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(Tooth Extraction)
At the age of eight, men experience the fullness of Kidney Qi, and teeth begin to grow. By the age of twenty-four (three times seven), wisdom teeth emerge. By forty (five times eight), teeth become withered. By sixty-four (eight times eight), teeth fall out. Women follow a similar pattern based on multiples of seven. This is because the Kidneys govern bones, and teeth are considered the surplus of bone, nourished by marrow; thus, their condition fluctuates with the abundance or decline of Tian Gui (the substance governing reproductive function). Additionally, branch vessels of the Stomach Meridian enter the upper teeth, while branch vessels of the Large Intestine Meridian enter the lower teeth. Therefore, when Kidney essence and marrow are sufficient and the stomach and intestines are robust, teeth remain firm and solid; if deficient, teeth become loose. Toothache involves pain in the gingiva at the root of the tooth, caused by Wind-Heat-Dampness pathogens gathering to form fluids and saliva, which clash with the Qi and Blood between the teeth, causing pain. When Damp-Heat is abundant, there is both pain and swelling; when Wind-Heat is abundant, there is pain but little swelling. Furthermore, Damp-Heat generates worms that erode the tooth roots, also causing pain. If Wind-Heat is excessive and clashes with the blood vessels, bleeding occurs; if severe, Qi and Blood rot into pus, discharging foul-smelling fluid, known as Dental Caries (Chu Yu). If the gingival tissue atrophies, exposing the tooth root so it protrudes, it is called Gingival Retraction (Chi Ting). Heat in the Kidneys causes teeth to turn black and wither; exhaustion of Kidney Essence causes the face to turn black as well.

For toothache due to Kidney Deficiency without Heat, there is only loosening without pain. Pain must be caused by Wind-Fire or Worms. Wind can be external or internal; internal wind refers to Heat, while external wind refers to exogenous Cold-Wind. Internal Fire, constrained by external Wind, becomes more intense, resulting in severe pain. There are cases where the head suffers from exogenous Cold-Wind, causing headache radiating to the teeth; these should be treated with Qianghuo Fuzi Decoction to dissipate the pathogen, indicating Kidney Meridian deficiency invaded by Cold-Wind. Teeth belong to the Kidneys, and the brain also belongs to the Kidneys; Cold-Evil invading the Kidneys damages the root, requiring urgent treatment, for delay leads to incurability (True Headache results in death, as mentioned here). Baizhi Powder may also be used. This condition invariably prefers warmth, with no swelling or caries of the teeth, representing an acute illness distinct from chronic dental disease. If the pain does not extend to the head but only to the neck, it is due to external Wind constraining internal Heat; Lifxiao San should be used. For severe pain due to Damp-Heat, Chengqi Tang (see Constipation) should be administered to purge; for mild cases, Qingwei San is appropriate. For pain due to the Six Stagnations (Qi, Blood, Phlegm, Fire, Dampness, Food), Yueju Wan should be used (see Stagnation). For pain due to Wind-Heat, Duohuo San is indicated; if ineffective, Yinchensan is used. For pain due to Middle Qi Deficiency (where Clear Yang fails to ascend and Turbid Fire flares upward), Buzhong Yiqi Tang should be used (see Qi Deficiency; this condition often presents with distension in the gum spaces preventing chewing). For Heat in the Kidney Meridian due to deficiency, Liuwei Wan is prescribed (see Deficiency Syndromes). If various syndromes cannot be distinguished in detail, Xiaofeng San (see Headache) may be applied topically. Additionally, Chaohei Xiangfu (Charred Cyperi Rhizoma) 3 fen and Chao Yan (Fried Salt) 1 fen, ground together, may be rubbed on the area. Alternatively, Shigao (Gypsum Fibrosum) and Hujiao (Piperis Longi Fructus) ground into powder can be rubbed for immediate relief. If cooling herbs worsen toothache, contrary treatment (Fan Zuo) should be employed: Bi Bo (Long Pepper Fruit), Chuanjiao (Sichuan Pepper), Bohe (Menthae Haplocalycis Herba), Jingjie (Schizonepetae Spica), Xixin (Asari Radix et Rhizoma), Zhangnao (Borneolum Syntheticum), and Qingyan (Halitum) ground into powder and rubbed will dissipate heat without stagnation. For pain relieved by cold and aggravated by heat, where the patient constantly desires cool air, use the bitter-cold properties of Huanglian (Coptidis Rhizoma) and Wutonglü (Styphnolobii Semen) combined with the acrid-cool properties of Boheye (Menthae Haplocalycis Folium) and Jingjiesui (Schizonepetae Spica) to treat Damp-Heat. Add Shengma (Cimicifugae Rhizoma) to guide to the Stomach Meridian, Yangjiaohui (Cornu Bubali Ash) to guide to the Kidney Meridian, and a small amount of Shexiang (Moschus) ground into powder for topical application. Also administer Tiaowei Chengqi Tang (see Constipation) minus Mangxiao, plus Huanglian, to purge three to five times. For unbearable pain due to Stomach Heat radiating to the head, with facial fever and severe pain, where teeth prefer cold and dislike heat, use Qingwei San. Some cases hurt upon exposure to cold due to constrained Heat; some dislike Wind-Cold because Heat is constrained by Wind-Cold, leading to aversion; Jifeicao San (see Cough) is indicated. For red flesh protruding from gum spaces, Xiaofeng San (see Headache) taken with tea before bed is suitable. Decoct Jingjie, Fangfeng, Baizhi, and Fengfang (Vespa Nidus) for frequent mouth rinsing. Cases with simultaneous aversion to cold and heat involve mixed Cold-Heat pathogens; Danggui Longdan San or Yizhi Mulu San are appropriate. If aversion to cold exceeds aversion to heat (Cold > Heat), Caodoukou San is used. If aversion to heat exceeds aversion to cold (Heat > Cold), Lifxiao San or Shexiang San are used. For upper toothache, Shengma San is used; for those disliking heat, moxa is applied to Zusanli (ST36). For lower toothache, Baizhi San is used; for those disliking cold, moxa is applied to Sanjian (LI3). For Kidney Deficiency causing floating gums, loosening, impending loss, and pain, select Liuwei Wan, Bawei Wan (both see Deficiency Syndromes), or Heixi Dan (see Hiccups). Progressive elongation of teeth making eating difficult is called Marrow Overflow (Sui Yi), caused by Kidney Water failing to store and floating superficially; wash the mouth and drink Baizhu decoction. Regular brushing with Laoya San, Baiya San, or Yangjing San strengthens teeth.

Dental caries persisting for years should be treated as Yangming Blood Accumulation; Taoren Chengqi Tang (see Blood Syndromes) dosage, prepared as pills, is taken. Alcoholics are prone to this (refer to Epistaxis in Blood Syndromes). For worm-caused toothache, insert Lushui (Aloe) and Baijiaoxiang (Elemi Resin) into the cavity. Insert sharp pine resin into the hole; after a moment, worms crawl out onto the resin. Rinse with warm rice vinegar to remove worms for cure. Smoke Tianxianzi (Datura Seed) using a bamboo tube against the tooth to fumigate until worms die. Place oil-mixed Jiuzi (Allii Tuberosi Semen) on a water tile, burn smoke over a bowl of water covered by a funnel to fumigate teeth; needle-like worms fall into the water. For pain in empty cavities after worm expulsion, roast Ruxiang (Olibanum) until soft and pack the site. Mix Zhangnao and Chuanjiao (5 fen each), grind, place in a copper spoon, cover with a tea cup, seal edges with thick flour paste to prevent gas escape, apply gentle heat. When Borneol scent is detected, remove, cool on ground, open, collect sublimated medicine from cup bottom, store in porcelain. Apply small amount to painful spot for immediate relief.

For gingival recession, decoct Manjingzi (Viticis Fructus), Shengdihuang (Rehmanniae Radix), Digupi (Lycii Cortex), Qinghao (Artemisiae Annuae Herba) each 1 liang, and Yuligenpi (Prunus Humilis Root Bark) 2 liang. Use 5 qian per dose, decoct in water, hold hot in mouth, spit out when cool. Mix earthworm feces with water to make mud, fire until red-hot, grind to powder, mix with pig fat from the twelfth lunar month, apply externally three times daily. For loose teeth, use Huanshao Dan or Dihuang Wan (see Deficiency Syndromes). For Yin Deficiency with internal Heat, use Ganlu Yin.

For failure of teeth to erupt, take 30 black beans, burn with cow dung until smoke ceases, grind finely, add a little Shexiang (Moschus), mix evenly. First prick the non-erupting area with a needle to draw blood, then apply medicine. Avoid wind; avoid sour and salty foods. Lu Fengfang San or Chuan Shengma San may be used.

Alveolar Pyorrhea (Yacao Feng) involves persistent toothache, swelling of gingiva extending to cheeks, purple-black discoloration, bleeding, and putrefaction. Add Niuhuang (Calculus Bovis) to Kougan medicines, double Zhenzhu (Pearl) and Ercha (Camellia Leaf Extract), and blow frequently into the lesion. If unhealed for a long time, pus discharges from gum spaces, eventually causing tooth loss, termed Alveolar Fistula (Ya Lou); (loss of upper central incisors is incurable). Use external blowing powders for Kan (mouth ulcers), internally use Yin-nourishing and Fire-descending formulas. After ulceration of Alveolar Pyorrhea, if swelling and hardness persist without pus discharge but with foul blood, it is termed Alveolar Gangrene (Ya Gan). The odor is repulsive; use Qingwei San. Add Fangfeng (Saposhnikoviae Radix) if Wind is present; for severe cases, use Wuyi Xiao Gan Tang to purge several times. For blackened gangrenous lesions, preventing cheek perforation, use Lushui Xiao Gan Yin externally and Renzhongbai (Urinae Siccata) powder externally. Rapid progression, rotting one fen per day or one cun per two days, killing fastest, is called Running Horse Gangrene (Zou Ma Gan). Red spots on nasal bridge like cinnabar or loss of upper central incisors indicate death; add Niuhuang to Kougan medicines (see Mouth). Post-smallpox toxin eruption often manifests as this syndrome. Alternatively, burn Lvfan (Green Vitriol) on a rusty iron vessel until dry. Clean mouth with green silk dipped in strong tea, then apply. If aversion to cold and preference for heat indicates Stomach Qi injury, use Buzhong Yiqi Tang (see Deficiency Syndromes).

Dental Abscess (Ya Yong), commonly known as Ya Qi, initially presents as linear swelling and hardness of gingiva above, below, inside, or outside. Blow Kougan medicine into it. "Ya Yao" refers to swelling at the end of the teeth. Initial stage is vigorous, with severe night pain; treat with Qingyang Sanhuo Tang, externally blow Jin Dan and Bi Dan (both see Throat). If trismus (lockjaw) occurs, carve Huangshu Xiang (Benzoin Resin) into a nail, gradually pry open the jaw, then apply blowing powder. Gingival swelling like a bean, located variably inside or outside, first treat with Jin Dan, then Kougan medicine.

Penetrating Dental Carbuncle (Chuan Ya Ding) begins with two days of toothache and chills/fever, followed by intensified pain and a purple patch on the gingiva with purple-black discoloration. Treat with Jin Dan and Bi Dan blown into the site, internally administer Blood-cooling, Fire-clearing, and Detoxifying agents. If ruptured, add Niuhuang to Kougan medicine. Infantile "Horse Teeth" appear as white, brittle-bone-like structures on the gingiva; sneezing precedes this toxicity. Prick daily with a needle. "Ya Chu" (tooth soreness) is caused by acidic food; walnuts resolve it.

Generalized gingival bleeding: Grind Gouqi (Lycii Fructus), decoct for rinsing, then swallow; bleeding stops immediately. Alternatively, burn horse manure to ash (retain nature), rub on gums for immediate hemostasis.

To extract teeth: Grind Fengxianhua Zi (Impatiens Balsamina Seed), sprinkle on gum root for natural detachment. Gan Yuzanhua Gen (Disporum Cantoniense Root) is also effective.