수상한 여론조사···응답자 절반이 文투표층이었다 [출처: 중앙일보]
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서울시도 내년 '슈퍼 예산'...40조 원 육박
Posted : 2019-10-31
서울시 내년 예산…39조 5,282억 원
사회복지 예산, 전체 예산 3분의 1 넘어
서울시, 임신·출산·보육 공적 지원 강화
--->문죄인과 박원숭이 대한민국의 재산을 다 탕진하고 죽으려는 것 같다.
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초전도 송전 기술을 보유한 나라는 전세계 약 10개 정도 되고 이중 가장 앞서가고 있는게 미국 > 일본 > 독일 순임.
한국은 뒤늦게 뛰어 들었음에도 매우 빠른 발전속도를 보여서 10개중에 속하게 되었고 송전용량에 대해선 가장높은 실증기록을 보유함.
송전용량에 대해선 한국 > 미국 > 일본 이렇게 되었지
근데 여기서 중요한건 송전용량을 높이는 방법인데 용량자체에만 욕심을 내면 꽁수가 있음.
따라서 송전용량에 대한 실증경쟁은 2015년 이후 각국이 자제하는 모습이고 초전도 기술의 가장중요한 핵심인 저비용화에 주력을 하고 있음
왜냐면 시장에선 20년전부터 끊임없이 기사화를 접했기 때문에 아 이제 알았으니까 기돈 도체를 대체할 정도로 이제 싸냐고? 라고 묻고 있기 때문임.
그래서 2015년대 부터 여러가지 꽁수를 써가면서 대응하고 있는데 공통적으로 저초온으로 만드는 냉매를 순환시켜 재활용하는 방안을 쓰고 있고(이번 발표한 한국의 방법도 이거) 이것만으로 만족스럽지 않아서 각국이 다들 자기만의 필살기(일본은 케이블 자체의 크기를 줄여 비용절감을 하면서 기존 공장들에서 평소에 낭비되는 냉매까지 재활용. 미국도 캐이블및 냉매자체의 소재or 생산 비용절감화, 도체생산비용절감,) 를 준비해서 2025~2030년쯤 상업화를 목표로 하고 있음.
이들모두 초저온초전도체 관련 배경기술들로 아직 갈길이 멀다.
따라서 얼마나 싸냐가 관건인거지 저런 뉴스는 미래에 열릴 세계 시장에 중요하지 않다.
그래서 이번에 발표한 상용화 뉴스의 기술자체는 3년전에 실증되었지만 그동안 오더가 3년째 없었던 거임
자국에서 비용이 얼마나들던 1키로 밖에 안되는 송전을 하는 수준의 사용화는 10개국 누구나 가능함. 무슨 생각인지모르겠지만
한전이 세계최초라는 타이틀을 따기위해서 한 행동으로 보임. 홍보효과는 있겠지만 왜 그래야 했을까 의심도 드는건 어쩔수 없다.
기술독립 뉴스에 목마른 문죄인 정부의 압박이 있었을까? / 일베
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강기정 폭거, 국회통한 체제전복 징후/ "북 서울점령후 3일지체,
국회 소집 이승만 해임 노렸다" 남파간첩 증언
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앞집아저씨
관전 포인트 :앞집아저씨
초전도 송전 기술을 보유한 나라는 전세계 약 10개 정도 되고 이중 가장 앞서가고 있는게 미국 > 일본 > 독일 순임.
한국은 뒤늦게 뛰어 들었음에도 매우 빠른 발전속도를 보여서 10개중에 속하게 되었고 송전용량에 대해선 가장높은 실증기록을 보유함.
송전용량에 대해선 한국 > 미국 > 일본 이렇게 되었지
근데 여기서 중요한건 송전용량을 높이는 방법인데 용량자체에만 욕심을 내면 꽁수가 있음.
따라서 송전용량에 대한 실증경쟁은 2015년 이후 각국이 자제하는 모습이고 초전도 기술의 가장중요한 핵심인 저비용화에 주력을 하고 있음
왜냐면 시장에선 20년전부터 끊임없이 기사화를 접했기 때문에 아 이제 알았으니까 기돈 도체를 대체할 정도로 이제 싸냐고? 라고 묻고 있기 때문임.
그래서 2015년대 부터 여러가지 꽁수를 써가면서 대응하고 있는데 공통적으로 저초온으로 만드는 냉매를 순환시켜 재활용하는 방안을 쓰고 있고(이번 발표한 한국의 방법도 이거) 이것만으로 만족스럽지 않아서 각국이 다들 자기만의 필살기(일본은 케이블 자체의 크기를 줄여 비용절감을 하면서 기존 공장들에서 평소에 낭비되는 냉매까지 재활용. 미국도 캐이블및 냉매자체의 소재or 생산 비용절감화, 도체생산비용절감,) 를 준비해서 2025~2030년쯤 상업화를 목표로 하고 있음.
이들모두 초저온초전도체 관련 배경기술들로 아직 갈길이 멀다.
따라서 얼마나 싸냐가 관건인거지 저런 뉴스는 미래에 열릴 세계 시장에 중요하지 않다.
그래서 이번에 발표한 상용화 뉴스의 기술자체는 3년전에 실증되었지만 그동안 오더가 3년째 없었던 거임
자국에서 비용이 얼마나들던 1키로 밖에 안되는 송전을 하는 수준의 사용화는 10개국 누구나 가능함. 무슨 생각인지모르겠지만
한전이 세계최초라는 타이틀을 따기위해서 한 행동으로 보임. 홍보효과는 있겠지만 왜 그래야 했을까 의심도 드는건 어쩔수 없다.
기술독립 뉴스에 목마른 문죄인 정부의 압박이 있었을까? / 일베
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Gordon G. Chang
#HongKong society is in full revolt, and without major political concessions from #China the insurgency will only grow. So why won't Beijing back down? Because Mainlanders would demand the same rights granted in Hong Kong. There are no solutions for the Chinese tyrants.
중국이 홍콩에 양보하지 못하는 이유는, 그럴 경우 본토인들도
같은 권리를 요구하기 때문이다.
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Yuan Yang
"The answer which some people may not want to hear is that we are dependent upon Chinese researchers and Chinese graduate students... A decoupling at the human level would hurt the United States."
인적 자원 차원에서 디커플링은 미국에 손해이다.
Ex-Google chief warns of need for AI co-operation with China
파이낸셜타임즈
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Our 4Q2019 outlook for China’s economy is here!
@hzsong predicts that:
- Growth is unlikely to dip below 6% & no major
stimulus is expected.
- Conditions could deteriorate in 2020.
- Beijing will take this time to prepare for the
expected global slowdown.
중국 경제의 전망
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Damien Ma 더 보기
People seem to forget these days how important the environment has become in the "Mak3 China Great Again" agenda - it is very much embedded in Xi's rejuvenation strategy. Blue mountains and green rivers are now as important as GDP.
시진핑의 중흥 계획에서 환경은 국민소득만큼 중요해졌다.
--->그렇다면 한국의 환경을 위해서도 다행한 일이다.
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Vala Afshar 더 보기
22 inventions that are saving the Earth
지구를 살리는 22가지 발명
This brilliant painting shows human aging in real time
시간에 따라 늙어가는 모습을 보여주는 놀라운 그림
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@FinancialTimes
"Generational inequality has left baby boomers in clover while their children eke out their lives in rented flats with only the occasional slice of avocado toast. This creates a problem for brokers: where to find the next generation of investors." https://www.ft.com/content/a4bd626f-2069-429d-8382-98bdb995983c?segmentId=957c4f0e-4bf3-a094-e9f5-03a132f5d75b …
세대간 불평등으로 베이비 부머는 잘 사는데 비해, 그 자녀들은 겨우 생활을 이어나가고 있다. 그리고 다음 세대의 투자자들은?
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Anna Fifield
China’s Communist Party is lionizing Huang Wenxiu, a woman who was Xi Jinping’s model citizen — and became a martyr for the cause. My story about the 21st century Lei Feng
중국 정부가 황원시우를 21세기 레이펑으로 만들고 있다.
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Niall Ferguson 더 보기
The social credit system will not prevent China from succumbing to the combination of a slowing economy, a rising and expectant middle class, a chronically corrupt political system, a corrosive culture of dissembling, and fragmentation on the periphery.
증하는 중산층, 고질적으로 부패한 정치제도, 본심을 숨기는
문화 그리고 변방의 파편화 등을 피할 수 없다.
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Matt Ridley
The decision to halt shale gas will eventually be seen as a historic mistake. It followed the same script as genetically modified foods: well funded and unprincipled opposition resulting in environmentally more damaging alternatives getting their way.
셰일 가스 생산을 중단시킨 결정은 역사적인 실수이다. 이로
인해 환경에 더 해로운 대안이 득세하게 될 것이다.
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Matt Ridley
The economic illiteracy is strong in this one
경제 문맹들의 바보 짓거리
James Murray
Labour's promise to upgrade the entire UK housing stock to make it warmer and greener prompts plenty of questions, the absolutely least interesting of which is people who still have not explained how they'll pay for a Hard Brexit asking 'how are you going to pay for it?'
영국 노동당이 영국 전체의 가옥을 더 따듯하게 그리고 친환경적으로 만들어주겠다는 공약을 했다. 그런데 과연 그 돈은 어디에서 나오지?
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Matt Ridley 더 보기
"In order to achieve its green goal, Boeing had to use much bigger engines that didn’t fit in the usual position under the wing... As a result, the aerodynamics changed, and the planes had a tendency to pitch up and potentially stall on takeoff."
비행기를 친환경적으로 만들기 위해 보잉이 엔진을 크게 만들
었는데, 그것이 날개 밑의 기존의 위치에 잘 맞지 않았다. 그로
인해 공기역학이 변했고, 비행기가 이륙시에 기체가 불안정하
게 되었다.
--->엔진 개조가 보잉 추락사고의 원인으로 지목되고 있다.
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Claire Lehmann
"Comedy columnist"
코미디 칼럼니스트라고?
@nytimes
On his first tour since admitting to sexual misconduct, Louis C.K. is not offering audiences any reckoning with the damage he's done. “He turned his new reputation in the #MeToo era into a springboard for jokes,” writes our comedy columnist Jason Zinoman. https://nyti.ms/34ts30n
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Quillette
"On Twitter, there is new trend of people giving themselves communist-themed names: 'Gothicommunist,' 'Trans-Communist,' 'Commie-Bitch,' 'Eco-Communist.' The hammer & sickle flag has been re-appearing on campuses. How could we have forgotten?"
망치와 낫을 그린 깃발이 나타나고 있다. 어떻게 공산주의의
만행을 잊을 수 있단 말인가?
Milan Kundera Warned Us About Historical Amnesia. Now It’s Happening Again' by Ewan Morrison
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자유시장이란 무엇인가?
중상주의자들은 모든 거래에서 한쪽은 이익을 얻고 한쪽은 손해를 본다고 믿었다. 하지만 쌍방이 기꺼이 거래했다는 것은 양쪽 모두가 이익을 본다는 뜻이다. 그러니까 거래는 현대 게임 이론의 용어를 빌리면 포지티브 섬이고, 윈-윈 상황인 것이다.
정부는 유일하게 합법적인 강압의 시스템이다.
정부의 강압이 최고에 이른 시스템이 바로 사회주의이다.
자유시장이 번성하는 데 필수 요소는 사유재산권이 존중되고 보호받는 사회이어야 한다.
인권, 인권하는데, 사실 언론 자유의 권리든, 사유재산에 대한 권리든, 모든 권리는 인권이다.
What Is the Free Market?
Murray N. Rothbard
The Free Market is a summary term for an array of exchanges that take place in society. Each exchange is undertaken as a voluntary agreement between two people or between groups of people represented by agents. These two individuals (or agents) exchange two economic goods, either tangible commodities or nontangible services. Thus, when I buy a newspaper from a news dealer for fifty cents, the news dealer and I exchange two commodities: I give up fifty cents, and the news dealer gives up the newspaper. Or if I work for a corporation, I exchange my labor services, in a mutually agreed way, for a monetary salary; here the corporation is represented by a manager (an agent) with the authority to hire.
Both parties undertake the exchange because each expects to gain from it. Also, each will repeat the exchange next time (or refuse to) because his expectation has proved correct (or incorrect) in the recent past. Trade, or exchange, is engaged in precisely because both parties benefit; if they did not expect to gain, they would not agree to the exchange.
This simple reasoning refutes the argument against free trade typical of the "mercantilist" period of sixteenth- to eighteenth-century Europe, and classically expounded by the famed sixteenth-century French essayist Montaigne. The mercantilists argued that in any trade, one party can benefit only at the expense of the other, that in every transaction there is a winner and a loser, an "exploiter" and an "exploited." We can immediately see the fallacy in this still-popular viewpoint: the willingness and even eagerness to trade means that both parties benefit. In modern game-theory jargon, trade is a win-win situation, a "positive-sum" rather than a "zero-sum" or "negative-sum" game.
How can both parties benefit from an exchange? Each one values the two goods or services differently, and these differences set the scene for an exchange. I, for example, am walking along with money in my pocket but no newspaper; the news dealer, on the other hand, has plenty of newspapers but is anxious to acquire money. And so, finding each other, we strike a deal.
Two factors determine the terms of any agreement: how much each participant values each good in question, and each participant's bargaining skills. How many cents will exchange for one newspaper, or how many Mickey Mantle baseball cards will swap for a Babe Ruth, depends on all the participants in the newspaper market or the baseball card market — on how much each one values the cards as compared to the other goods he could buy. These terms of exchange, called "prices" (of newspapers in terms of money, or of Babe Ruth cards in terms of Mickey Mantles), are ultimately determined by how many newspapers, or baseball cards, are available on the market in relation to how favorably buyers evaluate these goods. In shorthand, by the interaction of their supply with the demand for them.
Given the supply of a good, an increase in its value in the minds of the buyers will raise the demand for the good, more money will be bid for it, and its price will rise. The reverse occurs if the value, and therefore the demand, for the good falls. On the other hand, given the buyers' evaluation, or demand, for a good, if the supply increases, each unit of supply — each baseball card or loaf of bread — will fall in value, and therefore, the price of the good will fall. The reverse occurs if the supply of the good decreases.
The market, then, is not simply an array, but a highly complex, interacting latticework of exchanges. In primitive societies, exchanges are all barter or direct exchange. Two people trade two directly useful goods, such as horses for cows or Mickey Mantles for Babe Ruths. But as a society develops, a step-by-step process of mutual benefit creates a situation in which one or two broadly useful and valuable commodities are chosen on the market as a medium of indirect exchange. This money-commodity, generally but not always gold or silver, is then demanded not only for its own sake, but even more to facilitate a re-exchange for another desired commodity. It is much easier to pay steelworkers not in steel bars, but in money, with which the workers can then buy whatever they desire. They are willing to accept money because they know from experience and insight that everyone else in the society will also accept that money in payment.
The modern, almost infinite latticework of exchanges, the market, is made possible by the use of money. Each person engages in specialization, or a division of labor, producing what he or she is best at. Production begins with natural resources, and then various forms of machines and capital goods, until finally, goods are sold to the consumer. At each stage of production from natural resource to consumer good, money is voluntarily exchanged for capital goods, labor services, and land resources. At each step of the way, terms of exchanges, or prices, are determined by the voluntary interactions of suppliers and demanders. This market is "free" because choices, at each step, are made freely and voluntarily.
The free market and the free price system make goods from around the world available to consumers. The free market also gives the largest possible scope to entrepreneurs, who risk capital to allocate resources so as to satisfy the future desires of the mass of consumers as efficiently as possible. Saving and investment can then develop capital goods and increase the productivity and wages of workers, thereby increasing their standard of living. The free competitive market also rewards and stimulates technological innovation that allows the innovator to get a head start in satisfying consumer wants in new and creative ways.
Not only is investment encouraged, but perhaps more important, the price system, and the profit-and-loss incentives of the market, guide capital investment and production into the proper paths. The intricate latticework can mesh and "clear" all markets so that there are no sudden, unforeseen, and inexplicable shortages and surpluses anywhere in the production system.
But exchanges are not necessarily free. Many are coerced. If a robber threatens you with "Your money or your life," your payment to him is coerced and not voluntary, and he benefits at your expense. It is robbery, not free markets, that actually follows the mercantilist model: the robber benefits at the expense of the coerced. Exploitation occurs not in the free market, but where the coercer exploits his victim. In the long run, coercion is a negative-sum game that leads to reduced production, saving, and investment, a depleted stock of capital, and reduced productivity and living standards for all, perhaps even for the coercers themselves.
Government, in every society, is the only lawful system of coercion. Taxation is a coerced exchange, and the heavier the burden of taxation on production, the more likely it is that economic growth will falter and decline. Other forms of government coercion (e.g., price controls or restrictions that prevent new competitors from entering a market) hamper and cripple market exchanges, while others (prohibitions on deceptive practices, enforcement of contracts) can facilitate voluntary exchanges.
The ultimate in government coercion is socialism. Under socialist central planning the socialist planning board lacks a price system for land or capital goods. As even socialists like Robert Heilbroner now admit, the socialist planning board therefore has no way to calculate prices or costs or to invest capital so that the latticework of production meshes and clears. The current Soviet experience, where a bumper wheat harvest somehow cannot find its way to retail stores, is an instructive example of the impossibility of operating a complex, modern economy in the absence of a free market. There was neither incentive nor means of calculating prices and costs for hopper cars to get to the wheat, for the flour mills to receive and process it, and so on down through the large number of stages needed to reach the ultimate consumer in Moscow or Sverdlovsk. The investment in wheat is almost totally wasted.
Market socialism is, in fact, a contradiction in terms. The fashionable discussion of market socialism often overlooks one crucial aspect of the market. When two goods are indeed exchanged, what is really exchanged is the property titles in those goods. When I buy a newspaper for fifty cents, the seller and I are exchanging property titles: I yield the ownership of the fifty cents and grant it to the news dealer, and he yields the ownership of the newspaper to me. The exact same process occurs as in buying a house, except that in the case of the newspaper, matters are much more informal, and we can all avoid the intricate process of deeds, notarized contracts, agents, attorneys, mortgage brokers, and so on. But the economic nature of the two transactions remains the same.
This means that the key to the existence and flourishing of the free market is a society in which the rights and titles of private property are respected, defended, and kept secure. The key to socialism, on the other hand, is government ownership of the means of production, land, and capital goods. Thus, there can be no market in land or capital goods worthy of the name.
Some critics of the free-market argue that property rights are in conflict with "human" rights. But the critics fail to realize that in a free-market system, every person has a property right over his own person and his own labor, and that he can make free contracts for those services. Slavery violates the basic property right of the slave over his own body and person, a right that is the groundwork for any person's property rights over nonhuman material objects. What's more, all rights are human rights, whether it is everyone's right to free speech or one individual's property rights in his own home.
A common charge against the free-market society is that it institutes "the law of the jungle," of "dog eat dog," that it spurns human cooperation for competition, and that it exalts material success as opposed to spiritual values, philosophy, or leisure activities. On the contrary, the jungle is precisely a society of coercion, theft, and parasitism, a society that demolishes lives and living standards. The peaceful market competition of producers and suppliers is a profoundly cooperative process in which everyone benefits, and where everyone's living standard flourishes (compared to what it would be in an unfree society). And the undoubted material success of free societies provides the general affluence that permits us to enjoy an enormous amount of leisure as compared to other societies, and to pursue matters of the spirit. It is the coercive countries with little or no market activity, notably under communism, where the grind of daily existence not only impoverishes people materially, but deadens their spirit.
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葦莖湯
別名 千金葦莖湯（《金匱要略·肺痿肺癰咳嗽上氣篇·附方》）。
處方 葦莖（銼）30克 薏苡仁15克 桃仁50枚（去尖、皮、雙仁者）瓜瓣15克
製法 上四味藥，哎咀。
功能主治 清肺化痰，逐瘀排膿。治肺癰。咳吐腥臭黃痰膿血，胸中肌膚甲錯，隱隱作痛，咳時尤甚，口乾咽燥，舌紅苔黃，脈滑數。現用於肺膿瘍、肺炎；急慢性支氣管炎、支氣管擴張合併感染、百日咳等屬於肺熱者。
用法用量 以水1升，先煮葦莖，煮取500毫升，去滓，悉納諸藥，煮取300毫升，分二次服6當吐如膿。
備註 本方為治肺癰名方。方中葦莖甘寒輕浮，清肺瀉熱為君；瓜瓣化痰排膿為臣；桃仁活血祛瘀，薏苡仁清肺破毒腫，共為佐使。四藥合用，共成清肺化痰，逐瘀排膿之功。肺癰未成或已成者均可使用。
葦莖湯，中醫方劑名。為清熱劑，具有清臟腑熱，清肺化痰，逐瘀排膿之功效。主治肺癰，熱毒壅滯，痰瘀互結證。身有微熱，咳嗽痰多，甚則咳吐腥臭膿血，胸中隱隱作痛，舌紅苔黃膩，脈滑數。臨床常用於治療肺膿腫、大葉性肺炎、支氣管炎等肺熱痰瘀互結者。
中文名
葦莖湯
功用
清肺化痰，逐瘀排膿
主治
肺癰，熱毒壅滯，痰瘀互結證
分類
清熱劑-清臟腑熱
出處
《外台秘要》
歌訣
葦莖瓜瓣苡桃仁，清肺化痰逐瘀能，熱毒痰瘀致肺癰，膿成未成均勝任。
組成
葦莖、瓜瓣、薏苡仁、桃仁。
用量
葦莖60g，瓜瓣60g，薏苡仁30g，桃仁24g。
用法
上四味。以水一斗。先煮葦莖。得五升。去滓。內諸藥。煮取二升。服一升。再服。當吐膿。
功用
清肺化痰，逐瘀排膿。
主治
肺癰，熱毒壅滯，痰瘀互結證。身有微熱，咳嗽痰多，甚則咳吐腥臭膿血，胸中隱隱作痛，舌紅苔黃膩，脈滑數。
方義
本方多由熱毒壅肺，痰瘀互結，血敗肉腐成癰所致，治療以清肺化痰，逐瘀排膿為主。痰熱壅肺，氣失清肅則咳嗽痰多；《內經》說：「熱盛則肉腐，肉腐則成膿」，邪熱犯肺，傷及血脈，致熱壅血瘀，若久不消散則血敗肉腐，乃成肺癰；癰膿潰破，藉口咽而出，故咳吐腥臭黃痰膿血；痰熱瘀血，互阻胸中，因而胸中隱痛；舌紅苔黃膩，脈滑數皆痰熱內盛之象。方中葦莖甘寒輕浮，善清肺熱，故為君藥。瓜瓣清熱化痰，利濕排膿，能清上徹下，肅降肺氣，與葦莖配合則清肺宣壅，滌痰排膿；薏苡仁甘淡微寒，上清肺熱而排膿，下利腸胃而滲濕，二者共為臣藥。桃仁活血逐瘀，可助消癰，是為佐藥。方僅四藥，結構嚴謹，藥性平和，共具清熱化痰、逐瘀排膿之效。
加減化裁
若肺癰膿未成者，宜加金銀花、魚腥草以增強清熱解毒之功；膿已成者，可加桔梗、生甘草、貝母以增強化痰排膿之效。
附註
附方
桔梗湯
組成
桔梗、甘草。
用量
桔梗30g，甘草60g。
用法
上兩味，以水三升，煮取一升，去滓，分溫再服。
功用
宣肺止咳，祛痰排膿。
主治
肺癰。咳而胸痛，振寒，脈數，咽干不渴，時出濁唾腥臭，久久吐膿如米粥。
重要文獻摘要
①《成方便讀》：癰者，壅也，猶土地之壅而不通也。是以肺癰之證，皆由痰血火邪，互結肺中，久而成膿所致。桃仁、甜瓜子皆潤燥之品，一則行其瘀，一則化其濁；葦莖退熱而清上，苡仁除濕而下行。方雖平淡，其散結通瘀、化痰除熱之力實無所遺。以病在上焦，不欲以重濁之藥重傷其下也。[1]
②《金匱要略論注》：此治肺癰之陽劑也。蓋咳而有微熱，是在陽分也；煩滿，則挾濕矣；至胸中甲錯，是內之形體為病，故甲錯獨見於胸中，乃胸上之氣血兩病也。故以葦莖之輕浮而甘寒者，解陽分之氣熱；桃仁瀉血分之結熱；薏苡下肺中之濕；瓜瓣清結熱而吐其敗濁，所謂在上者越之耳。
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外感系列方——千金葦莖湯
作者：羅大倫
肺部感染，我們中醫中藥的效果非常好，我覺得這是我們現在往往忽略的，我們認為西藥快，中藥慢，殊不知，中藥對症了，效果一樣快的。
肺部感染，中醫也分各個證型，也有陽氣不足的，但是，在最初階段，多數是熱邪壅滯的熱症。
此時患者的症狀，多是發燒，嚴重了，甚至會咳吐腥臭痰，或膿血，胸中隱隱作痛，咳嗽的時候尤其嚴重。此時患者的舌質紅，苔黃膩，脈滑，跳動得很快，中醫叫脈數。
這裡面，看舌非常關鍵，舌質此時是紅色的，越紅說明熱越嚴重。
此時，中醫會用清熱解毒、化痰清肺的藥物，而我建議，在這個時候，可以在清熱解毒的基礎上，加上中醫的經典方子：葦莖湯。
這個方子，因為是孫思邈的《備急千金要方》裡面的方子，所以也叫千金葦莖湯，以區別於後世的其他同名方劑。
這個方子的原來的劑量是這樣的：葦莖（二升）、薏苡仁（半升）、桃仁（五十粒）、瓜瓣（半升）、上四味。以水一鬥。先煮葦莖。得五升。去滓。內諸藥。煮取二升。服一升。
我現在使用，通常用這樣的劑量：蘆根60克、 薏苡仁30克、 冬瓜子30〜60克、 桃仁9克。
這個方子裡面，原方用的是葦莖，對於什麼是葦莖，稍微有點爭議，多數醫家認為是蘆葦的莖，因為莖在水上，主升發透邪的作用較強，而後世葦莖不大用了，都用蘆根，過去認為蘆根與葦莖藥性稍有不同，蘆根生於水中，清熱透熱的作用更好。現在我們已經主要用蘆根來代替葦莖了，我的體會是效果還是不錯的。原方是先煮葦莖，然後用這個水來熬其他的藥物，我們今天放在一起熬就可以了。
方子裡面的“瓜瓣”，也有爭議，《張氏醫通》等醫書認為是甜瓜子，我們現在則多用冬瓜子，效果也非常好。
這個方子，我們現在常用於配合治療肺膿腫、大葉性肺炎、支氣管炎、百日咳等屬肺熱痰瘀互結者。
對於這個方子的解釋，《成方便讀》這樣說：“癰者，壅也，猶土地之壅而不通也。是以肺癰之證，皆由痰血火邪，互結肺中，久而成膿所致。桃仁、甜瓜子皆潤燥之品，一則行其瘀，一則化其濁；葦莖退熱而清上，苡仁除濕而下行。方雖平淡，其散結通瘀、化痰除熱之力實無所遺。以病在上焦，不欲以重濁之藥重傷其下也。”
這個方子裡面，蘆根是透熱的，清肺部之壅結，用到幾十克，透熱的力量是很大的，薏苡仁祛濕解毒，將濕熱之邪向下導，肺氣不能下行，則壅滯，濕熱去，則清輕之氣可升，肺金之氣可以下肅。冬瓜子，清代的《本草述鉤元》述：“主腹內結聚，破潰膿血，凡腸胃內壅，最為要藥”。冬瓜子有利水解毒的作用，此處用了效果很好，但是如果是肺部膿腫，則選甜瓜子為好。
這方子裡面，我覺得用的最妙的，是活血化瘀的桃仁。要知道，一般熱結於內，多有瘀滯，此時如果瘀滯不破，用各種解毒的藥物可能效果都有限，所以一般我遇到僵持不下的病情，往往加入活血化瘀的藥物，比如三七、桃仁、紅花、丹參等藥物，往往可以立刻獲效。這是經驗心得，可以和大家交流。而肺部紋理細微，患病後更容易導致絡脈不通，此時用活血化瘀的藥物，更有意義。
一般這個葦莖湯我也很少單獨用，往往是在肺部感染嚴重的時候，用了其他清解的藥物，此時配合葦莖湯，去除濕熱之結，往往效果非常好，我通常還會配合一些鮮竹瀝，則效果會更好。
大家看了方子，會覺得薏苡仁是祛濕的，這方子是不是調理濕熱嚴重的肺部感染呢？
這樣想是有道理的，如果遇到濕熱為患的，此方效果非常好。
但是，如果肺部感染嚴重了，如果是因為燥邪引起的，或者是熱邪傷陰，導致肺部津液不足，此時，也可以用養陰清肺的方子，同時也是可以配合此方的。因為肺為嬌髒，受外邪感染，熱邪壅盛，雖然可能津液不足，但是也會出現局部濕邪瘀滯的情況，也就是說：津液不足，和濕邪壅滯，是兩個層面的事情，在同一時間，不同位置與不同層面，會同時存在，需要同時兼顧。
給大家舉個例子，我有位親戚，是位老人，年輕時曾患結核後來痊癒，此次由感冒開始，逐漸肺部感染住院，西醫拍片判斷是肺炎，主要在右肺。用頭孢類抗生素兩周，高熱改為低熱，出院，停藥後再次高熱，原來醫院不收入院，換另外一家醫院繼續換抗生素七天，仍然效果不明顯，低熱，查結核沒有問題，西醫醫生此時因為用抗生素太多，也不主張繼續用了，讓請中醫調理。我評價抗生素有效果，但是沒有最終解決問題，高熱會隨時再起。老人脈數，手腳心熱，判斷為熱邪傷陰，但是痰聲不斷，還要清熱化痰，於是用養陰清肺之藥，配合葦莖湯，因為在右肺，為肺胃不降之象，故加焦三仙各九克、炒雞內金九克，鮮竹瀝口服液兩支。五天後基本正常，五天裡面的最後兩天，白天體溫皆正常，他們每晚量體溫五次，發現只是每天夜裡有片刻體溫上到三十七度，時間多在淩晨，一會兒就恢復正常。此時診脈，脈弱，說明與外邪鬥爭後正氣不足，用小柴胡湯重用人參，扶正驅邪，兩天，痊癒。
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千金葦莖湯加減輔助治療慢性阻塞性肺疾病急性加重60例療效觀察
邱磷安 陳懷宇
（福建中醫藥大學附屬人民醫院，福建 福州 350004）
【摘要】目的：探討千金葦莖湯慢性阻塞性肺疾病急性加重患者的臨床療效。方法：將60例慢性阻塞性肺疾病急性加重患者隨機分為兩組，對照組30例，治療組30例，對照組採用西醫常規治療，治療組在西醫常規治療基礎上加用千金葦莖湯，療程2周，觀察治療前及治療2周後兩組患者的症狀、體徵、血氣分析、血常規、降鈣素原、胸部X線影像、肺功能等情況變化，採用SPSS 13.0軟件進行統計學分析。結果：治療組綜合療效優於對照組，差異有統計學意義（P<0.05）。結論：千金葦莖湯治療慢性阻塞性肺疾病急性加重療效可靠、副作用少，且費用低廉，值得臨床推廣應用。
【關鍵詞】千金葦莖湯 肺疾病 阻塞性 慢性 急性加重
千金葦莖湯源自唐代孫思邈《備急千金藥方》，由葦莖、薏苡仁、冬瓜仁、桃仁組成，具有清肺化痰、逐瘀排膿之功效，目前廣泛應用於治療大葉性肺炎、慢性阻塞性肺病急性加重、肺部感染、鼻竇炎等多種證屬熱毒內蘊、痰瘀互結所致的疾病。隨着抗生素的廣泛使用，大葉性肺炎的發生率明顯降低，但慢性阻塞性肺疾病的患病率極高，病程遷延難癒，西醫多以抗生素、化痰藥、解痙平喘藥物治療慢性阻塞性肺病急性加重期病人，但療效一般，費用昂貴，且容易反復發作及合併二重感染。慢阻肺急性加重期患者主要表現為咳嗽、咯痰量多色黃，喘息、發熱等症狀，證屬中醫咳嗽之痰熱內蘊或夾血瘀。我科自2010年以來採用千金葦莖湯配合抗生素治療慢阻肺急性加重期患者，取得了較好療效，現總結報道如下：
1 臨床資料
1.1 一般資料：選擇符合條件的病例60例，隨機分為治療組和對照組（各30例）。治療組中男性20例，女性10例，年齡最小55歲，最大89歲，平均年齡（72.07±8.39）歲；病程最短8.5年，最長52年，平均（16.79±10.53）年；臨床分級：中型11例，重型19例。對照組中男性22例，女性8例；年齡最小54歲，最大87歲，平均年齡（71.05±7.93）歲；病程最短5年，最長30年，平均（17.20±11.25）年；臨床分級：中型13例，重型17例。兩組在性別、年齡、病程及病情嚴重程度等方面均無顯著性差異（P>0.05），具有可比性。
2 治療方法：
2.1 對照組採用西醫常規治療，具體治療方案包括：（1）持續低流量吸氧；（2）多索茶礆0.3g qd靜脈滴注；萬托林2噴tid吸入，異丙托溴氨1支qd霧化；左氧氟沙星0.4g qd靜脈滴注，如感染嚴重者抗生素升級為第三代頭孢菌素類或碳希青霉素類；氨溴索30mg tid靜脈注射；喘促嚴重者可配合呼吸機無創正壓通氣治療，必要時氣管插管行有創通氣治療。
2.2 治療組在此基礎上加用千金葦莖湯[4]。葦莖由蘆根替代，具體用法用量如下：蘆根30g，桃仁15g，冬瓜仁15g，薏苡仁15g組成，由福建中醫藥大學第一附屬醫院製劑室代煎，每日1劑（濃煎，每劑熬2包，每包約40ml），分2次服。2周為1療程。
3 療效觀察
3.1 療效標準：參照中華人民共和國衛生部制定的《中藥新藥臨床研究指導原則》[5]中的有關標準制定。顯效：間斷咳嗽，痰量少且易咯，兩肺偶聞噦音，心肺功能改善達2級，可做輕微活動，1年以內無急性加重；有效：陣咳、痰易咯，兩肺有散在囉音，心肺功能改善達2級，生活自理，1年內出現1-2次急性加重；無效：上述各項指標均無改善或惡化者。
3.2 觀察指標和方法（1）詳細記錄兩組患者治療前後症狀、體徵的變化。（2）治療前後血常規、降鈣素原、血氣分析、胸部X線影像、肺功能的變化。
4 結果
5 討論
慢性阻塞性肺病屬中醫「肺脹」、「咳嗽」等範疇。《靈樞．脹論》中云：「肺脹者，虛滿而喘咳」，首先描述了「肺脹」的主要臨床表現為「咳、喘、胸滿」。《丹溪心法．咳嗽》有云：「肺脹而嗽，或左或右不得眠，此痰挾瘀血礙氣而病」，提出了肺脹的病因主要是痰瘀阻肺所致，發展至後期可見氣虛陽衰，痰濁內生，伏着於肺，氣血運行不暢；主要症狀為面色晦暗、胸腹脹滿、咳喘痰涌、心悸煩躁，納減少尿等。古代多數醫家認為本病的發生為久病肺虛，痰濁瀦留，復感外邪致病情加重或復發，屬本虛標實之證。肺為嬌臟，主宣降，外邪犯肺則宣降失司，肺氣上逆則發咳喘。脾為生痰之源，肺為貯痰之器。久病失治，肺病及脾，脾失健運，肺脾兩虛，不能正常的運化水濕，濕聚為痰，上干於肺；或外邪入裏，鬱而化熱，痰熱鬱肺，肺失宣降，致咳、痰、喘發作。該病急性發作期多以標實為主，主要病機[6]為「因痰致瘀、痰瘀互阻」，臨床上多以痰熱壅肺之證多見。故選用千金葦莖湯，該方具有化痰泄熱，通瘀散結作用。方中以葦莖（現以蘆根替代）為君藥，可清解肺熱；桃仁散結通瘀、潤肺滑腸，冬瓜仁清熱化痰、利濕排膿；與桃仁配伍使痰熱瘀從大便而解，生薏苡仁上清肺熱而排膿，下利腸胃而滲濕，使濕熱之邪從小便而去。現代研究表明[7]：薏苡仁具有抗菌作用；蘆根、冬瓜仁具有鎮咳、化痰功效，部分還有抗菌、免疫促進作用。本研究通過對2組治療前後結果變化情況進行比較，結果表明：2組治療後血氣分析中PaO2、PaCO2明顯優於治療前（P<0.01）；且治療後治療組的PaO2、PaCO2明顯優於對照組（P<0.01）。2組治療後FEV1、FEV1/FVC均明顯優於治療組（P<0.05）；治療後治療組FEV1、FEV1/FVC變化明顯優於對照組（P<0.05）。治療組治療後在體溫、肺部體徵、周圍血象、胸片恢復時間方面明顯優於對照組（P<0.05）。2組治療後降鈣素原水平明顯低於治療前，且治療後治療組的降鈣素原水平明顯優於對照組。2組治療前後中醫證候療效比較，結果表明治療組總有效率為80％，明顯高於對照組。提示西醫常規治療同時聯合中醫藥治療COPD急性加重期，可更快地抑殺細菌、病毒，消除誘發因素，促進痰液引流，改善肺部功能及臨床症狀，其療效優於單純中藥治療或西藥治療。綜上所述，本研究通過西醫常規治療聯合中醫千金葦莖湯治療COPD急性加重期，中西醫結合，優勢互補，具有副作用小，療效好的特點，值得臨床上推廣運用。
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