大意
齿者。骨之余。髓之所养。故齿属肾。上下龈属阳明。凡动摇豁脱。或大痛或不痛。或出血或不出血。如欲脱
之状者。皆属肾病。其虫疳龈肿。溃烂秽臭而不动者。皆属阳明。或兼诸经错杂之邪。（医贯）
内因
若阳明膏粱之变。湿热上攻。则牙床不清。而为肿为痛。或出血。或生虫而黑烂脱落。（玉纶）若肾虚作痛者。
遇劳即发。午后更甚。口渴面黧。倦怠遗精。此皆脾肾虚热之症。（医贯）
外候
精完则齿坚。肾衰则齿豁。虚热则齿动。髓溢则齿长。（入门）肾虚牙疼。其齿浮。血虚牙疼。其齿痒。火热牙疼。
其齿燥。虫蚀牙疼。其齿黑。风热牙疼。其齿肿。湿热牙疼。其齿木。（绳墨）又有风热相搏。吸风即痛者。寒气犯
脑。头项连齿者。痰热毒瓦斯。注痛咳嗽者。血搏齿间。钻刺掣痛者。（入门）
齿痛寒热
足阳明胃之脉。贯络于齿上龈。手阳明太阳之脉。贯络于齿下龈。手阳明恶寒饮而喜热饮。足阳明恶热
饮而喜冷冻饮料。故齿痛有恶寒恶热之不同。（正传）恶寒饮者。外吸风寒所致。恶热饮者。内生风热使然。（汇补）
脉法
尺脉虚大者肾虚。洪数者阴火。关脉浮弦者风热。洪滑者痰火。
治法
齿根宣露动摇者。肾元虚也。治宜滋肾。恶寒热而口臭者。阳明热也。治宜清胃。（正传）
用药
阳明经病。治以清胃散。加干葛、石膏、黄芩、连翘、花粉、山栀。如胃火盛。倍加石膏。大肠实。加大黄。挟痰。
加贝母。挟风。加防风。酒毒。加干葛。虫蚀。加槟榔。龈痒。加白芷。龈烂。加胆草。若劳倦而胃虚齿浮。补中益气
汤。肾虚。地黄汤加元参、补骨脂。阳虚豁落。加续断、枸杞、茴香。阴虚浮动。加知、柏、地骨皮、生地。外用敷药
绿袍散。或香盐散。
【附走马牙疳】
牙床腐烂。一时脱落。因湿热毒瓦斯。蕴积既久。一时齐发。势莫可遏。患此病者。十难一治。惟初发之时。急服
泻胃清火之药。外以疳药敷之。庶可保全。
【附齿蚀】
凡饮食不洁。臭腐之气。淹积日久。由是热盛生风。风胜生虫。蛀食齿中。根有黑点。蚀尽一齿。又度其余。甚
至疳 。皆其种类。宜清彻肠胃以治其本。擦牙诛虫以理其标。
齿病选方
清胃散 统治阳明经齿痛。
黄连 生地（各二分） 升麻 丹皮（各五分） 当归 芍药（各三分）
一方 用 生地 丹皮 山栀 知母 玄参 黄芩 石膏 升麻 干葛 甘草
六味汤 统治少阴经齿痛。
补中益气汤（方见中风）
独活散 治风牙。吸风痛甚。走注不定。
独活 羌活 川芎 防风（各五分） 细辛 荆芥 薄荷 生地（各一钱）
每服三钱。水煎。
白芷散 治寒牙痛连脑户。动摇肉脱。
麻黄 草蔻（各一钱半） 黄 桂枝（各二钱半） 吴萸 白芷（各四分） 本（三分） 羌活（八分） 当
归熟地（各五分） 升麻（一钱）
末之。以水漱口。用此擦齿。
化痰汤 治痰热毒瓦斯。攻注齿痛。
贝母 枳实 黄芩 黄连 花粉 桔梗 元参 升麻 甘草
外用二陈汤。加细辛、姜黄、荜茇等分。煎汤浸舌取涎。
细辛散 治风蛀牙虫。
荆芥 细辛 砂仁 白芷 川椒 鹤虱 牙皂 荜茇
为末。擦患处。
犀角地黄汤 治风热挟瘀血。搏结齿间。瘀而作痛。
犀角 丹皮 生地 白芍
绿袍散
黄柏（四两） 炙草（二两） 青黛（一两）
为末敷用。
地黄丸 固齿益肾。
白茯苓 人参 山茱萸（各四两） 枸杞（三两） 生地（五斤取汁） 蜜（一斤） 酥（少许）
以前四味。用好酒一斗。煎至三升。去渣。入地黄汁、蜜、酥。同煎至可丸。丸如小豆大。每服二十丸。温酒下。
日三服。
外治法 因寒作痛。得热饮稍宽者。用干姜、荜茇、细辛作汤漱之。因火作痛。得寒饮稍停者。用石膏、朴
硝、牙皂、荆芥作汤漱之。虫蚀作痛者。用苦参煎汤。日漱三升。痛已止。齿衄。用烧盐、金墨。研匀擦之。
牙寒痛。用胡椒、荜茇为君。细辛、石膏为佐。研末擦之。或用橄榄细嚼。即愈。
【大意】
牙齿，是骨骼的余气所生，由骨髓滋养。因此，牙齿归属于肾；上牙龈和下牙龈归属于阳明经（手阳明大肠经和足阳明胃经）。凡是牙齿松动、脱落，或者剧烈疼痛或不痛，或者出血或不出血，呈现出想要脱落的样子的，都归属于肾病。那些因虫蛀导致的牙龈肿胀、溃烂、散发恶臭但牙齿不松动的，都归属于阳明经病变。有时也可能兼夹其他经络错杂的病邪。（引用自《医贯》）
【内因】
如果是由于长期食用肥甘厚味导致阳明经发生病变，湿热之气向上攻冲，就会导致牙床不清洁，从而出现肿胀、疼痛，或者出血，或者生虫导致牙齿变黑、腐烂、脱落。（引用自《玉纶》）。如果是肾虚引起的牙痛，通常在劳累后发作，午后症状加重，伴有口渴、面色黧黑、倦怠乏力、遗精等症状。这些都是脾肾两脏虚热的病症。（引用自《医贯》）
【外候】
精气充盈则牙齿坚固，肾气衰败则牙齿稀疏松动，虚热内生则牙齿动摇，髓液外溢则感觉牙齿变长。（引用自《入门》）。肾虚引起的牙疼，表现为牙齿浮起；血虚引起的牙疼，表现为牙龈发痒；火热引起的牙疼，表现为牙齿干燥；虫蚀引起的牙疼，表现为牙齿发黑；风热引起的牙疼，表现为牙龈肿胀；湿热引起的牙疼，表现为牙齿麻木。（引用自《绳墨》）。又有风热相互搏结，吸入冷风即感疼痛的；寒气侵犯脑部，导致头项连及牙齿疼痛的；痰热毒气注滞，引起疼痛并伴随咳嗽的；血液瘀搏于齿间，产生钻刺样牵掣痛的。（引用自《入门》）
【齿痛寒热辨析】
足阳明胃经的经脉，贯穿络属于上牙龈；手阳明大肠经和手太阳小肠经的经脉，贯穿络属于下牙龈。手阳明经患者厌恶冷饮而喜欢热饮，足阳明经患者厌恶热饮而喜欢冷饮。因此，齿痛有厌恶寒冷或厌恶热热的不同表现。（引用自《正传》）。厌恶冷饮者，是由外感风寒所致；厌恶热饮者，是由内生风热使然。（引用自《汇补》）
【脉法】
尺脉虚大的，提示肾虚；尺脉洪数的，提示阴火亢盛；关脉浮弦的，提示风热；关脉洪滑的，提示痰火。
【治法】
齿根宣露且松动的，是肾元虚损。治疗应当滋补肾肾。既怕冷又怕热且伴有口臭的，是阳明胃热。治疗应当清泻胃火。（引用自《正传》）
【用药】
阳明经病变，使用清胃散治疗。加入干葛、石膏、黄芩、连翘、花粉、山栀。如果胃火旺盛，加倍增加石膏用量。大肠实热，加入大黄。夹杂痰湿，加入贝母。夹杂风邪，加入防风。酒毒所致，加入干葛。虫蚀所致，加入槟榔。牙龈瘙痒，加入白芷。牙龈腐烂，加入胆草。如果是因劳倦导致胃虚、牙齿浮起的，使用补中益气汤。肾虚的，使用地黄汤加入元参、补骨脂。阳虚导致的牙齿豁落，加入续断、枸杞、茴香。阴虚导致的牙齿浮动，加入知母、黄柏、地骨皮、生地。外用敷药使用绿袍散，或者香盐散。
【附：走马牙疳】
牙床腐烂，短时间内牙齿脱落。这是由于湿热毒气蕴积日久，一时全部爆发，病势猛烈无法遏制。患此病的人，十个里面难得治好一个。只有在初发之时，急服泻胃清火的药物，外用疳药敷贴患处，才可能保全生命。
【附：齿蚀】
凡是饮食不洁净，臭腐之气淹积日久，由此热盛生风，风胜生虫。虫子蛀食牙齿中间，根部有黑点，腐蚀完一颗牙齿后，又蔓延至其余牙齿，甚至导致疳证，都是这一类病因。应当清彻肠胃以治其本，擦牙杀虫以治其标。
【齿病选方】
清胃散：统管阳明经齿痛。
黄连、生地（各二分）、升麻、丹皮（各五分）、当归、芍药（各三分）。
另一方案：用地黄、丹皮、山栀、知母、玄参、黄芩、石膏、升麻、干葛、甘草。
独活散：治疗风牙，吸风时疼痛剧烈，疼痛游走不定。
独活、羌活、川芎、防风（各五分）、细辛、荆芥、薄荷、生地（各一钱）。
每次服用三钱，水煎服。
白芷散：治疗寒性牙痛牵连脑户，牙齿动摇、牙龈萎缩。
麻黄、草蔻（各一钱半）、黄芪、桂枝（各二钱半）、吴茱萸、白芷（各四分）、藁本（三分）、羌活（八分）、当归、熟地（各五分）、升麻（一钱）。
研成末，用水漱口后，用此药粉擦牙。
化痰汤：治疗痰热毒气攻注引起的齿痛。
贝母、枳实、黄芩、黄连、花粉、桔梗、元参、升麻、甘草。
外用二陈汤，加入细辛、姜黄、荜茇等量，煎汤浸舌以引出痰涎。
细辛散：治疗风蛀牙虫。
荆芥、细辛、砂仁、白芷、川椒、鹤虱、牙皂、荜茇。
研成末，擦涂患处。
犀角地黄汤：治疗风热挟带瘀血，搏结于齿间，瘀阻而作痛。
犀角、丹皮、生地、白芍。
绿袍散：
黄柏（四两）、炙甘草（二两）、青黛（一两）。
研成末敷用。
地黄丸：固齿益肾。
白茯苓、人参、山茱萸（各四两）、枸杞（三两）、生地（五斤取汁）、蜂蜜（一斤）、酥油（少许）。
将前四味药材，用好酒一斗，煎至三升，去渣。加入地黄汁、蜜、酥，同煎至可制成丸药的程度。制成如小豆大小的丸药。每次服用二十丸，温酒送下。每日三次。
【外治法】
因寒邪作痛，喝热饮稍感舒缓的，用干姜、荜茇、细辛煎汤漱口。因火邪作痛，喝冷饮稍感停止的，用石膏、朴硝、牙皂、荆芥煎汤漱口。虫蚀作痛的，用苦参煎汤，每天漱口三次，每次三升。疼痛已止，出现齿衄（牙龈出血），用烧过的盐、金墨，研匀后擦涂。
牙寒痛，以胡椒、荜茇为主药，细辛、石膏为辅佐药，研末擦涂。或者用橄榄细细咀嚼，即可痊愈。
[General Principle]
Teeth are the surplus of bones and are nourished by marrow. Therefore, teeth belong to the Kidney (Shen), while the upper and lower gums belong to the Yangming channels (Hand-Yangming Large Intestine and Foot-Yangming Stomach). Any condition characterized by loose or falling teeth, severe pain or no pain, bleeding or non-bleeding, presenting a state of impending detachment, all belong to Kidney disease. Conditions involving gum swelling, ulceration, foul odor due to dental caries, but without tooth mobility, all belong to Yangming pathology. Sometimes, these may be complicated by mixed pathogens from various meridians. (Cited from *Yi Guan*)
[Internal Causes]
If pathological changes occur in the Yangming channel due to long-term consumption of rich and sweet foods, damp-heat attacks upward, causing the gingiva to become unclean, leading to swelling, pain, bleeding, or dental caries resulting in blackening, rotting, and shedding of teeth. (Cited from *Yu Lun*). If toothache is caused by Kidney deficiency, it occurs upon exertion and worsens in the afternoon, accompanied by thirst, dark complexion, fatigue, and seminal emission. These are all symptoms of deficiency-heat in the Spleen and Kidney. (Cited from *Yi Guan*)
[External Manifestations]
When essence is complete, teeth are firm; when Kidney qi declines, teeth become loose; with deficiency-heat, teeth move; with marrow overflow, teeth appear elongated. (Cited from *Ru Men*). Toothache due to Kidney deficiency presents with floating teeth; toothache due to Blood deficiency presents with itchy gums; toothache due to Fire-heat presents with dry teeth; toothache due to worm erosion presents with black teeth; toothache due to Wind-heat presents with swollen gums; toothache due to Damp-heat presents with numbness of the teeth. (Cited from *Sheng Mo*). There are also cases where Wind-heat combats each other, causing pain upon exposure to wind; Cold pathogen invades the brain, causing pain radiating from the head and neck to the teeth; Phlegm-Heat toxic gas stagnates, causing pain accompanied by coughing; Blood stasis binds between the teeth, causing drilling and pulling pain. (Cited from *Ru Men*)
[Differentiation of Cold and Heat in Toothache]
The meridian of the Foot-Yangming Stomach passes through and connects to the upper gums; the meridians of the Hand-Yangming Large Intestine and Hand-Taiyang Small Intestine pass through and connect to the lower gums. Patients with Hand-Yangming channel issues dislike cold drinks and prefer hot drinks, while those with Foot-Yangming channel issues dislike hot drinks and prefer cold beverages. Therefore, toothaches differ in their aversion to cold or heat. (Cited from *Zheng Zhuan*). Aversion to cold drinks is caused by external contraction of Wind-Cold; aversion to hot drinks is caused by internally generated Wind-Heat. (Cited from *Hui Bu*)
[Pulse Diagnosis]
A Xu (deficiency) and Da (large) pulse at the Chi position indicates Kidney deficiency; a Hong (surging) and Shuo (rapid) pulse indicates Yin Fire hyperactivity; a Fu (floating) and Xian (wiry) pulse at the Guan position indicates Wind-Heat; a Hong (surging) and Hua (slippery) pulse indicates Phlegm-Fire.
[Therapeutic Methods]
Exposed and loose tooth roots indicate deficiency of Kidney Yuan Qi. Treatment should focus on nourishing the Kidney. Symptoms of both aversion to cold and heat accompanied by bad breath indicate Yangming Stomach Heat. Treatment should focus on clearing the Stomach. (Cited from *Zheng Zhuan*)
[Medication]
For Yangming channel diseases, use Qingwei San (Stomach-Clearing Powder). Add Qianjin Ge (Puerariae Radix), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), Lian Qiao (Forsythiae Fructus), Hua Fen (Trichosanthis Radix), and Shan Zhi (Gardeniae Fructus). If Stomach Fire is excessive, double the dosage of Shi Gao. For excess in the Large Intestine, add Da Huang (Rhei Radix et Rhizoma). If complicated by Phlegm, add Bei Mu (Fritillariae Bulbus). If complicated by Wind, add Fang Feng (Saposhnikoviae Radix). For alcohol toxicity, add Qianjin Ge. For worm erosion, add Bing Lang (Arecae Semen). For itchy gums, add Bai Zhi (Angelicae Dahuricae Radix). For ulcerated gums, add Dan Cao (Gentianae Radix). For tooth floating due to Stomach deficiency from overwork, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For Kidney deficiency, use Dihuang Tang (Rehmannia Decoction) added with Yuan Shen (Scrophulariae Radix) and Buguzhi (Psoraleae Fructus). For Yang deficiency with tooth loss, add Xuduan (Drynariae Rhizoma), Gouqi (Lycii Fructus), and Huixiang (Foeniculi Fructus). For Yin deficiency with tooth mobility, add Zhimu (Anemarrhenae Rhizoma), Baipi (Phellodendri Cortex), Digupi (Lycii Cortex), and Shengdi (Rehmanniae Radix). For external application, use Lv Pao San (Green Robe Powder) or Xiang Yan San (Fragrant Salt Powder).
[Appendix: Walking Horse Gangrene of the Gums]
The gums rot and teeth fall out within a short time. This is caused by the long-term accumulation of damp-heat toxic gas, which suddenly erupts all at once. The progression is unstoppable. Few patients recover; only ten out of one hundred might survive. Only during the initial onset can life be preserved by urgently administering drugs that purge the Stomach and clear Fire, combined with external application of gangrene-specific medicines.
[Appendix: Dental Erosion]
Whenever diet is unclean, foul and putrid gases accumulate over a long period. Consequently, excessive Heat generates Wind, and excessive Wind generates worms. These worms bore into the teeth, leaving black spots at the roots. After eroding one tooth completely, they spread to others, potentially leading to Gan syndrome (gangrenous stomatitis). All these belong to this category. One should clear and purify the intestines and stomach to treat the root cause, and brush the teeth to eliminate worms to treat the branch symptoms.
[Selected Formulas for Dental Diseases]
Qingwei San (Stomach-Clearing Powder): Treats toothache of the Yangming channel.
Huang Lian (Coptidis Rhizoma), Sheng Di (Rehmanniae Radix) (each 2 fen); Sheng Ma (Cimicifugae Rhizoma), Dan Pi (Moutan Cortex) (each 5 fen); Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba) (each 3 fen).
Alternative prescription: Use Sheng Di, Dan Pi, Shan Zhi, Zhi Mu, Xuan Shen, Huang Qin, Shi Gao, Sheng Ma, Qian Jin Ge, Gan Cao.
Liuyin Tang (Six-Ingredient Decoction): Treats toothache of the Shaoyin channel.
Buzhong Yiqi Tang (see Stroke chapter).
Duhuo San (Angelica Pubescens Powder): Treats Wind-toothache, where pain is severe upon exposure to wind and migratory.
Du Huo (Angelicae Pubescentis Radix), Qiang Huo (Notopterygii Rhizoma et Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fang Feng (Saposhnikoviae Radix) (each 5 fen); Xi Xin (Asari Radix et Rhizoma), Jing Jie (Schizonepetae Herba), Bo He (Menthae Haplocalycis Herba), Sheng Di (Rehmanniae Radix) (each 1 qian).
Take 3 qian per dose, decoct in water.
Baizhi San (Angelica Dahurica Powder): Treats Cold-toothache radiating to the brain, with loose teeth and receding gums.
Ma Huang (Ephedrae Herba), Cao Kou (Amomi Fructus Rotundus) (each 1.5 qian); Huang Qi (Astragali Radix), Gui Zhi (Cinnamomi Ramulus) (each 2.5 qian); Wu Zhu Yu (Evodiae Fructus), Bai Zhi (Angelicae Dahuricae Radix) (each 4 fen); Ben Cao (Ligustici Rhizoma) (3 fen); Qiang Huo (Notopterygii Rhizoma et Radix) (8 fen); Dang Gui (Angelicae Sinensis Radix), Shu Di (Prepared Rehmanniae Radix) (each 5 fen); Sheng Ma (Cimicifugae Rhizoma) (1 qian).
Grind into powder. Rinse mouth with water, then use this powder to rub the teeth.
Huatan Tang (Phlegm-Resolving Decoction): Treats toothache caused by Phlegm-Heat toxic gas attacking.
Bei Mu (Fritillariae Bulbus), Zhi Shi (Aurantii Fructus Immaturus), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Hua Fen (Trichosanthis Radix), Jie Geng (Platycodonis Radix), Yuan Shen (Scrophulariae Radix), Sheng Ma (Cimicifugae Rhizoma), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Externally, use Erchen Tang (Two-Aged Decoction) added with Xi Xin, Jiang Huang (Curcumae Longae Rhizoma), and Bi Bo (Piperis Longi Fructus) in equal parts. Decoct and soak the tongue to induce salivation.
Xixin San (Asari Powder): Treats Wind-bored teeth and worms.
Jing Jie (Schizonepetae Herba), Xi Xin (Asari Radix et Rhizoma), Sha Ren (Amomi Fructus), Bai Zhi (Angelicae Dahuricae Radix), Chuan Jiao (Zanthoxyli Pericarpium), He Shi (Hirudo), Ya Zao (Gleditsiae Spina), Bi Bo (Piperis Longi Fructus).
Grind into powder and apply to the affected area.
Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction): Treats Wind-Heat complicated by blood stasis binding between the teeth, causing pain due to stasis.
Xi Jiao (Rhino Ceruos Cornu - *Note: Substitute with Water Buffalo Horn/Shui Niu Jiao in modern practice*), Dan Pi (Moutan Cortex), Sheng Di (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba).
Lv Pao San (Green Robe Powder):
Huang Bo (Phellodendri Cortex) (4 liang); Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) (2 liang); Qing Dai (Indigo Naturalis) (1 liang).
Grind into powder and apply externally.
Dihuang Wan (Rehmannia Pill): Strengthens teeth and benefits the Kidney.
Bai Fu Ling (Poria), Ren Shen (Ginseng Radix et Rhizoma), Shan Zhu Yu (Corni Fructus) (each 4 liang); Gou Qi Zi (Lycii Fructus) (3 liang); Sheng Di (Rehmanniae Radix) (extract juice from 5 jin); Honey (1 jin); Su You (Butyrum) (a little).
Decoct the first four ingredients in 1 dou of good wine until reduced to 3 sheng. Strain. Add Rehmannia juice, honey, and butter. Simmer until pillable consistency. Roll into pills the size of small beans. Take 20 pills per dose with warm wine. Three times daily.
[External Therapies]
For pain caused by Cold, relieved slightly by hot drinks: Decoct Gan Jiang (Zingiberis Rhizoma), Bi Bo (Piperis Longi Fructus), and Xi Xin (Asari Radix et Rhizoma) to rinse the mouth.
For pain caused by Fire, relieved slightly by cold drinks: Decoct Shi Gao (Gypsum Fibrosum), Xiao Ming (Natrii Sulfas), Ya Zao (Gleditsiae Spina), and Jing Jie (Schizonepetae Herba) to rinse the mouth.
For pain caused by worm erosion: Decoct Ku Shen (Sophorae Flavescentis Radix) and rinse the mouth three times daily, using 3 sheng per rinse.
For toothache cessation followed by epistaxis (gingival bleeding): Use burnt salt and gold ink, grind evenly, and rub onto the gums.
For Cold-induced toothache: Use Hu Jiao (Piperis Nigris Fructus) and Bi Bo as the sovereign herbs, with Xi Xin and Shi Gao as ministering herbs. Grind into powder and rub onto the teeth. Alternatively, chew an olive slowly until cured.