Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Zhi Zi Chi Tang has two ingredients and comes from the Shanghan Lun. It is recorded for a state the classical texts call empty vexation: a person who cannot settle, who turns and turns, who has an oppressive, undefinable discomfort behind the breastbone, in the aftermath of a febrile illness that has otherwise passed. It is one of the smallest formulas in the canon and one of the hardest to read correctly, because the complaint it names is a feeling rather than a finding.
That is precisely why it needs saying plainly first. An oppressive sensation in the chest and upper abdomen, in someone who has recently been ill, is today worked through as a differential and not named. Acute coronary syndrome is at the top of that list, and it can present without classic crushing pain, particularly in older adults, in women and in people with diabetes. Alongside it sit gastro-oesophageal reflux, oesophageal spasm, pericarditis, pulmonary embolism, pneumonia, pancreatitis, and anxiety and panic. Chest discomfort with breathlessness, sweating, nausea, or radiation to the jaw or arm is an emergency assessment, and no formula is part of that assessment. The classical word for the sensation, nao nong, means an indescribable oppression, and it is exactly the kind of description that today earns an electrocardiogram.
The classical tradition also wrote its own exclusion rule into this one, and it is worth quoting because it is unusually concrete. The Shanghan Lun states that if a person habitually passes loose stools, the gardenia decoctions are not given. A text that names the people it should not be used in is doing something modern readers rarely expect from an ancient formulary, and this library records the rule rather than smoothing it away. The same text also built variants around this pair — adding licorice for the person who is given to sighing and short of breath, ginger for the person who vomits, magnolia bark and immature bitter orange for abdominal fullness — which shows the classical authors adjusting to the presentation rather than defending a fixed recipe.
The two ingredients each carry a note. Gardenia fruit contains geniposide; liver enzyme elevation has been reported with gardenia-containing preparations, the preclinical hepatotoxicity signal is stronger than the human evidence, and the fruit is also the source of a yellow food colourant, so it reaches people through more than one route. Fermented soybean, the dan dou chi of the formula, is black soybean fermented with mulberry leaf and sweet wormwood according to the Pharmacopoeia. Soy is a declared major allergen, which matters more than any subtle argument about its properties. Fermented soy foods as a class can contain tyramine, and the interaction with monoamine oxidase inhibitors is the reason that class carries a caution; how much tyramine a given batch of this particular product holds is not well characterised, and this library does not pretend otherwise.
This page is not a recommendation. No quantity, no preparation, no regimen, no claim. Restless inability to sleep is assessed for its own causes — depression and anxiety, sleep apnoea, restless legs, thyroid disease, caffeine and alcohol, shift work, and medication effects — before it is classified. Pregnancy, breastfeeding, children, liver disease, and any antidepressant, immunosuppressant or anticoagulant medicine taken on medical advice each remove what room there was.
栀子豉汤出自《伤寒论》，全方两味。它所对应的状态，古典文献称为「虚烦」：一个人静不下来，反复颠倒，胸膈之间有一种说不清的憋闷不适，发生在一次热病已经过去之后。它是方书里最小的方之一，也是最难读对的方之一 —— 因为它命名的主诉是一种**感觉**而不是一项所见。
正因为如此，有一句话必须先说清楚。一个近期生过病的人，胸与上腹的憋闷不适，今天是要逐一鉴别而不是直接命名的。急性冠脉综合征排在这张单子的最前面，而且它可以不以典型的压榨样疼痛出现 —— 在老年人、女性与糖尿病人身上尤其如此。紧随其后的是胃食管反流、食管痉挛、心包炎、肺栓塞、肺炎、胰腺炎，以及焦虑与惊恐发作。**胸不适伴气短、出汗、恶心，或向颌部与手臂放射，属于需要急诊评估的情形**，评估里没有任何一味药的位置。古典用来描述这种感觉的词是「懊憹」，意思是说不清的憋闷 —— 而恰恰是这类描述，在今天会换来一张心电图。
古典传统还给这首方写了一条自己的排除条款，值得引出来，因为它异常具体：《伤寒论》明言「凡用栀子汤，病人旧微溷者，不可与服之」—— 平素大便溏薄的人，栀子类方不与。一部古代方书主动写明「哪些人不宜用」，是现代读者很少预期的事；本库记录这条规则，而不把它抹平。同一部书还在这两味之外做了加减：气短者加甘草，呕者加生姜，腹满者加厚朴与枳实 —— 这说明古典作者是随证加减，而不是守着一个固定配方。
两味药各自都有一条注脚。栀子含京尼平苷；含栀子制剂已有肝酶升高的报告，临床前肝毒性信号强于人体证据；栀子同时也是黄色食用色素的来源，因此它不止一条路径到达人身上。方中的香豉即淡豆豉，按药典是黑大豆与桑叶、青蒿一并发酵加工的制品。**大豆是法定主要致敏原**，这一点比关于其性味的任何细微争论都更要紧。发酵豆制品作为一类可能含酪胺，与单胺氧化酶抑制剂的相互作用是这一类被提示的原因；至于某一批淡豆豉具体含多少酪胺，并未被很好表征 —— 本库不假装知道。
本页不是建议。不列用量、不列制法、不列服法，也不做任何疗效主张。静不下心的失眠，要先查它自己的原因 —— 抑郁与焦虑、睡眠呼吸暂停、不宁腿综合征、甲状腺疾病、咖啡因与酒精、轮班工作、以及药物影响 —— 然后才谈归类。妊娠、哺乳、儿童、肝病，以及正在使用抗抑郁／免疫抑制／抗凝类处方药，任何一项都足以抹去残余的空间。