Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Gua Lou Xie Bai Bai Jiu Tang is recorded in Jingui Yaolüe, in the chapter on chest painful obstruction, and the classical indication is given in a single line: chest painful obstruction with laboured breathing, spitting, pain in the chest and back, and shortness of breath. Three ingredients, one of which is wine. The reading offered by the classical literature is that when yang fails to reach the chest and cold phlegm binds there, chest pain and breathlessness follow, and the formula is described as unblocking yang, dissipating the binding, moving qi and transforming phlegm. The same chapter sets out Zhi Shi Xie Bai Gui Zhi Tang, already in this library, for the presentation that has added a sense of fullness and counterflow below the ribs.
This entry begins somewhere else, because the presentation the formula was written for is, in a modern emergency department, an emergency first and a pattern second. Chest pain radiating to the back together with breathlessness and sweating is acute coronary syndrome until a clinician demonstrates otherwise, and it is also the presentation of aortic dissection, pulmonary embolism, pericarditis and pneumothorax. Inferior myocardial infarction can present as upper abdominal pain with nausea and vomiting, which is precisely the region the classical text calls the area below the heart. Gastro-oesophageal reflux, musculoskeletal pain and anxiety also produce chest pain, and they are conclusions reached after exclusion, not the default. Nothing on this page sorts those apart. Chest pain needs assessment, and chest pain with sweating, breathlessness, faintness, or pain that woke a person from sleep, needs emergency assessment.
The ingredient that makes this entry unusual is the wine. The bai jiu of the formula name is a fermented grain wine of the kind made in the Han period, closer in character to a low-alcohol rice wine than to distilled spirits, and this is one of the places a modern reader most reliably misreads the text. Wine is still alcohol, however, and that means the formula carries every alcohol caution at once: liver disease, a history of pancreatitis, pregnancy, alcohol dependence, driving, and interactions with sedatives, hypoglycaemic drugs, warfarin and paracetamol, together with disulfiram-type reactions with certain antibiotics. Alcohol is classified as a Group 1 carcinogen, and no classical authority changes that.
Gua lou is trichosanthes fruit. Gua lou pi, the peel, and gua lou ren, the seed, are parts of the same plant used differently: the peel is directed more at clearing and transforming phlegm in the lung, the seed at moistening and opening the bowel, and the seed contains fatty oil so looseness of stool follows from it. Trichosanthes root is a different substance altogether and is called tian hua fen.
Xie bai is the bulb of an Allium species related to garlic and onion. Its sulphide constituents and their effects on platelet aggregation have been studied, and the theoretical concern about additive bleeding risk with antiplatelet and anticoagulant drugs is stated here because it is the obvious question, not because it has been settled. Allium species are poisonous to dogs and cats.
Classical compatibility lists place gua lou opposite aconite among the traditionally opposed pairs. This library records that as a traditional statement rather than as a demonstrated interaction.
Research on gua lou xie bai type formulas consists largely of animal experiments and small clinical studies. This library makes no claim of efficacy for any condition.
瓜蒌薤白白酒汤著录于《金匮要略》「胸痹心痛短气病脉证治」篇，古典指征只有一句：胸痹之病，喘息咳唾，胸背痛，短气。三味药，其中一味是酒。古典的读法是：阳不达于胸中，寒痰凝滞，则胸痛与短气并见，本方通阳散结、行气祛痰。同一篇另有枳实薤白桂枝汤（本库已收），用于兼见痞气、气结在胸、胁下逆抢心的一路。
本条的正文从这里写起，理由很简单：**这个方所描述的症候，在今天首先是急症，其次才是辨证。** 胸背痛伴呼吸困难与出汗，在排除之前按急性冠脉综合征处理；它同样也是主动脉夹层、肺栓塞、心包炎与气胸的表现。**下壁心肌梗死可以表现为上腹痛伴恶心呕吐**，而这正落在古典文献所说「心下」的范围里。胃食管反流、肌肉骨骼痛与焦虑也会造成胸痛，但它们是排除之后得出的结论，不是默认答案。本页没有任何内容能把这几者区分开。胸痛需要评估；胸痛伴出汗、气短、近乎晕厥或夜间痛醒者，需要急诊评估。
使本条特殊的一味是酒。方名里的「白酒」是汉代酿造的谷物酒，性质上更接近低度米酒，而**不是今天的蒸馏白酒** —— 这是现代读者最容易读错的一处。酒毕竟是乙醇，于是本方同时承担全部酒精禁忌：肝病、胰腺炎史、孕期、酒精依赖、驾驶，以及与镇静催眠药、降糖药、华法林、对乙酰氨基酚的相互作用；与某些抗菌药的双硫仑样反应也在其中。乙醇被列为第一类致癌物，任何古典权威都不改变这一点。
瓜蒌是栝楼的果实。**瓜蒌皮与瓜蒌仁是同一植株的不同部位**：皮偏清肺化痰，仁偏润燥滑肠，仁含脂肪油，故大便偏溏随之而来；**栝楼的根是另一物，名为天花粉**。
薤白是葱属（与大蒜、葱同属）的鳞茎。其含硫成分与对血小板聚集的影响已被研究；与抗血小板药、抗凝药叠加出血的理论关注在此写明，是因为这是读者必然会问的问题，而不是因为它已有定论。**葱属植物对犬与猫有毒。**
古典配伍文献把瓜蒌与乌头列入相对的一组（「半蒌贝蔹及攻乌」）。本库把这一条记为**传统说法**，而不是已被证实的相互作用。
瓜蒌薤白类方的研究多为动物实验与小样本临床研究。本库不对任何疾病作疗效主张。