人有牙齿痛甚不可忍，涕泪俱出者，此乃脏腑之火旺，上行于牙齿而作痛也。
治法不泻其火则不能取效。然火实不同，有虚火，有实火，大约虚火动于脏，实火
起于腑。而实火之中，有心包之火，有胃火；虚火之中有肝火，有脾火，有肺火，
有肾火。同一齿痛，何以别之？不知各经在齿牙之间，各有部位也。两门牙上下四
齿，同属心包也，门牙旁上下四齿，属肝也，再上下四牙乃胃也，再上下四牙乃脾
也，再上下四牙乃肺也，再上下之牙乃肾也。大牙亦属肾，肾经有三牙齿，多者贵。
治病不论多寡，总以前数分治之多验。火既有如许之多，而治火之法，宜分经以治
之矣。虽然，吾实有统治火之法，方用治牙仙丹∶
玄参（一两） 生地（一两） 水煎服。
无论诸火，服之均效。察其为心包之火，加黄连五分；察其为肝经之火，加炒
栀子二钱；察其为胃经之火，加石膏五钱；察其为脾经之火，加知母一钱；察其为
肺经之火，加黄芩一钱；察其为肾经之火，加熟地一两。饮一剂而火轻，再剂而火
散，四剂而平复如故矣。
夫火既有虚实不同，何以一方而均治？不知火之有余，无非水之不足也。我滋
其阴，则阴阳之火，无不相戢矣。况玄参尤能泻浮游之火，生地亦能止无根之焰，
二味又泻中有补，故虚实咸宜，实治法之巧，而得其要者也。况又能辨各经之火，
而加入各经之药，有不取效如神乎。或曰∶火生于风，牙齿之疼，未有不兼风者，
治火而不治风，恐非妙法。不知火旺则生风，未闻风大而生火，人身苟感风邪，则
身必发热，断无风止人牙而独痛之理。况火病而用风药，反增其火热之势，是止痛
而愈添其痛矣。或疑膀胱有火，肝经有火，心经有火，大小肠、三焦俱有火，何俱
遗之而不言，不知脏病则腑亦病，腑病则脏亦病，治脏不必治腑，泻腑不必又泻脏，
况膀胱、心与三焦、大小肠俱不入于齿牙，故略而不谈也。
此症外治亦可，用荜芫汤∶
荜茇 芫花（各二钱） 水一碗煎半盏，漱口即止痛。
内治用沙豆汤亦妙。
沙参（一两） 荆芥 丹皮（各三钱） 山豆根（一钱） 水煎服。二剂即愈。
人有多食肥甘，齿牙破损而作痛，如行来行去者，乃虫痛也。夫齿乃骨之余，
其中最坚，何能藏虫乎？不知过食肥甘，则热气在胃，胃火日冲于口齿之间，而湿
气乘之，湿热相搏而不散，乃虫生于牙矣。初则止生一二虫，久则蕃衍而多，于是
蚀损其齿，遂致堕落。一齿既朽，又蚀余齿，往往有终身之苦者。此等之痛，必须
外治，若用内治之药，未必杀虫，而脏腑先受伤矣。方用五灵至圣散∶
五灵脂（三钱，研绝细末） 白薇（三钱） 细辛（五分） 骨碎补（五分） 各研为细末。先用滚水含
漱齿至净，然后用前药末五分，滚水调如稀糊，含漱齿半日，至气急吐出，如是者三次，痛止而
虫亦死矣，断不再发。
盖齿痛原因虫也，五灵脂、白薇最杀虫于无形，加入细辛以散火，骨碎补以透骨，引五灵脂、
白薇直进于骨内，则虫无可藏，尽行剿杀，虫死而痛自止也。
此症用破颜丹，亦可外治，甚效。
丹砂（三分） 麝香（半分） 冰片（一分） 雄黄（一钱） 为细末，将末搽于痛处，口吐涎而痛
立止。
内治亦可用安宁饮∶
玄参 生地 麦冬（各五钱） 白薇（一钱） 骨碎补（五钱） 天门冬（三钱） 水煎服。三剂亦愈。
人有牙痛日久，上下牙床尽腐烂者，至饮食不能用，日夜呼号，此乃胃火独盛，
有升无降之故也。人身之火，惟胃最烈，火既升于齿牙，而齿牙非藏火之地，于是
焚烧于两颊，而牙床红肿，久则腐烂矣。似乎亦可用治牙仙丹加石膏以治之，然而
其火蕴结，可用前方，以消弭于无形，今既已溃破腐烂，则前方又不可用，以其有
形难于补救也。方用竹叶石膏汤加减∶
石膏（五钱） 知母（二钱） 半夏（二钱） 茯苓（三钱） 麦冬（三钱） 竹叶（二百片）
葛根（三钱） 青蒿（五钱）
水煎服。连服四剂，而火退肿消矣。然后再用治牙仙丹，以收功也。
石膏汤以泻胃火，用之足矣，何加入葛根、青蒿也？不知石膏但能降而不能升，
增入二味，则能引石膏至于齿牙以逐其火。而葛根、青蒿尤能退胃中之阴火，所以
同用之以出奇，阴阳之火尽散，齿牙之痛顿除，何腐烂之不渐消哉。
此症可用石母降炎汤∶
石膏 茯苓 荆芥（炒黑，各三钱） 知母（一钱） 麦冬（一两） 玄参（一两） 甘草（一钱）
升麻（五分） 天花粉（三钱） 水煎服。
四剂全愈。
人有牙齿疼痛，至夜而甚，呻吟不卧者，此肾火上冲之故也。然肾火乃虚火，
非实火也，若作火盛治之，多不能胜，即作虚火治之，亦时而效时而不效。盖火盛
当作火衰，有余当认作不足，乃下虚寒，而上现假热也。人身肾中不寒，则龙雷之
火下安于肾宫，惟其下寒之甚，而水又无多，于是上冲于咽喉，而齿牙受之。正如
龙雷之火，至冬则地下温暖而龙雷皆蛰，春气发动，则地底寒冷而不可蛰，乃随阳
气上升矣。至于夜分，尤肾水主事，水不能养火，而火自游行于外，仍至齿而作祟。
譬如家寒难以栖处，必居子舍而作威，而子又贫乏，自然触动其怒气矣。治法急大
补其肾中之水，而益以补火之味，引火归源，则火有水以养之，自然快乐，而不至
于上越矣。方用八味地黄汤加骨碎补治之，一剂而痛止，再剂而痛不发也。
盖六味地黄汤补其肾水，桂附引火以归于命门，但补水引火之药，不先入齿中，
则痛之根不能除，所以必用骨碎补以透入齿骨之中，而后直达于命门之内，此拔本
塞源之妙法耳。
此症亦可用制火汤∶
熟地（二两） 生地（一两） 玄参（五钱） 肉桂（三分） 骨碎补（一钱） 车前子（二钱）
水煎服。二剂即止痛。
人有上下齿牙疼痛难忍，闭口少轻，开口更重，人以为阳明之胃火也，谁知是
风闭于阳明、太阳二经之间乎。此病得之饮酒之后，开口向风而卧，风入于齿牙之
中，留而不出，初小疼而后大痛也。论理去其风宜愈，而风药必耗人元气，因虚以
入风，又耗其气，则气愈虚，风邪即欺正气之怯而不肯出，疼终难止也。古人有用
灸法甚神，灸其肩尖微近骨后缝中，小举臂取之，当骨解陷中，灸五壮即瘥。但灸
后，项必大痛，良久乃定，而齿疼永不发也。然而人往往有畏灸者，可用散风定痛
汤治之。
白芷（三分） 石膏（二钱） 升麻（三分） 胡桐泪（一钱） 当归（三钱） 生地（五钱）
麦冬（五钱） 干葛（一钱） 天花粉（二钱） 细辛（一钱） 水煎服。一剂轻，二剂即愈，不必三剂
也。此方补药重于风药，正以风得补而易散也。
此症可用宣扬散∶
柴胡（五分） 白芍（五钱） 甘草 白芷 干葛 细辛（各一钱） 青蒿（三钱） 天花粉（三钱）
石膏（二钱） 水煎服。二剂愈。
人有上下齿痛甚，口吸凉风则暂止，闭口则复作，人以为阳明之火盛也，谁知
是湿热壅于上下之齿而不散乎。夫湿在下易散，而湿在上难祛，盖治湿不外利小便
也。水湿下行其势顺，水湿上散其势逆，且湿从下受易于行，湿从上感难于散，故
湿热感于齿牙之间，散之尤难。以饮食之水，皆从口入，必经齿牙，不已湿而重湿
乎。湿重不散，而火且更重矣，所以经年累月而痛，不能止也。治法必须上祛其湿
热，又不可单利小便，当佐之以风药，则湿得风而燥，热得风而凉，湿热一解，而
齿痛自愈矣。方用上下两疏汤∶
茯苓（五钱） 白术（三钱） 泽泻（二钱） 薏仁（五钱） 防风（五分） 白芷（三分） 升麻（三分）
荆芥（二钱） 胡桐泪（五分） 甘草（一钱） 水煎服。四剂而湿热尽解，而风亦尽散也。
盖茯苓、白术、泽泻、薏仁原是上下分水之神药，又得防风、白芷、升麻、荆
芥风药以祛风。夫风能散湿，兼能散火，风火既散，则湿邪无党，安能独留于牙齿
之间耶，仍恐邪难竟去，故加入甘草、胡桐泪引入齿缝之中，使湿无些须之留，又
何痛之不止耶。况甘草缓以和之，自不至相杂而相犯也。
A person suffers from severe toothache that is unbearable, accompanied by flowing tears and nasal discharge. This is caused by the excessive fire of the Zang and Fu organs ascending to the teeth.
If the treatment does not purge the fire, it cannot be effective. However, fire is not uniform; there are deficient fire (Xu Huo) and excess fire (Shi Huo). Generally, deficient fire originates from the Zang organs, while excess fire arises from the Fu organs. Among excess fires, there is Pericardium fire and Stomach fire; among deficient fires, there is Liver fire, Spleen fire, Lung fire, and Kidney fire. Since they all present as toothache, how can they be distinguished? The answer lies in the fact that each meridian has specific locations within the teeth. The four upper and lower central incisors belong to the Pericardium; the four upper and lower lateral incisors belong to the Liver; the next four upper and lower premolars belong to the Stomach; the following four upper and lower molars belong to the Spleen; the subsequent four upper and lower molars belong to the Lung; and the innermost upper and lower molars belong to the Kidney. The large molars also belong to the Kidney meridian, which corresponds to three teeth; having more teeth is considered auspicious. In treating disease, regardless of the number of teeth, one should always treat according to these meridians, which yields high efficacy. Given the variety of fires, the method of treating fire should be differentiated by meridian. Nevertheless, I possess a comprehensive method for treating all types of fire, using the formula *Zhi Ya Xian Dan* (Fairy Elixir for Toothache):
*Shu Di Huang* (Prepared Rehmannia Root, 1 liang), *Sheng Di Huang* (Fresh Rehmannia Root, 1 liang). Decoct in water and take orally.
This formula is effective for any type of fire. If it is identified as Pericardium fire, add *Huang Lian* (Coptis Rhizome, 5 fen); if Liver meridian fire, add *Chao Shan Zhi Zi* (Stir-fried Gardenia Fruit, 2 qian); if Stomach meridian fire, add *Shi Gao* (Gypsum Fibrosum, 5 qian); if Spleen meridian fire, add *Zhi Mu* (Anemarrhena Rhizome, 1 qian); if Lung meridian fire, add *Huang Qin* (Scutellaria Root, 1 qian); if Kidney meridian fire, add *Shu Di Huang* (Prepared Rehmannia Root, 1 liang). After one dose, the fire subsides; after two doses, the fire dissipates; after four doses, recovery is complete.
Since fire differs in deficiency and excess, how can one formula treat both? It is because an excess of fire is essentially a deficiency of water. By nourishing Yin, the fire of both Yin and Yang will harmonize. Moreover, *Xuan Shen* (Scrophularia Root) specifically clears floating fire, and *Sheng Di Huang* stops rootless flames. These two herbs clear heat while tonifying, making them suitable for both deficiency and excess. This is a clever therapeutic approach that grasps the essence. Furthermore, by identifying the fire of each meridian and adding corresponding herbs, why would it not be miraculously effective? Some may argue: Fire generates wind, and toothache is rarely without wind involvement. Treating fire without addressing wind may not be a subtle method. However, excessive fire generates wind; it is unheard of for strong wind to generate fire. If the body contracts wind pathogen, fever must occur; there is no scenario where wind causes only toothache without systemic symptoms. Additionally, using wind-dispersing herbs for fire diseases exacerbates the heat, increasing pain rather than relieving it. Others might question: Why omit Bladder fire, Liver fire, Heart fire, Small Intestine fire, Large Intestine fire, and San Jiao fire? Because Zang and Fu organs are interrelated; treating the Zang addresses the Fu, and purging the Fu addresses the Zang. Moreover, the Bladder, Heart, San Jiao, and Intestines do not directly connect to the teeth, so they are briefly mentioned.
External treatment is also possible using *Bi Yan Tang* (Piper and Genkwa Decoction):
*Bi Bo* (Long Pepper Fruit, 2 qian), *Yuan Hua* (Genkwa Flower, 2 qian). Decoct in one bowl of water until half remains, then use for mouthwash to stop pain immediately.
Internal treatment with *Sha Dou Tang* (Adenophora and Soybean Decoction) is also excellent.
*Sha Shen* (Glehnia Root, 1 liang), *Jing Jie* (Schizonepeta Spike, 3 qian), *Dan Pi* (Moutan Cortex, 3 qian), *Shan Dou Gen* (Sophora Tonkinensis Root, 1 qian). Decoct in water and take orally. Cure occurs in two doses.
Some individuals suffer from toothache due to excessive consumption of rich and sweet foods, leading to dental decay and throbbing pain. This is "worm pain." Teeth are extensions of bone, the hardest tissue, so how can worms reside there? Excessive intake of rich foods creates heat in the Stomach. Stomach fire constantly assaults the oral cavity, and dampness exploits this condition. The interaction of damp-heat breeds worms in the teeth. Initially, one or two worms appear, but over time they multiply, eroding the teeth until they fall out. One decaying tooth infects others, causing lifelong suffering. Such pain requires external treatment; internal medicines may fail to kill worms and damage the Zang-Fu organs first. Use *Wu Ling Zhi Sheng San* (Five-Spirit Supreme Powder):
*Wu Ling Zhi* (Trogopterus Dung, 3 qian, finely ground), *Bai Wei* (Cynanchum Atratum Root, 3 qian), *Xi Xin* (Asarum Root, 5 fen), *Gu Sui Bu* (Drynaria Rhizome, 5 fen). Grind each into fine powder separately. First, rinse teeth thoroughly with boiling water. Then, mix 5 fen of the powder with boiling water to form a thin paste, hold in the mouth for half a day, and spit out when breath becomes short. Repeat three times. Pain ceases, worms die, and recurrence is prevented.
The cause of toothache is worms. *Wu Ling Zhi* and *Bai Wei* kill worms invisibly. *Xi Xin* disperses fire, and *Gu Sui Bu* penetrates bone, guiding the other herbs into the bone to eradicate worms completely. Once worms die, pain stops.
External treatment with *Po Yan Dan* (Face-Breaking Pill) is also highly effective.
*Dan Sha* (Cinnabar, 3 fen), *She Xiang* (Musk, 0.5 fen), *Bing Pian* (Borneol, 1 fen), *Xiong Huang* (Realgar, 1 qian). Grind into fine powder and apply to the painful area. Saliva secretion increases, and pain stops instantly.
Internal treatment with *An Ning Yin* (Peaceful Drink) is also applicable.
*Xuan Shen*, *Sheng Di Huang*, *Mai Dong* (Ophiopogon Tuber, 5 qian each), *Bai Wei* (1 qian), *Gu Sui Bu* (5 qian), *Tian Men Dong* (Asparagus Tuber, 3 qian). Decoct in water and take orally. Cure occurs in three doses.
Some patients suffer from chronic toothache with complete rotting of the upper and lower gums, unable to eat or drink, crying day and night. This is due to excessive Stomach fire rising without descending. Stomach fire is the fiercest in the body. When it rises to the teeth, which cannot contain fire, it burns the cheeks, causing gum redness and swelling, eventually leading to rot. One might consider using *Zhi Ya Xian Dan* plus *Shi Gao*, but since the fire is entrenched and now manifested as physical rot, the previous formula is unsuitable for有形 (tangible) lesions. Use modified *Zhu Ye Shi Gao Tang* (Bamboo Leaf and Gypsum Decoction):
*Shi Gao* (5 qian), *Zhi Mu* (2 qian), *Ban Xia* (Pinellia Tuber, 2 qian), *Fu Ling* (Poria, 3 qian), *Mai Dong* (3 qian), *Zhu Ye* (Bamboo Leaves, 200 leaves), *Ge Gen* (Kudzu Root, 3 qian), *Qing Hao* (Artemisia Annua Herba, 5 qian). Decoct in water and take orally. Take four doses consecutively to reduce fire and swelling. Follow up with *Zhi Ya Xian Dan* to consolidate the cure.
Why add *Ge Gen* and *Qing Hao* to *Shi Gao Tang* for clearing Stomach fire? *Shi Gao* descends but does not ascend. Adding these two guides *Shi Gao* to the teeth to驱赶 (drive away) the fire. *Ge Gen* and *Qing Hao* specifically clear deficient fire in the Stomach. Their combined use is ingenious, dispersing both excess and deficient fire, instantly relieving pain and gradually resolving rot.
Alternatively, use *Shi Mu Jiang Yan Tang* (Mother-of-Stone Flame-Reducing Decoction):
*Shi Gao*, *Fu Ling*, *Jing Jie* (Stir-fried black, 3 qian each), *Zhi Mu* (1 qian), *Mai Dong* (1 liang), *Xuan Shen* (1 liang), *Gan Cao* (Licorice Root, 1 qian), *Sheng Ma* (Cimicifuga Rhizome, 5 fen), *Tian Hua Fen* (Trichosanthes Root, 3 qian). Decoct in water and take orally. Complete cure in four doses.
Some experience worsening toothache at night, moaning and unable to sleep, due to Kidney fire rushing upward. However, Kidney fire is deficient fire, not excess. Treating it as excess often fails; treating it as deficient yields inconsistent results. One must view apparent excess as deficiency and apparent fullness as emptiness. This is lower jiao cold with upper jiao false heat. If the Kidney is not cold, the Dragon-Lei fire rests in the Kidney palace. Due to extreme lower cold and insufficient water, the fire rushes to the throat and teeth. Like Dragon-Lei fire hibernating in warm winter earth but rising in cold spring, nighttime is governed by Kidney water. Insufficient water fails to nourish fire, allowing it to wander externally to the teeth. It is like a poor son hosting an angry father; the father's anger is triggered by the son's poverty. Treatment requires massively tonifying Kidney water and adding fire-tonifying herbs to guide fire back to its source (*Yin Huo Gui Yuan*). With water to nourish it, the fire becomes content and does not rise. Use *Ba Wei Di Huang Wan* (Eight-Ingredient Rehmannia Pill) plus *Gu Sui Bu*. Pain stops after one dose, recurrence prevents after two.
*Liu Wei Di Huang Wan* tonifies Kidney water; *Gui Zhi* (Cinnamon Twig) and *Fu Zi* (Aconite Root) guide fire to the Mingmen gate. However, to remove the root of pain, herbs must enter the teeth first. *Gu Sui Bu* penetrates the tooth bone, reaching the Mingmen, achieving the effect of pulling up the root and blocking the source.
Alternatively, use *Zhi Huo Tang* (Fire-Restraining Decoction):
*Shu Di Huang* (2 liang), *Sheng Di Huang* (1 liang), *Xuan Shen* (5 qian), *Rou Gui* (Cinnamon Bark, 3 fen), *Gu Sui Bu* (1 qian), *Che Qian Zi* (Plantago Seed, 2 qian). Decoct in water and take orally. Pain stops after two doses.
Some suffer unbearable toothache, relieved slightly by closing the mouth and worsened by opening it. People attribute this to Yangming Stomach fire, but it is actually wind obstructing between the Yangming and Taiyang meridians. This occurs after drinking alcohol and sleeping with the mouth open facing the wind. Wind enters the teeth and stays, causing initial mild pain progressing to severe pain. While wind-dispersing herbs should help, they consume Qi. Since the patient is already deficient, further Qi loss makes the pathogen cling to the weak Zheng Qi, preventing expulsion and perpetuating pain. Ancient practitioners used moxibustion on the shoulder tip near the posterior bone seam (lifting the arm slightly to locate the depression). Five moxa cones cured it. Post-moxibustion neck pain resolves later, and toothache never returns. For those fearing moxibustion, use *San Feng Ding Tong Tang* (Wind-Dispersing Pain-Relieving Decoction):
*Bai Zhi* (Angelica Dahurica Root, 3 fen), *Shi Gao* (2 qian), *Sheng Ma* (3 fen), *Hu Tong Lei* (Tallow Tree Tears, 1 qian), *Dang Gui* (Chinese Angelica Root, 3 qian), *Sheng Di Huang* (5 qian), *Mai Dong* (5 qian), *Gan Ge* (Kudzu Root, 1 qian), *Tian Hua Fen* (2 qian), *Xi Xin* (1 qian). Decoct in water and take orally. Lighter after one dose, cured in two. This formula emphasizes tonics over wind-dispersers, as wind disperses easily when supported by Qi.
Alternatively, use *Xuan Yang San* (Propagating Yang Powder):
*Chai Hu* (Bupleurum Root, 5 fen), *Bai Shao* (White Peony Root, 5 qian), *Gan Cao*, *Bai Zhi*, *Gan Ge*, *Xi Xin* (1 qian each), *Qing Hao* (3 qian), *Tian Hua Fen* (3 qian), *Shi Gao* (2 qian). Decoct in water and take orally. Cured in two doses.
Some have severe upper and lower toothache, temporarily relieved by inhaling cool air and recurring upon closing the mouth. Attributed to Yangming fire, it is actually damp-heat stagnation in the teeth. Dampness below is easy to scatter, but dampness above is hard to remove, primarily treated by promoting urination. Downward flow is natural; upward dispersion is contrary. Dampness acquired from below moves easily; from above, it is hard to disperse. Thus, damp-heat in the teeth is difficult to resolve. Drinking water passes through the teeth, adding dampness to dampness. Heavy dampness traps fire, causing chronic pain. Treatment must clear damp-heat above without solely relying on diuretics; add wind-dispersing herbs. Wind dries dampness and cools heat. Once resolved, pain heals. Use *Shang Xia Liang Shu Tang* (Upper and Lower Both-Draining Decoction):
*Fu Ling* (5 qian), *Bai Zhu* (Atractylodes Macrocephala Rhizome, 3 qian), *Ze Xie* (Alisma Rhizome, 2 qian), *Yi Yi Ren* (Coix Seed, 5 qian), *Fang Feng* (Saposhnikovia Root, 5 fen), *Bai Zhi* (3 fen), *Sheng Ma* (3 fen), *Jing Jie* (2 qian), *Hu Tong Lei* (5 fen), *Gan Cao* (1 qian). Decoct in water and take orally. Damp-heat and wind disperse in four doses.
*Fu Ling*, *Bai Zhu*, *Ze Xie*, and *Yi Yi Ren* separate dampness. *Fang Feng*, *Bai Zhi*, *Sheng Ma*, and *Jing Jie* disperse wind. Wind scatters dampness and fire. Without support, dampness cannot remain in the teeth. To ensure complete removal, *Gan Cao* and *Hu Tong Lei* guide herbs into the gum crevices, leaving no dampness behind. *Gan Cao* harmonizes, preventing conflict among ingredients.