姚(右) 营分久虚,木失涵养,阳气上逆,乘于胃络。牙痛牵引颊际,宜养血而引导阳气下行。
白归身 白僵蚕 大麦冬 女贞子 炒地骨皮 上安桂 肥知母 川柏片 黑豆衣
二诊 前拟桂柏等方,原为引导虚阳而设。夫齿属于肾,龈属于胃,牙肉常肿,是阴气乘入胃络。特刚
药可以制病,不能生水,改进和阳熄风法。
大天冬 决明 生牡蛎 大生地 女贞子 川石斛 旱莲草 广皮白 真二泉阿胶 蜜水炒香附
左 辛温以开寒饮,舌痛牙疼俱退。足见饮邪内阻,则气火上浮。再以重药镇之。
赭石 旋复花 橘红 白蒺藜 炒苏子 海蛤粉 白茯苓 竹茹 制半夏 炒枳壳
金(右) 头晕耳窍失聪,牙龈作胀。肝阳上升。宜和肝胃之阴。
金石斛(三钱) 白蒺藜(三钱) 半夏曲(一钱五分) 钩钩(三钱) 橘白(一钱) 阿胶珠(二钱)
云茯苓(三钱) 滁菊花(一钱五分) 酒炒杭白芍(二钱) 石决明(四钱)
左 左脉虚弦。牙疼胸闷,肝阳走于胃络也。
金石斛(四钱) 大天冬(三钱) 白蒺藜(去刺炒三钱) 炒香玉竹(二钱) 西洋参(二钱) 石决明(四
分) 甘菊花(一钱五分) 净双钩钩(三钱) 滋肾丸(二钱淡盐汤下)
右 产后而更经多,营血亏损。木失水涵,牙痛头疼舌痛。木叩金鸣,咳嗽不止。再拟清金平木,兼和营气。
北沙参 川贝母 甜杏仁 砂仁 枇杷叶 金石斛 青蛤散 石决明 钩钩 肺露
王(左) 左偏齿痛微肿,先觉脚冷,火升则其痛益剧,其为阴虚火痛无疑。脉滑而数,苔薄白,治宜养阴
降火,略参清疏之法。
酒蒸女贞子(三钱) 米泔炒旱莲草(三钱) 盐水炒灵磁石(四钱)
大玄参(三钱) 白蒺藜(三钱) 法半夏(一钱五分) 冬桑叶(一钱五分盐水炒) 石决明(生打先煎四钱)
朱茯神
(三钱) 丹皮炭(一钱五分) 夏枯草(酒炒五分) 酒炒淡苦参(一钱)
江(右) 阴分素亏,虚阳上亢。牙缝出血,时觉浮动。脉弦带数。虚热走于胃络,此谓齿衄,又谓牙宣。
当育阴以制其阳。
炙甘草 泽泻 杭白芍 炒麦冬 盐水炒骨碎补 牛膝炭 茯神 黑大豆 炒丹皮
李(右) 牙龈肿胀,牙缝出脓,畏风肢体疲软。脉象细涩,关部独弦。厥阳走于胃络。拟清胃泄肝。
川石斛(四钱) 炒白归身(一钱五分) 金铃子(一钱五分) 海蛤粉(三钱包) 川雅连(三分鸡子黄拌炒)
朱茯神(三钱)
炒杭白芍(一钱五分) 蛤粉拌炒真阿胶(一钱五分) 半夏曲(二钱) 潼白蒺藜(盐水炒各二钱)
姚(右侧)营血长期亏虚,肝木失去滋养,阳气上逆,侵犯胃络。牙齿疼痛牵引至脸颊两侧,应当养血并引导阳气下行。
白归身 白僵蚕 大麦冬 女贞子 炒地骨皮 上安桂 肥知母 川柏片 黑豆衣
二诊:之前拟定的桂枝、黄柏等方剂,原本是为了引导虚阳而设的。牙齿属于肾,牙龈属于胃,牙肉经常肿胀,这是阴气侵入胃络的表现。刚烈的药物可以制约病邪,但不能滋生阴液,因此改进为调和阳气、平息内风的方法。
大天冬 决明子 生牡蛎 大生地 女贞子 川石斛 旱莲草 广皮白 真二泉阿胶 蜜水炒香附
左侧患者:使用辛温药物开通寒饮后,舌痛和牙疼都退去了。可见饮邪内部阻滞,导致气火上浮。再用重镇药物来安定它。
赭石 旋复花 橘红 白蒺藜 炒苏子 海蛤粉 白茯苓 竹茹 制半夏 炒枳壳
金(右侧)头晕且耳窍失聪,牙龈发胀。肝阳上升。应当调和肝胃之阴。
金石斛(三钱) 白蒺藜(三钱) 半夏曲(一钱五分) 钩藤(三钱) 橘白(一钱) 阿胶珠(二钱)
云茯苓(三钱) 滁菊花(一钱五分) 酒炒杭白芍(二钱) 石决明(四钱)
左侧患者:左脉虚弦。牙疼胸闷,是肝阳走窜到胃络所致。
金石斛(四钱) 大天冬(三钱) 白蒺藜(去刺炒三钱) 炒香玉竹(二钱) 西洋参(二钱) 石决明(四分) 甘菊花(一钱五分) 净双钩钩(三钱) 滋肾丸(二钱淡盐汤送服)
右侧患者:产后又月经量多,导致营血亏损。肝木失去水的涵养,出现牙痛、头痛、舌痛。金木相克(木叩金鸣),咳嗽不止。再拟定清肺平肝,兼以调和营气的方子。
北沙参 川贝母 甜杏仁 砂仁 枇杷叶 金石斛 青蛤散 石决明 钩藤 肺露
王(左侧)左侧偏侧牙齿疼痛微肿,先感觉脚冷,火热上升则疼痛加剧,这无疑是阴虚火旺引起的疼痛。脉象滑而数,苔薄白,治疗应当养阴降火,略微参酌清疏的方法。
酒蒸女贞子(三钱) 米泔炒旱莲草(三钱) 盐水炒灵磁石(四钱)
大玄参(三钱) 白蒺藜(三钱) 法半夏(一钱五分) 冬桑叶(一钱五分盐水炒) 石决明(生打先煎四钱)
朱茯神(三钱) 丹皮炭(一钱五分) 夏枯草(酒炒五分) 酒炒淡苦参(一钱)
江(右侧)阴分素来亏虚,虚阳上亢。牙缝出血,时常感觉牙齿浮动。脉象弦带数。虚热走窜到胃络,这称为齿衄,也称为牙宣。
应当滋养阴液以制约阳气。
炙甘草 泽泻 杭白芍 炒麦冬 盐水炒骨碎补 牛膝炭 茯神 黑大豆 炒丹皮
李(右侧)牙龈肿胀,牙缝出脓,怕风且肢体疲软。脉象细涩,关部特别弦。厥阳走窜到胃络。拟定清胃泄肝的方法。
川石斛(四钱) 炒白归身(一钱五分) 金铃子(一钱五分) 海蛤粉(四钱包) 川雅连(三分鸡子黄拌炒)
朱茯神(三钱)
炒杭白芍(一钱五分) 蛤粉拌炒真阿胶(一钱五分) 半夏曲(二钱) 潼白蒺藜(盐水炒各二钱)
Yao (Right): Long-standing deficiency of Ying blood (nutritive blood) causes the Liver Wood to lose nourishment, leading to upward reversal of Yang Qi which invades the Stomach collaterals. Tooth pain radiates to the cheek; treatment should nourish blood and guide Yang Qi downward.
Bai Guishen (Radix Angelicae Sinensis), Bai Jiangcan (Bombyx Batryticatus), Da Maidong (Radix Ophiopogonis Japonici), Nvzhenzi (Fructus Ligustri Lucidi), Chao Digupi (Cortex Lycii Radicis), Shang Angui (Ramulus Cinnamomi Cassiae), Fei Zhimu (Rhizoma Anemarrhenae), Chuan Baopian (Cortex Phellodendri Chinensis), Heidouyi (Semen Sojae Nigrae Integrum).
Second visit: The previously prescribed formula containing Guizhi (Cinnamon Twig) and Huangbai (Phellodendron Bark) was originally intended to guide deficient Yang. Teeth belong to the Kidney, gums belong to the Stomach; frequent swelling of the gingiva indicates Yin pathogenic factors invading the Stomach collaterals. Rigid/harsh medicines can suppress disease but cannot generate Yin fluid; therefore, the method is improved to harmonize Yang and extinguish internal wind.
Da Tiantong (Radix Asparagi Officinalis), Juemingzi (Fructus Cassiae), Sheng Muli (Concha Ostreae), Da Shengdi (Radix Rehmanniae Preparata), Nvzhenzi (Fructus Ligustri Lucidi), Chuan Shihu (Stem Dendrobii), Hanliancao (Herba Ecliptae), Guang Pi Bai (Pericarpium Citri Reticulatae Albugo), Zhen Erquan Ejiao (Colla Corii Asini), Xiangfu (Rhizoma Cyperi Rotundi) stir-fried with honey water.
Left patient: After using acrid-warm herbs to open cold-fluid retention, tongue pain and tooth pain both subsided. This demonstrates that fluid retention obstructing internally causes Qi-fire to float upward. Heavy sedatives are now used to anchor it.
Zhe Shi (Haematitum), Xuan Fu Hua (Flos Inulae), Ju Hong (Pericarpium Citri Reticulatae Rubrum), Bai Jili (Fructus Tribuli), Chao Su Zi (Semen Lepidii seu Descurainiae), Hai Ge Fen (Concha Meretricis seu Cyclinae), Bai Fuling (Poria), Zhu Ru (Caulis Bambusae in Taenia), Zhi Banxia (Rhizoma Pinelliae Preparatum), Chao Zhike (Fructus Aurantii).
Jin (Right): Dizziness and deafness in the ear orifices, gum distension. Liver Yang rising. Treatment should harmonize the Yin of the Liver and Stomach.
Jin Shihu (Stem Dendrobii Nobile), Bai Jili (Fructus Tribuli), Banxia Qu (Massa Medicata Fermentata), Gou Gou (Ramulus Uncariae cum Uncis), Ju Bai (Pericarpium Citri Reticulatae Albugo), Ejiao Zhu (Colla Corii Asini processed into pearls), Yun Fuling (Poria), Chu Juhua (Flos Chrysanthemi Indici), Jiu Chao Hang Baishao (Radix Paeoniae Alba stir-fried with wine), Shijueming (Concha Haliotidis).
Left patient: Left pulse is deficient and wiry. Tooth pain and chest tightness indicate Liver Yang wandering into the Stomach collaterals.
Jin Shihu (Stem Dendrobii Nobile), Da Tiantong (Radix Asparagi Officinalis), Bai Jili (Fructus Tribuli, thorns removed, stir-fried), Chao Xiang Yuzhu (Rhizoma Polygonati Odorati stir-fried with fragrance), Xiyangshen (Radix Panacis Quinquefolii), Shijueming (Concha Haliotidis), Gan Juhua (Flos Chrysanthemi Indici), Jing Shuang Gougou (Ramulus Uncariae cum Uncis), Zishen Wan (Kidney-Nourishing Pill) taken with light salt broth.
Right patient: Postpartum condition complicated by excessive menstruation leads to Ying blood depletion. Liver Wood loses Water nourishment, causing tooth pain, headache, and tongue pain. Wood striking Metal results in incessant coughing. A new prescription clears Lung metal and pacifies Liver wood, while harmonizing Ying Qi.
Beishashen (Radix Glehniae), Chuan Beimu (Bulbus Fritillariae Cirrhosae), Tian Xingren (Semen Armeniacae Amarum), Sharen (Fructus Amomi Rotundus), Pipaye (Folium Eriobotryae), Jin Shihu (Stem Dendrobii Nobile), Qing Ge San (Green Clam Powder), Shijueming (Concha Haliotidis), Gou Gou (Ramulus Uncariae cum Uncis), Feilu (Lung Dew).
Wang (Left): Pain and slight swelling on the left side of the teeth, preceded by cold feet; pain intensifies when fire rises, undoubtedly indicating deficiency-fire pain. Pulse is slippery and rapid, coating thin white. Treatment should nourish Yin and descend fire, slightly incorporating clearing and dispersing methods.
Jiu Zheng Nvzhenzi (Fructus Ligustri Lucidi steamed with wine), Mi Jiang Chao Hanliancao (Herba Ecliptae stir-fried with rice wash water), Yan Shui Chao Ling Cishi (Magnetitum stir-fried with salt water), Da Xuanshen (Radix Scrophulariae), Bai Jili (Fructus Tribuli), Fa Banxia (Rhizoma Pinelliae Preparatum), Dong Sangye (Folium Mori), Shijueming (Concha Haliotidis, raw, pounded, decocted first), Zhu Fushen (Poria with hostwood dyed red), Danpi Tan (Cortex Moutan carbonized), Xiakucao (Herba Prunellae), Jiu Chao Dan Kushen (Radix Sophorae Flavescentis stir-fried with wine).
Jiang (Right): Innate deficiency of Yin sub-system, with deficient Yang hyperactivity. Bleeding from gum margins, sensation of tooth mobility. Pulse is wiry and rapid. Deficient heat wanders into the Stomach collaterals; this is called Chi Nu (bleeding gums) or Ya Xuan (gum suppuration/atrophy).
Treatment should nourish Yin to control Yang.
Zhi Gancao (Radix Glycyrrhizae Preparata), Zexie (Rhizoma Alismatis), Hang Baishao (Radix Paeoniae Alba), Chao Maidong (Radix Ophiopogonis Japonici), Yan Shui Chao Gusuibu (Radix Derridis), Niuxi Tan (Radix Achyranthis Bidentatae carbonized), Fushen (Poria with hostwood), Heida Dou (Semen Sojae Nigrae), Chao Danpi (Cortex Moutan stir-fried).
Li (Right): Gingival swelling, pus discharge from gum margins, aversion to wind, and limb flaccidity. Pulse is fine and choppy, particularly wiry at the Guan position. Jue Yang wanders into the Stomach collaterals. Prescription clears Stomach heat and drains Liver fire.
Chuan Shihu (Stem Dendrobii Officinalis), Chao Bai Guishen (Radix Angelicae Sinensis stir-fried), Jinlingzi (Fructus Meliae Toosendan), Hai Ge Fen (Concha Meretricis seu Cyclinae), Chuan Yalian (Rhizoma Coptidis), Zhu Fushen (Poria with hostwood dyed red), Chao Hang Baishao (Radix Paeoniae Alba stir-fried), Ha Fen Ban Chao Zhen Ejiao (Colla Corii Asini stir-fried with clam powder), Banxia Qu (Massa Medicata Fermentata), Tong Bai Jili (Fructus Tribuli from Tong and Bai sources, stir-fried with salt water).