bubble_chart Concept

Toothache refers to pain in the teeth caused by certain reasons.

This condition is called "tooth pain" in Huangdi Neijing; Zhubing Yuanhou Lun further distinguishes between "tooth" and "teeth," with the upper part referred to as "tooth" and the lower part as "teeth," and differentiates between "toothache," "tooth pain," and "teeth pain." Subsequently, in classical medical texts, it is sometimes referred to as "toothache" and sometimes as "tooth pain," both indicating this condition.

Toothache is often accompanied by varying degrees of gum swelling and pain. Therefore, this condition is closely related to gum swelling and pain.

Dental caries, known in classical medical texts by various names such as "dental caries," "dental caries," "tooth worm," "tooth insect," "teeth worm," and "teeth decay," is also a common cause of toothache, hence it is discussed alongside this condition.

bubble_chart Pattern Analysis

1. Wind-heat︰It manifests as tooth distending pain, which worsens with heat or consumption of spicy foods and alleviates when the affected area is cooled. Symptoms include swollen gums, inability to chew food, or swollen and hot cheeks, thirst, red tongue tip, thin white or slightly yellow and dry tongue coating, and a floating and rapid pulse. This is caused by the invasion of wind-heat pathogens into the teeth, resulting in toothache accompanied by swollen and hot gums, thirst, red tongue tip, slightly yellow and dry tongue coating, and a floating and rapid pulse. The pain is characterized by a distending sensation, which intensifies with heat and lessens with cooling. Treatment involves dispersing wind and clearing heat to relieve pain. Commonly used internally is Lonicera and Forsythia Powder with modifications, and externally, Mentha and Natrii Sulfas Powder is applied to the painful area.
2. Wind-cold︰It manifests as toothache with a pulling sensation, aggravated by exposure to cold air and relieved by warmth, accompanied by aversion to wind and cold, absence of thirst, pale red tongue with thin white coating, and floating-tight or slow pulse. The invasion of wind-cold pathogens into the teeth causes wind-cold toothache, accompanied by aversion to wind and cold, absence of thirst, pale red tongue with thin white coating, and floating-tight or slow pulse. The treatment focuses on dispersing wind and dissipating cold to relieve pain. Commonly used formulas include Cultivated Purple Perilla Leaf Decoction or Ephedra, Asarum and Aconite Decoction taken orally, and externally, Asarum Powder is applied to the toothache area.
3. Stomach Heat︰It manifests as toothache, primarily with a distending pain sensation, radiating to the head or accompanied by red and swollen gums, flushed face, fever, thirst, frequent desire for cold drinks, fetid mouth odor with a hot and foul smell, aversion to heat and preference for cold, or swelling and pain in the lips, tongue, cheeks, and jaw, severe constipation, yellow urine, reddish tongue texture, dry tongue, yellow tongue coating, and a pulse manifestation that is surging and rapid or slippery and rapid. This is caused by a constitution prone to heat, coupled with excessive consumption of pungent, spicy, and drying foods, leading to accumulated heat in the stomach that ascends along the meridians. The presentation includes toothache along with signs of internal heat excess pattern (thirst with a preference for drinking, aversion to heat, fetid mouth odor with a hot and foul smell, severe constipation, reddish tongue texture, dry and yellow tongue coating, and a surging and rapid or slippery and rapid pulse). The treatment focuses on clearing and draining stomach heat to relieve pain, commonly using Stomach-Clearing Powder or Jade Lady Decoction, with Scrophularia Root replacing Prepared Rehmannia Root for particularly swift efficacy. Additionally, when diagnosing stomach heat toothache, it is necessary to further differentiate whether it is in the blood aspect or the qi aspect. If toothache is accompanied by redness, swelling, and bleeding, it belongs to the blood aspect, and the aforementioned formulas can be enhanced with increased doses of Cimicifuga Rhizome and Moutan Bark to disperse stagnant heat in the blood aspect. If toothache occurs without gum swelling, it leans toward the qi aspect, and the same approach is applied, but with the addition of Schizonepeta, Saposhnikovia Root, and Asarum to disperse heat in the qi aspect.
4. Kidney Yin Deficiency︰It manifests as intermittent toothache, loose tooth roots, red lips and flushed cheeks, dry and sore throat, flusteredness, dizziness, restlessness and insomnia, aching pain in the waist and spine, a red tongue with scant fluid, scant tongue coating, and a thin, rapid pulse. This is caused by aging and physical weakness, depletion of the kidney's primordial yin, and deficiency fire flaming upward. The key points of pattern identification are: dull toothache accompanied by signs of kidney yin deficiency and deficiency fire flaming upward (such as loose teeth, flushed cheeks and dry throat, sore and weak lower back, red tongue with scant fluid, scant coating, and thin, rapid pulse). The treatment principle is to enrich yin and tonify the kidneys, commonly using the Left-Restoring Pill.
5. Qi Deficiency︰Manifested as dull toothache with lingering pain, mild redness and swelling of the gums, or swelling without redness, pale complexion, shortness of qi and reluctance to speak, low and weak voice, fatigue and lack of strength, spontaneous sweating and palpitations, dizziness and tinnitus, clear and frequent urination, pale and swollen tongue body, thin white or white tongue coating, weak or feeble pulse. It is mostly caused by excessive strain, prolonged illness, or malnutrition leading to the depletion of original qi. The toothache is lingering, but the teeth are not loose, with little local redness and swelling, and no "heat signs" of deficient fire. Instead, it presents a series of signs of qi deficiency (such as shortness of qi and reluctance to speak, fatigue and lack of strength, low and timid voice, pale complexion, pale and swollen tongue body, white tongue coating, weak or feeble pulse), making it easy to distinguish. Treatment involves tonifying qi to alleviate pain, commonly using Middle-Tonifying Qi-Replenishing Decoction with the addition of Prepared Rehmannia Root, Moutan Bark, Poria, and Peony Root.
6. Dental Caries︰It manifests as pain from dental cavities, occurring intermittently. For example, biting something that irritates the tooth can trigger immediate pain, while the tongue and pulse remain normal. This condition is caused by habitual consumption of rich, fatty foods or excessive intake of sugary substances, leading to food debris accumulating between the teeth and eroding the tooth structure. Bianzheng Lu states: "Those who frequently consume rich and sweet foods may suffer from tooth damage and pain..." Dental caries toothache may not cause pain in the early stages when cavities have not yet formed, though the affected area may appear ink-stained or yellowish-brown. Later, cavities of varying depths and sizes may develop, easily trapping food debris. Consuming cold, hot, sour, or sweet foods, or even exposure to cold air, can induce pain. Treatment focuses on *clearing heat to stop pain*, primarily using topical medications. A common prescription involves grinding *Pricklyash Peel* and burnt lime into powder, mixing it with *honeyed pill*, and stuffing it into the cavity.

Toothache can manifest in both exterior and interior pattern. From the perspective of the location of the toothache, the upper teeth are often attributed to the Stomach Meridian of Foot Yangming, while the lower teeth are often attributed to the Large Intestine Meridian of Hand Yangming. This is because the collateral of the stomach enters the upper teeth, and the collateral of the large intestine enters the lower teeth. In clinical practice, by analyzing the cold, heat, deficiency, and excess conditions in the organs and meridians, and paying attention to the characteristics of meridian tropism, the therapeutic effect can be improved.

bubble_chart Documentation

1. Jingyue Quanshu．Teeth and Gums: "All those who suffer from fire-related diseases must have the illness located between the muscles of the gums, either as swelling and pain, or as erosion, or as foul-smelling and falling out, or as continuous bleeding from the gaps between teeth. These are all diseases in the meridians, with the upper teeth belonging to the Foot Yangming and remaining still, while the lower teeth belong to the Hand Yangming and move continuously when chewing. This disease is necessarily caused by excessive consumption of rich foods, sweet and greasy delicacies, leading to dampness-heat accumulating in the intestines and stomach, which then rises and clogs the meridians, resulting in this condition. Treatment should focus on avoiding rich flavors and clearing fire pathogens.…Those with kidney deficiency and dental diseases have their illness not in the meridians but in the organs, as teeth are the ends of bones, and bones are governed by the kidneys. Therefore, renal failure leads to loose teeth, while strong essence leads to firm teeth. As for the disease, it includes teeth that are brittle and not strong, easily shaken, sparse, or protruding and not solid. All dental diseases not caused by worms or fire are necessarily due to insufficient kidney qi, which may be due to innate deficiencies or acquired damages. The treatment should focus on tonifying the kidneys."
2. Yizong Jinjian．Zabing Xinfa Yaojue："Not very swollen or painful, not afraid of cold or heat, is wind toothache, suitable for using Wenfeng Powder.…Not very swollen or painful, prefers to drink hot soup, is cold toothache, suitable for this formula plus Notopterygium, Ephedra, and Sichuan Aconite Lateral Root to warm and disperse. Both formulas should be taken half orally and half as a mouth rinse, spitting out the saliva continuously until better.…For all toothaches, it is suitable to use Yixiao Pill, which is made from seven Pricklyash Peels ground into powder, one Croton Fruit peeled and ground evenly, and rice to form pills, wrapped in cotton and bitten at the painful area, spitting out the saliva to stop the pain. It is also suitable to use Yuchi Powder,…for worm teeth, this bite and rinse is also suitable."
3. Yixue Zhongzhong Canxilu．Medical Cases: "Medical books on treating toothache have not seen the use of hematite Achyranthes Root, because I once cured my own toothache with these two medicines, and since then, whenever encountering toothache caused by stomach qi failing to descend, I always use these two medicines in the prescription. For those with substantial heat in the Yangming stomach, I often add several qian of raw Gypsum."