중공의 침략, 이지경까지 되도록 부역질한 세력들 공개? 이제봉교수 https://youtu.be/fUDEI_9KHI0 ------------------------------------------------------------------------------------- 정말 간도 무진장 크다” / 어떻게 원본을 삭제할 생각? / 투표지 이미지는 실물투표지와 같아서, 실물표를 없애버렸다는 말과 같아 / 정말 충격적인 일 [공병호TV] https://youtu.be/33RhTkupsRE 정말 성한데가 없구나" / 한 군데서 나온 증거물이 이 정도이니 / 앞으로 얼마나 희안하 것들이 나올까 / 물건을 훔쳐도 그것에 가는데 하물며 / 침묵의 기이함 [공병호TV https://youtu.be/OcQQlA_abqU ---------------------------------------------------------------------------------------------------- 미국, 남중국해에 구축함 급파, 중국 불법 점령 암초 파괴 시나리오 검토 중 김영호 교수 https://youtu.be/OFXy-yucQ34 -------------------------------------------------------------------------------------------------- [단독] 최재형 “통합-치유의 정치할것”…‘反文’ 윤석열과 차별화 동아일보 --->조금 기대를 했는데, 통합과 치유는 아무래도 아닌 것 같다. 지금은 좌파들과 싸워도 부족한데, 다시 그들을 끌어안겠다고? 아무래도 이 사람도 위장 우파인 듯. ---------------------------------------------------------------------------------------------------- 월가도 떠는 화폐환상 나타났다?… 한국, 풀린 돈 3385조원 사상 최대 조선일보 요즘 미국 월가에서는 ‘화폐 환상(money illusion)’에 대한 얘기가 심심치 않게 나온다. 화폐 환상이란, 경제 주체들이 물가 변화에 따른 실질 가치 증감을 제대로 인식하지 못하는 현상을 말한다. 일종의 화폐 가치 착시라고도 말할 수 있다 ------------------------------------------------------------------------------------------------------ 드디어 개발자가 입을 열었습니다...냉정과 열정 사이 김필재 티비 https://youtu.be/J7KOw0QnpOU ---->코로나는 사실은 그리 치사율이 높지 않은데, 한번 공포에 휩사인 대중은 대중 매체의 거짓말에서 잘 헤어나오지 못하고 있다. ------------------------------------------------------------------------------------------------------ 심각한 법안 2개가 나타났습니다 . . .디시인저장소 http://www.ilbe.com/view/11354201617 https://gall.dcinside.com/m/uspolitics/200731 https://gall.dcinside.com/m/uspolitics/200588 이준석이 우편 투표에 동의한건 그러려니 할 수 있겠지만 가장 경악스러운건 탈북자인 지성호 의원이 친이슬람 법안에 이름을 올렸다는 점입니다. --->우리가 알고 있는 탈북자들은 어쩌면 위장된 북한의 첩자들일 수 있다. --------------------------------------------------------------------------------------------------- 독립선포 빼고 하고 싶은 것 다해"/ 바이든 행정부 타이완 정책의 본질은 박상후의 문명개화 미 바이든 행정부가 타이완 독립에 대해 반대한다고 선을 그었습니다. 미 백악관 NSC의 인도 태평양 담당 조정관 Kurt Campbell은 공개적으로 타이완 독립에는 반대한다고 밝혔습니다. 그는 미국, 타이완간 굳건한 비공식 관계는 지지하지만 타이완 독립은 너무나도 민감한 사안으로 이해한다고 말했습니다. 그러면서도 미국은 중공과 평화롭게 공존할 수는 있지만 그 도전은 점점 커지고 있으며 베이징도 갈수록 호전성을 띠고 있다고 또 다른 여지를 남겼습니다. 말 한마디 한마디가 정교하게 계산된 겁니다. 미국이 타이완의 독립선포에 대해 부정적인 입장을 취하고 있는 것은 새로운게 아닙니다. 타이완 역시 중공에 전쟁의 빌미를 주는 독립선포를 자제하고 있습니다. 중공이 타이완에 대한 무력공격 위협을 계속하고 있는 가운데 나온 뉴스여서 주목받고 있지만 사실 레토릭에 불과합니다. 미국의 기본 입장은 타이완 독립을 제외하고는 모든 것을 지원한다는 방침입니다. 난해하게 보이지만 현상들을 들여다 보면 쉽게 이해됩니다. 오늘 방송에서는 바이든 행정부 대타이완 정책의 본질을 다각도로 분석했습니다. https://youtu.be/57FMF8NNH8w ---> 신세기 티비에서 미국의 대만 독립 반대를 대만을 버리는 것이라는 설명했는데, 박상후 씨는 여기에서 그를 반박하고 있다. ------------------------------------------------------------------------------------- 법률 질서 대 법률가 질서: 배심원 독립의 발전 분석. Law Order vs. Lawyer Order: Analyzing the Development of Jury Independence Feler Bose ABSTRACT: This essay develops a model to analyze jury independence. Jury independence can be seen as a game between elites and the citizens who make up the jury. This essay first presents a historical look at jury independence by looking at jury nullification. Then using the model developed, the evolution of jury independence is analyzed as well as how juries and the elites operate today. The essay finds that jury independence has changed due to changes in the philosophical/moral understanding of the law, which has resulted in the movement from law order to lawyer order. Feler Bose (bosef@iue.edu) is an Associate Professor of Economics and Finance at the School of Business and Economics at Indiana University East. “Only the checks put upon magistrates make nations free; and only the want of such checks makes them slaves. They are free, where their magistrates are confined within certain bounds set them by the people … And they are slaves, where the magistrates choose their own rules, and follow their lust and humours … those nations only who bridle their governors do not wear chains.” – John Trenchard, 1722 “If we could eliminate the jury, we would save a lot of time. You can try a case without a jury in one day that would take you a week or two weeks with a jury.” – Chief Justice Warren Earl Burger, Time Magazine, June 20, 1969 INTRODUCTION There have been different theories as to the development of law and the relationship between the elites and the people in the West and the United States in particular. One such theory is that the development of American law was the product of conflict between economic interests. In this conflict, the commercial interests benefitted at the expense of the less powerful groups such as farmers, workers, and consumers. The commercial and industrial interests sought more efficient debt collection, restricted the state in areas of “fair dealing,” and sought low-cost economic development, among other reforms (Horwitz 1975). An example is the law of contributory negligence which was pushed by the business interests as they influenced the courts (Burns 2017, 2). Another perspective comes from the idea that the revival of Roman law with the discovery of Corpus iuris civilis resulted in a move from the medieval “enumerative” approach to law to a more mathematical/scientific deductive approach to law. Hence, Roman law was elitist, as it was only accessible to a few who could understand and apply the details (Hoeflich 1986). Although these theories provide insight into the development of the law in the US, the approach presented in this paper will seek an explanation using the jury system and the philosophy underpinning the understanding of the law. This explanation provides a complementary explanation for the development of law in the US by focusing on jury independence. The development of the independence of the jury has a long history mainly situated in the English-speaking world. The hypothesis to be tested in this paper is that when the jury and the elite have a Blackstonian understanding of the origins of the law, there is minimal conflict between them, resulting in law order; however, when the understanding of the law becomes Darwinian, elites seek to have control of the law and its development, resulting in lawyer order and conflict between elites and juries. The Blackstonian-Darwinian distinction is not new, and a similar distinction has been suggested before by Chafee (1947), who uses the terms Blackstonian and Austinian (after John Austin, a legal scholar from the 1800s). Austin believed that judges make law as opposed to discovering law (as William Blackstone believed); however, Chafee’s understanding of the nineteenth-century changes in the understanding of law is not complete. He believes that the changes are as natural as a pendulum swinging back and forth between the Blackstonian and Austinian understanding of law over hundreds of years (1947, 420), but he does not provide much evidence for this repeating pattern and further his understanding of the Blackstonian view needs further development. If there is one theme that runs through the works of Horwitz (1975), Hoeflich (1986), and Chafee (1947), it is that the law has become elitist, leaving the common person with minimal input. This article arrives at the same outcome, but the explanation comes from moral/philosophical changes. This article will mainly focus on the role of juries in criminal cases in the US but will also look at juries in civil cases. Jury nullification is when a criminal trial jury decides not to enforce a law because they believe it would be unjust or misguided to convict. This allows average citizens, in deliberative bodies, to limit the scope of the criminal sanction, so that acts not broadly condemned are not widely punished. History shows juries have taken this enormous power very seriously, and have used it responsibly (Conrad 2003, xix). The article is organized as follows. First, a brief historical overview of the development of the jury system is provided. A model is then developed as a framework for analyzing the jury system. The model is then used to analyze jury nullification over time by highlighting the philosophical underpinnings and also discusses possibilities for reform. The final section concludes. INITIAL DEVELOPMENT OF JURY INDEPENDENCE This section focuses on the early development of juries and the development of jury independence. Although many historians begin with jury development in England, one in fact must go further back in history to the Hebrews. The Ancient Hebrew Court The ancient Hebrew courts had four levels of appellate courts. The court at the top was the Great Sanhedrin of seventy-one elders located in Jerusalem. The Small Sanhedrin of twenty-three elders1 were the next level, located in the other major cities. The third level was the Bench of Twelve,2 and each synagogue had one of these bodies. Below that was the Authorized Bench, composed of experienced men. Finally, there was the Unauthorized Bench, or the Bench of Idiots. The Unauthorized Bench was so named because it was not authorized by the Great Sanhedrin and ιδιος (idios), meaning unique, one of a kind, indicating that this unauthorized bench met for a particular case only, “bringing to bear the idios-syncracies of the conscience of each juror”(Winters 2008, 461) resulting in independence from the influence of elite preferences. This model of the Hebrews was also adopted by the early church, especially the Unauthorized Bench, even when under Roman civil law. Paul encouraged the church to use the “least esteemed” to judge the small matters, i.e., not those who held offices in the church (Winters 2008).3 The Unauthorized Bench model followed by the early church diffuses and disperses judicial power from the professional class. England Prior to the Magna Carta, the criminal justice system in England had three types of trials. The first was trial by compurgation, the second was trial by ordeal, and the third was trial by battle (Levy 1999, 4). Only the trial by compurgation seems to be non–elite based, as it entailed wider involvement from the people. The trial by ordeal required the accused person to undergo a physical test such as putting their hand in hot water, drinking poison, walking through fire, etc. If one was injured, then one was guilty. The trial by ordeal was practiced by some in Europe but was opposed by the church and others such as the Norman kings of England. The trial by ordeal was based on the belief that nature is normative and determines one’s innocence or guilt (Rushdoony 1973, 606). The trial by battle gained ascent when the trial by ordeal was abolished. Here the idea was that the winner was the one who was right. This method of trial gradually disappeared in the Middle Ages (Conrad 1998, 16). The trial by compurgation required an accused person to prove their innocence and provide several witnesses to take an oath attesting to the accused person’s innocence. This method was like the jury trial in that it involved nonelites, and some defendants preferred this method to the jury trial, as one could select one’s own compurgators or oath hurlers. This method was outlawed in England only in 1833 (Conrad 1998, 16). The root of the modern jury system began in 1164, “the Constitutions of Clarendon prescribed the use of a recognition by twelve sworn men to decide any dispute between laymen and clergy on the question whether land was subject to lay or clerical tenure” (Levy 1999, 11). The Assize of Clarendon in 1166 further encouraged the growth of what would become known as the jury trial (Levy 1999, 11). In 1215, at the time of the Magna Carta, the trial by jury was established for civil cases but not criminal cases. The Fourth Lateran Council of 1215 forbade the clergy from being involved in the use of ordeals, which reduced the approved methods of trial in criminal trials (Levy 1999, 16). Over the decades the trial by jury replaced the other methods for criminal trials (Levy 1999, 16ff.). Further, the jury could be moved by “whim, mercy, sympathy, or pigheadedness, refused to convict against all law and evidence, the prisoner was freed, and that was that” (Levy 1999, 46). If the jury made a prejudicial judgment against a prisoner, the judge could request that the king pardon the prisoner. The unanimity rule4 for criminal trials seems to have been settled in the late fourteenth century. Juries that did not return verdicts pleasing the Star Chamber5 could be punished; however, their verdicts were honored in criminal trials. It was only in 1670 that it was finally established that a jury could not be punished if it returned a verdict not in line with the evidence or the direction the court desired (Levy 1999, 49). The jury system was transplanted to the American colonies. In 1606, the charter for the Virginia Company provided for jury trials. The other colonies also introduced jury trials (see table 1 for dates). An early case of interest occurred in New York, where a printer, Peter Zenger, was charged with being a “seditious person” for criticizing the royal governor. In the defense, his lawyer stated that Zenger did print the articles but that they were the truth. The chief justice said that truth could not be used as a defense. The jurors were instructed that “it was their duty to decide the case as stated in the indictment, namely, whether Zenger had published the articles” (Vidmar and Hans 2007, 46). The jury declared him not guilty. Table 1: Dates of official recognition of jury trials in colonial America. Note that jury trials were common in many of these colonies prior to the official recognition (Vidmar and Hans 2007, 47). One of the effects of the Zenger trial and other earlier trials was the issue of whether English law and precedent could be directly applied in America, which had different religious, cultural, economic, and social conditions. Out of this difference developed the idea of double jeopardy, the mistrust of lawyers who might try to find loopholes, the use of juries extensively, etc., (Vidmar and Hans 2007, 49). During colonial times, common law was based on natural justice, and in many cases, judges did not provide any instructions to the jury on the law and at times might even provide contradictory instructions. This allowed the jury to decide the law and the facts in the various cases they confronted (Vidmar and Hans 2007, 49ff.). After independence, many states guaranteed jury trials through the Constitution for civil and criminal trials. However, although the federal government allowed for jury trial for criminal cases (in Article III6 and the Sixth Amendment7), the right to a civil jury trial was limited via the Seventh Amendment8 to those trials tied to common law actions (Vidmar and Hans 2007, 54). MODELING THE RELATIONSHIP BETWEEN THE ELITE AND JURIES Juries can be seen as councils since their advice is valuable for judges/elites9 to hear in reaching a just decision. Further, juries improve the decisions made. The Condorcet jury theorem suggests that the median opinion tends to be accurate over extreme opinions (Mueller 2003, 128). On the issue of whether laws are just or not, if the majority of juries rule against a law, for example, the information coming from juries is that the law is unjust. Figure 1: Matrix indicating the role of juries resulting in different orders based on whether juries have anything to say regarding the validity of the law and whether they have access to relevant facts. Figure 1 shows the scope of juries. On one axis is the validity of the law: Is the jury allowed to discern the validity of the law? On the other axis is the truth of the facts: Does the jury have access to relevant facts to make a determination of the truth? If the jury has access to the relevant facts to apply the law and is allowed to discern validity of the law, there is law order (quadrant I). The jury is truly independent in this scenario. If the jury has access to the relevant facts but is not allowed to discern the validity of the law, there is lawyer order under common law (quadrant II). If the jury is not authorized to discern the validity of the law nor has access to relevant facts, this also is lawyer order (quadrant III). In this quadrant the jury is for intents and purposes eliminated. If the jury is authorized to discern the validity of the law but does not have access to the relevant facts, this is also lawyer order (quadrant IV). EROSION OF THE RIGHT TO JURY INDEPENDENCE This section provides a concise overview of the erosion of jury independence in the US and the status of jury independence today. Further, this section uses the model to analyze the conflict between elites and the people in the area of jury independence. Finally, this section also discusses how changes in the philosophical underpinnings of the understanding of the law have affected jury independence. Phase 1: The Blackstonian View of the Law and the Era of Law Order During phase I, the view of law was that it was based on natural justice (Vidmar and Hans 2007, 49). This era is the Blackstonian era because during this time Blackstone’s Commentaries on the law was the most popular textbook; “most students, and no doubt most bar examiners, felt that a mastery of Blackstone was an adequate preparation for the practice of the law … it may safely be assumed that practically all lawyers in the United States prior to 1900, at one time or another, read all or part of the Commentaries” (Lockmiller 1938). The Blackstonian era was the time of law order, as the elites and juries had much in common and juries judged both law and facts. As Blackstone’s work suggests, under the common law, judges were basically managers and juries were the superintendents (Stacey 2008). Moreover, the origin of common law is based on two sources: scripture and natural law.10 As Blackstone (who is one of the most-cited thinkers in the American founding era [Lutz 1984, 194]) states: Man, considered as a creature, must necessarily be subject to the laws of his Creator, for he is entirely a dependent being…. And consequently, as man depends absolutely upon his Maker for everything, it is necessary that he should in all points conform to his Maker's will. This will of his Maker is called the law of nature…. This law of nature, being coeval with mankind and dictated by God himself, is of course superior in obligation to any other. It is binding over all the globe, in all countries, and at all times: no human laws are of any validity, if contrary to this. . . The doctrines thus delivered we call the revealed or divine law and they are to be found only in the Holy Scriptures. These precepts, when revealed, are found upon comparison to be really a part of the original law of nature…. Upon these two foundations, the law of nature and the law of revelation, depend all human laws; that is to say, no human laws should be suffered to contradict these. (Blackstone [1753] 1893, 2:39, 2:41-42) For this reason, Blackstone believed that if a bad law is overturned, then it was not law in the first place. “For if it be found that the former decision is manifestly absurd or unjust, it is declared, not that such a sentence was bad law; but that it was not law” (Blackstone [1753] 1893, 2:69–70, italics in original). With this understanding of the law and with people at this time carrying their Bibles and Blackstone Commentaries with them, John Adams could write in his diary that the “general Rules of Law and common Regulations of Society” were “well enough known to ordinary Jurors,” and that the “Great Principles of the Constitution, are intimately known” by every Briton, such that “it is scarcely extravagant to say, they are drawn in and imbibed with the Nurses Milk and first Air” ([1771] 2007). Further, the Protestant Reformation had emphasized universal schooling as a means to read the Bible (Becker and Woessmann 2009). Therefore, it made sense that during this period many judges gave the jury no instructions on the law, as the jury was to discover the law11 from scripture and natural law, or that judges would give differing instructions regarding the law, which then gave the jury a wide latitude to interpret the law and facts (Vidmar and Hans 2007, 49). In fact, the framers of the Constitution saw “judges as equals to laymen with regard to knowledge of the Law” and juries as playing the role of “spoiler in the judicial branch, protecting local citizens against arbitrary acts of government power” (Roots 2011, 5, 13). Hence, under common law, justice was administered by amateurs who acted based on a “Christian sense of justice and the legal tradition of the community” (Rushdoony 1984, 88). In this era, both the jury and elites understood what the “rule of law” meant, and the elites and juries did not have much conflict, hence being in quadrant 1 (a law order). Further, since the law was understood by all, the hurdle to practice law was low. One just had to pass the bar exam, and this could be done with only a high school diploma. Many individuals used apprenticeships with judges or lawyers as a pathway to study for the bar (Stacey 2008, 97–99; Hoeflich 1986, 118) while others attended a preparatory school to get the necessary training (Lind 2004, 96). However, conflicts with the juries arose when the elites tried to impose English imperial laws and taxes on the colonies, which resulted in juries ruling against the elite by refusing to convict those who violated English law (Vidmar and Hans 2007, 52). Finally, in the Supreme Court decision in Georgia v. Brailsford,12 Chief Justice John Jay states that juries have the right “to determine the law as well as the fact in controversy” solidifying the juries’ role as credible veto players and being in quadrant 1. There was to be no asymmetrical informational relationship between juries and judges. Phase 2: The Darwinian View of the Law and the Rise of Lawyer Order In the 1800s, the older Blackstonian view of law was slowly being replaced with the “scientific” approach to law. This resulted in more conflict between the elites and juries, and juries lost their power to decide civil cases in Massachusetts in the early part of the nineteenth century. This was partly due to the desire of industrial interests to have more uniform laws instead of a patchwork of local laws. Further, instead of having many judges in a courtroom as in the past, only one judge would now be there to explain what the law meant. Virginia, on the other hand, took a longer time in curbing the power of juries (Vidmar and Hans 2007, 54). However, in criminal cases the efforts by judges to control the juries met with resistance. This conflict resulted in the voters of Indiana (1851) getting passed into the Indiana Constitution the right by the jury to decide law as well as fact.13 However, the same year, the Supreme Court of Indiana ruled that juries should limit themselves to understanding the law as determined by the judge. Other states continued to struggle with the role of juries in determining the law and facts, and nearly all state courts have come in favor of limiting juries to determining fact, even if some of the state constitutions provide for the jury to determine law and fact (Vidmar and Hans 2007, 55). This limiting of the juries results in less trust of the judge (Marder 2017). The federal courts also worked to limit the right of the jury to decide the law as well as fact. This culminated in Sparf et. al. v. United States, where the court ruled 5–4 that the federal judges did not have to inform the jurors of their inherent right to decide the law.14 The Philosophical/Moral Change Much of this shift toward elite control and direction of law occurred when the Blackstonian type of understanding of the origin of law was replaced by a Darwinian understanding of law. The Darwinian idea of evolution through natural selection had an impact beyond the biological sciences. Charles Darwin’s successors brought the Darwinian method into the social sciences and the law. [T]here proceeded during the 19th century, under the influence of the evolutionary concept, a thoroughgoing transformation of older studies like History, Law and Political Economy; and the creation of new ones like Anthropology, Social Psychology, Comparative Religion, Criminology, Social Geography. (Branford 1949, 912) The Darwinian method was developed in 1870 by Christopher Columbus Langdell, the dean of Harvard Law School. Although Langdell developed this method, there were many antecedents (Hoeflich 1986). The doctrine of evolution had been anticipated in the eighteenth century, and insofar as its implications for the social sciences meant the rejection of the notion of fixed and unchangeable laws…. [w]hat shattered that traditional world was science which … substituted the operation of the laws of evolution for the laws of God. (Commager 1978, 1005–06) Langdell introduced the case study method (Lind 2004). Whereas Blackstone saw law as derived from the divine and natural law, Langdell focused on law as derived from man’s experience (through cases) and sought to divorce legal education from natural law. Law, considered as a science, consists of certain principles or doctrines…. Each of these doctrines has arrived at its present state by slow degrees;…. This growth is to be traced in the main through a series of cases; and much the shortest and best, if not the only way of mastering the doctrine effectively, is by studying the case in which it is embodied (Langdell 1871, vi). Further, professional experts (e.g., university professors) were now needed to identify the cases (fossils) to make up the curriculum. This evolutionary progress must be made by experts and not through passive adaptation via jury cases. Experts must use foresight and calculation to achieve the ends. The superiority of expert-directed adaptation over passive adaption via jury trials is that it reduces enormous waste (e.g., dead-end mutations and extinct species) and increases efficiency (Ward 1883, 73–74). These ideas were further developed by Oliver Wendell Holmes Jr.,15 who believed that laws could change fast and that nothing is self-evident: We do not realize how large a part of our law is open to reconsideration upon a slight change in the habit of the public mind. No concrete proposition is self evident no matter how ready we may be to accept it (Holmes 1897, 9). This legal revolution turned upside down the Blackstonian view of law. An additional major innovation occurred with Louis Brandeis’s introduction of what is now known as the Brandeis brief in a Supreme Court case (Muller v. Oregon).16 Brandeis argued not just legal theory, but also used empirical studies. The Brandeis brief naturally flows from the idea that experts should direct the evolution of law, and it made social science the foundation of law. Therefore, when social science changes through statistical analysis, the law also must change. “If laws of social events could be statistically formulated, they could be used for scientific lawmaking” (Ward 1915, 46). With this legal revolution, the law became professionalized such that only the elite could understand and explicate it; juries had to follow the instruction of judges and experts, as they were not capable of understanding the law. The notion of “rule of law” now meant only what the elites understood the law to be and, hence, there was a move away from law order to a lawyer order (from quadrant I to quadrant II). Further, to train in law now required attending law school (Lind 2004, 96).17 The motivation and justification for “curtailing the power of the jury to decide questions of law was a desire for greater certainty and consistency in the application of law” (Lahn 2009, 574), hence the Darwinian perspective allowed for the law to be seen as an endeavor directed by experts. Independent nullifying juries would introduce an unpredictableness (harmful mutations) that could not be tolerated. Additionally, the developments in quantum physics18 in the 1920s also provided the impetus to the notion that laws are not fixed but are evolving. As a former Harvard Law School’s dean states: Nothing has been so upsetting to political and juristic thinking as the growth of the idea of contingency in physics. It has taken away the analogy from which philosophers had reached the very idea of law. It has deprived political and juristic thought of the pattern to which they had conceived of government and law as set up. Physics had been the rock on which they had built. When physicists began to play with the idea of chance, when they began to entertain an idea of jumps and breaks … [it] uprooted the faith in discovered eternal and immutable laws (Pound 1940, 34). The Twentieth Century The twentieth century saw the rise of controversy over civil juries awarding large tort awards. Much of this change came with the rise of the Industrial Revolution and product liability. Costs were applied to those who could diffuse them, i.e., manufacturers of the product. Further, trial by jury was declining at the federal and state levels as elites shifted disputes out of the courts. Much of this was due to the rise of alternative dispute resolution with mediators and negotiators, which kept many cases out of the courts (Vidmar and Hans 2007, 61ff.). Moreover, nontrial dispositions (“e.g. settlement, plea agreement, summary judgement”) continued the decline in jury trials (Bornstein and Greene 2017, 8). Under summary judgments the judge now weighs the evidence and not the jury, especially in civil trials. Although this is done in the name of efficiency, it denies the role of the jury as a check on state power and minimizes it as an effective veto player (Steagall 2009, 470–73). The jury is not to take part in the development or discovery of the law, which means that it is functioning in quadrant-III (lawyer order). Another innovation that favored the elites was the rise of administrative law. Harold Berman saw the West losing its liberties in the twentieth century with the rise of administrative law: In the United States, for example, fields of administrative law such as taxation, labor management relations, securities regulation, public housing, social security, environmental protection, and a dozen others, which hardly existed before the Great Depression of the early 1930s, have now achieved predominance. (Berman 1983, 34) The rise of administrative law means that the ability of the jury to access relevant facts and discern the validity of the law is eliminated. All laws/rules are written by bureaucrats and interpreted by lawyers, bureaucrats, and judges, i.e., the elites. This is the ultimate expression of lawyer order, quadrant III in the model elaborated here. Further, private law, such as contract law, tort law, and property law, has been so heavily influenced by legislation and bureaucracy, that governmental permission is needed, for example, to work on your own property (Berman 1983, 35). This revolution, as Berman pointed out, is a threat to the liberty of the West, as instead of emphasizing the individualism of traditional law through “private property and freedom of contract,” law now emphasizes collectivism on “state and social property, regulation of contractual freedom in the interest of society” (Berman 1983, 36). Blackstone also foresaw this threat when he stated that “[e]very new tribunal, erected for the decision of facts, without the intervention of a jury … is a step towards establishing aristocracy, the most oppressive of absolute governments” (Blackstone [1753] 1893, 1:380). One change that has helped juries is the abandoning of the key man system. The key man system is when “jury commissioners or court clerks asked prominent members of the community to supply names of potential jurors” (Knack 1993, 100). It was established in colonial times as a check against an abusive judiciary, particularly the royally appointed justices. Even after independence, when judges rode circuit, judges might not always be familiar with the local customs and sense of justice. The jury commissioner’s job “was to identify ‘key men’ who would represent the interests and values of the community when deciding cases” (Hannaford-Agor and Waters 2010, 49). This was especially useful in small communities. This system worked well under the Blackstonian era, when everyone had a general understanding of the law and the law was simple to understand (law order); however, in the Darwinian era, this method could skew the results toward the elites as the system moved toward a lawyer order. For example, in some states key men preferred white jurors over black jurors either intentionally or simply because of divisions in communities where key people may not have interacted with minorities (Fukurai, Butler, and Krooth 1991; Hannaford-Agor and Waters 2010, 49). But in the 1960s, states and the federal government19 started using voter registration lists (some states also used driver’s license lists) to select jurors in order to obtain a wider jury pool (Vidmar and Hans 2007, 76). This innovation protected the common person against the elite in the lawyer order era. Another innovation by the elites which has complicated matters, is vague laws that make it easy for any individual to become the target of a federal prosecution (Silverglate 2011). Through jury suppressions, vague laws used by clever prosecutors can result in many innocents being targeted. Malleable law gives elites the ability to manipulate juries into seeing the law as the elites see it due to asymmetric information. Further, multicount indictments, whose goal is for some charge to stick on the defendant, is a tool for elites to overwhelm juries into finding the defendant guilty (Roots 2013). In the area of sex laws, the elite in the American Law Institutes (ALI) developed the Model Penal Code (MPC) to replace much of the common law provisions protecting women and children. Much of the MPC is written in a way that suppresses the power of juries to judge and increases the power of experts through their testimonies to direct which subclassification and penalty is applied. Richard Kuh, a prosecutor from New York succinctly states this problem: If the draftsmen [ALI/MPC] wish to force trial judges to stop and puzzle over abstruse wording, that discipline can do no harm. But the trouble is that the draftsmen are here engaged in linguistic embroidery to which lay jurors would inevitably be exposed. This worries me…. But awkward phrases and shrouded concepts bother me; for instructions in the law—jury charges—are delivered to jurors orally, and may go on for hours. Furthermore, they may contain a variety of precepts with which the jurors have never before had to deal, and concerning which, if a verdict is to be reached, the jurors must all end up as of one mind, convinced beyond a reasonable doubt. (Kuh 1963, 622) Further, even when there is a jury trial, the jury is not always informed about its power to judge the law. Even in the three states whose constitutions allow for juries to judge the law, the courts “in these jurisdictions have eviscerated any literal translation of these constitutional provisions” resulting in lawyer order (Parmenter 2006, 391). Moreover, even in the vast majority of criminal cases the jury trial has been eliminated through the use of plea bargaining and is only used when defendants can be sentenced to more than six months in prison (Roots 2011, 4), again resulting in lawyer order (quadrant III). Current Trends The advent of high-profile jury nullification in the 1990s such as those of Jack Kevorkian and O. J. Simpson resulted in a visceral reaction from the elites. The courts have: (1) begun removing any juror who is aware of their nullification power; (2) interfered with jury deliberations by investigating jurors who may intend to nullify; (3) removed jurors who seem poised to nullify, even after the start of deliberations; (4) interfered with the discretion of trial judges to render jury instructions or admit evidence which might allow a jury to consider jury nullification; and (5) arrested and jailed jury nullification advocates. (Parmenter 2006, 411) This clampdown by the elites has not, it seems, resulted in any reduction in the jury nullification rate (Hannaford-Agor et al. 2002, 2). Further, when there is a hung, or acquittal, jury, it does not mean that jury nullification is the cause (Hannaford-Agor and Hans 2003, 1276). However, people have reacted to the clampdown on juries in unanticipated ways. Much of this has been assisted by the internet. Organizations such as the Fully Informed Jury Association have used the internet to educate citizens of their right to judge the law and to use jury nullification to battle the elites. Some of this effort seems to be providing dividends. In 2012, New Hampshire passed a law (HB 146) that allowed defense attorneys to inform the jurors of their right to judge the law and possibly nullify it. One case that seems to highlight the quadrant-IV lawyer order scenario in our model is the Bundy case in Las Vegas. This was a highly politicized case in which the government prosecutors sought a certain outcome. “The prosecution exploited every possible advantage, winning rulings from the judge which barred the defendants from even mentioning most of their possible defenses” (Roots 2018). In other words, the relevant facts were not accessible to the jury. The defense lawyers ended up making no closing arguments due to the stifling of the judge. However, the jury did nullify the case on most counts, indicating that they found the law as applied unjust and the tactics used unjust. Will major reform be possible? This is unlikely in the near future, since the change that has to occur is for the elites to recognize the common person/juror as one who can understand and interpret the laws. For this to occur, a major shift toward a Blackstonian understanding of the law is required. This would require a deprofessionalization of the legal system and a giving-up of power by the elites. Moreover, the laws should not be vague. The internet as a tool to convey information widely certainly helps with educating jurors about their ability to strike down laws that do not comport with notions of justice. CONCLUSION The understanding of law has changed from the Blackstonian view to the Darwinian view, and this has minimized the power of the juries. Further this philosophical change has resulted in a movement in the US from a law order to a lawyer order. “Power and discretion have shifted away from the jury and more and more now is in the hands of the judge. To put it another way, the long-term historical development is to shift decision making from amateurs to professionals” (Friedman 2004, 10). This article has provided a framework to study the interaction of elites and juries. This interaction had different outcomes in the different phases of US history. Although juries still have a lot of power in certain areas, they are currently not informed of that power. In other areas of law, such as administrative law, juries have no power. The only way for juries to be relevant again as a check to judicial/elite power is through a Blackstonian/organic understanding of the law, where the “law of the lawyers ha[s] to justify itself in the eyes of the community through its proxy the jury, a space of ethical action in which lay people ha[ve] the power and the right to determine the rules of decision in a given case” (Lahn 2009, 572). ------------------------------------------------------------------------------------------------------ 황황 교수의 구강편평태선口腔扁平苔癬 치료 경험 黃煌經方治療口腔扁平苔癬驗案劉曉麗（南京中醫藥大學） 2019-01-17 由 經方學堂 發表于健康 口腔扁平苔癬為發生在口腔黏膜的慢性表淺的非感染性疾病。 經方治療口腔疾病的特點, 一是專病專方, 針對疾病的特點用藥, 有時可不辨體質, 有是病、證, 用是方; 二是可達到整體治療的效果, 口腔疾病雖為局部病變, 但常在整體上有特徵可尋, 並有相應的經方可用。 按照黃煌教授人- 病- 方的方證三角理論, 病的人∀是辨證的核心, 體質不同的患者用方亦多不相同。黃老師從醫多年, 尤擅長經方結合患者體質治療口腔扁平苔癬, 一般投之, 多能守方獲效。現擇驗案如下。 1 大柴胡湯合梔子厚朴湯女, 64 歲, 2007 年3 月27 日初診。 2006 年7月因口腔黏膜疼痛而手術, 病理診斷為扁平苔癬不典型增生。因咳嗽至淋巴結腫大, 服用羅紅黴素後咳嗽減輕, 而淋巴結仍漸見增大。自服木瓜片後浮腫加重。就診時患者形體充實, 浮腫貌, 精神可, 頸部有兩個腫大淋巴結, 一如花生米大, 一如蠶豆大小, 疼痛。自覺眼睛睜不開, 瞼腫, 仍咳嗽, 胸痛, 少痰, 胃脘脹滿, 時有泛酸。腹診: 腹部結實, 有抵抗。下肢凹陷性浮腫, 時有抽筋, 大便不干, 舌暗紅。既往史: 乳腺腫瘤術後7 年, 有膽結石、藥源性脂肪肝病史。 黃老師治以大柴胡湯合梔子厚朴湯加連翹:柴胡10 g, 黃芩10 g , 制半夏10 g, 枳殼20 g , 赤芍10 g, 白芍10 g, 制大黃6 g, 連翹20 g, 乾薑5 g, 紅棗15 g, 梔子10 g, 厚朴10 g, 7 劑, 水煎服。 2007 年4 月3 日複診, 口腔黏膜扁平苔癬好轉, 張口輕鬆,氣色好, 自訴服藥後很舒服, 全身感覺輕鬆, 渾身腫脹大有改善, 胃中不適好轉, 咳嗽漸愈, 右頸淋巴結仍痛, 時有泛酸, 大便成形, 日1 次。且藥後體重已減3 kg 。 查體: 右頸淋巴結有壓痛, 腹部大滿, 有牴觸感, 下肢輕度浮腫。 原方連翹加至25 g , 續服。每當扁平苔癬發作時服用此方, 總能收效。 按: 患者的乳腺腫瘤、膽結石、藥源性脂肪肝、淋巴結腫大都在! 柴胡帶[ 1] 上, 又屬於比較充實的柴胡體質[ 2] 。 黃老師以證應方, 故方用大柴胡湯。方中芍藥解痙止痛, 同時治療抽筋, 故腿抽筋也是大柴胡湯證的指征, 扁平苔癬患者多伴煩躁不安等精神症狀及消化道症狀, 故合梔子厚朴湯, 《傷寒論》雲:心煩腹滿, 臥起不安, 梔子厚朴湯主之。二診加大連翹劑量以消除淋巴結腫大。2 甘草瀉心湯女, 28 歲, 2007 年4 月30 日初診。 2006 年10月發病, 經多方治療效果不佳轉至我處。見: 口腔兩側、舌頭上下都嚴重潰爛, 臉部有痤瘡。黃老師治以甘草瀉心湯: 黃連5 g , 黃芩15 g, 制半夏6 g, 黨參12 g , 生甘草15 g, 乾薑20 g, 大棗5 g , 7 劑, 水煎服。 2007 年5 月8 日複診, 自訴藥後感覺口腔潰爛好轉, 黃芩加至20 g, 藥後臉部仍有痤瘡, 睡眠不佳,多夢, 月經正常, 無血塊。見其焦慮, 煩躁不安, 遂將原方甘草加至15 g, 黃芩增至25 g, 繼服。以後原方進退十餘劑, 病情逐漸好轉。 按: 甘草瀉心湯為������金匱要略������中治療狐惑病的專方, 後世以此方治療口腔潰瘍、口腔扁平苔癬、白塞氏病( 狐惑病) 等。黃老師認為該方為消化道黏膜修復劑, 即從口腔到肛門的消化道黏膜的潰瘍、糜爛均可使用, 也是口腔潰瘍的專方。 口腔扁平苔癬久病不愈可影響情緒, 並導致免疫力低下, 睡眠質量下降, 多數患者因心火旺, 而致煩躁、失眠、焦慮, 注意力不集中, 頭昏頭痛, 甚至神志錯亂等, 同時有燥熱感、胸中苦悶感、心臟悸動感等, 黃連[ 3] 主治的! 心中煩∀即為以上症狀。金匱要略������甘草瀉心湯條下有! 目不得閉, 臥起不安，不欲飲食, 惡聞食臭∀的症狀描述。 舌為心火之苗∀, 故臨床心火旺者亦多見患口腔疾患。 3 小柴胡湯合甘草瀉心湯女, 65 歲, 2007 年3 月6 日初診。患口腔扁平苔癬10 餘年, 面頰黏膜有白色網狀改變, 吃刺激性食物後易發作, 牙齦易出血, 一觸即發, 服地塞米松、潑尼松龍後可好轉, 現已停用西藥, 舌淡紅, 苔薄。 既往史: 患者高血壓病史10 年, 有早搏, 坐骨神經痛, 曾有手僵。 黃老師治以甘草瀉心湯合小柴胡湯( 即甘草瀉心湯加柴胡) 加枸杞子: 柴胡10 g , 黃芩20 g, 制半夏6 g, 黨參12 g , 生甘草10 g , 乾薑5 g,枸杞子12 g , 黃連3 g, 大棗15 g。14 劑, 水煎服。 2007 年3 月20 日二診, 自訴吃韭菜後口腔扁平苔癬發作, 近日好轉, 牙齦不再出血, 小關節晨僵好轉,無不適感, 但覺口中澀, 有唇炎。調整方: 生、炙甘草各12 g, 柴胡12 g, 黃芩20 g , 制半夏6 g, 黨參12 g,黃連3 g, 乾薑5 g, 大棗20 g, 7 劑。 2007 年4 月10日三診, 患者自覺病情改善, 口腔扁平苔癬網狀面積縮小。自訴晨起全身乏力, 睡眠尚可, 有惡夢, 大便正常。 原方黃連增至5 g , 繼服14 劑。囑其不吃刺激性食物。後原方進退一二, 病情穩定。 按: 患者屬於敏感體質, 病情易於反覆發作, 可 看作是小柴胡湯證的! 休作有時。現代藥理表 明, 小柴胡湯抗過敏, 其中柴胡皂苷的抗炎強度與 潑尼松龍相似。黃芩為傳統的清熱藥, 藥理研究 證明黃芩有抗變態反應、抗菌、解熱、降壓、鎮靜等 作用, 常與黃連相配伍, ������傷寒論������ 中多首方都採用 這種配伍。該患者又發扁平苔癬, 故重用甘草, 成 甘草瀉心湯。 扁平苔癬患者多伴有精神症狀和較為嚴重的胃 腸症狀。 黃老師使用甘草瀉心湯的經驗為, 舌紅、唇 紅, 女性經來有血塊者, 重用黃芩至20~ 30 g ; 淋巴 結腫大者, 加連翹20~ 30 g ; 便秘、口臭, 潰瘍局部紅 腫, 假膜色黃者, 加大黃3~ 10 g; 心煩不安者, 加黃 連3~ 6 g。 [ 參考文獻] [ 1] 黃煌 中醫十大類方[ M]������ 南京: 江蘇科學技術出版社, 2004: 53������ [ 2] 黃煌 中醫十大類方[ M]������ 南京: 江蘇科學技術出版社, 2004: 54������ [ 3] 黃煌 張仲景五十味藥證[ M ]������ 北京: 人民衛生出版社, 2004: 小編按：本文摘自山東中醫雜誌 2008 年 3 月第 27 卷第3 期，版權所有歸原著作者所有，如有使用不妥請聯繫小編刪除。 原文網址：https://kknews.cc/health/kyk48xp.html ------------------------------------------------------------------------------------------------- 최고의 고혈압 치료방들이 모두 여기 있다. 史上最全高血壓驗方都在這兒了 高血壓是臨床最為常見的慢性疾病，也是心腦血管疾病最主要的危險因素。回顧中國高血壓的防治歷史，中醫藥對於高血壓的防治具有一定的臨床價值與意義。越來越多的臨床試驗與實驗研究證據表明，中醫藥不僅能夠降低血壓、改善癥狀、提高生存質量，部分研究更顯示出其能提高遠期生存率和減少心血管事件發生率。 高血壓的辨證思路高血壓屬於中醫學「眩暈」範疇，根據我們的經驗，高血壓病存在三大病機，即「火證」「飲證」和「虛證」。臨床上，應「首辨虛實」，即首先要辨別患者是屬於實證還是虛證。「次辨邪氣性質」，即實證患者需辨別是火證為主，還是飲證為主。「三辨病位」，即在火證階段要區分屬於心、肝、胃、腸其中的一個病位還是多個病位同時為病；在飲證階段要區分屬於上焦、中焦還是下焦；在虛證階段需要辨別是脾虛為主還是腎虛為主。當然，臨床實際中，往往病情錯綜複雜，變化多端，虛實並見，需要綜合分析，小心求證。常見辨證誤區現今臨床治療高血壓病，似乎已經形成一種認識誤區，將西醫的病名與中醫的辨證論治簡單對應，即認為高血壓多屬於「肝陽上亢」，進而多從「肝陽」、「肝風」進行論治。我們認為，肝陽上亢、肝火上炎等僅是高血壓「火證」的某一特定階段、特殊類型，除此之外，高血壓中醫證型還包括飲證、虛證。不同階段、不同層次的方劑選擇同時，在辨證分型的基礎上，應根據「有是證用是方」的原則，對證選方用藥，切忌「隨意論治」「隨症論治」，否則很可能貽誤病情。 在火證階段常用的經典名方包括：鎮肝熄風湯、天麻鉤藤飲、建瓴湯、龍膽瀉肝湯、羚角鉤藤湯(肝火)；黃連解毒湯、三黃瀉心湯、梔子豉湯(心火)；白虎湯、保和丸(胃火)；大柴胡湯、柴胡加龍骨牡蠣湯、調胃承氣湯、增液湯(腸火)。 在飲證階段常用的經典名方包括：澤瀉湯(上焦)；半夏白朮天麻湯、二陳湯、平胃散、溫膽湯、小陷胸湯(中焦)；五苓散、豬苓湯(下焦)。在虛證階段常用的經典名方包括：苓桂術甘湯、四君子湯、六君子湯(脾虛)；六味地黃丸(腎陰虛)；腎氣丸、真武湯(腎陽虛)。值得注意的是，從靶向層次分析，中醫藥治療高血壓分別有針對癥狀、證候以及疾病這3個層次。即某些方葯可以緩解高血壓癥狀，而對證候、疾病療效不足，治療血壓難控因素的方劑即為這一層次；部分方劑可以改善有效證候，但在降壓上證據不足；而部分方劑具有降壓作用，往往此類方劑兼有對證作用。上述經典名方既包括對病方(如鎮肝熄風湯、天麻鉤藤飲、建瓴湯、半夏白朮天麻湯)，又包括對證方(如黃連解毒湯、三黃瀉心湯、白虎湯、保和丸、大柴胡湯)和對症方(如梔子豉湯、調胃承氣湯、增液湯)。火證階段四大常見證型及用方經驗火證屬於實證、陽證。火性炎上，高血壓患者出現的頭暈、頭痛部分與火證有關。根據疾病的病位，常見的證型包括心火亢盛證、肝火上炎證、胃火熾盛證、熱結腸燥證等。值得注意的是，肝火上炎證、肝陽上亢證的辨證及治療已經得到廣泛認識，而對心火亢盛證、胃火熾盛證、熱結腸燥證相對認識不足。心火亢盛證心火亢盛證在高血壓病中非常常見，臨床多表現為頭暈，面紅目赤，精力旺盛，或睏倦嗜睡，乏力，記憶力差，煩躁不安，心悸不寧，失眠多夢，口乾欲冷飲，皮膚黏膜容易充血、出血，皮膚容易發紅瘙癢，蕁麻疹，濕疹，小便短黃，舌上、舌邊潰瘍，色赤疼痛，舌邊尖紅，苔黃乾燥少津，脈數有力等。選方一：黃連解毒湯是治療心火亢盛證的代表性方劑。黃連解毒湯由黃連、黃芩、黃柏、梔子4味藥物組成，出自《外台秘要•崔氏方一十五首》。本方可以清心瀉火解毒，主治火毒熱盛證。「時疾(酷熱)，苦煩乾嘔，口燥呻吟，錯語不得卧」是本方的辨證要點。本方證不僅在急性熱病中可見，在慢性疾病的實熱證階段也可以見到。除高血壓外，本方方證還常見於快速性心律失常、上消化道出血、腦血管意外、腦外傷後遺症等。日本漢方家矢數道明認為，本方可用於頭腦清醒不能入睡，興奮不衰，無故發怒，心情焦躁，似頭昏眼花者，高血壓或更年期障礙時之不眠症亦可用。漢方家大冢敬節運用本方的經驗是「在高血壓，頭昏眼花，顏面潮紅，不眠，情緒不舒等情況下，可本方加鉤藤、黃芪、薺菜」。南京中醫藥大學的黃煌教授臨床也善用此方治療高血壓火毒內盛證。黃教授歸納總結的「黃連解毒湯體質」有助於本方的臨床運用，即患者大多營養狀況良好，面色潮紅，脈搏實而有力，上腹部膨滿或痞悶、按壓有不適感，還伴有煩躁不安或失眠、精神亢奮，皮膚易出現瘙癢、濕疹等疾患，有出血史或出血傾向。【筆者經驗】筆者臨證運用本方的辨證要點在於「紅」「煩」「悸」「失眠」，只要符合上述指征，並且排除本方的禁忌證(如虛證、寒證)，就可以考慮運用本方。另外，因本方證的病理機制與交感神經興奮有關，筆者又將黃連解毒湯稱為「天然的交感神經抑製劑」。雖然本方降壓、抗心律失常作用不如β腎上腺素受體阻斷葯，但是本方還具有調脂、抗炎、降糖等多種心血管藥理作用。在合方運用上，本方常與三黃瀉心湯(大黃、黃連、黃芩)合用以增強清熱瀉火之功，實質即本方加大黃；與梔子豉湯(梔子、淡豆豉)合用以增強清熱除煩安神之力，實質即本方加淡豆豉；與大柴胡湯合用以增強疏肝清肝，瀉火通便之力。在隨症加減上，本方常加天麻、鉤藤以增強平肝潛陽、清利頭目之功；加川芎、葛根以增強疏風活絡，活血止痛之功。選方二：心火亢盛兼見熱結腸腑證可選擇三黃瀉心湯。三黃瀉心湯由大黃、黃連、黃芩3味藥物組成，出自《傷寒論•辨太陽病脈證並治下》，本方可以瀉火解毒，燥濕泄熱，也是治療高血壓火熱內盛的代表性方劑。「心下痞，按之濡，其脈關上浮(即關脈浮大)」是為本方的辨證要點。因本方與黃連解毒湯均有黃連、黃芩這兩味相同藥物，因此其主治症與黃連解毒湯部分相似，即均可見到顏面潮紅，目赤，口乾口渴，心煩易怒，失眠多夢等心火亢盛證。不同的是，因本方中有大黃，患者腹脹、便秘癥狀突出。《餐英館療治雜話》中對本方應用指征記載值得參考，即「此方以心下痞，大便秘，上氣為目的，並治一切上焦蓄熱，或口舌生瘡，或逆上，目赤者，皆應以大便秘為目的」。大冢敬節在其《漢方診療三十年》中也記載有運用本方的經驗。「59歲婦女，患高血壓已年久，前日起出現眩暈，頭微動即噁心、嘔吐與頭重。顏面發熱而潮紅，足冷，耳鳴，大便2-3日未行，與三黃瀉心湯，服用2周諸證消失。其後2年，又出現過同樣癥狀，亦與三黃瀉心湯奏效」。【筆者經驗】筆者臨證運用本方的辨證要點在於「紅」「煩」「悸」「便秘」。便秘是常見的血壓難控因素。在部分患者，尤其是老年人中，反覆發作的頑固性便秘是導致血壓波動的重要誘因，因此，通便對高血壓患者的血壓平穩具有一定臨床價值。在高血壓患者中，筆者但凡見到上述指征，即考慮於基本方中合用本方。肝火上炎證肝為剛臟，體陰而用陽。肝氣鬱結化火而成肝火上炎證，臨床症見頭暈脹痛，程度劇烈，面紅目赤，口苦口乾，急躁易怒，耳鳴如潮，甚或突發耳聾，失眠，惡夢紛紜，或脅肋灼痛，吐血、衄血，小便短黃，大便秘結，舌紅苔黃，脈弦數。肝火上炎日久，耗傷肝陰，而成肝陽上亢證，可見有急躁易怒，失眠多夢，腰膝酸軟，頭重腳輕，舌紅少津，脈弦或弦細數等陰虛徵象。選方：在本階段可選擇鎮肝熄風湯、天麻鉤藤飲、建瓴湯、龍膽瀉肝湯、羚角鉤藤湯等方劑平肝清肝，熄風定眩，由於對此證的認識比較廣泛，故不再贅述。胃火熾盛證胃火熾盛證一般不單獨為患，常與其他火證證型合併出現。臨床可見口乾欲飲冷，口臭，齒衄，齒齦紅腫疼痛，舌紅，苔黃，脈洪數大。選方：治療本證常見的經典名方有白虎湯、保和丸。若症見面赤，口煩渴，欲飲冷水，汗出，惡熱，脈洪大有力則可選白虎湯清胃降火。若症見口中穢濁，口臭，口乾，不思飲食，腹脹，矢氣臭則可選保和丸和胃清熱。熱結腸燥證熱結腸燥證在高血壓患者中較為常見，臨床可見有大腹便便，腹脹腹痛，大便秘結，多日一行，排便時肛門劇痛，甚則面赤汗出，甚至有痔瘡等慢性肛腸疾病病史，舌質紅，苔黃，脈洪數。由於胃腸功能減弱，腸道傳導失司，久久郁而化熱，而形成熱結腸燥證。本證型不僅在中年患者體質壯實的患者中常見，在老年患者中也不少見。值得注意的是，熱結腸燥常與其他火證合併出現。選方：治療本證常見的經典名方包括大柴胡湯、柴胡加龍骨牡蠣湯、調胃承氣湯、增液湯等。若症見往來寒熱，心煩，胸脅苦滿，口苦，食慾不佳，噁心嘔吐，甚至嘔不止，胃腹脹痛，腹部查體可見腹直肌緊張，按之脹痛加劇，大便久久不解，或大便稀溏，下利，舌苔黃，脈弦數有力，則可選大柴胡湯以和解少陽，內瀉熱結；若症見往來寒熱，口乾口苦，胸脅苦滿，腹脹，煩躁不安，甚至驚狂不定，時有譫語，汗出，心慌不寧，噩夢紛紜，則可選柴胡加龍骨牡蠣湯以和解清熱，鎮驚安神；若僅見腹脹，大便不通，多日未行，屬熱結腸燥輕症，可選調胃承氣湯以緩下熱結；若症見便秘，口渴，舌干紅，脈細數，證屬熱結陰虧，可選增液湯以增液潤燥。作者中國中醫科學院廣安門醫院 熊興江 -----------------------------------------------------------------------------------------