（头风 雷头风 眉棱风痛 真头痛 头重 头摇 颈项强痛 天白蚁）
经云。风气循风府而上。则为脑风。新沐中风。则为首风。首风之状。头面多汗恶风。当先
风一日则病甚。头痛不可以出内。至其风日则病少愈。头痛数岁不已。当有所犯大寒。内至骨髓。
髓者以脑为主。脑逆。故令头痛齿亦痛。名曰厥逆。头痛巅疾。下虚上实。过在足少阴巨阳。甚
则入肾。心烦头痛。病在膈中。过在手巨阳少阴。头痛耳鸣。九
窍不利。肠胃之所生也。真头痛。头痛甚则脑尽痛。手足寒至节。死不治。难经曰。手三阳之脉
受风寒。伏留而不去。则名厥头痛。入连在脑者。名真头痛。
按。头者。天之象。阳之分也。六腑清阳之气。五脏精华之血。皆朝会于高巅。天气所发。
六淫之邪。人气所变。五贼之运。皆能犯上而为灾害。或蔽覆其清明。或坠遏其经隧。与正气相
搏。郁而成热。则脉满而痛。若邪气稽留。亦脉满而痛。是皆为实也。若寒湿所侵。虽正气衰微。
不与相搏而成热。然邪袭于外。则血凝而脉缩。收引小络而痛。得温则痛减。是为虚也。因风而
痛者。抽掣恶风。或汗自出。因暑而痛者。或有汗。或无汗。皆恶热而耳前与额胀痛。因湿而痛
者。头必重。遇阴天尤甚。因痰饮而痛者。亦昏重而痛。愦愦欲吐。因寒而痛者。绌急恶寒。因
气虚而痛者。遇劳则甚。其脉大。因血虚而痛者。痛连鱼尾。善惊惕。其脉芤。或沉数。头痛自
有多因。而古方每用风药者。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。亦假引经耳。
薛立斋云。按头痛除风寒外。多主于痰。痛甚者。乃风毒上攻。有血虚者。有气虚者。有诸
经气滞者。有六气外伤。有劳役内伤。有可吐者。有可下者。当分虚实寒热兼变而治之。痰多。
加味导痰汤。风毒。消风散。血虚。芎归汤加葱、豉、全蝎。气虚。六君子加葱、豉。气滞。苏
子降气汤。痰多宜吐者。稀涎散。或栀子豉汤加葱白。火郁宜下者。凉膈散加清酒。痰火俱盛者。
滚痰丸。头痛诸药不效。其痛更甚者。此督脉为病也。宜茸朱丹。上热头痛目赤。下寒足 为甚。
大便微秘。即济解毒汤。大寒犯脑。内至骨髓。则头痛齿亦痛。羌活附子汤。头痛干呕吐涎沫。
吴茱萸汤。风气循风府而上。则为脑风。项背恶寒。脑户极冷。当归四逆汤。因发散太过。头痛
转剧。小建中加当归、童便。风火相煽。额与
眉棱俱痛。选奇汤加葱、豉。徇蒙招尤。目瞑耳聋。肝虚风动也。六君子加钩藤、羌、防、芎、
归、甘菊。头痛耳鸣。九窍不利。肠胃之所生。或劳役动作则痛。此气虚火动也。补中益气加川
芎、蔓荆子。胃热火炎。动作则痛。烦渴引饮。面赤便秘者。川芎茶调散加酒炒芩、连、栀子、
石膏。势盛脉实者。酒炒大黄末五钱。浓茶调服。血虚痛连鱼尾。四物加人参、细辛、蔓荆。有
霉疮毒发头痛。颐下左右如蚯蚓徐行入耳。顶上起疙瘩块。冷则痛甚者。山牛汤。不应。作结毒
治之。头与腹俱痛有五。臭毒头痛。则与腹俱痛。一味香附。煎成放凉服。伤酒伤湿。亦有头
腹俱痛但。伤酒食。则兼呕逆眩晕。外台茯苓饮加煨葛根。伤湿则腹隐隐痛。头重不能举。羌活
胜湿汤。外用瓜蒂散搐鼻。有不伏水土头腹俱痛者。藿香正气散。有疮毒入腹。头与腹俱痛者。
黄连解毒汤加腊茶。有头痛止则腹痛。腹痛止则头痛。此属脾阴血虚。胃中有火。随气辄上辄下
而然。芎、归、芍药、黄连、木香。不应。加童便、香附、葱白。
〔诊〕寸口脉中手短者曰头痛。寸口紧急。或短或弦或浮皆头痛。浮滑为风痰。易治。短涩为
虚。难治。浮弦为风。浮洪为火。沉细或缓。为湿。寸弦曰头痛。寸口脉浮。中风发热头痛。
头风 薛立斋云。偏正头风。久而不愈。乃挟痰涎风火。郁遏经络。气血壅滞。甚则目昏紧小。
二便秘涩。宜砭其血以开郁解表。逍遥散。偏左。加黄芩、葱、豉。偏右。加石膏、葱、豉。郁
甚。合越鞠。兼湿。瓜蒂散搐鼻。兼风火而发。选奇汤加石膏、葱、豉、芽茶。夜甚。加酒白芍。
或川芎茶调散加细辛、石膏、甘菊。凡怒则太阳作痛者。先用小柴胡加茯苓、山栀。后用六味丸。
常服以滋肾降火。永不再发。凡头痛必吐清水。不拘冬夏。食姜即止者。此中气虚寒。六君子加
当归、黄 、木香、炮姜。烦劳则头痛。此阳虚不能上升。补中益气加蔓荆子。头风宜热药者多。
间有挟热而不胜热剂者。
消风散。或川芎茶调散加酒黄芩。轻者只用姜汁收入。陈茶叶内煎服汗。出即愈。此屡验者。凡
风热头痛。并宜用之。与选奇汤不殊。头风多汗。当先风一日则痛甚。至其风日则病少愈者。半
夏苍术汤。湿热头风。遇风即发。选奇汤加川芎、柴胡、黄连。名清空膏。不拘偏正并用。偏正
头风作痛。痛连鱼尾。常如牵引之状。发则目不可关。眩晕不能抬举。芎辛汤。每服加全蝎五个。
觉上膈有热。川芎茶调散加片芩。有痰湿头痛。其人呕吐痰多。发作无时。停痰上攻所致。导痰
汤加减。或合芎辛汤尤妙。寒痰厥逆头痛。三因芎辛汤。一切偏正头风攻注。属虚寒者。大追风
散。肾气厥逆头痛。四肢逆冷。胸膈痞闷多痰者。玉真丸。有肾脏阳虚之人。素有头风。发动则
挟湿热上攻。头面肿胀。项后两向筋紧作痛。甚则牵引腰脊。其脉虚细而数。千金大三五七散。
并用金匮头风摩散。慎不可用清热败毒等药。有风痰头痛。发时面颊青黄晕眩。目不欲开。懒言
身体重。兀兀欲吐。此欲成头风也。二陈汤加胆星、天麻、蝎尾。痰厥头痛。两寸脉滑而弦。眼
重头旋。恶心烦乱。吐清水。气短促。心神不安。语言颠倒。目不敢开。如在风露中。头疼如裂。
身重如山。胸满呕逆。四肢厥冷。半夏白术天麻汤。有肥白气虚多痰人。卒然头痛。脉沉细。四
肢厥逆。痰响吐涎。星香汤加生附子。热厥头痛。数年不愈。虽当严冬。犹喜风寒。其痛便止。
略近温暖。稍见烟火。其痛便甚。或为灸火。或为热药所致。宜选奇汤加川芎、柴胡、黄连、生
地、当归、黄柏、知母、荆芥、芽茶。风热伏于血分。加以寒邪外郁。即痛剧热甚。宝鉴石膏散。
湿热头痛。脉数而濡。或两寸脉沉伏而数。身重肢节痛。或四肢面目浮肿。此证多见于酒客。宜
散湿解热。二陈、二术、酒芩、羌、防之类。不已。用透顶散搐鼻取涎。随左右搐之。涎出即安。
丹方。治头风用蛇蜕炙脆为末。每服一钱。葱、豉煎数沸。和滓热服。不拘偏正皆效。后发渐轻。
再发再服。或加蜈蚣末三分。或加全蝎末三分。皆取截风之力也。每发轻者一服。重不过二服也。
偏头风者。其人平素先有湿痰。加以邪风袭之。久而郁热为火。总属少阳厥阴二经。有左痛
忽移于右。右痛忽移于左者。风火击动其痰湿之气。所以互换也。痛久不已。令人丧目。目者肝
之窍。肝风内动。则害空窍也。盖木邪亢盛。则生风生火。鼓动胸中之痰积。皆随火上逆为患耳。
先以川芎茶调散吐之。吐讫。可服川芎、薄荷等辛凉清上搜风之剂。偏头风。亦先风一日即发。
湿痰与火伏头中。虽夏月常欲包裹。越婢汤加减。湿。加泔制苍术。黑豆制川乌。火。加姜汁炒
山栀。左。加酒黄芩。右。加姜汁、 石膏。湿热甚。连目肿者。加酒大黄。有邪风。加细辛、
川芎。防风之类。妇人头风。兼白带甚者。用白蜀葵花七朵去蒂。川芎、当归各一钱。蕲艾八分。
水酒各半煎成。乘热先熏后服。头风兼呕涎者。白槿树花。阴干焙脆为末。每服三钱。热酒调服。
或用荷叶蒂七枚。生姜七片。陈芽茶一撮。水酒各半煎服。覆汗瘥。头风脑中空痛。用当归、川
芎各三钱。黄牛脑子一个。和匀分三次。热酒送下。尽醉卧醒即愈。头风诸药不效。用大附子一
只切片。同绿豆一升煮熟。去附子。但服绿豆及汁即愈。偏头风。左属风者则浮肿。荆芥、薄荷。
左属血者则疼热。川芎、当归。右属痰者必体肥。苍术、半夏。左属热者必形瘦。黄芩、石膏。
产后须倍用芎、归。遇寒即痛者。属寒伏于脑。用金匮头风摩散。一法。用川乌末。醋调涂痛处。
又法。荜茇、细辛为末。猪胆汁调搐鼻中。蓖麻子五钱去皮。大枣十五个擘。共捣烂。涂纸上。
用箸卷之。去箸纳鼻中。良久取下清涕即止。或牙皂末吹鼻中取嚏。又法。以红娘子七枚。茴香
七瓣。研为细末。同葱白头七个。连须研烂。涂痛处。痛止。永不再发。不拘偏正皆效。又外用
诸方。如搐鼻瓜蒂散、透顶散、篦麻贴法、一字散、一滴金、火筒散等。皆应用之药。然不若用
蒸法最效。方用川芎半两。晚蚕砂二
两。僵蚕如患者年岁之数。以水五碗。煎至三碗。就砂锅中以浓纸糊满。中开钱大一孔。取药气
熏蒸痛处。每日一次。虽年久者。不过三五次。永不再发。平时置新鲜木瓜于枕边。取香气透达。
引散肝风。亦良法也。
雷头风 头痛而起核块者。雷头风也。或头中如雷之鸣。为风客所致。清震汤。肿块宜刺出
血。亦有因痰热生风者。半夏用牙皂姜汁制。取净一两。大黄酒浸透纸包煨。再浸再煨。熟极为
度。净二两。白僵蚕、连轺、橘红、桔梗、天麻各五钱。片芩七钱。薄荷三钱。硝 青礞石、白
芷、炙甘草各一钱。蒸饼丸绿豆大。临卧茶吞二饯。
眉棱骨痛 此证多属阳明风热。有虚实二途。虚而痛者。见光明即发。选奇汤加归、芍。实
则眼不可开。昼静夜剧。选奇汤加葱、豉。风盛。加葛根。火盛。加石膏。按戴复庵云。二证皆
属于肝火。虚则地黄丸。实则导痰汤。大抵此证清火散风不应。即当滋阴。若泛用风药。则火热
上升。其痛愈甚矣。痛久成头风。发则眉棱骨痛者。选奇汤加川芎、白芷、荆芥、柴胡。
真头痛 天门真痛。上引泥丸。旦发夕死。夕发旦死。脑为髓海。真气所聚。卒不受邪。受
邪则不可治。古法。用黑锡丹。灸百会穴。猛进参、附。可救十中之一。然天柱折。手足寒至节。
必死不治。
头重 湿热上攻。所以头重。秋冬春俱宜羌活胜湿汤。夏暑苍术白虎汤。并瓜蒂搐鼻。若时
行疫疠之时。患头重者。败毒散加苍术、 本。内伤元气。头重气乏。补中益气加苍术、蔓荆子。
头摇 头摇有二证。风火相煽。卒然头摇。项背强痛。少阳经证也。小柴胡去参加防风。里
实腹痛。不大便而头摇者。阳明府证也。凉膈散、大柴胡选用。若老人及病后辛苦人。因气血虚。
火犯上而鼓动者。十全大补汤、大建中汤并
加羌活。
颈项强痛 邪客于三阳则痛。寒搏则筋急。葛根汤。风搏则筋弛。桂枝汤加葛根。然多有挟
痰。难以回顾者。乃痰客太阳。二陈加酒芩、羌活、红花。
天白蚁 头内如虫蛀响者。名天白蚁。多属于火。亦有因痰湿在上者。丹溪云。瘦人皆属于
火。宜薄荷、栀子、茯苓、甘草、细辛、川芎、黄芩、石膏、芽茶之类。肥人皆属湿痰。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、礞石丸下夺之。虚者非独参、保元、六味、八味、茸朱丹、鹿茸丸等药调补不应也。
丹方。用茶子为细末。吹鼻中。盖响属火。茶子轻清。行清道。散遏伏之火故也。凡头风药中必
用茶引。即此可悟。
程文彬治一妇患头风。虽盛暑必以帕蒙首。稍见风寒。痛不可忍。百药不效。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。以姜汁灌入鼻中。痛立止。与补中益气
加细辛、川芎、蔓荆、白芍。数服而愈。用姜汁滴鼻中。开久郁之风寒也。若寒湿郁痛。用独颗
葱汁滴之。火郁头痛。以白莱菔汁滴之。左患滴右鼻。右患滴左鼻良。
李士材治顾淡之。劳神之后。躁热甚。头角掣痛。时作时止。医禁其食而解表。四日议攻里。
诊之脉不浮紧。安得表邪。又不沉实。安得里邪。只手太阴大而无力。为神劳太过。乃虚烦类伤
寒也。先饮糜粥。用大剂归脾汤而愈。
【头风、雷头风、眉棱骨痛、真头痛、头重、头摇、颈项强痛、天白蚁】
《黄帝内经》说：风气顺着风府穴上行，就会形成脑风。刚洗完头就受风，就会形成首风。首风的症状是头面部多汗且怕风，在起风的前一天病情加重，头痛剧烈无法出门或待在室内；到了起风的日子，病情会稍微好转。头痛持续数年不愈，是因为遭受了大寒之邪，寒气深入骨髓。髓以脑为主宰，寒气逆乱上冲，所以导致头痛，牙齿也会疼痛，这种病名叫厥逆。巅顶部的头痛疾病，属于下虚上实，病位在足少阴肾经和足太阳膀胱经，严重时病邪入肾。心烦且头痛，病位在膈中，病位在手太阳小肠经和手少阴心经。头痛伴耳鸣，九窍不通利，这是肠胃功能失调产生的病变。真头痛的症状是头痛极其剧烈，感觉整个脑部都痛，手脚冰冷直到关节，这是死证，无法治愈。《难经》说：手三阳经脉受到风寒侵袭，邪气潜伏停留而不消散，这就叫厥头痛；如果疼痛牵连到脑部，就叫真头痛。
按语：头部是天象的象征，属于阳气分布的部位。六腑清阳之气，五脏精华之血，都会汇聚于头顶高处。天气所引发的六淫邪气，人气所转化的五贼（五行之变）运化，都能侵犯上部造成灾害。或者遮蔽覆盖头部的清明之气，或者阻滞压迫经络隧道，与正气相互搏结，郁积而化热，导致脉道充盈而疼痛。如果邪气稽留不去，也是脉道充盈而疼痛，这些都是实证。如果是寒湿侵袭，虽然正气衰微，不与邪气搏结化热，但邪气袭表，会导致血液凝滞、脉管收缩，牵引细小络脉而疼痛，得温热则疼痛减轻，这是虚证。因风邪引起的头痛，会有抽搐掣痛、怕风，或者自汗出；因暑邪引起的头痛，或者有汗，或者无汗，都怕热且耳前与额部胀痛；因湿邪引起的头痛，头部一定沉重，遇到阴天尤其严重；因痰饮引起的头痛，也昏沉沉重且痛，心中烦闷想吐；因寒邪引起的头痛，拘急收缩、怕冷；因气虚引起的头痛，劳累后加重，脉象大；因血虚引起的头痛，疼痛牵连眼角（鱼尾），容易受惊惕，脉象芤或沉数。头痛本身有多种原因，但古方常用风药，因为高巅之上，只有风药能到达，气味薄弱的药物，属于阴中之阳，是从地升天的。对于风寒湿邪，这确实是正用；即使是虚证和热证，也是借用风药作为引经药。
薛立斋说：按头痛除了风寒之外，大多主责于痰。疼痛剧烈的，是风毒上攻。有血虚的，有气虚的，有各条经络气机阻滞的，有六淫外感的，有劳役内伤的，有的可以用吐法，有的可以用下法。应当分辨虚实寒热兼夹变化来治疗。痰多者，用加味导痰汤；风毒者，用消风散；血虚者，用芎归汤加葱、豆豉、全蝎；气虚者，用六君子汤加葱、豆豉；气滞者，用苏子降气汤；痰多宜用吐法的，用稀涎散，或用栀子豉汤加葱白；火郁宜用下法的，用凉膈散加清酒；痰火俱盛者，用滚痰丸。头痛诸药无效，疼痛更剧烈的，这是督脉发病，宜用茸朱丹。上热头痛目赤，下寒足冷，大便微秘，用即济解毒汤。大寒犯脑，深入骨髓，导致头痛且牙齿痛，用羌活附子汤。头痛干呕、吐涎沫，用吴茱萸汤。风气循风府而上，形成脑风，项背怕冷，脑户穴极冷，用当归四逆汤。因发散太过，头痛反而加剧，用小建中汤加当归、童便。风火相煽，额头与眉棱骨俱痛，用选奇汤加葱、豆豉。视物模糊、耳聋，肝虚风动，用六君子汤加钩藤、羌活、防风、川芎、当归、甘菊。头痛耳鸣，九窍不利，由肠胃产生，或因劳役动作则痛，这是气虚火动，用补中益气汤加川芎、蔓荆子。胃热火炎，动作则痛，烦渴引饮，面红便秘，用川芎茶调散加酒炒黄芩、黄连、栀子、石膏；势盛脉实者，用酒炒大黄末五钱，浓茶调服。血虚痛连眼角，用四物汤加人参、细辛、蔓荆子。有霉疮毒发引起的头痛，颐下左右如蚯蚓徐行入耳，顶上起疙瘩块，遇冷痛甚，用山牛汤；无效，按结毒治疗。头与腹俱痛有五种情况：臭毒头痛，则与腹俱痛，用一味香附煎成放凉服；伤酒伤湿，也有头腹俱痛，但伤酒食则兼呕吐眩晕，用外台茯苓饮加煨葛根；伤湿则腹部隐隐作痛，头重不能抬起，用羌活胜湿汤，外用瓜蒂散搐鼻；有不适应水土导致头腹俱痛者，用藿香正气散；有疮毒入腹，头与腹俱痛者，用黄连解毒汤加腊茶；有头痛止则腹痛，腹痛止则头痛，这属于脾阴血虚，胃中有火，随气机上上下下所致，用川芎、当归、芍药、黄连、木香；无效，加童便、香附、葱白。
〔诊法〕寸口脉摸起来短促的，称为头痛。寸口脉紧急，或短、或弦、或浮，都是头痛。浮滑为风痰，易治；短涩为虚，难治。浮弦为风，浮洪为火，沉细或缓为湿。寸脉弦称为头痛。寸口脉浮，中风发热头痛。
头风：薛立斋说：偏正头风，久治不愈，是挟带痰涎风火，郁遏经络，气血壅滞，严重时眼睛昏花紧缩，二便秘涩，宜刺破出血以开郁解表，用逍遥散。偏左痛，加黄芩、葱、豆豉；偏右痛，加石膏、葱、豆豉；郁结甚，合越鞠丸；兼湿，用瓜蒂散搐鼻；兼风火发作，用选奇汤加石膏、葱、豆豉、芽茶；夜间痛甚，加酒白芍，或用川芎茶调散加细辛、石膏、甘菊。凡是发怒则太阳经作痛的，先用小柴胡汤加茯苓、山栀，后用六味丸常服以滋肾降火，永不复发。凡是头痛必吐清水，不拘冬夏，吃姜就停止的，这是中气虚寒，用六君子汤加当归、黄芪、木香、炮姜。烦劳则头痛，这是阳虚不能上升，用补中益气汤加蔓荆子。头风多用热药，间或有挟热而不能耐受热剂的，用消风散，或川芎茶调散加酒黄芩。轻者只用姜汁收纳入陈茶叶内煎服，出汗即愈，这是屡试有效的。凡是风热头痛，都适宜使用，与选奇汤没有太大区别。头风多汗，当先风一日则痛甚，至其风日则病少愈的，用半夏苍术汤。湿热头风，遇风即发，用选奇汤加川芎、柴胡、黄连，名清空膏，不拘偏正头痛并用。偏正头风作痛，疼痛牵连眼角，常像被牵引一样，发作时眼睛不能闭合，眩晕不能抬举，用芎辛汤，每服加全蝎五个。觉得上膈有热，用川芎茶调散加片芩。有痰湿头痛，其人呕吐痰多，发作无定时，是停痰上攻所致，用导痰汤加减，或合芎辛汤更好。寒痰厥逆头痛，用三因芎辛汤。一切偏正头风攻注，属虚寒者，用大追风散。肾气厥逆头痛，四肢逆冷，胸膈痞闷多痰者，用玉真丸。有肾脏阳虚之人，素有头风，发动时挟湿热上攻，头面肿胀，项后两侧筋紧作痛，甚至牵引腰脊，其脉虚细而数，用千金大三五七散，并配合金匮头风摩散，千万不要用清热败毒等药。有风痰头痛，发作时面颊青黄晕眩，眼睛不想睁开，懒言身体重，昏昏欲吐，这是要成为头风了，用二陈汤加胆星、天麻、蝎尾。痰厥头痛，两寸脉滑而弦，眼重头旋，恶心烦乱，吐清水，气短促，心神不安，语言颠倒，眼睛不敢睁开，像在风露中，头疼如裂，身重如山，胸满呕逆，四肢厥冷，用半夏白术天麻汤。有肥白气虚多痰的人，突然头痛，脉沉细，四肢厥逆，痰响吐涎，用星香汤加生附子。热厥头痛，数年不愈，即使在严冬，也喜欢风寒，疼痛就停止；稍微靠近温暖，稍见烟火，疼痛就加剧，这可能是灸火或热药所致，宜用选奇汤加川芎、柴胡、黄连、生地、当归、黄柏、知母、荆芥、芽茶。风热伏于血分，加上寒邪外郁，就疼痛剧烈热甚，用宝鉴石膏散。湿热头痛，脉数而濡，或两寸脉沉伏而数，身重肢节痛，或四肢面目浮肿，此证多见于饮酒之人，宜散湿解热，用二陈汤、二术、酒芩、羌活、防风之类；无效，用透顶散搐鼻取涎，随左右搐之，涎出即安。丹方：治头风用蛇蜕炙脆为末，每服一钱，葱、豆豉煎数沸，和滓热服，不拘偏正皆效，后发渐轻，再发再服，或加蜈蚣末三分，或加全蝎末三分，都是取其截断风邪之力。每次发作，轻者一服，重不过二服。
偏头风者，其人平素先有湿痰，加上邪风侵袭，久而郁热为火，总属少阳、厥阴二经。有左痛忽移于右，右痛忽移于左的，是风火击动其痰湿之气，所以互换。痛久不已，令人丧目，眼睛是肝之窍，肝风内动，则伤害空窍。大概木邪亢盛，则生风生火，鼓动胸中之痰积，都随火上逆为患。先用川芎茶调散吐之，吐完后，可服川芎、薄荷等辛凉清上搜风之剂。偏头风，也是先风一日即发，湿痰与火伏于头中，即使夏天也常想包裹头部，用越婢汤加减。湿重，加泔制苍术、黑豆制川乌；火重，加姜汁炒山栀；左痛，加酒黄芩；右痛，加姜汁、石膏；湿热甚，连目肿者，加酒大黄；有邪风，加细辛、川芎、防风之类。妇人头风，兼白带甚者，用白蜀葵花七朵去蒂，川芎、当归各一钱，蕲艾八分，水酒各半煎成，乘热先熏后服。头风兼呕涎者，用白槿树花，阴干焙脆为末，每服三钱，热酒调服。或用荷叶蒂七枚，生姜七片，陈芽茶一撮，水酒各半煎服，覆被出汗痊愈。头风脑中空痛，用当归、川芎各三钱，黄牛脑子一个，和匀分三次，热酒送下，尽醉卧醒即愈。头风诸药无效，用大附子一只切片，同绿豆一升煮熟，去附子，只服绿豆及汁即愈。偏头风，左属风者则浮肿，用荆芥、薄荷；左属血者则疼热，用川芎、当归；右属痰者必体肥，用苍术、半夏；左属热者必形瘦，用黄芩、石膏。产后须倍用川芎、当归。遇寒即痛者，属寒伏于脑，用金匮头风摩散。一法，用川乌末，醋调涂痛处。又法，荜茇、细辛为末，猪胆汁调搐鼻中。蓖麻子五钱去皮，大枣十五个擘开，共捣烂，涂纸上，用筷子卷之，去筷子纳入鼻中，良久取下，流清涕即止。或用牙皂末吹鼻中取嚏。又法，以红娘子七枚，茴香七瓣，研为细末，同葱白头七个，连须研烂，涂痛处，痛止，永不再发，不拘偏正皆效。又外用诸方，如搐鼻瓜蒂散、透顶散、蓖麻贴法、一字散、一滴金、火筒散等，都是应用的药。然而不如用蒸法最效。方用川芎半两，晚蚕砂二两，僵蚕数量如患者年岁之数，以水五碗，煎至三碗，就在砂锅中用浓纸糊满，中间开钱大一孔，取药气熏蒸痛处，每日一次，虽年久者，不过三五次，永不再发。平时置新鲜木瓜于枕边，取香气透达，引散肝风，也是良法。
雷头风：头痛而起核块的，叫雷头风。或者头中像打雷一样鸣响，为风客所致，用清震汤。肿块宜刺出血。也有因痰热生风者，半夏用牙皂姜汁制，取净一两，大黄酒浸透纸包煨，再浸再煨，熟极为度，净二两，白僵蚕、连轺、橘红、桔梗、天麻各五钱，片芩七钱，薄荷三钱，硝石、青礞石、白芷、炙甘草各一钱，蒸饼丸绿豆大，临卧茶吞二钱。
眉棱骨痛：此证多属阳明风热，有虚实二途。虚而痛者，见光明即发，用选奇汤加归、芍；实则眼不可开，昼静夜剧，用选奇汤加葱、豆豉。风盛，加葛根；火盛，加石膏。按戴复庵说：二证皆属于肝火，虚则用地黄丸，实则用导痰汤。大抵此证清火散风不应，即当滋阴，若泛用风药，则火热上升，其痛愈甚矣。痛久成头风，发作时眉棱骨痛者，用选奇汤加川芎、白芷、荆芥、柴胡。
真头痛：天门真痛，向上牵引泥丸宫，旦发夕死，夕发旦死。脑为髓海，真气所聚，猝然不受邪，受邪则不可治。古法，用黑锡丹，灸百会穴，猛进人参、附子，可救十中之一。然而天柱骨折，手足寒至关节，必死不治。
头重：湿热上攻，所以头重。秋冬春俱宜羌活胜湿汤，夏暑用苍术白虎汤，并配合瓜蒂搐鼻。若时行疫疠之时，患头重者，用败毒散加苍术、本草。内伤元气，头重气乏，用补中益气汤加苍术、蔓荆子。
头摇：头摇有二证。风火相煽，卒然头摇，项背强痛，是少阳经证，用小柴胡汤加防风。里实腹痛，不大便而头摇者，是阳明腑证，用凉膈散、大柴胡汤选用。若老人及病后辛苦人，因气血虚，火犯上而鼓动者，用十全大补汤、大建中汤并加羌活。
颈项强痛：邪客于三阳则痛，寒搏则筋急，用葛根汤；风搏则筋弛，用桂枝汤加葛根。然多有挟痰，难以回顾者，乃痰客太阳，用二陈汤加酒芩、羌活、红花。
天白蚁：头内像虫蛀响的，名叫天白蚁。多属于火，也有因痰湿在上者。丹溪说：瘦人皆属于火，宜薄荷、栀子、茯苓、甘草、细辛、川芎、黄芩、石膏、芽茶之类；肥人皆属湿痰，用半夏、茯苓、枳实、黄连、天麻、胆星、苍术、黄柏、芽茶之类。戴复庵说：头中鸣响，有虚有实。实者用凉膈散、礞石丸下夺之；虚者非独参、保元、六味、八味、茸朱丹、鹿茸丸等药调补不应也。丹方：用茶子为细末，吹鼻中。盖响属火，茶子轻清，行清道，散遏伏之火故也。凡头风药中必用茶引，即此可悟。
程文彬治一妇人患头风，虽盛暑必以帕蒙首，稍见风寒，痛不可忍，百药不效。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，以姜汁灌入鼻中，痛立止。给予补中益气汤加细辛、川芎、蔓荆、白芍，数服而愈。用姜汁滴鼻中，开久郁之风寒也。若寒湿郁痛，用独颗葱汁滴之；火郁头痛，以白菜菔汁滴之。左患滴右鼻，右患滴左鼻良。
李士材治顾淡之，劳神之后，躁热甚，头角掣痛，时作时止。医生禁其食而解表，四日议攻里。诊之脉不浮紧，安得表邪？又不沉实，安得里邪？只手太阴大而无力，为神劳太过，乃虚烦类伤寒也。先饮糜粥，用大剂归脾汤而愈。
[Head Wind, Thunder Head Wind, Eyebrow Bone Pain, True Headache, Heavy Head, Head Trembling, Stiff and Painful Neck and Nape, Heavenly White Ant]
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When wind pathogen follows the Fengfu point (GV16) upward, it becomes Brain Wind. If one is exposed to wind immediately after washing hair, it becomes First Wind. The symptoms of First Wind include excessive sweating on the head and face and aversion to wind. The condition worsens significantly one day before windy weather, with severe headache preventing one from going out or staying indoors; on windy days, the condition improves slightly. Chronic headache lasting for years is caused by exposure to severe cold, which penetrates deep into the bone marrow. Since the brain is the master of marrow, rebellious cold causes headache and toothache, a condition named Jue Ni (Rebellious Inversion). Headache at the vertex belongs to deficiency below and excess above, involving the Foot Shaoyin Kidney meridian and Foot Taiyang Bladder meridian; in severe cases, the pathogen enters the Kidney. Restlessness and headache indicate pathology in the Diaphragm region, involving the Hand Taiyang Small Intestine meridian and Hand Shaoyin Heart meridian. Headache accompanied by tinnitus and dysfunction of the nine orifices arises from disorders of the intestines and stomach. True Headache is characterized by extremely severe pain throughout the entire brain, with cold limbs extending to the joints; this is a fatal condition that cannot be treated. The *Nanjing* (Classic of Difficult Issues) states: When the three Yang meridians of the hand are invaded by wind and cold, and the pathogen lingers without dispersing, it is called Jue Headache. If the pain extends to the brain, it is called True Headache.
Commentary: The head represents the image of Heaven and is the domain of Yang Qi. The clear Yang Qi of the six Fu organs and the essence blood of the five Zang organs all converge at the high peak of the head. Pathogenic factors generated by heavenly weather (the Six Excesses) and transformations of human energy (the Five Thieves/Five Elements) can all invade the upper body and cause harm. They may obscure the clarity of the head or block the meridians, fighting with healthy Qi, leading to stagnation and heat, causing fullness and pain in the vessels. This is an Excess pattern. If invaded by cold-dampness, even if healthy Qi is weak and does not fight to generate heat, the external pathogen causes blood stasis and vessel contraction, pulling on small collaterals to cause pain, which alleviates with warmth; this is a Deficiency pattern. Headache due to wind involves twitching pain, aversion to wind, or spontaneous sweating. Headache due to summerheat involves sweating or no sweating, aversion to heat, and distending pain in the ears and forehead. Headache due to dampness involves heaviness of the head, worsening on cloudy days. Headache due to phlegm-fluids involves dizziness, heaviness, pain, nausea, and desire to vomit. Headache due to cold involves stiffness, contraction, and aversion to cold. Headache due to Qi deficiency worsens with exertion and presents with a large pulse. Headache due to Blood deficiency involves pain radiating to the temporal region (fish tail), palpitations, and a thready or deep-rapid pulse. Although headaches have various causes, ancient formulas often use wind-dispelling herbs because only wind herbs can reach the high peaks; thin-flavored herbs belong to Yin within Yang and rise from earth to heaven. For wind-cold-dampness, these are direct treatments; for Deficiency and Heat patterns, they serve as guiding herbs.
Xue Lizhai stated: Apart from wind-cold, most headaches are primarily due to phlegm. Severe pain indicates attacking wind-toxin. Causes include Blood deficiency, Qi deficiency, Qi stagnation in various meridians, external invasion of the Six Qi, and internal injury from overwork. Treatments may involve emesis or purgation depending on the case. One must differentiate between excess/deficiency and cold/heat. For excessive phlegm, use Jiawei Daotan Tang (Modified Phlegm-Draining Decoction). For wind-toxin, use Xiaofeng San (Wind-Dispersing Powder). For Blood deficiency, use Xiong Gui Tang (Ligusticum and Angelica Decoction) plus scallion, fermented soybean, and whole scorpion. For Qi deficiency, use Liujunzi Tang (Six Gentlemen Decoction) plus scallion and fermented soybean. For Qi stagnation, use Suzi Jiangqi Tang (Perilla Fruit Descending Qi Decoction). For phlegm requiring emesis, use Xixian San (Saliva-Thinning Powder) or Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) plus scallion white. For fire stagnation requiring purgation, use Liangge San (Cooling the Diaphragm Powder) plus clear rice wine. For simultaneous phlegm-fire, use Guntan Wan (Rolling Phlegm Pill). If all medicines fail and pain intensifies, it is a disease of the Du Meridian; use Rongzhu Dan (Velvet Antler Cinnabar Pill). For upper heat headache with red eyes and lower cold with cold feet and slight constipation, use Jiji Jiedu Tang (Mutual Crossing Detoxification Decoction). For severe cold invading the brain and marrow causing headache and toothache, use Qianghuo Fuzi Tang (Notopterygium and Aconite Decoction). For headache with dry vomiting and salivary discharge, use Wuzhuyu Tang (Evodia Decoction). For Brain Wind following the Fengfu point with aversion to cold in the neck and back and extreme cold at Naohu (GV19), use Danggui Sini Tang (Angelica Sinensis Cold-Reversal Decoction). If excessive diaphoresis worsens headache, use Xiao Jianzhong Tang (Minor Construct the Middle Decoction) plus Angelica Sinensis and child’s urine. For wind-fire stirring causing forehead and eyebrow bone pain, use Xuanqi Tang (Select Marvelous Decoction) plus scallion and fermented soybean. For blurred vision and deafness due to Liver deficiency and internal wind, use Liujunzi Tang plus Uncaria, Notopterygium, Saposhnikovia, Ligusticum, Angelica, and Chrysanthemum morifolium. For headache, tinnitus, and nine-orifice dysfunction arising from the intestines and stomach, or worsening with exertion due to Qi deficiency and fire agitation, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Ligusticum and Vitex. For stomach heat and flaming fire causing headache with exertion, thirst, red face, and constipation, use Chuanxiong Chatiao San (Chuanxiong Tea-Tuning Powder) plus wine-fried Scutellaria, Coptis, Gardenia, and Gypsum. For vigorous conditions with excess pulses, take five qian of wine-fried Rhubarb powder mixed with strong tea. For Blood deficiency pain radiating to the temples, use Siwu Tang (Four Substances Decoction) plus Ginseng, Asarum, and Vitex. For headache caused by syphilis toxin with crawling sensations under the jaw entering the ear and nodules on the crown worsening with cold, use Shanniu Tang; if ineffective, treat as a chancre sore. There are five types of simultaneous headache and abdominal pain: foul-toxin headache causes both pains, treated with single-herb Cyperus decoction cooled before drinking; alcohol/dampness injury causes both pains, with alcohol injury adding vomiting/dizziness, treated with Waitai Fuling Yin plus baked Pueraria; dampness injury causes dull abdominal pain and heavy head, treated with Qianghuo Shengshi Tang externally with Genti extract snorted; maladaptation to local climate causes both pains, treated with Huoxiang Zhengqi San; toxin entering the abdomen causes both pains, treated with Huanglian Jiedu Tang plus aged tea; alternating headache and abdominal pain indicates Spleen Yin/Blood deficiency with Stomach fire, treated with Ligusticum, Angelica, Peony, Coptis, and Aucklandia; if ineffective, add child’s urine, Cyperus, and scallion white.
[Diagnosis] A short pulse at Cun Kou indicates headache. An urgent, short, wiry, or floating pulse at Cun Kou indicates headache. Floating and slippery indicates wind-phlegm (easy to treat); short and choppy indicates deficiency (difficult to treat). Floating and wiry indicates wind; floating and surging indicates fire; deep, fine, or slow indicates dampness. Wiry pulse at Cun indicates headache. Floating pulse at Cun Kou with fever indicates wind-stroke headache.
Head Wind: Xue Lizhai stated: Chronic lateral or central head wind is due to phlegm-fluids, wind, and fire obstructing meridians and stagnating Qi and blood, potentially causing blurred vision, tight pupils, and constipation/urinary difficulty. Bleeding therapy opens depression and releases the exterior; use Xiaoyao San. Lateral left pain adds Scutellaria, scallion, and fermented soybean; lateral right pain adds Gypsum, scallion, and fermented soybean. Severe depression combines Yueju Wan; dampness combines Genti extract snorted; wind-fire combines Xuanqi Tang plus Gypsum, scallion, fermented soybean, and young tea; night worsening adds wine-processed White Peony Root; alternatively, Chuanxiong Chatiao San plus Asarum, Gypsum, and Chrysanthemum. Anger-induced Taiyang headache uses Xiao Chaihu Tang plus Poria and Gardenia initially, then Liuwei Dihuang Wan long-term to nourish Kidney and descend fire. Headache with clear water vomiting relieved by ginger indicates Middle Jiao deficiency-cold; use Liujunzi Tang plus Angelica Sinensis, Astragalus, Aucklandia, and roasted Ginger. Exertion-induced headache indicates Yang deficiency failing to ascend; use Buzhong Yiqi Tang plus Vitex. Head wind usually requires warm herbs; if heat-clause resists warm herbs, use Xiaofeng San or Chuanxiong Chatiao San plus wine-fried Scutellaria. Mild cases use ginger juice with aged tea to induce sweat. This works for wind-heat headache similarly to Xuanqi Tang. Head wind with sweating worsening pre-wind and improving on wind days uses Banxia Cangzhu Tang (Pinellia and Atractylodes Macrocephala Decoction). Damp-heat head wind triggered by wind uses Xuanqi Tang plus Ligusticum, Bupleurum, and Coptis, named Qingkong Gao (Clear Sky Paste), applicable to all head winds. Lateral/central head wind radiating to temples with eye closure inability and vertigo uses Xiong Xin Tang plus five whole scorpions per dose. Upper chest heat adds Huang Qin to Chuanxiong Chatiao San. Phlegm-damp headache with frequent vomiting uses Daotan Tang modified or combined with Xiong Xin Tang. Cold-phlegm Jue Ni headache uses Sanyin Xiong Xin Tang. Deficiency-cold head wind uses Da Zhuifeng San (Great Wind-Chasing Powder). Kidney Qi Jue Ni headache with cold limbs and chest fullness uses Yuzhen Wan. Kidney Yang deficiency head wind with damp-heat attack causing swelling and neck tension uses Qianjin Da San Wu Qi San and Jin Gui Toufeng Mosa San; avoid cooling/toxic-clearing herbs. Wind-phlegm headache with yellow-green face, dizziness, and lethargy uses Erchen Tang plus Arisaema cum Bile, Gastrodia, and scorpion tail. Phlegm-Jue headache with slippery-wiry Cun pulses, heavy eyes, vertigo, nausea, shortness of breath, and confusion uses Banxia Baizhu Tianma Tang (Pinellia, Atractylodes, and Gastrodia Decoction). Sudden headache in obese Qi-deficient phlegmatic persons with deep-fine pulse and cold limbs uses Xingxiang Tang plus raw Aconite. Heat-Jue headache preferring cold despite winter uses Xuanqi Tang plus Ligusticum, Bupleurum, Coptis, Rehmannia, Angelica, Phellodendron, Anemarrhena, Schizonepeta, and young tea. Wind-heat in Blood level with external cold uses Baojian Shigao San (Treasure Mirror Gypsum Powder). Damp-heat headache with rapid-soggy or deep-hidden-rapid Cun pulses, body heaviness, and edema in drinkers uses Erchen Tang, Atractylodes, wine-fried Scutellaria, Notopterygium, and Saposhnikovia; if ineffective, use Touting San snorted to drain phlegm. Folk prescription: Snakeskin powder with scallion and fermented soybean decoction. Add centipede or scorpion powder for stronger wind-blocking effect. Lateral head wind involves Shaoyang/Jueyin meridians with shifting pain due to wind-fire moving phlegm-damp. Long-term pain damages eyes (Liver opening). Treat initially with Chuanxiong Chatiao San to induce vomiting, then cool/wind-dispersing herbs. Pre-wind onset with damp-phlegm/fire hiding in head uses Yebi Tang modified: damp adds processed Atractylodes and Black Bean-processed Aconite; fire adds Ginger-processed Gardenia; left adds wine-fried Scutellaria; right adds Ginger and Gypsum; severe damp-heat eye swelling adds wine-fried Rhubarb; wind adds Asarum and Ligusticum. Women’s head wind with leukorrhea uses Malva flowers, Ligusticum, Angelica, and Mugwort steamed and drunk. Head wind with salivary vomiting uses Hibiscus manihot flower powder with hot wine. Lotus stem tips, ginger, and aged tea induce sweat. Empty brain pain uses Angelica, Ligusticum, and ox brain with hot wine. Refractory cases use boiled adzuki beans with removed Aconite. Lateral wind-left causes edema (Schizonepeta/Mint); blood-left causes burning pain (Ligusticum/Angelica); phlegm-right causes obesity (Atractylodes/Pinellia); heat-left causes emaciation (Scutellaria/Gypsum). Postpartum doubles Ligusticum/Angelica. Cold-aggravated pain uses Jin Gui Toufeng Mosa San. External methods include Aconite vinegar paste, Bi Bo/Asarum bile snuff, Castor bean/date nasal roll, or Soapberry snuff. Red ladybug and fennigel paste applied to pain site cures permanently. Steam therapy with Ligusticum, Silkworm feces, and Bombyx Batryticatus is highly effective. Fresh papaya pillow disperses Liver wind.
Thunder Head Wind: Headache with nodules or thunder-like roaring in the head is caused by wind guests; use Qingzhen Tang. Nodules should be pricked to bleed. Phlegm-heat generating wind uses Banxia processed with Soapberry and Ginger Juice, Rhubarb wine-steamed, plus Bombyx, Lonicera, Citrus, Platycodon, Gastrodia, Huang Qin, Mint, Nitre, Lingmu Shi, Angelica Dahurica, and Licorice, formed into pills with steamed dough, taken with tea at bedtime.
Eyebrow Bone Pain: Mostly Yangming wind-heat, with deficiency/excess types. Deficiency pain triggers with light; use Xuanqi Tang plus Angelica and Peony. Excess pain prevents eye opening, worse at night; use Xuanqi Tang plus scallion and fermented soybean. Wind excess adds Pueraria; fire excess adds Gypsum. Dai Fuan attributed both to Liver fire: deficiency uses Dihuang Wan, excess uses Daotan Tang. If clearing fire/dispersing wind fails, nourish Yin; avoid wind herbs to prevent rising fire. Chronic pain becoming head wind uses Xuanqi Tang plus Ligusticum, Angelica Dahurica, Schizonepeta, and Bupleurum.
True Headache: Pain extending to the brain center causes death within a day. The brain is the sea of marrow and gathers true Qi; it rarely accepts pathogens, but if invaded, it is incurable. Ancient methods used Heixi Dan, moxa at Baihui (GV20), and aggressive Ginseng/Aconite, saving one in ten. However, broken Tianzhu bone with cold limbs to joints is fatal.
Heavy Head: Caused by damp-heat ascending. Use Qianghuo Shengshi Tang in autumn/winter/spring, Cangzhu Baizhu Tang in summer, plus Genti snuff. Epidemic heavy head uses Baidu San plus Atractylodes and Bencao. Internal injury Qi deficiency uses Buzhong Yiqi Tang plus Atractylodes and Vitex.
Head Trembling: Two types. Wind-fire sudden trembling with stiff neck/back is Shaoyang syndrome; use Xiao Chaihu Tang plus Saposhnikovia. Yangming fu syndrome with constipation and trembling uses Liangge San or Da Chaihu Tang. Elderly/post-illness Qi/Blood deficiency with fire agitation uses Shiquan Dabu Tang or Da Jianzhong Tang plus Notopterygium.
Stiff Neck: Exterior pathogens in Three Yang cause pain. Cold binding causes spasms (Ge Gen Tang); wind binding causes flaccidity (Guizhi Tang plus Ge Gen). Phlegm in Taiyang causing limited rotation uses Erchen Tang plus wine-fried Scutellaria, Notopterygium, and Carthamus.
Heavenly White Ant: Internal head buzzing like insect chewing. Mostly fire, sometimes phlegm-damp. Danxi noted: Emaciated persons are fire-type (Mint, Gardenia, Poria, Licorice, Asarum, Ligusticum, Scutellaria, Gypsum, young tea); obese persons are phlegm-damp type (Pinellia, Poria, Immature Bitter Orange, Coptis, Gastrodia, Arisaema, Atractylodes, Phellodendron, young tea). Dai Fuan noted: Real excess uses Liangge San or Mengshi Wan to purge; deficiency uses Danshen, Baoyuan, Liuwei, Bawei, Rongzhu Dan, or Deer Antler Pills. Folk prescription: Tea seed powder snuffed to clear fire. Tea guides wind medicines.
Case 1: Cheng Wenbin treated a woman with head wind covering her head even in summer, intolerable pain with wind/cold, unresponsive to drugs. Cause: Brain wind-cold with Qi/Blood deficiency and failure of Qi to ascend. Method: Patient held cold water in mouth, supine, ginger juice instilled in nose stopped pain immediately. Then gave Buzhong Yiqi Tang plus Asarum, Ligusticum, Vitex, and White Peony. Ginger juice opens stagnant wind-cold. Green onion juice for cold-damp; radish juice for fire-stagnation. Instill opposite nostril.
Case 2: Li Shicai treated Gu Danzhi. After mental labor, severe irritability/heat, throbbing temple pain. Doctors forbade food and released exterior; later considered purging interior. Pulse was not floating-tight (no exterior) nor deep-solid (no interior); only Lung meridian large and powerless indicated excessive mental labor causing deficiency-heat resembling shaoyang syndrome. Fed gruel first, then cured with large dose of Guipi Tang.