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There are nine clauses in the *Shanghan Lun* (Treatise on Cold Damage) discussing anhidrosis (lack of sweating), four discussing inability to sweat, and one discussing non-sweating. The *Mingli Lun* (Theory of Manifestations) and the works of Tao Hua (Tao Shi) only address cold pathogen, which is too brief. It is acceptable to consider anhidrosis as mostly a exterior syndrome, but it is incorrect to assert that anhidrosis is solely caused by cold pathogen. In the *Shanghan Lun*, Taiyang disease presents with anhidrosis, fever, body pain, cold hands and feet, and a floating-tight pulse; in winter, Mahuang Tang (Ephedra Decoction) is used. Taiyang wind-strike disease presents with a floating-tight pulse, anhidrosis, and irritability; this indicates injury to both Ying (Nutritive) and Wei (Defensive) levels, and Da Qinglong Tang (Major Blue Green Dragon Decoction) is used in winter. Yangming disease presents with headache, nasal dryness, floating pulse, anhidrosis, and wheezing; in winter, Gange Tang (Pueraria Decoction) is used. These are all cases where cold pathogen is at the exterior causing anhidrosis, treated with exterior-releasing methods. If Yangming disease presents with anhidrosis and the body must become jaundiced, Yinchen Zhizi Douchi Tang (Artemisia Capillaris, Gardenia, and Fermented Soybean Decoction) is used. If Yangming disease presents with anhidrosis, thirst for drinking water, and no exterior syndrome, Baihu Tang (White Tiger Decoction) is used. These are all cases where heat pathogen is at the interior causing anhidrosis, treated with interior-clearing methods. It is also stated that Jie Xiong syndrome (Chest Binding Syndrome) presenting with sweating only on the head is treated with Da Xiexiong Tang (Major Interior-Draining Decoction); sweating only on the head with body jaundice is treated with Yinchen Tang (Artemisia Decoction); mental restlessness and oppression with sweating only on the head is treated with Zhizi Douchi Tang (Gardenia and Fermented Soybean Decoction). This is due to internal accumulation of fluid retention causing anhidrosis. It is also stated that a floating and slow pulse indicates "no Yang," inability to produce sweat, and inevitable body itching; this occurs when a person with Yang deficiency is exposed to exterior pathogens but cannot produce sweat to resolve them externally, thus requiring methods to support Yuan Qi (Primal Qi) and induce sweating. The above are all symptoms of anhidrosis within the Shanghan category. Currently, there are cases of vomiting and nausea, chest and diaphragm fullness, anhidrosis with wheezing, and a slippery but not rapid pulse; this is phlegm accumulation causing anhidrosis, treated with Er Chen Tang (Two-Cured Decoction) or Daotan Tang (Phlegm-Resolving Decoction). There are cases of bloating, belching, fever, anhidrosis, and a slippery-large pulse at the Right Guan position; this is food stagnation in the Middle Jiao, where Stomach Yang cannot distribute, causing anhidrosis, treated with Pingwei Baohe San (Stomach-Pacifying and Harmony Powder) etc. There are cases of fever, aversion to cold, anhidrosis, and a pulse that does not emerge; this is exterior pathogen lying latent internally, treated with Shengyang Sanhuo Tang (Raising Yang and Dispersing Fire Decoction). There are cases of fever and anhidrosis suppressed by cold-cooling measures, treated with warming the middle and dispersing upward. All these are extended treatment methods employed out of necessity. However, for anhidrosis symptoms, dispersing methods are predominantly used. For example, if the pulse is hidden and there is anhidrosis, using ascending-dispersing methods is correct; if the pulse is large and there is anhidrosis, using ascending-dispersing methods is inappropriate; even if the pulse is fine, or if cold suppression is present, or if phlegm coagulation and food stagnation exist, using ascending-dispersing methods causes no hindrance. As for Shuangjie San (Double-Resolution Powder), Xiaochaihu Tang (Minor Bupleurum Decoction), and Zhizi Douchi Tang treating anhidrosis with exterior pathogen and interior heat, if used for hidden-pulse anhidrosis, the half-cold nature of the herbs will hinder exterior resolution; if used for chest fullness, phlegm accumulation, cold coagulation, and food stagnation, the half-cold nature will cause further stagnation. Similarly, Baihu Tang is a harmonizing and sweating formula for Yangming disease. The clause notes that if exterior sweat has not occurred and exterior signs remain, it should not be taken. If lips and mouth are dry and thirsty but unable to consume water, and the pulse is not rapid and large, it should not be taken either. Since Shigao Tang (Gypsum Decoction) is so restricted, Huanglian (Coptis) and Dahuang (Rhubarb) are even less suitable. Only anhidrosis caused by heat depression and fire closure does not forbid cold-natured herbs. However, for anhidrosis, the first step is to examine the pulse. The Classics state: "In febrile diseases, if the pulse is restless and strong, and there is no sweat, it is the extreme of Yang pulses, indicating death." It also states: "If Yang disease presents with Yin pulses, it indicates death." Examining the "Yang pulse restless-strong with anhidrosis" clause closely, regardless of life or death prognosis, sweat can originally be produced and expelled outward. If sweating occurs after chills and shivering, and the Qi becomes harmonious, the patient lives. If there are no chills, but profuse sweating ensues, with coarse breathing and open mouth, the patient dies with the sweat. Regarding the "Yang disease with Yin pulse and anhidrosis" clause, this indicates insufficient Stomach Yang and depletion of fluids internally, leading to persistent anhidrosis and often death. Generally, for fever with anhidrosis, sweat must be obtained for the body heat to resolve. Since the heat is in the skin, without sweat, where can the heat pathogen dissipate? Therefore, treating fever with anhidrosis, regardless of the number of days, requires skillful induction of sweating. One must know that Mahuang (Ephedra) and Guizhi (Cinnamon Twig) can only disperse cold pathogen causing anhidrosis in winter that has not yet郁 (depressed/accumulated) into heat; they should not be used during the hot seasons of spring, summer, and autumn. Qianghuo Tang (Notopterygium Decoction) and Ganche Chaihu Tang (Pueraria and Bupleurum Decoction) can disperse exterior anhidrosis but cannot disperse interior fire-closure anhidrosis. Huashi (Talcum) and Shigao (Gypsum) can disperse interior fire-closure anhidrosis but cannot disperse exterior anhidrosis. Dansh Douchi (Fermented Soybean) and Bai Doukou (Amomum Villosum Fruit) can acridly disperse Middle Jiao suppression-induced anhidrosis but cannot disperse skin-hair pore closure-induced anhidrosis. Zhike (Aurantii Fructus) and Mutong (Akebia Vine) can disperse anhidrosis caused by blockage of the lower orifices (urination and defecation) but cannot disperse exterior pathogen-induced anhidrosis. Sangbaipi (Mulberry Root Bark), Digupi (Lycium Root Bark), and Jiegeng (Platycodon Root) can disperse anhidrosis caused by Lung Qi congestion affecting the skin-hair pores but cannot disperse anhidrosis caused by closure of other meridians. Zhang Zhongjing adds Xingren (Apricot Seed) to exterior-releasing formulas; its brilliance lies in opening and moistening the Lung to affect the skin-hair pores, which is also an excellent method for inducing sweating. Thus, inducing sweat can also be achieved by regulating Lung Qi. However, treating anhidrosis requires cross-referencing the clauses on head sweating.

Guizhi Tang (Cinnamon Twig Decoction) is originally intended for resolving the muscle layer. If the patient has a floating-tight pulse, fever, and no sweat, it must not be administered. One must recognize this to avoid error.

The following five sections all describe anhidrosis due to cold pathogen at the exterior. In northern winters, Mahuang is used to induce sweat, hence it is said that Guizhi Tang should not be used.

Taiyang disease presenting with headache, fever, body pain, lower back pain, joint pain, aversion to wind, anhidrosis, and wheezing is primarily treated with Mahuang Tang (Ephedra Decoction).

This clause clarifies that for the fever-without-sweat syndrome mentioned in the previous chapter, Guizhi Tang should not be used, and Mahuang Tang is appropriate. It details the aversion to cold and headache.

Taiyang wind-strike disease presenting with a floating-tight pulse, fever, aversion to cold, body pain, anhidrosis, and irritability is primarily treated with Da Qinglong Tang (Major Blue Green Dragon Decoction).

This clause clarifies that for injury to both Ying and Wei levels, Mahuang Tang should not be used, and Da Qinglong Tang is appropriate. It details the irritability.

Taiyang disease presenting with a floating-tight pulse, anhidrosis, fever, and body pain, persisting for eight or nine days without resolution, with exterior signs still present, should be treated by inducing sweat. After taking the medicine, symptoms may slightly improve; the patient may experience vexation, heat, and closed eyes. In severe cases, nosebleed (Xue Ni) will occur, and the disease resolves after the bleed. This happens because the Yang Qi is heavy. It is primarily treated with Mahuang Tang (Ephedra Decoction).

This clause details nosebleed. The phrase "primarily treated with Mahuang Tang" appears under "should induce sweat."

Taiyang disease with a floating-tight pulse, fever, and body anhidrosis, if spontaneous nosebleed occurs, the disease heals itself.

For Taiyang disease with a floating-tight pulse, fever, and anhidrosis, Mahuang Tang should be used. Because the patient's Zheng Qi (Upright Qi) is robust, the disease resolves via spontaneous nosebleed before administering Mahuang Tang. This clarifies the Taiyang anhidrosis syndrome from the previous chapter: if spontaneous nosebleed occurs, the disease resolves, and Mahuang Tang need not be used again.

Shanghan (Cold Damage) with a floating pulse, fever, and anhidrosis, where the exterior is not resolved, Baihu Tang (White Tiger Decoction) must not be given. If there is thirst for drinking water and no exterior syndrome, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is used.

The first half states that for anhidrosis, inducing sweat is appropriate, warning against using Baihu Tang; the second half states that for thirst for water with no exterior syndrome, inducing sweat is contraindicated, and Baihu Tang is appropriate.

Yangming disease with anhidrosis, difficulty in urination, and mental restlessness/oppression results in inevitable body jaundice.

In Yangming disease, anhidrosis combined with difficulty in urination means heat-dampness is suppressed and cannot dissipate, causing mental restlessness and oppression. Prolonged depression of damp-heat inevitably leads to body jaundice. This clause does not prescribe a specific formula but implies four treatments for Yangming anhidrosis: 1. Anhidrosis with exterior heat is treated with Gange Fangfeng Tang (Pueraria and Saposhnikovia Decoction) to release the exterior; 2. Anhidrosis with difficulty in urination is treated with Zhu Ling Tang (Polyporus Decoction) to clear and drain; 3. Anhidrosis with mental oppression is treated with Zhizi Douchi Tang (Gardenia and Fermented Soybean Decoction) to relieve vexation; 4. Anhidrosis with body jaundice is treated with Yinchen Tang (Artemisia Decoction) to treat jaundice.

Shaoyin disease presenting only with cold limbs and anhidrosis, if forcibly induced to sweat, will disturb the blood. It is unknown which pathway the blood will exit, whether from the mouth/nose or ears/eyes. This is named "Lower Cold and Upper Exhaustion" and is difficult to treat.

This clause describes a Shaoyin transmitted interior heat syndrome. The physician sees cold limbs and anhidrosis, mistaking it for unextended exterior cold pathogen, and erroneously uses Mahuang and Guizhi to forcibly disperse sweat with acrid-warm herbs. The blood, heated by these herbs, flows recklessly and exits from the mouth, nose, ears, or eyes.

Da Qinglong Tang (Major Blue Green Dragon Decoction) - See Irritability clause.
Gange Tang (Pueraria Decoction) - See Malaria-like Symptom clause.
Yinchen Zhizi Douchi Tang (Artemisia, Gardenia, and Fermented Soybean Decoction) - Composed of three ingredients.
This is interior heat stasis evaporating to cause jaundice. The author's secret addition includes Gange and Fangfeng to simultaneously disperse exterior depression, achieving complete interior-exterior dispersion.
Baihu Tang (White Tiger Decoction) - See Tidal Fever clause.
Xiao Qinglong Tang (Minor Blue Green Dragon Decoction) - See Cough clause.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)
Renshen (Ginseng) Baizhu (Atractylodes Macrocephala) Danggui (Angelica Sinensis) Huangqi (Astragalus) Chenpi (Citrus Reticulata Peel) Chaihu (Bupleurum) Shengma (Cimicifuga) Gancao (Licorice)
When exterior pathogen is closed and depressed causing anhidrosis, and pure exterior-releasing fails because Middle Qi deficiency prevents sweat production, this formula is used. The author's secret addition includes Jingjie and Fangfeng to treat fatigue-induced common cold.
Er Chen Tang (Two-Cured Decoction) and Daotan Tang (Phlegm-Resolving Decoction) - Both see Malaria-like Symptom clause.
Pingwei San (Stomach-Pacifying Powder) - See Delirium clause.
Shengyang Sanhuo Tang (Raising Yang and Dispersing Fire Decoction)
Shengma (Cimicifuga) Gegen (Pueraria) Duhuo (Angelica Pubescens) Qianghuo (Notopterygium) Renshen (Ginseng) Chaihu (Bupleurum) Fangfeng (Saposhnikovia) Gancao (Licorice) Baishao (White Peony)
When exterior pathogen lies latent internally, suppressed by cold, causing fever and anhidrosis with cold hands and feet, this is heat pathogen unable to vent forth, thus treated by "venting fire depression."
Xiaozhi Shengyang Tang (Eliminate Stagnation and Raise Yang Decoction)
Houpo (Magnolia Bark) Banxia (Pinellia) Zhike (Aurantii Fructus) Guangpi (Citrus Peel) Shengma (Cimicifuga) Gegen (Pueraria)
Yangming anhidrosis with chest fullness indicates phlegm and food stagnation in the Stomach. Thus, Banxia and Zhipo are used to eliminate gastric stagnation, supplemented by Shengma and Gegen to vent and release exterior pathogen.
Shuangjie San (Double-Resolution Powder) - See Mania clause.
If purely exterior pathogen causes anhidrosis, use exterior-releasing methods; if exterior has pathogen and interior has heat, use this formula for double resolution.
Xiaochaihu Tang (Minor Bupleurum Decoction) - See Aversion to Cold and Headache clause.
For Three Yang channels with exterior pathogen and interior heat, use the former Double-Resolution formula; for Shaoyang channel with exterior pathogen and interior heat, use this formula.
Lifei Fabiao Tang (Regulate Lung and Release Exterior Decoction) - Author's secret prescription for Lung Qi suppression causing fever and anhidrosis.
Qianghuo (Notopterygium) Duhuo (Angelica Pubescens) Chaihu (Bupleurum) Gange (Pueraria) Zhijie (Aurantium and Platycodon) Sangpi (Mulberry Root Bark)
Pingwei Fabiao Tang (Stomach-Pacifying and Release Exterior Decoction) - Author's secret prescription for Stomach Qi suppression causing fever and anhidrosis.
Qianghuo (Notopterygium) Duhuo (Angelica Pubescens) Chaihu (Bupleurum) Gange (Pueraria) Zhipo (Aurantium and Magnolia) Banxia (Pinellia)

Zhang Zhongjing's first clause establishes Mahuang Tang to treat fever with anhidrosis, rebellious Qi, wheezing, and fullness, using Xingren (Apricot Seed). This implicitly reveals that the Lung governs the skin-hair pores; Lung Qi congestion causes wheezing, rebellious Qi, and anhidrosis. Developing and moistening Lung Qi is the true secret of inducing sweat. Under the Guizhi Tang clause, it says: "After taking the medicine, eat thin porridge to assist the medicinal power." This implicitly reveals that fever with sweating indicates no gastric stagnation, allowing thin porridge to assist the medicine in dispersing pathogens. If fever with anhidrosis occurs, it indicates gastric coagulation preventing sweat production, thus requiring development. The Stomach governs muscles; smoothing and benefiting Stomach Yang is the true secret of inducing sweat. In the head-sweat clause, it clarifies that sweating only on the head with no body sweat is due to fluid retention and stagnant heat coagulating in the Middle Jiao, blocking pathways throughout the body. Treatment should focus on venting Stomach Qi and unblocking meridians. Carefully studying Mahuang and Guizhi, they are suitable for the North but not the South. Therefore, the author modified the Baidu San (Anti-Toxin Powder) method, adding Zhike, Jiegeng, and Sangpi, naming it Lifei Fabiao Tang (Regulate Lung and Release Exterior Decoction), to treat wind-cold congesting the Lung, causing fever, wheezing, rebellious Qi, and anhidrosis. This treatment is derived from the Mahuang-Xingren formula. Furthermore, by adding Zhishi, Houpo, Banxia, and Cangzhu to the Baidu San formula, it is named Pingwei Fabiao Tang (Stomach-Pacifying and Release Exterior Decoction), to treat phlegm-saliva and food stagnation, chest fullness, fever, headache, body pain, and anhidrosis. This is derived from the Taiyang disease with exterior signs and fluid retention under the Diaphragm, treated with Xiao Qinglong Tang (Minor Blue Green Dragon Decoction). By acridly dispersing fluid retention and distributing it in the Stomach, the internally retained fluid transforms into sweat, and the externally contracted exterior pathogen resolves with the sweat. This achieves two solutions with one action, demonstrating the profound understanding of transforming methods and applying formulas.