Twice daily, morning and evening, on an empty or near-empty stomach. Drink copious warm water after each dose, and engage in physical activity such as jumping, walking, or climbing stairs to help dislodge and move stones downward.

6 days per course, with a 3-day rest between courses. Multiple courses may be needed (commonly 2-4 courses). Reassess with imaging after each course.

Drink large amounts of warm water throughout treatment (aim for at least 2 liters daily) to help flush stones and support the formula's diuretic action. Avoid greasy, fried, and rich foods, as these generate Dampness and Heat. Reduce intake of high-oxalate foods such as spinach, strong tea, nuts, and chocolate. Limit high-purine foods including organ meats, shellfish, sardines, and excessive red meat. Reduce salt intake, as excess sodium increases calcium excretion in the urine. Avoid alcohol and beer in particular, which contain purines and promote dehydration. Eat more fresh vegetables, whole grains, and fruit to maintain alkaline urine balance. Light, easily digestible foods are preferable during treatment to avoid taxing the Spleen and Stomach, which are already challenged by the formula's cold nature.

Diuretics (thiazides, loop diuretics, potassium-sparing diuretics): San Jin Pai Shi Tang has strong diuretic effects through multiple herbs (Jin Qian Cao, Che Qian Zi, Hua Shi, Bian Xu, Qu Mai, Mu Tong). Concurrent use with pharmaceutical diuretics may cause excessive fluid loss, electrolyte imbalances (particularly hypokalemia or hyponatremia), and dehydration. Electrolytes should be monitored if combined use is necessary.

Lithium: The formula's potent diuretic action could alter lithium clearance and serum levels, potentially leading to lithium toxicity. Patients on lithium therapy should avoid this formula or have their lithium levels closely monitored.

Nephrotoxic drugs (aminoglycosides, NSAIDs, certain antivirals): If the formula version contains Mu Tong (particularly Guan Mu Tong from Aristolochia manshuriensis, which contains aristolochic acid), there is a risk of additive nephrotoxicity. Even with safer Mu Tong species, caution is warranted when combining with drugs that stress the kidneys.

Anticoagulants and antiplatelet drugs (warfarin, aspirin, clopidogrel): Some expanded versions of this formula include Blood-moving herbs like Dan Shen, Chi Shao, and Wang Bu Liu Xing, which may potentiate anticoagulant effects and increase bleeding risk. Dan Shen in particular has documented interactions with warfarin.