A middle-aged woman suffered from a headache as a sequela of an external contraction. Despite undergoing various treatments including acupuncture and moxibustion, and medication, there was no improvement for over two years. She reported that each episode began around 18:00, initially accompanied by slight nausea but no vomiting. After 21:00, the pain intensified, becoming unbearable, as if being split by a knife. Her pulse was deep and choppy, and her tongue color was dark. Learning from Ye Tian-shi's experience, it was considered that a prolonged illness had entered the collaterals, and the Orifice-Opening Blood-Activating Decoction from Yilin Gaicuo was used, with Sichuan Lovage Rhizome increased to 18g. After three doses, the effect was minimal. Subsequently, three colleagues were invited for a consultation, who believed that the wind pathogen had not been eliminated and strongly advocated for the use of Tea-Blended Ligusticum Powder with added Magnolia, centipede, and Black-Tail Snake. After five doses, her mouth became drier, but the headache remained unchanged. Multiple treatments were ineffective, and the situation was at an impasse.

This condition, having persisted for a long time without cure, had exhausted conventional prescriptions. Simply repeating them would likely be meaningless; both the Orifice-Opening Blood-Activating Decoction and the Tea-Blended Ligusticum Powder with modifications had been personally tried without success, proving that the headache was not due to static blood stasis, nor was it due to wind pathogen invasion without dispersion; the condition's nocturnal onset, with a strong temporal regularity, had not been given sufficient attention before. The next steps in pattern identification, prescription selection, and medication timing must pay special attention to this point. Based on her pulse manifestation, it was suspected to be yin exuberance with cold obstruction, and it was advisable to refer to Zhang Zhong-jing's jueyin treatment principles. Although there was no symptom of "spitting saliva," the possibility of turbid pudendal coldness with rising qi should also be considered. Although there are numerous warming interior and tonifying yang medications, for treating pudendal coldness headache, the Evodia Decoction is precise and straightforward. Inspired by Zhang Zhong-jing's mention that "Angelica Cold-Extremities Decoction" for those with "long-standing cold within" should add Evodia Fruit and Fresh Ginger Rhizome, the original Evodia Decoction was used, increasing Evodia Fruit to 15g and Fresh Ginger Rhizome to 50g, with the prescription as follows:

Initially, the symptoms were "barely reduced," but as the number of doses increased, after ten doses, the changes were very significant, with the duration of episodes halved and the pain localized around Baihui (GV20) instead of the entire head. The prescription was not changed thereafter, only adjusted to one dose every two days. After a total of 60 doses, the stubborn condition of several years was completely resolved.