.
In traditional Chinese medicine, the understanding of headaches varies based on different patterns and underlying imbalances. Headaches in the Taiyang stage are considered exterior patterns with a heat imbalance. If the exterior is deficient, there will be fever, aversion to wind, sweating, and a floating and slow pulse. Gui Zhi Tang is used in this case. If the exterior is excess, there will be fever, aversion to cold, no sweating, and a floating and tight pulse. Ma Huang Tang or Da Qing Long Tang is prescribed, followed by Gui Zhi Jia Ge Gen Tang for post headache stiffness.
Headaches in the Shaoyin stage are also exterior patterns, but with a cold imbalance. If the exterior is deficient, there will be aversion to wind and cold, weak pulse, and Gui Zhi Jia Fu Zi Tang is used. If the limbs are cold due to stagnation of blood circulation, Dang Gui Si Ni Tang is employed. If the exterior is excess, there will be aversion to wind and cold, alternating fever and chills, and a sinking pulse, requiring Ma Huang Fu Zi Xi Xin Tang.
Yangming stage headaches indicate interior patterns with a heat imbalance. If the Yangming organs are excessive, there will be thirst, constipation, and a deep and strong pulse, treated with Cheng Qi Tang. If the Yangming channels are involved, there will be excessive sweating and great thirst, treated with Bai Hu Tang. For posterior headaches, Ge Gen Qin Lian Tang is used. If there is Yin deficiency with heat, resulting in restlessness and insomnia, Suan Zao Ren Tang is prescribed.
Headaches in the Taiyin stage indicate interior patterns with a cold imbalance. If there is vomiting and frothy saliva, Wu Zhu Yu Tang is used. For cases with menstrual pain, Wen Jing Tang is employed. If there is cold in the limbs, Si Ni Tang is used.
Shaoyang stage headaches typically manifest on both sides of the head and involve both exterior and interior imbalances. Xiao Chai Hu Tang or Chai Hu Jia Long Gu Mu Li Tang can be used. For excess heat, Da Chai Hu Tang is prescribed. For deficient cold, Chai Hu Gui Zhi Gan Jiang Tang is used.
Jueyin stage headaches present a mix of cold and heat, often changing. Wu Mei Wan or Ban Xia Xie Xin Tang can be used. External treatments include head wind dispersion therapy, used to treat episodic headaches.
In cases of pain, dull pain is usually associated with deficiency, distending pain with excess, dizziness with phlegm dampness, and stabbing pain with blood stasis. This pattern also generally applies to other types of pain conditions.
Case Study 1: Treating Fever and Headache with Da Qing Long Tang
Patient Wang, 34 years old, presented on April 25, 2011. The patient had a high fever of 39.5-40°C for three consecutive days, with severe headache, body ache, aversion to cold, no sweating, restlessness, thirst, pale red tongue, and a floating, tight, and rapid pulse. The patient was admitted to the hospital for “fever awaiting diagnosis.”
Prescription:
Ma Huang 18g, Gui Zhi 6g, Xing Ren 10g, Zhi Gan Cao 10g, Shi Gao 50g, Sheng Jiang 10g, Hong Zao 10g, Cang Zhu 10g, water 9 bowls. First, decoct Ma Huang for 15 minutes, removing the foam on top of the decoction. Then add the other herbs and decoct for about 30 minutes until 3 bowls of liquid remain. The patient drinks one bowl, covers themselves to induce sweating, and stops taking the decoction if sweating relieves the heat. If sweating is insufficient, the patient can drink cold water to stop sweating.
After drinking the first bowl of the decoction, the patient sweated for half an hour, the fever subsided, and the headache and body ache decreased. Four hours later, the patient’s fever returned to 38.2°C, and after drinking the second bowl of the decoction, they sweated slightly, and the fever subsided. The patient recovered the next day.
Commentary:
This case represents a Taiyang stage headache with exterior, heat, and excess patterns. The main features are headache, aversion to cold, fever, heat in the body, no sweating, a floating and tight pulse, and restlessness. This pattern is common in cases of severe cold or flu.
Apart from severe headache, the patient often had a fever exceeding 39°C. As long as it’s in the early stages, there’s heat in the body, little or no sweating, a floating and rapid pulse, and no severe sore throat, this formula can be used. If there’s accompanying muscle soreness, Cang Zhu can be added.
The usage of Ma Huang needing to be at least 18g. Even for three year old children, 12g can be used. If prepared correctly, it not only has no side effects but often results in rapid cooling and recovery before the full dosage is finished, which patients often consider miraculous.
The preparation method for this formula follows the instructions in the “Treatise on Cold Damage” for Da Qing Long Tang and should not be deviated from; otherwise, it will be ineffective. For Taiyang stage headac.
傳統中醫是如何認識頭痛的
雜誌編輯部
太陽病頭痛，屬於表证、熱证，若表虚者，必發熱、惡風、汗出、脈浮緩，用桂枝湯，後頭痛，項背强，用桂枝加葛根湯；若表實者，必發熱、惡寒、無汗、脈浮緊，用麻黄湯、大青龍湯，後頭痛用葛根湯。
少陰病頭痛，屬於表证、寒证，若表虚者，惡風寒，脈緩弱，用桂枝加附子湯；四肢厥冷，因爲血行不暢，陽氣不能通達者，用當歸四逆湯；若表實者，惡風寒、反發熱、脈沉，用麻黄附子細辛湯。
陽明病頭痛，屬於裡证、熱证，若陽明腑實，則口渴，大便秘結，脈沉實，用承氣湯；若陽明經证，則汗多，口大渴，用白虎湯；若後頭痛，用葛根芩連湯；若陰虚有熱，則心煩不眠，用酸棗仁湯。
太陰病頭痛，屬於裡证、寒证，若干嘔、吐涎沫者，用吴茱萸湯，若有痛經，用温經湯；四肢厥逆，用四逆湯。
少陽病頭痛，一般偏於頭部兩側，屬於半表半裡证，可用小柴胡湯、柴胡加龍骨牡蠣湯；偏實熱者，用大柴胡湯；偏虚寒者，用柴胡桂枝乾薑湯。
厥陰病頭痛，呈寒熱錯雜，或上熱下寒，可用烏梅丸、半夏瀉心湯等。外治法則有頭風摩散，用之治療陣發性頭痛。
疼痛屬於虚证者，一般是隱隱而痛；屬於實证者，一般是脹痛、劇痛；屬於痰濕者，一般是暈痛、昏痛；屬於血瘀者，一般是刺痛。這個規律也基本適合於其他疼痛症。
案例1：大青龍湯治療頭痛發熱〖HT〗
王某， 34 歲， 2011年4月25日一診。患者高燒39.5～40℃，已經連續三天，頭痛欲裂，全身肌肉酸痛，怕冷，始終未出大汗，煩躁，口渴，舌淡紅，脈浮緊、滑數。目前住院治療，正在“發熱待查”。
處方：
麻黄18克 桂枝6克 杏仁10克 炙甘草10克 石膏50克 生薑10克 紅棗10克 蒼术10克 水9碗，先煎麻黄15分鐘，邊煎邊去掉浮在藥罐上面的泡沫，再加入其他藥，煎半小時左右，煎至3碗水，先喝一碗，蓋被子取汗，汗出熱退，則停服。汗出不多，仍然發熱者，兩小時後，繼續服第二碗。汗出太多，則喝冷水一杯止汗。
患者服第一碗藥後，持續出汗半小時，熱退，頭痛、身痛减輕，四小時後，又開始發熱至38.2℃，繼續服第二碗，微微出汗，熱退。第二天痊癒。
按語：
本案爲太陽病頭痛，屬於表证、熱证、實证，以頭痛、怕冷、發熱、身熱、無汗、脈浮緊、煩躁爲主要特徵，在重感冒、流感患者中非常普遍。
患者除了頭痛劇烈之外，發熱經常達到39℃以上。但只要屬於初起，身上熱，不出汗，摸上去干干的，或者出汗不多，脈浮數、浮緊、滑數，没有劇烈咽喉疼痛，都可以用此方。兼有身體肌肉酸痛者，可加蒼术10克。
在應用時候，麻黄必須用到18克，三歲的小孩，可用12克，只要煎煮得法，不但没有副作用，而且往往一劑未盡，就熱退身凉，患者常常視爲奇迹。
本方煎煮法，一概遵照《傷寒論》大青龍湯方後的介紹，不可違背，否則無效。太陽病頭痛，即使不發熱，只要怕冷，身熱，不出汗，脈浮緊，煩躁或緊張，仍然可以用大青龍湯。
