头痛之症人以为阳之病也然阳虚而头痛与阳实而头痛者有殊盖阳虚之病即阴虚之症也阳
气之
虚以致阳邪之旺倘阴气不衰则阳邪有制何能作祟乎然则头痛不可尽言阳症也吾今辨明有阳虚
之头痛有阴虚之头痛或曰头乃六阳之首阴气不能到头如何说是阴虚之故不知阴气到头而还
而阳气既衰不能接续阴气以致头痛虽是阳虚之故而实亦阴气之衰阴气苟旺亦能上接夫阳气也
阴阳原两相根亦两相接原不可分为二也惟其一偏之虚遂至两相之隔矣然则治之法何可不辨
阴症与阳症乎阴症之痛也颠顶若晕而头重似痛不痛昏昏欲睡头重而不可抬非若阳症之痛之甚
也其症朝轻而晚重身胝又不觉十分之重此乃肾水之衰而肝气克脾虚火升上之故也方用平颠化
晕汤治之自然平复但非一二剂可以奏功盖阴病多无近效非药饵之不灵万勿责之近功可也此即
四物汤之变方妙在用桔梗细辛于补阴之中阴足而二味解其头之晕是顾阴为本而散邪为末也若
阳虚之头疼多是风邪侵袭而然阳气不虚邪何从入于脾胃之阳虚而气遂不能顾首风邪因而相犯
然则祛风而可不补正乎但其间阳气之虚从何辨之亦观之症以辨之其症必鼻塞而多涕口渴而多
痰其痛必走来走去不定于一方而痛连齿牙或痛连于项背彻夜号呼竟夜不寐者是也吾有一方最
佳方名解痛神丹一剂而痛如失此方用川芎至一两而又佐之天麦二冬纯是补阴之味如何治之阳
虚有邪之头痛也不知阳邪之旺终由于阴气之衰补其阴而阳自旺阳旺而邪自衰况方中各有散邪
之品用之于阴药之中愈足以见其功用之大倘纯用风药未尝无功然真气散尽头痛虽除而他病将
见又不可不知也
平颠化晕汤
熟地(一两) 麦冬(一两) 细辛(三分) 山茱萸(五钱) 川芎(五钱) 当归(三钱) 白芍(三
钱) 北五味(一钱) 白芥子(三钱) 桔梗(一钱)水煎服
解痛神丹
川芎(一两) 辛夷(一钱) 黄芩(三钱) 蔓荆子(一钱) 细辛(五分) 麦冬(五钱) 甘草(一
钱) 天门冬(五钱) 桔梗(三钱) 天花粉(二钱)水煎服
头痛这一病症,人们通常认为是阳经的病变。然而,阳虚引起的头痛与阳实(邪气盛)引起的头痛是有区别的。所谓阳虚的病证,其实就是阴虚的病证。阳气虚弱导致阳邪亢盛,如果阴气不衰弱,那么阳邪就会受到制约,怎么能兴风作浪呢?既然如此,头痛就不能一概而论为阳症。我现在要辨明:有阳虚导致的头痛,也有阴虚导致的头痛。有人会说:头是六阳经汇聚之首,阴气不能到达头部,怎么能说是阴虚的缘故呢?不知道阴气上达头部后返回,而阳气既然衰败,不能接续阴气,从而导致头痛。这虽然是阳虚的缘故,但实际上也是阴气衰弱的表现。如果阴气旺盛,也能向上承接阳气。阴阳原本互相根基、互相连接,本来不可分为二。正因为其中一方偏虚,才导致两者相互隔绝。那么治疗的方法,怎么可以不辨别阴症与阳症呢?
阴症引起的头痛,表现为头顶昏晕,头部沉重似痛非痛,昏昏欲睡,头重得无法抬起,不像阳症那样疼痛剧烈。其症状特点是早晨轻而晚上重,身体也没有感到十分沉重。这是肾水衰弱,肝气克制脾土,虚火上升的缘故。方剂用平颠化晕汤治疗,自然能平复痊愈。但这不是一两剂药就能见效的,因为阴病大多没有立竿见影的效果,并非药物不灵验,千万不要责怪它不能迅速奏效。这就是四物汤(补血调血的基础方)的变方,妙处在于使用桔梗和细辛,在补阴之中,阴液充足后,这两味药能解除头部的昏晕,这是以顾护阴液为本,以疏散邪气为末。
如果是阳虚引起的头疼,多是风邪侵袭所致。如果阳气不虚,邪气从哪里进入呢?脾胃的阳气虚弱,气就不足以护卫头部,风邪因而侵犯。那么祛风的时候能不补正气吗?但是其中的阳气之虚如何辨别呢?也是通过观察症状来辨别。其症状必定是鼻塞且多鼻涕,口渴且多痰,疼痛必定游走不定,不在一个固定部位,疼痛牵连牙齿,或者疼痛牵连项背,彻夜号呼,整夜不能入睡。我有一个方子最好,名叫解痛神丹,一剂药服下,疼痛就像消失了一样。这个方子重用川芎至一两,又佐以天冬和麦冬,纯粹是补阴的药味,怎么能治疗阳虚有邪的头痛呢?不知道阳邪的亢盛终究是由于阴气的衰弱,补益阴气而阳气自然旺盛,阳气旺盛而邪气自然衰退。况且方中各有疏散邪气的药物,用在滋阴药之中,更足以显示其功用的宏大。如果纯用风药,未尝没有功效,但真气散尽,虽然头痛消除,其他疾病将会出现,这也是不可不知道的。
平颠化晕汤
熟地黄(一两) 麦冬(一两) 细辛(三分) 山茱萸(五钱) 川芎(五钱) 当归(三钱) 白芍(三钱) 北五味子(一钱) 白芥子(三钱) 桔梗(一钱),水煎服。
解痛神丹
川芎(一两) 辛夷(一钱) 黄芩(三钱) 蔓荆子(一钱) 细辛(五分) 麦冬(五钱) 甘草(一钱) 天门冬(五钱) 桔梗(三钱) 天花粉(二钱),水煎服。
The symptom of headache is generally considered by people to be a disease of the Yang channels. However, there is a distinction between headaches caused by Yang deficiency and those caused by Yang excess (exuberance of pathogenic factors). The so-called disease of Yang deficiency is essentially a syndrome of Yin deficiency. When Yang Qi is deficient, it leads to the exuberance of Yang pathogens; if Yin Qi were not depleted, these Yang pathogens would be restrained and unable to cause havoc. Therefore, headaches cannot be indiscriminately classified as Yang syndromes. I now clarify that there are headaches due to Yang deficiency and headaches due to Yin deficiency. Some may argue: "The head is the gathering point of the six Yang channels; Yin Qi cannot reach the head, so how can it be said to be caused by Yin deficiency?" In fact, Yin Qi ascends to the head and then returns. If Yang Qi is decadent and fails to connect with the Yin Qi, headache results. Although this stems from Yang deficiency, it is essentially also due to the depletion of Yin Qi. If Yin Qi were vigorous, it could ascend to connect with Yang Qi. Yin and Yang originally serve as mutual roots and connections, inherently inseparable. It is precisely because one side is deficient that they become separated. Thus, treatment methods must distinguish between Yin and Yang syndromes.
Headaches caused by Yin syndromes present with dizziness at the vertex, a heavy sensation in the head that feels like pain but is not sharp pain, lethargy, and an inability to lift the head due to heaviness, unlike the severe pain seen in Yang syndromes. These symptoms are lighter in the morning and heavier in the evening, and the body does not feel excessively heavy. This is caused by the depletion of Kidney Water, where Liver Qi overacts on Spleen deficiency, leading to the ascent of deficient fire. The formula Pingdian Huayun Tang should be used for treatment, which will naturally restore health. However, it will not take effect in just one or two doses, as diseases of Yin often lack immediate results. This is not due to the ineffectiveness of the medicine; do not blame it for failing to produce quick effects. This is a modification of Siwu Tang (Four Substances Decoction), whose brilliance lies in the use of Jiegeng (Platycodon Root) and Xixin (Asarum Root). Within the context of nourishing Yin, once Yin fluids are sufficient, these two herbs resolve the dizziness of the head. This approach prioritizes protecting Yin as the root and dispersing pathogens as the branch.
Headaches caused by Yang deficiency are mostly due to the invasion of Wind pathogens. If Yang Qi were not deficient, how would pathogens enter? When the Yang Qi of the Spleen and Stomach is deficient, Qi fails to protect the head, allowing Wind pathogens to invade. Therefore, when dispelling Wind, one must not neglect tonifying Zheng Qi (Upright Qi). But how to identify the deficiency of Yang Qi among them? It is also identified by observing symptoms. The symptoms must include nasal congestion with excessive discharge, thirst with excessive phlegm, pain that wanders without staying in one fixed location, pain radiating to the teeth, or pain radiating to the neck and back, accompanied by wailing throughout the night and insomnia. I have a best formula named Jietong Shendan (Divine Elixir for Pain Relief). After one dose, the pain disappears as if lost. This formula uses Chuanxiong up to one liang, assisted by Tianshuodong (Asparagus Root) and Maidong (Ophiopogon Tuber), which are purely Yin-nourishing ingredients. How can this treat headaches of Yang deficiency with pathogens? One must understand that the exuberance of Yang pathogens ultimately stems from the depletion of Yin Qi. By tonifying Yin, Yang naturally becomes vigorous; when Yang is vigorous, pathogens naturally decline. Moreover, since the formula contains herbs that disperse pathogens, using them within Yin-nourishing medicines sufficiently demonstrates their great efficacy. If one uses only Wind-dispelling herbs, there may indeed be no lack of efficacy, but if Zhen Qi (True Qi) is scattered, although the headache may be relieved, other diseases will appear. This is something one must know.
Pingdian Huayun Tang
Shudihuang (Rehmanniae Radix Praeparata, 1 liang), Maidong (Ophiopogonis Tuber, 1 liang), Xixin (Asari Radix et Rhizoma, 3 fen), Shanzhuyu (Corni Fructus, 5 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma, 5 qian), Danggui (Angelicae Sinensis Radix, 3 qian), Baishao (Paeoniae Radix Alba, 3 qian), Bei Wuweizi (Schisandrae Chinensis Fructus, 1 qian), Baijiezi (Brassicae Semen, 3 qian), Jiegeng (Platycodonis Radix, 1 qian). Decoct in water and take orally.
Jietong Shendan
Chuanxiong (Ligustici Chuanxiong Rhizoma, 1 liang), Xinyi (Magnoliae Flos, 1 qian), Huangqin (Scutellariae Radix, 3 qian), Manjingzi (Vittaginis Fructus, 1 qian), Xixin (Asari Radix et Rhizoma, 5 fen), Maidong (Ophiopogonis Tuber, 5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian), Tianshudong (Asparagi Radix, 5 qian), Jiegeng (Platycodonis Radix, 3 qian), Tianhuafen (Trichosanthis Radix, 2 qian). Decoct in water and take orally.