Source 出处 · Jisheng Fang · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Di Tan Tang is recorded in Jisheng Fang, Yan Yonghe's thirteenth-century collection; later formularies also carry formulas under this name and this entry does not adjudicate between them. Eleven herbs: processed ban xia, bile-processed nan xing, ju hong, bran-fried zhi shi, fu ling, ren shen, shi chang pu, zhu ru, honey-fried gan cao, sheng jiang and da zao.
The first thing to say about this formula is also the most important, and it is not about herbs at all. This is a formula written for a person whose consciousness is clouded — the classical phrase is phlegm veiling the orifices of the heart. In a modern setting, sudden clouding of consciousness is an emergency. Stroke, hypoglycaemia, intracranial infection, poisoning including opioid overdose, the postictal state after a seizure, sepsis, hepatic encephalopathy, carbon dioxide retention in advanced lung disease, electrolyte disturbance and head injury all present this way, and several of them are measured in minutes. New facial droop, one-sided weakness, slurred speech or sudden inability to speak belongs on an emergency pathway; so does altered consciousness in a person taking insulin or a sulfonylurea, where hypoglycaemia is rapidly fatal and rapidly reversible. Nothing in this entry is a basis for self-management, and no formula should be given by mouth to a person who is not fully conscious: an impaired swallow reflex makes aspiration a real route to death, not a theoretical one.
Read as a composition, the formula is a phlegm formula with an opening pair added. Ban xia and dan nan xing are the two phlegm herbs, the second of them bile-processed precisely to reduce toxicity and turn a warm acrid herb into a cooling one. Ju hong and zhi shi move qi. Fu ling leaches. Shi chang pu is the herb traditionally described as opening the orifices. Ren shen, gan cao, sheng jiang and da zao support the person while the others work — a formula for someone who is failing includes support, and that is worth noticing.
Safety. Raw arisaema is toxic; the calcium oxalate raphides in the fresh root cause intense burning and swelling of the mouth and throat, and the bile processing is a detoxification step, not a flavouring. It must never be substituted with the raw herb. Ban xia raw is likewise acrid and irritant, and only processed forms are used. Both ban xia and nan xing appear in the classical list of herbs antagonistic to the aconite group. Shi chang pu belongs to the Acorus genus; beta-asarone has attracted genotoxicity concern in the literature, with the main evidence drawn from related species, and this library states the concern rather than inflating it. Acorus materials are also sold under several similar names and are not all the same substance. Zhi shi contains p-synephrine, the sympathomimetic amine behind regulatory attention to bitter orange extracts. Honey-fried gan cao carries the pseudoaldosteronism risk of prolonged licorice intake. Ren shen has mixed evidence with warfarin, and mixed is what this library writes. This library does not claim this formula clears phlegm, opens the orifices, restores consciousness or treats stroke or any other specific disease.
涤痰汤著录于严用和《济生方》；后世方书亦有以同名方收入者，本条不替读者裁决。十一味：制半夏、胆南星、橘红、枳实（麸炒）、茯苓、人参、石菖蒲、竹茹、炙甘草、生姜、大枣。
关于这首方，第一件要说的事也是最要紧的一件，而它与药无关：**这是一首为意识不清的人而设的方**（古典说法是「痰迷心窍」）。在今天，突发的意识改变是急症：卒中、低血糖、颅内感染、中毒（含阿片过量）、癫痫发作后状态、脓毒症、肝性脑病、晚期肺病的二氧化碳潴留、电解质紊乱与颅脑损伤都会这样起病，其中几项以分钟计。新出现的口角歪斜、一侧肢体无力、言语含糊或突然说不出话，属于急救路径；正在使用胰岛素或磺脲类药物者的意识改变同样属于 —— 低血糖可以很快致命，也可以很快逆转。本条没有任何一句是自行处理的依据，且**任何东西（含汤药）都不可以经口喂给意识不完全清醒的人**：吞咽反射受损时，误吸是一条真实的致死路径，不是理论顾虑。
作为方剂读，它是一首化痰方加上一组开窍的药。半夏与胆南星是化痰的两味，后者之所以要**胆汁炮制**，正是为了减毒并把一味温燥辛烈之品转为凉润 —— 这个炮制环节不可退回生品。橘红与枳实行气，茯苓渗湿，石菖蒲是传统描述为「开窍」的一味。人参、炙甘草、生姜、大枣是在其余几味做事时护住人的那一部分：一首为虚衰之人而设的方含扶正之品，这一点值得注意。
安全上：**生天南星有毒** —— 鲜根中的草酸钙针晶会造成口腔与咽喉的剧烈灼痛与肿胀，胆汁炮制是减毒步骤而不是调味，绝不可用生品替代。生半夏同样辛烈刺喉，实际只用炮制品。半夏与天南星都在古典「反乌头」之列。**石菖蒲属菖蒲属（Acorus）**，其中的 β-细辛醚在文献中有遗传毒性关注，主要证据来自同属其他种；本库据实说明而不夸大。菖蒲类药材另有数种近名，并非同一物。枳实含对辛弗林（p-synephrine），苦橙提取物正是因该成分在心血管事件上受到监管关注。炙甘草带来长期摄入甘草的假性醛固酮增多症风险。人参与华法林的证据是混杂的，本库写混杂。本库不声称本方能涤痰、开窍、促醒或治疗中风或任何具体疾病。