Source 出处 · Jingyue Quanshu · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Zhou Che Wan is recorded in the Jingyue Quanshu and it is the most heavily loaded formula this library has had to write. Five of its ten ingredients act downward with force, and the tenth is a mercury compound. The name is an image: boats and carts, the traffic of water being carried out. The classical text attaches a condition to the indication — form and qi both replete — meaning the person is robust enough to withstand it. That condition is the classical literature's own exclusion criterion, and it is not a criterion a modern reader can apply to himself. Robustness is not a self-assessment.
The mercury cannot be written down gently. Qing fen is calomel, mercurous chloride, and this is the third time this library has had to record mercury or lead in a formula: cinnabar came first, in Zhu Sha An Shen Wan and Ci Zhu Wan, then lead tetroxide in Chai Hu Jia Long Gu Mu Li Tang. Inorganic mercury taken by mouth is documented to cause inflammation of the mouth, tremor, the withdrawn and irritable nervous state that gave an old trade its saying, and injury to the renal tubules; it accumulates. Modern pharmacopoeial practice does not accept the internal use of mercury compounds, and a number of modern Chinese formularies either drop the ingredient or annotate it heavily. It is listed here because the classical composition contains it, and it is listed as history.
The purgatives carry, in compounded form, the hazards described in the entry on Shi Zao Tang: three irritant roots, plus pharbitis seed, plus rhubarb. Pharbitis seed is the seed of a morning glory and a resin-glycoside hydragogue; its resemblance to the seed of ornamental morning glory is a documented route of accidental poisoning. Rhubarb is an anthraquinone stimulant laxative with the familiar profile of potassium loss, dependence with prolonged use, and melanosis coli that is usually reversible once it is withdrawn. Areca seed contains arecoline, a cholinergic stimulant, and the international cancer research agency under the World Health Organization classifies areca nut as carcinogenic to humans; a seed inside a classical composition is not the same exposure as the quid, but it is the same plant and the same alkaloid.
The presentation belongs to modern diagnosis, as always. Generalised oedema with abdominal distension and laboured breathing has a differential: heart failure, cirrhosis, nephrotic syndrome, chronic kidney disease, protein-losing enteropathy, venous insufficiency, lymphatic obstruction, and drug-induced oedema from calcium channel blockers, non-steroidal anti-inflammatory drugs, corticosteroids and others. Swelling with pain in one leg raises deep vein thrombosis. Oedema in pregnancy with headache, visual change or upper abdominal pain raises pre-eclampsia. The modern response is to find the cause, to use diuretics under supervision, and to drain where drainage is indicated. It is not violent purgation. Adding a hydragogue on top of diuretics a person is already taking, or digoxin, or corticosteroids, is a way to produce swings in potassium and sodium that can be fatal; correcting sodium too quickly afterwards carries its own hazard of osmotic demyelination.
This library records compositions. It gives no amounts, no preparation, no instructions, and makes no claim that this formula does anything for any disease.
舟车丸著录于《景岳全书》，是本库载录的最重的一首方：十味里有五味峻下之品，第十味是汞的化合物。方名是一个意象 —— 舟与车，水湿被搬运出去。古典原文给指征时自带一条前提：「形气俱实」，即人还扛得住。这条前提就是古典文献自己的排除标准，而它不是读者可以对自身施用的标准；扛不扛得住不是自我评估的项目。
汞的部分无法写轻。轻粉即甘汞（氯化亚汞），这是本库第三次记录汞或铅：前两次是朱砂安神丸与磁朱丸中的硫化汞，另一次是柴胡加龙骨牡蛎汤中的铅丹（四氧化三铅）。无机汞口服的记载包括口腔黏膜炎症、震颤、易激惹与退缩并存的神经精神状态，以及肾小管损伤，且会在体内蓄积。现代药典实践不接受汞化合物的内服，多种现代方剂学著作对此味或删去、或加注警示。本条列出它，是因为古典组成中有它；列它是作为历史记录。
峻下诸味以叠加的形式承托十枣汤条中已述的危险：三味刺激性根类，再加牵牛子与大黄。牵牛子是旋花科牵牛的种子，属树脂苷类峻下药，其外形与观赏牵牛种子相近，误食中毒有实际报道。大黄属蒽醌类刺激性泻药，钾丢失、久用依赖、停用后通常可逆的结肠黑变病，是它既有的画像。槟榔含槟榔碱，具胆碱能兴奋作用；世界卫生组织下设的国际癌症研究机构将槟榔果列为人类致癌物 —— 方中一味不等于咀嚼块那种暴露，但植物与生物碱是同一个。
处置顺序仍属今天。遍身水肿、腹胀、气急，在今天有一份鉴别清单：心衰、肝硬化、肾病综合征、慢性肾脏病、蛋白丢失性肠病、静脉功能不全、淋巴回流障碍，以及钙通道阻滞剂、非甾体抗炎药、糖皮质激素等药物所致。单侧下肢肿痛要考虑深静脉血栓；妊娠期水肿伴头痛、视物改变或上腹痛要考虑子痫前期。现代的处理是查因、在监测下利尿、必要时穿刺引流，而不是峻下逐水。在已使用利尿剂／地高辛／糖皮质激素的情况下再加峻下之品，等于制造可能致命的钾钠波动；其后若纠正低钠过快，本身又有渗透性脱髓鞘的风险。
本库只列组成；不列用量、不列制法、不列服法，也不主张此方对任何疾病有效。