Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Three ingredients, and they are the same three that appear in Xiao Chengqi Tang: magnolia bark, rhubarb, immature bitter orange. In this formula magnolia bark governs; in Xiao Chengqi Tang, rhubarb does. The classical text therefore treats a change in proportions as producing a different formula with a different indication, not as a variation on one. This library lists no quantities and no ratios, and so it records that the proportions were understood to matter — it does not supply them, because supplying numbers would be inventing them.
The indication is two syllables: 痛而闭 — pain, and closure. Closure means that nothing is passing. Read together with the neighbouring lines of the chapter, the picture is abdominal pain with obstruction of the bowel, and that is the one place in this library where a laxative ingredient needs to be named as moving in the wrong direction. Rhubarb contains anthraquinones; they are stimulant laxatives, and stimulant laxatives are contraindicated where mechanical obstruction is on the table, because driving a bowel that cannot empty is the mechanism by which a closed loop distends and perforates. This library states the direction and offers no plan.
What the closure itself means today is worth stating plainly. No stool and no flatus, with colicky pain and vomiting, is bowel obstruction until imaging says otherwise, and the branch that sets the clock is strangulation — ischaemia of a segment, with a window measured in hours. The common causes are adhesions after surgery, hernias, tumours, inflammatory strictures, volvulus and faecal impaction, and one of the most frequently identifiable causes is medication: opioids, anticholinergics, calcium channel blockers and some antipsychotics all slow the gut. Lactate, a rising white cell count and CT findings are among the signals looked for when ischaemia is the question. This library records that these exist; it does not sort them.
Two materia notes and then the safety line. 枳实 is the immature fruit of Citrus — a different thing from the peel, and it contains synephrine, a sympathomimetic amine; cardiovascular events have been reported for synephrine combined with caffeine. Bergamot and grapefruit furanocoumarins are a separate matter and are not what is being said here. 大黄 is rhubarb: anthraquinone stimulant laxatives carry records of dependence, of melanosis coli, of potassium loss, and — because the same root contains tannins — of constipation following the purgation. European regulators restrict anthraquinone laxatives to short-term use. 厚朴 is Magnolia bark, containing magnolol and honokiol; the flower, 厚朴花, is a different part with its own entry.
The name is worth one more sentence, because four other formulas in this library contain 厚朴 — 半夏厚朴汤, 厚朴七物汤, 厚朴温中汤 and 厚朴麻黄汤 — and none of them is this one. Reliable safety data for pregnancy and breastfeeding are lacking, and this library does not suggest use in either. Chinese-language literature reports observations of formulas of this class, small in scale and limited in method; this library records that such studies exist, not that benefit has been established.
三味药，而且它们与小承气汤那三味完全相同：**厚朴、大黄、枳实**。本方以**厚朴为君**，小承气汤以**大黄为君**。也就是说，古典把「比例变了」当成「方变了、主治也变了」，而不是当成同一首方的微调。本库**不列用量、不列比例** —— 所以只能记「古典认为比例改变主治」，**不代补一个比例**，因为补数字就是在编数字。
主治只有两个字：**痛而闭**。「闭」是**不通**；与本篇前后条文连读，画面是**腹痛并且大便不通**，而这正是本库里唯一一处必须把「泻下药」说成**方向是错的**的地方。**大黄**含蒽醌类，属于刺激性泻药；在**机械性肠梗阻**尚未排除时，刺激性泻药是禁忌方向 —— 驱动一段排不出去的肠子，正是闭袢扩张乃至穿孔的机制。本库只说方向，**不给任何方案**。
「闭」本身今天是什么意思，值得直接写出来：**不排便也不排气，伴绞痛与呕吐，在影像给出别的答案之前就是肠梗阻**；而给这件事定时钟的是那条分支 —— **绞窄**（一段肠子缺血，窗口按小时计）。常见原因是术后粘连、疝、肿瘤、炎症性狭窄、肠扭转与粪便嵌塞；而**最常被识别出来的一类原因是药物**：阿片类、抗胆碱药、钙通道阻滞剂与部分抗精神病药都会让肠子慢下来。当问题指向缺血时，临床上会去看乳酸、白细胞与 CT 征象。本库记「这些存在」，**不替人排序**。
两味本草备注，然后是安全线。**枳实**是柑橘属的**幼果**，与「皮」不是同一物，含**辛弗林（synephrine，拟交感胺）**；辛弗林与咖啡因合用有心血管事件的报告。**佛手柑／柚子的呋喃香豆素是另一回事**，本条说的不是那个。**大黄**：蒽醌类刺激性泻药有依赖、结肠黑变病、失钾的记录，而且因为同一根里含鞣质，**泻过之后可以接着便秘**；欧洲监管机构把蒽醌类泻药限制在短期使用。**厚朴**是木兰科树皮，含厚朴酚与和厚朴酚；**厚朴花**是另一部位，另有其位。
方名还值得多说一句：本库含「厚朴」的方另有四首 —— 半夏厚朴汤、厚朴七物汤、厚朴温中汤、厚朴麻黄汤 —— **没有一首是本方**。孕期与哺乳期缺乏可靠的安全性数据，本库不主张使用。中文文献有本方一类方剂的观察报告，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」**。