头为天象六腑清阳之气。五脏精华之血。皆会于此。天气六淫之邪。人气五。贼之逆皆
能相
害或蒙蔽其清明。或壅遏其经隧。与正气相搏。郁而成热脉涩而痛。若邪气稽留脉满而气血
乱。则痛乃甚。此实痛也。寒湿所侵真气虚弱。虽不相搏成热。然邪客于脉外。则血涩脉寒
。卷缩紧急。引小络而痛。得温则痛减此虚痛也。因风痛者抽掣恶风。因热痛者。烦心恶热
。因湿痛者。头重。天阴转甚。因痰痛者。昏重。愦愦欲吐。因寒痛者绌急而恶寒战栗。气
虚痛者。恶劳动。其脉大血虚痛者。善惊惕其脉芤头痛自有多因。而古方每用风药者。高巅
之上惟风可到。味之薄者。阴中之阳。自地升天者也。在风寒湿者。固为正用。即虚与热者
。亦假引经。
医书多分头痛头风为二门。然一病也。浅而暴者名头痛。深而久者名头风。头风必害眼
者。经所谓东风生于春。病在肝。目者肝之窍。肝风动。则邪害空窍也。
久头痛而略感风寒便发。须重绵包裹者。此属郁热。盖本热而标寒也。因其本有郁热。
毛窍长疏。故风寒易入。□□内热。闭逆为痛。惟泻火凉血。佐以辛温散表。
头痛虽各经皆有火证。阳明为最。正以阳明胃火盛于头面。而直达头维故其痛必甚。脉
必洪
。多内热口渴。其或头脑振振痛而兼脉绝无表邪者。必火邪也。白虎汤加生地麦冬木通泽泻
。他经则芍药花粉芩连知 龙胆栀子择用之。但治火不宜佐以升散。盖外邪之火。可散而去
。内郁之火。得升愈炽矣。
头部是天象所在，六腑清阳之气汇聚之处。五脏精华之血，也都汇聚于此。天气中的六淫邪气，以及人体正气受五贼（五行之邪）逆乱的影响，都能相互侵害。它们要么蒙蔽头部的清明，要么壅塞经络隧道，与正气相搏结，郁积而化热，导致脉道涩滞而疼痛。如果邪气稽留不去，导致脉道充盈满实，气血紊乱，那么疼痛就会更加剧烈，这属于实证疼痛。若是寒湿侵袭，真气虚弱，虽然邪气不与正气搏结化热，但邪气客居在脉外，会导致血液涩滞、脉管寒冷，进而卷缩紧急，牵引细小的络脉而产生疼痛，遇到温暖则疼痛减轻，这属于虚证疼痛。因风邪引起的头痛，表现为抽搐掣痛、怕风；因热邪引起的头痛，表现为心烦、怕热；因湿邪引起的头痛，表现为头重如裹，阴天时加重；因痰浊引起的头痛，表现为头昏沉重、心中烦闷欲吐；因寒邪引起的头痛，表现为拘急收缩、怕冷战栗；因气虚引起的头痛，表现为厌恶劳累；其脉象大而无力的是气虚痛，脉象中空如葱管的是血虚痛。头痛的原因多种多样，但古方中常使用风药，是因为“高巅之上，惟风可到”，气味轻薄的药物，属于阴中之阳，能自地上升于天。对于风寒湿邪，风药固然是正治之法；即使是虚证或热证，也借风药作为引经报使。
医书多将头痛和头风分为两个门类，但实际上是一种病。发病浅表且急骤的称为头痛，发病深在且病程长久的称为头风。头风必定会损害眼睛，正如《内经》所说：“东风生于春，病在肝”，眼睛是肝的窍穴，肝风内动，邪气就会侵害空窍。
久患头痛，稍微感受风寒就发作，必须用厚棉包裹头部才能缓解的，这属于郁热证。这是因为本体内有郁热，标象为寒。因为体内本有郁热，毛孔长期疏松，所以风寒容易侵入，导致内热闭阻逆乱而引发疼痛。治疗只需用泻火凉血的方法，佐以辛温药物发散表邪。
头痛虽然各条经脉都可能出现火证，但以阳明经最为严重。正因为阳明胃火旺盛于头面部，并直达头维穴，所以疼痛必然剧烈，脉象必然洪大，多伴有内热、口渴。如果是头脑振振动痛，兼见脉象绝无表邪表现的，必然是火邪所致。可用白虎汤加生地黄、麦冬、木通、泽泻。其他经脉的火证，则根据情况选用芍药、天花粉、黄芩、黄连、知母、龙胆草、栀子等药物。但是，治疗火证不宜佐用升散药物。因为外感邪气之火，可以通过发散去除；而内郁之火，若用升散药，火势会更加炽盛。
The head is the manifestation of Heaven, where the clear Yang Qi of the Six Fu Organs converges. The essence blood of the Five Zang Organs also gathers here. The pathogenic factors of the Six Excesses (Liu Yin) from the weather, and the rebellious influences of the Five Thieves (Wu Zei - pathogenic factors derived from the Five Elements) on human Qi, can all mutually harm. They may either obscure the clarity of the head or obstruct the meridians and collaterals, contending with the healthy Qi, leading to stagnation and heat generation, resulting in astringent pulses and pain. If pathogenic factors linger, causing fullness in the vessels and disorder of Qi and Blood, the pain becomes severe; this is excess pain. When invaded by Cold-Dampness and the True Qi is deficient, although there is no contention generating heat, the pathogen residing outside the vessels causes blood astringency and coldness in the vessels, leading to contraction and tension, pulling on small collaterals to cause pain; relief upon warmth indicates deficiency pain. Headache caused by Wind presents with twitching, pulling pain, and aversion to wind. Headache caused by Heat presents with vexation and aversion to heat. Headache caused by Dampness presents with heaviness in the head, worsening on cloudy days. Headache caused by Phlegm presents with dizziness, heaviness, and a sensation of nausea. Headache caused by Cold presents with contraction, aversion to cold, and shivering. Headache due to Qi deficiency presents with aversion to exertion; a large pulse indicates Qi deficiency headache, while a hollow (Kou) pulse indicates Blood deficiency headache. There are many causes for headache, yet ancient formulas often employ Wind-dispersing herbs because "above the high summit, only Wind can reach." Herbs with thin flavors belong to Yang within Yin and ascend from earth to heaven. For Wind-Cold-Dampness, these are indeed the primary treatment; even for deficiency and heat patterns, they are borrowed as guiding herbs.
Medical texts often divide headache and Tou Feng (Chronic Headache) into two categories, but it is one disease. Superficial and acute onset is named Headache; deep and chronic onset is named Tou Feng. Tou Feng inevitably affects the eyes; as the Classics state, "East Wind arises in Spring, damaging the Liver." The eyes are the orifices of the Liver; when Liver Wind moves, pathogens damage the orifices.
Long-standing headache that flares up upon slight exposure to Wind-Cold, requiring thick cotton wrapping for relief, belongs to Stagnant Heat. This is because the root is Heat while the branch is Cold. Due to underlying stagnant Heat, the pores are chronically open, allowing Wind-Cold to easily enter, causing internal heat to close and rebel, resulting in pain. Treatment requires purging fire and cooling blood, assisted by acrid-warm herbs to disperse the exterior.
Although Fire syndromes can occur in any meridian regarding headache, the Yangming meridian is the most severe. This is because Yangming Stomach Fire flourishes in the head and face, reaching directly to the Touwei point (ST8), so the pain must be severe, the pulse must be洪 (Hóng - Surging), and there is often internal heat and thirst. If there is throbbing pain in the head and neck without any exterior pathogen signs in the pulse, it must be Fire pathogen. Use Baihu Tang (White Tiger Decoction) plus Shengdi Huang (Rehmanniae Radix), Maidong (Ophiopogonis Radix), Mutong (Akebiae Caulis), and Zexie (Alismatis Rhizoma). For other meridians, select Shaoyao (Paeoniae Radix), Huafen (Trichosanthis Radix), Huangqin (Scutellariae Radix), Lianzi (Corydalis Rhizoma/Zhizi depending on context, likely Huanglian here given pairing), Zhimu (Anemarrhenae Rhizoma), Longdan Cao (Gentianae Radix), and Zhizi (Gardeniae Fructus) as appropriate. However, treating Fire should not assist with ascending and dispersing methods. Fire from external pathogens can be dispersed and removed; Fire from internal stagnation will become more intense if ascended.