Absence of sweating

[Guest guest]

hi all!

 

Is there any kind of differential diagnosis for absence of sweating?

 

thanks you,

dan

[Guest guest]

>Is there any kind of differential diagnosis for absence of sweating?

>

>thanks you,

>dan

 

Lack of sweating (Wu Han):

 

The basics:

 

The most common cause of no sweating is Exterior Excess Cold. Exterior Cold

will cause pores to contract, and sweating can't take place. Exterior Cold

also will cause muscles to contract and stiffen, intefering with all kinds

of movement. Closed pores and lack of sweating is one of the prime

indicators that the person is under attack by Exterior Excess Cold.

 

In addition, if the Exterior Cold (or some other pathogen like Heat) starts

to invade the body, moving to the Interior, certain stages of the process

will be marked by the lack of sweating. For example, the TaiYang Exterior

Cold stage of the 6 Stages of Cold-Induced Evils usually will be marked by

closed pores and the lack of sweating. As the Evil moves into the Interior,

the ShaoYang stage may also be marked by closed pores and absence of

sweating. The treatment is is use diaphoretic herbs to induce sweating so

the Evil can escape from the body through the pores and sweat. Otherwise,

for example, the trapped Cold of the common cold can transform into the Fire

of pneumonia.

 

Causing sweating is contraindicated during other stages of Cold-Induced

Evils.

 

In addition, lack of sweating (as well as sweating) can occur during warm

disease (Wen Bing).

 

The main things to remember is that Exterior Cold will cause pores to close

and that during certain stages of an Evil moving to Interior of the body,

one wants to cause sweating so the Evil has a way of getting out of the

body.

 

Getting into it deeper (for students):

 

" In general, a healthy person's yang ai is most open and flowing in spring

and summer, so that qi and blood move toward the surface, and this is when

sweating is most appropriate. In autumn and winter the qi and blood tend

toward the interior, so perspiration is reduced or absent. These are normal

conditions. " (Steven Clavey, Fluid Physiology and Pathology in Traditional

, p. 47.)

 

The term Wu Han refers to situation during which the person should be

sweating but isn't - like when the person is active, the person has too many

clothes on, or the environment is warm.

 

There are 3 Exterior situations which can result in lack of perspiration: 1.

Wind-Cold Exterior Excess, 2. Exterior Cold With Simultaneous Interior Heat,

and 3. Cold-Damp Fettering the Exterior. (Clavey, p. 47.)

 

Wind-Cold Exterior Excess is the most common. " Lack of perspiration, chills

and fever, aching body and head, blocked nose, raspy voice, sneezing and

runny nose, itchy throat and cough, thin white tongue coat, floating tight

pulse. " (Clavey, p. 47) Some examples include some cases of " allergies " , the

common cold, some cases of the flu, etc.)

 

Exterior Cold With Simultaneous Interior Heat is all of the above (Wind-Cold

Exterior Excess) plus Heat in the Interior. The Interior Heat can be due to

two things. The person already has Interior Heat from some other cause

(like Yin Deficiency, Qi Stagnation, etc.), or, the Wind-Cold Exterior

Excess which invaded into the Interior became blocked because of those

closed pores and the Cold transformed into Heat. " Colloquially this is known

as 'cold enveloping heat'. " (Clavey, p. 48.)

 

Exterior Cold With Interior Heat: " Lack of perspiration, fever and chills,

restless aching of the limbs, blocked nose, sore throat, insatiable thirst,

cough with yellow phlegm, constipation and dark yellow urine, tongue coat

white or thin yellow, pulse floating and rapid. " (Clavey, p. 47)

 

Note the references to yellow. Yellow frequently means Heat. Great thirst

usually means Heat; lack of thirst usually means Cold (and/or Dampness

accumulation).

 

Note the rapid pulse. Heat speeds things up - body movements, speech, and

the pulse. Cold slows things down. Typically people who are suffering from

Cold will move and speak slowly and have slow pulses. (There are

exceptions.) Both Heat and Cold are present here, but the Interior Heat

often will affect the pulse the most, causing it to be fast.

 

Note the floating pulse in both cases. A floating pulse is one which can be

felt easiest near the surface. A deep pulse is one that you have to apply

more pressure to be able to feel. Exterior conditions usually are marked by

a floating pulse. Interior conditions often are revealed by a deep pulse.

 

Cold-Damp Fettering the Exterior: " Lack of perspiration, heaviness and

distention of the head as if wrapped up, heaviness of the limbs, aching

joints, chills with slight fever, worse in the late afternoon, white greasy

tongue coat, floating tight and possibly slow pulse. " This includes but is

not limited to some (not all) cases of arthritis. (In TCM, arthritis is

viewed primarily as triggered by Wind, Cold, and/or Damp. Heat may also be

present.)

 

" This condition of cold-damp obstruction in the surface tissues is a result

of exposure to pahogenic wind while sweating, or prolonged residence in a

damp-cold environment, or injury from foggy moist weather conditions while

weak. " (Clavey, p. 48.)

 

" Pathogenic cold is contracting, while damp's nature is sticky and

obstructive. The flow of yang qi through the surface tissues can become

blocked by either pathogen on its own; in combination they are particularly

deleterious: the yang qi cannot carry out its warming controlling functions,

the pores fail to open as they should, and lack of perspiration is the

result. " (Clavey, p. 48.)

 

What are the important differentiating factors of Cold-Damp from simple

Exterior Cold? " Head distension as if wrapped in something, heavy limbs,

chills, fever worse in the late afternoon. " (Clavey, p. 49.)

 

Both Exterior and Interior Dampness can result in feelings of heavy limbs.

In the case of Interior Dampness the limbs can feel particularly heavy.

(Note: Magnesium deficiency also can result in a feeling of heavy limbs.)

Feelings of the head wrapped up can result from either Exterior or Interior

Dampness. One very descriptive term that many PWCs (People With CFIDS)

frequently use to describe their lack of cognitive abilities is " brain fog " .

(The words people use to describe symptoms frequently will give clues as to

the TCM diagnosis.)

 

Also note the greasy tongue coat. A greasy tongue coat is associated with

Dampness.

 

Also note that the pulse will change relatively quickly compared to the

condition of the tongue. The pulse can be changed following an acupuncture

treatment or within minutes after consuming herbs. It takes longer for the

condition of the tongue to change. This is not Dampness from a one time

exposure that just happened. This is Dampness that has been present for

some time - long enough to affect the tongue. Review the triggers for

Cold-Damp Fettering the Exterior: " Exposure to pathogenic wind while

sweating, or prolonged residence in a damp-cold environment, or injury from

foggy moist weather condtions while weak. " (Clavey, p. 48) While it's true

that Exterior Dampness can invade the Interior rather quickly, the tongue

reveals that this is Dampness that has lodged in the body. Each new

exposure to Exterior Dampness can make it worse, but it's already

established in the body.

 

The Chinese caution against exposure to Wind when one is sweating. Like

immediately after getting up, after taking a bath, or after exercising. It's

not a good idea to retrieve the morning newspaper immediately after getting

up or after taking a morning bath.

 

The treatment principle for Exterior Excess Cold is to warm the Exterior and

induce pespiration. There are any number of herbs which will do this -

fresh ginger, cinnamon twigs, Ma Huang, etc. Ma Huang Tang (Ephedra

Decoction) frequently gets used for this.

 

If the condition is Exterior Cold With Simultaneous Interior Heat, one will

need to both disperse Exterior Cold and clear Interior Heat. Clavey

recommends Cong Bai Jie Geng Tang ( " Scallion and Platycoden Decoction -

milder cases), or Da Qing Long Tang (Major Blue Green Dragon Decoction - for

more severe cases).

 

For Damp-Cold Fettering the Exterior, Clavey recommends Ma Xing Yi Gan Tang

(Ephedra, Apricot Kernel, Coicis and licorice Decoction) or Qiang Huo Sheng

Shi Tang (Notopterygium Decoction to Overcome Dampness). These will disperse

Cold while expeling Dampness.

 

These are Exterior conditions that result in a lack of sweating. There also

are Interior conditions that can result in lack of sweating as well as

excessive perspiration in some of the cases. What happens is that the

syndrome originally may manifest as excessive sweating which in time

develops into a lack of sweating. The 5 basic mechanisms which can result

immediately or in time in lack of sweating are 1. Protective Yang Unaroused,

2. Liver Qi Blockage, 3. Heat from Liver and Gall Bladder Stasis, 4. Spleen

Deficiency Gan Accumulation, and 5. Spleen and Kidney Yang Deficiency

( " originating in childhood or persisting for over twenty years " ) From

Clavey, pp. 49-51, detailing the findings of Dr. Gong Wen-De et al at their

hospital in Shanghai from 1985-1990. These will be gone into in more detail

in a future post.

 

The important thing to remember at this point is that the Exterior patterns

which can result in lack of sweating are 1. Wind-Cold Exterior Excess, 2.

Exteior Cold With Simultaneous Interior Heat, and 3. Cold-Damp Fettering the

Exterior.

 

It also is important to keep in mind that " differentiation is essential,

not only of internal or external, but also of hot or cold, excess or

deficiency. " (Clavey, p. 50.) In other words the basic 8 Principals Patterns

(Exterior/ Interior, Excess/ Deficiency, Hot/ Cold, and Yang/ Yin). Exactly

why keeping this in mind will become more obvious as one learns about the

Interior mechanisms of lack of sweating. For the time being, some

conditions are both Exterior and Interior. For example, in cases of Exterior

Cold With Simultaneous Interior Heat, it is not enough just to disperse the

Exterior Cold. The Interior Heat also has to be cleared. In addition,

certain Interior conditions will cause a person to be more susceptible to

Exterior conditions. Qi Deficiency - in particular Protective Qi Deficiency

- is one example. Exterior Cold can be either Excess or Deficiency. It

will have to be very cold for a person with strong Protective Qi and

adequate clothing to be affected. The cold will have to be Excessive - like

below freezing. But a person who is Qi Deficient, in particular a person

who is Yang Deficient, may suffer problems if temperatures are as high as 60

degrees F or even in the 70s. There is an underlying Deficiency which makes

the person vulnerable to temperatures that are comfortable to others and

which cause no problems for others. Another example is " injury from foggy

moist weather conditions while weak " that can form the basis of Cold-Damp

Fettering the Exterior. If the person wasn't already weak, s/he never would

have been affected by a foggy, wet day. Sometimes conditions are strictly

Exterior, sometimes a mixture of both (like when an Exterior Excess invades

to the Interior and becomes trapped), and sometimes a pre-existing Interior

condition will cause the person to be more vulnerable to an Exterior Evil.

 

For more information on the 8 Principal Patterns, so a search in the message

section.

 

Victoria

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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