【内伤齿痛之症】或齿豁，或动而长，或浮痒燥黑，时常作痛，此内伤之症也。若右
痛，属胃与大肠；右下盘痛，属肺胃二经；左上盘痛，属胆经；左下盘痛，属肝经；上正门
痛，属心经；下正门痛，属肾经；上左右二虎牙痛，属胃经；下左右二虎牙痛，属脾经。
【内伤齿痛之因】齿豁而浮者，肾衰；齿动而长者，胃热；痒为血热；痛为火烁；黑
则是虫蚀。此内伤齿痛之因也。
【内伤齿痛之脉】尺脉虚大，肾水有亏。若见洪数，阴火旺动。左关弦急，肝胆之火
。左关洪滑，痰火内烁。
【内伤齿痛之治】肾虚阴火者，凉八味玄武胶为丸，或知柏天地煎。左关弦急，龙胆
泻肝汤，右关洪滑，化痰汤。应下者，三黄丸。大凡牙痛症，寒者少，热者多，故内伤门都用
凉剂。若劳倦而胃虚齿浮者，又当用补中益气汤，不可拘痛无补法也。
凉八味丸
即六味丸加黄柏、知母，共为细末，玄武胶为丸。
知柏天地煎
黄柏 知母 天门冬 生地黄
同煎三四次，冲玄武胶收膏
龙胆泻肝汤 见前。
化痰汤
贝母 枳实 黄芩 黄连 花粉 桔梗 元参 升麻 甘草
家秘三黄丸
黄芩 黄连 大黄 甘草 广皮
补中益气汤
人参 黄 当归 白术 广皮 升麻 柴胡 甘草
齿痛虽有各经虚实不同，然阳明积热者多，故清胃汤治齿痛总司。然尚有分别，若膏
粱食气已化，惟存积热，所谓热而无滞，可用清胃汤，苦寒直折；若积热虽重，浓味尚未化
尽，所谓热而有滞，若以苦寒直折，则滞气凝遏，而热愈甚。倒如郁火症，用苦寒则火愈郁
，服升阳散火汤则愈。东垣以清胃汤加砂仁，香附，更名清胃散，散者，散也，家秘加白豆
蔻、黑山楂末，同是此意。以肠胃积热，大抵酒肉食滞，蒸酿而成，故化散胃滞，积热自清
。余以平胃保和散，治口疮齿痛，及疳火疳积，俱获奇效，此深得清积热根本。故疮癣齿痛
之人，不能淡薄滋味，必缠绵难愈也。
【内伤齿痛的症状】有的牙齿松动脱落，有的牙齿伸长且松动，有的牙龈浮起、发痒、干燥、发黑，时常疼痛，这是内伤引起的病症。如果右侧疼痛，属于胃与大肠经；右下侧（下盘）疼痛，属于肺和胃两经；左上侧（上盘）疼痛，属于胆经；左下侧（下盘）疼痛，属于肝经；正上方门牙疼痛，属于心经；正下方门牙疼痛，属于肾经；上方左右两侧虎牙疼痛，属于胃经；下方左右两侧虎牙疼痛，属于脾经。
【内伤齿痛的病因】牙齿松动且浮起的，是肾气衰败；牙齿伸长且松动的，是胃中有热；发痒是血分有热；疼痛是火邪灼烧；发黑则是虫蚀所致。这是内伤齿痛的病因。
【内伤齿痛的脉象】尺脉虚大，表示肾水亏虚。如果见到洪数脉，说明阴火旺盛躁动。左关脉弦急，表示肝胆之火亢盛。左关脉洪滑，表示痰火在内灼烧。
【内伤齿痛的治疗】肾虚伴有阴火的，用凉八味丸（玄武胶为丸），或者知柏天地煎。左关脉弦急的，用龙胆泻肝汤；右关脉洪滑的，用化痰汤。应当使用泻下法的，用三黄丸。大凡牙痛病症，寒证少，热证多，所以内伤门类都使用凉性方剂。如果是因劳累疲倦导致胃虚而牙齿浮起的，又应当使用补中益气汤，不可拘泥于“痛无补法”的说法。
凉八味丸
即六味地黄丸加入黄柏、知母，共研为细末，用玄武胶制成丸剂。
知柏天地煎
黄柏、知母、天门冬、生地黄
共同煎煮三四次，冲入玄武胶收膏。
龙胆泻肝汤 见前文。
化痰汤
贝母、枳实、黄芩、黄连、天花粉、桔梗、玄参、升麻、甘草
补中益气汤
人参、黄芪、当归、白术、广皮（陈皮）、升麻、柴胡、甘草
齿痛虽然各经络虚实不同，但阳明经积热者居多，所以清胃汤治疗齿痛总领全局。然而仍有分别，如果膏粱厚味的食气已经消化，只残留积热，所谓“热而无滞”，可以使用清胃汤，以苦寒之药直接折降火势；如果积热虽然严重，但浓味食物尚未完全化尽，所谓“热而有滞”，如果用苦寒之药直接折降，则会导致滞气凝结遏制，从而使热势更甚。例如郁火症，使用苦寒药则火气更加郁结，服用升阳散火汤则痊愈。李东垣将清胃汤加入砂仁、香附，改名为清胃散，“散”的意思就是发散，我家秘传的方法加入白豆蔻、黑山楂末，也是同样的意思。因为肠胃积热，大抵是由于酒肉饮食停滞，蒸酿而成，所以化解消散胃中的滞气，积热自然清除。我用平胃保和散，治疗口疮齿痛，以及疳火疳积，都获得奇效，这深得清除积热的根本。所以患有疮癣齿痛的人，如果不能清淡饮食，必定缠绵难愈。
[Symptoms of Internal Injury Toothache] Some experience loose or falling teeth, some have teeth that elongate and become loose, some have gums that are swollen, itchy, dry, and blackened, with frequent pain; this is a condition caused by internal injury. If the pain is on the right side, it belongs to the Stomach and Large Intestine meridians; if the pain is on the lower right quadrant, it belongs to the Lung and Stomach meridians; if the pain is on the upper left quadrant, it belongs to the Gallbladder meridian; if the pain is on the lower left quadrant, it belongs to the Liver meridian; if the pain is in the upper central incisors, it belongs to the Heart meridian; if the pain is in the lower central incisors, it belongs to the Kidney meridian; if the pain is in the upper left and right canines, it belongs to the Stomach meridian; if the pain is in the lower left and right canines, it belongs to the Spleen meridian.
[Etiology of Internal Injury Toothache] Teeth that are loose and floating indicate Kidney decline; teeth that elongate and loosen indicate Stomach heat; itching indicates blood heat; pain indicates fire scorching; blackening indicates erosion by worms. These are the etiologies of internal injury toothache.
[Pulse Patterns of Internal Injury Toothache] A deficient and large Chi pulse indicates a deficiency of Kidney Water. If a surging and rapid pulse is seen, it indicates hyperactive Yin Fire. A wiry and urgent Left Guan pulse indicates Hyperactive Fire of the Liver and Gallbladder. A surging and slippery Left Guan pulse indicates internal scorching by Phlegm-Fire.
[Treatment of Internal Injury Toothache] For Kidney deficiency with Yin Fire, use Liang Ba Wei Wan (Cooling Eight-Ingredient Pill) made into pills with Xuanwu Jiao (Black Tortoise Shell Glue), or Zhi Bai Tian Di Jian (Anemarrhena and Phellodendron Heaven-Earth Decoction). For a wiry and urgent Left Guan pulse, use Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction); for a surging and slippery Right Guan pulse, use Hua Tan Tang (Phlegm-Resolving Decoction). If purgation is indicated, use San Huang Wan (Three-Yellow Pill). Generally, in cases of toothache, cold patterns are few and heat patterns are many; therefore, in the category of internal injury, cooling formulas are predominantly used. However, if tooth swelling occurs due to fatigue and exhaustion leading to Stomach deficiency, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) should be used; one must not rigidly adhere to the notion that "pain has no tonification method."
Liang Ba Wei Wan (Cooling Eight-Ingredient Pill)
Consists of Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) plus Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma), ground into fine powder, and formed into pills with Xuanwu Jiao (Testudinis Carapax et Plastrum Glue).
Zhi Bai Tian Di Jian (Anemarrhena and Phellodendron Heaven-Earth Decoction)
Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma), Tian Dong (Asparagi Radix), Sheng Di Huang (Rehmanniae Radix).
Decocted together three to four times, mixed with Xuanwu Jiao (Testudinis Carapax et Plastrum Glue) to form an electuary.
Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) See previous text.
Hua Tan Tang (Phlegm-Resolving Decoction)
Bei Mu (Fritillariae Bulbus), Zhi Shi (Aurantii Fructus Immaturus), Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Hua Fen (Trichosanthis Radix), Jie Geng (Platycodonis Radix), Yuan Shen (Scrophulariae Radix), Sheng Ma (Cimicifugae Rhizoma), Gan Cao (Glycyrrhizae Radix).
Jia Mi San Huang Wan (Secret Three-Yellow Pill)
Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Da Huang (Rhei Radix et Rhizoma), Gan Cao (Glycyrrhizae Radix), Guang Pi (Citri Reticulatae Pericarpium).
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Guang Pi (Citri Reticulatae Pericarpium), Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Gan Cao (Glycyrrhizae Radix).
Although toothache varies in deficiency and excess across different meridians, accumulation of heat in the Yangming meridian is most common; thus, Qing Wei Tang (Stomach-Clearing Decoction) serves as the general treatment for toothache. However, distinctions remain. If rich food qi has already been digested, leaving only accumulated heat ("heat without stagnation"), Qing Wei Tang can be used to directly subdue the fire with bitter-cold herbs. If accumulated heat is severe but rich flavors have not yet fully transformed ("heat with stagnation"), using bitter-cold herbs to directly subdue the fire will cause stagnant Qi to coagulate and obstruct, thereby exacerbating the heat. For example, in cases of constrained fire, using bitter-cold herbs causes further constraint, whereas Sheng Yang San Huo Tang (Raise Yang and Disperse Fire Decoction) leads to recovery. Li Dongyuan added Sha Ren (Amomi Fructus) and Xiang Fu (Cyperi Rhizoma) to Qing Wei Tang, renaming it Qing Wei San (Stomach-Clearing Powder); "San" implies dispersing. My secret method adds Bai Dou Kou (Amomi Fructus Rotundus) and Hei Shan Zha (Crataegi Fructus Nigricans), which shares the same intent. Since gastrointestinal accumulated heat largely results from stagnation of wine and meat foods steaming and fermenting, resolving and dispersing gastric stagnation naturally clears the accumulated heat. I use Ping Wei Bao He San (Peace the Stomach and Preserve Harmony Powder) to treat mouth sores, toothache, as well as Gan fire and Gan accumulation, achieving remarkable effects; this deeply grasps the root of clearing accumulated heat. Therefore, individuals suffering from sores, tinea, or toothache who cannot maintain a bland diet will inevitably suffer from lingering and difficult-to-cure conditions.