교육공무원과 전교조 등을 위한 교육이 되어서는 안됩니다
소위 전교조가 주축이 된 좌파교육이 대한민국 교육을 휩쓴 지 10-15년, 그들이 활동을 한 지는 30년이 넘었습니다. 처음에는 촌지퇴출 운동을 하며 참교육, 참교육 하길래 모두가 그런 줄만 알았고, 평준화 교육이라길래 모두가 일정 수준 이상이 될 거라고 믿었습니다. 나중에는 혁신교육 운운 자율성 창의성 하길래 그런 줄 알았습니다.
그런데 알고보니…참교육을 외쳤던 전교조는 기득권 꼰대가 되어 자랑스런 대한민국의 국가정신을 부정하면서 비뚤어진 대립적 세계관을 아이들한테 주입한 것이었고, 평준화 교육은 하향평준화에 다양성이 무시된 획일적 교육으로 절대 개천에서 용이 날 수 없는 구조였습니다. 혁신교육은 진정한 자유와 창의가 빠진 채 치열한 세계 경쟁의 현실을 일시적으로 도피하는 것이었고, 자유학기제 자유학년제는 자율성이 빠진 형식적 프로그램에 머물러 있었습니다.
심지어 이제는 인권조례니 뭐니 아직 인격이 성숙되지 못한 아이들에게 동성애 등 성적 취향이나 종북적 역사관이나 계급투쟁관을 심어주는 교육을 주입하고 있는 실정입니다. 결국 우리나라의 공교육은 그전보다 더 추락하여 이제는 완전히 죽어버린 상황입니다. 파괴된 인성교육과 공적 의식, 경쟁원리가 파괴되어 다른 경쟁국들을 따라잡지 못하는 인재양성 시스템…
이제 교육의 주권을, 선택권을 학부모에게, 교육의 수요자에게, 시장에 돌려주어야 합니다. 더이상 교육공급층 즉 교육공무원과 전교조 등을 위한 교육이 되어서는 안됩니다. 국가나 기관은 사회안전망으로서의 교육, 인성교육과 공동체 교육에 집중해야 합니다. 더이상 전교조 등 좌파가 만들어낸 거짓 구호에 속아서는 안됩니다. 그 이면에 숨겨진 본질을 간파해야 합니다. 이제는 교육의 패러다임을 바꾸어야 합니다.
--->학교에 다니지 않을 자유를 국민들에게 주어야 한다.
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목적은 수단을 정당화 시킨다.
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https://www.justice.gov/opa/file/897051/download
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김원봉, 그를 둘러싼 모든 논란을 한번에 정리해 드립니다
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왼쪽 댄서를 보면 중앙의 댄서가 시계방향으로 회전하고, 오른쪽 댄서를 보면 시계 반대 방향으로 회전한다.
하지만 사람들의 의견이 상호 의존적이고, 다양하지 못하고, 편향적이라면, "특이한 대중 착란 및 대중의 광기"를 나타낸다.
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https://twitter.com/RexChapman/status/1142890093415489536
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문명은 어떻게 멸망하는가?
로마가 멸망한 이유는 독재자들이 로마의 경제를, 그리고 번영을 가져왔던 제도들을 망쳐놓았기 때문이다.
독재자들은 도로와 궁전, 사원 등의 거대 사업을 벌였고, 방만한 관료, 급료가 높은 군대를 유지했다. 그리고 여기에 돈을 대기 위해 징벌적으로 세금을 높였고, 그들의 화폐를 타락시켜 인플레를 유발했다.
How to Destroy a Civilization
Jeffrey Harding
There are lots of ways to kill off a civilization. Wars, politics, economic collapse. But what are the actual mechanics? It might be a useful thing to know whether or not we are killing ourselves off.
Ancient Rome is a good place to start. They had an advanced civilization. They had running water, sewers, flush toilets, concrete, roads, bridges, dams, an international highway system, mechanical reapers, water-powered mills, public baths, soap, banking, commerce, free trade, a legal code, a court system, science, literature, and a republican system of government. And a strong army to enforce stability and peace (Pax Romana). It wasn’t perfect, but they were on their way to modernity.
One of my favorite quotes is from Marcus Tullius Cicero, statesman, orator and writer (106-43 BCE):
Times are bad. Children no longer obey their parents, and everyone is writing a book.
If that isn’t a mark of a civilized society I don’t know what is.
But Rome collapsed. I often wonder what would have happened if it hadn’t. Could we have avoided a thousand years of the Dark Ages. Could we have been flying airplanes and driving cars in the year 1000?
What the hell happened to Rome?
Dictators. After 500 years, the famous Roman Republic ended with the dictator Julius Caesar taking power. Four hundred years later his progeny and usurpers ran the Empire into the ground and Rome fell to invading barbarians.
The standard explanation for Rome’s decline and fall is that they devolved into dictatorships (true, but not the cause of their fall). Or they became decadent and corrupt (true, but not the cause of their fall). They fell to barbarian invasions (true, but not the cause of their fall).
Rome fell because the dictators ruined the Roman economy and the institutions that had made it prosperous. Rome was falling apart before the barbarian invasions.
How did the Caesars do that? They were profligate spenders. As emperors with absolute power usually do, they thought big: infrastructure (roads, temples, palaces), a huge bureaucracy, and, as the key to maintaining their power they had a very large, loyal, and well paid army. As a consequence, massive government spending far outstripped revenue. They had what today we call a deficit problem.
They did two disastrous things to solve their deficit.
First, they kept raising taxes which became punitive. Not caring much about the consequences to the merchants, small farmers, and peasants, they came up with new ways to squeeze money out of their citizens. Onerous taxes led to tax evasion. The government’s response was to double down and implement laws that restricted economic freedoms in order to raise even more taxes. Heavy taxes forced property owners, small and large, off the land. Large feudal estates run by political cronies arose in their place. Laws were enacted that forced peasants into virtual serfdom. Business owners and their children were prevented from changing jobs or towns. And, taxes had to be paid either in gold or in kind or they would lose everything. Gold became scarce. Gold money was only lawfully available to the government, army, and bureaucrats.
Second, they debased the currency which led to inflation. It was the equivalent of printing money to pay for things. The resulting bouts of high inflation destroyed much of commerce and agriculture. Like most dictators they thought they could stop rising prices by implementing price controls, but that just led to gold and goods disappearing from the economy. Black markets grew despite threats of capital punishment. Unemployment and homelessness rose. Their large welfare system kept running short of money. Commercial, legal, and moral institutions were falling apart. Corruption was endemic. The resulting booms and busts and depressions were destroying the economy.
By the time the Goth and Visigoth invaders came along, Rome was so weakened that they could not hold back the waves of invasions. At the end, Roman citizens saw the government as the enemy and the invading barbarians as their saviors. Rome fell in 410 CE. What emerged was what we now know as the Middle Ages — it lasted for a thousand years. You know what that was like. They didn’t call it the Dark Ages for nothing.
Much of Rome’s economic history is quite familiar in modern times. Even after thousands of years of evidence of repeated failure, bad ideas simply don’t die. Proponents of bad ideas are either ignorant of history or just ignorant. Or they are politicians (as Mark Twin said, “But I repeat myself.”).
One bad idea with ancient precedents is Modern Monetary Theory (MMT). MMT is the New Thing among Progressives in America. Politicians like Alexandria Ocasio-Cortez (AOC) and Bernie are quite excited about MMT. They think they have discovered the Holy Grail of economics.
Progressives believe that government can and should cause economic growth and prosperity. They believe government can do this by various controls, regulations, spending programs, and monetary manipulation. They believe proper government spending will stimulate demand, generate consumer spending, kick-start production, and, voila! we have full employment and prosperity. Along the way we can solve various social problems.
The idea of MMT takes this one step further. They believe that the government can spend/buy whatever it wants and print pieces of greenish paper to pay for it. Government doesn’t need to tax us or borrow money to do this — it can print whatever money it needs to pay for it. Deficits don’t matter because by printing money to pay for stuff they instantly solve the deficit problem. MMTers claim, with no shortage of arrogance, that they, Oz-like, can fine-tune the mechanics of how the economy is to be run and generate prosperity, prevent inflation, end inequality, and save the planet.
In other words, everything will be perfect; “just trust us” to run things. It sounds too good to be true.
AOC and Bernie Sanders and their supporters heartily embrace MMT. They want to break free of old-fashioned concepts such as fiscal integrity, balanced budgets, and monetary stability because they want no limits on their utopian schemes.
MMT is a crackpot idea. It is the monetary equivalent of the Perpetual Motion Machine — it ignores the laws of economics. It’s like asking third graders to invent money. (“I’m gonna print me a bunch of money and buy me a Ferrari an’ a jet an’ all the coolest video games an’ …”). Proponents confuse pieces of greenish paper with wealth and, as history has repeatedly proven, you can’t print your way to wealth and prosperity.
There is nothing “modern” about Modern Monetary Theory. It has been tried many times over the centuries and it has never worked. In every case where governments have printed money to pay for things, the result has been cycles of boom and bust, inflation (and hyperinflation), economic stagnation, and social disorder. MMTers simply don’t understand what money is or the mechanics of the business cycle or the concept of malinvestment and the destruction of capital.
Why is it not possible that we could go the way of Rome? Franklin D. Roosevelt’s New Deal resulted in 25 years of economic stagnation. Only post-FDR deregulation, more economic freedoms, capital investment, and fiscal and monetary sanity led to economic growth.
AOC’s Green New Deal plus MMT would be worse than the old New Deal in that it places no limit on government’s ability to spend which means government can command economic resources and control the direction of the economy. History has shown that governments aren’t very good at that. Absolute power in the hands of the few is a bad idea.
How much destruction could MMT and utopian Progressive schemes like AOC’s utopian Green New Deal inflict on our civilization? It is hard to tell, but I hope we don’t have to look back some day and say the end started now.
Jeffrey Harding is a real estate investor in Santa Barbara, California. He currently writes at An Independent Mind.
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간병의 치료
肝病
1.常见的肝病如病毒感染引发的病毒性肝炎、药物损伤导致的药物性肝炎、营养过剩所致的脂肪肝、以及胆道蛔虫或结石梗阻诱发的感染性肝炎、以及原发性或继发性的肝脏肿瘤。
2.肝脏是个复杂的消化器官，中医将肝脏主要的生理机能归位于脾主运化，所以肝病在中医的脾病范围。
3.1、肝脏血液供应丰富，肝病必定导致血液流变学改变，中医认为血不循经，可辨证为瘀滞。
2、肝组织炎性充血水肿，中医认为血不利则为水，可辨证为湿浊。凡中医辨证为湿病者，皆与现代病理学的组织水肿、体液潴留有关。
3、肝胆管阻塞引致的黄疸，中医认为是湿毒淤积，可辨证为湿病。
4、病毒侵入肝脏，引发的传染性肝病，中医认为是湿热疫毒，而湿热疫毒因病程或病变的轻重、或深浅，区分为气分、营分或血分的不同。
5、重症肝病的抽搐震颤属肝风内动、肝性脑病、肝昏迷属痰迷心窍。
6、脂肪肝归结于痰浊结滞。
7、肝脏肿瘤的实质性肿块，中医归类于痰毒结滞，属积聚范畴。等等。
4.以乙肝为例，将乙肝从伤寒六经辩证论治的一般规律大致可析分如下：
病毒携带者，大多有轻微的咽喉症状，可理解为太阳表证，治疗主方可选用麻黄连翘赤小豆汤或葛根芩连汤。
经常便秘者，体质壮实，小便必黄，可理解为阳明病腑实，治疗主方可选用泻心汤。
久病体弱，胃虚纳差，病情迁延，可理解为太阴病脾虚，治疗主方可选用桂枝加芍药汤或桂枝加大黄汤、理中汤，薯蓣丸对肿瘤化疗后的虚劳状态效好。
转氨酶居高不降，可理解为厥阴病寒热错杂，治疗主方可选用乌梅丸。
炎性活动期症状表现呈复杂性，或静止期无证可辨，均可理解为少阳病，治疗主方可选用小柴胡汤。
脘腹胀满，伴寒热，大便难，可理解为三阳合病，治疗主方可选用大柴胡汤。
5.凡黄疸，皆可配以茵陈五苓散。
黄疸伴发热，主以栀子柏皮汤，
黄疸伴身痒，主以麻黄连翘赤小豆汤
黄疸伴腹痛而呕，主以小柴胡汤或大柴胡汤
黄疸兼哕，主以小半夏汤
黄疸久久不除，余症不显但体弱易汗出，主以桂枝加黄芪汤或小建中汤。
肝癌早期，可理解为太阳少阳合病，治疗主方可选用柴胡桂枝汤。肝癌随着肿块的逐渐加大，可伴有明显的“心下支结”症状，及早截断、预防性用药是十分重要的。
鼓胀，腹水肢肿，可理解为少阴病，治疗主方可选用真武汤或大黄甘遂汤。
脾肿大、肝硬化、肿瘤，属杂病中的症积范畴，为血不利则为水，并非单纯气滞血瘀，治当行气活血利水为主导，破瘀散结为辅助，从病情轻重缓急可选取枳实芍药散、当归芍药散、桂枝茯苓丸、薏苡附子败酱散以斟酌配伍，下瘀血汤、抵当汤、抵当丸、大黄蛰虫丸等含有虫类药的方药需谨慎运用。
6.1.治未病。“夫治未病者，见肝之病，知肝传脾，当先实脾，四季脾旺不受邪”（《金匮要略•脏腑经络先后病脉证第一》），强调了“脾旺”的重要性，未病先防、既病防变的治未病思想是传统中医的预防医学模式。现代认为“脾旺”与免疫功能相关。现代医学的肝病属消化系统疾病，其病毒感染的预后与免疫调控有关，所以病毒性肝炎的治疗取效的关键在于免疫治疗，尤其是自身免疫功能的恢复。实践证明乙肝病毒的清除从太阴脾论治是最有效的方法。
7.温病派的治疗方法在乙肝病程的一定阶段具有不可替代性，如急性重症肝炎的凉血解毒法、肝性脑病的豁痰开窍法等皆卓有疗效。然而在温病派一统天下的今天，炎症不分寒热，乙肝的治疗现状毫不例外慨以清热解毒为主，是乙肝治疗后慢性迁延化的主要原因，反观用经方治疗者，见效快，治愈率也高。
8.再如肝癌的脉象，随着肝癌程度的由轻趋重，“上关上”呈现的脉象也由最初的细涩似无，渐次演变为细弦→弦细→弦滑→弦硬，脉象变化与癌变程度呈正相关。
9.肝病的脉象急性期、危重期多见弦大、弦滑、弦数，属胆胃不和、邪盛腑实。为何兼弦？弦主气滞、主饮，滑主痰热，此脉象与肝细胞炎性水肿相关。《伤寒论•辨少阳病脉证并治》篇说：“三阳合病，脉浮大，上关上”、又：“伤寒，脉弦细，头痛发热者，属少阳。”肝胆居少阳，寸口脉法位于关上，主气机疏泄，气机失调故有弦象，弦势减弱，是向愈之象，所以，条文接着解释：“伤寒三日，少阳脉小者，欲已也。”
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코피 그치는 약
止衄汤
止衄汤，出自<<辨证奇闻>>。先 师朱老先生喜用之。我用本方就是跟朱老学来的，现简述二个病例以作抛砖引玉。
康XX，男33岁，鼻衄反复发作8天。左鼻孔出血，自塞后从右鼻孔或口腔流出。非李特氏区出血乃是后鼻道出血。用肾上腺素棉球不能止血。刺双少商出血，针上星后出血减少。该患者素体瘦性急，脉寸关弦尺弱。断为上盛下虚，虚火上升，开药三副，瞩其静养。元参40克，生地15克，麦冬10克。肉桂1克。
二诊：未再出血，原方三副。
男孩，10余岁(回忆病例)鼻出血反复发作半年。吃了不少西药未能根治，开三剂止衄汤未来再诊。数年后因其它病来诊说："服了您三剂药后鼻子未出过一次血"。
这个方子是按五行学说构成的，甚至是反五行学说．不过方子很有效，我不想自密，希望别人也能应用于临床．只要有疗效就说明其有道理．
青光眼的治疗体会
肝肺郁热
眼红目账视力减，看灯有彩虹，瞳孔放大，头疼胸闷恶心，便秘溲黄，舌质红，脉弦滑数
治法泻肝散加减，舒肝清肺，通经明目
黄芩6大黄4枳壳6当归10酒胆草4知母6羌活6柴胡6桔梗10车前子10
大便糖稀去大黄加葶苈子6大枣3枚
脾虚湿痰
健脾渗湿，化气利水
苓桂术甘汤合五苓散加减
茯苓15桂枝10白术12猪苓10泽泻10清半夏10甘草4
阴虚阳亢
肝肾阴虚，虚火上亢，肝风内动所致
滋肝益肾，育阴潜阳
珍珠母30磁石24制香附6夏枯草10女贞子10旱莲草12黑芝麻10茯苓15泽泻10霜桑叶10赤芍10白芍10
服汤药不便时可考虑成药
1.肝肺郁热龙胆泻肝丸or防风通圣丸2.脾虚湿痰五苓散或参苓白术丸3.阴虚阳亢杞菊地黄丸知柏地黄丸
过敏煎之应用
祝谌予所制过敏煎组方简单，药味平淡，但立方确有巧思，非常严谨。四药组合，有收有散，有补有泄，有升有降，阴阳并调，实乃大家之也！在临床应用中随症加减，并采用西医的辨病，中医的辨证，加减有制，应用广泛，值得临证参考。本方曾经上海某医院实验研究和临床验证确有抗过敏作用。祝氏应用于临床几十年，属于过敏疾患者，均获得满意疗效。是以推荐，造福民众。
组方：防风、银柴胡、乌梅、五味子各10克。
用法：水煎，每日一剂，早晚服。
适应症：凡过敏试验阳性者，均可采用本方。
随症加减：如过敏性荨麻疹属于风寒者，加桂枝、麻黄、升麻、荆芥；风热者加菊花、蝉衣、银花、薄荷；血热者加丹皮、紫草、白茅根；热毒内盛加连翘、银花、甘草、蒲公英、紫花地丁、板蓝根。过敏性哮喘，常加莱菔子、白介子、苏子、葶苈子、杏仁。过敏性紫癜，常加藕节炭、血余炭、荆芥炭、茜草根、旱莲草、仙鹤草。过敏性鼻炎，常加白芷、菖蒲、辛夷、菊花、细辛、生地、苍耳子、葛根。冷空气过敏症，加桂枝、白芍、生姜等。
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승강산 응용
升降散之应用
升降散
【来源】《伤寒温疫条辨》卷四。
【组成】白僵蚕(酒炒) 6克全蝉蜕(去土)3克姜黄(去皮)9克川大黄(生)12克
【用法】共研细末，和匀。据病之轻重，分2～4次服，用黄酒，蜂蜜调匀冷服。中病即止。
方中以僵蚕为君，僵蚕辛苦气薄，性轻浮可生阳中之阳，清热解郁为主，“能辟一切拂郁之气”；蝉衣气寒，以清热解毒；姜黄气味辛苦，以行气解郁为主；大黄大寒大苦可降浊阴。书中谓此方＂升阳中之清阳，降阴中之浊阴，一升一降，内外通和。故名升降
【功用】升清降浊，散风清热。
【主治】温病表里三焦大热，其证不可名状者
升降散又名太极丸，为清代温病名家杨栗山所创，杨栗山升降散原治温病“表里三焦大热”诸症，根据诸多老中医、特别是北京赵绍琴老先生的经验，只要见有气机郁滞诸证升降散加减用之，均有良效。赵绍琴先生80年代用升降散恒为白僵蚕10g蝉蜕10g片姜黄6g酒制大黄3g，笔者应用该方加味治疗寒热如疟、口渴不已、咽喉肿痛、阳萎盗汗、狂乱躁烦、神经质症、盆腔炎症、斑疹搔痒等症，也取得很好的疗效。兹简述于下：
一。热郁少阳寒热不已
袁XX：男，51岁，农民。恶寒发热间作，头痛泛恶不已，延绵已十月有余，中西药治疗不断。身热38度，颈背筋脉拘紧，两手无名指、小指发麻，纳眠尚调，大便不畅，苔薄黄腻，脉弦细滑带数。热郁少阳，三焦气机不畅。治宜清疏肝胆，调畅气机。方拟柴胡、黄芩、法半夏、片姜黄、白僵蚕各10克，蝉衣、片姜黄、薄荷各6克，竹茹、枳壳、蔓荆子各12克，大黄、甘草各5克。服5剂，寒热除，头痛、手指麻木不作。一周后午后略有低热，腰背肩胛酸滞，舌红苔薄，脉细弦。少阳郁热已解，阴血也见亏损。续清余邪，佐以养阴退虚热。银柴胡、地骨皮、白僵蚕、秦艽各10克，蝉衣、片姜黄各6克，生首乌、制女贞、枸杞子、川楝子各12克，生甘草5克，红枣10枚。7剂，未再来诊。
外感失治，邪留不去，缠绵少阳，枢机受阻，以致寒热间作，头痛泛恶，太少阳经气不利，则项背肩胛拘紧，两手无名、小指麻木不适；苔薄黄腻，脉细弦滑带数，此少阳郁热、痰浊内滞之征。治用小柴胡汤清疏少阳，合升降散疏理气机，加薄荷、蔓荆子疏风散热，竹茹、枳壳利痰下气。肝胆气机流畅，表里营卫协和，外邪无滞留之地。然郁热延绵数月，营阴暗灼于里，寒热除而午后微热，腰背酸滞，郁热伤阴，肝肾已亏。复诊于升降散疏调气机的基础上加滋补肝肾、养阴退虚热之品，邪去阴复，肝肾得以充养，诸症消除。
二。痰热壅滞咽喉肿痛
钱XX：男，43岁，农民。咽喉梗塞，如有物阻，吞吐不去，甚于半年前淋雨感冒，西药消炎滴注、中成药润喉利咽，用之无数，终无大效。诊见咽喉红肿，漏泡壅塞，咯痰白沫，纳少便解不畅，苔白滑腻，脉来细缓。此湿郁气阻，酿痰成浊。治宜疏调气机、芳化痰湿。蝉衣、姜黄、陈皮、木蝴蝶6克，白僵蚕、杏仁、苦桔梗、苏梗、茯苓、苍术、厚朴、牛蒡子各10克，甘草各5克。服7剂，咽喉稍感爽利，但局部红肿、漏泡未平，苔腻，脉细、重按弦数。湿滞见松，郁热已现，当清疏并进。山豆根、白僵蚕、黄芩、茯苓、竹茹、黛蛤散（包）、桔梗、牛蒡子各10克，蝉衣、姜黄、木蝴蝶、苏梗各6克，甘草5克。再14剂，咽喉红肿见退，梗阻不适轻减；原方去姜黄，加玄参，咽喉不适缓解；前方再去山豆根、蝉衣，加生谷麦芽、炙枇杷叶各12克以巩固。
慢性咽炎因雨湿外袭而甚，咽喉梗塞不适，杨氏升降散也治“咽喉肿痛，痰涎壅盛，滴水不能下咽者”。该患痰湿气阻，郁热内伏，先拟升降散去大黄疏调气机、升阳散火、祛风胜湿，合四七汤理气化痰、平胃散芳香化湿，加杏仁、木蝴蝶肃肺平肝，桔梗、甘草宣肺利咽。气机一转，脾运有权，湿痰渐化，而郁热未清，症势未减。复诊再以山豆根、黄芩、黛蛤散、木蝴蝶清肝肺伏火，茯苓、竹茹渗湿涤痰，升降散升清降浊、疏利气机，获效甚速。后二诊酌加润肺助脾之品，意在固护湿火戕伤之气阴。
三。流行性腮腺炎
孙某某，7岁初诊
初春患感，身热，微有恶寒，两侧耳下腮肿作痛，舌红苔白根厚，大便略千，小便短黄，口渴心烦，脉象浮滑且数，按之滑数有力。此温邪毒热内蕴，痄腮初起，当以轻宣清解，火郁当发也，宜外用热敷法。忌荤腥油腻，宜静卧休息。
薄荷2克(后下)，杏仁10克，蝉衣6克，僵蚕10克，前胡6克，片姜黄6克，浙贝12克，茅芦根各24克，焦山楂12克，二付
连服两剂，药后得小汗而身热已退，大便已通，腮肿亦退，原方加元参24克，赤芍10克又三付而愈。
[按]：痄腮多见于儿童，颌下肿硬作痛，伴发热恶寒，此为温毒之一种，必素体蕴热，复感温邪，热毒上攻，结于少阳之分，少阳乃枢机所在，枢机不利，则邪结不散澈治之以升降散疏调气机，运转枢机，合杏仁、前胡、薄荷宣肺散邪，浙贝母消肿散结，茅芦根泄热利水道，焦山楂和胃助消化。药合病机，故能两剂而愈。其外用热敷之法乃先生独到经验，取“温则消而去之”之意，亦《内经》“火郁发之”之一法也
四。病历摘要
例1，男，52岁，2000年10月24日初诊。患者诉5天前不慎受凉，而出现鼻塞、流清涕、打喷嚏、全身酸痛；自服感冒冲剂后，症状好转，后出现发热、口干、咽痛、咳嗽、咯白黄痰，故来求治。就诊时患者恶寒发热，测T38.9℃，汗出，口干舌燥，咽喉疼痛，全身酸痛，咳嗽，咯白黄痰，纳呆，小便黄，大便3日未解，舌质淡红，苔薄黄，脉浮数；查血常规：白细胞7.4×109/L；咽部充血，双侧扁桃腺Ⅰ°大。西医诊断：上呼吸道感染。中医诊断：感冒，辨证为外感风寒，郁而化热。治以：疏风清热，宣肺降火，方用升降散加味：蝉衣10g，僵蚕10g，片姜黄10g，生大黄（后下）6g，荆芥10g，防风10g，生石膏（先煎）30g，知母10g，杏仁12g，桔梗12g，板蓝根30g，生甘草6g；水煎服，每日1剂。服药3剂后，体温恢复正常，口干咽痛、咳嗽、全身酸痛明显减轻，大便已通。二诊，原方去生石膏、知母，加陈皮12g、炒麦芽15g，改生大黄（后下）3g，续服3剂后咳嗽、咽痛、全身酸痛症状均消失，纳食、大便、舌脉均恢复如常。
本例患者为外感风寒，治不彻底，风寒入里化热，热毒袭咽致口干咽痛；热郁于肺，出现咳嗽、咯黄痰；而肺与大肠相表里，故出现大便干结。治疗时用升降散加味疏风清肺、泻热通腑，宣上与清下并用，收到事半功倍的效果。
例2，女，30岁，2000年11月17日初诊。患者因咳喘反复发作5年，加重1周来就诊，就诊时患者咳嗽频作伴喘憋，咯黄痰，口干舌燥，咽痒，气短乏力，纳呆，大便干燥，排出不畅，舌质红、边有齿痕，苔薄黄，脉滑数；查血常规正常；胸部X线片示两肺纹理增粗，紊乱。中医诊断：喘证，辨证为痰热蕴肺，兼气阴不足。治以清肺化痰为主兼益气养阴，方用升降散合生脉散加味。方药：僵蚕10g，片姜黄10g，生大黄（后下）6g，蝉衣6g，黄芩12g，桑白皮12g，鱼腥草15g，炙麻黄5g，太子参15g，麦冬10g，五味子10g，桔梗10g，杏仁10g，生
甘草5g。服7剂后咳喘明显改善。二诊：原方续服7剂，患者喘憋咳嗽消失，饮食、大便、舌脉恢复正常。
升降散治疗咳喘，既能止咳平喘，祛风解痉，又能调畅肺气，行气活血，对于咳喘属于痰热内郁，气血失调，气机不畅者疗效颇佳；尤其是伴有咽痒、胸闷、憋气等气道高反应状态或过敏性咳嗽，更是效如桴鼓。
例3，女，63岁，2002年6月5日初诊。主诉：间断性眩晕、耳鸣2年余，复发1月。诊见：头晕、胀痛，眼胀视物模糊，耳鸣，口干苦，失眠多梦，腰酸腿软，纳食欠佳，小便黄，大便秘结，舌红苔薄黄，脉弦细；既往有高血压病史，测血压165/113mmHg（1mmHg≈0.133kPa），眼科测双侧眼压正常。西医诊断：高血压病；中医诊断：眩晕，辨证为肝肾阴虚，肝阳上亢，肝火上炎，治以平肝潜阳、清肝火为主，辅以滋补肝肾，方用升降散合天麻钩藤饮加减。处方：蝉衣6g，片姜黄10g，生大黄（后下）6g，僵蚕10g，天麻10g，钩藤（后下）15g，菊花10g，生地30g，寄生15g，牛膝15g，石决明（先煎）30g，川芎15g，甘草5g。服药7剂后，头晕头胀痛、口干苦、耳鸣明显好转，大便已通，测血压135/90mmHg，舌淡红，苔薄黄，脉细弦。二诊以原方去生大黄加夜交藤30g，连服14剂，除时有耳鸣、视物模糊、腰酸外其余症状消失。后改用杞菊地黄丸进行调理。
本病例眩晕，证属肝肾阴虚，肝阳上亢，肝火上炎。用升降散散郁热，升清阳，降浊邪，升降气机，行气活血，合天麻钩藤饮加减，以清肝火，平肝阳，滋肝肾，标本兼顾、补虚泻实而收效。
例4，男，62岁，2002年4月19日就诊。主诉：排尿不畅反复发作1年余，加重1周。诊见：排尿不尽，点滴而下，尿量少，少腹痛，会阴部不适，夜尿4～5次，小便黄，大便干，舌红苔薄黄脉弦数。西医诊断：前列腺增生；中医诊断：癃，辨证为气滞血瘀；治以活血行气，通瘀利水，方用：升降散合沉香散加减。处方：酒大黄6g，蝉衣12g，僵蚕10g，姜黄10g，沉香面（冲服）3g，王不留行12g，当归12g，茯苓皮15g，土茯苓12g，冬葵子12g，猪苓12g，香附12g，泽兰15g，炙甘草5g。服7剂后，小便通，夜尿次数为2次，其余症状改善。二诊：原方加牛膝15g，续服14剂，小腹及会阴部不适症状消失，余症悉除。
本病例证属气滞血瘀，水道不利。方中蝉衣、僵蚕辛散肺气，宣肺利水，以通调水道起到提壶揭盖作用；姜黄、酒大黄破血活血，散结止痛；配以茯苓皮、冬葵子、沉香、泽兰等活血利水，行气止痛，以达气机升降有序，气血得行，水道得通。
例5高热张某某，男，9岁，1997年8月5日初诊。
高热6天，体温波动于39～40℃，无汗，面红，目赤，手足凉而手足心及胸腹灼热，口干喜饮，大便2日未行，小便黄，舌红、苔黄少津，脉沉弦数。
证属卫气郁遏，火郁于里。处方：蝉衣8g，僵蚕10g，菊花10g，连翘12g，大黄3g(后下)，片姜黄1g，竹叶10g，银花15g，石膏15g。每日1剂，水煎服。患儿服1剂后遍体微汗出，体温由39.7℃降至37.1℃。2剂尽即热退身凉。
按：本例患儿虽有高热、面红、目赤、口干、喜饮、便干、尿赤等一派热在气分之象，但同时伴无汗，手足凉，胸腹灼热等火郁于里的症状，故治疗上不宜单用寒凉之品，而宜用轻宣之品，导邪外出。方中蝉衣、僵蚕、连翘、菊花轻清宣透，导邪外出；片姜黄行气散郁，通达全身，以助邪气外出，但本例热象较重，故片姜黄仅用1g，以防其性燥，反助火势；大黄通腑，竹叶清心利尿，二药均导热自下而出；石膏清内热。诸药合用，宣畅气机，给邪以出路，使郁火外达而热退身凉。
例6.头痛肖某某，女，47岁，1997年9月8日初诊。
半月前因心情不畅出现全头胀痛，午后加重，伴头晕目憋，心烦不寐，口干苦喜饮，大便3日未行，舌红、苔白厚，脉沉细。证属肝郁化火，上扰清窍。处方：僵蚕10g，蝉衣10g，片姜黄3g，大黄3g(后下)，柴胡10g，郁金10g，菊花10g，薄荷6g(后下)，丹皮10g，栀子10g，川芎15g，白芍20g。每日1剂，水煎服。服2剂后，诸症大减，后继服3剂，头痛已失
按：本例由情志不畅引起，气滞日久，郁而化火，上扰清窍，故头痛、头晕、目憋；扰乱心神则心烦不寐；热灼津伤则口干、喜饮、便干、尿赤。舌红、口苦为肝火盛之表现。脉沉为气机郁滞之象。综观其证，皆由气郁而起，故以升降散调畅三焦气机。方中片姜黄、蝉衣、僵蚕、菊花、薄荷调畅气机，宣泄郁火；柴胡、郁金、川芎、白芍舒肝解郁，条达气机；丹皮、栀子以增清肝之力；大黄通腑，使火自下泄。诸药合用，使气血畅达，通则不痛。
例7五心烦热赵某某，女，60岁，1997年7月22日初诊。
五心烦热1月余。现症：手足心及左胸自觉灼热，心烦懊浓少寐，胸以上烘热汗出，口苦，胸胁胀满，喜叹息，大便3～5日一行，小便黄热，舌红、苔黄厚少津，脉沉弦数。证属木郁化火。处方：僵蚕10g，蝉衣10g，大黄3g(后下)，片姜黄4g，柴胡10g，黄芩10g，郁金10g，栀子10g，生地15g。每日1剂，水煎服。2剂尽诸症减轻，继服3剂而愈。
按：患者情志不遂，肝郁气滞则胸胁胀满叹息；郁久化火，火热内郁则五心烦热、口苦，郁火扰心则心烦不寐；两脉沉弦，主气机阻滞；数乃郁火内逼之象。故方以蝉衣、僵蚕、片姜黄宣畅气机，疏解郁火；生地清热养阴；柴胡、郁金疏肝解郁；大黄清泄郁热，黄芩、栀子以泄火。诸药合用，气机得畅，郁火外达，故愈。
2体会
升降散由4味药物组成。方中僵蚕味辛气薄，能升阳中之清阳，既可祛风除湿，清热解郁，又可化痰散结、解痉；蝉衣甘咸能疏风清热，通散郁热，是祛风解痉、宣肺止咳良药；姜黄辛苦温，能行气散结，活血通络，宣通气血，用于气血不畅的全身酸痛效佳；大黄苦寒，能解毒祛火，攻里通下，活血化瘀，使热去毒解瘀化。总之升降散一升一降调畅气机，气分血分药物并用，能宣畅卫、气、营、血，调理三焦；既能升清阳又能降浊邪，既宣肺气又散郁火，使邪热去，腑气通。该方泻热通腑，升降同施，气血并治，调节人体气机出入，使人体气血调和，升降畅通。临床运用该方以外有表邪，里有郁热，以口干、便干、脉数为辨证要点，在辨证的基础上，配以其他方药，以求标本同治，虚实兼治，收效更速。现代药理也认为，僵蚕有镇静、抗惊厥，抗凝血，降脂之作用；蝉衣有解热、抗惊厥、镇静、抗过敏作用；姜黄有抗炎、利胆、降脂等作用；大黄有导泻、利胆、抗炎止血、活血等作用，说明升降散用于以上临床诸证有一定的药理依据。
外科名方，如意金黄散，按照《医宗金鉴》，药味多达十几味。据太老师张大昌先生经验，大黄、姜黄、白芷三味即可。我曾试用过多次，外敷痈肿，疗效确切。看来大黄、姜黄这二味药是不可分隔的一对。
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대시호탕에 석고를 가미할 경우
大小柴胡加生石膏汤
小柴胡加生石膏汤是在小柴胡汤证的基础上出现红肿，肌肉挛急，口干汗出等阳明热盛之象而设的，大柴胡加生石膏汤当然也是如此。石膏有透表的意思，像上体部，肌肉方面的病变，也不能仅仅依靠大黄，该加石膏还是要加。小柴胡脾家虚，大柴胡胃家实这一点应该是很明确的。病人反映出柴胡证，判断津液是否充足就成了区别大小柴胡汤的重要依据了。方法有很多，小柴胡心下痞应该是喜按的，大柴胡多半拒按。
具体到肺炎上，小柴胡加生石膏证多半是干咳无痰的，他本来津液就虚，脾不够津上承至肺，肺里水分本来就不够，又有邪热耗伤，要有痰也是又稀又少的，我见过的小柴胡加生石膏证几乎都没有多少痰，但咳得凶，大柴胡加生石膏就不同了，津液不虚而有热，热盛而水液粘稠于上就成结胸了，水盛而协热于下就变协热利了。不结胸也不协热利，多半是患者不断地咳痰（大都是浓痰）排除部分病理性水和热，使得体内的水同热不够互结演变为结胸和协热利，这就是身体自我防御机制在起作用了，六经传变也就是这么形成的，那么我们因势利导去掉多余的水和热就行了。
患者既然产生了柴胡证，那么身体的防御机制就是在希望从半表半里解除疾病，我们顺其意，具体到方证上，小柴胡汤加生石膏主要是用黄芩、生石膏清热的没有多少水，津液虚嘛，只清热就够了；大柴胡加生石膏证是湿热，当然不能用人参助湿，湿病讲究分利，要想方设法把湿（这里湿指痰饮）同热分开，使湿热不能相互为用，就容易各个击破。这种办法有效但相当慢。
伤寒可不管这些，热是无形的，湿是有形的，热附于湿，无形加诸于有形湿热当然是有形的，那就是实热证了，那么我们连湿带热一起攻就是了，大黄攻下，大黄不仅下热，也下痰，其实能下热就是连痰带热一起下。大便干用大黄，这种情况大便不干也可用大黄，让患者轻泻几次，往往咳痰连带发热迅速缓解，比温病手法快捷的多。用的是釜底抽薪的手法。
患者大便干时，怎样区别是小柴胡加生石膏证还是大柴胡加生石膏证？用口渴当然不对了，无论是小柴胡加生石膏证还是大柴胡加生石膏证都是太阳阳明同病，都有口渴的可能性，那要看有没有其它的症候，小柴胡加生石膏证大便干是因为津液虚，这是阳微结，阳微结是带阴证转机的，所以通常患者没有大热，也没有多大的汗，而大柴胡加生石膏证大便干往往就是阳明内结了，患者发潮热，手脚汗出。
病案1.钱某，女，52岁，初诊： 2006年11月6日。主诉：发热七天。患者七天前外感出现发热，38.7°，考虑倒换着年事已高，当日入院治疗，白细胞135000每升，中性粒细胞0.38.胸片左上肺片状阴影，诊断为肺部感染。入院后抗感染治疗，并配合补液，柴胡针对症治疗患者热退复升，反复无常冯诊：体温38.9°，口干苦，咽干，渴欲饮水，胸胁部胀满，右胁痛，无咳嗽咳痰，无恶寒身痛，汗出热不退，大便干燥，三日一行，小便调眠差，舌质红，苔薄黄腻，脉弦滑。此系一老年患者，且有肺部感染症状，根据症状特点辩证，患者发热、咽干口干苦，胁肋部胀痛，属少阳病，同时有口渴欲饮，大便干舌质红，苔薄黄腻，脉弦滑，辨证属里热壅盛之阳明病，无恶寒身痛，可排除太阳病，可辩证为少阳阳明合病。大柴胡汤加生石膏汤。处方：柴胡24克黄芩12克大黄6克枳实12克白芍10克清半夏12克生石膏（同煎）45克生姜15克大枣4枚。1剂水煎服。患者服用一剂后，体温由38.9°降至37.2°口干苦渴欲饮水胸胁部胀满等症状缓解，大便通畅继服上方一剂，体温降至正常无其它不适，胸片示肺部正常。观察两天出院
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방풍통성산을 다시 본다
再看防风通圣散
安徽温兴韬医师认为，防风通圣散主要由由三部分组成。荆防四物汤，用于证见皮肤瘙痒、干燥脱屑，且无明显湿热症象者，用于治疗老年性皮肤瘙痒证等效果显着；越婢加术汤，治疗汗出而肿、小便不利的清热利尿方；凉膈散，为清上焦风火、通下焦实热方。如有三方兼有之证，选用本方者有效。对于皮肤粗糙、形体壮实、汗出不多、烦热且大便干结的表里俱实型体质患者，使用防风通圣散能改善体质。
在此皮肤瘙痒、干燥脱屑有的不属于“肌肤甲错”的范畴，程度较轻者，不属于桃仁证用当归、芍药、川芎即可。
皮肤粗糙如蛇皮、松树皮等才属肌肤甲错，兼有便秘、失眠、狂燥、或有脑梗病史者，才是桃仁证。
刘完素在《保命集》中提出：治疗风刺、隐疹（荨麻疹）应在防风通圣散原方基础上倍加麻黄、盐豉、葱白，目的是“出其汗”还要去掉芒硝，因为“咸走血而内凝，不能发”
治疗荨麻疹除了应加大发汗药的使用外、还要加大生甘草、苍术等有类激素样作用药物的使用，并且还应减去芒硝防止其副作用”。
防风通圣散原方以滑石最重，甘草次之，这两味药比它药重几倍，所以应看作是六一散加味。后世大方以此方和五积散为代表，此方性凉，五积散性温，都有很广的适应证。
一个是一个胃脘胀满1年余的患者，心下痞满，舌苔黄腻，上呕中痞下利的症状全有，然而用半夏泻心汤无效，枳术汤无效，参考《名医类案》中用活血化瘀法亦无效，求助于黄老师，黄老师的回答只有五个字，令我大吃一惊：黄芪建中汤。这样厚的舌苔也能用温补的方子？我半信半疑地给患者开了此方，没想到3剂痞满即大有缓解，10剂后痊愈。我再次询问黄老师，黄老师说他的舌质是淡的，这就是一个虚弱体质，是“虚痞”，要用补法，而不要管舌苔，舌质比舌苔重要。
一是一例过敏性鼻炎患者，麻黄体质，清水涕，舌苔水滑，正是黄老师书中描述的“青龙水”，用小青龙+附子20克，5剂后症状大减，10剂后全消。
二是一位卖刀削面的老板娘，也是鼻炎，经常流鼻涕影响做生意，用小青龙15剂无效。再仔细观察患者烦躁不安，主诉很多，属于柴胡体质，用小柴胡加细辛10克后鼻涕明显减少。黄老师书上写到小柴胡汤也可以治疗过敏体质的鼻炎，是真知灼见。
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