Source 出处 · Taiping Huimin Hejiju Fang · Doses are not given here: they are set by a licensed practitioner for the individual.
Safety. Wu Ji San is the largest formula in this batch and the most difficult one to describe honestly, because it is a deliberately composite composition. It comes from the Taiping Huimin Hejiju Fang, the Song-dynasty government formulary, and its structure is usually explained as several smaller formulas overlapping: the damp-dispersing core of 苍术、厚朴、陈皮、甘草, the phlegm-transforming group of 半夏、陈皮、茯苓、甘草, the blood-moving set of 当归、川芎、白芍 with 干姜 and cassia for cold, and 麻黄、白芷、桂枝、生姜、葱白 for the exterior. 'Five accumulations' - cold, food, qi, blood and phlegm - is the mnemonic attached to it. - A formula with that many moving parts is better read as a historical artefact of a particular prescribing style than as a targeted treatment, and the safety discussion is correspondingly long. - 麻黄, ephedra, is the first ingredient that governs it. Its ephedrine and pseudoephedrine alkaloids are sympathomimetic amines that raise blood pressure and heart rate, and ephedra use is linked in case reports and case series to myocardial infarction, stroke, arrhythmia, seizure and sudden death. In 2004 the US FDA ruled dietary supplements containing ephedrine alkaloids adulterated and that ruling was upheld on appeal; ephedrine and pseudoephedrine are also controlled or monitored as precursor chemicals in many countries. Hypertension, coronary disease, arrhythmia, hyperthyroidism, glaucoma, prostate enlargement, anxiety, insomnia, and any concurrent use of stimulants, decongestants, beta-agonists or MAOI-type antidepressants put a person in the group this concerns. - This is also the second formula in the batch that contains 麻黄, which is worth saying plainly: ephedra is not a background ingredient here, it recurs across the exterior-interior category, and the caution is not diluted by being in a mixture. - 半夏 is pinellia, and raw pinellia contains calcium oxalate raphides and a lectin; chewing it causes immediate and severe burning and swelling of the mouth and throat, and swelling at that site can threaten the airway. Only the processed forms belong in a preparation, and the classical incompatibility rule places pinellia against the aconite group. - 当归 and 川芎 both carry antiplatelet and warfarin-interaction signals in the literature. 当归 is an apiaceous root, so furanocoumarin photosensitivity is theoretically possible, and case reports describe raised INR in people taking warfarin. 川芎 contains ligustrazine and is traditionally avoided where there is a bleeding tendency; it is also one of the names that gets confused with related apiaceous roots. 白芷 is a second apiaceous root with the same furanocoumarin caveat. 白芍 is a different article from 赤芍, and the classical rule places the peonies against 藜芦. - Cassia is high in coumarin relative to true cinnamon, a hepatotoxicity concern with sustained intake. 厚朴 is stripped bark from a tree that dies in the process, and wild Magnolia officinalis is listed among China's nationally protected wild plants and is now largely cultivated. 苍术 is not 白术, and the two are used differently. 桔梗 contains saponins that are emetic in larger amounts. 干姜 and the other warming components mean the formula is not neutral for people with reflux or peptic disease. 甘草 in sustained amounts produces a mineralocorticoid-like syndrome. - Traditional sources caution against this formula in pregnancy and in people who are depleted or already sweating, which is consistent with its contents: a diaphoretic, blood-moving, warming composition. - Whether it changes the course of anything 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.
五积散是本批中最大的一首，也是最难诚实描述的一首，因为它本身就是一首刻意复合的方。它出自宋代官修方书《太平惠民和剂局方》，其结构通常被解释为若干小方的叠合：化湿的 苍术、厚朴、陈皮、甘草 一组，化痰的 半夏、陈皮、茯苓、甘草 一组，温通活血的 当归、川芎、白芍 配 干姜 与桂类，以及走表的 麻黄、白芷、桂枝、生姜、葱白。附着其上的名目是「五积」—— 寒、食、气、血、痰。 - 一味药味如此庞杂的方，更适合被读作某种处方风格的历史产物，而不是某种靶向治疗；其安全讨论也因此相应更长。 - 麻黄 是第一个主导安全讨论的药味。其所含麻黄碱与伪麻黄碱属拟交感胺类，可升高血压与心率；病例报告与病例系列把麻黄的使用与心肌梗死、脑卒中、心律失常、癫痫发作及猝死联系在一起。2004 年美国 FDA 裁定含麻黄碱类生物碱的膳食补充剂为掺假产品，该裁定在上诉中得以维持；麻黄碱与伪麻黄碱在许多国家亦作为前体化学品受管制或监测。高血压、冠心病、心律失常、甲状腺功能亢进、青光眼、前列腺增生、焦虑、失眠者，以及正在使用兴奋剂、减充血剂、β 受体激动剂或单胺氧化酶抑制剂类抗抑郁药者，是这一条所关心的那组人。 - 这也是本批中第二首含 麻黄 的方，值得直说：麻黄在这里不是背景药味，它在表里双解这一类中反复出现，而进入复方并不会稀释这条警示。 - 半夏 含草酸钙针晶与凝集素（生品），咀嚼后立即引起口腔与咽喉剧烈灼痛肿胀，而该部位的肿胀可能威胁气道；任何制剂中只应使用炮制品，十八反条目中半夏与乌头类相反。 - 当归 与 川芎 在文献中均有抗血小板与华法林相互作用的信号。当归 属伞形科根类，呋喃香豆素光敏反应在理论上可能，且有个案报告描述服用华法林者 INR 升高。川芎 含川芎嗪，传统上在出血倾向者慎用；它也是容易与相近伞形科药材混淆的名称之一。白芷 同属伞形科，同样存在呋喃香豆素光敏的顾虑。白芍 与 赤芍 是两种不同药材，十八反「诸参辛芍叛藜芦」条目把芍药列入其中。 - 桂皮类（cassia）的香豆素含量高于真肉桂，长期摄入存在肝毒性顾虑。厚朴 取皮即致树死，野生厚朴已列入中国国家重点保护野生植物名录，现多为栽培品。苍术 不是 白术，两者用法不同。桔梗 含皂苷，量较大时可致恶心呕吐。干姜 与其他温里药味意味着本方对反流或消化性溃疡者并非中性。甘草 长期摄入产生类盐皮质激素综合征。 - 传统文献对本方在孕期以及正气不足、已有汗出者有所告诫，这与它的组成是一致的：一首发汗、活血、温里的方。 - 本方是否改变任一疾病的结局，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。