Professor Zhu Chenyu's Empirical Formulas for Toothache and Gingival Swelling and Pain
Professor Zhu Chenyu held that, according to traditional TCM theory, the teeth belong to the kidney and the gums to the stomach; therefore all toothache or gingival swelling and pain should be treated by nourishing the kidney and clearing heat, and by clearing and draining stomach fire. In addition, toothache is related to exuberant heat of the large intestine steaming upward, so it may also be treated by clearing heat and freeing the bowels. Professor Zhu divided such diseases into two patterns: the excess pattern of exuberant stomach and large-intestine heat steaming upward, and the deficiency pattern of kidney yin insufficiency with deficient fire flaring upward.
The excess pattern of steaming stomach and large-intestine heat presents as toothache radiating to the head, a hot face that prefers cold, dry mouth with a desire to drink, pus in the gums, and dry stool. Such patients should be treated by clearing heat and draining fire, and by moving the bowels and resolving toxins, using Qingwei San combined with Huanglian Jiedu Tang with modifications.
His empirical formula: Chinese angelica (danggui) 10g, cimicifuga (shengma) 10g, Coptis rhizome (huanglian) 10g, moutan bark (mudanpi) 10g, raw gypsum (shigao) 30g (decoct first), rehmannia root (shengdi) 10g, scutellaria root (huangqin) 10g, Phellodendron bark (huangbai) 10g, gardenia fruit (zhizi) 10g, dandelion herb (pugongying) 30g, raw licorice (shenggancao) 6g. For dry stool, add raw rhubarb (sheng dahuang) 10g.
This pattern resembles acute gingivitis or pulpitis in modern medicine. Patients not only have swollen, painful gums but also, due to the gingival nerves, pain radiating to the face and head. The pain is often described as "toothache isn't a disease, but when it hits it's deadly"; patients suffer severe pain and cannot stand it for a moment.
From a modern medical viewpoint, Professor Zhu's empirical formula has a certain anti-inflammatory and analgesic effect. But in the author's experience, combining it with Chinese-Western patent medicines such as bezoar-metronidazole or cefuroxime axetil gives faster effect and a shorter course. If pain is severe, external borneol may be applied to the affected cheek, or borneol wrapped in a cotton ball inserted into the nostril on the affected side; this gives quick pain relief, though it does not last. It can, however, buy time for the oral medicine to work. Note that borneol is a medicinal herb, not ordinary ice crushed into chips.
The kidney-yin insufficiency with deficient fire flaring pattern usually presents as dull toothache, loose tooth roots, vexation and insomnia, dry mouth and sore throat, aching and weakness of the lower back and knees, a red tongue with scant coating, and a thin, rapid pulse. This type mostly corresponds to periodontitis in modern medicine; periodontal tissue is continuously inflamed and can loosen the teeth. TCM usually attributes loose teeth to kidney yin insufficiency.
For this type, Professor Zhu's empirical formula uses Zhibai Dihuang Tang (consisting of prepared rehmannia, cornus fruit, Chinese yam, alisma, Poria, moutan bark, Anemarrhena, and Phellodendron) plus Achyranthes (niuxi), Asarum (xixin), cimicifuga (shengma), and Coptis (huanglian). Professor Zhu did not give detailed doses; the clinician may adjust each herb according to the patient's actual condition. Zhibai Dihuang Tang may be replaced by the patent medicine Zhibai Dihuang Wan; such patients may likewise combine it with bezoar-metronidazole.
Toothache or gingival swelling and pain usually come on fiercely; patients suffer unbearably, and some go to the hospital for extraction or root canal treatment. Severe or repeatedly recurrent cases do indeed need such handling. But most first-time or mild cases need not rush to such destructive treatment; taking an effective oral medicine in time can also relieve them. During treatment and after relief, patients should avoid spicy food and should not stay up late or overexert themselves.