Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Dang Gui Shao Yao San is recorded in Jingui Yaolüe in two adjacent lines, one for a pregnant woman with pain in the abdomen and one, more broadly, for painful conditions of the abdomen in women. Six ingredients, half directed at the blood and half at water, and the continuing interest of the formula is precisely that it refuses to choose between them: dang gui, shao yao and chuan xiong on the blood side, fu ling, bai zhu and ze xie on the water side. In Japan it became one of the most widely used kampo preparations, tokishakuyakusan, and it is still manufactured there, which is why more of the published literature on it is Japanese than Chinese.
This entry opens with the fact that it is a pregnancy formula, because the classical text says so in its first line. Herbal medicine in pregnancy is a decision for the person's own obstetric and medical clinicians, and this library's position is that it does not belong to self-management at all. That is not a formality. Abdominal pain in early pregnancy together with bleeding is ectopic pregnancy until an emergency department excludes it, and ectopic pregnancy kills by rupture. Vaginal bleeding, miscarriage, placental abruption, pre-eclampsia presenting with headache, visual change, upper abdominal pain or oedema, preterm labour, appendicitis whose position shifts as the uterus enlarges, ovarian cyst torsion and urinary stones all enter the same differential. Any abdominal pain in pregnancy warrants assessment, and abdominal pain with bleeding, faintness, shoulder-tip pain or reduced fetal movement warrants emergency assessment. This library will not put a sixth-century formula in front of that.
Outside pregnancy, the same presentation in anyone of reproductive age includes ectopic pregnancy first, then pelvic inflammatory disease, ovarian cysts and torsion, endometriosis and adenomyosis, urinary infection and stone, and the whole bowel list. Pain with fever, with vomiting, with a rigid abdomen, or that is sudden and severe, is not something to be differentiated at leisure.
On the ingredients. The classical text says shao yao, and before the Song period the character did not separate red and white peony; later practice reads it mostly as bai shao. Paeoniflorin has been studied for antiplatelet and uterine smooth muscle effects. Dang gui and chuan xiong are both traditionally treated with caution in pregnancy, and both are the subject of theoretical and case-report concern about additive bleeding with warfarin and antiplatelet drugs. Dang gui also carries a photosensitivity caution from its furanocoumarin content. Ze xie is a diuretic, diuretics add to the effect of diuretic medicines and disturb electrolytes, and there are animal reports of kidney effects at high exposure which this library labels animal evidence. Fu ling is a fungal sclerotium and is not the same plant as tu fu ling, which is a Smilax species; the two names are routinely confused. Bai zhu is drying.
Clinical research on this formula exists and is inconsistent: small trials, heterogeneous preparations, and outcomes that have not been reproduced. This library makes no claim of efficacy.
当归芍药散著录于《金匮要略》，原文相邻两句：一是「妇人怀妊，腹中㽲痛」，二是「妇人腹中诸疾痛」。六味药，一半治血，一半治水，本方至今仍被讨论，正因为它拒绝在两者之间取舍：当归、芍药、川芎在血一边，茯苓、白术、泽泻在水一边。它在日本成为最常用的汉方制剂之一（当帰芍薬散），至今仍有生产，因此它的公开文献日本方面多于中国方面。
本条必须先把一件事写在最前：**这是一首孕期方**，因为古典原文第一句就是这么说的。孕期用方应由本人的产科与主诊医生共同决定；本库的立场是，这根本不属于自我处理的范畴。这不是一句客套。**孕早期腹痛伴阴道流血，在急诊排除之前按异位妊娠对待，而异位妊娠是因破裂致命的。** 阴道流血、流产、胎盘早剥、以头痛／视物模糊／上腹痛／水肿起病的子痫前期、早产、随子宫增大而位置改变的阑尾炎、卵巢囊肿扭转、泌尿系结石，都在同一张鉴别清单里。孕期任何腹痛都值得评估；腹痛伴流血、近乎晕厥、肩尖痛或胎动减少，需要急诊评估。本库不会把一首六世纪的方放在这前面。
非孕期而言，育龄者同样的表现，鉴别顺序同样是异位妊娠在先，其后是盆腔炎、卵巢囊肿与扭转、子宫内膜异位与腺肌病、泌尿系感染与结石，以及肠道的整张清单。**伴发热、呕吐、腹肌紧张、或突发而剧烈的腹痛，不是可以慢慢辨证的场合。**
关于药味：原文写「芍药」，宋代以前这个字并不区分赤芍与白芍，后世多作白芍用。芍药苷在抗血小板与子宫平滑肌方面已有研究。当归与川芎都是传统孕期慎用之列，并且都有与华法林、抗血小板药叠加出血的理论与个案关注；当归另因含呋喃香豆素而有光敏提示。**泽泻**利尿，与利尿药作用叠加并扰乱电解质，高暴露下另有动物肾毒性报告，本库标注为**动物证据**。**茯苓是真菌的菌核，与土茯苓不是一物** —— 土茯苓是百合科菝葜属；这两个名字被反复混用。白术偏燥。
本方的临床研究存在，但结果不一致：样本小、制剂异质、结局未被重复。本库不对任何疾病作疗效主张。