부산386
더불어민주당 대전 시장 후보로 나온 허태정이 오늘 하는 말이 “발가락이 왜 잘렸는지 1989년 일이라 기억나지 않는다" “발가락을 다친 경위를 정확히 기억할 수 없다”고 말했다고 한다.
강원도 지사를 했던 같은 더불어민주당 이광재가 손가락 자르고 군대 안간 걸 둘러대면서, ‘85~86년 인천 부평공장에서 혼자 일하다가 프레스 기계에 손가락이 잘렸다’고 하며 직접 공장을 보여주겠다며 기자까지 데리고 가서는 2시간이나 돌아다니고는 위치를 모르겠다며 찾지 못했고, 공장과 사장 이름 등도 기억하지 못한다고 했다는데, 아주 흡사한 경우다. (조갑제닷컴 발췌)
--->범죄자, 위선자, 사기꾼들의 집합소, 더불당
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1989년경 국유지사기단의 사주를 받아
고성군 고성읍 호병계장(호적·병사관련 업무담당)이던
자신의 신분을 이용해 국가에 귀속된 일제시대 토지를
문서를 위조해주며 토지불법편취를 도왔고
이 조건으로 뇌물을 약속 받았다는 것이다.
이에 대해선 김 후보 본인도 구체적인 사실을 밝힌 바 없다.
그는 자서전 격인 ‘사람이 있었네’에서도 부친에 대해선,
‘면사무소 근무’, ‘개천면 면사무소 서기’ 등으로
당시 부친의 신분을 축소해 표현하고 있다.
[출처] 우육빛깔 김경수 아버님 bogogara
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강경화가 미국가서 CVID PVID 동의한 것그는 자서전 격인 ‘사람이 있었네’에서도 부친에 대해선,
‘면사무소 근무’, ‘개천면 면사무소 서기’ 등으로
당시 부친의 신분을 축소해 표현하고 있다.
[출처] 우육빛깔 김경수 아버님 bogogara
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몰락의 시작
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일종의 미필적 고의라는 말이 있음.
현재 청와대는 멘붕도 아닌 무개념 상태.
책임지는 이도 없고 컨트롤타워도 없음.
사방에서 들어오는 미국의 압박에 사실상 GG친
상황. 한미회담 때 어떻게 되겠지 하는 반자포자기 심정. 북에 도움을 주고 싶어도 줄 수 없는 상황.
그렇다고 적극적으로 미국 따라갈 생각도 없는데 뮨제는 그게 맘대로 안된다는 점.
강경화가 폼페이오와의 회담 전에 전 외교안보과 조율이나 지침이 있어야 하는데 그런 것 없이 갔음.
그런 수퍼비전을 줄만한 조직이나 인물이 대통령 포함 없는 상황임.
강경화가 자격미달이기는 하지만 아주 바보는 아님.
특히 지난 1년간 한미관계에서 일어난 일들과 현상황 구리고 청와대 속성을 이제는 잘 인지하고 있었음.
지침도 없겠다 미국도 압박하겠다 그냥 미국의 주장을 쉽게 받아들임.
에에라 한반도 비핵화 그만하고 PVID합시다 해버린 것.
지금 북한은 개빡침. 누가 적이고 아군인지 모름.
문재인정부는 어쩌면 정말 햇볕정책을 하는지도 모름. ㅋㅋㅋ
[출처] 강경화가 미국에서 CVID PVID 동의는 미필적 고의
--->두고 보면 안다.
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솔창의 향기, 301쪽/ 출처 일베
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[변희재의 시사폭격] 후쿠시마 수산물 방사능 괴담으로, 대한민국 수산업이 무너지고 있다
https://youtu.be/fAVkSoVibxs
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확률 수학을 알리지 않고 표준 통계학을 가르치는 건 최악의 일이다. 그러면 임의성에 농락당하게 된다. p 밸류는 대개 헛소리이다.
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4차 십자군이 이집트로 가지 않고 비잔틴의 수도인 콘스탄티노플로 간 이유는?
당시 심자군의 영주들이 베네치아에 진 빚을 갚기 위해, 콘스탄티노플을 정복하는데 도움을 주면 거금의 은화를 주겠다는 제안을 받아 들임.
트럼프에게 보내는 홍준표의 공개서한, 핵심을 찔렀다!
조갑제
https://youtu.be/CGtUU6tuQTc
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인간의 분석과 지식의 진실성은 정의(定意)의 진실성에 달려 있다. 하지만 현재의 주류 경제학의 대부분의 용어는 엉터리 정의들이다.
실제 세계에서 부는 누군가에 의해 창조되고 누군가에 속한다. 상품과 서비스는 통합적으로 생산되고 최고 권력자에 의해 감독되는 게 아니다. GDP라는 개념은 현실의 기초가 없는 개념이다. 그것은 공허한 개념이다.
또 전체 생산량을 계산하려면, 여러 가지 상품들이 합계되어야 한다. 하지만 상품의 합계를 얻기 위해 냉장고와 자동차 그리고 셔츠 등을 더하기 하는 게 가능한가? 전체 실제 생산량이 제대로 정의되지 않았기 때문에, 그것은 계량화 될 수 없다.
Why Do Economists Make so many Arbitrary Assumptions?
•Frank Shostak
Various assumptions employed by mainstream economists appear to be of an arbitrary nature. The assumptions seem to be detached from the real world.
For example, in order to explain the economic crisis in Japan, the famous mainstream economist Paul Krugman employed a model that assumes that people are identical and live forever and that output is given. While admitting that these assumptions are not realistic, Krugman nonetheless argued that somehow his model can be useful in offering solutions to the economic crisis in Japan.1
The employment of assumptions that are detached from the facts of reality originates from the writings of Milton Friedman. According to Friedman, since it is not possible to establish "how things really work," then it does not really matter what the underlying assumptions of a model are. In fact anything goes, as long as the model can yield good predictions. According to Friedman,
The ultimate goal of a positive science is the development of a theory or hypothesis that yields valid and meaningful (i.e., not truistic) predictions about phenomena not yet observed…. The relevant question to ask about the assumptions of a theory is not whether they are descriptively realistic, for they never are, but whether they are sufficiently good approximation for the purpose in hand. And this question can be answered only by seeing whether the theory works, which means whether it yields sufficiently accurate predictions.2
Observe that on this way of thinking, the formation of the view regarding the real world is arbitrary – in fact, anything goes as long as the model could generate accurate forecasts.
In his "Philosophical Origins of Austrian Economics," David Gordon wrote that Bohm Bawerk maintained that concepts employed in economics must originate from the facts of reality - they need to be traced to their ultimate source. If one cannot trace it the concept should be rejected as meaningless.
Similarly, Ayn Rand has suggested that concept formation is not something arbitrary. The role of concepts is to integrate relevant existents while the role of definitions is to identify the nature of existents of a concept. According to Rand,
A definition is a statement that identifies the nature of the units subsumed under a concept. It is often said that definitions state the meaning of words. This is true, but not exact. A word is merely a visual- auditory symbol used to represent a concept; a word has no meaning other than that of the concept it symbolizes, and the meaning of a concept consists of its units. It is not words, but concepts that man defines – by specifying their referents. The purpose of a definition is to distinguish a concept from all other concepts and thus to keep its units differentiated from all other existents.3
The purpose of a definition then is to distinguish a given group of existents from other existents. Given that a definition provides the essence of existents of a particular concept, obviously then definitions are not arbitrary. At any stage, it is determined by the facts of reality, within the context of one’s knowledge.
For instance, one can observe that people are engaged in a variety of activities. They may be performing manual work, driving cars, walking on the street or dining in restaurants. The essence of these activities is that they are purposeful.
Furthermore, we can establish the meaning of these activities. Thus, manual work may be a means for some people to earn money, which in turn enables them to achieve various goals like buying food or clothing. Dining in a restaurant can be a means for establishing business relationships. Driving a car may be a means for reaching a particular destination.
The knowledge that human actions are purposeful also implies that they are conscious.
Popular economics employs arbitrary definitions
The arbitrary nature of popular economics is depicted by how it defines money supply. According to mainstream economics the correct definition of money is not something permanent but flexible. What dictates whether M1, M2 or some other M will be labeled as money is its correlation with national income. On this way of thinking, sometimes M2 could be considered as the valid definition of money and on some other occasion it could be some other M.
Most economists hold that since the early 1980’s, due to financial deregulation the nature of financial markets has changed and consequently past definitions of money do no longer hold. On this Rothbard wrote,
The Chicago School defines the money supply as that entity which correlates most closely with national income. This is one of the most flagrant examples of the Chicagoite desire to avoid essentialist concepts, and to “test” theory by statistical correlation; with the result that the supply of money is not really defined at all. Furthermore, the approach overlooks the fact that statistical correlation cannot establish causal connections; this can only be done by a genuine theory that works with definable and defined concepts.4
According to Salerno,
Measures of the U.S. money stock in current use in economic and business forecasting and in applied economics and historical research are flawed precisely because they are not based on an explicit and coherent theoretical conception of the essential nature of money. Given the all-pervasive role of money in the modern market economy, existing money-supply measures therefore tend to impede, rather than to facilitate, a clear understanding of the past or future development of actual economic events.5
To establish the definition of money we have to ascertain how the money-using economy came about. Money emerged because of the fact that barter could not support the market economy. The distinguishing characteristic of money is that it is the general medium of exchange. It has evolved from the most marketable commodity. On this Mises wrote,
There would be an inevitable tendency for the less marketable of the series of goods used as media of exchange to be one by one rejected until at last only a single commodity remained, which was universally employed as a medium of exchange; in a word, money.6
Money is the thing that all other goods and services are traded for. This fundamental characteristic of money must be contrasted with other goods. For instance, food supplies the necessary energy to human beings. Capital goods permit the expansion of the infrastructure that in turn will permit the production of a larger quantity of goods and services. Contrary to mainstream thinking then, the essence of money has nothing to do with financial deregulation, as the essence of money will remain intact in the most deregulated of markets.
Through the ongoing selection process over thousands of years, people have settled on gold as money. In other words gold served as the standard money. In today’s monetary system the core of the money supply is no longer gold, but coins and notes issued by the government and the central bank. Consequently, coins and notes constitute the standard money also known as cash that is employed in transactions.
Why arbitrary formations of concepts and definitions undermine individuals’ well-beings?
The arbitrary process of forming concepts and definitions in mainstream economics is not something that should be taken lightly. For instance, one of the main mandates of the central bank is to pursue a policy that is aiming at stabilizing the price level.
The concept of the price level however, cannot be traced to anything real for it does not exist. It is not possible to add up the purchasing power of money with respect to various goods and services in order to obtain the total purchasing power.
For instance, the purchasing power of a unit of money is established in the market as two potatoes and one loaf of bread. Arithmetically one however cannot add up two potatoes to one loaf of bread in order to establish the total purchasing power of a unit of money with respect to bread and potatoes.
If we cannot ascertain what something is, then obviously it is not possible to keep it stable. A policy that is aimed at stabilizing a fiction can only lead to a disaster.
Likewise, if one defines inflation as changes in the prices of goods and services while ignoring the valid definition of inflation being changes in the money supply, one is likely to set in motion policies that will undermine the well-beings of individuals rather than protecting them from the menace of inflation.
To gain insight into the state of an economy, economists rely on statistical indicators called Gross Domestic Product (GDP). The GDP framework looks at the value of final goods and services produced during a particular time interval, usually a quarter or a year.
The idea of GDP gives the impression that there is such a thing as the national output. In the real world, however, wealth is produced by someone and belongs to somebody. Goods and services are not produced in totality and supervised by one supreme leader. This in turn means that the entire concept of GDP is devoid of any basis in reality. It is an empty concept.
In addition to all these issues, there are serious problems regarding the calculation of GDP. To calculate a total, several things must be added together. To add things together, they must have some unit in common. It is not possible to add refrigerators to cars and shirts to obtain the total of final goods. Since the total real output cannot be meaningfully defined, obviously it cannot be quantified.
So what are we to make out of the periodical pronouncements that the economy, as depicted by real GDP, grew by a particular percentage? All we can say is that this percentage has nothing to do with real economic growth and that it most likely mirrors the pace of monetary pumping.
As a rule, the more money created by the central bank and the banking sector, the larger the monetary spending will be. This in turn means that the growth rate of what is labeled as the real economy will closely mirror rises in money supply.
So it is no wonder that in the GDP framework, the central bank can cause real economic growth, and most economists who slavishly follow this framework believe that this is so. Much so-called economic research produces "scientific support" for popular views that, by means of monetary pumping, the central bank can grow the economy. It is overlooked by all these studies that no other conclusion can be reached once it is realized that GDP is a close relative of the money stock.
Since GDP is an empty concept obviously then once the central bank reacts to the so-called GDP growth rate it pursues arbitrary actions thereby undermining the life and well-beings of individuals.
Conclusion
In mainstream economics most key terms are ill defined. Following the view that the facts of reality cannot be known economists have adopted the framework of Milton Friedman. On this framework, the validity of a theory is assessed on how accurately it can predict the future.
This runs contrary to the view of thinkers such as Ayn Rand, Mises and Rothbard who held that the truth of man’s analysis and knowledge rests on the truth of his definitions.
The fallacious nature of mainstream economics cannot be fixed by a framework of thought that states that what matters is the accuracy of predictions of a given theory.
A theory that is based on false concepts cannot be made valid because it made accurate predictions during a particular time interval. If the foundation of a theory is flawed obviously, any forecast by means of such theory cannot be trustworthy.
1. Paul Krugman, "Japan’s Trap," May 1998 at Krugman’s website.
2. Milton Friedman, Essays in Positive Economics, Chicago: University of Chicago Press, 1953.
3. Ayn Rand, Introduction to Objectivist Epistemology, A Meridian Book p 40.
4. Murray N. Rothbard, Economic Controversies, Mises Institute P 727.
5. Salerno, Joseph T. 1987. “The ‘True’ Money Supply: A Measure of the Supply of the Medium of Exchange in the U.S. Economy.” Austrian Economics Newsletter(Spring).
6. Ludwig von Mises, Theory of Money and Credit, pp.32-33.
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완고성 구토의 치료
선복대자석탕 합 석고
선복대자석탕 합 석고
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고환염을 치료하는 목향오공산
睾丸炎一症，成人小儿皆可发生，大多病因不明。其临床待点为一侧或两侧辜丸肿胀疼痛，缠绵难愈。中西内外之常规治疗均疗效不显，患者苦不堪言。陈潮祖教授早年于其堂兄陈继戎处得一无名秘方，专治本病。该方以木香30克，蜈蚣10条共为细末，成人每次3克，每日3次，白酒送服；小儿每次2克，每日3次，甜酒煮服。陈老命之曰“木香娱松散”。他和他的门人弟子以此治疗本病多例，无不尽剂而愈，因而倍加珍视。睾丸炎多为无名邪毒与寒邪相合，凝滞于经而成，气滞则痛，毒聚则肿。本方木香行气疏肝，蜈蚣解痉攻毒，酒性温热悍烈，窜经透络，活血散寒，既能助木香以行气，又能助蜈蚣以解痉，全方共奏散寒行气破毒之功。寒去则痉解，气行则滞通，毒消则结散
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각기를 치료하는 계명산, 그리고 계명산의 활용
《证治准绳》里的“鸡鸣散”，由槟榔、陈皮、木瓜、吴萸、紫苏叶、桔梗、生姜及皮等药组成。有行气降浊，宣化寒湿的作用。主治湿脚气，足胫肿重无力、麻木冷痛，恶寒发热等。
鸡鸣散是绝奇方，苏叶茱萸桔梗姜，
瓜橘槟榔煎冷服，肿浮脚气①效彰彰。来源：《朱氏集验方》。
词解：①脚气：古称“壅疾”，有干、湿之别，脚肿者为湿脚气，不肿者为干脚气。
药物：槟榔七枚(9克) 橘红(6～9克) 木瓜(9克)各一两 吴茱萸(3克) 苏叶(7克)各三钱桔梗生姜各半两(各7克)用法：研为粗末，分作八服，隔宿水三大碗，慢火煎留碗半，去滓(按：应为过滤留滓)，再入水二碗，煎取一大碗。二汁相和。次日五更分二、三次冷服，冬日略温亦可。服后用饼饵压下，如服不尽，留次日渐渐吃亦可。服此药至天明，当下黑水粪，即肾家所感寒湿之毒气下来也，早饭前后痛住肿消，但只是放迟吃物，候药力过，并无所忌。
功效：温宣降逆，开郁利湿。
适应症：脚气，两膝以下肿胀、痹痛，足部尤甚，以指按之不起，脉迟而涩，或见濡软，甚则寒热，或饮食减少，腹痛下痢，或有胸闷泛恶者。
方义：本方是治疗脚气的一张要方。方中吴茱萸散寒下气，能“治肾气脚气水肿”(大明)；木瓜舒筋化湿，善治“湿痹脚气”(别录)和“脚气冲心”(藏器)。《千金》有张专治脚气入腹的吴茱萸汤，即是此二药组成。可见这二药对于湿性脚气而肿胀痹痛有殊效。至于紫苏、桔梗、陈皮三味，主要用作开肺利气，“气利则湿行”。因为脚气为壅疾，所以重用槟榔一药，下气降逆，以泻下泄壅，使湿气从大使而出，即所谓“当下黑水粪，即肾家所感寒湿之毒气”。此外，佐用生姜，也不外温散寒气，协助解除脚气。综合起来，本方对于湿性脚气有较好的疗效。假如症见肿热上犯入腹，湿气冲胸，呕恶腹胀，喘息抬肩，自汗淋漓，乍寒乍热，脉短促者，是“脚气冲心”的危险之症，必须加入温阳降逆的附子等品，始能挽救。
本方方名“鸡鸣散”，意在要求于五更鸡鸣时服药，这实际上是取空腹时药物吸收较易，尤其易于达到泻下以除水湿的目的。因此，本方在清晨空腹时服用亦可。
1 病例资料
患者，男，65岁，主因右侧腹股沟可复性囊性肿物5年，于2003年6月20日入院。入院后根据病史、症状、体征初步诊断为右斜疝，在手术室2%利多卡因连续硬膜外麻醉下，行右斜疝修补术，术中顺利。术后第3天双侧窝处可见鸡卵大小囊性肿物，右侧略大，质中等，触压痛，推之不移，皮温不高，致双下肢屈伸困难，双下肢胫前可见指凹性水肿，临床除外腘窝囊肿，化验尿常规正常，肾功能正常，局部彩超提示:囊肿无血供，与肌肉关系密切，呈梭形液体，位于肌肉间隙，随体位变化，并除外深浅静脉血栓形成。因滑囊为肌肉的辅助结构，综上理化检查初步诊断为滑囊炎，予以鸡鸣散加减，方用:槟榔15g，陈皮10g，木瓜12g，吴茱萸7g，紫苏10g，桔梗10g，生姜4片，生姜皮5g，薏米20g，制附子10g，肉桂6g，3剂，凌晨空腹冷服。服药后至天明，大便下大量黑粪水，至早饭痛止肿消，3剂后窝处肿块完全消失，效如桴鼓。
2 讨论
本方来自《证治准绳》，主要用于治疗脚气肿痛。方用槟榔、木瓜以祛湿;吴萸、生姜、附子以温散寒湿;又辅以紫苏、陈皮宣通气机，具有温宣开上，降浊导下之功，且木瓜、吴萸二药配用是治疗脚气肿痛常用配对药。本方服法特殊，凌晨空腹冷服，取其鸡鸣时始服用，故名鸡鸣散。临床治疗风湿流注，脚足痛不可忍，筋脉浮肿，确有神效。
评按：此例从处方、用药，服药时间，谨守原方法度。药后反应，亦与记载妙合。且其效若神。值得深思。
姑射真人：腰痛，晨鸡鸣甚，起床活动后痛全无：鸡鸣乃是阳气萌动之时，有乃肝气疏泄调达，活动后自行消失，只需用流通气血之剂便可。病在鸡鸣时，鸡鸣散可用！此间奥妙，请诸位祥思之！呵呵。
木瓜15克吴茱萸2克橘皮12克苏叶6克生姜2片苡米90克 2付必愈！
木瓜按：此论地道，多见于西医所谓之肌肉纤维炎（或肌肉筋膜炎）属。如法试用，效果肯定。
鸡鸣散在伤科中的应用
病例1：患者于某，男性，25岁，2003年5月14日就诊，半月前踢球扭伤左踝关节，拍х线片，未见骨质异常改变，遂服用跌打丸，外用正骨水，无效来诊。查：左踝及足部肿胀明显，足跟部及踝部后侧有散在的紫色瘀癍，活动不利，舌淡红，舌边有瘀点，遂用槟榔12克，吴萸8克，木瓜8克，独活12克，薏苡仁12克，陈皮12克，茯苓12克，白术10克，桔梗10克，生姜皮8克，丹参10克，桃仁8克，当归10克，熟地10克，川芎10克，服10剂后而愈。
分析：患者于损伤后，气血瘀阻，瘀久而又复感风寒湿邪，久病而湿聚，壅阻经络，气血不得宣通，故见足部肿胀，因湿性重浊，又为阴邪，故行走劳累后，其症状加重，故以鸡鸣散为主加味治疗。方中以鸡鸣散宣通气机，行气降浊，开壅行滞，宣化寒湿，配伍独活祛筋骨之间的风寒湿邪，防风可祛风、舒通经脉、散郁结，茯苓、白术、陈皮、薏苡仁健脾理气利湿，诸药合用，共奏疏通经络，行气降浊，宣化湿邪。当归、熟地、川芎、桃仁、丹参的运用主要基于陈士铎的“……筋之舒，在于血和……盖血亏则筋病，用补血药以治筋……则筋得其养而宽，筋宽则诸症悉愈矣……”共奏活血化瘀、开壅行滞，化湿消肿之功。
病例2：患者齐某某，女性，48岁，体形较胖，曾有慢性膝关节滑膜炎病史。2005年4月12日就诊。于一周前行走稍多，而出现右膝关节肿痛，无红无热，浮髌试验阳性，x线显示：骨质轻度增生，余未见异常。舌淡红，舌体胖大有齿痕，苔薄，舌边有散在瘀点。方药：槟榔15克，陈皮15克，独活15克，防风15克，吴萸8克，茯苓20克，薏苡仁15克，木瓜15克，葛根15克，桔梗10，寄生15克，苍术l2克，泽泻20克，当归15克，牛膝20克，丹参15克，每日实施按摩治疗，并嘱咐患者适当锻炼股四头肌，15剂后痊愈。
分析：慢性膝关节滑膜炎属中医痹证，多为素体肝肾阴虚，外感风、寒、湿三气合而为痹，而以挟湿者居多。肥胖者，脾虚湿盛，劳累后，加重湿气下注于膝关节而发病。故本方以鸡鸣散为主，宣通气机，行气降浊，开壅行滞。配伍寄生、牛膝、当归、泽泻补益肝肾；独活祛下焦与筋骨之间的风寒湿邪；党参、茯苓、苍术、薏苡仁、陈皮健脾理气燥湿消肿；丹参活血化瘀，共奏开壅行滞，宣化湿邪之功。以及嘱咐患者适当锻炼股四头肌，配合局部按摩，有利于改善局部的血液循环，促进营养供给，滑利关节，解除粘连，促进组织修复，防治肌肉萎缩，提高膝关节的稳定性，可起到消肿止痛作用。
鸡鸣散是治湿脚气的一首要方。出自《类编朱氏集验医方》。湿脚气以两胫肿大重着、软弱麻木而无力为其辨证要点，也是施治的依据。《外台秘要》云：“脚气者，壅疾也，惟宣通可以去壅滞。”故根据“着者行之”之原则，采取宣散湿邪，下气降浊的方法。方中重用槟榔，其性重坠下达，以降气除逆，泄泻壅滞，配伍木瓜，下行祛湿利痹，舒筋活络，二药合用，对于湿性脚气而肿胀痹痛有特效，辅以吴茱萸散寒降浊。吴茱萸，辛温暖脾胃而散寒邪，开郁化滞，逐冷降气，则中自温，气自下，而诸证悉除。吴茱萸与木瓜配伍能治脚气冲心之证。佐以紫苏叶，辛温疏散风寒；桔梗宣开上焦肺气；陈皮以行气燥湿，醒脾。三味药之主要作用为开肺利气，行脾化湿，达到“气行则湿行”。此外，使以生姜，温散寒气，共奏宣通气机，行气降浊，开壅行滞，宣化寒湿之功，而解除脚气，故本方具有开上、导下，疏中、温宣，降浊之效。
下面再谈谈“寒湿脚气”与“脚气冲心”的问题。由我校编撰的《名医经验录》,内有宋孝志教授临床治疗寒湿脚气总结一文,验之于临床,其实用价值为高,应当加以推广。在治疗心衰水肿过程中,宋教授尤其对风心病心衰的辨治,有其独特见解和经验。他提出以开肺散肝,温散寒湿之法,治疗风心病心衰水肿,而并不刻意单纯消肿利水。并推出以“鸡鸣散”为主方,苦降酸收,温散寒湿。数十年来,他以此法,治疗了许多风心病心衰的病人,收到了显著的疗效,曾被周围许多的医患,称为治疗水肿一绝。宋老认为,风心病心衰的特殊发病机制是:初期为风、寒、湿三邪合而为病,尤以寒湿为重。因寒湿困阻肝脉,流注于四肢关节,久则经络痹阻,寒湿凝滞,气血失和,发为水肿。因肝为心之子,母病及子,故久病寒湿上冲于心,旁及于肺,而见心悸、喘憋等证。治疗当以开上导下,温经散寒,宣降湿浊为主。并以此为机理,选用鸡鸣散为主方。
鸡鸣散一方,出自于宋代朱君辅的《类编朱氏集验医方》一书。原为治疗“湿脚气”两腿肿之要方,组方以“着者行之”为原则,以槟榔、橘皮、木瓜、吴茱萸、柴胡、苏叶、桔梗、生姜行气降浊湿、化寒湿。方中诸药均以气为胜,因治肿必治水,治水必治气,气行则水散。方中苏叶温散风寒,桔梗开宣上焦,橘皮开中焦之气,吴茱萸泄降寒浊,槟榔重坠至达下焦,而成三焦同治。同时木瓜配吴茱萸,可平冲心上逆之气,而使湿邪不得上冲。总之,诸药皆主以气,使寒湿之邪,或从汗出而解,或从下利而出。必须强调此方宜在鸡鸣五更时,冷服为佳,以从阳注阴,从阴解邪。加减之法:寒重加附子;心阳虚加桂枝;痰中带血加小量桃仁;水肿较甚加茯苓、泽泻;妇女月经不调加香附、桃仁、益母草。
鸡鸣散是一张名方,治疗寒湿脚气与脚气冲心而为专长。宋老虽已逝世,但他留下了很多的医疗经验,极为珍贵。余在临床,治疗水气腿肿,每以五苓散与防己黄芪汤取效,然有时也并不见效。而病人催促消肿,势如风火,急不可耐,往往使我无从措手足。就在这个时刻,使我想起了宋老推出的“鸡鸣散”,治疗腿肿甚至肾囊也肿,疗效惊人,使我为之惊叹。
鸡鸣散加减治疗湿脚气21例
脚气病即维生素B1缺乏病，临床上可分为干脚气(干型，以对称性多发性周围神经炎为主)、湿脚气(湿型，以水肿为主)及混合型3型。湿脚气临床表现为足胫肿重无力，麻木冷痛，严重者导致心脏病变，初起心悸，气促，甚至心包、胸腔积液，常发生右心衰竭，甚至全心衰。笔者1994-1999年运用鸡鸣散加减治疗湿脚气21例，临床效果满意。
1 临床资料
21例均来自门诊，男13例，女8例，年龄33～71岁，平均46岁，病程最短3d，最长2年，平均3个月。病例选择根据《中医病证诊断疗效标准》而确诊，无严重心、脑疾患，均有不同程度的下肢水肿。
2 治疗方法
以鸡鸣散加减：槟榔15g，陈皮、木瓜各12g，吴茱萸、紫苏叶各3g，桔梗、生姜各5g。若气虚者加党参15g，炙黄芪20g；腰酸痛者加续断、桑寄生、菟丝子各10g；寒湿较重者加附子15g，肉桂6g；表证明显者加桂枝、防风各9g；心悸胸闷者加瓜蒌12g，薤白9g。每日1剂，水煎2次，取汁约150ml，凌晨空腹冷服。
所有病例均嘱其进食富含维生素B1的食物，如糙米、麦类、豆、禽蛋等。
4 典型病例
王某，男，58岁，干部，1998年3月初诊。两足麻木冷痛、足胫肿重无力、行走困难已3月余。曾诊为“痹证”，予消炎痛、头孢氨苄及外用中药浸泡等治疗，疗效不显。刻诊根据临床症状及实验室检查(血丙酮酸169.0μmol/L)，诊为湿脚气。予鸡鸣散加减治疗，并嘱其食用富含维生素B1食物，10d后疼痛、肿胀明显减轻，自觉行走较前轻松，继服20剂，疼痛肿胀完全消除，实验室检查血丙酮酸正常(98.0μmol/L)，停止服药，随访1年至今未复发。
5 体会
祖国医学认为，湿脚气证系寒湿之邪下着两足所致。寒湿壅阻经络，气血不得宣通，故两足麻木冷痛，足胫肿重无力，气逆上壅于胃，则胸闷泛恶。治疗大法，当逐湿祛邪，宣通气机。方中以槟榔为君，质重下达，行气逐湿；臣以木瓜舒筋活络，并能化湿；陈皮健脾燥湿理气；佐以紫苏叶、桔梗宣通气机，外散表邪，内开郁结；吴茱萸、生姜温化寒湿，降逆止呕。诸药相合，祛湿化浊，宣通散邪，温化寒湿，行气开壅。
加减鸡鸣散治疗肾病水肿
鸡鸣散出自《类编朱氏集医方》，是治疗浮肿和湿脚气病的方剂。笔者多年来以本方化裁，加大剂量治疗肾病水肿，取得了满意的效果，现报道如下。
1 药物组成与加减
基本方：木瓜、茯苓、泽泻各30g，吴萸20g，槟榔、炮附片各60g，陈皮15g，甘草、苏叶、葶苈子各10g，生姜6g。头昏目眩、血压高者加石决明、地龙各20g，恶心呕吐者加半夏、黄芩各10g，尿少带血者加白茅根15g，海金沙10g。
2 典型病例
例1：裴某，男，34岁。1983年8月10就诊。1981年6月以来，全身反复浮肿2年之久。近日面色白，精神不振，全身高度浮肿，腹部隆起，明显腹水征，双下肢凹陷性水肿，小便短少，恶心呕吐，四肢发冷。尿蛋白(+++)，颗粒管型(+)，白细胞(+)，红细胞少许。诊断为：慢性肾病综合征(脾肾阳虚型)。治以温阳化水，方用鸡鸣散加减：木瓜、吴萸、茯苓、泽泻各30g，槟榔、炮制片各60g，甘草、葶苈子、丝瓜络各10g，生姜6g。水煎取汁350ml。于清晨鸡鸣时服下。药后解稀黑便2次，小便尿量增加，腹胀缓解。以后药量减半，服药6剂肿消。后以金匮肾气丸调理而愈，随访9年未复发。
按：此例病程2年之久，反复发作，肾气逐渐衰微，阳不化气，水湿下聚，致腰以下肿甚，按之凹陷不起。肾与膀胱相表里，肾阳不足，膀胱气化不行，尿量逐渐减少，用陈皮、生姜温中止呕，重用附子、吴萸温补肾阳，茯苓、泽泻、丝瓜络通利小便；葶苈子通调肺气，使水气下行，渗入膀胱，小便通利，水肿得消。
例2：常某，女，19岁，1986年6月21日就诊。反复浮肿3年。1986年4月某医院诊为慢性肾炎，用青霉素、双氢克尿塞治疗，症状好转后出院。来诊时全身浮肿加重，尿少色黄，双下肢凹陷性水肿，腹水征明显。小便常规：颜色黄，蛋白(++)，红血球、白血球少许。西医诊为慢性肾小球肾炎，中医辨证为脾肾阳虚。
治则：重在治标，兼顾治本。药用鸡鸣散基本方加黄芪20g，党参12g，海金沙10g，茅根15g。水煎取汁300ml，清晨空服。药后解稀黑便数次，尿量增加。水肿消退后，以金匮肾气丸调治而愈。
3 体会
鸡鸣散方中，重用槟榔通腑除湿、行气利小便，生姜、吴萸温中散寒，紫苏为血中之气药，气行则血行。佐以木瓜之酸，桔梗之苦，酸苦涌泄为阴。寒湿之气，得行气之药，微汗解之，解之不尽，从大便泄之。方中重用附片，以增强温阳之力，用葶苈子泻肺气，茯苓、泽泻增强排尿之功。五更服药，疗效更显。
鸡鸣散加减治疗结节性痤疮
贺某某，40岁。从18岁开始面部潮红瘙痒、结节、囊肿，多方诊治未效。1999年4月21日初诊，见面部潮红，大小不等的丘疹如黄豆或绿豆大小，彼此凸凹不平，呈结节状广泛分布于面部两颊及下颌，整个面部尤如蟾蜍皮一样，每于说话及情绪激动时，面色由潮红转为紫暗如茄子色，局部瘙痒，面部虽粗糙而不干燥，毛囊丘疹虽起伏不平而未角化，无鳞屑，抚之不棘手，伴口淡乏味，头重嗜睡。舌淡苔润，舌质晦暗，脉沉微。观其既往用药，中药以清热解毒，活血化瘀，泻火祛湿为主，外治大多为各类激素软膏。分析病机为脾虚湿盛，寒滞经脉，气机不利，阳气失于清展，湿浊之邪侵淫肌肤，泛溢面部，盘踞不解，成为痼疾。治拟燥湿健脾，芳香化浊，通阳化气。方以鸡鸣散加减：苏叶、木瓜、良姜、吴萸、橘红各15g，桔梗25g，槟榔50g。服5剂后，觉瘙痒减轻，但面部症状如故。再予上方加苍术30g，连服30剂，面色由紫红色转为淡红，但说话时面部颜色略变赤，结节性丘疹明显缩小变软，数量减少，瘙痒消失，面颊及耳部前后已光整，对比原先，判若二人，且食欲大增，舌质转为淡红舌，白腻苔已退。药中病机，守方再进30剂后，面部结节性丘疹全部消失，肌肤润泽，告愈。
痤疮以局部毛囊红色丘疹，或黑头粉刺、脓疮、结节、囊肿等为主要表现。临床分为肺热、胃热、血热、湿毒、血瘀等型，在治法上各有千秋。而本例患者历时20余年，更医数十人而无功，可谓棘手。笔者认为关键是病机不明，未能摆脱热与毒的束服，按常法施治，难得建树。对久治不愈的慢性病，既要知悉其常，又要知其变证，不必拘于常规常法，更要善于思考和总结前医不应之因，从而达到明能烛幽，避免重蹈覆辙。笔者首诊抓住脾虚湿盛，寒滞经脉，淫气妄行之关键所在，用燥湿健脾、芳香僻浊、通阳化气为法，以鸡鸣散展示其开上、导下、疏中、温宣、降浊之功。药用色赤气香、辛温之苏叶，辛者能散，温者能通，散经脉之淫气湿毒，通阳明之沉寒痼浊；木瓜和胃化湿、舒筋活络、通行气血、宣络脉、达百骸、辟湿浊；桔梗、橘红开中上焦之气，气行则湿自化，络自通；良姜、吴萸温运中州、散寒通阳，以扶脾燥湿，脾旺则湿去阳复，气行血畅则湿浊无容藏之所；槟榔宣利五脏六腑经络之湿滞，行气逐湿，则结节自消；味香气烈之苍术入太阴、阳明二经，燥湿健脾、运脾和胃、开郁宽中，无所不至，发水谷之气，越经络之滞，能入清经，通行湿滞，特别对久羁之阴寒湿浊，非此莫属，非此不举。诸药合用，气味雄厚，安内攘外，消痤疗疮，标本兼治。一可入脏腑达中州，运转枢机，荡涤阴邪，则脾健阳振，湿化机畅，以正本清源。二可温经散寒，舒筋活络，通行气血，则久羁于面部的湿毒浊邪得以消散，恢复其庐山真面目。
孙太太香港脚入腹治验
杭垣水沟巷孙太太。两足自至跗皆肿。热痛甚。皮色光亮。至晚发厥。延余诊之。脉沉而弦。余曰。此名香港脚入腹。亦危症也。冲心即死。其足上有诸络现者。尽刺出血。并刺委中。遂与鸡鸣散。令五更鸡鸣时服。外以蚕矢汤熏洗。次晚果不厥而热痛仍然。乃用槟榔、蚕沙、海桐皮、木瓜、片子姜黄、黄芩、滑石、薏仁等而愈。---------------------------------------------------
고환염을 치료하는 목향오공산
睾丸炎一症，成人小儿皆可发生，大多病因不明。其临床待点为一侧或两侧辜丸肿胀疼痛，缠绵难愈。中西内外之常规治疗均疗效不显，患者苦不堪言。陈潮祖教授早年于其堂兄陈继戎处得一无名秘方，专治本病。该方以木香30克，蜈蚣10条共为细末，成人每次3克，每日3次，白酒送服；小儿每次2克，每日3次，甜酒煮服。陈老命之曰“木香娱松散”。他和他的门人弟子以此治疗本病多例，无不尽剂而愈，因而倍加珍视。睾丸炎多为无名邪毒与寒邪相合，凝滞于经而成，气滞则痛，毒聚则肿。本方木香行气疏肝，蜈蚣解痉攻毒，酒性温热悍烈，窜经透络，活血散寒，既能助木香以行气，又能助蜈蚣以解痉，全方共奏散寒行气破毒之功。寒去则痉解，气行则滞通，毒消则结散
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각기를 치료하는 계명산, 그리고 계명산의 활용
《证治准绳》里的“鸡鸣散”，由槟榔、陈皮、木瓜、吴萸、紫苏叶、桔梗、生姜及皮等药组成。有行气降浊，宣化寒湿的作用。主治湿脚气，足胫肿重无力、麻木冷痛，恶寒发热等。
鸡鸣散是绝奇方，苏叶茱萸桔梗姜，
瓜橘槟榔煎冷服，肿浮脚气①效彰彰。来源：《朱氏集验方》。
词解：①脚气：古称“壅疾”，有干、湿之别，脚肿者为湿脚气，不肿者为干脚气。
药物：槟榔七枚(9克) 橘红(6～9克) 木瓜(9克)各一两 吴茱萸(3克) 苏叶(7克)各三钱桔梗生姜各半两(各7克)用法：研为粗末，分作八服，隔宿水三大碗，慢火煎留碗半，去滓(按：应为过滤留滓)，再入水二碗，煎取一大碗。二汁相和。次日五更分二、三次冷服，冬日略温亦可。服后用饼饵压下，如服不尽，留次日渐渐吃亦可。服此药至天明，当下黑水粪，即肾家所感寒湿之毒气下来也，早饭前后痛住肿消，但只是放迟吃物，候药力过，并无所忌。
功效：温宣降逆，开郁利湿。
适应症：脚气，两膝以下肿胀、痹痛，足部尤甚，以指按之不起，脉迟而涩，或见濡软，甚则寒热，或饮食减少，腹痛下痢，或有胸闷泛恶者。
方义：本方是治疗脚气的一张要方。方中吴茱萸散寒下气，能“治肾气脚气水肿”(大明)；木瓜舒筋化湿，善治“湿痹脚气”(别录)和“脚气冲心”(藏器)。《千金》有张专治脚气入腹的吴茱萸汤，即是此二药组成。可见这二药对于湿性脚气而肿胀痹痛有殊效。至于紫苏、桔梗、陈皮三味，主要用作开肺利气，“气利则湿行”。因为脚气为壅疾，所以重用槟榔一药，下气降逆，以泻下泄壅，使湿气从大使而出，即所谓“当下黑水粪，即肾家所感寒湿之毒气”。此外，佐用生姜，也不外温散寒气，协助解除脚气。综合起来，本方对于湿性脚气有较好的疗效。假如症见肿热上犯入腹，湿气冲胸，呕恶腹胀，喘息抬肩，自汗淋漓，乍寒乍热，脉短促者，是“脚气冲心”的危险之症，必须加入温阳降逆的附子等品，始能挽救。
本方方名“鸡鸣散”，意在要求于五更鸡鸣时服药，这实际上是取空腹时药物吸收较易，尤其易于达到泻下以除水湿的目的。因此，本方在清晨空腹时服用亦可。
1 病例资料
患者，男，65岁，主因右侧腹股沟可复性囊性肿物5年，于2003年6月20日入院。入院后根据病史、症状、体征初步诊断为右斜疝，在手术室2%利多卡因连续硬膜外麻醉下，行右斜疝修补术，术中顺利。术后第3天双侧窝处可见鸡卵大小囊性肿物，右侧略大，质中等，触压痛，推之不移，皮温不高，致双下肢屈伸困难，双下肢胫前可见指凹性水肿，临床除外腘窝囊肿，化验尿常规正常，肾功能正常，局部彩超提示:囊肿无血供，与肌肉关系密切，呈梭形液体，位于肌肉间隙，随体位变化，并除外深浅静脉血栓形成。因滑囊为肌肉的辅助结构，综上理化检查初步诊断为滑囊炎，予以鸡鸣散加减，方用:槟榔15g，陈皮10g，木瓜12g，吴茱萸7g，紫苏10g，桔梗10g，生姜4片，生姜皮5g，薏米20g，制附子10g，肉桂6g，3剂，凌晨空腹冷服。服药后至天明，大便下大量黑粪水，至早饭痛止肿消，3剂后窝处肿块完全消失，效如桴鼓。
2 讨论
本方来自《证治准绳》，主要用于治疗脚气肿痛。方用槟榔、木瓜以祛湿;吴萸、生姜、附子以温散寒湿;又辅以紫苏、陈皮宣通气机，具有温宣开上，降浊导下之功，且木瓜、吴萸二药配用是治疗脚气肿痛常用配对药。本方服法特殊，凌晨空腹冷服，取其鸡鸣时始服用，故名鸡鸣散。临床治疗风湿流注，脚足痛不可忍，筋脉浮肿，确有神效。
评按：此例从处方、用药，服药时间，谨守原方法度。药后反应，亦与记载妙合。且其效若神。值得深思。
姑射真人：腰痛，晨鸡鸣甚，起床活动后痛全无：鸡鸣乃是阳气萌动之时，有乃肝气疏泄调达，活动后自行消失，只需用流通气血之剂便可。病在鸡鸣时，鸡鸣散可用！此间奥妙，请诸位祥思之！呵呵。
木瓜15克吴茱萸2克橘皮12克苏叶6克生姜2片苡米90克 2付必愈！
木瓜按：此论地道，多见于西医所谓之肌肉纤维炎（或肌肉筋膜炎）属。如法试用，效果肯定。
鸡鸣散在伤科中的应用
病例1：患者于某，男性，25岁，2003年5月14日就诊，半月前踢球扭伤左踝关节，拍х线片，未见骨质异常改变，遂服用跌打丸，外用正骨水，无效来诊。查：左踝及足部肿胀明显，足跟部及踝部后侧有散在的紫色瘀癍，活动不利，舌淡红，舌边有瘀点，遂用槟榔12克，吴萸8克，木瓜8克，独活12克，薏苡仁12克，陈皮12克，茯苓12克，白术10克，桔梗10克，生姜皮8克，丹参10克，桃仁8克，当归10克，熟地10克，川芎10克，服10剂后而愈。
分析：患者于损伤后，气血瘀阻，瘀久而又复感风寒湿邪，久病而湿聚，壅阻经络，气血不得宣通，故见足部肿胀，因湿性重浊，又为阴邪，故行走劳累后，其症状加重，故以鸡鸣散为主加味治疗。方中以鸡鸣散宣通气机，行气降浊，开壅行滞，宣化寒湿，配伍独活祛筋骨之间的风寒湿邪，防风可祛风、舒通经脉、散郁结，茯苓、白术、陈皮、薏苡仁健脾理气利湿，诸药合用，共奏疏通经络，行气降浊，宣化湿邪。当归、熟地、川芎、桃仁、丹参的运用主要基于陈士铎的“……筋之舒，在于血和……盖血亏则筋病，用补血药以治筋……则筋得其养而宽，筋宽则诸症悉愈矣……”共奏活血化瘀、开壅行滞，化湿消肿之功。
病例2：患者齐某某，女性，48岁，体形较胖，曾有慢性膝关节滑膜炎病史。2005年4月12日就诊。于一周前行走稍多，而出现右膝关节肿痛，无红无热，浮髌试验阳性，x线显示：骨质轻度增生，余未见异常。舌淡红，舌体胖大有齿痕，苔薄，舌边有散在瘀点。方药：槟榔15克，陈皮15克，独活15克，防风15克，吴萸8克，茯苓20克，薏苡仁15克，木瓜15克，葛根15克，桔梗10，寄生15克，苍术l2克，泽泻20克，当归15克，牛膝20克，丹参15克，每日实施按摩治疗，并嘱咐患者适当锻炼股四头肌，15剂后痊愈。
分析：慢性膝关节滑膜炎属中医痹证，多为素体肝肾阴虚，外感风、寒、湿三气合而为痹，而以挟湿者居多。肥胖者，脾虚湿盛，劳累后，加重湿气下注于膝关节而发病。故本方以鸡鸣散为主，宣通气机，行气降浊，开壅行滞。配伍寄生、牛膝、当归、泽泻补益肝肾；独活祛下焦与筋骨之间的风寒湿邪；党参、茯苓、苍术、薏苡仁、陈皮健脾理气燥湿消肿；丹参活血化瘀，共奏开壅行滞，宣化湿邪之功。以及嘱咐患者适当锻炼股四头肌，配合局部按摩，有利于改善局部的血液循环，促进营养供给，滑利关节，解除粘连，促进组织修复，防治肌肉萎缩，提高膝关节的稳定性，可起到消肿止痛作用。
鸡鸣散是治湿脚气的一首要方。出自《类编朱氏集验医方》。湿脚气以两胫肿大重着、软弱麻木而无力为其辨证要点，也是施治的依据。《外台秘要》云：“脚气者，壅疾也，惟宣通可以去壅滞。”故根据“着者行之”之原则，采取宣散湿邪，下气降浊的方法。方中重用槟榔，其性重坠下达，以降气除逆，泄泻壅滞，配伍木瓜，下行祛湿利痹，舒筋活络，二药合用，对于湿性脚气而肿胀痹痛有特效，辅以吴茱萸散寒降浊。吴茱萸，辛温暖脾胃而散寒邪，开郁化滞，逐冷降气，则中自温，气自下，而诸证悉除。吴茱萸与木瓜配伍能治脚气冲心之证。佐以紫苏叶，辛温疏散风寒；桔梗宣开上焦肺气；陈皮以行气燥湿，醒脾。三味药之主要作用为开肺利气，行脾化湿，达到“气行则湿行”。此外，使以生姜，温散寒气，共奏宣通气机，行气降浊，开壅行滞，宣化寒湿之功，而解除脚气，故本方具有开上、导下，疏中、温宣，降浊之效。
下面再谈谈“寒湿脚气”与“脚气冲心”的问题。由我校编撰的《名医经验录》,内有宋孝志教授临床治疗寒湿脚气总结一文,验之于临床,其实用价值为高,应当加以推广。在治疗心衰水肿过程中,宋教授尤其对风心病心衰的辨治,有其独特见解和经验。他提出以开肺散肝,温散寒湿之法,治疗风心病心衰水肿,而并不刻意单纯消肿利水。并推出以“鸡鸣散”为主方,苦降酸收,温散寒湿。数十年来,他以此法,治疗了许多风心病心衰的病人,收到了显著的疗效,曾被周围许多的医患,称为治疗水肿一绝。宋老认为,风心病心衰的特殊发病机制是:初期为风、寒、湿三邪合而为病,尤以寒湿为重。因寒湿困阻肝脉,流注于四肢关节,久则经络痹阻,寒湿凝滞,气血失和,发为水肿。因肝为心之子,母病及子,故久病寒湿上冲于心,旁及于肺,而见心悸、喘憋等证。治疗当以开上导下,温经散寒,宣降湿浊为主。并以此为机理,选用鸡鸣散为主方。
鸡鸣散一方,出自于宋代朱君辅的《类编朱氏集验医方》一书。原为治疗“湿脚气”两腿肿之要方,组方以“着者行之”为原则,以槟榔、橘皮、木瓜、吴茱萸、柴胡、苏叶、桔梗、生姜行气降浊湿、化寒湿。方中诸药均以气为胜,因治肿必治水,治水必治气,气行则水散。方中苏叶温散风寒,桔梗开宣上焦,橘皮开中焦之气,吴茱萸泄降寒浊,槟榔重坠至达下焦,而成三焦同治。同时木瓜配吴茱萸,可平冲心上逆之气,而使湿邪不得上冲。总之,诸药皆主以气,使寒湿之邪,或从汗出而解,或从下利而出。必须强调此方宜在鸡鸣五更时,冷服为佳,以从阳注阴,从阴解邪。加减之法:寒重加附子;心阳虚加桂枝;痰中带血加小量桃仁;水肿较甚加茯苓、泽泻;妇女月经不调加香附、桃仁、益母草。
鸡鸣散是一张名方,治疗寒湿脚气与脚气冲心而为专长。宋老虽已逝世,但他留下了很多的医疗经验,极为珍贵。余在临床,治疗水气腿肿,每以五苓散与防己黄芪汤取效,然有时也并不见效。而病人催促消肿,势如风火,急不可耐,往往使我无从措手足。就在这个时刻,使我想起了宋老推出的“鸡鸣散”,治疗腿肿甚至肾囊也肿,疗效惊人,使我为之惊叹。
鸡鸣散加减治疗湿脚气21例
脚气病即维生素B1缺乏病，临床上可分为干脚气(干型，以对称性多发性周围神经炎为主)、湿脚气(湿型，以水肿为主)及混合型3型。湿脚气临床表现为足胫肿重无力，麻木冷痛，严重者导致心脏病变，初起心悸，气促，甚至心包、胸腔积液，常发生右心衰竭，甚至全心衰。笔者1994-1999年运用鸡鸣散加减治疗湿脚气21例，临床效果满意。
1 临床资料
21例均来自门诊，男13例，女8例，年龄33～71岁，平均46岁，病程最短3d，最长2年，平均3个月。病例选择根据《中医病证诊断疗效标准》而确诊，无严重心、脑疾患，均有不同程度的下肢水肿。
2 治疗方法
以鸡鸣散加减：槟榔15g，陈皮、木瓜各12g，吴茱萸、紫苏叶各3g，桔梗、生姜各5g。若气虚者加党参15g，炙黄芪20g；腰酸痛者加续断、桑寄生、菟丝子各10g；寒湿较重者加附子15g，肉桂6g；表证明显者加桂枝、防风各9g；心悸胸闷者加瓜蒌12g，薤白9g。每日1剂，水煎2次，取汁约150ml，凌晨空腹冷服。
所有病例均嘱其进食富含维生素B1的食物，如糙米、麦类、豆、禽蛋等。
4 典型病例
王某，男，58岁，干部，1998年3月初诊。两足麻木冷痛、足胫肿重无力、行走困难已3月余。曾诊为“痹证”，予消炎痛、头孢氨苄及外用中药浸泡等治疗，疗效不显。刻诊根据临床症状及实验室检查(血丙酮酸169.0μmol/L)，诊为湿脚气。予鸡鸣散加减治疗，并嘱其食用富含维生素B1食物，10d后疼痛、肿胀明显减轻，自觉行走较前轻松，继服20剂，疼痛肿胀完全消除，实验室检查血丙酮酸正常(98.0μmol/L)，停止服药，随访1年至今未复发。
5 体会
祖国医学认为，湿脚气证系寒湿之邪下着两足所致。寒湿壅阻经络，气血不得宣通，故两足麻木冷痛，足胫肿重无力，气逆上壅于胃，则胸闷泛恶。治疗大法，当逐湿祛邪，宣通气机。方中以槟榔为君，质重下达，行气逐湿；臣以木瓜舒筋活络，并能化湿；陈皮健脾燥湿理气；佐以紫苏叶、桔梗宣通气机，外散表邪，内开郁结；吴茱萸、生姜温化寒湿，降逆止呕。诸药相合，祛湿化浊，宣通散邪，温化寒湿，行气开壅。
加减鸡鸣散治疗肾病水肿
鸡鸣散出自《类编朱氏集医方》，是治疗浮肿和湿脚气病的方剂。笔者多年来以本方化裁，加大剂量治疗肾病水肿，取得了满意的效果，现报道如下。
1 药物组成与加减
基本方：木瓜、茯苓、泽泻各30g，吴萸20g，槟榔、炮附片各60g，陈皮15g，甘草、苏叶、葶苈子各10g，生姜6g。头昏目眩、血压高者加石决明、地龙各20g，恶心呕吐者加半夏、黄芩各10g，尿少带血者加白茅根15g，海金沙10g。
2 典型病例
例1：裴某，男，34岁。1983年8月10就诊。1981年6月以来，全身反复浮肿2年之久。近日面色白，精神不振，全身高度浮肿，腹部隆起，明显腹水征，双下肢凹陷性水肿，小便短少，恶心呕吐，四肢发冷。尿蛋白(+++)，颗粒管型(+)，白细胞(+)，红细胞少许。诊断为：慢性肾病综合征(脾肾阳虚型)。治以温阳化水，方用鸡鸣散加减：木瓜、吴萸、茯苓、泽泻各30g，槟榔、炮制片各60g，甘草、葶苈子、丝瓜络各10g，生姜6g。水煎取汁350ml。于清晨鸡鸣时服下。药后解稀黑便2次，小便尿量增加，腹胀缓解。以后药量减半，服药6剂肿消。后以金匮肾气丸调理而愈，随访9年未复发。
按：此例病程2年之久，反复发作，肾气逐渐衰微，阳不化气，水湿下聚，致腰以下肿甚，按之凹陷不起。肾与膀胱相表里，肾阳不足，膀胱气化不行，尿量逐渐减少，用陈皮、生姜温中止呕，重用附子、吴萸温补肾阳，茯苓、泽泻、丝瓜络通利小便；葶苈子通调肺气，使水气下行，渗入膀胱，小便通利，水肿得消。
例2：常某，女，19岁，1986年6月21日就诊。反复浮肿3年。1986年4月某医院诊为慢性肾炎，用青霉素、双氢克尿塞治疗，症状好转后出院。来诊时全身浮肿加重，尿少色黄，双下肢凹陷性水肿，腹水征明显。小便常规：颜色黄，蛋白(++)，红血球、白血球少许。西医诊为慢性肾小球肾炎，中医辨证为脾肾阳虚。
治则：重在治标，兼顾治本。药用鸡鸣散基本方加黄芪20g，党参12g，海金沙10g，茅根15g。水煎取汁300ml，清晨空服。药后解稀黑便数次，尿量增加。水肿消退后，以金匮肾气丸调治而愈。
3 体会
鸡鸣散方中，重用槟榔通腑除湿、行气利小便，生姜、吴萸温中散寒，紫苏为血中之气药，气行则血行。佐以木瓜之酸，桔梗之苦，酸苦涌泄为阴。寒湿之气，得行气之药，微汗解之，解之不尽，从大便泄之。方中重用附片，以增强温阳之力，用葶苈子泻肺气，茯苓、泽泻增强排尿之功。五更服药，疗效更显。
鸡鸣散加减治疗结节性痤疮
贺某某，40岁。从18岁开始面部潮红瘙痒、结节、囊肿，多方诊治未效。1999年4月21日初诊，见面部潮红，大小不等的丘疹如黄豆或绿豆大小，彼此凸凹不平，呈结节状广泛分布于面部两颊及下颌，整个面部尤如蟾蜍皮一样，每于说话及情绪激动时，面色由潮红转为紫暗如茄子色，局部瘙痒，面部虽粗糙而不干燥，毛囊丘疹虽起伏不平而未角化，无鳞屑，抚之不棘手，伴口淡乏味，头重嗜睡。舌淡苔润，舌质晦暗，脉沉微。观其既往用药，中药以清热解毒，活血化瘀，泻火祛湿为主，外治大多为各类激素软膏。分析病机为脾虚湿盛，寒滞经脉，气机不利，阳气失于清展，湿浊之邪侵淫肌肤，泛溢面部，盘踞不解，成为痼疾。治拟燥湿健脾，芳香化浊，通阳化气。方以鸡鸣散加减：苏叶、木瓜、良姜、吴萸、橘红各15g，桔梗25g，槟榔50g。服5剂后，觉瘙痒减轻，但面部症状如故。再予上方加苍术30g，连服30剂，面色由紫红色转为淡红，但说话时面部颜色略变赤，结节性丘疹明显缩小变软，数量减少，瘙痒消失，面颊及耳部前后已光整，对比原先，判若二人，且食欲大增，舌质转为淡红舌，白腻苔已退。药中病机，守方再进30剂后，面部结节性丘疹全部消失，肌肤润泽，告愈。
痤疮以局部毛囊红色丘疹，或黑头粉刺、脓疮、结节、囊肿等为主要表现。临床分为肺热、胃热、血热、湿毒、血瘀等型，在治法上各有千秋。而本例患者历时20余年，更医数十人而无功，可谓棘手。笔者认为关键是病机不明，未能摆脱热与毒的束服，按常法施治，难得建树。对久治不愈的慢性病，既要知悉其常，又要知其变证，不必拘于常规常法，更要善于思考和总结前医不应之因，从而达到明能烛幽，避免重蹈覆辙。笔者首诊抓住脾虚湿盛，寒滞经脉，淫气妄行之关键所在，用燥湿健脾、芳香僻浊、通阳化气为法，以鸡鸣散展示其开上、导下、疏中、温宣、降浊之功。药用色赤气香、辛温之苏叶，辛者能散，温者能通，散经脉之淫气湿毒，通阳明之沉寒痼浊；木瓜和胃化湿、舒筋活络、通行气血、宣络脉、达百骸、辟湿浊；桔梗、橘红开中上焦之气，气行则湿自化，络自通；良姜、吴萸温运中州、散寒通阳，以扶脾燥湿，脾旺则湿去阳复，气行血畅则湿浊无容藏之所；槟榔宣利五脏六腑经络之湿滞，行气逐湿，则结节自消；味香气烈之苍术入太阴、阳明二经，燥湿健脾、运脾和胃、开郁宽中，无所不至，发水谷之气，越经络之滞，能入清经，通行湿滞，特别对久羁之阴寒湿浊，非此莫属，非此不举。诸药合用，气味雄厚，安内攘外，消痤疗疮，标本兼治。一可入脏腑达中州，运转枢机，荡涤阴邪，则脾健阳振，湿化机畅，以正本清源。二可温经散寒，舒筋活络，通行气血，则久羁于面部的湿毒浊邪得以消散，恢复其庐山真面目。
孙太太香港脚入腹治验
杭垣水沟巷孙太太。两足自至跗皆肿。热痛甚。皮色光亮。至晚发厥。延余诊之。脉沉而弦。余曰。此名香港脚入腹。亦危症也。冲心即死。其足上有诸络现者。尽刺出血。并刺委中。遂与鸡鸣散。令五更鸡鸣时服。外以蚕矢汤熏洗。次晚果不厥而热痛仍然。乃用槟榔、蚕沙、海桐皮、木瓜、片子姜黄、黄芩、滑石、薏仁等而愈。---------------------------------------------------
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