今舌色青上加黄而胖，其为肝脾之虚无疑，而胀非实胀、痛非实痛可知矣。胖而兼嫩且滑，其为肝脾之寒无疑，
而胀为寒胀、痛为寒痛可知矣。使不有此法，则何以阴阳虚实，见之悉得其真？补泻寒温，投之辄神其应哉？
星川乃大悟曰∶不服药为中医。（杨乘六）
黄宛超饵方士金丹。唇舌枯燥，医谓火不归原，用人参桂、附，喉肿大渴，二便艰难，不能食寝者七昼夜，
已备棺衾。邀予诊视，笑曰∶何至是哉！可一剂愈耳。时间疾者多人，咸倾耳侧目。予俱罔顾，但使治犀角、
生地、元参、黄连等药，约重四两，浓煎灌下，诸证全失。（程华仲）
南邻朱翁，年六十余，身热数日，舌根和尖肿至满口。外科以燔针刺其两旁下廉泉穴，病势转凶。戴人曰∶
血实宜决之。用 针磨令锋极尖，轻砭之。日砭八、九次，出血约一二盏。如此三日，渐觉血少，痛减肿消。
夫舌者，心之外候；心主血，故血出则愈。又诸痛痒疮，皆属心火，燔针艾火，殊失此义。（《儒门事亲》）
一妇产后，舌出不收。用丹砂敷之，暗掷盆盎惊之，即收。
经义
女子七岁肾气盛，齿更发长。三七，肾气平均，故真牙生而长极。○丈夫八岁，肾气实，发长齿更。三
八，肾气平均，筋骨
劲强，故真牙生而长极。五八，肾气衰，发堕齿枯。八八则齿发去。（《素问》）
天有列星，人有牙齿。○齿者，骨之所终。○手阳明之脉，其支者从缺盆上颈，贯颊，入下齿中。足阳明
之脉，下循鼻外，入上齿中。（《灵枢》）
齿为户门。（《难经》）
哲言
齿得咸则坚，得甘则蚀，得酸则软，得辛、苦则若不知。咸益本脏也，甘主克制也，酸夺母气也，辛为其
所自生，苦为其所胜，故相安也。○齿先生而牙后生，齿薄而牙浓也；牙先落而齿后落，齿逸而牙劳也。齿为
户门，为饮食所入之路，百物之精皆由此入，可不惜与？○牙齿得自生后，七八月生，亦七八岁易，既易而缺，
即不复生。所以既生复易者，如草木之孚甲，虽草木所以生而长自落。所以既易不复生者，如草木之株干，伤
一枝则一枝折而不能更发也。来自生后，去自生前，亦犹草木之华实耳。（《张氏医通》）
齿者肾之标，口者脾之窍，诸经多会于口。其牙齿乃手、足阳明之所过，上龈隶于坤土，足阳明胃脉之所
贯也，止而不动；下龈嚼动不休，手阳明大肠脉之所贯也。手阳明恶寒饮而喜热，足阳明喜寒饮而恶热，故其
病不一。牙者肾之标，亦喜寒，寒则坚牢。热甚则齿动、龈断而痛，故治疗不同。（李东垣）
精完则齿固，肾衰则齿豁，虚热则齿动，髓溢则齿长。（《医学入门》）
肾主骨，齿者骨之余，髓之所养。足阳明之支者，入于上齿；手阳明之支者，入于下齿。若骨髓不足，阳
明脉虚，则齿之诸病生矣。阳明实则齿坚牢，阳明虚则齿浮动。又有齿痛者，乃阳明经有风、冷、湿、热之邪，
乘虚而入，聚而为液、为涎，与齿间之气血相搏击而痛也。若热壅盛则肿而痛也，热不盛则齿龈微肿
而根浮也。有虫牙痛者，由湿热生虫，蚀其根也。有齿间血出者，乃风热之邪，由阳明之支入齿龈，搏于血也。
有齿龋者，亦风热之邪入阳明，搏于齿龈，气血腐化为脓也。有齿 者，是虫蚀齿至龈，脓烂汁臭也。有齿挺
者，由风热传入齿龈间，液沫为脓，气血竭，肉龈消，故齿根露而挺出也。有齿动摇者，由阳明气血虚也。有
齿蠹者，由骨髓不荣，故令牙齿黯黑也。以此而言，岂非诸齿病皆因阳明之所致哉？（《证治准绳》）
肾虚牙疼其齿浮，血虚牙疼其齿痒，火热牙疼其齿燥，虫蚀牙疼其齿黑，风热牙疼其齿肿，湿热牙疼其齿
木。（《绳墨》）
牙痛∶外冒风热、吸受寒冷者，外因也；阴虚火动、气郁血热、虫蛀者，内因也；硬物所支、打击所致者，
不内外因也。（陈无择）
牙证不外乎风、火、虫、虚，此但言其痛耳。他如牙宣、牙菌、牙痈、穿牙毒、骨槽风、走马牙疳之类，
皆由于湿火热毒蕴结牙床。须分上下二齿，辨明手、足阳明及少阴之异。（《临证指南》）
齿牙之痛有三证∶一曰火，二曰虫，三曰肾虚。三者不同，辨得其真，无难治矣。○古有晨昏叩齿之说，
虽亦可行，然而谷谷震动，终非善道。余每因劳、因酒，尝觉齿有浮突之意，但轻轻咬实，渐咬渐齐，或一、
二次而根自固。又小解时，先咬定牙根而后解，则肾气亦赖以摄。非但固精，亦能坚齿。（张景岳）
今人漱齿，每以早晨，是倒置也。凡一日饮食之毒，积于齿缝，当于夜晚刷洗，则垢秽尽去，齿自不坏。
故云∶晨漱不如夜漱，此善于养齿者。（《金丹全书》）
唇肿、齿焦者死，脾、肾绝也。○齿变黑者死，少阴绝也。○阴阳俱竭，其齿如熟小豆者死。（扁鹊）
补编
湿热齿痛者，承气汤下之。上、下牙痛不可忍，牵引入脑，
或喜寒恶热，脉洪数有力者，凉膈散。肠热齿龈胀痛者，清胃散。火郁痛者，越鞠丸。肾虚痛者，六味汤加骨
碎补。虚寒痛者，八味汤加骨碎补。风热痛者，羌、独、荆、防、芎、辛、薄荷、生地之类，水煎漱咽。风毒
及热壅上攻，牙龈痛或龈缝肉 出者，消风散，临卧漱服。风寒入脑痛者，羌活附子汤。（薛立斋）
凡牙痛必用胡椒、荜茇，能散浮热。监以升麻、寒水石，佐以薄荷、荆芥、细辛之类。如用清凉药痛反甚
者，须从治之。（《丹溪心法》）
凡饮食不洁，臭腐之气淹积日久，由是热盛生风，风胜生虫，蛀食齿中。根有黑点，蚀尽一齿，又度其
余，甚至疳 皆其种类。宜清彻肠胃，以治其本；擦牙诛虫，以理其标。（《证治汇补》）
牙床腐烂、齿牙脱落，谓之'走马'。此盖热毒蕴畜而然，大为凶候。速泻阳明之火，兼服绿豆饮；外用
冰白散敷之。（张景岳）
温热病看舌后，亦须验齿。齿为肾余，龈为胃络，热邪不燥胃津，必耗肾液。且二经之血，皆走其地，病
深动血，结瓣于上。阳血色紫如干漆，阴血色黄如豆瓣。阳血若见，安胃为主；阴血若见，救肾为要。然豆瓣
色者多险。若证不逆，尚在可治，否则难治。盖阴下竭、阳上厥也。○齿光燥如石者，胃热甚也。若无汗、恶
寒，卫偏胜也，辛凉泄胃透汗为要。若如枯骨色者，肾液枯也，为难治。若上半截燥者，水不上承，心火炎上
也，急急清心救水，俟枯处转润为妥。○ 齿者，湿热化风，痉病也。切牙者，胃热走络也。若切牙而脉证皆
衰者，胃虚无谷气内荣，虚则喜实也。舌本不缩而硬，牙咬难开者，非风痰阻络，即欲作痉也，用酸物擦之即
开，酸走筋，木泄土故也。○齿垢如灰糕样者，胃气无权，津亡、湿浊用事，多死。○初病齿缝流血痛者，胃
火冲激也；不痛者，龙火内燔也。齿焦无垢者死。齿焦有垢者，肾热胃劫也，当微下之，或玉女煎，清胃救肾
可也。（《指南续刻》）
脉候
齿病∶尺脉虚大者肾虚，洪数者阴火；关脉浮弦者风热，洪滑者痰火。（《证治汇补》）
选案
汪丞相之宠，好食浓味。一日热大作，齿间壅出有肉，渐大胀满，口不能闭，水浆不入。一医用生地黄
汁一碗；牙皂角数挺炙热，蘸汁令尽为末，敷壅肉上。随即消缩，不日而愈。（《医统》）
吴东吉之内齿痛，医用辛散不效，又用苦寒下之，头晕自汗，大渴大喘。予至诊曰∶此肾虚也，与八味
汤，一服痛止。（程华仲）
附方
出牙虫方 用瓦片上置油拌韭子烧烟，搁水碗上，另用漏升覆之。以蛀牙受漏升口中烟，其牙内虫如针
者，皆落水碗中。累效。
哭来笑去散 治牙痛神效。用雄黄、乳香、胡椒、麝香、荜茇、良姜、细辛各等分为末，每用少许，吹男
左、女右鼻中。如牙痛脸肿，用纸卷药末作条，蘸香油点着，燎牙痛处，条烧尽，痛即止。
舌色青中泛黄且舌体胖大，这无疑是肝脾两脏虚弱的表现，由此可知腹胀并非实证之胀、疼痛并非实证之痛。若舌体胖大兼见质地娇嫩且表面滑润，这无疑是肝脾有寒的表现，由此可知腹胀属于寒性胀满、疼痛属于寒性疼痛。如果没有这种辨证方法，怎么能准确辨别阴阳虚实呢？补泻温凉之法，投药后为何能产生神奇疗效呢？
星川于是恍然大悟地说：“不服药算是中等水平的治疗。”（杨乘六）
黄宛超服用方士的金丹。导致嘴唇和舌头干燥枯槁，医生说是火不归原（肾阳虚衰，虚火上炎），用人参、桂枝、附子等药，结果咽喉肿大、极度口渴，大小便困难，七天七夜无法进食睡眠，已经准备好了棺材和寿衣。邀请我诊治，我笑着说：“何至于此！一剂药就能痊愈。”当时瘟疫流行，许多人都在旁侧耳倾听、斜目观看。我都不予理会，只让人准备犀角、生地黄、玄参、黄连等药物，大约四两重，浓煎后灌服，各种症状全部消失。（程华仲）
南邻朱老先生，六十多岁，身体发热数日，舌根和舌尖肿胀直至充满口腔。外科医生用烧红的针燔刺其两旁下廉泉穴，病情反而加重。戴人（张从正）说：“血实宜决之（实证宜用泄法）。”他用针磨得极其锋利，轻轻点刺出血。每天点刺八九次，出血约一二盏。如此三天，逐渐觉得血量减少，疼痛减轻，肿胀消退。舌是心的外候；心主血脉，所以出血就能痊愈。另外，各种疼痛、瘙痒、疮疡，都属于心火，使用燔针艾灸，完全违背了这一医理。（《儒门事亲》）
一位产妇在产后，舌头伸出不能收回。用丹砂敷在舌上，暗中打翻盆罐制造惊吓声，舌头随即收回。
【经义】
女子到了七岁，肾气开始旺盛，牙齿更换，头发变长。到了二十一岁（三七），肾气充盈平和，所以智齿长出，身高发育到极点。男子到了八岁，肾气充实，头发变长，牙齿更换。到了二十四岁（三八），肾气充盈平和，筋骨强劲有力，所以智齿长出，身高发育到极点。到了四十岁（五八），肾气开始衰退，头发脱落，牙齿干枯。到了六十四岁（八八），牙齿和头发就会脱落。（《素问》）
天上有列星，人有牙齿。○牙齿是骨骼的外在终结表现。○手阳明大肠经的支脉，从缺盆上行至颈部，穿过面颊，进入下齿中。足阳明胃经的经脉，向下沿鼻外侧，进入上齿中。（《灵枢》）
牙齿是门户。（《难经》）
【哲言】
牙齿遇到咸味则坚固，遇到甜味则被腐蚀，遇到酸味则变软，遇到辛味、苦味则感觉迟钝。咸味补益本脏（肾），甜味主要起克制作用，酸味夺取母气（肝木生心火，此处指酸入肝，可能涉及五行生克关系中的特定语境，或指酸收），辛味是其自生之源，苦味是其所胜之行，所以相互安宁。○牙齿先生出而牙床（牙龈/牙槽骨部分）后生长，牙齿薄而牙床厚；牙床先脱落而牙齿后脱落，牙齿逸乐而牙床劳损。牙齿作为门户，是饮食进入的通道，万物的精华都由此进入，怎能不珍惜呢？○牙齿出生后，七八个月时萌出，也对应人七八岁时换牙，换过之后如果缺失，就不再生长。之所以既生又换，就像草木的果实外壳，虽然草木生长时外壳会自然脱落。之所以换了不再长，就像草木的主干，折断一枝就折了一枝，不能再发芽。从出生后到出生前（指代生命周期），也像草木的花果一样。（《张氏医通》）
牙齿是肾的外标，口是脾的窍道，各条经脉多汇聚于口。其牙齿是手、足阳明经经过的地方，上牙龈隶属坤土（脾胃），由足阳明胃经贯穿，静止不动；下牙龈咀嚼运动不停，由手阳明大肠经贯穿。手阳明大肠经厌恶冷饮而喜欢热饮，足阳明胃经喜欢冷饮而厌恶热饮，所以它们的病变各不相同。牙床是肾的外标，也喜欢寒凉，寒凉则坚固牢靠。热邪严重则牙齿松动、牙龈断裂疼痛，所以治疗方法不同。（李东垣）
精气充足则牙齿坚固，肾气衰弱则牙齿稀疏，虚热则牙齿松动，髓液溢出则牙齿显得过长。（《医学入门》）
肾主骨，牙齿是骨骼的余气，由髓液滋养。足阳明胃经的支脉，进入上齿；手阳明大肠经的支脉，进入下齿。如果骨髓不足，阳明经脉虚弱，那么牙齿的各种疾病就会产生。阳明经实证则牙齿坚固牢靠，阳明经虚证则牙齿浮动。又有牙齿疼痛的，是阳明经有风、冷、湿、热之邪，乘虚而入，聚而成液体、成涎沫，与齿间的气血相搏击而产生疼痛。如果热邪壅盛则肿胀疼痛，热邪不盛则牙龈微肿而牙根浮动。有虫牙痛的，是由湿热生虫，侵蚀牙根所致。有齿间出血的，是风热之邪，由阳明经的支脉进入齿龈，与血液相搏所致。有龋齿的，也是风热之邪进入阳明经，搏结于齿龈，气血腐化为脓所致。有牙齿腐烂的，是虫子侵蚀牙齿直到牙龈，脓烂汁液发臭。有牙齿挺出的，是由风热传入齿龈间，液沫化为脓，气血枯竭，肉龈萎缩，所以牙根暴露而挺出。有牙齿动摇的，是由阳明经气血虚弱所致。有牙齿蛀蚀变黑的，是由骨髓不能荣养，所以令牙齿黯黑。以此而言，难道不是所有的牙齿疾病都因阳明经引起的吗？（《证治准绳》）
肾虚牙疼则牙齿浮动，血虚牙疼则牙齿发痒，火热牙疼则牙齿干燥，虫蚀牙疼则牙齿发黑，风热牙疼则牙齿肿胀，湿热牙疼则牙齿麻木。（《绳墨》）
牙痛：外感风热、吸入寒冷的，是外因；阴虚火动、气郁血热、虫蛀的，是内因；硬物支撑、打击导致的，是不内外因。（陈无择）
牙证不外乎风、火、虫、虚，这里只谈论了疼痛。其他如牙宣（牙龈萎缩溢脓）、牙菌（牙龈赘生物）、牙痈、穿牙毒、骨槽风、走马牙疳之类，都是由于湿火热毒蕴结在牙床。必须区分上下二齿，辨明手、足阳明经及少阴经的不同。（《临证指南》）
牙齿疼痛有三种证型：一是火，二是虫，三是肾虚。三者不同，辨别清楚，就没有难治的了。○古时有早晚叩齿的说法，虽然也可行，但谷谷震动，终究不是好方法。我每次因为劳累、饮酒，常觉得牙齿有浮突的感觉，只要轻轻咬合固定，渐渐咬齐，或者一两次后牙根自然稳固。又在小便时，先咬定牙根然后解手，则肾气也能借此固摄。不仅能固精，也能坚齿。（张景岳）
现代人漱口刷牙，多在早晨，这是本末倒置。凡是一天饮食的毒素，积聚在齿缝，应当在夜晚刷洗，则污垢尽去，牙齿自然不坏。所以说：早晨漱口不如晚上漱口，这是善于养护牙齿的方法。（《金丹全书》）
嘴唇肿胀、牙齿焦黑的，预后不良，是脾、肾之气绝断。○牙齿变黑的，预后不良，是少阴肾气绝断。○阴阳俱竭，牙齿像熟小豆颜色的，预后不良。（扁鹊）
【补编】
湿热牙痛者，用承气汤攻下。上、下牙痛不可忍受，牵引至头部，或者喜寒恶热，脉象洪数有力的，用凉膈散。肠热导致牙龈胀痛者，用清胃散。火郁疼痛者，用越鞠丸。肾虚疼痛者，用六味地黄汤加骨碎补。虚寒疼痛者，用八味地黄汤加骨碎补。风热疼痛者，用羌活、独活、荆芥、防风、川芎、白芷、薄荷、生地黄等药，水煎后含漱咽下。风毒及热邪壅盛上攻，牙龈疼痛或牙龈缝隙长出肉芽者，用消风散，睡前含漱服用。风寒入脑引起头痛者，用羌活附子汤。（薛立斋）
凡是牙痛必用胡椒、荜茇，能疏散浮热。配合升麻、寒水石监制，佐以薄荷、荆芥、细辛等药。如果使用清凉药疼痛反而加剧的，必须采用反治法。（《丹溪心法》）
凡是饮食不洁，臭腐之气积聚日久，因此热盛生风，风胜生虫，蛀食牙齿。根部有黑点，腐蚀完一颗牙齿，又蔓延其余，甚至形成疳积，都是这类虫害。应当清彻肠胃，以治其本；擦牙杀虫，以治其标。（《证治汇补》）
牙床腐烂、牙齿脱落，称为“走马”（走马牙疳）。这大概是热毒蕴蓄所致，是非常凶险的征候。迅速泻除阳明经的火邪，兼服绿豆饮；外用冰白散敷贴。（张景岳）
温热病查看舌象后，也必须查验牙齿。牙齿是肾之余，牙龈是胃之络，热邪如果不燥伤胃津，必定耗损肾液。而且这两条经脉的血，都流向这些部位，病深入动血，凝结成瓣在上部。阳血色紫如干漆，阴血色黄如豆瓣。见到阳血色，以安胃为主；见到阴血色，以救肾为要。然而豆瓣色的多危险。如果证候没有逆乱，尚在可治范围，否则难治。这是因为阴在下枯竭、阳在上厥逆。○牙齿光亮干燥如石头般的，是胃热严重。如果没有汗、恶寒，是卫气偏胜，辛凉泄胃透汗是关键。如果像枯骨颜色的，是肾液枯竭，为难治。如果上半截干燥的，是水气不能上承，心火炎上，急急清心救水，等到干燥处转润才妥当。○牙齿颤动，是湿热化风，属于痉病。咬牙切齿，是胃热走窜经络。如果咬牙切齿而脉证都衰弱的，是胃虚无谷气内荣，虚则喜实。舌根不收缩而僵硬，牙咬难开的，不是风痰阻络，就是将要发作痉病，用酸物擦拭即可张开，酸走筋，木泄土的缘故。○齿垢像灰糕样的，是胃气无权，津液亡失、湿浊当道，大多死亡。○初病齿缝流血疼痛的，是胃火冲激；不疼痛的，是龙火内燔。牙齿焦黑无垢的，死症。牙齿焦黑有垢的，是肾热胃劫，应当轻微攻下，或用玉女煎，清胃救肾即可。（《指南续刻》）
【脉候】
牙齿疾病：尺脉虚大的，是肾虚；洪数的，是阴火；关脉浮弦的，是风热；洪滑的，是痰火。（《证治汇补》）
【选案】
汪丞相的宠妾，喜欢吃浓厚滋味的食物。一天热势大作，牙齿间壅出肉芽，渐渐胀满，嘴巴不能闭合，水浆不能入口。一个医生用生地黄汁一碗；牙皂角几段烤热，蘸取地黄汁使其吸尽，研成粉末，敷在壅出的肉芽上。随即消缩，不久痊愈。（《医统》）
吴东吉的妻子牙痛，医生用辛散药无效，又用苦寒药攻下，导致头晕自汗，大渴大喘。我去诊治说：“这是肾虚”，给予八味地黄汤，一服药后疼痛停止。（程华仲）
【附方】
出牙虫方 用瓦片上放置油拌韭菜子烧烟，搁在水碗上，另用漏斗罩住。让蛀牙接受漏斗口中的烟，牙内的虫子如针状，都会落入水碗中。屡次有效。
哭来笑去散 治疗牙痛神效。用雄黄、乳香、胡椒、麝香、荜茇、良姜、细辛各等分为末，每次用少许，吹入男性左鼻孔、女性右鼻孔中。如果牙痛脸肿，用纸卷药末做成条状，蘸香油点燃，燎灼牙痛处，药条烧尽，疼痛即止。
The tongue color is greenish with a yellowish tint and the tongue body is swollen; this undoubtedly indicates deficiency of the Liver and Spleen. Consequently, it can be known that the distension is not excess-type distension, and the pain is not excess-type pain. If the tongue is swollen and also tender and slippery, this undoubtedly indicates cold in the Liver and Spleen. Consequently, it can be known that the distension is cold-type distension, and the pain is cold-type pain. Without such diagnostic methods, how could one accurately discern Yin and Yang, Excess and Deficiency? Why would tonification, purgation, warming, and cooling therapies produce miraculous effects upon administration?
Xingchuan then had a great enlightenment, saying: "Not taking medicine is considered medium-level treatment." (Yang Chengliu)
Huang Wanchao ingested golden elixirs from Daoist alchemists. This resulted in dryness and withering of the lips and tongue. Physicians diagnosed it as "Fire failing to return to its source" (deficiency of Kidney Yang leading to floating deficient fire) and prescribed Ren Shen (Ginseng), Gui Zhi (Cinnamon Twig), and Fu Zi (Aconite). Consequently, his throat became swollen, he experienced extreme thirst, difficulty in urination and defecation, and was unable to eat or sleep for seven days and nights. He had already prepared his coffin and shroud. I was invited to examine him and laughed, saying, "How has it come to this! One dose will suffice for recovery." At that time, an epidemic was spreading, and many people were listening intently and watching sideways. I ignored them all, only instructing the preparation of Xi Jiao (Rhinoceros Horn - *Note: Substitute with Buffalo Horn in modern practice*), Sheng Di Huang (Rehmannia Root), Xuan Shen (Scrophularia Root), and Huang Lian (Coptis Rhizome), totaling approximately four taels. These were decocted strongly and administered orally. All symptoms completely disappeared. (Cheng Huazhong)
Old Mr. Zhu from the southern neighbor, over sixty years old, had been suffering from fever for several days. The root and tip of his tongue were swollen until they filled his entire mouth. A surgeon used burning needles to cauterize the sides at the Xia Lian Quan acupoint, but the condition worsened. Dai Ren (Zhang Congzheng) said: "When blood is excessive, it should be drained." He sharpened a needle to an extremely fine point and performed light pricking therapy (bloodletting). He pricked eight or nine times daily, extracting about one to two cups of blood. After three days of this, he gradually felt less bleeding, reduced pain, and subsided swelling. The tongue is the external manifestation of the Heart; the Heart governs blood. Therefore, bleeding leads to recovery. Furthermore, various pains, itching, and sores belong to Heart Fire. Using burning needles and moxibustion completely contradicts this principle. (*Ru Men Shi Qin*)
A woman, postpartum, had her tongue protruding and unable to retract. Cinnabar (Dan Sha) was applied to the tongue, and pots and pans were secretly overturned to startle her. Her tongue immediately retracted.
[Scriptural Meanings]
At age seven, a girl's Kidney Qi becomes abundant; her teeth change, and her hair grows. At twenty-one (three sevens), her Kidney Qi is balanced and average; thus, her wisdom teeth emerge, and her growth reaches its peak. At age eight, a boy's Kidney Qi becomes solid; his hair grows, and his teeth change. At twenty-four (three eights), his Kidney Qi is balanced and average; his sinews and bones become strong, his wisdom teeth emerge, and his growth reaches its peak. At forty (five eights), his Kidney Qi begins to decline; his hair falls out, and his teeth wither. At sixty-four (eight eights), his teeth and hair fall out. (*Su Wen*)
Heaven has constellations; humans have teeth. ○ Teeth are the terminal manifestation of bone. ○ The branch meridian of the Hand-Yangming Large Intestine channel ascends from the Que Pen area to the neck, passes through the cheek, and enters the lower teeth. The Foot-Yangming Stomach channel descends along the lateral side of the nose and enters the upper teeth. (*Ling Shu*)
Teeth are the gatehouse. (*Nan Jing*)
[Philosophical Remarks]
Teeth become firm when exposed to salty flavors, corroded by sweet flavors, softened by sour flavors, and feel numb to pungent and bitter flavors. Salty flavor benefits the home organ (Kidney); sweet flavor primarily exerts a controlling effect; sour flavor deprives the mother qi (Liver); Pungent flavor is self-generated; Bitter flavor is what controls it; thus, they remain in harmony. ○ Teeth appear first, while the gums/alveolar process grow later; teeth are thin, while gums are thick. Gums fall out first, while teeth fall out later; teeth are leisurely, while gums are fatigued. Teeth serve as the gatehouse, the pathway for food intake, through which the essence of all things enters. How can one not cherish them? ○ After birth, teeth erupt around seven to eight months, corresponding to the tooth replacement at seven to eight years of age. Once replaced, if lost, they do not grow again. The reason for both eruption and replacement is like the husks of plants; although plants grow, their husks naturally fall off. The reason for non-regrowth after replacement is like the trunk of a plant; if one branch breaks, it cannot sprout again. From post-birth to pre-birth stages, it is akin to the flowers and fruits of plants. (*Zhang Shi Yi Tong*)
Teeth are the external marker of the Kidney; the mouth is the orifice of the Spleen; numerous meridians converge at the mouth. The teeth are traversed by the Hand and Foot Yangming meridians. The upper gum belongs to Kun Earth (Spleen/Stomach), penetrated by the Foot-Yangming Stomach channel, remaining still. The lower gum moves continuously during chewing, penetrated by the Hand-Yangming Large Intestine channel. The Hand-Yangming channel dislikes cold drinks and prefers heat; the Foot-Yangming channel prefers cold drinks and dislikes heat. Thus, their pathologies differ. The gum is the external marker of the Kidney and also prefers cold; cold makes it firm. Severe heat causes loose teeth, broken gums, and pain; hence, treatments differ. (Li Dongyuan)
Complete essence results in firm teeth; declining Kidney Qi results in loose teeth; deficient heat causes loose teeth; marrow overflow makes teeth appear long. (*Yi Xue Ru Men*)
The Kidney governs bone; teeth are the surplus of bone, nourished by marrow. The branch of the Foot-Yangming Stomach channel enters the upper teeth; the branch of the Hand-Yangming Large Intestine channel enters the lower teeth. If marrow and essence are insufficient, and the Yangming channels are weak, various dental diseases arise. Excess in the Yangming channels makes teeth firm; deficiency in the Yangming channels makes teeth loose. Regarding toothache: Wind, Cold, Dampness, and Heat pathogens enter the Yangming channels due to deficiency, accumulating into fluids and saliva, battling with Qi and Blood in the teeth to cause pain. If Heat is severe, swelling and pain occur; if Heat is mild, slight gum swelling and loose roots occur. Toothache caused by worms results from Damp-Heat generating worms that erode the roots. Bleeding from between teeth results from Wind-Heat pathogens entering the gums via Yangming branches, battling with blood. Dental caries result from Wind-Heat pathogens entering the Yangming channel, battling with gums, causing Qi and Blood to rot into pus. Rotting teeth result from worms eroding teeth to the gums, with smelly pus. Protruding teeth result from Wind-Heat entering the gums, turning fluids into pus, exhausting Qi and Blood, shrinking the gums, exposing the roots. Loose teeth result from deficiency of Qi and Blood in the Yangming channels. Dark/black teeth result from lack of marrow nourishment. Thus, are not all dental diseases caused by the Yangming channels? (*Zheng Zhi Zhun Sheng*)
Kidney-deficiency toothache presents with loose teeth; Blood-deficiency toothache presents with itchy teeth; Fire-Heat toothache presents with dry teeth; Worm-erosion toothache presents with black teeth; Wind-Heat toothache presents with swollen teeth; Damp-Heat toothache presents with numb teeth. (*Sheng Mo*)
Toothache: External exposure to Wind-Heat or inhalation of Cold are external causes; Yin deficiency with Fire hyperactivity, Qi stagnation with Blood Heat, and worm erosion are internal causes; pressure from hard objects or trauma are neither-internal-nor-external causes. (Chen Wuzhe)
Dental syndromes revolve around Wind, Fire, Worms, and Deficiency; this text only discusses pain. Others, such as periodontal disease (Ya Xuan), gingival polyps (Ya Jun), gingival abscess (Ya Yong), penetrating tooth poison, alveolar osteomyelitis (Gu Cao Feng), and noma (Zou Ma Ya Gan), all stem from the accumulation of Damp-Heat and Fire-Toxin in the gums. One must distinguish between upper and lower teeth and differentiate among the Hand-Yangming, Foot-Yangming, and Shaoyin channels. (*Lin Zheng Zhi Nan*)
There are three types of toothache: Fire, Worms, and Kidney Deficiency. If differentiated correctly, there is no difficulty in treatment. ○ Ancient texts mention morning and evening teeth-clapping. While feasible, the vibration is not ideal. Whenever I am fatigued or drink alcohol, I feel my teeth becoming loose. By gently biting firmly and aligning them, often once or twice, the roots stabilize. Also, clamping the teeth before urinating helps consolidate Kidney Qi. This not only secures essence but also strengthens teeth. (Zhang Jingyue)
Modern people brush their teeth in the morning, which is inverted. Toxins from daily diet accumulate in the interdental spaces overnight. Brushing at night removes all dirt, preventing decay. Thus, morning rinsing is inferior to night brushing; this is the proper way to care for teeth. (*Jin Dan Quan Shu*)
Swollen lips and scorched teeth indicate death, signifying the exhaustion of Spleen and Kidney. ○ Black teeth indicate death, signifying the exhaustion of Shaoyin. ○ Exhaustion of both Yin and Yang, with teeth resembling cooked adzuki beans, indicates death. (Bian Que)
[Supplementary Compilation]
For Damp-Heat toothache, use Cheng Qi Tang to purge. For unbearable upper and lower toothache radiating to the head, or preference for cold/dislike of heat with a surging, rapid, forceful pulse, use Liang Ge San. For intestinal heat causing gum swelling and pain, use Qing Wei San. For Fire-stagnation pain, use Yue Ju Wan. For Kidney-deficiency pain, use Liu Wei Di Huang Tang plus Gu Sui Bu. For deficiency-cold pain, use Ba Wei Di Huang Tang plus Gu Sui Bu. For Wind-Heat pain, use Qiang Huo, Du Huo, Jing Jie, Fang Feng, Chuan Xiong, Bai Zhi, Bo He, and Sheng Di Huang, decocted for gargling and swallowing. For Wind-Toxin and Heat-toxin attacking upward, causing gum pain or gingival overgrowth, use Xiao Feng San, gargling and administering before bed. For Cold-Wind invading the brain causing headache, use Qiang Huo Fu Zi Tang. (Xue Lizhai)
For any toothache, Hu Jiao (Pepper) and Bi Bo (Long Pepper) must be used to disperse floating heat. Monitor with Sheng Ma and Han Shui Shi, assist with Bo He, Jing Jie, and Xi Xin. If pain worsens with cooling herbs, counter-treatment is required. (*Dan Xi Xin Fa*)
Unclean diet and foul odors accumulating over time lead to intense Heat generating Wind, and Wind generating Worms, which bore into teeth. Black spots at the roots indicate complete erosion of one tooth, spreading to others, even forming infantile malnutrition syndromes (Gan Ji). Clear the intestines and stomach to treat the root; clean teeth and kill worms to treat the branch. (*Zheng Zhi Hui Bu*)
Rotting gums and falling teeth are called "Running Horse" (Noma). This is caused by accumulated Heat-Toxin, a very ominous sign. Quickly purge Fire from the Yangming channels, take Mung Bean Drink concurrently, and apply Bing Bai San externally. (Zhang Jingyue)
After examining the tongue in warm-heat diseases, one must also inspect the teeth. Teeth are the surplus of the Kidney; gums are the network vessels of the Stomach. If Heat pathogens do not dry up Stomach fluids, they must consume Kidney fluids. Blood from both channels flows to these areas. Deep disease moving blood forms clots on the surface. Yang-blood is purple like dried lacquer; Yin-blood is yellow like soybeans. If Yang-blood appears, prioritize stabilizing the Stomach; if Yin-blood appears, prioritize saving the Kidney. However, bean-yellow color is dangerous. If the syndrome is not rebellious, it is treatable; otherwise, it is difficult. This is because Yin is exhausted below and Yang is reversed above. ○ Teeth shiny and dry like stone indicate severe Stomach Heat. If without sweat and aversion to cold, Wei-Qi is dominant;辛-Liang (Pungent-Cool) herbs to vent Stomach Heat and induce sweat are key. If resembling dead bone color, Kidney fluids are exhausted, making it difficult to treat. If only the upper half is dry, Water fails to ascend, and Heart Fire flares up; urgently clear the Heart and save Water until the dryness turns moist. ○ Trembling teeth indicate Damp-Heat transforming into Wind, a spasm syndrome. Clenching teeth indicates Stomach Heat traveling through collaterals. If clenching teeth with weak pulse and signs, Stomach deficiency lacks Grain Qi to nourish internally; deficiency favors fullness. If the tongue base is stiff and teeth cannot open, it is either Wind-Phlegm blocking collaterals or impending spasm; rub with sour substances to open, as Sour enters sinews, and Wood drains Earth. ○ Tooth coating resembling gray cake indicates powerless Stomach Qi, loss of fluids, and dominance of turbid Dampness; mostly fatal. ○ Initial bleeding from gum lines with pain indicates Stomach Fire rushing; without pain, it is Dragon Fire burning internally. Scorched teeth without coating indicate death. Scorched teeth with coating indicate Kidney Heat and Stomach depletion; mild purgation or Yu Nu Jian to clear Stomach and save Kidney is appropriate. (*Zhi Nan Xu Ke*)
[Pulse Diagnosis]
Dental diseases: Chi pulse empty and large indicates Kidney deficiency; surging and rapid indicates Yin Fire. Guan pulse floating and wiry indicates Wind-Heat; surging and slippery indicates Phlegm-Fire. (*Zheng Zhi Hui Bu*)
[Selected Cases]
The favorite concubine of Chancellor Wang loved rich and heavy foods. One day, severe heat erupted, flesh grew out from between her teeth, expanding until her mouth could not close, preventing intake of water or gruel. A physician used one bowl of Sheng Di Huang juice; several pieces of Ya Zao Jiao (Gleditsia Sinensis Fruit) were roasted hot, dipped in the juice until fully absorbed, then ground into powder and applied to the fleshy growth. It immediately shrunk, and she recovered in a few days. (*Yi Tong*)
Wu Dongji's wife suffered from toothache. A physician used pungent-dispersing herbs without effect, then used bitter-cold purgatives, resulting in dizziness, spontaneous sweating, extreme thirst, and severe panting. Upon examination, I said, "This is Kidney deficiency," and prescribed Ba Wei Di Huang Tang. Pain ceased after one dose. (Cheng Huazhong)
[Attached Formulas]
Formula to Expel Tooth Worms Place oil-mixed Chive Seeds on a tile and burn to produce smoke. Hold a water bowl underneath. Cover with a funnel. Let the smoke from the funnel enter the cavity of the decayed tooth. Worms inside the tooth, needle-like, will fall into the water bowl. Repeatedly effective.
Cry-Laugh-Away Powder Extremely effective for toothache. Equal parts of Xiong Huang (Realgar), Ru Xiang (Frankincense), Hu Jiao (Pepper), She Xiang (Musk), Bi Bo (Long Pepper), Liang Jiang (Galangal), and Xi Xin (Asarum) are ground into powder. Apply a small amount to the left nostril of males and the right nostril of females. If face is swollen with toothache, roll the powder in paper into strips, dip in sesame oil, ignite, and cauterize the painful tooth area. When the strip burns out, pain stops.