宝鉴顺气和中汤治年高气弱清气不能上升头面昏闷本无表邪因发汗数次清阳之气愈虚故
苦头痛恶风不喜饮食气短脉弱弦细而微宜升阳气
黄 (一钱半) 人参(一钱) 白术 陈皮 当归 白芍(五分) 甘草(七分) 升麻 柴
胡(各三分) 川芎 细辛 蔓荆子(各二分)
上锉作一服水煎食后服
按此即补中益气汤加减法也内伤头痛本方加蔓荆子三分痛甚加川芎二分项痛脑痛加 本
二分若苦头痛者加细辛二分诸头痛并用此四味足矣若头上有热则此不能治当以清空之剂
机要四物汤治头疼
四物汤中倍加川芎
元戎古方治头痛欲裂
当归(二两酒一升煮取六合)
按此二方并出厥阴例药也
搐药
本事方治八般头风
草乌尖 细辛(等分)
黄丹(少许) 为末搐入鼻中立效
秘方治头痛不可忍
玄胡(七枚) 猪牙皂角(肥实者二个) 青黛(二钱)
上为末水丸成小饼子如杏仁大用时令病者仰卧以水化开用竹管送入男左女右鼻中觉药至
喉少酸令病者坐却令咬定铜钱一个于当门齿当见涎出成盆即愈
三因搐鼻药
荜茇 良姜(各一分) 白芷(一钱) 细辛(半钱)
上为末每服一小字先含水一口分搐鼻内吐水即止
秘藏搐鼻郁金散治风热头痛
石膏 芒硝 白芷(各二钱) 郁金(一钱) 薄荷(三分)
上为末极细口含水鼻内搐之
按此阳明经药也
太阳经嚏药
防风(二分) 羌活(二分) 红豆(二个)
上为末鼻内搐之
元戎搐药瓜蒂散治偏头痛久不愈服药及针灸不效者以其湿气在头也
瓜蒂一味为末少许吹鼻中清水徐徐出一昼夜湿尽病止为度
按此以上搐药元戎云亦吐之义也经云湿气在上以苦吐之故邪在胸中服之邪在头目搐之皆
吐之属也张子和点目出泪搐鼻流涕口含漉涎皆以同乎吐也
贴药
前本事方或三因药为末和葱白捣泥为膏贴两额上
杂方
严氏葱附丸治元气虚壅上攻头痛
附子(一只炮去皮脐)
上为末葱涎为丸桐子大空心茶清下
玉真丸治肾厥头痛不可忍其脉举之则弦按之则坚
生硫黄(二两另研) 石膏(硬者) 半夏(汤洗十次) 硝石(另研各一两)
上为末研匀用生姜自然汁煮糊为丸桐子大每服四十丸食前米饮下
按头痛古人多从风而议治故其药虽有辛平辛凉辛温辛热之殊大抵皆于解散之中分所挟之
寒热
耳至于伤寒头痛仲景论中亦详兹不详载但内因痰厥气虚血虚头痛之类东垣虽有论有方学人亦
宜随病审机而用药亦难拘于所录之方以尽其变也又严氏治气虚头痛用附子治肾厥头痛用硫黄
等药本出三因之论其义皆未切当今姑存之以备其说耳
《宝鉴》中的顺气和中汤,治疗年高体弱、清气不能上升导致头面昏闷的病证。本无表邪,但因多次发汗,致使清阳之气更加虚弱,因此出现剧烈头痛、怕风、不想饮食、气短、脉象弱且弦细微弱的症状,适宜提升阳气。
药物组成:黄(一钱半)、人参(一钱)、白术、陈皮、当归、白芍(五分)、甘草(七分)、升麻、柴胡(各三分)、川芎、细辛、蔓荆子(各二分)。
以上药材切碎为一剂,加水煎煮,饭后服用。
按语:此方即补中益气汤的加减法。内伤引起的头痛,本方加蔓荆子三分;疼痛严重者加川芎二钱;项部疼痛或脑部疼痛加藁本二分;若苦于剧烈头痛者加细辛二分。各种头痛使用这四味药足矣。如果头部有热象,则此方不能治疗,应当使用清热的方剂。
元戎的古方治疗头痛欲裂的症状:当归(二两,用酒一升煮取六合)。
按语:这两个方剂都出自厥阴经的用药范畴。
搐鼻药方
《本事方》治疗八般头风:
草乌尖、细辛(等分),黄丹(少许)。研为细末,搐入鼻中,立见疗效。
秘方治疗难以忍受的头痛:
玄胡索(七枚)、猪牙皂角(肥实者二个)、青黛(二钱)。
以上研为细末,用水泛丸成小饼状,大小如杏仁。使用时令病人仰卧,用水化开药饼,用竹管送入鼻孔,男左女右。感觉药力到达喉咙时稍感酸味,令病人坐起,咬住门齿间的一个铜钱,见到唾液流出如盆多即痊愈。
《三因方》中的搐鼻药:
荜茇、良姜(各一分)、白芷(一钱)、细辛(半钱)。
以上研为细末,每次服用一小字量,先含一口水,分次搐入鼻内,吐出清水后即停止。
《秘藏》中的搐鼻郁金散治疗风热头痛:
石膏、芒硝、白芷(各二钱)、郁金(一钱)、薄荷(三分)。
以上研为极细末,口含水,将药粉搐入鼻内。
按语:这是阳明经的用药。
太阳经嚏药:
防风(二分)、羌活(二分)、红豆(二个)。
以上研为细末,搐入鼻内。
元戎的搐药瓜蒂散治疗偏头痛久治不愈,服药及针灸无效者,因其湿气在头部。
仅用瓜蒂一味研为细末,少许吹入鼻中,待清水徐徐流出,一昼夜湿气排尽,病止为止。
按语:以上的搐鼻药,元戎说也有催吐的含义。经文说:“湿气在上,以苦吐之。”所以邪气在胸中,服药使其呕吐;邪气在头目,搐鼻使其流涕,都属于催吐的范畴。张子和点眼流泪、搐鼻流涕、口含漉涎,都是与催吐原理相同的方法。
贴敷药方
《本事方》或《三因方》的药方研为细末,与葱白捣烂成泥状作为膏药,贴敷在两额上。
杂方
严氏的葱附丸治疗元气虚壅、上攻导致的头痛:
附子(一只,炮制,去皮脐)。
以上研为细末,用葱汁和丸,如梧桐子大,空腹时用茶清送下。
玉真丸治疗肾厥头痛,难以忍受,其脉象举之则弦,按之则坚:
生硫黄(二两,另研)、石膏(质地硬的)、半夏(汤洗十次)、硝石(另研,各一两)。
以上研为细末,混合均匀,用生姜自然汁煮糊为丸,如梧桐子大。每服四十丸,饭前用米饮送下。
按语:古人治疗头痛多从风邪议论,所以虽然药物有辛平、辛凉、辛温、辛热的不同,但大体都是在解散邪气的同时,区分所夹杂的寒热性质。
至于伤寒引起的头痛,仲景的论著中也详细论述,此处不详载。但是像内因痰厥、气虚、血虚引起的头痛之类,李东垣虽有论述和方剂,学习的人也应当根据病情审察病机而用药,也难以拘泥于所记录的方剂来穷尽其变化。另外,严氏治疗气虚头痛用附子,治疗肾厥头痛用硫黄等药,原本出自《三因方》的论述,其义理都未切中要害,当今姑且保存这些说法以备参考。
Shunqi Hezhong Decoction (Smooth Qi and Harmonize Middle Decoction) from *Baojian* treats conditions in the elderly with weak constitution, where clear Yang fails to ascend, causing dizziness and stuffiness in the head and face. There is no exterior pathogen initially; however, due to multiple instances of sweating therapy, the Clear Yang Qi becomes further deficient. Consequently, there is severe headache, aversion to wind, loss of appetite, shortness of breath, and a pulse that is weak, wiry, thin, and minute. The treatment should focus on raising Yang Qi.
Ingredients: Huangqi (Astragali Radix, 1.5 qian), Renshen (Ginseng Radix, 1 qian), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba, 0.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 0.7 qian), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix, each 0.3 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma), Xixin (Asari Radix et Rhizoma), Manjingzi (Vittariae Spora, each 0.2 qian).
Crush the ingredients into one dose, decoct with water, and take after meals.
Note: This formula is a modification of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For headaches caused by internal injury, add Manjingzi 0.3 qian; for severe pain, add Chuanxiong 2 qian; for occipital or brain pain, add Gaoben (Ligustici Jingwei Rhizoma) 0.2 qian; if suffering from intense headache, add Xixin 0.2 qian. These four herbs are sufficient for various types of headaches. If there is heat in the head, this formula is not suitable; instead, use a clearing-heat formula.
Siwu Tang (Four Substances Decoction) from *Jiyao* treats headache: Double the amount of Chuanxiong in Siwu Tang.
Yuanrong's ancient prescription treats splitting headache: Danggui (2 liang, boiled with 1 sheng of wine until 6 he remains).
Note: Both of these formulas belong to the Jueyin channel medication category.
Nasal Snuffing Formulas
*Banshi Fang* treats eight types of wind-headache: Caowu Jian (Aconiti Kusnezoffii Radix Lateralis Preparata tip) and Xixin (each equal parts), along with a small amount of Huangdan (Minii Oxidum). Grind into fine powder and insufflate into the nose for immediate effect.
Secret Recipe treats unbearable headache: Yanhusuo (Corydalis Rhizoma, 7 pieces), Zhuya Zaojiao (Gleditsiae Fructus, 2 plump ones), Qingdai (Indicum). Grind into powder, make pills with water into small cakes the size of apricot kernels. When using, have the patient lie supine, dissolve the cake with water, and insert it into the nostril using a bamboo tube (left for males, right for females). When the medicinal sensation reaches the throat with a slight sour taste, have the patient sit up and bite a copper coin between the front teeth. Recovery occurs when saliva flows out like a basin.
*Sanyin Fang* nasal snuffing medicine: Biba (Long Pepper Fruit), Liangjiang (Galangal Rhizome, each 1 fen), Baizhi (Angelicae Dahuricae Radix, 1 qian), Xixin (0.5 qian). Grind into powder. Take a small amount ("Xiao Zi"), first hold a mouthful of water, then insufflate into the nose. Stop when clear water is expelled.
*Mizang* Yujin San (Curcuma Powder) for nasal snuffing treats wind-heat headache: Shigao (Gypsum Fibrosum), Mangxiao (Natrii Sulfas), Baizhi (each 2 qian), Yujin (Curcumae Radix, 1 qian), Bohe (Menthae Haplocalycis Herba, 0.3 qian). Grind into extremely fine powder. Hold water in the mouth and insufflate the powder into the nose.
Note: This belongs to the Yangming channel medication.
Taiyang Channel Sneezing Medicine: Fangfeng (Saposhnikoviae Radix, 2 fen), Qianghuo (Notopterygii Rhizoma et Radix, 2 fen), Hongdou (Adenophorae Radix, 2 pieces). Grind into powder and insufflate into the nose.
Yuanrong's Nasal Snuffing Gou Ti San (Momordica Seed Powder) treats chronic migraines unresponsive to oral medication and acupuncture, caused by dampness in the head. Use only Gou Ti (Momordicae Fructus), grind into powder, and blow a small amount into the nose. Wait for clear fluid to drain slowly. Continue until all dampness is exhausted within one day and night, at which point the illness stops.
Note: Regarding the above snuffing medicines, Yuanrong stated they also possess the meaning of inducing vomiting. The Classic says: "Dampness located above should be treated by bitter vomiting." Thus, pathogens in the chest are expelled via oral emetics, while pathogens in the head and eyes are expelled via nasal snuffing inducing rhinorrhea; both belong to the category of vomiting. Zhang Zihe’s methods of inducing tears by eye stimulation, rhinorrhea by nasal snuffing, and salivation by holding liquid in the mouth all share the same principle as vomiting.
Topical Application Formulas
Powders from *Banshi Fang* or *Sanyin Fang* mixed with scallion white, pounded into a paste, applied to both foreheads.
Miscellaneous Formulas
Yan Shi's Congfu Wan (Scallion and Aconite Pill) treats headache caused by deficiency and stagnation of Original Qi attacking upwards: Fuzi (Prepared Aconiti Lateralis Radix, one piece, processed, skin and umbilicus removed). Grind into powder, bind with scallion juice into pills the size of paulownia seeds. Take on an empty stomach with tea infusion.
Yuzhen Wan treats Ren Jue (Kidney Reversal) headache, unbearable, with a pulse that feels wiry upon light palpation and firm upon heavy pressure: Sheng Liuhuang (Native Sulphur, 2 liang, separately ground), Shigao (hard Gypsum Fibrosum), Banxia (Pinelliae Rhizoma, washed ten times in boiling water), Xiaoshi (Natrii Nitras, separately ground, each 1 liang). Grind into powder, mix evenly. Cook paste using fresh ginger juice, form into pills the size of paulownia seeds. Take 40 pills before meals with rice drink.
Note: Ancient treatments for headache mostly discussed wind pathogens. Therefore, although drugs vary in being acrid-neutral, acrid-cool, acrid-warm, or acrid-hot, they generally aim to disperse pathogens while distinguishing accompanying cold or heat.
Regarding headache caused by Shanghan (Cold Damage), Zhang Zhongjing’s treatises discuss it in detail, so it is not repeated here. However, for headaches caused internally by Phlegm-Jue, Qi deficiency, or Blood deficiency, although Li Dongyuan has discussions and formulas, students should examine the pathology according to the specific condition and apply medication accordingly. One cannot rigidly stick to recorded formulas to exhaust all variations. Furthermore, Yan Shi used Fuzi for Qi-deficiency headache and Liuhuang for Ren Jue headache, originally derived from *Sanyin Fang*. Their rationale is not entirely precise; thus, they are preserved here merely for reference.