李土材曰∶经之论头痛，风也，寒也，虚也。运气论头痛十条，《伤寒论》太阳头痛一条，皆六气相
侵，与真气相搏，经气逆上，乾清道，不得营运，壅遏而痛也。头为天象，六腑清阳之气，五脏清华之血，
皆会于此。故天气六淫之邪，人气五贼之变，皆能相害。或蔽覆其清明，或瘀塞其经络，与气相搏，郁而
成热，脉满而痛。若邪气稽留，脉满而气血乱，则痛乃甚，此实痛也。寒湿所侵，真气虚弱，虽不相搏成热，
然邪客于脉外，则血泣脉寒，卷缩紧急，外引小络而痛，得温则痛止，此虚痛也。因风痛者，抽掣恶风。
因热而痛者，烦心恶热。因湿而痛者，头重而天阴转甚。因痰痛者，昏重而欲吐不休。因寒而痛者。绌急而恶
寒战栗。气虚痛者，恶劳动，其脉大。血虚痛者，善惊惕，其脉芤。
头痛自有多因，而古方每用风药。盖高巅之上，惟风可到，味之薄者，阴中之阳，自地升天者也，
在风寒湿者，固为正用，即虚与热者，亦假引经。
须知新而暴者，但名头痛；深而久者名为头风。头风必害眼者，经所谓东风生于春，病在肝，目者
肝之窍，肝风动则邪害空窍也。
头痛九窍不利属气虚，补中益气汤加芍药、川芎、细辛、眉尖后近发际曰鱼尾，鱼尾上攻头痛属血虚，
四物汤加薄荷。动作头痛，胃热也，酒炒大黄，浓茶煎服。心烦并头痛，清
空膏加麦冬、丹参。
张三锡曰∶《内经》云诸风掉眩，皆属肝木。其气虚肥白之人，湿痰滞于上，阴火起于下，是以痰挟
虚火上冲头目，正气虚不能胜敌，故忽然眼黑生花，如坐舟车而旋晕，甚而至于卒倒无所知者有之。丹溪
所谓无痰不作晕者，此也。若黑瘦之人，躯体弱，真水亏欠，或劳役过度，相火上炎，亦有时时眩晕，何湿
痰之有？《原病式》曰∶静顺清谧，水之化也；动乱劳扰，火之用也。脑者，地之所生，故藏阴于目，
为瞳子，系肾水至阴所主，二者喜静谧而恶动扰，若掉眩散乱，故脑转目眩也。治法∶肥白人作眩运，宜清痰
降火，兼补阴；黑瘦人宜滋阴降火而带抑肝之剂。亦有感风邪而为眩运者，宜祛风顺气，伐肝降火为良。
有因呕血而眩运，多是血亏气损，虚火泛上，与产后血晕同。《准绳》曰∶凡有过节，即随其所动经脏之气
而妄起。又或肾水不足，或精血伤败，不能制其五阳之火独光。或中土虚衰，不能提防下气之逆，则龙雷之
火得此震动于巅。诸火上至于头，轻则旋转为眩晕，重则搏击而为痛矣。
薛立斋曰∶头目眩运，丹溪先生曰∶眩者言其黑运旋转，其状目闭眼暗，身转耳聋，如立舟车之上，
起则欲倒。盖虚极乘寒得之，亦不可一途而取轨也。若风则有汗，寒则掣痛，暑则热闷，湿则重滞，此四气乘
虚而眩运也。若郁结生痰而眩运者，此肾虚气不归元也。若吐衄崩漏而眩运者，元气虚也，正元饮下黑锡
丹。伤湿头晕，用肾着汤加川芎。有痰用青州白丸子。头风，风热也，久则目昏；偏头风，相火也，久则目
紧便涩，皆宜出血以开表之。窃谓前症肝虚头晕，用钩藤散；肾虚头晕，六味丸。头晕吐痰，养正丹，不应，
八味丸。血虚四物参、苍、白术，不应，当归补血汤。气虚，四
君归、 ，不应，补中益气汤。肝木实，泻青丸；虚，地黄丸，不应，川芎散。脾气虚，二陈参、术、柴、
升，不应，益气汤加茯苓、半夏。脾胃有痰，半夏白术天麻汤。风痰上涌，四神散。发热恶寒，八物汤。
七情气逆，四七汤。伤寒而晕，除湿汤。
朱丹溪曰∶头眩，痰挟气虚并火。治痰为主，挟补气药及降火药。无痰则不作眩。左手脉数热多，
肺涩有死血。右手脉实有痰积，脉大是久病之人。气血俱虚而脉大，痰浊不降也。
头痛多主于痰，痛甚者火多。有可吐者，可下者。头痛可用川芎。如不愈，各加引经药∶太阳川芎，
阳明白芷，少阳柴胡，太阴苍术，少阴细辛，厥阴吴茱萸。肥人是湿痰，宜半夏、苍术；瘦人是热，宜酒制
黄芩、防风。感冒头痛，宜羌活、 本、芷。风热在上，宜天麻、蔓荆子、台芎、酒芩。肥白人是气虚，
宜黄 、生地、南星、秘藏安神汤。形瘦苍黑是血虚，宜芎、归、酒芩。如苦头痛，用细辛。顶巅痛，宜
本、防风、柴胡。且如太阳头痛，恶风，脉浮紧，川芎、羌活、独活、麻黄之属为主；少阳头痛，脉弦细，
往来寒热，柴胡为主；阳明头痛，自汗，发热恶寒，脉浮缓长实，升麻、葛根、石膏、白芷为主；太阴头痛
，必有痰，体重，或肠痛，脉沉缓，
以苍术、半夏、南星为主；少阴头痛，足寒气逆，为寒厥，其脉沉细，麻黄、附子、细辛为主；厥阴头痛，
或吐痰沫，厥冷，其脉浮缓，吴茱萸汤主之。血虚头痛，川芎、当归为主；气虚头痛，参、 为主；气血俱
虚头痛，调中益气，内加川芎、蔓荆子、细辛，其效如神。
头风，属痰者多，有热，有风，有血虚。在左属风，薄荷、荆芥；属血虚，川芎、当归。在右属痰，
苍术、半夏；属
热，酒芩为主；又，属湿痰，川芎、南星、苍术。偏头风，在左属风者，荆芥、薄荷，此二味即是治之至药。
须要察其兼见何症而佐使之，如有痰，即以二陈治痰而佐之。察识病情，全在活法。
王海藏曰∶头汗出，剂颈而还，血证也。额上偏多，何谓也？曰∶首者，六阳之所会也，故热蒸熏而头
汗出也。额上偏多，以部分，左颊属肝，右颊属肺，鼻属中州，颐属肾，额属心。三焦之火，涸其肾水，
沟渠之余，迫而上入于心之分，故发为头汗。而额上偏多者，属心之部，而为血证也。饮酒饮食头汗出者，
亦血症也。
至于杂症，相火迫肾水上行，入于心，为盗汗，或自汗，传而为头汗出者，或心下痞者，俱用血症例
治之，无问伤寒、杂症。
酒积下之而心下痞者，血症也，何以然？曰∶下之亡阴。亡阴者，则损脾胃而亡血。气在胸中，以亡
其血。陷在心之分也，故心下痞。世人以为血病，用气药导之，则痞病愈甚。而又下之，故变为中满膨胀。
非其治也。独益中州脾土，为血药治之，其治无以加矣。
王节斋曰∶久头痛，略感风寒便发，寒月须重绵浓帕包裹者，此属郁热，本热而标寒。世人不识，
率用辛温解散之剂，临时得效，误认为寒。殊不知因其本有郁热，毛窍常疏，故风寒易入，外寒束其内热，
闭逆而为痛。辛热之药，虽能开通闭逆，散其标之寒邪，然以热济热，病本益深，恶寒益甚矣。惟当泻火凉
血为主，而佐以辛温散表之剂，以从法治之，则病可愈而根可除也。
戴院使曰∶有头风眩晕，不可谓其无痛而不以为风。切宜详审，未可遽作虚治，若投补剂愈甚。别
又无疾，又非诸
般病后，卒然得此，是风晕分晓，宜小续命汤加全蝎三四个。
眼眶骨痛，有二症∶有肝虚而痛，才见光明，则眶骨痛甚，宜生熟地黄丸；又有肝经停饮一证，发则
眉棱骨痛，眼不可开，昼静夜剧，宜导痰饮，或芎辛汤去茶芽，或二陈汤吞青州白丸子。
张介宾曰∶头痛，须先审久暂，次辨表里。暂痛必因邪气，久病必兼元气。暂痛有表邪，治宜疏散，
忌清降；有里邪，治宜清降，忌升散。久病者或发或愈，或表虚，微感则发；阳胜，微热则发；或水亏于下，
虚火乘之；或阳虚于上，阴寒胜之而发，所重元气。此大纲也。亦有暂病而虚，久病而实，当以脉证辨之。
火邪痛，诸经有之，阳明为最。无表邪者，白虎汤加生地、麦冬、木通、泽泻。他经则芩、连、知、
柏。治火不宜佐以升散，外邪之火，可散而去；内郁之火，得升愈炽矣。
张景岳曰∶眩运一证，河间取《内经》诸风掉眩，皆属于肝。丹溪曰∶痰在上，火在下，火炎上而动
其痰，无痰不能作眩也。据此二说，则凡眩运，无非风火痰症也。然痰饮之症，轩岐绝不言此，但曰上气不
足，头为之倾，目为之眩；曰上虚则眩；曰督脉虚则头重高摇；曰髓海不足，则脑转耳鸣而眩冒。凡此，
岂皆痰症耶？丹溪以无痰不能作眩，余则以为无虚不能作眩。当以治虚为主，而兼酌其标。
且头痛之与头眩，有虚实之辨。《内经》分别甚明，曰∶头痛巅疾，上实下虚，为厥巅疾。此以邪气
在上，所以为痛，故曰上实也。若至眩运，则曰上气不足，又曰上虚则眩，未闻言上之实也，岂非头眩为上
虚证耶？诸家以气逆奔上，下虚上实，何与《内经》相反若此？夫眩运之症，或为头重，或为眼黑，或脑髓
旋转，不可以动。求其言实之由，不过以头
重。不知头本不重于往日，惟不胜其重者，乃甚于往日耳。上
力不胜，阳之虚也，岂上实乎？
然头眩犹有大小之异。今人气禀薄弱，或劳倦酒色，忽有耳鸣如磨，头眩眼黑，倏顷而止者，乃人
所常有之事。至于中年之外，多见眩仆卒倒等症，亦人所常有之事。但忽运即止者，皆谓头运眼花；卒倒不
醒者，必谓中风、中痰。不知忽止者，以气血未败，故旋见旋止，即小中风也。卒倒而甚，以根本既亏，
故遽病而难复，即大头眩也。于此察之，是风非风，是痰非痰，虚实从可悟矣。
然头眩虽属上虚，不能无涉于下。盖上虚者，阳中之阳虚也；下虚者，阴中之阳虚也。阳虚宜治其气，
四君子、异功散、归脾汤、补中益气汤；阴虚宜补其精，左归、右归、四物等汤主之。故伐下者，必枯其上；
滋苗者，必灌其根。当以兼补气血为最。兼火清火，兼痰清痰，有气顺气，在乎因机应变，无不当以治虚为
先也。
李士材说：《内经》论述头痛，原因有风邪、寒邪、虚损。运气学说中关于头痛的十条论述，《伤寒论》中关于太阳经头痛的一条，都是六气（风、寒、暑、湿、燥、火）相互侵扰，与人体真气相搏结，导致经络之气逆乱上行，侵犯清窍，使得气血不能正常营运，壅滞阻塞而引发疼痛。头部如同天象，六腑的清阳之气和五脏精华之血，都汇聚于此。所以，自然界六淫（风、寒、暑、湿、燥、火）之邪，以及人体内部五贼（喜怒忧思恐等情志变化或脏腑失调）之变，都能伤害头部。或者遮蔽覆盖头部的清明之气，或者瘀塞经络，与气机相搏结，郁积而成热，脉道充盈而疼痛。如果邪气稽留不去，脉道充盈且气血紊乱，那么疼痛就会加剧，这是实痛。若是寒湿侵袭，真气虚弱，虽然不相互搏结化热，但邪气客居在脉外，导致血液凝涩、经脉寒冷，经脉卷缩紧急，向外牵引细小的络脉而疼痛，遇到温暖则疼痛停止，这是虚痛。因风邪引起的头痛，表现为抽搐掣痛、怕风。因热邪引起的头痛，表现为心烦、怕热。因湿邪引起的头痛，表现为头重如裹，遇阴天加重。因痰饮引起的头痛，表现为头昏沉重、想吐不止。因寒邪引起的头痛，表现为拘急收缩、怕冷战栗。气虚引起的头痛，表现为厌恶劳动，脉象大而无力。血虚引起的头痛，表现为容易惊恐惕动，脉象芤（中空）。
头痛的原因有很多，但古方常使用风药。因为高处的头顶，只有风药能够到达，气味薄弱的药物，属于阴中之阳，是从地上升发到天的，对于风寒湿邪引起的头痛，这确实是正治之法；即使是虚证和热证，也借助它们作为引经药来引导药力上行。
需要知道的是，新近突发且短暂的，只称为头痛；深沉且久治不愈的，才称为头风。头风必定会损害眼睛，正如经文所说：“东风生于春季，病变在肝脏”，眼睛是肝的窍穴，肝风内动则邪气侵害空窍。
头痛伴有九窍不通利的，属于气虚，用补中益气汤加芍药、川芎、细辛。眉尖后方靠近发际处称为鱼尾，此处攻冲疼痛属于血虚，用四物汤加薄荷。活动后加重的头痛，是胃热所致，用酒炒大黄，浓茶煎服。心烦并伴有头痛，用清空膏加麦冬、丹参。
张三锡说：《内经》说“诸风掉眩，皆属肝木”。那些气虚且形体肥胖面白的人，湿痰停滞在上部，阴火起于下部，因此痰挟带虚火上冲头目，正气虚弱不能抵御邪气，所以突然眼前发黑、出现花影，像坐在车船中一样旋转晕眩，甚至有的突然昏倒失去知觉。这就是朱丹溪所说的“无痰不作晕”的情况。如果是形体黑瘦的人，躯体虚弱，真水亏欠，或者劳累过度，相火上炎，也会有时时眩晕的情况，哪里有湿痰呢？刘完素《原病式》说：“静顺清谧，是水的气化表现；动乱劳扰，是火的作用表现。”脑是由地气所生，所以在眼中藏阴，成为瞳子，由肾水这一至阴之物所主，这两者喜欢静谧而厌恶动扰，如果出现掉眩散乱，就会导致头脑旋转、眼睛昏眩。治疗方法：肥胖白嫩之人发生眩晕，宜清热化痰降火，兼补阴液；黑瘦之人宜滋阴降火并配合平抑肝火的药物。也有感受风邪而导致眩晕的，宜祛风顺气，以伐肝降火为良法。有因呕血而导致眩晕的，多是血亏气损，虚火泛上，与产后血晕相同。李梴《医学准绳六要》说：凡是过节饮食起居失常，就会随着所动的经络脏腑之气而妄起。又或者是肾水不足，或者精血损伤败坏，不能制约五阳之火独亢。或者是中焦脾胃虚弱衰败，不能提防下焦之气上逆，那么龙雷之火得以震动于头顶。各种火气上至于头，轻则旋转成为眩晕，重则搏击而成为疼痛。
薛己（立斋）说：头目眩晕，朱丹溪先生说：眩是指黑晕旋转，其症状是闭眼昏暗，身体转动，耳聋，像站在车船之上，站起来想要跌倒。大概是因为极度虚弱又乘受寒邪所致，也不可一概而论。若因风邪则有汗，因寒邪则掣痛，因暑邪则热闷，因湿邪则重滞，这是四气乘虚导致眩晕。若因郁结生痰而眩晕，这是肾虚气不归元。若因吐血、衄血、崩漏而眩晕，是元气虚，服用正元饮送服黑锡丹。伤湿头晕，用肾着汤加川芎。有痰用青州白丸子。头风，属于风热，日久则目昏；偏头风，属于相火，日久则目紧、小便涩滞，都适宜放血以开泄表邪。我认为前症中肝虚头晕，用钩藤散；肾虚头晕，用六味地黄丸。头晕吐痰，用养正丹，无效时，用八味地黄丸。血虚头晕，用四物汤加人参、苍术、白术，无效时，用当归补血汤。气虚头晕，用四君子汤加当归，无效时，用补中益气汤。肝木实证，用泻青丸；虚证，用地黄丸，无效时，用川芎散。脾气虚，用二陈汤加人参、白术、柴胡、升麻，无效时，用益气汤加茯苓、半夏。脾胃有痰，用半夏白术天麻汤。风痰上涌，用四神散。发热恶寒，用八物汤。七情气逆，用四七汤。伤寒而晕，用除湿汤。
朱丹溪说：头眩，是痰挟带气虚并伴有火。治疗以化痰为主，兼用补气药及降火药。没有痰就不会发生眩晕。左手脉数表示热多，肺中有涩滞的死血。右手脉实表示有痰积，脉大是久病之人。气血俱虚而脉大，是痰浊不降的表现。
头痛多主因于痰，痛剧烈的多为火。有的可以用吐法，有的可以用下法。头痛可用川芎。如果不愈，各加引经药：太阳经头痛用川芎，阳明经头痛用白芷，少阳经头痛用柴胡，太阴经头痛用苍术，少阴经头痛用细辛，厥阴经头痛用吴茱萸。肥胖人是湿痰，宜用半夏、苍术；瘦人是热，宜用酒制黄芩、防风。感冒头痛，宜用羌活、藁本、白芷。风热在上，宜用天麻、蔓荆子、台芎、酒芩。肥白人是气虚，宜用人参、生地、南星、秘藏安神汤。形瘦色苍黑是血虚，宜用川芎、当归、酒芩。如果苦于头痛剧烈，用细辛。顶巅痛，宜用藁本、防风、柴胡。比如太阳头痛，怕风，脉浮紧，以川芎、羌活、独活、麻黄之类为主；少阳头痛，脉弦细，往来寒热，以柴胡为主；阳明头痛，自汗，发热恶寒，脉浮缓长实，以升麻、葛根、石膏、白芷为主；太阴头痛，必有痰，身体沉重，或者肠痛，脉沉缓，以苍术、半夏、南星为主；少阴头痛，足部寒冷气逆，为寒厥，脉沉细，以麻黄、附子、细辛为主；厥阴头痛，或者吐痰沫，四肢厥冷，脉浮缓，以吴茱萸汤主治。血虚头痛，以川芎、当归为主；气虚头痛，以人参、黄芪为主；气血俱虚头痛，用调中益气汤，内加川芎、蔓荆子、细辛，效果如神。
头风，属痰的多，有热，有风，有血虚。在左侧属风，用薄荷、荆芥；属血虚，用川芎、当归。在右侧属痰，用苍术、半夏；属热，以酒芩为主；另外，属湿痰，用川芎、南星、苍术。偏头风，在左侧属风的，用荆芥、薄荷，这两味药就是治疗的良药。必须观察其兼见什么症状而加以佐使，如果有痰，就用二陈汤治痰而佐之。识别病情，全在于灵活变通。
王好古（海藏）说：头汗出，仅到颈部而止，这是血证。额头出汗偏多，为什么呢？回答说：头部是六阳经交会的地方，所以热气蒸熏而头汗出。额头出汗偏多，根据部位来说，左颊属肝，右颊属肺，鼻属中州（脾），颐属肾，额属心。三焦之火，耗竭了肾水，沟渠的余水，逼迫而上入于心之分野，所以发生头汗。而额头出汗偏多的，属于心的分野，而为血证。饮酒或饮食后头汗出的，也是血症。
至于杂病，相火逼迫肾水上行，进入心中，形成盗汗，或者自汗，传变为头汗出的，或者心下痞满的，都按照血症的例子治疗，不论伤寒还是杂病。
酒积用下法治疗后出现心下痞满的，是血症，为什么这样说？回答说：下法导致亡阴。亡阴，就会损伤脾胃而亡血。气在胸中，因为失去了血，陷在心之分野，所以心下痞。世人以为是血病，用理气药导引，则痞病更加严重。而又用下法，所以变为中满膨胀。这不是正确的治法。只有补益中焦脾土，用血药治疗，治疗就没有比这更好的了。
王纶（节斋）说：长期头痛，稍微感受风寒就发作，寒冬月份必须用厚绵浓帕包裹的，这属于郁热，本质是热而表象是寒。世人不了解，通常用辛温解散的药物，临时见效，误认为是寒。殊不知因为其本有郁热，毛窍常疏松，所以风寒容易侵入，外寒束缚其内热，闭塞逆乱而引发疼痛。辛热药物，虽然能开通闭塞逆乱，疏散表象的寒邪，然而以热助热，病的根本更加深重，怕冷也更加严重了。只应当以泻火凉血为主，而佐以辛温发散表邪的药物，以从法治之，那么病可愈而病根可除。
戴元礼（院使）说：有头风眩晕，不可因为它不痛就不认为是风邪。切宜详细审察，不可匆忙当作虚证治疗，如果投用补剂会更加严重。另外如果没有其他疾病，也不是各种病后，突然得此病，这是风晕明确的表现，宜用小续命汤加全蝎三四个。
眼眶骨痛，有两种病症：有肝虚而痛，刚见到光亮，眶骨就疼痛剧烈，宜用生熟地黄丸；又有肝经停饮一证，发作时眉棱骨痛，眼睛无法睁开，白天安静晚上加剧，宜用导痰饮，或者芎辛汤去掉茶芽，或者二陈汤吞服青州白丸子。
张介宾（景岳）说：头痛，必须先审察病程的久暂，其次辨别表里。暂时疼痛必然因邪气引起，久病必然兼有元气亏损。暂时疼痛有表邪，治疗宜疏散，忌用清降；有里邪，治疗宜清降，忌用升散。久病者有时发作有时痊愈，或者表虚，轻微感受就发作；阳气胜，轻微发热就发作；或者下焦水亏，虚火乘袭；或者上焦阳虚，阴寒胜袭而发作，重视元气。这是大纲。也有暂病而虚，久病而实的，应当以脉证辨别。
火邪引起的疼痛，各经都有，以阳明经最为常见。没有表邪的，用白虎汤加生地、麦冬、木通、泽泻。其他经则用黄芩、黄连、知母、黄柏。治疗火邪不宜佐以升散，外邪之火，可以散发而去；内郁之火，得到升散反而更炽烈。
张景岳说：眩晕一证，刘河间取《内经》“诸风掉眩，皆属于肝”。朱丹溪说：“痰在上，火在下，火炎上而动其痰，无痰不能作眩也。”根据这两种说法，那么凡眩晕，无非是风、火、痰症。然而痰饮之症，轩岐（黄帝岐伯）绝口不提这些，只说“上气不足，头为之倾，目为之眩”；说“上虚则眩”；说“督脉虚则头重高摇”；说“髓海不足，则脑转耳鸣而眩冒”。所有这些，难道都是痰症吗？朱丹溪认为无痰不能作眩，我却认为无虚不能作眩。应当以治虚为主，而兼酌其标。
而且头痛与头眩，有虚实之辨。《内经》区分得很清楚，说：“头痛巅疾，上实下虚，为厥巅疾。”这是因为邪气在上，所以为痛，故曰上实。如果到了眩晕，则说“上气不足”，又说“上虚则眩”，从未听说上实的，难道头眩不是上虚证吗？各家认为气逆奔上，下虚上实，为何与《内经》相反如此？眩晕的症状，或者头重，或者眼黑，或者脑髓旋转，不可以动。寻求它言实的理由，不过是因为头重。不知道头本来不比往日重，只是不胜其重者，乃甚于往日耳。上部力量不胜任，是阳之虚，难道是上实吗？
然而头眩还有大小之异。现在人气禀薄弱，或者劳倦酒色，忽然有耳鸣如磨，头眩眼黑，片刻即止的，是人所常有之事。至于中年之外，多见眩仆卒倒等症状，也是人所常有之事。但忽运即止的，都称为头运眼花；卒倒不醒的，必称为中风、中痰。不知道忽止的，是因为气血未败，所以旋见旋止，即小中风。卒倒而严重的，是因为根本既亏，所以遽病而难复，即大头眩也。在此处察验，是风非风，是痰非痰，虚实就可以领悟了。
然而头眩虽属上虚，不能不涉及下焦。上虚者，是阳中之阳虚；下虚者，是阴中之阳虚。阳虚宜治其气，用四君子汤、异功散、归脾汤、补中益气汤；阴虚宜补其精，用左归丸、右归丸、四物汤等主治。所以伐下者，必枯其上；滋苗者，必灌其根。应当以兼补气血为最。兼火清火，兼痰清痰，有气顺气，在乎因机应变，无不应当以治虚为先。
Li Shicai stated: The *Neijing* discusses headache, attributing it to wind, cold, and deficiency. The ten articles on headache in the Theory of Five Movements and Six Qi (Yunqi), and the one article on Taiyang headache in the *Shanghan Lun* (Treatise on Cold Damage), all describe how the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade each other and contend with the True Qi (Zhenqi). This causes the Qi of the meridians to rebel and ascend, invading the clear orifices, preventing normal circulation, leading to stagnation and obstruction, resulting in pain. The head is like the sky; the Clear Yang Qi of the six Fu organs and the Essence-Blood of the five Zang organs all converge here. Therefore, the pathogenic factors of the Six Excesses (Liu Yin) from nature, and the variations of the Five Thieves (Wu Zei - referring to pathological emotional or internal changes) within the body, can both cause harm. They may obscure the clarity of the head, or block the meridians, contending with Qi, accumulating into heat, causing fullness in the vessels and pain. If pathogenic factors linger, vessels are full, and Qi and Blood are chaotic, the pain becomes severe; this is Excess Pain. When invaded by Cold-Dampness, if True Qi is weak, although there is no contention generating heat, the pathogen resides outside the vessels, causing blood to congeal and vessels to become cold. The vessels contract and tighten, pulling on the small collaterals externally, causing pain; warmth stops the pain. This is Deficiency Pain. Headache caused by Wind presents with twitching, pulling pain, and aversion to wind. Headache caused by Heat presents with vexation and aversion to heat. Headache caused by Dampness presents with heaviness in the head, worsening on cloudy days. Headache caused by Phlegm presents with dizziness, heaviness, and incessant nausea. Headache caused by Cold presents with contraction, tightness, aversion to cold, and shivering. Headache due to Qi Deficiency presents with aversion to labor and a large, forceless pulse. Headache due to Blood Deficiency presents with easily startled anxiety and a Kou (hollow) pulse.
Headaches have many causes, yet ancient formulas often use Wind-dispersing herbs. This is because at the high peak of the head, only Wind herbs can reach. Herbs with thin flavors belong to Yin transforming into Yang, rising from earth to heaven. For headaches caused by Wind, Cold, and Dampness, this is indeed the correct treatment; even for Deficiency and Heat patterns, they are used as guiding herbs to direct medicinal action upwards.
It must be known that acute and sudden onset is merely called "headache"; deep-seated and chronic cases are called "head wind" (Toufeng). Head wind inevitably damages the eyes, as the classic states: "East wind arises in Spring, disease affects the Liver." The eyes are the orifice of the Liver; when Liver Wind moves, pathogens侵害 the empty orifices.
Headache accompanied by dysfunction of the nine orifices belongs to Qi Deficiency; treat with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Shaoyao (Paeoniae Radix Alba), Chuanxiong (Chuanxiong Rhizoma), and Xixin (Asari Radix et Rhizoma). The area behind the eyebrow tip near the hairline is called "Fish Tail" (Yuwel); attacking pain here belongs to Blood Deficiency; treat with Siwu Tang (Four Substances Decoction) plus Bohe (Menthae Haplocalycis Herba). Headache worsened by movement indicates Stomach Heat; treat with Da Huang (Rhei Radix et Rhizoma) fried in wine, decocted in strong tea. Vexation combined with headache is treated with Qingkong Gao (Clear the Empty Orifice Paste) plus Maidong (Ophiopogonis Radix) and Danshen (Salviae Miltiorrhizae Radix et Rhizoma).
Zhang Sanxi said: The *Neijing* states, "All wind-induced tremors and vertigo belong to Liver Wood." In individuals who are Qi-deficient and obese with white complexion, Damp-Phlegm stagnates in the upper part, while Yin Fire rises from below. Thus, Phlegm carries Deficient Fire upward to the head and eyes. Because Righteous Qi is weak and cannot overcome the pathogen, sudden blackouts, visual spots, and rotational vertigo occur, as if sitting in a boat or carriage. In severe cases, sudden collapse and loss of consciousness may happen. This is what Zhu Danxi referred to as "No Phlegm, No Vertigo." However, in dark-skinned, thin individuals with weak constitutions, if True Water is deficient, or due to overwork, Ministerial Fire flares upward, they also experience frequent vertigo. Where is the Damp-Phlegm? Liu Wansu's *Yuanbing Shi* states: "Stillness and tranquility represent the transformation of Water; agitation and disturbance represent the function of Fire." The brain is generated by Earth Qi, storing Yin in the eyes as the pupil, governed by Kidney Water, the ultimate Yin. These two prefer stillness and dislike agitation. If tremors and vertigo occur, scattering and confusion result, leading to spinning of the brain and dizzy eyes. Treatment: For obese, fair-skinned individuals with vertigo, clear Phlegm, descend Fire, and supplement Yin. For dark, thin individuals, nourish Yin, descend Fire, and include herbs to suppress Liver. For vertigo caused by Wind Pathogens, dispel Wind, regulate Qi, and subdue Liver and descend Fire. Vertigo due to hematemesis is mostly due to Blood and Qi depletion, with Deficient Fire floating upward, similar to postpartum blood vertigo. Li Chan's *Yixue Zhunsheng* states: Whenever festivals or irregularities occur, Qi of the affected meridians and organs rises recklessly. Or, if Kidney Water is insufficient, or Essence and Blood are damaged, failing to control the solitary brilliance of the Five Yang Fires. Or, if Spleen-Stomach Earth is weak, failing to guard against rebellious Qi from below, then Dragon-Lei Fire vibrates at the crown. Various Fires ascending to the head cause mild rotational vertigo or severe beating pain.
Xue Lizhai stated: Regarding head and eye vertigo, Mr. Zhu Danxi said: "Vertigo refers to black rotational dizziness, characterized by closed eyes and dim vision, body rotation, deafness, feeling like standing on a vehicle, and wanting to fall when standing up." This is generally due to extreme deficiency compounded by Cold. However, treatment should not follow a single path. If caused by Wind, there is sweating; by Cold, pulling pain; by Summer-heat, heat and stifling; by Dampness, heaviness and stagnation. These four pathogens cause vertigo when exploiting deficiency. If caused by stagnation generating Phlegm, it is due to Kidney Deficiency where Qi does not return to its source. If caused by vomiting blood, epistaxis, or metrorrhagia, it is Yuan Qi Deficiency; administer Zhengyuan Yin with Heixi Dan (Black Tin Pill). For dampness-induced dizziness, use Shen Zhuo Tang plus Chuanxiong. For Phlegm, use Qingzhou Bai Wanzi (Qingzhou White Pills). Head wind is Wind-Heat; long-term leads to blurred vision. Hemilateral head wind is Ministerial Fire; long-term leads to tight eyes and urinary difficulty. Bleeding is suitable to open the exterior. I suggest: Liver-Deficiency dizziness uses Gouteng San; Kidney-Deficiency dizziness uses Liuwei Wan (Six-Ingredient Pill with Rehmannia). Dizziness with phlegm expectoration uses Yangzheng Dan; if ineffective, Bayi Wan (Eight-Ingredient Pill). Blood-Deficiency dizziness uses Siwu Tang plus Renshen, Cangzhu, Baizhu; if ineffective, Danggui Buxue Tang. Qi-Deficiency dizziness uses Sijunzi Tang plus Danggui; if ineffective, Buzhong Yiqi Tang. Liver-Fire Excess uses Xieqing Wan; Deficiency uses Dihuang Wan; if ineffective, Chuanxiong San. Spleen-Qi Deficiency uses Erchen Tang plus Renshen, Baizhu, Chaihu, Shengma; if ineffective, Yiqi Tang plus Fuling, Banxia. Spleen-Stomach Phlegm uses Banxia Baizhu Tianma Tang. Wind-Phlegm surging upward uses Sishen San. Fever and aversion to cold uses Bawu Tang. Seven Emotions Qi rebellion uses Siqi Tang. Cold damage with vertigo uses Chushi Tang.
Zhu Danxi said: Head vertigo is Phlegm combined with Qi Deficiency and Fire. Treatment focuses on resolving Phlegm, supplemented by Qi-tonifying and Fire-descending herbs. Without Phlegm, there is no vertigo. A rapid pulse on the left indicates excess Heat; sluggishness suggests fixed Blood. A solid pulse on the right indicates Phlegm accumulation; a large pulse indicates chronic illness. Qi and Blood both deficient with a large pulse indicates turbid Phlegm failing to descend.
Headache is mostly due to Phlegm; severe pain is mostly due to Fire. Some cases can be treated with emesis or purgation. Chuanxiong can be used for headache. If ineffective, add guiding herbs according to the meridian: Taiyang uses Chuanxiong; Yangming uses Baizhi; Shaoyang uses Chaihu; Taiyin uses Cangzhu; Shaoyin uses Xixin; Jueyin uses Wuzhuyu. Obese individuals have Damp-Phlegm; use Banxia, Cangzhu. Thin individuals have Heat; use wine-processed Huangqin, Fangfeng. Common cold headache uses Qianghuo, Gaoben, Baizhi. Wind-Heat above uses Tianma, Manjingzi, Taixiong, wine-Huangqin. Obese, fair-skinned individuals have Qi Deficiency; use Renshen, Shengdi, Nanxing, Micang Anshen Tang. Thin, dark-complexioned individuals have Blood Deficiency; use Chuanxiong, Danggui, wine-Huangqin. For severe headache, use Xixin. Vertex pain uses Gaoben, Fangfeng, Chaihu. For example, Taiyang headache with aversion to wind and floating-tight pulse uses Chuanxiong, Qianghuo, Duhuo, Mahuang as main herbs. Shaoyang headache with wiry-thin pulse and alternating chills and fever uses Chaihu as main herb. Yangming headache with spontaneous sweating, fever, aversion to cold, and floating-slow-long-solid pulse uses Shengma, Gegen, Shigao, Baizhi as main herbs. Taiyin headache involves Phlegm, heavy body, or intestinal pain, with sinking-slow pulse; use Cangzhu, Banxia, Nanxing as main herbs. Shaoyin headache with cold feet and rebellious Qi (Cold Jue) and sinking-thin pulse uses Mahuang, Fuzi, Xixin as main herbs. Jueyin headache with spitting of frothy phlegm, cold limbs, and floating-slow pulse is primarily treated with Wuzhuyu Tang. Blood-Deficiency headache uses Chuanxiong, Danggui as main herbs. Qi-Deficiency headache uses Renshen, Huangqi as main herbs. Combined Qi and Blood Deficiency headache uses Tiaozhong Yiqi Tang added with Chuanxiong, Manjingzi, Xixin; efficacy is miraculous.
Head wind is mostly due to Phlegm, involving Heat, Wind, or Blood Deficiency. On the left, it is Wind; use Bohe, Jingjie. Blood Deficiency; use Chuanxiong, Danggui. On the right, it is Phlegm; use Cangzhu, Banxia. Heat; use wine-Huangqin as main herb. Additionally, Damp-Phlegm; use Chuanxiong, Nanxing, Cangzhu. Hemilateral head wind on the left due to Wind uses Jingjie, Bohe; these two are supreme remedies. One must observe accompanying symptoms to add assistants. If Phlegm exists, use Erchen Tang to resolve Phlegm as an assistant. Recognizing the condition relies entirely on flexible methods.
Wang Haizang stated: Head sweating stopping at the neck is a Blood syndrome. Why is forehead sweating predominant? The head is the convergence of the Six Yang meridians, so heat steams and causes head sweating. Forehead predominance is determined by location: left cheek belongs to Liver, right cheek to Lung, nose to Central Region (Spleen), chin to Kidney, forehead to Heart. Sanjiao Fire depletes Kidney Water; residual water from channels is forced upward into the Heart region, causing head sweating. Forehead predominance belongs to the Heart region and is a Blood syndrome. Head sweating after drinking alcohol or eating is also a Blood syndrome.
Regarding miscellaneous diseases, if Ministerial Fire forces Kidney Water upward into the Heart, causing night sweats or spontaneous sweats, which transmit to head sweating, or epigastric fullness, all are treated according to Blood syndrome protocols, regardless of Cold Damage or miscellaneous diseases.
Epigastric fullness after purging alcoholic accumulation is a Blood syndrome. Why? Purging causes loss of Yin. Loss of Yin damages Spleen-Stomach and leads to loss of Blood. Qi in the chest, having lost Blood, sinks into the Heart region, causing epigastric fullness. People mistakenly think it is a Blood disease and use Qi-regulating drugs, worsening the fullness. Further purging leads to abdominal distension. This is incorrect treatment. Only tonifying the Central Spleen Earth and treating with Blood herbs is optimal.
Wang Jiezhai stated: Chronic headache triggered by slight Wind-Cold exposure, requiring thick wrapping in winter, belongs to Depressed Heat, with Heat as the root and Cold as the branch. Laypeople do not understand this and usually use acrid-warm dispersing agents. Temporary relief leads to misdiagnosis as Cold. However, because there is underlying Depressed Heat and loose pores, Wind-Cold enters easily. External Cold binds internal Heat, causing obstruction and pain. Acrid-hot drugs can open obstruction and disperse superficial Cold, but using heat to aid heat deepens the root disease and worsens aversion to cold. Treatment should focus on draining Fire and cooling Blood, assisted by acrid-warm exterior-dispersing agents. Following this method cures the disease and removes the root.
Dai Yuanli stated: Head wind vertigo should not be dismissed as non-Wind just because it is not painful. Careful examination is essential; do not hastily treat as Deficiency. Tonics will worsen it. If there are no other diseases or post-illness conditions, and this occurs suddenly, it is clearly Wind Vertigo. Treat with Xiao Xuming Tang plus Quanxie (Scorpio) 3-4 pieces.
Orbital bone pain has two syndromes: Liver Deficiency pain, severe upon seeing light, treat with Shengshu Dihuang Wan. Liver Meridian Fluid Retention, causing brow bone pain, inability to open eyes, quiet by day and worse by night, treat with Daotan Yin, or Xiongin Tang removing tea buds, or Erchen Tang swallowing Qingzhou Bai Wanzi.
Zhang Jiebin stated: Headache requires assessing duration first, then distinguishing Exterior/Interior. Acute pain is due to pathogens; chronic pain involves Yuan Qi. Acute pain with Exterior pathogens requires dispersion; avoid descending/clearing. Interior pathogens require clearing/descending; avoid ascending/dispersing. Chronic pain comes and goes, or is triggered by slight Exterior deficiency, slight Heat (Yang excess), Lower Water deficiency with Deficient Fire, or Upper Yang deficiency with Cold dominance. Focus on Yuan Qi. This is the general principle. Acute illness can be Deficient; chronic illness can be Excess; distinguish by pulse and symptoms.
Fire Pathogen pain occurs in all meridians, most commonly Yangming. Without Exterior pathogens, use Baihu Tang plus Shengdi, Maidong, Mutong, Zexie. Other meridians use Huangqin, Huanglian, Zhimu, Huangbai. Treating Fire should not assist with ascending/dispersing herbs. Exterior Fire can be dispersed; Internal Depressed Fire becomes fiercer with ascending herbs.
Zhang Jingyue stated: Regarding vertigo, Hejian cites *Neijing*: "All wind tremors and vertigo belong to Liver." Danxi says: "Phlegm above, Fire below; Fire flares up moving Phlegm; without Phlegm, no vertigo." Based on these, vertigo is Wind, Fire, or Phlegm. However, Xuandi never mentioned Phlegm for fluid disorders, only stating "Upper Qi insufficiency causes head tilting and eye vertigo"; "Upper Deficiency causes vertigo"; "Du Mai Deficiency causes heavy head and shaking"; "Marrow Sea insufficiency causes brain spinning, tinnitus, and vertigo." Are all these Phlegm syndromes? Danxi says no Phlegm, no vertigo; I say no Deficiency, no vertigo. Treatment should focus on Deficiency, considering the branch.
Headache and vertigo have Deficiency/Excess distinctions. *Neijing* clarifies: "Headache and vertex disease, Upper Excess Lower Deficiency, causes Jue vertex disease." This is because pathogens are above, causing pain, hence Upper Excess. For vertigo, it says "Upper Qi insufficiency" and "Upper Deficiency causes vertigo," never mentioning Upper Excess. Is vertigo not an Upper Deficiency syndrome? Why do some authors claim Qi rebellion creates Lower Deficiency and Upper Excess, contrary to *Neijing*? Vertigo symptoms include heaviness, blackouts, or brain spinning, unable to move. Seeking reasons for "Excess," people cite heaviness. But the head is not heavier than usual; it is simply unable to bear the weight, feeling heavier than before. Upper weakness is Yang Deficiency, not Upper Excess.
However, vertigo varies in severity. People with weak constitutions, or due to fatigue/alcohol/sex, may experience sudden tinnitus like grinding, vertigo, and blackouts, resolving quickly. This is common. After middle age, fainting and collapse are common. Quick resolution is "eye vertigo"; collapse without waking is "Stroke" or "Phlegm Stroke." Quick resolution means Qi and Blood are not ruined, hence transient; this is minor Stroke. Severe collapse means root is depleted, hard to recover; this is major vertigo. Observing this reveals whether it is Wind or Phlegm, Deficiency or Excess.
Although vertigo is Upper Deficiency, it relates to the Lower. Upper Deficiency is Yang within Yang Deficiency; Lower Deficiency is Yang within Yin Deficiency. Yang Deficiency treats Qi with Sijunzi Tang, Yigong San, Guipi Tang, Buzhong Yiqi Tang. Yin Deficiency supplements Essence with Zuogui Wan, Yougui Wan, Siwu Tang. Thus, damaging the lower withers the upper; nourishing the shoot irrigates the root. Supplementing Qi and Blood is best. Clear Fire if present, resolve Phlegm if present, regulate Qi if needed. Adapt to circumstances, but always prioritize treating Deficiency.