京都谈××，年五十二岁，得脑充血头疼证。
病因 因劳心过度，遂得脑充血头疼证。
证候 脏腑之间恒觉有气上冲，头即作疼，甚或至于眩晕，其夜间头疼益甚，恒至疼不能寐。医治
二年无效，浸至言语謇涩，肢体渐觉不利，饮食停滞胃口不下行，心中时常发热，
大便干燥。其脉左右皆弦硬，关前有力，两尺重按不实。
诊断 弦为肝脉，至弦硬有力无论见于何部，皆系有肝火过升之弊。因肝火过升，恒引动冲
气胃气相并上升，是以其脏腑之间恒觉有气上冲也。人之血随气行，气上升不已，血即随之上升不已，
以致脑中血管充血过甚，是以作疼。其夜间疼益剧者，因其脉上盛下虚，阴分原不充足，是以夜则
加剧，其偶作眩晕亦职此也。至其心常发热，肝火炽其心火亦炽也。
其饮食不下行，大便多干燥者，又皆因其冲气挟胃气上升，
胃即不能传送饮食以速达于大肠也。其言语肢体蹇涩不利者，因脑中血管充血过甚，有妨碍于
司运动之神经也。此宜治以镇肝、降胃、安冲之剂，而以引血下行兼清热滋阴之药辅之。又须知
肝为将军之官，中藏相火，强镇之恒起其反动力，又宜兼用舒肝之药，将顺其性之作引也。
处方 生赭石（一两轧细） 生怀地黄（一两） 怀牛膝（六钱） 大甘枸杞（六钱）
生龙骨（六钱捣碎） 生牡蛎（六钱捣碎） 净萸肉（五钱） 生杭芍（五钱）
茵陈（二钱） 甘草（二钱）
共煎汤一大盅，温服。
复诊 将药连服四剂，头疼已愈强半，夜间可睡四五点钟，诸病亦皆见愈，脉象之弦硬已减，
两尺重诊有根，拟即原方略为加减俾再服之。
处方 生赭石（一两轧细） 生怀地黄（一两） 生怀山药（八钱） 怀牛膝（六钱）
生龙骨（六钱捣碎） 生牡蛎（六钱捣碎） 净萸肉（五钱） 生杭芍（五钱）
生鸡内金（钱半黄色的捣） 茵陈（钱半） 甘草（二钱）
共煎汤一大盅，温服。
三诊 将药连服五剂，头已不疼，能彻夜安睡，诸病皆愈。惟办事，略觉操劳过度，头仍作
疼，脉象犹微有弦硬之意，其心中仍间有觉热之时，拟再治以滋阴清热之剂。
处方 生怀山药（一两） 生怀地黄（八钱） 玄参（四钱） 北沙参
（四钱） 生杭芍（四钱） 净萸肉（四钱） 生珍珠母（四钱捣碎） 生石决明
（四钱捣碎） 生赭石（四钱轧细） 怀牛膝（三钱） 生鸡内金（钱半黄色的捣） 甘草（二钱）
共煎汤一大盅，温饮下。
效果 将药连服六剂，至经理事务时，头亦不疼，脉象已和平如常。遂停服汤药，俾日用生山
药细末，煮作茶汤调以白糖令适口，送服生赭石细末钱许，当点心服之以善其后。
证候：患者感觉脏腑之间常有气向上冲逆，头部随即疼痛，甚至出现眩晕。夜间头痛更加严重，常常痛到无法入睡。经过两年治疗无效，病情逐渐发展到言语謇涩（说话不流利），肢体逐渐感到活动不便，饮食停滞在胃中不能下行，心中时常发热，大便干燥。其脉象左右手都呈现弦硬之象，关前部位有力，两尺部重按则感觉不实（空虚）。
诊断：弦脉是肝的脉象，无论出现在哪个部位，只要脉象弦硬有力，都是肝火过盛上炎的弊病。由于肝火过盛上炎，常常引动冲气和胃气一同上升，所以患者感觉脏腑之间有气上冲。人的血液随着气运行，气不断上升，血也随之不断上升，导致脑中血管充血过于严重，从而引起疼痛。夜间疼痛加剧的原因，是因为脉象上部盛而下部虚，阴分原本就不充足，所以到了夜晚症状就会加重，偶尔出现的眩晕也是因为这个原因。至于心中常觉发热，是因为肝火炽盛带动了心火也炽盛。饮食不能下行、大便多干燥，也是因为冲气挟带胃气上升，导致胃无法迅速传送饮食到达大肠。言语和肢体蹇涩不利，是因为脑中血管充血过于严重，妨碍了主管运动的神经功能。这种情况应当用镇肝、降胃、安冲的方剂来治疗，并辅以引血下行兼清热滋阴的药物。另外须知，肝被称为“将军之官”，其中潜藏相火，强行镇压往往会引起反弹之力，因此适宜兼用舒肝的药物，顺应其本性作为引导。
处方：生赭石（一两，轧成细粉） 生怀地黄（一两） 怀牛膝（六钱） 大甘枸杞（六钱）
生龙骨（六钱，捣碎） 生牡蛎（六钱，捣碎） 净萸肉（五钱） 生杭芍（五钱）
茵陈（二钱） 甘草（二钱）
以上药物共煎成一碗汤，温服。
复诊：连续服用四剂药后，头痛已经好了大半，夜间可以睡四五个小时，其他病症也都见好转，脉象的弦硬程度已减轻，两尺部重诊有根气，打算就在原方基础上稍作加减，让患者继续服用。
处方：生赭石（一两，轧成细粉） 生怀地黄（一两） 生怀山药（八钱） 怀牛膝（六钱）
生龙骨（六钱，捣碎） 生牡蛎（六钱，捣碎） 净萸肉（五钱） 生杭芍（五钱）
生鸡内金（一钱半，黄色的，捣碎） 茵陈（一钱半） 甘草（二钱）
以上药物共煎成一碗汤，温服。
三诊：连续服用五剂药后，头已经不疼了，能整夜安稳睡觉，所有病症都痊愈了。只是因办事略感操劳过度，头又开始疼痛，脉象仍微有弦硬之意，心中仍有时觉得发热，打算再用滋阴清热的方剂治疗。
处方：生怀山药（一两） 生怀地黄（八钱） 玄参（四钱） 北沙参（四钱） 生杭芍（四钱） 净萸肉（四钱） 生珍珠母（四钱，捣碎） 生石决明（四钱，捣碎） 生赭石（四钱，轧成细粉） 怀牛膝（三钱） 生鸡内金（一钱半，黄色的，捣碎） 甘草（二钱）
以上药物共煎成一碗汤，温饮下。
效果：连续服用六剂药后，在处理事务时头也不再疼痛，脉象已平和如常。于是停止服用汤药，让日常将生山药磨成细末，煮成茶汤，调入适量白糖使其可口，送服约一钱许的生赭石细末，当作点心服用，以巩固疗效。
Mr. Tan from Beijing, aged fifty-two, suffered from a headache syndrome caused by cerebral congestion (cerebral hyperemia).
Etiology: The condition arose due to excessive mental exertion (overuse of the mind), leading to cerebral congestion and headache.
Symptoms: The patient constantly felt qi rushing upward between the viscera and bowels, followed immediately by head pain, sometimes extending to dizziness (vertigo). The headache was particularly severe at night, often preventing sleep. After two years of ineffective medical treatment, the condition gradually progressed to slurred speech (dysarthria) and gradual impairment of limb movement. Food stagnated in the stomach without descending, the heart frequently felt hot, and stools were dry. The pulse was wiry and stiff on both left and right sides; it was forceful at the Guan position but empty/unrooted upon heavy pressure at the Chi positions.
Diagnosis: A wiry pulse is associated with the Liver. Regardless of its location, a wiry, stiff, and forceful pulse indicates excessive rising of Liver Fire. Due to this excessive Liver Fire, it invariably stirs up Chong Qi (Penetrating Vessel Qi) and Stomach Qi to rise together, causing the sensation of qi rushing upward. Blood follows Qi in its circulation; as Qi rises incessantly, blood rises with it, leading to excessive congestion in the blood vessels of the brain, which causes pain. The aggravation of pain at night occurs because the pulse shows excess above and deficiency below, indicating an original insufficiency of Yin fluids; thus, symptoms worsen at night. Occasional dizziness is also due to this mechanism. The frequent sensation of heat in the heart is because excessive Liver Fire ignites Heart Fire. The inability of food to descend and the dryness of stools are because Chong Qi carries Stomach Qi upward, preventing the Stomach from rapidly transporting food to the Large Intestine. The slurred speech and impaired limb movement are due to excessive congestion in the brain's blood vessels interfering with the nerves responsible for motor function. This condition should be treated with a formula that settles the Liver, descends Stomach Qi, and calms the Chong vessel, assisted by herbs that guide blood downward while clearing heat and nourishing Yin. It must also be noted that the Liver is referred to as the "General," harboring Ministerial Fire; strong suppression often triggers a counter-reaction. Therefore, it is appropriate to simultaneously use herbs that soothe the Liver, accommodating its nature to act as a guide.
Prescription: Raw Hematite Ore (Shi Zhie, Ochre) [1 liang, finely ground] Raw Huai Rehmannia Root (Di Huang) [1 liang] Huai Achyranthes Bidentata Root (Niu Xi) [6 qian] Large Sweet Goji Berry (Gou Qi Zi) [6 qian] Raw Dragon Bone (Long Gu) [6 qian, crushed] Raw Oyster Shell (Mu Li) [6 qian, crushed] Clean Cornus Fruit (Yu Rou) [5 qian] Raw Hang Peony Root (Bai Shao) [5 qian] Artemisia Capillaris Herb (Yin Chen) [2 qian] Licorice Root (Gan Cao) [2 qian]
Decoct all ingredients in one large cup of water and take warm.
Second Visit: After taking four doses consecutively, the headache had improved by more than half, allowing for four to five hours of sleep at night. Other symptoms also showed improvement, and the wiry and stiff quality of the pulse had decreased. The Chi positions showed root upon heavy palpation. It was planned to slightly modify the original prescription for continued use.
Prescription: Raw Hematite Ore (Shi Zhie, Ochre) [1 liang, finely ground] Raw Huai Rehmannia Root (Di Huang) [1 liang] Raw Huai Chinese Yam Rhizome (Shan Yao) [8 qian] Huai Achyranthes Bidentata Root (Niu Xi) [6 qian] Raw Dragon Bone (Long Gu) [6 qian, crushed] Raw Oyster Shell (Mu Li) [6 qian, crushed] Clean Cornus Fruit (Yu Rou) [5 qian] Raw Hang Peony Root (Bai Shao) [5 qian] Raw Chicken Gizzard Lining (Ji Nei Jin) [1.5 qian, yellow variety, crushed] Artemisia Capillaris Herb (Yin Chen) [1.5 qian] Licorice Root (Gan Cao) [2 qian]
Decoct all ingredients in one large cup of water and take warm.
Third Visit: After taking five doses consecutively, the headache ceased completely, allowing for uninterrupted sleep throughout the night, and all other symptoms resolved. However, due to slight overexertion in handling affairs, the headache returned slightly, the pulse still showed a faint wiry and stiff tendency, and there were intermittent sensations of heat in the chest. It was decided to treat again with a formula for nourishing Yin and clearing heat.
Prescription: Raw Huai Chinese Yam Rhizome (Shan Yao) [1 liang] Raw Huai Rehmannia Root (Di Huang) [8 qian] Scrophularia Root (Xuan Shen) [4 qian] North Glehnia Root (Bei Sha Shen) [4 qian] Raw Hang Peony Root (Bai Shao) [4 qian] Clean Cornus Fruit (Yu Rou) [4 qian] Raw Pearl Mother-of-Pearl (Zhen Zhu Mu) [4 qian, crushed] Raw Abalone Shell (Shi Jue Ming) [4 qian, crushed] Raw Hematite Ore (Shi Zhie, Ochre) [4 qian, finely ground] Huai Achyranthes Bidentata Root (Niu Xi) [3 qian] Raw Chicken Gizzard Lining (Ji Nei Jin) [1.5 qian, yellow variety, crushed] Licorice Root (Gan Cao) [2 qian]
Decoct all ingredients in one large cup of water and take warm.
Outcome: After taking six doses consecutively, even when managing affairs, the headache did not recur, and the pulse became peaceful and normal. Decoction therapy was then stopped. Instead, the patient was instructed to consume fine powder of raw Chinese Yam rhizome boiled as a tea, sweetened with white sugar to taste, accompanied by approximately 1 qian of fine powder of raw Hematite Ore (Shi Zhie, Ochre), taken as a snack to consolidate the recovery.