Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Ji Jiao Li Huang Wan comes from the phlegm-fluid chapter of the Jingui Yaolüe, and the line is unusually specific: 腹满，口舌干燥，此肠间有水气，己椒苈黄丸主之 — abdominal fullness with a dry mouth and tongue; this is water qi between the intestines. The text adds a follow-up observation: once the mouth has moisture again, the fluid has begun to move.
Abdominal fullness together with thirst is a pair of findings that today is sorted before it is named, because the two biggest things it can be are both urgent. Free fluid in the abdomen — ascites — has a cause, and finding that cause is the entire job: cirrhosis, malignancy, heart failure, nephrotic syndrome and tuberculous peritonitis are the common ones, and which of them it is changes everything that follows. The other is bowel obstruction, in which distension, thirst and a dry mouth go together because fluid is being sequestered into the bowel and lost from the circulation; obstruction with vomiting, absolute constipation, or a tense tender abdomen is a surgical matter. Neither is a pattern to be read.
The composition carries one of the best-documented safety stories in the entire materia medica, and it sits in the first ingredient. 防己 in modern Chinese Pharmacopoeia usage is the root of Stephania tetrandra, 粉防己. But the same name has historically been applied to 广防己, the root of Aristolochia fangchi, which contains aristolochic acid. Aristolochic acid is the cause of the nephropathy and urothelial carcinoma seen in the Belgian weight-loss clinic cohort of the early 1990s, and of Balkan endemic nephropathy; it is classified as a human carcinogen, and the renal failure is progressive and continues after exposure stops. The harm happened because two unrelated roots were traded under one name. That is worth knowing independently of this formula, because the same naming problem affects several other medicinals in this group and is the single most consequential identity issue in Chinese herbal practice.
Two smaller identity points. 椒目 is the seed of Zanthoxylum, not the pericarp — the pericarp is the familiar Sichuan pepper used as a spice, the seed is a different part used for a different purpose. And 大黄 is rhubarb, whose anthraquinones are stimulant laxatives with a substantial literature on dependence, melanosis coli, and potassium loss with sustained use. Anything producing copious watery stool in a person who also has cirrhosis, heart failure or kidney disease is interacting with medicines whose margins are narrow — diuretics, digoxin, lithium, and every medicine where potassium is the whole game. 葶苈子 is the seed of Descurainia sophia or Lepidium apetalum, members of the mustard family; preclinical studies report cardiotonic activity and the human evidence is not established, so it is recorded here as unestablished rather than as either a claim or a dismissal.
Ji Jiao Li Huang Wan is recorded because it is the most concrete statement in the classical corpus about fluid lying in the wrong compartment. It is also one of the places where the two systems differ most in what they can actually do, because the modern answer to the same finding is: identify the cause, remove the fluid, and watch the electrolytes.
己椒苈黄丸出自《金匮要略》痰饮咳嗽篇，条文異常具体：**腹满，口舌干燥，此肠间有水气**，己椒苈黄丸主之。原文还补了一句效验观察：口中有津液者，是水去之验。
「腹满」配上「口渴」，在今天是一组**先分诊、后命名**的见症，因为它最可能是的两种情况都很急。其一是**腹水** —— 腹水必有病因，找出病因就是全部工作：肝硬化、恶性肿瘤、心衰、肾病综合征、结核性腹膜炎是常见的几种，而究竟是哪一种，会改变其后的一切。其二是**肠梗阻** —— 腹胀、口渴、口干同时出现，是因为液体被隔离进肠腔、从循环中丢失；伴呕吐、完全不排气排便、或腹肌紧张压痛的梗阻是外科问题。这两者都不是可以拿来「辨证」的东西。
本方的组成里带着整个本草中**记录最完备的安全事件之一**，而且就在第一味药上。今《中国药典》的「**防己**」是**粉防己**（Stephania tetrandra）的根。但历史上「防己」这个名字也被用于**广防己** —— 马兜铃科**Aristolochia fangchi** 的根，**含马兜铃酸**。马兜铃酸正是 1990 年代初比利时减肥诊所队列中出现的肾病与尿路上皮癌的病因，也是巴尔干地方性肾病的病因；它被列为人类致癌物，其肾损害是进行性的，**在停止接触后仍继续进展**。伤害之所以发生，是因为两种毫无关系的根被当作同一个名字在流通。这一点值得脱离本方单独记住，因为同样的命名问题波及这一类里的好几种药材，是中药实践中最要紧的辨物问题。
另外两个小一点的辨物点：**椒目是花椒的种子**，不是果皮 —— 果皮是作香料的花椒，种子是同一植物上不同部位、用途也不同。**大黄**含蒽醌类，属刺激性泻药，关于依赖、结肠黑变病以及长期使用导致失钾的文献相当充分。任何能造成大量水样便的东西，用在同时有肝硬化、心衰或肾病的人身上，就是在与治疗窗很窄的药打交道 —— 利尿剂、地高辛、锂盐，以及一切以血钾为命门的药。**葶苈子**是播娘蒿或独行菜的种子（十字花科）；临床前研究报道了强心活性，**人体证据未建立**，本条如实记为未建立，既不作为主张也不作为否定。
收录己椒苈黄丸，是因为它是古典文献中关于「水停在错误的腔隙里」最具体的一次陈述；也因为它是两种体系在「实际能做什么」上差距最大的地方之一 —— 今天面对同一组见症的答案是：找病因、放腹水、盯电解质。