东垣治一妇人。年三十。齿痛甚。口吸凉风则暂止。闭口则复作。乃湿热也。足阳明贯
于上齿。手阳明贯于下齿。阳明多血聚。加以膏粱之味助其湿热。故为此病。用黄连、梧桐
泪苦寒。薄荷、荆芥穗辛凉。治湿热为主。升麻苦辛。引入阳明为使。牙者骨之余。以羊
骨灰补之为佐。麝香少许入内为引。作细末擦之。痛减半。又以调胃承气去硝。加黄连以
治其本。二三行而止。其病良愈。不复作。
一人因服补胃热药。致上下牙疼痛不可忍。牵引头脑。满面发热大痛。足阳明之别络入
脑。喜寒恶热。乃是手阳明经中热盛而作也。其齿喜冷恶热。以清胃散治之而愈。
震按齿痛不属阳明。即属少阴。此二条与后易案。乃两大局正面文章也。
卫生十全方云。一人牙齿日长。渐渐胀开口。难为饮食。盖髓溢所致。只服白术愈。
魏云。可见肾虚者。不宜服术。
易思兰治一人患齿病。每遇房劳。或恼怒。齿即俱长。痛不可忍。热汤凉水。俱不得入
发必三五日。苦状难述。竟绝欲。服补阴丸、清胃饮。俱不效。易诊其脉。上二部俱得本
体。惟二尺洪数有力。愈按愈坚。乃曰。沉濡而滑者肾脉。洪数有力者心脉。今于肾部见心
脉。是所不胜者侮其所胜。乃妻入乘夫。肾中火邪盛矣。清胃饮惟胃脉洪数者为宜。今胃脉
平和。清之何益。肾主骨。齿乃骨余。火盛而齿长。补之何益。况有干姜。更非所宜。乃用
黄柏三钱。以滋水泄火。青盐一钱为引。升麻一钱。升出肾中火邪。药入口。且漱且咽。服
后即觉丹田热气上升。自咽而出。再进二帖。病即全愈。
震按此案医理讲得最精。由于脉象诊得的真。而更运以巧思。斯发无不中矣。清胃散之
庸。诚不足责。即泛用滋阴药。亦难应手。只此三味。铨解甚明。信乎缺一味不可。多一味
不必也。余乡有患齿痛数年。诸药不效者。叶天士先生用山萸肉、北五味、女贞子、旱莲草
各三钱。淮牛膝、青盐各一钱而全愈。此取酸盐下降。引肾经之火。归宿肾经。可与易公之
方。并垂不朽。而其义各别。
李东垣治疗一位三十岁的妇女。她牙齿疼痛剧烈，吸入凉风时暂时缓解，闭口时疼痛又发作。这是湿热证。足阳明胃经贯穿上齿，手阳明大肠经贯穿下齿。阳明经多血多气，加上饮食肥甘厚味助长湿热，因此导致此病。使用黄连、梧桐泪（梧桐树的树脂），性味苦寒，以清热燥湿为主；薄荷、荆芥穗，性味辛凉，辅助清热；升麻，性味苦辛，作为引经药引入阳明经；牙齿是骨骼的余气所生，用羊骨灰作为佐药进行补益；少许麝香作为引药加入。将药物研成细末外擦，疼痛减轻一半。随后又使用调胃承气汤去掉芒硝，加入黄连以治其根本，服用二三剂后大便通畅而停止，病情痊愈，不再复发。
另一人因服用温补胃热的药物，导致上下牙齿疼痛难忍，疼痛牵引至头部，满面发热剧痛。足阳明胃经的别络进入脑部，患者喜冷恶热，这是手阳明大肠经中热盛所致。他的牙齿喜冷恶热，使用清胃散治疗而痊愈。
俞震按语：牙齿疼痛不属于阳明经，就属于少阴肾经。这两条医案与后面的易思兰医案，是论述牙病的两大主要方面。
《卫生十全方》记载：有一人牙齿逐渐变长，慢慢胀大张口，难以进食。这大概是骨髓溢出所致。只服用白术便治愈了。
易思兰治疗一人患牙病，每当房事劳累或发怒时，牙齿就会感觉变长，疼痛难忍，无论是热水还是凉水都无法入口，症状持续三五天，痛苦难以言表。后来他断绝房事，服用补阴丸、清胃饮，均无效。易思兰诊察其脉象，寸关两部（上部）均为正常脉象，唯独两尺部（下部）脉象洪大、数且有力，越按越坚实。于是他说：“沉濡而滑的是肾脉，洪数有力的是心脉。现在在肾部出现了心脉，这是‘所不胜者侮其所胜’（水不制火），即妻乘夫（女乘男，指相火妄动克制肾水）。肾中火邪炽盛。清胃饮仅适用于胃脉洪数的情况，现在胃脉平和，使用清热法有何益处？肾主骨，牙齿是骨骼的余气，火盛导致牙齿感觉变长，使用补法有何益处？况且方中有干姜，更加不适合。”于是使用黄柏三钱，以滋补肾水、泄降火邪；青盐一钱作为引药；升麻一钱，升提并引出肾中的火邪。药物入口，一边漱口一边吞咽，服药后立即感觉丹田的热气上升，从咽喉排出。再服用两帖，疾病完全痊愈。
俞震按语：此案医理阐述最为精辟，由于脉象诊断得真实准确，再加上巧妙的构思，所以用药无不中的。清胃散的平庸之处，确实不值得指责；即使是泛用滋阴药，也难以见效。仅用这三味药，解释非常明确。确实是一味不可缺，一味也不必加。我家乡有一位患牙痛数年、各种药物无效的人，叶天士先生使用山萸肉、北五味子、女贞子、旱莲草各三钱，淮牛膝、青盐各一钱，结果完全治愈。这是取酸味和咸味下降的作用，引导肾经之火回归肾经，可以与易思兰的方子一起流传不朽，但其中的医理各不相同。
Li Dongyuan treated a thirty-year-old woman. She suffered from severe toothache, which temporarily ceased when she inhaled cool air but recurred when her mouth was closed. This was a Damp-Heat syndrome. The Foot-Yangming Stomach Meridian passes through the upper teeth, and the Hand-Yangming Large Intestine Meridian passes through the lower teeth. The Yangming meridians are rich in blood and qi; compounded by a diet rich in fatty and sweet foods that exacerbate Damp-Heat, this disease arose. He used Huanglian (Coptidis Rhizoma) and Wutong Lei (Liquidambaris Resina), both bitter and cold, to primarily clear heat and dry dampness; Bohe (Menthae Haplocalycis Herba) and Jingjie Sui (Schizonepetae Spica), both acrid and cool, to assist in clearing heat; Shengma ( Cimicifugae Rhizoma), bitter and acrid, as a guiding herb to lead the action into the Yangming meridians. Since teeth are considered the surplus of bones, Yang Gu Fen (Bone Ash of Sheep) was used as an adjuvant to tonify. A small amount of Shexiang (Moschus) was added as a guide. The herbs were ground into a fine powder for external application, reducing pain by half. Subsequently, Tiaowei Chengqi Tang (Regulate the Stomach Order the Qi Decoction) with Mangxiao (Natrii Sulfas) removed and Huanglian (Coptidis Rhizoma) added was used to treat the root cause. After two or three bowel movements, the treatment stopped, and the illness was thoroughly cured without recurrence.
Another patient, due to taking warming and tonifying stomach-heat herbs, suffered unbearable pain in both upper and lower teeth, radiating to the head, accompanied by facial fever and severe pain. The collateral vessels of the Foot-Yangming Stomach Meridian enter the brain. The patient preferred cold and disliked heat, indicating excessive heat in the Hand-Yangming Large Intestine Meridian. His teeth favored cold and disliked heat. He was cured using Qingwei San (Clear the Stomach Powder).
Yu Zhen’s commentary: Toothache belongs either to the Yangming meridian or the Shaoyin kidney meridian. These two cases, along with the subsequent case by Yi Silan, represent the two major primary approaches to discussing dental diseases.
*Weisheng Shiquan Fang* (Complete Ten Thousand Prescriptions for Health Preservation) records: One person’s teeth gradually grew longer, swelling so much that opening the mouth became difficult, hindering eating. This was attributed to marrow overflow. Only Baizhu (Atractylodis Macrocephalae Rhizoma) was taken, resulting in a cure.
Wei commented: This shows that those with Kidney Deficiency should not take Baizhu (Atractylodis Macrocephalae Rhizoma).
Yi Silan treated a man suffering from dental disease. Whenever he engaged in sexual intercourse or became angry, his teeth would feel like they were growing longer, causing unbearable pain. Neither hot nor cold liquids could be tolerated. The condition lasted three to five days, with indescribable suffering. He eventually abstained from sex and took Buyin Wan (Tonify Yin Pill) and Qingwei Yin (Clear the Stomach Drink), but neither was effective. Yi diagnosed his pulse: the Cun and Guan positions (upper parts) showed normal pulses, but the Chi positions (lower parts) were Hong (Surging), Shu (Rapid), Forceful, and hard upon pressure. He said, “Chen Ru Hua (Deep, Soft, Slippery) is the Kidney pulse; Hong Shu Youli (Surging, Rapid, Forceful) is the Heart pulse. Now, seeing the Heart pulse in the Kidney position indicates ‘the unconquered insulting the conquered’ (Water failing to control Fire), akin to the wife overpowering the husband. The fire pathogen in the Kidney is excessive. Qingwei Yin is suitable only when the Stomach pulse is Surging and Rapid; now that the Stomach pulse is peaceful, what benefit is there in clearing heat? The Kidney governs bones, and teeth are the surplus of bones. Excessive fire causes the sensation of teeth growing; what benefit is there in tonification? Moreover, Ganjiang (Zingiberis Rhizoma) is present, which is even more inappropriate.” Therefore, he used Huangbai (Phellodendri Cortex) 3 qian to nourish Water and drain Fire; Qinyan (Halitum) 1 qian as a guide; and Shengma (Cimicifugae Rhizoma) 1 qian to ascend and expel the fire pathogen from the Kidney. Upon ingestion, the patient swished and swallowed the medicine, immediately feeling heat rising from the Dantian and exiting through the throat. After two more doses, the illness was completely cured.
Yu Zhen’s commentary: The medical theory in this case is explained with utmost precision. Because the pulse diagnosis was accurate and combined with ingenious reasoning, every prescription hit the mark. The mediocrity of Qingwei San (Clear the Stomach Powder) is indeed blameless; even the generalized use of Yin-nourishing herbs is hard to apply effectively. With just these three ingredients, the explanation is very clear. Indeed, one ingredient cannot be omitted, nor is another necessary. In my hometown, there was a person suffering from toothache for years, unresponsive to various medicines. Mr. Ye Tianshi used Shanyurou (Corni Fructus), Bei Wuweizi (Schisandrae Chinensis Fructus), Nuzhenzi (Ligustri Lucidi Fructus), and Hanliancao (Ecliptae Herba), each 3 qian, along with Huai Niuxi (Dioscoreae Hypoglaucae Rhizoma) and Qinyan (Halitum), each 1 qian, resulting in a complete cure. This method utilizes the descending nature of Sour and Salty flavors to guide the fire of the Kidney meridian back to its source. It can be immortalized alongside Master Yi’s formula, although their underlying principles differ.