（附雷头风、头响、头摇、头重）
经义
故春气者病在头。○头痛数岁不已，当犯大寒，内至骨髓。髓者，以脑为主，脑逆故头痛，齿亦痛，名曰厥
逆。○头痛巅疾，下虚上实，过在足少阴、巨阳。○心烦头痛，病在膈中，过在手巨阳、少阴。○头痛耳鸣，九
窍不利，肠胃之所生。（《素问》）
真头痛，头痛甚，脑尽痛，手足寒至节，死不治。（《灵枢》）
哲言
头痛有正头痛、偏头痛、风寒头痛、湿热头痛、厥逆头痛、痰厥头痛、热厥头痛、湿厥头痛、气厥头痛、
真头痛、醉后头痛，又有脑风、首风，炭气熏人，亦作头痛。（《东医宝鉴》）
外感头痛，如破如裂，无有休歇；内伤头痛，其势稍缓，时作时止。（《见闻录》）
太阳头痛∶恶风寒，脉浮紧，痛在巅顶、两头角。少阳头痛∶往来寒热，脉弦细，痛连耳根。阳明头痛∶
发热自汗，脉长大，痛连目 、颊、齿。太阴头痛∶有痰，体重，脉沉缓。少阴头痛∶足寒气逆，脉沉细。厥
阴头痛∶吐痰沫，厥冷，脉浮缓，痛引目系。此六经头痛，兼挟外邪也。（《东垣十书》）
因风而痛，抽掣恶风；因暑而痛，烦心恶热；因寒而痛，细急、恶寒、战栗；因湿而痛，头重，天阴尤甚；
因痰而痛，昏愦欲吐；气虚痛，遇劳则甚，其脉大；血虚痛，痛连鱼尾，善惊惕，其脉芤。若诸药不效，此督
脉为病。（罗谦甫）
《内经》云∶头痛巅疾，下虚上实，过在足少阴、巨阳，甚则入肾。 蒙招尤，目冥耳聋，下实上虚，过
在足少阳、厥阴，甚则入肝。按∶下虚者，肾虚也，肾虚则头痛。上虚者，肝虚也，肝虚则头晕。 蒙者，如
以物蒙其首，招摇不定。目冥、耳聋，皆晕之状也。肝虚头晕，肾厥巅痛，不同如此。（娄全善）
头痛一证，病家视其疾微而轻忽之，医家尽认伤寒而妄治之，此辨之不可不早也。夫经言外感有头痛，内
伤亦有头痛，岂容混治而无所区别？第外感头痛，有阳经、有阴经。如太阳、阳明、少阳头痛，属阳经；厥阴
头痛属阴经。然其初发，身必寒热，背必酸痛，项必强痛，或目珠额痛，或耳聋胁痛，其脉必紧数。其厥阴头
痛，无热，呕而吐沫。若素无头痛之患，而忽然暴发，痛兼表证，及按摩缚束而痛不定者，乃外感之头痛。治
在风池、风府，调其阴阳。汗在表而散在巅；清在阳而温在阴也。内伤头痛，有阴虚，有阳虚。如火升巅顶作
痛者，必烦躁内热，面赤口渴，大便秘结，其脉大数而空，或细数而弦，属阴虚。如寒冲髓海作痛者，必羞明
畏寒，手足厥冷，面多青惨，大便溏泄，其脉细迟而微，或虚大无力，属阳虚。然其初发，身无寒热，神必倦
怠，食必不甘。若素有头痛之患，而忽然暴发，痛无表证，及按摩缚束而痛稍缓者，乃内伤之头痛。治在水火
二脏，调其营卫，补真阴而益元阳，病在上而治在下也。夫六腑清阳之气，五脏精华之血，皆会于头，为至清
至高之处，故谓之元首。至尊而不可犯也。苟外因风寒雾露之触，内因痰火湿热之熏，及偏正头风之证，其
痛不见杀人于数日之间。而杀人于数日之间者，则为内伤之真头痛也。盖脑为神脏，谓之泥丸宫，而精髓藏焉。
人生精气实于下，
则髓海满于上。精神内守，病安从来？无如以酒为浆，以妄为常，以欲竭其精，以耗散其真。致肾阴不足，而
阴火冲逆；肾阳不壮，而寒气犯脑。医者不达其故，复温之、散之。夫既亏在阴矣，我又从而温之，不益亏其
真阴乎？既亏在阳矣，我又从而散之，不愈亏其真阳乎？无怪乎变证蜂起，痛极而厥，神为之昏，目为之定，
牙为之噤，舌为之黑，面为之戴阳，手足为之抽掣，语言为之 妄。斯时真知其亏在阴也，则用六味归芍汤，
加人参、童便，壮水之主，以镇阳光；真知其亏在阳也，则用八味养血汤，加人参、鹿茸，益火之原，以消阴
翳。此证尤惟妇人血海空虚者，多有此患，安可不以补元为汲汲耶？奈何庸碌之辈，不明肝肾为髓海之原，精
气为神藏之根？一见头痛，概以伤寒目之，及至病势危笃，尚引伤寒书，需待用药，不知病者竟以痛剧而顷刻
亡矣！夫痛在经者，轻而易治；痛在脏者，重而难疗。若头风害目者，肝阴亏则内风动摇，邪害空窍，痛在经
也。头痛昏愦者，脑脏伤则神志失守，心火不平，痛在脏也。头痛而痰厥者，阳虚则气寒饮聚，阴虚则火炽液
凝，经脉不行，阴阳之气不相顺接也。头痛而积热在阳明，实火、实痰为虐，脉洪数而有力者，则又利于清
凉攻下也。头痛而红肿、壮热、口渴，脉浮数而有力者，此大头天行时热之邪，宜从疫法治也。头痛而手足寒，
且青至节，脉悬悬欲绝者，此危脱之证。旦发夕死，夕发旦死，药亦不能治也。（《会心录》）
头痛当先审久暂，次辨表里。盖暂痛者必因邪气，久痛者必兼元气。以暂痛言之，则有表邪者，此风寒外
袭于经也，治宜疏散，最忌清降；有里邪者，此三阳之火炽于内也，治宜清降，最忌升散。此治邪之法也。其
有久痛者，则或发、或愈。或以表虚者，微感则发；或以阳胜者，微热则发；或以水亏于下，而虚火乘之则发；
或以阳虚于上，而阴寒胜之则发。所以暂痛者当重邪气，久痛者当重元气，此固其大纲也。然亦有暂痛而虚者，久痛
而实者，又当因脉、因证而详辨之。（张景岳）
头为诸阳之会，与厥阴肝脉会于巅。诸阴寒邪不能上逆，惟阳气窒塞，浊邪得以上据，厥阴风火乃能逆上
作痛。故头痛一证，皆由清阳不升，火风乘虚上入所致。如阳虚浊邪阻塞，气血瘀痹者，用虫蚁搜逐血络、宣
通阳气。火风变动，与暑风邪气上郁者，用荷叶、苦丁茶、蔓荆、山栀等，轻清辛散。阴虚阳越者，用复脉汤、
甘麦大枣法，加胶、芍、牡蛎，镇摄益虚，和阳熄风。厥阴风木上浊者，用首乌、柏子仁、 豆、甘菊、白芍、
枸杞辈，熄肝风、滋肾液。○头风一证，有偏正之分。偏者主乎少阳，而风淫火郁为多。前人立法，以柴胡为
要药，无如与之阴虚火浮、气升吸短者，则厥脱由是而来矣。先生则以桑叶、丹、栀、荷叶轻清凉泄。久则伤
及肝阴，参入咸凉柔镇。所云正者，有气虚、血虚、痰厥、肾厥、阴伤阳浮、火亢邪风之不同。至于肝阴久耗，
内风日旋，厥阳无一息之安，痛掣之势已极，惟与复脉之纯甘壮水，胶、黄之柔婉，以熄风和阳。（《临证指南》）
医书分头痛、头风为二门，然同一病也，但有新、久、浅、深之分耳。浅而近者名头痛，其痛卒然而至，
易于解散速安也。深而远者为头风，其痛作止不常，愈后遇触复发也。皆当验其邪所从来而治之。（《证治准绳》）
头痛久发，多主于痰。然有风毒上攻者，有血虚者，有气虚者，有诸经气滞者，有六气外伤者，有劳役所
伤者。有可吐者，有可下者，当分虚、实、寒、热、兼、变而治之。若夫偏正头风，久而不愈，乃内挟痰涎，
风火郁遏，经络气血壅滞。甚则目昏紧小、二便秘涩，宜砭出其血，以开郁解表。（薛立斋）
东风生于春，病在肝。目为肝窍，肝风动则邪害空窍。有年久头风，便躁、目赤、眩晕者，肺金乘肝、气
郁血壅而然也。治宜清上彻下之法。世人不知此理，专行苦寒，使火无发越，上攻于目；或专行辛散，使血耗
火炎，上瘀于目。宜乎必害眼也。
（《证治汇补》）
头痛有久痛感寒便发，外用重绵包裹者，此属郁热。盖本热而标寒也。因其本有郁热，毛窍常开，风寒
易入，束其内火，闭逆为痛。惟泻火凉血，佐以辛凉散表。（王纶）
头痛引经药∶太阳，羌活；阳明，白芷；少阳，柴胡；太阴，苍术；少阴，细辛；厥阴，吴茱萸。○头
痛用羌、防、川芎、升、柴、细辛、 本之异者，分各经祛风也。用芩、连、知、柏、石膏、生地之异者，分
各脏泻火也。用苓、泽者，导湿也。用参、 者，补气也。用归、地者，养血也。（汪 庵）
白术半夏天麻汤，治痰厥头痛药也；青空膏，治风湿热头痛药也； 活附子汤，治厥阴头痛药也。如湿
气在头者，以苦吐之，不可执方而治。（李东垣）
痰厥头痛，非半夏不能除；头旋眼黑，虚风内作，非天麻不能解。平人头痛，属痰火居多。肥人多是湿
痰，宜二陈苍术；瘦人多是血虚有火，宜酒炒芩、连、薄荷、芎、归，巅顶痛加 本。（《医学六要》）
头痛不可专泥风药，愈虚其虚，使风入于脑，永不可拔。亦不可偏于逐火，使风火上乘空窍而从眼出，如
腐之风火相扇而成衣焉。（《冯氏锦囊》）
凡治头痛多用辛温气药者，由风木不得升，土寡于畏，是以壅塞而痛，故用此助肝木，散其壅塞也。若疏
散太过而痛反甚者，又宜酸收以降之。东垣云∶高巅之上，惟风可到。味之薄者，阴中之阳，自地升天者也，
所以头痛皆用风药，总其大体而言。然患头痛者，血必不足，风药最能燥血，故有愈治而愈甚者，此其要尤在
养血，不可不审也。（王宇泰）
脉候
寸口脉中手短者曰头痛。○推而下之，上而不下，头项痛也。○来疾去徐，上实下虚，为厥巅疾。（《素问》）
寸口紧盛，或短、或弦、或浮，皆主头痛。又浮弦为风，浮洪为火，细濡为湿，滑大为痰，短涩为虚。（《医鉴》）
选案
一妇患头风，虽盛暑必以帕蒙首，稍见风寒，痛不可忍。盖因脑受风寒，气血两虚，气不能升，故药不效。
令病患口含冷水仰卧，以姜汁滴入鼻中，其痛立止。与补中益气汤，加细辛、川芎、蔓荆子、白芍，数服而愈。
用姜汁滴入鼻中者，开其久郁之风寒也。若寒湿郁痛，用蒜汁滴之。火郁头痛，以莱菔汁滴之。左患滴右，右
患滴左。（程文彬）
一人病头痛，医用表散、祛痰、升阳、养阴药，均不效。病年余矣。偶见有伤食，以神曲、山楂、麦芽作
汤，试饮一瓯，顿觉神爽，其日即不痛剧。因频饮之，愈饮愈快，沉 如失。因知食积中州，阻塞清阳不升，
亦能令人头痛。（《医参》）
附雷头风
雷头风者，头上赤肿，核如酸枣状。先用茶调散吐之，次用神芎丸下之，后服愈风饼子。甚者用 针刺出
血，则愈。（张子和）
雷头风者，震卦主之。震仰盂，予制药内加荷叶者，象震之形，其色青，乃比类象形。当煎局方升麻汤主
之。治头面疙瘩、憎寒、拘急、发热，状如伤寒。（《保命集》）
按∶二论以结核疙瘩而用风药，指震为雷，为譬固美，然犹未尽善也。夫此病未有不因于痰火者，盖痰生
热，热生风，核块疙瘩，有形可征。痰火上升，壅于气道，兼于风化，则有声如雷之响，其发如雷之迅速。设
如前论，尽作风热治之，恐认标而忘其本也。予附一方于后，方用僵蚕、粉草、半夏、连翘、片芩、陈皮、桔
梗、大黄、薄荷、白芷、天麻、礞石为末，水浸 饼为丸，卧时茶吞二钱，以痰利为度，然后用药调理。（孙一奎）
附头响
头内如虫蛀响者，名天白蚁。多属于火，赤有因痰湿在上者。
丹溪云∶瘦人皆属于火，宜用薄荷、栀子、茯苓、甘草、细辛、川芎、黄芩、石膏、芽茶之类。肥人皆属湿痰，
宜用半夏、茯苓、枳实、黄连、天麻、胆星、苍术、黄柏、芽茶之类。戴复庵云∶头中鸣响，有虚、有实。实
者用凉膈散、礞石丸下之；虚者非用独参、保元、六味、八味、茸珠丹、鹿茸丸等药调补不可。又方用茶子
为末，吹鼻中，甚效。盖响属火，茶子轻清，行清道、散遏伏之火故也。凡治头风，药中必用茶引，即此可悟。
（《张氏医通》）
附头摇
头摇者，虽属于风，实因于火。《经》谓诸风眩掉，皆属肝木。木得风则摇动，然乃肝经火盛而生虚风。
故高年病后辛苦，人多犯之。盖因气血虚而火犯上鼓动也。有小儿病摇头，三年不止，以河车入药而愈。
（《冯氏锦囊》）
附头重
头重者，因天之湿淫外着，人之湿痰上蒸，下之阴气逆上也。夫头象天，其气轻清。地气重浊，阴也，湿
也。外着内蒸，壅蔽清道，致气血不利，沉滞轻络，故重。《经》曰∶因于湿，首如裹。东垣云∶头重如山，
湿气在头也。治用红豆散，鼻内搐之，犹物在高巅，必射而取之也。（《证治准绳》）
【经文义理】
所以春季的邪气致病，病位多在头部。○头痛数年不愈，是因为遭受了大寒之邪，寒气内侵至骨髓。骨髓以脑为主宰，脑气上逆故导致头痛，牙齿也会疼痛，这种病症称为厥逆。○头痛及头顶部的疾病，属于下虚上实，病机在于足少阴肾经和足太阳膀胱经。○心烦且头痛，病位在膈中，病机涉及手太阳小肠经和手少阴心经。○头痛耳鸣，九窍不通利，是由肠胃功能失调所产生的。（出自《素问》）
真正的真头痛症，头痛非常剧烈，整个脑部都感到疼痛，手脚冰冷直到关节，这是死证，无法医治。（出自《灵枢》）
【哲人言论】
头痛分为正头痛、偏头痛、风寒头痛、湿热头痛、厥逆头痛、痰厥头痛、热厥头痛、湿厥头痛、气厥头痛、真头痛、醉后头痛，另外还有脑风、首风，以及炭火烟气熏人，也会引起头痛。（出自《东医宝鉴》）
外感引起的头痛，感觉像要破裂一样，没有停歇的时候；内伤引起的头痛，病情相对缓和，时作时止。（出自《见闻录》）
太阳经头痛：恶风怕冷，脉象浮紧，疼痛部位在头顶、两侧头角。少阳经头痛：忽冷忽热，脉象弦细，疼痛牵连耳根。阳明经头痛：发热自汗，脉象长大，疼痛牵连眼睛、面颊、牙齿。太阴经头痛：有痰，身体沉重，脉象沉缓。少阴经头痛：脚部寒冷且气机上逆，脉象沉细。厥阴经头痛：呕吐痰沫，四肢厥冷，脉象浮缓，疼痛牵引目系。这六经头痛，都是兼夹外邪所致。（出自《东垣十书》）
因风邪而痛，伴有抽搐、怕风；因暑邪而痛，心烦怕热；因寒邪而痛，经脉拘急、怕冷、战栗；因湿邪而痛，头部沉重，阴天时尤其严重；因痰邪而痛，头昏沉欲吐；气虚引起的头痛，劳累后加重，脉象大而无力；血虚引起的头痛，疼痛牵连眼角（鱼尾），容易受惊心悸，脉象芤。如果各种药物都不见效，这是督脉发病。（罗谦甫）
《内经》说：头痛及头顶部的疾病，下虚上实，病在足少阴、巨阳，严重时入肾。出现头晕眼花、视物不明、耳聋，这是下实上虚，病在足少阳、厥阴，严重时入肝。按语：下虚是指肾虚，肾虚则头痛。上虚是指肝虚，肝虚则头晕。“蒙招尤”是指感觉像有东西蒙住头部，摇晃不定。视物不明、耳聋，都是眩晕的症状。肝虚导致的头晕，与肾厥导致的巅顶痛，情况不同如此。（娄全善）
头痛这一证候，患者往往认为病情轻微而轻视它，医生却全都当作伤寒来胡乱治疗，因此辨证不能不提前进行。经典记载外感有头痛，内伤也有头痛，怎么可以混淆治疗而不加区别？只是外感头痛，有阳经、阴经之分。如太阳、阳明、少阳头痛，属于阳经；厥阴头痛属于阴经。然而初发时，身体必定有寒热，背部酸痛，项部强痛，或者眼球额头痛，或者耳聋胁痛，脉象必定紧数。厥阴头痛，无发热，呕吐且吐痰沫。如果平素没有头痛的毛病，而突然暴发，疼痛兼有表证，以及按摩束缚后疼痛不固定的，是外感头痛。治疗应在风池、风府穴，调和阴阳。汗法用于解表，发散药用于治巅顶；清热药用于阳经，温补药用于阴经。内伤头痛，有阴虚、阳虚之分。如火气上升冲顶作痛的，必定烦躁内热，面红口渴，大便秘结，脉象大数而空，或细数而弦，属于阴虚。如寒气冲击髓海作痛的，必定畏光怕冷，手足厥冷，面色青惨，大便溏泄，脉象细迟而微，或虚大无力，属于阳虚。然而初发时，身体无寒热，精神必定倦怠，饮食必定不甘味。如果平素有头痛的毛病，而突然暴发，疼痛无表证，以及按摩束缚后疼痛稍缓解的，是内伤头痛。治疗应针对水火二脏（心肾），调和营卫，补真阴而益元阳，病在上而治在下。六腑的清阳之气，五脏精华之血，都会聚于头部，这是最清高至尊的地方，所以称为元首。至尊而不可侵犯。如果外因风寒雾露的侵袭，内因痰火湿热的熏蒸，以及偏正头风的证候，其疼痛不会在数日内致死。而在数日内致死的，则是内伤的真头痛。因为脑为神脏，称为泥丸宫，精髓藏于此。人生精气充实于下，则髓海充盈于上。精神内守，病从何而来？无奈世人以酒当水喝，以妄动为常态，以欲望耗竭精气，以散乱损耗真气。导致肾阴不足，阴火上冲；肾阳不壮，寒气犯脑。医者不明白这个道理，反而用温散之法。既然阴已亏损，我又用温法，不是更加亏损真阴吗？既然阳已亏损，我又用散法，不是更加亏损真阳吗？难怪变证蜂起，痛极而厥，神志昏迷，两眼呆定，牙关紧闭，舌色发黑，面色戴阳（两颧泛红如妆），手足抽搐，语言错乱。此时若真知是阴亏，则用六味归芍汤，加人参、童便，壮水之主，以镇阳光；若真知是阳亏，则用八味养血汤，加人参、鹿茸，益火之原，以消阴翳。此证尤其多见于妇人血海空虚者，怎能不急于补元气呢？奈何庸碌之辈，不明白肝肾是髓海的源头，精气是神藏的根基？一见头痛，一概视为伤寒，等到病势危重，还引用伤寒书，等待用药，不知道病人竟会因剧痛而顷刻死亡！痛在经络的，轻而易治；痛在脏腑的，重而难疗。如果是头风害眼，肝阴亏则内风动摇，邪气侵害空窍，痛在经络。头痛昏沉的，脑脏受伤则神志失守，心火不平，痛在脏腑。头痛而痰厥的，阳虚则气寒饮聚，阴虚则火炽液凝，经脉不通，阴阳之气不相顺接。头痛而积热在阳明，实火、实痰为患，脉洪数有力的，则利于清凉攻下。头痛而红肿、壮热、口渴，脉浮数有力的，这是大头天行时热之邪，应从疫病法治。头痛而手足寒冷，且青色至关节，脉悬悬欲绝的，这是危脱之证。早晨发作晚上死，晚上发作早晨死，药物也不能治疗。（出自《会心录》）
头痛应当先审辨病程久暂，其次辨别表里。大概暂时疼痛的一定因邪气，长久疼痛的一定兼有元气虚弱。就暂时疼痛而言，有表邪的，是风寒外袭于经络，治疗宜疏散，最忌清降；有里邪的，是三阳之火炽盛于内，治疗宜清降，最忌升散。这是治邪的方法。那些长久疼痛的，则或发作、或痊愈。有的因表虚，微感邪气则发作；有的因阳胜，微热则发作；有的因水亏于下，虚火乘之则发作；有的因阳虚于上，阴寒胜之则发作。所以暂时疼痛者当重视邪气，长久疼痛者当重视元气，这固然是大纲。然而也有暂时疼痛而属虚的，长久疼痛而属实的，又应当根据脉象、症状详细辨别。（张景岳）
头为诸阳之会，与厥阴肝脉会于巅顶。诸阴寒邪不能上逆，只有阳气窒塞，浊邪得以占据上部，厥阴风火才能逆上作痛。所以头痛一证，皆由清阳不升，火风乘虚上入所致。如阳虚浊邪阻塞，气血瘀痹者，用虫蚁类药搜逐血络、宣通阳气。火风变动，与暑风邪气上郁者，用荷叶、苦丁茶、蔓荆子、山栀等，轻清辛散。阴虚阳越者，用复脉汤、甘麦大枣法，加阿胶、白芍、牡蛎，镇摄益虚，和阳熄风。厥阴风木上浊者，用首乌、柏子仁、黑豆、甘菊、白芍、枸杞辈，熄肝风、滋肾液。○头风一证，有偏正之分。偏头痛主乎少阳，而风淫火郁为多。前人立法，以柴胡为要药，无奈对于阴虚火浮、气升吸短的患者，使用柴胡则会导致厥脱。先生则以桑叶、丹皮、栀子、荷叶轻清凉泄。久则伤及肝阴，参入咸凉柔镇之品。所谓正头痛，有气虚、血虚、痰厥、肾厥、阴伤阳浮、火亢邪风的不同。至于肝阴久耗，内风日旋，厥阳无一息之安，痛掣之势已极，只给予复脉汤的纯甘壮水，阿胶、黄柏的柔婉，以熄风和阳。（出自《临证指南》）
医书将头痛、头风分为两门，然而其实是同一疾病，只有新久、浅深之分罢了。浅而近的叫头痛，其痛突然而至，易于解散速安。深而远的叫头风，其痛作止无常，痊愈后遇触复发。都应当验证邪气来源而治疗。（出自《证治准绳》）
头痛久发，多主于痰。然而有风毒上攻者，有血虚者，有气虚者，有诸经气滞者，有六气外伤者，有劳役所伤者。有可吐者，有可下者，应当分虚实、寒热、兼证、变证而治疗。至于偏正头风，久而不愈，乃内挟痰涎，风火郁遏，经络气血壅滞。甚则目昏紧小、二便秘涩，宜砭刺出血，以开郁解表。（薛立斋）
东风生于春，病在肝。目为肝窍，肝风动则邪害空窍。有年久头风，伴急躁、目赤、眩晕者，是肺金乘肝、气郁血壅所致。治疗宜清上彻下之法。世人不知此理，专行苦寒，使火无发越，上攻于目；或专行辛散，使血耗火炎，上瘀于目。必然伤害眼睛。（出自《证治汇补》）
头痛有久痛感寒便发的，外用重绵包裹的，这属于郁热。盖本热而标寒也。因其本有郁热，毛窍常开，风寒易入，束其内火，闭逆为痛。唯有泻火凉血，佐以辛凉散表。（王纶）
头痛引经药：太阳经，羌活；阳明经，白芷；少阳经，柴胡；太阴经，苍术；少阴经，细辛；厥阴经，吴茱萸。○头痛用羌活、防风、川芎、升麻、柴胡、细辛、藁本的异同，是区分各经祛风。用黄芩、黄连、知母、黄柏、石膏、生地的异同，是区分各脏泻火。用茯苓、泽泻的，是导湿。用人参、黄芪的，是补气。用当归、生地的，是养血。（汪昂）
白术半夏天麻汤，是治疗痰厥头痛的药；青空膏，是治疗风湿热头痛的药；活附子汤，是治疗厥阴头痛的药。如湿气在头者，用苦味药催吐，不可固执一方而治。（李东垣）
痰厥头痛，非半夏不能除；头旋眼黑，虚风内作，非天麻不能解。普通人头痛，属痰火居多。肥人多湿痰，宜二陈汤加苍术；瘦人多血虚有火，宜酒炒黄芩、黄连、薄荷、川芎、当归，巅顶痛加藁本。（出自《医学六要》）
头痛不可专泥于风药，否则愈虚其虚，使风入于脑，永不可拔。也不可偏于逐火，使风火上乘空窍而从眼出，如腐之风火相扇而成衣焉。（出自《冯氏锦囊》）
凡治头痛多用辛温气药的，是由于风木不得升发，土寡于畏，是以壅塞而痛，故用此助肝木，散其壅塞也。若疏散太过而痛反甚者，又宜酸收以降之。东垣说：高巅之上，惟风可到。味之薄者，阴中之阳，自地升天者也，所以头痛皆用风药，总其大体而言。然而患头痛者，血必不足，风药最能燥血，故有愈治而愈甚者，此其要尤在养血，不可不审也。（王宇泰）
(Attached: Thunderhead Wind, Head Resonance, Head Trembling, Heavy Head)
[Scriptural Principles]
Therefore, when the Qi of Spring causes disease, the pathology is located in the head. ○ If headache persists for years without cessation, it indicates exposure to severe Cold, which has penetrated inward to the bone marrow. The bone marrow is governed by the brain; when Brain Qi rebels upward, it causes headache, and the teeth also hurt. This condition is named Jue Ni (Rebellious Counterflow). ○ Headache and diseases of the vertex belong to "Deficiency below and Excess above," with the pathological focus on the Foot Shaoyin Kidney Meridian and the Foot Taiyang Bladder Meridian. ○ Heart vexation accompanied by headache indicates pathology in the Diaphragm Middle, involving the Hand Taiyang Small Intestine Meridian and the Hand Shaoyin Heart Meridian. ○ Headache with tinnitus and dysfunction of the nine orifices arises from disorders of the Stomach and Intestines. (From *Suwen*)
True Tou Tong (True Headache) involves severe headache where pain permeates the entire brain, with cold hands and feet extending to the joints. This is a fatal condition that cannot be treated. (From *Lingshu*)
[Philosophical Discourses]
Headache is categorized into Zheng Tou Tong (Central Headache), Pian Tou Tong (Lateral Headache), Feng Han Tou Tong (Wind-Cold Headache), Shi Re Tou Tong (Damp-Heat Headache), Jue Ni Tou Tong (Jue-Ni Headache), Tan Jue Tou Tong (Phlegm-Jue Headache), Re Jue Tou Tong (Heat-Jue Headache), Shi Jue Tou Tong (Damp-Jue Headache), Qi Jue Tou Tong (Qi-Jue Headache), Zhen Tou Tong (True Headache), and Zui Hou Tou Tong (Post-drunkenness Headache). Additionally, there are Nao Feng (Brain Wind) and Shou Feng (Head Wind); smoke from charcoal stoves can also induce headache. (From *Dongyi Bobian*)
Exogenous headache feels as if the head is breaking or splitting, with no respite; endogenous headache has a milder intensity, appearing intermittently. (From *Jianwen Lu*)
Taiyang Meridian Headache: Aversion to wind and cold, floating-tight pulse, pain located at the vertex and lateral temples. Shaoyang Meridian Headache: Alternating chills and fever, wiry-thin pulse, pain radiating to the root of the ear. Yangming Meridian Headache: Fever with spontaneous sweating, large-long pulse, pain radiating to the eyes, cheeks, and teeth. Taiyin Meridian Headache: Presence of phlegm, heavy body, sinking-slow pulse. Shaoyin Meridian Headache: Cold feet with rebellious Qi, sinking-thin pulse. Jueyin Meridian Headache: Vomiting frothy saliva, cold limbs, floating-slow pulse, pain drawing into the eye cords. These six-meridian headaches are all caused by concurrent exogenous pathogens. (From *Dongyuan Shishu*)
Pain due to Wind involves twitching and aversion to wind; pain due to Summerheat involves heart vexation and aversion to heat; pain due to Cold involves tightness, aversion to cold, and shivering; pain due to Dampness involves heaviness of the head, worsening on cloudy days; pain due to Phlegm involves dizziness and nausea; Qi Deficiency headache worsens with exertion, presenting with a large but empty pulse; Blood Deficiency headache radiates to the temporal corners (fish tails), accompanied by palpitations, presenting with a Kou (hollow) pulse. If various medications fail, this indicates pathology of the Du Mai (Governing Vessel). (Luo Qianfu)
*Neijing* states: Headache and vertex diseases involve deficiency below and excess above, affecting the Foot Shaoyin and Juyang (Taiyang), and severely entering the Kidney. Symptoms include dizziness ("Meng Zhao You"), blindness, and deafness, indicating excess below and deficiency above, affecting the Foot Shaoyang and Jueyin, and severely entering the Liver. Commentary: "Deficiency below" refers to Kidney Deficiency, which causes headache. "Deficiency above" refers to Liver Deficiency, which causes dizziness. "Meng Zhao You" describes a sensation of something covering the head, causing unsteadiness. Blindness and deafness are manifestations of vertigo. Liver Deficiency vertigo differs significantly from Kidney Jue vertex headache. (Lou Quanshan)
In the syndrome of headache, patients often neglect it considering it minor, while physicians mistakenly treat it all as Shanghan (Cold Damage) indiscriminately. Therefore, differentiation must be performed early. Classics state that both exogenous and endogenous conditions cause headache; how can they be treated identically without distinction? Exogenous headache involves Yang and Yin meridians. Taiyang, Yangming, and Shaoyang headaches belong to Yang meridians; Jueyin headache belongs to Yin meridians. Initially, there is chills and fever, back soreness, neck stiffness, or pain in the eyes/forehead or ears/flanks, with a tight-numerous pulse. Jueyin headache presents without fever, with vomiting and frothy saliva. If a person without prior headache suddenly develops acute pain accompanied by exterior signs, and massage/binding does not stabilize the pain, it is exogenous headache. Treatment should target Fengchi (GB20) and Fengfu (GV16) acupoints to harmonize Yin and Yang. Sweating resolves exterior pathogens; dispersing herbs treat the vertex; clearing heat treats Yang meridians; warming treats Yin meridians. Endogenous headache involves Yin Deficiency and Yang Deficiency. Fire rising to the vertex causes pain, accompanied by internal vexation/heat, red face, thirst, constipation, and a large-numerous but empty or thin-numerous-wiry pulse, indicating Yin Deficiency. Cold rushing to the Marrow Sea causes pain, accompanied by photophobia/cold aversion, cold extremities, pale/gloomy complexion, loose stools, and a thin-slow-micro or deficient-large-weak pulse, indicating Yang Deficiency. Initially, there is no chills/fever, but fatigue and poor appetite. If a person with chronic headache suddenly experiences acute pain without exterior signs, and massage/binding provides slight relief, it is endogenous headache. Treatment should focus on the Water and Fire organs (Heart and Kidney), harmonizing Ying and Wei, tonifying True Yin and benefiting Original Yang. Pathology is above, but treatment is below. The Clear Yang Qi of the Six Fu Organs and the Essence-Blood of the Five Zang Organs converge at the head, the highest and purest region, hence called "Yuan Shou" (Chief Head). It is supreme and inviolable. If invaded by exogenous Wind-Cold-Fog-Dew, or by endogenous Phlegm-Fire-Damp-Heat, or suffering from Lateral/Central Head Wind, the pain does not kill within days. Those who die within days suffer from Endogenous True Headache. The brain is the Spirit Organ, called Niwan Palace, storing essence and marrow. When Jing-Qi is solid below, the Marrow Sea is full above. When Spirit is guarded internally, how can disease arise? Yet people treat wine as water, make recklessness their norm, exhaust essence through lust, and dissipate truth. This leads to insufficient Kidney Yin with rebelling Yin Fire, and weak Kidney Yang allowing Cold Qi to invade the brain. Physicians failing to understand this use warming and dispersing methods. Since Yin is already deficient, using warming methods further depletes True Yin. Since Yang is already deficient, using dispersing methods further depletes True Yang. No wonder complications arise: extreme pain leading to Jue collapse, unconsciousness, fixed gaze, locked jaw, black tongue, Dai Yang (false flush on cheeks), and limb convulsions. At this time, if one truly knows it is Yin Deficiency, use Liuwei Guishao Tang (Six-Ingredient Decoction with Rehmannia, Cinnamon Twig, Moutan, Alisma, Poria, and Cornus) plus Ginseng and Child's Urine to strengthen the source of Water to suppress Solar Fire. If one truly knows it is Yang Deficiency, use Bawei Yangxue Tang (Eight-Ingredient Blood-Nourishing Decoction, likely referring to Jin Gui Shen Qi Wan variations) plus Ginseng and Deer Antler to benefit the source of Fire to eliminate Yin Shadows. This condition is particularly common in women with empty Blood Seas; how can one not urgently tonify Yuan Qi? Regrettably, mediocre practitioners do not understand that Liver-Kidney are the source of the Marrow Sea, and Jing-Qi is the root of the Spirit Store. Seeing headache, they universally diagnose Shanghan. By the time the condition is critical, they still cite Shanghan texts, waiting for medication, unaware that the patient may die instantly from severe pain. Pain in meridians is light and easy to treat; pain in organs is heavy and difficult to cure. If Head Wind harms the eyes, Liver Yin deficiency causes internal Wind shaking, pathogenic factors harming empty orifices, pain is in the meridians. Headache with dizziness indicates Brain organ injury, loss of Spirit control, and uncalmed Heart Fire, pain is in the organs. Headache with Phlegm Jue indicates Yang Deficiency leading to Cold Qi and fluid accumulation, or Yin Deficiency leading to blazing Fire and coagulated fluids, meridian blockage, and failure of Yin-Yang connection. Headache with accumulated Heat in Yangming, caused by Excess Fire and Phlegm, with a洪-numerous-strong pulse, benefits from cooling purgatives. Headache with redness/swelling, high fever, thirst, and floating-numerous-strong pulse indicates Da Tou Tian Xing (Big Head Epidemic) seasonal heat pathogen, requiring epidemic treatment. Headache with cold extremities, cyanosis up to joints, and pulse hanging like a thread about to vanish indicates critical collapse. Death occurs morning-to-evening or evening-to-morning; drugs cannot treat this. (From *Huixin Lu*)
Headache requires first assessing duration, then distinguishing Exterior/Interior. Acute pain is definitely due to pathogenic factors; chronic pain definitely involves Qi Deficiency. Regarding acute pain: Exterior pathogens indicate Wind-Cold attacking meridians, treated by dispersing, strictly avoiding descending/clearing. Interior pathogens indicate blazing Fire of Three Yang meridians, treated by descending/clearing, strictly avoiding ascending/dispersing. This is the method for treating pathogens. For chronic pain, symptoms fluctuate. Some flare due to Exterior Deficiency with slight pathogen exposure; some due to Yang Excess with slight heat; some due to Water Deficiency below with vacuous Fire attacking; some due to Yang Deficiency above with Yin-Cold prevailing. Thus, acute pain emphasizes pathogens, chronic pain emphasizes Yuan Qi. This is the general principle. However, acute pain can be Deficient, and chronic pain can be Excess; detailed differentiation based on pulse and symptoms is necessary. (Zhang Jingyue)
The head is the convergence of all Yang meridians and meets the Jueyin Liver Meridian at the vertex. Yin-Cold pathogens cannot rebel upward; only when Yang Qi is obstructed can Turbid Pathogens occupy the upper region, allowing Jueyin Wind-Fire to rebel upward and cause pain. Therefore, headache is always caused by failure of Clear Yang to ascend, with Fire-Wind taking advantage of deficiency to enter upward. In cases of Yang Deficiency with Turbid Pathogen obstruction and Qi-Blood stasis, use insect/ant-like herbs to search blood collaterals and unblock Yang Qi. In cases of Fire-Wind movement and Summer-Wind pathogen stagnation, use Lotus Leaf, Kuding Cha, Vitex Fruit, Gardenia, etc., for light-clearing and pungent-dispersing. In cases of Yin Deficiency with Yang Hyperactivity, use Fumai Tang (Restore the Pulse Decoction) or Ganmai Dazao Fa, plus Ejiao, White Peony, Oyster Shell, to anchor and tonify deficiency, harmonize Yang, and extinguish Wind. In cases of Jueyin Wind-Wood turbidity, use Polygonum Multiflorum, Biota Seed, Black Soybean, Chrysanthemum, White Peony, Goji Berry, etc., to extinguish Liver Wind and nourish Kidney Fluid. ○ Head Wind has lateral and central types. Lateral type relates to Shaoyang, mostly Wind-Flaring and Fire-Stagnation. Predecessors used Chai Hu (Bupleurum) as the key herb; however, in patients with Yin Deficiency, floating Fire, and shortness of breath, Chai Hu can lead to Jue collapse. Our master uses Mulberry Leaf, Moutan, Gardenia, Lotus Leaf for light-cooling and clearing. Long-term use damages Liver Yin, so add salty-cool softening and anchoring agents. Central headache varies by Qi Deficiency, Blood Deficiency, Phlegm Jue, Kidney Jue, Yin Injury with Yang Floating, and Fire Excess with External Wind. In cases of long-term Liver Yin consumption, daily internal Wind rotation, and no peace for Jue Yang, with extreme pulling pain, only Pure Sweet Tonification of Water (Fumai Tang style), plus Ejiao and Huang Bo for softness, can extinguish Wind and harmonize Yang. (From *Linzheng Zhinan*)
Medical books separate Headache and Head Wind into two categories, but it is the same disease, differing only in new/chronic and shallow/deep. Shallow and recent is Headache, sudden onset, easily resolved. Deep and distant is Head Wind, intermittent pain, recurring upon trigger. Treatment depends on verifying the origin of the pathogen. (From *Zhengzhi Zhunsheng*)
Chronic headache is mostly due to Phlegm. However, there are cases of Wind-Toxin attacking upward, Blood Deficiency, Qi Deficiency, Qi Stagnation in various meridians, Exogenous Six Qi, and Labor/Fatigue injury. Some require emesis, some require purgation. Treatment must distinguish Deficiency/Excess, Cold/Heat, Concurrent/Variable syndromes. For chronic Lateral/Central Head Wind, internal Phlegm-Saliva, stagnant Wind-Fire, and meridian Qi-Blood congestion occur. Severe cases present with dim vision, small pupils, constipation/urinary difficulty. Pricking to bleed is indicated to open stagnation and release the exterior. (Xue Lizhai)
East Wind generates in Spring, disease affects the Liver. The Eye is the orifice of the Liver; Liver Wind movement allows pathogens to harm empty orifices. Chronic Head Wind with irritability, red eyes, and vertigo is caused by Metal insulting Wood, Qi Stagnation, and Blood Congestion. Treatment requires clearing above and penetrating below. People ignorant of this principle use only bitter-cold herbs, trapping Fire so it attacks the eyes; or use only pungent-dispersing herbs, consuming Blood and flaring Fire, causing congestion in the eyes. This inevitably harms the eyes. (From *Zhengzhi Huibu*)
Headache triggered by Cold after long-term occurrence, relieved by wrapping in thick cotton, belongs to Stagnant Heat. The root is Heat, the branch is Cold. Due to underlying Stagnant Heat, pores are open, allowing Wind-Cold to enter, binding internal Fire and causing rebellion/pain. Treatment requires draining Fire and cooling Blood, assisted by pungent-cool exterior-releasing herbs. (Wang Lun)
Headache Channel-Guiding Herbs: Taiyang, Qiang Huo (Notopterygium); Yangming, Bai Zhi (Angelica Dahurica); Shaoyang, Chai Hu (Bupleurum); Taiyin, Cang Zhu (Atractylodes Lancea); Shaoyin, Xi Xin (Asarum); Jueyin, Wu Zhu Yu (Evodia). ○ Differences in using Qiang Huo, Fang Feng, Chuan Xiong, Sheng Ma, Chai Hu, Xi Xin, Gao Ben relate to dispelling Wind in specific meridians. Differences in using Huang Qin, Huang Lian, Zhi Mu, Huang Bo, Shi Gao, Sheng Di relate to draining Fire in specific organs. Using Fu Ling, Ze Xie guides out Dampness. Using Ren Shen, Huang Qi tonifies Qi. Using Dang Gui, Sheng Di nourishes Blood. (Wang Ang)
Baizhu Banxia Tianma Tang treats Tan Jue Headache; Qing Kong Gao treats Wind-Damp-Heat Headache; Huo Fu Zi Tang treats Jueyin Headache. If Dampness is in the head, use bitter herbs to induce vomiting; do not stick rigidly to formulas. (Li Dongyuan)
Tan Jue Headache cannot be removed without Ban Xia (Pinellia); Vertigo and blurred vision due to internal Vacuous Wind cannot be resolved without Tian Ma (Gastrodia). Common people's headache is mostly due to Phlegm-Fire. Obese people mostly have Damp-Phlegm, suitable for Er Chen Tang plus Cang Zhu. Thin people mostly have Blood Deficiency with Fire, suitable for wine-fried Huang Qin, Huang Lian, Bo He, Chuan Xiong, Dang Gui; add Gao Ben for vertex pain. (From *Yixue Liuyao*)
Headache treatment should not rely solely on Wind herbs, as this further depletes deficiency and allows Wind to enter the brain, becoming incurable. Nor should one偏 (bias) towards draining Fire, allowing Wind-Fire to attack empty orifices and exit through the eyes, like rotting wind-fire fanning clothes. (From *Fengshi Jinnang*)
Treating headache with pungent-warm Qi herbs is because Wind-Wood fails to ascend, Earth lacks fear/control, causing congestion and pain; these herbs assist Liver Wood and disperse congestion. If excessive dispersal worsens pain, sour-astringent herbs should be used to descend. Dongyuan said: "Above the high vertex, only Wind can reach." Herbs with thin flavors are Yang within Yin, rising from earth to heaven; thus, Wind herbs are generally used for headache. However, headache patients invariably have Blood Deficiency; Wind herbs are drying to Blood, so treatment may worsen the condition. The key lies in nourishing Blood, which must be carefully considered. (Wang Yutai)