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In Taiyang cold damage (Shanghan) presenting with anhidrosis (absence of sweating), it is because sweat is accumulated from body fluids (Jinye). When disturbed by wind, summerheat, or dampness pathogens, if the pathogen attacks the exterior skin, it leads to spontaneous sweating; however, if cold pathogen invades the meridians, causing internal body fluids to fail in evaporating outward, anhidrosis occurs. The Classics state that in Yangming disease, presenting with anhidrosis, difficulty in urination, and inner restlessness (Aonao), jaundice will inevitably develop. Furthermore, in cold damage with fever and anhidrosis, thirst desire for water, but without exterior syndrome signs, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated. Additionally, diseases of the Three Yin meridians typically do not present with sweating; this is also a case where pathogens reside in the interior resulting in anhidrosis. In cases where fluid retention (Shuiyin) accumulates internally leading to anhidrosis, it is because water disperses to become body fluids and seeps into the skin to form sweat. If fluid retention accumulates internally and fails to circulate, body fluids become extremely deficient. If after taking one dose of Guizhi Tang (Cinnamon Twig Decoction) the symptoms persist, and even after three doses there is still no sweating, it indicates a fatal condition. Moreover, in heat diseases, if the pulse is rapid and vigorous yet no sweat occurs, it is also a fatal sign. These two conditions represent true pathological anhidrosis and cannot be compared with other common forms of anhidrosis.

The verse states: Cold damage anhidrosis is divided into seven types, including Gang Jing (Stiff Spasm), Three Yin diseases, and Taiyang disease. There is also Yangming disease presenting with contrary anhidrosis, connecting downwards to Yin Yi responding to Kuigang (indicating severe/complex pathology). It further says: In cold damage with agitation and fullness but no sweat, even if Mahuang Tang (Ephedra Decoction) is used and sweat does not occur, this represents the extreme of all Yang pulses; among a hundred cases, none can survive. If there is anhidrosis accompanied by whole-body itching, and the pulse is floating and slow indicating deficiency, this is due to lack of Yang making sweat production difficult; Jianzhong Shu Fu Tang (Center-Building Aconite and Atractylodes Decoction) is recorded in medical texts. For anhidrosis with body itching due to Yang deficiency, Guizhi Mahuang Gemban Tang (Half-Dose Combination of Cinnamon Twig and Ephedra Decoction) may be used. Yangming disease typically presents with sweating; now presenting with contrary anhidrosis and a sensation like insects crawling under the skin, Shu Fu Tang (Atractylodes and Aconite Decoction) or Jianzhong Tang (Center-Building Decoction) may be used. Only when cold pathogen invades the meridians, causing dense interstices (Couli) and body fluids seeping inward exclusively, does anhidrosis occur alone. These are manifestations of cold damage at the exterior level. If it were a Yin disease, sweating should necessarily occur.

The *Jia Yi Jing* states: In heat diseases, if the pulse is constantly rapid and vigorous but no sweat occurs, this is the extreme of Yang pulses and indicates death. If the pulse is rapid and vigorous but sweat occurs, life is preserved. Generally speaking regarding cold damage... [text fragment] ... steaming method: Burn firewood on the ground for a long time, then sweep away the ashes and sprinkle water on the ground. Silkworm sand, cypress leaves, peach leaves, and bran can all be used mixed together and spread on the bed.

Cold damage can also involve Qi deficiency failing to produce sweat. Zhang Zhongjing stated: A floating and slow pulse indicates absence of Yang, inability to produce sweat, and inevitable body itching; Guizhi Mahuang Gemban Tang (Half-Dose Combination of Cinnamon Twig and Ephedra Decoction) is appropriate. Another discussion states: In cold damage desiring sweat, if multiple doses of Mahuang Tang (Ephedra Decoction) fail to induce sweating, the condition is incurable. In heat diseases, if the pulse is rapid and vigorous but no sweat occurs, it represents the extreme of all Yangs and is also incurable. These two are considered true severe diseases. There are also cases of fever with cold limbs, suddenly with no pulse in both or one hand, resembling the time before heavy Yin rain falls, where... [text fragment] ... Qi deficiency causes... [text fragment]