Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. This is the Jingui Yaolüe's formula for bleeding that the tradition reads as spleen yang failing to contain the blood, and it is the one in this knowledge base where the classical and modern readings diverge most usefully. The composition looks like a contradiction until you see what it is doing: prepared aconite, atractylodes and oven earth warm and bind from below, dried rehmannia and donkey-hide gelatin nourish and supplement, and scutellaria - a cold, heat-clearing herb - sits in the middle of all that warmth. The classical reason is that warming alone would aggravate the bleeding. A modern reader will notice that the formula manages to be astringent, warming and cooling at once, which is either sophisticated or unfalsifiable depending on how much charity one brings.
The safety note is again the indication. Blood in the stool is the complaint, and it does not sort itself out. Rectal bleeding carries a differential that includes colorectal cancer, inflammatory bowel disease, angiodysplasia, diverticular bleeding, haemorrhoids, fissure, peptic ulcer, and upper gastrointestinal bleeding presenting as melena. New rectal bleeding in anyone over forty, or with weight loss, iron-deficiency anaemia, a change in bowel habit, or a family history of colorectal cancer, is a reason for endoscopic investigation rather than for a pattern diagnosis. Black tarry stool, heavy bleeding, or bleeding with dizziness or fainting is an emergency. Uterine bleeding carries the points made under Wen Jing Tang, and nosebleed and vomiting blood have their own causes - including, for nosebleed, a posterior epistaxis that will not stop on its own.
Three ingredients deserve more than a line.
Prepared aconite is a genuine poison and a genuine medicine. Aconitine and related alkaloids affect voltage-gated sodium channels and produce ventricular arrhythmias, conduction block, paraesthesia and asystole; poisoning is well documented from improperly processed root, from decoctions that were not cooked long enough, and from topical preparations. Proper processing hydrolyses much of the alkaloid content, which is why the text specifies prepared and why the traditional cooking method matters more here than anywhere else in this library. Anyone with heart rhythm problems, or on antiarrhythmics or digoxin, should not treat this as a warming herb with no ceiling. It is avoided in pregnancy.
Oven earth is the ingredient I would not know how to source responsibly, and I would rather say so than write around it. Fu long gan is clay from the floor of a long-used wood-fired cooking stove, and its rationale is partly that it has been through fire and partly that it is astringent and mineral. There are two problems. The first is that the thing itself has largely disappeared. The second is that a material whose entire history is adsorption from wood smoke carries a real question about polycyclic aromatic hydrocarbons, dioxins and heavy metals, and that question has not been answered by any analysis I can point to. Substitution with other mineral astringents is practised, but this is not a knowledge base that will name one.
Scutellaria has its own literature: liver injury has been reported around Scutellaria-containing preparations, and baicalin is an active research subject. Donkey-hide gelatin is animal-derived and carries the adulteration problem noted under Wen Jing Tang. Atractylodes is comparatively unremarkable.
这是《金匮要略》中为止血而立、传统读作脾阳不足不能统血的一首方，也是本知识库里古典读法与现代读法分歧最有意义的一首。组成看似自相矛盾，看清它在做什么就通顺了：炮附子、白术与灶心黄土在下温阳固涩，干地黄与阿胶滋养补益，而黄芩——一味苦寒清热药——正处在这片温热之中。传统的解释是：纯用温药反而会加重出血。现代读者会注意到，这个方子同时具备收涩、温阳与清热三种性质，这究竟是精巧还是不可证伪，取决于读者愿意给出多少善意。
安全提示同样属于适应症。主症是便血，而便血不会自己分出类别。便血的鉴别范围包括结直肠癌、炎症性肠病、血管发育异常、憩室出血、痔、肛裂、消化性溃疡，以及表现为黑便的上消化道出血。四十岁以上者、或伴体重下降、缺铁性贫血、排便习惯改变、结直肠癌家族史者新出现的便血，理由在于做内镜检查，而不是做辨证。柏油样黑便、大量出血、或伴头晕昏厥者属急症。子宫出血方面适用温经汤条下的那些说明；鼻衄与呕血各有其原因——其中后鼻孔出血是不会自行止住的那一类。
三味药值得多说几句。
炮附子是真毒也是真药。乌头碱及其相关生物碱作用于电压门控钠通道，可致室性心律失常、传导阻滞、麻木与心脏停搏；因炮制不当、煎煮时间不足以及外用制剂而中毒者记载充分。规范的炮制可水解大部分生物碱含量，这正是原文写明「炮」的原因，也是本库中煎煮方法在此处比别处更要紧的原因。有心律问题者，或正在服用抗心律失常药、地高辛者，不应把它当作没有上限的温阳药。孕期不用。
灶心黄土是我不知道该如何负责任地获取的一味药，我宁愿这样说，也不要绕着写。伏龙肝是长期柴灶灶底的焦土，其取义一半在于它经受过火，一半在于它涩而属土。这里有两个问题：其一，这种东西本身已基本消失；其二，一种全部来历都是吸附木烟的材料，在多环芳烃、二噁英与重金属方面存在真实的疑问，而这个疑问并没有我能指出的分析数据来回答。以其他矿物涩药替代的做法是存在的，但本知识库不负责指出是哪一种。
黄芩自有其文献：含黄芩制剂周围有肝损伤的报告，黄芩苷是活跃的研究课题。阿胶为动物来源，带有温经汤条下所述的掺伪问题。白术相对平淡。