Disease and Condition Overview
Toothache is characterized by the pain in the teeth caused by various reasons. It's the most common symptom of oral diseases. In Chinese medicine, the Large Intestine channel of hand-yangming passes through lower set of teeth and the Stomach channel of foot-yangming passes through the upper set of teeth, Therefore, regardless whether it’s the attack by external pathogenic wind, or excess stomach fire flares up, rising upwards along the channel can all cause toothache. Also, kidney governs bones, and teeth are the odds and ends of bone. Hence, kidney yin deficiency, empty fire rising upwards can both result in empty fire toothache.
Dental caries or tooth decay, pulpitis, apical periodontitis, periodontitis, alveolus or periodontal abscess, pericoronitis and sensitive teeth can all cause toothache. Clinically, it is important to differentiate with "trigeminal neuralgia".

Pair-point Treatment Combinations

(1) Hegu (LI4), Quchi (LI11) (Fig 7)
Hegu (LI4) is the yuan-souree point of hand-yangming channel. Quchi (LI11) is the he-sea point of hand-yangming channel. This pair point combination, connects channels and qi within the channels, disperses and opens qi in the yangming channel, clear and reduce yangming pathogenic heat, harmonize qi all over the face. Appropriate for toothache caused by excess yangming heat.

Needling techniques:
1. Hegu (LI4) perpendicular insertion 1 cun.
2. Quchi (LI11) perpendicular insertion 1 cun.

(2) Hegu (LI4), Neiting (ST44) (Fig 62)
Hegu (LI4): on the dorsum of the hand, midway between the junction of the first and second metacarpal bones.
Neiting (ST44): on the dorsum of the foot, between the second and third toe, at the junction of the red and white skin, proximal to the margin of the web.
Hegu (LI4) is the yuan-source point of hand-yangming channel, dispels wind reduce heat, opens fu organs reversing the rising. Neiting (ST44) is the ying-spring point of foot-yangming channel, reduces yangming fire heat, reversing the rising, harmonizing stomach. This pair point combination, one superior and one inferior, both belonging to the yangming channel, they echo and couple the effects of each other, clear reduce yangming pathogenic heat, opens fu organs reversing the rising. Appropriate for wind-fire toothache.

Needling techniques:
1. Hegu (LI4) perpendicular insertion 1 cun.
2. Neiting (ST44) perpendicular insertion 0.5 cun.

(3) Xiaguan (ST7), Hegu (LI4) (Fig 50)
Xiaguan (ST7) is confluence point foot-yangming and shaoyang on the face, disperses reduce yangming and shaoyang qi, opens the luo-connecting channels to stop pain. Hegu (LI4) is the yuan-source point of hand-yangming channel. It dispels wind to release the exterior; opens channels and invigorates luo-connecting channels. This pair point combination, one superior, one inferior, both belonging to the yangming channel, the two points echo and couple the effects of each other, have greater effects on the qi of that channel, regulate and yangming and shaoyang qi and blood, opens the luo-connecting channels to reduce swelling and stop pain. Appropriate for toothache caused by excess yangming and shaoyang heat.

Needling techniques:
1. Xiaguan (ST7) perpendicular insertion 1 cun.
2. Hegu (LI4) perpendicular insertion 1 cun.

(4) Shousanli (LI10), Taixi (KI3) (Fig 63)
Shousanli (LI10): On the radial side of the dorsal surface of the forearm, 2 cun distal to the cubital crease, on the line connecting Yangxi (LI5) and Quchi (LI11).
Taixi (KI3): on the medial side of the foot, posterior to the medial malleolus, in the depression between the prominence of the medial malleolus and the Achilles tendon.
Shousanli (LI10) disperses and opens qi on the yangming channel to reduce swelling and stop pain. Taixi (KI3) tonifies kidney yin and clears empty fire. This pair point combination, one superior and one inferior, to simultaneously tonify and reduce: clearing heat and tonifying yin, lowers fire stops pain. Appropriate for toothache caused by yin deficiency which led to inner heat rising upward.

Needling techniques:
1. Shousanli (LI10) perpendicular insertion 1 cun.
2. Taixi (KI3) perpendicular insertion 1 cun.

(5) Shenshu (BL23), Sanjian (LI3) (Fig 64)
Shenshu (BL23): on the lower back, below the spinous process of the second lumbar vertebra (L2), 5 cun lateral to the posterior midline.
Sanjian (LI3): on the radial side of the index finger, in the depression proximal to the second metacarpo-phalangeal joint on the radial side. Slightly clench fist to locate the point.
Shenshu (BL23) is location on the back where the qi from the kidney infuse. It tonifies kidney and restores the marrow. Sanjian (LI3) is the shu-stream point of hand-yangming channel, reduces heat and stops pain. This pair point combination, one tonifies while one reduces, work in synergy to tonify yin, lower fire, reduce swelling and stop pain. Appropriate for toothache caused by excess of yin deficiency fire.

Needling techniques:
1. Shenshu (BL23) towards spine, anterior direction, oblique insertion 1 cun.
2. Sanjian (LI3) perpendicular insertion 0.5 cun.

(6) Waiguan (SJ5), Zulinqi (GB41) (Fig 14)
Waiguan (SJ5) unobstructs qi stagnation, disperses stagnate heat at sanjiao (upper, middle and lower jiao). Zulinqi (GB41) disperses, reduces liver and gallbladder to regulate qi and blood. This pair point combination, one superior and one inferior, both located on the shaoyang channel, they echo and couple the effects of each other, clear reduce shaoyang pathogenic heat. Appropriate for toothache caused by liver and gallbladder fire and uprising of wind heat.

Needling techniques:
1. Waiguan (SJ5) perpendicular insertion 1 cun.
2. Zulinqi (GB41) perpendicular insertion 1 cun.

Commentaries
Acupuncture treatment has definite result in treating the symptoms of toothache by stopping pain. Acupuncture also has anti-inflammatory effect as well. Usually the pain will stop immediately after 1 treatment. However, for cases such as dental caries or tooth decay, the acupuncture treatment can only stops the pain temporarily. There are many causes to toothache, it is important to identify the root cause before employing treatment.
Clinically, when treating toothache, it is crucial to differentiate the causes and select channels accordingly, primarily both hand, foot-yangming and foot-shaoyin channel of the Kidney channel. Hegu (LI4) and Quchi (LI11) or Neiting (ST44) is a most used combination. However, Shousanli (LI10), Taixi (KI3) or Shenshu (BL23), Sanjian (LI3), can unobstruct the channel and treat both excess and empty fire. In addition, toothache caused by Shaoyang wind heat, select Waiguan (SJ5), Zulinqi (GB41).