齿者，骨之余，髓之所养，故齿属肾，上龈
属胃，下龈属太阳。凡动摇豁脱，或大痛，或不痛，或出血，或不出血，如欲脱之状，皆属肾病。其虽疳，龈肿
溃烂，臭秽而不动者，皆属阳明，或兼诸经错杂之邪。（《医贯》）若阳明膏粱之变，湿热上攻，则牙床不清而
为肿为痛，或出血生虫，而黑烂脱落。（玉纶）若肾虚作痛者，遇劳即发，午后更甚口渴面黑，倦怠遗精，此皆
脾胃虚之证。（《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》）肾虚牙痛其齿浮，血虚牙痛其齿
痒，火热牙痛其齿燥，虫蚀牙痛其齿黑，风热牙痛其齿肿，湿热牙痛其齿木。（《绳墨》）又有风热相搏，吸风
即痛者；有寒气犯脑，头项连齿痛者；有痰气、热气、毒瓦斯注痛，咳嗽者；有血搏齿间，钻刺掣痛者。（《正传》）
湿热蕴积日久，则发为走马牙疳。（《司命》）
齿痛有恶寒恶热之不同。手阳明恶寒而喜热饮，足阳明恶热而喜冷冻饮料，故齿痛有恶寒热之不同。（《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，痰火也。
治法 齿根宣露动摇者肾。元虚也治宜补肾恶寒热而口臭者，阳明热也，治宜清胃。（《医衡》）齿蚀宜清肠
胃以治其本，擦牙诛虫以绝其标。（李惺庵）走马牙疳急宜泻胃清火，敷牙疳之药。（日胗）牙疳亦有急宜大剂
滋阴温补者。（岫云）
用药加减法 阳明病清胃散加干葛、石膏、芩、连、花粉、山栀。如胃火盛倍石膏。大肠实加大黄。挟痰加
贝母。挟风加防风。酒毒倍干葛。虫蚀加槟榔。龈痒加白芷。龈烂加龙胆草。若劳倦而胃虚齿浮用补中益气汤。
肾虚用地黄汤加玄参、补骨脂。阳虚豁落加续断、枸杞、茴香。阴虚浮动加知、柏、生地、丹皮。（《汇补》）
牙齿，是骨骼的余气所生，由骨髓滋养，因此牙齿归属于肾，上牙龈归属于胃，下牙龈归属于太阳经。凡是牙齿松动脱落，或者剧烈疼痛，或者不痛，或者出血，或者不出血，呈现出想要脱落的状况，都归属于肾病。那些虽然患有疳疾，牙龈肿胀溃烂，气味臭秽但牙齿不松动的，都归属于阳明经，或者是兼有各条经络错杂的邪气。（出自《医贯》）如果是由于长期食用肥甘厚味导致的阳明病变，湿热向上攻冲，就会导致牙床不干净而肿胀疼痛，或者出血生虫，进而发黑腐烂脱落。（出自玉纶）如果是肾虚引起的疼痛，一劳累就会发作，午后更加严重，伴有口渴、面色发黑、倦怠乏力、遗精等症状，这都属于脾胃虚弱的证候。（出自《医贯》）
外在表现：精气充足则牙齿坚固，肾气衰退则牙齿稀疏松动，虚热内生则牙齿动摇，髓液外溢则牙齿显得变长。（出自《入门》）肾虚引起的牙痛，牙齿会有浮动感；血虚引起的牙痛，牙齿会发痒；火热引起的牙痛，牙齿干燥；虫蚀引起的牙痛，牙齿发黑；风热引起的牙痛，牙龈肿胀；湿热引起的牙痛，牙齿感觉麻木。（出自《绳墨》）又有因风热相搏，吸入风即感疼痛的；有寒气侵犯脑部，导致头项连及牙齿疼痛的；有痰气、热气、毒瓦斯注滞引起疼痛并伴有咳嗽的；有血液瘀搏在齿间，产生钻刺牵拉样疼痛的。（出自《正传》）湿热蕴结积聚日久，就会发展为走马牙疳。（出自《司命》）
牙痛也有怕冷和怕热的不同。手阳明大肠经怕冷而喜欢热饮，足阳明胃经怕热而喜欢冷冻饮料，所以牙痛也有怕冷或怕热的不同。（出自《正传》）怕冷饮的，是由于外感风寒所致；怕热饮的，是由于内生风热使然。（出自《汇补》）
脉法：尺脉虚弱且大的，是肾虚；洪大数急的，是阴火；关脉浮弦的，是风热；洪滑的，是痰火。
治法：齿根宣露且松动的，是肾元虚弱，治疗应当补肾；怕冷怕热且口臭的，是阳明热盛，治疗应当清胃。（出自《医衡》）牙齿腐蚀应当清理肠胃以治其本，刷牙杀虫以绝其标。（李惺庵）走马牙疳急需泻胃火、清实火，并敷用治疗牙疳的药物。（日胗）牙疳也有急需使用大剂量滋阴温补药物的情况。（岫云）
用药加减法：阳明病使用清胃散，加入干葛、石膏、黄芩、黄连、花粉、山栀。如果胃火旺盛，加倍使用石膏。大肠实证加大黄。挟痰加贝母。挟风加防风。酒毒加倍使用干葛。虫蚀加槟榔。牙龈痒加白芷。牙龈烂加龙胆草。如果是劳倦导致胃虚、牙齿浮动，使用补中益气汤。肾虚用地黄汤，加入玄参、补骨脂。阳虚导致牙齿脱落加续断、枸杞、茴香。阴虚导致牙齿浮动加知母、黄柏、生地、丹皮。（出自《汇补》）
Teeth are the surplus of bones and nourished by marrow; therefore, teeth belong to the Kidney (Shen), the upper gums belong to the Stomach (Wei), and the lower gums belong to the Taiyang (Greater Yang) channel. Any loosening or shedding of teeth, whether accompanied by severe pain, no pain, bleeding, or no bleeding, presenting a state of impending loss, all belong to Kidney disease. Cases where there is gan disease (nutritional deficiency disorder with gum involvement), characterized by swollen and ulcerated gums with foul odor but without tooth mobility, all belong to the Yangming (Bright Yang) channel, or involve mixed pathogens from various channels. (From *Yi Guan*) If the condition arises from dietary excesses in the Yangming channel, where damp-heat attacks upward, it leads to unclean alveolar processes resulting in swelling and pain, or bleeding with worm generation, followed by black rot and shedding. (From Yulun) If the pain is caused by Kidney deficiency, it occurs upon exertion, worsens in the afternoon, and is accompanied by thirst, dark complexion, fatigue, and spermatorrhea; these are all signs of Spleen and Stomach deficiency. (From *Yi Guan*)
External manifestations: When essence is complete, teeth are firm; when Kidney qi declines, teeth become loose; when deficient heat exists, teeth move; when marrow overflows, teeth appear elongated. (From *Ru Men*) For toothache due to Kidney deficiency, teeth feel floating; for toothache due to Blood deficiency, teeth itch; for toothache due to Fire-Heat, teeth are dry; for toothache due to worms, teeth are black; for toothache due to Wind-Heat, gums swell; for toothache due to Damp-Heat, teeth feel numb. (From *Sheng Mo*) There are also cases where Wind and Heat struggle against each other, causing pain upon exposure to wind; cases where Cold Qi invades the brain, causing pain radiating from the head and neck to the teeth; cases where Phlegm-Qi, Heat Qi, and toxic vapors cause pain accompanied by coughing; and cases where Blood stagnation between teeth causes drilling and pulling pain. (From *Zheng Chuan*) When Damp-Heat accumulates for a long time, it develops into Zouma Gangrene (Noma). (From *Si Ming*)
Toothaches may differ in aversion to cold or heat. The Hand-Yangming Large Intestine channel fears cold and prefers hot drinks; the Foot-Yangming Stomach channel fears heat and prefers cold drinks. Thus, toothaches vary in their aversion to cold or heat. (From *Zheng Chuan*) Aversion to cold drinks is caused by external invasion of Wind-Cold; aversion to hot drinks is caused by internally generated Wind-Heat. (From *Hui Bu*)
Pulse Diagnosis: A weak and large Chi pulse indicates Kidney deficiency; a surging and rapid pulse indicates Yin Fire; a floating and wiry Guan pulse indicates Wind-Heat; a surging and slippery pulse indicates Phlegm-Fire.
Treatment Methods: Receding gums with mobility indicate deficiency of Kidney Yuan Qi; treatment should tonify the Kidney. Aversion to cold/heat with bad breath indicates Yangming Heat; treatment should clear the Stomach. (From *Yi Heng*) Dental caries should be treated by clearing the intestines and stomach to address the root, and brushing teeth to eliminate worms to address the branch. (Li Xing'an) Zouma Gangrene urgently requires purging Stomach Heat and clearing Fire, along with applying topical medicines for gangrene. (Rizhen) Gangrene may also require urgent administration of large doses of Yin-nourishing and warming tonics. (Xiuyun)
Medication Modification Rules: For Yangming disease, use Qingwei San (Clear the Stomach Powder) with added Gan Ge (Puerariae Radix), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Hua Fen (Trichosanthis Radix), and Shan Zhi (Gardeniae Fructus). If Stomach Fire is excessive, double the dose 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, double the dose of Gan Ge. For worm infestation, add Bing Lang (Arecae Semen). For itchy gums, add Bai Zhi (Angelicae Dahuricae Radix). For ulcerated gums, add Long Dan Cao (Gentianae Radix). If fatigue leads to Stomach deficiency and floating teeth, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). For Kidney deficiency, use Dihuang Tang (Rehmannia Decoction) with added Xuan Shen (Scrophulariae Radix) and Buguzhi (Psoraleae Fructus). For Yang deficiency with tooth loss, add Xuduan (Dipsaci Radix), Gouqi (Lycii Fructus), and Huixiang (Foeniculi Fructus). For Yin deficiency with floating teeth, add Zhimu (Anemarrhenae Rhizoma), Baipi (Phellodendri Cortex), Shengdi (Rehmanniae Radix), and Danpi (Moutan Cortex). (From *Hui Bu*)