伤寒无汗者。盖以汗乃津液之所积也。为风暑湿气所干。外凑皮肤则为自汗。若寒邪中
经。
内
汗
而
者
不外蒸发者则无汗。经所谓阳明病。无汗小便不利。心中懊 者身必发黄。及伤寒发热无汗
。渴欲饮水。无表证者白虎加人参汤主之。与夫三阴为病。不得有汗。是数者皆邪行于里而
无汗者也。其水饮内蓄而无汗者。盖水散而为津液。渗而为汗。水饮内蓄而不行。则津液不
足
桂
阳
皮
服汤一剂病证仍在。至于服三剂而不汗者。死病也。又热病。脉躁
极也死。兹二者以无汗为真病。讵可与其余之无汗者同日而语也。
歌曰。伤寒无汗分为七。刚痉三阴与太阳。更有阳明反无汗。下连阴易应魁罡。
又云。伤寒躁盛身无汗。或用麻黄汗不行。此是诸阳之脉极。百中无一可全生。
若还无汗浑身痒。脉更浮迟本属虚。自是无阳难作汗。建中术附载医书。
无阳身痒。桂枝麻黄各半汤。阳明主有汗。今反无汗。如虫行皮中。术附汤建中汤。汗
不流
皆令自汗。惟寒邪中经。腠理致密。则津液内渗独无汗也。此皆伤寒在表则然耳。若阴病。
若水
当
于
必
甲乙经云。热病脉常躁盛。而不得汗者此阳脉之极也。死。脉躁盛而得汗者生。大抵伤
寒。
汗不
蒸法。用薪火烧地。良久扫除去火。以水洒之。蚕砂、柏叶、桃叶、糠麸皆可用。相和
铺于
床。
伤寒亦有气虚不能作汗者。仲景云。脉浮而迟为无阳。不能作汗。其身必痒。宜桂枝麻
黄各
中汤
又论云。伤寒欲得汗。与麻黄汤数剂而汗不出者不治。热病脉躁盛而不得汗者。诸阳之
极也。亦不治。二者盖真病也。亦有发热而厥。忽两手或一手无脉。是犹重阴欲雨之时。必
不能
癖
气虚
发
根
伤寒病中无汗的情况，是因为汗是津液积聚而成的。如果受到风、暑、湿气的干扰，邪气向外侵袭皮肤，就会导致自汗；如果是寒邪侵入经脉，导致体内津液不能向外蒸发，就会出现无汗。《内经》中提到阳明病，表现为无汗、小便不利、心中烦闷懊恼，这种情况下身体一定会发黄。还有伤寒发热无汗，口渴想喝水，但没有表证（如恶寒、脉浮等）的，用白虎加人参汤主治。以及三阴经发病，本来就不应该有汗，这几种情况都是因为邪气在里而无汗。如果是水饮内停蓄积导致的无汗，因为水分散开成为津液，渗透出来成为汗，如果水饮在内停滞不运行，那么津液就会极度不足。服用桂枝汤一剂后病证仍在，甚至服用三剂仍然不出汗的，属于死症。另外热病，脉象躁动盛大而完全不出汗的，也是死症。这两种情况是以无汗为真正的重病，怎能与其他普通的无汗情况相提并论呢？
歌诀说：伤寒无汗分为七种情况，包括刚痉、三阴病和太阳病。更有阳明病反而无汗，下连阴易应魁罡（指病情危重复杂）。又说：伤寒躁动盛实而身体无汗，如果用麻黄汤发汗却仍不出汗，这是诸阳之脉到了极点，百人中没有一个能保全性命的。如果还出现无汗且浑身瘙痒，脉象更见浮迟，原本属于虚证，这是因为无阳（阳气虚衰）难以作汗，建中汤、术附汤记载在医书中可以使用。无阳导致的身痒，可用桂枝麻黄各半汤。阳明病主有汗，现在反而无汗，感觉像虫子在皮肤中爬行，可用术附汤、建中汤。汗液不流动，都会导致自汗，只有寒邪侵入经脉，腠理致密，津液向内渗透，才会唯独无汗。这都是伤寒在表时的表现。如果是阴病，应当必然……（原文此处有缺漏或错乱，结合上下文推测意为阴病当有特定表现，但此处主要讲寒邪中经致无汗）。
《甲乙经》说：热病脉象常躁动盛大，而不得出汗的，这是阳脉的极点，主死。脉象躁动盛大而能出汗的，主生。大抵伤寒……（原文此处有缺漏）蒸法。用柴火烧地，很久之后扫去火灰，用水洒在地上。蚕砂、柏叶、桃叶、糠麸都可以使用，混合铺在床上。
伤寒也有因气虚而不能作汗的。张仲景说：脉象浮而迟，称为无阳，不能作汗，身体必定瘙痒，适宜用桂枝麻黄各半汤。又论述说：伤寒想要出汗，给予麻黄汤数剂却仍不出汗的，无法治疗。热病脉象躁动盛大而不得出汗的，是诸阳之极，也无法治疗。这两种大概都是真重病。也有发热而四肢厥冷，忽然两手或一手无脉的，这就像重阴欲雨之时，必不能……（原文此处有缺漏）气虚发……（原文此处有缺漏）根。
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]