【内伤牙衄之症】身无表邪，牙龈出血，一涌而上，来血甚多，此阳明经牙衄之症。
若身无表邪，牙龈时或出血，来血不多，久而不愈，肌肉消瘦，此少阴肾经牙衄之症也。
【内伤牙衄之因】膏粱积热，辛辣炙 ，好酒香燥，肠胃有热，血中伏火，则上冲
而出，若肾阴不足，水中之火上炎，亦令牙龈出血，久而不愈。
【内伤牙衄之脉】脉多洪数；右关洪数，阳明经热；两尺洪数，肾经之血。
【内伤牙衄之治】右关沉数，阳明血热者，犀角地黄汤，加酒浸黄芩。右关洪数，肠
胃积热者，升麻清胃散，加酒蒸大黄。左尺脉数，龙火上冲者，知柏肝肾丸，加玄武胶。
犀角地黄汤 见吐血。
升麻清胃散
升麻 生地 川连 丹皮 山栀 当归 大黄（酒蒸）
知柏肝肾丸
凡治血症，要明血去火亦去，可用血脱益气；若血去火存，但可补血凉血，切不可用温
燥。至牙衄阳明经血热，用升麻清胃汤、酒大黄、生犀角，则血立止；即肾阴不足，亦是阴
虚火旺，用知柏肝肾丸，苟大便不滑，亦加大黄、生犀，要知血得热而妄行，以当归三黄同
煎，则血凉尽而下顺归经，世人不明，妄言当归辛散，不宜治血逆上冲及胎前安胎，岂知血
热上冲，凉血则下顺归经，胎前血热、胎气不宁，仲景立安胎饮，用当归、黄芩各一斤，以
血中热减，则归经养胎而自安。家秘化四物三黄同用，治血热上冲，开化方妙法。
[Symptoms of Internal Injury Gingival Bleeding] The body has no exterior pathogenic factors (pathogens located at the exterior level, typical of early-stage exogenous diseases), gingival bleeding occurs, with blood gushing out rapidly and in large volume; this is a symptom of Yangming Meridian gingival bleeding.
If the body has no exterior pathogenic factors, but gingival bleeding occurs occasionally, with small volume, persisting for a long time without healing, accompanied by emaciation, this is a symptom of Shaoyin Kidney Meridian gingival bleeding.
[Etiology of Internal Injury Gingival Bleeding] Accumulation of heat from prolonged consumption of rich and sweet foods, preference for spicy and roasted foods, indulgence in alcohol and aromatic/dry substances, leading to heat in the intestines and stomach, latent fire within the blood, which then rushes upward and causes bleeding; if Kidney Yin is insufficient, the ministerial fire rising from water also causes gingival bleeding, persisting for a long time without healing.
[Pulse Diagnosis of Internal Injury Gingival Bleeding] The pulse is mostly Hong-Shu (Surging and Rapid: wide and forceful like waves, strong on arrival and weak on departure, with rapid frequency); Hong-Shu at the Right Guan position (corresponding to Spleen and Stomach) indicates Heat in the Yangming Meridian; Hong-Shu at both Chi positions (corresponding to Kidneys) indicates Heat in the Blood aspect of the Kidney Meridian.
[Treatment of Internal Injury Gingival Bleeding] If the Right Guan pulse is Chen-Shu (Deep and Rapid), indicating Yangming Blood Heat, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) added with Huangqin (Scutellaria Root) soaked in wine. If the Right Guan pulse is Hong-Shu, indicating accumulated Heat in the Intestines and Stomach, use Shengma Qingwei San (Cimicifuga Powder to Clear the Stomach) added with Dahuang (Rhubarb Root) steamed with wine. If the Left Chi pulse is Shu, indicating Ministerial Fire rushing upward, use Zhibai Lishen Wan (Anemarrhena, Phellodendron and Liver-Kidney Pill) added with Xuanwu Jiao (Tortoise Shell Glue).
Xijiao Dihuang Tang See section on Hematemesis.
Shengma Qingwei San
Ingredients: Shengma (Cimicifugae Rhizoma), Shengdi (Rehmanniae Radix Preparata), Chuanlian (Coptidis Rhizoma), Danpi (Moutan Cortex), Shanzhi (Gardeniae Fructus), Danggui (Angelicae Sinensis Radix), Dahuang (Rhei Radix et Rhizoma) steamed with wine.
Zhibai Lishen Wan
In treating blood disorders, one must understand that when blood is lost, fire often dissipates with it; thus, the method of "Tonifying Qi for Blood Loss" (using Qi tonification to generate or secure blood) may be applied. However, if blood is lost but fire remains, only Blood-nourishing and Blood-cooling methods should be used; warm and drying herbs must strictly be avoided. For gingival bleeding due to Yangming Meridian Blood Heat, using Shengma Qingwei Tang, wine-processed Dahuang, and raw Xijiao (Rhinoceros Horn) will stop bleeding immediately. Even in cases of Kidney Yin insufficiency, which constitutes Yin Deficiency with Fire Hyperactivity, Zhibai Lishen Wan is used; provided there is no loose stool, Dahuang and raw Xijiao can also be added. It must be known that blood acts recklessly when heated; decocting Danggui with Sanhuang (typically Huanglian, Huangqin, and Dahuang) cools the blood, allowing it to descend smoothly and return to its vessels. People who do not understand this falsely claim that Danggui’s acrid dispersing nature makes it unsuitable for treating rebellious blood flow or for calming the fetus during pregnancy. They fail to realize that cooling blood allows rebellious blood to descend and return to its vessels; for fetal restlessness due to Blood Heat during pregnancy, Zhang Zhongjing established Antai Yin (Calming Fetus Decoction), using equal parts of Danggui and Huangqin. As heat in the blood subsides, blood returns to its vessels to nourish the fetus, ensuring natural stability. A secret family formula combines Siwu Tang (Four Substances Decoction) with Sanhuang to treat rebellious blood flow due to Blood Heat, representing a brilliant method of formula transformation.