Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Ling Gan Wu Wei Jiang Xin Tang is recorded in Jingui Yaolüe, in the chapter on phlegm-rheum and cough. Five herbs: fu ling, honey-fried gan cao, wu wei zi, gan jiang and xi xin. It cannot be read properly on its own, because the classical text presents it as one station on a chain. The chapter follows a person given a larger warm formula for cough and breathlessness who then develops new signs; the text removes or adds one or two herbs at each turn — first a formulation with gui zhi, then this one, then ban xia is added, then xing ren, then da huang — and each addition answers one specific change in the presentation. This is the closest thing in the classical literature to an explicit rule for what to do when a person gets worse on a formula, and it is worth reading for that shape rather than for any single herb.
Inside this formula the pairing is the point. Gan jiang and xi xin warm and disperse; wu wei zi is astringent and is traditionally said to gather the lung and stop cough. Dispersing and binding in the same pot is not a contradiction to the classical writers — it is the same 'one opens, one restrains' arrangement seen elsewhere in this library. Fu ling leaches dampness downward through urination, and gan cao harmonises.
The phrase usually quoted from this chapter is short: where there is phlegm-rheum, harmonise it with warm herbs. It is a statement about method, made before anyone could measure airway calibre, ejection fraction or gastric reflux, and this entry reports it as a statement about method.
A modern reader should know what the presentation can be. Cough that forces a person to sit upright to breathe — the classical 'cough and counterflow, leaning and unable to lie flat' — is a description that today points at acute heart failure, an asthma exacerbation and advanced lung disease before it points anywhere else. Chronic cough lasting more than eight weeks has a short differential that is worth stating plainly: upper airway cough syndrome, cough-variant asthma, gastro-oesophageal reflux, ACE inhibitor therapy, chronic bronchitis, bronchiectasis, tuberculosis, lung cancer, interstitial lung disease and heart failure. Cough with blood, weight loss, night sweats or fever needs investigation rather than self-management. None of these is separable by pulse and tongue.
Safety, and this is the most important part of the entry. Xi xin belongs to the Aristolochiaceae, the birthwort family. Aristolochic acid is nephrotoxic and carcinogenic with cumulative exposure and no established safe threshold, and for this reason the Pharmacopoeia restricts the herb to root and rhizome; the aerial parts were never the intended part. This is reported in full elsewhere in this library and is restated here because the herb appears in this formula. Wu wei zi has two separate Pharmacopoeia entries, northern and southern, and they are not interchangeable. Honey-fried gan cao carries the pseudoaldosteronism risk of prolonged daily licorice intake: sodium and water retention, potassium loss and raised blood pressure, which matters more rather than less in someone already taking a diuretic. Herbs of this group are traditionally cautioned in pregnancy. This library does not claim this formula resolves rheum or treats any specific disease.
苓甘五味姜辛汤著录于《金匮要略·痰饮咳嗽病脉证并治》。五味药：茯苓、炙甘草、五味子、干姜、细辛。它不能单独读，因为原文把它放在一条链上：痰饮篇里有一个人服了较大的温散方之后出现新的变化，原文于是一步步做加减 —— 先是有桂枝的一方，然后是本方，然后加半夏，再加杏仁，最后加大黄 ——**每一次加减都对着一个具体的变化**。这是古典文献里最接近「服方后变差了怎么办」的明文规则的一处，值得为这个形状去读，而不是为某一味药去读。
方内的配对才是要点：干姜与细辛温散，五味子酸收敛肺止咳。散与收在同一罐药里，对古典医家不是矛盾，而是本库别处也见过的「一开一收」的安排。茯苓引湿从小便出，甘草调和。
这一篇最常被引用的一句话很短：**病痰饮者，当以温药和之**。这是一句关于**方法**的话，成于气道口径、射血分数与胃食管反流都还无法测量的年代；本条只把它当作关于方法的话来记。
今天的读者需要知道这个表现可能是什么。咳到必须坐起来才能呼吸 —— 原文「咳逆倚息不得卧」—— 在今天的鉴别里，先指向急性心衰、哮喘急性发作与晚期肺病，然后才轮到别的。持续八周以上的慢性咳嗽有一张短清单值得直说：上气道咳嗽综合征、咳嗽变异性哮喘、胃食管反流、ACEI 类药物、慢性支气管炎、支气管扩张、结核、肺癌、间质性肺病、心衰。咳嗽伴咯血、体重下降、盗汗或发热，需要检查而不是自行调理。这些没有一项是脉与舌能分开的。
安全上（本条最要紧的一段）：**细辛属马兜铃科**。马兜铃酸具肾毒性与致癌性，累积暴露且无确定安全阈值，故药典限用根及根茎 —— 地上部分从来不是规定部位。本库别处已完整记述，此处因本方含细辛而重述。五味子在药典分列为北五味子与南五味子两条，不可互代。**炙甘草**带来长期每日摄入甘草的假性醛固酮增多症风险（钠水潴留、失钾、升压），在已服利尿剂者身上这一点更重而不是更轻。方中药味传统列为孕期慎用。本库不声称本方能化饮或治疗任何具体疾病。