上用蝉壳为末，以猪胆汁和蜜，调敷肿处。
东垣曰∶夫齿者肾之标，口者脾之窍，诸经多有会于口者其齿牙者是也。手足阳明之所
过，上龈隶于坤上，乃足阳明胃之脉贯络也，止而不动。下断嚼物，动而不休，手阳明大肠
之脉所贯络也。手阳明恶寒，饮而喜热，足阳明喜寒，饮而恶热，其病不一。牙者肾之标，
亦喜寒，寒者坚牢，为病不同，热甚则齿动龈，龈袒脱，作痛不已，故所治疗不同也。有恶
寒冷之物作痛者，有恶热物而作痛者，又有恶寒物又恶热物而作痛者，有恶寒饮少热饮多而
作痛者，有恶热饮少寒饮多而作痛者，有牙齿动摇而作痛者，有齿袒而为痛者，有齿为疳所
蚀缺少血出为痛者，有齿龈肿起为痛者，有脾胃中有风邪，但觉风而作痛者。又有牙上多为
虫所蚀，其齿缺少，而色变为虫牙痛者；有胃中气少，不能卫寒，袒露其齿作痛者；有牙齿
疼痛，而秽臭之气不可近者。痛既不一，岂可一药而治之。大抵齿之诸痛，皆胃热火旺之故
。且齿者骨之精华，骨乃肾之所主，外板则为牙，内床则为齿。肾气强盛，则齿自坚，衰则
齿必为病。且手阳明之脉，贯颊入于下齿缝中，灌注于牙。倘风寒壅热之气，或郁滞胸中，
冲发于口，则病之于齿，轻者为宣露，龈颊浮肿，甚者则为疳 龋脱之证。齿牙之病，，在
乎手足阳明二经，动摇龈脱，是以足少阴，故此三经所主为多。然齿袒虫疳，湿热龈肿，血
出作痛，痛而秽臭者，皆胃热火盛所致。亦有诸经错杂之邪，与夫外因得之者，学人宜深究
之。陈无择云∶齿为关门，肾之荣，骨之余也。肾衰则齿豁，精固则齿坚。又大肠支脉在牙
龈，主灌注于牙，大肠壅则齿之为浮，大肠虚则齿露，挟风则攻目，头面或肿盛，动作不时
。东垣又云∶有刘经历乃内年三十余，病齿痛不可忍，须骑马外行，口吸凉风，其痛立止，
至家其痛复作。家人以为祟神，祷于巫师而不能愈。病乃湿热为邪也。足阳明多血多气，加
以膏粱之味，助其湿热，故为此痛。因立一方，不须骑马，常令风寒之气生于齿间∶以黄连
胡桐泪之苦寒，新薄荷叶荆芥穗之辛凉，四味相合，而作风寒之气，治其湿热为主，以新升
麻行阳明经为使，牙齿骨之余，以羊胫骨灰补之为佐，麝香少许，入肉为引，共为细末擦之
，痛乃减半。又以调胃承气汤，去硝加黄连以治其本，服之下三两行，其痛良愈，遂不复作
。是以前人立方，用辛凉风剂，风能胜湿，苦以泄热也。世俗多有用芫花大戟小麦川椒细辛
苍耳熬汤，热漱而牙痛立止者，人之牙齿，致病实多，内则气郁血热等因，兼啖炙爆，或以
寒水咸酸，辛辣之味适口，岂不渍搏，且如以醋沃石，则石苏矣，况人之骨余者余？然虽经
络之喜寒热，气各不同，受病之由，自有虚实。后之学人，熟究此论，治之获功，在乎克日
矣。
取适量蝉蜕研成粉末，用猪胆汁调和蜂蜜，涂抹于肿胀部位。
李东垣说：牙齿是肾脏的外在表现，口腔是脾脏的孔窍，多条经络都汇聚于口腔，其中就包括牙齿。手阳明大肠经和足阳明胃经经过此处。上牙龈归属于坤位（下方），由足阳明胃经贯穿联络，其脉气静止不动。下牙龈负责咀嚼食物，运动不止，由手阳明大肠经贯穿联络。手阳明大肠经厌恶寒冷，饮水喜欢温热；足阳明胃经喜好寒冷，饮水厌恶温热，它们的病变各不相同。牙齿作为肾脏的外在表现，也喜好寒冷，寒冷则坚固，但致病情况不同。热邪严重时会导致牙齿松动、牙龈萎缩脱落，疼痛不止，因此治疗方法也不同。有的因厌恶寒冷物体而疼痛，有的因厌恶热物而疼痛，有的既厌恶寒物又厌恶热物而疼痛，有的因少喝冷饮多喝热饮而疼痛，有的因少喝热饮多喝冷饮而疼痛，有的因牙齿动摇而疼痛，有的因牙龈萎缩而疼痛，有的因牙齿被虫蚀缺损出血而疼痛，有的因牙龈肿痛而疼痛，有的因脾胃中有风邪，一感觉到风就疼痛。还有牙齿多被虫蚀，牙齿缺损变色，属于虫牙痛；有因胃中气虚，不能抵御寒冷，导致牙齿暴露而疼痛；有牙齿疼痛，且伴有不可接近的秽臭气味。疼痛原因不一，怎么能用一种药物治疗呢？大抵牙齿的各种疼痛，大多是因为胃火旺盛所致。而且牙齿是骨骼的精华，骨骼由肾脏所主，外面的硬壳称为牙，里面的牙床称为齿。肾气强盛，牙齿自然坚固；肾气衰弱，牙齿必然生病。况且手阳明大肠经，穿过面颊进入下齿缝中，灌注于牙齿。如果风寒壅滞热邪之气，或者郁结在胸中，冲发于口腔，就会引起牙齿疾病，轻者表现为牙齿暴露、牙龈脸颊浮肿，重者则出现疳积、龋齿、牙齿脱落等证候。牙齿的疾病，关键在于手阳明和足阳明两条经络，牙齿动摇、牙龈萎缩脱落，也与足少阴肾经有关，所以这三条经络主管的情况最多。然而，牙齿暴露、虫蚀疳积、湿热引起的牙龈肿胀、出血疼痛、疼痛伴有秽臭气味，都是由于胃热火盛所致。也有其他经络错杂的邪气，以及外因导致的，学习者应当深入探究。陈无择说：牙齿是关门的守卫，是肾脏的荣华，是骨骼的剩余部分。肾气衰退则牙齿稀疏，精气固守则牙齿坚固。另外大肠的支脉在牙龈，主要灌注于牙齿，大肠壅滞则牙齿浮起，大肠虚弱则牙齿暴露，挟带风邪则攻冲眼睛，头面部可能严重肿胀，动作不协调。李东垣又说：有一位刘经历，年龄三十多岁，患牙痛难以忍受，必须骑马外出，口吸凉风，疼痛立即停止，回到家疼痛又发作。家人认为是鬼神作祟，向巫师祈祷也不能治愈。这病其实是湿热为邪。足阳明胃经多血多气，加上食用肥甘厚味的食物，助长了湿热，所以产生这种疼痛。因此创立一方，不需要骑马，常让风寒之气生于齿间：用黄连、胡桐泪的苦寒之性，配合新薄荷叶、荆芥穗的辛凉之性，四味药相合，形成风寒之气，以治疗湿热为主，以新升麻行阳明经为使药，牙齿是骨骼的剩余部分，用羊胫骨灰补益作为佐药，少许麝香，入肉作为引经药，共研为细末擦拭，疼痛减半。又用调胃承气汤，去掉芒硝加入黄连以治其根本，服用后大便下行两三三次，疼痛痊愈，不再复发。所以前人立方面，使用辛凉祛风剂，风能胜湿，苦能泄热。世俗中有人常用芫花、大戟、小麦、川椒、细辛、苍耳子熬汤，趁热漱口而牙痛立即停止的方法。人的牙齿致病原因确实很多，内则有气郁、血热等原因，兼吃烤炸食物，或者食用寒水、咸酸、辛辣口味适口之物，难道不会浸渍搏结吗？就像用醋浇灌石头，石头就会酥碎，何况是人的骨骼剩余部分呢？虽然经络对寒热的喜好不同，受病的缘由自有虚实之分。后来的学习者，熟究此论，治疗获得功效，指日可待了。
Apply a fine powder of *Cicadae Periostracum* (Chanke, 蝉壳) mixed with honey and pig bile to the swollen area.
Li Dongyuan stated: The teeth are the external manifestation of the Kidney (Shen, 肾), and the mouth is the orifice of the Spleen (Pi, 脾). Many meridians converge in the mouth, including those related to the teeth. The Hand-Yangming Large Intestine Meridian (Shou Yangming Dachang Jing, 手阳明大肠经) and Foot-Yangming Stomach Meridian (Zu Yangming Weijing, 足阳明胃经) pass through this region. The upper gums belong to the Kun position (inferior aspect) and are connected by the Foot-Yangming Stomach Meridian, whose qi remains relatively static. The lower gums are involved in chewing and move constantly, connected by the Hand-Yangming Large Intestine Meridian. The Hand-Yangming meridian dislikes cold and prefers warm drinks; the Foot-Yangming meridian likes cold and dislikes hot drinks; their pathologies differ. As the external manifestation of the Kidney, the teeth also prefer cold, which ensures firmness, yet the pathological conditions vary. Excessive heat causes tooth mobility and gum recession, leading to persistent pain; thus, treatments differ. Some experience pain triggered by cold objects, some by hot objects, some by both, some by drinking little cold water but much hot water, and some by drinking little hot water but much cold water. Others suffer pain due to tooth mobility, gum recession, tooth decay with bleeding, gum swelling, or wind-pathogen in the Spleen and Stomach causing pain upon exposure to wind. Additionally, teeth may be eroded by "worms" (dental caries), becoming loose, discolored, and painful; or pain may arise from deficient Stomach Qi failing to ward off cold, exposing the teeth; or pain may be accompanied by foul odor intolerable to others. Since the causes of pain are diverse, how can one single remedy suffice? Generally, various dental pains stem from excessive Stomach Fire (Wei Huo, 胃火). Teeth are the essence of bones, governed by the Kidney. The outer hard layer is the tooth crown, while the inner bed is the root. Strong Kidney Qi ensures firm teeth; weak Kidney Qi leads to dental disease. The Hand-Yangming meridian passes through the cheek into the lower interdental space, irrigating the teeth. If wind-cold obstructs heat qi, or stagnation occurs in the chest, rising to the mouth, it causes dental issues: mild cases present as exposed teeth and swollen gums/cheeks; severe cases manifest as canker sores, caries, and tooth loss. Dental diseases primarily involve the Hand-Yangming and Foot-Yangming meridians, with tooth mobility and gum recession also involving the Foot-Shaoyin Kidney Meridian (Zu Shaoyin Shenjing, 足少阴肾经); thus, these three meridians are most relevant. However, exposed teeth, worm-eaten cankers, damp-heat gum swelling, bleeding pain, and foul-smelling pain are all caused by excessive Stomach Fire and Heat. There are also cases involving mixed pathogens from other meridians or external factors, which students should investigate deeply. Chen Wuyue said: Teeth are the guards of the gate, the glory of the Kidney, and the surplus of bone. When Kidney Qi declines, teeth become loose; when essence is secured, teeth remain firm. Furthermore, collateral branches of the Large Intestine reside in the gums, irrigating the teeth. Large Intestine stagnation causes floating teeth; deficiency causes exposed teeth; if complicated by wind, it attacks the eyes, causing facial swelling and irregular movements. Li Dongyuan also recounted: A official named Liu, aged thirty-something, suffered unbearable toothache. He had to ride a horse outside, inhaling cool air, which immediately relieved the pain, but it returned home. His family thought it was a spirit possession and prayed to a shaman without success. The disease was actually caused by damp-heat pathogen. The Foot-Yangming Stomach Meridian has abundant blood and qi; combined with rich, greasy foods, it exacerbates damp-heat, causing this pain. Therefore, he formulated a prescription that does not require riding a horse, aiming to generate a cooling sensation in the teeth: using the bitter-cold properties of *Coptidis Rhizoma* (Huanglian, 黄连) and *Tamarisci Caulis* (Hutonglei, 胡桐泪), combined with the acrid-cool properties of fresh *Menthae Haplocalycis Herba* (Bohe, 薄荷) and *Schizonepetae Spica* (Jingjie, 荆芥). These four ingredients create a cooling effect to treat damp-heat as the primary focus. Fresh *Bupleuri Radix* (Shengma, 升麻) acts as the guiding drug for the Yangming meridian. Since teeth are the surplus of bone, *Ossus Tibiae Caprae* (Yangjinggu, 羊胫骨) ash is used as an adjuvant to tonify. A small amount of *Moschus* (Shexiang, 麝香) serves as a guide to penetrate tissue. All are ground into a fine powder and applied to rub the teeth, reducing pain by half. Subsequently, *Tiaowei Chengqi Tang* (Regulate the Stomach and Direct Downward Decoction) was modified by removing *Natrii Sulfas* (Mangxiao, 芒硝) and adding *Coptidis Rhizoma* to treat the root cause. After two to three bowel movements, the pain healed completely and did not recur. Thus, previous physicians used acrid-cool wind-dispelling agents, where wind overcomes dampness, and bitterness drains heat. In common practice, some boil *Genkwa Flos* (Yuanhua, 芫花), *Kansui Radix* (Daji, 大戟), *Triticum aestivum* (Xiaomai, 小麦), *Zanthoxyli Fructus* (Chuanjiao, 川椒), *Asari Radix et Rhizoma* (Xixin, 细辛), and *Atractylodis Macrocephalae Rhizoma* (Can'erzi, 苍耳子) decoction, rinsing the mouth while hot to stop toothache instantly. There are indeed many causes of dental disease internally, such as qi stagnation and blood heat, compounded by fried foods or tastes like cold water, salty/sour, or spicy flavors, which may soak and bind the tissues. Just as vinegar dissolves stone, how much more would it affect human bone surplus? Although meridians have different preferences for cold and heat, and disease origins vary between deficiency and excess, students who thoroughly study this theory will achieve therapeutic success soon.