外感发热，必得遍身汗出，方得邪气外解。然所以致其汗出者。皆赖胃阳敷布，而能升降阴
阳发越毛窍者也。故凡中焦无病，则上下通达，遍身汗出而解。若中焦痞塞，则热结、水
结，寒结、痰结、气滞、夹食、蓄血，皆能壅滞经络，但头有汗，遍身无汗，邪气不能外
解。是以头汗非轻症也，然亦有各条分别。外邪传入少阳，结于胸胁，上薰于头，则心烦
懊而头汗，小柴胡汤合栀子豆豉汤。阳明烦渴多饮，温热不得发越，上冲头角，而发黄
头汗者，神术干葛汤。若见背强身痛，不能转侧，恶寒而头汗者，当治太阳，用羌活胜湿
汤。水饮蓄结中焦，怔忡上攻，但结胸无发热，但头微汗无表症者，半夏茯苓汤，甚者陷
胸汤。若瘀血在上，红花桃仁汤。若瘀血在下，小便利，大便黑，小腹硬而头汗者，桃仁承
气汤。若热入血室，迫血妄行，下血谵语而头汗者，归芍柴胡汤。甚则刺期门，以泻血室之
热。中焦痞结，子和每用吐法。痰饮食积，凝结中焦，但头有汗，遍身无汗，家秘用干葛、
柴胡、防风三味煎汤，调保和散，频服神效。若有燥火，冲葡萄汁、竹沥。若里热火闭无
汗，用山栀、豆豉、葱头、滑石。夫柴胡、干葛、羌活、防风，但能发在表无汗，不能发在
里火闭无汗。栀子、豆豉、滑石、葱白，但能发在里火闭无汗，不能发在表无汗。麻黄、桂
枝，但能发寒邪外束，内无积热无汗，不能发风热外闭，内有积热之无汗。凉膈泻心汤，但
能发热结肠胃无汗，不能发在表风寒闭郁之无汗。是以外有表邪，内有积热，妙在双解表
里。胸前凝塞，胃阳不能敷布而无汗者，妙在开发胸前，升扬胃气。是以治头汗之症，必要
互参无汗条。
伤寒十余日，热结在里，复往来寒热，大柴胡汤。若但结胸无大热者，此水结胸胁也。但头
微汗，大陷胸汤。详注结胸条。
伤寒五六日，头汗微恶寒，手足冷，心下满，口不欲食，大便硬，脉细者，与夫伤寒五六
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，此未解
也，宜柴胡桂桂干姜汤。
此申明头汗症之未解者。头汗微恶寒，手足冷，表症也。心下满，口不欲食，大便硬，里
症也。表里两见之症，若脉数大，可以双解。今脉细则未能解，又伤寒五六日，已汗复
下，反见胸胁满，微结，小便不利，渴而不呕，但头汗，遍身无汗，又寒热心烦，少阳太
阳表症未解也，故宜此汤。
太阳中风，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，阴虚则小便难，阴阳俱虚弱，身体则枯燥，但头汗出，剂颈而还，腹满而喘，口燥
咽烂，或不大便。久则谵语，甚者至哕，手足躁扰，捻衣摸床，小便利者可治。
太阳中风，阳邪也，以火劫之，血气沸腾，灼其身发黄。火伤阳分，上冲作衄；火伤阴
分，小便遂难。阴阳俱伤，身枯燥，但头汗。火伤脾肺，则腹满而喘，口干咽烂，大便不
行。久则谵语，甚者至哕，手足扰乱。此时惟赖小便利者，津液尚存，尚可救。
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，
膈内拒痛，胃中空虚，客气动膈，短气躁烦，心中懊 ，阳气内陷，心下因硬，则为结胸，
大陷胸汤主之。若不结胸，但头汗出，余处无汗，剂颈而还，小便不利，身必发黄。此条详注结胸。
阳明病发热汗出，此为热越不能发黄也。但头汗出，身无汗，小便不利，渴饮水浆，此为淤
热在里，身必发黄，茵陈汤主之。又云阳明病被火，额上微汗出，小便不利，必发黄。
此二条反复明头汗身无汗，湿热不得内外分消，必发黄而小便不利。
阳明病，下之，其外有热，手足温者，不结胸，心中懊 ，饥不能食，但头汗出，栀子豉汤。
此言阳明病下后，外有热，手足温，则表邪尚未内陷，当解表。今因心中懊 ，但头汗，
故用栀子，去烦涤热，豆豉宣散，胃阳敷布，作汗外解。
阳明病，下血谵语者，此为热入血室。但头汗出者，刺期门，随其实而泄之， 然汗出而愈。
阳明有热，深入藏血藏魂之所，火扰神明，则下血谵语，如见鬼状。热邪闭而不宣，故但
头汗。刺期门，则营卫得通，遍身汗出而愈。可见小柴胡汤，治热入血室，不从少阳起
见，乃清解厥阴邪热。小柴胡汤治往来寒热，不从厥阴起见，清解少阳邪热也。
小柴胡汤 见恶寒头眩。
栀子豆豉汤 见懊 。
干葛神术汤
干葛 苍术 防风 石膏
阳明湿热，闭郁中焦，胃阳不能敷布，但头汗周身无汗，故以此方宣发胃气。
羌活胜湿汤 见身重。
阳明头汗，用前干葛神术汤。太阳头汗，当用此方。
半夏茯苓汤
熟半夏 白茯苓
中焦闭塞，则周身不能敷布，但头有汗，逐胃家水饮，则胃气清和，而 汗出。
红花桃仁汤
血瘀上焦，常有发黄头汗者，此方瘀血散则汗出而邪散。
桃仁承气汤 见蓄血。
血瘀上部，前方红花桃仁汤。若血瘀下部，头汗而脐腹硬满者，当用此方。
归芍柴胡汤
柴胡 黄芩 广皮 甘草 当归 白芍药 牡丹皮 地骨皮
热入血室，但头汗出，仲景以小柴胡汤治之。家秘重加当归、白芍药，则功力愈专；加二
皮，则身热易退。
大柴胡汤 见潮热。
大陷胸汤 见结胸。
茵陈汤 见发黄。
发黄头汗症，皆系湿热，治分发表清里二条。前方干葛神术汤发表之法，此方清里之法也。
Exogenous febrile diseases require sweating over the entire body to allow pathogenic factors to resolve from the exterior. However, the mechanism inducing sweat relies on the distribution of Stomach Yang, which facilitates the ascending and descending of Yin and Yang, and the venting of pathogens through the hair follicles. Therefore, if the Middle Jiao is free of disease, Qi flows smoothly up and down, resulting in whole-body sweating and recovery. If the Middle Jiao is obstructed, conditions such as Heat accumulation, Water retention, Cold coagulation, Phlegm obstruction, Qi stagnation, Food retention, or Blood stasis can block the meridians. This leads to sweating only on the head with no sweat on the rest of the body, preventing the resolution of pathogens from the exterior. Thus, cephalic hyperhidrosis (sweating only on the head) is not a mild condition, but it must be differentiated according to specific syndromes.
When exogenous pathogens transmit to Shaoyang (Lesser Yang), accumulating in the chest and hypochondrium, heat steams upward to the head, causing mental restlessness (Ao Nao) and cephalic hyperhidrosis; this is treated with Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). In Yangming (Bright Yang) syndrome characterized by irritability, thirst, and excessive drinking, if warm-heat cannot vent and rushes upward to the temples, causing jaundice and cephalic hyperhidrosis, Shen Shu Gan Ge Tang (Atractylodes and Kudzu Decoction) is used. If back stiffness, body pain, inability to turn, aversion to cold, and cephalic hyperhidrosis are present, Taiyang (Greater Yang) should be treated using Qiang Huo Sheng Shi Tang (Notopterygium Decoction for Overcoming Dampness). If water-fluid retention accumulates in the Middle Jiao, palpitations attack upward, presenting as Jie Xiong (Chest Binding) without fever, with only slight cephalic sweating and no exterior symptoms, Ban Xia Fu Ling Tang (Pinellia and Poria Decoction) is indicated; for severe cases, Xian Xiong Tang (Pitfall Chest Decoction) is used. For blood stasis in the upper part, Hong Hua Tao Ren Tang (Safflower and Peach Kernel Decoction) is prescribed. For blood stasis in the lower part, with free urination, black stool, abdominal hardness, and cephalic hyperhidrosis, Tao Ren Cheng Qi Tang (Peach Kernel Draining the Intestines Decoction) is used. If heat enters the Blood Chamber (Xue Shi), forcing blood to move recklessly, resulting in vaginal bleeding, delirium, and cephalic hyperhidrosis, Gui Shao Chai Hu Tang (Angelica and White Peony Bupleurum Decoction) is used; for severe cases, puncture Qi Men (Liv 14) to drain heat from the Blood Chamber. For Middle Jiao obstruction, Zhang Hezi advocated emesis. For phlegm-food accumulation condensing in the Middle Jiao, causing cephalic sweating without body sweat, a secret family formula uses Gan Ge (Kudzu Root), Chai Hu (Bupleurum Root), and Fang Feng (Saposhnikovia Root) decocted, taken with Bao He San (Preserve Harmony Powder) frequently for miraculous effect. If dry fire exists, administer grape juice or Zhu Li (Bamboo Sap). If interior fire closure causes anhidrosis, use Shan Zhi (Gardenia Fruit), Dou Chi (Fermented Soybean), Cong Tou (Scallion Head), and Hua Shi (Talcum). Chai Hu, Gan Ge, Qiang Huo, and Fang Feng can only induce sweating for exterior anhidrosis, not for interior fire-closure anhidrosis. Zhi Zi, Dou Chi, Hua Shi, and Cong Bai can only induce sweating for interior fire-closure anhidrosis, not for exterior anhidrosis. Ma Huang (Ephedra Herb) and Gui Zhi (Cinnamon Twig) can only induce sweating for cold-pathogen exterior constraint without interior accumulated heat, not for wind-heat exterior closure with interior accumulated heat. Liang Ge Xie Xin Tang (Cool the Diaphragm and Drain the Heart Decoction) can only induce sweating for heat accumulation in the intestines and stomach, not for exterior wind-cold closure. Therefore, when exterior pathogenic factors exist alongside interior accumulated heat, the essence lies in simultaneously resolving both exterior and interior. When anterior chest congestion prevents Stomach Yang distribution leading to anhidrosis, the essence lies in opening the anterior chest and uplifting Stomach Qi. Thus, treating cephalic hyperhidrosis requires cross-referencing the articles on anhidrosis.
In Shang Han (Cold Damage) for more than ten days, with heat accumulating internally and alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is used. If there is Jie Xiong without significant heat, this indicates water accumulation in the chest and hypochondrium. With only slight cephalic sweating, Da Xian Xiong Tang (Great Pitfall Chest Decoction) is used. See detailed notes under Jie Xiong.
In Shang Han for five to six days, with slight cephalic sweating, mild aversion to cold, cold hands and feet, fullness below the heart, desire not to eat, hard stool, and fine pulse; or after five to six days of Shang Han, following sweating and purgation, presenting with chest and hypochondriac fullness, slight binding, difficult urination, thirst without vomiting, only cephalic sweating, alternating chills and fever, and irritability: this indicates unresolved disease, suitable for Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction).
This clarifies unresolved cephalic hyperhidrosis. Slight cephalic sweating, mild aversion to cold, and cold extremities are exterior signs. Fullness below the heart, lack of appetite, and hard stool are interior signs. When exterior and interior signs appear together, if the pulse is rapid and large, simultaneous resolution is possible. Now, with a fine pulse, resolution is not yet achieved. Furthermore, after five to six days of Shang Han, following sweating and purgation, the appearance of chest/hypochondriac fullness, slight binding, difficult urination, thirst without vomiting, only cephalic sweating, absence of body sweat, along with alternating chills/fever and irritability, indicates that Shaoyang and Taiyang exterior signs remain unresolved; hence, this decoction is appropriate.
In Taiyang Wind Strike, if forced sweating via fire therapy occurs, the wind pathogen combined with fire causes blood and Qi to overflow abnormally. The interaction of two Yangs scorches the body, causing jaundice. Excess Yang leads to epistaxis; Yin deficiency leads to difficult urination. With both Yin and Yang weakened, the body becomes dry. Only the head sweats, stopping at the neck. Abdominal fullness and wheezing, dry mouth, and throat ulceration may occur, or constipation. Prolonged cases lead to delirium; severe cases involve hiccups, restless limbs, and picking at clothes/bedsheets. If urination is free, treatment is feasible.
Taiyang Wind Strike involves Yang pathogens. Fire therapy boils blood and Qi, scorching the body to cause jaundice. Fire injuring Yang causes upward rushing and epistaxis; fire injuring Yin causes difficult urination. Injury to both Yin and Yang results in dryness and cephalic sweating. Fire injuring Spleen and Lung causes abdominal fullness, wheezing, dry mouth, throat ulceration, and constipation. Prolonged cases lead to delirium and hiccups. At this stage, free uritation indicates preserved fluids, allowing for rescue.
In Taiyang disease, with floating-rapid pulse, headache, fever, slight night sweats, and paradoxical aversion to cold, the exterior is unresolved. If the physician incorrectly uses purgation, the pulse changes from rapid to slow. Rejection pain in the diaphragm, empty Stomach, disturbing pathogenic Qi in the diaphragm, shortness of breath, irritability, and mental restlessness occur. Yang Qi sinks inward, causing hardness below the heart, forming Jie Xiong, treated with Da Xian Xiong Tang. If Jie Xiong does not form, but only cephalic sweating occurs (stopping at the neck), with difficult urination, jaundice will inevitably develop. See detailed notes under Jie Xiong.
Yangming disease with fever and sweating indicates heat venting outward, so jaundice will not occur. Cephalic sweating, absence of body sweating, difficult urination, and thirst for fluids indicate stagnant heat in the interior, leading to jaundice, treated with Yin Chen Tang. It is also stated that Yangming disease subjected to fire therapy presents with slight forehead sweating and difficult urination, inevitably leading to jaundice.
These two passages repeatedly clarify that cephalic sweating without body sweating, where damp-heat cannot dissipate internally or externally, inevitably leads to jaundice and difficult urination.
After purgation in Yangming disease, if external heat remains, hands and feet are warm, no Jie Xiong forms, mental restlessness occurs, hunger without ability to eat, and only cephalic sweating appears, Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) is used.
This explains that after purgation in Yangming, external heat and warm extremities indicate exterior pathogens have not sunk inward, requiring exterior resolution. Due to mental restlessness and only cephalic sweating, Zhi Zi is used to remove irritability and clear heat, while Dou Chi disperses, allowing Stomach Yang to distribute and transform into sweat for exterior resolution.
In Yangming disease, with bloody discharge and delirium, this indicates heat entering the Blood Chamber. With only cephalic sweating, puncture Qi Men (Liv 14) to drain excess; profuse whole-body sweating leads to recovery.
Yangming heat penetrating the organs storing blood and soul disturbs the Spirit, causing bloody discharge and delirium (seeing ghosts). Heat closure prevents dispersion, resulting in only cephalic sweating. Puncturing Qi Men unblocks Ying and Wei, leading to whole-body sweating and recovery. Thus, Xiao Chai Hu Tang treats heat entering the Blood Chamber not from a Shaoyang perspective, but by clearing Jueyin pathogenic heat. Xiao Chai Hu Tang treats alternating chills and fever not from a Jueyin perspective, but by clearing Shaoyang pathogenic heat.
Xiao Chai Hu Tang: See Aversion to Cold and Vertigo.
Zhi Zi Chi Tang: See Mental Restlessness.
Gan Ge Shen Shu Tang
Ingredients: Gan Ge (Kudzu Root), Cang Zhu (Atractylodes Rhizome), Fang Feng (Saposhnikovia Root), Shi Gao (Gypsum).
For Yangming damp-heat closing the Middle Jiao, preventing Stomach Yang distribution, causing cephalic sweating without body sweating, this formula promotes Stomach Qi.
Qiang Huo Sheng Shi Tang: See Heavy Body.
For Yangming cephalic hyperhidrosis, use the aforementioned Gan Ge Shen Shu Tang. For Taiyang cephalic hyperhidrosis, use this formula.
Ban Xia Fu Ling Tang
Ingredients: Shu Ban Xia (Prepared Pinellia Tuber), Bai Fu Ling (Poria).
Middle Jiao obstruction prevents whole-body distribution, causing only cephalic sweating. Removing Stomach water-fluids clears Stomach Qi, leading to whole-body sweating.
Hong Hua Tao Ren Tang
For blood stasis in the Upper Jiao, often presenting with jaundice and cephalic sweating, this formula resolves stasis, allowing sweat to emerge and pathogens to disperse.
Tao Ren Cheng Qi Tang: See Blood Accumulation.
For blood stasis in the upper part, use the previous Hong Hua Tao Ren Tang. For blood stasis in the lower part, with cephalic sweating and umbilical/abdominal hardness/fullness, use this formula.
Gui Shao Chai Hu Tang
Ingredients: Chai Hu (Bupleurum Root), Huang Qin (Scutellaria Root), Guang Pi (Tangerine Peel), Gan Cao (Licorice Root), Dang Gui (Angelica Sinensis), Bai Shao Yao (White Peony Root), Mu Dan Pi (Moutan Cortex), Di Gu Pi (Cortex Lycii).
For heat entering the Blood Chamber with only cephalic sweating, Zhang Zhongjing used Xiao Chai Hu Tang. The secret family formula adds Dang Gui and Bai Shao Yao for focused efficacy; adding the two barks (Mu Dan Pi, Di Gu Pi) helps reduce body heat.
Da Chai Hu Tang: See Tidal Fever.
Da Xian Xiong Tang: See Jie Xiong.
Yin Chen Tang: See Jaundice.
Jaundice with cephalic hyperhidrosis is caused by damp-heat. Treatment divides into releasing the exterior and clearing the interior. The former formula, Gan Ge Shen Shu Tang, releases the exterior; this formula clears the interior.