罗谦甫治柏参谋。六十一岁。初患头昏闷微痛。医作伤寒治。汗后其痛弥笃。再汗之。
不堪其痛矣。易医用药。大都相近。甚至痛不能卧。且恶风寒。不喜饮食。罗诊之。六脉弦
细而微。气短促。懒言语。内经云。春气者。病在头。今年高气弱。清气不能上升头面。故
昏闷耳。且此证本无表邪。汗之过多。则清阳之气愈亏。不能上荣。亦不得外固。所以头痛
楚而恶风寒。气短弱而憎饮食。以黄 一钱五分。人参一钱。炙甘草七分。白术、陈皮、归
芍各五分。升、柴各三分。细辛、川芎、蔓荆子各二分。名之曰顺气和中汤。食后进之。一
饮而病减。再饮而病却。
戴人治一妇。头偏痛五七年。大便燥结。双目赤肿。眩晕。凡疗头风之药。靡所不试。
且头受针灸无数。戴人诊之。急数而有力。风热之甚也。此头角痛是三焦相火之经。乃阳明
燥金胜也。燥金胜乘肝则肝气郁。肝气郁则气血壅。气血壅则上下不通。故燥结于中。寻至
失明。以大承气汤倍加芒硝。下泄二十余行。次服七宣丸、神功丸以润之。目豁首轻。燥泽
结释而愈。
薛立斋治刘尚宝。怒则太阳作痛。用小柴胡加茯苓、山栀以清肝火。更用六味以生肾水
遂不复作。
李士材治少宰蒋恬庵。头痛如破。昏重不宁。风药血药痰药。久治无功。李曰。尺微寸
滑。肾虚水泛为痰也。地黄四钱。山药、丹皮、泽泻各一钱。茯苓三钱。沉香八分。日服四
帖。两日辄减六七。更以七味丸。人参汤送。五日其痛若失。
孙东宿治蔡乐门令眷。头痛如破。发根稍动。则痛延满头。晕倒不省人事。逾半时乃苏
遍身亦作疼。胸膈饱闷。饮汤水。停膈间不下。先一日吐清水数次。蛔虫三条。原为怒
起。今或恶风。或恶热。口或渴或不渴。大便秘。脉则六部皆滑大有力。孙曰。此痰厥头痛证
也。先以藿香正气散止其吐。继以牛黄丸、黑虎丹清其人事。头仍疼甚。又以天麻、 本各
三钱。半夏二钱。麻黄、薄荷、白芷、陈皮、生姜、葱白煎服。得少汗而头痛少止。至晚再
服之。五更痛止大半。而人事未全清。孙谓此中焦痰盛。非下不可。乃用半夏五钱。巴霜一
分。面糊丸。每服三十丸。生姜汤送下。午后大便行三次。皆稠粘痰积也。由此饮食少进。
余证差可。惟遍身仍略疼。改用二陈汤加前胡、 本、薄荷、黄芩、石膏、枳壳、石菖蒲
调理而安。
僧慎柔治一贵介。年三旬。先因齿痛。用石膏三钱煎服。顷即满头皆肿痛。牙龈上 。
肿势尤甚。天明稍退。盖得阳气故也。诊之右关细涩。左关洪。左尺亦涩。慎柔谓须纳气下
达。方得脉和。定方名羌活散火汤。羌活酒炒五分。防风三分。酒连一分。酒芩二分。白茯
苓一钱。人参二钱。甘草五分。半夏一钱。破故纸一钱。枸杞子一钱。二剂。其细涩脉即粗
大。是阳气下行矣。头痛稍止。可见前头痛是下焦无阳。阴火上冲。服至八剂。头痛全止。
齿根肿犹未退。脉则益和。曰。将愈矣。此阳气已至恙所。果四五日后。出脓少许而瘳。
震按罗案是气虚头痛。张案是积热头痛。薛案是肝火头痛。李案是肾虚头痛。孙案是痰
厥头痛。僧案是阳升不降头痛。六种之外。又有因风痛者。抽掣恶风。鼻塞眼胀。因寒痛者
恶寒战栗。面惨肢冷。因湿痛者。头痛且重。天阴转甚。或四肢疼肿。面目浮肿。此皆外
因也。内因则气虚之外。血虚更多。积痰之外。积食亦有。丹溪云。肥人头痛。多是湿痰。
瘦人头痛。多是血虚有火。斯诚要言。然因虽数端。靡不兼风。无风人只作眩不作痛也。故
古方中川芎茶调散、大追风散。颇亦取效。痛久则成头风。其方更繁。不能缕述。真头痛乃
死证。外灸百会穴。内进参附汤、黑锡丹。或冀挽回。实未试验。寻常头痛亦有死者。高阳
生云。头痛短涩应须死。生平曾见之矣。头与腹俱痛有五证。臭毒、伤酒、伤湿、不伏水土
疮毒入腹也。有头痛止则腹痛。腹痛止则头痛。此属脾阴虚。胃火随气上下。芎、归、芍
药、木香、香附、黄连、葱白。又有头痛诸药不效。其痛更甚者。或因督脉为病。宜用茸朱
丹。次则香茸八味丸。复有雷头风。另是一项。乃内郁痰火。外束风热。大头风即大头瘟。
或痛或不痛。或溃或自消。死生反掌。至如眉棱骨痛。系足少阳风热与痰。最能伤目。至两
耳出脓则危矣。宜以浓茶一碗探吐之。次用清上药。如选奇汤、清空膏之类。妇人注目针绣
往往眉骨酸痛。必须益阴养血。
〔附〕子和治一僧头热而痛。且畏明。以布围其顶上。置冰于其中。日数易之。此三阳
蓄热故也。复灼炭火于暖室。出汗涌吐。三法并行。至七日而瘥。
一人稚年气弱。于气海三里穴时灸之。及长。成热厥头痛。虽严冬喜朔风吹之。其患辄
止。少处暖及近烟火。其痛即作。此灸之故也。东垣治以清上泻火汤。寻愈。
一室女近窗做女工。忽患头疼甚。诸药不效。一医徐察之。窗外畜鹅。知为鹅虱飞入耳
内咬而痛也。以稻秆煎浓汁灌之。虱死而出。遂不痛。
一人患头风。自颐下左右。有如两蚯蚓徐行入耳。复从耳左右分上顶。左过右。右过左
顶上起疙瘩二块。如猪腰然。前后脑如鼓声 然。冷痛甚。须重绵帕裹包。疼甚四肢俱
不为用。医效罔奏。后得一方。用四物各一钱。皂角刺一钱。萆 四两。猪肉四两。水煎。
去药渣。将汁同肉食之。服至二十剂。减十之三。四十剂。减十之六。百剂乃安。江氏曰。
此非头风也。其人曾患霉疮。头块坟起。皆轻粉结毒。故萆 为君。四物养血。皂刺为引。
其毒深。故多服取效也。
震按萆 当是土茯苓。广笔记治霉疮头痛方更佳。但治病必以脉为凭。丹方有效有不效
且录之不胜录。上四条虽不载脉。然证颇疑难。法殊整暇。定当入选。他如江篁南治从婶
以补中益气加川芎、细辛、蔓荆子。翟文炳治陆母。先与抑青丸。继以补中益气二条。只
叙见证。未可摹仿。且陆母证甚繁杂。抑青丸一服而愈。其然岂其然乎。
又南唐书载其相冯延己。苦脑中痛累日不减。太医令吴廷绍。密诘厨人曰。相公平日嗜
何等物。对曰。多食山鸡鹧鸪。廷绍曰。吾得之矣。投以甘豆汤而愈。盖山鸡鹧鸪。皆食乌
豆、半夏。故以此解其毒。
震按此与名医录所载王夫人面上忽生黑斑点。日久满面皆黑。识者云。病因日食斑鸠。
而斑鸠尝食半夏苗。故中其毒。乃用生姜一片捣汁。将滓焙干。却用生姜汁煮糊丸。服一月
愈。其搏物同而用药之辛甘温平不同矣。
罗谦甫治疗柏参谋。患者六十一岁。起初患头昏闷微痛。医生当作伤寒治疗。发汗后疼痛更加剧烈。再次发汗。
患者无法忍受这种疼痛了。更换医生用药。药方大多相近。甚至痛到不能躺卧。并且恶风寒。不喜欢饮食。罗谦甫诊察他。六脉弦细而微。气短促。懒于言语。《内经》说。春天的气机。病位在头部。今年高天之气弱。清气不能上升到头面。所以昏闷。况且这个证候本来没有表邪。发汗过多。则清阳之气更加亏损。不能上荣（滋养）。也不能外固（护卫肌表）。所以头痛楚且恶风寒。气短弱且厌恶饮食。用黄芪一钱五分。人参一钱。炙甘草七分。白术、陈皮、当归、白芍各五分。升麻、柴胡各三分。细辛、川芎、蔓荆子各二分。命名为顺气和中汤。饭后服用。喝一次病减轻。再喝一次病痊愈。
戴人治疗一位妇女。头部偏侧疼痛五七年。大便燥结。双目赤肿。眩晕。凡是治疗头风的药。没有不试过的。而且头部接受过无数针灸治疗。戴人诊察她。脉象急数而有力。是风热非常严重。这头角痛属于三焦相火的经脉。是阳明燥金胜克所致。燥金胜克乘袭肝木则肝气郁结。肝气郁结则气血壅滞。气血壅滞则上下不通。所以燥结在中焦。寻至失明。用大承气汤加倍芒硝。泻下二十多次。随后服用七宣丸、神功丸以润肠通便。眼睛明亮头脑轻松。燥结解除而痊愈。
薛立斋治疗刘尚宝。发怒时太阳穴作痛。用小柴胡汤加茯苓、山栀以清肝火。再用六味地黄丸以滋肾水。于是不再发作。
李士材治疗少宰蒋恬庵。头痛如破。昏重不安宁。风药、血药、痰药。久治无功。李士材说。尺脉微弱寸脉滑。是肾虚水泛为痰。用地黄四钱。山药、丹皮、泽泻各一钱。茯苓三钱。沉香八分。每日服四帖。两天就减轻六七成。再用七味丸。用人参汤送服。五天疼痛消失。
孙东宿治疗蔡乐门令的眷属。头痛如破。发根稍动。则疼痛蔓延满头。晕倒不省人事。过了半个时辰才苏醒。遍身也作疼。胸膈饱闷。饮水停膈间不下。前一天吐清水数次。吐出蛔虫三条。原本因愤怒而起。现在有时恶风。有时恶热。口有时渴有时不渴。大便秘。脉象六部皆滑大有力。孙东宿说。这是痰厥头痛证。先用藿香正气散止其呕吐。继以牛黄丸、黑虎丹清心开窍。头仍疼甚。又用天麻、藁本各三钱。半夏二钱。麻黄、薄荷、白芷、陈皮、生姜、葱白煎服。得少许汗而头痛稍止。到了晚上再服。五更时分痛止大半。但神志未全清。孙东宿说这是中焦痰盛。非攻下不可。于是用半夏五钱。巴豆霜一分。面糊为丸。每服三十丸。生姜汤送下。午后大便行三次。都是稠粘痰积。由此饮食稍进。其余症状尚可。只是遍身仍略疼。改用二陈汤加前胡、藁本、薄荷、黄芩、石膏、枳壳、石菖蒲调理而安。
僧慎柔治疗一位贵族子弟。年三十岁。先前因齿痛。用石膏三钱煎服。不久即满头皆肿痛。牙龈上溃烂。肿势尤其严重。天明稍退。因为得到阳气的原因。诊察他右关脉细涩。左关脉洪。左尺脉亦涩。慎柔说必须纳气下达。才能使脉和。定方名羌活散火汤。羌活酒炒五分。防风三分。酒黄连一分。酒黄芩二分。白茯苓一钱。人参二钱。甘草五分。半夏一钱。补骨脂一钱。枸杞子一钱。两剂后。细涩脉即变粗大。是阳气下行矣。头痛稍止。可见前头痛是下焦无阳。阴火上冲。服药至八剂。头痛全止。齿根肿犹未退。脉则益和。说。快要痊愈了。这是阳气已到达病所。果然四五日后。出脓少许而痊愈。
俞震按：罗案是气虚头痛。张景岳案（注：原文此处“张案”疑指代不明或漏字，结合上下文及常见医案分类，通常指张景岳或泛指某张姓医家，此处依原文直译）是积热头痛。薛案是肝火头痛。李案是肾虚头痛。孙案是痰厥头痛。僧案是阳升不降头痛。六种之外。又有因风痛者。抽掣恶风。鼻塞眼胀。因寒痛者恶寒战栗。面惨肢冷。因湿痛者。头痛且重。天阴转甚。或四肢疼肿。面目浮肿。此皆外因也。内因则气虚之外。血虚更多。积痰之外。积食亦有。朱丹溪说。肥人头痛。多是湿痰。瘦人头痛。多是血虚有火。这确实是精辟之言。然而病因虽多端。无不兼夹风邪。无风之人只作眩不作痛也。所以古方中川芎茶调散、大追风散。颇有效验。痛久则成头风。其方更繁。不能一一叙述。真头痛乃是死证。外灸百会穴。内进参附汤、黑锡丹。或许希望挽回。实际未经验证。寻常头痛也有死者。高阳生说。头痛短涩应须死。生平曾见过这种情况。头与腹俱痛有五证。臭毒、伤酒、伤湿、不服水土、疮毒入腹也。有头痛止则腹痛。腹痛止则头痛。这属于脾阴虚。胃火随气上下。用川芎、当归、芍药、木香、香附、黄连、葱白。又有头痛诸药不效。其痛更甚者。或因督脉为病。宜用茸朱丹。其次用香茸八味丸。又有雷头风。另是一类。乃内郁痰火。外束风热。大头风即大头瘟。或痛或不痛。或溃或自消。生死反掌之间。至于眉棱骨痛。系足少阳风热与痰。最能伤目。至于两耳出脓则危矣。宜用浓茶一碗探吐之。次用清上药。如选奇汤、清空膏之类。妇人注目针绣往往眉骨酸痛。必须益阴养血。
〔附〕戴人治疗一僧人头热而痛。且畏光。用布围其顶上。置冰于其中。每天多次更换。这是三阳蓄热所致。又在暖室中灼烧炭火。出汗涌吐。三法并行。至七日而痊愈。
一人年幼时气弱。在气海、足三里穴时常艾灸。及长。成热厥头痛。虽然严冬喜欢吹北风。其患辄止。稍处暖和及近烟火。其痛即作。这是艾灸的缘故。李东垣治疗用清上泻火汤。不久痊愈。
一室女靠近窗做女工。忽患头疼甚。诸药不效。一医徐察之。窗外养鹅。知道是鹅虱飞入耳内咬而痛也。用稻秆煎浓汁灌之。虱死而出。遂不痛。
一人患头风。自颐下左右。有如两条蚯蚓徐徐爬入耳内。又从耳左右分上头顶。左过右。右过左。顶上起疙瘩两块。如猪腰然。前后脑如鼓声咚咚然。冷痛甚。须厚绵帕包裹。疼甚四肢俱不能用。医效罔奏。后得一一方。用四物汤各一钱。皂角刺一钱。萆薢四两。猪肉四两。水煎。去药渣。将汁同肉食之。服至二十剂。减十之三。四十剂。减十之六。一百剂乃安。江氏说。这不是头风。其人曾患梅毒。头块坟起。皆是轻粉结毒。故萆薢为君药。四物汤养血。皂角刺为引经药。其毒深。故多服取效也。
俞震按：萆薢当是土茯苓。广笔记治梅毒头痛方更佳。但治病必以脉为凭。丹方有效有不效。且录之不胜录。上四条虽不载脉。但证颇疑难。法殊整暇。定当入选。其他如江篁南治疗从婶以补中益气汤加川芎、细辛、蔓荆子。翟文炳治疗陆母。先与抑青丸。继以补中益气汤二条。只叙见证。不可模仿。且陆母证甚繁杂。抑青丸一服而愈。其然岂其然乎？
又南唐书载其相冯延己。苦脑中痛累日不减。太医令吴廷绍。密问厨人曰。相公平日嗜何等物。对曰。多食山鸡鹧鸪。廷绍说。我得知原因了。投以甘豆汤而愈。盖山鸡鹧鸪。皆食乌豆、半夏。故以此解其毒。
俞震按：此与名医录所载王夫人面上忽生黑斑点。日久满面皆黑。识者云。病因日食斑鸠。而斑鸠尝食半夏苗。故中其毒。乃用生姜一片捣汁。将滓焙干。却用生姜汁煮糊丸。服一月愈。其搏物同而用药之辛甘温平不同矣。
Luo Qianfu treated Advisor Bo. The patient was sixty-one years old. Initially, he suffered from dizziness, stuffiness, and slight headache. The physician treated it as Taiyang disease (disease of the Taiyang channel), and after inducing sweating, the pain became more severe. After inducing sweating again,
the patient could no longer bear the pain. A different physician prescribed medication, but the formulas were mostly similar. The pain became so severe that he could not lie down, accompanied by aversion to wind and cold, and loss of appetite. Luo Qianfu examined him and found the pulse in all six positions wiry, thin, and faint. He had shortness of breath and was reluctant to speak. The *Neijing* states: "In spring, diseases manifest in the head." This year, the clear Qi of heaven is weak, and the Clear Yang cannot ascend to the head and face, causing dizziness and stuffiness. Moreover, this syndrome originally lacked exterior pathogenic factors. Excessive sweating further depleted the Clear Yang Qi, preventing it from nourishing the upper body and securing the exterior. Thus, the headache and aversion to wind and cold occurred, along with shortness of breath, weakness, and anorexia. He prescribed Huangqi (Astragali Radix) 1.5 qian, Renshen (Ginseng Radix) 1 qian, Zhi Gancao (Honey-fried Glycyrrhizae Radix et Rhizoma) 0.7 qian, Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix), and Baishao (Paeoniae Radix Alba) each 0.5 qian, Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) each 0.3 qian, Xixin (Asari Radix et Rhizoma), Chuanxiong (Chuanxiong Rhizoma), and Manjingzi (Vittariae Spora) each 0.2 qian. It was named Shunqi Hezhong Tang (Regulating Qi and Harmonizing Middle Decoction). Taken after meals, the symptoms alleviated after one dose and resolved after a second dose.
Dairen treated a woman who had suffered from unilateral headache for five to seven years. She had dry stool constipation, red and swollen eyes, and vertigo. She had tried every medicine for treating Head Wind without success, and her head had undergone countless acupuncture treatments. Dairen examined her and found the pulse rapid, forceful, and strong, indicating severe Wind-Heat. The pain at the temporal region belongs to the Sanjiao Ministerial Fire channel, caused by the excess of Yangming Dry Metal. When Dry Metal overacts on Liver Wood, Liver Qi becomes stagnant. Stagnant Liver Qi leads to Qi and Blood congestion. Congestion blocks the upper and lower flow, causing dryness and accumulation in the middle jiao, eventually leading to blindness. He prescribed Dachengqi Tang (Major Order the Qi Decoction) with doubled Mangxiao (Natrii Sulfas), resulting in more than twenty purgative stools. Subsequently, she took Qixuan Wan (Seven-Ventilation Pill) and Shengong Wan (Divine Merit Pill) to moisten the intestines. Her vision cleared, her head felt light, and the dryness and accumulation resolved, leading to recovery.
Xue Lizhai treated Liu Shangbao. When angry, his Taiyang area (vertex/supraorbital) would hurt. He prescribed Xiaochaihu Tang (Minor Bupleurum Decoction) plus Fuling (Poria) and Zhizi (Gardeniae Fructus) to clear Liver Fire, followed by Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish Kidney Water. The condition did not recur.
Li Shicai treated Jiang Tian'an, Shaozai. He suffered from splitting headaches, heavy dizziness, and restlessness. Treatments with Wind-dispelling, Blood-invigorating, and Phlegm-resolving medicines had failed for a long time. Li said, "The Chi position pulse is faint, and the Cun position pulse is slippery. This indicates Kidney deficiency with water flooding transforming into Phlegm." He prescribed Dihuang (Rehmanniae Radix) 4 qian, Shanyao (Dioscoreae Rhizoma), Danpi (Moutan Cortex), and Zexie (Alismatis Rhizoma) each 1 qian, Fuling (Poria) 3 qian, and Chenxiang (Aquilariae Lignum) 0.8 fen. Four doses were taken daily. Within two days, the symptoms reduced by six or seven tenths. He then used Qiwu Wan (Seven-Ingredient Pill) delivered with Renshen Tang (Ginseng Decoction). After five days, the pain disappeared completely.
Sun Dongsu treated the wife of Magistrate Cai Leming. She suffered from splitting headaches; slight movement of the hair roots caused pain to spread over the entire head. She fainted and lost consciousness, recovering after half an hour. Her whole body ached. She felt fullness and oppression in the chest and diaphragm, and drinking water stopped in the diaphragm without going down. The day before, she vomited clear fluid several times and expelled three roundworms. The condition originated from anger. Now, she sometimes had aversion to wind, sometimes aversion to heat, sometimes thirst, sometimes no thirst. Her stool was constipated. The pulse in all six positions was slippery, large, and forceful. Sun said, "This is Phlegm-Jue Headache." First, he used Huoxiang Zhengqi San (Agaricus Rectifying Qi Powder) to stop vomiting. Then, he used Niuhuang Wan (Calculus Bovis Pill) and Heihu Dan (Black Tiger Elixir) to clear the mind and open the orifices. The headache remained severe. He then used Tianma (Gastrodiae Rhizoma) and Gaoben (Ligustici Chuanxiong-Rhizoma et Radix) each 3 qian, Banxia (Pinelliae Rhizoma) 2 qian, Mahuang (Ephedrae Herba), Bohe (Menthae Haplocalycis Herba), Baizhi (Angelicae Dahuricae Radix), Chenpi (Citri Reticulatae Pericarpium), Shengjiang (Zingiberis Rhizoma Recens), and Congbai (Allii Fistulosi Bulbus) decocted and administered. After obtaining slight sweating, the headache subsided slightly. Taking it again at night, by Wu Geng (3-5 AM), the pain reduced by more than half, but mental clarity was not fully restored. Sun stated, "There is excessive Phlegm in the Middle Jiao; purgation is necessary." He used Banxia (Pinelliae Rhizoma) 5 qian and Bashuang (Crotonis Seminis Extract) 1 fen, made into pills with flour paste. Each dose consisted of thirty pills, taken with Ginger Decoction. In the afternoon, she had three bowel movements consisting of thick, sticky phlegmatic accumulation. Consequently, her appetite improved, and other symptoms were manageable. However, her whole body still ached slightly. He switched to Erchen Tang (Two-Aged Decoction) plus Qianhu (Peucedani Radix), Gaoben (Ligustici Chuanxiong-Rhizoma et Radix), Bohe (Menthae Haplocalycis Herba), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Zhike (Aurantii Fructus Immaturus), and Shichangpu (Acori Tatarinowii Rhizoma) for regulation, leading to stability.
Monk Shenrou treated a noble youth, aged thirty. Previously, due to toothache, he took Shigao (Gypsum Fibrosum) 3 qian decocted. Soon after, his entire head became swollen and painful, with severe gingival ulceration and swelling. The swelling subsided slightly at dawn because Yang Qi had arrived. Examination revealed the Right Guan pulse was fine and choppy, the Left Guan pulse was surging, and the Left Chi pulse was also choppy. Shenrou said, "Qi must be guided downward to harmonize the pulse." He formulated Qianghuo Sanhuo Tang (Notopterygium Dispersing Fire Decoction): Qianghuo (Notopterygii Rhizoma et Radix) wine-fried 0.5 fen, Fangfeng (Saposhnikoviae Radix) 0.3 fen, Jiulianlian (Wine-processed Coptidis Rhizoma) 0.1 fen, Jiuqingqin (Wine-processed Scutellariae Radix) 0.2 fen, Bai Fuling (Poria) 1 qian, Renshen (Ginseng Radix) 2 qian, Gancao (Glycyrrhizae Radix et Rhizoma) 0.5 fen, Banxia (Pinelliae Rhizoma) 1 qian, Pogu Zhi (Evodiae Fructus) 1 qian, and Gouqizi (Lycii Fructus) 1 qian. After two doses, the fine and choppy pulse became coarse and large, indicating Yang Qi descending. The headache subsided slightly. This shows that anterior headache was due to lack of Yang in the Lower Jiao with Yin Fire rushing upward. After eight doses, the headache ceased completely. Gingival swelling persisted, but the pulse became more harmonious. Shenrou said, "It is nearly cured. Yang Qi has reached the site of illness." Indeed, after four or five days, a small amount of pus discharged, and he recovered.
Yu Zhen commented: Luo's case is Qi-deficiency headache. Zhang's case (Note: Text says "Zhang An", likely referring to a specific case not fully detailed here or a typo for another name, translated literally) is Accumulated-Heat headache. Xue's case is Liver-Fire headache. Li's case is Kidney-Deficiency headache. Sun's case is Phlegm-Jue headache. Monk's case is Ascending-Yang-not-Descending headache. Beyond these six types, there are Wind-pain cases: pulling sensations, aversion to wind, nasal congestion, and eye distension. There are Cold-pain cases: aversion to cold, shivering, pale face, and cold limbs. There are Damp-pain cases: heavy headache worsening on cloudy days, or limb swelling and edema of face and eyes. These are all external causes. Internal causes include, besides Qi deficiency, more frequently Blood deficiency. Besides accumulated Phlegm, there is also accumulated Food stagnation. Zhu Danxi said, "Headaches in fat people are mostly due to Damp-Phlegm. Headaches in thin people are mostly due to Blood deficiency with Fire." This is indeed essential wisdom. However, although etiologies vary, they all involve Wind. Without Wind, there is only vertigo, not pain. Therefore, ancient formulas like Chuanxiong Chatiao San (Chuanxiong Tea-Tonifying Powder) and Da Zhuifeng San (Great Wind-Chasing Powder) are quite effective. Chronic pain becomes Head Wind, with even more complex formulas, which cannot be listed here. True Headache (Zhen Tou Tong) is a fatal syndrome. External moxibustion at Baihui (GV20) and internal administration of Shenfu Tang (Ginseng and Aconite Decoction) or Heixi Dan (Black Tin Elixir) might hope for reversal, though untested. Ordinary headaches can also be fatal. Gao Yangsheng said, "Headache with short and choppy pulse indicates death." I have seen this in my life. Simultaneous headache and abdominal pain have five syndromes: Odor-Toxin, Alcohol Injury, Dampness Injury, Acclimatization Failure, and Toxin from Sores entering the abdomen. There is a pattern where headache stops then abdominal pain starts, and vice versa. This belongs to Spleen Yin Deficiency, with Stomach Fire moving up and down with Qi. Use Chuanxiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Muxiang (Aucklandiae Radix), Xiangfu (Cyperi Rhizoma), Huanglian (Coptidis Rhizoma), and Congbai (Allii Fistulosi Bulbus). For headaches unresponsive to various medicines, with worsening pain, it may be due to Du Mai (Governing Vessel) pathology, suitable for Rongzhu Dan (Velvet Antler and Cinnabar Elixir), followed by Xiangrong Bawei Wan (Fragrant Velvet Eight-Ingredient Pill). There is also Lei Tou Feng (Thunder Head Wind), a separate category, caused by internally constrained Phlegm-Fire and externally bound Wind-Heat. Da Tou Feng (Big Head Wind) is equivalent to Da Tou Wen (Big Head Plague). It may or may not hurt, may ulcerate or resolve spontaneously, with life and death hanging in the balance. Pain in the supraorbital ridge is due to Foot-Shaoyang Wind-Heat and Phlegm, most damaging to the eyes. Suppuration in both ears is critical. One should induce vomiting with a bowl of strong tea, followed by Upper-Clearing medicines such as Xuanqi Tang (Select Extraordinary Decoction) or Qingkong Gao (Clear Sky Ointment). Women focusing on needlework often suffer sore and aching supraorbital ridges, requiring nourishment of Yin and Blood.
[Appendix] Dairen treated a monk with hot and painful head, and photophobia. He wrapped cloth around the top of his head, placed ice inside, and changed it multiple times daily. This was Heat accumulation in the Three Yang channels. He then burned charcoal in a warm room to induce sweating and performed emesis. The three methods were applied simultaneously, and he recovered in seven days.
A person with weak Qi in childhood was frequently moxa-burned at Qihai (CV6) and Zusanli (ST36). As an adult, he developed Heat-Jue Headache. Even in severe winter, he preferred north winds to stop the pain. If he stayed in warm places or near fire/smoke, the pain would start. This was due to moxibustion. Li Dongyuan treated him with Qing Shang Xie Huo Tang (Clear Upper and Drain Fire Decoction), and he recovered soon.
A young unmarried woman working near a window suddenly suffered severe headache, unresponsive to medicines. A physician observed carefully and saw geese outside the window. He deduced that goose lice flew into her ear and bit her, causing pain. He poured concentrated rice straw decoction into her ear. The lice died and came out, and the pain ceased.
A person suffered from Head Wind. From the jawline left and right, it felt like two earthworms slowly crawling into the ears, then branching up to the vertex from both ears, crossing left to right and right to left. Two lumps rose on the vertex, resembling pig kidneys. The front and back of the head sounded like drumbeats when tapped, with severe cold pain. Thick cotton pads were needed for wrapping. Severe pain rendered the limbs useless. Medical efforts failed. Later, a formula was obtained: Siwu Tang ingredients each 1 qian, Zaogelaci (Gleditsiae Sinensis Spina) 1 qian, Bibo (Dioscoreae Hypoglaucae Rhizoma) 4 liang, and Pork Meat 4 liang. Decocted in water, filtered, and eaten with the juice. After twenty doses, symptoms reduced by three-tenths. After forty doses, by six-tenths. After one hundred doses, stability was achieved. Jiang said, "This is not Head Wind. The person previously suffered from Syphilis (Mei Chuang). The raised lumps on the head are toxins condensed from Calomel (Qingfen). Therefore, Bibo is the chief herb. Siwu Tang nourishes Blood. Zaogelaci acts as a guide. The toxin is deep, hence prolonged administration yields results."
Yu Zhen commented: Bibo should be Tuberosum Dioscorea Spongiosa Rhizoma (Tu Fuling). Guangji Biji has a better formula for Syphilis headache. However, treatment must rely on the pulse. Alchemical formulas have varying efficacy, and recording them all is impossible. Although the above four cases do not record pulses, the syndromes are difficult, and the methods are rigorous. They deserve selection. Others, such as Jiang Huangnan treating his aunt with Buzhong Yiqi Tang plus Chuanxiong, Xixin, and Manjingzi, and Zhai Wenbing treating Mother Lu with first Yiqing Wan then Buzhong Yiqi Tang, only describe symptoms and should not be imitated. Mother Lu's case was very complex; Yiqing Wan cured her in one dose. Is this really so?
Furthermore, the History of Southern Tang records that Chancellor Feng Yanji suffered from persistent brain pain for days. Imperial Physician Wu Tingshao secretly asked the kitchen staff, "What does the Chancellor usually crave?" They replied, "He eats much pheasant and partridge." Tingshao said, "I know the cause." He administered Gandou Tang (Sweet Bean Decoction), and he recovered. This is because pheasants and partridges eat black beans and Pinellia, so this formula resolves the toxicity.
Yu Zhen commented: This is similar to the case in Mingyi Lu where Lady Wang suddenly developed black spots on her face, spreading over time. Experts said the cause was daily eating turtle doves, which eat Pinellia seedlings, leading to poisoning. They used ginger slice crushed for juice, dried the residue, and made pills with ginger juice paste. One month of服用 cured her. The ingested object was the same, but the medicinal properties (acrid, sweet, warm, neutral) differed.