凡诊头痛者，当先审久暂，次辨表里。盖暂痛者，必因邪气；久病者，必兼元气。以暂
病言之，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。其有久病者，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。所以暂病者当重邪气，久病者当重元气，此固其太纲也。然亦有暂病而虚者，久
病而实者，又当因脉、因证而详辨之，不可执也。
一、头痛有各经之辨。凡外感头痛，当察三阳、厥阴。盖三阳之脉俱上头，厥阴之脉亦
会于巅，故仲景《伤寒论》则惟三阳有头痛，厥阴亦有头痛，而太阴、少阴则无之。其于辨
之之法，则头脑、额颅虽三阳俱有所会，无不可痛，然太阳在后，阳明在前，少阳在侧，此
又各有所主，亦外感之所当辨也。至若内伤头痛，则不得以三阳为拘矣。如本经所言，下虚
上实，过在足少阴、巨阳；若《厥病篇》所论，则足六经及手少阴、少阳皆有之矣。《奇病
论》曰∶脑者阴也，髓者骨之充也。凡痛在脑者，岂非少阴之病乎？此内证外证之异，所不
可不察也。（厥病篇义详《类经》）
一、外感头痛，自有表证可察，盖其身必寒热，脉必紧数，或多清涕，或兼咳嗽，或兼
脊背酸痛，或兼项强不可以左右顾，是皆寒邪在经而然，散去寒邪，其痛自止，如川芎
、细辛、蔓荆子、柴胡之类，皆最宜也。若寒之甚者，宜麻黄、桂枝、生姜、葱白、紫苏、
白芷之类，随其虚实而加减用之。
一、火邪头痛者，虽各经皆有火证，而独惟阳明为最。正以阳明胃火，盛于头面而直达
头维，故其痛必甚，其脉必洪，其证必多内热，其或头脑振振，痛而兼胀，而绝无表邪者，
必火邪也。欲治阳明之火，无如白虎汤加泽泻、木通、生地、麦冬之类，以抑其至高之势，
其效最速。至若他经之火，则芍药、天花、芩、连、知、柏、龙胆、栀子之类，无不可择而
用之。但治火之法，不宜佐以升散，盖外邪之火，可散而去，内郁之火，得升而愈炽矣，此
为忌也。
一、阴虚头痛，即血虚之属也，凡久病者多有之。其证多因水亏，所以虚火易动，火动
则痛，必兼烦热、内热等证，治宜壮水为主，当用滋阴八味煎、加减一阴煎、玉女煎之类主
之。火微者，宜六味地黄丸、四物汤、三阴煎、左归饮之类主之。
一、阳虚头痛，即气虚之属也，亦久病者有之。其证必戚戚悠悠，或羞明，或畏寒，或
倦怠，或食饮不甘，脉必微细，头必沉沉，遇阴则痛，逢寒亦痛，是皆阳虚阴胜而然。治宜
扶阳为主，如理阴煎、理中汤、十全大补汤、补中益气汤之类，皆可择用，或以五福饮，五
君子煎加川芎、细辛、蔓荆子之类，以升达阳气，则最善之治也。
一、痰厥头痛，诸古方书皆有此名目，然以余论之，则必别有所因，但以头痛而兼痰者
有之，未必因痰头痛也。故兼痰者必见呕恶、胸满、胁胀，或咳嗽气粗多痰，此则不得不兼
痰治之，宜二陈汤、六安煎、和胃饮、平胃散加川芎、细辛、蔓荆子之类主之。如多痰兼火
者，宜用清膈煎，或二陈汤、六安煎加黄芩、天花粉之类主之，火甚者加石膏亦可。如多痰
兼虚而头痛者，宜金水六君煎，或六君子汤加芎、辛之类，酌而用之。东垣治痰厥头痛，恶
心烦闷，头旋眼黑，气短促，上喘无力，懒言，心神颠倒，目不能开，如在风云中，头苦痛
如裂，身重如山，四肢厥冷，不得安卧，如范天FS 之妻，因两次下之而致头痛者，用
半夏白术天麻汤。
凡诊治头痛，应当首先审察病程的长短，其次辨别病位的表里。一般来说，病程短暂的疼痛，必定是因为邪气侵袭；病程长久的疾病，必定兼有元气的亏损。从短暂发病的情况来说，如果有表邪，这是风寒之邪外袭经络所致，治疗宜用疏散法，最忌使用清降法；如果有里邪，这是三阳经的火邪炽盛于体内所致，治疗宜用清降法，最忌使用升散法，这是祛除邪气的治法。那些病程长久的头痛，或者发作或者缓解，有的因为体表虚弱，轻微感受外邪就会发作；有的因为阳气偏胜，轻微发热就会发作；有的因为肾水亏虚于下，导致虚火上冲而发作；有的因为阳气虚弱于上，导致阴寒之气上乘而发作。所以，短暂发病应当重视祛邪，长久发病应当重视扶正，这确实是总纲。然而也有短暂发病却表现为虚证，长久发病却表现为实证的情况，又应当根据脉象和症状详细辨别，不可固执己见。
一、头痛有各条经络的辨证区别。凡是外感引起的头痛，应当观察太阳、阳明、少阳三阳经以及厥阴经。因为这三阳经的经脉都上行至头部，厥阴经的经脉也交会于头顶，所以张仲景《伤寒论》中只提到三阳经有头痛，厥阴经也有头痛，而太阴经、少阴经则没有头痛。在辨别方法上，虽然头脑、前额虽然是三阳经汇聚之处，没有不能疼痛的，但是太阳经在后头，阳明经在前额，少阳经在两侧，这又有各自的主管部位，也是外感头痛所必须辨别的。至于内伤引起的头痛，就不能拘泥于三阳经了。如本书所言，下虚上实，病位在足少阴肾经和足太阳膀胱经；如果参考《厥病篇》的论述，那么足六经以及手少阴心经、手少阳三焦经都有可能出现头痛。《奇病论》说：脑属于阴，髓是充盈骨骼的物质。凡是疼痛在脑部的，难道不是少阴经的病吗？这是内证与外证的不同，是不可以不仔细察辨的。（《厥病篇》的含义详见《类经》）
一、外感头痛，自然有表证可以观察，大概患者身体必然有恶寒发热，脉象必然紧或数，或者伴有流清鼻涕，或者兼有咳嗽，或者兼有脊背酸痛，或者兼有项部僵硬不能左右回顾，这些都是寒邪在经络中的表现，散去寒邪，头痛自然停止，如川芎、细辛、蔓荆子、柴胡这类药物，都非常适宜。如果寒邪严重的，适宜用麻黄、桂枝、生姜、葱白、紫苏、白芷这类药物，根据患者的虚实情况进行加减使用。
一、火邪引起的头痛，虽然各条经络都有火证，但唯独阳明经最为严重。正因为阳明胃火，旺盛于头面部并直达头维穴，所以其疼痛必然剧烈，脉象必然洪大，症状必然多有内热，或者头脑震颤，疼痛且伴有胀感，而且完全没有表邪的，一定是火邪。想要治疗阳明经的火邪，没有比白虎汤加泽泻、木通、生地、麦冬这类药物更好的，用以抑制其至高无上的火势，疗效最快。至于其他经络的火邪，那么芍药、天花粉、黄芩、黄连、知母、黄柏、龙胆草、栀子这类药物，没有不可以选择使用的。但是治疗火邪的方法，不宜辅助以升散的药物，因为外邪之火，可以通过发散去除，内郁之火，得到升散反而会更加炽烈，这是禁忌。
一、阴虚头痛，即属于血虚一类，凡是久病患者多患有此症。其症状多因肾水亏虚，所以虚火容易妄动，火动则引起疼痛，必然兼有烦热、内热等症状，治疗应以滋补肾水为主，应当使用滋阴八味煎、加减一阴煎、玉女煎这类方剂为主治。火邪轻微的，适宜用六味地黄丸、四物汤、三阴煎、左归饮这类方剂为主治。
一、阳虚头痛，即属于气虚一类，也是久病患者所患。其症状必然表现为神情忧郁不乐，或者畏光，或者怕冷，或者倦怠乏力，或者饮食无味，脉象必然微细，头部必然沉重，遇到阴天则痛，遇到寒冷也痛，这都是阳气虚弱、阴气偏胜所致。治疗应以扶持阳气为主，如理阴煎、理中汤、十全大补汤、补中益气汤这类方剂，都可以选择使用，或者用五福饮、五君子煎加入川芎、细辛、蔓荆子这类药物，以升发通达阳气，这是最好的治疗方法。
一、痰厥头痛，各种古代方书中都有这个名称，然而根据我的论述，则必定有别的原因，只是有头痛兼有痰湿的情况，未必是因为痰湿导致头痛。所以兼有痰湿的患者必然出现恶心呕吐、胸膈满闷、胁肋胀满，或者咳嗽气粗多痰，这种情况下不得不兼顾化痰治疗，适宜用二陈汤、六安煎、和胃饮、平胃散加入川芎、细辛、蔓荆子这类方剂为主治。如果多痰兼有火邪的，适宜用清膈煎，或者二陈汤、六安煎加入黄芩、天花粉这类方剂为主治，火邪严重的加石膏也可以。如果多痰兼有虚证而头痛的，适宜用金水六君煎，或者六君子汤加入川芎、细辛这类方剂，酌情使用。李东垣治疗痰厥头痛，症见恶热心烦闷，头晕眼花，气短急促，上气喘促无力，懒言，心神错乱，眼睛不能睁开，如同处于风云变幻之中，头部痛苦如撕裂一般，身体沉重如山，四肢冰冷，无法安卧，如范天FS的妻子，因为两次误用攻下法而导致头痛的，使用半夏白术天麻汤。
Whenever diagnosing headache, one must first examine the duration of the illness and then distinguish between exterior (Biao) and interior (Li) patterns. Generally, acute pain is caused by pathogenic factors, while chronic disease involves a deficiency of Yuan Qi (Primordial Qi). Regarding acute conditions: if there are exterior pathogens, this is due to Wind-Cold invading the meridians externally; treatment should focus on dispersing and releasing, strictly avoiding cooling and descending methods. If there are interior pathogens, this is due to excessive Fire in the Three Yang meridians blazing internally; treatment should focus on clearing and descending, strictly avoiding ascending and dispersing methods. These are methods for eliminating pathogens. In cases of chronic headache, symptoms may wax and wane. Some flare up due to exterior deficiency with slight exposure to external pathogens; some flare up due to Yang excess with slight heat; some flare up due to Kidney Water deficiency below, allowing Deficient Fire to ascend; some flare up due to Yang deficiency above, allowing Yin-Cold to prevail. Therefore, in acute conditions, emphasis should be placed on eliminating pathogens; in chronic conditions, emphasis should be placed on supporting Yuan Qi. This is indeed the general principle. However, there are acute conditions presenting as deficiency and chronic conditions presenting as excess; these must be carefully distinguished based on pulse and symptoms, and one must not adhere rigidly to rules.
1. Differentiation of Headache by Meridians. For all exogenous headaches, one must observe the Taiyang, Yangming, Shaoyang, and Jueyin meridians. The meridians of the Three Yang all ascend to the head, and the Jueyin meridian also converges at the vertex. Thus, in Zhang Zhongjing's *Treatise on Cold Damage* (*Shanghan Lun*), only the Three Yang and Jueyin are mentioned as having headaches, while the Taiyin and Shaoyin do not. Regarding differentiation: although the brain and forehead are convergence points for the Three Yang and can all experience pain, the Taiyang governs the back of the head, Yangming the front, and Shaoyang the sides; these have specific dominions and must be distinguished in exogenous headaches. As for endogenous headaches, one cannot be confined to the Three Yang. As stated in this text, "deficiency below and excess above" relates to the Foot-Shaoyin and Foot-Taiyang meridians. If referring to the discussion in the *Jue Bing Pian* (Chapter on Jue Diseases), then all six Foot meridians, as well as the Hand-Shaoyin and Hand-Shaoyang meridians, can present with headaches. The *Qi Bing Lun* (Treatise on Rare Diseases) states: "The brain is Yin; marrow fills the bones." Is pain in the brain not a disease of the Shaoyin? This distinction between internal and external syndromes must not be overlooked. (The meaning of the *Jue Bing Pian* is detailed in *Lei Jing*).
1. Exogenous Headache naturally presents with exterior signs. Typically, the patient has aversion to cold and fever, the pulse is tight or rapid, accompanied by clear nasal discharge, cough, soreness and pain in the spine and back, or stiffness in the neck preventing turning the head left or right. These are all caused by Cold pathogens in the meridians. Dispersing the Cold will stop the pain spontaneously. Herbs such as Chuanxiong Rhizome (Chuanxiong), Asarum Root (Xixin), Vitex Fruit (Manjingzi), and Bupleurum Root (Chaihu) are most suitable. If the Cold is severe, Ephedra Stem (Mahuang), Cinnamon Twig (Guizhi), Fresh Ginger (Shengjiang), Scallion White (Congbai), Perilla Leaf (Zisu), and Angelica Dahurica Root (Baizhi) should be used, added or subtracted according to the patient's deficiency or excess.
1. Headache caused by Fire Pathogens: Although Fire syndromes can occur in any meridian, they are most prominent in the Yangming. This is because Stomach Fire in the Yangming flares up in the head and face, reaching directly to the Touwei point (ST8). Consequently, the pain is severe, the pulse is surging (Hong), and symptoms include internal heat, trembling of the head, pain with distension, and an absolute absence of exterior pathogens; this indicates Fire Pathogen. To treat Yangming Fire, nothing is better than Baihu Tang (White Tiger Decoction) added with Alisma Rhizome (Zexie), Akebia Stem (Mutong), Rehmannia Root (Shengdi), and Ophiopogon Tuber (Maidong) to suppress its high-reaching intensity, yielding the fastest effect. For Fire in other meridians, Paeonia Root (Shaoyao), Trichosanthes Root (Tianhua), Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Anemarrhena Rhizome (Zhimu), Phellodendron Bark (Huangbai), Gentian Root (Longdan), and Gardenia Fruit (Zhizi) can all be selected and used. However, when treating Fire, one should not assist with ascending and dispersing herbs. External Fire can be dispersed away, but Internal Stagnant Fire becomes more intense with ascending agents; this is a contraindication.
1. Headache due to Yin Deficiency belongs to Blood Deficiency and is common in chronic diseases. Symptoms often arise from Kidney Water deficiency, causing Deficient Fire to move easily; when Fire moves, pain occurs, accompanied by vexation, heat, and internal heat. Treatment should primarily nourish Water (Kidney Yin), using Ziyin Bawei Jian (Nourishing Yin Eight-Flavor Decoction), Jiayi Yiyin Jian (Modified One-Yin Decoction), or Yinvu Jian (Jade Woman Decoction). If the Fire is mild, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Siwu Tang (Four-Substance Decoction), Sanyin Jian (Three-Yin Decoction), or Zuogui Yin (Left Restoring Drink) may be used.
1. Headache due to Yang Deficiency belongs to Qi Deficiency and is also seen in chronic diseases. Symptoms include a sense of gloom or lingering discomfort, photophobia, aversion to cold, fatigue, lack of appetite, a fine and weak pulse, a heavy sensation in the head, pain worsening on cloudy days or in cold weather. These are all due to Yang deficiency and Yin excess. Treatment should primarily support Yang. Formulas such as Liyin Jian (Supporting Yin Decoction), Lizhong Tang (Regulate the Middle Decoction), Shiquan Dabu Tang (Ten Significant Tonifying Decoction), or Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can be selected. Alternatively, Wufu Yin (Five Blessings Drink) or Wu Junzi Jian (Five Gentlemen Decoction) added with Chuanxiong, Xixin, and Manjingzi can be used to ascend and diffuse Yang Qi; this is the optimal treatment.
1. Headache due to Phlegm-Jue (Phlegm Obstruction): Ancient formularies list this term, but in my view, there must be other causes. While headache may be accompanied by Phlegm, it is not necessarily caused by Phlegm. When accompanied by Phlegm, symptoms must include nausea, vomiting, chest fullness, hypochondriac distension, or cough with coarse breathing and abundant sputum. In such cases, treatment must address Phlegm simultaneously. Suitable formulas include Erchen Tang (Two-Aged Decoction), Liu'an Jian (Liu'an Decoction), Hewei Yin (Harmonize the Stomach Drink), or Pingwei San (Calm the Stomach Powder) added with Chuanxiong, Xixin, and Manjingzi. If there is abundant Phlegm accompanied by Fire, Qingge Jian (Clear the Diaphragm Decoction) or Erchen Tang/Liu'an Jian added with Huangqin and Tianhuafen should be used; if Fire is severe, Gypsum (Shigao) may be added. If there is abundant Phlegm accompanied by Deficiency leading to headache, Jinshui Liujun Jian (Metal-Water Six-Gentlemen Decoction) or Liujunzi Tang (Six-Gentlemen Decoction) added with Chuanxiong and Xixin should be used judiciously. Li Dongyuan treated Phlegm-Jue headache characterized by aversion to heat, vexation, dizziness, blurred vision, shortness of breath, labored breathing, reluctance to speak, mental confusion, inability to open the eyes, feeling as if amidst wind and clouds, severe splitting headache, heaviness of the body like a mountain, cold limbs, and inability to lie down. For example, the wife of Fan Tian FS developed headache after two instances of inappropriate purgative treatment; she was treated with Banxia Baizhu Tianma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction).