Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. The clause that carries this formula is 喉中水鸡声 - a sound in the throat like a water hen, a frog-like croaking. It is a lay description of an airway noise, written before anyone could listen through a stethoscope or look at a larynx, and it is more precise than it first appears because it localises the sound to the throat. Today that one observation has to be split in two before anything else happens, because the two kinds of airway noise point at entirely different lists.
Stridor is an inspiratory noise from the upper airway. In a child it suggests croup, foreign body, epiglottitis, or laryngomalacia; in an adult it suggests foreign body, laryngeal oedema including anaphylaxis and hereditary angioedema, vocal cord dysfunction, laryngospasm, subglottic or tracheal stenosis, and laryngeal or tracheal tumour. Several of those close the airway in minutes to hours, and epiglottitis in particular is managed as an airway emergency rather than with medicine. Wheeze is a different sound with a different list: asthma, COPD, acute heart failure - cardiac asthma, which is a real entity and is treated as heart failure, not as asthma - foreign body, aspiration, allergic reactions with lower airway involvement, eosinophilic lung disease, allergic bronchopulmonary aspergillosis, bronchiectasis, endobronchial tuberculosis and bronchial tumour.
Three clinical features separate those lists faster than any reasoning about hot and cold. Onset that is sudden and witnessed, in a child or in an older person with swallowing difficulty or dementia, is foreign body aspiration until it is excluded - it is a bronchoscopy question. Wheeze that is unilateral, fixed and monophonic is an endobronchial lesion - tumour, foreign body, tuberculous stenosis - until imaging has been done; that one is audible with a stethoscope and is still missed. Wheeze with orthopnoea, paroxysmal nocturnal dyspnoea and a history of hypertension or infarction is heart failure, and giving it the asthma treatment is an error in the wrong direction. Fever with productive cough, chest pain and weight loss is a chest radiograph at minimum.
The materials carry the heaviest safety content in this batch. 细辛 is Asarum, and Asarum species contain aristolochic acid: aristolochic acid nephropathy and upper urinary tract urothelial carcinoma are documented, and the material is restricted or prohibited in many countries. This library has met that fact in other entries and will keep repeating it, because the name 细辛 is still on shelves. 款冬花, coltsfoot flower, contains pyrrolizidine alkaloids of the kind associated with hepatic sinusoidal obstruction syndrome, which is why several regulators set limits on it and why it is not a material to take long-term or during pregnancy. 射干 is Belamcanda chinensis, also classified as Iris domestica, a rhizome in the Iridaceae that is a common garden plant - a name that is easy to source and easy to mis-source. Prepared pinellia (半夏) is a processed material; the raw rhizome causes severe irritation of the mouth and throat and is not used internally. 五味子 is Schisandra. 紫菀 is an Asteraceae root, and Asteraceae contact dermatitis is common. Ephedra carries the sympathomimetic cautions set out in the entry on 越婢汤. Jujube is a sugar load. There are no adequate safety data for pregnancy or breastfeeding and pregnancy is an absolute exclusion.
Chinese clinical reports on this formula exist, chiefly in asthma and COPD contexts, small in scale and methodologically limited; this library records that the research exists, not that benefit has been established. And the symptom the formula is named for - a croaking sound in the throat - is a reason to be examined, not a reason to self-treat.
这首方靠的是「喉中水鸡声」—— 喉咙里有像水鸡（蛙）叫的声音。这是听诊器与喉镜都还没有的年代，对气道音的一句白话描写，而它比看上去更精确：它把声音定位在了喉。今天这条观察必须先分成两类，因为两种气道音指向完全不同的两张清单。
喉鸣(stridor)是吸气相、来自上气道。儿童想到哮吼、异物、会厌炎、喉软化；成人想到异物、喉水肿（含过敏反应与遗传性血管性水肿）、声带功能障碍、喉痉挛、声门下或气管狭窄、喉与气管的肿瘤。其中几项在几分钟到几小时内就能闭合气道，会厌炎尤其是按气道急症处理，而不是按用药处理。哮鸣(wheeze)是另一种声音、另一张清单：哮喘、慢阻肺、急性心衰（「心源性哮喘」是真实存在的一类，按心衰治而不是按哮喘治）、异物、误吸、累及下气道的过敏反应、嗜酸粒细胞性肺病、变应性支气管肺曲霉病、支气管扩张、支气管内膜结核、支气管肿瘤。
三个临床特征，比任何寒热推理都更快地把这两张清单分开：**起病突然且有人亲眼看见**，发生在儿童，或发生在有吞咽困难、痴呆的老人身上 —— 在排除之前是异物吸入，这是支气管镜的问题；**单侧、固定、单音调的哮鸣** —— 在影像做完之前是支气管内病变（肿瘤、异物、结核性狭窄），这一项用听诊器就能听出来，却仍然常被漏掉；**哮鸣伴端坐呼吸、夜间阵发性呼吸困难，以及高血压或心梗史** —— 这是心衰，按哮喘给药是把方向弄反。发热＋咳脓痰＋胸痛＋体重下降，今天至少是一张胸片。
药味承担了这批里最重的安全内容。**细辛是细辛属（Asarum），含马兜铃酸** —— 马兜铃酸肾病与上尿路尿路上皮癌均有记载，多国禁限；本库在别的条目里已经遇过这个事实，会一直复述，因为「细辛」这两个字现在还在柜台上。**款冬花含吡咯里西啶类生物碱**，即与肝窦阻塞综合征相关的那一类，这是若干监管机构对它设限的理由，也是它不宜长期或孕期使用的理由。射干是射干（Belamcanda chinensis，亦归入 Iris domestica），鸢尾科根茎，常见园艺植物 —— 名字好找，也容易找错。半夏是炮制品；生半夏对口腔与咽喉有强烈刺激，不入内服。五味子是五味子属。紫菀是菊科的根，菊科接触性皮炎常见。麻黄带越婢汤条目里写明的拟交感胺各项禁忌。大枣是糖负荷。孕期与哺乳期没有充分的人体安全性数据，孕期为绝对排除项。
中文文献里这方多用于哮喘与慢阻肺场景，规模小、方法学质量有限；本库如实记「研究存在」，不记「疗效已被确立」。而这首方得名于的那个症状 —— 喉咙里的蛙鸣声 —— 是去就诊的理由，不是自己处理的理由。