Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Five ingredients, and the first two are the reason this entry cannot be written casually. 附子 is prepared aconite lateral root; 半夏 is pinellia rhizome. Among the classical incompatibility lists — 十八反, the eighteen antagonisms — one line reads 半蒌贝蔹及攻乌, setting pinellia, trichosanthes, fritillaria, ampelopsis and bletilla against the aconite group. This formula places two members of exactly that pair in the same pot. This library records both facts — that the classical text does this, and that a later tradition lists it as an antagonism — adjudicates neither, and does not quietly drop one side to make the page tidier.
Then the picture the line draws. Cold in the abdomen, thunderous bowel sounds with cutting pain, counterflow fullness that reaches the chest and flanks, and vomiting. Read the four together and what is being described is loud, high-pitched bowel sounds against colicky pain, in a distended abdomen, with vomiting. That is the textbook opening of bowel obstruction. The reason it is urgent is the branch that cannot be seen from outside: strangulation, in which the blood supply to a segment of bowel is compromised and the useful window is measured in hours rather than days. The cardinal sign is obstipation — neither stool nor flatus passing. Where the obstruction sits determines what comes first: high obstruction vomits early and distends late, and vomiting that has become faeculent is a late finding rather than an early one.
The differential a clinician carries into that room is longer than one line. Appendicitis, cholecystitis, diverticulitis, ureteric stone, testicular torsion with pain referred upward, ectopic pregnancy, a leaking or ruptured abdominal aortic aneurysm, diabetic ketoacidosis, and mesenteric ischaemia — the last of which is known for pain out of proportion to the abdominal examination and for occurring in people with atrial fibrillation or heart failure. Signs of peritonitis are recorded as absent or muted in older people and in immunosuppressed people, which is why a soft abdomen settles nothing. This library records these as possibilities a clinician carries; it does not sort them, and it offers no plan for an acute abdomen of any kind.
On the materials. Aconitine poisoning has no specific antidote and ventricular arrhythmia is what kills; the diester alkaloids are hydrolysed by prolonged decoction, which is why the classical tradition insists on the cooking rather than the weighing. 附子 is not 白附子, which is Typhonium. Raw pinellia contains needle-shaped calcium oxalate raphides and a lectin, and swelling of the mucous membranes with airway compromise is documented for the raw form; only the processed form belongs in any modern discussion, and this library describes no preparation. 粳米 is polished non-glutinous rice — a real carbohydrate load, and also a known dietary source of inorganic arsenic, for which several regulators set limits specifically on rice-based foods for infants and young children. 甘草 is liquorice: glycyrrhizin produces a mineralocorticoid-like picture of potassium loss, sodium retention and raised blood pressure, and when it is taken alongside digoxin or a diuretic, hypokalaemia is the mechanism that kills. 大枣 is jujube, a sugar load. Reliable safety data for pregnancy and breastfeeding are lacking; for a formula containing an aconite member, this library treats pregnancy as an exclusion rather than as a caution.
五味药，前两味正是这条不能随手写的原因。**附子**是炮附子（乌头子根的加工品），**半夏**是半夏。后世「十八反」里有一句 —— **「半蒌贝蔹及攻乌」** —— 把半夏、栝楼、贝母、白蔹、白及与乌头类相对。而这首方，恰恰把这一对放在了同一个锅里。本库的写法是：**古典这么用、后世这么列，两边都记，不裁决** —— 也不为了页面干净而悄悄略去任何一边。
再看条文的画面：**腹中寒气，雷鸣切痛，胸胁逆满，呕吐**。四句放在一起读，描述的是**腹鸣很响、绞痛很锐、肚子胀、并且吐**。这正是**肠梗阻**教科书式的开头。它之所以要紧，是那条从外面看不见的分支：**绞窄** —— 一段肠子的血供被掐断，可用的窗口按**小时**算而不是按天算。最核心的体征是**停止排气排便**；梗阻位置决定先后：**位置越高，吐得越早、胀得越晚**，而**吐出粪臭物是晚期的表现，不是早期的表现**。
一个临床医生带着进那个房间的鉴别，比一行字长得多：阑尾炎、胆囊炎、憩室炎、输尿管结石、**睾丸扭转（疼痛向上传导）**、异位妊娠、腹主动脉瘤渗漏或破裂、糖尿病酮症酸中毒，以及**肠系膜缺血** —— 最后这一条的特点是**疼痛程度与腹部体征不成比例**，且多见于房颤与心衰的人。**老年人与免疫抑制者的腹膜炎体征可以缺如或很轻**，所以「肚子还是软的」不能给任何结论。本库把这些记成「临床上要抱在手里的可能性」，**不替人排序，也不对任何急腹症提供方案**。
药物本身：**乌头碱中毒没有特异解毒剂，致死机制是室性心律失常**；双酯型生物碱靠久煎水解，这就是古典强调先煎久煎是在**用加工而不是用称量**来控制毒性。附子**不是白附子**（Typhonium）。**半夏生品**含针晶与凝集素，黏膜肿胀乃至气道受累是为生品记载的，**只有炮制品才属于任何现代讨论的范围**，本库不描述任何炮制方法。**粳米**是碾过的非糯大米 —— 是真实的碳水负荷，也是**已知的无机砷膳食来源**（多国专门为婴幼儿米制品设限，本库记有此监管、不量化）。**甘草**的甘草酸造成盐皮质激素样的一组变化：**失钾、钠潴留、升压**；与地高辛或利尿剂同用时，**低钾是杀人的那条机制**。**大枣**是糖负荷。孕期与哺乳期缺乏可靠的安全性数据；**对含乌头类的方，本库按排除处理而不是按慎用处理**。