牙痛不外风火虫虚,此但言其痛也。他如牙宣、牙FS 、牙疳、牙菌、牙痈穿牙、去骨槽风、
走马青腿牙疳之类,皆由乎湿火热毒,肝郁湿痰,蕴结牙床。须分上下二齿,辨明手足阳明及少阴之异。
木生于土牙生床,床本阳明牙肾乡。下床嚼物大肠属,上床不动胃经当。牙宣肿痛胃湿
热,竹叶石膏是主方。
温邪上蒸牙疼(痛连头颠,用玉女煎法)
火郁牙痛(连顶颠,属厥阴)
犀角 元参 生草 连翘 夏枯草 铃角 知母 银花 山栀
风热牙痛(龈胀头痛,用轻清泄上法)
芦根 西瓜翠 连翘 滑石 绿豆皮 银花
阴虚火炎牙痛(嗜饮,牙宣,衄血,咳血)
人中白 鲜石斛 大泽泻 旱莲草 生牡蛎 绿豆皮
牙痛后络痹(颊车穴,闭口不能张,用宣通法)
羚角片 煨天麻 制僵蚕 桂枝尖 炒山栀 炒丹皮
骨槽风痛(或缓或甚,连空穴胀痛甚,心烦)
先用阳和汤法 天桂 鹿角胶 大熟地 净麻黄 白芥子 甘草
走马青腿牙疳即名牙啸,牙龈出衄紫色,口臭,脉反涩细,两腿青如靛,此湿热郁火蕴
结阳明,肝肾阴亏。
犀角 石膏 知母 怀牛膝 银花 元参 郁金 生地 熟地 丹皮 人中白 麦
冬旱莲 女贞子 连翘 碧玉散 茯苓 龟版心 炒山栀 羚羊片 生草 川石斛
川贝 安南桂 料豆衣
牙痛不外乎风、火、虫、虚四种病因,这里只谈论疼痛这一症状。其他的如牙宣(牙龈萎缩出血)、牙疳(牙龈溃烂)、牙菌(牙龈生息肉或赘生物)、牙痈(牙龈脓肿)、穿牙(牙齿松动脱落)、骨槽风(颌骨骨髓炎)、走马青腿牙疳(一种严重的坏疽性口炎)等病症,都是由湿火热毒、肝郁湿痰蕴结在牙床所致。必须区分上齿和下齿,辨明手足阳明经及少阴经的差异。木生于土,牙齿生于牙床,牙床本属阳明经,而牙齿则与肾相关。下齿咀嚼食物,归属于大肠经;上齿不动,归属于胃经。牙宣肿痛多因胃有湿热,竹叶石膏汤是主要方剂。
温邪上蒸引起的牙痛(疼痛牵连头顶,采用玉女煎法治疗):犀角、玄参、生甘草、连翘、夏枯草、铃铛花(注:原文“铃角”疑为笔误或别名,此处保留原词意译或指代清热药,结合语境可能指代某种清热解毒药,但标准术语中无此名,暂按字面处理,若指羚羊角则另当别论,此处依原文列出)、知母、金银花、山栀。
火郁引起的牙痛(疼痛牵连头顶,属于厥阴经):犀角、玄参、生甘草、连翘、夏枯草、铃角、知母、金银花、山栀。
风热引起的牙痛(牙龈肿胀头痛,采用轻清泄上的方法治疗):芦根、西瓜翠衣、连翘、滑石、绿豆皮、金银花。
阴虚火炎引起的牙痛(嗜好饮酒,牙宣,鼻衄,咳血):人中白、鲜石斛、大泽泻、旱莲草、生牡蛎、绿豆皮。
牙痛后导致经络痹阻(颊车穴处,闭口不能张开,采用宣通经络的方法治疗):羚羊角片、煨天麻、制僵蚕、桂枝尖、炒山栀、炒丹皮。
骨槽风疼痛(病情或缓或急,牵连空穴胀痛剧烈,心烦):先用阳和汤法治疗,药物包括:天麻、桂枝、鹿角胶、大熟地、净麻黄、白芥子、甘草。
走马青腿牙疳又名牙啸,表现为牙龈出血呈紫色,口臭,脉象反而涩细,双腿青色如靛蓝,这是由于湿热郁火蕴结于阳明经,且肝肾阴亏所致。
药物包括:犀角、石膏、知母、怀牛膝、金银花、玄参、郁金、生地、熟地、丹皮、人中白、麦冬、旱莲草、女贞子、连翘、碧玉散、茯苓、龟版心、炒山栀、羚羊片、生甘草、川石斛、川贝、安南桂、料豆衣。
Toothache is generally caused by wind, fire, insects (caries), or deficiency; this section only discusses the pain itself. Other conditions such as Ya Xuan (gingival recession and bleeding), Ya Gan (noma/cancrum oris of the gums), Ya Jun (gum polyps or hyperplasia), Ya Yong (gum abscess), Chuan Ya (loose teeth falling out), Gu Cao Feng (osteomyelitis of the jaw), and Zou Ma Qing Tui Ya Gan (a severe gangrenous stomatitis with cyanotic legs) are all caused by the accumulation of damp-heat, fierce toxins, liver qi stagnation with damp-phlegm, settling in the dental alveolus. One must distinguish between the upper and lower teeth, differentiating the involvement of the Hand and Foot Yangming meridians and the Shaoyin meridians. Wood grows from Earth; teeth grow from the alveolar bone. The alveolar bone belongs to the Yangming meridian, while the teeth relate to the Kidney. The lower teeth, which chew food, belong to the Large Intestine meridian; the upper teeth, which remain relatively stationary, belong to the Stomach meridian. Ya Xuan with swelling and pain is due to damp-heat in the Stomach; Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) is the primary formula.
Toothache caused by warm pathogens steaming upward (pain radiating to the vertex, treat using the method of Yu Nu Jian): Xi Jiao (Rhinoceros Horn), Yuan Shen (Scrophulariae Radix), Sheng Gan Cao (Raw Licorice Root), Lian Qiao (Forsythiae Fructus), Xia Ku Cao (Prunellae Spica), Ling Jiao (Bell Horn - *Note: likely a textual variant or specific local term, retained as per source*), Zhi Mu (Anemarrhenae Rhizoma), Yin Hua (Lonicerae Japonicae Flos), Shan Zhi (Gardeniae Fructus).
Toothache caused by constrained fire (pain radiating to the vertex, belonging to the Jueyin meridian): Xi Jiao (Rhinoceros Horn), Yuan Shen (Scrophulariae Radix), Sheng Gan Cao (Raw Licorice Root), Lian Qiao (Forsythiae Fructus), Xia Ku Cao (Prunellae Spica), Ling Jiao (Bell Horn), Zhi Mu (Anemarrhenae Rhizoma), Yin Hua (Lonicerae Japonicae Flos), Shan Zhi (Gardeniae Fructus).
Toothache caused by wind-heat (swollen gums and headache, treat using the method of light and clear descending): Lu Gen (Reed Rhizome), Xi Gua Cui (Watermelon Rind Peel), Lian Qiao (Forsythiae Fructus), Hua Shi (Talcum), Lv Dou Pi (Mung Bean Skin), Yin Hua (Lonicerae Japonicae Flos).
Toothache caused by yin deficiency with flaming fire (history of alcoholism, Ya Xuan, epistaxis, hemoptysis): Ren Zhong Bai (Calcinata Dentium), Xian Shi Hu (Fresh Dendrobii Caulis), Da Ze Xie (Large Alisma Rhizome), Han Lian Cao (Ecliptae Herba), Sheng Mu Li (Ostreae Concha), Lv Dou Pi (Mung Bean Skin).
Meridian obstruction following toothache (at Jiache acupoint, inability to open the mouth, treat using the method of unblocking collaterals): Ling Yang Jiao Pian (Antelope Horn Slices), Wei Tian Ma (Prepared Gastrodiae Rhizoma), Zhi Jiang Can (Processed Bombyx Batryticatus), Gui Zhi Jian (Cinnamomi Ramulus Tip), Chao Shan Zhi (Stir-fried Gardeniae Fructus), Chao Dan Pi (Stir-fried Moutan Cortex).
Pain from Gu Cao Feng (condition varies in severity, pain radiating to Kong Xue acupoint is severe, irritability): First use the method of Yang He Tang: Tian Ma (Gastrodiae Rhizoma), Gui Zhi (Cinnamomi Ramulus), Lu Jiao Jiao (Colla Cornus Asini), Da Shu Di (Prepared Rehmanniae Radix), Jing Ma Huang (Cleaned Ephedrae Herba), Bai Jie Zi (Sinapis Semen), Gan Cao (Licorice Root).
Zou Ma Qing Tui Ya Gan, also known as Ya Xiao, presents with purple gingival bleeding, foul breath, a wiry-thin pulse, and legs cyanotic like indigo. This is caused by damp-heat and constrained fire accumulating in the Yangming meridians, combined with Liver and Kidney yin deficiency.
Herbs include: Xi Jiao (Rhinoceros Horn), Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Huai Niu Xi (Achyranthis Bidentatae Radix), Yin Hua (Lonicerae Japonicae Flos), Yuan Shen (Scrophulariae Radix), Yu Jin (Curcumae Longae Radix), Sheng Di Huang (Rehmanniae Radix), Shu Di Huang (Prepared Rehmanniae Radix), Dan Pi (Moutan Cortex), Ren Zhong Bai (Calcinata Dentium), Mai Dong (Ophiopogonis Tuber), Han Lian Cao (Ecliptae Herba), Nu Zhen Zi (Ligustri Lucidi Fructus), Lian Qiao (Forsythiae Fructus), Bi Yu San (Jade Green Powder), Fu Ling (Poria), Gui Ban Xin (Core Testudinis Carapacis), Chao Shan Zhi (Stir-fried Gardeniae Fructus), Ling Yang Pian (Antelope Horn Slices), Sheng Gan Cao (Raw Licorice Root), Chuan Shi Hu (Dendrobii Officinalis Caulis), Chuan Bei Mu (Fritillariae Cirrhosae Bulbus), An Nan Gui (Cinnamomi Cortex), Liao Dou Yi (Vigna Sinensis Seed Coat).