《经》曰∶男子八岁，肾气实，而齿更；三八真牙生；五八则齿槁；八八而齿去矣。
女子亦然，以七为数。盖肾主骨，齿者，体之标，髓之所养也。凡齿属肾，上下断属阳
明，上龈痛，喜寒饮而恶热饮，取足阳明胃，下断痛，喜热饮而恶寒饮，取手阳明大
肠，故病有恶寒热之不同也。凡动摇疼痛出血，或不出血，齿缝疏豁，全具欲落之状
者，皆属肾也。《经》曰∶肾热者，色黑而齿槁。又曰∶少阴经病者，面黑齿长而垢，
其虫疳断肿，不动而滞烂痛秽者，此属阳明，或诸经错杂之邪，与外因为患，俱分虚
实而治，肾经虚寒者，安肾丸、还少丹，重则八味丸。其冬月大寒犯脑，连头痛齿牙动
摇，疼痛者，此太阳并少阴伤寒也。仲景用麻黄附子细辛汤，凡肾虚者多有之，加齿痛
摇动，肢体倦怠，饮食少思者，脾肾亏损之症，安肾丸补中益气并服。如喜寒恶热者，
胃血伤也，消胃汤。恶寒喜热者，胃气伤也，补中益气汤。
齿者，骨之余，肾之标，寄于龈，养于气血，上龈属足阳明胃，下龈属手阳明大
肠。然齿者，骨也。本乎干元以资始，龈者，肉也，本乎坤元以资生，譬之木生于
土，藉土以为养也。故齿之为病，手阳明、足阳明、足少阴三经之所致，盖上下龈属阳
明金也。齿属少阴，水也。故阳明实，则荣荫其齿而坚牢，阳明虚，则齿失所养而浮
豁。故凡动摇脱落，牙脆剥下齿缝渐稀，畏冷畏热浮豁不坚。隐隐而艰，乃肾之本虚，
以致标亦虚焉。至于虫牙浮肿，牙宣出血，臭秽腐烂者，乃肠胃湿热壅盛，所谓热胜则
肉腐也。虚者补之，湿热者泻之，胃火壅者清之，风寒外束者散之，外以末药擦之，甚
而断烂齿落者，犹土崩而木倒也。其治在断，断坚则齿自固矣。走马疳者，热毒上
攻，虚脏所受，肾脏主虚，齿为骨余，上奔而溃，势如走马，故名之。
牙床肿痛，齿痛动摇，或黑烂脱落者，此属阳明湿热，盖此虽属阳明，而生于牙床
上下，乃属阳明大肠与胃，犹木生于土也。肠胃伤于美酒浓味，以致湿热上攻，则牙床
不清，为肿为痛，或出血，或生虫，由是齿不得而安。如地土不坚而树木为之摇动矣。
此宜泻阳明之湿热，则牙床清宁，齿自安固。如调理不退，落齿一二个者，多死不
治。
凡齿病退劳即发，及午后甚者，或口渴面黧及遗精者，皆脾肾虚热，用补中益气，
及六味丸或十全大补汤。
海藏云∶牙齿等龋，臭秽不可近，数年不愈，当作阳明蓄血治。好饮者，多有此
症，桃仁承气汤，为末，蜜丸服之，甚效。
然牙得清凉而痛甚者为寒；口汲凉风而痛止者为热。
牙痛之症，自因伤胃，而素有湿热，故上浮于牙龈之间，遇风寒或冷冻饮料所郁，则湿
热不得外达，故作痛也。其病情有标本之分，用药有湿凉之异，当以寒为标，故外擦
漱之药，宜用荜茇、细辛之类，辛温以散寒开郁，兼可拔散郁热也。以热为本，故内服
之药宜用生地、丹皮、连翘、薄荷之类，辛凉以散热清中。如此内外交攻，标本俱得，
岂有不愈者乎。若骤发大痛者，多属龙火。如疾风暴雷，焚灼草木，最速最烈，必用从
治之法，热药冷冻饮料，则火得其源而归之矣。若投正治，妄用寒凉，益增其病至若痛不可
忍，牵引入脑，喜寒恶热，脉洪数有力者，凉膈散，倍加酒蒸大黄泻之。
干姜、南枣（各烧至存性，即保留药性而去除水分）与枯白矾（等量），研为细末，外敷患处即可痊愈。
《黄帝内经》说：男子八岁时，肾气充实，乳齿脱落恒齿生出；二十四岁（三八）时智齿长出；四十八岁（五八）时牙齿开始干枯；六十四岁（八八）时牙齿脱落。女子也是如此，以七为周期计算。大概因为肾主骨，牙齿是骨骼的外在表现，由骨髓滋养。凡是牙齿的问题归属于肾，上下牙龈的病变归属于阳明经。上牙龈疼痛，喜欢冷饮而厌恶热饮，治疗取足阳明胃经；下牙龈疼痛，喜欢热饮而厌恶冷饮，治疗取手阳明大肠经，所以疾病有怕冷或怕热的不同表现。凡是牙齿松动、疼痛、出血或不出血，牙缝宽大稀疏，完全呈现将要脱落的状况的，都归属于肾。《黄帝内经》说：肾有热的人，面色发黑且牙齿干枯。又说：少阴经患病的人，面色发黑、牙齿显得长且有污垢。如果是虫疳导致的牙龈断肿，不松动但停滞腐烂、疼痛且有秽臭气味，这归属于阳明经，或者是各经错杂的病邪以及外因致病，都要根据虚实分别进行治疗。肾经虚寒的，用安肾丸、还少丹，病情重的用八味丸。如果在冬季大寒侵袭脑部，连带头痛和牙齿动摇疼痛的，这是太阳经与少阴经同时感受伤寒。张仲景使用麻黄附子细辛汤，肾虚的人多有此症，如果伴有牙齿疼痛动摇、肢体倦怠、饮食减少不想进食的，这是脾肾亏损的症状，服用安肾丸并配合补中益气汤。如果喜欢寒冷厌恶炎热的，是胃血受损，用消胃汤。如果厌恶寒冷喜欢温暖的，是胃气受损，用补中益气汤。
牙齿，是骨骼的剩余部分，是肾的外在标志，寄居在牙龈中，由气血滋养。上牙龈属于足阳明胃经，下牙龈属于手阳明大肠经。然而牙齿本质上是骨头，源于乾元（天/阳）以资始；牙龈本质上是肉，源于坤元（地/阴）以资生，就像树木生长在土壤中，借助土壤来供养一样。所以牙齿的疾病，是由手阳明、足阳明、足少阴这三条经脉引起的，大概上下牙龈属于阳明金。牙齿属于少阴水。所以阳明经实证，则营气荫蔽牙齿使其坚固；阳明经虚证，则牙齿失去滋养而浮松稀疏。所以凡是牙齿动摇脱落、牙齿脆弱剥落、牙缝逐渐变稀、怕冷怕热、浮松不坚硬的，隐隐作痛且艰难，这是肾的本源虚弱，导致标部也随之虚弱。至于虫牙浮肿、牙宣出血、恶臭腐烂的，这是肠胃湿热壅盛，所谓热盛则肌肉腐烂。虚证的用补法，湿热的用泻法，胃火壅盛的用清法，风寒外束的用散法，外用药物粉末擦拭，严重到牙龈腐烂牙齿脱落的，就像土崩木倒一样。治疗的关键在于稳固牙龈，牙龈坚固了牙齿自然牢固。走马疳，是热毒向上攻冲，虚弱的脏腑受邪，肾脏主虚，牙齿为骨之余，热气上奔而溃烂，势态如走马般迅速，所以叫这个名字。
牙床肿痛，牙齿疼痛动摇，或者发黑腐烂脱落的，这归属于阳明湿热。虽然这属于阳明经，但生于牙床上下，实际上是阳明大肠与胃的问题，就像树木生长在土壤中一样。肠胃被美酒厚味所伤，导致湿热上攻，那么牙床不清爽，出现肿胀疼痛，或者出血，或者生虫，因此牙齿不得安宁。就像土地不坚固而树木为之动摇一样。这种情况应该泻除阳明经的湿热，那么牙床就会清静安宁，牙齿自然安稳牢固。如果调理后不退，掉落一两个牙齿的，大多死亡无法治愈。
凡是牙齿疾病在劳累后退去又发作，或者午后加重的，或者口渴、面色黧黑以及遗精的，都是脾肾虚热，用补中益气汤，以及六味丸或十全大补汤。
李东垣（海藏）说：牙齿龋坏，恶臭不可靠近，数年不愈的，应当当作阳明蓄血证治疗。喜好饮酒的人，多有这种症状，用桃仁承气汤，研为细末，蜜丸服用，效果很好。
然而，牙齿遇到清凉反而疼痛加剧的是寒证；口吸入凉风而疼痛停止的是热证。
牙痛的病症，起因于损伤胃气，且素有湿热，所以上浮于牙龈之间，遇到风寒或冷冻饮料郁遏，则湿热不能向外发散，所以发生疼痛。其病情有标本之分，用药有温凉之异，应当以寒为标，所以外擦漱口的药物，宜用荜茇、细辛之类，辛温以散寒开郁，兼可拔散郁热。以热为本，所以内服的药物宜用生地、丹皮、连翘、薄荷之类，辛凉以散热清中。这样内外兼治，标本兼顾，哪有不好的呢？如果突然发作剧烈疼痛的，多属于龙火（相火妄动）。像疾风暴雷，焚烧灼烧草木，速度最快最猛烈，必须用从治的方法，用热药配合冷冻饮料，那么火就能找到源头而归顺。如果采用正治法，妄用寒凉，只会增加病情。至于疼痛难以忍受，牵引入脑，喜欢寒冷厌恶炎热，脉象洪数有力的，用凉膈散，加倍加入酒蒸大黄来泻下。
Dried Ginger (Shengjiang, 干姜) and Southern Jujube (Nanzao, 南枣) (each calcined to retain efficacy), along with Dried Alum (Kubai Fan, 枯白矾) in equal parts, are ground into powder and applied externally to the affected area for immediate cure.
The *Classic of Medicine* (*Huangdi Neijing*, 黄帝内经) states: At the age of eight, a man's Kidney Qi becomes substantial, leading to the shedding of deciduous teeth and the growth of permanent teeth; at twenty-four (three times eight), wisdom teeth emerge; at forty-eight (five times eight), teeth begin to wither; and at sixty-four (eight times eight), teeth fall out. Women follow the same pattern but based on multiples of seven. This is because the Kidneys govern bones, and teeth are the external manifestation of the skeletal system, nourished by marrow. Generally, dental issues belong to the Kidneys, while the upper and lower gums belong to the Yangming channels. Pain in the upper gums, preferring cold drinks and disliking hot ones, is treated by selecting the Foot-Yangming Stomach channel; pain in the lower gums, preferring hot drinks and disliking cold ones, is treated by selecting the Hand-Yangming Large Intestine channel. Thus, diseases may present with aversion to cold or heat differently. Conditions involving tooth mobility, pain, bleeding or non-bleeding, wide interdental spaces, and a state resembling imminent loss all belong to the Kidneys. The *Classic* states: Those with Kidney heat have dark complexion and withered teeth. It also states: Those with Shaoyin channel disease have dark faces and long, dirty teeth. If caries cause gum swelling and necrosis without mobility but with stagnation, rotting, pain, and foul odor, this belongs to the Yangming channel, or mixed pathogenic factors from various channels and external causes. Treatment should distinguish between deficiency and excess. For Kidney channel deficiency-cold, use Anshen Wan (Kidney-Anchoring Pill), Huanshao Dan (Return-to-Youth Elixir), or Ba Wei Wan (Eight-Ingredient Pill) for severe cases. In winter, if extreme cold invades the brain causing headache and tooth mobility/pain, this is Taiyang and Shaoyin Cold Damage. Zhang Zhongjing used Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction). This is common in those with Kidney deficiency. If accompanied by tooth pain/mobility, limb fatigue, and poor appetite, it indicates Spleen-Kidney depletion; treat with Anshen Wan combined with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). If one prefers cold and dislikes heat, it indicates Stomach Blood injury; use Xiaowei Tang (Clear the Stomach Decoction). If one dislikes cold and prefers heat, it indicates Stomach Qi injury; use Buzhong Yiqi Tang.
Teeth are the surplus of bone and the external marker of the Kidneys, residing in the gums and nourished by Qi and Blood. The upper gums belong to the Foot-Yangming Stomach channel, and the lower gums to the Hand-Yangming Large Intestine channel. However, teeth are essentially bone, originating from Qianyuan (Heaven/Yang) to initiate life; gums are essentially flesh, originating from Kunyuan (Earth/Yin) to sustain life, like trees growing in soil, relying on it for nourishment. Therefore, dental diseases arise from the Hand-Yangming, Foot-Yangming, and Foot-Shaoyin channels. The gums belong to Yangming Metal. Teeth belong to Shaoyin Water. When Yangming is excess, Ying Qi nourishes teeth making them firm; when Yangming is deficient, teeth lose nourishment and become loose. Thus, mobility, shedding, brittleness, widening gaps, aversion to cold/heat, and looseness indicate root deficiency of the Kidneys leading to branch deficiency. Caries with swelling, periodontal bleeding, and foul rotting indicate excessive damp-heat in the intestines and stomach, where "excess heat causes flesh to rot." Deficiency is tonified, damp-heat is purged, Stomach fire is cleared, and exterior wind-cold is dispersed. External powders can be applied. Severe cases with gum necrosis and tooth loss resemble collapsing earth and falling trees. Treatment focuses on stabilizing the gums; firm gums secure the teeth. "Zouma Gan" (Running Horse Gangrene) is caused by heat-toxin attacking upward due to visceral deficiency, particularly Kidney deficiency. Since teeth are bone surplus, heat rushes up causing ulceration rapidly, hence the name.
Swollen and painful gums with mobile teeth, or blackening/rotting/shedding, belong to Yangming damp-heat. Although related to Yangming, occurring in the upper and lower gums, it involves the Large Intestine and Stomach, like trees in soil. Injury to the intestines and stomach from rich wine and food leads to damp-heat attacking upward, clouding the gums, causing swelling, pain, bleeding, or insect infestation, disturbing the teeth. Just as unstable soil shakes trees, here damp-heat must be purged from Yangming to clear the gums and stabilize the teeth. If symptoms persist after regulation and teeth fall out, prognosis is poor, often fatal.
Dental diseases that recur after exertion, worsen in the afternoon, or present with thirst, dark complexion, and seminal emission are due to Spleen-Kidney deficiency-heat. Treat with Buzhong Yiqi Tang, Liuwei Wan (Six-Ingredient Pill with Rehmannia), or Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction).
Li Dongyuan (Haizang) stated: Dental caries with foul odor persisting for years should be treated as Yangming Blood Stasis. Those who enjoy drinking alcohol often suffer this; use Tao Ren Cheng Qi Tang (Peach Kernel and Da Huang Decocting Agent) powdered and formed into honey pills for excellent effect.
However, teeth pain worsening with cooling indicates cold; pain stopping upon inhaling cool air indicates heat.
Toothache originates from Stomach injury and pre-existing damp-heat floating to the gums. Constrained by wind-cold or cold beverages, damp-heat cannot disperse externally, causing pain. Pathogenesis has root and branch distinctions, requiring warm or cool medications. Treating cold as the branch, external rinses should use Bi Bo (Long Pepper) and Xi Xin (Asarum), acrid-warm to dispel cold and open depression, also dispersing constrained heat. Treating heat as the root, internal meds should use Sheng Di Huang (Rehmannia Root), Mu Dan Pi (Moutan Bark), Lian Qiao (Forsythia), and Bo He (Mint), acrid-cool to dissipate heat and clear the center. Internal and external treatment addressing both root and branch ensures recovery. Sudden severe pain often belongs to Dragon Fire (Hyperactive Ministerial Fire), rapid and fierce like storms burning wood. One must use contrary treatment (treating heat with heat): using warm medicines with cold drinks allows fire to return to its source. Using orthodox treatment with cold/cool herbs aggravates the condition. For unbearable pain radiating to the head, preferring cold/disliking heat, with surging-rapid-forceful pulse, use Liang Ge San (Cool the Chest Powder) with doubled Jiuzheng Dahuang (Wine-processed Rhubarb) to purge.