Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. The line contains a sentence that a classical text does not often write down: 灸刺诸药不能治 — moxibustion, needling and other formulas have not worked. This library records that sentence and does not read it as a licence to escalate. Read as a description of a state, it is the more interesting thing here: a person in abdominal pain whose hands and feet are cold — 逆冷, counterflow cold — whose hands and feet do not feel — 手足不仁 — and whose body aches.
Put those together and what is being described is abdominal pain in a person with failing perfusion and an altered nervous system. That combination has a modern form and it is measured, not argued: blood pressure, heart rate, oxygen saturation, temperature, blood glucose and lactate. Sepsis, hypoglycaemia, adrenal insufficiency, myxoedema, acute coronary syndrome, aortic dissection with pain radiating to the back, and stroke all live on that list. Two of them deserve a sentence each. Sepsis in an older person can present with hypothermia rather than fever, and hypothermia carries the worse prognosis. Hypoglycaemia can cause irreversible brain damage within minutes, and measuring glucose takes thirty seconds. This library records these as possibilities a clinician carries; it does not sort them and it offers no plan.
Now the overlap this library will not smooth away. 手足不仁 — numbness and loss of sensation in the hands and feet — is also among the earliest recorded manifestations of aconitine poisoning, which begins with tingling and numbness of the mouth, tongue and extremities. The same four characters describe both the indication and the toxicity of the formula's principal ingredient. This library records that the overlap exists. It does not assert that the classical authors were describing poisoning, and it does not delete the overlap to make the entry cleaner.
On the materials. 乌头 is the main root of Aconitum; 附子, which appears elsewhere in this batch, is the daughter root of plants of the same genus, and 白附子 is Typhonium, a different plant entirely. Aconitine has no specific antidote, ventricular arrhythmia is what kills, and the diester alkaloids are hydrolysed by prolonged decoction — which is why the classical tradition insists on the cooking rather than on the weighing. The source text decocts the aconite in honey. Honey is a sugar load, and honey is a known source of infant botulism: it must not be given to a child under twelve months, because that is a hard paediatric rule rather than a caution of degree. Honey is also among the allergens that are declared on labels.
The other five carry quieter notes. 桂枝 is cinnamon twig and contains coumarin, for which European food safety bodies set a tolerable daily intake. 芍药 has a white and a red form, and peony is set against veratrum in the eighteen antagonisms. 甘草 is liquorice: glycyrrhizin produces a mineralocorticoid-like picture of potassium loss, sodium retention and raised blood pressure, and hypokalaemia is the mechanism that kills when it is taken with digoxin or a diuretic. 生姜 is fresh ginger, not dried. 大枣 is jujube, a sugar load. Reliable safety data for pregnancy and breastfeeding are lacking; for a formula whose principal ingredient is an aconite member, this library treats pregnancy as an exclusion rather than as a caution. Chinese-language literature reports observations of formulas of this class, small in scale and limited in method; this library records that such studies exist, not that benefit has been established.
这条条文里有一句古典不常写下来的话：**「灸刺诸药不能治」** —— 灸法、针刺与别的方剂都没有奏效。本库记录这句话，并**不把它读成「所以可以再加码」**。把它当成对一个状态的描述来看，它反而更值得读：一个人在腹痛，**手足逆冷**，**手足不仁（麻木不知）**，并且**身疼痛**。
这三句放在一起，描述的是**一个灌注在往下走、神经系统表现也异常的人同时腹痛**。这个组合今天有它的形式，而且它是**被测量出来的，不是被讨论出来的**：血压、心率、血氧、体温、血糖、乳酸。**脓毒症、低血糖、肾上腺皮质功能不全、黏液性水肿、急性冠脉综合征、放射到背的主动脉夹层、卒中**都在这张表上。其中两条值得各说一句：**老年人的脓毒症可以表现为低体温而不是发热，而低体温的预后更差**；**低血糖可以在几分钟内造成不可逆的脑损伤，而测血糖是三十秒的事**。本库把这些记成「临床上要抱在手里的可能性」，**不排序，也不提供任何方案**。
然后是本库不打算抹平的那个重叠：**「手足不仁」** —— 手脚麻木、感觉失灵 —— 同时正是**乌头碱中毒最早记载的表现之一**：中毒从口、舌与四肢的麻刺与麻木开始。**同样的四个字，既在主治里，也在这首方主药的毒性里。** 本库的做法是：**记下这个重叠存在**；不断言古典作者描写的是中毒，也不为了条目好看而把重叠删掉。
药物本身：**乌头**是乌头属的母根；本批另一首里的**附子**是同属植物的子根；**白附子**则是 Typhonium，完全是另一种植物。**乌头碱没有特异解毒剂，致死机制是室性心律失常**，双酯型生物碱靠久煎水解 —— 这正是古典强调先煎久煎、用**加工**而不是用**称量**来控制毒性的原因。原方以**蜜**煎乌头：蜂蜜是真实的糖负荷，而且蜂蜜是**婴儿肉毒中毒的已知来源** —— **12 个月以下绝不给**，这是一条硬性儿科规则而不是程度上的慎用；蜂蜜同时也是标签上须标注的过敏原之一。
其余五味的注释较轻：**桂枝**是肉桂嫩枝，含**香豆素**（欧洲食品安全机构为其设耐受摄入量）；**芍药**有白芍与赤芍之别，且十八反中与藜芦相对；**甘草**的甘草酸造成盐皮质激素样的一组变化 —— 失钾、钠潴留、升压 —— 与地高辛或利尿剂同用时**低钾是杀人的那条机制**；**生姜**是鲜姜不是干姜；**大枣**是糖负荷。孕期与哺乳期缺乏可靠的安全性数据；**对主药为乌头类的方，本库按排除处理而不是按慎用处理**。中文文献有本方一类方剂的观察报告，多为小规模、方法学有限；本库记「有这类研究」，**不记「疗效已被确立」**。