不得越而上达也如瘀热在里身必发黄及热入血室与其虚烦或阳明被火及水结胸数者皆头汗出俱是热不得越故或吐或下
以除其热也且邪但在表则无头汗之证必也寒湿相搏与邪在半表半里乃有头汗如伤寒五六日已发汗而复下之胸胁满微结
小便不利渴而不呕但头汗出往来寒热心烦及伤寒五六日头汗微恶寒手足冰冷心下满口不欲食大便硬脉细者此皆邪在表
里两间令头汗出也湿家但头汗出欲得被覆向火者寒湿相搏故头汗也此皆不得谓之逆然小便不利而成关格若头汗者乃阳
脱也经云关格不通不得尿头无汗者生有汗者死又湿家下后头额汗出而微喘者亦阳脱也经云湿家下之额上汗出小便不利
者死下利不止者亦死二者乃头汗之逆
太阳 伤寒十余日热结在里复往来寒热大柴胡汤但结胸无大热者此水结胸但头
微汗者大陷胸汤 伤寒五六日已汗复下胸胁满微结小便不利渴而不呕但头汗出往来寒热心烦者此为未解宜柴胡桂枝干
姜汤 太阳病中风以火劫发汗邪风被火热血气流溢失其常度两阳相熏灼其身发黄阳盛则欲衄阴盛则小便难阴阳俱虚竭
则身体枯燥但头汗出剂颈而还腹满微喘口干咽烂或不大便久则谵语甚者至哕手足躁扰捻衣摸床小便利者其人可治（成
风为阳邪因火热之气则邪气愈甚迫于血气使血气流溢失其常度风与火气谓之两阳两阳相熏灼热发于外必发身黄若热搏
于经络为阳盛外热迫血上行必衄热搏于内者为阴虚内热必小便难若热消血气血气少为阴阳俱虚血气虚少不能荣于身体
为之枯燥三阳经络至颈三阴经络至胸中而还但头汗剂颈而还者热气炎上搏阳而不搏于阴也内经曰诸腹胀大皆属于热腹
满微喘者热气内郁也内经曰火气内发上为口干咽烂者火热上熏也热气上而不下者则大便不硬若热气下入胃消耗津液则
大便硬故云或不大便久则胃中燥热必发谵语内经曰病深者其声哕火气大甚正气逆乱则哕又曰四肢者诸阳之本也阳盛则
四肢实火热太甚故手足躁扰捻衣摸床扰乱也小便利者为火未剧津液未竭而犹可治也 宜黄芩栀子柏皮汤衄黄芩汤小便
难五苓散小便利津液未竭其不利者上干下竭故名不治大柴胡汤承气汤）太阳病脉浮动数头痛发热微盗汗出而反恶寒者表
未解也医反下之动数变迟阳气内陷心中因硬则为结胸若不结胸但头汗出余处无汗剂颈而还小便不利身必发黄（赵 头汗
出有数种如发黄头汗出者热不得越而上泄也背强恶寒头汗出者寒湿客抟经络也下血谵语头汗出者热入血室虚烦懊 头
汗出者邪客胸中熏发于上也水结胸头汗出者水气停蓄不得外行也阳微结与往来寒热头汗出者邪在半表半里也发黄鼻衄
小便难头汗出者邪风火热熏灼上炎也此数者皆为邪风所干而然今活人书却称病患表实里虚元府不开五内干枯胞中空虚
津液寡所致于上数证皆非也外有二证又为头汗出之逆经云关格不通不得尿头无汗者生有汗者死又湿家下之额上汗出微
喘小便利者死下利不止者亦死以阳气上脱故也活人书此问不言何以为可治不可治之别）
阳明 病发热汗出此为热越不能
发黄也但头汗出身无汗剂颈而还小便不利渴引水浆此为瘀热在里身必发黄茵陈汤主之（或用茵陈五苓散）三阳合病腹满
身重难以转侧口不仁而面垢谵语遗尿发汗则谵语下之则额上生汗手足逆冷若自汗出者白虎汤 阳明病被火额上微汗出
小便不利必发黄（成 阳明病则为内热被火则火热相合而甚若遍身汗出而小便利者热得泄越不能发黄今额上微汗出而小
便不利则热不得越郁蒸于胃必发黄也茵陈五苓散栀子柏皮汤）阳明病下之其外有热手足温者不结胸心中 饥不能食但
头汗出栀子豉汤阳明病下血谵语者此为热入血室但头汗出者刺期门随其实而泻之 然汗出而愈（成 阳明病热入血室
迫血下行使下血谵语阳明病法多汗以夺血者无汗故但头汗出也刺期门以散血室之热随其实而泻之以除阳明之邪热散邪
除则荣得通津液得复 然汗出而解）伤寒五六日头汗出微恶寒手足冷心下满口不欲食大便硬脉细者此为阳微结必有表复
有里也脉沉亦在里也头汗出为阳微假令纯阴结不得复有外证悉入在里此为半在里半在外也脉虽沉紧不得为少阴病所以
然者阴不得有汗今头汗出故知非少阴也可与小柴胡汤若不了了者得屎而解（成 伤寒五六日邪当传里之时头汗出微恶寒
者表仍未解也手足冷心下满口不欲食大便硬脉细邪结于里也大便硬为阳结此邪热虽传于里然以外带表邪则热结犹浅故
曰阳微结脉沉虽为在里若纯阴结则更无头汗恶寒之表证诸阴脉皆至颈胸中而还不头循而上今头汗出知非少阴也与小柴
胡汤以除半表半里之邪服汤已外证罢而不了了者为里热未除与汤取其微利则愈故云得屎而解）
孙 凡水结胸胁间头必有汗治以半夏茯苓汤
活 病患表实里虚元府不开则阳气上出汗见于头凡头汗出者五脏干枯胞中空虚津液少也慎不可下下之则重虚
海 头汗出剂颈而还血证也额上偏多者属心部为血证也独益中州脾土以血药治之其法无以加矣
手足汗
胃主四肢为津液之主故病则手足汗出也手足汗出为热聚于胃是津液之旁达也经曰手足 然汗出大便已硬
又曰手足 汗出大便难而谵语二者俱宜下之又阳明中寒不能食小便不利手足 然汗出此欲作痼瘕不下为宜二者俱手
足汗出一则大便初硬后溏胃中冷水谷不别故不可下一则大便难谵语为阳明证具故宜下也 二阳并病太阳证罢但发潮热
手足 汗出大便难而谵语下之则愈用大承气汤 阳明病脉迟虽汗出不恶寒身重短气腹满而喘潮热者此外欲解可攻里
也手足 然而汗出此大便已硬也亦大承气汤主之（详潮热）阳明病若中寒不能食小便不利手足 然汗出此欲作痼瘕必大
便初硬后溏以胃中冷水谷不别故也（浓朴生姜甘草半夏人参汤吴茱萸汤理中汤）
无汗
有数种寒邪在表而无汗者 邪气行于里而无汗者 水饮内蓄而无汗者 阳虚无汗者 经谓太阳病无汗而喘
及脉浮紧无汗发热及不出汗而烦躁阳明病反无汗而小便利二三日呕而咳手足厥若头痛及鼻干不得汗脉浮无汗而喘与其
刚痉无汗是数者皆寒邪在表而无汗者也经谓阳明病无汗小便不利心中懊 身必发黄及伤寒发热无汗渴欲饮水无表证者
白虎加人参汤与夫三阴为病不得有汗（惟少阴亡阳一证有得汗是转属少阴者也）是数者皆邪行于里而无汗者也其水饮内
蓄无汗者经谓服桂枝汤或下之仍头痛项强翕翕发热无汗心满微痛小便不利桂枝去桂加茯苓白术是也其阳虚无汗者经谓
脉浮而迟迟为无阳不能作汗其身必痒是也
太阳发热恶寒身疼无汗而喘麻黄汤证 发热恶寒身疼不汗出而烦躁大青龙汤证 服桂枝或下之仍头项强痛发热
无汗心下微痛小便不利桂枝去桂加茯苓白术汤证 项背强KT KT 无汗恶风葛根汤证 阳明 脉浮无汗而喘麻黄汤证
（以上俱前见）伤寒脉浮发热无汗其表不解不可与白虎汤渴欲饮水无表证者白虎加人参汤 阳明病法多汗反无汗身如虫
行皮中状者久虚故也（胃为津液之主病患久虚津液竭不能为汗胃主肌肉实则为痛虚则为痒宜用黄 建中汤得津液既和而
阳明证仍在以小柴胡汤徐解之）阳明病反无汗而小便利二三日呕而咳手足厥者必苦头痛若不咳不呕手足不厥者头不痛
阳明病无汗小便不利心中懊 者必发黄（成 阳明病无汗而小便不利热蕴于内而不得越心中懊 者热气郁蒸欲发于外而
为黄也宜茵陈五苓散桂枝柏皮汤）
少阴病但厥无汗强发之必动其血或从口鼻或从目出名下厥上竭为难治（成 但厥无汗热行于里也而强发汗虚其经
络热乘经虚迫血妄行从虚而出或从口鼻或从目出诸厥者皆属于下但厥为下厥血亡于上为上竭伤气损血邪甚正虚故为难
治也）
不得汗
太阳病以火熏之不得汗其人必躁到经不解必清血名为火邪（成 此火邪迫血而血下行也太阳病用火熏之不
得汗则热无从出阴虚被火必发躁也六日传经尽至七日再到太阳经则热气当解若不解热气迫血下行必清血清厕也柏皮汤
犀角地黄汤）太阳病八九日如疟状发热恶寒热多寒少其人不呕则便便欲清一日二三度发脉微缓者为欲愈脉微恶寒者此阴
阳俱虚不可更汗吐下也面色反有热色者以不得小汗出身必痒宜桂麻各半汤 太阳病二日反燥乃熨其背而大汗出火热入
胃胃中水竭躁烦必发谵语十余日振栗自下利者为欲解从腰以下不得汗欲小便不得反呕欲失溲足下恶风大便硬小盒饭数
反不数及多大便已头卓然痛足心必热谷气下流故也（或云汗多先服桂枝汤后用调胃承气汤谷气下流小和之小承气汤）阳
明中风脉弦浮大而短气腹满胁下及心痛久按之气不通鼻干不得汗嗜卧一身面目悉黄小便难有潮热时时哕者柴胡汤但脉
浮无余证者麻黄汤 或当汗而汗之服汤至三剂而不得汗者死病也 或热病脉躁盛而不得汗者黄帝谓阳脉之极也死此二
者为真病不治 然有当和解之证汗之而不得汗者和解之力到汗自出而解矣慎莫错会作死证也
热邪不能向外透达，因此出现如下几种情况：瘀热郁结在体内，身体必然发黄；热邪侵入血室，或者虚烦不安，或者阳明病误用火法治疗，或者水饮结聚于胸膈，这几种情况都会导致只有头部出汗。这都是因为热邪无法向外发散，所以治疗方法或是催吐，或是攻下，以清除体内的热邪。
况且，如果邪气仅在体表，就不会有头汗的症状。只有在寒湿相互搏结，或者邪气处于半表半里之间时，才会出现头汗。例如伤寒发病五六天，已经发过汗又误用攻下法，导致胸胁部胀满且轻微痞结，小便不利，口渴但不呕吐，仅头部出汗，伴有往来寒热、心烦等症状；或者是伤寒五六天，头部微汗出，轻微恶寒，手脚冰凉，胃脘部胀满，口不想吃东西，大便干硬，脉象细弱。这些情况都是因为邪气位于表里之间，导致头部出汗。
患有湿病的患者，如果仅头部出汗，想要盖被子靠近火源取暖，这是因为寒湿相互搏结所致，所以头部出汗。这些情况都不能称为逆证。然而，如果因为小便不利而发展为关格（小便不通），此时若出现头汗，则是阳气外脱的表现。经书说：“关格不通，小便不得排出，头部无汗的能生，有汗的必死。”另外，湿病患者被误用攻下法后，额头出汗且轻微气喘，这也是阳气外脱的表现。经书说：“湿病患者被误下，额头出汗，小便不利的必死；腹泻不止的也必死。”这两种情况属于头汗的逆证。
太阳病篇：伤寒十余日，热邪结聚在体内，又出现往来寒热，适用大柴胡汤。如果是结胸证，但体表没有大热，这是水饮结聚于胸膈，仅头部微微出汗，适用大陷胸汤。伤寒五六天，已经发汗又误用攻下，胸胁胀满微结，小便不利，口渴但不呕吐，仅头部出汗，往来寒热，心烦，这是病邪未解，适宜用柴胡桂枝干姜汤。
太阳病中风，用火劫法强行发汗，邪风受火热熏灼，血气流溢失常。两阳（风与火）相熏灼，身体发黄。阳热盛则想流鼻血，阴液盛则小便困难。阴阳俱虚竭，则身体干枯。仅头部出汗，至颈部而止，腹部胀满，轻微气喘，口干咽烂，或者大便不通。时间久了会出现谵语，严重的甚至发生呃逆，手足躁扰，捻衣摸床。如果小便通利，其人可治。（成无己注：风为阳邪，因火热之气则邪气更甚，逼迫血气，使血气流溢失常。风与火气称为“两阳”，两阳相熏灼，热发于外，必然身体发黄。若热邪搏结于经络，为阳盛外热，迫血上行则流鼻血；热邪搏结于内，为阴虚内热，必然小便困难。若热邪消耗气血，气血少则为阴阳俱虚，血气虚少不能滋养身体，导致身体干枯。三阳经络至颈部，三阴经络至胸中而还。仅头部出汗至颈部而止，是因为热气炎上，搏结于阳而不搏结于阴。《内经》说：“各种腹胀大，都属于热。”腹满微喘是热气内郁。《内经》说：“火气内发，上为口干咽烂”是火热上熏。热气上而不下，则大便不硬；若热气下入胃中，消耗津液，则大便硬。所以说“或不大便”。时间久了，胃中燥热必然发谵语。《内经》说：“病深者其声哕”。火气太甚，正气逆乱则发生呃逆。又说：“四肢是诸阳之本”，阳盛则四肢充实，火热太甚，所以手足躁扰，捻衣摸床，这是扰乱之象。小便利，说明火邪未剧，津液未竭，还可以治疗。适宜用黄芩栀子柏皮汤。若流鼻血，用黄芩汤；小便难，用五苓散。小便利，津液未竭，若不利的，上干下竭，故名不治。大柴胡汤、承气汤。）
太阳病，脉象浮而动数，头痛发热，微微盗汗，反而恶寒，这是表证未解。医生反而用攻下法，导致脉由动数变为迟缓，阳气内陷，心中因邪结而硬，则形成结胸。如果不形成结胸，仅头部出汗，身体其他部位无汗，至颈部而止，小便不利，身体必然发黄。（赵嗣真注：头汗出有好几种情况。如发黄伴头汗出，是热邪不能向外透达而上泄；背强恶寒伴头汗出，是寒湿客抟经络；下血谵语伴头汗出，是热入血室；虚烦懊憹伴头汗出，是邪气客于胸中，熏蒸于上；水结胸伴头汗出，是水气停蓄，不得外行；阳微结与往来寒热伴头汗出，是邪在半表半里；发黄、鼻衄、小便难伴头汗出，是邪风火热熏灼上炎。这几种情况都是被邪风所干犯所致。现在的《活人书》却称病患表实里虚，元府不开，五脏干枯，胞中空虚，津液寡少所致，对于上述几种证候都不符合。此外还有两种证候，属于头汗出的逆证。经书说：“关格不通，小便不得排出，头部无汗的能生，有汗的必死。”另外，“湿病患者被误下，额头出汗，轻微气喘，小便利的必死；腹泻不止的也必死。”这是因为阳气上脱的缘故。《活人书》在此问中没有说明如何区分可治与不可治的区别。）
阳明病篇：病发热汗出，这是热邪向外发散，不能发黄。仅头部出汗，身体无汗，至颈部而止，小便不利，口渴引饮水浆，这是瘀热郁结在体内，身体必然发黄，茵陈汤主治（或用茵陈五苓散）。三阳合病，腹部胀满，身体沉重，难以转侧，口不知味且面部垢腻，谵语，遗尿。发汗则谵语加重，攻下则额上出汗，手脚逆冷。如果是自汗出的，用白虎汤。
阳明病被火法治疗后，额头微汗出，小便不利，必然发黄。（成无己注：阳明病则为内热，被火法则火热相合而更甚。若遍身汗出而小便利，热得泄越，不能发黄。今额头微汗出而小便不利，则热不得越，郁蒸于胃，必然发黄。宜用茵陈五苓散、栀子柏皮汤。）
阳明病被攻下后，体表仍有热，手脚温暖，不形成结胸，心中饥嘈但不能进食，仅头部出汗，用栀子豉汤。阳明病下血谵语的，这是热入血室。仅头部出汗的，刺期门穴，随其实而泻之，濈然汗出而愈。（成无己注：阳明病热入血室，迫血下行，致使下血谵语。阳明病法多汗，以夺血者无汗，故仅头部出汗。刺期门以散血室之热，随其实而泻之，以除阳明之邪热。散邪除热，则营气得通，津液得复，濈然汗出而解。）
伤寒五六天，头部出汗，轻微恶寒，手脚冷，胃脘部胀满，口不想吃东西，大便硬，脉细弱的，这是阳微结。必有表证，又有里证。脉沉也在里。头部出汗为阳微结。假令是纯阴结，不得再有外证，全部入在里。此为半在里半在外。脉虽沉紧，不得诊断为少阴病。之所以这样，是因为阴证不得有汗，现在头部出汗，所以知道不是少阴病。可以给予小柴胡汤。如果服药后仍感觉不舒服的，排便后则解。（成无己注：伤寒五六天，是邪气应当传里的时期。头部出汗，轻微恶寒，是表仍未解。手脚冷，胃脘部胀满，口不想吃东西，大便硬，脉细，是邪结于里。大便硬为阳结。此邪热虽传于里，然以外带表邪，则热结犹浅，故曰阳微结。脉沉虽为在里，若纯阴结，则更无头汗、恶寒之表证。诸阴脉皆至颈胸中而还，不循头而上。今头部出汗，知非少阴。与小柴胡汤以除半表半里之邪。服汤已，外证罢而仍感觉不舒服的，为里热未除，与汤取其微利则愈，故云得屎而解。）
活人书注：病患表实里虚，元府不开，则阳气上出，汗见于头。凡头汗出，都是五脏干枯，胞中空虚，津液少。千万不要攻下，攻下则重虚。
海藏注：头汗出至颈部而止，是血证。额头偏多的，属心部，为血证。只益中州脾土，以血药治疗，其法无以加矣。
手足汗：
胃主四肢，为津液之主，所以生病则手足汗出。手足汗出，是热聚于胃，是津液的旁达。经书说：“手足濈然汗出，大便已硬。”又说：“手足漐漐汗出，大便难而谵语。”这两种情况都适宜攻下。另外，阳明中寒，不能食，小便不利，手足濈然汗出，这是欲作痼瘕，不宜攻下。这两种情况都有手足汗出，一种是大便初硬后溏，胃中冷水，谷食不分，所以不可攻下；一种是大便难，谵语，为阳明证具，所以适宜攻下。
二阳并病，太阳证罢，但发潮热，手足濈然汗出，大便难而谵语，攻下则愈，用大承气汤。
阳明病，脉迟，虽然汗出，不恶寒，身体重，短气，腹满而喘，潮热，这是表欲解，可攻里。手足濈然而汗出，这是大便已硬，也用大承气汤主治（详潮热）。
阳明病若中寒，不能食，小便不利，手足濈然汗出，这是欲作痼瘕，必然大便初硬后溏，因为胃中有冷水，谷食不分所致。（可用浓朴生姜甘草半夏人参汤、吴茱萸汤、理中汤。）
无汗：
无汗有好几种情况。寒邪在表而无汗者；邪气行于里而无汗者；水饮内蓄而无汗者；阳虚无汗者。经书谓太阳病无汗而喘，及脉浮紧无汗发热，以及不出汗而烦躁，阳明病反无汗而小便利，二三日呕而咳，手足厥，若头痛及鼻干不得汗，脉浮无汗而喘，与其刚痉无汗，这几种情况都是寒邪在表而无汗。
经书谓阳明病无汗，小便不利，心中懊憹，身体必然发黄；以及伤寒发热无汗，渴欲饮水，无表证者，用白虎加人参汤；以及三阴为病不得有汗（惟少阴亡阳一证有得汗，是转属少阴者也），这几种情况都是邪行于里而无汗。
其水饮内蓄无汗者，经书谓服桂枝汤或攻下后，仍头痛项强，翕翕发热无汗，心满微痛，小便不利，用桂枝去桂加茯苓白术汤。
其阳虚无汗者，经书谓脉浮而迟迟，为无阳，不能作汗，其身必痒，这是阳虚无汗。
太阳发热恶寒，身疼无汗而喘，麻黄汤证。
发热恶寒，身疼不汗出而烦躁，大青龙汤证。
服桂枝或攻下后，仍头项强痛，发热无汗，心下微痛，小便不利，桂枝去桂加茯苓白术汤证。
项背强几几，无汗恶风，葛根汤证。
阳明脉浮，无汗而喘，麻黄汤证（以上俱前见）。
伤寒脉浮发热无汗，其表不解，不可与白虎汤。渴欲饮水，无表证者，白虎加人参汤。
阳明病法多汗，反无汗，身如虫行皮中状者，久虚故也（胃为津液之主，病患久虚，津液竭，不能为汗。胃主肌肉，实则为痛，虚则为痒，宜用黄芪建中汤。得津液既和，而阳明证仍在，以小柴胡汤徐解之）。
阳明病反无汗而小便利，二三日呕而咳，手足厥者，必苦头痛。若不咳不呕，手足不厥者，头不痛。
阳明病无汗，小便不利，心中懊憹者，必发黄（成无己注：阳明病无汗而小便不利，热蕴于内而不得越，心中懊憹，是热气郁蒸，欲发于外而为黄也。宜茵陈五苓散、桂枝柏皮汤）。
少阴病但厥无汗，强发之必动其血，或从口鼻，或从目出，名下厥上竭，为难治（成无己注：但厥无汗，热行于里也。而强发汗，虚其经络，热乘经虚，迫血妄行，从虚而出，或从口鼻，或从目出。诸厥者皆属于下，但厥为下厥，血亡于上为上竭，伤气损血，邪甚正虚，故为难治也）。
不得汗：
太阳病以火熏之，不得汗，其人必躁，到经不解，必清血，名为火邪（成无己注：此火邪迫血而血下行也。太阳病用火熏之，不得汗，则热无从出，阴虚被火，必发躁也。六日传经尽，至七日再到太阳经，则热气当解，若不解，热气迫血下行，必清血，清厕也。柏皮汤、犀角地黄汤）。
太阳病八九日，如疟状，发热恶寒，热多寒少，其人不呕，干干净净欲清，一日二三度发，脉微缓者为欲愈。脉微恶寒者，此阴阳俱虚，不可更汗吐下也。面色反有热色者，以不得小汗出，身必痒，宜桂麻各半汤。
太阳病二日，反燥，乃熨其背而大汗出，火热入胃，胃中水竭，躁烦，必发谵语。十余日振栗，自下利者为欲解。从腰以下不得汗，欲小便不得，反呕，欲失溲，足下恶风，大便硬，小盒饭数，反不数，及多大便已，头卓然痛，足心必热，谷气下流故也（或云汗多先服桂枝汤，后用调胃承气汤。谷气下流，小和之，小承气汤）。
阳明中风，脉弦浮大而短气，腹满，胁下及心痛，久按之气不通，鼻干不得汗，嗜卧，一身面目悉黄，小便难，有潮热，时时哕者，柴胡汤。但脉浮无余证者，麻黄汤。
或当汗而汗之，服汤至三剂而不得汗者，死病也。或热病脉躁盛而不得汗者，黄帝谓阳脉之极也，死。此二者为真病，不治。
Heat pathogen fails to diffuse outward, leading to the following scenarios: When stasis-heat accumulates in the interior, jaundice will inevitably manifest; when heat enters the Blood Chamber (Xue Shi), or in cases of deficiency vexation, or when Yangming disease is treated with fire therapy erroneously, or when water retention binds in the chest, all these conditions result in sweating only on the head. In all these instances, it is because heat cannot diffuse outward; therefore, treatment involves either emesis or purgation to eliminate the internal heat.
Furthermore, if the pathogen remains solely at the exterior, there will be no sweating on the head. Sweating on the head occurs only when cold-dampness combats each other, or when the pathogen resides between the exterior and interior. For example, in Shanghan (Cold Damage) after five or six days, if sweating was induced first and then purgation was erroneously applied, resulting in fullness and slight binding in the chest and hypochondrium, difficulty in urination, thirst without vomiting, sweating only on the head, alternating chills and fever, and vexation; or if after five or six days of Shanghan, there is slight sweating on the head, mild aversion to cold, cold hands and feet, fullness in the epigastrium, lack of desire for food, hard stools, and a fine pulse—these are all due to the pathogen residing between the exterior and interior, causing sweating on the head.
Patients with dampness diseases who sweat only on the head and wish to cover themselves and seek warmth from fire do so because cold-dampness combats each other, hence the head sweating. These situations should not be termed "adverse" (Ni). However, if difficulty in urination develops into Guan Ge (obstruction syndrome characterized by inability to urinate), and sweating on the head appears, this indicates the collapse of Yang Qi. The Classics state: "When Guan Ge obstructs and urination is impossible, those with no sweating on the head survive, while those with sweating die." Additionally, if a dampness patient is erroneously purged, resulting in sweating on the forehead and slight asthma, this also signifies the collapse of Yang Qi. The Classics state: "If a dampness patient is purged and sweats on the forehead with difficulty in urination, death ensues; if diarrhea persists unceasingly, death also ensues." These two cases represent adverse manifestations of head sweating.
In the Taiyang Chapter: If Shanghan persists for more than ten days with heat binding in the interior and alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is indicated. If it is Jie Xiong (Chest Binding) but without significant external heat, indicating water binding in the chest with only slight sweating on the head, Da Xian Xiong Tang (Major Draining the Chest Decoction) is indicated. If after five or six days of Shanghan, sweating was induced followed by erroneous purgation, leading to slight binding in the chest and hypochondrium, difficulty in urination, thirst without vomiting, sweating only on the head, alternating chills and fever, and vexation, the pathogen has not resolved; Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is appropriate.
In Wind Strike (Zhong Feng) of Taiyang disease, if forced sweating is induced by fire therapy, the wind pathogen combined with fire causes blood and Qi to overflow abnormally. The combination of two Yangs (wind and fire) scorching each other leads to jaundice. Excess Yang heat may cause nasal bleeding; excess Yin fluid deficiency leads to difficult urination. If both Yin and Yang are depleted, the body becomes dry. Sweating occurs only on the head, stopping at the neck, accompanied by abdominal fullness, slight asthma, dry mouth, sore throat, or constipation. Prolonged cases may develop delirium; severe cases may exhibit hiccups, restlessness of hands and feet, and picking at clothes and beds. If urination is free, the patient can be treated. (Cheng Wuji notes: Wind is a Yang pathogen; combined with fire, the pathogen intensifies, forcing blood and Qi to overflow. Wind and fire are called "two Yangs." Their scorching effect causes external heat and jaundice. If heat binds in meridians, causing Yang excess and external heat, it forces blood upward, causing nasal bleeding. If heat binds internally, causing Yin deficiency and internal heat, urination becomes difficult. If heat consumes blood and Qi, leading to deficiency of both Yin and Yang, the body lacks nourishment and becomes dry. The Three Yang meridians reach the neck; the Three Yin meridians reach the chest and return. Sweating only on the head up to the neck indicates heat flaring upward, binding with Yang but not Yin. The Neijing states: "All abdominal distensions belong to Heat." Abdominal fullness and slight asthma indicate internal stagnation of heat. "Fire qi arising internally causes dry mouth and sore throat" due to heat scorching upward. If heat does not descend, stool is not hard; if heat descends to the stomach and consumes fluids, stool becomes hard. Thus, "or constipation." Over time, stomach dryness and heat cause delirium. The Neijing states: "In deep disease, the voice is hoarse/hiccupping." Extreme fire qi disrupts Zheng Qi, causing hiccups. Also, "The four limbs are the root of all Yang." Yang excess makes limbs solid; extreme heat causes restlessness and picking at clothes. Free urination indicates fire is not severe and fluids are not exhausted, allowing for treatment. Suitable formulas include Huang Qin Zhi Zi Bai Pi Tang (Scutellaria, Gardenia, and Phellodendron Bark Decoction). For nasal bleeding, use Huang Qin Tang (Scutellaria Decoction); for difficult urination, use Wu Ling San (Five Ingredient Powder with Poria). If urination is free, fluids are not exhausted; if obstructed, upper dryness and lower depletion make it untreatable. Da Chai Hu Tang and Cheng Qi Tangs are mentioned.)
In Taiyang disease, if the pulse is floating, rapid, and numbing, with headache, fever, slight night sweating, yet aversion to cold persists, the exterior is unresolved. If the physician erroneously applies purgation, the pulse changes from rapid to slow, Yang Qi sinks inward, and hardness in the heart region indicates Jie Xiong (Chest Binding). If Jie Xiong does not form, but there is sweating only on the head, no sweating elsewhere up to the neck, difficulty in urination, and inevitable jaundice. (Zhao Sizhen notes: There are several types of head sweating. Jaundice with head sweating indicates heat failing to diffuse downward. Back stiffness and aversion to cold with head sweating indicate cold-dampness binding in meridians. Lower bleeding and delirium with head sweating indicate heat entering the Blood Chamber. Vexation with head sweating indicates pathogen in the chest steaming upward. Water binding in the chest with head sweating indicates water retention blocking external diffusion. Yang micro-binding with alternating chills/fever and head sweating indicates pathogen between exterior and interior. Jaundice, nasal bleeding, difficult urination with head sweating indicate wind-fire scorching upward. All these are caused by wind pathogen invasion. The *Huo Ren Shu* incorrectly attributes these to exterior excess and interior deficiency, opening of Yuan Fu being blocked, drying of five zang organs, emptiness of Bao Zhong, and scarcity of fluids, which does not fit these syndromes. Furthermore, two specific cases are adverse head sweating. The Classics state: "Guan Ge obstruction prevents urination; no head sweating means survival, head sweating means death." Also, "Purging dampness patients causing forehead sweating and slight asthma with free urination leads to death; persistent diarrhea also leads to death" due to upward collapse of Yang Qi. The *Huo Ren Shu* fails to distinguish treatable from untreatable cases here.)
In Yangming disease, fever with sweating indicates heat diffusing outward, preventing jaundice. Sweating only on the head, no sweating elsewhere up to the neck, difficulty in urination, and thirst for liquids indicate stasis-heat binding in the interior, inevitably leading to jaundice. Yin Chen Tang (Artemisia Capillaris Decoction) is the primary treatment (or Yin Chen Wu Ling San). In San Yang He Bing (Combined Disease of Three Yangs), abdominal fullness, heavy body, difficulty turning, insensitivity of the mouth, greasy face, delirium, and urinary incontinence occur. Inducing sweating worsens delirium; purgation causes forehead sweating and cold extremities. If spontaneous sweating occurs, Bai Hu Tang (White Tiger Decoction) is used.
If Yangming disease is treated with fire therapy, slight sweating on the forehead and difficulty in urination inevitably lead to jaundice. (Cheng Wuji notes: Yangming disease involves internal heat; fire therapy exacerbates it. Generalized sweating with free urination allows heat to diffuse, preventing jaundice. Here, forehead sweating with difficult urination prevents heat diffusion, causing steaming in the stomach and jaundice. Use Yin Chen Wu Ling San or Zhi Zi Bai Pi Tang.)
After purgation in Yangming disease, if external heat remains and hands/feet are warm, Jie Xiong does not form. Hunger in the epigastrium without desire to eat, and sweating only on the head, are treated with Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). If Yangming disease involves lower bleeding and delirium, this is heat entering the Blood Chamber. With sweating only on the head, puncture Qi Men (LR14) to drain excess. Profuse sweating follows, and the patient recovers. (Cheng Wuji notes: Heat entering the Blood Chamber forces blood downward, causing bleeding and delirium. Yangming disease typically involves sweating; since blood loss reduces sweating, only head sweating occurs. Puncturing Qi Men dissipates Blood Chamber heat and drains Yangming pathogenic heat. Once pathogens are cleared, Ying Qi flows, fluids restore, profuse sweating occurs, and resolution follows.)
After five or six days of Shanghan, with head sweating, mild aversion to cold, cold hands/feet, epigastric fullness, lack of desire for food, hard stools, and fine pulse, this is Yang Micro-Binding (Yang Wei Jie). There is both exterior and interior involvement. A deep pulse also indicates interior involvement. Head sweating indicates Yang Micro-Binding. If it were pure Yin Binding, there would be no exterior signs, as everything enters the interior. This is half-exterior, half-interior. Although the pulse is deep and tight, it is not Shaoyin disease because Yin syndromes do not typically present with sweating. The presence of head sweating confirms it is not Shaoyin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given. If the patient still feels uncomfortable afterward, passing stool resolves the condition. (Cheng Wuji notes: Five to six days is when pathogen transmits to the interior. Head sweating and mild aversion to cold indicate the exterior is unresolved. Cold extremities, epigastric fullness, etc., indicate pathogen binding in the interior. Hard stool indicates Yang binding. Although heat has transmitted, the presence of exterior pathogen keeps the binding shallow, hence "Yang Micro-Binding." Deep pulse indicates interior, but pure Yin Binding lacks exterior signs like head sweating and aversion to cold. Yin meridians stop at the neck/chest; they do not ascend to the head. Head sweating confirms non-Shaoyin. Xiao Chai Hu Tang clears the semi-exterior/semi-interior pathogen. If discomfort persists after taking the decoction, it indicates residual interior heat; mild purgation resolves it, hence "resolution upon passing stool.")
Sun Simiao notes: In water binding in the chest and hypochondrium, the head invariably sweats. Treat with Ban Xia Fu Ling Tang (Pinellia and Poria Decoction).
*Huo Ren Shu* notes: In patients with exterior excess and interior deficiency, blocked Yuan Fu causes Yang Qi to rise, resulting in head sweating. Head sweating indicates dried five Zang organs, empty Bao Zhong, and scant fluids. Do not purge, as this causes双重 deficiency.
Hai Zang notes: Head sweating stopping at the neck is a Blood syndrome. Predominant forehead sweating belongs to the Heart region and is a Blood syndrome. Tonify the Middle Jiao Spleen Earth using blood-invigorating herbs; this method is supreme.
Sweating on Hands and Feet:
The Stomach governs the four limbs and is the master of Body Fluids. Disease manifests as sweating on hands and feet. This indicates heat gathering in the Stomach, causing fluids to leak laterally. The Classics state: "Profuse sweating on hands and feet indicates hardened stool." Also: "Dripping sweat on hands and feet with difficult stool and delirium." Both cases require purgation. Conversely, Yangming Cold-Dampness with inability to eat, difficulty in urination, and profuse hand/foot sweating suggests impending Gu Jia (stubborn mass); purgation is inappropriate. Both present with hand/foot sweating: one involves initial hard stool followed by loose stool due to cold water in the Stomach mixing with grain, making purgation contraindicated; the other involves difficult stool and delirium, confirming full Yangming syndrome, making purgation appropriate.
In Er Yang Bing Bing (Concurrent Disease of Two Yangs), once Taiyang signs cease, tidal fever, profuse hand/foot sweating, difficult stool, and delirium appear. Purgation cures it using Da Cheng Qi Tang (Major Order the Qi Decoction).
In Yangming disease, a slow pulse with sweating but no aversion to cold, heavy body, shortness of breath, abdominal fullness, asthma, and tidal fever indicate the exterior is resolving and interior can be attacked. Profuse hand/foot sweating indicates hardened stool; Da Cheng Qi Tang is indicated (see Tidal Fever).
If Yangming disease involves Cold-Dampness, inability to eat, difficulty in urination, and profuse hand/foot sweating, it suggests impending Gu Jia, with stool initially hard then loose due to cold water in the Stomach. (Use Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang, Wu Zhu Yu Tang, or Li Zhong Tang.)
No Sweating:
There are several types of no-sweating conditions. Cold pathogen at the exterior; Pathogen moving in the interior; Internal retention of water-fluids; Yang deficiency. The Classics mention Taiyang disease with no sweating and asthma, floating-tight pulse with no sweating and fever, and no sweating with irritability. Yangming disease with no sweating and free urination, vomiting/cough after 2-3 days, cold extremities, headache, dry nose, no sweating, floating pulse with asthma, and Gang Jing (Stiff Spasm) with no sweating—all indicate cold pathogen at the exterior.
The Classics mention Yangming disease with no sweating, difficulty in urination, inner vexation, and inevitable jaundice; Shanghan with fever, no sweating, thirst for water, and no exterior sign (treated with Bai Hu Jia Ren Shen Tang); and Three Yin diseases generally having no sweating (except Shaoyin Yang Collapse where sweating indicates transmission to Shaoyin)—all indicate pathogen in the interior.
For no sweating due to internal water retention: After taking Gui Zhi Tang or purgation, if headache, stiff neck, low-grade fever, no sweating, chest fullness, slight pain, and difficulty in urination persist, use Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction).
For no sweating due to Yang deficiency: A floating and sluggish pulse indicates lack of Yang, inability to sweat, and likely itching skin.
Taiyang fever, aversion to cold, body ache, no sweating, and asthma: Ma Huang Tang (Ephedra Decoction) syndrome.
Fever, aversion to cold, body ache, no sweating, and irritability: Da Qing Long Tang (Major Green Dragon Decoction) syndrome.
After Gui Zhi or purgation, persistent headache/stiff neck, fever, no sweating, slight epigastric pain, difficulty in urination: Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang syndrome.
Stiff neck/back, no sweating, aversion to wind: Ge Gen Tang (Kudzu Decoction) syndrome.
Yangming floating pulse, no sweating, and asthma: Ma Huang Tang syndrome (See above).
Shanghan with floating pulse, fever, no sweating, and unresolved exterior: Do not give Bai Hu Tang. Thirst for water with no exterior sign: Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng).
Yangming disease typically involves sweating; reverse no sweating with sensation of insects crawling in skin indicates chronic deficiency. (Stomach is master of fluids; chronic deficiency exhausts fluids, preventing sweating. Stomach governs muscles; excess causes pain, deficiency causes itching. Use Huang Qi Jian Zhong Tang (Astragalus Decoction for Establishing the Middle). Once fluids harmonize, if Yangming signs persist, use Xiao Chai Hu Tang to gradually resolve.)
Yangming disease with reverse no sweating but free urination, vomiting/cough after 2-3 days, and cold extremities必然 causes severe headache. If no vomiting/cough and extremities are warm, no headache.
Yangming disease with no sweating, difficulty in urination, and inner vexation inevitably leads to jaundice. (Cheng Wuji notes: No sweating and difficult urination trap heat internally, unable to diffuse. Inner vexation indicates heat steaming, attempting to exit as jaundice. Use Yin Chen Wu Ling San or Gui Zhi Bai Pi Tang.)
Shaoyin disease with only cold extremities and no sweating: Forced sweating will disturb blood, causing bleeding from mouth/nose or eyes. This is named Xia Jue Shang Jie (Lower Cold, Upper Exhaustion), which is difficult to treat. (Cheng Wuji notes: Cold extremities and no sweating indicate heat in the interior. Forced sweating damages meridians; heat exploits deficiency, forcing blood to escape via weak points (mouth, nose, eyes). All Jue syndromes relate to the lower; cold extremities are Lower Jue. Blood loss from above is Upper Exhaustion. Damaging Qi and Blood with severe pathogen and deficient Zheng Qi makes it difficult to treat.)
Inability to Sweat:
If Taiyang disease is fumigated with fire and sweating does not occur, the patient becomes irritable. If the cycle completes without resolution, rectal bleeding occurs, termed Fire Pathogen. (Cheng Wuji notes: Fire pathogen forces blood downward. Fumigation without sweating traps heat; Yin deficiency exacerbated by fire causes irritability. By day seven, returning to Taiyang, heat should resolve. If not, heat forces blood downward, causing rectal bleeding. Use Bai Pi Tang or Xi Jiao Di Huang Tang.)
In Taiyang disease after eight to nine days, resembling malaria with fever/aversion to cold, more heat than cold, no vomiting, clean desire to defecate, occurring 2-3 times daily: A slightly slow pulse indicates recovery. A slight pulse with aversion to cold indicates dual deficiency of Yin and Yang; do not induce sweating, vomiting, or purgation. If the face shows redness due to inability to sweat slightly, the body itches; Gui Ma Ge Han Tang (Gui Zhi and Ma Huang Combined Half Dosage Decoction) is suitable.
If Taiyang disease on day two presents with dryness, and the back is ironed causing profuse sweating, fire heat enters the Stomach, exhausting fluids, causing irritability and delirium. After ten days, shaking and spontaneous diarrhea indicate resolution. If no sweating from waist down, difficulty urinating, vomiting, urge to lose urine, cold feet, hard stool, frequent small bowel movements (but not truly rapid), and large stools finally passed, sudden head pain and hot soles indicate Grain Qi flowing downward. (Alternatively, take Gui Zhi Tang first due to excessive sweating, then Tiao Wei Cheng Qi Tang. Grain Qi flowing downward requires mild harmony with Xiao Cheng Qi Tang.)
Yangming Wind Strike with stringy-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac/heart pain, unrelieved by pressure, dry nose, no sweating, lethargy, generalized jaundice, difficulty in urination, tidal fever, and frequent hiccups: Chai Hu Tang. If only floating pulse without other signs: Ma Huang Tang.
If sweating is indicated but fails after three doses of decoction, it is a fatal condition. If heat disease presents with rapid pulse and no sweating, Huangdi considers this extreme Yang pulse and fatal. These two are true fatal conditions.
However, in cases requiring Harmonization, if sweating fails, the power of Harmonization will eventually induce sweating and resolution. Do not mistakenly interpret this as a fatal condition.