秦子曰∶牙衄者，即牙龈出血之症也。有两经分别，一主阳明肠胃，一主少阴肾经。若
血来如涌，来势甚暴，来血甚多，此阳明牙衄之血也，有外感、有内伤。若血来点滴，来势
缓慢，来血不多，此少阴肾经之血也，有内伤、无外感。以经络而论，有脏腑阴阳之别；以
病因而论，皆属血中有火，但有虚实别，而无阴寒者也。
【外感牙衄之症】身发寒热，烦闷不安，目痛头额痛，鼻干不眠，牙血暴出，此阳明
【外感牙衄之因】或太阳表邪，侵入阳明，或阳明自冒风热，本经热甚，阳明多血多
气，气血皆热，则上攻阳明所过之经，得牙龈之窍缝而直出也。
【外感牙衄之脉】脉多浮数；浮主表邪，数主血热。左脉浮数，太阳侵邪；右脉浮数
，阳明之热。浮数解表，沉数凉血。
【外感牙衄之治】左脉浮数，身热无汗，有表邪者，葛根羌活汤。右脉浮数，身热无
汗，有表邪者，干葛防风汤；右脉浮数，身热有汗，无表邪者，干葛清胃汤。表邪已解，脉沉而
数，犀角地黄汤，未效，加酒蒸大黄，其血即止。
干葛羌活汤 即羌活汤加干葛。
干葛防风汤
干葛 防风 荆芥 石膏 知母
干葛清胃汤
升麻 生地 丹皮 川连 甘草 干葛 石膏
犀角地黄汤 见前咳血嗽血。
里热甚，加酒蒸大黄。
秦子说：牙衄，就是牙龈出血的症状。主要有两条经络分别主管，一条主属阳明肠胃，一条主属少阴肾经。如果血液涌出，来势非常猛烈，血量很多，这是阳明牙衄的出血，分为外感和内伤两种情况。如果血液点滴而出，来势缓慢，血量不多，这是少阴肾经的出血，只有内伤，没有外感。从经络角度分析，有脏腑阴阳的区别；从病因角度分析，都属于血中有火，但需辨别虚实，而不属于阴寒证。
【外感牙衄的症状】身体出现恶寒发热，心烦闷乱不安，眼睛疼痛，前额头痛，鼻子干燥无法入睡，牙龈血液突然大量涌出，这属于阳明（胃经）的外感牙衄。
【外感牙衄的病因】或者是太阳表邪侵入阳明经，或者是阳明经自身感受风热，本经热势炽盛。阳明经多血多气，气血皆受热邪影响，就会向上攻冲经过阳明经循行部位，通过牙龈的缝隙直接流出。
【外感牙衄的脉象】脉象多为浮数脉；浮脉主表邪，数脉主血热。左脉浮数，是太阳经受邪侵扰；右脉浮数，是阳明经的热盛。治疗上，浮数脉宜解表，沉数脉宜凉血。
【外感牙衄的治疗】左脉浮数，身体发热无汗，有表邪者，用葛根羌活汤。右脉浮数，身体发热无汗，有表邪者，用干葛防风汤；右脉浮数，身体发热有汗，无表邪者，用干葛清胃汤。若表邪已解除，脉象转为沉而数，用犀角地黄汤，若无效，加酒蒸大黄，出血即可停止。
犀角地黄汤 见前文咳血嗽血章节。
Qin Zi said: Ya Nu (gingival bleeding) refers to the symptom of bleeding from the gums. It is primarily governed by two meridians: one belongs to the Yangming Stomach and Intestines, and the other to the Shaoyin Kidney meridian. If blood gushes out with a violent onset and in large quantities, this is Yangming gingival bleeding, which can be caused by either external pathogens or internal injury. If blood drips out slowly in small amounts, this is bleeding from the Shaoyin Kidney meridian, which is caused only by internal injury and not by external pathogens. From the perspective of meridians, there are distinctions between Zang-Fu organs and Yin-Yang; from the perspective of etiology, all cases belong to "fire" within the blood, requiring differentiation between deficiency and excess, but they do not belong to Yin-cold patterns.
[Symptoms of External Pathogen Gingival Bleeding] The body presents with aversion to cold and fever, restlessness and discomfort, eye pain, headache in the forehead, dry nose, and insomnia, accompanied by sudden profuse bleeding from the gums. This belongs to Yangming [Stomach Meridian] external pathogen gingival bleeding.
[Etiology of External Pathogen Gingival Bleeding] This may occur when exterior pathogens from the Taiyang meridian invade the Yangming meridian, or when the Yangming meridian itself contracts wind-heat, leading to intense heat within the meridian. The Yangming meridian is abundant in both Qi and Blood. When both Qi and Blood are affected by heat, they attack upwards along the pathways traversed by the Yangming meridian, exiting directly through the gaps in the gums.
[Pulse Diagnosis for External Pathogen Gingival Bleeding] The pulse is typically Floating-Rapid (Fu Shu); a Floating pulse indicates exterior pathogens, while a Rapid pulse indicates heat in the blood. A Floating-Rapid pulse on the left position indicates invasion by Taiyang pathogens; a Floating-Rapid pulse on the right position indicates heat in the Yangming meridian. For Floating-Rapid pulses, the treatment principle is to release the exterior; for Deep-Rapid pulses, the principle is to cool the blood.
[Treatment for External Pathogen Gingival Bleeding] For a Floating-Rapid pulse on the left, with fever, absence of sweating, and presence of exterior pathogens, use Gegen Qianghuo Tang (Pueraria and Notopterygium Decoction). For a Floating-Rapid pulse on the right, with fever, absence of sweating, and presence of exterior pathogens, use Gange Fangfeng Tang (Pueraria and Saposhnikovia Decoction); for a Floating-Rapid pulse on the right, with fever, presence of sweating, and absence of exterior pathogens, use Gange Qingwei Tang (Pueraria and Stomach-Clearing Decoction). If the exterior pathogens have been resolved and the pulse becomes Deep and Rapid, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). If ineffective, add Jiuzheng Dahuang (Wine-processed Rheum officinale), and the bleeding will stop.
Gegen Qianghuo Tang is Qianghuo Tang added with Gegen (Puerariae Radix).
Gange Fangfeng Tang
Gegen (Puerariae Radix)
Fangfeng (Saposhnikoviae Radix)
Jingjie (Schizonepetae Spica)
Shigao (Gypsum Fibrosum)
Zhimu (Anemarrhenae Rhizoma)
Gange Qingwei Tang
Shengma (Cimicifugae Rhizoma)
Shengdi (Rehmanniae Radix Preparata)
Danpi (Moutan Cortex)
Chuanlian (Coptidis Rhizoma)
Gancao (Glycyrrhizae Radix et Rhizoma)
Gegen (Puerariae Radix)
Shigao (Gypsum Fibrosum)
Xijiao Dihuang Tang See previous section on Hemoptysis and Coughing Blood.
If interior heat is severe, add Jiuzheng Dahuang (Wine-processed Rheum officinale).