2018년 4월 19일 목요일

특검으로 가지 않는 이상, 드루킹 사건은 경찰과 검찰에 의해 축소, 왜곡되어 두루뭉실해질 것이다.
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네이버의 기사 바꿔치기.


드루킹 민주당댓글부대의 댓글조작에만 집중되어서
간과하기 쉬운 데
댓글 공감 비공감 조작만 여론조작이 아니다.


어찌보면 이보다 더 큰 심각한 여론조작이
 네이버의 정부에 비우호적인 댓글여론이 많을 경우
자행되는 기사 바꿔치기다.
이건 그동안 끊임없이 네티즌들에의해
문제제기가 되어 왔다.
가령 어떤 사건에 대해 같은 유형의 기사가 여러 언론에 의해 수없이 양산되는 데 예를 들어 그 중 댓글이 하나도 없는  뉴스1 기사 메인에 배치했다고보자.메인에 뜨면 네티즌들이 그 기사에 몰려들기 시작한다.
이 경우 초기 댓글 여론형성이 민주당이나 문재인정권에 우호적인 댓글보다는 비판적인 댓글들이 많이 형성될라하면 그 기사를 내리고 비슷한  유형의 다른 기사로  갈아치우는 행태를 수도 없이 보여왔다.


문재인 정권에 유리한 기사 배치도 모자라 우호적인 댓글이 많이 달린 기사는 오래 노출시키고 비판하는 댓글이 우위에서면 수시로 다른 기사로 바꿔치기해서 여론을 차단ㆍ유도해 댓글공작을 사실상 네이버가 조장한다고해도 과언이 아닌 것이다.


야당 국회의원들은 이번 기회를 빌어 단순히 나무만 보지말고 숲을 봐서 포털이 자행한 여론조작의혹에 대해 그 실태와
총체적인 문제점을 국민들에게 고발해줬으면 좋겠다.이


네이버의 이런 정치적 편향적인 구태와 악습이 근절되지않으면
앞으로도 제2  제3의 드루킹이 계속해서 활개치고 다닐 것이다.

[출처] 특검이 반드시 전면수사 들어가야 할 부분.
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<전희경 의원>
온 나라를
카톨릭으로 일색화 하겠다면서 유대인 상인들을 탄압하는 바람에 유능한 상공인들을
다른 나라로 떠나게 만든
스페인 펠리페 2세의 얘기를 들으면서
'어리석은 지도자'라고 생각했다.
20세기 초
세계에서
다섯 손가락 안에 들어가는
부자 나라였던 아르헨티나가 페론의 포퓰리즘으로
나라를 말아먹은 얘기에
‘바보 같은 국민’이라고 생각했다.
일본이
1930년대에 1류 국가였던
미국-영국과의 동맹을 깨고,
2류 국가였던
독일-이탈리아와
손을 잡은 역사를 보면서
‘멍청한 놈들’이라고 생각했다.
자기에게 정치적으로 도전할까봐 유능한 장군들을 학살했다가 독일군의 침공과
자기 군대의 궤멸을 자초한
소련 스탈린의 얘기를 읽으면서 '어처구니 없는 지도자'라고 생각했다.
월남에서
대통령 비서실장이
월맹의 간첩이었다는
얘기를 들으면서
‘망해도 싼 놈들’이라고 생각했다.
문화 대혁명 한답시고
홍위병들을 앞세워서
10년 동안 나라를 피바다로 만든 중공의 경우를 보면서
‘천하의 얼간이들’이라고 생각했다.
경제력이 받쳐주지도 못하는데 선진국 수준의 복지를 따라하고, 개도 소도 공무원 시켜주다가 빚더미에 올라앉은
그리스를 보면서
‘병신 중의 상병신’이라고 생각했다.
교만한 생각이었다.
지금
대한민국에서는 
그 모든 일들이
한꺼번에 벌어지고 있는것 같아서
참으로 안타깝다.

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【서울=뉴시스】정윤아 홍지은 기자 = 홍준표 자유한국당 대표는 이르면 금주 말에서 늦어도 내주 초 기자간담회를 열고 여론조사기관인 한국 갤럽의 편향성에 대한 문제점을 조목조목 지적한다는 계획이다. 

 홍 대표는 이번 간담회에서 여론조사기관의 표본 선정 방식 등과 관련 응답자 편향성 등에 대해 지적할 계획이다. 아울러 한국 갤럽에 대한 미국 갤럽의 입장도 소개한다. 

 한편 홍 대표는 포털 다음과 네이버와 관련한 여론 조작 실체 고발도 내주 안으로 진행할 것으로 알려졌다. 
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리서치뷰 대표이사 안일원은


1. 노무현 정부 청와대 행정관
2. 술퍼먹고 택시기사 갑질 폭행으로 사퇴
3. 과거 여론조사 더민주당 유리하게 조작해서 걸린적 있음

그리고 리서치뷰는 조사기관이라기 보다는 정치인들 광고기획해주는 컨설팅회사다
한마디로 광고비받고 광고해주는 업체다

[출처] 문재인 지지율 70%조사기관인 리서치뷰 정체다
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빙하기와 온난기를 포함하는 거대한 기후 변화 기간에도 거대 포유동물들은 살아남았다.
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상한론 경방에서 깨달은 것들
 
毛进军学用伤寒论经方的感悟
 
经方的是六经方证辨治法则
 
我注意到咱们师承班的创建有这么一个愿景三年期满皆能行道救人
这句话说的很好是一个充满自信心的祈望
行道道是什么
素问·阴阳应象大论中有句名言阴阳者天地之道也……老子的道德经中有个非常具有哲理性的句子道可道非常道这个的意义就是道理法则和规律
我们经方的道就是伤寒论的六经方证辨证施治的大法和总规律
我们能在这里共同学习研究和探讨这个经方的首先要感谢经方大师胡希恕先生创立的伤寒方证辨证学说
胡老的学说明白易懂崇尚实效而无一丝浮华将六经思辨步步落实在方证上辨证识机方证相应药症相对形成了一套完整而独特的六经方证辨证施治体系这个体系大道至简疗效彰明可操作性强真正是发皇了伤寒经方济世救人的古义
还要感谢胡希恕先生的学术继承人著名经方医家冯世纶教授的无私奉献
冯老不遗余力地传授弘扬和创新胡希恕先生的学术思想使得胡老的学术思想和经验不被湮灭真正是造福于世功莫大焉
三年学成而行道救人这个愿望是好的但时间是非常紧迫的也注定不会是一帆风顺的
我们不能光是说说而已重要的是要下真功夫
唐代文人吕岩有句诗莫言大道人难得只是功夫不到头这句话说的很实在这就是说不要说高深的道理和学问不易学到手, 只是你下的功夫还不到家罢了
说到这个吕岩他的名字可能大家都不太清楚而说到中国的神话传说八仙过海大家可能就人人皆知了这个吕岩就是吕洞宾吕洞宾一生博学多才乐善好施扶危济困苦心修道有成后下山云游四方广为百姓解除病痛深得百姓敬仰百姓认为他有神仙手眼奉他为八仙之一
我们读伤寒论》,学习应用仲景经方也要有这种苦心修道的精神有坚忍不拔的意志即使达不到这个神仙手眼的功夫最起码也能成为一个明白医
 
多读或熟背打好基本功
大家不要以为伤寒论高不可及只能仰望而很难企及实际上这部经典是非常朴素的临床治疗术
虽然唐代医家孙思邈在备急千金要方·大医精诚中曾说经方之难精由来尚矣但我们只要怀着一颗先发大慈恻隐之心誓愿普救含灵之苦的决心和信心利用一切业余时间勤学苦钻拜师多思考多临证就一定能够得以掌握经方这个道能够登堂入室
怎么学呢
我认为对于伤寒论》,我们首先要下苦功夫背诵条文所谓书读百遍其义自现就是这个意思只有多读多背诵才能理解其意顿悟其理
背诵伤寒条文或重点条文实际上就是练基本功
我们对一个病望闻问切后要进行辩证施治这个辨证和这个施治具体应用什么方子必须得有理论依据来支持而这个理论依据就得从伤寒论中去找因此没有对伤寒论经方方证理解和记忆的基本功是不行的这就如同我们做数学题物理题等最基本的公式和定理必须熟记并理解了才能知道如何入手去解析
常言道熟读唐诗三百首不会吟诗也会吟清乾隆蘅塘退土孙洙·唐诗三百首·》),这就是说通过熟背可以将诗文中精华融入到自己的脑海中化为自己的知识这样一来作诗写文章就可以张口就来挥笔成章这就是扎实基本功的魅力我们学习伤寒论》,也要先打好这个扎实的基本功
然后主要结合胡希恕先生的学术思想来理解条文的内涵因为我们这个师承班主要是学习伤寒论方证辨证的那么胡老的学说就是这个辨治体系的范本
刚才已经说了方证辨证是一个大道至简可操作性很强的学说所谓大道至简就是这个学说是比较透彻地贯通了伤寒论的辨治实质将其基本原理方法和规律用一个极其简明扼要的方法予以阐释和应用非常切合临床实用
大家知道大凡武林高手在搏击时总能一招制敌绝对不会大战几十甚至数百回合才击倒对手经方高手呢也是总能见病知源审证识机明辨方证药到病除
这个大道至简的实际上是浓缩了伤寒论高深道理和辨治实质的正所谓真传一句话假传万卷书如果掌握了这种方法正如冯老师所说的那样人人可入仲景门
冯世纶老师在教学中对胡老学术思想的阐释不仅有继承而且有创新我们一定要深入进去边学习边思考
多做临床多总结
伤寒论条文的意义有一个比较明晰的认识之后最重要的是多做临床紧密结合临床实践在学习中临证临证中学习对所学内容在临床上多总结做到触类旁通举一反三不人云亦云从而形成自己的独到见解这才是真正的学习继承和弘扬伤寒经方
我们都是临床医生在学习中必须要结合所学多做临床反复实践多体悟多总结不仅会用还要活用努力达到融汇贯通圆机活法的境界法到活时用即灵学到深时方通神
经方的组成比较简单但临床效果很好一般没有经常使用经方辨治的医生是没有这个体会的
过去我在临床上对一些常见的病证多是应用时方多按照教科书上的分型来辨治有些病证自觉辨证没错选方也比较贴切但是临床疗效并不是太好这使我感到非常困惑难道中医治病就是不如西药吗
对于伤寒论金匮要略我也都学过甚至考试的成绩还比较好不过那基本上都是为了应付考试而学的考完之后就万事大吉了束之高阁了
虽然老师在讲课时也大都强调这个伤寒论金匮要略在临床上的重要性但多是从理论到理论地解读并没有多少在临床上实际应用的具体阐释所以学的不深入不扎实只知其然而不知所以然最终只是机械地背诵重点条文以应考并没有更深层次地理解这些条文的重要临床意义即使是毕业了也还不会在临床上用这些经方治病
 
 
我最初对经方重要性的认识是从一次治疗重感冒而引起的
有一次一位重感冒的病人46感冒已经3天了症状表现为浑身冷得直发抖体温39以上自诉头痛如箍着了一般全身筋骨关节也都是疼痛难忍鼻塞流涕咽痛咳嗽无汗心烦异常体温愈高心烦不安愈重口渴喜热饮舌苔薄白脉浮紧数连续肌注了2次退热针剂热退后不久旋即又起诸症仍然不减轻西药没有多大效果想服用中药治疗我辨证后认为是风寒感冒就给他开了一剂荆防败毒散作汤剂加味患者服用后症状也是基本上没有多少减轻病人更是心情烦乱
我也有些着急思考良久忽然想起大青龙汤证条文太阳中风脉浮紧发热恶寒身疼痛不汗出而烦躁者大青龙汤主之心中一亮这个病不就是这个大青龙汤证嘛但我还从来没有用过这个大青龙汤特别是怕这个方中有麻黄会不会服了更加心烦呢抱着试试看的态度给开了一剂大青龙汤原方方中麻黄只用了9
本来要求患者一剂药分二次服用但病人心急煎好的二汁一次就服完了没想到病人头天晚上服药后睡了一个好觉第二天病证就豁然而愈了
从此之后我就开始注意在临床上应用伤寒经方了但这时的经方应用基本上都是按图索骥根据条文所说机械地对号入座辨证还不是太确切临床虽然是得失参半但对一些病证的疗效也多是比应用时方好的
我对经方临证逐渐有了浓厚的兴趣和信心并重新复习并记诵伤寒论条文
为了摸索经方的应用规律我读过古今一些有关伤寒论注释研究的相关书籍也曾对学习过中医运气学中的标本中气气化理论和开合枢理论在伤寒论六经中的应用但可能是学习的不深入没有把握住这些理论的要领的缘故总觉得在临床上遇见比较复杂的病证时很难将这些理论应用于六经辨证中去
可能是机缘成熟了吧自从得以接触到了胡希恕先生独特的方证辨证体系学术观点之后顿感耳目一新这种注重实效地解读伤寒论方证内涵直接将经方作用于病证靶点的辨治方法使我对六经辨证有了一个全新的理念真感觉到是找到了一把活用经方的金钥匙
我悟出了不论人体疾病有多少种不论病证如何千变万化最终也不会越出三阴三阳的表半表里的病位半寒热的病性半虚实的病势
在这些理论的框架下定位定性思辨简洁精确方证相应的确可以做到出手即效
此后我将胡老的学术思想体系应用于临证实践中边学边悟边临证实践感到中医辨治真正是进入了一个全新的境界和层次疗效的确迅速提升
古人说至道不繁其实有时候复杂深奥的理论最终的深意是简洁明了的简单的才是最好的
实际上我们遣方用药也是这样经方药味虽然简单大多只是三到七味一般不超过十二味但是经方组方法度谨严药简效宏
而现在的不少中医喜欢开大方动辄十七八味三十味认为是韩信用兵多多益善实际上你如果没有韩信之才如此点兵就是多多易乱
也就是说你如果不明白伤寒经方的用药法度处方遣药时心中没底见一个症状就加一味药头痛加点医头的药脚痛加点儿治脚的药甚至用西医的思路来开中药见细菌或病毒感染就清热解毒见血压升高就平肝潜阳等等处方成了药物的堆砌方无章法药无定见君臣不分佐使不明杂药乱投想大撒网一般面面俱到却一面也顾不到这样的疗效就只能靠碰运气了
伤寒论方证辨证理论虽然明白易懂容易入门但真正地做到融会贯通圆机活法应用也不会是一帆风顺一蹴而就的是要有不畏困难的毅力和意志力去学去钻研的
北宋诗人苏东坡说古之成大事者不惟有超世之才亦有坚忍不拔之志
我认为我们学习经典经方能否有所成就就在于我们能否做到坚持不懈是否做到面对再大的困难也能坚持下去不言放弃
这个不言放弃就是在于要有一个坚忍不拔的意志力切不可学着学着理论深入了难懂了便产生畏难情绪了坚持不下去了如果这样是难以成功的
英国首相丘吉尔1948年在牛津大学演讲时谈到他的成功秘诀时说道总结一生我送你们三句话第一句决不放弃第二句是决不决不放弃第三句是决不决不决不放弃
这个决不放弃就是一种自信心只有决不放弃博学之审问之慎思之明辨之笃行之(《礼记》),才能最终得到经方的真谛
开场白就先说这么多吧
这也是前一段有学员问我有没有学习伤寒论》,伤寒经方应用于临床的好方法上面这些话就权当是回答吧
 
经方辨治要诀
俗话说不读张仲景辨证无要领不读伤寒论下手没分寸不读本草经用药总不应作者在长期的临证实践中总结了活用经方的要诀明辨六经顾及兼证重视两本方证对应据机合方药参神农
 
 
1节明辨六经
六经实则六大类病
太阳病——表阳证阳明病——里阳证少阳病——半表半里阳证
少阴病——表阴证太阴病——里阴证厥阴病——半表半里阴证
证是对疾病过程中所处一定阶段的病位病因病性以及病势等所作的病理性概括临床辨证时遇见一个病不论其多么错综复杂要明确阴阳辨证(病证类别)表里辨证(病位)寒热辨证(病性) 虚实辨证(邪正盛衰病性)
 
首先要明辨六经阴阳属性辨清属于六经中哪一经的病证或哪几经合病并病确定病位病证的部位),即确定病变现阶段证候所在的位置如六经辨证中的太阳阳明少阳太阴少阴厥阴在表在里或在半表半里
 
然后分辨病性病证的性质),即区分基本病性阴阳盛衰所表现的寒实病性为主具体病性湿毒及气血津液与精髓等的盈亏等以及辨病势(病证的演变趋势发展缓急)病证的病势以表里病位)、热寒病性)、实虚病势分类然后据证选方用药实际上临床所见病症复杂合病并病较多故使用合方的机会也较多
 
 
辨治举例
侯某某32脓血便52009-8-5初诊5天前患者因前一天晚上食用剩肉菜于第二天凌晨开始发热T38.9℃)腹痛腹泻继之小腹下坠肛门灼热便脓血一日数十次服用不少治疗菌痢的药物并输液2发热退便次稍减但仍然腹痛里急后重脓血便非常痛苦
 
诊见精神差每半小时一次少许脓血便腹痛里急后重口苦口干口渴欲饮小便黄舌红苔黄腻脉弦细数
六经方证辨析从六经辨析患者有口苦口干苔黄腻脉弦细之脉证故辨为少阳郁热兼湿滞又有肛门灼热便脓血口渴欲饮小便黄舌红舌红苔黄腻脉数之脉证辨为为阳明热毒内积
四诊合参六经辨证为少阳阳明合病挟湿热邪毒积滞病位属于阳证少阳阳明),病性属于实证湿热毒邪病势属于急证
方拟白头翁汤合黄芩汤化裁白头翁白芍各30g黄柏黄芩秦皮炙甘草各15g黄连12g大枣7掰开)。33剂共煎取1200ml4小时服200ml连续进服
二诊药后便次明显减少肛门灼热及里急后重明显减轻仍有轻度腹痛下坠感效不更方原方加木香15g续进3痊愈
患者饮食不洁而湿热毒邪入于少阳内迫阳明热毒内蕴气血被阻传导失司湿热毒邪郁遏不解损伤肠道脉络化腐成脓而致诸症病机关键在于湿热毒邪内迫气滞壅塞治之宜清热解毒调气行血故以白头翁汤清热解毒燥湿止利合以黄芩汤清热止利和中缓急一诊因病重瞩患者连服疗效明显患者谓比输液效果强多了二诊加木香,《神农本草经谓其主邪气辟毒疫能通行肠胃气滞以导三焦气壅与方中黄连暗合太平惠民和剂局方之香连丸调气清热以加强治疗下痢赤白脓血相杂里急后重之力该方药味较苦须向患者讲清宜中病即止不可常服
 
 
2节顾及兼证
人之病症是复杂多变的辨六经辨方证还要注意顾及病证所挟杂的兼症在病变过程中湿痞这八个兼证是非常普遍的湿痞既是发病因素又是病理产物
经方大师胡希恕有一篇论食水瘀血致病冯世伦主编胡希恕讲伤寒杂病论》)谈到了食毒水毒瘀血可致疾病认为瘀血三者均属人体的自身中毒为发病的根本原因胡老认为凡病的发作盖由于患者的机体隐伏有食水瘀血的自中毒
受此启发我在临床上总结出了水湿痞八证理念活用经方可在治疗主证的同时顾及兼症通盘考虑全面调治
 
1.湿
伤寒论的六经辨证中水与三阴关系极大三阴证以虚寒为主虚寒则水饮易于内停故三阴病水饮多见
 
辨治举例
咳嗽慢性阻塞性肺病
银某某81剧烈咳嗽咳痰伴咳而遗尿10余天加重42006-11-21初诊
有慢性支气管炎史20余年每遇寒冷吸入凉气便咳嗽咳痰10余天前因患感冒咳嗽咳痰曾在一诊所用了头孢曲松加地塞米松针输液5病情不仅不减轻而且更加严重咳嗽频繁咳大量白色痰每咳时便遗出尿来5天来咳嗽咳痰加剧夜间尤甚无法入眠求治
 
诊见精神萎靡阵咳不断剧烈时上气不接下气咳白色痰剧咳时遗尿畏冷乏力困倦思睡无汗口不渴不苦不干面暗唇青舌淡暗舌体胖大边有齿痕苔白滑润脉沉细
六经方证辨析咳嗽咳白色痰畏冷无汗为太阳伤寒表不解寒饮内伏
精神萎靡乏力困倦思睡纳差面暗唇青舌暗舌淡舌体胖大边有齿痕苔白滑润脉沉细为太阴少阴虚寒兼痰饮
咳时遗尿为膀胱咳乃中下焦阳虚水停膀胱失约
四诊合参辨证为太阳太阴少阴虚寒兼痰饮阻肺阳虚水停治宜温阳化饮通阳利水方拟四逆汤小青龙汤合茯苓甘草汤加减炮附子先煎1h)、干姜炙甘草茯苓生姜30g桂枝半夏白芍五味子各15g麻黄细辛各12g31水煎分3次服
二诊药后精神好转诉服1剂后当夜咳嗽咳痰次数已明显减少3剂服完咳而遗溺症状基本消失仍乏力倦怠又加炮附子先煎1.5h45g嘱再服3
该案患者久病年高感寒即入于太少二阴致使阳虚寒盛水饮内停治之关键在于扶阳温化水饮故以四逆汤温扶太少二阴之阳以小青龙汤解表蠲饮以茯苓甘草汤温阳行水治咳则遗尿元代医家王好古在此事难知中用茯苓甘草汤通阳利水治膀胱咳效佳
 
 
2瘀血
伤寒论》、《金匮要略治疗瘀血的有几个非常有效的并适用范围很广的方剂抵挡汤桃核承气汤桂枝茯苓丸当归芍药散这是经常用到的有效方剂
 
抵挡汤
本人对于心脑血管病患者特别是脑梗塞后遗症患者凡有较重瘀血见证者常合用抵挡汤其中的虻虫多是以当归红花代替疗效较好
 
桃核承气汤
桃核承气汤由桃仁桂枝大黄芒硝炙甘草五味药组成方中桃仁活血化瘀以破蓄血,《神农本草经谓桃仁下瘀血血闭,……破症瘕积聚桂枝辛温辛散血结温通经脉用在本方不是解表而在于理气通阳通阳可行阴血理气能助血行因为活血化瘀理气为要气机活泼则血行畅达再者在大量寒凉药中加如桂枝一味辛温之品可增强桃仁大黄芒硝的功用大黄苦寒既能清泻热邪又能去瘀生新破积滞芒硝咸寒软坚散结功能泻热破结大黄虽可祛瘀生新但力尚不足故加滑利之桃仁与大黄协同清热逐瘀之疗效更佳炙甘草既能护胃安中又能缓诸药峻烈之性
本汤证的病机为瘀热互结于下焦证候特点为少腹急结神识异常小便自利脉见沉涩这是蓄血证辨证的四大依据
使用本方要点
1.芒硝用量可活用如血瘀而无热象大便通畅者可以少用或不用
 
2.桂枝在本方中必不可少因为桃仁破血而行桂枝行血不破桂枝桃仁两药配伍对活血化瘀起着重要作用
 
3. 空腹服用因为本证病位在下焦先服药后再进食有利于药达病所
 
古人服药经验
 
其一病在胸膈以上者先进食后服药病在心腹以下者先服药后进食
其二本方药力猛烈只可暂用不可久服孕妇及年老体弱者慎用
 
其三药后病人有轻度腹泻当微利也有少数病人有轻微腹痛反应一般停药即止毋需处理
综观全方虽为攻瘀逐血之剂但较抵当汤的作用和缓因而服后并不一定下瘀血而反取其通泄作用故方后自注当微利即是药后的效应
现代临床应用
脑血管意外精神分裂症脑外伤后遗症糖尿病肾功能不全高脂血症血瘀头痛头晕等
 
 
当归芍药散
我抓住肝血虚而血郁滞脾虚而湿停肝脾不和之病机而用于心脑血管病中收效良好
当归芍药散中芍药敛养肝血缓急止痛当归助芍药补养肝血川芎行血中之滞气川芎乃血中之气药治气血郁滞之证最适宜应用川芎川芎味辛气温归肝心包经功能活血行气祛风止痛能上行头目中开郁结下调经水既能活血化瘀又可行气通滞川芎一味最能达到王清任在医林改错中所谓之气通而不滞血活而不瘀气通血活何患不除的功效),三药共以调肝养血活血泽泻利湿降浊白术茯苓健脾益气除湿三药以治脾诸药合用肝血足则气得调达脾得健运肝脾两和气机调顺不仅原文所谓腹痛主证可除而且由肝脾失和所致之眩晕头身疼痛肢体麻木挛急浮肿小便不利等症均为所宜
当归芍药散运用之妙在于药量的调节血虚为主者白术茯苓泽泻三味水药量宜小血郁滞者当归芍药川芎三味血药量宜大湿盛浮肿者三味水药应重用
 
 
桂枝茯苓丸
桂枝茯苓丸出自金匮要略·妇人妊娠病脉证》:妇人宿有癥病经断未及三月而得漏下不止胎动在脐上者为癥痼害妊娠六月动者,前三月经水利时胎也下血者后断三月衃也所以血不止者其癥不去故也当下其癥桂枝茯苓丸主之是临床常用经方由桂枝茯苓丹皮桃仁芍药等5味药组成具有活血化瘀缓消癥块的功能其特点是祛邪以固本下瘀不伤正行水不伤阴阴阳兼顾气血并调对于病机与瘀血阻滞湿痰凝滞有关的病证皆可以本方化裁使用特别对于心脑病的治疗具有良好地消除痰瘀互结痹阻脉络即消除动脉粥样硬化斑块实际上动脉粥样硬化斑块与中医之癥结”“癥块的意义相近只不过癥结癥块是指腹内结块的病而动脉粥样硬化斑块是在血脉中结块的作用方中桂枝既可温通经脉以达活血通经之功又可通阳化气以显温化痰饮之效赤芍祛瘀止痛破坚散癥桃仁破血消癥丹皮为血中之气药入血分能行气滞祛瘀血有活而不留行而不峻的特点茯苓渗利下行而益心脾之气有助于行瘀血现代药理研究表明本方能明显降低全血比粘度全血还原比粘度血浆比粘度纤维蛋白原浓度增加红细胞电泳速度
我国近代著名的经方大师胡希恕教授临证最擅长应用桂枝茯苓丸当归芍药散这两个经方常常据证灵活加减与它方合用特别在辨治冠心病和脑病时更是将这两个方子活用到了炉火纯青的境界我通过研读胡老先生的学术理论和医案对桂枝茯苓丸和当归芍药散在心脑血管病的应用上也深有体会常常据证合以扶阳方药温通阳气以促通脉活血大大提升了这两个方子的养血活血健脾利湿当归芍药散),温通经脉化瘀消癥桂枝茯苓丸的功效
 
 
辨治举例
眩晕腔隙性脑梗塞
杨某某76退休工人头晕伴极度乏力1月余2007-9-22初诊
患者1月前曾因头晕语言不清伴乏力去市某医院诊为腔隙性脑梗塞住院治疗12出院后语言不清基本消失但仍有头晕头昏懵乏力且乏力渐加重每天不坐即躺躺也睡不着不想活动汗出多动辄甚服用不少治疗脑梗塞的中西药物基本无效求治诊见精神萎顿神志清楚头晕头昏懵伴极度乏力自汗纳差口干不欲饮水口不苦眠差二便调舌质紫暗舌体胖大苔白厚滑腻脉沉细弱
六经方证辨析精神萎顿头晕头昏懵乏力自汗纳差眠差脉沉弱为太阳表虚阴阳不和之证合太阴中气亏虚证
口干不欲饮水舌质紫暗舌体胖大苔白厚滑腻脉沉细为水饮内停兼瘀
四诊合参辨证为太阳太阴合病兼瘀血阻滞水饮上犯治宜调和阴阳去瘀化饮方拟黄芪建中汤合桂枝茯苓丸化裁黄芪桂枝茯苓党参炙甘草生姜各30g白芍赤芍各18g茯苓30g当归桃仁各15g山萸肉60g红枣7掰开)。51水煎分2次服
二诊头晕头昏懵明显减轻乏力自汗好转仍失眠上方加茯神30g继服5
三诊诸症明显好转已可外出活动但走不远就想歇息仍气力不够上方加黄芪量至45g又服5痊愈
该案年高慢性病久气血阴阳俱虚瘀血阻滞水饮内停而致诸症病机主在阴阳不和中气亏虚故以黄芪建中汤证补益中气调和阴阳合以桂枝茯苓丸以丸为汤剂活血化瘀温化水饮方中以当归代丹皮是用当归既能补血又能活血之功加山萸肉是取其温中(《本经》,既可补阳又可益阴且有涩精敛汗之功加党参主要在于加强补中益气之力
 
 
3.
伤寒论所论的痞证是临床上最常见的病证不仅可单独发病而更多见于一些急慢性病症的兼症中
痞证是患者的自觉症状自觉心下窒塞胀闷不舒但按之却柔软没有压痛其特点可以概括为外无形迹内无压痛自觉痞满不舒正如伤寒论149条所说但满而不痛者此为痞154条所说心下痞按之濡
痞证的部位为心下即胃脘部因胃脘居于心之下所以说痞的病变部位就是胃脘部但与肝脾密切相关中焦脾胃,《伤寒论154条所谓其脉关上浮也证实了痞证的病变在于中焦因为关脉候中焦
痞证的成因是因为误下伤寒论131条谓病发于阴而反下之因作痞也病发于阴是指胃气虚内无有形之痰水内结却被误下脾胃损伤寒热错杂于中焦升降失职所致而从临床实践来看痞证误下者并不太多见而因为多种因素如表邪入里所谓肠胃型感冒),饮食饥饱无常饮食不洁起居无常情志失调脾胃虚弱等所致之多见正如素问·太阴阳明论所谓饮食不节起居不时者阴受之,……入五脏则瞋满闭塞;《素问·异法方宜论脏寒生满痛实际上西医之急慢性胃炎功能性消化不良胃肠神经官能症胃下垂等疾病凡表现为上腹部满闷不舒者皆可按痞证辨治
痞证之病机总由气机痞塞心下所致即所谓但气痞耳151),即中焦气机阻滞升降失常
痞证类型主要谈谈五个泻心汤证根据其病邪性质的不同和临床表现之异主要分为以下2
 
1热痞
热痞分为三种其一是单纯的热痞证伤寒论154条云心下痞按之濡其脉关上浮者大黄黄连泻心汤主之此即无形邪热壅聚心下胃热气滞气机痞塞所致除具有心下痞按之濡的主症外必伴内热之象如寸关脉浮盛或浮数烦渴苔黄等
其二是热痞兼表证的治法伤寒论164条所谓伤寒大下后复发汗心下痞恶寒者表未解也不可攻痞当先解表表解乃可攻痞解表宜桂枝汤攻痞宜大黄黄连泻心汤此因表证误下汗下失序表邪化热内陷结于心下滞塞气机而为热痞在既有热又有表证的情况下应当先解表后治痞但也可以在解表的同时兼以除痞
其三是热痞兼表阳虚证伤寒论155条所谓心下痞而复恶寒汗出者附子泻心汤主之这一条方药由大黄黄连泻心汤加附子组成除具有大黄黄连泻心汤的典型热痞证之外又见恶寒汗出恶寒汗出没有头痛流清涕脉浮等表证所以不是表证而是表阳虚卫外不固病机乃胃热气滞卫阳不固
 
 
2寒热错杂痞证
脾胃升降失常寒热错杂中焦气机痞塞所致此包括三个泻心汤证半夏泻心汤证生姜泻心汤证和甘草泻心汤证这三个泻心汤证在证候上除皆有心下痞的主症外必有呕逆肠鸣下利的脾胃不和之症这是寒热错杂之痞证的显著临床特征而三者的病情偏重不同证候表现亦各有侧重
伤寒论149但满而不痛者的半夏泻心汤证之是由寒热之邪痞塞中焦脾胃升降失常所致半夏泻心汤证的突出特点是偏重于胃失和降胃气上逆呕逆症状一般较甚
伤寒论157胃中不和心下痞硬干噫食臭胁下有水气腹中雷鸣下利的生姜泻心汤证心下痞硬是按之腹肌有紧张感但按之不痛乃脾胃不和水饮食滞阻结于中焦气机痞塞较甚所致生姜泻心汤证偏重于胃虚不化水谷水食停滞故有干噫食臭的特有症状同时心下痞与肠鸣亦较半夏泻心汤证为甚
伤寒论158其人下利日数十行谷不化腹中雷鸣心下痞硬而满干呕心烦不得安的甘草泻心汤证此痞为脾胃虚弱水谷不化痞利俱甚所致甘草泻心汤证偏重于脾胃虚弱故其证以痞下利俱甚为显著特点因其中虚气逆较甚影响心神不安故还并见心烦不得安之症
 
 
痞证的治法和方药。《伤寒论创立的五个泻心汤一方代表一法法度谨严组方合理且煎法特殊不仅成为治痞名方而且可广泛运用于多种疾病中
大黄黄连泻心汤功效为泻热消痞以其轻扬之剂清宣无形邪热是治疗单纯热痞证之主方方用小量大黄以泻热和胃黄连黄芩清热诮痞妙在本方不用煎煮的方法不是取其荡实攻下之力而是以麻沸汤即开水浸泡少顷服用取其气轻味薄轻扬清淡以清泄心下之邪热本方不仅治热痞而且常用治胃热吐血之证,《金匮要略用治心气不足吐血衄血·唐容川用作胃热吐血之主剂并云泻心即是泻火泻火即是止血
附子泻心汤功效为泻热消痞扶阳固表以大温大热的附子与大苦大寒的大黄黄连黄芩相伍寒温并用补泻兼施为治疗热痞兼表阳虚之主方方用大黄黄连黄芩以麻沸汤即开水浸泡少顷取汁仍是取其气轻味薄轻扬清淡以清泄心下之邪热之功附子一味另煎取汁是取其辛热醇厚之性直入下焦以发挥其温阳扶阳的作用再将两汁混合2次温服二者寒热异气生熟异性寒热生熟并用邪正兼顾药虽同行但各司其职共奏泻热消痞扶阳固表之功
半夏泻心汤功效为和中降逆消痞以其寒温并用辛开苦降攻补兼施阴阳并调为治疗寒热错杂之痞的代表方方以半夏为君且以半夏名方故当偏重于和胃降逆止呕尤适用于寒热错杂之痞证中胃失和降胃气上逆较甚者在煎法上去滓再煎欲使其寒热之性融合为一体以共奏调和阴阳祛除寒热之功
生姜泻心汤功效为和胃降逆散水消痞本方与半夏泻心汤基本相同亦属辛开苦降甘调之法因本证胃虚实滞兼有水饮内停所以仍用半夏泻心汤辛开苦降散结消痞但减少干姜用量加生姜并重用为主药偏重于宣中温胃宣散水饮主用于寒热错杂之痞证中偏重胃虚不化水谷水食停滞者在煎法上仍如半夏泻心汤去滓再煎欲使其寒热之性融合为一体以共奏调和阴阳祛除寒热之功
甘草泻心汤功效为和胃补中消痞止利本方是半夏泻心汤加重炙甘草用量而成重用炙甘草并以此名方主要是取其甘温补中健脾和胃之力仍属辛开苦降法取半夏泻心汤以辛开苦降散结消痞重用炙甘草以补中虚适用于寒热错杂之痞证中偏重于胃气虚弱痞利俱甚者重在调补中气以消痞止利在煎法上仍如半夏泻心汤去滓再煎欲使其寒热之性融合为一体以共奏调和阴阳祛除寒热之功三方皆去滓再煎主要是取其药性和合而共奏和解之功
 
 
3辨治举例
胃痛胃炎胆囊炎
张某某43营业员阵发性胃脘部胀满疼痛1+月余2009-7-16初诊
患者平时饮食不规律经常发作胃脘部胀痛不适1月前患者因感冒发热后过食油腻便感到胃脘部胀满不适继之阵发性疼痛时轻时重伴烧灼嘈杂不适感阵阵嗳气严重时恶心呕吐如此反复发作不愈非常痛苦曾去市某医院查胃镜和B诊为慢性糜烂性胃炎胆囊炎服用多种药物效不明显求治诊见精神差面色苍白纳差口渴不欲饮口不苦不干二便调舌质淡红苔黄滑腻脉弦细
四诊合参辨证为太阴厥阴合病寒热错杂升降失常方拟半夏泻心汤合理中汤化裁法半夏白芍各30g党参干姜生姜各20g炙甘草炒白术黄芩各15g黄连6g红枣十枚掰开)。31水煎分3次服
二诊胃脘部胀满及烧灼嘈杂不适感减轻已不恶心呕吐仍有阵发性隐痛上方去生姜干姜加至30g加醋元胡30g继服3
三诊诸症明显好转精神转佳已有食欲二诊方又服6痊愈
该案患者脾胃素弱外感后又过食油腻难以消化中焦阳损胃气伤伐寒热互结气机阻滞升降失常而致诸症病机关键在于中焦虚弱升降失常寒热错杂治宜寒温并用和中降逆解痉消痞故以理中汤温运中阳以复中州之升降调和合以半夏泻心汤辛开苦降甘补寒温并用交通阴阳以调理中焦降逆消痞加白芍是与炙甘草合成芍药甘草汤意在解痉缓急止痛二诊加醋元胡是因其治心气小腹痛有神(《汤液本草》),意在加强行气止腹胀痛之力二方寒温并用既兼顾到了患者素体中焦虚寒之证又兼顾到了患者现发病之寒热错杂升降失司之证
 
口疮复发性口疮
邓某35口腔溃疡半月余2009-8-1初诊
患者有经常发作口腔溃疡史一般常因感冒劳累过度等而诱发半月前患者因加班疲劳过度而诱发口腔多处溃疡感到口腔内痛如火烧火燎无法进食夜间较重影响睡眠曾服用维生素及不少清热解毒泻火药无明显疗效非常痛苦诊见乏力心烦纳差右侧舌边下唇内侧及左侧颊粘膜处有4处溃疡纳差二便调舌暗红苔黄腻滑脉细
四诊合参辨证为厥阴少阴合病少阴虚寒湿郁化热寒热错杂阴火上僭甘草泻心汤合四逆汤化裁炙甘草30g炮附子先煎1h)、干姜法半夏各20g党参黄芩各15g黄连9g大枣7掰开)。3水煎服13次服
二诊1剂药服后当夜便不太疼痛了3剂药服完诸症明显减轻上方继服3诸症悉除
该案患者经常发作口腔溃疡也曾常服牛黄解毒片黄连上清丸等清实火之品这是当前治疗口疮复发性口疮的误区不少医生也是这么开药为患者服用的实是不明之举该案患者素体阳虚此次因过劳而发病既有少阴阳虚阴气上僭之证又有寒湿郁而化热湿热内壅胃气不和之证病机关键是寒热错杂阴火上僭治之宜寒温并用一方面温扶阳气引火归元另一方面清热燥湿和中解毒故方拟甘草泻心汤辛开苦降寒温并用补泻兼施主治湿热内壅胃气不和热毒蚀于口舌之证合以四逆汤温扶少阴之阳引火归元主治阴火上逆之证二方相合方证相应疗效很好
活用经方必须要重视经典原文但又不能生搬硬套而局限在原文上经方的加减要慎重要按伤寒论的原则加减所加药味要参照并合乎神农本草经对药物功用的论述药物的比例要合乎经方比例要多都多要少都少经方的合方主要应与经方相合但也可与时方相合经方不是少了而是应用无穷经方不仅应于经方合用也可以与唐宋以来的许多行之有效的时方合用
 
真传一句话假传万卷书
真传은 한 마디로 족하지만, 假传은 만권 서가 필요하다
현대의 가짜 서구의학은 수백만권의 책을 쌓아놓고 있지만, 한의학은 사실 상한론과 금궤요략, 황제내경, 본초경 등 몇 권만 통달하면, 질병의 90%를 치료할 수 있다.
(더구나 서구의학은 고가의 각종 장비, 기계와 역시 고가의 각종 약들을 개발하거나 개발된 약들을 이용해야 한다. 간단히 약초 몇 가지 끓여먹으면 되는 일을, 수십만원 또는 수백, 수천만원을 들여 하지만, 결과는 한의학보다 못하다.)
 
 한예슬이 의료사고를 당했다고 한다. 저게  서구의학의 본질이다.
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 러시아와 중국, 그리고 실크로드의 지정학
중구이 신 실크로드와 일대일로(一帶一路) 계획에 의해 중앙아시아와 중동으로 경제, 전략적 진출을 하고, 여기에 러시아가 가담하면서, 미국은 러시아를 견제하게 위해 제재를 가하고 있다.
 
Russia, China and the Geopolitics of the Silk Road
 
Marcia Christoff-Kurapovna
 
 
The most prominent feature of the geopolitics of Russia and the West pivots upon a relatively obscure feature of the geopolitics of Russia and China. The mainstream media in the U.S. has covered minimally and only rather incidentally the estimated $900 billion construction of a complex matrix of strategic transport routes known generally as the “New Silk Road” or the “Belt Road Initiative” (BRI) project initiated by Beijing in 2013. It is one of the largest infrastructure and investment mega-projects in history, covering more than 68 countries, equivalent to 65% of the world's population and 40% of the global GDP as of 2017.
 
The project has been the central factor in Moscow’s intensified relations with Beijing despite the fact that, at the outset, Russia hesitated out of concern over China’s territorial objectives. Since then the partnership has grown aggressively and has been a particular boon to Moscow’s sphere of influence. One of the immediate positive consequences for Russia has been for Eurasian countries and Iran to grow closer to that country, a development of potentially explosive repercussions vis-à-vis the West since energy geopolitics of the Caucasus have been a source of tension with both the EU and the U.S. But it is energy geopolitics that comprise the entire basis of the Russia question in the East-West endgame, with the Mideast the locus of rising tensions to come.
 
China’s current position is such that to date, “more than 90 percent” of container shipments from China to Europe are delivered by sea. Beijing’s plan is a plethora of diverse transit options through a network of transcontinental land routes; Central Asia and the Mideast obviously play a key role and all intersect with Moscow’s interests. China also wants access to the Arctic where one major part of the planned routes will be constructed as an addition to the continental corridor across Eurasia (and a planned Indo-Pacific maritime route). In fact, China has declared itself a “Near Artic state” and aims to build what it is calling a Polar Silk Road.
 
What’s more, this new Sino-Russian economic strategy, combined with China’s decision to back the yuan with gold as part of a larger Russia-China move to move off dependence of the petro-dollar, comes at a time when Beijing has recently introduced the “gold-backed petro-yuan”. One cannot underestimate the major shift in global energy markets that this could cause given that, among other factors, up until now any nation wanting to buy oil had to first buy dollars in order to pay for the trade. With the launch of the petro-yuan denominated oil futures contract on the Shanghai International Energy Exchange, the exchange will handle seven kinds of crude, particularly from the Middle East, including Iraq’s Basra Light, Dubai and Oman crude. This will create an Asian crude oil benchmark in pricing for the oil imported and consumed in Asia, the world’s top importing region.
 
The move is designed to give China more power in crude pricing as well as promote its currency as a bona fide global one. The timing here is interesting particularly in view of the fact China obviously has little fear of retribution by the United States.
 
Russia is ambitiously welcoming all of this. “Despite initial misgivings in Moscow, China’s penetration of Central Asia under the Silk Road banner has not, so far, done any substantial harm to Russian interests”, wrote Russian scholar Artyom Lukin in an article of February 8 in The Washington Post. China’s ambitions have, in fact, done quite the opposite
 
On November 9 of last year, Vladimir Putin and Nursultan Nazarbayev of Kazhakstan announced plans for one of the railway routes from China to Europe via the territories of Russia and Kazakhstan. In realizing this project, “the geopolitical and economic consequences will affect not only Kazakhstan and Uzbekistan, but also the other countries in and around the Central Asian region”, noted Lukin, a professor at the Far Eastern Federal University in Vladivostok. The Kremlin’s influence in Central Asia and the South Caucasus will only strengthen as a result of Russia’s domination of Eurasian land routes.
 
The benefits to Moscow could not come at a better time given the country’s economic position with the West over the past dozen years: the first ‘energy war’ with Europe over Ukraine’s 2006 Orange Revolution; the disruption of gas deliveries to the Continent in the wake of the civil war in Ukraine after 2014; competitive energy geopolitics in the Caucuses; sanctions and, as of this past weekend, new sanctions. The focus is not eastward and it works thus: Chinese cargos bound for Europe must cross Kazakhstan and then transit through the Russian railway network. Central Asian “stans”, nonetheless, are wary of China’s desire for a free-trade zone fearing that they will be essentially eaten alive. Populations in Central Asia, particularly in Kazakhstan and Kyrgyzstan, tend to be Sinophobic in a way “that by far exceed any resentment they might feel toward Russian imperialism”, writes Lukin, the scholar quoted above. In short, Central Asian nations are not going to abandon Russia in favor of China and they will need Moscow even more to hedge against Beijing’s ever-rising economic influence. All of this works to Russia’s great favor.
 
Then there is Iran, which for its part, is also major part of the Silk Road project. This features an approximately 2000 mile connection between Urumqi, the capital of China’s Western Xinjiang province, and Tehran, from which point that connection would join Iran’s network running through Turkey into Eastern Europe and then throughout the rest of Europe via developing rail routes from southern Iranian points to Azerbaijan. The route “will become a tailwind for transport of goods and energy between Iran and China, which have set a long-term bilateral trade target of $600 billion/year”, according to Iran’s English-language Financial Tribune. For Iran, the line is part of wider rail development plans stipulating the electrification of all railroads by 2025. The country is aware of its capacity regarding global transport and logistics: Iran, Russia and Turkey are regarded in the region as the carriers of Eurasia into the future.
 
It goes without saying that the energy sector is Russia’s number one economic priority. Energy revenues were key to the recovery of its economy and hence allowed for Moscow’s stance in the international sphere. Energy earnings “enabled the Russian state to pay back all Soviet and post-Soviet foreign debt, to enlarge the country’s stabilization fund and the currency reserves of the Central Bank of Russia and to maintain a non-deficit budget for many years”, according to one white paper of the University of Leeds (UK), which allowed for a certain independence on the world stage.
 
The loss of Ukraine, the second-largest post-Soviet economy, a market of about 44 million people, and with whom Moscow sought to create an economic bloc economically equal to the European Union. Precipitated the rush eastward. “Lacking a market of sufficient size to create its own viable geo-economic area, Russia was left with the only option of moving into another nation’s economic orbit”, writes Lukin. In 2015, Russia hesitatingly joined the China-controlled Asian Infrastructure Investment Bank, and the most decisive step came a few months later in May, when Xi and Russian President Vladimir Putin met in Moscow to pledge to work toward a “link-up” between Russia’s Eurasian Economic Union and the Silk Road Economic Belt.
 
U.S. actions and new sanctions against Russia are viewed in Moscow as ultimately designed to upset this growing geostrategic energy policy with China and the Middle East. Combined with increasingly provocative statements from Washington concerning actions toward Iran in view of next month’s review of the “nuclear deal” of 2015, the next decade could prove the worst yet in Russian-U.S. relations (if that could be at all possible). How this all plays out on a regional game-board of pipelines, and powerbrokers may turn out to be less a case of clever multidimensional chess as it does the same predictable moves in the same predictable game that cannot tell its kings apart from its pawns.
 
Marcia Christoff-Kurapovna contributed feature pieces and op-eds on Swiss and Liechtenstein banking issues for The Wall Street Journal Europe while based in Vienna, Austria; she also authored a column, ‘Swiss Watch.’ She currently lives in Washington, DC where she is a speech and op-ed writer to foreign dignitaries.
 

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