bubble_chart Concept

Without sweating refers to the condition where sweating should occur but does not, as recorded in Suwen. Maiyao Jingwei Lun states, "Excess yang qi leads to body heat without sweating... Excess yin-yang results in cold without sweating."

Generally, in normal individuals, yang qi disperses in spring and summer, causing qi and blood to move towards the surface, thus resulting in sweating. In autumn and winter, yang qi is stored, and qi and blood move inward, leading to less sweating or no sweating, which is a natural tendency. However, if external pathogens invade the body surface and the opening and closing of the striae and interstice are impaired, sweating should occur but does not, indicating a pathological condition. This section discusses the latter scenario.

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰The whole body without sweating, aversion to cold with fever, headache and body pain, nasal congestion with a heavy voice, sneezing and runny nose, itchy throat and cough, thin white tongue coating, floating and tight pulse manifestation. The syndrome is purely caused by wind-cold exterior excess without sweating, due to the invasion of wind-cold binding the exterior. Cold, as a yin pathogen, has a congealing and blocking nature, which most easily damages yang, leading to the stagnation of defensive yang, hence the whole body without sweating. "The Cold-Damage Disease Clarified Theory" states: "Cold evil apoplexy involving meridians, striae and interstices becoming dense, with body fluids internally seeping, results in without sweating." The key points of differentiation are: in addition to the symptom of without sweating, there are other clinical manifestations of wind-cold fettering the exterior (aversion to cold with fever, headache and body pain, thin white tongue coating, floating and tight pulse manifestation). The treatment should focus on releasing the exterior with pungent-warm diaphoresis, and the prescription selected is Ephedra Decoction.
2. Exterior Cold and Interior Heat︰The whole body without sweating, fever and chills, limb restlessness and pain, nasal congestion with a heavy voice, dysphoria and thirst, sore throat, cough with yellow phlegm, dark urine, constipation, a white or thin yellow tongue coating, and a floating and rapid pulse. It is accompanied by signs of internal heat pattern. Due to inherent excessive heat in the body or internal accumulation of lung heat, coupled with exposure to wind-cold, the internal heat is constrained by external cold, forming a pattern of external cold and internal heat, commonly known as "cold enveloping fire." As stated in Chongding Tongsu Shanghan Lun: "When warm disease or latent summerheat is about to manifest but is constrained by wind-cold, this is external cold binding internal heat, also called guest cold enveloping fire." There are also cases where the exterior pathogen of cold-damage disease has not yet resolved, but the external pathogen is already showing signs of transforming into heat internally, as in *Treatise on Cold-Damage Disease: Differentiation of Taiyang Disease Pulse and Symptoms and Treatment*: "taiyang apoplexy, with a floating and tight pulse, fever and chills, body pain, and no sweating but dysphoria..." The key points of differentiation are: in addition to the symptoms of wind-cold fettering the exterior (absence of sweating, aversion to cold with fever, body pain), there are also signs of interior heat (body restlessness, thirst, sore throat, thin yellow tongue coating). The treatment should focus on dispersing wind-cold while clearing interior heat, using Fistular Onion Stalk, Fermented Soybean and Platycodon Decoction. If wind-cold is predominant, Major Blue Dragon Decoction may be used.
3. Cold-dampness Binding the Exterior︰The whole body without sweating, head distension as if wrapped, heavy limbs, joint pain and irritation, fear of cold with mild fever, especially worse in the late afternoon, tongue coating white and greasy, pulse floating and tight or slow. The condition arises from sweating while exposed to wind, or prolonged residence in damp and cold environments, or injury from mist and dew, leading to cold-dampness stagnating in the superficial muscles. Cold causes contraction, dampness is sticky and stagnant, yang qi is depressed, striae and interstices are blocked, hence sweat cannot be discharged. Jingui Yaolue．"On Abnormal Pulses in Convulsions, Dampness, and Summerheat Syndrome" states: "When a patient experiences generalized body pain, fever, and worsening in the late afternoon, it is called wind-dampness. This illness is caused by sweating while exposed to wind or prolonged exposure to cold." The key points of differentiation: without sweating, accompanied by symptoms of cold-dampness stagnating in the exterior (head distension as if wrapped, heavy limbs, fear of cold, fever worsening in the late afternoon). The treatment principle is to dissipate cold and eliminate dampness, with prescriptions such as Ephedra Bitter Apricot Seed Coix Liquorice Root Decoction, Notopterygium Overcoming Dampness Decoction.

The symptom of "without sweating" can occur in both exterior and interior pattern. It is essential to differentiate between cold and heat, deficiency and excess, and not to rashly use diaphoresis, which may lead to the reckless dissipation of healthy qi and mistakenly violate the principle of not depleting the already deficient.

bubble_chart Documentation

1. Volume 1 of "The Theory of Cold-Damage Diseases": "There are several reasons for the absence of sweating, such as when the cold-damage disease is on the surface, or when the pathogenic factor moves inside, or when there is internal accumulation of water, or when there is prolonged yang exhaustion, all of which can cause the absence of sweating; in the case of cold-damage disease without sweating, it is due to the tightness of the striae and interstices; when wind attacks the defensive qi, the striae and interstices open and spontaneous sweating occurs, when cold attacks the nutrient qi, there is no sweating, which is referred to as the closure of the striae and interstices; as mentioned in the classics, taiyang disease, aversion to wind without sweating and panting, floating and rapid pulse, fever without sweating, and dysphoria without sweating, yangming disease, conversely without sweating but with smooth urination, vomiting and coughing for two or three days, cold extremities, headache, dry nose without sweating, floating pulse without sweating and panting, and exogenous convulsive disease without sweating, all these are cases where the cold pathogenic factor is on the surface and there is no sweating; ...yangming disease, conversely without sweating, with a sensation as if insects are crawling under the skin, this is due to prolonged deficiency, all are cases of yang deficiency without sweating. These are the normal principles, how can they be different?"
2. Wenyi LunVolume 1: "In the past, people considered massive hemorrhage without sweating, now we consider the loss of fluids without sweating, although the blood and fluids are different, the dryness is the same."