【内伤牙衄之症】身无表邪，牙龈出血，一涌而上，来血甚多，此阳明经牙衄之症。
若身无表邪，牙龈时或出血，来血不多，久而不愈，肌肉消瘦，此少阴肾经牙衄之症也。
【内伤牙衄之因】膏粱积热，辛辣炙 ，好酒香燥，肠胃有热，血中伏火，则上冲
而出，若肾阴不足，水中之火上炎，亦令牙龈出血，久而不愈。
【内伤牙衄之脉】脉多洪数；右关洪数，阳明经热；两尺洪数，肾经之血。
【内伤牙衄之治】右关沉数，阳明血热者，犀角地黄汤，加酒浸黄芩。右关洪数，肠
胃积热者，升麻清胃散，加酒蒸大黄。左尺脉数，龙火上冲者，知柏肝肾丸，加玄武胶。
犀角地黄汤 见吐血。
升麻清胃散
升麻 生地 川连 丹皮 山栀 当归 大黄（酒蒸）
知柏肝肾丸
凡治血症，要明血去火亦去，可用血脱益气；若血去火存，但可补血凉血，切不可用温
燥。至牙衄阳明经血热，用升麻清胃汤、酒大黄、生犀角，则血立止；即肾阴不足，亦是阴
虚火旺，用知柏肝肾丸，苟大便不滑，亦加大黄、生犀，要知血得热而妄行，以当归三黄同
煎，则血凉尽而下顺归经，世人不明，妄言当归辛散，不宜治血逆上冲及胎前安胎，岂知血
热上冲，凉血则下顺归经，胎前血热、胎气不宁，仲景立安胎饮，用当归、黄芩各一斤，以
血中热减，则归经养胎而自安。家秘化四物三黄同用，治血热上冲，开化方妙法。
【内伤牙衄的症状】身体没有表邪（外感病初期邪气在表的证候），牙龈出血，血液涌出迅速，出血量很大，这是阳明经牙衄的症状。
如果身体没有表邪，牙龈偶尔出血，出血量不多，病程迁延不愈，肌肉消瘦，这是少阴肾经牙衄的症状。
【内伤牙衄的病因】长期食用肥甘厚味积聚成热，嗜好辛辣烤炙食物，喜欢饮酒及香燥之品，导致肠胃有热，血中潜伏火热之邪，于是向上冲逆而出；若是肾阴不足，水中的虚火上炎，也会导致牙龈出血，且久治不愈。
【内伤牙衄的脉象】脉象多表现为洪数（脉形宽大如波涛汹涌，来盛去衰，且脉搏跳动快速）；右关部（对应脾胃）脉象洪数，提示阳明经有热；两尺部（对应肾）脉象洪数，提示肾经血分有热。
【内伤牙衄的治疗】若右关部脉象沉数，属于阳明血热者，使用犀角地黄汤，加入酒浸过的黄芩。若右关部脉象洪数，属于肠胃积热者，使用升麻清胃散，加入酒蒸的大黄。若左尺部脉象数，属于龙火（相火）上冲者，使用知柏肝肾丸，加入玄武胶（龟板胶）。
犀角地黄汤 参见吐血篇。
升麻清胃散
组成：升麻、生地、川连（黄连）、丹皮（牡丹皮）、山栀（栀子）、当归、大黄（酒蒸）
知柏肝肾丸
凡治疗血症，必须明白血液流失后火邪也会随之而去，此时可以使用“血脱益气”法（通过补气来生血或固摄血液）；若血液流失但火邪尚存，则只可补血凉血，切不可使用温燥药物。至于牙衄属于阳明经血热的，使用升麻清胃汤、酒大黄、生犀角，则血液立即停止；即使是肾阴不足，也是阴虚火旺，使用知柏肝肾丸，倘若大便不稀溏，也可以加大黄、生犀角。要知道血液遇到热邪就会妄行，将当归与三黄（通常指黄连、黄芩、大黄）同煎，能使血液冷却并向下顺行回归经脉，世人不明此理，胡乱说当归辛散，不适合治疗血逆上冲及胎前安胎，哪里知道血热上冲时，凉血则血液下行归经，胎前血热导致胎气不宁，张仲景创立安胎饮，使用当归、黄芩各一斤，因为血中热势减退，则血液归经滋养胎儿而自然安宁。家传秘方将四物汤与三黄同用，治疗血热上冲，这是开化方剂的妙法。
[Symptoms of Internal Injury Gingival Bleeding] The body has no exterior pathogenic factors (pathogens located at the exterior level, typical of early-stage exogenous diseases), gingival bleeding occurs, with blood gushing out rapidly and in large volume; this is a symptom of Yangming Meridian gingival bleeding.
If the body has no exterior pathogenic factors, but gingival bleeding occurs occasionally, with small volume, persisting for a long time without healing, accompanied by emaciation, this is a symptom of Shaoyin Kidney Meridian gingival bleeding.
[Etiology of Internal Injury Gingival Bleeding] Accumulation of heat from prolonged consumption of rich and sweet foods, preference for spicy and roasted foods, indulgence in alcohol and aromatic/dry substances, leading to heat in the intestines and stomach, latent fire within the blood, which then rushes upward and causes bleeding; if Kidney Yin is insufficient, the ministerial fire rising from water also causes gingival bleeding, persisting for a long time without healing.
[Pulse Diagnosis of Internal Injury Gingival Bleeding] The pulse is mostly Hong-Shu (Surging and Rapid: wide and forceful like waves, strong on arrival and weak on departure, with rapid frequency); Hong-Shu at the Right Guan position (corresponding to Spleen and Stomach) indicates Heat in the Yangming Meridian; Hong-Shu at both Chi positions (corresponding to Kidneys) indicates Heat in the Blood aspect of the Kidney Meridian.
[Treatment of Internal Injury Gingival Bleeding] If the Right Guan pulse is Chen-Shu (Deep and Rapid), indicating Yangming Blood Heat, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Huangqin (Scutellaria Root) soaked in wine. If the Right Guan pulse is Hong-Shu, indicating accumulated Heat in the Intestines and Stomach, use Shengma Qingwei San (Cimicifuga Powder to Clear the Stomach) added with Dahuang (Rhubarb Root) steamed with wine. If the Left Chi pulse is Shu, indicating Ministerial Fire rushing upward, use Zhibai Lishen Wan (Anemarrhena, Phellodendron and Liver-Kidney Pill) added with Xuanwu Jiao (Tortoise Shell Glue).
Xijiao Dihuang Tang See section on Hematemesis.
Shengma Qingwei San
Ingredients: Shengma (Cimicifugae Rhizoma), Shengdi (Rehmanniae Radix Preparata), Chuanlian (Coptidis Rhizoma), Danpi (Moutan Cortex), Shanzhi (Gardeniae Fructus), Danggui (Angelicae Sinensis Radix), Dahuang (Rhei Radix et Rhizoma) steamed with wine.
Zhibai Lishen Wan
In treating blood disorders, one must understand that when blood is lost, fire often dissipates with it; thus, the method of "Tonifying Qi for Blood Loss" (using Qi tonification to generate or secure blood) may be applied. However, if blood is lost but fire remains, only Blood-nourishing and Blood-cooling methods should be used; warm and drying herbs must strictly be avoided. For gingival bleeding due to Yangming Meridian Blood Heat, using Shengma Qingwei Tang, wine-processed Dahuang, and raw Xijiao (Rhinoceros Horn) will stop bleeding immediately. Even in cases of Kidney Yin insufficiency, which constitutes Yin Deficiency with Fire Hyperactivity, Zhibai Lishen Wan is used; provided there is no loose stool, Dahuang and raw Xijiao can also be added. It must be known that blood acts recklessly when heated; decocting Danggui with Sanhuang (typically Huanglian, Huangqin, and Dahuang) cools the blood, allowing it to descend smoothly and return to its vessels. People who do not understand this falsely claim that Danggui’s acrid dispersing nature makes it unsuitable for treating rebellious blood flow or for calming the fetus during pregnancy. They fail to realize that cooling blood allows rebellious blood to descend and return to its vessels; for fetal restlessness due to Blood Heat during pregnancy, Zhang Zhongjing established Antai Yin (Calming Fetus Decoction), using equal parts of Danggui and Huangqin. As heat in the blood subsides, blood returns to its vessels to nourish the fetus, ensuring natural stability. A secret family formula combines Siwu Tang (Four Substances Decoction) with Sanhuang to treat rebellious blood flow due to Blood Heat, representing a brilliant method of formula transformation.