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The patient presents with deficiency in the interior and excess in the exterior. The Xuanfu (sweat pores) are closed, and the Couli (interstices) are dense. There is an inability to produce sweat to moisten the skin, so Yang Qi ascends and exits only from the head. Once body fluids are exhausted, the five Zang organs become dry. Misusing purgative methods will further deplete healthy Qi, leading to severe illness. (When the exterior is excess and Xuanfu are closed, sweat cannot permeate the whole body, thus it steams upward and emerges at the neck and forehead. After excessive sweating, the fluids of the five Zang organs are diminished; forcing more sweat will inevitably cause serious disease.) Head sweating often follows meridian pathways, stopping at the neck, followed by jaundice. (Zhang Zhongjing stated: If there is no Jie Xiong [Chest Binding] syndrome, but only head sweating with no sweat elsewhere on the body, stopping at the neck, accompanied by difficulty in urination, jaundice will likely occur.) Alternating chills and fever indicate the exterior pattern has not resolved. (Zhang Zhongjing stated: In Shang Han [Cold Damage] after five or six days, if the patient has already undergone diaphoresis and then purgation, presenting with slight fullness and hardness in the chest and hypochondrium, difficulty in urination, thirst without vomiting, only head sweating, alternating chills and fever, and irritability, this indicates the exterior pattern remains unresolved. Xiao Chai Hu Tang (Minor Bupleurum Decoction) combined with Guizhi Tang (Cinnamon Twig Decoction) may be used.) Cold extremities do not necessarily indicate a Yin pattern. (Zhang Zhongjing stated: In Shang Han after seven or eight days, presenting with head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, desire not to eat, hard stools, and a fine pulse, this is Yang Wei Jie [Yang Mild Binding], involving both exterior and interior patterns. Although the pulse is deep and tight, it cannot be diagnosed as Shao Yin [Lesser Yin] disease. This is because Yin patterns should not have sweat; since there is head sweating, it is known not to be Shao Yin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) can be administered.) Liver Qi invading the Lungs requires needling of Qimen (LR14). (Zhang Zhongjing stated: In Shang Han, with fever and shivering aversion to cold, extreme thirst desiring vinegar water, abdominal fullness, spontaneous sweating, and free urination, the condition is about to resolve. This is Liver Qi invading the Lungs, named Heng [Horizontal] syndrome, requiring needling of Qimen acupoint. Qimen is located below the nipple.) Mental restlessness and vexation require Zhi Zi Tang (Gardenia Decoction). (Zhang Zhongjing stated: In Yang Ming [Greater Yang] disease, after purgation, if there is external heat, warm hands and feet, no Jie Xiong syndrome, mental restlessness and vexation, feeling hungry but unable to eat, and only head sweating, Zhi Zi Tang (Gardenia Decoction) is appropriate.) Fullness and hardness in the diaphragm region require Fu Ling Tang (Poria Decoction). These six scenarios must be carefully examined and verified.

Sweating occurs when Yang acts upon Yin. One must understand the pulse of "passing the pass." (Su Wen states: When Yang adds to Yin, it is called having sweat. Commonly referred to as the pulse of passing the pass.) Sometimes the pulses in both wrists suddenly disappear, resembling the time before rain under heavy Yin conditions. (Absence of pulse in one or both wrists belongs to the category of sweating syndromes.) If the patient was originally deficient, trembling/shivering will definitely occur; if not deficient, why would trembling occur after sweating? Without trembling and without sweating, natural recovery occurs; with harmonious Yin and Yang, what is there to doubt? Previous emesis, purgation, and blood loss led to internal fluid depletion, hence this presentation. (Zhang Zhongjing stated: Why does a patient shiver and then sweat to recover? Answer: A floating and tight pulse that feels hollow upon pressure indicates original deficiency, necessitating shivering before sweating. If the pulse is floating and rapid without hollowness, the person is not originally deficient; for self-recovery, simple sweating occurs without shivering. Why does some recover without shivering or sweating? Answer: A naturally weak pulse indicates that diaphoresis was indicated. If preceded by emesis, purgation, or blood loss, resulting in internal fluid depletion, Yin and Yang will spontaneously harmonize, leading to inevitable self-healing.) Uniform moisture over the whole body is desired; profuse dripping sweat is contraindicated. (Sweat should reach all parts of the hands and feet evenly; this is ideal, but continuous dripping is undesirable.) Sweat like oil is a bad omen; sudden worsening with panting indicates critical danger. (Zhang Zhongjing stated: Sweat like oil with incessant panting indicates the end of life.) Phlegm retention and Pi masses [abdominal lumps] obstruct sweating; they must first be cleared through treatment. (Shang Han is most feared when pre-existing conditions exist, such as phlegm-fluid retention or Pi masses, which can obstruct sweating. One must first open the pathways and ensure meridian patency.) When Kidney Water ascends and Heart Fire descends, Yin and Yang unite; the arrival of profuse sweat can save life. (Kidney Water rises, Heart Fire descends, Kan and Li interact, Yin and Yang harmonize, and profuse sweat will inevitably arrive.)