일본에서 최초로 開花 선언된 고치(高知)市의 왕벚꽃 표본목(標本木)
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Doris Day singing No Moon At All
https://youtu.be/4GxvSALRLzM
Ella Fitzgerald & Bill Doggett ~ No Moon At All
https://youtu.be/785sBbRwyRE
이 곡은 여러 가수들이 불렀는데, 내 생각엔 엘라 피츠제럴드의 노래가 가장 멋지다. 도리스 데이가 교통사고로 다리를 다쳐서, 병원에 누워 엘라의 노래를 많이 들으며 노래를 배웠다는 건, 도리스가 스스로 밝힌 얘기다. 엘라의 노래는 재즈풍인데, 이 노래를 잘 살리고 있다.
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막스는 그의 저서 어디에서도 “계급”이 무엇인지 정의하지 못했다. 문제는 막스가 의미하는 사회적 계급이 존재하느냐의 여부가 아니다. 문제는 막스가 의미했던 사회적 계급의 개념을 우리가 사용할 수 있느냐는 것이다.
개인이나 계급의 “이익”의 문제를 해결하려면, 1)이들 이익이 어떤 궁극적인 목적으로 사람들을 인도하는가?, 2)사람들은 어떤 수단으로 이들 목적에 이르려 하는가?, 위의 두가지 질문에 답해야 한다.
막스의 임금의 철칙에 따르면, 노동자들은 자손들을 부양하고, 그 자손들이 다시 노동자가 되는데 충분한 만큼에서 임금이 유지된다고 하는데, 그의 역사철학에서는 또 노동자들이 점점 궁핍으로 몰려서 마침내는 반란에 이르고, 이어서 사회주의를 건설한다고 했으므로, 두 가지 말이 서로 모순된다.
노동자들이 점진적으로 궁핍하게 된다는 막스의 생각은 치명적 오류였다. 그는 자본주의의 가장 중요한 특징이 대중을 위한 대량생산이고, 자본가들의 주목적은 광범위한 대중을 위한 생산이라는 것을 몰랐다.
막스는 헤겔의 정신의 진화를, 물질적 생산요소의 진화로 바꿔치기 했다. 그는 물질적 생산 요소, 즉 도구와 기계들이 결국은 인간의 정신의 산물이라는 사실을 깨닫지 못했다.
Class Conflict and Revolutionary Socialism
•Ludwig von Mises
Marx assumed that “interests” were independent of human ideas and thoughts. He said that socialism was the ideal system for the proletariat. He said class interests determine the thinking of individuals and that this situation causes irreconcilable conflicts between the various classes. Marx then returned to the point at which he had started—namely, that socialism is the ideal state.
The fundamental concept of the Communist Manifesto (1848) was that of “class” and “class conflict.” But Marx didn’t say what a “class” was. Marx died in 1883, 35 years after the publication of the Communist Manifesto. In those 35 years he published many volumes, but in not one of them did he say what he meant by the term “class.”After Marx’s death, Friedrich Engels published the unfinished manuscript of the third volume of Marx’s Das Kapital. Engels said this manuscript, on which Marx had stopped work, many years before he died, had been found in Marx’s desk after his death. In one three-page chapter in that volume, Marx tells us what a “class” was not. But you may search through all his writings to learn what a “class” was without ever finding out. In fact, “classes” don’t exist in nature. It is our thinking—our arranging in categories—that constructs classes in our minds. The question is not whether social classes exist in the sense of Karl Marx; the question is whether we can use the concept of social classes in the way in which Karl Marx meant it. We can’t.
Marx did not see that the problem of the “interest” of an individual, or of a class, cannot be solved simply by referring to the fact that there is such an interest and that men must act according to their interests. Two questions must be asked: (1) Toward what ultimate ends do these “interests” lead people? (2) What methods do they want to apply in order to reach these ends?
The First International was a small group of people, a committee of a few men in London, friends and enemies of Karl Marx. Someone suggested that they cooperate with the British labor-union movement. In 1865, Karl Marx read at the meeting of the International Committee, a paper, Value, Price, and Profit, one of his few writings originally written in English. In this paper, he pointed out that the methods of the union movement were very bad and must be changed. Paraphrasing:“The unions want to improve the fate of the workers within the framework of the capitalist system—this is hopeless and useless. Within the framework of the capitalist system there is no possibility of improving the state of the workers. The best the union could achieve in this way would be some short-term success. The unions must abandon this ‘conservative’ policy; they must adopt the revolutionary policy. They must fight for the abolition of the wage society as such and work for the coming of socialism.” Marx didn’t have the courage to publish this paper during his lifetime; it was published only after his death by one of his daughters. He didn’t want to antagonize the labor unions; he still had hopes they would abandon their theory.
Here is an obvious conflict of opinions among the proletarians themselves concerning the right means to use. The proletarian unions and Marx disagreed as to what was in the “interest” of the proletarians. Marx said that the “interest” of a class was obvious—there could be no doubt about it—everyone would know it. Then here comes a man who doesn’t belong to this proletarian class at all, a writer and a lawyer who tells the unions they were wrong. “This is bad policy,” he said. “You must radically change your policy.” Here the whole idea of the class breaks down, the idea that an individual may sometimes err but that a class as a whole can never err.
Criticisms of Marxian doctrines have always been superficial. They haven’t pointed out how Marx contradicted himself and how he failed to explain his ideas. Böhm-Bawerk’s critique was good but he didn’t cover the entire system. Critics of Marx didn’t even discover Karl Marx’s most manifest contradictions.
Marx believed in the “iron law of wages.” He accepted that as the fundamental basis of his economic doctrine. He didn’t like the German term for this law, the “brazen” law of wages, about which Ferdinand Lassalle [1825–1864] had published a pamphlet. Karl Marx and Ferdinand Lassalle were not friends; they were competitors, very serious competitors. Marx said Lassalle’s only contribution was the term itself, the “brazen” law of wages. And what was more, the term, was borrowed, borrowed from the dictionary and from Goethe.
The “iron law of wages” still survives in many textbooks, in the minds of politicians, and consequently in many of our laws. According to the "iron law of wages,” the wage rate is determined by the amount of food and other necessities required for the preservation and reproduction of life to support the workers’ children until they can themselves work in the factories. If wage rates rise above this, the number of workers would increase and the increased number of workers would bring wage rates down again. Wages cannot drop below this point because there would then develop a shortage of labor. This law considers the worker to be some kind of microbe or rodent without free choice or free will.
If you think it is absolutely impossible under the capitalist system for wages to deviate from this rate, how then can you still talk, as Marx did, about the progressive impoverishment of the workers as being inevitable? There is an insoluble contradiction between the Marxian idea of the iron law of wage rates, according to which wages will remain at a point at which they are sufficient to support the progeny of workers until they can themselves become workers, and his philosophy of history, which maintains that the workers will be more and more impoverished until they are driven to open rebellion, thus bringing about socialism. Of course, both doctrines are untenable. Even 50 years ago the leading socialist writers were forced to resort to other elaborate schemes in the attempt to support their theories. What is amazing is that, during the century since Marx’s writings, no one has pointed out this contradiction. And this contradiction is not the only contradiction in Marx.
What really destroyed Marx was his idea of the progressive impoverishment of the workers. Marx didn’t see that the most important characteristic of capitalism was large-scale production for the needs of the masses; the main objective of capitalists is to produce for the broad masses. Nor did Marx see that under capitalism the customer is always right. In his capacity as a wage earner, the worker cannot determine what is to be made. But in his capacity as a customer, he is really the boss and tells his boss, the entrepreneur, what to do. His boss must obey the orders of the workers as they are members of the buying public. Mrs. Webb, like other socialists, was the daughter of a well-to-do businessman. Like other socialists, she thought her father was an autocrat who gave orders to everybody. She didn’t see that he was subject to the sovereignty of the orders of the customers on the market. The “great” Mrs. Webb was no smarter than the dumbest messenger boy who sees only that his boss gives orders.
Marx had no doubt as to what the ends were toward which men aim. Nor did he have any doubts as to the best way to attain these ends. How is it that a man who read so much and interrupted his reading only to write, didn’t realize the discrepancy in his ideas?
To answer that question, we must go back to the thinking of his time. That was the time of Charles Darwin’s Origin of the Species [1859]. It was the intellectual fashion of that day to look upon men merely from the point of view of their membership in the zoological class of mammals, which acted on the basis of instincts. Marx didn’t take into account the evolution of mankind above the level of very primitive men. He considered unskilled labor to be the normal type of labor and skilled labor as the exception. He wrote in one of his books that progress in the technological improvement of machines causes the disappearance of specialists because the machine can be operated by anyone; it takes no special skill to operate a machine. Therefore, the normal type of man in the future will be the non-specialist.
With regard to many of his ideas, Marx belonged to much earlier ages, especially in constructing his philosophy of history. Marx substituted for Hegel’s evolution of Geist the evolution of the material factors of production. He didn’t realize that the material factors of production, i.e., the tools and machines, are actually products of the human mind. He said these tools and machines, the material productive forces, inevitably bring about the coming of socialism. His theory has been called “dialectical materialism,” abbreviated by the socialists to “diamet.”
Marx reasoned from the thesis to the negation of the thesis to the negation of the negation. Private ownership of the means of production by every individual worker was the beginning, the thesis. This was the state of affairs in a society in which every worker was either an independent farmer or an artisan who owned the tools with which he was working. Negation of the thesis—ownership under capitalism—when the tools were no longer owned by the workers, but by the capitalists. Negation of the negation was ownership of the means of production by the whole society. Reasoning in this way, Marx said he had discovered the law of historical evolution. And that is why he called it “scientific socialism.”
Marx branded all previous socialists “utopian socialists” because they tried to point out why socialism was better. They wanted to convince their fellow citizens to their view because they expected people would adopt the socialist social system if they were convinced it was better. They were “utopians,” Marx said, because they tried to describe the future earthly paradise. Among the forerunners of Marx whom he considered “utopians” were Saint-Simon, a French aristocrat; Robert Owen [1757–1858], a British manufacturer; and Charles Fourier [1772–1837], a Frenchman who was without doubt a lunatic. (Fourier was called the “fou [fool] du Palais-Royal.” He used to make such statements as “In the age of socialism, the ocean will no longer be salt but lemonade.”) Marx considered these three as great forerunners. But, he said, they didn’t realize that what they were saying was just “utopian.” They expected the coming of socialism because of a change in the opinions of the people. But for Marx, the coming of socialism was inevitable; it would come with the inevitability of nature.
On the one hand, Karl Marx wrote of the inevitability of socialism. But on the other hand, he organized a socialist movement, a socialist party, declared again and again that his socialism was revolutionary, and that the violent overthrow of the government was necessary to bring about socialism.
Marx borrowed his metaphors from the field of gynecology. The socialist party is like obstetrics, Marx said; it makes the coming of socialism possible. When asked if you consider the whole process inevitable, why do you not favor evolution instead of revolution, the Marxists reply, “There are no evolutions in life. Is not birth itself a revolution?”
According to Marx, the goal of the socialist party was not to influence, but only to help the inevitable. But obstetrics itself influences and changes conditions. Obstetrics has actually brought about progress in this branch of medicine, and even saved lives. And by saving lives it could be said obstetrics has actually changed the course of history.
The term “scientific” acquired prestige during the course of the nineteenth century. Engels’ Anti-Dühring (1878) became one of the most successful books among the writings of philosophical Marxists. One chapter in this book was reprinted as a pamphlet under the title “The Development of Socialism from Utopia to Science,” and it had enormous success. Karl Radek [1885–1939], a Soviet Communist, later wrote a pamphlet called “The Development of Socialism, from Science to Action.”
Marx’s doctrine of ideology was concocted to discredit the writings of the bourgeoisie. [Tomás] Masaryk [1850–1937] of Czechoslovakia was born of poor people, farmers and workers, and he wrote about Marxism. Yet the Marxians called him a bourgeois. How could he be considered “bourgeois” if Marx and Engels called themselves “proletarian”?
If the proletarians must think according to the “interests” of their class, what does it mean if there are disagreements and dissent among them? The confusion makes the situation very difficult to explain. When there is dissent among proletarians, they call a dissenter a “social traitor.” After Marx and Engels, the great man of the Communists was a German, Karl Kautsky [1854-1938]. In 1917, when Lenin tried to revolutionize the whole world, Karl Kautsky was opposed to the idea. And because of this disagreement, the former great man of the party became overnight a “social traitor,” and he was called that as well as many other names.
This idea is like that of the racists. The German racists declared that a definite set of political ideas were German and every real German must necessarily think according to this particular set of ideas. This was the Nazi idea. According to the Nazis, the best situation was to be in a state of war. But some Germans—Kant, Goethe, and Beethoven, for instance—had different “un-German” ideas. If not every German must think in a certain way, who is to decide which ideas are German and which are un-German? The answer can only be that an “inner voice” is the ultimate standard, the ultimate yardstick. This position necessarily leads to conflicts that must result in civil, or even international, war.
There were two groups of Russians, both of whom considered themselves proletarians—the Bolsheviks and the Mensheviks. The only method to “settle” disagreements between them was to use force and liquidation. The Bolsheviks won. Then within the ranks of the Communist Bolsheviks there arose other differences of opinion—between Trotsky and Stalin — and the only way to resolve their conflicts was a purge. Trotsky was forced into exile, trailed to Mexico, and there in 1940 he was hacked to death. Stalin originated nothing; he went back to the revolutionary Marx of 1859—not to the interventionist Marx of 1848.
Unfortunately, purges are not something which happen just because men are imperfect. Purges are the necessary consequences of the philosophical foundation of Marxian socialism. If you cannot discuss philosophical differences of opinion in the same way you discuss other problems, you must find another solution—through violence and power. This refers not only to dissent concerning policies, economic problems, sociology, law, and so on. It refers also to problems of the natural sciences. The Webbs, Lord and Lady Passfield, were shocked to learn that Russian magazines and papers dealt even with problems of the natural sciences from the point of view of the philosophy of Marxism-Leninism-Stalinism.
For instance, if there is a difference of opinion with regard to science or genetics, it must be decided by the “leader.” This is the necessary unavoidable consequence of the fact that, according to Marxist doctrine, you do not consider the possibility of dissent among honest people; either you think as I do, or you are a traitor and must be liquidated.
The Communist Manifesto appeared in 1848. In that document, Marx preached revolution; he believed the revolution was just around the corner.
He believed then that socialism was to be brought about by a series of interventionist measures. He listed ten interventionist measures—among them the progressive income tax, the abolition of the rights of inheritance, agricultural reform, and so on. These measures were untenable, he said, but necessary for socialism to come.
Thus, Karl Marx and Engels believed in 1848, that socialism could be attained by interventionism. By 1859, eleven years after the Communist Manifesto, Marx and Engels had abandoned the advocacy of interventions; they no longer expected socialism to come from legislative changes. They wanted to bring about socialism by a radical change overnight. From this point of view, followers of Marx and Engels considered later measures— the New Deal, the Fair Deal, and so forth—to be “petty bourgeois” policies. In the 1840s Engels had said British labor laws were a sign of progress and a sign of the breakdown of capitalism. Later they called such interventionist measures or interventionist policy (Sozialpolitik) very bad.
In 1888—40 years after the publication of the Communist Manifesto — a translation was made by an English writer. Engels added some comments to this translation. Referring to the ten interventionist measures advocated in the Manifesto, he said these measures were not only untenable, as the Manifesto claimed, but precisely because they were untenable, they would necessarily push further and further toward still more measures of this kind, until eventually these more advanced measures would lead to socialism.
Excerpted from Marxism Unmasked: From Delusion to Destruction/ 노년에 미제스가 쓸 글은 하이에크 글보다 논리의 치밀성이 떨어진다.
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광견병은 금궤요략의 하어혈탕下淤血汤으로 치료할 수 있다.
这个方子就是下淤血汤,原记载于张仲景的《金匮要略》中,是一剂破血下瘀,通络止痛的方剂。下淤血汤的方证为:小腹刺痛拒按,按之有硬块,或见水恐惧,或见恶露量少而色紫暗;或见恶露不下,月经痛或闭经,舌干口燥,大便燥结,小便短赤,面色无华,甚则肌肤甲错,或有青紫斑,指甲青紫不荣,或神疲乏力,舌质紫暗或舌边有瘀点,舌苔黄燥,脉沉、涩、弦、迟。其方组成为:桃仁 4g、大黄6g、土鳖虫 10g。
下淤血汤原来并未用于治疗狂犬病,而是近代的扩展应用。已故名医叶橘泉曾指出:本方(下瘀血汤)也治被疯狗咬伤之狂犬病(恐水症)的特效验方,临床不用丸而用散,方以桃仁、大黄各三钱(11克),土鳖虫7只,共研末,加蜜三钱(11 克),老酒一杯,水煎,连渣服用不拘剂数,小儿减半,孕妇不忌,初服大便泄下如鱼汤猪肝状,小便如苏木汁,药力尽则大小便正常,仍须继续服之,要以大小便清楚无恶物为度,不可中止,恐余毒为患,以至复发。如果非疯狗所咬,则大便仅见溏泄而已。
我认为狂犬症实为毒入血分,瘀血蓄热之症,排瘀下血乃为上乘治法,下淤血汤正和病机,是为顺治攻下法。
各位看官若不信,再提供一则狂犬病医案:黄道六医案:1956年8月,余在某某县人民医院搞中医药治疗“乙脑”试点,该县某区转来一狂犬病人,不能见水,喝水时要用毛巾遮目,方可饮下,病情十分严重,院领导召集全院医务人员会议,并邀余参加,讨论治疗方案。西医称狂犬疫苗早已用过,效果不显,别无良法。征询余之意见,爰书《金匮》下瘀血汤方,嘱即配服。翌日晨,果下恶物甚多,怕水尚未尽除,嘱继续配服原方,恶物下尽,病亦霍然。下瘀血汤配制和服用方法如下。处方:生大黄9克,桃仁7粒(去皮尖),地鳖虫7只(活去足,酒醉死)。
配制和服法:上3味共研细末,加白蜜9克,陈酒1碗,煎至七分,连滓服之。如不能饮酒者,用水对和,小儿减半,孕妇不忌。空腹服此药后,别设粪桶1只,以验大小便,大便必有恶物如鱼肠猪肝色者,小便如苏木汁者,如此数次后,大小便如常。不拘剂数,要服至大小便无恶物为度,不可中止,如留有余毒,则有再发之虞。如服后大小便正常而无恶物者,非狂犬病也。愈后不禁忌。余用本方治疗狂犬病多例,屡试屡验。(江苏医药·中医分册1979;(2):41)
值得感慨的是,现代西医多认为狂犬症为不治之症,仅能依靠疫苗预防,大大小小的医院也拿来当成赚钱门道,一针狂犬疫苗要将近1000元。却不知张仲景在1800年前已提供了解决方案,上述例子中,治好那狂犬病的方子仅需花区区几元钱,孰是孰非,相信各位看官已心中了然。
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경방에 대한 펑스룬 교수의 견해
冯世纶教授伤寒临床纲要(1)传道解惑话经方—访冯世纶教授
传道解惑话经方——访冯世纶教授
黄 波 南京中医药大学
冯世伦教授是我国著名的伤寒学者和经方临床家,先后师承董建华、赵绍琴、胡希恕等著名老中医。冯先生教学、临床近半个世纪,专注于经方研究,整理总结了经方大师胡希恕先生对经方的研究成果,并考证了经方的理论体系,著作颇丰,为中医界所敬仰。
2006 年12 月,应南京中医药大学文献研究所“中医药文献在我心中”活动的邀请,冯世伦教授来作了两场精彩的报告。晚上报告结束后,我们有幸到冯教授下榻的宾馆拜访,冯教授娓娓而谈,启迪后学,对众多学生一个又一个的问题阐发观点,或分析、或引据、或举例,生动形象地解开了我们在读张仲景医学时遇到的诸多疑问。
冯世纶简介
冯世纶,1965年毕业于北京中医药大学中医系,当年被分配于北京中医药大学东直门医院工作,最初受教于董建华、赵绍琴、张志纯老师,半年后师承于胡希恕老师,业余时间听取讲授《伤寒论》,对胡希恕老师以八纲释六经,不以脏腑经络讲《伤寒》有所了解。1966 至1967 年到延庆巡回医疗,用经方得心应手,体悟到经方的优越性。70 年代担负中医内科教学、实习、编写教材中、及担负防治气管炎、痹症科研中,亦常试用经方。70代末期至80年代初期再次听取胡希恕老师讲授《伤寒论》,并录音、整理资料力争出版,但只是争得了部分临床经验刊出。1983 年调任至卫生部中日友好医院工作,更重视经方考证,撰写了《伤寒论》溯源、《伤寒论》与《马王堆汉墓帛书》和《内经》等论文。1991年在香港出席中日学术会议讲“五苓散的临床应用”,受到国内外好评。1994年几经努力主编的《经方传真》终于有中国中医药出版社出版。并于1997 年主编出版了《古今养生法500 种》。1998~2000 年曾赴瑞士巴登中医治疗中心工作,其间再次整理胡希恕先生对《伤寒论》和《金匮要略》全文的研究,为《中国汤液经方》一书的出版做好了充沛准备工作。2001 年应中医管理局之约,主编出版了《百年百名中医临床家胡希恕》;2004 年出版了《张仲景用方解析》;2005年倡导学经方要学《伤寒论》原文,并在北京中道堂讲授《伤寒论》原文。该年终于出版了《中国汤液经方》;2006 年出版了《解读张仲景医学》;2006 年6 月应宁波中医学会邀请、2006年12月应南京中医药大学邀请讲授经方研究经验,受到中医界关注,爱好经方者开辟网站,传承、探讨胡希恕先生学术观点。2007年出版了《胡希恕讲伤寒杂病论》,胡希恕先生学术思想得到较全面传承。
有是证,用是方
冯世伦教授认为《伤寒论》是症状反应学。方证就是用某方的症状综合群,如桂枝汤的方证是“发热、汗出、恶风、脉浮缓”等,如果患者于某时某地反应出此方证,为用方提供了上述合适的依据时均可使用桂枝汤治疗。这种以方名证的形成,是古人长期医疗经验的总结,是经方发展的特点,也是构成《伤寒杂病论》的主要内容和理论体系的特点。经方方证即为人体患病后常见症状的规律反应。
辨方证是一种朴素的、对应性很强的、凝聚了古人几千年临床经验的辨证方法,有规律可寻,具有可操作性。凡是疾病表现与原文相符,即可用原文所提之方治疗,这种通过选择、辨别然后确认,以期找到适于病情之方的过程,称为辨方证。此谓“有是证,用是方”。
少阴病为表阴证
“先辨六经,继辨方证”,冯教授将伤寒六经病以阴阳和表里分为表阳证(太阳病)、表阴证(少阴病)、里阳证(阳明病)、里阴证(太阴病)、半表半里阳证(少阳病)和半表半里阴证(厥阴病)。“少阴病之为病,脉微细,但欲寐也”为少阴病提纲证。少阴病以八纲解当为表阴证,与太阳病之表阳证相对应,此为邪在表而呈虚寒一类的证候。并将《伤寒论》第7条“病有发热恶寒者,发于阳也;无热恶寒者,发于阴也”视为少阴病的辅助提纲证,将“无热恶寒”作为少阴病“脉微细,但欲寐”的补充。
单纯少阴病之“脉微细”是相对于太阳病脉浮或紧或缓而言,纯少阴病之“脉微细”时亦当为浮,然而少阴病因气血俱衰,故而脉虽浮但微细,治疗时以发汗然不能太过,同时必须配以附子甘草等温性亢奋、强壮之品。而麻黄附子细辛汤之“脉沉”者,当为少阴合并痰饮之证,或素有痰饮者出现表邪为水饮所郁而化热的少阴证,故在微发汗的同时加强壮之附子,温化痰饮之细辛。以此亦可理解桂枝加附子汤、桂枝去芍药加附子汤、桂枝去芍药加麻黄附子细辛汤等为少阴病范畴。
“专病专方”不可取
对于专病用专方治疗方法,冯教授的态度是否定的。他说,疾病本身并非一成不变,每种疾病都有其自身发生发展的规律,不同阶段证是需要辨别的,即便是疾病各个阶段的症状相对稳定,人亦有不同,则用方不可能完全相同。以专方治疗专病违背中医学规律,将贻害无穷。冯教授曾亲眼见过曾有医生治疗咳喘病患者,病人已出现心功能不全,汗多脉促,无麻黄证而仍用麻黄剂治疗后惨死的悲剧,也曾见过陈慎吾老母肺炎出现可下之证时胡希恕先生用泻下剂而愈的事实。冯教授认为医者当根据不同的症状来辨六经、辨方证,及时调整处方,“观其脉证,知犯何逆,随证治之”。对于某些学术会议只知道介绍某张秘方治疗什么病,而对于《伤寒论》则知之甚少,对伤寒论学说的临床地位和作用不能认识的现象,冯教授感到遗憾。
腹诊虽客观,辨证需全面
腹诊并非日本人独创。冯教授说腹诊属于中医切诊的一部分,其重要作用历代大家均有认识。《伤寒论》中就有“心下急”、“心下痞”等,张仲景用词十分讲究,此何以知“急”知“痞”?通过腹诊。腹诊能直接、迅速、客观地反映人的生理病理变化,具有独特的临床价值。日本人特别重视和强调腹诊,这确是事实。腹诊对于某些方证的把握的确有效,但并非每方必有腹诊,更非单凭腹诊而处方。冯教授举例说,日本医家将八味丸的“少腹不仁”的腹诊描述为耻骨上至脐有铅笔芯样感觉,此形象而容易把握。但将沿肋弓往下按出现的不适感称为胸胁苦满征,并且将其分为3级,据此用不同的柴胡类方,就有不妥。殊不知,沿肋弓往下按的不适感并非柴胡剂存在,其中亦有用大小陷胸汤的可能,另外胸胁苦满很多情况下还包括患者的主观感受在内,并非完全是客观指征。冯教授认为经方辨证重要的是讲求综合的症状反应,要靠整体的判断,对于腹诊的价值不能夸大。
六经辨证的扩展运用
冯教授认为张仲景六经辨证体系是一个开放的体系,后世的一些良方,总的来说没有离开仲景六经辨证的范畴,所以对于一些后世良方也可纳入伤寒六经辨证的范畴中。如补中益气汤属于少阳病(半表半里的阳证)方,其中的柴胡甘草可证,同时升麻乃苦寒之品,有发散疮疡、清热解毒之功效,与小柴胡汤中的黄芩有相似之处,因出现乏力消瘦等虚弱症,故方中用人参、黄芪、当归、白术以益气养血,入陈皮以防虚不受补。另有后世王清任名方血府逐瘀汤,此亦为王氏据仲景之意而制,乃治疗气滞伴有血瘀之证。
短暂的访谈,我们感受到了冯老对中医学经方事业的热爱,感受到了他那经方家的谦逊和朴实,更感受到了他对后辈的关爱和所寄予的殷切希望。
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