Gingival hemorrhage, also known as gingival bleeding, refers to the seepage of blood from the gaps between teeth or the gums.

This condition is categorized under "blood overflow" and "epistaxis" in the Neijing; Jingui Yaolue classifies it under the special section of "vomiting blood"; "The Treatise on the Causes and Symptoms of Diseases" includes a section on "bleeding between teeth"; it was not until the Ming Dynasty's Jingyue Quanshu that the term "gingival hemorrhage" was first used. The Foot Yangming Stomach Meridian runs through the upper teeth, and the Hand Yangming Large Intestine Meridian runs through the lower teeth; moreover, the kidneys govern the bones, and the teeth are the surplus of the bones, hence this condition is closely related to the stomach, large intestine, and kidneys, but the pathological changes of the stomach meridian are the most common.

Gingival hemorrhage and tongue bleeding both involve blood coming from the mouth, but in tongue bleeding, the blood comes from the surface of the tongue, which often has stye-like bleeding points, making it easy to distinguish upon inspection. There is also a condition called "gingival atrophy," where blood often seeps from between the teeth, but this condition is characterized by the gums first swelling and then the gum tissue atrophying, exposing the tooth roots, hence it is not discussed in this section.

bubble_chart Pattern Analysis

1. Stomach and Intestine Excess Fire︰Gingival bleeding like a gush, with bright red blood, accompanied by red and swollen gums and pain, fetid mouth odor, thirst with a preference for hot drinks, constipation, a surging and rapid pulse with strong force, a red and crimson tongue texture, and a yellow greasy coating. Due to excessive consumption of spicy foods, heat accumulates in the stomach and intestines, transforming into fire, which scorches the teeth, injuring the blood vessels, hence manifesting as gingival hemorrhage, belonging to the yang, heat, and excess pattern. The key points for pattern identification are: bright red blood, profuse or gushing bleeding, swollen and painful gums, thirst with a desire to drink, severe constipation, and a surging and rapid pulse. Treatment should focus on clearing stomach fire, and the recommended formulas are Stomach-Clearing Powder or Decoction for Clearing Heat from Spleen and Stomach.
2. Stomach Yin Deficiency︰Gingival bleeding with pale red blood, accompanied by gingival erosion but mild swelling and pain, dry mouth with desire to drink, slippery and rapid but weak pulse, tongue texture bright red with scant fluid, thin and dry coating. Mostly caused by pre-existing deficiency of stomach yin, leading to floating deficient fire ascending to the gums and scorching the stomach collaterals, resulting in this condition. The key diagnostic points are: gingival hemorrhage coexisting with gingival erosion, dry mouth and thirst but drinking little. Treatment should focus on nourishing stomach yin and clearing stomach fire. The recommended formula is Sweet Dew Decoction with added Typha to stop bleeding; if deficient fire is intense with brighter red blood, Jade Lady Decoction can be used to guide stomach fire downward while nourishing yin.
3. Kidney Yin Deficiency︰Gingival bleeding with pale red blood, loose and weak teeth, or mild pain, accompanied by dizziness, tinnitus, soreness and weakness in the lumbar and knees, a thin and rapid pulse, and a tender red tongue with scant coating. This condition is commonly seen in individuals with inherent kidney yin deficiency or those with insufficient kidney yin after illness. Teeth are considered the extension of bones and belong to the kidney. Kidney yin deficiency fails to control fire, leading to the upward flaring of deficient fire, which causes gingival hemorrhage as the yin blood follows the fire upward. The key points for pattern identification are: the co-occurrence of gingival hemorrhage and loose teeth, accompanied by symptoms of kidney yin deficiency such as dizziness, tinnitus, feverish feeling in palms and soles, and lumbar soreness, with a thin and rapid pulse being particularly characteristic. The treatment should focus on nourishing kidney yin and descending ministerial fire. The recommended formula is Anemarrhena, Phellodendron, and Rehmannia Pill with the addition of Achyranthes Root and Fortune's Drynaria Rhizome for treatment.
4. Spleen Failing to Control Blood︰Gingival bleeding, with bright red blood, pale gum color, scattered bleeding spots or purpura on the body, pulse manifestation slow or soggy-rapid, tongue body swollen and large, tongue texture pale, with thin white coating. Mostly caused by improper diet, excessive fatigue, injury to the spleen and stomach, leading to deficiency of middle qi, failure of qi to control blood, resulting in blood extravasation and gingival hemorrhage. The key points of pattern identification are: bright red blood, accompanied by a small amount of subcutaneous bleeding spots or purpura, along with symptoms of spleen qi deficiency (such as pale complexion, mental fatigue, lack of strength in the limbs, low and timid voice, swollen and pale tongue, etc.). Treatment should focus on tonifying the spleen and replenishing qi to control blood. The recommended formula is Returning to Spleen Decoction supplemented with hairyvein agrimonia herb and fried Platycladus for treatment.

Gingival hemorrhage is a common clinical symptom, with excessive fire in the stomach meridian being particularly prevalent. The "Xiezheng Lun" states: "Excessive fire in the stomach causes thirst, swollen gums, fever, constipation, and a rapid, full pulse." This diagnosis is quite accurate. If the syndrome can be clearly differentiated and meridian-specific guiding herbs are selected accordingly—such as adding Cimicifuga Rhizome for upper teeth related to the stomach and Rhubarb Rhizoma for lower teeth related to the large intestine—the therapeutic effect will be even better. However, if gingival hemorrhage persists and is accompanied by continuous fever and multiple bleeding sites, it should be considered as a severe condition. The "Suwen" ． "Daqi Lun" says: "A pulse that is strong and rapid, with epistaxis and fever, indicates death," which is very similar to hemorrhagic diseases in modern medicine. It should not be taken lightly or ignored.

bubble_chart Documentation

1. Jingyue Quanshu．hemorrhagic syndrome: "Bleeding from the gaps between teeth and gums is called gingival hemorrhage. This is a disease of the two meridians of Yangming in the hands and feet, and the kidney of the Shaoyin in the feet. The hand Yangming enters the lower teeth, and the foot Yangming enters the upper teeth. Moreover, the kidney governs the bones, and the teeth are the ends of the bones. Although all these can cause dental diseases, when blood comes out of the meridians, it is most related to Yangming. Therefore, when the fire of Yangming is excessive, it causes fetid mouth odor, and the roots of the teeth rot, swell, and ache. Or the blood may gush out, and the teeth do not loosen. This must be due to the person's habitual consumption of rich, sweet, and spicy hot foods, or a strong stomach from heavy drinking, often showing signs of substantial heat in Yangming."