Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Nine ingredients, the longest formula in this batch, and the line that records it is one clause: 咳而脉浮者 — a cough with a floating pulse. What makes the line worth reading is not the formula but the pair. The same sentence splits one complaint, a cough, into two formulas on the strength of the pulse, giving 泽漆汤 to the cough with a sunken pulse. That is a decision rule the text states and does not justify, and this library records that it is there and does not supply the reasoning the text withheld.
It is also worth saying, without polemic, what a pulse description can and cannot be today. Rate is measured, rhythm is measured, and irregularity is named. Floating and sunken are not among the categories that have a measurement behind them, and a reader cannot carry them into a clinic as findings. The formula is recorded here for the complaint, not because the rule has been verified.
Nine ingredients fall into clusters that a reader who knows other formulas will recognise, and naming them is more useful than praising the composition. 麻黄, 石膏 and 杏仁 together are the structure of 麻杏石甘汤. 干姜, 细辛, 五味子 and 半夏 together are the cluster shared with 小青龙汤. 厚朴, which lends the formula its name, is not in either. And 小麦 — ordinary wheat grain — is the ingredient a reader stops on: a cereal in a formula for cough. Wheat is a real gluten load, which matters for coeliac disease, for wheat allergy and for the people who report non-coeliac gluten sensitivity; this library does not suggest that a gluten-free diet is indicated for anyone else.
The safety record is the longest in this batch and each line of it is independent. 细辛 is Asarum, and Asarum contains aristolochic acid: the same substance behind the Belgian weight-loss clinic episode of the early 1990s, classed as a human carcinogen, causing a rapidly progressive interstitial fibrosis that is documented to continue after exposure has stopped, and appearing together with a high rate of urothelial cancer. The current Chinese Pharmacopoeia admits the root and rhizome of Asarum rather than the aerial parts, which carry more of it. The name on the label does not tell a buyer which part is in the packet.
麻黄 carries ephedrine-type alkaloids, which are sympathomimetic: blood pressure and heart rate rise, sleep suffers, and the prostate is a reason for retention. Interactions with monoamine oxidase inhibitors and with blood pressure medicines are documented, ephedra is on sport prohibition lists, and the United States Food and Drug Administration banned ephedra-containing dietary supplements in 2004. 半夏 is used only processed; the raw rhizome is a mucosal irritant that numbs the mouth and tongue, and this library records only processed use. 杏仁 contains amygdalin, a cyanogenic glycoside; it is not the sweet almond and not the almond of the supermarket, which is a Prunus seed of another species. 石膏 is hydrated calcium sulphate and is not 滑石, hydrated magnesium silicate, whatever the two names get called in a shop. 干姜 is the dried rhizome and is not 生姜. 五味子 is Schisandra chinensis in the north and Kadsura in the south, and interactions with liver enzymes have been reported for its lignans without this library adjudicating them.
Reliable safety data for pregnancy are lacking and several ingredients above carry records of their own; this library does not recommend use in pregnancy. Chinese-language clinical literature reports observations of this formula in cough and breathlessness, mostly small in scale and methodologically limited. This library records that such studies exist; it does not record that benefit has been established.
九味药，是本批最长的一首，而记载它的条文只有一句：**咳而脉浮者**。这一条值得读的不是方，是**成对**这件事：同一句话把同一个主诉（咳）按脉分成两首方，脉沉的那一个给了泽漆汤。这是条文**给出却不解释**的选择规则；本库记它在那里，不替它补上它没写的理由。
还有一点值得不带论战地说清：今天脉的**率**是测出来的、**律**是测出来的、不齐是有名字的；而**浮与沉**不属于背后有测量的那一类，读者不能把它当成一个能带进诊室的发现。本方是**为那个主诉**被记在这里的，不是因为这条规则已被验证。
九味可以分成几簇，认出它们比夸赞配伍更有用：**麻黄＋石膏＋杏仁**是麻杏石甘汤的结构；**干姜＋细辛＋五味子＋半夏**是与小青龙汤共有的一簇；**厚朴**（本方以此得名）不在上面任何一簇里；而**小麦** —— 普通的麦粒 —— 是读者会停下来的那一味：一味治咳的方里有谷物。小麦是真实的**麸质负荷**，对乳糜泻、小麦过敏、以及自述非乳糜泻麸质敏感的人是件事；本库不主张其他任何人都需要无麸质饮食。
安全线是本批最长的一段，而且每一条彼此独立。**细辛**是细辛属（Asarum）植物，含**马兜铃酸** —— 与 1990 年代初比利时减肥诊所事件同一种物质：明确人类致癌物，引起快速进展性肾间质纤维化，且**停止接触后仍继续进展**有文献记载，并在同一批患者中出现很高比例的尿路上皮癌。现行《中国药典》细辛药用部位为**根及根茎**，而地上部分含量更高 —— **标签上的名字不能保证袋子里是哪一部分**。
**麻黄**含麻黄碱类生物碱，属拟交感胺：升高血压与心率、影响睡眠，前列腺肥大者会出现尿潴留；与单胺氧化酶抑制剂及降压药的相互作用有记载，麻黄在运动禁用清单上，美国 FDA 于 2004 年禁止含麻黄的膳食补充剂。**半夏**只用炮制品，生品是黏膜刺激物、使口舌麻木，本库只记炮制后使用。**杏仁**含苦杏仁苷（氰苷类），它不是甜杏仁，也不是超市里那种「美国大杏仁」（扁桃）。**石膏**是含水硫酸钙，**不是滑石**（含水硅酸镁）—— 不管店里怎么叫这两个名字。**干姜**是干燥根茎，不是生姜。**五味子**北方为 Schisandra chinensis、南方为南五味子（Kadsura），其木脂素对肝酶的相互作用有报道，本库不裁决。
**孕期缺乏可靠的安全性数据**，且上面不止一味各带自己的记载，本库不主张孕期使用。中文临床文献有本方用于咳与喘的观察报告，多为小规模、方法学有限。本库记「有这类研究」，不记「疗效已被确立」；本条目也不构成对一次急性咳喘的处置。