2018년 6월 28일 목요일

대통령을 묻어버린 '거짓의 산' 108편 | 손석희의 JTBC는 대한민국 국민을 바보로 취급했다!


https://youtu.be/brNx8j7NWyU
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이인규 前 중수부장 vs. 원세훈 前 국정원장
노무현 전 대통령 시계수수 범죄사실 수사 관련 입장문
조갑제닷컴
무학산     2018-06-28 오후 2:13
이게 다 이명박 정권이 노무현 뇌물 사건을
야무딱지게 처리하지 않았기 때문에 있게 된 일이다.
이명박은 노무현 자살 앞에서 벌벌 떨었다. 그래서 우겨서 국장으로 했고
이는 국민들이 자살자에 대한 동정심을 유발시킨 가장 큰 원인이 되었으며
나아가 '폐족'들이 집권한 계기가 되었다.
세상 천지에 뇌물 피의자를 호텔에서 조사하는 나라가 어디에 있나?
그때 야무딱지게 처리했더라면 오늘 감방에 가 있지도 않을 것이며
박근혜 또한 여기서 자유로울 수 없다

지금 문재인 정권이 거칠 것 없이 나대는 것도
만약 다음에 정권 교체가 있더라도 우익은 자기들에게 보복하지 못할 거라고
믿기 때문에 일개 정권이 나라를 제 맘대로 휘젓는 것이다
. (발췌)
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약의 가격을 내릴 수 있는 방법
---->한의학의 약과 침구를 도입하면, 약값을 크게 낮출 수 있고, 치료 효과도 눂일 수 있다. 한의학의 약은 새롭게 개발하는 게아니라, 기존의 약초를 응용해 새로운 치료 방법을 찾는 것이므로, 개발비가 거의 들지 않는다.  
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주류 경제학의 수요 공급 이론의 헛점

 
Problems with Mainstream Theories of Supply and Demand
 
 
Frank Shostak
 
 
One of the few things economists agree on is that prices are determined by supply and demand. This is summarized by means of supply and demand curves, which describe the relationship between the prices and the quantity of goods supplied and demanded.
 
Within the framework of supply-demand curves, an increase in the price of a good is associated with a fall in the quantity demanded and an increase in the quantity supplied. Conversely, a decline in the price of a good is associated with an increase in the quantity demanded and in a decline in the quantity supplied.
 
The law of supply is depicted by an upward-sloping curve while the law of demand is presented by a downward-sloping curve.
 
The equilibrium price is established at the point where the two curves intersect. At this point, the quantity supplied and the quantity demanded is equal at the equilibrium price the market is said to "clear."
 
Graphs vs. Reality
 
In the conventional supply-demand framework, consumers and producers confront a given price; that is, at a given price, consumers demand and producers supply a certain quantity of a good. Demand is not a particular quantity, such as 10 potatoes, but rather a full description of the quantity of potatoes the buyer would purchase at each and every price that might be charged. Likewise, supply is not a particular quantity but a complete description of the quantity that sellers would like to sell at each and every possible price. At a given price, people demand a certain quantity of a good while producers supply a certain quantity.
 
Within this framework, neither consumers nor producers have anything to say as far as the origin of a good’s price is concerned. The price is just given. Both consumers and producers react to a given price. However, who has given the price? Where has the price come from?
 
The law of supply and demand originates from imaginary construction of economists
 
The law of supply and demand as presented by mainstream economics does not originate from the facts of reality but rather from the imaginary construction of economists. None of the figures that underpin the supply and demand curves originate from the real world; they are purely imaginary.
 
The framework of supply-demand curves rests on the assumptions of unchanged consumer preferences and income and the unchanged prices of other goods. In reality, however, consumer preferences are not frozen, and other things do not remain constant. Obviously, then, no one could have possibly observed these curves. According to Mises,
 
"It is important to realize that we do not have any knowledge or experience concerning the shape of such curves."1
 
Yet, economists heatedly debate the various properties of these unseen curves and their implications regarding government policies.
 
The whole idea that the price of a good is simply given produces the impression that the price is an attribute of a good--i.e., that it is part of the good itself. There is, however, no such thing as a price of a good in general. The prices of goods are established in a particular transaction at a particular place and at a given time. According to Ludwig von Mises,
 
A market price is a real historical phenomenon, the quantitative ratio at which at a definite place and at a definite date two individuals exchanged definite quantities of two definite goods. It refers to the special conditions of the concrete act of exchange. It is ultimately determined by the value judgments of the individuals involved. It is not derived from the general price structure or from the structure of the prices of a special class of commodities or services. What is called the price structure is an abstract notion derived from a multiplicity of individual concrete prices. The market does not generate prices of land or motorcars in general nor wage rates in general, but prices for a certain piece of land and for a certain car and wage rates for a performance of a certain kind.2
 
The value that an individual assigns to goods is the product of his mind judging the facts of reality. Individuals assess the usefulness of a good as a means to support their life and wellbeing. On this Carl Menger wrote,
 
 
Value is thus nothing inherent in goods, no property of them, nor an independent thing existing by itself. It is a judgment economizing men make about the importance of the goods at their disposal for the maintenance of their lives and wellbeing. Hence, value does not exist outside the consciousness of men. It is therefore, also quite erroneous to call a good that has value to economizing individuals a "value," or for economists to speak of "values" as of independent real things, and to objectify value in this way.3
 
Similarly, Mises wrote,
 
 
It would be absurd to look upon a definite price as if it were an isolated object in itself. A price is expressive of the position which acting men attach to a thing under the present state of their efforts to remove uneasiness.4
 
How Prices Are Determined
 
Contrary to the mainstream view, prices are not just given somebody sets them. This somebody is a producer. Whenever a producer sets a price for his product, it is in his interest to secure a price where the quantity that is produced can be sold at a profit.
 
In setting this price, the producer/entrepreneur will have to consider how much money consumers are likely to spend on the product, the prices of various competitive products, and the cost of production.
 
Producers set the price. However, consumers, by buying or abstaining from buying, are the final decision-makers as to whether the price set will lead to a profit.
 
Producers in this regard are at the total mercy of consumers. If, at a set price, a producer cannot make a positive return on his investment because not enough people are willing to buy his product, the producer will be forced to lower the price to boost turnover. Obviously, by adjusting the price of the good, the entrepreneur must also adjust his costs in order to make a profit.
 
A producer will secure a profit when, at the set price of a good, consumer buying will generate revenue that will exceed the cost plus interest. Profit is an indication that both producers and consumers have improved their wellbeing.
 
By investing a given amount of money, producers have secured a greater amount of money. This, in turn, enables them to secure a greater amount of goods and services, which in turn promotes their lives and wellbeing. Likewise, consumers, by exchanging their money for goods that are on their highest-priority lists, have raised their living standards.
 
In fact, price setting is never mechanistic and automatic. It is up to the producer/entrepreneur to assess whether it is a good or a bad idea to raise prices; after all, what matters for him is making a profit.
 
When a good makes a profit at a particular price, then it is a signal to entrepreneurs that consumers are willing to support the product at the set price. Prices, therefore, are an important factor in establishing how producers employ their resources.
 
Observe, then, that what determines the amount of goods supplied is not some hypothetical demand schedule, but a producer's appraisal as to whether, at a given place and a given time, consumers will approve of the goods supplied. He has to be as accurate as possible in setting the right price that will enable him to sell his supply at a profit.
 
Further Issues with the Supply-Demand Framework
 
In the supply-demand framework, production cost is an important input in determining the prices of goods. In the supply-demand framework, an increase in the cost of production will shift the supply curve to the left. For a given demand curve, this will raise the price of a good.
 
We have already seen, however, that it is consumer buying or abstention from buying that is the sole determining factor for the prices of goods. No individual buyer is preoccupied with the cost of producing a particular good. The price that he will agree to pay for a good is in accordance with his particular priorities at a given point in time. The cost of production is of no relevance to him.
 
Moreover, the cost-of-production theory runs into trouble when attempting to explain the prices of goods and services that have no cost because they are not produced goods that are simply there, like undeveloped land. Likewise, the theory cannot explain the reason for the high prices of famous paintings. On this Murray Rothbard wrote,
 
 
Similarly, immaterial consumer services such as the prices of entertainment, concerts, physicians, domestic servants, etc., can scarcely be accounted for by costs embodied in a product.5
 
Using the supply-demand framework for a particular good, mainstream economists proceed further and introduce supply and demand curves for the whole economy. They hold, for example, that if the economy is under performing then what is needed is a bolstering of demand by means of fiscal or monetary policies.
 
For a given supply curve, they contend, this will push the demand curve to the right, thereby lifting overall output. Observe that the supply-demand framework provides the rationale for government and central bank interference with businesses.
 
This framework, however, says nothing how the increase in demand generates more output. Furthermore, it is silent regarding the funding required in order to raise output. Also, we have seen that, in reality, it is producers that initiate the introduction of new products. They set in motion increases in goods and services, and not consumers as such.
 
Producers present new products, so to speak, to consumers who, in turn, by buying or abstaining from buying, determine the fate of products. Hence, there is no such thing, as an autonomous demand that somehow triggers supply.
 
Supply-demand graphics also provide the justification for various imaginary monopolistic theories, which in turn provide the rationale for the government destruction of successful businesses. For instance, it is held that a company that forces the price above the competitive price level is engaged in monopolistic activities and therefore must be taken to task.
 
Even if we were to accept, this way of thinking as valid there is no way to establish whether the price of a good is above the so-called competitive price level (monopoly price). By what criteria can one decide what a competitive price is?
 
On this Rothbard wrote,
 
There is no way to define 'monopoly price' because there is also no way of defining the competitive price' to which the former must refer.6
 
In the supply-demand framework for the economy, economists employ the quantity of output produced and its average price. However, neither the average price nor the total output can be established.
 
It is not possible to establish an average price for $10 /shirt and $50/liter of wine. Likewise, it is not possible to add ten shirts and one liter of wine to establish the total output. Hence, the entire graphical framework of the supply and demand for the economy rests on misleading premises.
 
What’s more, the whole issue of so-called equilibrium is misleading in the way the supply-demand framework presents it. Equilibrium, in the context of conscious and purposeful behavior, has nothing to do with the intersection of supply and demand curves.
 
Equilibrium is established when an individual’s ends are met. When a supplier is successful in selling his supply at a price that yields profit, he is said to have reached equilibrium. Similarly, consumers who bought the supply have done so in order to meet their goals.
 
Therefore, government and central bank policies aimed at shifting imaginary curves toward so-called equilibrium in fact prevent both consumers and producers from attaining their goals and hence prevent the achievement of the true equilibrium.
 
Conclusion
 
 
Despite its great appeal because of its simplicity, the supply-demand graphic as employed by mainstream economics is a tool that is detached from the facts of reality.
 
The real-world economy is far too complex to be faithfully rendered by simple graphs that take no account of uncertainty, entrepreneurial speculation, and the ceaseless change of the market economy.
 
By no means is this framework harmless, because government and central bank decision-makers make use of this tool in forming various policies. This is why they are continually surprised when the real economy performs in a manner different from what their graphical analysis would seem to predict.
 
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   장중경의  본래 의도로 돌아가라

 
回归仲景原意 在临床中诠释经典

——《黄仕沛经方亦步亦趋录》评介

熊兴江 中国中医科学院广安门医院心内科

(本文发表于中国中医药报)
  近读中国中医药出版社出版的经方新著《黄仕沛经方亦步亦趋录——方证相对医案与经方问对》,获益匪浅,感慨良多。黄仕沛先生出生于中医世家,幼承庭训,正步杏林,从医多年,体验非凡。上世纪90年代起转攻仲景之学,于经方致力尤勤,尤其服膺仲景方证之学,大有“觉今是而昨非”之感。书中不仅通过大量经方治疗危急重症病案展示出一位当代中医临床名家疗效卓著、屡起沉疴的大师风范,更展示出先生对中医学的真挚感情,对中医学子的提携厚爱。黄师谆谆告诫后学学习中医学的关键与捷径——方证相对,笔者对此感同身受。
  忠实仲景原文,亦步亦趋
  黄师常谓“仲景步亦步,仲景趋亦趋,是学习经方最基本要求,也是最高境界”,黄师指出对医圣亦步亦趋,以仲景书为法,探索经方的辨治体系和用药规律是学习捷径所在。而学习、掌握、运用经方的基础与关键则在于忠实仲景经典原文。临证时,只有熟练掌握方证条文,才可以辨别方证进而据证用方。书中记载的大量经方验案与经典原文高度相似,可以说是经典条文的高频再现,是经方医案的原味翻版。如“胸中一股寒气上冲咽喉,时而数日一发,时而一日数发,发作时觉胸中窒息感”即“胸痹心中痞,留气结在胸,胸满,胁下逆抢心”之枳实薤白桂枝汤证;“上腹部跳动感半年”的十二指肠球部溃疡即“心中悸而烦者”的小建中汤证;应激性肠炎患者的“大便失禁,清稀如水状,量多”即“自利不渴者,属太阴,以其脏有寒故也”的理中汤证等。
  拓展运用经方,深入挖掘
  由于经典原文叙症极其简略,这给我们学习继承带来了极大的困难,因此如何做到古方新用、古方今用,还原、丰富、充实方证主治就成了学习经方的重要任务。黄师以其深厚的理论功底和扎实的临床实践经验,深入挖掘经典高效古方方证,拓展经方证治,还原经方剂量,读来启发甚多。以小续命汤为例,该方原文主治中风痱,黄老将本方拓展运用于治疗多发性硬化、脊髓膜瘤术后脊髓萎缩、急性胸颈段神经根炎、帕金森综合征、胸腺瘤术后放疗后脊神经受损等出现四肢肌力下降,肌张力降低,下肢活动不利、乏力,感觉障碍,麻痹不仁,言语不清,吞咽功能障碍,神经性疼痛等。黄师对方证的临证发挥还有很多,如不仅将木防己汤用于治疗关节疼痛,指(趾)端如鼓槌状,还用于慢性肺源性心脏病肺动脉高压出现指端发黑、杵状指的治疗,认为这是条文“面色黧黑”的延伸;甘草泻心汤治疗银屑病、慢性结膜炎、手足口病;防己地黄汤、风引汤治疗老年女性的嘴巴不自主抖动,脑梗后肢体不自主舞蹈等。
  不尚玄理空谈,力倡客观
  “仲景之学,至唐而一变”,自宋以降,中医学思辨盛行,徐灵胎针对当时医界诡辩盛行深有感慨,“今则以古圣之法为卑鄙不足道,又不能指出病名,惟以阳虚、阴虚、肝气、肾弱等套语概之”。黄师敏锐意识到该问题的严重性,临床不尚玄理,不尚空谈,不尚浮夸,反对以虚无飘忽的理论解释仲景学说。通过文献考证发现,《伤寒论》与《内经》并非同一传承体系,若以《内经》理论解释仲景学说则大失圣人之意,所以黄师反复告诫学生,“须知仲景用药,皆以证为依据”。如麻黄汤中桂枝为桂枝证而设,不仅能主治恶寒发热头痛,更能定悸,减轻麻黄发汗太过而出现“心下悸欲得按”之弊;芍药甘草汤并非“酸甘化阴”所能解;血府逐瘀汤中桔梗、牛膝一升一降只是基于良好主观愿望的一厢情愿,桔梗去之也无妨等。
黄师力倡回归仲景原意,主张在临床中诠释经典,反对以虚玄的理论敷衍解释伤寒,甚至在其《陋质铭》中说“可以丢素问、去难经,无生克之乱耳,无六气之无形”,看似偏激,但其言论切中时弊、掷地有声、振聋发聩。况且黄师也不完全反对《内经》,只是强调要把有限的精力放在重点上,而这里的重点则指“方证”。柯韵伯曾说,“夫仲景之道,至平至易,仲景之门,人人可入,而使之茅塞如此,令学人如夜行歧路,莫之指归,不深可悯耶?”中医学大道至简,而方证则是中医学的核心所在,是执简驭繁的关键。总的来说,笔者认为该书瑕不掩瑜,不失为学习经方之一大助,为嘉惠杏林的一部应时佳作。
 
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 黄仕沛의 지황 사용법


《神农本草经》谓干地黄“治折跌绝筋,伤中逐血脉,填骨髓,长肌肉,……除寒热、积聚,除痹。”
    《伤寒杂病论》中使用地黄的方剂有10首,分别是:胶艾汤、当归建中汤、黄土汤、炙甘草汤、薯蓣丸、三物黄芩汤、百合地黄汤、防己地黄汤、肾气丸、大黄庶虫丸。
10首方中地黄用量最大的是防己地黄汤,用生地黄二斤,其次是炙甘草汤用生地黄一斤。百合地黄汤则用生地黄汁一升。大黄庶虫丸用干地黄十两,肾气丸用干地黄八两,当归建中汤的加减法中,若去血过多,崩伤内衄不止,加地黄六两,胶艾汤、三物黄芩汤用干地黄四两,黄土汤用地黄三两,薯蓣丸用干地黄十分,用量皆相当大。
    地黄在配伍上有广泛的亲和力,如与养血、活血、益气、温阳、清热、养阴、利水均可配伍。
    从地黄的使用指征来看,地黄用于皮肤干燥枯槁,大便干结,口干舌干,唇干裂,舌瘦苔少,或唇红舌红,脉细数、结代。后世温病验齿,叶天士“看舌之后,亦须验齿”,所以地黄的药证当是唇舌干燥,牙齿枯槁。但无论用于何证,配伍何药,地黄都必须重用,非重用不足以为功。黄师用地黄常用30-90克,最大用至180克。
黄仕沛老师临床上善用地黄,他认为,综合来看,地黄之用在于滋阴养血,具体效能主要包括:1.润燥,2.制燥,3.定躁,4.安神、5.定悸。除此之外,地黄还可以止血、清热,本文不一一尽述。
    一、地黄剂的主要功效
    1 润燥
    1.1用于治疗皮肤科疾病
    《伤寒论》196条:“阳明病,法多汗,反无汗,其身如虫行皮中状者,此以久虚故也。”此乃阳明久虚,津液不足,汗源不充,故法多汗反无汗,而皮肤干燥瘙痒。如荨麻疹、带状疱疹、神经性皮炎等,特别是老年性皮肤干燥症,考虑为阳明久虚,津液不足,潮红,脱屑比较明显者,黄师常用大剂量生地,最大用至90g。
黄师曾治一过敏性皮炎患者,全身片状皮疹,干红,瘙痒明显,以甘草泻心汤加麻黄、生地、石膏治疗,处方:
    麻黄十二克(先)川连六克黄芩十五克 法夏二十四克
    干姜六克   大枣十五克  甘草三十克  党参三十克
    石膏九十克  生地三十克
    十剂后症状明显好转。
    黄师曾述,当年黄继祖师公,曾治一妇人,身痒久不愈,几欲自尽,嘱予生地煲瘦肉,服之越旬而愈。
我亦曾治一糖尿病周围神经病变患者,全身皮肤干燥、潮红,瘙痒难忍,满布搔抓的痕迹,抓痕处有渗血、谌液。发病已接近1年,时好时坏,本次加重接近1月,反复使用过多种抗过敏药物,甚至使用过激素,效果不佳。予百合地黄汤合麦门冬汤加减,处方:
    百合三十克  生地三十克  麦冬六十克  法夏二十四克
    大枣十五克  甘草十克  党参三十克
    并与生地三十克、甘草三十克煎水外洗,治疗十余天后皮肤干燥、瘙痒症状较前明显缓解。
    1.2用于治疗阴枯液竭的患者
    黄仕沛老师认为欲养真阴非重用生地、麦冬不足以为功。
    仲景的炙甘草汤、薯蓣丸,甚至大黄庶虫丸中使用生地,都是因为它能滋阴养血,改善阴液枯竭的症状。
炙甘草汤又名复脉汤,《金匮要略﹒肺痿肺痈咳嗽上气脉证并治》附《外台秘要》“肺痿涎唾多,心中温温液液者”。现代很多医生都用炙甘草汤改善肿瘤患者的恶液质状态。黄师曾以炙甘草汤治疗肺癌术后及冠心病支架植入术后阴液枯竭的患者,疗效显著。
    薯蓣丸和大黄庶虫丸都出自《金匮要略﹒血痹虚劳脉证并治》。“虚劳诸不足,风气百疾,薯蓣丸主之。”此方自然是补虚之剂。“五劳虚极羸瘦,腹满不能饮食,食伤,忧伤,饮伤,房室伤,饥伤,劳伤,经络营卫气伤,内有干血,肌肤甲错,两目黯黑。缓中补虚,大黄庶虫丸主之。”大黄庶虫丸是《金匮要略》治疗干血痨的方剂,治疗瘀血内结日久,伴有明显的阴液枯竭。与治疗妇人产后腹痛的下瘀血汤比较,本方重用地黄,并加用其他一些活血破瘀药物,这便足见仲景组方的用意。《千金要方》有治月水不通,脐下坚,大如盘。发热往来,下利羸瘦,方用生地黄三十斤,取汁,内干漆,为末一斤,微火煎,令为丸,每服酒下如梧丸大三丸。此方也是化在瘀的同时,重用大量生地治疗阴枯液竭。八十年代初,黄师就以大黄庶虫丸治愈一例疑为席汉氏综合征的消瘦、肌肤甲错、腹胀、闭经患者,取得了很好的效果。
    黄师曾治一鼻咽癌放化疗术后中年男性,2011年6月初确诊,6月中旬接受化疗,约两周前化疗完成。8月22日开始接受放射治疗,现仍进行中。9月初逐渐出现口腔溃疡,咽喉干痛,饮食难进,胃脘胀满,呕吐。曾用西药治疗,效果不显。9月27日经友人介绍请黄仕沛老师诊治。刻诊患者咽痛、咽干、口干,口腔双侧颊侧溃疡,舌面溃疡,吞咽障碍,饮食难进,胃脘胀满,时有呕吐,唇舌红色如染,舌干瘦,无苔。不寐而烦。
    黄师拟黄连阿胶鸡子黄汤合麦门冬汤加生地。
    处方:黄莲6克、黄芩15克、白芍15克、大枣5克、党参30克、法夏60克、麦冬30克、生地90克、甘草30克、阿胶15克(烊化,兑)、鸡蛋黄一枚(药成放之搅拌)。七剂。
    10月4日再诊,诸证悉除;唇舌红已退,如常色,口腔及舌痛溃疡己愈,唯余咽仍有少痛,能进食粥、面条。除10月3日一点醒来,个多小时后才再入睡,几天来睡得很好。
    2 制燥
    地黄在经方的配伍中还有制燥的作用。如炙甘草汤三分阳药,七分阴药,此方中地黄还有制桂枝温燥的作用。如防己地黄汤,生地二斤配伍防己、防风、桂枝等辛温的药物也是此意。《千金》、《外台》亦有多方是使用地黄制燥的。后世方如大秦艽汤用地黄也是此理。
    黄师用温燥药物时也常用生地制燥,如曾治一例脑梗塞恢复期患者,左侧肢体乏力,言语欠清,但舌红少苔,大便干结,便予续命汤加生地90克,治疗后舌红、便秘症状好转,肢体活动功能也较前改善。
    3定躁
    躁者,躁动不安,定躁即定躁熄风,风指的就是后世的所谓“内风”,所以这里所谓定躁就如同后世医家的育阴熄风。此时生地更应用大量,一般90-120克。
    防己地黄汤出自《金匮要略﹒中风历节病脉证并治》“治病如狂状,妄行,独语不休,无寒热,其脉浮。”黄仕沛老师认为,仲景的防己地黄汤重用生地二斤,滋阴养血,治疗以阴虚阳亢为主的中风,开后世育阴熄风的先河。
    叶天士喜用生地育阴,《临证指南医案﹒肝风门》的三十二个医案中,用地黄的有二十多案,可见地黄的重要。吴鞠通的复脉汤、一甲、二甲、三甲复脉汤、大定风珠及张锡纯的建瓴汤皆用地黄。
黄师曾以防己地黄汤治疗两例脑梗塞后出现不自主运动的患者,一例双手舞动不止,型似兰花,一例嘴巴不自主抖动,皆用生地九十克,治疗后症状缓解,未见再次发作。
    杨森荣师兄的伯父因慢性阻塞性肺病住院,除气促、咳痰以外,还出现双上肢不自主颤动,师兄以防己地黄汤,生地120克治疗,数剂后双上肢颤动停止。
    叶天士有:“凡肝阳有余,必须介类以潜之,柔静以摄之,味取酸收,或佐咸降,务清其营络之热,则升者伏矣”。黄师还认为后世提出的平肝熄风,育阴潜阳之法,实蕴含于风引、侯氏黑散、防己地黄汤三方之中。候氏黑散的菊花清肝热,皂矾除痰;风引汤介类潜阳,大黄通腑;防己地黄汤以地黄养阴血。临床上三方应互联使用。黄师曾治一脑梗塞急性期的老年男性,左侧上下肢不自主舞动不休,以防己地黄汤育阴合金石介类潜阳,生地最大用至一百二十克,十余剂后不自主运动得以控制,现行动如常。
    4 安神
    仲景用地黄的方剂十首,其中用生地黄的方剂包括炙甘草汤、防己地黄汤、百合地黄汤共有三首,这三个方证皆有“神”的症状,如防己地黄汤“如狂状,妄行,独语不休”,百合地黄汤所治百合病“意欲食复不能食,常默默,欲卧不能卧,欲行不能行,饮食或有美时,或有不闻食臭时”的“神识之疾”。此时生地也应用90-120克。
    黄师近期治疗一老年女性患者,近期常有幻听,似觉常常听见隔壁的敲击声,问其子女均未听见,故心烦意乱,心中怵惕不安,夜间常不能入睡。黄师先以柴胡加龙骨牡蛎汤治疗,一周后患者心悸症状明显缓解。但仍有明显幻觉,难以入睡,遂改予防己地黄汤加减,处方:
    防己二十四克  生地九十克  桂枝二十克  防风十五克
    甘草十克  生龙牡各三十克
    两周后幻听减少,地黄逐渐加量至一百五十克,继续服用治疗。
    5定悸
    《伤寒论》第178条:“伤寒,脉结代,心动悸,炙甘草汤主之”,炙甘草汤重用生地一斤,是治疗心悸的千古名方。
    曹颖甫用本方深有体会,他说:“脉结代,心动悸,炙甘草汤主之。此仲景先师之法,不可更变也。”可谓一语中的。仲景治悸有多方,但脉结代而又心动悸者,此无可替代之方也。《经方实验录》中共载有三案,如唐君案:“素有心脏病,每年买舟到香港,就诊于名医陈伯坛先生,先生用经方,药量特重,如桂枝、生姜之属动以两计。大锅煎熬,药味奇辣,而唐君服之,疾辄良已。今冬心悸,脉结代又发,师与炙甘草汤,服至三五剂,心悸愈,结代渐稀……。”深感粤沪两位经方大家,解读《伤寒论》虽各有见地,然审证用药则一也。
当然对于治疗心悸,桂枝是最关键的,但后世解释炙甘草汤多认为生地黄有此功效。黄师以炙甘草汤治疗心律失常包括频发室性、预激综合征等多例,每次皆能起效。
    二、地黄剂的煎煮法
    仲景凡地黄剂均与酒同用,几成定例。
    历代注家多从酒之性去诠释;如“酒可通经”,柯韵伯则曰:“清酒引之上行。”但细观仲师之地黄方,如胶艾汤亦与酒同煎,然胶艾汤乃止血方,无须通经,也无须引药上行。防己地黄汤是以酒渍防己等四味一宿,绞取汁,再与地黄汁和合。尤在泾释:“酒浸取汁,用是轻清,归之于阳,以散其邪。”可见注家常落臆解俗套,恐非仲景原意也。试想药与酒同煎,汤成则酒味俱挥发殆尽,何以通经、上行?近人解释地黄剂用酒同煎是起“溶媒”作用,有利于地黄等有效成份析出,应为仲师本意也。
    黄师于大剂量生地的地黄剂,如炙甘草汤、防己地黄汤等也常与酒同煎。汉代未有蒸馏酒,故不应是高粱酒之类,应是黄酒,如花雕酒之类。但如果如炙甘草汤以“清酒七升,水八升”同煎则酒费不菲也。我们往往是以水七、八碗煎至三碗左右,放花雕酒半支或一支。再煎成一碗。感觉放酒效果较好。
    三、生地固可凉血,但并非虚人不能用
    世人一般认为,熟地补血,生地败血,所以一般滋养补虚用熟地,凉血则用生地。其实并非如此。
    首先,汉时并无熟地,但仲景用地黄总体是用来治虚的。
    其次,熟地补血,生地败血,此说可能来自叶天士的“入血就恐耗血动血,直须凉血散血,如生地……”。但叶天士又有“舌淡红无色者,或干而色不荣者,当是胃津伤而气无化液也,当用炙甘草汤,不可用寒凉药” 之说。由此可见,叶氏认为重用一斤生地的炙甘草汤并不是寒凉药,而是改善胃津损伤的补虚药,那么叶氏同样也将生地用作补虚。
    再次,吴鞠通用生地皆是“非重用,不为功”。细看《温病条辨》中的各方,“阳明温病,无上焦症,数日不大便,当下之;若其人阴素虚,不可行承气者,增液汤主之。”又如“阳明温病,下后汗出,当复其阴,益胃汤主之”;“下后无汗,脉不浮数,清燥汤主之”;“下后数日,热不退,或退不尽,口燥咽干,舌苔干黑,或金黄色,脉沉而有力者,护胃承气汤微和之”;此外还有新加黄龙汤、增液承气汤。上述各方中用生地都是为了滋阴养血。
    由此可见,生地固可凉血,但并不是说虚人就不能用。
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어제인가 그제 kbs에서 현훈에 대한 프로그램을 했는데, 보지는 않았지만 물론 엉터리 서구의학 이론을 읊었을 것이다.  아래는 장중경의 책 중에서 현훈에 대한 약을 몇가지 추려낸 것이다.


论张仲景治眩晕之法
李玉玲 湖北中医学院05级教改实验班
  在《伤寒论》和《金匮要略》中,眩晕又称“癫眩”、“冒眩”、“眩"或“冒”,共有9处条文涉及此症,整理成篇,以飨同道,以希临床勿忘仲景之法。所列标明条数者,皆出自《伤寒论》,其他则出自《金匮要略》。
  阳虚饮停
  1.脾阳虚,水气上冲——苓桂术甘汤 
  “伤寒若吐若下后,心下逆满,气上冲胸,起则头眩,脉沉紧……苓桂术甘汤主之。”(67)脾胃阳虚,运化失司,水气上逆则心下逆满;脾虚不能制水,水气上冲则气上冲胸。水气上蒙清窍则头晕,起则清阳之气更难达头部,则头晕目眩加重。脉沉主水,脉紧为寒,水寒为病,故脉沉紧。治当温阳健脾,利水降冲,方用苓桂术甘汤。茯苓为主药,淡渗利水;桂枝温阳降冲,配合茯苓温阳化气,淡渗利水。白术与茯苓相配,健脾利水,与甘草相配,健脾益气。本方温能行气,甘能补脾,燥能祛湿,淡能利水,合奏温阳健脾,利水化饮之效。在《金匮要略》中“心下有痰饮,胸胁支满,目眩,苓桂术甘汤主之”与(67)条基本病机一致,故治法相同。
  2.肾阳虚,水泛于上——真武汤 
  “……其人仍发热,心下悸,头眩,身瞤动,振振欲擗地者,真武汤主之。”(82)肾阳虚不能化气行水,则水气不行,水气上凌于心上逆,蒙蔽清阳则头晕目眩。“阳气者,精则养神,柔则养筋。”筋肉为水气浸渍,加之阳虚失于温养则时跳动,身体振颤,站立不稳,而欲倒仆于地。发热乃虚阳浮越于外所致。治以温阳利水,方用真武汤。附子辛热,温肾壮阳,补命门之火使水有所主;白术苦温,燥湿健脾,使水有所制。白术附子同用,温煦经脉而除寒湿;生姜辛温,宣散水气,亦可行水;茯苓淡渗利水,与白术相合,健运中土;芍药敛阴和营,并制生姜,附子刚燥之性,保证二物既能温经散寒,又不伤阴耗液,五物合用,共奏温阳利水之功。
  3.饮停下焦——五苓散 
  “假令瘦人,脐下有悸,吐涎沫而癫眩,此水也,五苓散主之”证属下焦饮逆,饮停下焦,水气凌心,水饮上逆犯胃,胃失和降故吐涎沫;上蒙清阳,清阳不升故眩晕,治疗以五苓散化气行水,导饮下行外出;方中茯苓,猪苓,泽泻利水驱邪,白术健脾制水,桂枝辛温温阳化气兼具有发汗之功,故能使水饮之邪内外分消。
  饮邪偏盛
  1.饮停心下——泽泻汤
  “心下有支饮,其人若冒眩,泽泻汤主之”。心下泛指胸隔胃脘,饮停心下,邪盛上返,蒙蔽清窍故眩晕,法当健脾利水,用泽泻汤。张仲景用泽泻,利水祛邪,导浊阴下行,白术健脾燥湿,崇土制水。泽泻汤常用与水饮上泛引起的眩晕病种涉及梅尼埃病,前庭神经炎,高血压病,脑椎——基地动脉供血不足等,临证应随症加减,如呕吐甚者,可加小半夏汤;兼脾阳不足者,可加苓桂术甘汤,兼肝阳上亢者,可见菊花,钩藤,天麻;兼肝阴不足者,可加白芍,枸杞子;兼气血两虚者,可加党参,黄芪,当归;情志不畅诱发者,可加柴胡,郁金,合欢皮;兼耳鸣者,可加龙骨,牡蛎;兼耳聋者,可见石菖蒲。
  2.饮停隔间——小半夏加茯苓汤
  “卒呕吐,心下痞,隔间有水,眩悸者,小半夏加茯苓汤主之。"水饮停聚隔间,若犯及、胃,胃气上逆则呕,水饮阻滞气机则心下痞;,邪盛上犯清阳不升,故目眩,水气凌心乃心悸,法当蠲饮降逆,宣阳制水,用小半夏汤加茯苓汤。方中半夏,生姜既能蠲饮散结,开宣上中两焦阳气,又能降逆止呕,安胃和气,茯苓利水祛饮,宁心安神。
  3.妊娠水气——葵子茯苓散
  “妊娠有水气,身重,小便不利,洒淅恶寒,起则头眩,葵子茯苓散主之”。“妊娠有水气”即后世所称的“子肿”,此证多因胎气影响,膀胱气化被阻,水湿停聚所致。水盛身肿故身重,水停而卫气不行,故洒淅恶寒;水阻清阳,清阳不升则头眩。治以葵子茯苓散利水通阳,葵子滑利通窍,茯苓淡渗利水,使小便通利而水湿去,水有去路而气化阳通,则诸症自除,此为叶天士“通阳不在温,而在利小便”之谓也。
  浊邪上逆
  1.谷疸,湿热上熏——茵陈蒿汤 
  “谷疸之为病,寒热不食,食则头眩,心胸不安,久久发黄为谷疸,茵陈蒿汤主之。”此证为湿热黄疸,饮食不节,湿热蕴结脾胃,营卫生化不利而致形寒发热,不能饮食,若勉强进食则脾胃湿热更甚,上熏则头眩,心胸不安,久久湿热波及血分则发为谷疸。当治以清利湿热,活血退黄,方用茵陈蒿汤。茵陈清利湿热退黄,栀子清三焦之热兼凉血,大黄凉血活血,解毒。三药合用,湿热祛除,脾胃得健,头眩则自除。
  2.阳明燥屎内结——大承气汤
  “病人小便不利,大便乍难乍易,时有微热,喘冒不能卧者,有燥屎也,宜大承气汤。”(242)证属阳明里实,燥热与糟粕相结形成燥屎,腑气不通,燥屎阻结,热邪深伏于里,难达于外,故时有微热。腑气不通,燥热上迫于肺则喘,热邪上逆,扰乱清窍则头眩。治以泄热通腑,方用大承气汤。
  结语
  关于眩晕,后世多从虚实论治,病变脏腑与肝脾肾三脏有关,虚者为髓海不足或气血亏虚,清窍失养;实则为风,火,痰,淤,扰乱清空。虚者滋养肝肾,补益气血,填精益髓;实证则平肝潜阳,清肝泻火,化痰行瘀。常用处方有天麻钩藤饮、归脾汤、左归丸、半夏白术天麻汤、通窍活血汤之类。然仲景认为“无痰不作眩”,水湿痰饮等浊邪上泛,蒙蔽清窍则为眩。肾阳虚者治以真武汤;脾阳虚者治以苓桂术甘汤、五苓散;饮邪偏盛者治以泽泻汤、小半夏加茯苓汤;妊娠水气者治以龙葵茯苓散;浊邪上犯者,治以大承气汤、茵陈蒿汤。其中苓桂术甘汤,五苓散,小半夏加茯苓汤,均可用于治疗狭义痰饮出现头晕目眩症,但各有侧重。苓桂术甘汤证为饮停心下胃脘,波及胸胁,部位偏于中上,伴胸胁支满短气等,其重在温阳健脾蠲饮;五苓散证是饮停下焦,病位偏于中下,伴脐下悸、吐涎沫,重在化气行水;小半夏加茯苓汤汤是治疗悬饮停于心下胃脘及隔间,其部位偏于中上,伴有呕吐、心下痞、悸等,重在蠲饮,和胃降逆。
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2018년 6월 27일 수요일


이종명 의원, "대한민국이 백척간두에 놓여있다"


https://youtu.be/wE5OTZRUQrA


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앞에는 맞을 수 있는데, 트럼프가 굳이 전쟁에 돌입하지는 않을 것 같다.  북한이 핵무기로 미국을 위협하지 않는 한, 트럼프가 전쟁에 돌입할 이유가 없다.  반미였던 베트남이 수십년간 미친 짓을 하다가 다시 중국 때문에 친미로 돌아서지 않았는가?  가만 두면 내부에서 서로 총질하고 미친 짓을 하다가, 시간이 지나면 다시 친미로 돌아올 거라고 믿을 것이다.
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조양호 "검찰 조사에 성실히 응하겠다…죄송하다" / 연합뉴스 (Yonhapnews)


https://youtu.be/zyEEu4MbhRI


일베의 회원이 지난 60년대 중국의 문화혁명 상황이라고 했는데, 그 말이 적절한 표현인 듯 하다.


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공영방송 '피의 숙청' 실체를 밝힌다!


https://youtu.be/Ee3X-sOKg3U
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Holocene(홀로세)가 아닌 Anthropocene(안드로포세, 인간세)이다.
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ubs의 직원들이 시뮬레이션을 어떻게 해야하는지 알았다면, usb의 직원이 아니라, usb 개인은행의 고객이 되었을 것이다.
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https://imgur.com/gallery/B5xe3ug
추락했을 때 핸드폰을 보호하는 에어백
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Civility and Property vs. Politics
 
Jeff Deist
 
 
 
Calls for civility in politics are nothing new, and the incident involving White House spokesman Sarah Sanders at a restaurant has yielded plenty of smoke but little heat from both phony sides of this non-debate/non-issue.
 
I suppose we should be happy when property rights become part of the conversation. It's healthy when our Left progressive friends develop a situational private property ethic. Of course property owners have the unfettered right to remove people or refuse service. And of course we should all be civil with those who don't share our views. The day to day interactions that make any society at least tolerable, if not healthy, comport with customs and mutual-self interest, not positive laws.
 
But liberty requires property, and civility requires civil society. When politics and the state serve as the chief organizing principles in society, property rights and social cohesion necessarily suffer. Incivility is a feature, not a bug, of a highly political society. It is also a feature of an America where far too many things are decided by the federal government or its super-legislative Supreme Court.
 
What kind of healthy society devolves into cheering and jeering over judicial decisions, decisions swung by just a few judges voting one way or another? Should 320 million people have to worry so much about 5 or 7 Supreme Court justices?
 
It's hard to argue for civility in winner-takes-all political scenarios. In fact it's a recipe for hyperpartisanship, "othering," and tribalism. It's senseless to lament a loss of civility and then argue for overcoming our differences by voting harder and suing each other more.
 
Ludwig von Mises witnessed the collapse of the Habsburg civilization, the rise of Nazism in Austria and Germany, and two horrific European wars-- a series of events far beyond mere incivility. His answer to actual barbarity was real liberalism, distilled in its purest form to one word: property. "If history could teach us anything, it would be that private property is inextricably linked with civilization," Mises tells us in the aptly-titled Omnipotent Government.
 
But property is not part of the liberal program today; on the contrary, private ownership is under serious attack not only among rising "democratic socialists" like Alexandria Cortez and Bernie Sanders but also by protectionist and mercantilist forces in the Trump administration.
 
In fact only libertarians believe in full ownership--i.e. full control-- of private property. This is hardly an edgy argument at this point; Murray Rothbard made it 50 years ago. But nobody in politics or media actually believes this or argues for it. In the context of real estate, full property rights would require no property taxes, no zoning, no permits or building codes, complete freedom to alienate or sell at will, and most of all full control over who enters and who is required to leave. This kind of private property is not available to cake bakers or quaint southern restaurateurs.
 
America slowly but surely lost her sense of robust private ownership, the soul of a free society. It happened through the tax and regulatory state, by overturning the Lochner case and jettisoning economic substantive due process, through absurd readings of the Commerce Clause, through the creation of wildly extra-constitutional administrative agencies, and through the creation of an inferior form of property called "public accommodations."
 
By giving up property we gave up liberalism and civil society. By insisting on political control over vast areas of human affairs we gave up civility for force.
 
Remember, politics is zero sum. The restaurant owners view Sarah Sanders as a threat, as someone who is going to cause them harm if her (Trump's) administration prevails. That the owners acted absurdly is not the issue, nor is the incoherent argument that Trump somehow is beyond the pale relative to past presidents. The scene at the Red Hen restaurant was the result of the owners' not-unjustified perception that the US political system vanquishes people. To avoid being vanquished they must vanquish Trump, at least in their eyes.
 
Ideally, when asked to leave by the proprietors of the restaurant Ms. Sanders simply should have shrugged her shoulders and left quietly. Which is apparently what she did, although reportedly she was followed and harassed at a restaurant down the street. What's unfortunate is not merely the twitter incivility that followed, or the nasty news articles clamoring about a brewing civil war, but rather our blindness in understanding where "democracy," politics, and disrespect for private property lead.
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 마황승마탕


 《伤寒论》357条“伤寒六七日,大下后,寸脉沉而迟,手足厥逆,下部脉不至,喉咽不利,吐脓血,泻利不止,为难治。麻黄升麻汤主之。”组方:麻黄二两半、升麻一两一分、当归一两一分、知母、黄芩、葳蕤各十八铢,石膏、白术、干姜、芍药、天门冬、桂枝、茯苓、甘草各六铢。
此条文历来倍受争议,柯韵伯在《伤寒来苏集》中云:“六经方中,有不出于仲景者,合于仲景,则亦仲景而已矣。此方大谬者也……”。丹波元简云:“此条方证不对,注家皆以阴阳错杂之证,回护调停为之诠释,而柯氏断言为非仲景真方,可谓中古卓见矣。”


      观现今之医,亦有用此方者,但其对方证的把握往往强差人意。由于抓不到仲景的规律,揣度的成分大,把一首特殊的方,作一般视之,或离开仲景用药通则去强解方义,故即便用了此方,也不见得是此方之证。试举一例如下:


      李某,男,30岁,1985年1月28日初诊。患者腹痛腹泻,日3-5次,偶带脓血,时发时止年余,均以“肠炎”、“菌痢”处之。予抗菌素及“理中”、“四神”类,始而少效,久服如故,现消瘦神疲,畏寒肢冷,动则大汗蒸蒸,咽干口苦,但喜热饮,食后觉胃中荡水,肠鸣漉漉,时时欲便,里急后重,舌红,无苔,脉沉细数。查乙状结肠纤维镜示:进镜18-25cm处,粘膜呈多个浅表溃疡伴充血水肿。肠粘膜粗糙,可见脓性分泌物覆盖。


      诊断慢性溃疡性结肠炎(慢性复发型,中度,活动期)。《证因脉治》谓“此为中医内伤休息痢之症,无外感之邪,非暴发暴痢之症,但因脾胃亏损渐成积痢,或发或止,终年不愈。”此当属之。为湿热积滞而致邪留,因其虚实夹杂,治当清温兼施,补泻并用.升清通下并举,麻黄升麻汤加减主之:麻黄6g,升麻12g,黄芩12g,当归12g,白芍30g,炙甘草20g,玉竹20g,知母10g,茯苓30g,炒白术20g,桂枝l0g,干姜l0g,滑石60g,太子参30g.天冬12g,3剂,水煎服,日1剂。


      二诊腹痛减,欲饮水,舌脉如故,此为阳渐复,气化得助之兆。原方5剂。三诊:腹无所苦,大便成形,偶带白粘物,舌红苔薄白,此为阳复湿去热清,阴精得充之征。去滑石加山药20g,再进10剂,月后来诊,面润体丰,二便调。结肠镜复查示粘膜未见溃疡,分泌物较多。2年后随访无复发。


       原按:泄痢间作,久治乏效,气阴大伤,邪陷湿滞化热,腐肠化脓耗血为主要病机。方取麻黄、升麻升清举陷以宣上焦,太子参、白术、干姜、炙甘草宗理中,温脾散湿而启中焦枢机之升降;茯苓、桂枝、白术、甘草温药化饮伍滑石兼寓六一散渗利下焦;黄芩、知母、滑石渗湿清热而不伤阴,如是则湿热分消;当归、白芍、天冬、玉竹、太子参益气养阴,本虚可调,共成宣三焦、充精气、健脾胃、生化不息之法[1]


       我们认为,此例值得商榷之处甚显:


      1.麻黄升麻汤乃厥阴病上热下寒之厥证,属急性病范畴,而此例仅为慢性溃疡性结肠炎又非急危阶段,厥证并不明显。正如作者引用朱丹溪《证因脉治》所说:此为内伤休息痢之症,“无外感之邪,非暴发暴利之症,但脾胃亏损,渐成积痢,或发或止,终年不愈。”所以此案断非此证,用麻黄升麻汤则有捕风抓影之嫌。


      2.此案按语谓:“方取麻黄、升麻升清举陷以宣上焦。”此案关上焦什事?论中原文本有“喉咽不利,唾脓血”之证,但本证却无咽喉之证,即使是原方证,也非上焦表邪,故无需宣发。


3.升麻升清阳作用,实为后世之臆说,仲景断无此意。更何况此方仲景以麻黄升麻为名,全方用量最重,断非引经之药。


麻黄升麻汤看似是千古之谜,就如同其他《伤寒论》难解之方一样,用常理去解是终难得出结论的。本方疑点虽多,用仲景的用药常规观之,虽不能全面解释,但还是有脉络可寻的。黄师认为此方实含升麻鳖甲汤、白虎汤、理中汤、黄芩汤之意。


仔细分析此证,与现代医学危重病阶段,多器官功能障碍综合征(MODS)的表现甚为相似,现探讨如下:


      1. “咽喉不利,唾脓血


     “咽喉不利,唾脓血”,其实是全身炎症反应的症状,当然还极有可能伴有寒战、高热等表现。厥阴为寒热虚实错杂之证。此方证以热邪壅盛之咽喉不利,唾脓血为基础。


       本方以升麻为名,且重用之(一两一分),便是针对咽喉不利,唾脓血的。仲景用升麻仅有两方,一为麻黄升麻汤,一为升麻鳖甲汤。后者出自《金匮要略·百合狐惑阴阳毒脉证并治》篇:“阳毒之为病,面赤斑斑如锦纹,咽喉痛唾脓血……。”方用升麻为主(二两)配当归、鳖甲、甘草、蜀椒、雄黄。阴毒去蜀椒、雄黄。麻黄升麻汤证及阴毒、阳毒,三证均以升麻为主。可知升麻为解毒之品,能利咽喉。1894年前后,粤港发生严重的鼠疫,易巨荪为首的广东伤寒四大金刚,以升麻鳖甲汤治疗鼠疫取得极好的效果,一直传为佳话。


    《神农本草经》载,升麻“解百毒,辟温疫、瘴邪、蛊毒”。


      方中重用的升麻很可能可以通过对失控的炎症因子进行调节,从而逆转全身炎症反应的进一步发展。这里提到“唾脓血”,而在全身炎症反应综合征(SIRS)以及休克的阶段,微循环淤血、缺氧是很容易伴发弥漫性血管内凝血(DIC)的。升麻鳖甲汤、麻黄升麻汤均配以当归,以活血化瘀。则可改善血管舒缩功能以及血流速度,从而预防和控制DIC的发生、发展。


方中并以天冬、玉竹之润以制燥而利咽喉,与当归寒温互参。


       2.“泻利不止


      “泻利不止”不是一般之下利,是“不止”,来势之急可知。本因热邪致利,不止,则伤阴损阳,势所必然。在危重病阶段,肠源性细菌、内毒素异位,胃肠功能紊乱,水电解质平衡失调。出现寒热错杂的泻利,也是很常见的。观仲景方如半夏泻心汤、干姜黄连黄芩人参汤均是治泻利以寒热互用之例。本方以黄芩汤(黄芩、芍药)合理中汤(干姜、炙草、白术)寒热互用,标本兼顾,以针对不止之泻利,在情在理。


       3. “寸脉沉而迟,手足厥逆,下部脉不至


       此组证候,是本方证之焦点,是一种感染性休克的表现。


       感染性休克早期多是一种高排低阻型的休克,由于皮肤血管的扩张,多表现为暖休克,太阳、阳明病篇的白虎汤及白虎加人参汤证,汗出,身热,大渴便是这一时期的症状。由于血管扩张,故有阳明脉大,白虎加人参汤的脉洪大,白虎汤的脉滑。    


335条:“伤寒一二日至四五日,厥必发热,前热者后必厥,厥深者热亦深,厥微者热亦微。厥应下之,而反发汗者,必口伤赤烂。”350条“伤寒,脉滑而厥者,里有热,白虎汤主之”。热深厥亦深的白虎汤证则是血管收缩,有效循环不足的低排高阻的冷休克阶段。此时若血管进一步强烈收缩,有效循环不足,便出现了麻黄升麻汤脉不至的情况。


       杨麦青在《伤寒论现代临床研究》中提出:白虎汤就如同西医补液支持,他治疗高热时,多以冬眠合剂配合白虎汤使用。这和张锡纯阿司匹林加石膏汤的用意基本是一致的,都是在西药退热的同时,以白虎汤清热养气阴。这与黄师的见解相合:“白虎汤不治“大热”,是以养阴为主的方”。


       全方以麻黄为主,重用二两,以桂枝制之。仿“还魂汤”之意,还魂汤载《金匮要略》杂疗方。以麻、杏、甘三药,主“救卒死,客忤死。”《千金》用桂心二两,即麻黄汤。《千金》云:“此方主卒忤,鬼击飞屍,诸奄忽气绝复觉,或已无脉……”。《伤寒论》281条:“少阴病,脉微细,但欲寐也。”301条:“少阴病,始得之,反发热,脉沉者,麻黄附子细辛汤主之。”结合本方证观之“寸脉沉而迟,手足厥逆,下部脉不至”,应同类此,故用麻黄为主,振奋沉阳以救厥。程门雪认为本方之厥“不用附子者,防唾脓血之上热耳。”恐怕不能如此观之,是麻黄与附子之救厥,各有所用而已。四逆汤类方之厥,乃是寒厥、脏厥,故用附子。若真为防唾脓血的话,麻桂同样不利于喉咽,所谓:“桂枝下咽,阳盛则弊”。此方麻黄为主,配合白虎寒温互参。是针对热厥过渡至寒厥的一个法门。


       诚然,此方还有很多值得争议之处,如凡服桂枝汤吐者,其后必吐脓血也;麻桂下咽阳盛则弊;脉沉迟不可与白虎汤;下利不止洞泄不宜芍药、黄芩等都是常理。不过此证寒热错杂直非常理可解释。


       仲景书中称“难治”者多不载方,载方者仅四条:一为本方证,一为377条之四逆汤证,一为《金匮要略·黄疸》之硝石矾石散,一为178条“脉结代”之炙甘草汤。均为重症,可能有掷以孤注、背水一战之意。还有就是此证寒热错杂,虚实互见,认证颇难把握之谓。


       此方虽看似繁杂,却顾及了MODS的各个发病环节,如SIRS、休克、胃肠功能紊乱,甚至其后出现的弥散性血管内凝血(DIC)等危重证阶段可能出现的各种情况。重用麻黄、升麻、当归解决主要矛盾,其他各药均用量奇轻,只为照顾副证,其意甚明。


      本方之服法,亦与他方不同。方后云:“分温三服,相去如炊三斗米顷令尽。”即在短时内服完三服药,使药力持续,是治急性病的服药方法,因此此证不是如上所举李某案之类的慢性疾患。


       可见,经方是千百年临床实践的总结,不能以理喻之者,可以存疑,不要轻率弃之,更不要强解之。证之临床,本方仍有可遇见的机会,本方仍能救厥。柯氏等断言非仲景方,似嫌孟浪。所以,著名中医学家程门雪先生也发出概叹道:“前谓此方之误甚明,今觉不然……柯氏未之思,遽下断语,不当也。乙酉读此条,得其解,……学无止境,勿遽自以为是也,观此可证。”[2]


        典型病例


       例1:吴棹仙麻黄升麻汤医案一则


1939年,时值抗日战争,余居渝。一军人转战沙场,备受风雨寒热,一病而唾脓血,西医误用凉药,以至大下不已,滴水不饮,命在旦夕,余诊之,手足厥冷而胸中灼热,两手寸脉沉缓不现,下部趺阳、少阴脉不至,舌红赤。因思仲景有云:“伤寒六七日,大下后,寸脉沉而迟,手足厥逆,下部脉不至,喉咽不利,唾脓血,泄利不止者,为难治,麻黄升麻汤主之。”正与此证一一吻合。盖外感风寒,内伏积热,医反下之,以至表邪内陷,中气大伤,胸中积热依旧,津气虚而胁迫血热上行也。因投仲景原方:麻黄四钱、升麻四钱、当归三钱,茯苓、白术、白芍、天冬、石膏、干姜、桂枝、甘草各一钱,黄芩、知母、葳蕤各三钱。上药十四味,按法先煎麻黄,去浮沫,内诸药同煎,分温三服,一剂而病除,重返前线,凯旋归来,专程谒于渝之医庐,谈当时病笃,为余所救,九死一生,不胜感激之至云。


此证余五十余年仅见一例耳。


       例2:陈逊斋麻黄升麻汤医案一则


       李梦如子,曾二次患喉痰,一次患溏泻,治之愈。今复患寒热病,历十余日不退,邀余诊,切脉未竟,已下利二次。头痛,腹痛,骨节痛,喉头尽白而腐,吐脓样痰夹血。六脉浮中两按皆无,重按亦微缓,不能辨其至数。口渴需水,小便少。两足少阴脉似有似无。诊毕无法立方,且不明其病理,连拟排脓汤,黄连阿胶汤,苦酒汤,皆不惬意。复拟干姜黄连黄芩人参汤,终觉未妥。又改拟小柴胡汤加减,以求稳妥。继因雨阻,寓李宅附近,然沉思不得寐,复讯李父,病人曾出汗几次?曰:始终无汗。曾服下剂否?曰:曾服泻盐三次,而至水泻频仍,脉忽变阴。余曰:得之矣,此麻黄升麻汤证也。病人脉弱易动,素有喉痰,是下虚上热体质。新患太阳伤寒而误下之,表邪不退,外热内陷,触动喉痰旧疾,故喉间白腐,脓血交并。脾弱湿重之体,复因大下而成水泻,水走大肠,故小便不利。上焦热盛,故口渴表邪未退,故寒热头痛,骨节痛各证仍在。热闭于内,故四肢厥冷。大下之后,气血奔集于里,故阳脉沉弱;水液趋于下部,故阴脉亦闭歇。本方组成,有桂枝汤加麻黄,所以解表发汗,有苓、术、干姜化水,利小便,所以止利,用当归助其行血通脉,用黄芩、知母、石膏以消炎清热,兼生津液,用升麻解咽喉之毒,用玉竹以祛脓血,用天冬以清利痰脓。明日,即可照服此方。李终疑脉有败征,恐不胜麻、桂之温,欲加丽参。余曰:脉沉弱肢冷,是阳郁,非阳虚也。加参转虑掣消炎解毒之肘,不如勿用,经方以不加减为贵也。后果愈。


       按:以上两案皆为寒热错杂的急重之证,既有咽喉不利,唾脓血,又有下利、肢厥、脉不至,如吴棹仙所说:“正与此证一一吻合”。故此方虽因其不可理喻而引起多方争议,实一起沉疴,疗顽疾的良方。此方虽怪,但此证临床并非不可见,今年初黄师遇到一例小儿急性传染性单核细胞增多症,高热肢厥,咽峡炎,腹泻。方证极似麻黄升麻汤,可惜此患儿住市儿童医院病房,黄师不便参与治疗。


参考文献:


[1] 王灿勋,刘光西.麻黄升麻汤应用举隅[J],河南中医.1994,14(3):166-167


[2]程门雪《中医杂志》1979,(10):79
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北京中医药大学教授聂惠民
 
张仲景他对痢疾的病因就提出来以有热故也这就说明痢疾的病因是因为热邪而导致的从痢疾的临床表现来看它产生的原因是由于外感湿热疫毒之邪使得肠道的传导失职而导致出现下利便脓血形成痢疾这个病
 
解说痢疾分急性痢疾和慢性痢疾急性痢疾发病突然患者发病时畏寒发热体温可达摄氏39度左右同时伴有腹痛乏力恶心呕吐大便有脓血等症状一般每天排便15次左右而慢性痢疾由于在急性期没有完全治好从而造成腹部时常有下坠感大便每天35次左右而且大便常有脓泡出现对这两种性质的痢疾张仲景也有他自己的辨别方法
 
北京中医药大学教授聂惠民
 
辨别的方法呢下利便脓血如果是急性菌痢他便的脓血是鲜明的慢性的菌痢他便脓血是晦暗的急性菌痢它伴有热性的症状比如口渴脉数舌苔是黄苔慢性菌痢呢他是虚寒的所以他口不渴脉象是沉缓无力的舌苔是薄白的这二者就应该区分开来进行治疗
 
解说对急性期痢疾很多医生主要采用抗生素来抗菌消炎进行治疗而对慢性期的痢疾中药治疗则有较为明显的优势
 
北京中医药大学教授聂惠民慢性菌痢这一点在张仲景那个时期他已经就认识到了所以他在六经病的后期就提出来有下利便脓血桃花汤主治的方剂这个方子就是治疗虚寒性的下利便脓血按今天临床来看这就属于慢性菌痢
 
解说张仲景治疗痢疾有许多方剂可用他自己就常用白头翁汤为患者治疗痢疾他在伤寒论中就有下利欲饮水者以有热故也白头翁汤主之的记载这服方剂主要是由白头翁黄柏黄连秦皮等四味中药组成的
 
北京中医药大学教授聂惠民
 
其中白头翁是治疗痢疾的主药它能清除毒热止痢黄柏黄连这两味药是清热燥湿止痢的药秦皮是清肠道内的热来止痢的药所以白头翁汤就是用于治疗痢疾的主要方剂
 
解说张仲景在伤寒论金匮要略这两本书中对治疗痢疾这种病进行了分析他认为治疗痢疾不仅可以内服中药还可以采用中药穴位贴敷等外用的办法这些都能收到比较好的治疗效果
 
张仲景与抑郁症
 
解说抑郁症是一种发病率较高的精神方面的疾病发病病因及病理机制目前在临床上尚不清楚一般抑郁症患者的症状常见于情感上的精神障碍虽然中医对抑郁症没有明确的病名但张仲景在他的金匮要略伤寒论中对此病有过许多描述
 
北京中医药大学教授李峰
 
张仲景对抑郁症认识是非常独特的他是一种形神合一的观点来看待这个疾病因此抑郁症这个症状虽然纷繁复杂但是从中医角度来看它只是症状而它的产生是和脏腑功能失调和气血亏虚有关
 
解说脏腑功能失调就会影响到人的情绪很多抑郁症患者就是由于对生活失去了信心对一切事物失去了兴趣而造成了心情低落思维迟缓抑郁症在临床上较为常见的主要有烦失眠等三种症状
 
北京中医药大学教授李峰
 
那么烦呢病人经常表现为就是心境特别低落而且容易着急发脾气那么前一段有个病人来看病的时候就说哎不知道怎么心里烦老有无明火稍微有点小事别人本来没有什么事他就忍不住要发脾气了那么张仲景认为这种烦是跟肝胆功能失调有关如果病人还兼有郁闷做噩梦或者是害怕这种感觉就可以用柴胡加龙骨牡蛎汤进行治疗
 
解说对一些抑郁症患者经常出现的动不动就忧虑委屈不愿意做任何事情以及莫名其妙想哭的症状张仲景认为这些也都与病人五脏平衡的失调有关
 
北京中医药大学教授李峰这时候呢张仲景称之为脏躁认为心肝血虚所导致的那么他所用方剂也很有趣是一个像食品一样的叫甘麦大枣汤用的药是甘草小麦和大枣那么甘草能够和中缓急小麦可以养心和肝而大枣可以补气和血这三个药搁在一块可养血安神除烦效果也是非常好的很多病人吃完以后就觉得这种委屈想哭啊莫名其妙地想哭这种感觉都没有了
 
解说中医在治疗抑郁症时多从调理病人的肝肾五脏入手失眠是抑郁症患者的主要症状这些调理五脏功能的方法就是要保证抑郁症患者有充足的睡眠时间
 
北京中医药大学教授李峰张仲景在这方面有非常多有效的方子比方说有些病人他因为过度劳累心血暗耗而导致虚劳虚烦不得眠仲景的酸枣仁汤非常有效而有些病人在睡前非常焦虑烦躁反复颠倒怎么都睡不着这时候仲景用栀子豉汤治疗栀子可以清心除烦而豆豉呢可以宣透解郁这两种药合起来效果也是非常好的能很有效缓解病人焦虑的情绪
 
解说人的心理和生理之间有着密切的联系因此抑郁症患者在身体治疗的同时也一定要树立治疗的信心
 
北京中医药大学教授李峰其实呢治疗抑郁症最难的是病人对自己没有信心他老怀疑抑郁症是否能好经常来问大夫我这个抑郁症是永远好不了是不是老得犯实际上根据仲景看法是形神合一的因此我们经常说你看你感冒了咳嗽咳嗽能不能好咳嗽你吃药就好了那么抑郁症它表现也是个症状只要按照仲景方法把脏腑气血调和顺畅的话抑郁症同样是可以治疗的
 
张仲景与痛经
 
解说痛经是指妇女在月经期间出现的小腹或是腰部疼痛它是随着妇女月经周期而发生的有些严重的患者痛起来大汗淋漓手足发抖并伴有恶心呕吐等症状痛经属于妇科的常见病张仲景在他的金匮要略中就对痛经有过详细的描述
 
北京中医药大学教授李峰
 
经水不利少腹满痛这是对痛经症状的非常形象的描述另外仲景也在他的医书中给我们留下大量治疗痛经的有效方剂那么最常见的痛经呢有四型第一型是气滞血淤型这类患者她往往在月经来之前痛而且痛起来非常厉害乳房胀痛小腹胀痛腰胝酸痛坠痛这时候呢我们可以用仲景的当归芍药散进行治疗有时候还可以合枳实芍药散效果非常好
 
解说妇女痛经的第二种类型是寒凝胞宫型这一类型主要是由于女性长期受寒平时喜食生冷食物造成的
 
北京中医药大学教授李峰这类患者来月经痛呢往往在月经来的前的一二天或者月经第一二天那么她来的痛时候特别怕冷手脚发凉甚至肚子以后觉得冷痛的厉害用暖水袋捂一捂会好一些那么这时候我们可用仲景的桂枝茯苓丸进行治疗桂枝本身就是温经止痛的那么用这个方子效果也非常好
 
解说痛经的第三种类型是气血虚弱型这一类型的痛经主要是由于女性本身脾胃消化功能不好或是大病初愈后造成的气血不足月经期间患者会小腹隐隐作痛有空坠的感觉并且伴有月经量少经期不正常等症状
 
北京中医药大学教授李峰
 
那么仲景认为她是气血不足可以用胶艾汤进行治疗如果是患者不怕冷寒象不明显的话也可以用胶艾汤减去艾叶阿胶就形成了我们常用的妇科圣药四物汤效果也是非常好的
 
解说痛经的第四种类型是肝肾虚损型这一类型是由于女性肝肾亏虚日常工作又过度劳累造成的具体表现为月经量少而且颜色较暗
 
北京中医药大学教授李峰
 
患者月经也不是特别准来的时候也不舒服主要是腰酸小腹酸痛坠痛这时候我们可用仲景的金匮肾气丸或者是六味地黄丸进行治疗效果也是不错的
 
解说前面四种类型的痛经张仲景辨证使用了不同的方剂进行治疗都取得了较好的疗效除了中药方剂治疗痛经以外张仲景还提倡采用食疗的方法治疗妇女的痛经
 
北京中医药大学教授李峰
 
痛经常用的类型一个是寒凝胞宫型一个是气滞血瘀型那么针对寒凝胞宫型仲景的方子一个食疗方子叫当归生姜羊肉汤那么治疗起来非常好也适于平常的服用那么当归可以活血止痛的生姜可以散寒止痛而羊肉可以温中止痛这三个合起来做成汤煲成汤对平常爱痛经的妇女来说呢经常食用效果也是非常好的第二种就是对血瘀型的张仲景有一个食疗方叫红蓝花酒就是我们常用的红花泡酒服用那么红花本身活血效果非常好那么适量服用对治疗妇女瘀血型疼痛痛经效果是非常好的
 
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