齿统属足少阴肾经。分上下龈。上龈属足阳明胃经。下龈属手阳明大肠经。男子八岁肾气实。
发长齿更。三八真牙生。五八齿槁。八八则齿发去。女子以七为数。盖肾主骨。齿乃骨之余。髓
之所养。故随天癸之盛衰也。东垣云。齿者肾之标。口者脾之窍。诸经多有会于口者。下龈乃手
阳明大肠脉之所过。恶热饮而喜寒。上龈乃足阳明胃脉之所贯。喜热饮而恶寒。牙者肾之标。实
则坚牢。虚则浮动。热则袒动。作痛不已。其痛不一。有恶热而作痛者。有恶寒而作
痛者。有恶寒又恶热而作痛者。有牙齿动摇而作痛者。有齿袒而作痛者。有齿龈为疳所蚀缺少血
出而作痛者。有齿龈肿起而作痛者。有脾胃中有风邪。但觉风而作痛者。有胃中气少。不奈于寒。
袒露其齿作而痛者。有为虫蚀色变而作痛者。有牙齿疼痛而臭秽之气不可近者。痛既各异。岂可
一药而尽之哉。
薛立斋云。湿热甚而痛者。承气汤下之。上下牙痛不可忍。牵引入脑。或喜寒恶热。脉洪数
有力者。凉膈散倍酒蒸大黄泻之。大肠热而齿龈肿痛。清胃散。火郁而痛者。越鞠丸解之。肾经
虚而痛者。六味丸加骨碎补。肾经虚寒而痛者。八味丸加细辛。其属风热者。羌、独、荆、防、
芎、辛、薄荷、生地之类。水煎漱咽。不愈。茵陈散。风毒及热壅上攻牙龈痛。或龈缝有红肉努
出。消风散。临卧半漱半服。风寒入脑者。羌活附子汤。牙痛用清凉药更甚者。从治之。毕茇、
川椒、薄荷、细辛、龙脑、青盐。为末擦之。得热而痛。得凉则止者。小承气汤加甘草、川连。
凡齿痛。遇劳即发。或午后甚者。皆脾胃虚热。补中益气下六味丸。若齿龈肿痛。 赤腮颊。此
胃经风热。犀角升麻汤。若善饮者。齿痛腮颊 肿。此胃经湿热。清胃散加葛根。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。乃手阳明经中热甚而作。其齿喜冷恶热。清胃
散加兰香。寒热皆痛。当归龙胆散。上边痛。倍升麻。下边痛。倍白芷。胃中实热太甚。口臭不
可近。牙根疳蚀血出。乃恣食肥甘美酒所致。清胃散加茵陈、香薷。少佐白豆蔻。先以熟大黄泻
一二次。使胃中湿热去。而齿自安矣。肾虚牙浮而痛。甚则憎寒壮热。如欲脱之状。下安肾丸、
还少丹。间进黑锡丹。有房劳恼怒。牙即动摇长出。服补肾清胃药俱不效者。此肾经火邪盛也。
宜酒黄柏三钱。青盐、升麻各一钱。且漱且咽以摄之。或生地黄两许。骨碎补三钱。同细辛一分。
秦椒七粒。酒水浸捣。略煎入青盐少许。如上且漱且咽服之良。牙疳肿腐作痛。
人中白、青黛、冰片、玄明粉为散掺之。小儿好食糖霜生疳。治之不愈者。以石蜜不时嚼之。糖
因煎炼而助湿热。石蜜不经火熬。其性本寒。故能化疳。专取同气之相感也。
龋蛀 龋蛀数年不愈。当作阳明蓄血治。桃核承气为细末。炼蜜丸如桐子大服之。好饮者多
此。屡服有效。局方引涎止痛方。川椒、露蜂房微炙。等分为末。水煎入盐少许。乘热频漱。冷
即吐出。或用蟾酥、银朱掺和为丸。如莱菔子大。每用一丸搽患处。便不疼。至三丸。吐浓涎数
口即愈。又用不蛀皂角一荚。去皮子。于皂子处安巴豆一粒。盐泥固济。烧灰研细末。用剜耳子
抄少许。填入蛀孔内。白芷、细辛煎漱。或温米醋。漱出虫自愈。或用食盐之滴卤漱二三次。以
摄其虚阳。其痛即止。但可暂用。以其能损齿也。
牙齿动摇。还少丹常服。或六味丸加骨碎补。阴虚内热者。甘露饮。外用五倍子散、乌金散、
长春牢牙散。齿间肉壅。口不能开。水浆难入。以牙硝煎汤漱之。一法。用皂白二矾汤漱之。一
法。用五倍子煎汤漱之。一法。以热醋漱之。
骨槽风 生于耳前腮颊。痛引筋骨。寒热如疟。牙关紧闭。不能进食。不待腐溃而齿便脱落。
此风毒窜入骨槽所致。初则坚硬难消。急宜艾灸其外。针刺齿龈以泄其毒。用冰、硼、玄明粉。
为散吹搽。内服降火化痰消肿之剂。久则疮口难合。非参、 、归、芍补托。兼肉桂、冬、味之
类。不能破结敛肌。其治法。外科正宗颇详。疡医宜参究之。若腐肿不消。虚热不退。形焦体削者不治。
牙齿统属于足少阴肾经。牙龈分为上龈和下龈两部分。上龈归属于足阳明胃经，下龈归属于手阳明大肠经。男子到了八岁，肾气充实，头发开始生长，乳牙更换。到三八（二十四岁）时，智齿长出。五八（四十岁）时，牙齿开始枯槁。到了八八（六十四岁），牙齿和头发就会脱落。女子以七为基数计算生理周期。这是因为肾主骨，牙齿是骨的余气，由髓滋养，所以牙齿的盛衰随着天癸（指肾中精气充盈后产生的、与生殖机能有关的物质）的盛衰而变化。
李东垣说：牙齿是肾的外在表现，口是脾的外窍。许多经脉都交会于口腔。下龈是手阳明大肠经脉经过的地方，患者厌恶热饮而喜欢冷饮；上龈是足阳明胃经脉贯穿的地方，患者喜欢热饮而厌恶冷饮。牙齿的状态反映肾气的虚实：实证则牙齿坚固牢靠，虚证则牙齿松动浮动；受热邪影响则牙齿动摇不定，疼痛不止。牙齿疼痛的原因各不相同，有的因恶热而痛，有的因恶寒而痛，有的既恶寒又恶热而痛，有的因牙齿松动而痛，有的因牙齿暴露（牙根萎缩）而痛，有的因牙龈被疳虫侵蚀、缺损出血而痛，有的因牙龈肿胀而痛，有的因脾胃中有风邪，仅感觉风吹即痛，有的因胃中气虚，不耐寒冷，牙齿暴露而痛，有的因被虫蛀蚀、颜色改变而痛，有的因牙齿疼痛且伴有不可接近的臭秽气味。疼痛既然各异，怎么能用一种药物来治疗所有情况呢？
薛立斋说：湿热严重而导致疼痛的，用承气汤攻下。上下牙痛剧烈难忍，牵引至头部，或者喜欢寒冷厌恶热，脉象洪大数动有力的，用凉膈散加倍酒蒸大黄泻火。大肠有热导致牙龈肿痛，用清胃散。火郁结而疼痛的，用越鞠丸解郁。肾经虚弱而疼痛的，用六味地黄丸加骨碎补。肾经虚寒而疼痛的，用金匮肾气丸（八味丸）加细辛。属于风热的，用羌活、独活、荆芥、防风、川芎、细辛、薄荷、生地黄等药材水煎，含漱并咽下。如果无效，用茵陈散。风毒及热邪壅盛上攻导致牙龈疼痛，或牙龈缝隙有红肉突出，用消风散，睡前一半含漱一半服用。风寒侵入脑部导致的，用羌活附子汤。使用清凉药物治疗牙痛反而加重的，采用“从治”法（反佐法）。将毕茇、川椒、薄荷、细辛、龙脑、青盐研成粉末擦涂患处。遇到热就痛、遇凉就停止的，用小承气汤加甘草、黄连。凡是牙齿疼痛，劳累后即发作，或午后加重的，都是脾胃虚热，用补中益气汤配合六味地黄丸。如果牙龈肿痛，面颊发红，这是胃经风热，用犀角升麻汤。如果是喜欢饮酒的人，牙齿疼痛伴腮颊肿胀，这是胃经湿热，用清胃散加葛根。因为服用补胃热的药物，导致上下牙疼痛剧烈难忍，牵引头脑，满面发热剧痛，这是手阳明经热盛所致。牙齿喜冷恶热，用清胃散加兰香。寒热皆痛的，用当归龙胆散。上部疼痛，倍用升麻；下部疼痛，倍用白芷。胃中实热太甚，口臭不可近人，牙根患疳蚀出血，这是恣意食用肥甘厚味和美酒所致。先用清胃散加茵陈、香薷，少佐白豆蔻。先服用熟大黄泻下一两次，使胃中湿热去除，牙齿自然安宁。肾虚导致牙齿浮动疼痛，甚至憎寒壮热，像要脱失一样的状态，用下安肾丸、还少丹，间服黑锡丹。如果有房劳过度或恼怒，牙齿立即松动长出，服用补肾清胃药都不见效的，这是肾经火邪旺盛。宜用酒炒黄柏三钱，青盐、升麻各一钱，一边含漱一边咽下以收敛之。或者用生地黄一两许，骨碎补三钱，同细辛一分，秦椒七粒，用酒和水浸泡捣烂，略煎后加入少许青盐，如上法含漱咽下，效果良好。牙疳肿胀腐烂作痛，用人中白、青黛、冰片、玄明粉研成散剂掺敷患处。小儿喜欢吃糖霜而生疳，治疗不愈的，不时嚼食石蜜（天然蜂蜜块）。因为糖经过煎炼会助长湿热，而石蜜不经火熬，其性本寒，所以能化解疳积，这是专门利用同气相感的原理。
龋蛀 龋蛀几年不愈的，应当当作阳明蓄血证治疗。用桃核承气汤研成细末，炼蜜制成梧桐子大小的丸剂服用。喜欢喝酒的人多患此病，多次服用有效。局方引涎止痛方：川椒、露蜂房微炙，等分研末，水煎入少许盐，趁热频繁含漱，冷了就吐掉。或者用蟾酥、银朱混合做成丸剂，如莱菔子大小，每次取一丸涂抹患处，就不疼了。用到三丸，吐出浓稠涎液几口即可痊愈。又用不蛀的皂角一荚，去皮去子，在皂子处放入一粒巴豆，用盐泥密封固济，烧成灰研成细末，用挖耳勺取少许填入蛀孔内。用白芷、细辛煎汤含漱，或用温米醋含漱，可引出虫子自愈。或者用食盐卤水含漱二三次，以摄纳其虚阳，疼痛即止。但这只能暂时使用，因为它会损伤牙齿。
牙齿松动，常服还少丹。或者用六味地黄丸加骨碎补。阴虚内热的，用甘露饮。外用五倍子散、乌金散、长春牢牙散。齿间肉质壅塞，嘴巴不能张开，水浆难以进入，用牙硝煎汤含漱。另一种方法，用皂矾和白矾汤含漱。另一种方法，用五倍子煎汤含漱。另一种方法，用热醋含漱。
骨槽风 生于耳前腮颊部位，疼痛牵引筋骨，寒热往来像疟疾一样，牙关紧闭，不能进食，尚未溃腐牙齿便脱落。这是风毒窜入骨槽所致。初期坚硬难以消散，急需在外部艾灸，针刺齿龈以泄出毒邪。用冰片、硼砂、玄明粉研成散剂吹搽。内服降火化痰消肿的药物。时间久了疮口难愈合，非用人参、黄芪、当归、芍药补益托毒，兼用肉桂、冬虫夏草、五味子之类，不能破除结聚、收敛肌肉。其治疗方法，《外科正宗》记载得很详细，疡医应当参考研究。如果腐肿不消，虚热不退，形体焦枯消瘦的，属于不治之症。
The teeth are collectively governed by the Foot-Shaoyin Kidney Meridian (Zu Shao Yin Shen Jing). The gums are divided into upper and lower parts. The upper gums belong to the Foot-Yangming Stomach Meridian (Zu Yangming Wei Jing), and the lower gums belong to the Hand-Yangming Large Intestine Meridian (Shou Yangming Da Chang Jing). At the age of eight, men experience substantial Kidney Qi (Shen Qi), leading to hair growth and tooth replacement. By age twenty-four (three times eight), wisdom teeth emerge. By age forty (five times eight), the teeth begin to wither. By age sixty-four (eight times eight), the teeth and hair fall out. Women's physiological cycles are calculated based on the number seven. This is because the Kidneys govern bones, and teeth are considered the surplus of bone, nourished by marrow. Therefore, their condition fluctuates with the rise and decline of Tian Gui (Tian Gui, a substance related to reproductive function generated by Kidney essence).
Li Dongyuan stated: "Teeth are the external manifestation of the Kidneys; the mouth is the orifice of the Spleen." Many meridians converge at the oral cavity. The lower gums are traversed by the Hand-Yangming Large Intestine meridian; patients here dislike hot drinks and prefer cold ones. The upper gums are penetrated by the Foot-Yangming Stomach meridian; patients here prefer hot drinks and dislike cold ones. The state of the teeth reflects the deficiency or excess of Kidney Qi: in Excess conditions, teeth are firm and stable; in Deficiency conditions, they are loose and floating. Affected by Heat, they tremble and cause persistent pain. The causes of toothache vary: some hurt due to aversion to heat, some due to aversion to cold, some due to both, some due to loosening, some due to exposed roots, some due to canker sores eroding the gums causing bleeding, some due to gum swelling, some due to Wind pathogens in the Spleen and Stomach causing pain upon exposure to wind, some due to Stomach Qi deficiency failing to withstand cold causing exposed root pain, some due to caries changing color, and some due to foul odor accompanying pain. Since pains differ, how can one medicine treat all cases?
Xue Lizhai said: For pain caused by severe Damp-Heat, use Chengqi Tang (Cathartic Decoction) to purge. For unbearable upper and lower toothache radiating to the head, or preference for cold/aversion to heat with a surging, rapid, and forceful pulse, use Liangge San (Cooling the Chest Powder) with doubled Jiuzheng Dahuang (Alcohol-steamed Rhubarb) to drain fire. For Large Intestine Heat causing gum swelling and pain, use Qingwei San (Stomach-Clearing Powder). For pain due to Fire stagnation, use Yueju Wan (Yueju Pill) to resolve stagnation. For Kidney Meridian Deficiency causing pain, use Liuwei Wan (Six-Ingredient Pill) plus Gusuibu (Drynaria Root). For Kidney Meridian Deficiency-Cold causing pain, use Bawei Wan (Eight-Ingredient Pill) plus Xixin (Asarum). For Wind-Heat patterns, decoct Qianghuo (Notopterygium), Duhuo (Angelica Pubescens), Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Chuanxiong (Ligusticum), Xixin, Bohe (Mint), and Shengdi Huang (Rehmannia) as a rinse and swallow. If ineffective, use Yinchensan (Artemisia Capillaris Powder). For Wind-Toxin and Heat congestion attacking the gums, or red flesh protruding from gum fissures, use Xiaofeng San (Wind-Dispersing Powder), half rinsing and half swallowing before sleep. For Cold-Wind invading the brain, use Qianghuo Fuzi Tang (Notopterygium and Aconite Decoction). For toothache worsened by cooling medicines, apply the principle of "treating contrary" (counter-treatment). Grind Biba (likely Piper longum or similar), Chuanjiao (Sichuan Pepper), Bohe, Xixin, Longnao (Borneol), and Qingyan (Green Salt) into powder and apply externally. For pain relieved by cold and aggravated by heat, use Xiao Chengqi Tang (Minor Cathartic Decoction) plus Gancao (Licorice) and Chuanlian (Coptis). For toothaches triggered by exertion or worsening in the afternoon, indicating Spleen-Stomach Deficiency-Heat, use Buzhong Yiqi Tang (Middle-Boosting Qi-Invigorating Decoction) combined with Liuwei Wan. For gum swelling and red cheeks, indicating Stomach Meridian Wind-Heat, use Xijiao Shengma Tang (Rhinoceros Horn and Cimicifuga Decoction). For drinkers with toothache and cheek swelling, indicating Stomach Meridian Damp-Heat, use Qingwei San plus Gegen (Kudzu Root). For unbearable upper/lower toothache radiating to the head with facial heat after taking warming Stomach herbs, indicating excessive Heat in the Hand-Yangming Meridian with cold preference, use Qingwei San plus Lanxiang (Litsea). For pain from both cold and heat, use Danggui Longdan San (Angelica and Gentian Powder). For upper pain, increase Shengma dosage; for lower pain, increase Baizhi (Angelica Dahurica) dosage. For severe Stomach Excess-Heat causing bad breath and gingival bleeding from canker, resulting from indulgence in rich foods and alcohol, use Qingwei San plus Yichen (Artemisia Capillaris) and Xiangru (Elsholtzia), with a hint of Baixiudoukou (Cardamom). First, purge once or twice with Shu Dahuang (Prepared Rhubarb) to clear Stomach Damp-Heat, allowing teeth to settle. For Kidney Deficiency causing floating/painful teeth with chills and high fever resembling collapse, use Xiashen Wan (Kidney-Anchoring Pill) and Huanshao Dan (Revitalize-Essence Pill), intermittently using Heixi Dan (Black Tin Pill). For tooth loosening/extrusion after sexual exhaustion or anger, unresponsive to Kidney-tonifying/Stomach-clearing herbs, indicating vigorous Kidney Fire, use Jiu Huangbai (Wine-fried Phellodendron) 3 qian, Qingyan and Shengma 1 qian each, rinsing and swallowing. Alternatively, use Shengdihuang 1 liang, Gusuibu 3 qian, Xixin 1 fen, Qinjiao 7 seeds, soaked in wine/water, pounded, slightly boiled with Qingyan, and used as a rinse/swallow. For painful swollen/festering dental canker, apply Renzhongbai (Urine Sediment), Qingdai (Indigo Naturalis), Bingpian (Borneol), and Xuanmingfen (Mirabilite) as powder. For children with canker from sugar consumption unresponsive to treatment, chew Shimii (Rock Honey) occasionally. Sugar processing generates Damp-Heat, whereas raw honey is cold-natured and resolves canker via sympathetic resonance.
Carious Teeth: Caries persisting for years should be treated as Yangming Blood Stasis. Use Taohé Chengqi Tang (Peach Kernel Cathartic Decoction) powdered and honey-pilled. Common in drinkers, repeated doses are effective. Ju Fang Yinyan Zhitong Fang (Bureau Formula for Saliva-Induction and Pain Relief): Lightly roast Chuanjiao and Lufengfang (Honeycomb), powder equally, decoct in water with salt, rinse frequently while hot, spit when cold. Or mix Chan Su (Toad Venom) and Yinzhu (Cinnabar) into pills radish-seed sized, apply one pill to the site to stop pain. Three pills induce expulsion of thick saliva, curing the condition. Alternatively, take a non-decaying soap pod, remove skin/seeds, insert one Sibdou (Castor Bean) where the seed was, seal with clay, burn to ash, powder finely. Apply a small amount to the cavity with an ear pick. Rinse with Baizhi/Xixin decoction or warm rice vinegar to expel worms. Or rinse with saline brine 2-3 times to anchor deficient Yang and stop pain. Use only temporarily as it damages teeth.
Loose Teeth: Take Huanshao Dan regularly. Or Liuwei Wan plus Gusuibu. For Yin Deficiency with Internal Heat, use Ganlu Yin (Sweet Dew Drink). Externally use Wubeizi San (Gallnut Powder), Wujin San, or Changchun Laoya San. For gum tissue obstruction preventing mouth opening or fluid intake, rinse with Yaxiao (Saltpeter) decoction. Alternatives: rinse with Zaobai Erfan Tang (Alum Decoction), Wubeizi decoction, or hot vinegar.
Gu Cao Feng (Bone Trench Wind): Occurs in front of ears/cheeks, pain radiating to sinews/bones, chills/fever like malaria, trismus, inability to eat, teeth falling out before suppuration. Caused by Wind-Toxin penetrating the bone trench. Initially hard and indissolvable; urgently moxa externally, needle gums to drain toxin. Apply Bingpeng Xuanming Fen powder internally. Take Fire-descending, Phlegm-resolving, Swelling-reducing herbs. Chronic cases require Renshen (Ginseng), Huangqi (Astragalus), Danggui (Angelica), Shaoyao (Peony) to tonify and push out toxin, plus Rougui (Cinnamon Bark), Dongchongxiacao (Cordyceps), Wuweizi (Schisandra) to break knots and heal muscle. See *Waike Zhengzong* for details. If festering persists, deficiency-heat remains, and emaciation occurs, it is incurable.