Source 出处 · Beiji Qianjin Yaofang · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Wen Pi Tang is attributed to Beiji Qianjin Yaofang, the seventh-century compendium of Sun Simiao, and it is the standard example of a category this library had not covered until now: the warm purgative. The idea is easy to state and hard to read from a modern angle. A cold-type accumulation is said to need warmth to move it and a purgative to expel it, so the formula pairs fu zi and gan jiang, which warm, with da huang and mang xiao, which drain. Ren shen, dang gui and zhi gan cao are included to support what the draining depletes. In the classical material the indications cluster around abdominal pain with cold and bound stool.
One honest note on identity comes first. Wen Pi Tang is not a single formula. More than one composition circulates under that name in the classical literature, and a shorter five-ingredient version without dang gui and mang xiao is also transmitted. This entry follows the seven-ingredient composition that modern teaching texts attribute to Beiji Qianjin Yaofang. This library does not adjudicate which one is the real Wen Pi Tang; it reports that the name is shared.
What this entry states plainly is that two of the ingredients are, on their own, among the reasons people are admitted to hospital. Fu zi is processed aconite. Aconitine and the related diester alkaloids are cardiotoxic and neurotoxic, and the recognised picture is numbness of the mouth, tongue and limbs, nausea and vomiting, and ventricular arrhythmia. Traditional practice depends on prolonged decoction to hydrolyse the diester alkaloids into less toxic forms, and on processing; raw and processed aconite are different substances. This library describes the hazard and deliberately gives no method for reducing it, because that method is a preparation instruction and this site does not give those.
Da huang is a stimulant anthraquinone laxative. Taken over time it is associated with melanosis coli, usually reversible, with potassium loss, and with laxative dependence. Mang xiao is sodium sulphate, an osmotic laxative, and it is also a sodium load, which is not a neutral matter in heart failure, hypertension, impaired kidney function or ascites. Zhi gan cao causes potassium loss by a different route.
So the same formula contains four separate routes to low potassium, an anthraquinone laxative, an osmotic laxative, liquorice, and vomiting if aconite toxicity occurs, while it also contains an ingredient whose cardiac toxicity is amplified when potassium falls. This library is not making a rhetorical point by placing those side by side; the composition places them there.
Then the clinical boundary, which matters more than any of the above. Constipation with abdominal pain, vomiting and an inability to pass wind or stool is obstruction until a surgeon has said otherwise, and a stimulant purgative in that setting is dangerous. Constipation beginning after the age of fifty, blood in the stool, unintentional weight loss, iron-deficiency anaemia, a lasting change in stool calibre, and a family history of bowel or ovarian cancer all call for investigation before any purgative is considered. Ordinary causes are common too: opioid medicines, calcium channel blockers, anticholinergic medicines, iron, hypothyroidism, hypercalcaemia, and low fluid and fibre intake. Ren shen has mixed evidence in relation to warfarin, and this library writes mixed rather than safe; generous use over time is reported with insomnia, raised blood pressure, rash and diarrhoea. Dang gui contains coumarin-type constituents and is traditionally treated with caution in pregnancy. Research on this formula is largely preclinical. This library makes no claim of efficacy.
温脾汤归于七世纪孙思邈《备急千金要方》，是本库此前未收的一类的标准样本：**温下剂**。其思路说起来简单，放到今天读却不容易。古典认为冷积既需温以行之，又需下以去之，于是以附子、干姜之温，配大黄、芒硝之泻；人参、当归、炙甘草用于扶助被攻下所耗者。原文所指集中在腹痛与寒结、大便不通。
先写一条诚实的说明：**「温脾汤」不是唯一一首方**。古典文献中以此名流传的不止一个组成，另有不含当归与芒硝的五味版本同时流传。本条采用现代教科书归于《备急千金要方》的七味组成。本库不裁决哪一首才是「真正的」温脾汤，只如实说明**这个方名是共享的**。
本条要直说的是：方中有两味，各自单独就足以构成住院的原因。**附子**是乌头属的加工品。乌头碱及相关双酯型生物碱具心脏毒性与神经毒性，公认的表现是口舌与四肢麻木、恶心呕吐、室性心律失常。传统做法依赖**久煎使双酯型生物碱水解为毒性较低的形式**，也依赖炮制；生附子与炮附子是两种东西。本库写明危害，**并且刻意不写降低危害的方法** —— 那属于制备与用法，本站不给。
**大黄**是刺激性蒽醌类泻药。久服与结肠黑变病（通常可逆）、钾丢失、泻药依赖相关。**芒硝**是硫酸钠，属渗透性泻药，同时是一份**钠负荷** —— 对心衰、高血压、肾功能受损或腹水者不是中性的。**炙甘草**经另一条途径造成钾丢失。
于是同一首方里有**四条通向低钾的路径**（蒽醌泻药、渗透性泻药、甘草、以及乌头碱中毒时的呕吐），同时方中又含一种心脏毒性随低钾而升高的成分。本库把它们并排列出不是修辞，组成本身就是如此。
比以上更重要的，是临床的边界。**便秘伴腹痛、呕吐、停止排气排便，在外科判定之前按肠梗阻对待，此时刺激性攻下之剂是危险的。** 五十岁以后新发的便秘、便血、非自愿的体重下降、缺铁性贫血、大便形状持续变细、以及肠癌或卵巢癌家族史，都应在考虑任何泻下之前先行检查。常见原因同样常见：阿片类药、钙通道阻滞剂、抗胆碱药、铁剂、甲状腺功能减退、高钙、饮水与膳食纤维不足。人参与华法林的证据**混杂**，本库写混杂而不写「安全」；长期大量使用有失眠、血压升高、皮疹与腹泻的报告。当归属传统孕期慎用之列，并含香豆素类成分。本方的研究多在临床前阶段。本库不对任何疾病作疗效主张。