【纲】仲景曰。微盗汗出。反恶寒者。表未解也。
【目】刘完素曰。若邪气一切在表。于卫则汗自出。此则邪气侵行于里。外于表邪。及睡则卫
气行于里。乘表中阳气不致。津液得泄。故但睡而汗出。觉则气散于表而汗即止矣。
【纲】仲景曰。三阳合病。脉浮大。在关上。但欲睡眠。合目则汗。
【目】刘完素曰。合目则汗。是知邪气在半表半里之间明矣。且自汗有虚有实。其盗汗之症。
非若自汗有实者。悉当和表而已。
韩祗和曰。阳入于阴。故但欲睡眠。卫气行阴。故合目则卧。热淫于内。故卧则汗出。
陶华曰。无汗者。寒邪中经。腠理闭密。津液内渗而无汗也。若风湿暑干之。皆令汗出。惟寒邪独
不汗出。则当汗之。若与麻黄汤三剂而不汗者。此必不可疗也。自汗者。卫气所以肥腠理而固津液者也。卫为邪所干。
不能卫护于外。由是而汗出焉。且自汗
有表里虚实之分。若自汗出而恶风寒为表未解。当解肌。冬用桂枝汤。余月冲和汤加减。汗后恶风
寒。痛为表虚。黄 建中汤。若汗出不恶风寒。则为表解里未和。下之。设或汗出发润。如油如珠。
凝而不流。皆不可治。盗汗者。睡中则汗出。觉则不出。杂病责于阳虚。伤寒责在半表半里。故
知胆有热也。
李中梓曰。汗后不解者。或表邪未尽。或邪传于里。或邪气乘虚内客。故虽汗而病仍不解也。
汗后脉大如疟状。再汗之。桂枝二麻黄一汤。汗后心下痞硬。呕吐不和。大柴胡汤。大汗。大烦渴。
而脉大。人参白虎汤。汗后恶热。脉实。调胃承气汤。汗出而喘。无大热。麻黄杏仁甘草石膏汤。
大汗出。胃干。欲饮水。少少与之。汗出脉浮。小便不利。微热消渴。五苓散。汗后脉洪数。烦
渴。五苓散。汗后胀满。浓朴生姜人参汤。汗太多。心悸发颤。桂枝甘草汤。汗后恶寒。表虚也。
脉细神倦。芍药甘草附子汤。太阳汗出不解。发热心悸肉 。真武汤。汗后身痛脉沉。桂枝加芍药
人参汤。汗后热不去。内拘急。四肢疼。下利恶寒。四逆汤。汗后脐下悸。欲作奔豚。茯苓桂枝甘
草大枣汤。
[General Principle] Zhang Zhongjing stated: Slight nocturnal sweating accompanied by aversion to cold indicates that the exterior syndrome has not yet been resolved.
[Commentary] Liu Wansu stated: If pathogenic factors are entirely at the exterior, spontaneous sweating occurs due to disturbance of Wei Qi (Defensive Qi). This condition involves pathogenic factors invading and moving into the interior while simultaneously affecting the exterior. When a person sleeps, Wei Qi moves inward, failing to secure the Yang Qi at the exterior, allowing body fluids to leak out. Thus, sweating occurs only during sleep; upon waking, Qi disperses to the exterior, and sweating ceases.
[General Principle] Zhang Zhongjing stated: In combined diseases of the three Yang channels, the pulse is floating and large, particularly prominent at the Guan position. The patient desires sleep, and sweating occurs when closing the eyes.
[Commentary] Liu Wansu stated: Sweating upon closing the eyes clearly indicates that pathogenic factors reside between the exterior and the interior. Spontaneous sweating can be either deficiency or excess in nature. Nocturnal sweating differs from excess-type spontaneous sweating and cannot simply be treated by harmonizing the exterior.
Han Zhihe stated: Yang Qi enters Yin, causing drowsiness. Wei Qi travels through Yin, causing the subject to lie down with eyes closed. Heat pathogens overflow within, causing sweating during sleep.
Tao Hua stated: Absence of sweating occurs when cold pathogens strike the meridians, causing the Cou Li (pores) to close tightly, trapping body fluids internally. Conversely, wind-dampness or summerheat pathogens cause sweating; only pure cold pathogens prevent sweating, requiring diaphoretic treatment. If three doses of Mahuang Tang (Ephedra Decoction) fail to induce sweating, the condition is incurable. Spontaneous sweating arises because Wei Qi fails to thicken the Cou Li and secure body fluids due to pathogenic interference. Spontaneous sweating varies by exterior/interior and deficiency/excess. If spontaneous sweating is accompanied by aversion to wind and cold, the exterior is unresolved and requires releasing the muscle layer; Guizhi Tang (Cinnamon Twig Decoction) is used in winter, while Chonghe Tang (Harmonizing Decoction) modified is used in other seasons. Post-sweating aversion to wind/cold and pain indicate exterior deficiency, treated with Huangqi Jianzhong Tang (Astragalus Middle-Boosting Decoction). If sweating occurs without aversion to wind/cold, the exterior is resolved but the interior is disharmonious, requiring purgation. However, if sweat is moist like oil or pearls, congealed and non-flowing, it is untreatable. Nocturnal sweating occurs during sleep and stops upon waking. In miscellaneous diseases, it is attributed to Yang deficiency; in Shanghan (Cold Damage), it is attributed to the Shaoyang (half-exterior/half-interior) stage, indicating heat in the Gallbladder.
Li Zhongzi stated: Failure to resolve after sweating may result from residual exterior pathogens, transmission of pathogens to the interior, or pathogenic invasion exploiting deficiency. Hence, despite sweating, the disease persists.
If the pulse remains large resembling malaria after sweating, apply diaphoresis again using Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig and One Part Ephedra Decoction).
If epigastric fullness/stiffness and vomiting occur after sweating, use Da Chaihu Tang (Major Bupleurum Decoction).
If profuse sweating leads to severe restlessness and thirst with a large pulse, use Renshen Baihu Tang (Ginseng White Tiger Decoction).
If aversion to heat and a solid pulse appear after sweating, use Tiaowei Chengqi Tang (Regulating the Stomach and Purging Decoction).
If sweating is accompanied by wheezing without significant heat, use Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction).
If profuse sweating causes dry stomach and thirst, provide water sparingly.
If sweating is accompanied by a floating pulse, difficulty urinating, slight fever, and thirst, use Wuling San (Five-Ingredient Powder with Poria).
If a rapid, surging pulse with restlessness and thirst follows sweating, use Wuling San (Five-Ingredient Powder with Poria).
If abdominal distension follows sweating, use Nongpu Shengjiang Renshen Tang (Magnolia Bark, Fresh Ginger, and Ginseng Decoction).
If excessive sweating causes palpitations and tremors, use Guizhi Gancao Tang (Cinnamon Twig and Licorice Decoction).
If aversion to cold, fine pulse, and mental fatigue follow sweating, indicating exterior deficiency, use Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction).
If Taiyang disease remains unresolved after sweating, presenting with fever, palpitations, and muscle twitching, use Zhenwu Tang (True Warrior Decoction).
If body pain and a deep pulse follow sweating, use Guizhi Jia Shaoyao Renshen Tang (Cinnamon Twig Decoction plus Peony and Ginseng).
If fever persists after sweating, accompanied by internal cramping, limb pain, diarrhea, and aversion to cold, use Sini Tang (Frigid Extremities Decoction).
If subumbilical palpitations and a sensation of Qi rushing upward (Ben Tun) occur after sweating, use Fuling Guizhi Gancao Dazao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction).