［王阳明心学］9/9/2025

昨日文娟老师私信问我有没有升班的打算，其实内心有些挣扎。近期工作量大增，不仅身体容易感到疲惫，精神上的能量也需要补足。在诊治过程中，我发现自己还有许多不足，需要持续学习与提升，同时也要练习如何以良好的意念去面对病人，让治疗发挥更好的效果。

除了书本学习，我也会参加义诊活动，这常常占用休假的时间。而与父母、朋友的相处，以及独处的时光，我都还没有合理安排。这让我开始认真思考，怎样去分配有限的时间，找到更好的平衡。

王阳明心学让我认识到，学习的关键在于“致良知”与“知行合一”。虽然继续深入学习当然有益，但我觉得自己对其中的初步思考方式已大致理解。老师们也常提醒我们，学习不应成为压力。顺着内心真实的志向，我更清楚目前应该把大部分精力投入在专业的精进与实践上。

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【Pharmacology】Antidepressants

Antidepressants Depression: experience unusually long periods of sadness guilt and decreased interest in activities can occur alone or a part of a larger disorder such as bipolar disorder people with bipolar disorder experience periods of depression alternating with periods of mania in which person feels abnormally optimistic euphoric and energetic Treatment: Antidepressant drugs which work by elevating levels of certain neurotransmitters in the brain led to development of monoamine hypothesis Content: 1. Monoamine hypothesis 2. Five different classes 3. Serotonergic neuron & Noradrenergic neuron 4. Drug a. Selective serotonin reuptake inhibitors (SSRIs) b. Serotonin norepinephrine reuptake inhibitors (SNRIs) c. Tricyclic antidepressants (TCAs) d. Monoamine oxidase inhibitors (MAOIs) e. Atypical antidepressants 5. Lithium 6. Reference 1. Monoamine hypothesis states th...

【方剂学】解表攻里剂--疏凿饮子

解表攻里剂适用于外有表邪，里有实积之证代表方：大柴胡汤防风通圣散 3. 疏凿饮子--泻下逐水，疏风消肿《济生方》组成：商陆、茯苓皮、泽泻、木通、椒目、赤小豆、羌活、秦艽、生姜、大腹皮、槟榔 3a. 组成君：商陆------------------6g 苦寒有毒，其性下行，专于行水，可通利二便臣： a. 茯苓皮------------------15g b. 泽泻------------------12g c. 木通------------------12g d. 椒目------------------9g e. 赤小豆------------------15g 通利小便，渗利在里之水湿君臣相协：导在里之水湿从二便而出佐： a. 羌活------------------去芦（9g）　 b. 秦艽------------------去芦（9g） c. 生姜------------------5片疏风发表，开泄腠理，使在表之水湿从肌肤而散水壅气结，故👇👇 a. 大腹皮------------------15g b. 槟榔------------------9g 下气行水，使气化则湿亦化诸药合用，逐水发表，内攻外散，使壅盛之水湿自上下内外分消，犹如大禹治水，疏江凿河，以利水势，故有“疏凿”之名。【下、消、汗三法相伍，前后分消，表里同治，但主以逐水】遵《素问·汤液醪醴论》“去菀陈莝……开鬼门，洁净府”，《金匮要略》“诸有水者，腰以下肿，当利小便；腰以上肿，当发汗乃愈”等法，治宜疏风发表、泻下逐水，使水湿之邪从上下、表里分消。 3b. 主治阳水：水湿壅盛，泛溢上下、表里的阳水实证遍身水肿：水湿壅盛，泛溢肌肤喘呼气急：水迫于肺，肺气逆而不降烦躁口渴：水壅气结，津液不布二便不利：水壅于里，三焦气机闭阻，腑气不通脉沉实：实证，邪盛气实沉：轻取不应,重按始得。（沉脉显现的部位较正常脉深）病症：里证，为阴脉里实：沉而有力气血内困于里。多因水、寒、积滞所致（寒主收引，水性沉潜，积滞则阳气伏郁）。实：三部脉举按均充实有力，其势来去皆盛，应指愊愊。是一切有力脉的总称病症：见于实证。邪气亢盛而正气不虚，邪正相搏，气血涌盛，脉管内充盈度较高，脉管呈紧张状态,故脉来充实有力。

【TCM diary】跟诊日记：德教会义诊-罗达盛医师（三）

28/4/2025 居銮德教会义诊 - 罗达盛医师 ( 一）脚部糜烂今天接诊了几位脚部溃烂的病人，老师分别处方了二妙散和当归拈痛丸，并建议患者自行购买赛霉安散用于外敷。老师特别向我介绍了赛霉安散的成分与功效：该方由石膏、冰片、朱砂（水飞）组成，具有清热止血、收敛祛湿、化腐生肌的作用，广泛应用于多种皮肤和黏膜类疾病，包括口腔、鼻腔、咽喉溃疡，牙周炎性溃疡，以及皮肤碰伤、刀伤和慢性溃疡等。对于今天遇到的两位老人家，脚部伤口长时间无法结痂收口，老师观察其脉象偏无力，判断可能属于正气亏虚、气血不足，生肌乏力的情况，因此建议加用补中益气汤。此方具有补中益气、升阳举陷之功，方中黄芪尤擅生肌收口，对于久不收口的慢性伤口有一定帮助。老师还指出，许多伤口长期无法愈合，其中一个常见原因是包扎过于严密，导致伤口缺乏通风与氧气供应。虽然 “ 伤口不能碰水 ” 是防止感染的基本原则，但如果因此导致伤口长时间处于潮湿、封闭环境，也可能不利于组织修复。适当暴露在空气中，有助于干燥、结痂和加速愈合。此外，一些患者因糖尿病影响血液循环及免疫功能，也会出现伤口愈合迟缓的现象，临床上应加以辨识与调理。车祸后伤口糜烂不收口糖尿病伤口无法收口（二）手指肿痛今日接诊一例手指浮肿疼痛患者。初诊观察无明显红肿、灼热、剧痛等典型炎性表现，初步排除痛风性关节炎的可能。患者诉手指浮肿疼痛，屈伸乏力。追问病史，既往无高尿酸血症、高血压及糖尿病，仅胆固醇偏高。舌淡红，苔黄润，脉象濡。老师原拟予舒筋活血汤，以活血通络、缓解筋脉拘急。然问诊中发现患者频频擤鼻，进一步追问得知近期伴有伤风表现。故调整处方如下：荆防败毒汤 180g 、小柴胡汤 90g 、半夏天麻白术汤 90g （药水）。荆防败毒汤主治外感风寒湿邪，常用于发热、头痛、肢体酸楚等表证。该方除疏风解表、祛痰止咳外，...

【脉象】实脉的相类脉--长脉

6a.长脉首尾端直，超过本位正常：气血旺盛，精气盛满，脉气盈余。病症：主阳证、热证、实证。多由邪气盛实，正气不衰，邪正搏击所致。图像来自 https://www.sohu.com/a/440348806_749312

【TCM diary】跟诊日记：德教会义诊-罗达盛医师（一）

25/4/2025 居銮德教会义诊 - 罗达盛医师（一）腰痛跟湿的关系一位 Uncle 前来义诊，主诉腰酸背痛，食用生冷瓜果后症状加重。见舌色紫而偏干，脉弦。老师为其开立：柴胡疏肝散以疏解肝气，小柴胡汤以调理胃肠敏感，六味地黄丸以滋阴补肾（考虑其年高，顾护先天之本），藿香正气水以祛湿解暑、理气和中，并加用五苓散以利水渗湿。对于前方药的配伍，我基本理解，但对加用五苓散的思路尚有疑惑，遂向老师请教。老师解释道：腰为肾之外府，肾之精气所灌注之处。肾主水液，主持调节全身水液代谢。若体内水湿过重（如脾虚运化失常、肾阳不足或外感湿邪），湿气困阻经络，气血运行不畅，腰部筋脉肌肉失养，遂致沉重、酸胀、隐痛之感。湿气之于经络，犹如泥浆阻塞水道，气血难达，腰脊因‘粮食’（气血）不足而生酸痛沉重。尤其马来西亚地处热带，气候常年湿热多雨，湿邪更易郁滞于体内，损伤脾阳，助生内湿。生冷瓜果之性寒凉，进一步伤及脾阳，加重水湿困滞，经脉瘀阻，故见腰背酸痛加剧。故治疗此证，除疏肝理气、健脾和中、滋阴补肾外，尤应重视祛湿通络。此次加用五苓散，旨在利水渗湿、温阳化气，以助气血流通，祛除湿邪，从而缓解腰背酸痛之症。” 后续：老师过目之后，进一步分享患者原本有胃胀、呃气等症状，曾投香砂六君子汤无效，后改用柴胡疏肝散、小柴胡汤合藿香正气水，始见效。三周前因食凉物致腰酸复发，胃中微不适。实为肝气不疏，脾虚湿聚，加之患者素体肾湿邪乘虚内扰腰脊所致。老师提醒此例辨证要点为：舌面润滑，乃水湿内蕴之象，因此在前方基础上加用五苓散以加强利水，配合六味地黄丸以滋肾固本。之前是有胃胀呃气等症候，医用香砂六君子无效后，老师调治，投以柴胡舒肝散、小柴胡汤合藿香正气才有起效。3星期前因食凉物致腰酸，胃微不舒。这实乃木不疏脾虚湿聚，丌生致腰酸。老师也提醒我此例临床辨症要点为舌面润滑为水湿之候，故照原方加五苓散增强利水化湿，六味地黄丸补肾。经此一例，我深感此前对中医的理解尚浅，多停留在表面，未能真正做到“四诊合参”。中医治疗疾病，必须立足于中医基础理论，包括阴阳五行、脏腑经络学说及四诊八纲辨证。唯有通过精准辨证，方能确立治法，继而选择方药，从而环环相扣、切中病机，达到疗病之效。这正是中医“辨证论治”的核心价值所在。在临床中，我常易受西医检验数据及其病名诊断...

【Pharmacology】General and local anesthetics

Anesthesia A reversible condition induced by anesthetic drugs that cause reduction or complete loss of response to pain or another sensation such as consciousness and muscle movements during surgery or other invasive procedures that can be painful. Two main types of anesthesia: General anesthesia: makes the whole body lose feeling movement and consciousness drugs Local anesthesia: numbs only a specific targeted area of the body drugs Content: 1. Anesthesia stage 2. Mechanism of action 3. General anesthetics i. 1st group (Intravenous agents) ii. 2nd agent (Intravenous & Inhalation agent) iii. 3rd agent (halogenated volatile anesthetics) 4. Dexmedetomidine 5. Local anesthetics 6. Reference 1. Anesthesia stage Anesthesia performed with general anesthetics occurs in four stages: Stage 1: Induction a period during which the patient goes from state of consciousness to a state of unconsciousness Stage 2: Exc...

［王阳明心学］11/9/2025

最近看了一本《催眠治疗师的回溯实录》。是讲述张惠铭博士在催眠治疗过程中收集的真实个案故事，通过这些故事展示了回溯治疗如何引导个体深入潜意识，探索和解决当下的心理困扰、情绪障碍及人生课题，最终实现自我疗愈和转变。它的核心机制是 “直面内心的真实” ——无论是埋藏在内心深处的情绪、创伤，还是生命课题。和王阳心学的共同点就是：唯有真诚面对自己，才能获得疗愈、成长与自由。

【Pharmacology】Drug for Heart Failure

Drug for Heart Failure Review: 【Pharmacology】Heart Failure Content: 1. Beta-blockers 2. Angiotensin-converting enzyme (ACE) inhibitors 3. Angiotensin receptor blockers (ARBs) 4. Angiotensin receptor-neprilysin inhibitor 5. Aldosterone antagonists 6. Loop diuretics 7. Vasodilators 8. Digoxin 9. Reference 1. Beta-blockers work by binding to beta-1 receptors in the heart blocking the action of norepinephrine reducing heart rate and contractility decreases cardiac output and blood pressure *Decreased heart rate allows more diastolic filling time, so the stroke volume is typically not reduced. via blockade of the alpha 1 receptors of the renal juxtaglomerular complex, certain beta-blockers may also reduce renin secretion reducing the severity of angiotensin II-induced vasoconstriction & aldosterone-induced volume expansion ***however is not beta-blockers primary mechanism of action. Review: 【Pharmacology】Adrenergic drug (adrenergic antagonists) Currently only three have proven...

【Western diagnosis】Cough

Cough Reference: https://youtu.be/LDMEtNXik-A

【Pharmacology】Antibiotics part 1

Antibiotics Content: 1. Antibiotics classification 2. Mechanism of action antibiotics 3. Cell wall synthesis inhibitors 4. Cell membrane integrity disruptors ------------Part 1 5. Nucleic acid synthesis inhibitors 6. Protein synthesis inhibitors 7. Metabolic pathway inhibitors 8. Reference 1. Antibiotics classification broadly defined as chemical agents that kill or inhibit the growth of microorganisms classified as broad-spectrum: act against wide range of microorganisms narrow-spectrum: act against very few types of microorganisms bactericidal: kill bacteria bacteriostatic: only stop bacteria from growing Selection of antibiotic depends largely on clinical manifestation of the infection the patient profile often guided by Kirby-Bauer method: culture sensitivity dilution test: determine the lowest concentration of antibiotic that inhibits visible bacterial growth known as minimum inhibitory concentration (MIC) the lowest...

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