甘露饮(寒十) 加减八味丸(补一二二) 《直指》黄芩汤(寒百七 心肺热) 咽喉诸方
(详因阵一七五至二百一止)
《上古天真论》曰∶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,发堕齿槁。八八,则齿发去。
《邪客篇》曰∶天有列星,人有牙齿。
《五味论》帝曰∶苦走骨,多食之,令人变呕,何也?少俞曰∶苦入于胃,五谷之气,
皆不能胜苦,苦入下脘,三焦之道皆闭而不通,故变呕。齿者,骨之所终也,故苦入而走骨
,故入而复出,知其走骨也。
《经脉篇》曰∶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,还出挟口环唇,下交承浆。
《寒热病篇》曰∶臂阳明有入 遍齿者,名曰大迎,下齿龋取之。臂恶寒补
之,不恶寒泻之。足太阳有入 遍齿者,名曰角孙,上齿龋取之,在鼻与 前。
方病之时,其脉盛,盛则泻之,虚则补之。骨寒热者,病无所安,汗注不休。齿未槁,取其
少阴于阴股之络。齿已槁,死不治。骨厥亦然。
《杂病篇》曰∶齿痛,不恶清饮,取足阳明。恶清饮,取手阳明。
齿牙之病有三证∶一曰火,二曰虫,三曰肾虚。凡此三者,病治各有不同,辨得其真,
自无难治之齿病矣。凡火病者,必病在牙床肌肉间,或为肿痛,或为糜烂,或为臭秽脱落,
或牙缝出血不止,是皆病在经络。而上牙所属,足阳明也,止而不动。下牙所属,手阳明也
,嚼物则动而不休。此之为病,必美酒浓味,膏粱甘腻过多,以致湿热蓄于肠胃,而上壅于
经,乃有此证。治宜戒浓味,清火邪为主。虫痛者,其病不在经而在牙,亦由肥甘湿热,化
生牙虫以致蚀损蛀空,牙败而痛。治宜杀虫为主。湿热胜者,亦宜兼清胃火。肾虚而牙病者
,其病不在经而在脏。盖齿为骨之所终,而骨则主于肾也。故曰∶肾衰则齿豁,精固则齿坚
。至其为病,则凡齿脆不坚,或易于摇动,或疏豁,或突而不实。凡不由虫、不由火而齿为
病者,必肾气之不足。此则或由先天之禀亏,或由后天之斫丧,皆能致之,是当以专补肾气
为主。
一、齿有伤于外因者,或以击损,或以跌扑,或勉强咬嚼坚硬等物,久之无不损齿,此
岂药之可疗,知者自当慎也。
一、种齿法∶古有晨昏叩齿之说。虽亦可行,然而谷谷震动,终非尽善之道。余每因劳
因酒,亦尝觉齿有浮突之意,则但轻轻咬实,务令渐咬渐齐,或一二次,或日行二三次,而
根自固矣。又凡于小解时,必先咬定牙根而后解,则肾气亦赖以摄,非但固精,亦能坚齿。
故余年逾古稀,而齿无一损,亦大得此二方之力。
一、《金丹全书》云∶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。今观智者,
每于饭后必漱,则齿至老坚白不坏,斯存养之功可见矣。
甘露饮(用于寒证第十条) 加减八味丸(用于补益法第一百二十二条) 《直指方》黄芩汤(用于寒证第一百七十条,针对心肺热证) 治疗咽喉疾病的各类方剂(详见病因辨证部分第一百七十五至二百零一条)。
《上古天真论》说: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),肾气充盈平衡,所以智齿长出,身体发育达到顶峰。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),肾气充盈平衡,筋骨强劲有力,所以智齿长出,身体发育达到顶峰。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。
《邪客篇》说:天上有列星,人有牙齿。
《五味论》黄帝问:苦味入骨,多吃苦味食物,为什么会让人呕吐呢?少俞回答说:苦味进入胃中,五谷的精气都不能胜过苦味,苦味进入下脘后,三焦的通道都闭塞不通,所以导致呕吐。牙齿是骨骼的末端表现,所以苦味进入体内会走向骨骼,因此苦味入胃后反而吐出,这说明苦味是走骨的。
《经脉篇》说:手阳明大肠经的支脉,从缺盆上行经过颈部贯穿面颊,进入下齿中。足阳明胃经,向下沿着鼻外侧,进入上齿中,然后出来环绕口唇,在下部交会在承浆穴。
《寒热病篇》说:手臂阳明经有进入遍布牙齿部位的穴位,名叫大迎穴,下齿龋齿疼痛取此穴。手臂感觉寒冷时补此穴,不感觉寒冷时泻此穴。足太阳膀胱经有进入遍布牙齿部位的穴位,名叫角孙穴,上齿龋齿疼痛取此穴,位置在鼻子和颧骨前。刚发病的时候,脉搏盛大,盛大就泻之,虚弱就补之。骨寒热的病症,病人坐卧不安,汗出不止。如果牙齿还没有干枯,可以取足少阴肾经在大腿内侧的络穴进行治疗。如果牙齿已经干枯,就是死症,无法治愈。骨厥证也是如此。
《杂病篇》说:牙齿疼痛,如果不怕喝冷饮,取足阳明胃经穴位;如果怕喝冷饮,取手阳明大肠经穴位。
牙齿的疾病主要有三种证型:一是火证,二是虫证,三是肾虚证。这三种情况,治疗方法各不相同,辨别清楚根本原因,就没有难治的牙齿疾病了。凡是火证引起的,病位一定在牙床肌肉之间,或者出现肿痛,或者糜烂,或者口臭牙齿脱落,或者牙缝出血不止,这些都是病在经络。其中上牙属于足阳明胃经,静止不动;下牙属于手阳明大肠经,咀嚼时会动个不停。这类疾病,一定是因为过多食用美酒厚味、膏粱甘腻的食物,导致湿热蓄积在肠胃,向上壅滞于经络,从而产生这些症状。治疗应当以戒除浓味食物、清除火邪为主。虫痛引起的,病位不在经络而在牙齿本身,也是由于肥甘湿热,化生牙虫导致牙齿被腐蚀蛀空,牙齿败坏而疼痛。治疗应当以杀虫为主。如果湿热严重,也应当兼清胃火。肾虚引起的牙齿疾病,病位不在经络而在脏腑。因为牙齿是骨骼的末端,而骨骼由肾所主。所以说:肾衰则牙齿松动稀疏,精气固守则牙齿坚固。至于发病时,凡是牙齿脆弱不坚硬,或者容易摇动,或者稀疏,或者突出但不坚实。凡不是由虫、不是由火引起的牙齿疾病,必然是肾气不足。这或者是由于先天禀赋亏虚,或者是由于后天过度损耗所致,都应当以专门补肾气为主。
第一点:牙齿受到外因损伤的,比如被击打损坏,或者跌倒磕碰,或者勉强咬嚼坚硬物体等,久而久之无不损伤牙齿,这哪里是药物可以治疗的,明智的人自然应当谨慎小心。
第二点:种齿法:古代有早晚叩齿的说法。虽然也可以实行,但是牙齿震动,终究不是尽善尽美的方法。我每当劳累或饮酒后,也常觉得牙齿有浮突的感觉,这时只要轻轻咬实,务必让牙齿逐渐咬齐,或者一两次,或者每天两三次,牙根自然就会稳固。另外,凡是在小便时,必须先咬定牙根然后再解,这样肾气也能借此摄持,不仅固精,也能坚固牙齿。所以我年过七十,牙齿没有一颗受损,也是得力于这两个方法。
第三点:《金丹全书》说:现代人刷牙漱口,往往在早晨进行,这是本末倒置。因为一天的饮食毒素积聚在牙缝里,应当在晚上刷洗,这样污垢秽物才能完全去除,牙齿自然不坏。所以说:早晨漱口不如晚上漱口,这才是善于养护牙齿的方法。现在观察聪明的人,每顿饭后必定漱口,那么牙齿到老洁白坚固不坏,这种存养的功效就可见一斑了。
Mangu Yin (Cold Syndrome, Item 10) Jiajian Bawei Wan (Tonification, Item 122) Huangqin Tang from *Zhizhi Fang* (Cold Syndrome, Item 173; targeting Heart and Lung Heat) Various formulas for treating throat diseases (see detailed etiology and syndrome differentiation, Items 175-201).
The *Shanggu Tianzhen Lun* states: At the age of seven, a girl's Kidney Qi becomes abundant, her teeth change, and her hair grows. At twenty-one (three times seven), her Kidney Qi is balanced and average, so wisdom teeth emerge and growth reaches its peak. At the age of eight, a boy's Kidney Qi is solid, his hair grows, and his teeth change. At twenty-four (three times eight), his Kidney Qi is balanced and average, sinews and bones become strong, so wisdom teeth emerge and growth reaches its peak. At forty (five times eight), his Kidney Qi begins to decline, hair falls out, and teeth wither. At sixty-four (eight times eight), teeth and hair fall out.
The *Xieke Pian* states: Heaven has constellations, humans have teeth.
In the *Wuwei Lun*, the Yellow Emperor asked: Bitter flavor enters the bones. Why does excessive consumption of bitter substances cause vomiting? Shaoyu replied: Bitter flavor enters the Stomach. The Qi of the five grains cannot overcome the bitterness. When bitter flavor enters the lower epigastrium, the pathways of the Sanjiao (Triple Burner) become closed and obstructed, thus causing vomiting. Teeth are the culmination of the bones; therefore, bitter flavor enters and travels to the bones. Because it enters and then exits (vomits), we know that bitter flavor travels to the bones.
The *Jingmai Pian* states: The branch of the Hand-Yangming Large Intestine Meridian ascends from the Clavicle (Quepen), passes through the neck and cheek, and enters the lower teeth. The Foot-Yangming Stomach Meridian descends along the lateral side of the nose, enters the upper teeth, emerges, circles the lips, and intersects at Chengjiang below the chin.
The *Hanre Bing Pian* states: There is an acupoint on the Arm-Yangming meridian entering the area surrounding the teeth, named Daying. For lower tooth decay/pain, this point is selected. If the arm feels cold, tonify this point; if not cold, sedate it. There is an acupoint on the Foot-Taiyang Bladder Meridian entering the area surrounding the teeth, named Jiaosun. For upper tooth decay/pain, this point is selected, located anterior to the nose and zygoma. At the onset of the disease, the pulse is full/excessive; if full, sedate it; if deficient, tonify it. In Bone Cold-Heat syndrome, the patient finds no comfort in any position, and sweat pours down incessantly. If the teeth have not yet withered, treat by selecting the collateral points of the Foot-Shaoyin Kidney Meridian on the medial thigh. If the teeth have already withered, it is a death case and incurable. The same applies to Bone Jue (Reversal) syndrome.
The *Zabing Pian* states: For toothache, if the patient does not fear cold drinks, select points on the Foot-Yangming Meridian. If the patient fears cold drinks, select points on the Hand-Yangming Meridian.
There are three main syndromes for dental diseases: Fire, Worms, and Kidney Deficiency. The treatments for these three differ significantly. Once the true nature is identified, there are no incurable dental diseases. For Fire syndromes, the pathology is always within the gingival muscles. Symptoms may include swelling and pain, erosion, foul odor and tooth loss, or continuous bleeding from gum spaces. These indicate pathology in the meridians. The upper teeth belong to the Foot-Yangming Stomach Meridian and remain still. The lower teeth belong to the Hand-Yangming Large Intestine Meridian and move during mastication. Such diseases are caused by excessive consumption of rich wine, heavy flavors, and greasy/sweet foods, leading to damp-heat accumulation in the intestines and stomach, which then rises and congests the meridians. Treatment should focus on avoiding rich flavors and clearing Fire pathogens. For Worm-induced pain, the pathology is in the teeth themselves, not the meridians. It is also caused by damp-heat from rich foods transforming into "tooth worms" that corrode and hollow out the teeth, causing pain due to dental decay. Treatment should focus on eliminating worms. If damp-heat is severe, clear Stomach Fire concurrently. For Kidney Deficiency-induced dental disease, the pathology is in the Zang organs, not the meridians. Since teeth are the culmination of bones, and bones are governed by the Kidneys, it is said: "When Kidney Qi declines, teeth become loose and sparse; when Essence is secure, teeth are firm." Pathologically, teeth may be fragile, easily mobile, sparse, or protruding but insubstantial. Any dental disease not caused by worms or fire is necessarily due to insufficient Kidney Qi. This may result from congenital deficiency or postnatal depletion. Treatment should focus exclusively on tonifying Kidney Qi.
First, external trauma to teeth—such as blows, falls, or forcing teeth to chew hard objects—will inevitably damage them over time. This is not something medicine can cure; the wise will exercise caution.
Second, Method for Strengthening Teeth: Ancient texts mention knocking teeth together morning and night. While feasible, the vibration is not ideal. I often feel a sense of tooth looseness after fatigue or alcohol consumption. In such cases, gently bite firmly, ensuring gradual alignment. Doing this once or twice, or two to three times daily, will naturally stabilize the roots. Additionally, before urinating, one should clench the teeth firmly first. This helps the Kidney Qi to grasp and secure, benefiting both Jing (Essence) retention and tooth firmness. Thus, having passed seventy, my teeth remain undamaged, largely due to these two methods.
Third, the *Jindan Quanshu* states: Modern people brush their teeth in the morning, which is putting the cart before the horse. Toxins from food and drink accumulate in the gum spaces throughout the day. Brushing at night removes all filth, preventing dental decay. Therefore, "night brushing is superior to morning brushing"; this is the way of those who wisely nurture their teeth. Observing prudent individuals, they rinse their mouths after every meal, resulting in teeth remaining white and firm until old age. This demonstrates the efficacy of preservation and nurturing.