tag:blogger.com,1999:blog-41224226857163142862024-03-08T05:25:22.080-08:00言 師 醫 話中醫臨床 醫案實記 醫情醫話 綜觀醫林!採藥言師http://www.blogger.com/profile/15068585574518231539noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-4122422685716314286.post-17015384452676137962011-03-03T18:51:00.001-08:002011-03-03T18:51:57.546-08:00一例急性間質性肺炎死亡病例的探討<div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><strong>這是一例回溯性的病案</strong>:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">記得兩年前的初春,由高雄某藥廠</span><span lang="EN-US">A</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">經理的邀請,出診台北市中山北路某醫院的胸腔內科病患,個案為十五歲的男孩,三個月前罹患天疱瘡,後演變成間質性肺炎,進入病房時只見病患羸弱消瘦,坐在病床上呼吸困難,急促而喘,無法平臥,大汗淋漓,整個頭髮都濕掉了如水浸漬,舌瘦質紅絳,沒有一點舌苔,唇色紫粓,脈浮細而疾,口乾欲飲,間雜乾咳,每次咳嗽時像似要把心肺都要咳出來似的,男孩自訴胸部憋悶疼痛,無法呼吸,辨證為氣陰兩虧,似有陰脫危象,此時應以益氣養陰救逆為主,書方生脈飲加味:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">西洋參六錢、麥門冬<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="2" tcsc="1" unitname="兩" w:st="on">二兩</chmetcnv>、生地黃<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="2" tcsc="1" unitname="兩" w:st="on">二兩</chmetcnv>、五味子三錢、淨萸肉六錢、珠貝母三錢、玉竹五錢、蘆竹根<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="1" tcsc="1" unitname="兩" w:st="on">一兩</chmetcnv>、藿山石斛<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="1" tcsc="1" unitname="兩" w:st="on">一兩</chmetcnv>、石菖蒲三錢</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">給藥三帖,藥用七碗水熬成兩碗,不拘時服,一日一帖。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">三日後再診,病患大汗淋漓之象稍減,舌質仍紅絳無苔,脈浮細數,危象稍解,書方五帖,守方續服。後未見病患家屬續邀再診,此後常在心中常有所掛礙,不知病病患安否?</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">一個月後,介紹往診的</span><span lang="EN-US">A</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">經理到診所例行業務,詢問該男孩的近況,</span><span lang="EN-US">A</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">經理告知,該男孩已經往生死亡了,後續發展是這樣的:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">據</span><span lang="EN-US">A</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">經理告知這位男孩子的父親是醫檢師,雖然服了我所處方的方藥,病況稍有進步,但病患的父親認為痊癒的速度太慢,又經人介紹另請某醫學中心中醫院某醫師往診,這位大醫師開科學中藥百固金湯和龍膽瀉肝湯予服,男孩的父親還盛讚科學中藥科學服藥方便,不似飲片煎煮麻煩。但服用粉藥不到一天,即喘急氣促更甚,而轉進急診室,第二天就在該院的加護病房魂歸離恨天了。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">本病辨證氣陰兩虧並見,而且脫象已現,用藥當以大劑益氣養陰固脫之品,稍佐利竅之藥,或有救回之轉機,後醫用百合固金湯及龍膽瀉肝湯之粉藥予服,百合固金湯雖能養陰清熱,但緩不濟急,何況是藥力單薄之粉方,更莫名奇妙的是加入大苦大寒又利濕之龍膽瀉肝湯,斲傷元氣莫此為甚,辨證不清,用方錯誤,魂歸離恨天而萬劫不復矣!面對疑難重症,為醫者處方遣藥,能不戰戰驚驚,如走鋼絲嗎?</span></div>採藥言師http://www.blogger.com/profile/15068585574518231539noreply@blogger.com1tag:blogger.com,1999:blog-4122422685716314286.post-32083843969517241162011-03-03T05:36:00.000-08:002011-03-03T05:36:45.449-08:00僵直性脊椎炎病案二例<div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">一、因僵直性脊椎炎而深夜疼痛難忍哭泣難眠的病人<span lang="EN-US"></span></span></span></b></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">個案是我多年前在某醫院門診的病患,姓劉,<span lang="EN-US">25</span>歲,男性,住台北市延壽街,,僵直性脊椎炎已確診,在多家醫院免疫風濕科看診多年改善不大,頸椎及腰部僵硬疼痛,常在常夜睡眠時因腰背疼痛難忍而哭泣;<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">初診時面色蒼白,頸椎僵硬,俯仰及左右轉動艱難,腰部僵直,背部微駝,雙腳沈重無力,腳跟痛,天冷諸症加劇,<span lang="EN-US">HLA-B27</span>陽性,<span lang="EN-US">X-RAY</span>脊椎已有竹節狀現象,脈弦細澀,舌質有瘀斑,色淡白,以腎陽虧虛,瘀血阻絡診治,處方右歸丸加小活絡丹、蘄蛇、蜈蚣、全蝎、木瓜(處方中小活絡丹、蘄蛇、蜈蚣、全蝎醫院並無此藥,因此請患者自己到院外中藥房購買加入),以溫補腎陽,溫經活絡,活血袪瘀,方中有蘄蛇、蜈蚣、全蝎、經驗上免疫風濕的疾患,這些有情蟲品的治痛效果不錯,每次來診給藥七天,如此連診四次病情改善不大,看著患者一張期盼望殷切的臉,想了一想,開了一張煎劑處方簽,請患者到外面中藥房自行購藥煎服,處方如下:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">熟地黃<span lang="EN-US">8</span>、砂仁<span lang="EN-US">2</span>、山茱萸<span lang="EN-US">4</span>、懷山藥<span lang="EN-US">4</span>、炒杜仲<span lang="EN-US">3</span>、當歸<span lang="EN-US">6</span>、懷牛膝<span lang="EN-US">4</span>、狗脊<span lang="EN-US">10</span>、桂枝<span lang="EN-US">5</span>、蘄蛇<span lang="EN-US">5</span>、菟絲子<span lang="EN-US">3</span>、鹿茸<span lang="EN-US">3</span>、枸杞子<span lang="EN-US">5</span>、正北蓍<span lang="EN-US">6</span>、吉林參<span lang="EN-US">3</span>、獨活<span lang="EN-US">4</span>、木瓜<span lang="EN-US">3</span>、製川烏<span lang="EN-US">2</span>、製草烏<span lang="EN-US">2</span>、製南星<span lang="EN-US">2</span>、炙甘草<span lang="EN-US">2</span>、地龍乾<span lang="EN-US">3</span>、赤芍<span lang="EN-US">6</span>、全蝎<span lang="EN-US">1</span>、本<span lang="EN-US">3</span>(劑量單位:錢)藥用<span lang="EN-US">8</span>碗水熬成<span lang="EN-US">2</span>碗半,分<span lang="EN-US">3</span>次服用,一天一劑。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">七天後患者再診,見到我非常高興,欣喜之情溢於臉上,患者告訴我,此次開的藥非常有效果,晚上不痛了,可以一覺到天亮,但早晨起床時腰背頸仍僵硬,方有效,守方續服,連服半年後腰背、頸已不痛,僵硬感改善極多,服藥其間曾因服藥腹瀉而加蒼朮<span lang="EN-US">4</span>錢,可能是多服熟地的關係,按熟地的炮製法應酒拌砂仁,九蒸九晒,目前功利心態下,要找九蒸九製的熟地恐怕較為困難,行口(中醫藥界常稱中藥批發業為行口)所售久製熟地只有三蒸三晒,腸胃不好的患者服入處方有熟地的方劑常有腹瀉現象,在方內加砂仁、蒼朮健胃燥濕之品可防腹瀉。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">僵直性脊椎炎是種遺傳決定性疾病,中醫認為本病之患者皆為素體虛弱,稟賦不足,腎氣不充,本案患者之母親也罹患類風性關節炎,應有相關。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">本案的治療過程中有幾點可資以檢討的地方:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt 46.5pt; mso-line-height-rule: exactly; mso-list: l1 level1 lfo1; tab-stops: list 46.5pt; text-align: justify; text-indent: -15.75pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-size: 15pt; mso-bidi-font-family: 細明體; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;"><span style="font-family: 細明體;">1.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">患者到公立醫院就診,醫院因決策(或政策)關係,藥局只準備科學中藥,又有藥品品項不能太多以利庫存便於管理之規定,因此開方時常有無藥可用之憾,又健保局給付規定,每日給藥限新台幣<span lang="EN-US">30</span>元內給付,價較高的藥雖屬疾病必須使用,但患者卻因給付受限而無福享用。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt 46.5pt; mso-line-height-rule: exactly; mso-list: l1 level1 lfo1; tab-stops: list 46.5pt; text-align: justify; text-indent: -15.75pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-size: 15pt; mso-bidi-font-family: 細明體; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;"><span style="font-family: 細明體;">2.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">公立醫院藥皆是聯標進藥,低價者得標,因此造成想維持藥品品質的藥廠無法得標,而得標者因交貨藥價太低,而有降低藥品濃度交貨之事,(曾有某家藥廠以定價<span lang="EN-US">2.5</span>折之折扣搶標,真不知到所交藥品是什麼樣的品質),因此常覺得為何在公立醫院診病開藥,每日服用劑量越開越大仍達不到治病效果之憾,相信這是許多服務於公家醫院同道的共同心聲。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt 46.5pt; mso-line-height-rule: exactly; mso-list: l1 level1 lfo1; tab-stops: list 46.5pt; text-align: justify; text-indent: -15.75pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-size: 15pt; mso-bidi-font-family: 細明體; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;"><span style="font-family: 細明體;">3.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">有許多疑難雜症,處方科學中藥服之無效,改用飲片煎劑效果立現,而健保局卻規定健保患者給藥只用科學中藥,而且限每日藥價<span lang="EN-US">30</span>塊錢內開藥,所治之病難免受限,難怪中醫界健保給付佔整體健保給付不到<span lang="EN-US">4</span>%(還要扣除相當大量按摩院經營方法的傷科給付),真是情何以堪。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt 46.5pt; mso-line-height-rule: exactly; mso-list: l1 level1 lfo1; tab-stops: list 46.5pt; text-align: justify; text-indent: -15.75pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-size: 15pt; mso-bidi-font-family: 細明體; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;"><span style="font-family: 細明體;">4.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">本病患者雖未治癒,但每星期二帖煎劑可維持相當好的生活品質,總比長期服用類固醇造成庫欣氏症候群或骨質疏鬆及骨壞死來得理想。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><b style="mso-bidi-font-weight: normal;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">二、罹患僵直性脊椎炎的大陸台商<span lang="EN-US"></span></span></span></b></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">個案姓張,男性,<span lang="EN-US">45</span>歲,在大陸廣東經營工廠,幾乎每兩個月就會返台一趟,約二十年的僵直性脊椎炎的老病號,背微駝,頸腰背僵硬,脊椎常感疼痛,尤其早晨睡醒或長久時間休息後僵硬感讓患者覺得對自己的身體無法掌握而對人生感到失望,宿有高血壓,脈弦有力,口乾舌燥,治以滋補腎陰、平肝潛腸、通絡止痛,方如下:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">熟地<span lang="EN-US">4</span>、生地<span lang="EN-US">4</span>、山茱萸<span lang="EN-US">4</span>、懷山藥<span lang="EN-US">4</span>、龜板膠<span lang="EN-US">6</span>、炒杜仲<span lang="EN-US">5</span>、寄生<span lang="EN-US">10</span>、懷牛膝<span lang="EN-US">10</span>、當歸<span lang="EN-US">5</span>、山甲<span lang="EN-US">5</span>、枸杞子<span lang="EN-US">5</span>、菟絲子<span lang="EN-US">6</span>、蘄蛇<span lang="EN-US">5</span>、川天麻<span lang="EN-US">5</span>、雙鉤藤<span lang="EN-US">10</span>、乳香<span lang="EN-US">3</span>、沒藥<span lang="EN-US">3</span>、地龍乾<span lang="EN-US">3</span>、雞血藤<span lang="EN-US">10</span>、(劑量單位:錢)藥用<span lang="EN-US">9</span>碗水熬成<span lang="EN-US">2</span>碗半,分<span lang="EN-US">3</span>次服用,一天一劑。由於患者兩三天內要返回大陸,給藥<span lang="EN-US">15</span>帖,其實,處方之時患者曾和我商量,由於長期兩岸往返,熬藥帶藥並不方便,要我處方藥粉較為理想,經我解釋,僵直性脊椎炎服用煎劑療效較為確定,才欣然接受。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 21.6pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">約兩月後,<personname productid="張" w:st="on">張</personname>先生又出現診所再診,訴說服藥效果不錯,僵硬、疼痛皆有緩解,但服藥後有腹脹泄瀉的困擾,方有效,守方不改,只加蒼朮<span lang="EN-US">4</span>、砂仁<span lang="EN-US">2</span>、以解決藥後腹脹、泄瀉,並建議熬藥時改用<span lang="EN-US">8</span>碗水,<span lang="EN-US">1</span>碗白酒煎服,<personname productid="張" w:st="on">張</personname>先生此次帶了<span lang="EN-US">30</span>帖藥回有大陸。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 21.6pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">大約再過了<span lang="EN-US">3</span>、<span lang="EN-US">4</span>個月後,<personname productid="張" w:st="on">張</personname>先生再診,詢問病況,脊椎除了僵硬仍有外,疼痛已無,血壓也平穩了。幾次的診療,醫生和患者較無陌生之感,<personname productid="張" w:st="on">張</personname>先生極為健談,他告我很多親戚朋友常問,大陸中醫多,中藥材的原產地又出自大陸,為什麼反而看台灣中醫,從台灣帶中藥回大陸呢?其實<personname productid="張" w:st="on">張</personname>先生為了自己的僵直性脊椎炎,真是看遍了兩岸中西名醫,療效未稱滿意,而且大陸的中醫,似乎比台灣的醫師更會吹牛,更是郎中,久病成良醫,閱醫無數,對中藥材的辨識也由外行內行,<personname productid="張" w:st="on">張</personname>先生發覺大陸所用的中藥材等級比台灣所用的差而覺得迷惑。我向患者解釋,大陸等級好的藥材都外銷創匯去了,留在本地所用的以次級品較多,至於醫師的學識及格調,我看兩岸相差不多,郎中兩岸皆有,而且很多,患者只有自求多福了!<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 21.6pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">往<personname productid="後張" w:st="on">後張</personname>先生每三個月左右都會到診所門診,或帶<span lang="EN-US">15</span>帖,或帶<span lang="EN-US">30</span>帖藥到大陸服用,病況一直保持穩定,疼痛在變天或較為勞累時微有,脊椎也漸致柔軟。治療至此,雖不能說已全部痊癒,但<personname productid="張" w:st="on">張</personname>先生已非常滿意此種結果。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 21.6pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-indent: 30.75pt; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">本案也有值得檢討的地方:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 21.6pt; margin: 0cm 0cm 0pt 46.5pt; mso-line-height-rule: exactly; mso-list: l0 level1 lfo2; tab-stops: list 46.5pt; text-align: justify; text-indent: -15.75pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-size: 15pt; mso-bidi-font-family: 細明體; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;"><span style="font-family: 細明體;">1.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">台灣患者喜歡組團到彼岸就診,但不一定有滿意的療效,畢竟,兩岸分治已久,人民的就醫習慣,營養程度、運氣醫學、皆有不同,大<personname productid="陸" w:st="on">陸</personname>醫師要了解台灣人的體質可能還要花較長的時間去摸索、適應。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 21.6pt; margin: 0cm 0cm 0pt 46.5pt; mso-line-height-rule: exactly; mso-list: l0 level1 lfo2; tab-stops: list 46.5pt; text-align: justify; text-indent: -15.75pt; text-justify: inter-ideograph;"><span lang="EN-US" style="font-size: 15pt; mso-bidi-font-family: 細明體; mso-bidi-font-size: 10.0pt;"><span style="mso-list: Ignore;"><span style="font-family: 細明體;">2.</span><span style="font-family: "Times New Roman";"> </span></span></span><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">台灣中醫界有很多同道非常崇拜彼岸,視彼岸中醫為源頭,對自己一點自信心都沒有,又喜分幫結派,什麼中醫系派,後中醫系派、特考派,部分中醫醫學會及醫院更擁派自重,有些同道更有「齊人驕其妻妾」的行徑,想來實在有「無聊之極」的感受。<span lang="EN-US"></span></span></span></div><span lang="EN-US" style="font-family: Schoolbook; font-size: 15pt; letter-spacing: 0.3pt; mso-ansi-language: EN-US; mso-bidi-font-family: "Times New Roman"; mso-bidi-font-size: 10.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: 華康楷書體注音; mso-fareast-language: ZH-TW;"><br clear="all" style="mso-special-character: line-break; page-break-before: always;" /></span>採藥言師http://www.blogger.com/profile/15068585574518231539noreply@blogger.com7tag:blogger.com,1999:blog-4122422685716314286.post-28041444071876136302011-02-24T05:24:00.000-08:002011-02-24T05:24:24.211-08:00由病歷探討局方牛黃清心丸的臨床應用<div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">牛黃清心丸的組成應以《太平惠民和劑局方》原汁原味最為有效,坊間大路、香港、台灣藥廠所出之牛黃清心丸已失原味,實在可惜,牛黃清心丸原方組成是這樣的:</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">牛黃一兩二錢研、麝香研、羚羊角末、龍腦研各<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="1" tcsc="1" unitname="兩" w:st="on">一兩</chmetcnv>、當歸去蘆頭、防風去苗叉枝、黃芩、白朮、麥門冬去心、白芍藥各一兩半、柴胡去苗、白茯苓去皮、桔梗、杏仁去皮尖并炒黃雙仁者麩別研、芎藭各一兩二錢半、肉桂去粗皮不見火、阿膠碎炒、大豆卷碎炒各一兩七錢半、蒲黃炒、神麴研炒、人參去蘆各二兩半、雄黃八錢飛研、甘草剉炒<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="5" tcsc="1" unitname="兩" w:st="on">五兩</chmetcnv>、白歛、乾薑各七錢半、犀角末二兩(可用廣角代)、金箔一千二百片內百片片為衣、大棗一百枚蒸熟去皮核研亂成膏、乾山藥<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="7" tcsc="1" unitname="兩" w:st="on">七兩</chmetcnv>。以上除棗、杏仁、金箔三味,及牛黃、麝香、雄黃、龍腦四味外為細末,入餘藥。勻煉蜜與棗膏為圓每兩作一十圓,用金箔為衣。(犀牛角已保育,可以廣角代之)</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">每服一丸,溫水化下,食後服,小兒驚癇,即酌度多少,以竹葉湯溫化下。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">其實局方牛黃清心丸為《金匱要略》薯蕷丸的加味方,牛黃清心丸由</span><span lang="EN-US">29</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">味藥組成,薯蕷丸有</span><span lang="EN-US">20</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">味藥,薯蕷丸方出自血庳虛勞病脈證并治篇,主治虛勞諸不足,風氣百疾。全方由</span> <span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">薯蕷</span><span lang="EN-US">30</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、當歸、桂枝、麴、乾地黃、豆黃卷各</span><span lang="EN-US">10</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、甘草</span><span lang="EN-US">28</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、人參</span><span lang="EN-US">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、芎藭、芍藥、白朮、麥門冬、杏仁各</span><span lang="EN-US">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、柴胡、桔梗、茯苓各</span><span lang="EN-US">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、阿膠</span><span lang="EN-US">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、乾薑</span><span lang="EN-US">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、白斂</span><span lang="EN-US">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、防風</span><span lang="EN-US">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">分、大棗百枚為膏。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">由此可知,局方牛黃清心丸是可以久服的一味方藥,只可惜成本太高,雖然療效極佳,終非平民化藥品。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">翻開《太平惠民和劑局方》<span style="mso-bidi-font-weight: bold;">牛黃清心丸原方主治如此敘述<b>:</b></span>治諸風瘓瘲不隨,語言蹇澀,心忪健忘,恍忽去來,頭目眩冒,胃中煩鬱,痰涎壅塞,精神昏憒。又治心氣不足,神志不定,驚恐怕怖,悲憂慘戚,虛煩少睡,喜怒無時,或發狂昏亂。<span style="mso-bidi-font-weight: bold;">用現代藥理學解釋:牛黃清心丸</span>主要有鎮靜,鎮驚,降溫、解熱、抗高溫,提高缺氧耐力,降血壓作用。適應用在心腦血管及精神疾病的治療。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">請注意:大路陸中醫教科書方劑學也有牛黃清心丸,書中的</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">牛黃清心丸方出《痘疹世醫心法》,《痘疹世醫心法》之牛黃清心丸和局方牛黃清心丸雖都名為「牛黃清心丸」,但是組成及藥理不同,使用時應與之區別,</span> <span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">《痘疹世醫心法》之牛黃清心丸又稱萬氏牛黃清心丸,<span style="mso-bidi-font-weight: bold;">其組成為<b>:</b></span></span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">黃連5錢 黃芩3錢 山梔仁3錢 鬱金2錢 辰砂1錢5分 牛黃2分半</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">研細末,臘雪調麵糊為丸,如黍米大,每服7、8丸,燈心湯下。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">市售牛黃清心丸品牌很多,要注意,此為生死救急之藥,應以《太平惠民和劑局方》之藥物組成方或組成最接近原方者為最佳。如能自己按</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">《太平惠民和劑局方》原汁原味自治,那是最理想不夠了。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">局方牛黃清心丸使用注意:</span><span lang="EN-US"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">◇只能用於邪氣實而見口噤,兩手握固,脈象有力之實證,不能用於汗出肢冷,氣微遺尿,口開目合之脫證。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">◇陽明腑實不宜使用開竅劑,即使兼有邪陷心包,亦應根據病情,或服開竅,或二者合併。</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">◇只可暫用,中病即止,不可久服。</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"> </span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">◇孕婦忌用。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">◇如用於冠心病久服,需配合補養藥。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.0; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">◎</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">但是,本人的經驗,臨床應用上並非神昏竅閉時才能使用開竅藥,對症的急性病症也可辨證用之。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18pt;"><span lang="EN-US" style="font-family: Wingdings; mso-bidi-font-family: Wingdings; mso-bidi-font-weight: bold; mso-fareast-font-family: Wingdings;"><span style="mso-list: Ignore;">n<span style="font: 7pt "Times New Roman";"> </span></span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">我的臨床經驗,局方牛黃清心丸臨床上常用於腦血管意外、腦震盪、腦局方牛黃清心丸臨床上常用於腦血管意外、腦震盪、腦炎及腦膜炎、肝昏迷等有中樞神經症狀者,另心絞痛、心肌梗塞、心律不整亦可用之,惡性高血壓、焦慮、失眠如狂者、重症健忘、精神分裂症、躁鬱症躁症發作、復發性口瘡、頑固性嘔逆,皆有良效。尚可用於視神經炎、視神經萎縮、突發性耳聾及血管炎急性期。及腦膜炎、肝昏迷等有中樞神經症狀者,另心絞痛、心肌梗塞、心律不整亦可用之,惡性高血壓、焦慮、失眠如狂者、重症健忘、精神分裂症、躁鬱症躁症發作、復發性口瘡、頑固性嘔逆,皆有良效。尚可用於視神經炎、視神經萎縮、突發性耳聾及血管炎急性期。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">我曾經在</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2009</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">國際中醫學輔助醫學學術研討會及</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2010</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">國際精神醫學論壇報告從實際應用局方牛黃清心丸治療神經及經神疾病的案例,也在國內多場演講報告局方牛黃清心丸的臨床經驗,希望讓中醫界知道,中醫也能治急症及重症。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">局方牛黃清心丸驗案:</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">1</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:精神分裂的女孩</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">一位</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">24</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲的妙齡少女,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年前被精神科診斷為青春型精神分裂,平日有明顯的精神分裂人格,月經常多月未行,由同行某醫師介紹來診,初診時月經已</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">月未行,乳房脹痛手不能觸,精神亢奮,整夜不睡,狂亂多語,幻聽幻視,口乾欲飲冰水,大便祕結,多日未下,脈弦滑有力,舌紅苔黃滑膩,</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">《內經》:“諸躁狂越,皆屬於火”</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">,…“重陽則狂”</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">,又加上月經多月未行,下焦蓄血,瘀熱相結,上擾心神,故狂亂更甚,開方如下:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桃仁泥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">4</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桂枝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">酒大黃</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">炙甘草</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">芒硝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢(沖服)</span><span style="mso-bidi-font-weight: bold;"> <span lang="EN-US"></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 5.0; text-indent: 60pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">局方牛黃清心丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">丸(配服)</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">給藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">劑,以桃核承氣湯破血下瘀瀉熱,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">用局方牛黃清心丸清熱解毒,豁痰開竅。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日後再診,病人坐在候診室候診時,已能默默靜候,其母云服藥第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天,月經來潮,狂亂亢奮之狀大減,整個人萎頓臥床,熟睡一天一夜方醒,還喊肚餓吃了一大晚外面買來的廣東粥,瘀熱已解,火勢大衰,改處方科學中藥:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桃核承氣湯</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="15" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">15</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span lang="EN-US" style="mso-bidi-font-weight: bold;"> 3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">×</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">7/PC</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">礞石滾痰丸</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="3" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">睡前服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">針刺十三鬼穴。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">並囑以後兩天針次一次。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">礞石滾痰丸《泰定養生主論》的組成為:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">大黃(酒蒸)</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">片黃芩(酒洗淨)各</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="8" tcsc="0" unitname="兩" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">8</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">兩</span></chmetcnv><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">礞石</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1" tcsc="0" unitname="兩" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">兩</span></chmetcnv><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">(捶碎,同燄硝</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1" tcsc="0" unitname="兩" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">兩</span></chmetcnv><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">,投入小砂罐內蓋之,鐵線縛定,鹽泥固濟,晒乾,火煅紅,候冷取出)</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">沉香半兩</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">上為細末,水丸如梧桐子大,每服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">4</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">、</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">50</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">丸,量虛實加減服,清茶、溫水送下,臨臥食後服。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">礞石滾痰丸能瀉火逐痰,主治實熱老痰之證。《泰定養生論》說道此丸能治:“痰證,變生千般怪證,”癲狂驚悸,因痰火上蒙而生,用礞石滾痰丸瀉火逐痰,即為此義。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">要特別注意滾痰丸服法:</span><span lang="EN-US"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">《泰定養生論》的著者王珪交代了礞石滾痰丸的服藥法及服藥後可能的反應:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">“大抵服藥,必須臨睡就床,用熱水一口許,只送過咽,即便仰臥,令藥在咽膈間徐徐而下。如日間病出不測,疼不可忍,乾嘔惡心,必予除差者,須是一依臨睡服法,多半日不可飲食湯水,及不可起身坐行言語,直候藥丸除逐上焦痰滯惡物,過膈入腹,然後動作,方能中病。每次須連進兩夜,先夜所服,次日痰物既下三五次者,次夜減十丸;下一兩次者,仍服前數。下五七次,或只二三次,而病勢頓已者,次夜減二十丸。頭夜所服,並不下惡物者,次夜加十丸。壯人病實者,多至百丸。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">大抵服罷仰臥,咽喉稠涎壅塞不利者,乃痰氣泛上,藥物相攻之故也。少傾藥力既勝,自然寧貼。大抵次早先去大便一次,其餘遍次,皆是痰涕惡物,亦有看是溏糞,用水攪之,盡係痰片黏涎。或百中有一稍稍腹疼,腰腎拘急者,蓋有一個頑痰惡物滯殢,閉氣滑腸,裏急後重,狀如痢疾,片餉即已。此藥並不洞泄刮腸大泄,但能取痰積惡物,自胃腸次第穿鑿而下,腹中糟粕,並不相傷。”(《泰定養生主論‧痰論》)</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">泰定養生主論一書,世少傳本,轉載其方者,都略其服法。一般醫者,於服法亦未盡悉。服後,患者竟腹痛便泄。及詳其服法,依法服之,患者不僅腹不痛,即多年頑固之便秘,亦從此通暢無阻。可知王氏經驗,洵不我欺。</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"></span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><strong>十三鬼穴由以下十三穴組成</strong></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">百邪所病者,針有十三穴也:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">人中(鬼宮)、少商(鬼信)、隱白(鬼壘)、大陵(鬼心)、申脈(鬼路)、風府(鬼枕)、頰車(鬼床)、承漿(鬼市)、勞宮(鬼窟)、上星(鬼堂)、男會陰、女玉門(鬼藏)、曲池(鬼腿)、海泉(鬼封);舊說精神疾患是由鬼崇所致,故名鬼穴。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><b><span lang="EN-US"><span style="mso-spacerun: yes;"> </span></span></b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">※古書用十三鬼穴時曲池用火針,海泉(放血),我用此針法,皆下針後馬上出針,既不放血也不用火針,只是每個穴道的針感都非常強烈,用在這類病患,還需家屬從旁幫忙穩住病患才能順利下針。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">診:情志安定,門診時羞澀微笑,脈仍弦滑有力,舌紅苔白,但舌苔黃黏膩之象已無,排便通暢,仍開方:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桃核承氣湯</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="12" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">12</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">×</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">7/PC<span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">礞石滾痰丸</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="2" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span lang="EN-US" style="mso-bidi-font-weight: bold;">/</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">睡前臥服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">針刺</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">勞宮</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">少府</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">行間</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">人中</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">上脘</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">大鐘</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">豐隆</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">太衝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">配合針能刺有平肝瀉火,清心豁痰之功。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">以後</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個月同方續服,並一星期</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次針刺,大底前組輸穴處方及十三鬼穴輪流針刺,精神狀況持續改善,據其母云已能自行出門參觀郵展矣。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">由於症狀穩定,痰瘀熱結已退,改方科學中藥加味溫膽湯加琥珀以善其後。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">溫膽湯</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="10" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">10</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">遠志</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">西洋參</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生地黃</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">酸棗仁</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">琥珀</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="2" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span lang="EN-US" style="mso-bidi-font-weight: bold;"> /</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">服。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">此女從狂亂神志不清,到神志清明,除了初發病曾赴台×醫院精神科求診,並取得青春型精神分裂診斷外,從未服用西藥,一直以中醫藥及針刺治療,當狂亂亢奮之時,局方牛黃清心丸取得關鍵性的速效,也取得病患家屬的信任,才得以繼續使用中醫療法治療而取得滿意的療效。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><br />
</div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">2</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:躁鬱症躁症發作:</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">病患:女性,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">43</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲,未婚,為某大學副教授,父母健在,父親從事醫療器材生意,個案子除學校的授課及必要的教學研究外,也幫忙經營家族事業,</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">該病患有兩位哥哥,多年前在不同時間自殺身亡,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年前個案結束了一段經營</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> 5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">、</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年的感情後,開始出現躁鬱症的病情,第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次躁症發作出現亢奮、多日不眠、幻聽幻視、被神明附身現象,剛發病時,被認為「衝煞」而尋求不同宗教的幫忙未獲療效,後住院精神科治療才緩解出院,出院後後就一直服用精神科所處方的藥物。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">此次會前來門診是因為個案到新店刷卡同時預訂</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">10</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">間別墅,父、母親發覺不對勁,又觀察個案已有數天不太睡眠,整晚狂打電話親朋好有友因之困擾與困惑。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">初診時覺得個案長得還算漂亮,可是太瘦了(由此可知個案沒有遵循醫囑服藥),情緒有亢奮現象,應答講話節奏快,聲音洪亮,無病識感,脈滑有力,舌紅苔黃膩,此為肝鬱痰火,上擾神明,以至神魂失調,開方局方牛黃清心丸每日</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">丸/</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">分,早晚溫開水送服。用以清熱豁痰,醒腦安神。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日後再診,亢奮之勢已減,晚上睡眠改善,舌苔黃膩轉白微黃膩,痰火稍減。改方黃連溫膽湯加味配服礞石滾痰</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日與服:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">半夏 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 陳皮 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 茯苓 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 竹茹 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 甘草 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢半 枳實 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 黃連 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 遠志筒 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 鬱金 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 天竺黃 </span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢 紅棗</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">枚</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">礞石滾痰丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢(臨睡前臥服)</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">溫膽湯用於本證,恐清火之力不足,故加黃連清火,菖蒲、遠志、鬱金養心安神,袪痰開竅,天竺黃清熱化痰去內鬱之火。配服礞石滾痰丸以強化清熱豁痰之用。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">診:神情安定,改方加味溫膽湯和甘麥大棗湯合方繼續調養,其間如遇有躁症將要發作的現象,改服局方牛黃清心丸或礞石滾痰丸都能緩解病情。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">3</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:腦血管意外又有躁鬱症的病患</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">65</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲,女性,住台北縣金山鄉,宿有躁鬱症及高血壓病史,長期服西藥,因無病識感又常常有未服藥之空窗期,屢次因躁症發作亢奮狂亂不眠才被家人送院治療,個案因而成為全家人的困擾及負擔。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">初診:</span><span lang="EN-US"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">初診時正值慕雲春樹,鳥雨花香的春季,但在亞熱代的台灣卻以薰風拂面,頗有夏意,個案由其兒子與女兒攙扶前來門診,主訴今天剛出院,3星期前腦梗塞中風,左半身偏癱無力,在某醫院入院診治,個案住院期間精神一直處於亢奮狀態,對自己中風的病情不是很擔憂,整晚不眠,不停語言,主治醫師除中風用藥外,也開鎮靜劑使個案安靜睡眠以利病情恢復。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">初診所診所見及處方:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">BP154/96</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">,脈弦滑有力,舌紅苔滑膩,大便祕結,精神亢奮,喋喋不休,口渴引飲,毫無中風後之體倦乏力,但會愁訴頭暈頭痛,此時需要解決的有兩個病機:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><b><span lang="EN-US">1.</span></b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案平素肝腎陰虛,痰熱內蘊,因風陽內動,氣逆鬱於血分,著於腦絡,則腦梗塞生焉。,此時應育陰潛陽,鎮肝息風,滌痰通絡。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><b><span lang="EN-US">2.</span></b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">躁鬱症譟症發作,此時火邪作祟,臟火燔灼,躁擾躁動,煩熱擾亂而不寧,應與清熱豁痰開竅。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">處方鎮肝息風湯加減,配服局方牛黃清心丸。給藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日份,方如下,因個案畏針,故不予針刺治療,囑其配合西醫復健。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">處方如下:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">懷牛膝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">代赭石</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生龍骨</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生牡蠣</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">龜板</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">赤芍</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天門冬</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">玄參</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">綿茵陳</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">川楝子</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生麥芽</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生甘草</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">分</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">西紅花</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天麻</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">鉤藤</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1" tcsc="0" unitname="兩" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">兩</span></chmetcnv><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">(後下煎</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">20</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">分鐘)</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">局方牛黃清心丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒配服。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">處方之義鎮肝熄風湯加減用以鎮肝熄風,滌痰通絡,而局方牛黃清心丸用來清熱豁痰,滌痰開竅之用。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">診:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">此次由兩位女兒陪診,個案自訴服藥後眩暈頭痛改善,會覺得疲勞,晚上能睡眠,兩位女兒也說母親情緒安定多了,話也少了,不會再喋喋不休,大便通暢,脈仍弦滑有力,舌質仍紅,苔黃膩已較為薄化,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">BP138/91</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">,效不更方,仍用鎮肝息風湯加減,局方牛黃清心丸減為每日</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒於睡前</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">小時前服用,給藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">為何局方牛黃清心丸減量為</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒,由於局方牛黃清心丸價格昂貴,考慮家屬的負單,故為之減量。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天個案家屬來電話,告訴個案每日只服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒局方牛黃清心丸藥力不夠,睡前服丸劑仍可安眠,但早上醒來又訴說頭痛,煩躁而坐立不安,吵著非要再服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒牛黃清心丸不可,家屬只好予服,服後不久頭痛止,也不煩躁不安了,問我怎麼辦?</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">顯然個案仍處於重陽則狂,臟火燔灼的病象,建議家屬仍然早晚各服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒局方牛黃清心丸,丸劑數量不夠請家屬再來診所補足。也由此可見局方牛黃清心丸對躁鬱症躁症發作是有顯著的效果。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">診:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案自訴:晚上能睡,但早醒,已不眩暈頭痛,左手腳較為有力,情緒安定,脈弦滑,洪大之勢已減,舌紅,苔黃膩之象更薄,煎劑不更方,丸劑改為早服礞石滾痰丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢,睡前</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">小時服局方牛黃清心丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">躁鬱症為痰火上擾清竅則發為癲狂之症,個案病實,礞石滾痰丸用以瀉火逐痰之用。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案連續服用</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">診之處方</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個月,中風復健也持續在當地醫院復健科配合治療,神情安定正常,手腳偏癱無力改善,能自行洗澡,自己</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個人出外不用家屬陪同照顧。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">改方科學中藥:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天麻鉤藤飲</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="10" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">10</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">黃連溫膽湯</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="8" tcsc="0" unitname="克" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">8</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">克</span></chmetcnv><span lang="EN-US" style="mso-bidi-font-weight: bold;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">每日配服大活絡丹</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">處方之義:</span></b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天麻鉤藤飲用以平肝息風,清熱活血,調補肝腎;黃連溫膽湯去臟腑痰熱;大活絡丹能袪風活絡,此方藥性溫和,除邪而不傷正,作為中風偏癱善後調養之藥頗為恰當。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">*</span></b><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案直至目前仍陸續服用以上之處方已有</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個月,曾有</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次又有躁症發作現象,再服局方牛黃清心丸都能緩解病情。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">4</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:嚴重焦慮連續</span></b><b><span lang="EN-US" style="font-size: 14pt;">5</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">天不眠如狂</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案為女性,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">53</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲,公務員,晚婚,丈夫有離婚</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次之婚姻史,所以個案為其丈夫之第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">任妻子,結婚後個案對婚姻沒有安全感,所以極為努力去經營婚姻,個案之丈夫個性較為爆躁,因此夫妻常有磨擦,皆因個案的隱忍而無太大的衝突。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天前因為意見不合遭受丈夫嚴重的語言暴力,因個案覺得有離婚的威脅而忿怒及惶恐,已有</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天無法入眠,精神有即將崩潰之感。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">初診:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案精神有點恍忽,敘說婚姻的期望及這幾天的衝突過程,眼淚直掉,看得出傷心憤怒與恐慌,頭暈頭痛,極為焦慮煩躁,脈弦,舌質較紅,苔黃,一派痰火壅盛扔擾亂心神之狀,處方局方牛黃清心丸以鎮心滌痰,鎮靜安神,每日於早上及睡前</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">小時各服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒。給藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日份。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日後再診:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">已能睡眠,心情較為平靜,思維較為清楚,能用理智分析所發生的事情過程,處方局方牛黃清心丸日</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒,睡前</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">小時服。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 1.0; mso-para-margin-left: 3.0gd; text-indent: 12pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">※以後因其他病情來診,個案自訴,當婚姻發生風暴之時,心煩意亂,似要發狂,局方牛黃清心丸能安定個案心神,讓個案度過精神的黑暗期。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">5</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:高血壓飆高不降頭痛欲裂</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案男性,為退休的教育人員,之前擔任小學教師,高血壓病史將近</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">30</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年,由於個案的父親及</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">位兄長都因腦血管意外而死亡,因此生活作息及飲食都極為小心,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">20</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">多年來一直服用西藥降血壓藥而不敢稍有間斷,也因身體健康問題只要台北有中醫課程皆會報名上課,希望從中醫藥上得到健康的幫助。也因為此種原因上了不少我在台北市中醫師公會所開的課程。也開始嘗試服用中藥,個案平素體壯實,夜臥艱寐,常口咽乾燥,脈弦有力。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">記得兩年前的一個傍晚正在門診,接到個案打來的電話,語氣十分惶恐,個案因血壓飆高到</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">BP220/135</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">,頭痛欲裂,從中午就到××醫院急診室,經過</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個多小時的及診處置,血壓一直降不下來,擔心自以就要中風了!怎麼辦?想了一下,請診所人員送</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒局方牛黃清心丸到醫院去,囑個案兩小時服用</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天個案來診,敘述服下</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒丸藥,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">分中後頭就不痛了,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">6</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">小時後服了第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒,神清氣爽,血壓正常而出院了。診其脈仍弦而滑,舌紅苔微黃膩,肝陽偏亢,給藥天麻鉤藤飲加味</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">劑,用以平肝息風,清熱活血安神:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">鉤藤</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">8</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢(後下)</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天麻</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生石決</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">8</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">山梔子</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">黃芩</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">懷牛膝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">8</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">炒杜仲</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桑寄生</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">益母草</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">夜交藤</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">4</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">茯神</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生白芍</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生牡蠣</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">川楝子</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">紅麴</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢半(沖服)</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">用方之義以天麻鉤藤飲平肝熄風,清熱活血,並補益肝腎之陰以制肝陽之偏亢,由於牛膝善引上部之血下行,故重用之;加白芍滋陰柔肝,牡蠣善平肝潛陽,加之共助斂火以熄風;川楝子善引肝氣下達,條達肝氣之鬱滯;紅麴能化血管之痰瘀也。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日後再診,每夜皆好眠,血壓穩定正常,改開科學中藥:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天麻鉤藤飲</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> <chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="12" tcsc="0" unitname="克" w:st="on">12<span lang="EN-US" style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span lang="EN-US">克</span></span></chmetcnv></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">紅</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">麴</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="4" tcsc="0" unitname="克" w:st="on">4<span lang="EN-US" style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span lang="EN-US">克</span></span></chmetcnv> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日分</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">/</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">日</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">/PC</span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">用以治療兼調養,個案還自行準備局方牛黃清心丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">打在家以備不時之需。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">6</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:暫時性腦缺血(</span></b><b><span lang="EN-US" style="font-size: 14pt;">TIA</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">)</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案為</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">65</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲的家庭主婦,體態豐腴,宿有高血壓病史,在一個嚴冬的早晨正準備出門晨運時,忽然間右半身麻木不能動,由子女急送到××醫院急診,經過檢察診斷為暫時性腦血管意外,但從早上</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">8</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">點到</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">10</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">點左右半身麻木尚未緩解,由於個案的女兒是我的熟病人,××醫院又在我的診所附近,被邀請出診,往診中風病患我習慣性會隨身攜帶局方牛黃清心丸,到急診室時見到個案尚能語言,吞嚥能力正常,馬上給藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒吞服,大約</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">15</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">分鐘後麻木之手腳就恢復正常了,藥效之迅速令人嘆為觀止。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">短暫腦缺血發作的特點是瞬息症狀發作,常為某種神經功能的突然缺失,症狀不會從身體一處擴散至另一處,病程不呈“進行”。症狀歷時短暫,數分鐘或數小時(一般不超過</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">24</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">小時)內逐漸恢復而不後遺重要功能缺損。絕大多數並無意識障礙。患者常呈反覆發作,多則每日數次,少則數月或數年才發作一次或一陣。反覆復作的臨床表現大同小異。局灶性腦功能缺失症狀常按一定的血管支配。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">暫時性腦缺血不論是一次或多次,均應視為可能發生中風的訊號,並做詳細的檢查及必要的持續性治療。根據一些追蹤此症自然史的研究報告顯示:約有三分之一的患者在五年內發生腦梗塞(完全性中風);身為一位醫生,須記住前述之“完全性中風”通常在暫時性腦缺血後六個月內發生,所以對此症病人須特別注意。平常身邊可帶上</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒牛黃清心丸以便救急之用。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">7</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:腦梗塞</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案男性,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">56</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲,在台南縣鄉下小鎮經營雜貨店,妻子在</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年前因病死亡,但最近新交一位小十餘歲的女朋友並同居在一起,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個月前腦血管意外(梗塞性)被送往台南市××醫院急診,出院後右半身偏癱,右下肢尤其軟弱無力,生活無法自理,由於惟一的獨生子在台北市上班,因此將個案接到台北市就近照顧,經朋有介紹前來診治。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">初診時個案由兒子背負進診所,右半身偏癱無力,也無法利用助行器幫忙行動,三餐飲食、大小便、洗澡都要第三者從旁協助,語言應對正常,但語音低微,情緒低落,艱寐,排便不暢,血壓稍高(服西藥降壓藥),脈弦細澀無力,舌質紫淡苔白膩,氣虛血瘀兼有痰濁,處方補陽還五湯加味,配服局方牛黃清心丸:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">生黃耆</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">兩半</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">西紅花</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桃仁泥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">赤芍</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">當歸尾</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">地龍乾</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">雞血藤</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">8</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">烏稍蛇</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桂枝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">懷牛膝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">4</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桑寄生</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">全蠍粉</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">分(沖服)</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">紅麴</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢半(沖服)</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">局方牛黃清心丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">處方之義以補陽還五湯加味益氣活血通絡,牛黃清心丸豁痰開竅,這裡要說明:開竅藥不只可以用在竅閉昏迷,清醒時用之,對腦細胞及血管的發炎有保護及治療作用,教科書認為牛黃清心丸內含香竄,當中病即止,不宜過服、久服,但我的臨床經驗,只要配合補氣藥同服即無妨害,而且持續服用對心、腦血管疾病的療效更佳。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">除服用藥物外,並兩天針刺</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次,以三穴組輪流治療:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">穴組:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">方氏頭皮針伏象、伏臟、倒象、倒臟相應麻痺肢體相應穴位</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">穴組:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">肩禺</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">曲池</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">外關</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">合谷</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">環跳</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">風市</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">陽陵泉</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">懸鐘</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">太衝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">第三穴組:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">彭靜山眼針上焦區</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">下焦區</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">肝區</span><span style="mso-bidi-font-weight: bold;"> </span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">腎區</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">以後每兩天針刺</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次,一星期針刺</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次,補陽還五湯方中黃耆劑量由</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">兩半漸加至</span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="4" tcsc="0" unitname="兩" w:st="on"><span lang="EN-US" style="mso-bidi-font-weight: bold;">4</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">兩</span></chmetcnv><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">,每天仍服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒牛黃清心丸。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個月後手腳有力,生活能自理,高高興興回台南去了!</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">回鄉之前,個案兒子問我能不能繼服丸藥而不服煎劑?於是讓個案帶</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">30</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒牛黃清心丸,並開</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">30</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天科學中藥補陽還五湯和炙甘草湯合方與服。如此每個月回診</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次,連服</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個月停藥。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">大約半年後,個案的兒子因睡眠障礙來診,談到父親近況,說過案仍照顧著雜貨店,右手腳稍為無力,但看不出曾經中風過,和同居人感情好得不得了哩!</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span lang="EN-US" style="font-size: 14pt;">8</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:心律不整</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt; mso-char-indent-count: 2.5; text-indent: 30pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";"> 這是我自己的經驗,有一次因為多場演講不斷的趕稿準備講義,覺得有點心力交 悴, 忽然間心跳快速如擂戰鼓,整個心臟像要彈跳出來一般,急忙含</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">顆局方牛黃清心丸約半分鐘心跳就恢復正常了。以後曾因過勞心悸再發作</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次,一樣,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒牛黃清心丸仍是半分中內恢復正常心跳,療效神速。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">9</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:心律不整</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">用局方牛黃清心丸治心律不整的深刻治驗是一位從事田野文史調察的教授,個案為×博物館的研究員,也在學院兼課,由於對工作的過度投入,2年前常於壓力大又熬夜時引發嚴重心悸,每當心悸發作時會眩暈,並有兩次暈厥的記錄。××醫院診斷為陣發性室上性心博過速,經過治療還時常發作,個案宿有高血壓,脈弦,舌紅苔白,處方天麻鉤藤飲加代赭石、生牡蠣、珍珠母平肝熄風,清熱活血安神,並給局方牛黃清心丸3粒,囑其心悸發作時嚼服。往後個案一直在我的診所調治身體,心悸發作時局方牛黃清心丸都發揮快速的療效。</span><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">10</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:因再生不良性貧血做自體骨髓移植先後引發感染及腦血管出血</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案男性,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">24</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲,因再生不良性貧血在我的診所診治,服了將近</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年的培補脾腎中藥,雖然血象有上升,已不必每星期輸血</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">次,但仍不理想,因此接受××醫院血液腫瘤科安排做自體骨髓移植手術,誰知道,因此而開始了人生最大的生存挑戰;</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">當個案以充滿著希望的心情接受自體骨髓移植,祈望對身體的健康有一勞永逸之效,誰知天不從人願,卻發生巨細胞病毒感染?,出診到××醫院加護病房,看到個案昏迷在床,為升血壓急速輸液而全身腫脹,並用葉克膜維持生命機能,此時舌脈無法了解,和主治醫討論病情後同意配合灌服局方牛黃清心丸,但也擔心灌服後引起嘔吐而影響生機。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">從第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天每日灌食</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒牛黃清心丸直到第</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天終於甦醒,此種感染中醫溫病稱為熱陷心包,痰蒙心竅,吳鞠通治以涼開三寶(安宮牛黃丸、紫雪丹、至寶丹),用來清熱解毒,豁痰開竅,用局方牛黃清心丸亦常有良效。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案甦醒後住在該院無菌病房約</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個半月後出院。以後一直在原醫院進進出出接受治療,記得是出院後半年左右,有一天晚上個案在家中忽然全身無力倒地神識不清,經家人緊急送至同醫院急診,經神經外科醫師診斷腦內血管破裂出血(中醫稱中臟腑),又入加護病房治療及觀察,脈滑有力,舌紅苔黃膩,經主治醫師同意再日服局方牛黃清心丸每日</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒,經過</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">12</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">天又甦省。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">往後的復健及調治暫且不表,這個醫案要表達的是,同一個個案,不管熱陷心包,或腦中風中臟腑,發生神昏竅閉而昏迷,牛黃清心丸皆能開竅使之甦醒。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">11</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:腦震盪</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案女性,82歲,體胖,因衰老已臥床3年多,平日行動不便,日常生活及飲食大小便都委由外勞照護,有一日外勞扶起小便時不小心跌倒,頭部撞擊到馬桶,而引起頭痛嘔吐,嗜睡昏沉,有腦震盪現象,由於臥床已久,其子不想送去醫院診治,詢問中醫有無治療方法?我心裡思考個案兒子是不是老人家臥床多年已有「久病無孝子」的心情?但不送醫又怕親朋好友說其不孝的考慮?給與3粒局方牛黃清心丸每6小時服下1粒,3粒丸藥服完頭不痛嘔吐止,老人家發揮生命的韌性又持續臥床3年多才魂歸離恨天而往生。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 28.05pt;"><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">案</span></b><b><span lang="EN-US" style="font-size: 14pt;">12</span></b><b><span style="font-family: 新細明體; font-size: 14pt; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";">:血管炎急性發作</span></b><b><span lang="EN-US" style="font-size: 14pt;"></span></b></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">個案女性,</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">43</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">歲,為台北市××國民小學校長,罹患類風濕性關節炎及血管炎病史將近</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">20</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年之久,體瘦,十指關節已經畸屈變形,全身多處關節疼痛,四肢逆冷,脈弦細,多年來一直在××醫院免疫風濕科某醫師處診治,病情反覆,雖未完全康復但也維持「平盤」狀態,直至某醫師在一次出國墜機身亡才想到是否能以中醫幫助病情?經人介紹前來求診。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">初診時個案病情正處於發炎狀態,多個大小關節腫痛,觸之微熱,屈伸不利,肌膚乾澀暗沉,手足皮下有長條形結節,按之疼痛,脈弦細,舌質較淡,苔薄白,這是痰瘀互結,經脈痺組之證,處方身痛逐瘀湯合四妙勇安湯加減配局方牛黃清心丸:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">當歸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">元參</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">金銀花</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">5</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">懷牛膝</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">桃仁</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">西紅花</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">川芎</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">五靈脂</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">乾地龍</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">沒藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">秦艽</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">羌活</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">獨活</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">甘草</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">製半夏</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">枳殼</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">錢</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">局方牛黃清心丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">1</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">粒(配服)</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">給藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">劑,處方之義為活血化瘀,袪痰通絡,養陰清熱。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">診時諸症改善,效不更方,原方再給</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">7</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">劑。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">診時關節腫痛更為緩解,皮膚條索狀已消,改用科學中藥調養:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"> </span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">右歸丸</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="7" tcsc="0" unitname="克" w:st="on">7<span lang="EN-US" style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span lang="EN-US">克</span></span></chmetcnv></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">身痛逐瘀湯</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="7" tcsc="0" unitname="克" w:st="on">7<span lang="EN-US" style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span lang="EN-US">克</span></span></chmetcnv></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">黃耆</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1.5" tcsc="0" unitname="克" w:st="on">1.5<span lang="EN-US" style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span lang="EN-US">克</span></span></chmetcnv></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">吉林參</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1.5" tcsc="0" unitname="克" w:st="on">1.5<span lang="EN-US" style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span lang="EN-US">克</span></span></chmetcnv></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span></span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">玄參</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"><span style="mso-spacerun: yes;"> </span><chmetcnv hasspace="False" negative="False" numbertype="1" sourcevalue="1.5" tcsc="0" unitname="克" w:st="on">1.5<span lang="EN-US" style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-hansi-font-family: "Times New Roman";"><span lang="EN-US">克</span></span></chmetcnv></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">以後個案緩解期服用科學中藥緩治,發作期則改用煎劑配牛黃清心丸大力蕩滌,如此連治</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">3</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">年症安停藥,但偶有小發作個案都會來診,每次給科學中藥</span><span lang="EN-US" style="mso-bidi-font-weight: bold;">2</span><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">星期就會症狀緩解而安。</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">安宮牛黃丸在《溫病條辨》稱為涼開三寶的急救藥,也有甚多臨床醫師用在急症,我們將局方牛黃清心丸和安宮牛黃丸作比較:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">我們看到甚多治療精神及神經疾病的臨床報告,也有使用安宮牛黃丸者,但我仍然以局方牛黃清心丸為優先考慮,吾人以冉雪峰對兩方的比較作為結論:</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt 36pt; mso-char-indent-count: 2.0; mso-para-margin-left: 3.0gd; text-indent: 24pt;"><span style="font-family: 新細明體; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-weight: bold; mso-hansi-font-family: "Times New Roman";">冉雪峰在《歷代名醫良方注釋》對局方牛黃清心丸與安宮牛黃丸作比較,冉氏認為:“查此方(安宮牛黃丸)除熱解穢,宣竅透絡,亦鎮靜腦神經要方,…彼方(局方牛黃清心丸)只用甘寒鹹寒,不用苦寒,方制頗較優越。…本方(安宮)涼藥較重,…除熱力大也。…溫病深層義蘊,溫邪無形無質,徒攻胃腸無益,徒用苦寒亦無益。三黃除熱,究竟苦寒,邪熱圍蒸,固為適應,瀰漫蒙蔽,非苦寒可了了。邪有虛實,證有聚散,此中分際均不可不細密較量也。”</span><span lang="EN-US" style="mso-bidi-font-weight: bold;"></span></div><div align="left"></div>採藥言師http://www.blogger.com/profile/15068585574518231539noreply@blogger.com3tag:blogger.com,1999:blog-4122422685716314286.post-78972976052991836442011-01-19T18:30:00.000-08:002011-01-19T19:22:46.206-08:00胰臟膿腫治驗一例<div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><div class="separator" style="clear: both; text-align: center;"></div><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> </span></span><br />
<span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 湯××,男性,七十一歲,住桃園縣平鎮鄉平鎮村,七十多天前因頻頻嘔吐,左肋下劇痛連腰背,經台北×醫學中心診斷為急性胰臟炎,治療一個多月後病情轉變為胰臟膿腫,而住院治療,並且禁食。住院四十多天病況未見改善,內科診治醫師考慮放棄內科療法,會診外科計劃手術開刀。由於患者年歲已大,復經四十多天禁食,身體已呈衰象,手術危險性較大,全家人為此而煩惱猶疑。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> <personname productid="湯老" w:st="on">湯老</personname>先生也算和我有緣,就在全家人迷惑不決時,經人介紹請我到<personname productid="湯" w:st="on">湯</personname>先生住院的醫院出診,初診<chsdate day="28" islunardate="False" isrocdate="False" month="9" w:st="on" year="1980"></chsdate>時病人體溫在攝氏三十八、九度上下徘徊,整個人煩躁不安,晚上睡不著覺,左肋下疼痛,脈洪滑數,舌苔黃膩而厚,張口診舌時口臭極重,眼睛滿佈紅絲,久服抗生素引起耳鳴重聽,大便因長時間禁食而記不得有幾日未行了,一副肝胃實熱之象,此時當速清腸胃實熱,兼以疏肝理氣,書方如下:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> </span></span><span style="font-family: 標楷體; font-size: 15pt; mso-bidi-font-size: 10.0pt; mso-hansi-font-family: "Courier New";">柴胡四錢 黃芩三錢 金錢草<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="1" tcsc="1" unitname="兩" w:st="on">一兩</chmetcnv> 綿茵陳五錢 山梔子三錢 連翹三錢 皂刺三錢 鬱金三錢 金銀花<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="1" tcsc="1" unitname="兩" w:st="on">一兩</chmetcnv> 枳實三錢 紫蘇梗三錢 川連三錢 半夏三錢 高良薑三錢 浙貝母三錢 炙鱉甲四錢 炮山甲三錢 生甘草三錢 蒲公英六錢 紫花地丁六錢 板藍根六錢 白菊花四錢。<span lang="EN-US"></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 先給藥二天。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 開方之時,本來想下酒大黃,考慮再三,雖有實熱之象,但患者已四十多天未吃東西,體力已衰,因之棄而不用。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> <chsdate day="30" islunardate="False" isrocdate="False" month="9" w:st="on" year="1980"></chsdate>二診:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 服藥後泄下黑色黏稠之物多次,精神較佳,睡眠改善,左肋下微痛,平均體溫已降為攝氏三十七度多,原方不作加減再服二帖,並囑患者家居準備流質物及粥類,讓患者少量多次慢慢恢復進食</span></span><br />
<span style="font-family: 細明體;"> </span><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;">三診:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 因久臥病床而有小便淋瀝現象,體溫仍維持在攝氏三十七度左右,老先生宿有高血壓,呈不穩定狀態,昨日眩暈頭重,血壓上升至一七○/一一○,已服院方所給之降壓藥,降壓藥服後人極倦怠,大便一天兩次左右,形稀軟,顏色已正常,建議患者專服中藥,可停止點滴施打及服用西藥,患者每天有進食湯粥。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> </span></span><span style="font-family: 標楷體; font-size: 15pt; mso-bidi-font-size: 10.0pt; mso-hansi-font-family: "Courier New";">原方加川天麻三錢、夏枯草四錢、淮牛膝五錢、桑寄生五錢、生石決八錢諸潛陽之品,給藥五帖。<span lang="EN-US"></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> <chsdate day="7" islunardate="False" isrocdate="False" month="10" w:st="on" year="1980"></chsdate>四診:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 脈已濡緩,舌苔黃膩已退而成白微膩苔,左脅肋下微脹,不痛,血壓一四○/八十五。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 三診後曾有一天汗出不止、眩暈之低血糖現象,醫院曾給藥治療。體溫平均攝氏三十七度左右。三診<chsdate day="2" islunardate="False" isrocdate="False" month="10" w:st="on" year="2009"></chsdate>之處方加高麗參三錢,再給藥五天。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 初診後十<chsdate day="8" islunardate="False" isrocdate="False" month="10" w:st="on" year="1980">日</chsdate><personname productid="湯老" w:st="on">湯老</personname>先生的兒子打電話給我,告訴早上超音波診查膿腫已看不出來,但主治醫師又懷疑,胰臟膿腫不可能這樣就消失了,因而不做確定的診斷。白血球稍高,肝功能、胰澱粉酶、<span lang="EN-US">AFP</span>正常。中藥已發揮相當大的效果。至此<personname productid="湯老" w:st="on">湯老</personname>先生放心飲食,連點滴也要求停止施打。由於治療的觀點<personname productid="和主治" w:st="on">和主治</personname>醫師不同而被列為極不合作的病患,但這位<personname productid="和" w:st="on">和</personname>醫師極不配合的患者卻康復得出奇的快速與順利。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 半個月後<chsdate day="15" islunardate="False" isrocdate="False" month="10" w:st="on" year="1980"></chsdate>院方終於確定<personname productid="湯老" w:st="on">湯老</personname>先生的胰臟膿腫已經痊癒了,出院手續辦好後順便到我的診所再診查一下,脈濡緩,舌苔薄白,精神佳,胃納正常,大小便正常,開小柴胡湯加減作病後調理:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> </span></span><span style="font-family: 標楷體; font-size: 15pt; mso-bidi-font-size: 10.0pt; mso-hansi-font-family: "Courier New";">柴胡三錢 半夏三錢 高麗參三錢 生薑三大片 黃芩三錢 紅棗五枚 炙甘草三錢,淮牛膝五錢 夏枯草三錢 桑寄生五錢 川天麻三錢 生石決<chmetcnv hasspace="False" negative="False" numbertype="3" sourcevalue="1" tcsc="1" unitname="兩" w:st="on">一兩</chmetcnv> 雙藤六錢(後下) 川楝子二錢 鬱金二錢,給藥七帖。<span lang="EN-US"></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> <chsdate day="25" islunardate="False" isrocdate="False" month="10" w:st="on" year="1980"></chsdate>六診:<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 一切自覺無病,精神稍差,大小正常,脈濡緩,舌苔薄白,曾自行至桃園×醫院再作檢查,肝功能、血糖、胰澱粉、白血球、<span lang="EN-US">AFP</span>皆正常。<span lang="EN-US"></span></span></span></div><div class="MsoPlainText" style="line-height: 22pt; margin: 0cm 0cm 0pt; mso-line-height-rule: exactly; text-align: justify; text-justify: inter-ideograph;"><span style="font-size: 15pt; mso-bidi-font-size: 10.0pt;"><span style="font-family: 細明體;"> 這個病案在我手中從初診到痊癒,一直沒有機會和醫院的主治醫師溝通,患者接受中醫藥治療後就自行解除禁食治療開始吃東西,對醫院的治療也未配合,患者似乎接受了中西醫的治療,直到痊癒了兩<personname productid="方面的" w:st="on">方面的</personname>醫師卻從未謀面,這個治療過程,值得台灣醫療界深思。<span lang="EN-US"></span></span></span></div><div class="MsoNormal" style="margin: 0cm 0cm 0pt;"><br />
</div>採藥言師http://www.blogger.com/profile/15068585574518231539noreply@blogger.com5tag:blogger.com,1999:blog-4122422685716314286.post-65202596650309646262011-01-11T23:52:00.000-08:002011-01-12T01:29:26.162-08:00醫話部落格啟用 !醫 話 部落格 啟用 <br />
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<div>目錄內容如下 :</div><div></div><div>1.格主人宣言</div><div>2.醫案實記</div><div>3.醫情醫話</div><div></div><div>格主人 : 採藥言師</div>採藥言師http://www.blogger.com/profile/15068585574518231539noreply@blogger.com7