Source 出处 · Jingyue Quanshu · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Da Bu Yuan Jian is one of Zhang Jiebin's own formulas, from the supplementation array of his new formula arrangements in Jingyue Quanshu. Zhang did not describe it modestly; he called it the first formula of its kind for turning back what cannot be turned back, rescuing the root and banking the source. Set beside Zuo Gui Wan, which is also his, the relationship is instructive. The two share four herbs - prepared rehmannia, Chinese yam, cornus fruit and goji berry - and that shared four are the kidney-supplementing core of his system. Where they part is where the intent parts. Zuo Gui Wan adds the two animal glues, dodder seed and cyathula, aiming at essence and marrow. Da Bu Yuan Jian adds ginseng, angelica, eucommia and licorice, aiming at qi and blood. One is a formula about the deep store, the other about the person who is upright and depleted now.
The picture it is aimed at is extreme: exhaustion that does not lift, weight loss, pallor, coldness, palpitations, dizziness, a person emptied out by long illness. That is precisely why the differential matters more here than for a milder formula. Severe fatigue, unintentional weight loss, pallor and coldness are produced by iron, B12 and folate deficiency; by hypothyroidism; by diabetes; by depression; by chronic kidney disease and heart failure; by chronic infection including tuberculosis, endocarditis and HIV; by malignancy; by adrenal insufficiency; by obstructive sleep apnoea; and by ordinary undernutrition. Several of these are separated from the classical picture by one blood count, one TSH, one ferritin, one chest film. A person can be supplemented for months while a treatable cause runs underneath, and this library will not describe that as harmless.
Safety follows the pattern of this family with two additions. Honey-fried licorice is present, so the glycyrrhizin question is live: with sustained intake it can produce low potassium, raised blood pressure and oedema, and it interacts badly with diuretics, digoxin and corticosteroids. Prepared rehmannia is cloying, and formulas of this weight are traditionally withheld from anyone whose digestion is weak, whose appetite is poor or whose stool is loose, and during an acute illness. Ginseng has mixed evidence on warfarin - published studies point in different directions, so this library reports it as mixed - and it can lower blood sugar, which matters for anyone on glucose-lowering medicine. Goji berry has published case reports of interaction with warfarin. Cornus fruit, shan zhu yu, is unrelated to evodia, wu zhu yu, and the two names are confused in trade. Eucommia bark has reported effects on blood pressure in pharmacological work, so co-use with antihypertensive medicines warrants caution; as with any bark material the source should be traceable. This formula is not used in pregnancy or in children on this library's recommendation, and not during an acute illness.
大补元煎是张景岳自制的方，出自《景岳全书·新方八阵》的补阵。张氏自己没写得谦虚，称它为回天赞化、救本培元第一要方。与他的另一首左归丸并读最能看出关系。两方共有四味 —— 熟地、山药、山茱萸、枸杞 —— 这四味正是他体系中补肾的核心。分歧之处正是意图分歧之处：左归丸加龟鹿二胶、菟丝子、牛膝，对准精与髓；大补元煎加人参、当归、杜仲、甘草，对准气与血。一首是讲深层储备的方，一首是讲「此刻站着但已经空了」这个人的方。
它所对的画面极重：久病之后的大虚，疲乏不能复、消瘦、面色苍白、畏寒、心悸、头晕。正因为重，鉴别诊断在这里比在温和的方剂上更要紧。严重疲乏、非自愿的体重下降、苍白与畏寒，可由缺铁与维生素 B12、叶酸缺乏引起；也可由甲状腺功能减退、糖尿病、抑郁、慢性肾病与心力衰竭、慢性感染（含结核、心内膜炎、HIV）、恶性肿瘤、肾上腺皮质功能不全、睡眠呼吸暂停，以及单纯的营养不良引起。其中若干项与古典画面之间只隔着一次血常规、一次 TSH、一次铁蛋白、一次胸片。一个人可以一边被补着几个月，一边让一个可治的病因在底下继续走，本库不会把这种情形写成无害。
安全性沿用这一族的格局，另有两条补充。方中有炙甘草，甘草酸的问题就是活的：持续服用可引起低钾、血压升高与水肿，与利尿剂、地高辛、糖皮质激素同用风险更高。熟地滋腻，如此重量的方在脾胃弱、纳差、便溏时传统上不用，急性病期也不用。人参对华法林影响的证据方向不一致（不同研究结论相左），本库照实写证据混杂；它还能降血糖，对正在用降糖药的人有关系。枸杞子与华法林相互作用的病例报告有文献记载。山茱萸与吴茱萸来源无关，市场上有两个名字混淆的情况。杜仲在药理研究中有降压方面的报道，与降压药同用需谨慎；树皮类药材的来源应当可追溯。本库不推荐在孕期与儿童中使用此方，急性病期也不用。