Last week, a middle-aged woman came to my clinic with a chief complaint of hair loss and oily hair. She had just undergone minimally invasive varicose vein surgery. Years ago, imaging had revealed multiple hepatic hemangiomas. Her main symptoms included fatigue, a fine pulse, and a pale tongue with a white coating. I prescribed a modified Erzhi Wan combined with Bulaodan.

However, after taking the very first dose, she experienced gastric discomfort, followed by dizziness, dry mouth, and reduced urination. The symptoms resolved once she stopped the medication. At first, I suspected a xuanming (healing crisis) reaction and reassured her that the formula was simply potent — that she would adjust after a few more doses. But this patient continued for three days, and each time the herbs went down, dizziness returned promptly and worsened progressively. After three days, she stopped on her own, and everything returned to normal.

I was baffled. Reviewing my prescription, I thought it might be somewhat drying, but hardly enough to cause dizziness. The patient rarely took Chinese herbal medicine and had a constitutionally weak constitution, so some intolerance was understandable — but this reaction seemed abnormal.

Initially, I suspected the quality of the Cangzhu (Atractylodes rhizome). After all, practitioners in northern China mostly use Beichao Cangzhu rather than Mao Cangzhu, and the former tends to be more potent and more likely to provoke such reactions. But today I went specifically to inspect the herb dispensary and discovered a shocking problem:

The drawer labeled Cangzhu did not contain Cangzhu at all — it was filled with Qianghuo (Notopterygium root)!

In other words, the formula contained no Cangzhu whatsoever — every dose was actually Qianghuo. Qianghuo is an extremely vigorous herb used to dispel wind-cold, and it has an affinity for the upper body. Causing dizziness, dry mouth, and reduced urination is entirely plausible with this substitution. I searched the literature extensively and found that both classical and modern texts rarely discuss this specific issue. Most simply warn that patients with blood deficiency should absolutely avoid it. Modern reports do document allergic reactions to Qianghuo, presenting as rash, subcutaneous hemorrhage, and decreased urine output.

Dispensing herbs is like holding someone’s life in your hands!

The prescription was as follows:

Cinnamon twig 12g   Bran-fried Atractylodes rhizome 12g   White peony 12g   Earth bone skin 15g   Prepared Polygonum multiflorum 15g   Poria 20g

Achyranthes bidentata 12g   Wine-processed Ligustrum lucidum 10g   Eclipta 10g   Safflower 6g   Prepared Rehmannia root 15g

上周有一中年女性来诊，主诉为脱发，油性发质，刚刚做完静脉曲张手术（微创），多年前检查发现有多发性肝血管瘤，主要表现为乏力，脉细，舌淡苔白，我开了二至丸合不老丹加减。

可是吃了第一副药之后就感到胃中不适，既而发生头晕，口干，尿少，停药后好转。最初我以为是玄冥反应，安慰她药力太强，多喝几副就会好了，可是这位女士连喝了三天，只要药一下肚，很快就会头晕不适，且越发严重，三天后自行停药，一切正常。

我百思不得其解，观我之药方，可能是会有点燥，但也不至于头晕，非常不解，患者本人很少服用中药，体质偏弱，不能适应药力可以理解，但是这反应也略不正常了些。

一开始我怀疑是苍术的品质有问题，毕竟北方多用北朝苍术，不是茅苍术，药力比较强，容易引发这些反应。但今天我专门去药方查看了一下苍术的情况，发现了惊天的问题：

苍术的药斗子中放的不是苍术，而是羌活！

也就是说，这幅药中没有苍术，都是羌活，而羌活这位药药力十分猛烈，用于发散风寒，且偏于走人体上部，造成头晕口干尿少是很有可能的。查遍文献，发现古今文献记载中很少提及此事，多是说血虚者切不可服，近代亦有记载对羌活过敏者，其表现为皮疹、皮下出血以及小便量减少。

司药如司命！！！

药方如下：

桂枝 12g 麸炒苍术 12g 白芍 12g 地骨皮 15g 制何首乌 15g 茯苓 20g

川牛膝 12g 酒女贞子 10g 墨旱莲 10g 红花 6g 熟地黄 15g