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Heat pathogen fails to diffuse outward, leading to the following scenarios: When stasis-heat accumulates in the interior, jaundice will inevitably manifest; when heat enters the Blood Chamber (Xue Shi), or in cases of deficiency vexation, or when Yangming disease is treated with fire therapy erroneously, or when water retention binds in the chest, all these conditions result in sweating only on the head. In all these instances, it is because heat cannot diffuse outward; therefore, treatment involves either emesis or purgation to eliminate the internal heat.

Furthermore, if the pathogen remains solely at the exterior, there will be no sweating on the head. Sweating on the head occurs only when cold-dampness combats each other, or when the pathogen resides between the exterior and interior. For example, in Shanghan (Cold Damage) after five or six days, if sweating was induced first and then purgation was erroneously applied, 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; or if after five or six days of Shanghan, there is slight sweating on the head, mild aversion to cold, cold hands and feet, fullness in the epigastrium, lack of desire for food, hard stools, and a fine pulse—these are all due to the pathogen residing between the exterior and interior, causing sweating on the head.

Patients with dampness diseases who sweat only on the head and wish to cover themselves and seek warmth from fire do so because cold-dampness combats each other, hence the head sweating. These situations should not be termed "adverse" (Ni). However, if difficulty in urination develops into Guan Ge (obstruction syndrome characterized by inability to urinate), and sweating on the head appears, this indicates the collapse of Yang Qi. The Classics state: "When Guan Ge obstructs and urination is impossible, those with no sweating on the head survive, while those with sweating die." Additionally, if a dampness patient is erroneously purged, resulting in sweating on the forehead and slight asthma, this also signifies the collapse of Yang Qi. The Classics state: "If a dampness patient is purged and sweats on the forehead with difficulty in urination, death ensues; if diarrhea persists unceasingly, death also ensues." These two cases represent adverse manifestations of head sweating.

In the Taiyang Chapter: If Shanghan persists for more than ten days with heat binding in the interior and alternating chills and fever, Da Chai Hu Tang (Major Bupleurum Decoction) is indicated. If it is Jie Xiong (Chest Binding) but without significant external heat, indicating water binding in the chest with only slight sweating on the head, Da Xian Xiong Tang (Major Draining the Chest Decoction) is indicated. If after five or six days of Shanghan, sweating was induced followed by erroneous purgation, leading to 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 has not resolved; Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is appropriate.

In Wind Strike (Zhong Feng) of Taiyang disease, if forced sweating is induced by fire therapy, the wind pathogen combined with fire causes blood and Qi to overflow abnormally. The combination of two Yangs (wind and fire) scorching each other leads to jaundice. Excess Yang heat may cause nasal bleeding; excess Yin fluid deficiency leads to difficult urination. If both Yin and Yang are depleted, the body becomes dry. Sweating occurs only on the head, stopping at the neck, accompanied by abdominal fullness, slight asthma, dry mouth, sore throat, or constipation. Prolonged cases may develop delirium; severe cases may exhibit 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 scorching effect causes external heat and jaundice. If heat binds in meridians, causing Yang excess and external heat, it forces blood upward, causing nasal bleeding. If heat binds internally, causing Yin deficiency and internal heat, urination becomes difficult. If heat consumes blood and Qi, leading to deficiency of both Yin and Yang, the body lacks nourishment and becomes dry. 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 asthma indicate internal stagnation of heat. "Fire qi arising internally causes dry mouth and sore throat" due to heat scorching upward. If heat does not descend, stool is not hard; if heat descends to the stomach and consumes fluids, stool becomes hard. Thus, "or constipation." Over time, stomach dryness and heat cause delirium. The Neijing states: "In deep disease, the voice is hoarse/hiccupping." Extreme fire qi disrupts Zheng Qi, causing hiccups. Also, "The four limbs are the root of all 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, allowing for treatment. Suitable formulas include Huang Qin Zhi Zi Bai Pi Tang (Scutellaria, Gardenia, and Phellodendron Bark Decoction). For nasal bleeding, use Huang Qin Tang (Scutellaria Decoction); for difficult urination, use Wu Ling San (Five Ingredient Powder with Poria). If urination is free, fluids are not exhausted; if obstructed, upper dryness and lower depletion make it untreatable. Da Chai Hu Tang and Cheng Qi Tangs are mentioned.)

In Taiyang disease, if the pulse is floating, rapid, and numbing, with headache, fever, slight night sweating, yet aversion to cold persists, the exterior is unresolved. If the physician erroneously applies purgation, the pulse changes from rapid to slow, Yang Qi sinks inward, and hardness in the heart region indicates Jie Xiong (Chest Binding). If Jie Xiong does not form, but there is sweating only on the head, no sweating elsewhere up to the neck, difficulty in urination, and inevitable jaundice. (Zhao Sizhen notes: There are several types of head sweating. Jaundice with head sweating indicates heat failing to diffuse downward. Back stiffness and aversion to cold with head sweating indicate cold-dampness binding in meridians. Lower bleeding and delirium with head sweating indicate heat entering the Blood Chamber. Vexation with head sweating indicates pathogen in the chest steaming upward. Water binding in the chest with head sweating indicates water retention blocking external diffusion. Yang micro-binding with alternating chills/fever and head sweating indicates pathogen between exterior and interior. Jaundice, nasal bleeding, difficult urination with head sweating indicate wind-fire scorching upward. All these are caused by wind pathogen invasion. The *Huo Ren Shu* incorrectly attributes these to exterior excess and interior deficiency, opening of Yuan Fu being blocked, drying of five zang organs, emptiness of Bao Zhong, and scarcity of fluids, which does not fit these syndromes. Furthermore, two specific cases are adverse head sweating. The Classics state: "Guan Ge obstruction prevents urination; no head sweating means survival, head sweating means death." Also, "Purging dampness patients causing forehead sweating and slight asthma with free urination leads to death; persistent diarrhea also leads to death" due to upward collapse of Yang Qi. The *Huo Ren Shu* fails to distinguish treatable from untreatable cases here.)

In Yangming disease, fever with sweating indicates heat diffusing outward, preventing jaundice. Sweating only on the head, no sweating elsewhere up to the neck, difficulty in urination, and thirst for liquids indicate stasis-heat binding in the interior, inevitably leading to jaundice. Yin Chen Tang (Artemisia Capillaris Decoction) is the primary treatment (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 therapy, slight sweating on the forehead and difficulty in urination inevitably lead to jaundice. (Cheng Wuji notes: Yangming disease involves internal heat; fire therapy exacerbates it. Generalized sweating with free urination allows heat to diffuse, preventing jaundice. Here, forehead sweating with difficult urination prevents heat diffusion, causing steaming in the stomach and jaundice. Use Yin Chen Wu Ling San or Zhi Zi Bai Pi Tang.)

After purgation in Yangming disease, if external heat remains and hands/feet are warm, Jie Xiong does not form. Hunger in the epigastrium without desire to eat, and sweating only on the head, are treated with Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction). If Yangming disease involves lower bleeding and delirium, this is heat entering the Blood Chamber. With sweating only on the head, puncture Qi Men (LR14) to drain excess. Profuse sweating follows, and the patient recovers. (Cheng Wuji notes: Heat entering the Blood Chamber forces blood downward, causing bleeding and delirium. Yangming disease typically involves sweating; since blood loss reduces sweating, only head sweating occurs. Puncturing Qi Men dissipates Blood Chamber heat and drains Yangming pathogenic heat. Once pathogens are cleared, Ying Qi flows, fluids restore, profuse sweating occurs, and resolution follows.)

After five or six days of Shanghan, with head sweating, mild aversion to cold, cold hands/feet, epigastric fullness, lack of desire for food, hard stools, and fine pulse, this is Yang Micro-Binding (Yang Wei Jie). There is both exterior and interior involvement. A deep pulse also indicates interior involvement. Head sweating indicates Yang Micro-Binding. If it were pure Yin Binding, there would be no exterior signs, as everything enters the interior. This is half-exterior, half-interior. Although the pulse is deep and tight, it is not Shaoyin disease because Yin syndromes do not typically present with sweating. The presence of head sweating confirms it is not Shaoyin. Xiao Chai Hu Tang (Minor Bupleurum Decoction) may be given. If the patient still feels uncomfortable afterward, passing stool resolves the condition. (Cheng Wuji notes: Five to six days is when pathogen transmits to the interior. Head sweating and mild aversion to cold indicate the exterior is unresolved. Cold extremities, epigastric fullness, etc., indicate pathogen binding in the interior. Hard stool indicates Yang binding. Although heat has transmitted, the presence of exterior pathogen keeps the binding shallow, hence "Yang Micro-Binding." Deep pulse indicates interior, but pure Yin Binding lacks exterior signs like head sweating and aversion to cold. Yin meridians stop at the neck/chest; they do not ascend to the head. Head sweating confirms non-Shaoyin. Xiao Chai Hu Tang clears the semi-exterior/semi-interior pathogen. If discomfort persists after taking the decoction, it indicates residual interior heat; mild purgation resolves it, hence "resolution upon passing stool.")

Sun Simiao notes: In water binding in the chest and hypochondrium, the head invariably sweats. Treat with Ban Xia Fu Ling Tang (Pinellia and Poria Decoction).

*Huo Ren Shu* notes: In patients with exterior excess and interior deficiency, blocked Yuan Fu causes Yang Qi to rise, resulting in head sweating. Head sweating indicates dried five Zang organs, empty Bao Zhong, and scant fluids. Do not purge, as this causes双重 deficiency.

Hai Zang notes: Head sweating stopping at the neck is a Blood syndrome. Predominant forehead sweating belongs to the Heart region and is a Blood syndrome. Tonify the Middle Jiao Spleen Earth using blood-invigorating herbs; this method is supreme.

Sweating on Hands and Feet:
The Stomach governs the four limbs and is the master of Body Fluids. Disease manifests as sweating on hands and feet. This indicates heat gathering in the Stomach, causing fluids to leak laterally. The Classics state: "Profuse sweating on hands and feet indicates hardened stool." Also: "Dripping sweat on hands and feet with difficult stool and delirium." Both cases require purgation. Conversely, Yangming Cold-Dampness with inability to eat, difficulty in urination, and profuse hand/foot sweating suggests impending Gu Jia (stubborn mass); purgation is inappropriate. Both present with hand/foot sweating: one involves initial hard stool followed by loose stool due to cold water in the Stomach mixing with grain, making purgation contraindicated; the other involves difficult stool and delirium, confirming full Yangming syndrome, making purgation appropriate.

In Er Yang Bing Bing (Concurrent Disease of Two Yangs), once Taiyang signs cease, tidal fever, profuse hand/foot sweating, difficult stool, and delirium appear. Purgation cures it using Da Cheng Qi Tang (Major Order the Qi Decoction).

In Yangming disease, a slow pulse with sweating but no aversion to cold, heavy body, shortness of breath, abdominal fullness, asthma, and tidal fever indicate the exterior is resolving and interior can be attacked. Profuse hand/foot sweating indicates hardened stool; Da Cheng Qi Tang is indicated (see Tidal Fever).

If Yangming disease involves Cold-Dampness, inability to eat, difficulty in urination, and profuse hand/foot sweating, it suggests impending Gu Jia, with stool initially hard then loose due to cold water in the Stomach. (Use Hou Po Sheng Jiang Gan Cao Ban Xia Ren Shen Tang, Wu Zhu Yu Tang, or Li Zhong Tang.)

No Sweating:
There are several types of no-sweating conditions. Cold pathogen at the exterior; Pathogen moving in the interior; Internal retention of water-fluids; Yang deficiency. The Classics mention Taiyang disease with no sweating and asthma, floating-tight pulse with no sweating and fever, and no sweating with irritability. Yangming disease with no sweating and free urination, vomiting/cough after 2-3 days, cold extremities, headache, dry nose, no sweating, floating pulse with asthma, and Gang Jing (Stiff Spasm) with no sweating—all indicate cold pathogen at the exterior.

The Classics mention Yangming disease with no sweating, difficulty in urination, inner vexation, and inevitable jaundice; Shanghan with fever, no sweating, thirst for water, and no exterior sign (treated with Bai Hu Jia Ren Shen Tang); and Three Yin diseases generally having no sweating (except Shaoyin Yang Collapse where sweating indicates transmission to Shaoyin)—all indicate pathogen in the interior.

For no sweating due to internal water retention: After taking Gui Zhi Tang or purgation, if headache, stiff neck, low-grade fever, no sweating, chest fullness, slight pain, and difficulty in urination persist, use Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction).

For no sweating due to Yang deficiency: A floating and sluggish pulse indicates lack of Yang, inability to sweat, and likely itching skin.

Taiyang fever, aversion to cold, body ache, no sweating, and asthma: Ma Huang Tang (Ephedra Decoction) syndrome.
Fever, aversion to cold, body ache, no sweating, and irritability: Da Qing Long Tang (Major Green Dragon Decoction) syndrome.
After Gui Zhi or purgation, persistent headache/stiff neck, fever, no sweating, slight epigastric pain, difficulty in urination: Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang syndrome.
Stiff neck/back, no sweating, aversion to wind: Ge Gen Tang (Kudzu Decoction) syndrome.
Yangming floating pulse, no sweating, and asthma: Ma Huang Tang syndrome (See above).

Shanghan with floating pulse, fever, no sweating, and unresolved exterior: Do not give Bai Hu Tang. Thirst for water with no exterior sign: Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng).
Yangming disease typically involves sweating; reverse no sweating with sensation of insects crawling in skin indicates chronic deficiency. (Stomach is master of fluids; chronic deficiency exhausts fluids, preventing sweating. Stomach governs muscles; excess causes pain, deficiency causes itching. Use Huang Qi Jian Zhong Tang (Astragalus Decoction for Establishing the Middle). Once fluids harmonize, if Yangming signs persist, use Xiao Chai Hu Tang to gradually resolve.)
Yangming disease with reverse no sweating but free urination, vomiting/cough after 2-3 days, and cold extremities必然 causes severe headache. If no vomiting/cough and extremities are warm, no headache.
Yangming disease with no sweating, difficulty in urination, and inner vexation inevitably leads to jaundice. (Cheng Wuji notes: No sweating and difficult urination trap heat internally, unable to diffuse. Inner vexation indicates heat steaming, attempting to exit as jaundice. Use Yin Chen Wu Ling San or Gui Zhi Bai Pi Tang.)

Shaoyin disease with only cold extremities and no sweating: Forced sweating will disturb blood, causing bleeding from mouth/nose or eyes. This is named Xia Jue Shang Jie (Lower Cold, Upper Exhaustion), which is difficult to treat. (Cheng Wuji notes: Cold extremities and no sweating indicate heat in the interior. Forced sweating damages meridians; heat exploits deficiency, forcing blood to escape via weak points (mouth, nose, eyes). All Jue syndromes relate to the lower; cold extremities are Lower Jue. Blood loss from above is Upper Exhaustion. Damaging Qi and Blood with severe pathogen and deficient Zheng Qi makes it difficult to treat.)

Inability to Sweat:
If Taiyang disease is fumigated with fire and sweating does not occur, the patient becomes irritable. If the cycle completes without resolution, rectal bleeding occurs, termed Fire Pathogen. (Cheng Wuji notes: Fire pathogen forces blood downward. Fumigation without sweating traps heat; Yin deficiency exacerbated by fire causes irritability. By day seven, returning to Taiyang, heat should resolve. If not, heat forces blood downward, causing rectal bleeding. Use Bai Pi Tang or Xi Jiao Di Huang Tang.)

In Taiyang disease after eight to nine days, resembling malaria with fever/aversion to cold, more heat than cold, no vomiting, clean desire to defecate, occurring 2-3 times daily: A slightly slow pulse indicates recovery. A slight pulse with aversion to cold indicates dual deficiency of Yin and Yang; do not induce sweating, vomiting, or purgation. If the face shows redness due to inability to sweat slightly, the body itches; Gui Ma Ge Han Tang (Gui Zhi and Ma Huang Combined Half Dosage Decoction) is suitable.

If Taiyang disease on day two presents with dryness, and the back is ironed causing profuse sweating, fire heat enters the Stomach, exhausting fluids, causing irritability and delirium. After ten days, shaking and spontaneous diarrhea indicate resolution. If no sweating from waist down, difficulty urinating, vomiting, urge to lose urine, cold feet, hard stool, frequent small bowel movements (but not truly rapid), and large stools finally passed, sudden head pain and hot soles indicate Grain Qi flowing downward. (Alternatively, take Gui Zhi Tang first due to excessive sweating, then Tiao Wei Cheng Qi Tang. Grain Qi flowing downward requires mild harmony with Xiao Cheng Qi Tang.)

Yangming Wind Strike with stringy-floating-large pulse, shortness of breath, abdominal fullness, hypochondriac/heart pain, unrelieved by pressure, dry nose, no sweating, lethargy, generalized jaundice, difficulty in urination, tidal fever, and frequent hiccups: Chai Hu Tang. If only floating pulse without other signs: Ma Huang Tang.

If sweating is indicated but fails after three doses of decoction, it is a fatal condition. If heat disease presents with rapid pulse and no sweating, Huangdi considers this extreme Yang pulse and fatal. These two are true fatal conditions.

However, in cases requiring Harmonization, if sweating fails, the power of Harmonization will eventually induce sweating and resolution. Do not mistakenly interpret this as a fatal condition.