Source 出处 · Yifang Jijie · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Bai He Gu Jin Tang is recorded in the Yifang Jijie for 肺肾阴亏 with 虚火上炎 — depletion of the yin of lung and kidney and the upward flaring of what the tradition calls deficient fire. The listed picture is cough and breathlessness, blood-streaked sputum, a dry and painful throat, dizziness, and afternoon fever with night sweating. 金 here is the lung, and the formula's name says what it intends to do to it.
The symptom that must be dealt with before anything else in that list is 痰中带血. Blood in the sputum today is a work-up, not a pattern. The differential includes lung cancer — which can present with nothing more than streaks — tuberculosis, bronchiectasis, pulmonary embolism when there is also pleuritic pain or breathlessness, pulmonary aspergillosis, vasculitis such as granulomatosis with polyangiitis, mitral stenosis, and coagulation disorders, alongside benign sources such as the nose, the sinuses, the gums, or simply forceful coughing. In massive haemoptysis the lethal mechanism is asphyxiation from blood filling the airway rather than blood loss, which makes it an airway emergency. Any amount of blood beyond a single streak, any haemoptysis in a smoker or a person over forty, or any that recurs, belongs in front of imaging and sputum studies.
The second cluster asks the same question from a different direction: afternoon fever, night sweating and cough with weight loss is tuberculosis until it is excluded, and it sits alongside lymphoma, HIV and endocarditis on the same list. This is worth stating plainly because the classical description of 虚火上炎 and the modern description of a consumptive illness describe the same person, and only one of the two frameworks has a test that changes what happens next.
Several ingredients carry real identity or hazard notes. 百合 is a Lilium bulb; the medicinal bulb and the florist's lily are not the same product, several species are traded, and English "lily" covers unrelated plants including daylily, Hemerocallis. One household fact deserves recording: lilies are severely nephrotoxic to cats, and a cat that chews a leaf or drinks vase water can develop acute kidney injury. 贝母 is another name covering different species — 川贝 from Fritillaria cirrhosa and relatives, 浙贝 from Fritillaria thunbergii — with different alkaloid profiles and different traditional uses, and the group is named in the classical 十八反 as incompatible with 乌头, aconite. 玄参 is Scrophularia ningpoensis, and the character 参 it shares with 人参, 党参, 丹参 and 沙参 covers plants from several unrelated families. This formula contains both 生地黄 and 熟地黄, unprocessed and processed Rehmannia side by side, which is a deliberate pairing and a useful reminder that 地黄 is not one substance. 桔梗 (Platycodon grandiflorus) contains platycodin saponins that irritate mucous membranes and can provoke nausea. 当归 is Angelica sinensis, contains furanocoumarins that cause photosensitivity, and has case reports of interaction with warfarin. 白芍 is not 赤芍, and peony is named in the 十八反 with 藜芦. 甘草 contains glycyrrhizin, with the potassium-loss mechanism described elsewhere in this library.
This entry records a classical formulation and the reasoning behind it. It is not a way of evaluating blood in the sputum, and this library offers no view on what any individual should take.
百合固金汤著录于《医方集解》，主治**肺肾阴亏、虚火上炎**。所列表现为咳嗽气喘、**痰中带血**、咽喉燥痛、头晕目眩，以及**午后潮热、骨蒸盗汗**。方名里的「金」指肺，方名本身说明了它想对肺做什么。
这一串表现里必须放在最前面处理的是**痰中带血**。今天，咯血是要查的，不是一个证。鉴别包括**肺癌**（它可以只表现为痰里带血丝）、**结核**、**支气管扩张**、伴有胸膜性疼痛或气短时的**肺栓塞**、肺曲霉病、肉芽肿性多血管炎这类血管炎、**二尖瓣狭窄**、凝血障碍，同时也有鼻、鼻窦、牙龈或单纯剧烈咳嗽这类良性来源。**大咯血的致死机制是血液灌满气道导致窒息，而不是失血**，所以它是气道急症。痰中血量超过一次血丝、吸烟者或四十岁以上者任何咯血、以及反复出现的咯血，都应当去做影像与痰检。
第二组症状从另一个方向问出同一个问题：**午后潮热＋盗汗＋咳嗽＋体重下降，在排除之前就是结核**，而在这同一串里还并列着淋巴瘤、HIV 与感染性心内膜炎。这一点值得明说 —— 因为「虚火上炎」这个古典描述与消耗性疾病的现代描述指向的是同一个人，而两套框架里只有一套有能改变后续处理的检查。
几味药各有实在的辨物与风险提示。**百合**是百合属的鳞茎：药用干品与切花百合不是同一个产品，市售涉及多个种，而英文 lily 覆盖着互不相干的植物（包括黄花菜所属的萱草属）。有一条家庭场景的事实值得记下：**百合属对猫有严重肾毒性**，猫啃食叶片或饮用插花的水即可发生急性肾损伤。**贝母**同样是一个覆盖不同种的名字：**川贝**（卷叶贝母等）与**浙贝**（浙贝母）生物碱谱不同、传统用途不同，且贝母在十八反中与**乌头**相对。**玄参**是玄参科植物，它与**人参、党参、丹参、沙参**共用的那个「参」字，覆盖着好几个毫不相干的科。本方**生地黄与熟地黄同用**，炮制与未炮制并列一方，这是有意的配伍，也是「地黄不是一味药」的提醒。**桔梗**含桔梗皂苷，刺激黏膜，可引起恶心。**当归**是当归，含**呋喃香豆素**（光敏），并有与**华法林**相互作用的病例报告。**白芍不是赤芍**，且芍药在十八反中与**藜芦**相对。**甘草**含甘草酸，失钾机制见本库它处。
本条是古典组方与其思路的一份记录。它不是评估痰中带血的办法，本库也不对任何个人该用什么提出意见。