bubble_chart Concept

Headache can occur in various acute and chronic diseases and is an extremely common clinical symptom. This section only discusses pattern where headache is the main symptom.

Ancient medical texts refer to it as "real headache" or "brain pain." For example, Lingshu·Syncope states: "Real headache, severe headache, the brain is completely in pain, hands and feet are cold to the joints, it is incurable and fatal." Zhongcang Jing says: "When suffering from brain pain, if the pulse is slow and large, it is fatal." It can be seen that the so-called "real headache" or "brain pain" refers to a critical condition of headache. The brain is an important organ of the human body, anciently referred to as: "The brain is the sea of marrow, where vital qi gathers, it cannot be invaded by pathogens, if invaded, it is incurable." The location of real headache is in the brain, hence the condition is severe, with the saying "morning onset leads to evening death, evening onset leads to morning death." Sui Dynasty's Chao Yuan-fang Zhubing Yuanhou Lun·Phlegm Wind Reversal Headache states: "...or it may persist for several years, long-term brain pain, hence called phlegm wind reversal headache, if hands and feet are cold to the joints, it is fatal." Song Dynasty's Chen Wu-zhai Sanyin Jiyi Bingzheng Fanglun·Headache Syndrome Treatment discusses the causes of real headache: "Or it may penetrate upwards to the wind mansion, sinking into the brain palace and causing pain, this is real headache, it cannot be cured by medicine, evening onset leads to morning death, morning onset leads to evening death, the blame lies in the root qi being exhausted first." Yan Yong-he Jisheng Fang·Headache Treatment states: "Pain leading to the top of the brain, severe with cold hands and feet, is called real headache, it cannot be cured by medicine." It can be seen that this syndrome is extremely dangerous, with a high mortality rate.

There are also names such as "first wind," "tremor disease," "recurrent headache," etc., all containing symptoms of headache, such as Suwen·Feng Lun: "The condition of first wind, profuse sweating on the head and face, aversion to wind, the day before the wind arrives the condition worsens, headache prevents going out." Later generations often regard "recurrent headache" and "tremor disease" as types of headache, Qixiao Liangfang·Headache states: "All pathogens causing headache are the same, but there is a difference in newness, oldness, departure, and retention. ...Deep and distant ones are recurrent headaches, the pain comes and goes irregularly, after recovery, it recurs upon contact."

bubble_chart Modern Research

Headache caused by wind-cold corresponds to headache in Western medicine caused by common cold, allergic diseases, sinusitis, etc. Treatment mainly involves antipyretics, analgesics, and antibiotics.

Thunder-headache syndrome belongs to allergic disorders in Western medicine.

Headaches of wind-heat, phlegm-turbidity, and deficiency-cold types roughly correspond to vascular neurogenic headaches in Western medicine. Treatment is mostly symptomatic, using serotonin antagonists such as methylergotamine butanolamide, pizotifen, etc., β-adrenergic receptor blockers, monoamine oxidase inhibitors, etc. Regularly taking small doses of sedatives can prevent headache attacks.

Migraine in Western medicine is a type of vascular neurogenic headache, related to serotonin metabolism disorders in the body. It is more common in women, starting around puberty, characterized by periodic unilateral headaches accompanied by significant autonomic nervous system symptoms during attacks, and may have a family history. Commonly used drugs include serotonin antagonists, such as ergotamine caffeine; sedatives, such as diazepam, etc.

Blood deficiency headache patients correspond to those with insufficient cerebral blood supply in Western medicine, seen in patients with vertebral-basilar artery stenosis or occlusion and those with internal carotid artery, middle cerebral artery involvement. Headache due to insufficient cerebral blood supply may be caused by collateral vessel dilation during ischemia. Treatment mainly involves symptomatic management and brain tissue protection to prevent cerebral infarction, using antiplatelet drugs, vasodilators, and calcium channel blockers, etc.

Real headache corresponds to intracranial infectious diseases, space-occupying diseases, and acute cerebrovascular accidents in Western medicine. For example, encephalitis caused by various reasons, with severe headache, mostly in the whole head, presenting as throbbing, jumping, or tearing pain. Brain tumor patients with increased intracranial pressure often have headache accompanied by vomiting, papilledema, and other signs of intracranial hypertension. Cerebrovascular accident patients may also have severe headache at the onset, followed by unconsciousness. Subarachnoid hemorrhage patients have headache presenting as knife-cutting, explosive, or axe-splitting pain. Precursor and onset stages of cerebral artery thrombosis also often have headache attacks. Hypertensive encephalopathy attacks, besides severe headache, are accompanied by intracranial hypertension manifestations and various brain damage signs. "Cold extremities to the joints" is actually a manifestation of shock, with low perfusion state of blood circulation in the hands and feet leading to cold limbs.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰Headache sometimes extends to the nape and back, or there is a tight and constricting sensation. The pain worsens upon exposure to wind-cold, with a preference for wearing hats, fear of cold, fever, joint aching pain, absence of thirst, thin white tongue coating, and a floating, tight pulse. It is caused by the invasion of wind-cold pathogens, hence the onset occurs after exposure to wind or cold. The taiyang governs the exterior, and its meridians ascend to the vertex and descend along the nape and back. When wind-cold attacks externally, it ascends along the meridians and obstructs the clear yang qi, resulting in headache that radiates to the nape and back. Cold causes contraction, hence the tight and constricting sensation of pain. "Pain due to cold is characterized by tightness and aversion to cold with shivering." (Zhengzhi Huibu．Headache) Cold is a yin pathogen, and warmth alleviates it, hence the preference for wearing hats or wrapping the head to avoid wind-cold and retain warmth. Wind-cold in the exterior has not yet transformed into heat, so there is no thirst. A floating pulse indicates an exterior condition, while a tight pulse signifies the presence of cold pathogens. A thin white tongue coating also reflects wind-cold in the exterior. The key diagnostic points are: aversion to cold, a chilled body, tight and constricting headache that improves with warmth and worsens with wind-cold. Treatment should focus on dispersing wind and dissipating cold, using Tea-Blended Ligusticum Powder.
2. External Contraction of Wind-heat︰Head distension and pain, aggravated by heat, fever and aversion to wind, red face and eyes, swollen and sore throat, dry mouth and thirst, red tongue tip, thin yellow coating, floating and rapid pulse. It may be caused by unresolved wind-cold transforming into heat, or by wind carrying pathogenic heat attacking the yang collaterals. Heat is a yang pathogen, tending to rise and disperse, hence causing headache and distension, aggravated by heat or even distending pain as if splitting; intense heat in the upper body results in a red face and eyes; wind-heat invading the defensive level leads to fever and aversion to wind; floating and rapid pulse, red tongue tip, and thin yellow coating are all signs of wind-heat. The characteristic features are head distending pain, aggravated by heat, and severe pain as if splitting. Treatment should focus on clearing and dispersing wind-heat, using Saposhnikovia Powder. If the distending pain is severe, accompanied by sores in the mouth and nose, indicating intense internal heat, then clearing heat and purging fire is appropriate, using Coptis Upper-Clearing Pill.
3. External Contractionwind-dampness︰The head feels heavy as if wrapped, dull and painful, aggravated on rainy days, with chest tightness and discomfort, epigastric fullness and anorexia, heavy limbs, or scanty urine and loose stools, white greasy tongue coating, soggy or slippery pulse. This is due to wind carrying dampness invading upwards, with the seven orifices obscured by dampness, hence the head feels heavy as if wrapped, dull and painful. "For pain caused by dampness, the head feels heavy and worsens on cloudy days." (Zhengzhi Huibu．headache》) Rainy days increase dampness, thus aggravating the headache. Dampness is sticky and stagnant; when obstructing the chest, it causes qi stagnation and chest tightness; when disturbing the middle energizer, it leads to epigastric fullness and anorexia. The spleen governs the four limbs; when dampness encumbers spleen yang, the limbs feel heavy. When dampness accumulates internally, the function of separating the clear from the turbid becomes impaired, resulting in scanty urine and loose stools. A white greasy tongue coating and soggy or slippery pulse are all signs of excessive dampness. Treatment should focus on dispelling wind and overcoming dampness, using the formula Notopterygium Overcoming Dampness Decoction.
4. Ascendant Hyperactivity of Liver Yang︰Vertigo and pain, predominantly on both sides or extending to the vertex, dysphoria and irritability, aggravated by anger, tinnitus, insomnia, or hypochondriac pain, dry mouth and flushed face, red tongue with scant coating or thin yellow coating, wiry or thin and rapid pulse. This belongs to endogenous headache. It arises from emotional distress and anger damaging the liver, leading to liver fire flaring upward; or from liver yin deficiency, resulting in ascendant hyperactivity of liver yang, disturbing the seven orifices and causing vertigo and headache, which worsens with anger. The liver corresponds to the Foot Jueyin meridian, whose pathway runs along the ribs and ascends to the vertex. The Foot Jueyin and Foot Shaoyang gallbladder meridians are internally and externally related, and the gallbladder meridian Jingmai traverses both sides of the head and body. Hence, liver yang headache extends to the vertex or affects both sides, and may be accompanied by tinnitus and hypochondriac pain. Hyperactive liver yang and excessive fire consume yin fluids, leading to dry mouth and flushed face, while heat disturbing the heart spirit causes dysphoria, irritability, and difficulty sleeping. A red tongue with scant coating and a thin, rapid pulse are signs of yang hyperactivity and yin damage. The characteristic features are headache and vertigo, triggered or aggravated by anger, often accompanied by tinnitus and hypochondriac pain. The treatment principle is to pacify the liver and subdue yang, using Gastrodia and Uncaria Drink. If headache is accompanied by red eyes, dry mouth, bitter taste, dark urine, constipation, yellow tongue coating, and wiry, rapid pulse, it indicates excessive liver fire, and the approach should be to clear and drain liver fire, primarily treated with Gentian Liver-Draining Decoction. For liver yang headache that persists over time, with mild but lingering pain, along with aching pain in the waist and knees, night sweats, insomnia, red tongue, and thin pulse, it signifies liver disease affecting the kidneys, manifesting as deficiency of water and excess of fire. The treatment should focus on nourishing the yin of the liver and kidneys, using Wolfberry and Chrysanthemum Rehmannia Pill.
5. Spleen Qi Deficiency︰The mind is empty and painful, fatigue worsens, the body is weary and weak, appetite is poor, shortness of breath, loose stools, tongue coating thin and white, pulse weak and feeble. Qi deficiency causes clear yang to fail to rise and turbid yin to fail to descend, resulting in the seven orifices being impaired, causing lingering pain, body weariness and weakness, shortness of breath and reluctance to speak, worsening with exertion; deficiency of middle qi fails to nourish the upper body, leading to empty pain in the mind; insufficiency of middle qi and weakened transportation and transformation result in poor appetite and loose stools. Treatment should focus on tonifying the middle and replenishing qi, using the Shunqi Hezhong Decoction. Another cause is excessive blood loss or postpartum maladjustment, leading to insufficiency of yin blood.
6. Yin Deficiency︰A dull headache, dizziness, palpitations, insomnia, dry and blurry eyes, a pale complexion, pale lips and tongue, and a thin, weak pulse. Excessive blood loss or postpartum disorders lead to insufficient yin blood. Blood deficiency fails to nourish the upper body, resulting in a dull headache and dizziness, along with a pale complexion. When blood fails to nourish the heart, palpitations and insomnia occur. Blood deficiency also causes dry eyes and blurred vision. The treatment should focus on nourishing blood, using the Nourish the Liver and Nourish Blood Decoction. However, in clinical practice, qi deficiency and blood deficiency often coexist, requiring simultaneous tonification of qi and blood. The formulas used are Eight Precious Ingredients Decoction or Returning to Spleen Decoction.
7. Static Blood Obstructing the Collaterals︰The pain is fixed and persistent, sharp like a stab, possibly with a history of head trauma. The tongue texture is purplish, and the pulse is thin and choppy or deep and choppy. Static blood headache is often caused by prolonged pain entering the collaterals, leading to stagnant blood flow; or due to external injuries, as mentioned in Lingshu. Juebing chapter: "Headache that cannot be relieved by the usual methods is due to trauma, with stagnant blood remaining inside." Decayed blood stasis accumulates in the vessels, causing pain when circulation is blocked. Clinical features include headache like needle pricks, fixed pain location, and purple spots on the tongue. Treatment should focus on invigorating blood and resolving stasis to unblock the collaterals. The recommended formula is Blood House Stasis-Expelling Decoction.
8. Phlegm-Turbidity Obscuring the Upper︰headache dizziness, vertigo, chest tightness gastric stuffiness, vomiting of phlegm and saliva, anorexia, tongue coating white and greasy, pulse wiry and slippery. phlegm-turbidity headache is often caused by habitual dietary irregularities, leading to dysfunction of spleen and stomach in transportation and transformation, resulting in internal production of phlegm-turbidity. phlegm-turbidity, as a yin pathogen, clouds the seven orifices, causing dullness and pain, and obstructs the chest and epigastrium, leading to fullness and vomiting of saliva. as stated in Zhengzhi Huibu.headache: "headache due to phlegm is characterized by heaviness and vertigo with a desire to vomit." the treatment should focus on resolving phlegm, using the formula Pinellia, White Atractylodes and Gastrodia Decoction.

Headache can be divided into external contraction and internal damage. Exogenous headache is often a new condition with a shorter course, accompanied by exterior pattern, characterized by intense and continuous pain, and can be differentiated into wind-cold, wind-heat, and wind-dampness types. Endogenous headache is usually a long-standing pain, not accompanied by exterior pattern, with a longer course, and the pain is milder and intermittent. It should be differentiated into deficiency and excess, and treated according to the syndrome.

The head is the meeting place of all yang meridians, and the three yang Jingmai all traverse the head and face. The Jueyin Jingmai also reaches the vertex. Ancient practitioners often determined the location of the disease based on the location of the headache. For example, Taiyang headache is mostly in the back of the head, extending to the neck and back; Yangming headache is mostly in the forehead, extending to the eyebrows; Shaoyang headache is mostly on both sides of the head, extending to the ears; Jueyin headache is seen at the vertex, possibly extending to the eye connector. There is also the theory that all six meridians can cause headache, but the pattern types are no more than the above categories, and can be clearly differentiated by combining with accompanying symptoms, tongue, and pulse.

bubble_chart Documentation

1. Suwen-Qibing Lun: "When a person suffers from a headache that persists for several years without relief, ... it is likely due to exposure to the Great Cold (24th solar term), which penetrates deep into the marrow. The marrow is governed by the brain, and when the brain is adversely affected, it causes a headache, and the teeth may also ache. This condition is called cold extremities."
2. Cold-Damage Disease Treatise．Jueyin Chapter: "For symptoms such as retching, vomiting frothy saliva, and headache, Evodia Decoction is the primary treatment."
3. Jisheng Fang．Headache Section: "In general, pain arises when both qi and blood are deficient, and pathogenic factors such as wind, cold, summer heat, and dampness injure the yang meridians, remaining latent and unresolved. This condition is referred to as a real headache."
4. Lanshi Micang．Headache Section: "Taiyin headache is always accompanied by phlegm, with symptoms such as heaviness in the body or abdominal pain, indicating phlegm stagnation. The pulse is deep and slow, and the primary treatments are Atractylodes Rhizome, Pinellia, and Arisaema. Shaoyin meridian headache occurs when the three yin and three yang meridians fail to circulate properly, leading to cold feet and qi counterflow, resulting in cold reversal. The pulse is deep and thin, and the primary treatments are Ephedra, Aconite Lateral Root, and Asarum. Jueyin headache involves pain in the head and neck, or vomiting frothy saliva with cold extremities. The pulse is floating and slow, and Evodia Decoction is the primary treatment."
5. Linzheng Zhinan Yi'an．Headache: "The head resembles the heavens and should not be contaminated by turbidity. If there is prolonged pain with a protruding sensation, it is likely due to an intruding pathogen obscuring the clear and vital qi and blood... Considering that the upper half of the body belongs to yang, and the head is the yang within yang. Generally, when yang qi is deficient first, clear pathogens ascend, leading to qi and blood stasis, resulting in continuous pain. The treatment should focus on promoting the flow of clear yang, avoiding methods that disperse superficially."