Source 出处 · Jingui Yaolüe · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Two different formulas carry this name and they are not interchangeable. The one in the Jingui Yaolüe and the one in the Furen Daquan Liangfang differ in composition and in what they are for. This entry is the Jingui Yaolüe version, which is the one usually meant when the name is used without qualification.
The formula is worth reading as architecture rather than as a list. It warms at one end (evodia, cassia twig, ginger), nourishes and binds at the other (angelica, peony, donkey-hide gelatin, ophiopogon), moves what has settled (Sichuan lovage, moutan bark), and keeps the whole from drying out or rising (pinellia, liquorice). That combination - warming a cold that is real while supplementing a deficiency that is also real, in a person whose blood has stopped moving - is why it has stayed in use. Whether the classical diagnosis it is written for corresponds to anything a modern clinic would group together is, honestly, not answerable from the text.
The indication is where the safety note belongs. It is written for irregular menstruation, uterine bleeding, infertility and a cold dragging sensation in the lower abdomen, and none of those are self-interpreting. Any postmenopausal bleeding needs evaluation for endometrial hyperplasia and carcinoma before it is anything else. Abnormal uterine bleeding in someone who could be pregnant includes ectopic pregnancy, and that is lost by the day. Heavy bleeding in a person with a personal or family history of bleeding problems, or in someone on anticoagulants, is a different question from a pattern of deficient cold. Fibroids, adenomyosis, polyps, thyroid disease, coagulopathies and the bleeding changes of perimenopause all produce the same presenting complaint, and the classical framework has no method for telling them apart. None of this is a reason not to use the formula; it is a reason not to let it be the first thing that happens.
On the herbs:
- Evodia fruit carries the best-documented hazard. Wu zhu yu is classically listed as having mild toxicity, and liver injury has been reported around Evodia-containing preparations, so anyone with liver disease or on hepatically cleared medicines should not treat it as a warming spice.
- Pinellia needs saying plainly: raw pinellia contains calcium oxalate raphides and a lectin that can produce severe throat swelling, which is why it is used only processed, and the airway threat is not theoretical. It also belongs to the group classically said to oppose aconite.
- Donkey-hide gelatin is animal-derived, and adulteration with other hides is a documented problem in the trade; that is an authenticity question rather than a toxicological one, but vegetarians will want to know it is there.
- Moutan bark quickens blood and is traditionally used with caution in pregnancy, which matters here because infertility is one of the stated indications.
- Peony: whether this is red or white peony is not settled by the text and the two are not interchangeable. Both fall in the classical group of herbs said to oppose veratrum, which is a statement about what not to add to this formula, not about the formula itself.
- Ophiopogon is mai men dong, and the Liriope tuber sold as shan mai dong is a different material with a different name.
- Ginseng has a documented case report of reducing warfarin's effect and is stimulating for some people.
One last point: the formula contains blood-quickening herbs and is traditionally avoided in pregnancy, and the classical indication of infertility means pregnancy is a live possibility in exactly the population it was written for.
有两个不同的方子共用此名，且不可互代：《金匮要略》本与《妇人大全良方》本，组成与所主皆异。本条是《金匮要略》本，即单称「温经汤」时通常所指的那一首。
此方值得当作结构来读，而不是当作清单：一端温散（吴茱萸、桂枝、生姜），一端滋养固摄（当归、芍药、阿胶、麦门冬），中间推动已停之血（川芎、牡丹皮），并以半夏、甘草防止燥烈与气逆。寒是真的寒、虚也是真的虚，而血已不行——这三件事同时成立，正是它沿用至今的原因。至于它所主的古典诊断是否对应现代诊所会归为一类的任何情况，老实说，从文本本身无法回答。
安全提示属于适应症。它主月经不调、崩漏、不孕与少腹里急冷感，而这些都不是可以自行判断的。任何绝经后出血，在成为别的东西之前，首先需要评估子宫内膜增生与内膜癌。有妊娠可能的异常子宫出血包含异位妊娠，那是以天计而会失去的病。有个人或家族出血病史者、或正在服用抗凝药者的大量出血，与虚寒的证候是两类问题。子宫肌瘤、子宫腺肌症、内膜息肉、甲状腺疾病、凝血障碍以及围绝经期的出血改变，表现完全相同，而传统框架无法区分。这些都不是不用此方的理由，而是不让此方成为第一件事的理由。
单味药：
- 吴茱萸是有明确记载风险的那一味。传统列为有小毒，含吴茱萸制剂周围已有肝损伤的报告，故肝病者或正在服用经肝清除药物者不应把它当作温中香料。
- 半夏需要说清楚：生半夏含草酸钙针晶与凝集素，可致严重的咽喉肿痛，气道威胁并非理论上的事，所以它只经炮制后使用；它又属传统与乌头相反的一组。
- 阿胶为动物来源，市场上以其他皮掺伪是有记载的问题；这是真伪问题而非毒理问题，但素食者应当知道它的存在。
- 牡丹皮活血，传统认为孕期慎用——这一点在此处尤其要紧，因为不孕正是它的适应症之一。
- 芍药：此处是赤芍还是白芍，文本并未确定，而二者不可互代；两者都属传统「与藜芦相反」的一组，那是说不能往这个方子里加什么，不是说方子本身如何。
- 麦门冬是百合科沿阶草的块根，而百合科山麦冬（山麦冬）是另一种材料、另一个名字。
- 人参有降低华法林作用的病例报告，对部分人有兴奋作用。
最后一点：此方含活血之品，传统认为孕期不宜；而它所主的不孕一项，恰好意味着怀孕在这个方子所针对的人群中是可能发生的。