经云∶齿者肾之标，骨之余也。小儿禀受肾气不足，肾主骨髓，虚则髓脉不充，肾气不能上
营，故齿迟也，用地黄丸主之。
治验
一小儿三岁，言步未能，齿发尤少，骨瘦艰立，发热作渴，服肥儿丸，不应。余曰∶此肾虚
疳症也，盖肥儿丸脾胃经之药，久服则肾益虚，其疳益甚。不信，牙发渐落，余用地黄丸加
鹿茸、五味子，半载而元气壮健。
一小儿体瘦腿细，行步艰辛，齿不坚固，发稀短少。用六味地黄丸、补中益气汤，年余诸症
悉愈，形体壮实。
芎 散 治齿生迟，或齿嚼物少力。
芎 生地黄 山药 当归 芍药（炒） 甘草（各等分）
上各另为末，每服二钱，白汤调。
地黄丸（方见肾脏）
补中益气汤（方见虚羸）
夫齿属足少阴肾经，牙床属手足阳明经。小儿寤寐，不时切牙，其所致之经不同，或本于心
经之热，或本于肝经之热，或本于脾肺肾经之热。若发热饮水，叫哭而搐者，心经实热也。
睡因惊悸，合面而卧者，心经虚热也。面青目札，呵欠项强烦闷者，肝经实热也。手寻衣领
，及乱捻物者，肝经虚热也。发搐目青面赤，肝经风热也。烦闷喘促，见于申酉时者，肺经
热也。胸满气急，喘嗽上气，肺感风寒也。见于亥子丑时者，肾经热也。眼目畏明，及无睛
光，或解颅下窜，胎禀肾虚也。饮水口中气热，胃经实热也。饮汤口中气冷，胃经虚热也。
发搐呵欠面黄，脾虚发惊也。心经实热用泻心汤，虚热用导赤散。肝经实热先用柴胡清肝散
治肝火，后用六味丸生肝血，肝经风热亦用前药，虚热则用六味丸。肺经实热用泻白散；虚
热用保肺汤。肾经实热，用六味丸减茱萸二两，以生地易熟地；虚用地黄丸。胃经实热，用泻
黄散；虚用异功散。脾虚发惊，用五味异功散。若乳母多食膏粱浓味，致儿切牙者，用清胃散
。
治验
一小儿七岁，素喜食甘味，两手发热，夜睡切牙，用泻黄散而愈。后不守戒，仍作，用大黄
等药，前症益甚，更滞颐弄舌手足冷。余谓∶此脾胃复伤而虚甚也。用六君子加柴胡、升麻
，治之渐愈；又用五味异功散加柴胡、升麻而痊。
一小儿面素痿黄，或时变青，饮食过多，睡面切牙，服克伐之剂，口舌生疮，大便泄青，发
搐痰盛，唇青手冷，用六君加木香、柴胡、升麻，数剂而安。但饮食后，腹膨作嗳，用四君
子汤为细末，不时煨姜汤调服少许，月余而痊。
一小儿十五岁，盗汗面赤，睡中切牙。自服清胃散，前症益甚，更遗精晡热，口干倦怠，余
用六味地黄丸、补中益气汤而痊。
一小儿十四岁，素食膏粱炙 ，睡中切牙，此脾胃积热，先用清胃散及二陈、黄连、山楂、
犀角各数剂，间服补中益气汤而愈。
一女子十四岁，发热作渴，月经先期，睡中切牙，此肝脾二经虚热也，用加味逍遥散而安。
后因怒，前症俱作，用柴胡栀子散而瘥。
一小儿夜间切牙，或盗汗，或便血。审其母，怀抱郁结，又兼便血。用加味归脾汤、加味逍
遥散与母兼服，其子亦愈。
一小儿因母食膏粱醇酒，睡中切牙，或时鼻衄，右腮鼻准色赤。先用加味清胃散、加味逍遥
散与母服，儿亦愈。
一小儿病后不语，睡中切牙，惊悸饮水，困倦少食，用化痰镇惊等药益甚。余谓属心脾肾阴
虚。用六味地黄丸为主，佐以五味异功散、秘旨安神丸，诸症顿愈。
一小儿感冒风邪，咳嗽喘逆，不时切牙，右腮色赤，此肺经客热，用洁古黄 汤，一剂而痊
。后因停食，腹胀咳嗽，鼻塞切牙。用六君子汤加桔梗、桑皮、杏仁，一剂而愈。
一小儿切牙，审知因母大怒，先用小柴胡汤加山栀、牡丹皮治之，母子并愈。
洁古黄 汤
人参 黄 茯苓 白术 芍药（各一钱） 干姜 陈皮 藿香（各五分）
上水煎服。
保肺汤（方见伤风咳嗽）
柴胡栀子散
柴胡清肝散（二方见发热）
补中益气汤（方见虚羸）
小柴胡汤（方见痉症）
二陈汤（方见寒吐）
泻黄散（方见脾脏）
泻心汤
导赤散
秘旨安神丸（三方见心脏）
泻白散（方见肺脏）
地黄丸（方见肾脏）
六君子汤
归脾汤
四君子汤
加味逍遥散
清胃散
异功散（六方见内钓）
The *Classic of Medicine* (Huangdi Neijing) states: "Teeth are the external manifestation of the Kidney and the surplus of bone." Children with insufficient congenital Kidney Qi, where the Kidney governs the marrow, will experience a lack of nourishment in the marrow meridians due to deficiency. When Kidney Qi cannot ascend to nourish the teeth, delayed tooth eruption occurs; this is primarily treated with Dihuang Wan (Rehmannia Pill).
Clinical Cases
A three-year-old child could not speak or walk at the appropriate age, had particularly sparse hair and teeth, was emaciated and difficult to stand, and presented with fever and thirst. The previous administration of Fei'er Wan (Fattening Child Pill) was ineffective. I stated: "This is a malnutrition syndrome (Gan Syndrome) caused by Kidney deficiency. Fei'er Wan is a formula for the Spleen and Stomach meridians; long-term use further depletes Kidney Qi and exacerbates the Gan syndrome." The parents did not believe me, and the child's teeth and hair gradually fell out. I treated him with Dihuang Wan (Rehmannia Pill) added with Lurong (Deer Antler) and Wuweizi (Schisandra Berry). After half a year, his Yuan Qi (Original Qi) became robust.
Another child was thin with slender legs, walked with difficulty, had insecure teeth, and sparse, short hair. Treatment with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) resulted in the complete resolution of all symptoms after more than a year, and the child's physique became strong.
Xiong San (Ligusticum Powder): Treats delayed tooth eruption or weak chewing power.
Ingredients: Xiong (Ligustici Chuanxiong Rhizoma), Sheng Dihuang (Rehmanniae Radix), Shanyao (Dioscoreae Rhizoma), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix, stir-fried), Gancao (Glycyrrhizae Radix et Rhizoma) in equal parts.
Usage: Each herb is separately ground into powder. Take 2 qian per dose, mixed with warm water.
Dihuang Wan (See "Kidney" chapter for formula)
Buzhong Yiqi Tang (See "Emaciation" chapter for formula)
Teeth belong to the Foot-Shaoyin Kidney Meridian, while the gums belong to the Hand-Yangming Large Intestine Meridian and Foot-Yangming Stomach Meridian. During sleep or wakefulness, if a child grinds their teeth intermittently, the affected meridians vary. It may originate from Heat in the Heart Meridian, Liver Meridian, or Spleen, Lung, and Kidney meridians. If accompanied by fever, desire for water, crying, and convulsions, it indicates Excess Heat in the Heart Meridian. Sleeping on the stomach due to fright palpitations indicates Deficient Heat in the Heart Meridian. A blue complexion, blinking eyes, yawning, neck stiffness, and irritability indicate Excess Heat in the Liver Meridian. Grasping clothes or fidgeting with objects indicates Deficient Heat in the Liver Meridian. Convulsions with blue eyes and red face indicate Wind-Heat in the Liver Meridian. Irritability and rapid breathing appearing during Shen and You hours (3 PM–7 PM) indicate Heat in the Lung Meridian. Chest fullness, rapid breathing, coughing, and rebellious Qi indicate Cold-Wind affecting the Lung. Symptoms appearing during Hai, Zi, and Chou hours (9 PM–3 AM) indicate Heat in the Kidney Meridian. Photophobia, lackluster eyes, or open fontanelle sinking downward indicate congenital Kidney deficiency. Hot breath when drinking water indicates Excess Heat in the Stomach Meridian. Cold sensation in the mouth when drinking hot soup indicates Deficient Heat in the Stomach Meridian. Convulsions, yawning, and yellow face indicate Spleen deficiency leading to Fright. For Excess Heat in the Heart Meridian, use Xiexin Tang (Drain the Heart Decoction); for Deficient Heat, use Daochi San (Direct Flowing Red Powder). For Excess Heat in the Liver Meridian, first use Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) to treat Liver Fire, then Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) to nourish Liver Blood; for Wind-Heat in the Liver Meridian, use the aforementioned formulas; for Deficient Heat, use Liuwei Dihuang Wan. For Excess Heat in the Lung Meridian, use Xiebai San (Drain White Powder); for Deficient Heat, use Baofei Tang (Protect the Lung Decoction). For Excess Heat in the Kidney Meridian, use Liuwei Dihuang Wan minus Cornus officinalis (Shanzhuyu) by two liang, replacing Shu Dihuang (Prepared Rehmannia Root) with Sheng Dihuang (Raw Rehmannia Root); for Deficiency, use Dihuang Wan. For Excess Heat in the Stomach Meridian, use Xiehuang San (Drain Yellow Powder); for Deficiency, use Yigong San (Yi Gong Powder). For Spleen deficiency causing Fright, use Wuwei Yigong San (Five-Ingredient Yi Gong Powder). If the nursing mother consumes rich, greasy foods causing the infant to grind teeth, use Qingwei San (Clear the Stomach Powder).
Clinical Cases
A seven-year-old child who loved sweets presented with hot hands and nocturnal bruxism. Treated with Xiehuang San (Drain Yellow Powder) and cured. Later, disregarding dietary restrictions, the condition recurred. The use of Da Huang (Rhubarb) and other purgatives worsened the symptoms, leading to drooling, tongue protrusion, and cold extremities. I stated: "This is severe deficiency due to repeated injury to the Spleen and Stomach." Treated with Liujunzi Tang (Six-Gentlemen Decoction) added with Chaihu (Bupleuri Radix) and Shengma (Cimicifugae Rhizoma), showing gradual improvement; subsequently cured with Wuwei Yigong San (Five-Ingredient Yi Gong Powder) added with Chaihu and Shengma.
A child with a sallow complexion that occasionally turned green, excessive eating, and nocturnal bruxism while sleeping on the stomach, developed mouth ulcers, green loose stools, convulsions, and copious phlegm after taking harsh purgatives, along with cyanotic lips and cold hands. Treated with Liujunzi Tang added with Muxiang (Aucklandiae Radix), Chaihu, and Shengma, stabilizing after several doses. However, postprandial abdominal distension and belching were treated with Sizijunzi Tang (Four-Gentlemen Decoction) powdered and taken in small amounts with roasted ginger tea, curing within a month.
A fifteen-year-old child with night sweats, red face, and nocturnal bruxism took Qingwei San (Clear the Stomach Powder) self-medically, worsening symptoms and adding seminal emission, afternoon tidal fever, dry mouth, and fatigue. Treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and cured.
A fourteen-year-old child consuming greasy and fried foods presented with nocturnal bruxism due to Spleen-Stomach accumulated heat. Initially treated with Qingwei San (Clear the Stomach Powder) combined with Erchen Tang (Two-Aged Decoction), Huanglian (Coptidis Rhizoma), Shanzha (Crataegi Fructus), and Xijiao (Rhino Ceratoss) for several doses, interspersed with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), resulting in cure.
A fourteen-year-old girl with fever, thirst, early menstruation, and nocturnal bruxism suffered from Deficient Heat in the Liver and Spleen meridians. Treated with Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and stabilized. After an episode of anger, symptoms recurred and were cured with Chaihu Zhizi San (Bupleurum and Gardenia Powder).
A child with nocturnal bruxism, night sweats, or hematochezia. Upon inquiry, the mother exhibited emotional stagnation and hematochezia. Both mother and son were treated with Jiawei Guipi Tang (Modified Restore the Spleen Decoction) and Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), curing both.
A child with nocturnal bruxism and occasional epistaxis, with redness on the right cheek and nose tip, due to the mother consuming rich foods and alcohol. The mother was treated with Jiawei Qingwei San (Modified Clear the Stomach Powder) and Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), curing the child.
A child with post-illence muteness, nocturnal bruxism, fright palpitations, thirst, fatigue, and poor appetite worsened with phlegm-resolving and spirit-calming drugs. Diagnosed as Yin deficiency of the Heart, Spleen, and Kidney. Primarily treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), assisted by Wuwei Yigong San (Five-Ingredient Yi Gong Powder) and Mizhi Anshen Wan (Secret Purpose Spirit-Calming Pill), resulting in immediate recovery.
A child with wind-pathogen invasion, cough, wheezing, intermittent bruxism, and red right cheek suffered from Guest Heat in the Lung Meridian. Treated with Jiegu Huangqi Tang (Jiegu Astragalus Decoction), cured in one dose. Later, due to food stagnation causing abdominal distension, cough, nasal congestion, and bruxism, treated with Liujunzi Tang (Six-Gentlemen Decoction) added with Jiegeng (Platycodonis Radix), Sangbaipi (Mori Cortex), and Xingren (Armeniacae Semen), cured in one dose.
A child with bruxism caused by maternal anger was treated with Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardeniae Fructus) and Mudanpi (Moutan Cortex), curing both mother and child.
Jiegu Huangqi Tang (Jiegu Astragalus Decoction)
Ingredients: Renshen (Ginseng Radix), Huangqi (Astragali Radix), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Shaoyao (Paeoniae Radix) each 1 qian; Ganjiang (Zingiberis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Huoxiang (Agastaches Herba) each 0.5 qian.
Usage: Decoct in water and take orally.
Baofei Tang (Protect the Lung Decoction) (See "Wind-Cold Cough" chapter for formula)
Chaihu Zhizi San (Bupleurum and Gardenia Powder)
Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) (Both formulas see "Fever" chapter)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See "Emaciation" chapter for formula)
Xiao Chaihu Tang (Minor Bupleurum Decoction) (See "Spasm" chapter for formula)
Erchen Tang (Two-Aged Decoction) (See "Cold Vomiting" chapter for formula)
Xiehuang San (Drain Yellow Powder) (See "Spleen" chapter for formula)
Xiexin Tang (Drain the Heart Decoction)
Daochi San (Direct Flowing Red Powder)
Mizhi Anshen Wan (Secret Purpose Spirit-Calming Pill) (Three formulas see "Heart" chapter)
Xiebai San (Drain White Powder) (See "Lung" chapter for formula)
Dihuang Wan (Rehmannia Pill) (See "Kidney" chapter for formula)
Liujunzi Tang (Six-Gentlemen Decoction)
Guipi Tang (Restore the Spleen Decoction)
Sizijunzi Tang (Four-Gentlemen Decoction)
Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder)
Qingwei San (Clear the Stomach Powder)
Yigong San (Yi Gong Powder) (Six formulas see "Internal Hook" chapter)