明愛醫院合乎指引不近人情

【明報專訊】一個病人在明愛醫院門外心臟病發，就是因為只差幾步，沒有踏進醫院門內，結果醫院員工覑病人家屬致電999求救，病人在26分鐘後才送到急症室，最終不治。院方說員工是按指辦事，但這情猶如有人在警署門外遇劫，但警員卻覑你打999同樣荒謬。這個「引」的做法，實在太不合常理、不近人情，不能接受。

病人上周六下午2時43分到達明愛醫院門外的馬路，不支昏倒，病人兒子的朋友跑進醫院大堂，向詢問處一個文員求助。文員沒有通知急症室，反覑求助人打 999，其間醫院一個外科醫生經過，立即上前急救，並致電醫院急症室，但急症室沒有派人前來救助。病人在2時43分到醫院門外，幾經輾轉，2時53分消防急救人員到場，3時09分病人才被送到近在咫尺的急症室，足足花了26分鐘！

院方昨日解釋說，詢問處文員的做法沒有違反指引，在醫院門外有病人求助，應該覑他們致電999，因為派出急症室醫生到場要一段時間，現場亦與急症室有距離，致電999後救護人員可盡快到場。院方如此解釋實在難以令人接受。

醫院門外有人昏倒，醫院員工應如何做，實在不需要指引，當日途經現場協助救援的外科醫生韋樂申就做了最好的示範。

若根據指引，韋醫生根本毋須拔刀相助，一走了之也沒有人會怪他，但事實是韋醫生不單立即主動替病人施行體外心臟按摩，還致電急症室求助。醫護人員應盡之責，在韋醫生身上清楚看到——根據現場情，即使指引沒有規定要做的，也應立即施援。

要處理這次事件，按照常理，醫院員工應該立即聯絡急症室，看看可否派人來，又或是在醫院內找一張輪椅或擔架脇，送病人到急症室。據本報記者了解，從事發現場走到急症室，最多只是數分鐘路程，絕對不需要26分鐘，院方當日只要稍為變通，情已大大不同。

院方表示，日後要檢討若有病人在醫院附近求救，急症室應如何處理，這只是治標不治本之法，若以後指引說在醫院100米範圍內急症室要派人協助，那麼，病人在 101米外出事又如何？院方承認，這次若病人是在醫院範圍內昏倒，情會不同，原來是短短幾步之距令人陰陽相隔。除了「僵化」、「只按規則辦事」、「冷血」之外，實在難以找到其他詞彙來形容院方的思維。

制度是死的，人是活的，在制度之外靈活變通，盡力救活一條生命，這是作為一個人應盡的責任。這次事件，公眾實在看不到明愛醫院是盡了這個責任。

Review of Mark Leonard on Why Europe Will Run the 21st. Century

This book, published by Fourth Estate in 2005, is focused on the regionalizing aspect of ‘global influence’ and argues for the continued rise of European economic power and political influence and the relative decline of that of the United States. What is its thesis? How ought we to evaluate Leonard’s arguments?

The conventional view, according to Leonard, is that American power will hold good for another fifty years and then Asia will predominate, with India, and more especially China being the engines of world trade and the new superpowers. Leonard’s thesis is that American power has already shown serious signs of slipping. Its arsenal is huge; its willingness to threaten and to bully is based on this ‘hard power’ but its faith in the exercise of such power is over-confident, even misplaced. Branding states as rogue states and threatening them with military action is counter-productive. Such threats merely encourage them, as in the case of North Korea, in the very behavior that the United States is wishing to prevent. The more that the United States in its ‘war on terror’ attempts to exercise its military option, the more its ‘soft power’ (influence; diplomacy) is eroded. Indeed, the limits of American power are perfectly illustrated by the debacle in Iraq and by the fact that authoritative regimes in the Middle East have been reinforced rather than encouraged to change.

The power of the world’s most successful economic union, the EU, is of a different kind, according to Leonard. Whereas American power is ‘shallow and narrow’, that of the EU is ‘broad and deep’: ‘once sucked into its sphere of influence, countries are changed for ever’. Where America sees only ‘potential enemies’, Europe prefers to see ‘potential friends’. Leonard argues that it is the lack of a significant military option that has encouraged Europe to think of new ways of engaging the wider world. European power as experienced by and through the European Union is ‘transformative power’ accomplishing though negotiation and trade, democratic change in historically undemocratic nations. By operating through the existing ‘shell of political structures’ Europe has achieved a relatively silent political revolution within itself. The structures within the initial members remain the same but the key political process is that of a continuous engagement with other states within the European Union, a kind of ‘Network Europe’ (similar in function to the network that supports ‘Visa’). New states wishing to join participate in the process long before admission and are transformed as a result. Poland and Turkey and changes made in these countries are cited as part of the evidence for the existence of this ‘transformative power’. Key ideas are related to the development of European law: stable democratic institutions; the rule of law; human rights and a market economy. These changes are undertaken voluntary as a result of negotiation and diplomacy, whereas the changes in Iraq (such as they are) are imposed by force. At the same time, international companies are also regulated through changes in EU law, giving Europe a role in setting global regulatory standards. The model for further global developments, according to Leonard, is not that of the United States but rather regional groupings associated with Europe and constructed in similar ways.

China is on the rise and is starting to look at its own regional spheres of influence, aware of its need for sources of raw materials to further its industrial development. India is growing rapidly. The world cannot simply be run, Leonard argues, with out-of-date international institutions. The EU provides an effective model for increased regionalization. This has influenced the development of the North American Free Trade Association (NAFTA) between Canada, the United States and Mexico. This is not, however, a politically popular agreement, as far as I can judge, and has little scope for further development. Demands for protectionism are likely to be on the rise in the United States, especially given the recent changes in the composition of the Congress. Newly elected Democrats are not necessarily trade friendly. Leonard sees a ‘post-America world’ to which America can chose to adapt by becoming more interested in international law and institutions, world opinion and the soft power options of negotiations and alliances or to which it can turn its back. Leonard sees the European way as becoming by adoption, and adaptation, the world way, with or without the United States.

This book paints with a large brush and on a very large canvas so it does not give as much attention to China as may be required or to any backsliding in EU members or potential members who were once in the Soviet bloc. It does not pay much attention to the reform process within Europe (agricultural policy; export subsidies; the drive for increased competitiveness though it is true that this process is underway) nor does it give enough attention to the confusion in Russia and the growing leverage Russia has over trade in gas and oil with respect to Western Europe and elsewhere. Nor does it look at cooperation and competition in Central Asia between Russia, China, the United States and Europe. A significant theme is on trade and on the next stages of globalization i.e. on the rise of regionalism leading, in Leonard’s view, to a world of regional units modeled, more or less, on the EU. Such a world looks more and more like a possible world, in my view, especially given the collapse of the Doha Round. These are no doubt weaknesses in the coverage. However, the strength of the book is found in contrasting the steady progress of EU ‘transformative power’ with the problems in the recent policy of the United States, including the erosion of both ‘hard’ and ‘soft power’ by the demands of the ‘war on terror’ as recently constructed. Leonard may overplay his hand but the book is an interesting read even if it is short on detail.

Posted by William Henderson on November 21, 2006

沈睿：《中国怎样想？》：中国改革思想的地形图

英国学者马克·里奥纳德的《中国怎样想？》是一本非常新的书。这种新，不仅仅是本书出版于今年――二月在英国，四月在美国，十一月在台湾翻译出版，而是因为内容新。这本书跟踪描述和详细讨论的是中国目前活跃的经济学家、思想家们的主要思想，这些有影响的中国知识分子直到2006-7年在做什么和想什么；以及他们的所做所想又怎样影响了中国政府的各种政策，影响了中国发展方向。 ( http://www.tecn.cn )
本书描述中国改革三十年来，特别是近十五年来中国改革过程中思想轨迹。全书共有五章。前言题为《思想解放》，讨论中国知识分子在中国社会和改革中的作用。这个题目不仅隐喻中国八十年代的思想解放，也隐喻崔之元于1993年的文章中提出的从对西方资本主义的无条件的羡慕的解放。结论为《中国围墙内的世界》，讨论中国未来的影响。其他三章分别题为《黄河资本主义》讨论中国的经济改革思想和变化；《云雾中的民主》讨论中国的政治改革试验；以及《综合国力》讨论中国军事和外交思想。从以上各个方面，这本书试图描绘中国的思想地形图，并为这个地形图标注了主要界标。这些主要界标就是中国思想舞台上有政治影响力的人物诸如张维迎、崔之元、甘阳、汪辉、王绍光、王小东、杨毅、郎闲评、潘维，潘岳、俞可平、郑必坚、阎学通等等。这些“新右”或“新左”、保守主义或自由主义的思想对中国政府实施的各种各样政策有深浅不同的影响，左右着中国进步的方向。 ( http://www.tecn.cn )
写作这本书的出发点，据里奥纳德说是首先是他个人与中国知识分子接触的经验。他第一次来到中国，来到中国社科院，才意识到中国有这么多知识分子，他们给改革出谋划策，他们自己对改革中的每一个问题，每一个步骤进行争论和争辩。他认为中国的知识分子，因为中国的特殊政治制度，其在社会的作用比西方一般意义的知识分子作用大得多。中国的知识分子是中国社会改变、经济改革发展的顾问和谋士。个人的经验使他意识到，西方看到中国的经济发展，但是对促成中国经济改革、社会变革的思想一无所知，对中国思想界和主要思想一无所知。西方往往从自己的角度看待中国，或是争论中国会不会走向民主，或是把中国还是看出一党专制的权威主义或极权主义国家，以为中国根本没有真正的知识分子等等。中国思想界在想什么？在辩论什么？在做什么？里奥纳德相信，不知道这些问题的答案，人们根本无法真正理解当代中国，也无法理解中国在世界上的作用。他说，中国不仅是一个日益崛起的经济超级大国，也日益成为一个政治超级大国。事实是，中国还应该被看成是一个思想超级大国，“在中国发展出来的很多设想将会对世界其他地方产生影响。”在本书的开篇，他说: “中国，已经加入美国和欧洲成为塑造世界秩序的一员”。 ( http://www.tecn.cn )
里奥纳德认为中国改革开放的最初十年是新右派思想占主导。新右知识分子提倡市场经济，认为中国必须一步步市场化；主张解体国家企业，反对计划经济；提倡“小政府”，认为政府应当缩权。这些主张在很大意义上都被中国政府采纳，所以经济改革进行得相当迅猛。但是，与此同时，另一派知识分子“新左派”也提出反对意见。他们的思想建立在中国的经济发展现有成效之上，认为要正视收入不均造成的贫富差距等问题。自2002年以来，中国政府的很多政策都向新左理论靠拢，强调关注老百姓，建设和谐社会等等。从新右与新左两个学派出发，里奥纳德试图描绘分析中国经济发展的道路和全球化过程中“中国模式”形成的过程。中国的经济改革，他详细分析了珠江资本主义（深圳）和黄河资本主义（南街）的两种模式和思想，探讨这两种模式的意义。中国的政治改体，他介绍分析了中国的村庄选举制度，平昌和重庆的民主管理试验，以及某些知识分子对法制的提倡和对选举的怀疑。他探讨中国的“渐进、从下到上的民主、党内民主、商议民主”各种模式，认为中国的一党政权已经发展出越来越成熟有效的技巧，在某种程度上听取民意，适应民心，实现民愿，以延续其生存，证明其合法化，防止民众不满情绪的滋生扩大。中国政府在保持一党制的原则上推进经济改革发展，在体制民主改革上做各种试验，试图找到自己的与民众沟通的道路。这种方向发展下去，“中国模式”会对世界其他非西方民主国家有怎样的意义？ ( http://www.tecn.cn )
本书对中国经济改革思想和政治改革试验和思想的描述，给对中国所知不多的人提供了一副相当清晰的“中国在想什么”的图画，给研究当代中国的学者和学生既提供了一副比较全面理解中国的景图，也突出介绍了参与中国政策决定的知识分子。里奥纳德非常注重从中国的角度理解中国，从中国的视野看世界。这对西方了解中国来说是非常重要的。西方的媒体比较容易关注中国持不同证见者的意见，但是对参与中国经济改革和社会变革的知识分子往往持有偏见，以为这些人就是为中国政府服务的，忽视这些人在中国变革中的作用。这本书没有站在西方喜欢站的道德高人一等的立场看中国知识分子，而是努力了解这些探索中的思想者，他们的观点和试验，他们的立场和对未来的设想，叙述得相当清楚。这本书为中国改革思想勾画了一副精确的地形图。 ( http://www.tecn.cn )
本书既没有暗示中国威胁论也没有提倡与中国的对抗，相反，本书强调在现行状态下与中国的合作。作者认为世界必须从中国的角度理解中国，认知中国在世界舞台的经济、政治和思想的地位。作者还提出要高度重视在全球化的过程中“中国模式”的意义，指出“中国模式”已经在世界产生影响，并将产生越来越大的影响。通过对中国知识分子思想的描述，作者质疑西方所相信的西方的民主和经济发展方式在中国的可能性。强调中国特色，作者相信二十一世纪中期将是三足鼎立的状态：中国、美国和欧洲将塑造一个新的世界。中国的思想者们在为此铺平道路。理解这些思想者和参与决策的人，将是理解中国未来的钥匙。 ( http://www.tecn.cn )
这本书关注的是对中国的现行政策能出谋划策的人的主要观点和思想，因此重点是经济、政治、军事和外交，对中国社会和文化方面的思想变革和讨论讨论得非常不够。其实一个国家的经济结构是最容易变革的，政治体制变革也不那么难。中国在1911年一夜之间就推翻了两千年的帝制，建立了共和。中国这三十年从铁板一块的计划经济走向资本主义，三十年不过是历史的一瞬。但是，中国社会的进步、民主的真正实现和取得，恐怕还是要在中国文化上有根本的变革。中国的文化变革在近三十年来是怎样发展的？中国思想者怎样考虑中国的文化身份的？也许是因为本书写作的目的是为西方战略研究提供资源，中国文化的变革不是重要的议题。因此本书没有对此着墨，虽说是一个遗憾，也是可以理解的。 ( http://www.tecn.cn )
马克·里奥纳德本人是一个长期战略研究思想库的执行主任。这个思想库的名字是“外交关系欧洲协会”(The European Council on Foreign Relations)，主要研究国际关系长期战略和近期政策等等。里奥纳德的第一本研究著作是关于欧洲的：《《欧洲为什么将主导二十一世纪？》（Why Europe Will Run the 21st Century?）。《中国怎样想？》是他的第二本书。 ( http://www.tecn.cn )

这是马克·里奥纳德的网址：http://markleonard.net, 里面有他的很多文章，可供参考。
What Does China Think？ Mark Leonard. Fourth Estate Ltd， 2008

12/8/2008

Why Europe Won't Be Running the 21st Century

February 26, 2007

For a number of years now the European think tank world has been busy churning out report after report with ever more grandiose proposals for turning the European Union into a global superpower.

One of the more provocative essays in this genre is titled ‘Why Europe Will Run the 21st Century', which was written by Mark Leonard of the London-based Centre for European Reform. Leonard's thesis is that Europe will dominate this century because it is based on a new understanding of power, which is embodied in the institutions and norms of the European Union. He argues that the economic, political and social models of the European Union are irresistibly attractive to the countries around it, and as they adopt the European economic and legal framework, they are transformed from the inside out. By contrast, Leonard asserts, even though the United States might be able to use its military power to change regimes, it cannot change societies, and thus it is weak when compared to the ‘transformative' power of the European Union. This is why Europe will dominate the 21st century, or so Leonard would have us believe.

But is Europe really destined to become a global superpower? A growing body of research says no. Indeed, overwhelming evidence supports the view that contemporary Europe is beset by a mix of problems that is so complex, that apart from dramatic changes in public policy, Europe is headed toward certain decline, not ascendancy.

Demographic Collapse?

Although European elites imagine that their political and social models are so obviously attractive that they will be adopted by the rest of the world, ordinary Europeans don't seem to think so. In fact, demographic trends suggest that most Europeans don't even believe in the European ideal in sufficient numbers to want to pass it on to the next generation.

According to the European Commission, the average birth rate for the European Union as a whole is now 1.4 children per woman, which is well below the 2.1 replacement rate. By way of example, the country with lowest fertility rate in the world is Spain, where women have an average of only 1.07 children.

As a result, deaths will start out-numbering births in every member state of the European Union by as early as 2010. But some countries have already reached that point. According to Germany's Federal Statistics Office, more people died in that country in 2005 than were born. And Germany's demographic decline is the norm, not the exception in Europe. Indeed, Europe's population is forecast to decrease by more than 100 million by 2050.

But not only are Europeans declining in number, they are aging as well. According to the US Census Bureau, Europe in 2000 had the highest percentage of people aged 65 and older, and this figure is set to double by 2050.

Economic Uncertainty

Why should Europeans be worried about declining birth rates and aging populations? Economic stability is one reason. A shrinking workforce will find it increasingly difficult to pay for the rising costs of ever more retirees. Indeed, economists predict that European budget deficits will balloon as governments strain to reconcile declining tax bases with millions of elderly people who force up spending on pensions and health care.

But that's not all. German business leaders, for example, are already worried that the population decline with hurt their country's competitiveness. German demographers predict that by 2030, their country will have 7 million fewer people of working age than today, but 8.5 million more people of retirement age. So although today there are two workers supporting each retiree, within one generation the ratio will be one-to-one. Many economists say this will spell the end of the European social welfare state as we know it. And because Germany is Europe's largest economy, it serves as the benchmark for Europe as a whole.

Political Instability

As European countries edge closer to a pension crisis, political stability is another reason why Europeans should be concerned. Germany, for example, was brought to a standstill more than once by citizens protesting the Harz IV reform package. The aim of those reforms was to reduce payouts to unemployed people and to make it more difficult for them to refuse job offers. Although the government held firm, it was also voted out of office. In any case, two years later there is still no sign that the reforms have made Germany's stagnant economy any more competitive.

Economic frustrations among French and Dutch voters also contributed to their rejecting the European Constitution. Indeed, European citizens seem unwilling to sacrifice their social security benefits on the altar of further European integration. Der Spiegel, the leftwing German news magazine, recently ran a story in which it observed:

"Europe has become a continent of political crises with governments in Italy, France, Britain and Poland all suffering from paralysis or a lack of voter approval. Is the continent about to abandon its integration project and return to the old era of national rivalry?"

Geo-Political Decline

Europe's demographic situation is in stark contrast to that of the United States, where the population officially passed the 300 million mark in October 2006. The United States is now the third most populous country in the world, behind China and India. Moreover, the United States is growing faster than any other industrialized nation... in fact, it is virtually the only developed country expected to grow this century. All analysts agree that America's demographic dynamism will have major geo-political implications, especially for Europe.

Some Europeans are beginning to acknowledge this reality. The Paris-based EU Institute for Security Studies predicts that by 2025, Europe will represent only six percent of the world's population and that its relative share of global wealth and trade will have shrunk. It says that

‘the ongoing debate on the future of Europe suffers from a lack of perspective on the global developments that are changing the context of European integration itself...the risk is that the Union and its Member States will be increasingly subject to, rather than agents of, change.'

The False Promise of Immigration

How did the United States, which turned 230 years old in July 2006, get so big so fast? American growth has been fuelled by a combination of economic stability, high birth rates and immigration. Indeed, the United States is the largest immigrant-receiving country in the world. Some 50 percent of the 100 million newest Americans are recent immigrants or their descendents.

Europe, however, is also a magnet for immigration: It will attract up to 1 million newcomers this year. But the European experience with immigration is quite different from that of America. Part of the reason is that many immigrants to Europe end up on welfare, while in the United States, almost all immigrants take one or more entry-level jobs and work their way up the economic ladder. Welfare is simply not the American way.

Islamic Conquest of Europe?

Moreover, most immigrants to the United States are fully integrated into American society by the second generation, regardless of their country of origin. By contrast, most immigrants to Europe are Muslims who refuse to assimilate and instead tend to cluster in marginalized ghettos on the outskirts of cities across the continent.

Here, too, the American experience is quite different. The best available estimates show that there are between 1.9 million and 2.8 million Muslims in the United States. And unlike their European counterparts, American Muslims generally do not feel marginalized or isolated from political participation. According to a 2004 Zogby Poll, American Muslims are more educated and affluent than the national average, with 59 percent of them holding at least an undergraduate college degree. Moreover, the majority of American Muslims are employed in professional fields, with one in three having an income over $75,000 a year.

But back to Europe: The Muslim population of Europe has more than doubled since 1980, and according to some estimates, there are some 25 million Muslims living on the continent today. Demographers predict that this figure may double by 2015, and that the number of Muslims could outnumber non-Muslims in all of Western Europe by mid-century. This prompted Princeton University's Bernard Lewis to tell the German newspaper Die Welt that ‘Europe will be Islamic by the end of the century.'

This reality is already influencing European foreign policymaking and does not auger well for the future of transatlantic relations. Indeed, many analysts believe that the steady weakening of Europe is the underlying cause for the widespread anti-American and anti-Israel bigotry found among Europe's elites, many of whom are bowing to pressure from Muslim residents as a way to buy a fake peace with radical Islamists. Says Fouad Ajami, a well-known authority of the Arab world: ‘In ways both intended and subliminal, the escape into anti-Americanism is an attempt at false bonding with the peoples of Islam.'

A European Crisis of Spirit

Some analysts believe that what ails Europe is not primarily a crisis of demography, but rather a crisis of spirit. Michael Novak of the Washington-based American Enterprise Institute (AEI) says that in their blind pursuit of reason, secularism and materialism,

"European elites have done their withering best to empty Europe of its Christian spirit. They have swept Europe clean just in time for the rapid rise of a rival faith [Islam] prolific with children, vitality, passion and confidence in long-term victory."

But by removing Judaism and Christianity from European cultural, intellectual and public life, secular Europeans are largely responsible for the lack of confidence ordinary Europeans have in the future. Indeed, the lack of faith not only in tomorrow-but also in God-begets hopelessness. And without hope for the future, one is less likely to want to bring children into the world.

Will Europe Become More Like America?

Most economists agree that demographic decline goes hand in hand with economic decline, and that economic decline, by definition, leads to a loss of influence on the global stage. Although European elites dream about a day when Europe will act as a counterbalance to the United States, the facts imply that Europe's future will be considerably more modest.

There are solutions to almost every problem facing Europe today. But ironically, those solutions imply that Europe must become more (not less) like the United States in its political, economic and social models.

That is to say, as long as European elites insist on building a Europe whose main purpose is to check American power, Europeans are certain to lose over the long run. But if they can bring their ambitions more into line with reality, both Europeans and Americans are set to win.

Soeren Kern is Senior Analyst for Transatlantic Relations at the Madrid-based Grupo de Estudios Estratégicos / Strategic Studies Group.

林行止： 以人民血汗錢補貼投機虧蝕

　十月十三日，陳焱在「財經ＤＮＡ」的〈「放生」銀行責在金管局〉一文，寫一則「趣事」：「鄰桌客人食物遲遲未到，客人不耐煩找經理投訴，豈料這位經理氣 沖沖的回答：『這家餐廳真的離譜，我也覺得他們的服務出了問題！這家餐廳的服務實應改善，你說是嗎？』然後，經理便像沒事般施施然走開，留下客人傻了 眼。」陳焱說他看見這位經理名牌上的名字是任志剛；筆者昨天看到的名字是范鴻齡，在他後面「力」他的是餐廳老闆榮智健！

　　中信泰富周一停牌，收市後召開記者招待會，發出極具震撼性的「盈警」：「今年所賺已蝕光！」所以如此，皆因已辭職（並非被公司辭退）的財務董事和財務 總監，「未經授權簽訂了若干槓桿式外合約」亦即外accumulator，由於澳元及歐羅價急挫而美元則強勁勝昔，引致重大損失，「公司管理層」九 月七日發現後即時「止蝕」，但僅七月一日至十月十七日，便錄得八億零七百七十萬港元虧損；由於「賭注」太大，其所持空美元購澳元及歐羅的外合約，至二○ 一○年十月止，總額達九十億五千萬澳元，以現水平價計，中信的損失可能達（亦可能不只）一百四十七億……。這也許是本港非金融企業外損失最多的一 宗；ＢＢＣ昨天隆而重之發表有關消息並題之為〈中信泰富炒損失慘重股價狂跌〉，是實情的寫照。

　　炒賣外，是中信的「傳統」業務之一，料過去曾有驕人成績，不然二位出事董事的薪津不可能那麼可觀。此次在澳元及歐羅上投機，本來是有業務需要的對沖，因為中信為了保障內地的鋼鐵需求，「奉政府命」 在澳洲進行龐大的鋼鐵項目投資，為了減低是項投資的貨幣價風險，公司的政策是「以美元鎖定項目成本」，而以澳元及歐羅為「對沖」，結果當然事與願違，美 國經濟已陷衰退、美國金融業已瀕破產，但美元價「不按牌理出牌」，突然趨強，中信「押錯寶」，由於賭得太大，因此損失亦巨。

　　投機及投資，有蝕有賺，是市場的常理，可是，中信的「外虧損」引致的問題，值得特別關注。

　　第一、公司於九月七日（周日）已發現此事，十月二十日才公開，期間知道公司嚴重虧損內情者有否直接間接拋售公司股票？九月八日中信收市價二十六點一五元，十月二十日收市價十四點五二元，跌幅百分之四十四點四七，若有內幕客（不一定是董事局人員）於投資者被蒙在鼓裏的情形下上下其手，利潤十分驚人，彰彰明甚。筆者想知道的是，何以中信當局拖延一個多月才把投資者有權知道的事公布？試想，在九月八日便公布周知同時停牌並宣布進行內部檢查，豈不是對股東更公平、公道？證監會應該搜集九月八日迄今中信股票交易詳細資料，核查是否有人利用此「利淡消息」犧牲股東利益中飽私囊！

　　第二、公司「外合約」的可能虧損達一百四十七億，幾乎等同以昨天收市價六點五二元計總市價一百四十三億─造成這種驚人虧損的買賣，竟然是「未經授權」。據說該公司規定「有關外交易，必須要事先獲得主席批准」，為何有關部門負責人未獲主席允許便可大賭特賭，這是明顯的管理不力，主席榮智健和行政總裁范鴻齡都有疏忽責守導致股東「出血」之罪，他們不僅沒有引咎辭職，還以三言二語神色凝重卻毫無自責之意把責任推卸，如此不負責任的行徑，會令香港資 本市場蒙羞。上市公司和非上市公司的最根本分別在於前者必須對公眾（股東）負責，但中信泰富並未處罰「違規」董事（僅把捲入其間的一名財務部董事減薪調 職），讓他們自動辭職（享有一切薪津福利）。如果這二名「炒手」真的「違規」，以此事後果的嚴重，他們應該送交法辦，以免股東死不暝目！

　　第三、榮智健是紅色資本家（古稱「紅色大肥貓」），亦是國家領導人之後，做正項生意確有一手，舉其犖犖大者，買國泰賣大昌都是佳作，可是卻不適合在 「鱷魚潭」中打滾。大約十年前，他在認股事件中向銀行借進數十億元用作認股─以每股三十三元認購二億九千一百萬股中信泰富（榮氏目前持股量增至百分之十九 點一二），其後股價回落到十元水平，榮氏由賬面賺數十億變成蝕數十億，要不是中央出資（據說十億美元左右）「打救」，榮氏所持中信泰富股份早被債權銀行 「充私」了。這一次，國家再通過持有百分之二十九股權的中信泰富母公司中國中信集團，注資（「協調安排」）一百一十七億港元作為「備用信貸」，令中信泰富 不致資金周轉不靈「停擺」。母公司財援子公司，是應有之義，但中信的情況稍有不同，因為這是以國家的錢救援私人，「上綱上線」地說，這是以人民的血汗錢，補貼投機倒把失敗者；不論從哪一角度看，都是說不過去的。

　　雷曼「苦主」和中信泰富蝕掉整間公司市值，都因管理層管理不周闖禍。上級不知下級所幹何事，似為香港公營部門及私營企業的特色。金管局和證監會不知迷你債券的欺詐性（根本不是債券）及銀行推銷手法；中信泰富的「老闆」則不知下屬「大炒特炒以至炒」！香港作為大中華地區炒賣中心的地位，看來岌岌可危。

中藥西藥合用副作用

社會大眾對中醫醫療的接受度日益普及化，中西醫合併治療及重疊的範圍也就愈廣泛。隨 著全民健保實施，中西醫診所的快速成長，以及中西醫結合的優勢下，中西藥合用的情況愈來愈廣泛，尤其是慢性病患者，一邊服用西藥，一邊服用中藥的人數比例 愈來愈高。性能相近的中西藥結合後其治療作用會如虎添翼，有毒副作用的藥物在兩者協同作戰中，副作用也會明顯減少，例如：茵陳可以提高灰黴素（Griseofulvin）的吸收而增強其療效，酸性中藥如烏梅、女貞子、山茱萸、五味子、山楂等可促進四環素族（Tetracycline，Doxycycline，Minocycline）抗生素的吸收而增效，金銀花能增加青黴素（Penicillin，Ampicillin）對耐藥性金黃色葡萄糖菌的抑制作用，檳榔與夫喃丙胺（Furyl alanine）合用常用於治療血吸蟲病，等等。反之，中藥與西藥合用以後，必然也會發生各種物理的、化學的變化，若使用不當，不僅會引起療效降低，增加毒性反應，甚至造成嚴重的後果，因此，身為現代的藥師，也有必要了解中西藥物的配伍禁忌和特性。

1 物理化學性的配伍變化

並不是所有的中西藥結合都能產生巨大的物理功效，這主要和中藥所含的化學成分有關，一般而言能改變藥物物理化學性質的成分有許多，以下就鞣質、生物鹼、有機酸等三種主要成分來說明，因這些成分廣泛存在天然植物中藥裡頭。

1) 鞣 質：又稱丹寧或鞣酸，是一類分子較大的多元酚類化合物，廣泛存在於皮木、果實類藥材中，具有收斂、止血、止瀉、抗菌保護粘膜等作用，鞣質遇到重金屬鹽，會 產生黑綠色或藍黑色沉澱，遇到生物鹼，蛋白質能產生沉澱，從而降低了藥物的效果，含鞣質的藥材有很多，如地榆、石榴皮、玄參、虎杖、五倍子、訶子等，這些 中藥如果與硫酸亞鐵、枸櫞酸鐵銨溶液、等藥物合用，鞣質會和其中的鐵元素產生化學反應，生成一種難以溶解的沉澱物，而影響吸收，又如胃蛋白脢製劑，鞣質與 蛋白結合，發生凝固，使藥效降低，此外，鞣質還能使維他命B群失去效果，常與鞣質反應的西藥有：四環素（Tetracycline）、紅黴素（Erythromycin）、黃連素、麻黃素（Ephedrine）、安茶鹼、阿托品（Atropine）、利血平（Licodine）、洋地黃（Digitoxin）、地高辛（Digoxin）、大黃蘇打、磷酸可待因等（Codeine）片劑。

2) 生 物鹼：它是一種含氮的鹼性有機化合物，具有複雜的生理作用，具有類似鹼的性質，是中藥裡頭重要的有效成分，主要分布於雙子葉植物中，罌栗科，防己科，茜草 科，毛科，其他的科目也有，中藥如麻黃、益母草、檳榔、曼陀羅、洋金花、元胡索、黃連、黃柏、防己、山豆根、馬錢子、鉤藤、貝母、烏頭、石斛等都含有大量 生物鹼，一方面它能使芳酸及其衍生物類的藥物分解失效，這類西藥有水楊酸（Salicylic acid），乙西水楊酸（Autylsalicylic acid），它還能加速巴比妥類（Barbiturate）鎮靜藥物的代謝，而削弱其藥理作用，另外能和蛋白質、氨基酸類的藥物發生化學變化，生成一種不溶性的沉澱物，導致藥效下降，同時含有生物鹼之類的中成藥若與鏈黴素片（Streptomycin），同時口服，對第八對腦神經的毒性作用會增大，時間一長，會造成暫時性或永久性的耳聾，此外，含有生物鹼的洋地黃（Digitoxin）、麻黃素（Ephedrine）、阿托品（Atropine）、氨茶鹼等片劑不宜與烏頭、黃連、貝母合用，否則容易發生藥物中毒。

3) 有 機酸：凡具有酸味的中藥大多含有機酸，尤其果實類藥材居多，如山楂、烏梅、五味子、女貞子、山茱萸、蒲公英等均含有機酸，這類中藥不宜與磺胺類藥物合用， 因為磺胺藥最容易在尿中析出結晶，正好有機酸能提供磺胺藥物在尿中的濃度，使藥物在腎管、輸尿管、膀胱處析出結晶，加大對腎臟的刺激，從而引起尿閉、尿 血、腰痛等現象，再則含有機酸及其製劑的中藥不能與鹼性藥物同時口服，否則會使中藥酸鹼中和，失去作用，鹼性西藥有小蘇打、氫氧化鋁、三奎酸鎂、氧化鎂， 及一般常用製酸劑（例如：鎂、鋁錠，NaHCO₃ Sodium bicarbonate），此外芳香族有機酸藥物的阿斯匹林及NSAID類與鹿茸、甘草及其製劑同服，猶如火上加油，更加增大阿斯匹林及NSAID類藥物對胃粘膜的刺激，因為，甘草、鹿茸含有類糖皮質激素能促使胃酸分泌，降低了胃腸道黏膜的抵抗能力，因而副作用會明顯加劇，消化道潰瘍發生率增加，紅黴素（Erythromycin，目前有許多種劑型對酸穩定）也不宜與酸性中藥同服，因為口服後可進一步酸化胃液，提高酸度，增加紅黴素接觸酸性物質的機會，促使紅黴素的單鍵水解而失去抗菌作用。

4) 四環素族抗生素（Tetracyclines： 金黴素、土黴素、四環素等）不宜與含有二價或三價陽離子（如鈣、鎂、鋁、鐵等）的中藥（如磁石、代赭石、赤石脂、石決明、龍骨、牡蠣、石膏、瓦楞子、鐘乳 石、礞石等）及其製劑（如牛黃解毒片、磁硃丸等）同服，因為四環素族藥物結構都屬氫化并四苯的衍生物，分子中含有西胺基和多個酚基，能與鈣、鎂、鋁、鐵 等重金屬離子形成螫合物，降低其溶解度而吸收率減低，也不宜與鹼性中藥如硼砂、皂角等同服，因四環素族在鹼性條件下可引起分解而喪失藥效。

5) 臨 床上常用於止血的炮製中藥（如血餘炭、地榆炭、蒲黃等）由於在炮製過程中生成大量的具有吸附作用的活性炭，若與其他藥物如脢製劑、生物鹼等同服，會影響其 藥物的吸收，降低療效，此外，含膽汁的中藥或中成藥，如牛膽汁浸膏、蛇膽川貝末和茵陳（利膽作用中藥）及其製劑（如利膽片、消炎利膽片等）不宜與奎尼丁（Quiuidine）片同服，因為奎尼丁能與膽汁中的陰離子生成不溶性的結合物，而使吸收減少。

2 產生或增強毒副作用

1) 含 有朱砂的中成藥（如紫雪丹、七厘散、七珍丹、蘇合香丸、朱砂安神丸等）不宜與溴化鉀（鈉）、碘化鉀（鈉）等還原性西藥同服，同時也不宜與含苯甲酸鈉的藥物 合用，因為朱砂內含硫化汞，在腸道內與具還原性的碘，溴化物生成刺激性的碘化汞或溴化汞，引起排出赤痢樣大便而導致藥源性腸炎，與苯甲酸鈉會生成可溶性的 苯汞鹽而引起藥源性汞中毒。

2) 含有麻黃鹼的中成藥（高血壓患者注意）（如大活絡丹、人參再造丸、保金丸、哮喘沖劑、氣管炎糖漿等）皆不宜與含有單胺氧化脢抑制劑的西藥同服，因為麻黃鹼具緩慢而持久的升壓作用，與單胺氧化脢抑制劑（MAO抑制劑：抗憂鬱劑，抗高血壓如Pargyline）同服時，可使血壓升高而導致高血壓危象和腦出血。

3) 含 乙醇的中藥製劑如藥酒（虎骨酒、國公酒等）各種酊劑（安息香酊、遠志酊等）不宜與水合氯醛同服，因為乙醇不僅能與水合氯醛生成具有毒性的醇合氯醛，使毒性 增加，而且能使其加快吸收引起中毒死亡。與中樞抑制藥苯巴比妥等合用，能使作用加強而引起昏睡等副作用（乙醇本身即為中樞神經抑制劑），與具擴張血管的藥 物合用，也可加重體位性低血壓，與阿思匹林、水楊酸鈉等抗風濕藥同服能增加消化道的刺激性，嚴重時可導致胃腸道出血，大量乙醇可降低血鉀濃度，這種變化足 以產生機體對洋地黃類藥物的敏感度而導致中毒，乙醇還有脢促作用，可使戊巴比妥、丙酮（Acetone）、香豆素等代謝增加，而藥物之作用降低.

4) 含鈣的中藥及其製劑（如石膏、珍珠母、石決明、龍骨、牡蠣等），含甘草的中成藥及湯劑不宜與洋地黃等強心劑應用，因為鈣離子與強心劑對心臟有類似的作用，同用時能增加心肌收縮，抑制ATPase，增加強心劑的作用和毒性，甘草具有去氧皮質酮樣作用，能“保鈉排鉀”，使體內鉀離子減少，導致心臟對強心劑的敏感性而引起中毒。

5) 中藥六神丸中含有膽酥，膽酥為複雜的有強心作用的固醇混合物，有效成分有20種以上，主要有膽毒配基及膽酥毒，其中膽酥毒可水解生成膽配基、辛二酸、精氨酸，其基本結構與強心甘相似，故具有洋地黃的強心作用，應用時易引起心律不整，因此，含有膽酥的中成藥不宜與洋地黃類藥物合用，否則易引起洋地黃中毒。

6) 其他中西藥併用可能引起的交互作用，簡介如下：

檳榔

Flupenthizol and procyclidine 僵直、口顎顫抖。

Fluphenazine 顫抖、僵直、坐立不安

Prednisolone and salbutamol 無法適當的控制氣喘

辣椒

ACE inhibitor 咳嗽

Theophylline 增加吸收及生體可用率

丹參

Warfarin 增加療效

當歸

Warfarin 廣泛性瘀青

大蒜

Warfarin 增加療效

人參

Warfarin 降低療效

Phenelzin 頭痛及顫抖、癲癇

Alcohol 增加乙醇的清除率

甘草

Prednisolone Hydrocortisone 增加血中濃度

Oral contraceptives潛在性心血管副作用、高血壓、水腫、降低療效

木瓜

Warfarin 增加療效

以上僅就一些中藥、西藥合用時所可能產生的物理化學變化以及副作用做一番概說，雖然我們平常都會叮嚀病人，中西藥一般相隔二小時以上服用，不過從藥理學的觀點以及藥物動力學的角度來看，未經醫師診斷而自行合併服用中西藥，是十分危險的一件事。

Wafarin

Warfarin與銀杏、黨參、當歸、大蒜精

warfarin是一種抗凝血劑，當病人進行心臟瓣膜置換手術，或因血管狹窄而放置血管內支架，或中風後，為防止產生血栓而使用的。當劑量不足時， 抗凝血劑無法發揮作用；但劑量過高，則會有出血的危險；基本上，warfarin的療效範圍相當狹窄。因此，warfarin使用期間皆須監測凝血功能， 以確保病患用藥之療效及安全性。而銀杏萃取物之保健價值來自宣稱具抗氧化作用，可清除有害自由基，維持血管彈性，其並含有抑制血小板凝聚及使血管擴張作用 的成份，可使血流暢通，目前標榜用於煩防老年癡困症及間歇性跛行。有報導指出一位已服用warfarin五年之病人，於自行服用銀杏兩個月後發生出血性腦 中風，其可能的機制，或許是由於銀杏與warfarin產生交互作用，使warfarin濃度增加，進而造成抗凝血作用的過強所制。

大蒜中所含的蒜素（allicin），被認為對高血魯及高血壓有助益。但有研究發現，當蒜素與warfarin併用時，會使病患之血液凝固能力變慢 而導致容易出血，或在已出血的情況下不易止血。此外，當歸與黨參亦皆會影響血液之凝固，使服用warfarin的病人發生出血的風險更為提升。

Warfarin與人參

人參對warfarin的影響有別於上述之中草藥，它會降低warfarin的療效，若未能及時調高warfarin劑量，則將會影響其預防血栓生成之效果。

其它

對於常規性服用毛地黃digoxin、茶鹼theophylline、鋰鹽lithium、皮質類固醇、利尿劑、胰島素、口服降血糖劑等 藥品之患者，若要再併服中草藥、健康食品時，應仔細衡量。縱然目前尚未有確切證據可證實其真正之危害性，但就學理上推測，這些藥品極可能與某些產品發生有 害的交互作用，例如長期服用毛地黃併蘆薈或甘草等，基於蘆薈和甘草會促使鉀離子由胃腸道流失，造成血鉀濃度過低，此時即使血中毛地黃未達中毒濃度，病人仍 有可能出現心臟的毒性反應。

另外，皮質類固醇和利尿劑本身也會導致血鉀濃度過低，故當與蘆薈或甘草併用時，發生低血鉀症的機率會更形增加，此時應格外注意病患是否出現肌肉疼痛無力、抽筋及心悸等低血鉀症狀，必要時應儘速就醫。

Theophylline相關藥品，如麻黃所含的麻黃素及綠茶所含之咖啡因，皆有可能增強theophylline的毒性，故併用時須注意病人是否有血壓升高、心跳變快、失眠、精神緊張、手腳顫抖及頭痛等症狀。

人參對第二型糖尿病人，曾有導致血糖降低的報導，故當與胰島素、口服降血糖劑併用時，應更密集監測血糖值，以防發生低血糖症。