Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Gui Zhi Gan Cao Long Gu Mu Li Tang is recorded in Shanghan Lun, in the part of the text that deals with damage caused by treatment itself. That context is the most interesting thing about this formula and the first thing lost when it is simply filed among sedating formulas. The classical indication is agitation and fright in someone who has been treated wrongly: purged when purging was wrong, or cauterised with a heated needle. The classical reading is that the injury has left the heart yang unsettled and the floating yang has nothing to anchor it. Structurally the formula is two parts. Gui zhi and zhi gan cao are the acrid-sweet pair that generates yang, and that pair is itself the base formula Gui Zhi Gan Cao Tang. Onto it are added long gu and mu li, two heavy astringent drugs, one mineral and one shell, to hold what the pair has raised. The classical text gives gui zhi at half the quantity of the other three, which is worth noting because it tells you that generating yang is the smaller half of this formula and holding is the larger one.
Both heavy ingredients deserve the same plain description this library gives them wherever they appear. Long gu is fossil bone, the fossilised bone of large mammals. Mu li is oyster shell, calcium carbonate, traditionally calcined. Two cautions follow. The first is contamination: fossil and shell material carries the heavy-metal question that mineral drugs always carry, and lead and arsenic in long gu are raised repeatedly in the pharmaceutical quality literature; shells accumulate what the water they grew in contained. The second is calcium: both are substantial calcium sources, calcium carbonate separates in time from tetracyclines, quinolones, levothyroxine and bisphosphonates, and added calcium is not a neutral act for someone with hypercalcaemia, a history of calcium stones, or impaired renal function. Gui zhi is cinnamon twig, and cassia cinnamon contains coumarin, which is a liver question at sustained high intake and is not the same substance as the anticoagulant warfarin despite the shared name. Zhi gan cao carries the licorice caution: sustained daily intake can produce sodium and water retention, potassium loss and raised blood pressure, and it is worse rather than better alongside diuretics, digoxin or corticosteroids.
Agitation is where this entry has to be most careful, and the list is worth naming rather than gesturing at. New agitation, fright or restlessness has a differential diagnosis that includes hypoglycaemia, hypoxia, sepsis, meningitis and encephalitis, alcohol and benzodiazepine withdrawal, anticholinergic medication, electrolyte disturbance involving sodium, calcium or magnesium, thyroid disease, arrhythmia, pain, and urinary retention, and delirium, which in an older person is the first reading rather than the last. Palpitations have their own list: arrhythmia, thyrotoxicosis, anaemia, electrolyte disturbance, medicines including decongestants and beta-agonists, and anxiety. Agitation with chest pain, breathlessness, focal neurological signs or altered consciousness belongs to emergency care. This library does not claim that Gui Zhi Gan Cao Long Gu Mu Li Tang calms the spirit, settles palpitations, or treats anxiety, panic disorder, arrhythmia or any named disease.
桂枝甘草龙骨牡蛎汤著录于《伤寒论》中讨论**误治所致之变**的那一部分。这个语境是本条最耐人寻味之处，也恰恰是在把它简单列入「安神方」时最先被丢掉的那一层。**古典指征是烦躁与惊**：其人被误治过 —— 不当下而下之，或以烧针火劫 —— 而古典的读法是损伤之后心阳失守、浮阳无所依附。结构上本方是两截：**桂枝与炙甘草这一对**（辛甘合化以生阳，其本身即《伤寒论》桂枝甘草汤的底），再加**龙骨与牡蛎**两味重涩之品，一矿物一贝壳，用来收敛前面那一对所升起的。**原文所载桂枝之量为其余三味之半** —— 这一点值得写出，因为它说明「生阳」是较小的一截，而「重镇」是较大的一截。
两味重药都配得上本库在别处给它们的同一段平实描述。**龙骨是化石** —— 大型哺乳动物的骨骼化石；**牡蛎是牡蛎壳**，即碳酸钙，传统煅用。由此有两条提示。其一是污染：**化石与贝壳类带着矿物药永远带着的重金属问题，铅与砷在有关龙骨的药品质量文献里被反复提出**；贝壳类则蓄积其所生水域所含之物。其二是钙：**两者都是相当大的钙来源**，碳酸钙与四环素类、喹诺酮类、左甲状腺素、双膦酸盐之间需要隔开时间，而对高钙血症、有钙结石史或肾功能受损者，额外加钙不是中性行为。**桂枝是肉桂的嫩枝，而桂皮含香豆素** —— 长期大量摄入的肝毒性问题，且与抗凝药华法林虽同名而并非一物。**炙甘草**带着甘草这条提示：长期每日摄入可致钠水潴留、失钾与升压，与利尿剂、地高辛或糖皮质激素合用更重而非更轻。
「烦躁」是本条必须最谨慎的地方，而值得把清单写出来而不只是比划一下。**新出现的烦躁、易惊或坐卧不宁，其鉴别清单包含**：低血糖、缺氧、脓毒症、脑膜炎与脑炎、酒精与苯二氮䓬类戒断、抗胆碱能药物、电解质紊乱（钠、钙、镁）、甲状腺疾病、心律失常、疼痛与尿潴留，以及谵妄 —— 而在高龄者身上，**谵妄是第一读法而不是最后一读**。心悸另有其清单：心律失常、甲状腺毒症、贫血、电解质紊乱、包括减充血剂与 β 受体激动剂在内的药物，以及焦虑。**烦躁伴胸痛、呼吸困难、局灶神经体征或意识改变，属于急救**。**本库不声称桂枝甘草龙骨牡蛎汤能安神、定悸，或治疗焦虑、惊恐障碍、心律失常或任何具体疾病**。