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.