Source 出处 · Taiping Huimin Hejiju Fang · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Niu Huang Qing Xin Wan is recorded in the Taiping Huimin Hejiju Fang, and it is the most complicated of the formulas in this batch: roughly thirty ingredients, arranged so that clearing and opening sit alongside supplementing and warming. Ox gallstone, musk, borneol, antelope horn and cinnabar on one side; ginseng, atractylodes, poria, licorice, chinese yam, donkey-hide gelatin, jujube on the other; cinnamon bark and dried ginger warming underneath. It is worth saying plainly that a later, much shorter formula under the same name — six ingredients — circulates in other formularies. The library records that the two exist and are not interchangeable; it does not adjudicate between them.
The indication is clouded spirit, confused speech, agitation. The modern obligation is the same as for the rest of this batch, and it comes first: altered consciousness is a presentation, not a diagnosis. Hypoglycaemia, hypoxia, sepsis, meningitis and encephalitis, stroke, seizure and post-ictal state, head injury, metabolic encephalopathy from liver or kidney failure, drug and alcohol effects, carbon monoxide, thyroid storm, hyponatraemia. New-onset confusional states in older people very often have an ordinary cause behind them — infection, urinary retention, pain, medication, constipation, dehydration — and that cause is found by examination and a few tests, not by reading a formula. Stroke is measured in minutes. Sudden speech difficulty, facial droop or limb weakness is an emergency pathway, and nothing on this page belongs on it.
A mouth that cannot protect its airway should not receive anything by mouth. That is mechanics, not pharmacology.
Then the constituents. Cinnabar is mercuric sulfide; realgar is a sulfide of arsenic. Two heavy metals in one pill, both cumulative, neither with an established safe level for long-term use — and this is a formula that has historically been taken repeatedly, sometimes daily, by older people for extended periods. That combination is the reason the safety note here is longer than the efficacy note. Rhinoceros horn trade has been prohibited in China since 1993 and it is now routinely substituted with water buffalo horn; antelope horn comes from the CITES-listed saiga antelope; musk is from a CITES-listed animal and is often synthetic.
The supplementing half has its own interactions. Ginseng's reported interaction with warfarin is mixed and the library reports it as mixed rather than as safe. Donkey-hide gelatin is an animal product and its authenticity and chromium contamination have been reported as problems; apricot seed contains amygdalin, which can release cyanide, and that is why pharmacopoeial processing matters and why it is not a food. Licorice in sustained amounts causes pseudohyperaldosteronism — hypertension, oedema, hypokalaemia — and that risk rises together with diuretics, digoxin and corticosteroids. Cinnamon contains coumarin. Cattail pollen is the same drug that is used raw and charred in opposite directions elsewhere in this library; the form matters.
This page is not a recommendation. No dose, no preparation, no regimen, no claim of benefit. Pregnancy, breastfeeding, children, older adults, hepatic or renal impairment, hypertension, and any anticoagulant, antiplatelet, antihypertensive, antidiabetic, sedative or antiepileptic medicine taken on medical advice each remove the remaining room. If a preparation like this has been taken and there is vomiting, abdominal pain, tremor, numbness, confusion, or reduced urine output, treat it as an emergency and bring the packaging.
牛黄清心丸著录于《太平惠民和剂局方》，是本批四首中组成最繁的一首（约三十味）：清心开窍与益气养血同处一方 —— 牛黄、麝香、冰片、羚羊角、朱砂在一边，人参、白术、茯苓、甘草、山药、阿胶、大枣在另一边，底下还有肉桂、干姜之温。需要明说一句：后世方书中另有同名的六味简方，组成不同，二者不可互替；本库记其并存，不裁决优劣。
所主为神昏、语謇、心中烦乱。今天的义务与本批其余三首相同，且要写在前面：意识改变是一个**表现**，不是一个诊断。低血糖、缺氧、脓毒症、脑炎脑膜炎、卒中、癫痫发作及发作后状态、颅脑外伤、肝性或肾性脑病、药物与酒精、一氧化碳、甲亢危象、低钠血症，都在名单上。老年新发的谵妄状态背后极常见的是一些很普通的原因：感染、尿潴留、疼痛、药物、便秘、脱水 —— 那是靠查体和几项检查找出来的，不是靠读一首方。卒中仍以分钟计：突发的言语不清、口角歪斜或肢体无力走急救路径，本页不属于这条路径。
不能保护自己气道的口腔，不应经口给任何东西。这是机制，不是药理。
然后是组成。朱砂是硫化汞，雄黄是砷的硫化物 —— 一丸之中有两种重金属，均为蓄积性，均无确立的安全长期用量；而这首方在历史上恰恰被长期、有时是每日服用，对象又常常是老年人。本条的安全篇幅长于功效篇幅，原因就在这里。犀角贸易自 1993 年起在中国被禁止，今多以水牛角代；羚羊角取自列入 CITES 的赛加羚羊；麝香来自 CITES 所列物种，今多为人工麝香。
补益的一半另有相互作用要写：人参与华法林的证据是混杂的，本库写混杂而不写安全；阿胶是动物制品，掺伪与铬污染的报告都在；杏仁含苦杏仁苷，可释放氰化物，故药典炮制要紧，且它不当食物；甘草久服致假性醛固酮增多症（高血压、水肿、低钾），与利尿剂／地高辛／糖皮质激素同用时风险叠加；肉桂含香豆素；蒲黄与本站别处所记相同 —— 生用与炒炭方向相反，用哪一种是实质差别。
本页不是建议：不列用量、不列制法、不列服法，也不主张它对任何情况有益。妊娠、哺乳、儿童、老年、肝肾功能受损、高血压，以及正在使用抗凝／抗血小板／降压／降糖／镇静／抗癫痫类处方药，任何一项都足以抹去残余的空间。若已服用此类制剂并出现呕吐、腹痛、震颤、麻木、意识改变或尿少，属急症：立即就医，并把原包装带上。