Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. The indication is one clause long and easy to read past: 大病瘥后，从腰以下有水气者 - after a major illness has resolved, water beneath the waist. The classical text is describing convalescence, and the modern question is what new oedema after a serious illness actually is. It is not weakness left over. Lower-limb oedema has a differential: heart failure, nephrotic syndrome, cirrhosis with hypoalbuminaemia, protein-losing states, deep vein thrombosis, venous insufficiency, lymphoedema, thyroid disease, pregnancy, and drugs - calcium channel blockers, NSAIDs, corticosteroids, thiazolidinediones and gabapentinoids among them. Two features change the urgency. Oedema in one leg only is deep vein thrombosis until it is excluded, and someone who has been ill and immobile is exactly the person at risk; the consequence of missing it is pulmonary embolism. Oedema with breathlessness is heart failure until it is excluded. Both are assessments that take minutes to begin, and neither is settled by a formula that acts like a diuretic.
The formula itself is the most mineral- and animal-loaded in this batch, and its ingredients carry most of the interest. 商陆 is pokeweed root, Phytolacca: a recognised poison, producing gastroenteritis with vomiting and diarrhoea, dizziness, and in severe poisoning neurological features; and the reason it keeps appearing in poisoning reports is that the root is mistaken for ginseng or for 土人参. Processing does not turn an unquantified poison into a predictable one. 蜀漆 is the young shoot and leaf of Dichroa febrifuga, the plant that yields febrifugine - it has emetic activity and there are reports of liver injury. 海藻, seaweed, is an iodine load, which matters in thyroid disease and complicates the assessment of anyone taking antithyroid medicine or amiodarone; the classical method note says to wash the salt from it. 牡蛎 is oyster shell, a shellfish-derived material, and shellfish allergy is among the common food allergies. 栝楼根 is 天花粉, trichosanthes root; the protein isolated from it, trichosanthin, was investigated for terminating pregnancy and for ectopic pregnancy, which is the plainest available statement that it is not a material to take during pregnancy. 葶苈子 has reported cardiac glycoside-type activity that has not been established in humans.
Two classical notes close it. The formula sits in the chapter of Shanghan Lun on 差后劳复 - what goes wrong after the illness is over - which is a sensible home for this cluster, and a reminder that the classical corpus had a category for the aftermath. And the seven ingredients include 海藻 while containing no licorice: the classical 十八反 incompatibility list pairs 海藻 against 甘草, in the line 藻戟遂芫俱战草, and readers who know the list will notice that this formula is built to avoid that pairing. This library records the classical claim as a claim and takes no position on whether it is correct.
There are no adequate safety data for pregnancy or breastfeeding, and pregnancy is an absolute exclusion here. Chinese clinical reports on this formula are sparse compared with the rest of this library; the library records that research exists, not that benefit has been established.
主治只有一句，容易被读过：大病瘥后，从腰以下有水气者。古典讲的是病后恢复期，而今天要问的是「大病之后新出现的水肿到底是什么」。它不是「体虚没恢复」。下肢水肿有鉴别表：心衰、肾病综合征、肝硬化伴低白蛋白、蛋白丢失性状态、深静脉血栓、静脉功能不全、淋巴水肿、甲状腺病、妊娠，以及药物 —— 钙通道阻滞剂、非甾体抗炎药、皮质类固醇、噻唑烷二酮类、加巴喷丁类都在其中。有两个特征会改变紧急程度：**只有一条腿肿，在排除之前是深静脉血栓**，而刚病过、活动少的人正是高危人群，漏掉它的后果是肺栓塞；**水肿伴气短，在排除之前是心衰**。这两项的评估几分钟就能开始，也都不是一味利水方能了结的。
本方是这批里矿物与动物来源负荷最重的一方，看点在药味本身。商陆是商陆科商陆属（Phytolacca）的根，是有名的毒物：消化道刺激、呕吐腹泻、眩晕，重者出现神经症状；而它反复出现在中毒报告里的原因是**根被人当成人参或土人参误服**。炮制不会让一味含量不明的毒物变成可预期的东西。蜀漆是黄常山（Dichroa febrifuga）的嫩枝叶，即常山碱（febrifugine）的来源植物 —— 有催吐作用，并有肝损伤报道。海藻是碘负荷，甲状腺病患者须计入，也会干扰服用抗甲状腺药或胺碘酮者的判断；原方注「洗去咸」。牡蛎是牡蛎壳，属贝类来源，而**贝类过敏是最常见的食物过敏之一**。栝楼根即天花粉，从它分离出的天花粉蛋白曾被研究用于终止妊娠与异位妊娠 —— 这是「孕期不该用」最直白的一句说明。葶苈子有强心苷类活性报道，人体证据未建立。
另两条古典自记收尾。这首方落在《伤寒论》「差后劳复」篇 —— 讲病愈之后出问题的那一篇；古典为「病后」单立一门，本身值得记。此外七味里有海藻而无甘草：古典十八反歌诀「藻戟遂芫俱战草」把海藻与甘草相对，熟悉这条的读者会注意到本方是绕开这一对来组方的。本库把这条古典记载作为记载来记，不裁决它对不对。
孕期与哺乳期没有充分的人体安全性数据，**孕期是绝对排除项**。中文文献中这方的临床报告比本库其它方剂稀少；本库如实记「研究存在」，不记「疗效已被确立」。