginseng Radix et Rhizoma (Renshen) and [Licorice Root (Gancao)]; if deficiency is severe, add Aconite Lateralis Radix Praeparata (Fu Zi). The *Lingshu · Hai Lun* says: "Deficiency of the Sea of Marrow leads to spinning head, tinnitus, soreness of shins, vertigo, blindness, lassitude, and desire to lie down." This indicates pathology located upward but rooted downward, suitable for adding Cistanche Stem (Rou Cong Rong), Aconite Lateralis Radix Praeparata (Fu Zi), and Morinda Officinalis Root (Bajitian). If extremely deficient and various medicines fail, use One liang of Deer Antler (Lurong), decocted in wine, with one li of Musk (Shexiang) taken orally. This aligns with the *Lingshu · Jing Mai Pian*: "When the Du meridian is excess, the spine is stiff; when deficient, the head feels heavy and sways." Additionally, there are cases of overwhelming fire causing unbearable vertigo, treated with Rhubarb Rhizome (Dahuang) stir-fried three times in wine, ground to powder, and taken with tea infusion. This condition, along with headache, is not exclusively a exterior syndrome, because the head is the convergence of all yang meridians, and yang governs the exterior; thus, it is listed under exterior syndromes.
(Explanation of Classics) The *Suwen · Mai Yao Jing Wei Lun* states: "Floating and scattered pulse indicates falling." 'Pu' (fall) is synonymous with 'Shun'. The *Records of the Grand Historian · Biography of Xiang Yu* quotes: "Glaring eyes." Meaning causing eye movement. Falling face-up is called Jiang (stiff/rigid), falling face-down is called Pu (collapse/fall), which refers to sudden collapse due to wind-deficiency vertigo. The *Lingshu · Kou Kai Pian* states: "Insufficiency of upper qi leads to insufficient filling of the brain, bitter ringing in the ears, painful tilting of the head, and dizzy eyes." The *Lingshu · Jing Mai Pian* states: "When the qi of all five yin meridians is exhausted, the optic nerves twist; twisting causes eye spinning. Eye spinning means the spirit dies first; if the spirit dies first, death occurs in one and a half days."