月翁令爱患齿衄，药服生地、丹皮、赤芍、连翘、石膏、升麻之属，衄反甚。予于方内
除升
麻加犀角，一服即止。翁问曰∶古人治血证，用犀角、地黄汤云，无犀角代以升麻。盖升麻
能引诸药入阳明也，今服之不效，岂古方不足信与。予曰∶朱二允有言∶升麻性升，犀角性
降，用犀角止血，乃借其下降之气，清心肝之火，使血下行归经耳。倘误用升麻，血随气升
，不愈涌出不止乎。古方未可尽泥也。翁又问入阳明清胃热，药品尚多，惟犀角与齿衄相宜
者，得无齿属上部，角长于头，本乎天者亲上之义耶?予曰∶不宁惟是，人之上齿属足阳明
，《礼》云戴角者，无上齿。阳明之血脉，上贯于角，齿衄用之辄应者，职是故也。
安波按∶医工古方而不知更变，犹一匠人拆旧料起翻房地基，虽合而关笋钩角，总须
刀锯也。
予侨居岩镇，距祖居之东溪几五十里，丁亥春，族弟羲采证患吐血，近延予弟春圃门生
咏堂酌
治，血涌不止，势欲晕脱。专价星夜逆予。至见病者仰靠于床，气息奄奄，自云脐下热气上
冲，血即涌出。切脉虚大不敛，顾谓弟与生曰∶此水火失济之候也。经云水为阴，火为阳，
夫人身之阴阳相抱而不脱，是以百年有常，故阳欲上脱，阴下吸之，不能脱也。今阳但上越
，阴不下吸，恐蹈危机，所服皆滋纳之品，药病相当，其所以不验者，病重药轻故耳。方定
大剂两仪煎，合生脉散，更加龟板、怀牛膝、白芍、茯苓、山药、童便、阿胶之属，服后血
虽不涌，脉犹未敛。予曰∶慎之，防复吐，上午因亲属问病，应答烦劳，血又上涌，神思
飘
荡，几欲脱去，忙照原方熟地由一两增至二两，再加磁石，吸引肾气归原。另煮团鱼汤煎药
。盖治真阳之飞越，不以鼋鳖之类引之，下伏不能也。如言饮药，血旋止。日晡又因家人嘈
杂，血复溢出，虽不若前之甚，亦觉难支。思血属阴喜静，动则阳化，故越出上窍，令其闭
户屏烦。如此两昼夜，始得脉敛神安，血止不吐。仍守前法调治，月余而瘳。
安波按∶方论并妙。
许月邻老先生的女儿患有齿衄（牙龈出血），服用生地、丹皮、赤芍、连翘、石膏、升麻等药物后，出血反而加重。我在处方中去掉了升麻，加入了犀角，服一次药后出血即止。老先生问道：“古人治疗血证，有用犀角地黄汤的说法，如果没有犀角，就用升麻代替。因为升麻能引导诸药进入阳明经。现在服用升麻无效，难道古方不可信吗？”我回答说：“朱二允曾说：升麻性主升提，犀角性主沉降。使用犀角止血，是借助其下降的气机，清泻心肝之火，使血液下行回归经脉。如果误用升麻，血液随气机上逆，岂不是更加涌出不止吗？古方不可完全拘泥。”老先生又问：“进入阳明经清胃热，药品还有很多，为什么只有犀角与齿衄相适宜？莫非是因为牙齿位于上部，而角长在头部，符合‘本乎天者亲上’的道理吗？”我回答说：“不仅如此，人的上齿属于足阳明胃经，《礼记》中说‘戴角的动物没有上齿’。阳明的血脉向上贯通到角部，所以治疗齿衄使用犀角往往有效，就是这个原因。”
安波按语：医生拘泥于古方而不知道变通，就像一个工匠拆除旧料来重建地基，虽然结构吻合，但榫卯连接处总需要刀锯加工一样。
我侨居在岩镇，距离祖居东溪大约五十里。丁亥年春天，族弟程羲采患吐血症，最近请我的弟弟春圃的门生咏堂诊治，结果血涌不止，病情危重，几乎要晕厥脱气。家人专门派人星夜急召我去。到达时看到病人仰卧靠在床上，气息微弱，自称脐下有热气上冲，血随即涌出。切脉象虚大而不收敛，我对弟弟和医生说：“这是水火失济的征候。”《内经》说：水为阴，火为阳。人身上的阴阳相互抱持而不分离，所以能长寿百岁。因此阳气想要上脱，阴气在下吸引它，就不会脱失。现在阳气只是上越，阴气不能下吸，恐怕会陷入危险境地。所服用的都是滋阴纳气的药物，药证相符，之所以不见效，是因为病重药轻的缘故。”于是确定方剂为大剂量的两仪煎，合用生脉散，再加龟板、怀牛膝、白芍、茯苓、山药、童便、阿胶等药物。服药后血虽不再涌出，但脉象仍未收敛。我说：“要小心，防止再次吐血。上午因为亲属探病，应答烦劳，血又上涌，神思飘荡，几乎要脱气。急忙按照原方将熟地由一两增加到二两，再加入磁石，以吸引肾气归元。另外煮甲鱼汤来煎药。因为治疗真阳飞越，不用鼋鳖之类的东西引导，阳气无法下沉潜伏。”照此服药后，血很快停止。傍晚时分又因家人嘈杂，血再次溢出，虽然不如之前严重，但也觉得难以支撑。我想血属阴，喜静，动则阳气化散，所以导致血液从上窍溢出，于是让病人关闭门户，避开烦扰。这样经过两个昼夜，才使得脉象收敛、神志安宁，血止不吐。仍然遵循前面的方法调理治疗，一个多月后痊愈。
安波按语：方剂和论述都非常精妙。
Xu Yuelin's daughter suffered from gingival bleeding (Chi Nu). After taking herbs such as Shengdi Huang (Rehmanniae Radix), Dan Pi (Moutan Cortex), Chi Shao Yao (Paeoniae Radix Rubra), Lian Qiao (Forsythiae Fructus), Shi Gao (Gypsum Fibrosum), and Sheng Ma (Cimicifugae Rhizoma), the bleeding worsened. I removed Sheng Ma from the prescription and added Xi Jiao (Rhinocerotis Cornu). The bleeding stopped after one dose. Mr. Xu asked, "Ancient texts mention using Xijiao Dihuang Tang for blood disorders; if Xi Jiao is unavailable, Sheng Ma is used as a substitute because it guides other herbs into the Yangming channel. Since Sheng Ma was ineffective here, are ancient prescriptions unreliable?" I replied, "Zhu Eryun stated: Sheng Ma has an ascending nature, while Xi Jiao has a descending nature. Using Xi Jiao to stop bleeding relies on its descending qi to clear Heart and Liver fire, causing blood to descend and return to its vessels. If Sheng Ma is mistakenly used, blood will follow the ascending qi and continue to gush uncontrollably. One cannot rigidly adhere to ancient prescriptions." Mr. Xu further asked, "There are many herbs that enter the Yangming channel to clear stomach heat. Why is only Xi Jiao suitable for gingival bleeding? Is it because teeth are located in the upper part, and horns grow on the head, following the principle that 'those originating from heaven are close to the upper'?" I answered, "It is not just that. The upper teeth belong to the Foot-Yangming Stomach Channel. The *Book of Rites* states that animals with horns do not have upper teeth. The meridians of Yangming connect upwards to the horns. Therefore, using Xi Jiao for gingival bleeding is often effective due to this correspondence."
An Bo commented: A physician who sticks to ancient prescriptions without adapting them is like a carpenter demolishing old materials to rebuild a foundation; although the structure may fit, mortise and tenon joints still require saws and chisels.
I resided in Yanzhen, about fifty li east of my ancestral home, Dongxi. In the spring of the Dinghai year, my clan brother Yi Cai suffered from hematemesis (vomiting blood). Recently, he had been treated by Yongtang, a student of my brother Chunpu. The bleeding continued unabated, and his condition became critical, nearly leading to syncope and collapse. His family sent a messenger overnight to summon me urgently. Upon arrival, I found the patient lying supine against the bed, breathing faintly. He reported that a sensation of hot qi rushing upward from below the umbilicus triggered the bleeding. His pulse was deficient, large, and unconsolidated. I said to my brother and the doctor, "This is a sign of failure of water and fire to interact." The *Classic of Acupuncture and Moxibustion* states: Water is Yin, Fire is Yang. In the human body, Yin and Yang embrace each other without separation, allowing for a long life. Thus, if Yang Qi tends to ascend and escape, Yin Qi attracts it from below, preventing escape. Now, Yang Qi ascends freely, but Yin fails to attract it downward, posing a crisis. The medications taken were all yin-nourishing and astringent agents, matching the syndrome. The reason they failed is that the disease was severe while the medication was too light." I prescribed a large dose of Liangyi Jian (Two-Primal Decoction) combined with Shengmai San (Generate the Pulse Powder), plus Guiban (Testudinis Carapax et Plastrum), Huainiuxi (Achyranthis Bidentatae Radix), Baishao (Paeoniae Radix Alba), Fuling (Poria), Shanyao (Dioscoreae Rhizoma), Tongbian (Urine of a Healthy Child), Ejiao (Asini Corii Colla), etc. After taking the medicine, the bleeding ceased, but the pulse remained unconsolidated. I said, "Be cautious; prevent recurrence of vomiting. This morning, due to relatives visiting and answering questions, fatigue caused the blood to surge again, and his spirit drifted, nearly collapsing. I hastily adjusted the original formula, increasing Shudi Huang (Rehmanniae Radix Preparata) from 1 qian to 2 qian, and added Cishi (Hematitum) to guide Kidney Qi back to its origin. Additionally, prepare softshell turtle soup to decoct the herbs. To treat the flight of True Yang, one must use creatures like turtles or softshell turtles to guide it down, otherwise, it cannot settle." Following this instruction, the bleeding stopped quickly. In the late afternoon, noise from family members caused the blood to overflow again, though less severely than before, making him feel unable to endure. Blood belongs to Yin and prefers stillness; movement transforms it into Yang, causing it to exit through the upper orifices. I instructed him to close the doors and avoid disturbances. After two days and nights of this, his pulse consolidated, his spirit calmed, and the bleeding stopped. He continued with the previous method for regulation and recovery, recovering fully after more than a month.
An Bo commented: Both the prescription and the theoretical discussion are exquisite.