澄曰∶牙漏之患，多起于心胃火郁，肾阴消涸，或心事郁遏。多起于上门牙龈上，
或下门牙龈上，初则高肿作痛，久则上现黄泡，破后出脓渐安，虽然出脓，其口难
完，细如针孔。但遇操劳，或心绪烦扰，或
煎炒烟酒过度，发则肿痛，时出秽脓，更有串至左右齿根，遂成牙漏，虽不致命，颇
亦为累。初起治宜升阳散火，久则当用六味地黄汤加元参、钗斛，多服久服，自可
全愈。初治切不可妄用苦寒之药，内服外搽，致令心胃之火郁而又郁，反使火毒根
株愈深。亦不可早用敛药，亦能使火毒内敛，便有腐蚀脱龈、落齿之害。吹药，在
牙疳口疮门中，选用。
又曰∶溃后饮食后必须漱洗，庶不致饮食塞其脓窍，反令胀痛。
又曰∶远年近日，牙漏穿蚀，久不收功，用鲜竹一颗，锯成一头留节，一头无
节数段，将食盐装结实了，放炭火上 红，取出冷定去竹，将盐研细。每日擦漏齿上，
久则收功，经验多人。
岐天师曰∶牙宣，又名齿衄。齿乃骨之余，肾之所主也。肾火外越，故齿出血，
以六味地黄汤，加骨碎补一钱治之。（《秘录》）
陈实功曰∶牙龈血出如线，或鲜血时从外溢，名曰牙宣。此乃心肾火邪，逼血
妄行之故，治当凉心滋肾为主。如血出如线，其涌如泉者危。（《正宗》）
冯鲁瞻曰∶小儿二三岁后，乳食互进，或醉后房劳乳儿，致成肾疳。啼时满口皆
血，名曰宣露。（《锦囊》）
又曰∶凡血从齿缝中或齿根出者，谓之齿衄。有风壅，有肾虚。风壅者，清风
散，外以祛风擦牙散；肾虚者，以肾主骨，齿者骨之余，虚火上炎，服凉药而愈甚者，
此属肾虚，上盛下虚，宜盐汤下安肾丸，仍用青盐炒香附黑色为末擦之。然少阴气多
血少，故其血必点滴而出，齿亦隐隐而痛，多欲者犯之。亦有胃热而齿断出血者，阳
明气血俱多，火旺则血如潮涌，善饮者多犯此。宜清其热，清胃散主之。
又曰∶齿缝出血者，以大剂六味地黄
汤加骨碎补一剂即瘥。间有不瘥者，肾中火衰也，再加五味子、肉桂而愈。
窦汉卿曰∶牙宣，谓脾胃中热涌而宣露也，亦名龈宣。此候牙齿缝中出血，上
属脾，下属肾，吐血痰至斗，为难疗者。急宜速治，迟则难生。先用蚌水灌净，然后吹药。（《全书》）
汪省之曰∶牙宣乃阳明胃经实火上攻，故血从牙缝中出也。血出不止者杀人。（《理例》）
又曰∶胃虚火动，腐烂牙龈，亦能有此；但常常渗流淡血不止，非同实火鲜血
直出也。实火以清胃石膏汤为主；虚火宜归芍地黄汤为主。如齿龈腐烂血出不止者，
犀角地黄汤、人中白散主之。
奎光曰∶牙宣，乃齿缝出血，上属脾，下属胃，实火上攻所致。亦有胃虚火动，腐
烂牙龈，以致淡血渗漏不止，内服扶脾清火之剂，外用珍珠散吹。
Gu Shicheng stated: The condition of dental fistula (Ya Lou) often arises from the stagnation of fire in the Heart and Stomach, depletion of Kidney Yin, or emotional suppression. It typically originates on the gums of the upper or lower central incisors. Initially, there is high swelling and pain; over time, yellow blisters appear on the gums. After rupture, pus drains and symptoms temporarily alleviate, yet the wound remains difficult to heal, resembling a needle hole. Upon exertion, mental agitation, or excessive consumption of fried foods, tobacco, and alcohol, it flares up with swelling and pain, discharging foul-smelling pus. In severe cases, it may spread to the roots of adjacent teeth, forming a dental fistula. Although not fatal, it causes significant distress. In the early stage, treatment should focus on raising Yang and dispersing fire. For chronic cases, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) combined with Xuanshen (Scrophulariae Radix) and Chaihu (Dendrobii Caulis) should be taken for an extended period for complete recovery. Early treatment must strictly avoid bitter-cold herbs, whether ingested or applied externally, as this will further stagnate Heart and Stomach fire, deepening the root of fire-toxin. Astringent herbs should also not be used prematurely, as they may trap fire-toxin internally, leading to gum erosion and tooth loss. For insufflation therapy (Chui Yao), refer to the formulas in the section on Dental Gangrene and Mouth Ulcers.
He further stated: After ulceration, rinsing and cleaning must be performed after every meal to prevent food debris from blocking the pus drainage orifice, which would otherwise cause distension and pain.
He also stated: For long-standing dental fistulas with tissue erosion that fail to heal, take one fresh bamboo shoot, saw it into sections leaving one node at one end and several nodes-less sections at the other. Pack these tightly with salt, roast them red over charcoal fire, allow to cool, remove the bamboo, and grind the salt into fine powder. Apply this daily to the affected tooth until healing occurs. This method has been verified effective by many.
Master Qi stated: Ya Xuan (Gum Recession/Periodontal Disease), also known as Chi Nu (Tooth Bleeding), involves teeth which are the surplus of bone and governed by the Kidney. When Kidney fire escapes outward, it causes bleeding from the teeth. Treat with Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) plus Gusuibu (Drynariae Rhizoma), 1 qian. (From *Mi Lu*)
Chen Shigong stated: When gum bleeding appears like a thread or fresh blood oozes externally, it is called Ya Xuan. This results from Heart and Kidney fire pathogens forcing blood to move recklessly. Treatment should primarily clear the Heart and nourish the Kidney. If blood gushes out like a spring, the prognosis is critical. (From *Zheng Zong*)
Feng Luzhan stated: After children reach two or three years of age, if milk and solid foods are introduced improperly, or if a mother nurses while intoxicated, it can lead to Kidney Gan (Childhood Malnutrition Syndrome). The child cries with a mouth full of blood, termed Xuan Lu. (From *Jin Nang*)
He further stated: Any bleeding from the gingival sulcus or tooth root is termed Chi Nu. Etiologies include Wind Obstruction and Kidney Deficiency. For Wind Obstruction, use Qing Feng San (Clear Wind Powder) externally with Qu Feng Ca Ya San (Wind-Dispersing Tooth-Rubbing Powder). For Kidney Deficiency, since the Kidney governs bone and teeth are the surplus of bone, if deficiency fire flares upward and cooling herbs worsen the condition, it indicates Kidney Deficiency with Upper Excess and Lower Deficiency. Administer An Shen Wan (Kidney-Anchoring Pill) with salt water, and rub the area with powder made from Qing Yan (Green Salt) and Chao Xiang Fu (Stir-fried Cyperi Rhizoma charred black). However, the Shaoyin channel has abundant Qi but scarce Blood, so bleeding is merely dripping, accompanied by dull tooth pain, often affecting those with excessive sexual desire. There are also cases of tooth fracture and bleeding due to Stomach Heat; the Yangming channel has abundant Qi and Blood, so when fire is vigorous, blood surges like a tide, commonly affecting heavy drinkers. Clear the heat using Qing Wei San (Clear the Stomach Powder) as the primary formula.
He further stated: For bleeding from the gingival sulcus, a large dose of Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) with Gusuibu (Drynariae Rhizoma) cures it in one dose. If it fails to heal, it indicates declining Fire in the Kidney; add Wuweizi (Schisandrae Fructus) and Rougui (Cinnamomi Cortex) to cure it.
Dou Hanqing stated: Ya Xuan refers to gum recession caused by heat surging from the Spleen and Stomach, also named Yin Xuan. This condition involves bleeding from the teeth gaps, associated with the Spleen above and Kidney below. If vomiting blood and phlegm reaches a dou in volume, it is difficult to treat. Immediate treatment is required; delay makes healing difficult. First, irrigate thoroughly with蚌水 (Clam Water), then apply insufflation medicine. (From *Quan Shu*)
Wang Shengzhi stated: Ya Xuan is caused by excess fire attacking from the Yangming Stomach channel, leading to bleeding from the gingival sulcus. Unstoppable bleeding can be fatal. (From *Li Li*)
He further stated: Stomach Deficiency with moving fire can also rot the gums and cause this; however, it typically presents as continuous leakage of pale blood, distinct from the direct flow of fresh blood in excess fire. For excess fire, Qing Wei Shigao Tang (Clear the Stomach Gypsum Decoction) is primary; for deficiency fire, Guishao Dihuang Tang (Angelica and Peony Rehmannia Decoction) is primary. For rotting gums with unstoppable bleeding, Xijiao Dihuang Tang (Rhinoceros Horn Rehmannia Decoction) and Renzhongbai San (Human Ash Powder) are indicated.
Kui Guang stated: Ya Xuan is bleeding from the gingival sulcus, associated with the Spleen above and Stomach below, caused by excess fire attacking. There are also cases where Stomach Deficiency with moving fire rots the gums, causing continuous leakage of pale blood. Internally administer formulas that support the Spleen and clear fire; externally apply Zhenzhu San (Pearl Powder) via insufflation.