Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Gui Zhi Shao Yao Zhi Mu Tang is recorded in Jingui Yaolüe, in the chapter on wind stroke and joint disease, and its line is one of the most clinically evocative in the classical corpus: pain in all the limb joints, the body wasted, the feet swollen as though they might fall off, dizziness and shortness of breath, and a constant desire to vomit. That is a picture of advanced, untreated inflammatory joint disease, and it is worth saying so plainly, because the formula is now mostly read as a formula for arthritis and what the original describes is what arthritis looks like when nothing has been done for years.
The composition is the interesting part. Cinnamon twig, ephedra, ginger, atractylodes, saposhnikovia and prepared aconite are warm, acrid, dispersing and drying — a wind-cold-damp formula. Peony and anemarrhena are cooling and moistening. The formula therefore holds both directions at once, and the classical explanation is that wind-damp held for a long time generates heat and consumes yin, so the cooling pair is there to protect against the warming ones. Whether or not one accepts the mechanism, the structural fact is real: this is a formula that deliberately contains its own corrective.
It is also, by any modern regulatory reading, the heaviest formula in this library. It contains prepared aconite and it contains ephedra, and those two are among the most heavily regulated botanicals in the English-speaking world, for different reasons. Aconite has been described elsewhere in this library and the description does not soften with repetition: diester alkaloids hold sodium channels open, the effect lands on conducting tissue and nerve, and severe poisoning produces ventricular arrhythmia and asystole. Processing and long decoction are the two things that make it usable and neither is optional. Ephedra is the other half. In 2004 the United States Food and Drug Administration ruled ephedra-containing dietary supplements adulterated, and ephedrine alkaloids have not been lawfully sold in that category since; the herb also appears on prohibited lists in sport. As a sympathomimetic it is the wrong class of agent in heart failure, pulmonary embolism, arrhythmia, uncontrolled hypertension, thyrotoxicosis, prostatic obstruction and some glaucomas. A formula containing both herbs at once is not a gentle option and it is not a self-selection option.
What the formula points at clinically is joint pain and swelling, and that is where a modern reader should part company with the classical frame. A single hot swollen joint must be aspirated to exclude infection, because septic arthritis destroys cartilage in hours. Symmetrical small-joint disease with prolonged morning stiffness is rheumatoid arthritis, where disease-modifying treatment changes the long-term outcome and delay permits irreversible erosion. Polyarthritis with fever is a different question again — endocarditis, gonococcal infection, viral illness and Lyme disease all present that way. Gout and pseudogout mimic each other and are distinguished by crystals seen in aspirated fluid. Shoulder and hip girdle stiffness with headache or visual symptoms in an older adult raises temporal arteritis, which causes irreversible blindness if it is not treated within days. The oedema in the classical line has its own differential: heart failure, renal disease, venous insufficiency, lymphatic obstruction, and drugs including calcium channel blockers, non-steroidal anti-inflammatory drugs and corticosteroids — and unilateral painful calf swelling is deep vein thrombosis until disproven. This library does not present this formula as a treatment for rheumatoid arthritis, gout, osteoarthritis or any named rheumatic disease, and it gives no amounts.
Among the remaining ingredients: the atractylodes here is Atractylodes macrocephala, which is not the same herb as A. lancea; anemarrhena contains mangiferin with laboratory evidence of glucose-lowering effects, which is a reason for caution alongside diabetes medication; peony and licorice together are the classical spasm-relieving pair and carry the glycyrrhizin caution described elsewhere in this library.
桂枝芍药知母汤著录于《金匮要略·中风历节病脉证治》篇，它的原文是古典文献里临床画面感最强的一条：「诸肢节疼痛，身体尪羸，脚肿如脱，头眩短气，温温欲吐」。这是一幅晚期、未经治疗的炎性关节病的画面，值得直白地说出来 —— 因为此方今天多被当作「治关节炎的方」来读，而原文所写的是关节炎拖了许多年之后的样子。
组成是真正有意思的部分。桂枝、麻黄、生姜、白术、防风、附子（炮）是辛温散燥的一路，合起来是一首风寒湿方；芍药与知母则是凉润的一路。这首方因此同时握着两个方向，古典解释是：风湿久郁化热伤阴，凉润的这一对是用来制约温燥的那一组。机制能否接受可以两说，结构上的事实是真的：这是一首自带纠偏的方。
按现代任何监管口径读，它同时是本库安全负担最重的一首方 —— 方中含附子（炮），也含麻黄，而这两味恰好是英语世界监管最重的两味草药，理由各不相同。附子在本库其他条目里已经写过，重述并不会让它变软：双酯型生物碱把钠通道撑开，效应落在传导组织与神经上，严重中毒导致室性心律失常与心脏停搏；炮制与久煎是让它可用的两件事，两件都不可选。麻黄是另一半。2004 年美国食品药品管理局裁定含麻黄碱类的膳食补充剂为掺假，此后麻黄生物碱在该类别中不再合法销售；该药也出现在运动禁药名单上。作为拟交感胺，它在心衰、肺栓塞、心律失常、未控制的高血压、甲状腺毒症、前列腺增生排尿困难与某些青光眼里都属于错的一类。同时含这两味的方不是温和的选择，也不是可以自行选用的选择。
临床上它指向的是关节肿痛，而这正是现代读者该与古典框架分手的地点。单个红肿热痛的关节必须抽液以排除感染，因为感染性关节炎在数小时内破坏软骨。对称性小关节病变伴长时间晨僵是类风湿关节炎，改变病情的治疗改变远期结局，拖延会造成不可逆的骨侵蚀。多关节炎伴发热是另一个问题：感染性心内膜炎、淋球菌感染、病毒感染与莱姆病都以这种方式起病。痛风与假性痛风彼此相似，靠抽出的关节液里看到的结晶区分。老年人肩胛带与骨盆带僵硬伴头痛或视觉症状要想到颞动脉炎，不在数日内处理可致不可逆失明。原文里那个「脚肿如脱」也有自己的鉴别清单：心衰、肾病、静脉功能不全、淋巴回流障碍，以及钙通道阻滞剂、非甾体抗炎药与糖皮质激素等药物；而单侧小腿肿痛在没有排除之前是深静脉血栓。本库不声称此方治疗类风湿关节炎、痛风、骨关节炎或任何具体的风湿性疾病，也不列用量。
其余药味：此处白术为 Atractylodes macrocephala，与苍术（A. lancea）不是同一味；知母含芒果苷，有降血糖作用的实验室证据，与降糖药同用时应谨慎；芍药与甘草同用是古典的缓急止痛一对，并带着本库其他条目里写过的甘草酸风险。