Source 出处 · Shanghan Lun · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Shanghan Lun line 106: 太阳病不解，热结膀胱，其人如狂，血自下，下者愈. Its continuation carries the gate: if the exterior is not yet resolved, one must not attack; resolve the exterior first; once the exterior is resolved and what remains is urgency and binding in the lower abdomen, then one may attack. Two things in that sentence deserve more attention than the formula itself does.
The first is 其人如狂 — the person is as if crazed. That is an altered mental state, and an altered mental state is never a diagnosis; it is a differential that has to be run. Hypoglycaemia, hypoxia, sepsis and central nervous system infection, electrolyte disturbance, hepatic encephalopathy, uraemia, drugs and alcohol, withdrawal, intracranial bleeding or stroke, encephalitis and meningitis, thyroid storm, heat stroke, carbon monoxide, and anticholinergic medication all present this way, and several of them kill within hours. In the classical text 如狂 is one item inside a pattern. Today it is the trigger for a set of observations and tests that come first.
The second is 血自下，下者愈 — if the blood passes on its own, the person recovers. Read literally, that tells a modern reader that bleeding which stops by itself needs no investigation. It does. Haematuria carries a list: stones, tumour of kidney, ureter or bladder, tuberculosis, glomerulonephritis, prostatic disease, and anticoagulant effect. Bleeding per rectum carries another. Neither is something to watch until it stops. This is one of the places where the library records the classical statement and then says plainly that acting on it today would be a mistake.
少腹急结, the urgency and binding in the lower abdomen, carries the same kind of list: appendicitis, diverticulitis, bowel obstruction, ovarian torsion, ectopic pregnancy, testicular torsion, ureteric stone, ruptured abdominal aortic aneurysm, incarcerated hernia, pelvic inflammatory disease and tubo-ovarian abscess. And the line itself carries a gate — the exterior must be resolved before attacking. The classical text supplied its own exclusion criterion, and readers usually skip it.
Five ingredients: peach kernel, rhubarb, cinnamon twig, sodium sulphate, liquorice. Peach kernel contains amygdalin. Rhubarb is an anthraquinone laxative, with potassium loss and melanosis coli on prolonged use. Sodium sulphate here is hydrated sodium sulphate: a real sodium load. Liquorice brings the glycyrrhizin pseudoaldosteronism problem, potassium loss with rising blood pressure. That is three separate paths to low potassium in a five-ingredient formula, and one of them — rhubarb together with liquorice — is a combination with a known potentiation. Cinnamon twig carries coumarin.
The formula is used in Japanese kampo as tokakujokito, and there are small clinical observations for menstrual complaints and constipation. The library records that research exists; efficacy is not established. Pregnancy is an absolute exclusion.
《伤寒论》第 106 条：太阳病不解，热结膀胱，其人如狂，血自下，下者愈。后面跟着闸门 —— 其外不解者，尚未可攻，当先解其外；外解已，但少腹急结者，乃可攻之。这句话里有两处比方本身更值得注意。
第一处是「其人如狂」。这是一个改变了的精神状态，而精神状态改变永远不是诊断，它是一张必须跑完的鉴别表：低血糖、缺氧、脓毒症与中枢感染、电解质紊乱、肝性脑病、尿毒症、药物与酒精、戒断、颅内出血或卒中、脑炎脑膜炎、甲亢危象、热射病、一氧化碳、抗胆碱能药物，其中数项以小时计。在古典文本里「如狂」只是证候中的一项；今天它是先做一组观察与检查的扳机。
第二处是「血自下，下者愈」。照字面读，它告诉今天的读者：自己停下来的出血不必查。恰恰相反。血尿有清单：结石、肾／输尿管／膀胱肿瘤、结核、肾小球肾炎、前列腺疾病、抗凝作用。便血有另一张。两者都不该观察到它停为止。本库在这里记下古典原话，并直说照做在今天会是错的。
「少腹急结」带着同一类清单：阑尾炎、憩室炎、肠梗阻、卵巢扭转、异位妊娠、睾丸扭转、输尿管结石、腹主动脉瘤破裂、嵌顿疝、盆腔炎与输卵管卵巢脓肿。而条文自带闸门 —— 表未解不可攻，先解其外。**排除条款是古典自己写的，读者通常把它跳过去。**
五味药：桃仁、大黄、桂枝、芒硝、甘草。桃仁含苦杏仁苷。大黄是蒽醌类泻药，久用失钾并与结肠黑变病相关。芒硝是含水硫酸钠，是真实的钠负荷。甘草有甘草酸假性醛固酮增多症问题 —— 失钾升压。**五味药里三条各自通向低钾的路径**，其中大黄与甘草同方这一组合有已知的协同。桂枝含香豆素。
此方在日本汉方称 tokakujokito，对月经相关不适与便秘有小规模临床观察。本库如实记「研究存在」，疗效未被确立。孕期是绝对排除项。