Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. This is the largest of the ephedra formulas and the one whose own source text carries the sharpest warning, which is the first thing worth saying about it. Da Qing Long Tang is Ma Huang Tang - ephedra, cassia twig, apricot kernel and licorice - with gypsum, fresh ginger and jujube added and the ephedra increased. The presentation it was written for is the one the classical text names directly: chills and fever, body aches, no sweating, and irritability or restlessness. It is the irritability that separates it from the simpler Ma Huang Tang, and in the traditional reading that is the sign that heat is already established inside while the exterior is still closed. - The category is worth unpacking rather than accepting. 'Exterior cold with interior heat' is a classification inside a Han-dynasty framework, not a modern diagnosis, and the symptoms that populate it - fever, chills, muscle aches, no sweat - are also the symptoms of influenza, COVID-19, pneumonia, dengue, malaria, bacterial sepsis and many other conditions, which are not separable by any method that framework contains. Fever with a stiff neck, a rash that does not fade under pressure, confusion, breathlessness, chest pain, or fever in a person who is immunosuppressed, pregnant, very young or very old, is not a pattern to be sweated; it is an emergency assessment. - The source itself is unusually cautious. The Shanghan Lun states that the formula must not be given where the pulse is weak and faint and there is sweating with aversion to wind, and warns that giving it in that case produces counterflow cold of the limbs and twitching of the flesh. That is a second-century contraindication and it still reads correctly: a strong diaphoretic being withheld from someone who is already sweating and depleted. - 麻黄, ephedra, is the ingredient that governs the safety discussion. Its ephedrine and pseudoephedrine alkaloids are sympathomimetic amines: they raise blood pressure and heart rate, and case reports and case series link ephedra use to myocardial infarction, stroke, arrhythmia, seizure and sudden death. In 2004 the US FDA ruled dietary supplements containing ephedrine alkaloids adulterated, and that ruling was upheld on appeal; ephedrine and pseudoephedrine are also controlled or monitored as precursor chemicals in many countries. Anyone with hypertension, coronary disease, arrhythmia, hyperthyroidism, glaucoma, prostate enlargement, anxiety or insomnia, and anyone taking stimulants, decongestants, beta-agonists, MAOI-type antidepressants or other sympathomimetics, is the group this concerns. - 石膏 is gypsum, hydrated calcium sulfate. It is a mineral drug, and mineral drugs carry the general risk of heavy-metal and other inorganic impurities depending on source and processing. - 杏仁 is bitter apricot kernel, which contains amygdalin, a cyanogenic glycoside that can release cyanide when crushed or digested; poisoning is documented and children are at greater risk. - 桂枝 is cassia twig, and cassia cinnamon is notably higher in coumarin than true cinnamon, which is a hepatotoxicity concern with sustained intake. - 甘草, licorice, in sustained amounts produces a mineralocorticoid-like syndrome of sodium and water retention, potassium loss and raised blood pressure. - Whether this formula changes the course of any infection has not been established by well-conducted controlled trials. The honest verdict is unproven. Quantities are decided by a licensed practitioner; this site deliberately does not list them.
这是麻黄类方中力量最盛的一首，而关于它最该先说的一点是：它的出处文本本身就带着最严厉的警示。大青龙汤即麻黄汤（麻黄、桂枝、杏仁、甘草）再加石膏、生姜、大枣，并加重麻黄。其所主的表现，经典原文说得直接：恶寒发热、身疼痛、不汗出而烦躁。正是「烦躁」把它与更简单的麻黄汤分开，而传统读法把这一条视为里热已成、表气仍闭的征象。 - 这个类别值得拆开看，不宜照单接受。「外寒内热」是汉代框架内的一类分型，不是现代诊断；而填充这一类别的症状 —— 发热、恶寒、身痛、无汗 —— 同时也是流感、新冠、肺炎、登革热、疟疾、细菌性脓毒症以及许多其他疾病的表现，这套框架并不含任何能够区分上述疾病的方法。发热伴颈项强直、压之不褪色的皮疹、意识改变、气促、胸痛，或免疫抑制者、孕妇、婴幼儿与高龄者的发热，不是可以「发一发汗」的证，而是需要紧急评估的情形。 - 原文本身异常谨慎。《伤寒论》明言：脉微弱、汗出恶风者不可服之，服之则厥逆、筋惕肉瞤，此为逆也。这是一条公元二世纪的禁忌，今天读依然成立：一首峻汗之方，被明确禁止用于已经出汗且正气不足的人。 - 麻黄 是安全讨论的核心。其所含麻黄碱与伪麻黄碱属拟交感胺类，可升高血压与心率；病例报告与病例系列把麻黄的使用与心肌梗死、脑卒中、心律失常、癫痫发作及猝死联系在一起。2004 年美国 FDA 裁定含麻黄碱类生物碱的膳食补充剂为掺假产品，该裁定在上诉中得以维持；麻黄碱与伪麻黄碱在许多国家亦作为前体化学品受管制或监测。高血压、冠心病、心律失常、甲状腺功能亢进、青光眼、前列腺增生、焦虑或失眠者，以及正在使用兴奋剂、减充血剂、β 受体激动剂、单胺氧化酶抑制剂类抗抑郁药或其他拟交感药物者，是这一条所关心的那组人。 - 石膏 为含水硫酸钙，属矿物药，而矿物药普遍存在重金属与其他无机杂质风险，取决于来源与炮制。 - 杏仁 为苦杏仁，含苦杏仁苷，属氰苷，研碎或消化时可释放氰化物；其中毒确有记载，儿童风险更大。 - 桂枝 为桂类嫩枝，而桂皮类（cassia）的香豆素含量显著高于真肉桂，长期摄入存在肝毒性顾虑。 - 甘草 长期摄入产生类盐皮质激素综合征：钠水潴留、失钾、血压升高。 - 本方是否改变任一感染性疾病的病程，并未被设计良好的对照试验证实；诚实的结论是「未被证实」。用量由持证医师决定，本站刻意不列。