[출처] 지방분권개헌 이거 막아야한다./ 일베
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북한 주재 러시아 대사는 북한에 대한 원유 공급 중단이 북한 입장에서는 선전포고로 간주할 것이라고 밝혔다고 로이터통신이 31일 러시아 국영 RIA통신을 인용해 보도했다.
[출처] (((속보)))러시아 "북한, 원유공급 중단 선전포고로 간주할 것"(1보)/ 일베
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[법치수호#4] '태블릿 PC' 고소장에 드러난 또다른 진실
https://youtu.be/XRWcRAPAssY
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노영방송(勞營放送) MBC가 무너지는 소리
그들을 방송인의 양식과 방송인의 혼을 가진 정상적인 기자나 PD들로 보면 안된다. 임금이나 챙기고 방송권력에 눈독만 들이고 있는 이익집단의 노동자 집단일 뿐이다..
그들 마음대로 왜곡, 편파, 조작, 기획으로 기사를 쓰고 선동프로그램을 제작하여 여론을 오도하고 권력에 빌붙으려고 메시지나 날려 보내는 추한 나부랭이들이 그들의 민낯임을 국민들은 알아야 한다. (발췌)
문무대왕(조갑제닷컴 회원)
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'이니'가 아무리 일자리 상황판을 집무실에 걸어두고, 회의 소집하여 “청년실업이 국가재난 수준”이라고 호통쳐도 상황은 더 악화될 뿐입니다. 대통령 직속 일자리위원회 안에 범정부 차원의 “청년 일자리 대책 태스크포스”를 만들고 예산 3조 원을 조기 투입하더라도 소용 없습니다.
이유는 '이니노믹스'가 시장경제 원리에 역주행하기 때문입니다. 자유기업과 자유시장이 경제를 주도하는 것이지, 사회주의 계획경제처럼 대통령이나 공무원이 주도하는 최저임금 대폭 인상, 대기업주 구속수사, 부동산 세무조사, 공무원 단속, 금융제재로 경제가 좋아지지 않습니다. (김문수 전 의원)
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'이니'가 아무리 일자리 상황판을 집무실에 걸어두고, 회의 소집하여 “청년실업이 국가재난 수준”이라고 호통쳐도 상황은 더 악화될 뿐입니다. 대통령 직속 일자리위원회 안에 범정부 차원의 “청년 일자리 대책 태스크포스”를 만들고 예산 3조 원을 조기 투입하더라도 소용 없습니다.
이유는 '이니노믹스'가 시장경제 원리에 역주행하기 때문입니다. 자유기업과 자유시장이 경제를 주도하는 것이지, 사회주의 계획경제처럼 대통령이나 공무원이 주도하는 최저임금 대폭 인상, 대기업주 구속수사, 부동산 세무조사, 공무원 단속, 금융제재로 경제가 좋아지지 않습니다. (김문수 전 의원)
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최교일 "서·임 검사 말 앞뒤 안맞아…성추행 은폐 주장은 명예훼손
http://m.news.naver.com/read.nhn?mode=LSD&mid=sec&sid1=100&oid=003&aid=0008424453-----------------------------------------------------------------
관직 덕분에 번 돈은 지대 착취이다. 그에 비해 관직에 취임하기 전에 번 돈은 더 깨끗하다.
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한국 경제에 삼성이, 그리고 반도체가 차지하는 비중이 너무 크다. 이것들이 잘못되는 순간 한국 경제는 곤두박질 칠 수도 있다.
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오늘도 한국의 좌경화는 착실히 진행되고 있다.
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민주당 개헌안
모로코 남부 지방에 50년 만에 내린 눈! 지구 온난화의 생생한 증거!
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누구에게나 또 모든 것에 남녀차별주의자라는 딱지를 붙이면, 그 단어는 의미를 잃어버린다.
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현재의 경기 호황은 인위적인 금리 인하로 인한 것이다. 법정 화폐 체제에서는 2가지 시나리오 밖에 없다. 하나는 중앙은행이 계속해서 인위적으로 금리를 낮춰 당분간 호황을 지속하다 불황을 맞아하거나, 또는 중앙은행이 금리를 너무 높여서 현재의 호항을 불황으로 만드는 것이다.
Central Banks Put a Safety Net Under Financial Markets
•Thorsten Polleit
Most early business cycle indicators suggest that the global economy is pretty much roaring ahead. Production and employment are rising. Firms keep investing and show decent profits. International trade is expanding. Credit is easy to obtain. Stock prices keep moving up to ever higher levels. All seems to be well. Or does it? Unfortunately, the economic upswing shows the devil’s footprints: central banks have set it in motion with their extremely low, and in some countries even negative, interest rate policy and rampant monetary expansion.
Artificially depressed borrowing costs are fueling a “boom.” Consumer loans are as cheap as ever before, seducing people to spend increasingly beyond their means. Low interest rates push down companies' cost of capital, encouraging additional, and in particular risky investments – they would not have entered into under "normal" interest rate conditions. Financially strained borrowers – in particular states and banks – can refinance their maturing debt load at extremely low interest rates and even take on new debt easily.
By no means less important is the fact that central banks have effectively spread a “safety net” under financial markets: Investors feel assured that monetary authorities will, in case things turning sour, step in and fend off any crisis. The central banks’ safety net has lowered investors' risk concern. Investors are willing to lend even to borrowers with relatively poor financial strength. Furthermore, it has suppressed risk premia in credit yields, having lowered firms’ cost of debt, which encourages them to run up their leverage to increase return on equity.
The boom stands and falls with persisting low interest rates. Higher interest rates make it increasingly difficult for borrowers to service their debt. If borrowers’ credit quality deteriorates, banks reign in their loan supply, putting even more pressure on struggling debtors. Also, higher interest rates cause asset prices – stock and real estate market prices in particular – to come down, putting the banking system under massive strain. In fact, higher rates have the potential to turn the boom into bust.
The US Federal Reserve (Fed), at the beginning of the 21st century, hiked interest rates, putting an end to the "New Economy Boom." Stock markets collapsed. As a reaction, the Fed delivered hefty interest rate cuts – and triggered an unprecedented credit boom that burst in 2007/2008 and developed into a global economic and financial crisis. Then, the Fed lowered interest rates to record low levels and run the printing press on a colossal scale to keep financially overstretched states and banks afloat. The question is: will it be different this time?
Sound economics tells us that the boom-and-bust cycle has one root cause: fiat money. The US dollars, euros, Japanese yen, Chinese renminbi or Swiss franc: They all represent fiat money. Central banks hold the fiat money production monopoly, and they increase the quantity of fiat money relentlessly through bank lending — through loans that are not backed by real savings. As mentioned above, the issuance of fiat money distorts market interest rates and prices, and thus plays havoc with peoples' savings, consumption, and investment decisions.
A destructive side effect of fiat money is that the economy’s level of debt keeps rising over time: The growth of credit keeps outpacing production gains. This is because in a fiat money regime, credit-financed investments fall short of their expected profitability, and credit-financed consumption is unproductive. Quite a few investments turn out to be “flops. The economy gets caught in a debt trap. Credit-financed consumption and government spending make it even worse. To be sure: it has become a problem on a global scale.
In an attempt to prevent the day of redemption, central banks slash interest rates to ever lower levels to keep the system going. Once interest rates are lowered, however, they typically cannot (for political reasons, I should hasten to say) be brought back to pre-crisis levels – as this would make the debt pyramid, and with it the economy and the financial system, come crashing down. It is this economic insight that explains why interest rates show a marked trend decline over the last decades in all countries that have adopted fiat money.
The Fed, the world leading central bank, is on an interest rate hiking spree, though. Since December 2015 it has increased its Federal Funds Rate from 0.0 – 0.25 to 1.25 – 1.50 percent in December 2017. So far, higher rates have not done any damage to the US or international business cycle, or at least so it seems. How high can the US interest rate go without bringing the boom to its knees? To answer this question, we would need to know the height of the “natural interest rate” level. What does that mean?
The natural interest rate is the interest rate that emerges in an unhampered market through the supply of savings and the demand for investment. Unfortunately, however, the natural interest rate is unobservable, its height is unknown. If it is very low, rising Federal Funds Rates might quickly bring about a situation in which borrowing costs are “too high,” and the economy falls over the cliff. If, however, the natural interest rate is relatively high, a higher Fed interest rate may slow down the economy, but not necessarily push it into recession.
You may hope that the Fed, and all the other central banks, have learned their lesson and will, this time, master the delicate balancing act of bringing the interest rate to the “right” level: the level where the economy is doing just fine. Such hope, however, is built on sand. The reason is not just a lack of knowledge on the part of policymakers: they do not, and cannot, know where the level of the natural rate of interest is and set its interest rate accordingly. The real reason is that the natural interest rate level is a no-go area for central banks.
In a fiat money regime, the boom can only go on if and when the market interest rate is below the natural interest rate level. If, for instance, the Fed raises its interest rate to, let alone above, the natural interest rate, the boom comes to a shrieking halt. So either the Fed keeps borrowing costs artificially low, and the boom continues. Or it brings it in line with the natural interest rate, and the boom turns into bust. Unfortunately, there is no middle ground. That is the uncomfortable truth of the Fed’s interest rate policy.
We are thus left with two scenarios. First: The central banks will succeed in keeping the boom going – which is the case if and when they keep their interest rates at artificially suppressed levels. This, however, will come at the high price of growing malinvestment, speculative bubbles, and – due to a relentlessly increasing quantity of money – an ongoing loss of purchasing power of money. Second: Central banks will, by raising interest rates “too much”, put an end to the boom and turn it into bust.
Even if the first scenario unfolds, however, the boom can be expected to come to an end eventually – as it is relatively unlikely that there will be a continuous sequence of "favorable conditions" (such as, say, positive productivity shocks) coming to the rescue, postponing the boom from turning into bust forever. To put it differently: In a fiat money regime, the scenario that the boom turns into bust is not a question of if but of when. This is an insight which Ludwig von Mises (1881 – 1973) put succinctly:
“There is no means of avoiding the final collapse of a boom brought about by [circulation-] credit expansion. The alternative is only whether the crisis should come sooner as the result of a voluntary abandonment of further credit expansion, or later as a final and total catastrophe of the currency system involved.”
It is impossible to predict when business will deteriorate with a fair degree of precision. There is no formula according to which the timing of the boom turning into bust could be calculated. In view of political attempts to keep the boom going, however, the probability of a continuation of the inflationary boom seems to be higher than the probability of an immediate deflationary bust – as central banks appear to be determined to “fight” any new crisis with even lower interest rates and even more money printing, through which currencies will be debased.
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枳术汤是张仲景的一张小方，药仅两味，是治疗水饮结于心下的方子。然历代医家用此方治疗胃脘痛、痞满却效果非凡。读张璐的《张氏医通》，龚廷贤的《万病回春》、《寿世保元》等书，发现治疗胃病多用此方加减。临床实践发现此方可用于水饮或食积结于心下而影响脾之健运的胃脘痛和痞满证，对于很多的慢性胃炎，胃十二指肠溃疡、胃肠功能紊乱、胃下垂、便秘等病有很好的效果。方中枳实量大于白术一倍，行气散结除饮，白术量小于枳实一倍，健脾利水，用于因实而致的脾虚。两药一消一补，攻补兼施，互相为用，而消大于补为其特点。从传统气机上讲亦是一升一降，符合脾升胃降的生理特性。
我们家传用药的方证是：患者形体壮实，多胸闷、腹胀、嗳气、疼痛，腹诊心下胀满或疼痛，有压痛或有抵触，有明显的腹肌紧张。舌苔多厚而腻，脉右关滑实有力，或左关呈弦象。其合方为:
寒合四逆汤。
郁合四逆散。
而病程绵长，体形弱者白术量大于枳实一倍，法张洁古枳术丸之意。而用此方收效的关键是两药的剂量变化！而胡乱加减又需禁忌！
经方神效人人皆知，但往往很多人不注意小方的运用，或因为其药少而轻视，或因其追求经济效益而舍弃。胃病乃临床常见病，枳术汤为治疗胃病的主方、效方，望诸同道关注之！
枳术汤
[组成用法]枳实15～60g、白术20～30g。水煎，分三次温服。
[方证]
1．心下痞坚、小便不利或心下满痛、身重纳减、消瘦者。
2．胃脘痞硬，胀满如囊裹水，或如按杯盘，有形可见，且饮食减少；，肌肉瘦消者。
[现代应用]
1．胃石症、胃下垂、胃扩张、慢性胃窦炎、胃溃疡、十二指肠溃疡、胃神经官能症、胃黏膜脱垂症等出现动力障碍而有胃液潴留者多用本方；慢性肝炎、肝硬化腹水也可借用本方。
2．慢性结肠炎、过敏性结肠炎、消化不良性腹泻、非溃疡性消化不良等出现膻胀腹泻时也有使用本方的机会。
3，其他如胆石症，子宫脱垂、肛管直肠脱垂、单纯性睑下垂、面神经麻痹、震颤麻痹、疝气、痛经、肥胖症等疾病也有用到本方的时候。
[经验参考]根据经文描述，胃病出现排空减慢时可见到本方证。
如何任先生常用本方治疗胃下垂、胃肠功能紊乱症等。曾用本方加味治疗一男性病人，脘腹胀滞，食后为甚，自觉按之有坚实感。处方：枳实12g，炒白术9g，补中益气丸15g（包煎），水煎服。服药三剂后，即感脘腹胀滞减轻，十剂后疗效甚好（《金匮要略新解》）。
除了胃下垂、胃肠功能紊乱症容易出现胃排空减慢外，胃石症也是因素之一。如邱德泽曾用本方治疗一脾积的患者，因食牛肉而致上腹部有一包块，疼痛、呕吐不能进食，钡餐检查报告：慢性胃炎、胃内蛔虫、胃石症。超声波探测到剑突下稍偏左有一前后径5cmX
6．5cmX6．5cm的包块。处方：枳实24g，白术15g，山楂30g。服一剂，痛减呕止，六剂后胃疼大减。后于方中加半夏、槟榔配服“驱虫净”，排出蛔虫十余条。再于初诊方中加蒲黄、五灵脂，二十剂后，诸证若失。超声波复查证实包块消失（江西中医药，1984；4：26）。
另外，原南阳认为酒客容易出现本方证，他说：“心下有大结块，如盘，如覆杯，水饮作也。此为仲景之所论者。凡酒客恶酒，并忌闻酒气之后，其心下必成如是之症状。此因酒病所致，初起用中正汤等，即可治之，已成水肿，则死。若用枳术汤，与甘遂丸一下，而治如柴胡或柴胡加芒硝之腹证多者，可十痊三四（《业桂亭医事小言》）。”《方机》载本方主治心下痞坚，小便不利者或心下满痛，小便不利者。因为排空减慢而影响水分的吸收，所以还可以见到小便少的伴随证。
本方为小方，临床上多加味使用，如《医方集解》载本方（指枳术丸）《金匮》名枳术汤，治水饮，心下坚大如盘，边如旋盘。若改汤为丸，加半夏一两，名半夏枳术丸，治脾湿停痰，及伤冷食。淋者加泽泻一两。若加橘皮一两，名橘皮枳术丸，治饮食不消，气滞痞满。若加橘皮、半夏，名橘半枳术丸，健脾消痞化痰。若加木香、砂仁各一两，名香砂枳术丸，破滞气、消饮食、强脾胃。若加神曲、麦芽各一两，名曲蘖枳术丸，治内伤饮食，或泄泻。若加酒炒黄连；黄芩、大黄、炒神曲、橘红各一两，名三黄枳术丸，治伤肉食、湿面、辛热味厚之物，填塞闷乱不快。若加茯苓五钱、干姜七钱，名消饮丸，治停饮胸满呃逆。
《清代名医医案精华》载赵海仙治疗一五积患者，乃心之积也。因在脐上，大如杯，上至心下，宜伏梁丸法。处方：于白术，枳壳，洋参，制半夏，醋泛为丸。并载王九峰治疗积聚一案，经口：肝之积名肥气，脾之积名痞气。此左胁心下俱有形，大如覆杯，按之则痛，弹之有声。中虚木旺，健运失常，升降失司，血凝痰阻。拟枳术法加减，助坤顺之德，益乾健之功。处方：枳壳，冬术，人参，橘红，青皮，木香，红花，炮姜，水泛丸。近贤田宗汉先生用本方加半夏，名闩白术半夏枳壳汤，用以治疗各种痰饮。言可调理脾肺，通利三焦。主治痰饮为病，咳逆喘满气促，头脑眩闷，背搏胀痛，心下坚，胸胁痛，少腹满，小便不利．善太息；或关节痛烦，口燥嗌干，喜热饮，语音不宣，饮食减，肌肉消，皮肤不泽，善忘。以上诸症，但见一二即是，不必悉具。方取生白术、姜半夏各三钱，麸炒枳壳一钱。长流水一碗，煎至半碗，去滓，乘温顿服，日二服，夜一服，以愈为度。（《田宗汉医学研究》）。
本方虽然只有两味药，但适证运用，效果一般都很突出。尤其对于胃下垂、胃炎等疾病的疗效更优。但针对一些复杂疾病的治疗，宜参衷后世医家的经验，改汤为丸，或加减使用。《外台秘要》之“茯苓饮”就是本方加茯苓、人参、生姜、橘皮而成。对于胃下垂、胃溃疡及慢性胃炎的心下痞硬、外形如覆杯、纳少等，具有“消痰气，令能食”的作用。
现代常增加枳实的剂量来治疗各种内脏下垂症，一般效果很好。此处往往不能因枳实除痞破气一概而论。但编者认为在临床上，对于枳实药证不甚突出的体弱及年老病人，方中枳实的剂量还是小于白术为妥。也可把枳实易成枳壳，这样疗效也很好。总之，可根据临床具体见证和病者体质，适时地在攻补之间调换二药的比例。
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作者/张英栋 ⊙
编辑/闫立彬
摘要：作者从《伤寒论》论及瘙痒的三处条文中抽丝剥茧得出一结论，即《伤寒论》将瘙痒之原因归于无汗，此时此刻正在阅读这篇文章的读者们，您有何高见呢？如果您有不同的观点，或者需要补充的观点，我们欢迎您踊跃投稿发表自己的看法。
《伤寒论》从汗论治瘙痒
《伤寒论》中有三处提到瘙痒，机理各不相同。一为“以其不能得小汗”；二为“迟为无阳，不能作汗”；三为“无汗……以久虚故”，证机各异，但“不得汗”却同。于是我们可以得出结论：《伤寒论》将瘙痒之原因归于无汗。
第一处是《伤寒论》第23条：“太阳病，得之八九日，如疟状，发热恶寒，热多寒少……一日二三度发，脉微缓者，为欲愈也……面色反有热色者，未欲解也，以其不能得小汗出，身必痒，宜桂枝麻黄各半汤。”
李心机《伤寒论通释》解释为：太阳伤寒八九日，表邪将解，本当以小发汗之法，一疏即解。却失于发汗。病有向愈之机，而未顺势发泄，阳气怫郁在表。表邪欲解而不得，肌肤欲通而未通，邪扰肌肤，故痒。正邪交争已八九日之久，邪气微，正气也不盛。过汗则伤正，不汗则不能开启腠理、予邪以出路，治疗以桂枝麻黄各半汤小发其汗。验之临床，确有佳效。
笔者数年前以经方治疗皮肤病，曾治一七八岁男童，皮肤瘙痒数月，无疹，无余症，试开两服桂枝麻黄各半汤，隔数日，路遇其家人，言一剂即效，两剂瘙痒除。
第二处是“脉浮而迟，面热赤而战惕者，六七日当汗出而解，反发热者瘥迟，迟为无阳，不能作汗，其身必痒也。”
见于《医宗金鉴·订正仲景全书伤寒论注·卷三辨太阳病脉证并治下篇》，在该篇中紧随《伤寒论》第23条之后。两条相邻，均有“面赤身痒”，而证机却迥然不同。
关键在于脉象，23条脉是浮紧的，后来“脉微缓者，为欲愈”意为脉由浮紧变得略微缓和。而本条却是“脉浮而迟”。脉浮与脉迟并见之论还有一处，《伤寒论》第225条：“脉浮而迟，表热里寒，下利清谷者，四逆汤主之。”其“下利清谷”、“里寒”“（脉）迟”已经到了用四逆汤的程度，“表热”、“脉浮”只能是虚阳外越。反观此处之“脉浮而迟”、“面赤身痒”也可能是里阳虚甚、虚阳浮越于外，而不是肌表阳气怫郁。
此处之“不能作汗，其身必痒”，原因是“无阳”，即里阳虚，无力“加于阴”而作汗，浮阳扰动肌肤而痒。治疗时既要着眼于“汗”，更要注意到“无阳”，麻黄附子剂较为合拍。
笔者曾治疗一位慢性荨麻疹患者，脉象虽未体会到“浮而迟”，但证机却确为里阳虚寒，处以麻黄汤合麻黄附子细辛汤，患者得汗而愈。
需要指出的是此条不见于目前通行的《伤寒论》条文，录有“辨脉法”的版本在“辨脉法”中录有此条。这提示我们学习《伤寒论》时需要多个版本互参，有很多有价值的条文及字词在经过漫长的传承，及多次辑复后，会有所脱落、或杂陈于不重要的条文之间，但这些却可能正是临证之箴言。在谢观的《中国医学大词典》解释“痒”时收录了此条之“（脉）迟为无阳，不能作汗，其身必痒”。《古今图书集成医部全录之淋浊遗精血汗门·无汗篇》中也录有此条，“经所谓脉浮而迟，迟为无阳，不能作汗，其身必痒……皆阳虚而无汗者也。”
第三处是《伤寒论》第196条：“阳明病，法多汗，反无汗，其身如虫行皮中状者，此以久虚故也。”
对于“身如虫行皮中状”为瘙痒之意，并无异议。而对于“久虚”则见解多有不同。有认为阳明反无汗是因为阴津久虚、作汗无源、邪热欲解而无从疏解故痒。
如《聂氏伤寒学》在此条后言“今反无汗，乃其人久虚，津血均亏，无以作汗”，治疗“当取益气生津，以充汗源，宣透郁热，以清阳明之法。”方取白虎加人参汤、栀子豉汤化裁，也有选用竹叶石膏汤与桂枝二越婢一汤加减的，思路大致相同。
而另外一些学者将“久虚”理解为阳气虚，作汗无力。如上文引过的《古今图书集成医部全录之淋浊遗精血汗门·无汗篇》认为：“阳明病反无汗，其身如虫行皮中之状……阳虚而无汗者也。”选方亦截然不同，《太平圣惠方》此条后出方，“宜术附汤”。组成为：甘草（炒）二两，白术四两，附子（炮）一两半，方后明言“此药暖肌补中，助阳气。”
对于《伤寒论》第196条“久虚”的认识不同，选方不同，为我们临证选方拓宽了思路，而对于本条痒的核心机理的认识却没有分歧，即“无汗……久虚故。”《素问·阴阳别论》中将汗的机理归为“阳加于阴谓之汗”，无阴、无阳均不能作汗。广而言之，“久虚”可能是阴虚或阳虚，也可能是阴阳两虚，也可能是气虚、津亏，或气阴两亏。无论是什么不足，都可以导致“无汗”而“痒”，临证宜“机圆法活”，总以酿汗为要。
综上所述，《伤寒论》中论痒三条，一条讲肌腠不通而不得小汗，阳气怫郁在表故痒；一条讲阳虚较甚不能作汗，浮阳外扰肌肤而痒；一条讲久虚酿汗无力或无源，肌肤不得由汗而通却欲通，故痒。《内经》有言“知其要者，一言而终”，《伤寒论》中论瘙痒，“其要”即为“不得汗”，治疗目标则为“汗出而解”。
【本文摘自2010年3月5日《中国中医药报》，由中医书友会(微信号zhongyishuyou)整理编校发表，尊重知识与劳动，转载请保留版权声明。
《伤寒论》中有三处提到瘙痒，机理各不相同。一为“以其不能得小汗”；二为“迟为无阳，不能作汗”；三为“无汗……以久虚故”，证机各异，但“不得汗”却同。于是我们可以得出结论：《伤寒论》将瘙痒之原因归于无汗。
李心机《伤寒论通释》解释为：太阳伤寒八九日，表邪将解，本当以小发汗之法，一疏即解。却失于发汗。病有向愈之机，而未顺势发泄，阳气怫郁在表。
笔者数年前以经方治疗皮肤病，曾治一七八岁男童，皮肤瘙痒数月，无疹，无余症，试开两服桂枝麻黄各半汤，隔数日，路遇其家人，言一剂即效，两剂瘙痒除。
摘要：作者从《伤寒论》论及瘙痒的三处条文中抽丝剥茧得出一结论，即《伤寒论》将瘙痒之原因归于无汗，此时此刻正在阅读这篇文章的读者们，您有何高见呢？如果您有不同的观点，或者需要补充的观点，我们欢迎您踊跃投稿发表自己的看法。
《伤寒论》从汗论治瘙痒
《伤寒论》中有三处提到瘙痒，机理各不相同。一为“以其不能得小汗”；二为“迟为无阳，不能作汗”；三为“无汗……以久虚故”，证机各异，但“不得汗”却同。于是我们可以得出结论：《伤寒论》将瘙痒之原因归于无汗。
第一处是《伤寒论》第23条：“太阳病，得之八九日，如疟状，发热恶寒，热多寒少……一日二三度发，脉微缓者，为欲愈也……面色反有热色者，未欲解也，以其不能得小汗出，身必痒，宜桂枝麻黄各半汤。”
李心机《伤寒论通释》解释为：太阳伤寒八九日，表邪将解，本当以小发汗之法，一疏即解。却失于发汗。病有向愈之机，而未顺势发泄，阳气怫郁在表。表邪欲解而不得，肌肤欲通而未通，邪扰肌肤，故痒。正邪交争已八九日之久，邪气微，正气也不盛。过汗则伤正，不汗则不能开启腠理、予邪以出路，治疗以桂枝麻黄各半汤小发其汗。验之临床，确有佳效。
笔者数年前以经方治疗皮肤病，曾治一七八岁男童，皮肤瘙痒数月，无疹，无余症，试开两服桂枝麻黄各半汤，隔数日，路遇其家人，言一剂即效，两剂瘙痒除。
第二处是“脉浮而迟，面热赤而战惕者，六七日当汗出而解，反发热者瘥迟，迟为无阳，不能作汗，其身必痒也。”
见于《医宗金鉴·订正仲景全书伤寒论注·卷三辨太阳病脉证并治下篇》，在该篇中紧随《伤寒论》第23条之后。两条相邻，均有“面赤身痒”，而证机却迥然不同。
关键在于脉象，23条脉是浮紧的，后来“脉微缓者，为欲愈”意为脉由浮紧变得略微缓和。而本条却是“脉浮而迟”。脉浮与脉迟并见之论还有一处，《伤寒论》第225条：“脉浮而迟，表热里寒，下利清谷者，四逆汤主之。”其“下利清谷”、“里寒”“（脉）迟”已经到了用四逆汤的程度，“表热”、“脉浮”只能是虚阳外越。反观此处之“脉浮而迟”、“面赤身痒”也可能是里阳虚甚、虚阳浮越于外，而不是肌表阳气怫郁。
此处之“不能作汗，其身必痒”，原因是“无阳”，即里阳虚，无力“加于阴”而作汗，浮阳扰动肌肤而痒。治疗时既要着眼于“汗”，更要注意到“无阳”，麻黄附子剂较为合拍。
笔者曾治疗一位慢性荨麻疹患者，脉象虽未体会到“浮而迟”，但证机却确为里阳虚寒，处以麻黄汤合麻黄附子细辛汤，患者得汗而愈。
需要指出的是此条不见于目前通行的《伤寒论》条文，录有“辨脉法”的版本在“辨脉法”中录有此条。这提示我们学习《伤寒论》时需要多个版本互参，有很多有价值的条文及字词在经过漫长的传承，及多次辑复后，会有所脱落、或杂陈于不重要的条文之间，但这些却可能正是临证之箴言。在谢观的《中国医学大词典》解释“痒”时收录了此条之“（脉）迟为无阳，不能作汗，其身必痒”。《古今图书集成医部全录之淋浊遗精血汗门·无汗篇》中也录有此条，“经所谓脉浮而迟，迟为无阳，不能作汗，其身必痒……皆阳虚而无汗者也。”
第三处是《伤寒论》第196条：“阳明病，法多汗，反无汗，其身如虫行皮中状者，此以久虚故也。”
对于“身如虫行皮中状”为瘙痒之意，并无异议。而对于“久虚”则见解多有不同。有认为阳明反无汗是因为阴津久虚、作汗无源、邪热欲解而无从疏解故痒。
如《聂氏伤寒学》在此条后言“今反无汗，乃其人久虚，津血均亏，无以作汗”，治疗“当取益气生津，以充汗源，宣透郁热，以清阳明之法。”方取白虎加人参汤、栀子豉汤化裁，也有选用竹叶石膏汤与桂枝二越婢一汤加减的，思路大致相同。
而另外一些学者将“久虚”理解为阳气虚，作汗无力。如上文引过的《古今图书集成医部全录之淋浊遗精血汗门·无汗篇》认为：“阳明病反无汗，其身如虫行皮中之状……阳虚而无汗者也。”选方亦截然不同，《太平圣惠方》此条后出方，“宜术附汤”。组成为：甘草（炒）二两，白术四两，附子（炮）一两半，方后明言“此药暖肌补中，助阳气。”
对于《伤寒论》第196条“久虚”的认识不同，选方不同，为我们临证选方拓宽了思路，而对于本条痒的核心机理的认识却没有分歧，即“无汗……久虚故。”《素问·阴阳别论》中将汗的机理归为“阳加于阴谓之汗”，无阴、无阳均不能作汗。广而言之，“久虚”可能是阴虚或阳虚，也可能是阴阳两虚，也可能是气虚、津亏，或气阴两亏。无论是什么不足，都可以导致“无汗”而“痒”，临证宜“机圆法活”，总以酿汗为要。
综上所述，《伤寒论》中论痒三条，一条讲肌腠不通而不得小汗，阳气怫郁在表故痒；一条讲阳虚较甚不能作汗，浮阳外扰肌肤而痒；一条讲久虚酿汗无力或无源，肌肤不得由汗而通却欲通，故痒。《内经》有言“知其要者，一言而终”，《伤寒论》中论瘙痒，“其要”即为“不得汗”，治疗目标则为“汗出而解”。
【本文摘自2010年3月5日《中国中医药报》，由中医书友会(微信号zhongyishuyou)整理编校发表，尊重知识与劳动，转载请保留版权声明。
《伤寒论》从汗论治瘙痒
《伤寒论》中有三处提到瘙痒，机理各不相同。一为“以其不能得小汗”；二为“迟为无阳，不能作汗”；三为“无汗……以久虚故”，证机各异，但“不得汗”却同。于是我们可以得出结论：《伤寒论》将瘙痒之原因归于无汗。
第一处是《伤寒论》第23条：“太阳病，得之八九日，如疟状，发热恶寒，热多寒少……一日二三度发，脉微缓者，为欲愈也……面色反有热色者，未欲解也，以其不能得小汗出，身必痒，宜桂枝麻黄各半汤。”
李心机《伤寒论通释》解释为：太阳伤寒八九日，表邪将解，本当以小发汗之法，一疏即解。却失于发汗。病有向愈之机，而未顺势发泄，阳气怫郁在表。
表邪欲解而不得，肌肤欲通而未通，邪扰肌肤，故痒。正邪交争已八九日之久，邪气微，正气也不盛。过汗则伤正，不汗则不能开启腠理、予邪以出路，治疗以桂枝麻黄各半汤小发其汗。验之临床，确有佳效。
笔者数年前以经方治疗皮肤病，曾治一七八岁男童，皮肤瘙痒数月，无疹，无余症，试开两服桂枝麻黄各半汤，隔数日，路遇其家人，言一剂即效，两剂瘙痒除。
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