夫骨槽风之证,固有传变而成者矣,亦有非传变而成者。其人或有忧愁思虑惊恐悲伤,
以致气血凝滞;或由风寒袭入筋骨,邪毒交生。起于耳前,连及腮颊,筋骨之间,隐隐疼痛
,渐渐漫肿坚硬,寒热如疟,牙关紧急,难于进食,久则腐溃,腮之里外,仍然漫肿硬痛
。此证属在筋骨阴分,故初起肿硬难消,溃后疮口难合,肝脾受伤,热毒蕴积,是以筋骨紧
急,肌肉腐烂,而脓多臭秽。初宜用艾灸以解其毒,服降火化痰清热消肿之剂;溃后或用八
珍汤或十全大补汤,补托药中,宜加麦冬、五味。亦有过服寒凉,以致肌肉坚凝腐臭者,非
理中汤佐以附子不能回阳,非僵蚕不能搜风也。若牙关拘急不开,宜用生姜片垫灸颊车穴(
穴在耳垂下五分陷中)二七壮,兼用针刺口内牙尽处出血,其牙关自开。如外腐不脱,脓水
不清,久则必成朽骨,俟朽骨脱去,始能收口。如或穿腮落齿,虚热不退,形焦体削,痰盛
不食者,俱为逆证。设至后脾气醒复,饮食加增,亦有向愈收功者。其腐烂处,用口疳药加
牛黄、珍珠、儿茶吹之,外用升膏提之。
牙漏之患,起于心胃火郁,肾阴消涸,或心事郁遏,胃热挟其五志之火而发。有生于上
牙龈者,亦有生于下牙龈者。初则高肿作痛,久则上现黄泡,破后出脓渐安,然其口难合,
细如针孔,但遇操劳,或心绪烦扰,或煎炒烟酒过度,即再发而肿痛,时出秽脓,更有串至
左右齿根者。虽不妨命,为累亦甚。初起宜升阳散火法,或甘露饮;久则当用六味地黄汤加
元参、石斛、麦冬、芦根,或凉八味,或大补阴丸等,多服久服,自可全愈。初治切不可用
苦寒之药,内服外搽,致令心胃之火郁而又郁,反使火毒根株愈深;亦不可早用敛药,亦能
使火毒内敛,便有腐蚀脱根落齿之害。
牙宣又名齿衄,从牙缝中出血,或鲜血时从牙龈外溢。齿乃骨之余,肾之所主也。心肾
火邪逼血妄行,故齿出血;然少阴气多血少,血必点滴而出,齿亦隐隐而痛,多欲者恒犯之
。治当凉心滋肾,玉女煎或六味地黄汤,或凉八味加骨碎补、女贞子、阿胶、地骨皮等主之
。亦有胃经实火上攻,而齿龈出血者,阳明气血俱多,火旺则血如潮涌,善饮者每犯之。宜
清热凉血,犀角地黄汤主之,清胃散亦可。又有胃虚火动,腐烂牙龈,淡血常流者,宜归芍
地黄汤;仍不止,亦用犀角地黄汤,或玉女煎;吹以杀疳止血药。
风热牙疔,如寒热而起者,初则牙痛,后即龈肿,肿连腮颊,顶尖高突,按之引手,内
有脓也,刺之即瘥。治以清透散邪,牛蒡解肌汤或玉女煎,或犀角地黄汤,各宜酌量治之。
骨槽风这一病证,确实有由其他病症传变而来的,也有并非由传变而形成的。患者可能因为忧愁、思虑、惊恐或悲伤,导致气血凝滞;或者由于风寒之邪侵入筋骨,邪毒交织产生。病症起始于耳前,蔓延至腮颊,在筋骨之间隐隐作痛,逐渐出现漫肿且坚硬,伴有寒热往来如疟疾状,牙关紧急,难以进食,日久则腐烂溃破,腮部的里外依然漫肿硬痛。此证病位在筋骨阴分,所以初起时肿胀坚硬难以消散,溃破后疮口难以愈合,肝脾受损,热毒蕴积,因此筋骨拘急,肌肉腐烂,脓液多且气味臭秽。初期适宜用艾灸来解毒,服用降火、化痰、清热、消肿的药剂;溃破后可以使用八珍汤或十全大补汤,在补益托毒的药物中,宜加入麦冬、五味子。也有因过服寒凉药物,导致肌肉坚凝腐臭的情况,非理中汤配合附子不能回阳救逆,非僵蚕不能搜剔风邪。如果牙关拘急无法张开,适宜用生姜片垫着灸治颊车穴(穴位位于耳垂下五分处的凹陷中)十四壮,同时针刺口腔内牙齿尽头处使其出血,牙关自然就会张开。如果外部腐肉不脱落,脓水不清澈,日久必然形成朽骨,等到朽骨脱去之后,才能收口愈合。如果出现穿腮落齿,虚热不退,形体消瘦焦枯,痰多不能进食的情况,都属于逆证。如果后期脾气恢复,饮食增加,也有趋向痊愈而取得疗效的。对于腐烂的部位,使用治疗口疳的药物加入牛黄、珍珠、儿茶吹敷患处,外用升膏提脓祛腐。
牙漏这一疾患,起因于心胃之火郁结,肾阴枯竭,或者是心事郁结压抑,胃热挟带五志之火而发作。有的生于上牙龈,也有的生于下牙龈。初起时高肿疼痛,日久上方出现黄泡,破溃后流出脓液逐渐安宁,但是疮口难以愈合,细如针孔,只要遇到操劳,或者心绪烦扰,或者过度食用煎炒食物及烟酒,就会再次发作并肿痛,时常流出秽浊脓液,更有甚者窜连至左右齿根。虽然不危及生命,但带来的痛苦也很严重。初起适宜用升阳散火法,或者甘露饮;日久则应当使用六味地黄汤加入玄参、石斛、麦冬、芦根,或者凉八味,或者大补阴丸等,多服久服,自然可以痊愈。初期治疗切不可使用苦寒的药物,无论是内服还是外搽,都会导致心胃之火郁结更加严重,反而使火毒的根基扎得更深;也不可过早使用收敛药物,这也会使火毒内敛,从而产生腐蚀、脱根、落齿的危害。
牙宣又名齿衄,是从牙缝中出血,或者是鲜血不时从牙龈外溢。牙齿是骨骼的余气所生,由肾脏所主。心肾的火邪逼迫血液妄行,所以牙齿出血;然而少阴经气多血少,血液必定点滴而出,牙齿也隐隐作痛,房事过多的人常常患此病。治疗应当清心滋肾,使用玉女煎或六味地黄汤,或者凉八味加入骨碎补、女贞子、阿胶、地骨皮等为主方。也有因胃经实火上攻而导致齿龈出血的,阳明经气血俱多,火旺则血液如潮水般涌出,喜欢饮酒的人经常患此病。适宜清热凉血,使用犀角地黄汤为主方,清胃散也可以。又有因胃虚火动,导致牙龈腐烂,淡血常流的情况,适宜使用归芍地黄汤;如果仍不止血,也使用犀角地黄汤,或者玉女煎;并用杀疳止血药吹敷患处。
风热牙疔,如果是伴随寒热症状而起病的,起初牙齿疼痛,随后牙龈肿胀,肿胀牵连腮颊,肿势顶尖高突,按压时牵引手指疼痛,内部已有脓液,刺破即可痊愈。治疗以清透散邪为主,使用牛蒡解肌汤或玉女煎,或者犀角地黄汤,各宜酌情选用治疗。
The syndrome of Gucao Feng (Bone Trough Wind) indeed has cases that evolve through transmission, as well as those that do not. The patient may suffer from qi and blood stagnation due to worry, overthinking, fright, or sorrow; or the pathogenic factors may invade the sinews and bones due to wind-cold, with evil toxins intertwining. The condition begins in front of the ear, extending to the cheek and jaw, causing dull pain between the sinews and bones, gradually developing into diffuse swelling that is hard, accompanied by alternating chills and fever resembling malaria, stiffness of the jaw making eating difficult, and eventually leading to putrefaction and ulceration, with the inside and outside of the cheek remaining diffusely swollen, hard, and painful. This syndrome belongs to the yin aspect of the sinews and bones; therefore, in the early stage, the swelling and hardness are difficult to dissipate, and after ulceration, the wound fails to heal. The liver and spleen are injured, and heat toxins accumulate, resulting in stiffness of the sinews and bones, rotting of muscles, and profuse, foul-smelling pus. In the initial stage, moxibustion is suitable to resolve the toxin, and decoctions that descend fire, transform phlegm, clear heat, and reduce swelling should be taken. After ulceration, Bazhen Tang (Eight-Treasure Decoction) or Shiquan Dabu Tang (Ten Significant Tonifying Decoction) may be used; within these tonifying and pushing-out formulas, it is appropriate to add Maidong (Ophiopogon Rhizome) and Wuwei Zi (Schisandra Fruit). There are also cases where excessive use of cold-natured medicines leads to hardening, coagulation, and putrefaction of muscles; in such cases, Lizhong Tang (Regulate the Middle Decoction) combined with Fuzi (Prepared Aconite Root) is required to restore yang, and Jiangcan (Bombyx Batryticatus) is needed to search out wind pathogens. If the jaw is stiff and cannot open, it is suitable to apply moxibustion on Jiache ST6 (Stomach 6, located in the depression 0.5 cun below the tip of the earlobe) using slices of fresh ginger as a spacer for fourteen moxa cones, while simultaneously needling the area at the end of the teeth inside the mouth to induce bleeding, which will naturally allow the jaw to open. If external necrotic tissue does not detach and the pus water is not clear, rotten bone will inevitably form over time; only after the rotten bone detaches can the wound close. If there is perforation of the cheek, loss of teeth, unremitting deficiency heat, emaciation and withering of the body, excessive phlegm, and inability to eat, all these constitute adverse syndromes. However, if the spleen qi recovers later and food intake increases, there are cases that tend towards recovery and achieve therapeutic success. For the rotting areas, medicines for Kougan (Mouth Ulcers) mixed with Niuhuang (Calculus Bovis), Zhenzhu (Pearl), and Ercha (Camellia Camellia Seed) should be insufflated, and Shengao (Rising Paste) should be applied externally to promote pus discharge and remove necrosis.
The affliction of Yalou (Tooth Fistula) arises from the depression of heart and stomach fire, depletion of kidney yin, or emotional suppression, where stomach heat combines with the fire of the five emotions to manifest. It may occur on the upper gums or the lower gums. Initially, there is high swelling and pain; over time, yellow blisters appear on the surface. After rupture, pus drains and symptoms gradually ease, but the opening is difficult to close, being as small as a needle hole. Whenever physical exertion occurs, or mental agitation arises, or excessive consumption of fried foods, tobacco, and alcohol happens, the condition recurs with swelling and pain, discharging foul pus. In more severe cases, it extends to the roots of the teeth on both sides. Although it is not life-threatening, it causes significant suffering. In the initial stage, the method of raising yang and dispersing fire, or Ganlu Yin (Sweet Dew Drink), is suitable. In chronic stages, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) added with Xuanshen (Scrophularia Root), Shihu (Dendrobium Stem), Maidong (Ophiopogon Rhizome), and Lugen (Reed Rhizome), or Liang Bawei (Cool Eight Ingredients), or Dabu Yin Wan (Great Tonify Yin Pill), etc., should be taken for an extended period to ensure complete recovery. In the initial treatment, bitter-cold medicines must absolutely not be used, whether taken internally or applied externally, as this would cause further depression of heart and stomach fire, deepening the root of the fire toxin. Nor should astringent medicines be used early, as this can trap the fire toxin internally, leading to corrosion, detachment of roots, and tooth loss.
Yaxuan (Tooth Gland Erosion), also known as Chiniu (Tooth Hemorrhage), involves bleeding from the gum spaces, or fresh blood occasionally overflowing from the gums. Teeth are considered the surplus of bones and are governed by the kidneys. Fire pathogens of the heart and kidney force blood to flow recklessly, causing tooth bleeding; however, since the Shaoyin channel has abundant qi and little blood, the blood flows drop by drop, and the teeth ache faintly. Those with excessive sexual activity often suffer from this. Treatment should focus on cooling the heart and nourishing the kidney, using Yupu Jian (Jade Woman Decoction) or Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill), or Liang Bawei (Cool Eight Ingredients) added with Gusui Bu (Drynaria Rhizome), Nvzhen Zi (Ligustrum Fruit), Ejiao (Donkey-Hide Gelatin), and Digupi (Phellodendri Cortex), as the main formula. There are also cases of gingival bleeding caused by excess fire attacking from the stomach meridian; since the Yangming channel has abundant qi and blood, when fire is vigorous, blood surges like a tide, and heavy drinkers often suffer from this. Clearing heat and cooling blood is indicated, with Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) as the primary formula, or Qingwei San (Clear Stomach Powder) as an alternative. In cases of stomach deficiency with moving fire, leading to rotting gums and constant flow of pale blood, Guishao Dihuang Tang (Angelica and Peony Rehmannia Decoction) is suitable; if bleeding persists, Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) or Yupu Jian (Jade Woman Decoction) may be used, along with insufflation of anti-ulcer and hemostatic powders.
Fengre Yading (Wind-Heat Tooth Carbuncle), when arising with chills and fever, initially presents with tooth pain, followed by gum swelling that extends to the cheeks. The swelling peaks sharply and protrudes, and pressing it elicits pain radiating to the hand, indicating the presence of pus internally; puncturing it leads to immediate improvement. Treatment focuses on clearing and dispersing pathogenic factors, using Niubang Jieji Tang (Arctium Relieving Muscle Decoction) or Yupu Jian (Jade Woman Decoction), or Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction), selected according to the specific situation.