头汗之证有二，一为邪热上壅，一为阳气内脱也。盖头为诸阳之会，凡伤寒遍身得汗者，谓之
热越，若身无汗，则热不得越而上蒸阳分，故但头汗出也，治热蒸者，可清可散，甚者可下，在去
其热而病自愈。至若气脱一证，则多以妄下伤阴，或克伐太过，或泄泻不止，以致阴竭于下，则阳
脱于上，小水不通，而上见头汗，
则大危矣。
《论》曰∶伤寒五六日，头出汗，微恶寒，手足冷，心下满，口不欲食，大便难，脉细者，此
为阳微结，乃半在里半在外也。脉虽沉紧，不得为少阴病，所以然者，阴不得有汗，今头汗出，故
知非少阴也，可与小柴胡汤，得屎而解。曰∶伤寒五六日，已发汗而复下之，胸胁满微结，小便不
利，渴而不呕，但头汗出，往来寒热，心烦者，此为未解也，柴胡桂枝干姜汤主之。
《论》曰∶伤寒十余日，但结胸无大热者，此为水结在胸胁也，但头汗出者，大陷胸汤主之。
曰∶阳明病，下血谵语者，此为热入血室，但头汗出者，刺期门，随其实而泻之， 然汗出则愈。
《论》曰∶太阳病，医反下之，若不结胸，但头汗出，余处无汗，际颈而还，小便不利，身必
发黄也。曰∶阳明病，但头汗出，小便不利，必发黄。
《论》曰∶湿家下之，额上汗出，微喘，小便不利者死，若下痢不止者亦死。
《脉经》曰∶阳气上出，汗见于头者，盖阳脱也。
一、头汗，脉紧数，有表邪当散者，宜小柴胡汤，或柴胡桂枝干姜汤，及新方诸柴胡饮，俱可
酌用。若有火邪，脉洪滑，内多烦热，头汗，当清者，宜人参白虎汤、益元散之类主之。若水结胸
，心下满，头汗出者，或大陷胸汤，或小半夏茯苓汤。若便结，腹胀疼痛，头汗者，宜承气汤。若
诸虚泄泻，阳脱头汗者，宜速用独参汤，或大补元煎、六味回阳饮等，作急救之，庶可保全。
头汗这一病证主要有两种情况，一是邪热上壅，二是阳气内脱。因为头部是诸阳经汇聚的地方，凡是伤寒病全身出汗的，称为“热越”（热邪向外发散），如果身体无汗，则热邪无法向外发散而向上蒸腾于阳分，所以只有头部出汗。治疗热邪蒸腾引起的头汗，可以采用清热或解表散邪的方法，病情严重的可以使用泻下法，只要去除热邪，病自然痊愈。至于气脱这一证候，多是因为误用攻下法损伤阴液，或者过度使用克伐药物，或者泄泻不止，导致阴液在下方枯竭，阳气在上方脱失，小便不通畅，同时出现头部出汗，这就非常危险了。
《伤寒论》说：伤寒病五六天，头部出汗，轻微怕冷，手脚冰凉，心下部胀满，嘴里不想吃东西，大便困难，脉象细弱的，这叫做“阳微结”，病位一半在里、一半在表。脉象虽然沉紧，但不能诊断为少阴病，之所以这样判断，是因为少阴病通常不会有汗出，现在头部出汗，所以知道不是少阴病，可以给予小柴胡汤治疗，待大便通畅后病愈。又说：伤寒病五六天，已经发过汗又用了攻下法，胸胁部胀满且轻微痞结，小便不利，口渴但不呕吐，只有头部出汗，寒热往来，心烦的，这是病邪未解，应当用柴胡桂枝干姜汤主治。
《伤寒论》说：伤寒病十多天，只有结胸证而没有大热的，这是水饮结聚在胸胁部位，只有头部出汗的，应当用大陷胸汤主治。
又说：阳明病，便血并伴有谵语的，这是热邪陷入血室，只有头部出汗的，针刺期门穴，根据实证的情况进行泻法治疗，周身微微出汗就会痊愈。
《伤寒论》说：太阳病，医生反而用了攻下法，如果不形成结胸，只有头部出汗，身体其他部位无汗，汗止于颈部而还，小便不利，身体一定会发黄。又说：阳明病，只有头部出汗，小便不利，一定会发黄。
《伤寒论》说：患湿病的病人被误用攻下法，额头出汗，轻微气喘，小便不利的会死亡，如果下痢不止的也会死亡。
《脉经》说：阳气向上外脱，汗见于头部的，这是阳气脱失的表现。
一、头汗，脉象紧数，有表邪需要疏散的，适宜用小柴胡汤，或者柴胡桂枝干姜汤，以及新方中的各种柴胡饮剂，都可以酌情使用。如果有火邪，脉象洪滑，内部多有烦热，头部出汗，需要清热的，适宜用人参白虎汤、益元散之类的主治。如果是水饮结聚在胸，心下部胀满，头部出汗的，可以用大陷胸汤，或者小半夏茯苓汤。如果大便干结，腹部胀满疼痛，头部出汗的，适宜用承气汤。如果是各种虚损导致的泄泻，阳气脱失引起头部出汗的，应当迅速使用独参汤，或者大补元煎、六味回阳饮等，作为急救措施，才可能保全生命。
There are two types of headache sweating (Tou Han): one is caused by the accumulation of pathogenic heat upward, and the other is due to the internal collapse of Yang Qi. The head is the meeting point of all Yang meridians. In cases of Shanghan (Cold Damage), if sweat covers the whole body, it is called "Re Yue" (Heat Dispersal), meaning the heat is venting outward. If there is no sweat on the body, the heat cannot disperse outward but steams upward into the Yang regions, resulting in sweat only on the head. For treatment of head sweating caused by heat steaming, methods such as clearing heat or dispersing exterior pathogens can be used; for severe cases, purgation may be applied. Once the heat is eliminated, the disease will resolve spontaneously. Regarding the syndrome of Qi collapse, it is often caused by improper use of purgatives damaging Yin, excessive use of harsh draining herbs, or persistent diarrhea, leading to exhaustion of Yin below and collapse of Yang above. With obstruction of urination accompanied by head sweating, the condition is extremely critical.
The *Lun* (Shanghan Lun) states: "In Shanghan after five or six days, with head sweating, slight aversion to cold, cold hands and feet, fullness in the epigastrium, unwillingness to eat, difficulty in defecation, and a fine pulse, this is termed 'Yang Wei Jie' (Slight Yang Binding), where the pathogen is half in the interior and half in the exterior. Although the pulse is deep and tight, it should not be diagnosed as Shaoyin disease. The reason is that Shaoyin disease typically does not present with sweating; since there is head sweating here, we know it is not Shaoyin. Xiaochaihu Tang (Minor Bupleurum Decoction) may be given, and the patient will recover upon passing stool." It also states: "In Shanghan after five or six days, after having been treated with diaphoresis and then purgation, with slight binding/fullness in the chest and hypochondrium, obstructed urination, thirst without vomiting, head sweating only, alternating chills and fever, and irritability, this indicates the pathogen has not yet resolved. Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) is the primary formula."
The *Lun* states: "In Shanghan after ten-plus days, presenting only with Jie Xiong (Chest Binding) without significant heat, this is water binding in the chest and hypochondrium. With head sweating only, Da Xianxiong Tang (Major Draining the Chest Decoction) is the primary formula."
It further states: "In Yangming disease, with bleeding from the rectum and delirium, this is Re Ru Xue Shi (Heat Entering the Blood Chamber). With head sweating only, puncture Qimen (LR14); according to the excess pattern, apply draining techniques. When general sweating occurs, the patient will recover."
The *Lun* states: "In Taiyang disease, if the physician incorrectly uses purgation, and if Jie Xiong does not form, but there is only head sweating with no sweat elsewhere, stopping at the neck, along with obstructed urination, jaundice will inevitably develop." It also states: "In Yangming disease, with head sweating only and obstructed urination, jaundice will inevitably develop."
The *Lun* states: "If a patient suffering from dampness is incorrectly treated with purgation, and presents with sweating on the forehead, slight asthma/dyspnea, and obstructed urination, death ensues. Similarly, if dysentery persists without cessation, death ensues."
The *Mai Jing* (Pulse Classic) states: "When Yang Qi emerges upward, and sweat appears on the head, this indicates Yang collapse."
1. For head sweating with a tight and rapid pulse, indicating exterior pathogens requiring dispersion, Xiaochaihu Tang (Minor Bupleurum Decoction), or Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction), as well as various Chaihu Yin formulas from new prescriptions, may be酌情 (discretionarily) used. If there is Fire Evil, with a surging and slippery pulse, internal irritability and heat, and head sweating requiring clearing, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) or Yi Yuan San (Benefit Origin Powder) are appropriate. If water binds in the chest with epigastric fullness and head sweating, Da Xianxiong Tang (Major Draining the Chest Decoction) or Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction) may be used. If there is constipation, abdominal distension and pain, and head sweating, Chengqi Tang (Chengqi Decoction) is indicated. For various deficiency patterns with diarrhea and head sweating due to Yang collapse, Du Shen Tang (Single Ginseng Decoction), Da Bu Yuan Jian (Great Tonification of the Source Decoction), or Liu Wei Hui Yang Yin (Six-Ingredient Returning Yang Drink) should be administered urgently as emergency rescue measures to preserve life.