Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Dahuang Zhechong Wan is the most forceful blood-breaking formula in this library, and it is also the one the classical text describes in the language of supplementation. Jingui Yaolüe lists it under 血痹虚劳 — wasting and exhaustion — for a person who is emaciated, full in the abdomen, unable to eat, with 内有干血 (dry, static blood held inside), 肌肤甲错 (dry skin like fish scales) and 两目黯黑 (darkened skin around the eyes). The stated aim is 缓中补虚: to relax the centre and supplement the deficiency. Read the ingredient list back against that aim and the tension is immediate. Twelve ingredients; rhubarb leading; four of them insects or larvae; a tree resin; two cyanogenic kernels. Nothing here nourishes. "Supplementing" in this line means taking away what blocks nourishment — and that is exactly what makes a formula of attacking substances a tonic in the classical frame.
The sign list deserves to be taken apart, because every item on it has a modern differential that is not optional. Emaciation with abdominal fullness and inability to eat is, today, a workup: malignancy, cirrhosis with ascites, tuberculosis, HIV, inflammatory bowel disease, coeliac disease, pancreatic exocrine insufficiency, hyperthyroidism, depression, and the medication and social causes that sit behind unintentional weight loss. Nobody should land on "dry blood" before that list has been gone through. 肌肤甲错, the dry scaling skin, carries its own list: ichthyosis, severe xerosis, hypothyroidism, chronic kidney disease, malnutrition with zinc or essential fatty acid deficiency, chronic liver disease. 两目黯黑 — periorbital hyperpigmentation — is common and usually benign on its own, but inside a picture of wasting it belongs to the same workup rather than reading as a decorative touch.
The safety profile is the heaviest in this batch and it is not a mild one. Dried lacquer (干漆) is the processed resin of Toxicodendron vernicifluum, the lacquer tree — the same genus as poison ivy — and urushiol is a potent contact sensitiser. Peach kernel and apricot kernel both contain amygdalin, a cyanogenic glycoside; two of them sit side by side here. Leech (水蛭) contains hirudin and related anticoagulant peptides. Rhubarb is an anthraquinone laxative: with prolonged use it drives potassium loss and is associated with melanosis coli. Liquorice carries the glycyrrhizin pseudoaldosteronism problem — potassium loss with rising blood pressure, which becomes dangerous when stacked on diuretics, digoxin or anthraquinone laxatives. Two separate paths to potassium loss are present in this single formula.
Pregnancy is an absolute exclusion, not a caution. Everything leading in this formula acts on blood, the insect substances included, and the classical line itself describes a person who is already wasted rather than robust.
Chinese-language literature contains a substantial number of clinical reports on this formula for liver fibrosis and cirrhosis, mostly small and with methodological limitations. The library records that the research exists; it does not record that the effect has been established.
大黄䗪虫丸是本库药力最峻的破血方，而古典文献却把它写进「虚劳」篇、用「补」的语言来描述它。《金匮要略》把它列在血痹虚劳病下：五劳虚极羸瘦，腹满不能饮食，内有干血，肌肤甲错，两目黯黑，治法写作「缓中补虚」。把十二味药列出来再回头看这四个字，张力立刻显出来 —— 大黄为君，四味是虫类，一味树脂，两味种仁，其中没有任何一味是滋养之品。古典这里的「补」，指的是搬走挡住营养的东西，不是加进去什么；也正是这一点，让一首全是攻伐之品的方在古典框架里成为「补虚」之方。
症状清单每一项今天都有必须走完的鉴别。羸瘦＋腹满＋不能食＝体重下降待查：恶性肿瘤、肝硬化腹水、结核、HIV、炎症性肠病、乳糜泻、胰腺外分泌不足、甲亢、抑郁，以及药物与社会因素。不该在这张清单走完之前先落到「干血」上。「肌肤甲错」同样有清单：鱼鳞病、重度皮肤干燥、甲减、慢性肾病、营养不良与锌／必需脂肪酸缺乏、慢性肝病。「两目黯黑」（眶周色素沉着）单独看常见且多为良性，但放在消瘦的语境里，它属于同一个待查，而不是一句修辞。
安全线必须写清，且这一首最重。干漆是漆树（Toxicodendron vernicifluum）树脂的加工品，与毒葛同属，漆酚是强致敏原。桃仁与杏仁**两味同方都含苦杏仁苷（氰苷）**。水蛭含水蛭素类抗凝肽。大黄是蒽醌类泻药，久用导致失钾并与结肠黑变病相关。甘草有甘草酸假性醛固酮增多症问题 —— 失钾升压，与利尿剂、地高辛或蒽醌类泻药叠加时可致命；**这一方里就有两条各自通向失钾的路径**。
孕期是绝对排除项，不是「慎用」。全方皆入血分之品，虫类药尤其；而条文所指的人本已羸瘦，不是形气俱实。
中文文献里这方用于肝纤维化与肝硬化的临床观察数量不少，但多为小规模、方法学质量有限。本库如实记「研究存在」，不记「疗效已被确立」。