Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. The line in the Jingui Yaolüe is short: abdominal fullness with fever and a floating rapid pulse is treated with Hou Po Qi Wu Tang. That single sentence is the clearest statement in the classical corpus of what later textbooks call 表里双解, releasing the exterior and treating the interior in the same formula: 桂枝、生姜、大枣、甘草 work on the exterior, while 厚朴、枳实、大黄 work on the bowel. The interior half is close to the composition of Hou Po San Wu Tang, the magnolia, bitter orange and rhubarb formula for abdominal fullness with constipation, which makes the structure easy to see - a purgative core wrapped in an exterior-releasing frame. - The presenting picture it addresses is abdominal fullness and distension with constipation and fever, and that is exactly the picture where a modern reader needs the differential stated loudly, because the differential contains surgical emergencies. Abdominal pain with constipation and fever is appendicitis, bowel obstruction, perforation, cholecystitis, diverticulitis and ischaemic bowel, and in women ectopic pregnancy and pelvic inflammatory disease. A stimulant laxative given to an undiagnosed abdomen is one of the classical ways of turning a survivable problem into a fatal one, and that is a real property of this formula rather than a theoretical caution. Pain that is severe, localised or worsening, or accompanied by vomiting, a rigid abdomen, blood in the stool or inability to pass gas, is not constipation to be moved; it is a reason for imaging and a surgeon. - 大黄 is rhubarb root, and its anthraquinone glycosides make it a stimulant laxative. Chronic stimulant laxative use is associated with electrolyte disturbance, particularly potassium loss, with laxative dependence, with cathartic colon and with melanosis coli, and hypokalaemia in turn amplifies the toxicity of digoxin and interacts with diuretics and with medicines that prolong the QT interval. Rhubarb is contraindicated in intestinal obstruction, in undiagnosed abdominal pain, in acute inflammatory bowel disease, in appendicitis, and in pregnancy and breastfeeding. The name also covers more than one article: 大黄 is Rheum palmatum, R. tanguticum or R. officinale, and unofficial species traded as rhubarb, such as 土大黄 and 波叶大黄, have a different anthraquinone profile and should not be substituted. - 厚朴 is magnolia bark. It is stripped from the tree, which kills it, and wild Magnolia officinalis has been depleted to the point that it is listed among China's nationally protected wild plants and is now largely cultivated. The bark carries the constituents honokiol and magnolol, which have sedative and central nervous system effects in preclinical work and therefore a plausible additive effect with alcohol, benzodiazepines and other sedatives. - 枳实 is immature bitter orange and contains synephrine-type adrenergic amines, which matters for people with hypertension, arrhythmia or glaucoma and for anyone taking stimulants, decongestants or beta-agonists. - 桂枝 is cassia twig, and cassia cinnamon carries more coumarin than true cinnamon, a hepatotoxicity concern with sustained intake. - 甘草, licorice, in sustained amounts produces a mineralocorticoid-like syndrome. - Whether this formula changes the outcome of any of the conditions above has not been established by well-conducted controlled trials. The honest verdict is unproven. Quantities are decided by a licensed practitioner; this site deliberately does not list them.
《金匮要略》的条文很短：「病腹满，发热十日，脉浮而数，饮食如故，厚朴七物汤主之。」这一句是古典文献中对后世所谓「表里双解」最清晰的表达 —— 桂枝、生姜、大枣、甘草 走表，厚朴、枳实、大黄 走里。其里证那一半接近于厚朴三物汤（厚朴、枳实、大黄）治腹满便秘的结构，因此整方的骨架很好看清：一个攻下核心，外面裹着一层解表之品。 - 本方所针对的画面是腹胀满、便秘与发热并存，而这恰恰是最需要把现代鉴别清单大声说出来的画面，因为那份清单里包含外科急症。腹痛、便秘与发热同时出现，指向的是阑尾炎、肠梗阻、穿孔、胆囊炎、憩室炎、缺血性肠病，以及女性的异位妊娠与盆腔炎。把刺激性泻剂用在一个尚未诊断的腹部，是现实中把可救治的问题变成致命问题的经典路径之一；这对本方而言是真实属性，不是理论上的提醒。剧烈、局限、进行性加重的腹痛，或伴呕吐、板状腹、便血、不能排气者，不是可以「通一通」的便秘，而是需要影像检查与外科评估的理由。 - 大黄 为大黄根茎，其所含蒽醌苷使其成为刺激性泻剂。长期使用刺激性泻剂与电解质紊乱（尤其是失钾）、泻剂依赖、泻剂结肠与结肠黑变病相关；而低钾反过来会放大地高辛的毒性，并与利尿剂及延长 QT 间期的药物相互作用。肠梗阻、未诊断的腹痛、急性炎症性肠病、阑尾炎、孕期与哺乳期均属禁忌。这一名称也涵盖不止一种药材：正品大黄为掌叶大黄、唐古特大黄或药用大黄，而作为大黄流通的非正品物种（土大黄、波叶大黄等）蒽醌组成不同，不可代用。 - 厚朴 为厚朴树皮。剥皮取药会致树死亡，野生厚朴因过度采剥而枯竭，已列入中国国家重点保护野生植物名录，现多为栽培品；树皮也正是厚朴酚与和厚朴酚所在部位，二者在临床前研究中显示镇静与中枢神经系统作用，因此与酒精、苯二氮䓬类及其他镇静剂存在合理的叠加可能。 - 枳实 为酸橙幼果，含辛弗林类肾上腺素能胺，因此高血压、心律失常、青光眼患者，以及正在使用兴奋剂、减充血剂或 β 受体激动剂者需当心。 - 桂枝 为桂类嫩枝，桂皮类香豆素含量高于真肉桂，长期摄入存在肝毒性顾虑。 - 甘草 长期摄入产生类盐皮质激素综合征。 - 本方是否改变上述任一疾病的结局，并未被设计良好的对照试验证实；诚实的结论是「未被证实」。用量由持证医师决定，本站刻意不列。