内经云寸口脉中短者曰头痛
脉经云阳弦则头痛又云寸口脉浮中风发热头痛脉紧头痛是伤寒脉紧上寸口者风头痛
脉诀云头痛短涩应须死浮滑风痰皆易除
活人书云头痛者阳证也太阳证头痛发热恶寒无汗麻黄汤有汗桂枝汤若已发汗未发汗头痛
如破
者连须葱白汤不止者葛根葱白汤阳明证头痛不恶寒反恶热胃实也调胃承气汤少阳头痛小柴胡
汤太阴少阴并无头痛之证仲景只有厥阴一证吴茱萸汤
按伤寒以足三阳经上行至头并厥阴与督脉会于巅故止言四经头痛若杂病所感者诸经皆能
头痛也活人用葱白汤以通上下之阳气也
太阳头痛恶风寒川芎 少阳头痛往来寒热脉弦柴胡 阳明头痛自汗发热恶热白芷 太阴
头痛
体重痰实腹痛半夏 少阴头痛三阴三阳经不流行而足寒逆为寒厥头痛细辛 厥阴头痛项痛脉
微浮缓欲入太阳其疾痊然亦当用川芎(宝鉴作 本一作吴茱萸)气虚头痛黄 血虚头痛当归
(宝鉴作川芎下同)诸气血俱虚头痛黄 当归 伤寒太阳头痛麻黄汤桂枝汤 阳明头痛白虎汤
少阳头痛柴胡汤 太阴头痛脉浮桂枝汤脉沉理中汤 少阴头痛脉沉微 热麻黄附子细辛汤
厥阴头痛外伤本经桂枝麻黄各半汤 呕而微吐水吴茱萸汤
按此与后论重出者众然中间药味略有不同故两存之
东垣头痛论
金匮真言论云东风生于春病在肝俞在头项故春气者病在头又诸阳会于头面如足太阳之脉
病冲
头痛足少阳之脉病头角颔痛夫风从上受之风寒伤上邪从外入客于经络令人振寒头痛身重恶寒
治在风池风府调其阴阳不足则补有余则泻汗之则愈此伤寒头痛也头痛耳鸣九窍不利者肠胃之
所生乃气虚头痛也心烦头痛者病在膈中过在手巨阳少阴乃湿热头痛也如气上不下头痛巅疾者
下虚上实也过在足少阴巨阳甚则入肾寒湿头痛也如头半寒痛者先取手少阳阳明后取足少阳阳
明此偏头痛也有真头痛甚则脑尽痛手足寒至节者死不治有厥逆头痛者所犯大寒内至骨髓髓者
以脑为主脑逆故令头痛齿亦痛凡头痛者木也风则温也治以辛凉秋克春之意故头痛皆以风药治
之者总其大体而言之高巅之上惟风可到故味之薄者阴中之阳乃自地升天者也然有三阴三阳之
异故太阳头痛脉浮紧恶风寒川芎羌活独活麻黄之类为主少阳经头痛脉弦细往来寒热柴胡为主
阳明头痛身热目疼鼻干恶寒发热恶热其脉浮缓而长升麻汤或石膏白芷为主太阴头痛必有痰体
重或腹痛为痰癖其脉沉缓苍术半夏南星为主少阴经头痛三阴三阳经不流行而足寒气逆为寒厥
其脉沉细麻黄附子细辛汤为主厥阴头痛项痛或痰吐涎沫厥冷其脉浮缓吴茱萸汤主之诸血虚头
痛当归川芎为主诸气虚头痛人参黄 为主为主者主治也兼见何证以佐使药治之此立方之大法
也气血俱虚头痛者于调中益气汤中少加川芎蔓荆子细辛其效如神半夏白术天麻汤治痰厥头痛
药也青空膏乃风湿热头痛药也羌活附子汤厥逆头痛药也如湿气在头者以苦吐之不可执方而治
按此论头痛至为详悉首言伤寒内伤头痛历引内经以明湿热寒湿偏头痛真头痛厥逆头痛等
证细分六经用药之法后世无以加矣
《内经》说：寸口脉短促的，称为头痛。
《脉经》说：阳脉弦紧则头痛；又说：寸口脉浮，是中风发热头痛；脉紧而头痛，这是伤寒；脉紧在寸口以上部位，是风邪所致的头痛。
《脉诀》说：头痛若见短涩之脉，应当主死；若见浮滑之脉，则是风痰所致，容易治愈。
《活人书》说：头痛属于阳证。太阳病证见头痛、发热、恶寒、无汗，用麻黄汤治疗；若有汗，用桂枝汤治疗。如果已经发过汗或尚未发汗，头痛剧烈如破者，用连须葱白汤治疗；服后不止者，用葛根葱白汤治疗。阳明病证见头痛，不恶寒反而恶热，这是胃实热证，用调胃承气汤治疗。少阳病头痛，用小柴胡汤治疗。太阴病和少阴病并没有头痛的证候。张仲景只有厥阴病一证，用吴茱萸汤治疗。
按语：伤寒病中，足三阳经上行至头，并与厥阴经及督脉会合于头顶，所以只论述这四条经络的头痛。如果是杂病感受外邪，各条经络都能引起头痛。《活人书》使用葱白汤是为了通调上下阳气。
太阳头痛，症见恶风寒，主药为川芎；少阳头痛，症见往来寒热，脉弦，主药为柴胡；阳明头痛，症见自汗、发热、恶热，主药为白芷；太阴头痛，症见身体沉重、痰实、腹痛，主药为半夏；少阴头痛，因三阴三阳经气不流通，且足部寒冷逆冷，属寒厥头痛，主药为细辛；厥阴头痛，症见项痛，脉微浮缓，欲传入太阳经时疾病将愈，但也应当使用川芎（《宝鉴》作藁本，一作吴茱萸）。气虚头痛，主药为黄芪；血虚头痛，主药为当归（《宝鉴》作川芎，以下同）；气血俱虚头痛，主药为黄芪、当归。伤寒太阳头痛，用麻黄汤、桂枝汤；阳明头痛，用白虎汤；少阳头痛，用柴胡汤；太阴头痛，脉浮用桂枝汤，脉沉用理中汤；少阴头痛，脉沉微，用麻黄附子细辛汤；厥阴头痛，外伤本经，用桂枝麻黄各半汤；呕吐且微吐清水，用吴茱萸汤。
按语：此段与后文论述重复之处众多，但中间药物略有不同，故两者并存。
《金匮真言论》说：东风生于春季，病在肝俞，反映在头项，所以春气致病多在头部。又言诸阳经会聚于头面，如足太阳经脉病，冲逆致头痛；足少阳经脉病，致头角、下颌疼痛。风邪从上受入，风寒伤上，邪气从外侵入经络，使人战栗发冷、头痛、身体沉重、恶寒，治疗应在风池、风府穴，调和阴阳，不足则补，有余则泻，发汗即可痊愈，这是伤寒头痛。头痛伴耳鸣、九窍不利，是由肠胃虚弱产生的，属于气虚头痛。心烦头痛，病位在膈中，涉及手太阳、手少阴经，属于湿热头痛。如气机上逆不下行，导致头痛巅疾，属于下虚上实，涉及足少阴、足太阳经，严重则入肾，属于寒湿头痛。如头部一侧寒冷疼痛，先取手少阳、手阳明经穴，后取足少阳、足阳明经穴，这是偏头痛。有真头痛，严重时脑部尽痛，手足寒冷至关节，主死，不可治愈。有厥逆头痛，因触犯大寒，寒气内至骨髓，骨髓以脑为主，脑气逆乱故令头痛，牙齿也痛。大凡头痛，多属木火为患，风则温煦，治疗应用辛凉之法，体现秋克春之意，所以说头痛都用风药治疗，这是从大体而言。高巅之上，只有风药能到达，气味薄弱的药物属于阴中之阳，能自地升天。然而有三阴三阳的区别：太阳头痛，脉浮紧，恶风寒，以川芎、羌活、独活、麻黄等为主药；少阳经头痛，脉弦细，往来寒热，以柴胡为主药；阳明头痛，身热、目疼、鼻干、恶寒发热、恶热，脉浮缓而长，以升麻汤或石膏、白芷为主药；太阴头痛，必有痰，身体沉重或腹痛，为痰癖，脉沉缓，以苍术、半夏、南星为主药；少阴经头痛，三阴三阳经气不流通，足寒气逆，属寒厥，脉沉细，以麻黄附子细辛汤为主药；厥阴头痛，项痛或痰吐涎沫，四肢厥冷，脉浮缓，以吴茱萸汤主治。诸血虚头痛，以当归、川芎为主药；诸气虚头痛，以人参、黄芪为主药。“为主”即主治之意，兼见何证，便以佐使药治疗，这是立方的大法。气血俱虚头痛，在调中益气汤中少量加入川芎、蔓荆子、细辛，效果神奇。半夏白术天麻汤是治疗痰厥头痛的药物。青空膏是治疗风湿热头痛的药物。羌活附子汤是治疗厥逆头痛的药物。如湿气在头部，可用苦味药催吐，不可固执一方而治。
按语：此篇关于头痛的论述极为详尽，首先区分伤寒与内伤头痛，广泛引用《内经》以阐明湿热、寒湿、偏头痛、真头痛、厥逆头痛等证候，并细分六经用药方法，后世无法超越。
The *Neijing* states: A short pulse at the Cun Kou (radial artery) is termed headache.
The *Maijing* states: A wiry yang pulse indicates headache; it also states that a floating pulse at the Cun Kou, accompanied by wind-stroke, fever, and headache, or a tight pulse with headache, indicates cold damage (*Shanghan*); a tight pulse located above the Cun Kou indicates wind-induced headache.
The *Maijue* states: If a short and choppy pulse accompanies headache, death is likely; if a floating and slippery pulse appears, it indicates wind-phlegm, which is easy to cure.
The *Huo Ren Shu* states: Headache belongs to Yang syndromes. In Taiyang syndrome, symptoms include headache, fever, aversion to wind and cold, and anhidrosis, treated with Ma Huang Tang (Ephedra Decoction); if there is sweating, Gui Zhi Tang (Cinnamon Twig Decoction) is used. If sweating has already occurred or not yet occurred, and the headache is severe as if breaking, Lian Xu Cong Bai Tang (Scallion White Decoction with Roots) is used; if ineffective, Ge Gen Cong Bai Tang (Kudzu Root and Scallion White Decoction) is used. In Yangming syndrome, headache occurs without aversion to cold but with aversion to heat, indicating excess heat in the stomach, treated with Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction). Shaoyang headache is treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction). There are no headache syndromes in Taiyin and Shaoyin. Zhang Zhongjing mentions only one Jueyin syndrome, treated with Wu Zhu Yu Tang (Evodia Decoction).
Note: In cold damage diseases, the three Foot-Yang meridians ascend to the head, converging with the Jueyin meridian and the Du Mai (Governing Vessel) at the vertex; thus, only these four meridians' headaches are discussed. However, in miscellaneous diseases caused by external pathogens, all meridians can cause headache. The *Huo Ren Shu* uses Cong Bai Tang (Scallion White Decoction) to unblock the Yang qi of the upper and lower body.
Taiyang headache, characterized by aversion to wind and cold, is primarily treated with Chuan Xiong Rhizome (Chuanxiong). Shaoyang headache, characterized by alternating chills and fever and a wiry pulse, is primarily treated with Chai Hu Radix (Bupleurum). Yangming headache, characterized by spontaneous sweating, fever, and aversion to heat, is primarily treated with Bai Zhi Rhizome (Angelica Dahurica). Taiyin headache, characterized by heavy body, phlegm-fullness, and abdominal pain, is primarily treated with Ban Xia Rhizoma Preparatum (Pinellia). Shaoyin headache, due to non-circulation of Qi in the Three Yin and Three Yang meridians and cold/reversal in the feet, constitutes Cold-Jue headache, primarily treated with Xi Xin Herba (Asarum). Jueyin headache, characterized by neck pain and a slightly floating and slow pulse, suggests transmission to Taiyang where the disease will heal, but Chuan Xiong Rhizome should still be used (*Ba Jian* records Gao Ben Rhizome or Wu Zhu Yu Fructus). Qi-deficiency headache is primarily treated with Huang Qi Radix (Astragalus). Blood-deficiency headache is primarily treated with Dang Gui Radix (Angelica Sinensis) (*Ba Jian* records Chuan Xiong Rhizome, same below). Qi-and-Blood deficiency headache is primarily treated with Huang Qi Radix and Dang Gui Radix. For Taiyang headache in cold damage, use Ma Huang Tang or Gui Zhi Tang; for Yangming headache, use Bai Hu Tang (White Tiger Decoction); for Shaoyang headache, use Chai Hu Tang (Bupleurum Decoction); for Taiyin headache, if the pulse is floating use Gui Zhi Tang, if sinking use Li Zhong Tang (Regulate the Middle Decoction); for Shaoyin headache with a deep and faint pulse, use Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction); for Jueyin headache due to external injury to its own meridian, use Gui Zhi Ma Huang Ge Ban Tang (Half Cinnamon Twig and Half Ephedra Decoction); for vomiting with slight spitting of clear water, use Wu Zhu Yu Tang.
Note: This section repeats much of the following discussion, but with slight differences in ingredients, so both are preserved.
Li Dongyuan's *Headache Treatise*
The *Jingui Zhenyan Lun* states: East wind arises in spring, disease affects the Liver Shu, manifesting in the head and neck; thus, spring-pathogens often affect the head. Furthermore, all Yang meridians converge on the head and face. For instance, pathology of the Foot-Taiyang meridian causes rushing headache; pathology of the Foot-Shaoyang meridian causes headache at the temples and jaw. Wind pathogen enters from above; wind-cold damages the upper body, invading meridians from outside, causing shivering, headache, heavy body, and aversion to cold. Treatment should focus on Feng Chi (GB20) and Feng Fu (DU16 acupoints), regulating Yin and Yang; tonify deficiency, sedate excess, induce sweating, and the disease will resolve. This is cold-damage headache. Headache with tinnitus and dysfunction of the nine orifices arises from the stomach and intestines, constituting Qi-deficiency headache. Heart vexation with headache indicates pathology in the Diaphragm, involving Hand-Taiyang and Hand-Shaoyin meridians, constituting Damp-Heat headache. If Qi rises but does not descend, causing headache at the vertex, it is Lower Deficiency and Upper Excess, involving Foot-Shaoyin and Foot-Taiyang meridians; severe cases enter the Kidney, constituting Cold-Damp headache. If one side of the head feels cold and painful, first treat Hand-Shaoyang and Hand-Yangming, then Foot-Shaoyang and Foot-Yangming; this is lateral headache. True headache involves severe brain pain throughout, with cold limbs reaching the joints; this is fatal and incurable. Jue-ni headache results from exposure to severe cold, penetrating to the bone marrow; since marrow connects to the brain, brain Qi rebellion causes headache and toothache. Generally, headache is associated with Wood/Fire; wind brings warmth, so treatment should use Acrid-Cool methods, reflecting Autumn overcoming Spring. Thus, headache is generally treated with Wind-dispelling herbs, speaking broadly. High peaks can only be reached by Wind herbs; thin-flavored herbs belong to Yang within Yin, rising from earth to heaven. However, distinctions exist among the Three Yin and Three Yang: Taiyang headache, with floating-tight pulse and aversion to wind/cold, is primarily treated with Chuan Xiong Rhizome, Qiang Huo Radix Notopterygii, Du Huo Radix Saposhnikoviae, Ma Huang Herba, etc.; Shaoyang meridian headache, with wiry-thin pulse and alternating chills/fever, is primarily treated with Chai Hu Radix; Yangming headache, with body heat, eye pain, dry nose, aversion to cold/heat, and floating-slow-long pulse, is primarily treated with Sheng Ma Decoction or Shi Gypsum and Bai Zhi Rhizome; Taiyin headache necessarily involves phlegm, heavy body, or abdominal pain (phlegm-stagnation), with a deep-slow pulse, primarily treated with Cang Zhu Rhizoma, Ban Xia Rhizoma Preparatum, Nan Xing Rhizoma; Shaoyin meridian headache, with non-circulation of Qi in the Three Yin/Yang meridians, cold feet, and reversal, constituting Cold-Jue, with a deep-thin pulse, is primarily treated with Ma Huang Fu Zi Xi Xin Tang; Jueyin headache, with neck pain, phlegm/saliva expectoration, cold limbs, and floating-slow pulse, is primarily treated with Wu Zhu Yu Tang. All blood-deficiency headaches are primarily treated with Dang Gui Radix and Chuan Xiong Rhizome; all Qi-deficiency headaches are primarily treated with Ren Shen Radix and Huang Qi Radix. "Primary" means main treatment; accompanying syndromes are treated with assistant and guide herbs. This is the general principle of formula construction. For Qi-and-Blood deficiency headache, add small amounts of Chuan Xiong Rhizome, Man Jing Zi Fructus, and Xi Xin Herba to Tiao Zhong Yi Qi Tang (Regulate the Middle and Boost Qi Decoction) for miraculous effect. Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes Macrocephala, and Gastrodia Decoction) treats Phlegm-Jue headache. Qing Kong Gao treats Wind-Damp-Heat headache. Qiang Huo Fu Zi Tang treats Jue-ni headache. If dampness is in the head, bitter emetics may be used; do not adhere rigidly to one formula.
Note: This treatise on headache is extremely detailed. It first distinguishes cold-damage from internal-injury headache, extensively cites the *Neijing* to clarify Damp-Heat, Cold-Damp, lateral, true, and Jue-ni headaches, and subdivides medication methods by the Six Meridians. Later generations could not surpass it.