经曰∶天有列星,人有牙齿。又曰∶手阳明之脉,入下齿中。足阳明之脉,入上齿中。陈飞霞曰∶上齿属胃,
下齿属大肠,齿属肾,凡齿生迟者,肾气不足也。盖肾主骨,齿者,骨之余也。不足则髓亏,不能充乎齿。所以
齿迟,宜地黄丸。上下牙床肿者,此手足阳明实热也。凉膈散为君,加知母、升麻、石膏为佐,频频含咽。龈肿
者,肾脏积热,附龈而肿痛也。以针刺去其血,用盐汤洗净,黄柏为末敷之效。小儿有多食肥肉,齿牙臭烂,不可
近者,名为臭息,此胃膈实热也。内服沆瀣丹,外以荆竹沥和姜汁含嗽。牙疳者,初作臭气,次则牙齿黑。甚则
龈肉烂
而出血,名为宣露。此由肾热,其气直奔上焦,故以走马为喻,宜速治之。若上下唇破,鼻穿齿落者,名曰崩沙
。气喘痰潮,饮食减少,则不可治。内服沆瀣丹,外以如圣散敷之。梦中切牙,风热也。由手足阳明二经,积热
生风,故令相击而有声也,必在梦中也。风属阳明,动则风行于阳,静则风归于里也,宜风散。切牙一症,惟痘疹
见此为危候,余则皆无大害。亦有因病战栗,鼓颔而斗牙者,治其本证,则自止。牙齿落后,不复生者,由于
舌舔之故。其肉顽浓,用针刺去其血,以鼠骨散搽之自生。
六味地黄汤(见前喘哮方内)
凉膈散 (见前)
沆瀣丹 (见前伤湿方内)
如圣散 治小儿走马疳,并奔沙宣露。
用妇人尿桶中白垢刮下,瓦上 至烟尽,加铜绿二分,麝香五厘,共为细末,先以蜡树叶浸米泔水,洗净
后,搽此药。
宣风散 治小儿梦中切牙用。
尖槟榔(五两) 陈皮(一两五钱) 牵牛(一两炒,取头末) 甘草(五钱) 共为细末,每服一二钱,
加蜂蜜调之,空心服。
涂蔚生曰∶查宣风散所用之药,多系破气消食之药品,并无一味去风者。足见梦中切牙,亦是食积之热,名
为是风,则未免错了过半矣。
鼠骨散 治小儿齿落不生用。
雄鼠一支,烂去其皮。取全骨炙枯,研细末,加麝香一分,擦刺处,良久,以姜汤嗽之。
涂蔚生曰∶小儿除齿迟,龈肿等证外,颇少齿痛之症。然予于齿痛,除由于风火而外,得一虚火牙痛之方,
治疗最速,收效最神。盖齿总属于肾。肾阴一虚,不能上输滋养,则虚火炽炎,烁齿作痛。治之之方,唯有滋阴
降火,兼清阳明之燥热耳。方用加味玉女煎。至风火牙痛之外,治法以蒜瓣一片,研捣如泥,加
入轻粉少许,置于小蛤蜊壳内,放于虎口穴上(在合骨下),令其烧热至极痛时,始去之,顷刻此处肉起一小
泡,用针刺破,流出黄水,牙痛立止,终身不复牙痛。但此必须是牙痛由于风火内热者,否则亦不大效。
加味玉女煎
生地(二钱) 玄参(一钱) 骨碎补(一钱) 石膏(一钱) 知母(一钱) 寸冬(一钱) 甘草(一钱)
怀牛膝(二钱)
《黄帝内经》说:天上有排列的星辰,人有牙齿。又说:手阳明大肠经的经脉,进入下齿中。足阳明胃经的经脉,进入上齿中。陈飞霞说:上齿属于胃,下齿属于大肠,牙齿的根本归属在于肾,凡是牙齿生长迟缓的,是肾气不足的表现。因为肾主骨,牙齿是骨骼的余气所化。肾气不足则骨髓亏虚,不能充盈滋养牙齿,所以导致牙齿生长迟缓,适宜服用地黄丸(六味地黄丸)。上下牙床肿胀的,这是手阳明和足阳明二经实热所致。以凉膈散为主方,加入知母、升麻、石膏作为辅佐药,频频含在口中咽下。牙龈肿胀的,是肾脏积热,热气附着于牙龈而肿痛。用针刺破排出瘀血,用盐水汤洗净后,将黄柏研成粉末敷患处有效。小儿如果多吃肥肉,导致牙齿臭烂,气味难闻不可靠近的,名为“臭息”,这是胃膈有实热。内服沆瀣丹,外用荆竹沥混合姜汁含漱。牙疳病,起初发作时有臭气,随后牙齿变黑。严重时牙龈腐烂出血,名为“宣露”。这是由于肾热,热气直冲上焦,所以用“走马”来比喻其病情发展迅速,应当速治。如果上下嘴唇破裂,鼻梁穿孔牙齿脱落,名为“崩沙”。出现气喘痰多,饮食减少,则无法治愈。内服沆瀣丹,外用如圣散敷贴。睡梦中磨牙,属于风热证。由于手足阳明二经积热生风,致使牙齿相互撞击发出声音,且必定发生在睡眠中。风邪属于阳明经,活动时风邪行于阳分,静止时风邪归于里,适宜使用宣风散。磨牙这一症状,只有在痘疹病中出现时才被视为危重征候,其余情况都没有大害。也有因为疾病引起战栗,咬牙抖动牙齿的,治疗其根本病症,磨牙自然停止。牙齿脱落后不再生长的,是由于舌头舔舐的缘故。其肉质坚硬浓厚,用针刺去瘀血,涂抹鼠骨散即可重新生长。
六味地黄汤(见前文喘哮方剂内)
凉膈散(见前文)
沆瀣丹(见前文伤湿方剂内)
如圣散 治疗小儿走马疳,以及崩沙宣露。
取妇人尿桶中的白色垢物刮下,放在瓦片上烧至烟尽,加入铜绿二分,麝香五厘,共同研成细末。先用蜡树叶浸泡在米泔水中,洗净患处后,搽抹此药。
宣风散 治疗小儿睡梦中磨牙。
尖槟榔(五两) 陈皮(一两五钱) 牵牛子(一两炒制,取头末) 甘草(五钱) 共同研成细末,每次服用一二钱,加蜂蜜调匀,空腹服用。
涂蔚生说:查考宣风散所用的药物,多是破气消食的药物,没有一味祛风的药。足以说明睡梦中磨牙,也是食积产生的热,命名为风,未免错了一半。
鼠骨散 治疗小儿牙齿脱落后不再生长的。
取雄鼠一只,去皮烂处理。取全骨烤枯,研成细末,加入麝香一分,擦刺处,过一会儿,用姜汤漱口。
涂蔚生说:小儿除了牙齿生长迟缓、牙龈肿胀等证候外,很少见到牙齿疼痛的症状。然而我在治疗牙齿疼痛时,除了因风火引起的之外,得到一个治疗虚火牙痛的方子,治疗效果最快,收效最神奇。因为牙齿总归属于肾。肾阴一旦虚弱,不能向上输布滋养,则虚火炽盛炎上,灼烧牙齿产生疼痛。治疗的方子,唯有滋阴降火,兼清阳明燥热罢了。方剂使用加味玉女煎。至于风火牙痛之外的治法,可以用蒜瓣一片,研捣成泥,加入少许轻粉,置于小蛤蜊壳内,放置在虎口穴上(在手背合谷穴下方),令其烧热到极度疼痛时,才去掉它,顷刻间此处皮肤起一个小水泡,用针刺破,流出黄水,牙痛立即停止,终身不再牙痛。但这必须是牙痛由于风火内热引起的,否则也不大见效。
加味玉女煎
生地(二钱) 玄参(一钱) 骨碎补(一钱) 石膏(一钱) 知母(一钱) 寸冬(一钱) 甘草(一钱) 怀牛膝(二钱)
The *Huangdi Neijing* states: "Just as there are arranged stars in the heavens, so too do humans have teeth." It further states: "The Hand-Yangming Large Intestine Meridian enters into the lower teeth. The Foot-Yangming Stomach Meridian enters into the upper teeth." Chen Feixia stated: "The upper teeth belong to the Stomach, the lower teeth belong to the Large Intestine, and the teeth fundamentally belong to the Kidney. Any delay in tooth eruption indicates insufficient Kidney Qi. Since the Kidney governs the bones, and teeth are the surplus of the bones, insufficiency leads to marrow deficiency, which fails to fill and nourish the teeth. Therefore, delayed eruption is treated with Dihuang Wan (Rehmannia Pill). Swelling of the upper and lower alveolar ridges is caused by excess heat in the Hand-Yangming and Foot-Yangming meridians. Liangge San (Cooling the Diaphragm Powder) serves as the principal formula, supplemented with Zhimu (Anemarrhenae Rhizoma), Shengma (Cimicifugae Rhizoma), and Shigao (Gypsum Fibrosum), to be frequently held in the mouth and swallowed. Gum swelling results from accumulated heat in the Kidney, attaching to the gums causing pain and swelling. Pricking with a needle to release blood, washing with salt water, and applying Huangbai (Phellodendri Cortex) powder is effective. If children consume excessive fatty meat, leading to foul-smelling, rotting teeth that are unbearable to approach, this is named 'Chouxi' (Foul Breath), indicating excess heat in the Stomach and膈 (Diaphragm). Internally administer Hangxie Dan, and externally use Jingzhuli (Ampelopsis Japonica Juice) mixed with Jiangzhi (Ginger Juice) for gargling. Dental gangrene initially presents with foul odor, followed by blackening of the teeth. In severe cases, gum tissue rots and bleeds, named 'Xuanlu' (Exposure). This arises from Kidney heat rushing directly to the Upper Jiao; thus, it is likened to a 'running horse' due to its rapid progression, requiring urgent treatment. If the upper and lower lips crack, the nose perforates, and teeth fall out, it is named 'Bengsha'. With panting, tidal phlegm, and reduced appetite, it becomes incurable. Internally administer Hangxie Dan, and externally apply Rusheng San. Grinding teeth during dreams indicates Wind-Heat. Accumulated heat in the Hand-Yangming and Foot-Yangming meridians generates Wind, causing teeth to strike each other and produce sound, occurring specifically during sleep. Wind belongs to the Yangming meridian; when active, wind moves through the Yang aspects; when still, it returns inward. Xuanfeng San is indicated. This symptom of bruxism is considered a critical sign only when appearing in variola (smallpox/varioloid); otherwise, it poses no major harm. There are also cases where trembling due to illness causes jaw clenching and tooth chattering; treating the root condition will stop it naturally. Teeth falling out and not regrowing is due to tongue licking. The tissue becomes hard and thick; pricking with a needle to release blood and applying Shugu San allows regeneration.
Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) (see previous Asthma/Wheezing formulas)
Liangge San (Cooling the Diaphragm Powder) (see previous)
Hangxie Dan (see previous Dampness Injury formulas)
Rusheng San treats pediatric running horse dental gangrene and Bengsha/Xuanlu.
Scrape white scale from a woman's urine bucket, burn on a tile until smoke ceases, add Tonglv (Malachite) two fen, Muxiang (Musk) five li, grind to fine powder. First wash the area with rice water infused with Laoye leaves, then apply this medicine.
Xuanfeng San treats pediatric dream-related bruxism.
Jian Binglang (Arecae Semen, 5 liang), Chenpi (Citri Reticulatae Pericarpium, 1.5 liang), Qianniu (Pharbitidis Semen, 1 liang stir-fried, take the first flour), Gancao (Glycyrrhizae Radix et Rhizoma, 5 qian). Grind to fine powder. Take 1-2 qian per dose, mixed with honey, taken on an empty stomach.
Tu Weisheng commented: Examining the ingredients of Xuanfeng San, they are mostly qi-breaking and food-digesting herbs, with none dispelling wind. This proves that dream-bruxism is also heat from food stagnation; naming it 'wind' is half incorrect.
Shugu San treats pediatric tooth loss without regrowth.
Take one male rat, remove skin thoroughly. Roast the whole bone until dry, grind to fine powder, add Muxiang (Musk) one fen. Apply to the puncture site, wait a while, then rinse with ginger soup.
Tu Weisheng commented: Apart from delayed eruption and gum swelling, pediatric toothache is rare. However, I have found a formula for Deficient Fire Toothache that acts fastest and works miraculously. Teeth belong to the Kidney. When Kidney Yin is deficient, it cannot ascend to nourish, leading to blazing Deficient Fire that scorches teeth causing pain. The treatment must nourish Yin, descend fire, and clear Yangming dryness. Use Jiawei Yunnv Jian (Modified Jade Woman Decoction). For non-wind-fire toothaches, take one slice of garlic, mash into paste, add a little Qingfen (Calomel), place in a small clam shell, and apply to the Hukou acupoint (below Hegu). Heat until extreme pain, then remove. A blister forms instantly; prick it with a needle to drain yellow fluid, and toothache stops immediately, never returning. This is only effective if the toothache is due to wind-fire internal heat; otherwise, efficacy is poor.
Jiawei Yunnv Jian (Modified Jade Woman Decoction)
Shengdi (Rehmanniae Radix, 2 qian), Xuanshen (Scrophulariae Radix, 1 qian), Gusuibu (Drynariae Rhizoma, 1 qian), Shigao (Gypsum Fibrosum, 1 qian), Zhimu (Anemarrhenae Rhizoma, 1 qian), Cundong (Ophiopogonis Radix, 1 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 1 qian), Huai Niuxi (Achyranthis Bidentatae Radix, 2 qian).