Source 出处 · Jisheng Fang · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Yan Yonghe's Jisheng Fang gives this for blood lin and blood in the urine, and the logic is easy to state: cool the blood so that it stops leaving the vessels, and open the water passages so that whatever has settled gets out. The two halves are visible in the composition - field thistle, unprepared rehmannia, lotus node and cattail pollen on the bleeding side, talc, mu tong and lophatherum on the urination side, gardenia draining heat downward, and angelica and liquorice moderating the whole.
Then the honest part. Blood in the urine is one of those presentations where the classical name is the least useful thing about it. Visible haematuria in a modern clinic carries a differential that includes bladder and kidney cancer, ureteric and renal stones, urinary tract infection, glomerulonephritis, IgA nephropathy, prostate disease, schistosomiasis in endemic areas, tuberculosis, trauma, menstruation, strenuous exercise, and anticoagulant medication. Painless visible haematuria is specifically the presentation that urology services treat as a referral for cancer investigation until proven otherwise, because urothelial cancer of the bladder and upper tract presents exactly that way and is curable when found early. A knowledge base that let someone read 尿血 as a pattern and stop there would be doing harm. Blood in the urine gets investigated, and this formula does not change that. Fever, loin pain, or inability to pass urine alongside it moves the timetable up considerably.
The second honest part is the ingredient that has actually killed people, and it is a naming problem rather than a pharmacology problem. Mu tong is not one plant. In classical texts it most often means Akebia, and in modern Chinese practice it usually means the clematis stem called chuan mu tong; but it was also, for much of the twentieth century, supplied as guan mu tong, which is Aristolochia manshuriensis and contains aristolochic acid. Aristolochic acid causes a progressive interstitial nephropathy and is an established cause of urothelial carcinoma; the Belgian slimming-clinic cohort and the Balkan endemic nephropathy literature are the two bodies of evidence most often cited, and Chinese regulators withdrew the medicinal standard for guan mu tong in 2003. The point for a reader is not that this formula is dangerous. It is that the identity of the mu tong in it has to be known, and that a product which does not say which plant it used has not answered the question.
Other cautions:
- Talc is a mined mineral, and asbestos-form amphiboles are the classic contaminant; pharmaceutical-grade talc is tested for them and material of unknown origin is not. That is a reason to care about the source of a mineral ingredient, not a reason to assume the worst.
- Gardenia's iridoid constituents, geniposide among them, have produced liver toxicity in animal and laboratory studies, and liver injury has been reported around gardenia-containing preparations.
- Cattail pollen quickens blood and is traditionally used with caution in pregnancy.
- Unprepared rehmannia is not prepared rehmannia. Unprepared is the cooling one, and the two are not substitutes.
- Lophatherum is dan zhu ye and is not the same leaf as zhu ye. Angelica carries the warfarin and photosensitivity cautions that apply to angelica generally.
严用和《济生方》以此方主血淋、尿血，其理路不难说明：凉血则血不再离经，通利水道则已停之物得以排出。组成的两个部分清晰可见——凉血止血一边是小蓟、生地黄、藕节、蒲黄，通淋一边是滑石、木通、淡竹叶，栀子引热下行，当归与甘草调和全方。
接下来是诚实的部分。尿血属于古典病名最没有用的那类情况之一。现代诊所里的肉眼血尿，其鉴别范围包括膀胱癌与肾癌、输尿管与肾结石、尿路感染、肾小球肾炎、IgA 肾病、前列腺疾病、流行区的血吸虫病、结核、外伤、月经来潮、剧烈运动以及抗凝药物。其中无痛性肉眼血尿，正是泌尿外科视为须排查肿瘤而转诊的表现，因为膀胱与上尿路尿路上皮癌恰恰以此起病，而早期发现是可以获得良好结局的。一本让读到「尿血」二字就辨个证而止步的知识库，是在造成伤害。尿血需要检查，此方不改变这一点；若伴发热、腰痛或排尿不能，时程更要提前。
第二件诚实的事是那一味真正致过人命的药，而这是命名问题，不是药理问题。木通不是一种植物。古典文献中它多指木通科木通，现代中医实践通常指毛茛科的川木通；但在二十世纪的很长时间里，它也被作为关木通供应，而关木通是马兜铃科植物，含马兜铃酸。马兜铃酸可致进行性肾小管间质性肾病，并且是尿路上皮癌的确定原因；最常被引用的两类证据是比利时的减肥诊所队列与巴尔干地方性肾病的研究文献，中国药品监管部门于 2003 年取消了关木通的药用标准。对读者而言，要点不是此方危险，而是方中木通的基原必须明确——一个不写明用的是哪种植物的产品，等于没有回答这个问题。
其余注意：
- 滑石是矿物，闪石类石棉是典型污染物；药用级滑石经过检测，来源不明者则不然。这是关心矿物药来源的理由，不是假定最坏情况的理由。
- 栀子的环烯醚萜类成分（京尼平苷等）在动物与实验室研究中出现肝脏毒性，含栀子制剂周围亦有肝损伤报告。
- 蒲黄活血，传统认为孕期慎用。
- 生地黄不是熟地黄。生地黄是清热凉血者，两者不可互代。
- 淡竹叶是禾本科淡竹叶，与竹叶并非同一物；当归带有其通有的与华法林相互作用及光敏的注意。