8.30 영등포을, 주심 재판관 / 조재연으로 바꾼 이유 / 앞으로 문제를 덮기 위해 큰 역할을 할 것으로 전망 / 그는 이 건을 반드시 덮어야 한다고 생각 [공병호TV] https://youtu.be/MSZj-PjiBRM --------------------------------------------------------------------------------------------------- 윤희숙 사퇴는 비겁했다. 프리덤뉴스 https://youtu.be/LFNCYmS7HMU --->오세훈의 엉뚱한 짓이 생각난다. ------------------------------------------------------------------------------------------------ 충북동지회 은밀한 면회 "국정원 긴장했어, 박지원 날라갈 것" 중앙일보 ------------------------------------------------------------------------------------------------- [부정선거]법관들(부장판사+조재연 대법관)과 피고(선관위)의 공모가 드러난 한 장면 익명50마오 http://www.ilbe.com/view/11362820426 210823 양산 재검표 현장, 원고 : 투표지 무게 좀 재 봐도 되예? 부장판사 : 얘, 무게 재 보세요 무게 재고 크기 재고 가짜 투표지라는게 증거가 바로 나오자 피고(선관위) : 판사 지금 뭐하는거요? 이런건 조재연 대법관한테 물어보시오! 버럭! 부장판사 : 여보세요 조대법관님? 여기 무게 재는데 피고가 조대법관님한테 연락해서 재판하라는디요? 조재연 대법관 : 당신 뭐하는기요? 그라만 안돼. 버럭!! 부장판사 : 여러분 무게 재는 것은 취소합니다. 무게 안 잰걸로 합니다. 일동, 방금 한게 안한기라꼬예? --------- 이 장면은, 부장판사는 피고에게 쫄았고 대법관은 피고와 공범이라는 것을 확인한 한 장면 되시겠다. ------------------------------------------------------------------------------------------------------ 클린턴 전 정치고문 나오미 울프, 백신 여권에 내재된 위험성... 그리고 그들의 불경한 동맹? (상편) NTD Korea 제가 믿을 수 없었던 건 좌파가 표현의 자유를 위해 싸운다는 그 오랜 전통에도 불구하고.. 긴즈버그 대법관.. 하울 재판.. 채털리 부인 재판.. 읽고 쓰기 운동.. 노동자 교육.. 공교육에 무료 도서관까지.. 그런 것들이 우리의 유산인데 그 모든 걸 내다 버렸어요. 사우스 다코타에서 열린 ‘프리덤 페스티벌’에서 페미니스트 작가이자 저널리스트인 나오미 울프와 마주 앉았습니다. 빌 클린턴과 앨 고어의 정치 캠페인 자문을 맡기도 했습니다. 아울러 국민들이 민주적 절차에 참여하도록 돕는 플랫폼 ‘DailyClout.io’의 창업자이자 CEO를 맡고 있기도 합니다. 저희는 백신 여권에 내재된 위험에 대해 이야기를 나누고, 정부, 빅테크 검열, 대형 제약사로 이어지는 불경한 동맹에 대해 논의해봅니다 https://youtu.be/gAwoC_j1Uzc ----------------------------------------------------------------------------------------------------- 거시경제 통계자료들은 정부 개입의 도구이다. 최종 상품과 서비스의 가치를 뭉뚱그려서, 정부의 통계학자는 GDP나 기타 경제 지표를 통해 ‘경제’라는 허구를 구체화 한다. GDP와 기타 경제 지표를 통해 정부와 중앙은행의 관리들이 소위 말하는 경제를 통제할 수 있다는 것이다. 통계는 정부가 시민들의 생활에 개입하는 수단이다. 그래서 로스바드는 만일 통계가 없다면, 정부의 사회주의적 계획과 통제를 모두 엎어버릴 거라고 말한다. 국가의 전체 산출량을 계산하는 건 사실 불가능하다. 산술적으로 감자와 토마토를 더한다는 게 불가능하기 때문이다. 나아가 다양한 거시경제 지표들은 사실은 현실 세계와 거리가 있다. 따라서 존재하지 않는 “경제”를 허구적인 경제 지표를 통해 정부의 정책으로 밀어붙이면, 개인들은 피해를 입을 수 밖에 없다. 자유시장 경제에서는 정부와 중앙은행의 개입이 없으므로, 여러 경제 지표를 측정하고 발표할 하등의 이유가 없다. 통계는 개입주의자들, 정치가, 정부 관료 등의 눈과 귀이다. 이들의 눈과 귀를 잘라버리면, 정부 개입의 위협이 사라진다. Macroeconomic Data Is a Tool for Government Intervention Frank Shostak It is common for commentators and economists to refer to something called the “economy,” which sometimes performs well and at other times poorly. The “economy” is presented as a living entity apart from individuals. For example, various experts report that the “economy” grew by such and such percentage, or that the widening in the trade deficit threatens the “economy.” What do they mean by the term “economy”? Does such an entity actually exist? Within this framework of thinking, the “economy” is assigned a paramount importance while individuals are barely mentioned. The “economy” produces goods and services in this way of thinking. Once the output is produced by the “economy,” its distribution among individuals in the fairest way is required. In reality, goods and services are not produced in totality and supervised by one supreme commander. Every individual is preoccupied with his own production of goods and services. Consequently, there is no such thing as the total national output. By lumping the values of final goods and services together, government statisticians concretize the fiction of an “economy” by means of the GDP statistic and other economic indicators. It is held that if the “economy” were concretized by means of various economic indicators, policymakers could navigate the “economy” along the growth path that is considered by the experts as desirable. Again, by means of constructed economic indicators such as gross domestic product (GDP), government and central bank policymakers can control the so-called economy. According to Rothbard, Bureaucrats as well as statist reformers … in order to get “into” the situation that they are trying to plan and reform, they must obtain knowledge that is not personal, day-to-day experience; the only form that such knowledge can take is statistics. Statistics are the eyes and ears of the bureaucrat, the politician, the socialistic reformer. Only by statistics can they know, or at least have any idea about, what is going on in the economy. Moreover, It is true, of course, that even deprived of all statistical knowledge of the nation’s affairs, the government could still try to intervene, to tax and subsidize, to regulate and control. It could try to subsidize the aged even without having the slightest idea of how many aged there are and where they are located; it could try to regulate an industry without even knowing how many firms there are or any other basic facts of the industry; it could try to regulate the business cycle without even knowing whether prices or business activity are going up or down. It could try, but it would not get very far. The utter chaos would be too patent and too evident even for the bureaucracy, and certainly for the citizens. And this is especially true since one of the major reasons put forth for government intervention is that it “corrects” the market, and makes the market and the economy more rational. Obviously, if the government were deprived of all knowledge whatever of economic affairs, there could not even be a pretense of rationality in government intervention. Surely, the absence of statistics would absolutely and immediately wreck any attempt at socialistic planning. Once expressed in terms of various economic indicators such as the GDP statistic, the “economy” is expected to follow the growth path outlined by government planners. Thus, whenever the growth rate slips below the outlined growth path, government and central bank policymakers are expected to give the “economy” a suitable push by means of fiscal and monetary policies. Periodically, though, government officials also warn people that the “economy” has become overheated, i.e., it is “growing” too fast. In this case, government and central bank officials declare that it is their duty to prevent inflation. It must be realized that at no stage does the so-called economy have a life of its own, independent from individuals. Furthermore, it is not possible to establish the total real output, given that arithmetically we cannot add potatoes and tomatoes. The employment of various price indexes does not solve this issue. This in turn means that various macroeconomic indicators compiled by government statisticians are detached from the real world. Consequently, various policies to influence a nonexistent entity—the “economy”—via fictitious indicators inflict damage on individuals. Even government statisticians admit that the whole thing is not real. According to J. Steven Landefeld and Robert P. Parker from the Bureau of Economic Analysis, In particular, it is important to recognize that real GDP is an analytic concept. Despite the name, real GDP is not "real" in the sense that it can, even in principle, be observed or collected directly, in the same sense that current-dollar GDP cannot in principle be observed or collected as the sum of actual spending on final goods and services in the economy. Quantities of apples and oranges can in principle be collected, but they cannot be added to obtain the total quantity of "fruit" output in the economy. The “Hampered” Environment and Macroeconomic Data To succeed in a hampered market environment, entrepreneurs tend to respond to the prevailing conditions, which are influenced by central bank and government policies. A businessperson cannot afford to ignore changes in various economic indicators such as GDP, given that government and central bank officials react to changes in these indicators. For instance, if the central bank is expected to tighten its monetary stance in response to a strengthening in the GDP, a businessperson must take this into account in order to succeed in his business. In a hampered environment, businesspersons must try to interpret various economic indicators in terms of how authorities will respond to them and how this response is going to affect their business environment in the months ahead. Note that the government, in order to construct various economic indicators, is busy collecting the data from businesses that are allocating resources to supply the government with the information. The construction of various economic indicators generates employment opportunities for economists and experts in other fields such as mathematics and statistics. These experts are employed not only to compile various economic data, but they are also employed to interpret the data and provide guidance to businesses. Do We Need to Know about the Economy in a Free Market Environment? In a free market environment, free of government and central bank interference with businesses, it does not make much sense to measure and publish various economic indicators. This type of information is of little use to entrepreneurs. In a free market environment, what possible use can an entrepreneur make of information about the growth rate of GDP? How can the information that GDP rose by 4 percent help an entrepreneur succeed in his business? Alternatively, what possible use can be made of the data showing that the national balance of payments has moved into a deficit or a surplus? According to Rothbard, The individual consumer, in his daily rounds, has little need of statistics; through advertising, through the information of friends, and through his own experience, he finds out what is going on in the markets around him. The same is true of the business firm. The businessman must also size up his particular market, determine the prices he has to pay for what he buys and charge for what he sells, engage in cost accounting to estimate his costs, and so on. The only indicator to which entrepreneurs pay attention is profit in the activity concerned. The higher the profit, the more a particular business activity is in tune with the consumers’ wishes. Paying attention to consumers’ wishes means that entrepreneurs have to organize the most suitable production structure for that purpose. The information on various macroeconomic indicators will be of little assistance in this regard. What an entrepreneur requires is not general macroinformation, but rather specific information about consumers’ demand for a product or a range of products. Government-aggregated macroindicators will not be of much help to entrepreneurs. The entrepreneur will have to establish his own network of information concerning a particular venture. Only an entrepreneur will know what type of information he requires in order to succeed in the venture. If a businessperson’s assessment of consumers’ demand is correct, then he will make a profit. An incorrect assessment will result in a loss. The profit and loss framework penalizes those businesses that have misjudged consumer priorities and rewards those who have exercised a correct appraisal. The profit and loss framework makes sure that resources are withdrawn from those entrepreneurs who do not pay attention to consumer priorities to those who do. According to Mises, Thus profit and loss are generated by success or failure in adjusting the course of production activities to the most urgent demand of the consumers. We have seen that the construction of various economic indicators generates employment opportunities for economists and experts in other fields such as mathematics and statistics. These experts are employed not only to compile various economic data, but they are also employed to interpret the data and provide guidance to businesses. We have seen that in a free, unhampered market businesspersons in the pursuance of their goals will not require macroeconomic indicators. This means that there is likely going to be little interest in the services of economists, statisticians, and mathematicians. Macroeconomic data are the means that are employed by government and central bank policymakers to navigate the so-called economy toward the growth path that they set. As a rule, this navigation culminates in the boom-bust cycle menace and the weakening of the process of wealth generation. Hence, to prevent the menace of the boom-bust cycle and economic impoverishment, there is a place to consider not compiling and publishing various so-called economic data. As we have seen, this data is detached from reality. Hence, policymakers’ continuous response to a mirage undermines the process of wealth generation, thus undermining individuals’ well-being. On this Rothbard held, Statistics, to repeat, are the eyes and ears of the interventionists: of the intellectual reformer, the politician, and the government bureaucrat. Cut off those eyes and ears, destroy those crucial guidelines to knowledge, and the whole threat of government intervention is almost completely eliminated. ------------------------------------------------------------------------------------------------- 백신 강제 접종과 그레이트 리셋 국가는 공포를 통해 존재한다. 따라서 국민들에게 코로나 바이러스로 인한 위험을 과장해서 공포를 조장하는 건 국가의 이익에 부합한다. 또 코로나의 위험을 과장하고 또 과도하게 반응하는 건 정치가들에게 남는 장사인 것이다. 록다운에서 체면을 갖추고 빠져나가는 방법은 바로 백신 켐페인이다. 부정적인 뉴스는 언론에 호재일 뿐만 아니라, 백신을 통해 국민을 구했다는 시나리오 역시 언론이 반기는 이야기이다. 국가와 언론 그리고 제약회사, 초국가 조직 등은 모두 전체 국민의 백신 접종에 이해가 걸려 있다. 유엔이나 세계보건기구 등은 그레이트 리셋, 또는 거대한 변화를 그들의 목표로 삼고 있다. 레이먼드 엉거Raymond Unger는 이런 초국가적 계획이 그람시나 마르쿠제 등이 구상했던 문화전쟁의 일환이라고 본다. 초국가적 기구들은 코로나 위기를 그들의 어젠다를 확장시키는 데 이용하고자 한다. Vaccine Mandates and the "Great Reset" Philipp Bagus Pressure on the unvaccinated grows. While the vaccinated in some countries are getting back some of their freedoms taken away by the covid interventions, the unvaccinated are not so well off. They are being targeted for discrimination. Access to public spaces and traveling is being made more difficult for them. In some countries there is even mandatory vaccination for some professions. But why is the vaccination campaign so important to governments that they are increasing the pressure to such an extent? And who has an interest in the global vaccination campaign? To answer these questions, it is necessary to analyze the prevalent vaccination narrative and ask who benefits from it. In doing so, the alliance of interests between the state, the media, the pharmaceutical industry, and supranational institutions must be addressed. Let us start with the pharmaceutical industry. It has an obvious economic interest in the vaccination campaign. It makes enormous profits from widespread vaccination. What about the state? In the covid-19 crisis, politicians have systematically amplified fear and hysteria. This was no accident and is unsurprising, for the state builds its raison d'être on the argument that it protects the population from internal and external dangers. The state is built upon fear. The narrative is that without the help of the state, the citizen would be defenseless against hunger, poverty, accidents, war, terrorism, disease, natural disasters, and pandemics. It is, therefore, in the state's interest to instill fear of possible dangers, which it then pretends to resolve, expanding its power in the process. A relatively recent example is the restriction of civil liberties in the US in response to the threat of terrorism after the 9-11 attacks and the second Iraq war. Similarly, it was in the interest of governments to purposefully instill fear and portray covid-19 as a unique killer virus in order to expand state power to an extent unknown in peacetime at the expense of citizens' fundamental rights. When the corona crisis started and not much was known about the virus's potential danger politicians were faced with an asymmetric payoff. If politicians underestimate a danger and do not react, they are held responsible for the underestimation. They lose elections and power. Especially if they can be blamed for deaths. Photos of mass burials aside, the consequences of underestimating danger and failing to act are politically fatal. In contrast, overestimating the danger and taking decisive action are politically much more attractive. If it really is an unprecedented threat, politicians are celebrated for their tough measures such as lockdowns. And politicians can always argue that without their decisive action, there would indeed have been a disaster. If the measures ultimately turn out to have been exaggerated because the hazard was not so great after all, the possible negative consequences of the measures are not as directly associated with the politicians as the photos of mass burials, because these consequences are more indirect and long term. The indirect and long-term health costs of lockdowns include suicides, depression, alcoholism, stress-related illnesses, earlier deaths from canceled surgeries and screenings, and a generally lower standard of living. However, these costs are not directly associated with the drastic interventions and blamed on the policy. Many of these consequences will occur after the next elections or even later and are not visible. For instance, we cannot observe to what extent a higher standard of living would have increased life expectancy. And if someone dies six years from now from alcoholism or depression developed in the wake of lockdowns, most people probably will not make the lockdown politicians responsible, and if they do, these politicians will possibly already be out of office. Thus, it is in the interest of politicians to overestimate a threat and overreact. In order to justify and defend the harsh measures such as lockdowns that are so attractive to politicians, it is necessary to stir up fear. When politicians stoked fear and hysteria during the covid-19 crisis, implementing highly restrictive measures such as lockdowns, the damage to the economy and social fabric was immense. Yet a society cannot be locked down forever, as the costs keep rising. At some point, it must exit lockdown and return to some normality. However, how can one at the same time stir up fear of the threat of a killer virus and return to normalcy? The way out is vaccination. With to the vaccination campaign the state can stage itself as the savior from the great danger. The state organizes vaccination for its citizens and gives the vaccinations to the citizens for "free." Without this "vaccination rescue" and in a permanent lockdown, the negative economic and social consequences of the restrictions on civil rights would be so great that resentment among the population would continue to grow and ultimately unrest would threaten. So, sooner or later, the lockdown must be ended. If, however, the state authorities were to back out of the lockdowns and restrictions without further explanation and imply that the danger was not so great after all and that the restrictions were an exaggeration and a mistake, they would lose a great deal of support and trust among the population. Consequently, from a governmental perspective, a good and face-saving "exit scenario" from the most severe restrictions is needed, and the vaccination campaign provides it. Through state-provided vaccination, the state can continue to hold on to the narrative of the great threat and still get out of the lockdown. At the same time, it can pass itself off as a savior that is making somewhat more normality possibly through vaccination. To do this, it is necessary that as large a proportion of the population as possible also get vaccinated, because if only a fraction of the population gets vaccinated, the vaccination campaign cannot be sold as a necessary step toward opening up. Thus, it is in the state's interest to get a major part of the population vaccinated. If this strategy works, the state will have set a precedent, expanded its power, and also made citizens more dependent. Citizens will believe that the state has rescued them from a mortal predicament and that they will need its help in the future. In return, they will be willing to give up some of their liberties permanently. The announcement that a state-organized annual vaccination booster is needed will perpetuate the citizens' dependence. The mass media have fallen in line and actively support the vaccination narrative. The state and mass media are closely linked. Framing by the leading media and targeting the population have a long tradition. Already in 1928 Edward Bernays advocated the intelligent manipulation of the masses in his classic book Propaganda. In modern states, the mass media help to construct popular approval for political measures such as in the case of covid-19. The mass media's support of the state is due to several reasons. Some media are directly owned by the state, others are highly regulated or require state licenses. Furthermore, media houses are staffed with graduates from state educational institutions. In addition, especially in times of crisis, a good connection to the government offers advantages and privileged access to information. The willingness to carry the state's fear narrative also comes from the fact that negative news and the exaggeration of dangers bring attention. In the corona crisis, the one-sided media coverage that proliferated through social media and muted critical voices contributed to fear and panic and created great psychological stress among the population. However, it is not only negative news that is attractive to the media; the narrative of the state rescuing the population from a major crisis also sells well. Thus, the vaccination narrative plays into the hands of the mass media. In addition to nation-states, the media, and pharmaceutical companies, supranational organizations also have an interest in ensuring that the world's population is vaccinated. Supranational organizations are actively pursuing an agenda in which global vaccination campaigns play an important role. These organizations include the World Economic Forum (WEF), the United Nations (UN), the EU, the International Monetary Fund (IMF), and the World Health Organization (WHO), which are closely interconnected. Some of these organizations have set as their goal a great reset, or a great transformation. In the areas of pandemic and climate protection, gender, migration, and the financial system, these organizations want to find coordinated answers for the benefit of all people worldwide. They emphasize shared responsibility and global solidarity. The central control of vaccination, climate change, and financial and migration flows bears the hallmarks of a new world order. For example, the theme of the 2019 annual meeting of the WEF was "Globalization 4.0: Shaping a New Global Architecture in the Age of the Fourth Industrial Revolution." Another example of supranational planning is the UN's "Global Compact for Migration." At the national level, these radical ideas are supported, as shown by the German Advisory Council on Global Change's Welt im Wandel – Gesellschaftsvertrag für eine Große Transformation (World in transition: Social contract for a great transformation) policy paper. Raymond Unger (2021, pp. 84–89) sees this drive for supranational planning as part of a culture war envisioned by Antonio Gramsci and Herbert Marcuse. A global management of opinion and outrage is combined with scenes of fear and horror, especially in the fields of climate change and corona, to establish a new socialist world order. In fact, the WHO, the IMF, and the UN are led by former communists. The WEF is financed by global companies, including the pharmaceutical industry and the big tech companies. The WEF, for its part, significantly finances the UN's 2030 Agenda. The WHO is also significantly funded by pharmaceutical companies and the Bill and Melinda Gates Foundation, which spearheads global vaccination campaigns. During the covid-19 crisis, the pharmaceutical industry also exerted its influence on the WHO. And the IMF only aided nation-states if they complied with WHO recommendations. These interconnected supranational organizations see the covid-19 crisis as an opportunity to advance their agendas. The UN policy paper Shared Responsibility, Global Solidarity: Responding to the Socio-economic Impacts of COVID-19 views covid-19 as a turning point for modern society. The intention is to seize the opportunity and act in a globally coordinated manner. The major tech companies support these agendas. They are also members of the WEF and censored disagreeable information related to covid-19 on their platforms (Twitter, YouTube, and Facebook), just like the mass media. Videos critical of vaccination are particularly quickly deleted on YouTube. The title of a keynote speech by IMF director Kristalina Georgieva, "From Great Lockdown to Great Transformation" also underscores the idea that supranational organizations want to use the corona crisis for their agendas. Klaus Schwab, founder of the WEF, argues that the covid-19 crisis represents a "rare opportunity" to "lay new foundations for our economic and social systems." In COVID-19: The Great Reset, coauthored with Thierry Malleret, Schwab speaks of a defining moment and claims a new world will emerge. According to Schwab, it is time for a fundamental reform of capitalism. Thus, the globally coordinated vaccination program can be interpreted as a building block in a supranational strategy of a great reset. Global vaccination structures are being established that can be used for subsequent global vaccination campaigns. From the perspective of advocates of a great reset, globally coordinated covid-19 vaccination underscores the need for global structures and organizations that can then be used for other global purposes, such as effectively combating "climate change" and pushing for a great reset. In short, the state, the media, the pharmaceutical industry, and supranational organizations are closely intertwined and have a common interest in the vaccination narrative. From this perspective, the mounting pressure on the vaccine-free is unsurprising. ----------------------------------------------------------------------------------------------------- 불안퇴 종합증 불안퇴란 주로 노년의 여성들 다리에 형용하기 힘든 부적감不适感을 느끼는 증상이다. 증상은 아프다기 보다는 쑤시고 후끈거리는 등의 감각이다. 刘金生教授谈不安腿综合征中医心悟 时间：2015-07-16 许多患者就诊时主诉：一到夜间双下肢出现极度的不适感、没有一个舒适的地方可以放好双腿，痛苦难以忍受、难以形容，甚至痛不欲生。这是什么病？其实这是患了不安腿综合征。 一、认识不安腿综合征 不安腿综合征，又称不宁腿综合征，目前认为不安腿综合征属于中枢神经系统疾病，具体病因尚未完全阐明。早在1672年，英国医生Thomas Willis 首次描述了不安腿综合征(Restless legs Syndrome, RLS)，该病又称为Ekbom综合征，其临床表现是发生于下肢的一种自发的、难以忍受的痛苦的异常感觉。这种异常感觉常常累及患者小腿的深部如肌肉或骨头，尤其以腓肠肌最常见，部分患者大腿或上肢也可以出现，通常为对称性。患者常主诉在下肢深部有蚂蚁爬或虫子咬、瘙痒感、疼痛、刺痛、烧灼感、撕裂感、蠕动感等不适，有时患者的感觉难以形容。患者为此会有一种急迫的强烈要运动的感觉，并导致过度活动如翻来覆去、到处走动。休息时如久坐或长时开车时也会出现症状，活动可以部分或者完全缓解症状。正常情况下，夜间卧床时症状变得强烈并且在半夜后达到高峰，患者被迫踢腿、活动关节或者按摩腿部，患者往往形容“没有一个舒适的地方可以放好双腿”。严重者要起床不停地走路，部分患者需要不停的敲打腿部，方可得到缓解。 二、不安腿综合征是常见病吗 国外的流行病学资料表明其患病率为总人口的1－10％，我国的患病率估计在1.2－5％左右，中老年常见。该病是一种较常见的疾病，其发病率远远高于其它神经系统的疾病，如多发性硬化、帕金森病或者阿尔茨海默病。 三、为什么不安腿综合征患者常常被误诊或漏诊 不安腿综合征患病率较高，由于它是一种功能紊乱与失调性疾病，一般并无其它明显的体征和检查的异常，医生对此病认识不足，又缺乏客观指标，常造成误诊或漏诊。另一方面患者常常难以形容下肢的不适感，经常在骨科、风湿科、神经科等多个科室就诊，做了无数检查，却仍被误诊为失眠、抑郁症、或者腰椎病、下肢循环障碍、类风湿性关节炎、缺钙等，治疗效果不佳。 四、不安腿综合症的中医心悟 不宁腿综合症古今文献记录的较少，但早在《灵枢》、《素问》中记载“胫酸”、“髓酸”的记载都与本病表现类似。《伤寒杂病论》中亦有相似的描述如“血痹”、“痉病”、“腿挛急”等。现代多认为不宁腿综合症属于中医的“痹症”范畴，其基本病因病机为正虚邪恋，局部经气不利，肌肉筋脉失养，以黄芪桂枝五物汤等方加减治之。究其效果，有效者亦有不效者，尚未尽如人意。何以效果不佳？实未得病机之真谛！为医者需于望、闻、问、切四者中搜求病机，必有得心之处，胸中了了，用药方灵。不安腿症状具有典型的“旦慧昼安，夕加夜甚”特点，《灵枢》顺气一日分为四时：“夫百病者，多以旦慧昼安，夕加夜甚，何也？岐伯曰：···朝则人气始生，病气衰，故旦慧；日中人气长，长则胜邪，故安；夕则人气始衰，邪气始生，故加；夜半人气入脏，邪气独居于身，故甚也。”人气者，身之阳气也。邪气者，水湿也。夜半阳气衰，水湿趋下滞留两腿，气血凝滞，故两腿不安不宁症状在夜间加重，概肢体之轻捷敏健者，赖阳气之周流。水不升为病者，调肾之阳，阳气足，水气随之而升。血之性善降而易凝，和与温、养血之妙法。静而思之，豁然有悟：阳虚寒凝，水湿滞留两腿，气血凝滞，实为不宁腿综合症发生的病理机制！病理既明，法随理出。温阳益气，利水活血，当为治疗不宁腿综合症的不二法门。试举验案2则，供同道参考。 验案1 张某某，女，46岁，丰台人。初诊：2013年9月23日。 不安腿综合征7年余。历经北京各大医院诊治，效果不明显。两腿部强烈的不适感，表现为重胀感、麻痛但痛不重、难以形容的难受感。难受时下肢肌肉跳动，跳动节律与心脏节律一致，夜间10时至2时，明显加重，以致无法入睡，不得不起床捶腿，甚至下地不停地走动才能感觉舒服些，夜间痛苦异常，难以睡眠，终日烦躁，疲惫不堪，甚至出现了抑郁自杀的征象。两腿畏寒，夏季尤重，贫血，月经量少，口唇紫暗，大便溏，小便可。苔白水滑，舌胖大舌尖红，脉滑。 制附子10 白芍12 苍术15 茯苓30 生晒参10 当归15 川芎12 泽泻15 怀牛膝30 生薏仁30 防己15 炒杜仲15 生黄芪30 7剂，水煎服。药渣重煎，适温泡足。 2013 –9-30复诊。 服上药第三天症状加重，第四天继续加重，难以形容的难受感，第五天症状减轻，第六天症状消失，已可安卧。现月经2月未至，两腿畏寒减轻。大便溏，小便黄，苔白，舌胖大边有齿痕、舌尖红。 制附子10 白芍12 苍术15 茯苓30 生晒参10 当归15 川芎10 泽泻15 怀牛膝30 生薏仁30 炒杜仲15 鹿角胶6（烊化） 生黄芪30 龟板胶6（烊化）山甲粉3（分冲） 14剂，水煎服。药渣重煎，适温泡足。 2013 –10-14日，三诊。 服上药（9-30日方），面部发红，出现米粒大小红色丘疹，无瘙痒，2天后消退，蜕皮，自认为排毒反应。两腿部强烈的不适感消失，夜可安卧，困扰7年的睡眠障碍终于消除。面色紅润，精神焕发，唯两小腿仍有畏风现象，坐小轿车久，两腿部偶有轻度不适感。月经两月未至，右胁偶有胀痛，大便溏，小便可。苔白，舌淡红。脉弦滑。 柴胡12 当归12 白芍15 苍术15 茯苓30 炙甘草6 丹皮10 山栀10 川芎10 泽泻15 怀牛膝30 独活15 7剂，水煎服。药渣重煎，适温泡足。 2013 –10-21日，四诊。 服上药右胁胀痛消失。唯两小腿仍有畏风现象，坐小轿车久，两腿部偶有轻度不适感。月经两月未至，大便溏，小便可。苔白，舌淡红。脉缓。自觉这次方药不如9月30日方药效果好。仍以9-30日方加减进退，15剂后，月经来潮，诸症消失。 按：患病7年余，历经北京各大医院诊治，效果不明显。患者两腿部强烈的不适感，表现为重胀感、麻痛但痛不重、难受时下肢肌肉跳动，夜间10时至2时明显加重，两腿畏寒等症，一派阳虚寒凝，水湿滞留两腿，气血凝滞之象。以附子汤温经助阳、祛寒除湿，合当归芍药散养血调肝、健脾利湿，复加防己黄芪汤益气祛风、健脾利水，共成温阳益气，利水活血之剂。值得注意的是，服药第三天症状加重，第四天继续加重，第五天症状减轻，第六天症状消失。其间患者出现面部发红，出现米粒大小红色丘疹，蜕皮。病人自认为是排毒现象，实乃“瞑眩”，“若药不瞑眩，厥疾弗瘳”，此之谓也。所幸病人未因病情加重而停药，终获痊愈。医患之间的信任，实为取得疗效的关键！ 该患者随访8个月，不安腿综合征一直未发作。 验案2 孙某某，男，49岁。赤峰市人，乡镇干部。 2012-09-13日，初诊。 不安腿综合征3年余，患者两腿部强烈的不适感，表现为重胀麻痛，着床侧肢体难以形容的难受感，难以找到合适的体位，辗转反侧，呻吟不已，伴周身关节肌肉疼痛，夜间加重，晨起活动后疼痛消失。易感冒，感冒后气短，脸面发麻，持续月余方止。胃脘凉，腹胀，大便溏，日3-4次，肛门经常有水渗出，尿频，滴沥不尽，有泡沫。苔白，舌暗红、边有齿痕。脉沉无力。 制附子10 肉桂5 生晒参10 干姜10 炮姜炭10 炒苍白术各15 炙甘草10 砂仁10 白蔻仁10 茯苓30 补骨脂15 7剂。 2012-09-20日，二诊。 服上药失气频作，两腿部强烈的不适感减轻，夜间痛重明显好转，肛门水渗出好转。令患者意外高兴的是，出现了多年未有的晨间勃起。苔白黄，舌淡红暗，边有齿痕。脉弦。 制附子10 肉桂5 干姜10 炮姜炭10 炒苍白术各15 生晒参10 生黄芪30 炙甘草10 升麻10 砂仁10 茯苓30 补骨脂15 15剂。艾条20支灸关元、足三里穴位。 2012-10-18日，三诊。 两腿部强烈的不适感消失，周身关节肌肉疼痛消失。胃脘凉，大便溏，尿频等症减轻。苔白，舌淡红边有齿痕，脉弦。患者欣喜过望，求巩固疗效。以上方加减进退，20剂后，诸症消失。 按:本例患者表现为下肢及着床侧肢体难以形容的难受感，周身关节肌肉疼痛，夜间加重，晨起活动后疼痛消失，为什么表现这些症象？欲研此症之病理，须明中医气化之精妙。患者自觉向左卧，则体内血液水湿全沉于左侧，向右卧，则全沉于右侧，可以推知病者血流水湿已无自然循环流动之活力，此血流何以不能自动，则必由于脾肾阳气衰微。胃脘凉，腹胀，大便溏，肛门经常有水渗出，显系阳虚水停之明证。治以桂附理中加味，补肾助阳，温中健脾，益先天，补后天，标本兼治，阳气恢复，水湿自散，内外通气，血流自然，则大病终愈。 -------------------------------------------------------------------------------- 시호가용모탕으로 불안퇴 치료 不安腿综合征(restless legs syndrome，RLS)又称多动腿综合征或不宁腿综合征。本综合征为Willis(1685)首先记载，Wittonack(1861)称为胫骨不安症(anxietas tibia)，法国则称肌性焦热(impatience musculaire)，1943年Allison又称此征为腿部神经过敏症(leg jitters)，1944年Ekborn初称此征为无力性脚感觉异常症(asthenic crural paresthenia)，直到1945年Ekbom方称其为不宁腿综合征，后来人们又称为Ekbom综合征。Gorman认为正常人群中5%可发现RLS。 RLS在各年龄组皆可发病，但多见于40岁以上的壮年。症状主要发生在两下肢，但亦可累及大腿和足部，可以一侧为重，或仅限于一侧下肢，但上肢和手部则很少受累。受累的患肢深部酸、麻痛灼热、虫爬样、瘙痒样等多种痛苦感觉为主要表现的发作性疾病。症状在休息时出现，而在白天工作，劳动或运动时不出现症状。症状常迫使患者的小腿不停的活动，甚至在室内、外长久的徘徊，才能使症状缓解，因此命名为不宁腿综合征。本病的发病机制尚不清，病因不明，尽管对症治疗的方法很多，但迄今为止尚无对因治疗措施。 其主要临床表现为如下几方面。 　　1.不安，休息时常走来走去，或不停地搓腿，躺在床上时常翻来覆去或摇动身体。 　　2.感觉异常，在休息尤其清晨与夜间时大腿深部有爬行样不舒感，常为双侧受累，迫使患者要经常活动其两腿。 　　3.睡眠中周期性腿动，为刻板地屈曲运动，在6h的睡眠中至少发生40次以上的腿动。 　　4.醒时的不自主腿动，在卧位或坐位休息时常发生下肢的不自主屈曲运动。 　　5.睡眠障碍，由于感觉异常和腿动，常导致患者失眠。 　　6.夜间加重，尽管白天休息时也可有异常、腿动和不安症状，但夜间有明显的加重趋势。 笔者从几年前接触不安腿综合征尝试用过桂枝茯苓丸、芍药甘草汤、黄芪桂枝五物汤、地黄饮子等及一些传统中医模式滋补肝肾法及清热利湿法效果均不理想。遂改变治疗思路，决定从治疗失眠入手，因为不安腿综合症全部伴有睡眠障碍，把治疗失眠的方子筛选一遍柴胡加龙骨牡蛎汤觉得更合适，所以运用柴胡加龙骨牡蛎汤治疗不安腿综合征十余例，通过近一年的观察疗效甚佳。 柴胡加龙骨牡蛎汤主原文是：“伤寒八九日，下之，胸满烦惊，小便不利，谵语，一身尽重，不可转侧者，柴胡加龙骨牡蛎汤主之。” 林伯良在《小柴胡汤证的研究》一书中认为： ①柴胡主证及肝证：如胸满，烦惊，谵语之类。 ②外部证及内部从证：如身重，小便不利之类。” 他并根据以上基本状态，把症状进一步推广了。他认为： ①胸满方面，可以把胸腹膨胀，心下紧张，或往来寒热等，看做类似证。 ②从惊烦来说，烦惊即烦闷易惊，常可兼胸腹动悸，气上冲而烦惊，精神受劳，因此，可发生失眠多梦，精神过敏，容易兴奋，或眩晕头痛耳鸣等。严重的可发生谵妄，发狂癫痫等。”例如：《类聚方广义》称：“本方治狂证，腹胸动甚，惊惧逼人，兀坐独语，日夜不眠，或多猜疑，或欲自死。又治痛症，时寒热交作，郁悲愁，多梦不寐，或恶接人，屏居暗室。” 　③从外部及内部从证说：在上术柴胡主证及肝证的结合下，如下肢麻痹、水肿、半身不遂，四肢倦重或疼痛或牵搐等，以及失精、阳萎、月事失常等，都可和身重，小便不利看做类似的症状。 经过这样推广，就可使本方适用不安腿综合征的治疗。 案一：杨某 男 56岁 72kg 169cm 工人 下肢困乏不适二十余年，严重影响睡眠，每晚需双腿跪在床上才能入睡片刻，甚感痛苦，生不如死，晚上常起床走来走去、不停搓腿方感舒服片刻。在找笔者前经多处调理效果欠佳，口不渴、大便可、烦躁易怒、头晕头蒙头脑不清醒、记忆力减退、有吸烟史高血压病史，舌淡红、苔薄黄、脉弦细：柴胡15g 龙骨15g 牡蛎15g 桂枝10g 云苓15g 生姜15g 大枣15g 黄芩10g 琥珀10g 党参15g 半夏20g 制大黄10g 六副 药后症状大减，共服30余副上证全消。半年后上证又发，用药六副即好。 案二：梁某某 女 35岁 52kg 1.65cm 粉刷工人 不安腿综合征五年、有甲亢病史，中西药治疗无效，体瘦、食欲可、长久站立下肢困乏，难以忍受，似痒非痒、似疼非疼、似酸非酸、似困非困，严重影响睡眠，大便偏稀，脾气急躁，经前乳房胀痛，口稍苦：柴胡15g 龙骨15g 牡蛎30g 桂枝10g 云苓30g 生姜15g 大枣15g 黄芩6g 琥珀10g 党参15g 半夏20g 制大黄6g 上方六副 诸证大减，共服二十四副痊愈。 通过用柴胡加龙骨牡蛎汤治疗不安腿综合征感觉近期疗效甚佳，远期疗效还待观察。可不可以把柴胡加龙骨牡蛎汤看作不安腿综合征的专病专方，还待研究。一家意见不妥之处还望同道斧正。 --------------------------------------------------------------------------------------- 不安腿綜合徵又稱多動腿或不寧腿綜合徵。主要表現為雙下肢(膝踝間)深部肌肉有難以訴述或忍受的酸、麻、痛、爬蟲樣、灼熱等莫名不適，一般兩側對稱發作，也有一側較重，主要發作於休息時，尤以晚間臨睡前為多，發作時迫使按摩，叩打區域性或起床徘徊，可使症狀暫時緩解或減輕。但隨後又復出現，久久不能人睡。體檢包括神經系統以及肌電圖、腓腸肌診檢等未見異常。 中醫認為本**氣血不足，營衛虛弱，風寒之邪人侵經脈，使之阻滯不通所致。 (1)根據《浙江中醫雜誌》1991，(2)：78，尚禮儉報道：用芍藥甘草湯合二至丸加味**不安腿綜合徵25例，獲愈。處方：白芍50克，甘草10克，女貞子20克，旱蓮草18克，丹蔘30克，木瓜15克，懷牛膝15克。水煎服，每日1劑。加減：失眠多夢者，加炒酸棗仁、龍骨、牡蠣、夜交藤；心悸，氣短，面色不澤者，加黃芪、黨蔘、當歸、柏子仁；舌苔黃膩者，加蒼朮、黃柏、滑石、薏苡仁。 (2)根據《廣西中醫藥》1987，(5)：12，潘北桂等報道：用芍藥甘草湯**不安腿綜合徵7例，其中，**5例，好轉1例，無效1例。處方：白芍30克，甘草5克。每日1劑，水煎服，10天為1個療程。用藥最短4天，最長8天。 (3)根據《北京中醫雜誌》1987，(2)：43，王秀琴報道：用芍藥甘草湯加味**2例不安腿綜合徵。處方：白芍60克，炙甘草15克，木瓜30克，生薏苡仁30克，杜仲30克，丹蔘30克。水煎服，每日1劑。 (4)根據《河北中醫》1991，(5)：15，陳殿元報道：用加味芍藥甘草湯**不安腿綜合徵10例，其中，近期**7例，好轉2例，無效1例。處方：白芍30克，甘草6克，木瓜18克。每日1劑，水煎分2次口服。7劑為1個療程，最多連服3個療程。 -------------------------------------------------------------------------------------------------------- 不寧腿（肢）綜合徵的臨床特點是雙小腿深部難受或痠痛，小腿肌肉痙攣、發緊或深部如蟲爬、瘙癢等感覺。**常不明確。 1、劉氏認為肢體疼痛、痙攣等症內屬肝血不足，外為風寒溼邪所侵，經氣不利，筋脈失濡所致。以芍藥甘草湯加味（白芍、甘草、生米仁、生地、宣木瓜、蘇木、威靈仙、地龍）隨症加減，**本病32例，結果：痊癒18例（56．2％），顯效7例（22．06％），好轉4例（12．5％），無效3例（9．3％），總有效率90．7％ 2、李氏根據不寧腿綜合徵病在下肢及纏綿難愈等特點，認為下焦溼熱鬱蒸，·經脈氣機閉阻為本病的主要病機。以四妙丸加味（蒼朮、黃柏、薏苡仁、川牛膝、漢防己、忍冬藤、車前子）**本病13例，結果：**9例，顯效3例，有效1例 --------------------------------------------------------------------------------------------------- 김걸 교수의 가미사묘산 운용 경험 金傑運用加味四妙散經驗拾萃 作者 / 1王娜娜 1吳明陽 2金傑 1河南中醫藥大學第一臨牀醫學院 2河南中醫藥大學第一附屬醫院 編輯 / 許紅 ⊙ 校對 / 張芊芊 金傑教授從1999年至今一直從事臨牀教學科研工作，善於運用中西醫結合方法診斷治療精神、神經及心理障礙性疾病，臨牀療效顯著。筆者有幸跟隨金傑教授臨證學習，受益匪淺，現將其運用加味四妙散的經驗介紹如下。 1 加味四妙散的方解及其證治特點 四妙散載於清·張秉成《成方便讀》，而本方源自於元·危亦林《世醫得效方·卷第九》的蒼朮散加味而成。蒼朮散由黃柏、蒼朮各等分組成。原作散劑，可治療「一切風寒溼熱，令足膝痛，或赤腫，腳骨間作熱痛，雖一點，能令步履艱苦。及臀髀大骨疼痛，令人痿。一切腳氣，百用百效」。後至元·朱震亨《丹溪心法》一書中將其改稱爲二妙散。四妙散由二妙散加懷牛膝、薏苡仁共4味藥物組成，主治溼熱下注之痿、痺症。方中蒼朮味苦能燥溼、性辛溫、可散寒除痺，是燥溼健脾之要藥，《珍珠囊》有雲:「能健胃安脾，諸溼腫非此不能除。」黃柏味苦而性寒、沉降，善清溼熱且尤長於清下焦溼熱。如《脾胃論》所言:「黃柏之苦寒，降溼熱爲痿，乘於腎，救足膝無力，亦除陰汗、陰痿，而益精」，「如腳膝痿軟，行步乏力，或疼痛，乃腎肝中伏溼熱，少加黃柏」。據《神農本草經》載:「薏苡仁，主筋急，拘攣不可屈伸，風溼痺，下氣，久服輕身益氣」，是以方中用薏苡仁健脾胃、除溼痺、緩拘攣、舒筋絡;牛膝味苦酸、性平，《名醫別錄》曰:「補中續絕，填骨髓，除腦中痛腰脊痛，婦人月水不通，血結，益精，利陰氣」，《神農本草經》原文:「牛膝，味苦，主寒溼痿痺，四肢拘攣，膝痛不可屈伸，逐血氣。」金傑認爲四妙散方中蒼朮與黃柏配伍應用可共奏清熱燥溼之功效，使溼去而熱除，即邪氣盛、正氣不虛之二妙散功效；加入牛膝以補肝腎、強筋健，引蒼朮、黃柏入下焦而祛溼清熱；宗《黃帝內經》:「治痿獨取陽明」之旨，故用能獨入陽明經脈之薏苡仁以淡滲利溼，清熱除痺，舒利筋絡。金傑根據中醫學理論及多年臨牀經驗對四妙散進行加味，加入萆薢、木瓜、豨薟草、防己以增強祛風除溼、舒筋活絡之效，加入當歸、益母草以養血活血通絡，加入白芍、甘草即芍藥甘草湯以增平肝柔肝、緩急止痛之效，諸藥相合清熱燥溼、通筋利痺、標本兼顧，是治療溼熱痿、痺症之妙藥。臨證運用加味四妙散治療溼熱下注型吉蘭-巴雷綜合徵、不安腿綜合徵、腰椎病和抽搐等多種疾病，療效顯著。現代醫學認爲，吉蘭-巴雷綜合徵是以周圍神經和神經根的脫髓鞘病變及小血管炎性細胞浸潤爲病理特點的自身免疫性周圍神經病，經典的吉蘭-巴雷綜合徵被稱爲急性炎症性脫髓鞘性多發性神經病，臨牀表現爲急性對稱性弛緩性肢體癱瘓；不安腿綜合徵是指夜間或休息時出現的肢體難以忍受的不適感，運動、按摩可暫時緩解的一種綜合徵，其臨牀表現通常爲夜間睡眠時雙下肢出現極度的不適感，迫使患者不停地移動下肢或下地行走，導致患者嚴重的睡眠障礙。 2 典型病案 2.1 吉蘭-巴雷綜合徵 案1：王某，男，39歲，以「四肢無力2周」爲主訴於2015年5月21日入院。患者2周前感冒後出現四肢麻木無力、雙手持物無力、無言語不利、口角歪斜、頭痛頭暈、噁心嘔吐等症狀，未引起重視和治療。2周以來上述症狀進行性加重，逐漸出現行走不穩，遂來河南中醫藥大學第一附屬醫院住院治療，診斷爲「吉蘭-巴雷綜合徵」。患者既往無其他病史，否認腦出血及腦梗塞等病史。入院症見四肢無力，雙下肢膝以下發涼，腓腸肌壓痛，納眠可，二便調，舌質淡紅，苔黃厚膩，脈弦滑。查體神志清，言語流利清晰，雙上肢近端肌力Ⅲ級、遠端肌力Ⅱ級，雙下肢近端肌力Ⅲ+級、遠端肌力Ⅲ級，肌張力減低，腱反射減弱，病理反射未引出，淺深感覺未見明顯異常，共濟運動不能配合。顱腦磁共振成像檢查腦內未見明顯異常。肌電圖示周圍神經損害。中醫診斷痿證，證屬溼熱浸淫證，西醫診斷吉蘭-巴雷綜合徵。西醫給予營養神經、補充維生素、改善微循環等治療並對症處理。中醫以清熱利溼爲治法，方選四妙散加減：麩炒蒼朮、川牛膝、薏苡仁、豨薟草各30g，茯苓20g，當歸、益母草、木瓜、萆薢、白芍各15g，清半夏、黃柏各10g，陳皮、防己、炙甘草各12g，水煎服每天1劑，每日2次。配合針灸治療每天1次。治療3周後患者四肢麻木無力明顯減輕，可自行短距離行走，繼續治療4周後出院。出院症見四肢無力消失，雙下肢膝以下發涼、腓腸肌壓痛症狀消失，可自行長距離行走。雙上肢近端肌力Ⅴ-級、遠端肌力Ⅳ+級，雙下肢近端肌力Ⅴ-級，遠端肌力Ⅳ+級。隨訪患者3月病情無反覆。 2.2 不安腿綜合徵 案2：馬某，男，53歲，主訴雙下肢不適伴雙腓腸肌痙攣2周。2015年8月17日來診，症見雙下肢異樣不適感伴痙攣，雙腓腸肌痙攣夜間尤甚，常在夜間醒來揉按腿部，或下地行走活動稍有緩解，右下肢困沉，納眠可，二便正常，舌淡暗，苔黃膩，脈弦細。西醫診斷不安腿綜合徵，中醫診斷痺症，辨證屬溼熱下注、浸淫筋脈。治以四妙散加減：麩炒蒼朮、川牛膝、薏苡仁、益母草、豨薟草、木瓜、萆薢、白芍各30g，黃柏10g，當歸、防己、炙甘草各15g，水煎服每日1劑，每日2次。服藥6劑症狀大減，雙下肢異樣不適感明顯減輕，雙腓腸肌痙攣基本消失，偶覺右下肢困沉。守上方6劑以鞏固療效，服後症狀消失。 2.3 腰椎病 案3：瞿某，女，74歲，以「腰痛伴右下肢疼痛3年，加重3 d」爲主訴於2015年5月2日入院。患者3年前無明顯誘因出現腰痛伴右下肢疼痛、麻木，自覺晨起疼痛、麻木較輕，下午逐漸加重，曾於鄭州市某醫院診斷爲腰椎間盤突出症，住院治療(具體治療不詳)好轉後出院，3 d前因勞累後致上述症狀再發加重，今爲求中西醫結合治療入住我院。患者既往有冠心病、高血壓、腰椎間盤突出症，否認糖尿病和腦梗塞及腦出血等病史。入院症見腰痛、右下肢疼痛伴麻木，直腿高舉試驗陽性，納眠可，二便正常，舌紫暗，苔白厚，脈弦細滑。腰椎MRI示L1-2、L2-3、L3-4、L4-5、L5-S1椎間盤膨出、腰椎諸椎間盤變性、腰椎骨質增生、L3、L4椎體相對緣及L5、S1椎體相對緣終板變性。西醫診斷坐骨神經痛、高血壓病、冠狀動脈粥樣硬化性心臟病，中醫診斷痺症，肝腎虧虛證。西醫給予改善循環、營養神經等治療並對症處理，中醫給予四妙散合獨活寄生湯加減：麩炒薏苡仁、桑寄生、茯苓、鹽杜仲、牛膝各30g，麩炒蒼朮、黨參、秦艽、白芍、桂枝各15g，當歸、川芎各12g，獨活、防風、炙甘草、黃柏各10g，熟地黃20g，細辛3g，水煎服每日1劑，每日2次。治療1周後患者自訴腰痛及右下肢麻木等症狀均明顯減輕，右下肢疼痛已基本消失，繼續治療1周後出院。出院症見腰痛及右下肢疼痛、麻木消失，直腿擡高試驗陰性。 2.4 抽搐 案4：王某，女，60歲，主訴雙下肢不自主抽搐30餘年，加重伴雙上肢抽搐3d。2015年8月18日來診，症見雙下肢不自主抽搐夜間尤甚，3d前出現雙手抽搐，活動後加重，休息後抽搐緩解，但覺雙下肢沉困，納眠可，二便如常，舌暗紅，苔黃稍膩，脈弦細滑。西醫診斷肢體痙攣，中醫診斷痙證，溼熱下注證，治以四妙散加減：麩炒蒼朮、川牛膝、薏苡仁、益母草、木瓜、豨薟草各30g，當歸、防己、萆薢、炒白芍各15g，黃柏10g，炙甘草12g，服藥10劑後四肢已不抽搐，停藥則又發作，但程度較前明顯減輕，自覺症狀已減輕90%。繼服上方10劑症狀消失，隨訪1個月未再復發。 3 總結 加味四妙散治療病症衆多，但其所治疾病病機總與溼熱邪氣密切相關。金傑認爲隨著現代社會物質生活條件的改善，飲食習慣的變化，今人多飲食不節、恣食肥甘厚味、嗜食生冷之品，終致脾胃受損，溼熱合邪蘊結脾胃，百病乃生;加之長期處於溼熱環境中，或涉水淋雨，氣候突變，感受溼邪，溼熱相搏;或爲苦寒類藥物不當使用亦可損傷脾胃化生溼熱。溼熱侵襲人體常可導致「溼熱裹挾，如油入面，難捨難分」，是以徒清熱則溼不退，徒祛溼則熱愈熾;因溼性趨下、重著易襲陰位，多導致下肢困重無力或關節疼痛;溼邪爲陰邪易阻遏氣機，損傷陽氣致機體正氣受損，可致外邪乘虛侵襲，是故溼熱之邪又常挾他邪入侵;而溼爲有形之邪，熱爲無形之邪，熱邪須依附於溼邪方可留於經絡臟腑之間，致使局部關節屈伸不利甚或紅腫疼痛，終發爲痿證、痺症。金傑根據中醫學基本理論及多年臨證經驗，緊抓溼熱這一主要病機，運用古方四妙散加味治療溼熱引起的吉蘭-巴雷綜合徵、不安腿綜合徵、腰椎病和抽搐等現代疾病，收效甚佳。現代藥理研究亦表明，以蒼朮、黃柏爲主組成的方藥具有明顯的抗炎鎮痛、抑制免疫病理反應的作用。趙鵬飛研究發現，加味四妙散有減輕兔膝骨關節炎軟骨基質的降解、促進損傷軟骨修復的作用。 -----------------------------------------------------------------------------------