bubble_chart Concept

Rodentia refers to the grinding of upper and lower teeth against each other, producing a grating sound.

This condition has different names in classical medical texts. Jingui Yaolue and Zhubing Yuanhou Lun refer to it as "grinding of teeth." Since the Tang and Song dynasties, it has also been called "chi xie," "nie chi" (same as nie chi), "nie chi," "ga chi," and "yao ya," among other names.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰Shivering and teeth chattering, accompanied by fever and chills, headache, generalized body pain, without sweating, tongue texture pale red, tongue coating thin white, pulse floating and tight. This is due to external invasion of wind-cold pathogens contending with healthy qi at the exterior, manifesting as fever and chills, trembling and teeth chattering, headache, generalized body pain, thin white tongue coating, floating and tight pulse, and other exterior patterns; often occurs when awake. Treatment involves releasing the exterior, dispersing wind, and dissipating cold, commonly using Ephedra Decoction with modifications.
2. Heart and Stomach Fire Heat︰Often grinds teeth during sleep, thirst for cold drinks, rapid digestion with frequent hunger, vomiting or epigastric upset, or immediate vomiting after eating, fetid mouth odor, restlessness, red tongue, tongue coating yellow with scanty fluid, slippery and rapid pulse. This is caused by excessive heart and stomach fire. As the Yangming meridian enters the teeth, encircles the mouth, and embraces the lips, internal heat fills the collaterals, resulting in the symptom of audible teeth grinding. Accompanied by restlessness, fetid mouth odor, thirst for cold drinks, red tongue with yellow and scanty coating, and slippery-rapid pulse. These two conditions are distinct, one external and one internal. Often grinds teeth during sleep. Treatment involves clearing stomach fire, commonly using Stomach-Clearing Powder.
3. Food Retention︰Grinding teeth during sleep, gastric stuffiness, no desire to eat, indigestion, fatigue, difficulty in bowel movements, or diarrhea with abdominal pain, or severe constipation, dark urine, red tongue texture, greasy and slightly yellow tongue coating, slippery and solid pulse. It is caused by unclean diet, internal damage to milk and food, stagnation and indigestion, qi stagnation, and damage to the spleen and stomach. It is characterized by no desire to eat, indigestion, abdominal distension and fullness, emaciation, and irregular bowel movements. Treatment involves promoting digestion and removing food stagnation with the Harmony-Preserving Method, often using Harmony-Preserving Pill in decoction form with Neopicrorhiza for oral administration; or taking Immature Orange Fruit Stagnation-Removing Pill (or decoction) with modifications. Clinically, cases of food retention combined with roundworms may also occur and can be treated concurrently.
4. Ascaris︰Grinding teeth during sleep, epigastric upset, abdominal pain occurring intermittently, excessive appetite, abnormal cravings or peculiar eating habits, sallow complexion and emaciation, or itchy nostrils, blue spots or dots on the white of the eye, white worm spots on the face (lateral face and cheek areas), small dots inside the lips (translucent protrusions resembling foxtail millet grains), light red or bright red dot-like protrusions at the tip of the tongue or along both sides of the midline. Tongue texture is pale red, tongue coating is white, and the pulse is wiry and slippery. Characteristics of the worm pattern include abdominal pain concentrated around the navel and occurring intermittently, excessive appetite, abnormal cravings or peculiar eating habits, sallow complexion and emaciation, blue spots or dots on the white of the eye, white worm spots on the face, and foxtail millet-like dots inside the lips. Treatment primarily focuses on expelling worms, supplemented by invigorating the spleen and resolving dampness. Commonly used formulas include the Worm-Expelling Pill, Quisqualis Fruit Powder, or Mume Pill.
5. Deficiency of Both Qi and Blood︰The gnashing sound is faint, the complexion is pale, the lips, tongue, and nails are pale and dull, dizziness and blurred vision, palpitation or severe palpitation, fatigue and lack of strength, shortness of qi with reluctance to speak, low and weak speech, or numbness in the hands and feet, a swollen tongue, a pale tongue texture, a thin white or white tongue coating, and a thin weak or feeble large pulse. This is caused by deficiency of qi and blood leading to malnutrition of the tendons and vessels. In clinical manifestations, apart from the symptoms of gnashing, the signs of qi and blood deficiency serve as the main basis for diagnosis (reluctance to speak due to shortness of qi, weak and short qi, a pale and dull complexion, pale lips and nails, vertigo, or even convulsions, a pale tongue texture, a thin weak pulse, etc.). For gnashing teeth due to deficiency of qi and blood, the treatment should focus on tonifying qi and nourishing blood. The recommended formula is Eight Precious Ingredients Decoction with modifications.
6. Internal Stirring of Deficient Wind︰Gnashing of teeth, wriggling of limbs, or even spasm and convulsion, trembling of hands and feet, sallow complexion, flushed cheeks, or night sweat, vexing heat in the chest, palms and soles, or dry throat and mouth, red tongue texture, scant or no tongue coating, deep and thin pulse. Whether seen in miscellaneous diseases or in warm diseases, all are caused by the depletion of yin essence and water failing to nourish wood. The liver governs the tendons and relies on kidney water for nourishment. Old age, chronic illness, internal damage from the seven emotions, excessive overstrain, or prolonged pathogenic heat scorching the yin fluids are all causes of internal stirring of deficient wind. The key points of differentiation should focus on two aspects: first, the presence of liver-kidney yin deficiency symptoms (such as dry eyes, dizziness with ringing in the ears, soreness in the waist and weakness in the legs, palpitations, or flushed cheeks with tidal fever, vexing heat in the chest, palms and soles, mental fatigue, weak pulse, red tongue with scant coating, etc.). Second, in addition to gnashing of teeth, there are other signs of stirring wind (such as numbness and tremor, shaking of the head alone, wriggling of limbs, or even convulsion, or spasms of the limbs, opisthotonos, etc.). The treatment often involves emolliating the liver and nourishing the kidneys, nourishing yin and subduing yang, extinguishing wind and stopping convulsions, using formulas such as Liver-Settling Wind-Extinguishing Decoction or Major Wind-Stabilizing Pearl.
7. Excessive Heat Generating Wind︰Grinding teeth with sound, or lockjaw, high fever, thirst with desire to drink, preference for cold drinks, profuse sweating, pulse full and rapid, tongue texture red, tongue coating yellow and dry; or opisthotonos preventing lying flat, limb spasms and convulsions, or abdominal distension and tenderness, dry stool accumulation with constipation, tongue texture red, tongue coating thick, yellow, dry, and rough, pulse deep and replete or slippery, replete, forceful, and rapid. This is a common symptom in acute external-contraction febrile diseases, often seen in children. Its main characteristics include accompanying signs of excessive heat (high fever with dysphoria, thirst with preference for cold drinks, flushed face and parched lips, profuse sweating, constipation with dark urine; or abdominal and epigastric distension, tenderness, dry and bound stool, tongue texture red, tongue coating yellow and dry or yellow, rough, thick with prickles, pulse manifestation wiry and rapid or full and rapid or deep, replete and rapid or slippery, replete, forceful, and rapid). Excessive heat generating wind causing teeth grinding: If primarily due to liver channel excessive heat generating wind, mild cases present with dizziness and blurred vision, restlessness; severe cases may involve sudden convulsions, facial deviation, hemiplegia, opisthotonos, or even unconsciousness, with a pulse manifestation of wiry, tense, and rapid. If heat is in the Yangming qi aspect, there will be high fever, extreme thirst, profuse sweating, and a full, rapid pulse. If heat accumulates in the Yangming fu organs, symptoms include stuffiness, fullness, dryness, hardness, and repletion, with a tongue coating that is old yellow or scorched and prickly. Regardless of the condition, treatment should focus on urgently clearing pathogenic heat, as the fever subsides, the wind will extinguish, and teeth grinding will cease. For liver heat excess stirring wind, the method of pacifying the liver and extinguishing wind is appropriate. Use Antelope Horn and Uncaria Decoction with modifications, and depending on the condition, add Peaceful Palace Bovine Bezoar Pill, Supreme Treasured Pill, or Purple Cloud Elixir. For Yangming heat at the qi aspect stirring wind, clear the qi aspect heat to extinguish wind, using White Tiger Decoction with modifications. For Yangming heat excess in the fu organs stirring wind, urgently purge the fu and drain heat, using Diaphragm-Cooling Powder or Major Purgative Decoction. Excessive heat generating wind causing teeth grinding differs from teeth grinding due to heart and stomach fire excess. The former, in addition to teeth grinding, includes wind-stirring manifestations and prominent heat signs, unlike heart and stomach fire-heat teeth grinding, which is accompanied by vexation and fetid mouth odor.

In the condition of teeth grinding, external contraction of wind-cold, heart and stomach fire-heat, food accumulation stagnation, roundworms, and excessive heat generating wind are associated with stronger teeth grinding sounds, mostly indicative of excess pattern; while qi and blood deficiency, weak constitution, and internal movement of deficient wind are associated with lower and fainter teeth grinding sounds, mostly indicative of deficiency pattern.

bubble_chart Documentation

1. Yilin Gaicuo Commentary: "Half-body paralysis is discussed as follows: 'Lockjaw is lockjaw, and teeth grinding is teeth grinding. The ancients conflated lockjaw and teeth grinding into a single condition, showing how careless they were in clinical observation! Lockjaw is a deficiency condition, while teeth grinding is an excess condition. Lockjaw involves the inability to open the jaw, whereas teeth grinding involves audible teeth clenching.'"
2. "Ye Xiang-yan's 'External Contraction Warm Heat Chapter' states: 'If there is teeth grinding and gnashing, it indicates dampness-heat transforming into wind convulsive disease; if there is only teeth grinding, it indicates stomach heat traveling through its channels.'"
3. Wenre Jingwei "Article 28 of the Epidemic Pattern Identification: 'In miscellaneous syndromes, teeth gnashing indicates blood deficiency; in epidemic syndromes, it indicates liver heat. The appropriate formula (Plague-Clear Toxin-Vanquishing Decoction) should be modified by adding Gypsum, Unprocessed Rehmannia Root, Red Peony Bark, and Gentian Root.'"