医书多分头痛、头风为二门，然一病也。但有新久去留之分耳。浅而近者名头
痛，其痛卒然而至，易于解散速安也。深而远者为头风，其痛作止不常，愈后遇触
复发也。皆当验其邪所从来而治之。世俗治头痛，不从风则从寒，安知其有不一之邪乎。
试考《内经》论头痛所因以明之，如风从外入，振寒汗出头痛。新沐中风为首风，
当先风一日，头痛不可以出内。大寒内至骨髓，髓以脑为主，脑逆故头痛齿亦痛。
少阳司天之政，初之气，风胜乃摇，候乃大温，其病气怫于上头痛。二之气，
火反郁，白埃四起，其病热郁于上头痛。少阳司天，火淫所胜，民病头痛，发热恶
寒如疟。岁金不及，炎火乃行，复则阴厥且格，阳反上行，头脑户痛，延及脑顶发
热。太阳之胜，热反上行，头项顶巅脑户中痛，目如脱。太阳之复，心痛痞满，头
痛。太阴司天，湿淫所胜，腰脊头项痛时眩。太阴在泉，湿淫所胜，病冲头痛，目
似脱，项似拔。太阴之复，头顶痛重，而掉螈尤甚。阳明之复，咳哕烦心，病在膈
中，头痛。伤寒一日，巨阳受之，头项痛，腰脊强。《灵枢》谓风痹，股胫烁，足如
履冰，时如入汤，烦心头痛时眩，悲恐短气，不出三年死。凡此皆六气相侵，与清
阳之真气相薄而痛者也。至于头痛甚则脑尽痛，手足寒至节死。头痛巅病，下虚上
实。注以肾虚不能引膀胱之气故尔。心烦头痛耳鸣，九窍不利，肠胃之所生。心热
病者，卒心痛烦闷，头痛面赤，刺手少阴、太阳。肺热病者，头痛不堪，汗出而寒，
刺手太阴、阳明。肾热病者，项痛员员澹澹然，刺足少阴、太阳。《灵枢》谓厥头
痛，面若肿起而烦心，取足阳明、太阴。厥头痛，头脉痛，心悲善泣，取血与厥阴。
厥头痛，贞贞头重而痛，取手、足少阴。厥头痛，意善忘，按之不得，取头面左右
动脉，后取足太阴。厥头痛，项先痛，腰脊为应，先取天柱，后取足太阳。厥头痛，
头痛甚，耳前后脉涌有热，泻出其血，后取足少阳。头痛不可取于 者，有所击堕，
恶血在于内，若肉伤，痛未已，可侧取不可远取也。头痛不可刺者，大痹为恶，
日作者，可令少愈，不可已。头半寒痛，先取手少阳、阳明，后取足少阳、阳明。膀
胱足太阳所生病，头囟顶脑户中痛。胆足少阳所生病，头痛。凡此皆脏腑经脉之气
逆上，乱于头之清道，致其不得营运，壅遏经隧而痛者也。盖头象天，三阳六腑清
阳之气皆会于此，三阴五脏精华之血亦皆注于此。于是天气所发六淫之邪，人气所
变五贼之逆，皆能相害，或蔽覆其清明，或瘀塞其经络，因与其气相薄，郁而成热
则脉满，满则痛。若邪气稽留则脉亦满，而气血乱故痛甚，是痛皆为实也。若寒湿
所侵，虽真气虚，不与相薄成热，然其邪客于脉外则血泣脉寒，寒则脉缩卷紧急，
外引小络而痛，得温则痛止，是痛为虚也。如因风木痛者，则抽掣恶风，或有汗而
痛。因暑热痛者，或有汗，或无汗，则皆恶热而痛。因湿而痛者，则头重而痛，遇
天阴尤甚。因痰饮而痛者，亦头昏重而痛，愦愦欲吐。因寒而痛者，绌急恶寒而痛。
各与本脏所属，风寒湿热之气兼为之状而痛。更有气虚而痛者，遇劳则痛甚，其脉
大。有血虚而痛者，善惊惕，其脉芤。用是病形分之，更兼所见证察之，无不得之
矣。东垣曰∶金匮真言论云，东风生于春，病在肝，俞在颈项。故春气者、病在头。
又诸阳会于头面，如足太阳膀胱之脉，起于目内 ，上额交巅，直入络脑，还出别
下项，病则冲头痛。又足少阳胆之脉，起于目锐 ，上抵头角，病则头角额痛。夫
风从上受之，风寒伤上，邪从外入客经络，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。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。有厥逆头痛者，所犯大寒，内至骨髓，
髓以脑为主，脑逆故令头痛齿亦痛。有心烦头痛者，病在膈中，过在手巨阳、少阴，
乃湿热头痛也。凡头痛皆以风药治之者，总其大体而言之也。高巅之上，惟风可到，
故味之薄者，阴中之阳，自地升天者也。然亦有三阴三阳之异。太阳经头痛，恶风
寒，脉浮紧，川芎、独活之类为主。少阳经头痛，脉弦细，往来寒热，用柴胡、黄
芩主之。阳明经头痛，自汗发热，不恶寒，脉浮缓长实者，升麻、葛根、石膏、白
芷主之。太阴经头痛，必有痰，体重，或腹痛为痰癖，脉沉缓者，苍术、半夏、南
星主之。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
子细辛汤主之。厥阴经头疼，项痛，或吐痰沫，冷厥，其脉浮缓，吴茱萸汤主之。
三阳头痛药，羌活、防风、荆芥、升麻、葛根、白芷、柴胡、川芎、芍药、细辛、
葱白。（连须）阴证头痛，只用温中药，如理中、姜、附之类。风湿热头痛，上壅损目及
脑痛，偏正头痛，年深不愈，并以清空膏主之。如苦头痛，每料中加细辛二钱。如
太阴脉缓有痰，名曰痰厥头痛，去羌活、防风、川芎、甘草，加半夏一两半。如偏
头痛服之不愈，减羌活、防风、川芎一半，加柴胡一倍。如发热恶热而渴，此阳明
头痛，只与白虎汤加白芷。（丹溪云∶东垣清空膏，诸般头痛皆治，惟血虚头痛，从鱼尾相连
痛者不治。又云∶治少阳头痛。如痛在太阳、厥阴者勿用，盖谓头巅痛也。）头旋眼黑，头痛，
宜安神散、川芎散。热厥头痛，虽严寒犹喜风寒，微来暖处，或见烟火，其痛复作，宜清上泻
火汤，后用补气汤。风热头疼，石膏散、荆芥散。冬月大寒犯脑，令人脑痛齿亦痛，名曰厥逆。
出奇病论中。宜羌活附子汤。头痛，胸中痛，食减少，咽嗌不利，寒冷，脉左寸弦
急，宜麻黄吴茱萸汤。湿热在头而头痛者，必以苦吐之，轻者用透顶散搐鼻取涎。
新沐中风为首风，头面多汗恶风，当先风一日则病甚，至其风日则少愈，大川芎丸
主之。风气循风府而上，则为脑风，项背怯寒，脑户极冷，神圣散主之。凡治头痛，
皆用芎、芷、羌、防等辛温气药升散者，由风木虚不能升散，而土寡于畏，得以壅
塞而痛，故用此助肝木，散其壅塞也。若风盛疏散太过而痛，服辛散药反甚者，则
宜用酸涩，收而降之乃愈，乳香盏落散之类是也。（以上外因。）头痛耳鸣，九窍不利，
肠胃之所生，东垣以为此气虚头痛也，用人参、黄 主之。罗谦甫治柏参谋六十一
岁，先患头昏闷微痛，医作伤寒解之，汗出后痛转加，复汗解，病转加而头愈痛，
每召医用药雷同，到今痛甚不得安卧，恶风寒，不喜饮食，脉弦细而微，气短促，
懒言语。经曰∶春气病在头。今年高气弱，清气不能上升头面，故昏闷。此病本无
表邪，因发汗数四，清阳之气愈亏损，不能上荣，亦不能外固，所以病增甚。宜升
阳补气，头痛自愈，制顺气和中汤。经曰∶阳气者，卫外而为固也。误汗之，卫外
之气损，故黄 甘温，补卫实表为君。人参甘温补气，当归辛温补血，芍药味酸，
收卫气为臣。白术、陈皮、炙甘草苦甘温，养卫气，生发阳气，上实皮毛腠理为佐。
柴胡、升麻苦辛，引少阳、阳明之气上升，通百脉灌溉周身者也。川芎、蔓荆子、
细辛辛温，体轻浮，清利空窍为使。一服减半，再服全愈。血虚头痛，自鱼尾，（眉
尖后近发际曰鱼尾。）上攻头痛，当归、川芎主之。当归一两，酒一升，煮取六合，饮至醉
效。当归、川芎、连翘、熟 各二钱，水煎去渣，入龙脑薄荷末二钱，乘沸泡之，
鼻吸其气，候温即服，服即安卧效。气血俱虚头痛者，于调中益气汤加川芎、蔓荆
子、细辛，其效如神。痰厥头痛，眼黑头旋，恶心烦乱，半夏白术天麻汤主之。痰
厥头痛，非半夏不能疗。眼黑头旋，风虚内作，非天麻不能解。天麻苗，谓之定风
草，独不为风所摇，以治内风之神药。内风者，虚风是也。黄 甘温，泻火补元气，
实表虚，止自汗。人参甘温，调中补气泻火。二术甘温，除湿补中益气。泽泻、茯
苓利小便导湿。橘皮苦温，益气调中而升阳。炒面消食，荡胃中滞气。麦芽宽中助
胃气。干姜辛热，以涤中寒。黄柏苦寒用酒洗，以疗冬日少火在泉而发躁也。东垣
壮岁病头痛，每发时两颊尽黄，眩晕，目不欲开，懒于言语，身体沉重，兀兀欲吐，
数日方过。洁古老人曰，此厥阴、太阴合而为病，名曰风痰，宜以《局方》玉壶丸
治之，可加雄黄、白术以治风湿，更有水煮金花丸，灸侠溪二穴各二七壮，不旬日
愈。鼻鼽腹肿头痛，病在胃。经云∶阳明所谓客孙脉则头痛鼻鼽腹肿者，阳明并于
上，上者则其孙络太阴也，故头痛鼻鼽腹肿也。动作头重痛，热气潮者属胃。丹溪
云∶头痛如破，酒炒大黄半两，茶煎服。娄全善云∶病在胃而头痛者，必下之方愈
也。如孙兆以利膈药，下张学士伤食头痛，郭茂恂以黑龙丹，下其嫂产后污血头痛，
皆下咽即安是也。心烦头痛，病在膈中，过在手巨阳、少阴；乃湿热头痛也。东
垣清空膏之类治之。头痛巅病，下虚上实，过在足少阴、巨阳，甚则入肾，许学士
谓之肾厥头痛也。其脉举之则弦，按之则坚，用玉真丸治之。戴复庵用正元散，或
大三五七散，入盐煎服；或于正元散内入炒椒十五粒，下来复丹，间进黑锡丹。有
服诸药不效，其痛愈甚，宜茸朱丹。《素问》曰∶头疼巅疾，下虚上实，过在足少阴、
巨阳，甚则入肾。徇蒙招尤，目眩耳聋，下实上虚，过在足少阳、厥阴，甚则入肝。
下虚者、肾虚也，故肾虚则头痛。上虚者、肝虚也，故肝虚则头晕。徇蒙者，如以
物蒙其首，招摇不定，目眩耳聋，皆晕之状也。故肝厥头晕、肾厥巅痛、不同如此。
肚厥宜钓藤散。伤食头痛，胸膈痞塞，咽酸，噫败卵臭，畏食，虽发热而身不痛，
宜治中汤加砂仁一钱，或红丸子。伤酒头痛，恶心呕吐出宿酒，昏冒眩晕，宜葛花解酲汤。怒气伤肝，
及肝气不顺上冲于脑，令人头痛，宜沉香降气散，并苏子降气汤，下养正丹。上热头目赤肿而痛，胸
膈烦闷，不得安卧，身半以下皆寒，足 尤甚，大便微秘，宜既济解毒汤。外有臭毒头痛，一味吃炒
香附愈。头痛连睛痛，石膏、鼠粘子炒为末，茶清食前调下。头风搐鼻，白芷散、川芎散、如金散、
瓜蒂神妙散、火筒散、郁金散。
【偏头风】头半边痛者是也。丹溪云∶有痰者多。左属风，荆芥、薄荷。左属血虚，川芎、当归。上属痰，
苍术、半夏。上属热，黄芩。川芎散、细辛散。荜茇猪胆搐鼻中。荜麻子半两去皮，大枣十五枚去核，
上共捣令熟，涂纸上，用箸一只卷之，去箸，纳鼻中良久，取下清涕即止。生萝卜汁仰卧注鼻中，左
痛注右，右痛注左。一妇人患偏头痛，一边鼻塞不闻香臭，常流清涕，时作臭气，服遍治头痛药，如
芎、蝎等皆不效。后一医人教服《局方》芎犀丸，不十数服，忽作嚏，突出一铤稠脓，其疾遂愈。
【雷头风】头痛而起核块者是也。或云头如雷之鸣也，为风邪所客，风动则作声也。夫治雷头风，诸药不效
者，证与药不相对也。夫雷者、震也，震、仰盂，故东垣制药用荷叶者，象震之形，其色又青，乃述
类象形。当煎《局方》中升麻汤主之，名曰清震汤。张子和用茶调散吐之，次用神芎丸下之，然后服
乌荆丸及愈风饼子之类。衰者用凉膈散消风散热。头上赤肿结核，或如酸枣状，用排针出血则愈。亦
有因痰火者，痰生热，热生风故也。痰火上升，壅于气道，兼乎风化，则自然有声，轻如蝉鸣，重如
雷声，故名雷头风也。用半夏、（牙皂、姜汁煮，一两）大黄、（酒浸透，湿纸包煨，再浸再煨三次。
二两）白僵蚕、连翘、橘红、桔梗、天麻、（各五钱）片芩、（酒炒七钱）薄荷叶、（三钱）白芷、青礞
石、粉草（各一钱）末之，水浸蒸饼丸如绿豆大。食后、临卧茶吞二钱，以痰利为度，然后用清痰降
火煎药调理。
【真头痛】
天门真痛，上引泥丸，夕发旦死，旦发夕死。为脑为髓海，真气之所聚，卒不受邪，受邪则死，
不可治。古方云与黑锡丹，灸百会，猛进参、沉、乌、附，或可生，
然天柱折者，亦难为力矣。
【大头痛】头肿大如斗是也。是天行时疫病。东垣监济源税时，长夏多疫疠，初觉憎寒体重，次传面目肿盛，
目不能开，上喘，咽喉不利，舌干口燥。俗云大头天行，亲戚不相访问，如染之多不救。张县丞亦患
此，医以承气汤加蓝根下之稍缓，翼日其病如故，下之又缓，终莫能愈，渐至危笃。东垣诊视具说其
由曰，夫身半以上，天之气也，身半以下，地之气也。此虽邪热客于心肺之间，上攻头而为肿盛，以
承气下之，泻胃中之实热，是诛罚无过，殊不知适其病所为故，遂处方用黄连、黄芩，味苦寒，泻心
医书大多将头痛和头风分为两个门类，但实际上这是同一种病。只是有发病时间新久、病邪停留深浅的区别罢了。病位浅且病程短的称为头痛，其疼痛突然发作，容易解除并迅速痊愈。病位深且病程长的称为头风，其疼痛发作和停止没有固定规律，痊愈后遇到诱因又会复发。治疗时都应当查验病邪的来源而进行施治。世俗医生治疗头痛，不是从风邪论治就是从寒邪论治，怎么知道病邪不单一呢？
试着考察《黄帝内经》中关于头痛病因的论述来阐明这一点：如风邪从外侵入，出现恶寒、出汗、头痛。刚洗头就受风邪侵袭称为首风，在起风的前一天，头痛严重到无法进出室内。大寒之气内侵至骨髓，骨髓以脑为主宰，寒气逆冲于脑故导致头痛，牙齿也会痛。少阳司天之年，初之气阶段，风邪偏胜则摇动，气候变得大温，病证为气机郁结于上部而头痛。二之气阶段，火气被郁遏，白色尘埃四起，病证为热邪郁结于上部而头痛。少阳司天，火气过盛，百姓患病出现头痛、发热、恶寒，症状像疟疾一样。岁金不及之年，炎火盛行，复气到来时阴气厥逆且格拒，阳气反而上行，导致头脑户（头部）疼痛，延及头顶发热。太阳之气偏胜，热气反向上行，头项、头顶、脑户中疼痛，眼睛像要脱出一样。太阳之气偏复，出现心痛、痞满、头痛。太阴司天之年，湿气过盛，腰脊、头项疼痛，时常眩晕。太阴在泉之年，湿气过盛，病发冲头痛，眼睛像要脱出，颈部像被拔起一样。太阴之气偏复，头顶沉重疼痛，且抽搐痉挛尤为严重。阳明之气偏复，出现咳嗽、呃逆、心烦，病位在膈中，伴有头痛。伤寒第一天，巨阳经（足太阳膀胱经）受邪，出现头项痛、腰脊强直。《灵枢》说风痹症，大腿和小腿灼热，脚像踩在冰上，有时又像进入热水中，心烦、头痛、时常眩晕，悲伤恐惧、气短，不出三年就会死亡。以上这些都是六气相互侵犯，与清阳真气相搏结而导致疼痛的情况。至于头痛剧烈则脑部全部疼痛，手足寒冷至关节处则死亡。头痛属于巅顶疾病，是下虚上实之证。注解说这是因为肾虚不能引动膀胱之气所致。心烦、头痛、耳鸣，九窍不利，是由肠胃病变产生的。心热病患者，突然心痛、烦闷，头痛、面赤，针刺手少阴心经、手太阳小肠经。肺热病患者，头痛难忍，出汗且恶寒，针刺手太阴肺经、手阳明大肠经。肾热病患者，颈部疼痛，头晕目眩，针刺足少阴肾经、足太阳膀胱经。《灵枢》说厥逆头痛，面部像肿胀一样且心烦，取足阳明胃经、足太阴脾经穴位。厥逆头痛，头部血脉疼痛，心情悲伤爱哭泣，取血络放血并调理厥阴经。厥逆头痛，头部沉重且疼痛，取手少阴心经、足少阴肾经穴位。厥逆头痛，意念善忘，按压痛点找不到，取头面左右动脉，随后取足太阴脾经穴位。厥逆头痛，颈部先痛，腰部脊柱相应疼痛，先取天柱穴，后取足太阳膀胱经穴位。厥逆头痛，头痛剧烈，耳前后脉搏跳动且有热感，泻出其血液，后取足少阳胆经穴位。因击打或坠落导致的头痛不可单纯取穴，因为有瘀血在内，如果肌肉受伤，疼痛未止，可侧面取穴不可远端取穴。头痛不可针刺的情况，是大痹症恶化，每天发作，只能稍微减轻，不能治愈。头半侧冷痛，先取手少阳三焦经、手阳明大肠经，后取足少阳胆经、足阳明胃经。膀胱足太阳经所生的病证，头囟、头顶、脑户中疼痛。胆足少阳经所生的病证，头痛。以上这些都是脏腑经脉之气逆乱上行，扰乱头部清阳之道，导致气血不能正常运行，壅塞经络而疼痛。
大概头部象征天，三阳经和六腑的清阳之气都汇聚于此，三阴经和五脏的精华之血也都灌注于此。于是天气所发的六淫邪气，人气所变的五贼逆气，都能相互伤害，或者遮蔽覆盖头部的清明，或者瘀塞经络，因而与正气相搏结，郁积而成热则脉道充盈，充盈则疼痛。如果邪气稽留则脉道也充盈，气血紊乱所以疼痛剧烈，这种疼痛都属于实证。如果是寒湿侵袭，虽然真气虚弱，不与邪气相搏结成热，但邪气客居在脉外则血液凝涩、脉管寒冷，寒冷则脉管收缩卷曲紧急，向外牵引小络脉而疼痛，得温暖则疼痛停止，这种疼痛属于虚证。如果是因风木引起的疼痛，则会有抽掣感、恶风，或者有汗而痛。因暑热引起的疼痛，或者有汗，或者无汗，都恶热而痛。因湿邪引起的疼痛，则头重而痛，遇阴天尤其严重。因痰饮引起的疼痛，也是头昏重而痛，心中烦闷想吐。因寒邪引起的疼痛，拘急恶寒而痛。这些都与本脏所属的风寒湿热之气兼杂出现的状况而疼痛。更有气虚而痛的，遇劳累则疼痛加重，脉象大。有血虚而痛的，容易惊惕，脉象芤。用这些病形来区分，再结合见证来观察，没有不得知病因的。
李东垣说：《金匮真言论》记载，东风生于春季，病在肝，俞穴在颈项。所以春气致病，病位在头。又诸阳经会聚于头面，如足太阳膀胱经，起于目内眦，上额交巅，直入络脑，还出别下项，发病则冲头痛。又足少阳胆经，起于目锐眦，上抵头角，发病则头角额痛。风邪从上受之，风寒伤上，邪气从外侵入客居经络，令人恶寒头痛，身体沉重恶寒，治疗在风池、风府穴，调和阴阳。不足则补，有余则泻，发汗则痊愈，这是伤寒头痛。头痛耳鸣，九窍不利，是由肠胃产生的，这是气虚头痛。如气上不下，头痛巅疾，是下虚上实，病在足少阴肾经、足太阳膀胱经，严重时入肾，是寒湿头痛。有厥逆头痛者，触犯大寒，内至骨髓，骨髓以脑为主，脑气逆故令头痛牙齿也痛。有心烦头痛者，病在膈中，病在手太阳小肠经、手少阴心经，是湿热头痛。凡是头痛都用风药治疗的，是从大体上来说的。高巅之上，只有风药能到达，所以气味薄弱的药物，是阴中之阳，自地升天的药物。然而也有三阴三阳的不同。太阳经头痛，恶风寒，脉浮紧，以川芎、独活之类为主药。少阳经头痛，脉弦细，往来寒热，用柴胡、黄芩为主药。阳明经头痛，自汗发热，不恶寒，脉浮缓长实，用升麻、葛根、石膏、白芷为主药。太阴经头痛，必有痰，身体沉重，或腹痛为痰癖，脉沉缓，用苍术、半夏、南星为主药。少阴经头痛，三阴三阳经气血不流行，足部寒冷气逆为寒厥，脉沉细，用麻黄附子细辛汤为主药。厥阴经头疼，项痛，或吐痰沫，冷厥，脉浮缓，用吴茱萸汤为主药。三阳头痛药，羌活、防风、荆芥、升麻、葛根、白芷、柴胡、川芎、芍药、细辛、葱白（连须）。阴证头痛，只用温中药，如理中汤、干姜、附子之类。风湿热头痛，上壅损伤眼睛及脑痛，偏正头痛，年深不愈，都以清空膏为主药。如苦头痛，每料药中加细辛二钱。如太阴脉缓有痰，名叫痰厥头痛，去掉羌活、防风、川芎、甘草，加半夏一两半。如偏头痛服用后不愈，减羌活、防风、川芎一半，加柴胡一倍。如发热恶热而渴，这是阳明头痛，只给白虎汤加白芷。（朱丹溪说：李东垣的清空膏，各种头痛都能治，唯独血虚头痛，从鱼尾相连痛者不治。又说：治疗少阳头痛。如痛在太阳、厥阴者勿用，因为说的是头巅痛。）头旋眼黑，头痛，宜用安神散、川芎散。热厥头痛，虽然严寒也喜欢风寒，稍微来到暖处，或见到烟火，疼痛又发作，宜用清上泻火汤，后用补气汤。风热头痛，石膏散、荆芥散。冬月大寒犯脑，令人脑痛牙齿也痛，名叫厥逆。出自《奇病论》。宜用羌活附子汤。头痛，胸中痛，食量减少，咽喉不利，寒冷，脉左寸弦急，宜用麻黄吴茱萸汤。湿热在头而头痛者，必用苦味药催吐，轻的用透顶散搐鼻取涎。刚洗头受风为首风，头面多汗恶风，在起风前一天病情加重，到起风那天稍好，以大川芎丸为主药。风气循风府而上，则为脑风，项背怯寒，脑户极冷，以神圣散为主药。凡是治疗头痛，都用川芎、白芷、羌活、防风等辛温气药升散的，是因为风木虚不能升散，而土性寡于畏，得以壅塞而痛，所以用此助肝木，散其壅塞。如果风盛疏散太过而痛，服用辛散药反而加重的，则宜用酸涩药，收敛而降之乃愈，如乳香盏落散之类。（以上是外因。）头痛耳鸣，九窍不利，由肠胃产生，李东垣认为这是气虚头痛，用人参、黄芪为主药。罗谦甫治疗柏参谋六十一岁，先患头昏闷微痛，医生当作伤寒解表，汗出后疼痛加重，再次发汗解表，病情加重而头更痛，每次召医生用药雷同，到现在疼痛严重无法安卧，恶风寒，不喜欢饮食，脉弦细而微，气短促，懒言语。经文说：春气病在头。今年高气弱，清气不能上升头面，所以昏闷。此病本无表邪，因发汗数次，清阳之气更加亏损，不能上荣，也不能外固，所以病增重。宜升阳补气，头痛自愈，制成顺气和中汤。经文说：阳气者，卫外而为固也。误用发汗，卫外之气受损，所以黄芪甘温，补卫实表为君药。人参甘温补气，当归辛温补血，芍药味酸，收摄卫气为臣药。白术、陈皮、炙甘草苦甘温，养卫气，生发阳气，上实皮毛腠理为佐药。柴胡、升麻苦辛，引少阳、阳明之气上升，通百脉灌溉周身。川芎、蔓荆子、细辛辛温，体轻浮，清利空窍为使药。一服减半，再服全愈。血虚头痛，自鱼尾（眉尖后近发际叫鱼尾），上攻头痛，用当归、川芎为主药。当归一两，酒一升，煮取六合，喝到醉的效果。当归、川芎、连翘、熟地黄各二钱，水煎去渣，入龙脑薄荷末二钱，趁沸泡之，鼻吸其气，候温即服，服后即安卧有效。气血俱虚头痛者，在调中益气汤加川芎、蔓荆子、细辛，其效如神。痰厥头痛，眼黑头旋，恶心烦乱，用半夏白术天麻汤为主药。痰厥头痛，非半夏不能疗。眼黑头旋，风虚内作，非天麻不能解。天麻苗，叫做定风草，独不为风所摇，是治疗内风的神药。内风者，就是虚风。黄芪甘温，泻火补元气，实表虚，止自汗。人参甘温，调中补气泻火。二术（苍术、白术）甘温，除湿补中益气。泽泻、茯苓利小便导湿。橘皮苦温，益气调中而升阳。炒面消食，荡胃中滞气。麦芽宽中助胃气。干姜辛热，以涤中寒。黄柏苦寒用酒洗，以疗冬日少火在泉而发躁。李东垣壮年病头痛，每次发作两颊尽黄，眩晕，目不欲开，懒于言语，身体沉重，昏昏欲吐，数日才过。洁古老人说，这是厥阴、太阴合而为病，名叫风痰，宜用《局方》玉壶丸治疗，可加雄黄、白术以治风湿，还有水煮金花丸，灸侠溪穴各十四壮，不到十天痊愈。鼻鼽腹肿头痛，病在胃。经文说：阳明所谓客孙脉则头痛鼻鼽腹肿者，阳明并于上，上者则其孙络太阴也，故头痛鼻鼽腹肿也。动作头重痛，热气潮者属胃。朱丹溪说：头痛如破，用酒炒大黄半两，茶煎服。娄全善说：病在胃而头痛者，必须用下法才能痊愈。如孙兆以利膈药，下张学士伤食头痛，郭茂恂以黑龙丹，下其嫂产后污血头痛，都是咽下即安。心烦头痛，病在膈中，病在手太阳小肠经、手少阴心经；是湿热头痛。李东垣用清空膏之类治疗。头痛巅病，下虚上实，病在足少阴肾经、足太阳膀胱经，严重时入肾，许学士称之为肾厥头痛。其脉举之则弦，按之则坚，用玉真丸治疗。戴复庵用正元散，或大三五七散，入盐煎服；或在正元散内入炒椒十五粒，下来复丹，间进黑锡丹。有服诸药不效，其痛愈甚，宜用茸朱丹。《素问》说：头疼巅疾，下虚上实，病在足少阴肾经、足太阳膀胱经，严重时入肾。徇蒙招尤，目眩耳聋，下实上虚，病在足少阳胆经、足厥阴肝经，严重时入肝。下虚者，肾虚也，所以肾虚则头痛。上虚者，肝虚也，所以肝虚则头晕。徇蒙者，像有东西蒙住头部，摇动不定，目眩耳聋，都是晕的状态。所以肝厥头晕、肾厥巅痛，不同如此。肚厥宜用钓藤散。伤食头痛，胸膈痞塞，咽酸，打嗝有败卵臭味，畏食，虽发热而身不痛，宜用治中汤加砂仁一钱，或红丸子。伤酒头痛，恶心呕吐出宿酒，昏冒眩晕，宜用葛花解酲汤。怒气伤肝，及肝气不顺上冲于脑，令人头痛，宜用沉香降气散，并苏子降气汤，下养正丹。上热头目赤肿而痛，胸膈烦闷，不得安卧，身半以下皆寒，足胫尤甚，大便微秘，宜用既济解毒汤。外有臭毒头痛，一味吃炒香附即可痊愈。头痛连睛痛，石膏、鼠粘子炒为末，茶清食前调下。头风搐鼻，白芷散、川芎散、如金散、瓜蒂神妙散、火筒散、郁金散。
【偏头风】头半边痛的就是偏头风。朱丹溪说：有痰的多见。左侧属风，用荆芥、薄荷。左侧属血虚，用川芎、当归。上部属痰，用苍术、半夏。上部属热，用黄芩。川芎散、细辛散。荜茇猪胆搐鼻中。荜麻子半两去皮，大枣十五枚去核，一起捣烂涂在纸上，用一只筷子卷起来，去掉筷子，纳入鼻中良久，取下清涕即止。生萝卜汁仰卧注鼻中，左痛注右，右痛注左。一妇人患偏头痛，一边鼻塞不闻香臭，常流清涕，时常散发臭气，遍服治头痛药，如川芎、全蝎等都无效。后来一个医生教服《局方》芎犀丸，不到十数服，忽然打喷嚏，突出一铤稠脓，疾病遂愈。
【雷头风】头痛而起核块的就是雷头风。有人说头如雷鸣，是风邪客居所致，风动则作声。治疗雷头风，诸药不效的，是证与药不相对。雷者，震也，震卦象仰盂，所以李东垣制药用荷叶，是象震之形，其色又青，是述类象形。当煎《局方》中升麻汤主之，名叫清震汤。张子和用茶调散吐之，次用神芎丸下之，然后服乌荆丸及愈风饼子之类。体衰者用凉膈散消风散热。头上赤肿结核，或如酸枣状，用排针出血则愈。也有因痰火的，痰生热，热生风故也。痰火上升，壅于气道，兼乎风化，则自然有声，轻如蝉鸣，重如雷声，故名雷头风也。用半夏（牙皂、姜汁煮，一两）、大黄（酒浸透，湿纸包煨，再浸再煨三次，二两）、白僵蚕、连翘、橘红、桔梗、天麻（各五钱）、片芩（酒炒七钱）、薄荷叶（三钱）、白芷、青礞石、粉草（各一钱），研末，水浸蒸饼丸如绿豆大。食后、临卧茶吞二钱，以痰利为度，然后用清痰降火煎药调理。
【真头痛】
天门真痛，上引泥丸，晚上发作早晨死，早晨发作晚上死。脑为髓海，是真气聚集的地方，突然不受邪气，受邪则死，不可治。古方说给黑锡丹，灸百会穴，猛进人参、沉香、乌头、附子，或许能生，然而天柱骨折者，也难有力了。
【大头痛】头肿大如斗的就是大头痛。这是天行时疫病。李东垣监济源税时，长夏多疫疠，初觉憎寒体重，次传面目肿盛，目不能开，上喘，咽喉不利，舌干口燥。俗云大头天行，亲戚不相访问，如染之多不救。张县丞也患此，医生用承气汤加蓝根下之稍缓，第二天病情如故，再用下法又稍缓，终莫能愈，渐至危笃。李东垣诊视具说其由曰，身半以上，是天之气，身半以下是地之气。这虽然是邪热客居在心肺之间，上攻头而为肿盛，用承气汤下之，是泻胃中之实热，这是诛罚无过，殊不知适其病所为故，遂处方用黄连、黄芩，味苦寒，泻心
Medical texts mostly divide headache and head wind into two categories, but in fact, it is the same disease. The difference lies only in whether the onset is recent or chronic, and whether the pathogen remains superficial or deep. When the pathology is shallow and the course is short, it is called headache; the pain arrives suddenly, is easy to resolve, and heals quickly. When the pathology is deep and the course is long, it is called head wind; the pain comes and goes irregularly, and recurs upon exposure to triggers after recovery. Treatment should always be based on identifying the origin of the pathogen. Lay physicians often treat headache solely from the perspective of wind or cold pathogens; how can they know that the pathogenic factors are not diverse?
Let us examine the discussions on the etiology of headache in the *Huangdi Neijing* (Yellow Emperor's Inner Canon) to clarify this: For instance, when wind pathogen invades from the exterior, symptoms include aversion to cold, sweating, and headache. If one contracts wind immediately after washing hair, it is called "Shou Feng" (Initial Wind); one day before the actual windy weather, the headache becomes so severe that one cannot enter or leave the room. When severe cold penetrates internally to the bone marrow, and since the brain is the master of the marrow, the counterflow of cold qi causes headache and toothache. In years governed by Shaoyang (Lesser Yang), during the first phase of climate, excessive wind causes shaking and significant warming; the disease manifests as qi stagnation in the upper body leading to headache. During the second phase, fire qi is suppressed, white dust rises everywhere, and the disease manifests as heat stagnation in the upper body leading to headache. In Shaoyang-governed years, excessive fire causes the people to suffer from headache, fever, and aversion to cold resembling malaria. In years where Metal is deficient,炎火 (flaming fire) prevails; upon the arrival of the compensatory qi, yin jue (yin rebellion) occurs with blockage, causing yang qi to ascend reversely, resulting in pain at the Toubaohu point extending to the vertex with fever. When Taiyang (Greater Yang) qi prevails, heat ascends reversely, causing pain in the head, neck, vertex, and Naohu points, with eyes feeling as if protruding. When Taiyang qi rebounds, symptoms include heart pain, epigastric fullness, and headache. In Taiyin (Great Yin) governed years, excessive dampness causes pain in the lower back, spine, head, and neck, accompanied by frequent dizziness. In Taiyin-in-spring years, excessive dampness causes sudden headache, eyes feeling as if protruding, and neck feeling as if being pulled. When Taiyin qi rebounds, there is heavy pain in the vertex, with severe spasms. When Yangming (Bright Yang) qi rebounds, symptoms include coughing, hiccups, and vexation, with pathology in the diaphragm and accompanying headache. On the first day of Cold Damage (Shanghan), the Juyang channel (Foot-Taiyang Bladder Meridian) receives the pathogen, causing headache in the head and neck, and stiffness in the waist and spine. The *Lingshu* states that in Fengbi (Wind Bi syndrome), the thighs and calves feel burning, feet feel like walking on ice, sometimes like entering hot water, accompanied by vexation, headache, frequent dizziness, sadness, fear, and shortness of breath; death occurs within three years. All these cases involve the invasion of the Six Qi (Six Climatic Factors), which clash with the true clear yang qi, causing pain. As for severe headache causing total brain pain and cold hands/feet reaching the joints, this indicates death. Headache affecting the vertex is a condition of deficiency below and excess above. Annotations explain this is due to Kidney deficiency failing to guide Bladder qi. Vexation, headache, tinnitus, and dysfunction of the nine orifices arise from disorders of the Stomach and Intestines. In Heart Heat diseases, sudden heart pain, vexation, headache, and red face occur; needle Hand-Shaoyin (Heart) and Hand-Taiyang (Small Intestine). In Lung Heat diseases, unbearable headache, sweating, and aversion to cold occur; needle Hand-Taiyin (Lung) and Hand-Yangming (Large Intestine). In Kidney Heat diseases, neck pain and dizzy vertigo occur; needle Foot-Shaoyin (Kidney) and Foot-Taiyang (Bladder). The *Lingshu* states that for Jue (Rebellious) headache with facial swelling and vexation, select Foot-Yangming (Stomach) and Foot-Taiyin (Spleen). For Jue headache with pulsating head pain, sadness, and weeping, bleed the collaterals and regulate Jueyin. For Jue headache with heavy head pain, select Hand-Shaoyin and Foot-Shaoyin. For Jue headache with forgetfulness and unlocatable tenderness, select arteries on the left and right of the head, then select Foot-Taiyin. For Jue headache starting with neck pain corresponding to waist/spine pain, first select Tianzhu (BL10), then select Foot-Taiyang. For Jue headache with severe pain and surging heat in pulses around ears, bleed the vessels, then select Foot-Shaoyang. For headache caused by blows or falls, do not simply select distal points because blood stasis is internal; if muscle injury persists, select laterally rather than distally. Headache that cannot be needled involves severe Bi syndrome worsening with daily attacks; it may improve slightly but not cure. Half-head cold pain requires selecting Hand-Shaoyang (Sanjiao) and Hand-Yangming first, then Foot-Shaoyang and Foot-Yangming. Diseases generated by Foot-Taiyang Bladder include pain in the fontanelle, vertex, and Naohu. Diseases generated by Foot-Shaoyang Gallbladder include headache. All these result from rebellious qi of zang-fu and meridians ascending chaotically into the clear pathways of the head, obstructing circulation and blocking meridians, causing pain.
The head symbolizes Heaven; the clear yang qi of the Three Yang channels and Six Fu organs converge here, and the essence blood of the Three Yin channels and Five Zang organs also pour into it. Thus, the six exogenous pathogens released by heavenly weather and the five internal rebellions generated by human emotions can harm each other, either obscuring the clarity of the head or blocking the meridians. Clashing with qi, stagnation generates heat, filling the vessels; fullness causes pain. If pathogenic factors linger, vessels fill, and chaotic qi-blood causes severe pain; such pain is Excess. If invaded by cold-damp, even if true qi is deficient and does not clash to generate heat, the pathogen lodging outside the vessels causes blood stasis and vessel cold; cold causes vessels to contract and tighten, pulling on small collaterals externally, causing pain that stops with warmth; such pain is Deficiency. Pain due to Wind-Wood involves pulling sensations, aversion to wind, and possibly sweating. Pain due to Summerheat-Heat involves sweating or no sweating, and aversion to heat. Pain due to Dampness involves heavy head and pain, worse on cloudy days. Pain due to Phlegm-Fluid involves dizzy heaviness and nausea. Pain due to Cold involves contraction, aversion to cold, and pain. These pains combine with the specific manifestations of wind, cold, damp, and heat associated with their respective Zang organs. Additionally, pain due to Qi deficiency worsens with labor and presents with a large pulse. Pain due to Blood deficiency involves palpitations and a hollow pulse. By distinguishing these pathological forms and observing accompanying signs, the etiology can be determined.
Li Dongyuan stated: The *Jinkui Zhenyan Lun* says, East wind arises in Spring, damaging the Liver, with Shu points at the neck. Thus, Spring qi diseases affect the head. Furthermore, all Yang channels meet at the head and face. For example, the Foot-Taiyang Bladder meridian starts at the inner canthus, crosses the forehead to the vertex, enters the brain, emerges to descend the neck; disease causes sudden headache. The Foot-Shaoyang Gallbladder meridian starts at the outer canthus, reaches the temporal angle; disease causes temporal and frontal pain. Wind is received from above; wind-cold damages the upper body, pathogen enters meridians from outside, causing aversion to cold, headache, heavy body, and aversion to cold. Treatment focuses on Fengchi (GB20) and Fengfu (GV16), regulating Yin and Yang. Deficiency is tonified, excess is drained; sweating leads to recovery. This is Cold Damage headache. Headache with tinnitus and dysfunction of nine orifices arises from the Stomach and Intestines; this is Qi deficiency headache. If qi fails to descend, causing vertex headache, it is deficiency below and excess above, involving Foot-Shaoyin and Foot-Taiyang, progressing to Kidney; this is Cold-Damp headache. There is Jue Rebellious headache caused by severe cold penetrating to bone marrow, causing brain counterflow and headache/toothache. There is vexation and headache caused by pathology in the diaphragm, involving Hand-Taiyang and Hand-Shaoyin; this is Damp-Heat headache. Treating all headaches with wind-dispelling herbs is a generalization. High peaks can only be reached by wind herbs; thus, thin-flavored herbs are Yin-within-Yang, rising from earth to heaven. However, there are differences among the Three Yin and Three Yang. Taiyang channel headache involves aversion to wind/cold and floating-tight pulse; Chuanxiong and Du Huo are main herbs. Shaoyang channel headache involves string-thin pulse and alternating chills/fever; Chai Hu and Huang Qin are main herbs. Yangming channel headache involves spontaneous sweating, fever, no aversion to cold, and floating-slow-long-full pulse; Sheng Ma, Ge Gen, Shi Gao, and Bai Zhi are main herbs. Taiyin channel headache involves phlegm, heavy body, or abdominal pain from phlegm-stagnation, and sinking-slow pulse; Cang Zhu, Ban Xia, and Nan Xing are main herbs. Shaoyin channel headache involves non-flow of Three Yin/Yang qi, cold feet with rebellious qi (Cold Jue), and sinking-thin pulse; Mahuang Fuzi Xixin Tang is the main formula. Jueyin channel headache involves neck pain, vomiting phlegm, cold Jue, and floating-slow pulse; Wuzhuyu Tang is the main formula. Herbs for Three Yang headaches include Qiang Huo, Fang Feng, Jing Jie, Sheng Ma, Ge Gen, Bai Zhi, Chai Hu, Chuan Xiong, Bai Shao, Xi Xin, and Cong Bai (with roots). For Yin-pattern headaches, use only warm herbs like Lizhong Tang, Gan Jiang, and Fu Zi. For Wind-Damp-Heat headaches causing upper congestion, eye/brain pain, and chronic lateral/general headache, Qingkong Gao is the main formula. For bitter headache, add 2 qian of Xi Xin per dose. For Taiyin slow pulse with phlegm (Phlegm-Jue headache), remove Qiang Huo, Fang Feng, Chuan Xiong, and Gan Cao, adding 1.5 liang of Ban Xia. If lateral headache persists, reduce Qiang Huo, Fang Feng, and Chuan Xiong by half, double Chai Hu. If fever, aversion to heat, and thirst occur, this is Yangming headache; give Baihu Tang plus Bai Zhi. (Zhu Danxi said: Dongyuan's Qingkong Gao treats all headaches except Blood-deficiency headache radiating from the fish-tail area. Also, it treats Shaoyang headache; avoid if pain is in Taiyang or Jueyin, i.e., vertex pain.) For dizzy vision and headache, use Anshen San or Chuanxiong San. For Heat-Jue headache, preferring cool air despite cold, with pain recurring near warmth/smoke, use Qingshang Xiehuo Tang, followed by Buqi Tang. For Wind-Heat headache, use Shigao San or Jingjie San. Severe winter cold invading the brain causing brain/tooth pain is called Jue Ni; see *Qibing Lun*. Use Qianghuo Fuzi Tang. For headache with chest pain, reduced appetite, throat obstruction, coldness, and wiry-tight left Cun pulse, use Mahuang Wuzhuyu Tang. For Damp-Heat in the head causing headache, use bitter emetics; mild cases use Touding San insufflated into nose to extract fluid. Initial Wind after washing hair causes sweaty/aversion-to-wind head/face; worsens day before wind, improves on wind day; use Da Chuanxiong Wan. Wind qi ascending via Fengfu causes Brain Wind, with cold neck/back and extremely cold Naohu; use Shensheng San. Generally, treating headache uses acrid-warm ascending herbs like Chuanxiong, Bai Zhi, Qiang Huo, Fang Feng because Wood deficiency fails to ascend, allowing Earth to obstruct; these herbs aid Liver Wood and disperse obstruction. If wind dispersion is excessive and acrid herbs worsen pain, use sour/astringent herbs to collect and descend, such as Ru Xiang Zhansan San. (These are external causes.) Headache with tinnitus and nine orifice dysfunction arises from Stomach/Intestines; Dongyuan calls this Qi deficiency headache, using Renshen and Huang Qi. Luo Qianfu treated Commander Bo, 61, who had mild head dizziness/pain. Doctors treated as Cold Damage, sweating worsened pain. Repeated sweating worsened condition further. Patient feared wind/cold, disliked food, had wiry-thin-micro pulse, shortness of breath, and reluctance to speak. Classic says: Spring qi diseases affect head. This year high qi was weak, clear qi failed to ascend to head/face, causing dizziness. No exterior pathogen existed; repeated sweating damaged clear yang qi, preventing nourishment and consolidation. Treatment: Raise Yang and Tonify Qi; headache will self-resolve. Formula: Shunqi Hezhong Tang. Classic says: Yang qi guards the exterior. Mistaken sweating damaged guarding qi. Huang Qi (sweet/warm) tonifies guarding/exterior as Sovereign. Renshen (sweet/warm) tonifies Qi; Dang Gui (acrid/warm) tonifies Blood; Bai Shao (sour) collects guarding Qi as Ministers. Bai Zhu, Chen Pi, Zhi Gan Cao (bitter/sweet/warm) nourish guarding Qi, generate Yang, strengthen skin/pores as Assistants. Chai Hu, Sheng Ma (bitter/acrid) guide Shaoyang/Yangming qi upward to circulate veins. Chuan Xiong, Man Jing Zi, Xi Xin (acrid/warm) are light/floating, clearing empty orifices as Envoys. One dose halves pain; two doses cure. Blood deficiency headache radiating from fish-tail to vertex uses Dang Gui and Chuan Xiong. Recipe: 1 liang Dang Gui, 1 sheng Wine, boil to 6 ge, drink until drunk effect. Another recipe: Dang Gui, Chuan Xiong, Lian Qiao, Shu Di Huang (2 qian each), decoct, add Long Nao Bo He powder (2 qian), steep in boiling water, inhale vapor, drink warm, sleep for effect. Qi-Blood dual deficiency headache: Add Chuan Xiong, Man Jing Zi, Xi Xin to Tiaozhong Yiqi Tang; effect is miraculous. Phlegm-Jue headache with blackouts, dizziness, nausea, and vexation uses Banxia Baizhu Tianma Tang. Phlegm-Jue headache requires Ban Xia. Blackouts/dizziness require Tian Ma. Tian Ma seedling is called Ding Feng Cao (Wind-Calming Grass), unaffected by wind, a divine herb for internal wind. Internal wind is deficiency wind. Huang Qi (sweet/warm) drains fire, tonifies Yuan Qi, consolidates exterior/stops sweating. Renshen (sweet/warm) regulates middle, tonifies Qi, drains fire. Er Zhu (Cang Zhu/Bai Zhu) (sweet/warm) drain damp, tonify middle/Qi. Ze Xie, Fu Ling promote urination to drain damp. Ju Pi (bitter/warm) tonifies Qi, regulates middle, raises Yang. Fried flour digests food, clears stomach stagnation. Mai Ya broadens middle, aids Stomach Qi. Gan Jiang (acrid/hot) clears middle cold. Huang Bo (bitter/cold, wine-washed) treats winter minor fire in spring causing irritability. Li Dongyuan suffered headache in youth: yellow cheeks, vertigo, unwilling to open eyes, reluctant to speak, heavy body, retching, lasting days. Jiegu Lao said: Jueyin-Taiyin combined disease, named Wind-Phlegm. Use *Ju Fang* Yuhu Wan, add Xiong Huang, Bai Zhu for Wind-Damp. Also Shuizhu Jinhua Wan, moxa Xiaxi (GB43) 14 times each; cure in 10 days. Nasal discharge, abdominal swelling, headache indicate Stomach disease. Classic: Yangming guest Sun vessels cause headache, nasal discharge, abdominal swelling; Yangming merges upward, affecting Sun collaterals of Taiyin. Movement-induced heavy head pain and tidal heat belong to Stomach. Zhu Danxi: Breaking headache, use 0.5 liang Jiuhuang Da Huang, decoct in tea. Lou Quanshan: Stomach headache requires purgation. Sun Zhao used Lige medicine to purge Scholar Zhang's food-stagnation headache; Guo Maoxun used Heilong Dan to purge Sister-in-law's postpartum blood-stasis headache; both cured instantly. Vexation/headache in diaphragm involves Hand-Taiyang/Shaoyin; Damp-Heat headache. Treat with Dongyuan's Qingkong Gao. Vertex headache, deficiency below/excess above, involves Foot-Shaoyin/Taiyang, progressing to Kidney; Xu Xueshi calls this Kidney-Jue headache. Pulse wiry on lift, firm on press; use Yuzhen Wan. Dai Fu'an uses Zhengyuan San or Dasan Wuqi San with salt decoction; or Zhengyuan San with 15 fried Sichuan peppercorns, mixed with Laifudan, alternated with Heixi Dan. If all medicines fail and pain worsens, use Rongzhu Dan. *Suwen* says: Vertex headache, deficiency below/excess above, involves Foot-Shaoyin/Taiyang, progressing to Kidney. Xunmeng Zhaoyou (dizziness/heavy head), vertigo, deafness, excess below/deficiency above, involves Foot-Shaoyang/Jueyin, progressing to Liver. Deficiency below is Kidney deficiency, causing headache. Deficiency above is Liver deficiency, causing dizziness. Xunmeng means feeling covered, swaying, vertigo/deafness are dizziness states. Thus Liver-Jue dizziness and Kidney-Jue vertex pain differ. Du Jue uses Gouteng San. Food-stagnation headache with chest oppression, acid regurgitation, rotten egg belching, anorexia, fever without body pain: use Zhizhong Tang + 1 qian Sha Ren, or Hong Wanzi. Alcohol-intoxication headache with nausea/vomiting old alcohol, dizziness: use Gehua Jiecheng Tang. Anger damaging Liver/Liver qi rebelling upward causing headache: use Chenxiang Jiangqi San, Suzi Jiangqi Tang, and Yangzheng Dan. Upper heat with red/swollen painful head/eyes, chest vexation, insomnia, cold lower body especially legs, slight constipation: use Jiji Jiedu Tang. External foul toxin headache: roasted Xiang Fu alone cures. Headache connecting to eyes: Shi Gao and Niu Bang Zi roasted to powder, taken with tea before meals. Head wind nasal insufflation: Bai Zhi San, Chuanxiong San, Rujin San, Guiti Shenmiao San, Huotong San, Yujin San.
[Lateral Head Wind] Pain on one side of the head. Zhu Danxi: Often due to Phlegm. Left side Wind: Jing Jie, Bo He. Left side Blood deficiency: Chuan Xiong, Dang Gui. Upper side Phlegm: Cang Zhu, Ban Xia. Upper side Heat: Huang Qin. Formulas: Chuanxiong San, Xixin San. Bi Bie Pig Gall insufflate nose. Bi Ma Zi (0.5 liang, peeled) + 15 Dates (pitted), mash, spread on paper, roll with chopstick, insert into nose, wait, remove clear mucus stops. Raw Radish juice supine instillation: Left pain inject right, Right pain inject left. A woman with lateral headache, unilateral nasal congestion/anosmia, clear discharge, foul odor, failed all treatments including Chuanxiong/Quan Xie. Doctor prescribed *Ju Fang* Xiongxī Wan. After <10 doses, sneezed out thick pus, cured.
[Thunder Head Wind] Headache with nodules. Or described as thunder sound in head due to Wind pathogen. If herbs fail, mismatch of syndrome/treatment. Thunder = Zhen (Shock), image of inverted bowl. Dongyuan uses He Ye (Lotus Leaf) to mimic Zhen shape/color (Green). Decoct *Ju Fang* Shengma Tang, named Qingzhen Tang. Zhang Zihe uses Chatiao San to induce vomiting, then Shenxiong Wan to purge, then Wu Jing Wan/Yufeng Bingzi. Weak patients use Liangge San to dispel wind/heat. Red swollen nodules on head like jujube pit: bleed with needle to cure. Also due to Phlegm-Fire: Phlegm generates Heat, Heat generates Wind. Phlegm-Fire rises, blocks airway, combines with Wind transformation, producing sound (cicada-like light, thunder-like heavy). Formula: Ban Xia (Ya Zao/Ginger juice boiled, 1 liang), Da Huang (Wine-soaked, wet-paper wrapped baked, soaked/baked 3 times, 2 liang), Bai Jiang Can, Lian Qiao, Ju Hong, Jie Geng, Tian Ma (5 qian each), Pian Qin (Wine-fried, 7 qian), Bo He Ye (3 qian), Bai Zhi, Qing Meng Shi, Gan Cao (1 qian each). Powder, steamed dough pills like mung beans. Post-meal/bedtime, swallow 2 qian with tea until phlegm clears, then regulate with Phlegm-draining/Fire-purging decoction.
[True Headache] Heavenly True Pain, radiating to Ninian (Brain), dies morning if evening onset, evening if morning onset. Brain is Sea of Marrow, gathering place of True Qi, suddenly cannot accept pathogen; acceptance means death, incurable. Ancient formulas suggest Heixi Dan, moxa Baihui, aggressively administer Renshen, Chenxiang, Wutou, Fuzi; maybe survive, but if Tianzhu (neck pillar) breaks, difficult to save.
[Giant Headache] Head swollen like a bucket. Epidemic pestilence. Dongyuan supervised taxes in Jiyuan; midsummer many epidemics. Initially aversion to cold/heavy body, then face/eye swelling, inability to open eyes, panting, throat obstruction, dry tongue/mouth. Commonly called Giant Head Pestilence; relatives avoid contact; infection often fatal. Magistrate Zhang contracted it. Doctor used Chengqi Tang + Lan Gen to purge; slightly relieved next day, relapsed. Purged again, slightly relieved, never cured, became critical. Dongyuan diagnosed: Upper body Heaven Qi, Lower body Earth Qi. Pathogenic heat lodged between Heart/Lung, attacking head causing swelling. Using Chengqi to purge Stomach excess heat punishes the innocent. Should match disease cause. Prescribed Huang Lian, Huang Qin (Bitter/Cold) to drain Heart...