Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Shi Zao Tang is recorded in the Shanghan Lun, in the passage that begins with a condition rather than with a symptom: the exterior must be resolved before any attack downward is made. Only then comes the presentation itself — sweating that comes in episodes, headache, hardness and fullness below the heart, pain pulling at the flank, dry retching, shortness of breath. The classical reading is that water has collected and that this formula expels it. The same formula appears in the Jingui Yaolüe chapter on rheum, where the name given to the indication is suspended rheum. Three of the four ingredients are drastic. The fourth gives the formula its name.
The fourth ingredient is the reason this entry is worth writing. Ten jujubes, decocted; the other three taken as a powder washed down with that decoction. The classical literature builds a layer of protection into the formula and then names the formula after the protection rather than after the three herbs that do the work. The distance between a drastic hydragogue and injury to the gastrointestinal tract is one layer thick, and whoever wrote the text knew it. The same passage also contains stopping rules: once the purge has been obtained, it stops, and afterwards the person is fed thin congee and left alone. A text that carries its own stopping rules is a text that expects to be stopped.
What the presentation corresponds to now has to be said before anything else. Suspended rheum with pain in the chest and flank, coughing, and shortness of breath is, in modern terms, pleural effusion — and pleural effusion is a finding with a cause behind it: heart failure, hepatic hydrothorax, parapneumonic effusion, tuberculosis, malignancy, pulmonary embolism, renal disease, hypoalbuminaemia. The way that cause is found is imaging and thoracentesis, not purgation. Chest pain with breathlessness is also how pulmonary embolism and aortic dissection present, and both of them kill on a timescale that does not allow for self-treatment.
The three herbs are toxic. Kansui root and Beijing euphorbia root are Euphorbiaceae; genkwa flower bud is Thymelaeaceae — the three are not even from the same family. All three are violent irritants to the gastrointestinal mucosa, and the literature contains reports of haemorrhagic gastroenteritis, violent vomiting, dehydration and shock after they are taken by mouth. The classical text specifies a processed form for the genkwa, and later practice describes vinegar-processing for the others; processing is reported to reduce the irritant constituents, not to remove them, and this library deliberately describes no method intended to make these substances safer to take. All three are named in the classical incompatibility literature as opposed to liquorice root, recorded here as a traditional statement rather than as a finding.
Nothing on this page is a recommendation. This library records that the formula exists in the literature; it does not supply amounts, preparation or instructions, and it makes no claim of benefit for any condition. Pregnancy, childhood, older age, impaired kidney or liver function, existing dehydration or electrolyte disturbance, active ulceration or bleeding in the gut, and the concurrent use of diuretics, digoxin or corticosteroids each remove what little margin there might have been. If someone has already taken such a preparation and develops severe abdominal pain, bloody diarrhoea, persistent vomiting, dizziness, palpitations, scanty or absent urine, or confusion, that is an emergency: seek emergency care, and bring the package.
十枣汤著录于《伤寒论》。原文先立一条限制再写症状：表解者，乃可攻之 —— 表证已解，才可议攻下；其后才是「其人漐漐汗出，发作有时，头痛，心下痞硬满，引胁下痛，干呕短气」。古典的解释是水饮结聚，此方逐之。同一首方又见于《金匮要略·痰饮咳嗽病脉证并治》，那里给出的名目是「悬饮」。四味药里三味峻烈，第四味给了方名。
第四味是本条的重点。十枚大枣另煎，其余三味作散、以枣汤送服 —— 古典文献把一层保护写进方里，然后用这层保护给方命名，而不是用那三味干活的药。峻下逐水之品与胃肠道损伤之间只隔这一层，而写方的人知道。同一段原文还自带停止规则：得快下利后，糜粥自养 —— 下利一通即止，此后只给稀粥静养。一段自带停止规则的文字，是预期自己会被停下来的文字。
今天该先说的是这个证候对应什么。「悬饮」之胸胁痛、咳唾、短气，在今天就是胸腔积液；而胸腔积液是一个背后有因的体征：心衰、肝性胸水、肺炎旁积液、结核、恶性肿瘤、肺栓塞、肾病、低白蛋白。查因的手段是影像与胸腔穿刺，不是攻逐。胸痛伴呼吸困难同时也是肺栓塞与主动脉夹层的表现，两者的时间尺度都不允许自行处理。
三味药皆有毒：甘遂与大戟属大戟科，芫花属瑞香科 —— 三味甚至不同科。三味都是胃肠道黏膜的强烈刺激物，文献中确有口服后出血性胃肠炎、剧烈呕吐、脱水与休克的报告。古典原文对芫花注明「熬」，后世另有醋制等炮制字样；炮制被报道可降低而非消除刺激性成分，本库刻意不写任何意在使其更安全的做法。三味在古典配伍禁忌中都属「反甘草」之列（藻戟遂芫俱战草），此处仅记为传统说法，不作为研究结论。
本页不是建议。本库记录的是文献中有此方；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、儿童、老年、肝肾功能受损、已存在脱水或电解质紊乱、活动性消化道溃疡或出血、正在使用利尿剂／地高辛／糖皮质激素，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剧烈腹痛、血便、持续呕吐、头晕、心悸、尿少或无尿、意识改变，属急症：立即就医，并把原包装带上。