Source 出处 · Beiji Qianjin Yaofang · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Ci Zhu Wan is recorded in Beiji Qianjin Yaofang, the formulary of Sun Simiao, where it appears under the name Shen Qu Wan. Three ingredients: ci shi, magnetite, calcined and quenched in vinegar; zhu sha, cinnabar, water-levigated; and shen qu, medicated leaven, the fermented preparation made with wheat. It is worth saying at once what this formula is classically for and what it is not for, because the category it now sits in has partly rewritten its reputation. The classical indication is the eye: dimmed vision, and the tradition also used it for tinnitus. It is a formula for vision and hearing, and the reading of it as a heavy sedating formula became common only later. A reader who arrives here looking for something to help with sleep has arrived at an entry about eyes.
The three ingredients each carry a caution, and together they are a compact illustration of why the word heavy in this category deserves attention rather than romance. Ci shi is magnetite, an iron oxide mineral. Mineral drugs always carry the same question: what else came out of the same ore. Arsenic and lead are raised repeatedly in the pharmaceutical quality literature on mineral materia medica, and this library records the question rather than resolving it. Magnetite is also an iron source, which is not a free addition for someone with iron overload. Zhu sha is mercuric sulfide, and everything this library says about cinnabar in the Zhu Sha An Shen Wan entry applies here as well: levigation removes part of the soluble fraction and changes nothing about the fact that mercury is a neurotoxicant and nephrotoxicant, and heating is the thing the traditional instruction avoids. Two of the three ingredients are mineral, and one of them is a mercury compound. Shen qu is the third caution and the one most often missed because it sounds harmless: it is made with wheat and fermented, so it contains gluten and is not a coeliac-safe ingredient, and as a fermented product it raises the theoretical tyramine question that fermented foods raise with monoamine oxidase inhibitors.
The clinical obligation here is direct, because the two symptoms this formula was made for both have time-critical branches. Sudden or progressive loss of vision is not a self-management situation: acute angle-closure glaucoma, retinal detachment, temporal arteritis, optic neuritis, stroke and acute rises in intraocular pressure all present that way, and several of them are counted in hours. Tinnitus is usually benign and usually persistent, but unilateral tinnitus, tinnitus with sudden hearing loss, and tinnitus accompanied by neurological signs have their own urgency. Sudden sensorineural hearing loss is treated within a window, and unilateral symptoms with neurological findings raise vestibular schwannoma and demyelinating disease. Ordinary chronic bilateral tinnitus is best served by an audiological assessment and by approaches that have evidence behind them. This library does not claim that Ci Zhu Wan improves vision, improves hearing, or treats cataract, glaucoma, tinnitus or any named disease.
磁朱丸著录于孙思邈《备急千金要方》，原名**神曲丸**。三味药：**磁石**（煅、醋淬）、**朱砂**（水飞）、**神曲**（以麦发酵的制品）。这里应当先把本方古典所主与所不主说清楚，因为它今天所处的类别部分地改写了它的名声：**古典指征在目** —— 视物昏花，传统另用于耳鸣。它是一首**为目与耳而设**的方，把它读成重镇安神之方是后来才通行起来的。**为助眠而来的读者，落到的是一条关于眼睛的条目**。
三味药各带一条提示，合起来正好是这个类别里「重」字为何值得正视、而不是值得浪漫化的一个紧凑例子。**磁石是磁铁矿，一种铁的氧化物**。矿物药永远带着同一个问题：**同一矿脉里还出了什么**。**砷与铅在矿物类药材的质量文献中被反复提出**，本库记录这个问题而不替它下结论。磁铁矿也是一个铁的来源，对铁负荷过载者不是可以随意加的一项。**朱砂是硫化汞**，本库在朱砂安神丸一条里关于朱砂所说的全部内容在此同样适用：水飞能去掉一部分可溶部分，却改变不了**汞是神经毒物与肾毒性物质**这一事实，而加热正是传统做法所避免的。**三味里两味是矿物，其中一味是汞的化合物**。**神曲是第三条提示，也因为它听起来无害而最常被漏掉**：它**以麦发酵**，**含麸质**，不是乳糜泻安全的成分；作为发酵品，它也带出发酵食品与单胺氧化酶抑制剂之间那条理论上的酪胺问题。
这里的临床义务是直截了当的，因为本方所对的两个症状各自都有**以时间计的分支**。**突发或进行性视力下降不是自行处置的情形**：急性闭角型青光眼、视网膜脱离、颞动脉炎、视神经炎、卒中以及眼压急性升高都可以这样起病，其中几项是以小时计的。耳鸣通常良性、通常长期存在，但**单侧耳鸣、伴突发听力下降的耳鸣、伴神经体征的耳鸣**各有其紧迫性 —— **突发性感音神经性聋有治疗时间窗**，而单侧症状伴神经体征会引出听神经瘤与脱髓鞘疾病。普通双侧慢性耳鸣最该做的是听力评估与有实际证据支持的处理；**本库不声称磁朱丸能明目、聪耳，或治疗白内障、青光眼、耳鸣或任何具体疾病**。