(外感、内伤)
【外感齿痛之症】身发寒热,痛连头目,甚则攻注牙龈,肿痛作脓,此外感齿痛之症
【外感齿痛之因】齿痛属阳明少阳二经者多。胃家有热,胆经有火,外被风寒所束,
二经之热,不能发越,则郁而攻注作痛矣。
【外感齿痛之脉】右关浮数,阳明风热。右关沉数,肠胃积热。左关浮紧,少阳风寒
【外感齿痛之治】阳明风热者,葛根防风汤。阳明积热者,外刺合谷穴,内服葛根清
。少阳风寒者,柴胡防风汤。少阳风热者,柴胡清肝饮。肝胆积热者,龙胆泻肝汤。头痛恶
寒,太阳风寒外束,羌活汤。齿痛属阳明少阳者多,或有太阳症,故立后条。
干葛防风汤
干葛 防风 石膏 甘草
干葛清胃汤
升麻 甘草 生地 丹皮 山栀 干葛 川黄连
右上盘牙痛,加枳壳、石膏;
右下盘牙痛,加石膏、桑白皮;
上正门牙痛,加川黄连;
下正门牙痛,加知母、黄柏;
上二虎牙痛,加葛根、石膏;
下二虎牙痛,加白芍药;
左上盘牙痛,加柴胡、黄芩;
左下盘牙痛,加白芍药、黄芩。
柴胡防风汤
柴胡 防风 羌活 川芎 青皮 甘草
柴胡清肝饮
柴胡 白芍 山栀 黄芩 当归 丹皮 青皮 甘草 钩藤
龙胆泻肝汤
龙胆草 柴胡 黄芩 川黄连 山栀 知母 麦门冬 甘草
元气虚,加人参;血虚,加当归、白芍药;大便结,加大黄;气结,加青皮。
羌活汤
羌活 防风 川芎 白芷 苍术 甘草
【外感与内伤】
【外感齿痛的症状】身体出现恶寒发热,疼痛牵连头部和眼部,严重时攻冲注于牙龈,导致牙龈肿痛并化脓,这是外感引起的齿痛症状。
【外感齿痛的病因】齿痛多属于阳明经(足阳明胃经)和少阳经(足少阳胆经)。胃中有热,胆经有火,外部又被风寒邪气束缚,导致这两条经络的热邪不能发散透达,从而郁结并攻冲注致痛。
【外感齿痛的脉象】右关部脉浮而数,为阳明风热证;右关部脉沉而数,为肠胃积热证;左关部脉浮而紧,为少阳风寒证。
【外感齿痛的治疗】属于阳明风热的,用葛根防风汤治疗;属于阳明积热的,外部针刺合谷穴,内部服用葛根清胃汤;属于少阳风寒的,用柴胡防风汤治疗;属于少阳风热的,用柴胡清肝饮治疗;属于肝胆积热的,用龙胆泻肝汤治疗。若伴有头痛、恶寒,属太阳风寒外束,用羌活汤治疗。因为齿痛多属阳明、少阳二经,但也可能兼有太阳病症状,所以列出后一条作为补充。
右上盘牙痛,加枳壳、石膏;
右下盘牙痛,加石膏、桑白皮;
上正门牙痛,加川黄连;
下正门牙痛,加知母、黄柏;
上二虎牙痛,加葛根、石膏;
下二虎牙痛,加白芍药;
左上盘牙痛,加柴胡、黄芩;
左下盘牙痛,加白芍药、黄芩。
柴胡清肝饮
柴胡、白芍、山栀、黄芩、当归、丹皮、青皮、甘草、钩藤
龙胆泻肝汤
龙胆草、柴胡、黄芩、川黄连、山栀、知母、麦门冬、甘草
[Exogenous and Endogenous Etiologies]
[Symptoms of Exogenous Toothache] The body presents with aversion to cold and fever, pain radiating to the head and eyes. In severe cases, it attacks and infiltrates the gums, causing swelling, pain, and suppuration. These are the symptoms of exogenous toothache.
[Etiology of Exogenous Toothache] Toothache mostly belongs to the Yangming (Foot-Yangming Stomach Meridian) and Shaoyang (Foot-Shaoyang Gallbladder Meridian) meridians. There is heat in the stomach and fire in the gallbladder meridian. Externally bound by wind-cold pathogens, the heat of these two meridians cannot be dispersed and vented, leading to stagnation and attacking pain.
[Pulse Signs of Exogenous Toothache] Floating and rapid pulse at the right Guan position indicates Wind-Heat in Yangming; Deep and rapid pulse at the right Guan position indicates Accumulated Heat in the intestines and stomach; Floating and tight pulse at the left Guan position indicates Wind-Cold in Shaoyang.
[Treatment of Exogenous Toothache] For Yangming Wind-Heat, use Gegen Fangfeng Tang (Kudzu and Saposhnikovia Decoction). For Yangming Accumulated Heat, externally needle Hegu (LI4), and internally take Gegen Qingwei Tang (Kudzu and Stomach-Clearing Decoction). For Shaoyang Wind-Cold, use Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction). For Shaoyang Wind-Heat, use Chaihu Qinggan Yin (Bupleurum and Liver-Clearing Infusion). For Liver-Gallbladder Accumulated Heat, use Longdan Xiegan Tang (Gentian and Liver-Draining Decoction). If accompanied by headache and aversion to cold, indicating external binding of Taiyang Wind-Cold, use Qianghuo Tang (Notopterygium Decoction). Since toothache mostly belongs to Yangming and Shaoyang, but may occasionally present with Taiyang symptoms, this subsequent clause is established for supplementation.
Gegen Fangfeng Tang (Kudzu and Saposhnikovia Decoction)
Radix Puerariae Lobatae (Gegen), Radix Saposhnikoviae (Fangfeng), Gypsum Fibrosum (Shigao), Radix Glycyrrhizae Preparata (Gancao)
Gegen Qingwei Tang (Kudzu and Stomach-Clearing Decoction)
Rhizoma Cimicifugae (Shengma), Radix Glycyrrhizae Preparata (Gancao), Radix Rehmanniae Preparata (Shengdi), Cortex Moutan (Danpi), Fructus Gardeniae Jasminoidis (Shanzhi), Radix Puerariae Lobatae (Gegen), Rhizoma Coptidis (Chuanlianhuang)
For upper right molar toothache, add Fructus Aurantii (Zhike) and Gypsum Fibrosum (Shigao);
For lower right molar toothache, add Gypsum Fibrosum (Shigao) and Cortex Moriperi (Sangbaipi);
For upper central incisor toothache, add Rhizoma Coptidis (Chuanlianhuang);
For lower central incisor toothache, add Rhizoma Anemarrhenae (Zhimu) and Cortex Phellodendri (Huangbai);
For upper canine toothache, add Radix Puerariae Lobatae (Gegen) and Gypsum Fibrosum (Shigao);
For lower canine toothache, add Radix Paeoniae Alba (Baishao);
For upper left molar toothache, add Radix Bupleuri (Chaihu) and Radix Scutellariae (Huangqin);
For lower left molar toothache, add Radix Paeoniae Alba (Baishao) and Radix Scutellariae (Huangqin).
Chaihu Fangfeng Tang (Bupleurum and Saposhnikovia Decoction)
Radix Bupleuri (Chaihu), Radix Saposhnikoviae (Fangfeng), Rhizoma Notopterygii (Qianghuo), Radix Ligustici Chuanxiong (Chuanxiong), Pericarpium Citri Reticulatae (Qingpi), Radix Glycyrrhizae Preparata (Gancao)
Chaihu Qinggan Yin (Bupleurum and Liver-Clearing Infusion)
Radix Bupleuri (Chaihu), Radix Paeoniae Alba (Baishao), Fructus Gardeniae Jasminoidis (Shanzhi), Radix Scutellariae (Huangqin), Radix Angelicae Sinensis (Danggui), Cortex Moutan (Danpi), Pericarpium Citri Reticulatae (Qingpi), Radix Glycyrrhizae Preparata (Gancao), Uncaria rhynchophylla (Gouteng)
Longdan Xiegan Tang (Gentian and Liver-Draining Decoction)
Radix Gentianae Longdancao (Longdancao), Radix Bupleuri (Chaihu), Radix Scutellariae (Huangqin), Rhizoma Coptidis (Chuanlianhuang), Fructus Gardeniae Jasminoidis (Shanzhi), Rhizoma Anemarrhenae (Zhimu), Radix Ophiopogonis (Maidong), Radix Glycyrrhizae Preparata (Gancao)
If Yuan Qi (Primal Qi) is deficient, add Radix Ginseng (Renshen); if Blood is deficient, add Radix Angelicae Sinensis (Danggui) and Radix Paeoniae Alba (Baishao); if stool is constipated, add Radix Rhei (Dahuang); if Qi is knotted/stagnant, add Pericarpium Citri Reticulatae (Qingpi).
Qianghuo Tang (Notopterygium Decoction)
Rhizoma Notopterygii (Qianghuo), Radix Saposhnikoviae (Fangfeng), Radix Ligustici Chuanxiong (Chuanxiong), Radix Angelicae Dahuricae (Baizhi), Rhizoma Atractylodis Macrocephalae (Cangzhu), Radix Glycyrrhizae Preparata (Gancao)