Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. This is the second of the Jingui Yaolüe's chest-binding formulas and the one whose indication is hardest to read safely across two thousand years. The text places it in the chapter on chest painful obstruction, heart pain and shortness of breath; the presentation is a full stifling sensation in the chest, a feeling of something knotted behind the breastbone, and counterflow qi rising. In the classical reading that is yang failing to open with phlegm-cold binding in the chest, and the formula answers it with acrid-warm opening on one side - cassia twig, Chinese chive bulb, magnolia bark - and downward-moving, phlegm-clearing on the other - immature bitter orange, Trichosanthes fruit.
The honest translation problem is the important part. Chest painful obstruction in a Han-dynasty text is not a disease, it is a description of a symptom cluster; and that cluster is also the symptom cluster of acute coronary syndrome, myocardial infarction, pulmonary embolism, aortic dissection, pericarditis, gastro-oesophageal reflux, pneumothorax, pneumonia and panic. The classical examination has no way to separate them.
This is one of the few places in a knowledge base where the safety note has to come before the culture. New or worsening chest pain - especially with breathlessness, sweating, nausea, or pain spreading to arm, neck or jaw, or in anyone with known heart disease, diabetes, or over fifty - is an emergency and belongs with emergency services first, not with a pattern differentiation. A formula built on acrid-warm opening is not a neutral thing to take into undifferentiated chest pain.
On the herbs themselves:
- Immature bitter orange contains synephrine, a sympathomimetic amine, and products in this group have been linked to cardiovascular events, so caution is warranted in hypertension, coronary disease, arrhythmia and glaucoma, and alongside stimulant or monoamine-oxidase-inhibitor medicines.
- Magnolia bark's lignans, honokiol and magnolol, show central nervous system depression in animal work, which argues for care with sedatives and alcohol and in pregnancy.
- Cassia twig comes from the cinnamon plant whose bark contains coumarin; coumarin hepatotoxicity in susceptible people is documented for cassia cinnamon, so anyone on warfarin or with liver disease should treat it as more than a kitchen spice.
- Trichosanthes fruit belongs to the classical incompatibility group said to oppose Aconitum, and Chinese chive bulb is an Allium, so the antiplatelet and allergy cautions that apply to the onion and garlic family apply to it.
这是《金匮要略》胸痹方中的第二首，也是最难安全地跨两千年解读的一首。原文把它列在「胸痹心痛短气」篇，所述为胸中痞塞、心下痞气、气结在胸而气逆上冲之候。传统读法是阳气不宣、痰寒结聚胸中，故以辛温开通（桂枝、薤白、厚朴）与降气涤痰（枳实、瓜蒌）并行。
真正要紧的是翻译上的诚实问题：汉代的「胸痹」不是一种疾病，而是一组症状的描述；而这组症状同样是急性冠脉综合征、心肌梗死、肺栓塞、主动脉夹层、心包炎、胃食管反流、气胸、肺炎与惊恐发作的表现，传统诊察手段无法把它们区分开。
这是知识库里少数必须把安全提示放在文化阐释之前的条目。新发或加重的胸痛——尤其伴气促、出汗、恶心、向手臂颈部下颌放射，或发生于已知心脏病、糖尿病者及五十岁以上者——属于急症，应先交给急救系统，而不是先做辨证。以辛温开通为法的方子，在尚未鉴别的胸痛面前不是中性的东西。
单味药方面：
- 枳实含辛弗林，属拟交感胺，该类产品与心血管事件相关联，故高血压、冠心病、心律失常、青光眼者以及合用兴奋剂或单胺氧化酶抑制剂者须谨慎。
- 厚朴的木脂素（和厚朴酚、厚朴酚）在动物实验中出现中枢抑制，与镇静剂、酒精同用及孕期宜慎。
- 桂枝取自肉桂树，其树皮含香豆素，而卡西亚肉桂的香豆素肝毒性在易感人群中已有记载，故服华法林者或有肝病者不应仅把它当作厨房香料。
- 瓜蒌属于传统「十八反」中与乌头类相反的一组；薤白为葱属，故葱蒜一类的抗血小板与过敏注意同样适用于它。