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It cannot ascend and reach the exterior. If stagnant heat is in the interior, the body will necessarily turn yellow. If heat enters the Blood Chamber, or if there is deficiency vexation, or if the Yangming disease is treated with fire methods, or if water accumulation occurs in the chest, these five conditions all result in sweating only on the head. In all these cases, it is because heat cannot vent outward; therefore, emesis or purgation should be used to eliminate the heat. Furthermore, if pathogenic factors are solely in the exterior, there will be no sweating on the head. Sweating on the head occurs only when cold-dampness combats each other, or when pathogenic factors are at the half-exterior half-interior level. For example, in Shanghan (Cold Damage) after five or six days, if sweating has already been induced and then purgation is mistakenly applied, leading to 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 in Shanghan after five or six days, with slight sweating on the head, mild aversion to cold, cold hands and feet, fullness in the epigastrium, desire not to eat, hard stools, and a fine pulse—these are all cases where pathogenic factors are between the exterior and interior, causing sweating only on the head. Patients with dampness who sweat only on the head and wish to be covered and face the fire do so because cold-dampness combats each other, hence the head sweating. These situations should not be called adverse. However, if difficulty in urination leads to Guan Ge (obstruction syndrome), and if sweating occurs on the head, this indicates the collapse of Yang Qi. The Classics state: When Guan Ge is unblocked and urination is impossible, if there is no sweating on the head, the patient lives; if there is sweating on the head, the patient dies. Additionally, if a dampness patient is mistakenly purged and subsequently sweats on the forehead with slight panting, this is also Yang Qi collapse. The Classics state: If a dampness patient is purged and sweats on the forehead with difficulty in urination, the patient dies; if there is incessant diarrhea, the patient also dies. These two scenarios represent adverse head sweating.

Taiyang Disease: In Shanghan for more than ten days, with heat accumulating in the interior and recurring alternating chills and fever, Da Chai Hu Tang (Greater Bupleurum Decoction) is indicated. If it is Jie Xiong (Chest Binding) without high fever, this is water binding in the chest; if there is only slight sweating on the head, Da Xian Xiong Tang (Major Draining the Chest Decoction) is indicated. In Shanghan after five or six days, after sweating and mistaken purgation, 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, the pathogen remains unresolved; Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) is appropriate.

In Taiyang Wind Strike, if fire therapy is forcibly used to induce sweating, wind pathogen combined with fire forces blood and Qi to overflow abnormally. The combination of Wind and Fire (two Yangs) scorches the body, causing jaundice. Excess Yang may cause nasal bleeding; excess Yin may cause difficulty in urination. If both Yin and Yang are deficient and exhausted, the body becomes dry. Sweating only on the head up to the neck, abdominal fullness, slight panting, dry mouth, sore throat, or constipation, which over time leads to delirium, and in severe cases, 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 mutual scorching causes external heat and jaundice. If heat binds with meridians, causing Yang excess and external heat forcing blood upward, nasal bleeding occurs. If heat binds internally, causing Yin deficiency and internal heat, urination difficulty occurs. If heat consumes blood and Qi, leading to dual deficiency of Yin and Yang, insufficient nourishment causes dryness. 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 panting indicate internal heat stagnation. The Neijing states: Internal fire emission causes upper dryness and sore throat. Heat rising without descending keeps stool soft; heat descending into the stomach consumes fluids, hardening stool. Thus, "or constipation." Prolonged dryness-heat in the stomach causes delirium. The Neijing states: Deep disease manifests as hiccups. Extreme fire disrupts Zheng Qi, causing hiccups. Also, limbs are the root of 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, so treatment is possible. Indicated formulas include Huang Qin Zhi Zi Bai Pi Tang (Scutellaria, Gardenia, and Phellodendron Bark Decoction), Xu Huang Huang Qin Tang (Nasal Bleeding Scutellaria Decoction), and Wu Ling San (Five-Ingredient Powder with Poria). Free urination means fluids are not exhausted; obstruction implies upper dryness and lower exhaustion, termed untreatable. Da Chai Hu Tang and Cheng Qi Tangs are options.)

In Taiyang disease, if the pulse is floating, rapid, and moving, with headache, fever, slight night sweats, yet aversion to cold persists, the exterior is unresolved. If the physician mistakenly applies purgation, the rapid pulse becomes slow, Yang Qi sinks inward, causing hardness in the heart region, forming Jie Xiong (Chest Binding). If Jie Xiong does not form, but there is only head sweating, no sweating elsewhere up to the neck, difficulty in urination, and jaundice, Zhao Sizhen notes: Head sweating has several types: Jaundice with head sweating indicates heat unable to vent; back stiffness and aversion to cold with head sweating indicate cold-dampness lodging in meridians; lower bleeding and delirium with head sweating indicate heat entering the Blood Chamber with deficiency vexation; head sweating alone indicates pathogen in the chest steaming upward; water binding in the chest with head sweating indicates water retention blocking exterior flow; Yang Wei Jie (Yang slight binding) with alternating chills/fever and head sweating indicates pathogen at half-exterior/half-interior; jaundice, nasal bleeding, urination difficulty with head sweating indicate wind-fire scorching upward. These are caused by wind pathogen. The *Huoren Shu* incorrectly attributes them to exterior excess, interior deficiency, closed pores, dried viscera, empty bladder, and scant fluids, which does not fit these syndromes. Two adverse head sweating types exist: The Classics state Guan Ge obstruction with no urination: no head sweating means life, head sweating means death. Also, post-purgation forehead sweating with slight panting and free urination in dampness patients is fatal due to Yang collapse; incessant diarrhea is also fatal. The *Huoren Shu* fails to distinguish treatable from untreatable here.

Yangming Disease: Fever with sweating indicates heat venting outward, so jaundice will not occur. Only head sweating, no body sweating up to the neck, difficulty in urination, thirst for fluids indicates stagnant heat in the interior, leading to jaundice; Yin Chen Tang (Artemisia Capillaris Decoction) is primary (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, slight forehead sweating and difficulty in urination lead to jaundice. Cheng Wuji notes: Yangming involves internal heat; fire adds to it. General sweating and free urination allow heat venting, preventing jaundice. Forehead sweating and obstructed urination trap heat in the stomach, causing jaundice. Use Yin Chen Wu Ling San or Zhi Zi Bai Pi Tang.

After purgation in Yangming disease, if exterior heat remains and hands/feet are warm, Jie Xiong does not form. Hunger in the epigastrium without desire to eat, and only head sweating, indicate Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). Lower bleeding and delirium in Yangming indicate heat entering the Blood Chamber; only head sweating requires puncturing Qi Men (LR14) to drain excess. Natural sweating follows recovery. Cheng Wuji notes: Heat in the Blood Chamber forces blood downward, causing bleeding and delirium. Yangming usually has sweating, but blood loss prevents general sweating, leaving only head sweating. Puncturing Qi Men disperses Blood Chamber heat and drains Yangming pathogen, restoring Ying Qi and fluids, leading to natural sweating.

Shanghan after five or six days, with head sweating, mild aversion to cold, cold hands/feet, epigastric fullness, anorexia, hard stools, and fine pulse, indicates Yang Wei Jie (Yang slight binding). There is both exterior and interior involvement. Deep pulse indicates interior location. Head sweating suggests Yang Wei Jie. Pure Yin Binding would lack exterior signs like head sweating and aversion to cold. This is half-exterior, half-interior. Although pulse is deep/tight, it is not Shaoyin disease because Yin syndromes do not sweat. Head sweating confirms it is not Shaoyin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) is given. If discomfort persists, bowel movement resolves it. Cheng Wuji notes: Day 5-6 is when pathogen transmits inward. Head sweating and mild aversion to cold mean exterior remains. Cold limbs, epigastric fullness, anorexia, hard stools, fine pulse indicate interior binding. Hard stool is Yang binding. Pathogen transmitted inward but retains exterior link, so heat binding is shallow ("Yang Wei"). Deep pulse suggests interior, but pure Yin Binding lacks exterior signs. Yin meridians stop at neck/chest; head sweating rules out Shaoyin. Xiao Chai Hu Tang clears half-exterior/half-interior pathogen. After taking the decoction, if exterior resolves but discomfort remains, interior heat persists. Mild purgation cures it, hence "resolve with stool."

Sun Simiao notes: Water binding in chest/hypochondrium always causes head sweating; treat with Ban Xia Fu Ling Tang (Pinellia and Poria Decoction).

*Huoren Shu* notes: Exterior excess, interior deficiency, closed pores cause Yang Qi to rise and sweat on the head. Head sweating indicates dried viscera, empty bladder, and scant fluids. Do not purge, as it worsens deficiency.

Hai Zang notes: Head sweating up to the neck is a Blood syndrome. Forehead predominance relates to Heart and Blood. Tonify Middle Jiao Spleen Earth with Blood-invigorating herbs; this method is supreme.

Hand and Foot Sweating:
Stomach governs limbs and is the master of fluids. Disease causes hand/foot sweating due to heat gathering in Stomach, forcing fluids to periphery. Classics state: Ji Ran Han Chu (continuous sweating) of hands/feet with hard stool requires purgation. Hand/foot sweating with difficult stool and delirium also requires purgation. Conversely, Yangming Cold-Damp with inability to eat, difficulty urinating, and hand/foot sweating indicates impending Gu Jia (stubborn mass); purgation is contraindicated. Both have hand/foot sweating: one has hard-then-loose stool due to cold-water mixing in Stomach (contraindicates purgation); the other has difficult stool/delirium as complete Yangming syndrome (indicates purgation).

Er Yang Bing Bing (Dual Yang Disease): Taiyang signs cease, tidal fever, hand/foot sweating, hard stool, and delirium occur; purgation cures it using Da Cheng Qi Tang (Major Order the Qi Decoction).

Yangming disease with slow pulse, sweating without aversion to cold, heavy body, shortness of breath, abdominal fullness, panting, and tidal fever indicates exterior resolving and interior ready for attack. Hand/foot continuous sweating confirms hard stool; Da Cheng Qi Tang is primary (see Tidal Fever).

Yangming Cold-Damp with inability to eat, difficulty urinating, and hand/foot sweating indicates impending Gu Jia, likely hard-then-loose stool due to cold-water mixture. Use Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang (Magnolia Bark, Fresh Ginger, Licorice, Pinellia, and Ginseng Decoction), Wu Zhu Yu Tang (Evodia Decoction), or Li Zhong Tang (Regulate the Middle Decoction).

No Sweating:
Types include: Cold pathogen in exterior; Pathogen in interior; Water retention internally; Yang deficiency. Classics: Taiyang disease with no sweating and panting; floating-tight pulse with no sweating and fever; no sweating with irritability; Yangming disease with no sweating and free urination; 2-3 days vomiting/coughing with cold extremities; headache, dry nose, no sweating, floating pulse with panting; Gang Jing (Stiff Spasm) with no sweating—all indicate Cold in exterior. Classics: Yangming no sweating, difficulty urinating, Ao Nao (vexation), jaundice; Shanghan fever, no sweating, thirst for water, no exterior sign, use Bai Hu Jia Ren Shen Tang (White Tiger plus Ginseng Decoction); Three Yin diseases generally have no sweating (except Shaoyin Yang Collapse transforming to Shaoyin)—all indicate Pathogen in interior. Water retention no sweating: Post-Gui Zhi Tang or purgation, headache, stiff neck, low-grade fever, no sweating, epigastric fullness/pain, difficulty urination; use Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction). Yang deficiency no sweating: Floating-slow pulse indicates lack of Yang, inability to sweat, body itching.

Taiyang fever, aversion to cold, body pain, no sweating, panting: Ma Huang Tang (Ephedra Decoction).
Fever, aversion to cold, body pain, no sweating, irritability: Da Qing Long Tang (Major Green Dragon Decoction).
Post-Gui Zhi Tang/purgation, headache/stiff neck, fever, no sweating, epigastric pain, difficulty urination: Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang.
Stiff neck/back, no sweating, aversion to wind: Ge Gen Tang (Kudzu Decoction).
Yangming floating pulse, no sweating, panting: Ma Huang Tang (see above).

Shanghan floating pulse, fever, no sweating, exterior unresolved: Do not give Bai Hu Tang. Thirst for water, no exterior sign: Bai Hu Jia Ren Shen Tang.
Yangming usually sweats; reverse no sweating with sensation of insects crawling on skin indicates chronic deficiency. Stomach masters fluids; chronic deficiency exhausts fluids, preventing sweating. Stomach governs muscles: excess causes pain, deficiency causes itching. Use Huang Qi Jian Zhong Tang (Astragalus Decoction to Build the Middle). Once fluids harmonize, if Yangming signs persist, use Xiao Chai Hu Tang to gradually resolve.
Yangming reverse no sweating with free urination, 2-3 days vomiting/coughing, cold extremities, severe headache. No cough/vomit/cold extremities means no headache.
Yangming no sweating, difficulty urinating, Ao Nao: Jaundice inevitable. Cheng Wuji notes: No sweating + difficulty urination traps heat internally. Ao Nao indicates heat steaming outward to cause jaundice. Use Yin Chen Wu Ling San or Zhi Zi Bai Pi Tang.

Shaoyin disease with cold extremities and no sweating: Forced sweating moves blood, causing bleeding from nose/mouth/eyes. Named Xia Jue Shang Jie (Lower Cold, Upper Exhaustion), difficult to treat. Cheng Wuji notes: Cold/no sweating indicates heat in interior. Forced sweating damages collaterals; heat forces blood out through weak points. All Jue involve lower body; cold extremities are Lower Jue; blood loss from above is Upper Exhaustion. Damaged Qi/Blood, strong pathogen, weak Zheng Qi make it difficult.

Cannot Sweat:
Taiyang disease fumigated with fire, no sweating, irritability. By day 7 (cycle completion), if unresolved, blood in stool occurs, named Huo Xie (Fire Evil). Cheng Wuji notes: Fire forces blood downward. Fumigation without sweating traps heat; Yin deficiency + fire causes irritability. Day 7 cycle should resolve heat; if not, heat forces blood downward (hematochezia). Use Bai Pi Tang or Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction).

Taiyang 8-9 days, malaria-like fever/chills, more heat than cold, no vomiting, normal stool/urine, occurring 2-3 times daily, pulse slightly slow: recovering. Pulse slight with aversion to cold: Dual Yin/Yang deficiency, no sweating/emesis/purgation. Face red due to trapped heat, body itchy: Gui Ma Ge Ban Tang (Half Cinnamon Twig Half Ephedra Decoction).

Taiyang day 2, dryness, back fanning causes heavy sweating, fire enters Stomach, fluid exhaustion, irritability, delirium. After 10 days, shaking/diarrhea: resolving. Lower body no sweating, urge to urinate but cannot, vomiting, incontinence, foot aversion to cold, hard stool, frequent urination but slow pulse, eventual stool passage, sudden headache, hot soles: Grain Qi flowing down. (Some say: Heavy sweating first Gui Zhi Tang, then Tiao Wei Cheng Qi Tang; Grain Qi flows, use Xiao Cheng Qi Tang to harmonize slightly.)

Yangming Wind Stroke: String-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac/heart pain, blocked qi, dry nose, no sweating, lethargy, whole-body/jaundice, difficulty urinating, tidal fever, occasional hiccups: Chai Hu Tang. But if only floating pulse without other signs: Ma Huang Tang.

If sweating is indicated but fails after three doses of decoction: death.
If heat disease has rapid pulse but no sweating: Huangdi calls this extreme Yang pulse, death. These two are true untreatable diseases.
However, some require Harmonization. If sweating fails, Harmonizing power induces sweating and resolution. Do not mistake for death.