上四门牙属心，（一云∶上二门牙，下二门牙，属心包络；门牙旁左右上下四牙，属肝；再左右上下四
牙，属胃；再左右上下四牙，属脾；再左右上下四牙，属肺；再左右上下之牙，皆属肾。凡人齿多者贵。
治病不论多少，以前数分治之多效。）下四门牙属肾，上二侧牙属胃，下二侧牙属脾，上左尽牙属胆，
下左尽牙属肝，上右尽牙属肺，下右尽牙属大肠。又有牙龈肿高软者，此名牙痈。内
必有脓，当以针刺出脓自愈。如出血不止，用草纸冷水浸贴二三次，自止。（《正宗》）
风牙痛者，遇风发作，浮肿随后生痛。
火牙痛者，齿根必牵扯腮颧，阵阵作痛，时发时止。
湿热牙痛者，乃足阳明胃经。其患腮颧浮肿，甚则牵引太阳，疼连颊项，口中热气，大便结燥。
虫牙痛者，因喜食甘香，湿热化虫，攻痛频痛。
龋齿者，乃风热相搏，忿怒劳顿，牙根肿痛。是手阳明、足太阳之脉，系于齿
名龋齿。（《锦囊》）
又曰∶如牙痛不可忍，牵引入脑，喜寒恶热，脉洪数有力者，凉膈散倍加酒蒸大黄泻之。
又曰∶如骤发大痛者，多属龙火，如疾风暴雷，焚灼草木，最速最烈。必用从
治之法，热药冷冻饮料，则火得其源而归之矣。
窦汉卿曰∶牙边生痈如豆大，此脾胃二经火也。宜用小刀点破之，搽以冰片散，
再服清胃汤、甘桔汤，无不愈矣。
王海藏曰∶牙齿等龋，臭秽不可近，数年不愈，当作阳明蓄血治。好饮酒者，多
有此证。桃仁承气汤为末蜜丸，服之甚效。
又曰∶牙得清凉而痛甚者，为寒；口吸凉风而痛止者，为热。
冯鲁瞻曰∶齿黑碎片名曰崩砂。久而秽甚，牙根俱落，名曰腐龈。若跌扑所伤
者，或急疳所坠者，则久落难生矣。（《锦囊》）
陈远公曰∶牙齿疼甚不可忍，每至呼号，泪涕交出者，此脏腑火旺，上行齿牙
作痛也。若不泻火，何能取效之捷！然火有虚实，实火起于腑，虚火动于脏。而实
火之中，有胃火、心包火。虚火之中，肝、脾、肺、肾诸经之火，当分经以别之。予
有统治之法，用治牙仙丹∶元参，生地各一两，水煎服之。如察知为心包火，加黄
连五分，脾火加白术一钱，肺火加黄芩一钱，肝火加丹皮一钱，肾火加熟地一两。二
剂火散，四剂全愈。（《冰鉴》按∶火有虚实，何以一方均治？不知火之有余，无非水之不足，我滋其阴，则
阴阳之火无不相戢矣。况元参尤能泻浮游之火，生地止无根之焰，又泻中有补，故虚实咸宜。此治之巧，而得
其要者也。又能辨各经之火，加入各经之味，有不取效尽神乎。）
又曰∶贪食肥甘，齿牙破损作痛，如行来行去者，乃虫积也。夫齿乃骨，何以
藏虫乎？不知过食肥甘，则热气在胃，胃火上冲口齿，湿气乘之，则湿气相搏而不
散，则生虫于牙矣。初则只生一二虫，久则蕃衍，于是蚀损牙齿，遂致堕落。一齿
既朽，又蚀余齿，往往有终身之苦者。此证必须外治，若用内治，未必杀虫，而脏
腑先伤。用五灵至圣散∶白薇、五灵脂各三钱，细辛、骨碎补各五分，研细末，先
以滚水漱牙至净后，以药末五分，滚水调如稀糊，漱牙半日，至气急吐出，如是者
三，疼止虫死矣。断不再发。（盖齿因虫痛，灵脂、白薇杀虫于无形，细辛散火，碎补透骨，引药入骨，
则无可藏虫，虫尽则痛自止。）
又曰∶牙疼日久，牙床腐烂，饮食不能用，日夜呼号，此胃火独盛上升于牙也。
身中之火，惟胃最烈，火在何处，即于所在之处受病。火原易升而难降也，火升于
齿牙，齿牙非藏火之地，于是焚烧两颊，牙床红肿，久则腐烂矣。似可用治牙仙丹加
石膏治之。然其火蕴结，可用前方以消弥于无形，今既溃烂，则前方又不可用，以
有形难于补救也。宜加减竹叶石膏汤∶竹叶三百片，石膏、青蒿各五钱，知母、半
夏各二钱，麦冬、茯苓、葛根各三钱，水煎服。四剂火退肿消，后用治牙仙丹以收功也。
又曰∶牙疼至夜而甚，呻吟不卧者，此肾火上冲也。然此乃虚火，非实火。人作
火盛治之，多不效，即作虚火治，亦时有不效者，何故？盖火盛当作有余，火衰当
作不足，乃下是虚寒，上现假热也。人肾中不寒则龙雷之火下安，肾宫惟下寒甚，而
水又无多，则肾火无可藏，于是上冲咽喉，而牙受之；齿乃骨之余，同气相招，留恋
不去，夜分尤肾主事，水不能养火，火自游于外，乃至齿作祟矣。急大补肾水，益
以补火之味，引火归源，火自得水养，不上越矣。八味地黄汤加骨碎补，服一剂痛
止，二剂不发也。（六味补水，附、桂引火归于命门，何又加骨碎补？不知补水引火之味，必先入齿
则痛根始除，用之以透于齿骨之中，而后直入命门。此拔本塞源妙法也。）
又曰∶牙疼难忍，闭口稍轻，开口更重，人以为阳明胃火也，谁知乃风闭于阳
明太阳乎！此得之饮酒后，开口向风而卧，风入牙中不出，初小疼而后大痛也。论理
去风自愈，而风药必耗元气，因虚入风，又
耗其气，其气益虚，风邪欺正气之怯，而不肯出，疼难止也。古人用灸法甚神，灸
肩尖近骨后缝中，小举臂取之，当骨解陷中，灸五壮即瘥。但灸后必大痛，良久乃
定，永不发也。有畏灸者，可用散风汤∶生地、麦冬各五钱，当归三钱，石膏、花粉
各二钱，胡桐泪、干葛、细辛各一钱，白芷、升麻各三分，水煎服，二剂愈矣。此
方补重于散，正风得补而易散也。
又曰∶牙痛甚，吸凉水暂止，开口复作，人以为阳明火盛也，谁知湿热壅于上
下之齿不散乎！夫湿在下易散，在上难怯，盖治湿不外利小便也。水湿下行，其势顺，
上行其势逆，且湿从下受，易于行上，感难于散，故湿热感于牙间，散之尤难。以
饮食之水，皆必齿牙经过，不亦重甚湿乎！湿重不散，火且更重矣，所以经年月不止
也。治法必上祛其湿热，又不可单利小便也，佐以风药，则湿得风而燥，热得风而
凉，湿热解，牙疼自愈矣。
《医论选要》曰∶外板则为牙，内床则为齿。
汪省之曰∶虫牙，乃胃经风湿所致。薰法甚捷。（《理例》）
经曰∶男子八岁肾气实而齿更，三八真牙生，五八则齿槁，八八而齿去矣。女
子亦然，以七为数，盖肾主骨，齿者骨之标，髓之所养也。凡齿属肾，上下龈属阳
明，上龈痛，喜寒饮而恶热饮，取足阳明胃；下龈痛，喜热饮而恶寒饮，取手阳明
大肠，故病有恶寒恶热之不同也。凡动摇疼痛出血或不出血，齿缝疏豁，全具欲落
之状者，皆属肾也。经曰∶肾热者色黑而齿槁。又曰∶少阴经病者，面黑齿长而垢。
其虫疳，龈肿不动而溃烂痛秽者，皆属阳明。或诸经错杂之邪与外因为患，俱分虚
实而治。肾经虚寒者，安肾丸、还少丹，重则八味丸。其冬月大寒，犯脑连头痛，齿
牙动摇疼痛者，此太阳并少阴伤寒也。仲景用麻黄附子细辛汤。凡肾虚者，多有之。
如齿痛摇动，肢体倦怠，饮食少思者，脾肾亏损之证，安肾丸、补中益气并服。如
喜寒恶热者，胃血伤也，清胃汤。恶寒喜热者，胃气伤也，补中益气汤。
又曰∶齿者，骨之余，肾之标，寄于龈，养于气血。上龈属足阳明胃，下龈属
手阳明大肠。然齿者骨也，本乎干元以资始；龈者，肉也，本乎坤元以资生，譬之
木生于土，籍土以为养也。故齿之为病，手阳明、足阳明、足少阴三经之所致。盖上
下龈属阳明金也，齿属少阴木也，故阳明实，则荣荫其齿而坚牢，阳明虚，则齿失
所养而浮豁。故凡动摇脱落，牙脆剥下，齿缝渐稀，畏冷畏热，浮豁不坚，隐隐而痛，
乃肾之本虚，以致标亦虚焉。至于生虫浮肿，牙宣出血，臭秽腐烂者，乃肠胃湿热
壅盛，所谓热胜则肉腐也。虚者补之，湿热者泻之，胃火壅者清之，风寒外束者散
之，外以末药擦之，甚而龈烂齿落者，犹土崩而木倒也，其治在龈，龈坚则齿自固矣。
又曰∶牙床肿痛，齿痛动摇，或黑烂脱落者，此属阳明湿热。盖齿虽属肾，而
生于牙床上下，乃属阳明大肠与胃，犹木生于土也。肠胃伤于美酒浓味，以致湿热
上攻，则牙床不清，为肿为痛，或出血，或生虫，由是齿不得而安，如地土不坚，而
树木为之摇动矣。此宜泻阳明之湿热，则牙床清宁，齿自安固。如调理不退，落齿
一二个者，多死不治。
又曰∶凡齿痛遇劳即发，及午后甚者，或口渴面黧及遗精者，皆脾肾虚热。用补
中益气及六味丸，或十全大补汤。
海藏云∶牙痛证，有因伤胃而素有湿热，故上浮于牙龈之间，遇风寒或冷冻饮料所
郁，则湿热不得外达，故作痛也。其病情有标本之分，用药有温凉之异，当以寒为
标，故外擦漱之药，宜用荜茇、细辛之类，辛温以散开郁，兼可拔散郁热也；以热为
本，故内服之药，宜用生地、丹皮、连翘、
薄荷之类，辛凉以散热清中。如此内外交攻，标本俱得，岂有不愈者乎！若骤聚大
痛者，多属龙火。如疾风暴雷，焚灼草木，最速最烈，必用从治之法，热药冷冻饮料，则
火得其源而归之矣。若投正治，妄用寒凉，益增其病。至若痛不可忍，牵引入脑，喜
寒恶热，脉洪数有力者，凉膈散倍加酒蒸大黄泻之。
《夷门广牍》曰∶齿乃血之余，耳乃肾之余，顶乃髓之余，爪乃筋之余，语乃气之余。
《笔谈》云∶沈存中苦腰重，不能行。有将佐曰∶此乃病齿数年，用苦参擦齿，其
气味入肾，伤肾所致也。后太常少卿舒昭亮，亦用苦参擦齿，岁久亦病腰痛，自后
不用之，疾皆愈。此方书所不载者。
上排中间的两颗门牙归属于心。（另一种说法是：上排两颗门牙和下排两颗门牙，归属于心包络；门牙旁边左右上下共四颗牙齿，归属于肝；再往左右上下各四颗牙齿，归属于胃；再往左右上下各四颗牙齿，归属于脾；再往左右上下各四颗牙齿，归属于肺；其余的牙齿，都归属于肾。凡是牙齿多的人地位尊贵。治病时不论牙齿多少，按上述部位划分进行治疗，大多有效。）下排中间的两颗门牙归属于肾，上排两侧的第二颗牙齿归属于胃，下排两侧的第二颗牙齿归属于脾，上排最左侧的最后面一颗牙齿归属于胆，下排最左侧的最后面一颗牙齿归属于肝，上排最右侧的最后面一颗牙齿归属于肺，下排最右侧的最后面一颗牙齿归属于大肠。又有牙龈肿胀高起且柔软的，这种病名叫牙痈（牙龈脓肿）。内部必然有脓液，应当用针刺破排出脓液即可自愈。如果出血不止，用草纸浸冷水后贴敷二三次，出血自然停止。（出自《医宗金鉴·外科正宗》）
风邪引起的牙痛，遇到风就会发作，随后出现浮肿并产生疼痛。
火邪引起的牙痛，齿根必定牵连腮帮和颧骨，阵发性疼痛，时发时止。
湿热引起的牙痛，属于足阳明胃经病变。患者表现为腮帮和颧骨浮肿，严重时牵引至太阳穴，疼痛连及脸颊和颈部，口中感觉热气，大便干结燥硬。
虫蛀引起的牙痛，因为喜欢食用甘甜香腻的食物，湿热化生虫体，攻冲导致频繁疼痛。
龋齿，是由于风热相搏结，加上愤怒、劳累过度，导致牙根肿痛。这是手阳明大肠经和足太阳膀胱经的经脉联系于牙齿，所以称为龋齿。（出自《疡医锦囊》）
又说：如果牙痛剧烈难以忍受，疼痛牵引入脑，喜冷恶热，脉象洪大数而有力者，使用凉膈散加倍酒蒸大黄来泻下清热。
又说：如果是突然发作的剧烈疼痛，多属于“龙火”（相火妄动），像疾风暴雷一样，焚烧灼烧草木，速度最快、猛烈程度最高。必须采用“从治”的方法，将热药冷冻后服用，这样火气就能找到源头而回归本位。
窦汉卿说：牙边生出如豆子大小的痈肿，这是脾胃二经的火邪所致。适宜用小刀点破它，涂抹冰片散，再服用清胃汤、甘桔汤，没有不痊愈的。
王海藏说：牙齿等发生龋坏，气味臭秽不可靠近，多年不愈，应当按照阳明蓄血证来治疗。喜好饮酒的人，多有这种病症。使用桃仁承气汤研末，蜂蜜为丸服用，效果很好。
又说：牙齿得到清凉刺激则疼痛加剧的，属于寒证；口吸凉风则疼痛停止的，属于热证。
冯鲁瞻说：牙齿变黑碎裂的名字叫崩砂。时间久了污秽严重，牙根全部脱落，名字叫腐龈。如果是跌打损伤造成的，或者急疳导致的，那么牙齿长久脱落后很难再生。（出自《疡医锦囊》）
陈远公说：牙齿疼痛剧烈难以忍受，每次疼得呼号，眼泪鼻涕一起流出的，这是脏腑火旺，向上熏蒸齿牙导致疼痛。如果不泻火，怎么能取得迅速的效果！然而火有虚实之分，实火起源于腑，虚火发动于脏。而在实火之中，有胃火、心包火。在虚火之中，有肝、脾、肺、肾诸经之火，应当分经络来辨别它们。我有统管治疗的方法，使用治牙仙丹：玄参、生地各一两，水煎服。如果发现是心包火，加黄连五分；脾火加白术一钱；肺火加黄芩一钱；肝火加丹皮一钱；肾火加熟地一两。两剂火气消散，四剂完全痊愈。（《石室秘录》按语：火有虚实，为什么一个方子都能治疗？不知道火的有余，无非是水的不足，我滋养其阴，那么阴阳之火就没有不相安的了。况且玄参尤其能泻除浮游之火，生地能止住无根之焰，又是泻中有补，所以虚实都适宜。这是治疗的巧妙之处，抓住了关键。又能辨别各经之火，加入各经对应的药物，哪有不能取得神效的呢？）
又说：贪吃肥甘厚味，导致牙齿破损作痛，像虫子爬行一样的感觉，这是虫积。牙齿是骨头，怎么会有虫呢？不知道过食肥甘，热气就在胃中，胃火上冲口腔牙齿，湿气乘虚而入，湿气与热气相搏结而不散，就在牙齿里生虫了。起初只生一两条虫，久了就繁衍增多，于是侵蚀损坏牙齿，最终导致脱落。一颗牙齿既已朽坏，又侵蚀其他牙齿，往往有人终身受苦。这个病症必须外用治疗，如果用内服治疗，未必能杀虫，反而先损伤脏腑。使用五灵至圣散：白薇、五灵脂各三钱，细辛、骨碎补各五分，研成细末。先用滚开水漱口直到干净，然后用药末五分，滚开水调成稀糊状，含漱牙齿半天，直到感到气急吐出，像这样进行三次，疼痛停止，虫子也死了。断不会再复发。（大概是因为牙齿因虫而痛，五灵脂和白薇在无形中杀虫，细辛散火，骨碎补透入骨骼，引导药力进入骨中，那么虫子无处藏身，虫子尽除则疼痛自止。）
又说：牙疼日久，牙床腐烂，饮食无法进食，日夜呼号，这是胃火独盛上升于牙齿。人体中的火，以胃火最为猛烈，火在哪里，哪里就受病。火原本容易上升而难以下降，火升于齿牙，齿牙不是藏火的地方，于是焚烧两颊，牙床红肿，久了就会腐烂。似乎可以用治牙仙丹加石膏来治疗。但是火气蕴结，可以用前面的方子在无形之中消除，现在既然已经溃烂，那么前面的方子又不可用了，因为有形的溃烂难以补救。适宜用加减竹叶石膏汤：竹叶三百片，石膏、青蒿各五钱，知母、半夏各二钱，麦冬、茯苓、葛根各三钱，水煎服。四剂后火退肿消，之后用治牙仙丹来收功。
又说：牙疼到了晚上加重，呻吟不能躺卧的，这是肾火上冲。然而这是虚火，不是实火。人们当作火盛（实火）来治疗，大多无效，即使当作虚火治疗，有时也无效，为什么呢？盖火盛当作有余，火衰当作不足，这是下部虚寒，上部出现假热。人的肾中如果不寒，那么龙雷之火（相火）在下安守，肾宫只有下部非常寒冷，而肾水又不多，那么肾火无处藏身，于是上冲咽喉，牙齿受到波及；牙齿是骨的余气，同气相求，留恋不去，半夜时分尤其是肾主事的时候，水不能养火，火自然游走于外，以至于在牙齿作祟。急需大补肾水，辅以补火的味道，引火归源，火得到水的滋养，就不会上越了。八味地黄汤加骨碎补，服用一剂疼痛停止，二剂不再发作。（六味地黄丸补水，附子、肉桂引火归于命门，为什么还要加骨碎补？不知道补水引火的药物，必须先进入牙齿，疼痛的根源才能除去，用它来透达齿骨之中，然后才直入命门。这是拔除根本、堵塞源头的妙法。）
又说：牙疼难以忍受，闭口稍轻，开口更重，人们以为是阳明胃火，谁知道乃是风邪闭塞于阳明、太阳经呢！这是由于饮酒后，张着嘴对着风睡觉，风邪进入牙齿中出不来，起初轻微疼痛后来剧烈疼痛。按理说祛风就能自愈，但风药必然耗损元气，因为虚而入风，又耗损其气，其气更加虚弱，风邪欺负正气怯弱，而不肯退出，疼痛难以停止。古人使用灸法非常神奇，灸肩尖近骨后的缝隙中，小举手臂取穴，正当骨缝凹陷处，灸五壮即可痊愈。但灸后必然剧烈疼痛，很久才安定，永不复发。有畏惧灸法的人，可以使用散风汤：生地、麦冬各五钱，当归三钱，石膏、花粉各二钱，胡桐泪、干葛、细辛各一钱，白芷、升麻各三分，水煎服，两剂痊愈。此方补益重于疏散，正气得到补益就容易驱散风邪。
又说：牙痛剧烈，吸凉水暂时停止，张嘴又发作，人们以为是阳明火盛，谁知道是湿热壅滞于上下牙齿不散呢！湿在下部容易消散，在上部难除，大概治疗湿不外乎利小便。水湿下行，其势顺，上行其势逆，而且湿从下部受邪，易于行于上部，感受容易但消散困难，所以湿热感于牙间，消散尤其难。因为饮食的水，都必须经过牙齿，这不更加重了湿气吗！湿重不散，火气就更重了，所以经过年月不止。治疗方法必须上部祛除湿热，又不能单纯利小便，佐以风药，那么湿得风而燥，热得风而凉，湿热解除，牙疼自然痊愈。
《医论选要》说：外面的板状物叫做牙，里面的床状物叫做齿。
汪省之说：虫牙，是胃经风湿所致。熏蒸疗法非常快捷。（出自《理例》）
经典记载：男子八岁肾气充实而换牙，三八二十四岁时真牙（智齿）生长，五八四十岁时牙齿开始枯槁，八八六十四岁时牙齿脱落。女子也是如此，以七为数计算，大概因为肾主骨，牙齿是骨的标志，由髓滋养。凡是牙齿归属于肾，上下牙龈归属于阳明经，上牙龈痛，喜欢冷饮厌恶热饮，取足阳明胃经治疗；下牙龈痛，喜欢热饮厌恶冷饮，取手阳明大肠经治疗，所以疾病有厌恶寒冷和厌恶热的不同。凡是牙齿动摇疼痛出血或不出血，牙缝疏阔，完全呈现将要脱落状态的，都归属于肾。经典说：肾热的人面色黑而牙齿枯槁。又说：少阴经生病的人，面色黑而牙齿显得长且有垢。那些虫疳，牙龈肿胀但不松动却溃烂疼痛臭秽的，都归属于阳明经。或者是各经错杂的邪气与外因致病，都要分辨虚实来治疗。肾经虚寒的，用安肾丸、还少丹，重的用八味丸。如果在冬季大寒时，寒气犯脑连带头痛，牙齿动摇疼痛的，这是太阳经和少阴经伤寒。张仲景用麻黄附子细辛汤。凡是肾虚的人，多有这种情况。如果牙齿疼痛动摇，肢体倦怠，饮食减少思虑的，是脾肾亏损的证候，安肾丸、补中益气汤并服。如果喜欢寒冷厌恶热的，是胃血受伤，用清胃汤。厌恶寒冷喜欢热的，是胃气受伤，用补中益气汤。
又说：牙齿，是骨的余气，肾的标志，寄居在牙龈，由气血滋养。上牙龈归属于足阳明胃经，下牙龈归属于手阳明大肠经。然而牙齿是骨头，本乎乾元以资始；牙龈是肉，本乎坤元以资生，就像树木生长在土壤中，依靠土壤来滋养。所以牙齿的疾病，是由手阳明、足阳明、足少阴三经引起的。盖上下的牙龈属于阳明金，牙齿属于少阴木，所以阳明实，则荣养荫护牙齿而坚牢，阳明虚，则牙齿失去滋养而浮松豁落。所以凡是动摇脱落，牙齿脆剥落下，牙缝逐渐稀疏，畏冷畏热，浮松不坚固，隐隐作痛的，乃是肾的本虚，导致标也虚。至于生虫浮肿，牙宣出血，臭秽腐烂的，乃是肠胃湿热壅盛，所谓热胜则肉腐。虚的用补法，湿热的用泻法，胃火壅盛的用清法，风寒外束的用散法，外用粉末擦牙，严重的牙龈腐烂牙齿脱落的，就像土崩树倒一样，治疗重点在牙龈，牙龈坚固则牙齿自然稳固。
又说：牙床肿痛，牙齿疼痛动摇，或者黑烂脱落的，这属于阳明湿热。虽然牙齿归属于肾，但生于上下牙床，乃归属于阳明大肠与胃，就像树木生长在土壤中。肠胃被美酒浓味所伤，导致湿热上攻，那么牙床不清净，成为肿胀疼痛，或者出血，或者生虫，由此牙齿不得安宁，就像土地不坚固，而树木为之摇动一样。这适宜泻除阳明的湿热，那么牙床清宁，牙齿自然安固。如果调理后不退，掉落一两个牙齿的，大多死亡无法治愈。
又说：凡是牙齿疼痛遇到劳累就发作，以及午后加重的，或者口渴面色黧黑及遗精的，都是脾肾虚热。用补中益气汤及六味地黄丸，或者十全大补汤。
海藏说：牙痛证，有的因为伤胃而素有湿热，所以上浮于牙龈之间，遇到风寒或冷冻饮料所郁遏，那么湿热不得外达，所以作痛。其病情有标本之分，用药有温凉之异，应当以寒为标，所以外擦漱之药，适宜用荜茇、细辛之类，辛温以散开郁结，兼可拔散郁热；以热为本，所以内服之药，适宜用地黄、丹皮、连翘、薄荷之类，辛凉以散热清中。如此内外交攻，标本俱得，哪有不好的呢！如果骤然聚集成剧烈疼痛的，多属于龙火。像疾风暴雷，焚烧灼烧草木，速度最快、猛烈程度最高，必须采用从治的方法，热药冷冻后服用，那么火气就能找到源头而回归本位。如果投用正治，妄用寒凉，只会增加病情。至于疼痛难以忍受，牵引入脑，喜冷恶热，脉象洪大数而有力者，用凉膈散加倍酒蒸大黄来泻下。
《夷门广牍》说：牙齿是血的余气，耳朵是肾的余气，头顶是髓的余气，指甲是筋的余气，言语是气的余气。
《笔谈》说：沈存中苦于腰重，不能行走。有位将领说：这是因为患牙病数年，用苦参擦牙，其气味入肾，损伤肾脏所致。后来太常少卿舒昭亮，也用苦参擦牙，年久也得了腰痛，从此不再使用，疾病都痊愈了。这是方书所没有记载的。
The four upper central incisors belong to the Heart. (Another theory states: The two upper and two lower central incisors belong to the Pericardium; the four teeth on the left and right, upper and lower adjacent to the incisors, belong to the Liver; the next four teeth on the left and right, upper and lower, belong to the Stomach; the next four belong to the Spleen; the next four belong to the Lung; the remaining teeth all belong to the Kidney. Generally, having more teeth is considered auspicious. In treatment, regardless of the number of teeth, dividing them according to the aforementioned locations for therapy yields good results.) The four lower central incisors belong to the Kidney; the two upper lateral incisors belong to the Stomach; the two lower lateral incisors belong to the Spleen; the uppermost left molar belongs to the Gallbladder; the lowermost left molar belongs to the Liver; the uppermost right molar belongs to the Lung; the lowermost right molar belongs to the Large Intestine. There is also a condition where the gums are swollen, elevated, and soft, named Ya Yong (Dental Abscess). Pus must be present internally; it should be pricked with a needle to drain the pus, after which it will heal spontaneously. If bleeding does not stop, apply grass paper soaked in cold water two or three times, and the bleeding will cease naturally. (From *Zhengzong*)
Wind-induced toothache occurs upon exposure to wind, followed by swelling and pain.
Fire-induced toothache involves the tooth roots pulling into the cheeks and zygomatic area, with paroxysmal pain that comes and goes.
Damp-heat induced toothache belongs to the Foot-Yangming Stomach Meridian. Symptoms include swelling of the cheeks and zygomatic area, extending to the temporal region in severe cases, pain radiating to the jaw and neck, a sensation of heat in the mouth, and dry, constipated stools.
Cavity-induced toothache results from a preference for sweet and aromatic foods, where damp-heat transforms into worms, causing frequent painful attacks.
Tooth decay (Qu Chi) is caused by the struggle between wind and heat, combined with anger and overexertion, leading to swelling and pain at the tooth roots. This relates to the Hand-Yangming and Foot-Taiyang meridians connecting to the teeth, hence the name Tooth Decay. (From *Jinnang*)
Furthermore: If toothache is unbearable, radiating to the brain, with a preference for cold and aversion to heat, and a surging, rapid, and forceful pulse, use Liang Ge San (Cooling the Diaphragm Powder) with doubled Jiuzheng Dahuang (Wine-processed Rhubarb) to purge heat.
Furthermore: Sudden, severe pain often belongs to Long Huo (Dragon Fire/Ministerial Fire), resembling violent storms and thunder, burning wood and grass with utmost speed and intensity. One must employ Cong Zhi (Following Treatment) methods: administering hot medicine frozen and drunk cold, so that the fire finds its source and returns.
Dou Hanqing said: A bean-sized abscess growing on the gum edge indicates Fire in the Stomach and Spleen meridians. It should be punctured with a small knife, applied with Bingpian San (Borneol Powder), and followed by Qingwei Tang (Clear the Stomach Decoction) and Ganjie Tang (Licorice and Platycodon Decoction), ensuring recovery.
Wang Haicang said: Dental caries with foul odor persisting for years should be treated as Yangming Blood Accumulation. Those who enjoy alcohol often suffer from this condition. Tao Ren Cheng Qi Tang (Peach Kernel Draining the Epigastrium Powder) powdered and formed into honey pills is very effective.
Furthermore: Toothache exacerbated by cooling is Cold; toothache relieved by inhaling cool air is Heat.
Feng Luzhan said: Blackened, fragmented teeth are called Beng Sha (Falling Sand). Over time, with severe filth and root loss, it is called Fu Yin (Rotting Gums). If caused by trauma or acute cancrum oris, long-term loss makes regrowth difficult. (From *Jinnang*)
Chen Yuangong said: Severe, unbearable toothache causing wailing, tears, and snot indicates excessive Fire in the Zang-Fu organs rising to the teeth. Without purging Fire, how can quick effect be achieved? However, Fire has Deficiency and Excess types. Excess Fire originates in the Fu organs, while Deficiency Fire arises from the Zang organs. Among Excess Fire, there is Stomach Fire and Pericardium Fire. Among Deficiency Fire, there is Fire from the Liver, Spleen, Lung, and Kidney meridians, which must be distinguished by meridian. I have a universal method using Zhiya Xiandan (Tooth-Curing Immortal Elixir): Xuanshen (Scrophulariae Radix) and Shengdi (Rehmanniae Radix) each one tael, decocted in water. If Pericardium Fire is identified, add Huanglian (Coptidis Rhizoma) 5 fen; Spleen Fire, add Baizhu (Atractylodis Macrocephalae Rhizoma) 1 qian; Lung Fire, add Huangqin (Scutellariae Radix) 1 qian; Liver Fire, add Danpi (Moutan Cortex) 1 qian; Kidney Fire, add Shudi (Prepared Rehmanniae Radix) one tael. After two doses, Fire dissipates; after four doses, full recovery. (*Shishi Milu* Note: How can one formula treat both Deficiency and Excess Fire? The excess of Fire is essentially the insufficiency of Water. By nourishing Yin, Yin and Yang Fire are harmonized. Moreover, Xuanshen clears floating Fire, and Shengdi extinguishes rootless flames; thus, purging contains tonification, making it suitable for both. This is a skillful approach grasping the essence. By adding specific herbs for each meridian's Fire, efficacy is assured.)
Furthermore: Greed for rich and sweet foods causes tooth damage and pain, feeling like crawling insects, indicating Worm Accumulation. Teeth are bone; how can they harbor worms? Overconsumption of rich foods creates Heat in the Stomach, which rushes upward to the oral cavity and teeth. Dampness exploits this, combining with Heat without dispersing, thereby generating worms in the teeth. Initially few, they multiply over time, eroding teeth until they fall out. Once one tooth rots, it infects others, causing lifelong suffering. This condition requires external treatment; internal medication may fail to kill worms while damaging the Zang-Fu. Use Wuling Zhisheng San (Five-Spirit Supreme Holy Powder): Baiwei (Cynanchi Atrati Radix) and Wulingzhi (Trogopterori Faeces) each 3 qian, Xixin (Asari Radix et Rhizoma) and Gusui Bu (Drynariae Rhizoma) each 5 fen, ground to fine powder. Rinse teeth thoroughly with boiling water first, then mix 5 fen of powder with boiling water to a thin paste, swish in the mouth for half a day until breathlessness forces spitting. Repeat three times; pain stops, worms die, and recurrence is prevented. (Likely because Wulingzhi and Baiwei kill worms invisibly, Xixin disperses Fire, and Gusui Bu penetrates bone to guide medicine into the bone structure, leaving no hiding place for worms; once worms are gone, pain ceases.)
Furthermore: Chronic toothache with rotting gums, inability to eat, and day-and-night wailing indicates solitary Stomach Fire rising to the teeth. Stomach Fire is the most fierce in the body; where the Fire is, there lies the disease. Fire rises easily but descends with difficulty. Rising to the teeth, which are not meant to store Fire, it burns the cheeks, causing redness and swelling of the gums, eventually leading to rot. One might consider Zhiya Xiandan plus Shigao (Gypsum Fibrosum). However, if Fire is entrenched, the previous formula works invisibly; now that ulceration exists, it is unsuitable as有形 (formidable) damage is hard to repair. Use Jiajian Zhuye Shigao Tang (Modified Bamboo Leaf and Gypsum Decoction): Zhuye (Bamboo Leaves) 300 pieces, Shigao and Qinghao (Artemisiae Annuae Herba) each 5 qian, Zhimu (Anemarrhenae Rhizoma) and Banxia (Pinelliae Tuber) each 2 qian, Maidong (Ophiopogonis Tuber) and Fuling (Poria) each 3 qian, Gegen (Puerariae Lobatae Radix) 3 qian, decocted in water. After four doses, Fire retreats and swelling subsides; subsequently, use Zhiya Xiandan to conclude treatment.
Furthermore: Toothache worsening at night, preventing sleep due to groaning, indicates Kidney Fire rushing upward. This is Deficiency Fire, not Excess Fire. Treating it as Excess Fire often fails; even treating it as Deficiency Fire sometimes fails. Why? Excess implies surplus, Deficiency implies lack. Here, the lower part is Deficient-Cold, presenting false Heat above. If the Kidney is not cold, Dragon-Lei Fire (Ministerial Fire) remains settled below. Only when the lower Kidney palace is severely cold and Kidney Water is insufficient does Kidney Fire have no place to reside, rushing up to the throat and affecting the teeth. Teeth are the remainder of bone, attracting similar energies, lingering especially at night when the Kidney governs. Water cannot nourish Fire, so Fire wanders externally, tormenting the teeth. Urgently tonify Kidney Water significantly, aided by flavors that tonify Fire, guiding Fire back to its source. Nourished by Water, Fire will not rise. Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) plus Gusui Bu, taken for one dose stops pain, two doses prevent recurrence. (Liuwei Dihuang Wan tonifies Water; Fuzi and Guirou guide Fire to Mingmen. Why add Gusui Bu? Medicine tonifying Water and guiding Fire must first enter the teeth to remove the root of pain. Using it to penetrate the dental bone allows direct entry to Mingmen. This is a brilliant method of removing the root and blocking the source.)
Furthermore: Unbearable toothache, slightly lighter when closing the mouth, heavier when opening, is often mistaken for Yangming Stomach Fire, but is actually Wind obstructing the Yangming and Taiyang meridians! This occurs after drinking alcohol, sleeping with an open mouth facing the wind, trapping Wind inside the teeth. Initial mild pain escalates. Theoretically, dispelling Wind cures it, but Wind-dispersing drugs consume Yuan Qi. Due to deficiency, Wind enters and consumes Qi further, weakening Zheng Qi. Wind exploits the weakness of Zheng Qi and refuses to exit, making pain persistent. Ancient moxibustion was miraculous: Moxa at the seam near the shoulder tip, arm slightly raised, at the bony depression, five moxa cones cure it. Severe pain follows moxibustion but settles permanently. For those fearing moxibustion, use Sanfeng Tang (Dispel Wind Decoction): Shengdi and Maidong each 5 qian, Danggui (Angelicae Sinensis Radix) 3 qian, Shigao and Huafen (Trichosanthis Radix) each 2 qian, Hutong Lei (Tectona Grandis Resin), Genge (Puerariae Radix), and Xixin each 1 qian, Baizhu (Angelicae Dahuricae Radix) and Shengma (Cimicifugae Rhizoma) each 3 fen, decocted in water. Two doses cure. This formula emphasizes tonification over dispersion; strengthened Zheng Qi easily disperses Wind.
Furthermore: Severe toothache temporarily relieved by sucking cold water but returning upon opening the mouth is often mistaken for Yangming Fire, but is actually Damp-Heat stagnating in the upper and lower teeth. Dampness below is easy to disperse; above is difficult. Treating Dampness usually involves promoting urination. Downward flow is smooth; upward is contrary. Dampness enters from below but moves up, making infection easy but dispersion hard. Damp-Heat in the teeth is hard to clear because all ingested liquids pass through the teeth, aggravating Dampness. Undispersed Dampness exacerbates Fire, causing chronic persistence. Treatment must clear Damp-Heat above without solely relying on diuretics. Adjuvant Wind drugs dry Dampness and cool Heat via Wind action. Once Damp-Heat resolves, toothache heals.
*Yilun Xuanyao* states: The outer plate is the "Ya" (tooth crown), the inner bed is the "Chi" (tooth root/gum bed).
Wang Shengzhi said: Cavity teeth are caused by Wind-Damp in the Stomach meridian. Fumigation is very swift. (From *Lili*)
The Classics state: At age eight, men's Kidney Qi becomes substantial, replacing teeth; at twenty-four, wisdom teeth grow; at forty, teeth wither; at sixty-four, teeth fall out. Women follow a seven-year cycle. The Kidney governs bone; teeth are the manifestation of bone, nourished by Marrow. Generally, teeth belong to the Kidney; upper and lower gums belong to the Yangming meridians. Upper gum pain, preferring cold drinks and avoiding hot ones, treats the Foot-Yangming Stomach; lower gum pain, preferring hot drinks and avoiding cold ones, treats the Hand-Yangming Large Intestine. Thus, diseases differ in aversion to cold or heat. Any loosening, pain, bleeding or non-bleeding, wide interdental spaces, and impending loss belong to the Kidney. The Classics say: Kidney Heat manifests as black complexion and withered teeth. Also: Shaoyin disease presents as black face and elongated, dirty teeth. Cancri dentium with swollen, non-loose but ulcerated, painful, and foul gums belongs to Yangming. Mixed pathogenic factors from various meridians and external causes must be treated by distinguishing Deficiency and Excess. Kidney Deficiency-Cold uses Anshen Wan (Kidney-Anchoring Pill) or Huan Shao Dan (Return to Youth Elixir); severe cases use Bawei Wan. Winter severe cold invading the brain with headache and loose, painful teeth indicates Taiyang and Shaoyin Cold Damage. Zhang Zhongjing used Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asari Decoction). Common in Kidney Deficiency. Loose, painful teeth with limb fatigue and poor appetite indicate Spleen-Kidney depletion; combine Anshen Wan and Buzhong Yiqi Tang. Preference for cold and aversion to heat indicates Stomach Blood injury; use Qingwei Tang. Aversion to cold and preference for heat indicates Stomach Qi injury; use Buzhong Yiqi Tang.
Furthermore: Teeth are the remainder of bone, the mark of the Kidney, lodged in the gums, nourished by Qi and Blood. Upper gums belong to Foot-Yangming Stomach; lower gums to Hand-Yangming Large Intestine. Teeth are bone, originating from Qianyuan (Heavenly Origin); gums are flesh, originating from Kunyuan (Earthly Origin), like trees growing in soil, relying on it for nourishment. Thus, dental diseases arise from Hand-Yangming, Foot-Yangming, and Foot-Shaoyin meridians. Upper and lower gums belong to Yangming Metal; teeth belong to Shaoyin Wood. When Yangming is Excess, it nourishes and stabilizes teeth; when Deficient, teeth lose nourishment and become loose. Loosening, shedding, brittleness, widening gaps, aversion to cold/heat, and dull pain indicate fundamental Kidney Deficiency leading to superficial Deficiency. Worms, swelling, bleeding, foul odor, and rot indicate excessive Damp-Heat in the intestines and stomach ("Excess Heat causes flesh to rot"). Tonify Deficiency, purge Damp-Heat, clear Stomach Fire, scatter Wind-Cold. External powder application helps. Severe gum rot and tooth loss resemble collapsing earth and falling trees; treatment focuses on gums, for firm gums ensure stable teeth.
Furthermore: Swollen/painful gums, loose/painful teeth, or black/rotten/shedding teeth belong to Yangming Damp-Heat. Although teeth belong to the Kidney, they grow in the gum beds governed by Yangming Large Intestine and Stomach, like trees in soil. Damaged by rich food and alcohol, Damp-Heat attacks upward, clouding the gums, causing swelling, pain, bleeding, or worms, unsettling the teeth like unstable soil shaking trees. Purge Yangming Damp-Heat to calm the gums and stabilize teeth. If management fails and teeth fall out, prognosis is poor.
Furthermore: Toothache triggered by exertion or worsening in the afternoon, accompanied by thirst, dark complexion, or spermatorrhea, indicates Spleen-Kidney Deficiency-Heat. Use Buzhong Yiqi Tang, Liuwei Wan, or Shiquan Dabu Tang.
Haicang stated: Toothache due to Stomach injury with pre-existing Damp-Heat floating to the gums, constrained by Wind-Cold or cold drinks, prevents Damp-Heat from dispersing externally, causing pain. Pathology has Root/Branch aspects; medication varies by Warm/Cool. Treat Cold as Branch: external washes with Biba (Piperis Longi Fructus) and Xixin disperse constraint and vent trapped Heat. Treat Heat as Root: internal meds with Shengdi, Danpi, Lianqiao (forsythiae Fruit), and Bohe (Menthae Haplocalycis Herba) clear Heat with Pungent-Cool properties. Internal and external attack together ensures cure. Sudden severe pain is often Dragon Fire; use Cong Zhi (hot medicine cold drink). Direct Cold treatment worsens it. Unbearable pain radiating to the brain, preferring cold, surging pulse: use Liang Ge San with doubled wine-processed Rhubarb.
*Yimen Guangdu* states: Teeth are the remainder of Blood; ears are the remainder of Kidney; crown is the remainder of Marrow; nails are the remainder of Tendons; speech is the remainder of Qi.
*Bitan* records: Shen Cunzhong suffered heavy waist and immobility. A general attributed it to years of using Kushen (Sophorae Flavescentis Radix) to brush teeth, entering the Kidney and damaging it. Shu Zhaoliang later did the same and developed back pain; stopping usage cured him. This is unrecorded in medical texts.