阳明胃火留为殃。毒上冲牙生疳疮。此症非同口疮比。顷刻能令性命伤。
麻毒流连走马疳。牙龈黑烂食难尝。败唇崩鼻牙齿落。漏颊穿腮旦夕亡。
牙疳者。专于上下牙龈腐烂。其毒最重。其症最危。非若口疮舌珠之比。此乃胃火留而不去。
余毒上冲所致。急宜清胃凉血。佐以润大肠之剂。以秘本加味清胃散。加石膏、荆芥、火麻仁、杏
仁治之。大便秘者。以秘本洗心散（见八十条）去麻黄。加牛蒡子、石膏微利之。（有用当归散者。
实属无济。方仍存之。）外以桑根白皮煎汤漱洗。以马鸣散、文蛤散、救苦散、无比散、烧盐散等
方。随用以涂之。若麻一出即收。麻毒收入于里。致生牙疳。大热、谵语、不食等症。内宜用凉解之
剂。以加减清胃汤去陈皮、桔梗、甘草。加黄连、葛根、牛蒡子主之。外以熟附子切片。将水煮软。
敷患者两手心、两足心以拔之。如麻后牙疳肿痛者。以清胃散（见七十九条）加荆芥、元参、牛蒡
子主之。外以尿桶中白垢。火 如盐。加冰片研。和蜜调、搽之。凡麻后、牙龈黑烂、肉腐出血。呼
吸气息、臭气冲人者。名为走马牙疳。急用尿白火 。加冰片。以蜜调频涂。或用马鸣散等方。或
以龙硼散、黄龙散、雄黄散、神授丹等方吹之。又或以黄连、硼砂各一钱。胆矾三分。冰片五厘。研
末搽之。再加白盐梅、烧灰存性。人中白、火 、同研。搽之更应。内急以生犀地黄汤、加石膏治
之。俟症平。以四物汤（见二十五条）。用生地黄、加木通、栀仁、生犀角、西茵陈以利小便。使热
血下行。而毒火不致上冲矣。若牙疳白色。为胃烂不治之症。有用栗树根白皮。煎水洗患处。而
以五倍子、雄黄、百草霜、枯明矾、为末吹之者。间有取效。未必全验也。若通龈白色。自外延入内
者。无脓血者。牙眶烂而口臭者。喘促痰鸣者。面颊浮肿者。环口青黑者。颊漏腮穿者。喉穿齿落
者。唇崩鼻坏者。皆不治之症也。
朱曰 牙疳证虽危险。内外治法极多。按法治之。自可奏效。尚有一种似牙疳者。如小
儿口内生毒块。不能食乳。名螳螂子。用生地酒浸捣烂涂脚心。男左女右。自愈。
又一外治法。用生香附、生半夏等分为末。鸡子白调作饼。贴涌泉穴。男左女右。
一周时愈。
秘本加味清胃散 治斑疹口舌生疮。牙龈腐烂。
丹皮 当归 生地黄 黄连 犀角 连翘 升麻 甘草 水煎服。
马鸣散 治走马牙疳良方。
人中白（即尿桶中白垢、以竹刀刮取、用新瓦盛、以火 之、俟其色白如盐、取用五钱。） 蚕蜕
纸（又名马鸣退、烧灰、二钱） 生五倍子（一钱） 明矾（研细二钱） 又五倍子（一个、入明矾末于
内、装不尽、再用五倍子一个、装尽、以火 之、俟以矾枯为度、取用。） 同为细末。先用米泔水、
洗患处。然后以末搽之。
文蛤散
雄黄（五钱） 枯明矾（五分） 蚕蜕纸（烧灰一钱） 生五倍子（一钱） 又五倍子（一钱同明矾
炒枯用） 为末。先将米泔水、洗患处。然后以末搽上。一日数次。以愈为度。
救苦散 治口疮牙疳。
人中白（火 五钱） 寒水石（飞过三钱） 青黛（五分） 僵蚕（炒） 黄柏 冰片（各一
钱五分） 牛黄（二分） 为末。先以苦茶洗患处。然后以末搽上。三五次少愈。十次全愈。
无比散 治牙疳腐烂。
黄牛屎（ ） 冰片（少许） 为细末。吹患处。
烧盐散 治牙疳溃烂 取椽斗大者。实盐满壳。合起。将铁丝扎定。烧化存性。以 复地片时。取
起。加入麝香少许。研细。涂之。椽（音许、即栩字。诗陈风宛丘之栩柞栎也。一名杼。三四
月间开黄花。八九月内结子。子如皂斗。子外有房。可染皂。）
加减清胃汤 治麻后口疮。
元参 连翘 生地黄 黄柏 麦冬 木通 白茯苓 天花粉 陈皮 桔梗 甘草 灯心引。
龙硼散 治麻后口疮。
牡黄牛屎尖（ ） 明矾（五分） 冰片（一分五厘） 朴硝（一钱） 硼砂（二钱） 为
末。以鹅管盛末。吹患处。
黄龙散
牡黄牛屎尖（ ） 冰片（一分） 为末。以鹅管吹患处。
雄黄散
雄黄（一钱） 黄柏（二钱） 麝香（一分）为末。先以艾叶煎汤洗患处。然后以末搽之。以愈为度。
神授丹
枯明矾（七分） 麝香（一分） 白毡灰（三分）为末。以竹管盛。吹患处。
生犀地黄汤
连翘 葛根 元参 黄连 生地黄 荆芥穗 升麻 甘草 生犀角（另磨） 水煎。入犀角汁
二三匙对服。
阳明胃火滞留成为祸殃。毒气上冲至牙龈，生出疳疮。此症不同于口疮，片刻之间便能危及性命。
麻疹毒邪流连不去，演变为走马疳。牙龈黑烂，饮食难以下咽。嘴唇溃败崩塌，鼻子穿孔脱落，脸颊穿洞，腮部腐烂，早晚之间即可死亡。
所谓牙疳，专门指上下牙龈的腐烂。其毒性最重，病情最危急，不像口疮或舌部珠状溃疡那样轻微。这是胃火滞留不去，余毒上冲所致。应当紧急使用清胃凉血的药物，并辅以润肠通便的药剂。以《秘本》加味清胃散为基础，加入石膏、荆芥、火麻仁、杏仁来治疗。如果大便秘结，使用《秘本》洗心散（见第八十条），去掉麻黄，加入牛蒡子、石膏，使其轻微通利。（有人使用当归散，实际上毫无帮助，方剂仍保留在此供参考。）外用桑根白皮煎汤漱口清洗，并用马鸣散、文蛤散、救苦散、无比散、烧盐散等方药，根据情况涂抹患处。如果麻疹一出即收，导致麻毒内陷于里，从而引发牙疳，出现高热、说胡话、不能进食等症状，内服宜用清凉解表之剂，以加减清胃汤去掉陈皮、桔梗、甘草，加入黄连、葛根、牛蒡子为主治。外用熟附子切片，用水煮软后，敷在患者两手心和两足心，以拔除毒气。如果是麻疹后出现的牙疳肿痛，以清胃散（见第七十九条）加入荆芥、元参、牛蒡子主治。外用尿桶中的白色垢物，用火煅烧成盐状，加入冰片研细，调和蜂蜜后搽涂。凡是麻疹之后，牙龈黑烂，肌肉腐烂出血，呼吸气息臭气熏人的，称为走马牙疳。紧急使用煅烧过的尿白垢，加入冰片，用蜂蜜调和频繁涂抹。或者使用马鸣散等方药，或者用龙硼散、黄龙散、雄黄散、神授丹等方药吹入患处。又或者取黄连、硼砂各一钱，胆矾三分，冰片五厘，研成粉末搽涂。再加白盐梅，烧灰存性，与人中白一起煅烧后同研，搽涂效果更佳。内部紧急使用生犀地黄汤，加入石膏治疗。待症状平息后，使用四物汤（见第二十五条），用生地黄，加入木通、栀子仁、生犀角、西茵陈以利小便，使热血下行，从而使毒火不再上冲。如果牙疳呈现白色，是胃烂不治之症。有用栗树根白皮煎水清洗患处，并以五倍子、雄黄、百草霜、枯明矾为末吹入患处的，偶尔有效，但未必完全灵验。如果整个牙龈发白，从外部向内蔓延，没有脓血，牙槽腐烂且口臭，气喘急促痰鸣，面颊浮肿，口周青黑，脸颊漏孔腮部穿洞，喉咙穿孔牙齿脱落，嘴唇崩塌鼻子坏死的，都是不治之症。
朱氏说：牙疳证虽然危险，但内外治疗方法极多，按照方法治疗，自然可以奏效。还有一种类似牙疳的病，如小儿口腔内生毒块，不能吃奶，名叫螳螂子。用地黄酒浸捣烂涂脚心，男左女右，可自行痊愈。
另一种外治法，用生香附、生半夏等分为末，用鸡蛋清调成饼，贴敷涌泉穴，男左女右，一周时间可愈。
秘本加味清胃散 治疗斑疹引起的口舌生疮，牙龈腐烂。
丹皮、当归、生地黄、黄连、犀角、连翘、升麻、甘草，水煎服。
马鸣散 治疗走马牙疳的良方。
人中白（即尿桶中的白色垢物，用竹刀刮取，用新瓦盛放，用火煅烧，等到颜色像盐一样白时取用，五钱）、蚕蜕纸（又名马鸣退，烧灰，二钱）、生五倍子（一钱）、明矾（研细，二钱）。另外取一个五倍子，将明矾末装入其中，装不满为止，再取一个五倍子装满，用火煅烧，等到明矾枯干为止取用。以上共同研为细末。先用米泔水清洗患处，然后将药末搽涂。
文蛤散
雄黄（五钱）、枯明矾（五分）、蚕蜕纸（烧灰，一钱）、生五倍子（一钱）。另外取五倍子（一钱与明矾炒枯后使用）。研为细末。先将米泔水清洗患处，然后将药末搽上。一日数次，以痊愈为度。
救苦散 治疗口疮牙疳。
人中白（火煅，五钱）、寒水石（飞过，三钱）、青黛（五分）、僵蚕（炒）、黄柏、冰片（各一钱五分）、牛黄（二分）。研为细末。先用苦茶清洗患处，然后将药末搽上。三五次后稍有好转，十次后完全痊愈。
无比散 治疗牙疳腐烂。
黄牛屎（焙干）、冰片（少许）。研为细末，吹入患处。
烧盐散 治疗牙疳溃烂。取椽斗大小的栎树果实壳，装满盐，合拢，用铁丝扎紧，烧化至存性。冷却片刻后取出，加入少许麝香，研细，涂擦患处。椽（音许，即栩字，《诗经·陈风·宛丘》中的“栩”，柞栎之类，一名杼。三四月间开黄花，八九月间结果，果实像皂斗，外面有房壳，可用于染皂。）
加减清胃汤 治疗麻疹后的口疮。
元参、连翘、生地黄、黄柏、麦冬、木通、白茯苓、天花粉、陈皮、桔梗、甘草，灯心草为引。
龙硼散 治疗麻疹后的口疮。
牡黄牛屎尖（焙干）、明矾（五分）、冰片（一分五厘）、朴硝（一钱）、硼砂（二钱）。研为细末。用鹅管盛装药末，吹入患处。
黄龙散
牡黄牛屎尖（焙干）、冰片（一分）。研为细末，用鹅管吹入患处。
雄黄散
雄黄（一钱）、黄柏（二钱）、麝香（一分）。研为细末。先用艾叶煎汤清洗患处，然后将药末搽涂，以痊愈为度。
Yangming Stomach Fire lingers and causes disaster. Toxic heat rushes upward to the gums, generating canker sores (gangrenous ulcers of the mouth). This condition is not comparable to ordinary aphthous ulcers; it can endanger life within moments.
The measles toxin lingers and transforms into "Running Horse Gangrene" (Zouma Gan). The gums turn black and rot, making eating difficult. The lips collapse, the nose perforates, teeth fall out, cheeks leak, and the face is pierced; death may occur within a day or two.
"Gangrene of the Teeth" (Ya Gan) specifically refers to the rotting of the upper and lower gums. Its toxicity is the heaviest, and its condition is the most critical, unlike simple aphthous ulcers or tongue lesions. This is caused by lingering Stomach Fire that does not disperse, with residual toxic heat rushing upward. Emergency treatment should clear the Stomach and cool the Blood, assisted by agents that moisten the Large Intestine. Use the Modified Qingwei Decoction from the Secret Manual (Biben Jiawei Qingwei San), adding Gypsum Fibrosum (Shigao), Schizonepeta Herb (Jingjie), Hemp Seed (Huomaren), and Apricot Kernel (Xingren). If constipation is present, use Xixin Decoction from the Secret Manual (Biben Xixin San - see Article 80), removing Ephedra Herb (Mahuang), and adding Toosendan Fruit (Niubangzi) and Gypsum Fibrosum (Shigao) to induce mild purgation. (Some use Danggui San, which is actually ineffective; the formula is retained for reference.) Externally, rinse with a decoction of Mulberry Root Bark (Sangbaipipi). Apply Ma Ming San, Wen Ge San, Jiuku San, Wubi San, Shaoyan San, etc., as appropriate. If the measles rash disappears immediately upon appearing, causing the measles toxin to retreat inward and generate gangrene of the teeth, accompanied by high fever, delirium, and anorexia, internally use cooling and resolving agents. Use Jiajian Qingwei Tang, removing Tangerine Peel (Chenpi), Platycodon Root (Jiegeng), and Licorice Root (Gancao), and adding Coptis Rhizome (Huanglian), Kudzu Root (Gegen), and Toosendan Fruit (Niubangzi). Externally, apply slices of Prepared Aconite Root (Shu Fuzi), boiled soft in water, to the palms of both hands and soles of both feet to draw out the toxin. For post-measles gangrene with swelling and pain, treat with Qingwei San (see Article 79) added with Schizonepeta Herb (Jingjie), Scrophularia Root (Yuanshen), and Toosendan Fruit (Niubangzi). Externally, collect the white scale from urine buckets, calcine it like salt, add Borax (Bingpian), grind into powder, mix with honey, and apply. Whenever after measles, if the gums are black and rotten, flesh rots and bleeds, and breath smells foul, it is named "Running Horse Gangrene of the Teeth" (Zouma Yagan). Urgently use calcined urine scale added with Borax (Bingpian), mixed with honey for frequent application. Or use Ma Ming San, or blow Longbo San, Huanglong San, Xionghuang San, Shenshou Dan into the lesion. Alternatively, grind Coptis Rhizome (Huanglian) and Borax (Pengsha) each one qian, Chalcanthite (Danfan) three fen, and Borax (Bingpian) five li into powder for application. Add Salt Plum (Baiyanmei) calcined to retain its nature, and Human Urine Deposit (Renzhongbai) calcined together, ground and applied for better effect. Internally, urgently use Shengxi Dihuang Tang with added Gypsum Fibrosum (Shigao). Once symptoms subside, use Siwu Tang (see Article 25) with Rehmannia Root (Sheng Dihuang), added with Akebia Stem (Mutong), Gardenia Seed (Zhiren), Rhinoceros Horn (Sheng Xijiao), and Artemisia Capillaris (Xi Yinchen) to promote urination, allowing hot blood to descend so that toxic fire does not rush upward again. If the gangrene appears white, it indicates stomach rot and is incurable. Some use decoction of White Bark of Chestnut Tree Root (Lishugen Baipi) to wash the lesion, and blow powder made of Chinese Gall (Wubeizi), Realgar (Xionghuang), Burnt Grass Ash (Baicaoshuang), and Calcined Alum (Ku Mingfan). Occasionally effective, but not always reliable. If the entire gum turns white, spreading from outside to inside, without pus or blood, with rotting alveoli and bad breath, panting with rattling phlegm, swollen cheeks, dark cyanosis around the mouth, cheek leaks and cheek perforations, throat perforation and tooth loss, lip collapse and nose destruction, these are all incurable conditions.
Zhu said: Although gangrene of the teeth is dangerous, there are many internal and external treatments. Following the methods will yield results. There is also a condition resembling gangrene of the teeth, where children develop toxic masses in the mouth and cannot suck milk, called "Tadpole Child" (Tanglangzi). Apply crushed Rehmannia Root (Shengdi) soaked in wine to the sole of the foot (left for males, right for females), and it will heal spontaneously.
Another external treatment: Grind equal parts of Cyperus Rhizome (Sheng Xiangfu) and Pinellia Tuber (Sheng Banxia) into powder, mix with egg white to make a cake, and apply to Yongquan Acupoint (Yongquan, KI1) (left for males, right for females). It heals in one week.
Modified Qingwei Decoction from Secret Manual treats aphthous ulcers on lips and tongue due to macules and papules, and gum rot.
Moutan Bark (Danpi), Angelica Root (Danggui), Rehmannia Root (Sheng Dihuang), Coptis Rhizome (Huanglian), Rhinoceros Horn (Xijiao), Forsythia Fruit (Lianqiao), Kudzu Root (Shengma), Licorice Root (Gancao). Decoct in water and take orally.
Ma Ming San is an excellent prescription for Running Horse Gangrene of the Teeth.
Human Urine Deposit (Renzhongbai - i.e., white scale from urine buckets, scraped with bamboo knife, placed on new tile, calcined until white like salt, 5 qian); Silkworm Cast Skin (Can Tuizhi - also known as Ma Ming Tui, calcined ash, 2 qian); Raw Chinese Gall (Sheng Wubeizi, 1 qian); Alum (Mingfan, finely ground, 2 qian). Additionally, take one Chinese Gall, fill it with Alum powder, seal with another Chinese Gall, calcine until Alum is dry, and use. Grind all into fine powder. First wash the lesion with rice water, then apply the powder.
Wen Ge San
Realgar (Xionghuang, 5 qian); Calcined Alum (Ku Mingfan, 5 fen); Silkworm Cast Skin (Can Tuizhi, calcined ash, 1 qian); Raw Chinese Gall (Sheng Wubeizi, 1 qian). Additionally, Chinese Gall (1 qian stir-fried with Alum until dry). Grind into powder. First wash the lesion with rice water, then apply the powder several times a day until healed.
Jiuku San treats aphthous ulcers and gangrene of the teeth.
Human Urine Deposit (Renzhongbai, calcined, 5 qian); Halloysitum Rubrum (Han Shui Shi, purified, 3 qian); Indigo Naturalis (Qingdai, 5 fen); Bombyx Batryticatus (Jiangcan, stir-fried); Phellodendron Bark (Huangbai); Borax (Bingpian, each 1.5 qian); Calculus Bovis (Niuhuang, 2 fen). Grind into powder. First wash the lesion with bitter tea, then apply the powder. Slight improvement after 3-5 applications, full recovery after 10 applications.
Wubi San treats gangrene of the teeth with rot.
Cow Dung (Niu Huangshi, roasted); Borax (Bingpian, a small amount). Grind into fine powder and blow into the lesion.
Shaoyan San treats ulcerated gangrene of the teeth. Take oak gall shells (Ruan Dou) large enough to hold salt, fill with salt, close tightly, bind with iron wire, and calcine until carbonized. Cool on the ground for a moment, remove, add a little Musk (Shexiang), grind finely, and apply. Oak (Ruan, pronunciation Xu, same as Xu character; mentioned in *Shijing* "Chen Feng Wu Qiu", refers to Quercus species, also known as Zhu. Blooms yellow flowers in March-April, fruits in August-September. Fruits resemble soap pods, have outer casings, and can be used for dyeing soap.)
Jiajian Qingwei Tang treats aphthous ulcers after measles.
Scrophularia Root (Yuanshen), Forsythia Fruit (Lianqiao), Rehmannia Root (Sheng Dihuang), Phellodendron Bark (Huangbai), Ophiopogon Tuber (Maidong), Akebia Stem (Mutong), Poria (Baifuling), Trichosanthes Root (Tianhuafen), Tangerine Peel (Chenpi), Platycodon Root (Jiegeng), Licorice Root (Gancao). Use Centipede Grass (Dengxin) as guide.
Longbo San treats aphthous ulcers after measles.
Tip of Cow Dung (Mu Niu Huangshi Jian, roasted); Alum (Mingfan, 5 fen); Borax (Bingpian, 1.5 fen); Mirabilite (Puxiao, 1 qian); Borax (Pengsha, 2 qian). Grind into powder. Use a goose quill to hold the powder and blow it into the lesion.
Huanglong San
Tip of Cow Dung (Mu Niu Huangshi Jian, roasted); Borax (Bingpian, 1 fen). Grind into powder and blow into the lesion using a goose quill.
Xionghuang San
Realgar (Xionghuang, 1 qian); Phellodendron Bark (Huangbai, 2 qian); Musk (Shexiang, 1 fen). Grind into powder. First wash the lesion with mugwort decoction, then apply the powder until healed.
Shenshou Dan
Calcined Alum (Ku Mingfan, 7 fen); Musk (Shexiang, 1 fen); Ash of White Felt (Bai Zhan Hui, 3 fen). Grind into powder, store in a bamboo tube, and blow into the lesion.
Shengxi Dihuang Tang
Forsythia Fruit (Lianqiao), Kudzu Root (Gegen), Scrophularia Root (Yuanshen), Coptis Rhizome (Huanglian), Rehmannia Root (Sheng Dihuang), Schizonepeta Spike (Jingjie Sui), Kudzu Root (Shengma), Licorice Root (Gancao), Rhinoceros Horn (Sheng Xijiao, separately ground). Decoct in water, mix with 2-3 spoons of Rhinoceros Horn juice, and take orally.