【方歌】牙痈胃热肿牙床，寒热坚硬痛难当，破流脓水未收口，
误犯寒凉多骨妨。
【注】此证由阳明胃经热毒所致。生于牙床，坚肿疼痛，身发
寒热，腮颊浮肿。初宜服荆防散毒散，若大渴、烦呕者
，蟾酥丸汗之；便秘者，双解贵金丸下之；肿处宣软刺
破，搽冰硼散。若初时坚肿，破流血水，久不收口，过
食寒凉者，必生多骨。俟骨尖刺出，摇则内动，始可取
出，其口方能收敛而愈。
方剂：荆防败毒散（见项部脑疽）
蟾酥丸（见疔疮门）
双解贵金丸（见肿疡门）
冰硼散（见口部鹅口疮）
【方歌】走马牙疳证不轻，癖积疹痘毒火攻，牙根腐臭随变黑，
顽肉难脱不食凶。
【注】此证多由癖疾积火、疹痘余毒上攻，最为迅速，总因积
火热毒而成。牙根作烂，随变黑腐，臭秽难闻。若癖积
毒火攻牙者，初宜服芦荟消疳饮；脾胃虚者，兼服人参
茯苓粥。若疹痘余毒所中者，宜服清疳解毒汤。外势轻
者，俱用溺白散擦之。若坚硬青紫，渐腐穿腮、齿摇者
，宜芦荟散擦之；如牙缝黑腐不尽，及腐烂深坑，药不
能到，宜用勒马听徽丝塞之，再用手法，去其黑腐，内
见红肉流鲜血者吉。若取时顽肉难脱，坚硬腐烂渐开，
以致穿腮破唇，宜贴青莲膏，身热不食者逆。但此证惟
癖积攻牙成疳者，好后易犯，由积火时时上攻也。惟在
调理饮食得宜，如山药、粟子、鹅、蟹、甜、辣等物，
俱当禁忌。若稍有疏忽，必致复发，慎之，慎之。
方剂：人参茯苓粥
组成：人参（一钱） 白茯苓（六钱）
共研末，同粳米一茶钟，熬成粥。先以盐汤将口漱
净，后再食粥。
【方歌】人参茯苓善扶脾，饮食短少服之宜，二味研末加粳米，
熬粥食之理胃虚。
又方：清疳解毒汤
组成：人中黄 川黄连（生）
柴胡（各五分） 知母（生）
连翘（去心） 牛蒡子（炒，研）
犀角（镑） 黑参
荆芥 防风（各一钱）
石膏（〔火段〕，一钱五分）
淡竹叶一钱，灯心五十寸，水二钟，煎八分，食远
服。呕加芦苇根五钱。
【方歌】清疳解毒牙疳证，疹痘余毒化热成，中黄知连柴翘蒡，
犀角参膏荆芥风。
又方：溺白散
组成：溺垢（即妇人尿桶中白碱，火〔火段〕）
白霜梅（烧存性） 枯白矾（各二钱）
上研细末，先用韭根、松萝茶，煎成浓汁，乘热以
鸡翎蘸洗患处，去净腐肉，见津鲜血，再敷此药，日敷
三次。若烂至咽喉，以芦筒吹之。
【方歌】溺白散搽走马疳，溺垢白霜梅白矾，韭根茶叶煎汤涤，
蘸洗腐肉敷药痊。
又方：芦荟散
组成：芦荟（一钱） 黄柏（末，五钱）
人言（用红枣五枚，去核，每枣纳人言一分，火烧存
性）
共研细末，先用米泔水漱净疳毒，后敷此药于坚硬
及腐处。
【方歌】芦荟散搽牙疳烂，色紫牙摇腮硬穿，枣裹人言烧存性，
再加黄柏末同研。
又方：勒马听徽丝
组成：白砒（末，一分） 麝香（末，三分）
青绵（撕碎） 青黛（飞，末，各一分）
用香油拌匀用。时先以清米泔水漱口，次用镊尖将
丝挑少许，塞于牙根缝内，日三易之。
【方歌】勒马听徽疳渐蚀，牙缝腐黑急速施，油调砒麝青绵黛，
泔水漱口后塞之。
又方：青莲膏
组成：青黛（二钱）乳香轻粉（各一钱）麝香（五分）白砒（
即人言，一分）
上为细末，用香油调稠，薄摊纸上，用锤锤实，阴
干收之。每于卧时，以泔水漱净口，拭干，随疳证大小
，煎膏药贴之，至晓揭去，再以泔水将漱净吐之，至晚
再贴。
【方歌】青莲膏贴腐疽宜，化腐消坚效更奇，乳麝白砒轻粉黛，
研末油调纸摊之。
又方：芦荟消疳饮（见钻牙疳）
【方歌】牙痈（牙龈脓肿）由胃热引起，导致牙床肿胀，伴有恶寒发热、局部坚硬且疼痛难忍。若脓肿破溃流出脓水但伤口久不愈合，误用寒凉药物会导致死骨形成阻碍愈合。
【注】此证候是由阳明胃经的热毒所致。病变生于牙床，表现为坚硬肿胀、疼痛，身体出现恶寒发热，腮颊部浮肿。初期适宜服用荆防散毒散；若出现大渴、烦躁呕吐症状者，应用蟾酥丸发汗治疗；若便秘者，应用双解贵金丸泻下治疗；肿胀处变软后应刺破，并涂抹冰硼散。若在初期坚硬肿胀时刺破，流出血水且久不收口，或因过食寒凉食物者，必然会产生多块死骨。需等待骨尖刺出，摇晃时内部随之松动，此时方可取出，伤口方能收敛而痊愈。
方剂：荆防败毒散（见项部脑疽章节）
蟾酥丸（见疔疮门章节）
双解贵金丸（见肿疡门章节）
冰硼散（见口部鹅口疮章节）
【方歌】走马牙疳（一种迅速发展的坏疽性口腔炎症）病情不容轻视，多由癖积（虫积或食积）、疹痘余毒及火邪上攻所致。牙根腐烂发臭，随即变为黑色，顽固的肉芽难以脱落，患者无法进食则预后凶险。
【注】此证候多由癖疾积火、疹痘余毒上攻引起，病情进展最为迅速，总归是由于积热和火毒造成。牙根开始腐烂，随后变黑坏死，气味臭秽难闻。若是癖积毒火上攻牙齿者，初期适宜服用芦荟消疳饮；脾胃虚弱者，兼服人参茯苓粥。若是疹痘余毒侵袭者，适宜服用清疳解毒汤。外部症状较轻者，均使用溺白散擦拭患处。若患处坚硬呈青紫色，逐渐腐烂穿透面颊、牙齿松动者，适宜用芦荟散擦拭；如果牙缝间黑色腐肉未除尽，以及腐烂形成深坑，药物无法到达，适宜使用勒马听徽丝塞入，再用手法去除黑色腐肉，若内部露出红肉并流出鲜血则为吉兆。若取除时顽固肉芽难以脱落，坚硬腐烂部分逐渐扩大，以致穿透面颊、破裂嘴唇者，适宜贴敷青莲膏；若伴有身热、不能进食者属逆证（预后不良）。但这种证候中，只有因癖积攻牙成疳者，治愈后容易复发，这是由于积火时时上攻所致。关键在于调理饮食得当，如山药、栗子、鹅肉、螃蟹、甜食、辛辣等食物，都应当禁忌。若稍有疏忽，必然导致复发，务必谨慎，务必谨慎。
方剂：人参茯苓粥
组成：人参（一钱） 白茯苓（六钱）
共研为细末，与粳米一茶钟量一起，熬制成粥。先用盐汤将口腔漱洗干净，然后再食用粥。
【方歌】人参茯苓善于扶助脾气，饮食减少者适宜服用，两味药研末加入粳米，熬粥食用以调理胃虚。
又一方：清疳解毒汤
组成：人中黄 川黄连（生用）
柴胡（各五分） 知母（生用）
连翘（去心） 牛蒡子（炒制，研碎）
犀角（镑片） 黑参
荆芥 防风（各一钱）
石膏（煅烧，一钱五分）
淡竹叶一钱，灯心草五十寸，加水二钟，煎至八分，饭后服用。呕吐者加芦苇根五钱。
【方歌】清疳解毒汤治疗牙疳证，疹痘余毒化热而成，方中含有人中黄、知母、黄连、柴胡、连翘、牛蒡子，以及犀角、人参、石膏、荆芥、防风。
又一方：溺白散
组成：溺垢（即妇人尿桶中的白色碱垢，经火煅烧）
白霜梅（烧至存性） 枯白矾（各二钱）
以上研成细末，先用韭根、松萝茶煎成浓汁，趁热用鸡毛蘸取清洗患处，去除干净腐肉，见到津液和鲜血渗出，再敷上此药，每日敷三次。若腐烂延伸至咽喉，可用芦筒吹药入喉。
【方歌】溺白散搽涂走马牙疳，成分包括溺垢、白霜梅、白矾，用韭根茶叶煎汤洗涤，蘸洗去除腐肉后敷药痊愈。
又一方：芦荟散
组成：芦荟（一钱） 黄柏（研末，五钱）
人言（即砒霜，用红枣五枚，去核，每枣纳入人言一分，火烧至存性）
共研为细末，先用米泔水漱口洗净疳毒，然后将此药敷于坚硬及腐烂处。
【方歌】芦荟散搽涂牙疳烂疮，症见色紫、牙摇、腮硬穿破，用枣包裹人言烧至存性，再加黄柏末一同研碎。
又一方：勒马听徽丝
组成：白砒（研末，一分） 麝香（研末，三分）
青绵（撕碎） 青黛（飞研，研末，各一分）
用香油拌匀使用。使用时先用清米泔水漱口，然后用镊子尖端挑取少许丝状物，塞入牙根缝隙内，每日更换三次。
【方歌】勒马听徽丝治疗疳毒逐渐侵蚀，牙缝腐黑时需急速施用，用油调和砒霜、麝香、青绵、青黛，漱口后再塞入。
又一方：青莲膏
组成：青黛（二钱）乳香轻粉（各一钱）麝香（五分）白砒（即人言，一分）
以上研为细末，用香油调成稠状，薄摊在纸上，用锤子锤实，阴干后收存。每晚睡前，用米泔水漱口洗净口腔，擦干，根据疳证大小，煎膏药贴敷，至早晨揭去，再用米泔水漱口吐出，晚上再贴敷。
【方歌】青莲膏贴敷适用于腐疽，具有化腐消坚的奇特疗效，成分含乳香、麝香、白砒、轻粉、青黛，研末后用油调匀摊在纸上。
又一方：芦荟消疳饮（见钻牙疳章节）
[Prescription Verse] Stomatitis abscess (Ya Yong) is caused by stomach heat, leading to swelling of the gingiva, accompanied by aversion to cold and fever, local hardness, and unbearable pain. If the abscess ruptures and discharges pus but the wound fails to heal, misusing cold-natured drugs will lead to the formation of dead bone, hindering healing.
[Annotation] This syndrome is caused by heat-toxin in the Yangming Stomach Meridian. The lesion arises on the gingiva, presenting as hard swelling and pain, with systemic symptoms of aversion to cold and fever, and swelling of the cheeks. In the early stage, Jingfang Sandu San is suitable; if severe thirst, irritability, and vomiting occur, Chansu Wan should be used to induce sweating; if constipation is present, Shuangjie Guijin Wan should be used to purge. Once the swollen area softens, it should be lanced and Bingpeng San applied topically. If lanced during the initial hard-swollen stage, resulting in bloody discharge and failure to heal over time, or due to excessive consumption of cold foods, multiple pieces of dead bone will inevitably form. One must wait until the bone tip protrudes and becomes loose upon manipulation before extraction can be performed, allowing the wound to contract and heal.
Formulas: Jingfang Baidu San (see Section on Carbuncle of the Neck), Chansu Wan (see Chapter on Ding Chuang), Shuangjie Guijin Wan (see Chapter on Swelling Ulcer), Bingpeng San (see Section on Thrush).
[Prescription Verse] Gangrenous stomatitis (Zouma Yagan) is a serious condition, often caused by parasitic/food accumulation, residual toxins from exanthematous diseases, and fire pathogenic factors attacking upward. The gum roots rot and emit a foul odor, turning black subsequently. If stubborn necrotic tissue fails to detach and the patient cannot eat, the prognosis is ominous.
[Annotation] This syndrome is mostly caused by heat-fire from parasitic/food accumulation or residual toxins from exanthematous diseases attacking upward, progressing rapidly, fundamentally due to accumulated heat and fire-toxin. The gum roots begin to rot, turning black and necrotic with a foul smell. For cases where parasitic/toxic fire attacks the teeth, Lulu Xiaogan Yin is suitable initially; for those with Spleen-Stomach deficiency, Renshen Fuling Zhou should be taken concurrently. For cases caused by residual toxins from exanthematous diseases, Qinggan Jiedu Tang is suitable. For mild external symptoms, Niaobai San should be applied. If the lesion is hard, cyanotic/purple, gradually penetrating the cheek, and causing tooth mobility, Lulu San should be applied topically. If black necrotic tissue remains in the interdental spaces or deep pits exist where medication cannot reach, Lematinghui Si should be inserted, followed by manual removal of black necrosis; revealing red meat with fresh blood flow indicates a favorable outcome. If stubborn tissue is difficult to remove, and hard necrosis expands causing cheek penetration and lip rupture, Qinglian Gao should be applied; presence of fever and inability to eat indicates an adverse prognosis (ni zheng). Among these, only cases caused by parasitic/food accumulation attacking the teeth tend to recur after cure, due to recurring heat-fire attack. Proper dietary regulation is key; foods such as yam, chestnut, goose, crab, sweets, and spicy items must be strictly avoided. Negligence will inevitably lead to recurrence; exercise extreme caution.
Formula: Renshen Fuling Zhou
Composition: Renshen (1 qian), Baifuling (6 qian).
Grind into fine powder, cook with one tea-cup measure of Oryza sativa var. japonica (Jingmi) into porridge. Rinse mouth thoroughly with salt water first, then consume the porridge.
[Prescription Verse] Renshen and Fuling benefit the Spleen Qi, suitable for reduced appetite; grinding these two ingredients with Jingmi and cooking into porridge regulates Stomach deficiency.
Another Formula: Qinggan Jiedu Tang
Composition: Renzhonghuang, Huanglian (raw), Chaihu (each 5 fen), Zhimu (raw), Lianqiao (heart removed), Niubangzi (stir-fried, crushed), Xijiao (shaved), Heishen, Jingjie, Fangfeng (each 1 qian), Shigao (calcined, 1.5 qian), Danzhuyeye (1 qian), Dengxincao (50 cun). Add 2 zhong of water, decoct to 0.8 zhong, take after meals. Add Lubigen (5 qian) if vomiting occurs.
[Prescription Verse] Qinggan Jiedu Tang treats gangrenous stomatitis caused by heat transformation of residual toxins from exanthems; contains Renzhonghuang, Zhimu, Huanglian, Chaihu, Lianqiao, Niubangzi, Xijiao, Shen, Shigao, Jingjie, and Fangfeng.
Another Formula: Niaobai San
Composition: Niaogou (white alkali scale from women's urine pots, calcined), Baishuangmei (calcined to retain nature), Kubaijian (each 2 qian).
Grind into fine powder. First, decoct Jiugen (Allium tuberosum root) and Songluochacha (Song pine moss tea) into a concentrated liquid. While hot, use a chicken feather to dip and wash the lesion, removing all necrotic tissue until fluid and fresh blood appear, then apply this powder. Apply three times daily. If necrosis extends to the pharynx, insufflate using a reed tube.
[Prescription Verse] Niaobai San applied to gangrenous stomatitis consists of Niaogou, Baishuangmei, and Kubaijian; washed with Jiugen and tea decoction, applied after removing necrotic tissue for recovery.
Another Formula: Lulu San
Composition: Lulu (1 qian), Huangbai (powder, 5 qian), Renyan (Arsenic trioxide, placed inside five pitted red dates, roasted to retain nature).
Grind into fine powder. Rinse mouth with rice washing water to clear gan toxin, then apply this powder to hard and necrotic areas.
[Prescription Verse] Lulu San applied to gangrenous stomatitis with purple discoloration, mobile teeth, and hard cheeks penetrating the cheek; dates are used to enclose Renyan roasted to retain nature, mixed with Huangbai powder.
Another Formula: Lematinghui Si
Composition: Baipi (powder, 1 fen), Shexiang (powder, 3 fen), Qingmian (torn), Qingdai (levigated powder, each 1 fen).
Mix evenly with Sesame oil. Before use, rinse mouth with clear rice washing water. Use tweezers to pick up a small amount of the silk-like mixture and insert it into the interdental space at the gum root. Change three times daily.
[Prescription Verse] Lematinghui Si treats gradual erosion of gan toxin; apply urgently when interdental spaces turn black and necrotic. Mix Pi, Shexiang, Qingmian, and Qingdai with oil, rinse mouth, then insert.
Another Formula: Qinglian Gao
Composition: Qingdai (2 qian), Rushen and Qingfen (each 1 qian), Shexiang (5 fen), Baipi/Renyan (1 fen).
Grind into fine powder, mix with sesame oil to a thick consistency, spread thinly on paper, hammer solid, and dry in shade. At bedtime, rinse mouth with rice washing water, dry, and apply a piece sized according to the lesion. Remove in the morning, rinse mouth again, and reapply at night.
[Prescription Verse] Qinglian Gao is suitable for applying to necrotic ulcers, effectively resolving necrosis and hardness; composed of Rushen, Shexiang, Baipi, Qingfen, and Qingdai, ground and mixed with oil on paper.
Another Formula: Lulu Xiaogan Yin (see Section on Drill-tooth Gan).