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(Attached: Night sweats, Head sweat, Hand and foot sweat, Anhidrosis, Inability to sweat)

Wei Qi (Defensive Qi), which protects the skin, fills the interstices (Cou Li), and secures body fluids to prevent their reckless discharge, fails to guard the exterior when invaded by pathogenic factors. Consequently, body fluids leak recklessly. However, this moist sweating occurs spontaneously without the use of diaphoretic agents. Wind-stroke causes fever and spontaneous sweating; dampness-stroke causes sweating, aversion to wind, and thirst; severe wind-dampness causes profuse sweating and a damp sensation. Both wind and summerheat-dampness as pathogens lead to spontaneous sweating. Only cold pathogens injure Ying Qi (Nutritive Qi) without injuring Wei Qi, thereby closing the skin and interstices tightly, resulting in no sweating. Initially, although there is no sweating, if the pathogen transmits inward and transforms into heat, Ying and Wei Qi flow freely, the interstices open, and spontaneous sweating occurs.

Spontaneous sweating also distinguishes between exterior and interior syndromes, and deficiency and excess syndromes. If sweating is accompanied by aversion to wind or slight aversion to cold, it indicates that the exterior syndrome has not resolved, and dispersing methods are appropriate. If sweating leaks incessantly with aversion to wind, or if aversion to cold appears after sweating therapy, it indicates exterior deficiency, and warming methods are appropriate. These situations involve pathogens remaining at the exterior. If sweating occurs without aversion to wind or cold, it indicates that the exterior syndrome has resolved and the pathology is interior; purgation will cure it. For example, Yangming disease with fever and sweating indicates heat venting outward; and Yangming disease with fever and profuse sweating requires urgent purgation. Although spontaneous sweating is a common symptom, if sweat is like oil or beads sticking to the body without flowing, it is considered incurable. A favorable sign occurs only when the hands, feet, and entire body become uniformly moist, and after a moment, sweating stops and the body cools down.

Body heat, sweating, and aversion to cold belong to the exterior syndrome.
When a patient suffers from chronic spontaneous sweating, it is because the Ying Qi is harmonious but disharmonious with the exterior, due to the failure of Wei Qi to harmonize with Ying Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside them. Re-inducing sweating at this stage will restore harmony between Ying and Wei Qi. Guizhi Tang (Cinnamon Twig Decoction) should be used. (Wind injures Wei Qi, Cold injures Ying Qi. When Wei Qi is affected by wind but Ying Qi remains unaffected, it is called "Ying Qi is harmonious." Once Wei Qi is occupied by pathogens, it cannot harmonize with Ying Qi nor protect the skin and interstices, leading to chronic spontaneous sweating. Administering Guizhi Tang dissipates wind pathogens and harmonizes Ying and Wei Qi, leading to recovery. See the Taiyang Disease section for details.) If accompanied by stiffness and pain in the neck and back, Guizhi Jia Gegen Tang (Guizhi Tang with Pueraria Decoction) is indicated (for neck stiffness). If accompanied by painful joints, inability to flex and extend, and dysuria, Gancao Fuzi Tang (Licorice and Aconite Decoction) is indicated (see discussion on wind-dampness with fever).

If sweating leaks incessantly with aversion to cold after inducing sweat, Guizhi Fuzi Tang (Guizhi Tang with Aconite Decoction) is indicated (see subsequent sections). If sweating is accompanied by thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated; if there is no thirst, Lingzhi Jiangzhong Tang (Poria, Ginger, and Licorice Decoction) is indicated.

The *Liuren Shu* states: For wind-stroke with spontaneous sweating, Guizhi Tang must be used with caution. Suppose a patient with wind-stroke and spontaneous sweating presents with a floating and weak pulse. If Guizhi Tang is administered and the patient develops irritability without the typical Guizhi Tang signs, it should not be taken again. If wind-stroke with spontaneous sweating is accompanied by frequent urination, Guizhi Tang must absolutely not be given. Furthermore, in Taiyang disease with spontaneous sweating, stiff limbs difficult to flex and extend, and difficulty in urination, Fuzi (Aconite) may be added to Guizhi Tang. If urination is frequent, Guizhi Fuzi Tang is strictly contraindicated; Shaoyao Gancao Tang (Peony and Licorice Decoction) should be used instead. If Guizhi Fuzi Tang is mistakenly used to attack the exterior, causing dry throat, irritability, cold limbs, and vomiting, Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be given to restore Yang Qi. Once the limbs warm up, Shaoyao Gancao Tang should be administered to relieve leg cramps.

Zhao noted that post-sweating leakage with difficulty in urination resembles spontaneous sweating with frequent urination. Zhang Zhongjing repeated a chapter Q&A to clarify this distinction. The first case describes Taiyang disease where excessive sweating led to leakage, aversion to wind, difficulty in urination, and slight stiffness of the four limbs, treated with Guizhi Fuzi Tang. This was caused by excessive sweating medication, not spontaneous sweating. Aversion to wind indicates residual pathogens; difficulty in urination and limb stiffness indicate loss of body fluids and lack of nourishment to the sinews. This is Yang collapse from excessive sweating, with exterior deficiency and meridian qi pathology carrying exterior pathogens, not interior. Thus, Fuzi warms the meridians, Guizhi releases the exterior, and Shaoyao nourishes blood and relaxes sinews.

The second case describes a floating pulse indicating deficiency, spontaneous sweating, slight aversion to cold due to Yang deficiency failing to defend the exterior, frequent urination due to lower jiao deficiency-cold failing to control water, irritability due to Yin deficiency and blood shortage, and leg cramps due to blood depletion failing to nourish sinews. This condition involves simultaneous exterior and interior deficiency from the onset, with no exterior Yang signs, so Guizhi Tang is contraindicated. Mistakenly using Guizhi Tang to attack the exterior would cause further sweating, leading to cold limbs, dry throat, irritability, and vomiting. Cold limbs result from Yang collapse and failure of Yin-Yang connection; dry throat from fluid scarcity; irritability and vomiting from cold obstruction above. Ganjiang (Dried Ginger) warms the interior and restores Yang; Gancao and Shaoyao replenish blood lost to sweating, restoring Yin-Yang deficiency. After legs extend, if delirium occurs, it is due to prior fluid loss from sweating and frequent urination combined with the drying nature of Ganjiang, causing Yangming internal binding. Although not full excess, Tiaowei Chengqi Tang (Regulating the Stomach and Directing Downward Decoction) should be used sparingly.

Tracing back, Shaoyao Gancao Tang is specifically for treating calf cramps after reversal of cold limbs and warming of feet, not for treating floating pulse, spontaneous sweating, and frequent urination. The *Liuren Shu* claims it treats these symptoms and errors after Guizhi Tang. I question how such symptoms match Zhongjing's formulas. Upon reflection: ordinary people might think using Ganjiang for spontaneous sweating and frequent urination without diarrhea leads to dryness and delirium, later requiring cold herbs like Mangxiao and Dahuang, seeming out of order. Patients blame doctors for using hot/drying herbs first and cooling ones later. However, Zhongjing’s intent is not to fear Ganjiang’s heat but to address righteous Qi deficiency. Strengthening righteous Qi eliminates pathogens. For simultaneous exterior-interior deficiency, one must first restore righteous Qi using Ganjiang, Shaoyao, and Gancao. Once righteous Qi is restored and internally solid, even if stomach dryness and delirium occur due to internal binding, Dahuang and Mangxiao can lubricate and remove the binding without damaging righteous Qi. This sequence—hot then cold, tonifying then purging—seems reverse but is actually smooth, demonstrating Zhongjing’s brilliance. Scholars should apply this principle rather than blaming patients.

In summer heatstroke with spontaneous sweating, body heat, aversion to cold, weak pulse, thirst, and cold feet, Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) is indicated (see Summerheat section).

Body heat, sweating, and absence of aversion to cold belong to the interior syndrome, representing the fundamental Yangming syndrome.
Q: What are the external manifestations of Yangming? A: Body heat, spontaneous sweating, absence of aversion to cold, and aversion to heat. (Da Chengqi Tang)
Q: Why does a patient feel aversion to cold on the first day without fever? A: The initial aversion to cold will cease spontaneously, followed by spontaneous sweating and aversion to heat.
Q: Why does aversion to cold cease? A: Yangming belongs to Earth in the center, receiving all things without further transmission. Initial aversion to cold ceases by the second day, confirming Yangming disease.
When cold damage transfers to Yangming, the patient has slight continuous sweating. (Wind-stroke causes sweating, cold damage does not; only upon entering Yangming does sweating occur, hence "Yangming disease typically involves profuse sweating.")

If accompanied by hard stool and delirium, purgation is indicated.
Sweating, body heat, absence of aversion to cold, hard stool, and delirium require Chengqi Tang (see Delirium section). Yangming disease with fever and profuse sweating requires urgent purgation with Da Chengqi Tang (Major Order the Qi Decoction).

Xu recorded a case of cold damage with eye pain, nasal dryness, insomnia, constipation, and large pulses in all positions for several days. Overnight sweating occurred. I advised immediate purgation with Dachaihu Tang (Major Bupleurum Decoction). The physician objected, citing depleted fluids and recommending honey suppositories. I insisted on Dachaihu Tang, citing Zhongjing’s profound method. Two doses cured the patient. Critics argue that purging spontaneous sweating depletes fluids further, or that purging early in Shaoyin/Yangming dryness harms Yin. These doubts arise from misreading Zhongjing. "Urgent purgation" implies acting before fluids are fully depleted, preventing the need for suppositories. If understood clearly, there is no doubt; otherwise, suppositories are safer.

If accompanied by floating-tight pulse and bitter taste, sweating and acupuncture are contraindicated; harmonization is required.
Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, aversion to heat, and heaviness. Sweating causes mental confusion and delirium; moxibustion causes fright and insomnia. Purging empties the stomach, allowing rebellious Qi to disturb the chest, causing inner restlessness and tongue coating. Zhiizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. If thirst and dry mouth/tongue occur, Baihu Jia Renshen Tang is indicated. If floating pulse, fever, thirst, and dysuria occur, Zhuling Tang (Polyporus Decoction) is indicated. (Note: Floating/fever/bitter taste indicates exterior pathogen; tight pulse/sweating/abdominal fullness/no aversion to cold indicates interior pathogen. Simultaneous exterior-interior pathogens require harmonization.)

If accompanied by dysuria, distinguish between appetite present and absent.
Yangming disease with appetite, abnormal dysuria, normal stool, joint pain, feeling of heat, sudden madness, and continuous sweating resolves as Water fails to overcome Grain Qi, merging with sweat; tight pulse indicates recovery (use Guizhi Tang or Qianghuo Tang). Yangming disease with cold invasion, anorexia, dysuria, and continuous hand/foot sweating suggests impending mass formation; stool will be initially hard then loose due to cold water in the stomach mixing poorly with food (use Houpo Shengjiang Gancao Banxia Renshen Tang, Wuzhuyu Tang, or Lizhong Tang).

If accompanied by epigastric fullness (Pi):
Epigastric fullness with sweating has two patterns: soft/fullness with aversion to cold requires Fuzi Xiexin Tang; hard/fullness with rib pain and no aversion to cold requires Shizao Tang (Ten Jujube Decoction).

If accompanied by diarrhea:
Sweating, diarrhea, persistent heat, cold limbs, and aversion to cold require Sini Tang (Frigid Extremities Decoction). Clear undigested stool requires Tongmai Sini Tang (Pulse-Restoring Frigid Extremities Decoction). Sweating, diarrhea, slight heat with rapid pulse indicates self-healing; tight pulse indicates unresolved. Fever and diarrhea after six-seven days with incessant sweating indicate death (see Diarrhea section).

If accompanied by vomiting and diarrhea:
Tight pulse, sweating, sore throat, vomiting, and diarrhea indicate Shaoyin disease with Yang collapse. Vomiting, diarrhea, sweating, cold limbs, and faint pulse require Sini Tang. Cessation of vomiting/diarrhea with sweating, cold limbs, and faint pulse requires Tongmai Sini Tang plus Porcine Bile (see Vomiting/Diarrhea section).

Haizang stated: Taiyang spontaneous sweating uses Guizhi Tang; Yangming spontaneous sweating uses Baihu Tang; Shaoyin spontaneous sweating uses Sini Tang.
Yangming syndrome with body heat, eye/nasal pain, insomnia, no aversion to cold, spontaneous sweating, or aversion to heat with floating chi/cun pulses is treated with Baihu Tang. Cold damage with long pulses, profuse sweating, cold body surface, and thin interior pulses, or malaria with chills only, is Yangming transmitting to Shaoyin; Baihu Jia Guizhi Tang is indicated. Pulse speed distinguishes this case (fast, not slow). (See Malaria section; also suitable for summerheat with slight aversion to cold.)

*Liuren Shu* states: If moving Qi is on the left during attempted sweating in cold damage, do not sweat, as it causes dizziness, sweating, and muscle twitching (adverse reaction). First use Fangfeng Baizhu Muli San (Saposhnikovia, Atractylodes, and Oyster Shell Powder), then Jianzhong Tang.
Fangfeng Baizhu Muli San treats excessive sweating, dizziness, and twitching. Equal parts Saposhnikovia Root, Atractylodes Macrocephala Rhizome, and Calcined Oyster Shell. Take 2 qian with wine or rice drink, 2-3 times daily. After sweating stops, take Xiao Jianzhong Tang.

Jiyi Fang states: For excessive sweating in cold damage, needle Neiting (X), Hegu (X), and Fuliu (X).

Resembling Yangming External Syndrome:
Taiyang disease with post-vomit sweating, no aversion to cold, fever, and fine-rapid Guan pulse is minor deviation (resembles Yangming but Guan is fine). Taiyang fever, sweating, no aversion to cold is Rou Jing (Soft Spasm, resembles Yangming but with opisthotonos). Post-sweating burning heat is Feng Wen (Wind Warmth): floating pulse, sweating, heaviness, somnolence.

Post-sweat/vomit/purge spontaneous sweating:
Two-Yang concurrent disease: Initial Taiyang sweating incomplete leads to Yangming transfer, continuous slight sweating, no aversion to cold. If Taiyang signs persist, do not purge; use mild sweating. Persistent red face indicates stagnant Yang Qi at the exterior; resolve via fumigation. Incomplete sweating causes irritability, unknown pain location, shortness of breath. Check for choppy pulse to confirm incomplete sweating. (Cheng Wuji commentary: Concurrent disease involves Taiyang not resolving while transferring to Yangming. Slight sweating/no aversion to cold means Taiyang is gone, Yangming is present; purge. If Taiyang persists, exterior is unresolved; mild sweating first. Red face indicates Yang stagnation; fumigate. Choppy pulse confirms Yang stagnation and incomplete sweating.)

After purgation, do not use Guizhi Tang. If sweating, panting, and no high heat occur, use Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction).
Post-sweating, do not use Guizhi Tang. If sweating, panting, and no high heat occur, use Mahuang Xingren Gancao Shigao Tang.
After Guizhi Tang, if massive sweating and洪大 pulse occur, continue Guizhi Tang. If resembling malaria with twice-daily episodes, sweating resolves it; use Guizhi Er Mahuang Yi Tang (Guizhi Twice, Ephedra One Decoction).
Taiyang post-sweating massive sweating, dry stomach, insomnia, thirst: give small amounts of water. If floating pulse, dysuria, slight fever, and thirst occur, use Wuling San.
Cold damage day five-six, vomiting, fever, Chaihu signs persist after mistaken purgation: re-administer Chaihu Tang. Shivering and sweating will resolve it.
Taiyang Guizhi syndrome mistakenly purged leads to diarrhea. Rapid pulse indicates unresolved exterior; panting and sweating require Ge Gen Huang Lian Huang Qin Tang (Kudzu, Coptis, and Scutellaria Decoction). (Cheng Wuji commentary: Purging exterior pathogen causes interior heat diarrhea. Rapid pulse indicates exterior still unresolved despite diarrhea. Panting+sweating indicates interior heat/rebellious Qi; this formula clears exterior and interior heat.)
Floating-rapid pulse indicates sweating will cure. If purged, heavy body and palpitations indicate no sweating; spontaneous sweating will cure. Choppy Chi pulse indicates interior deficiency; restore interior/exterior balance and fluids for spontaneous curing. (Cheng Wuji commentary: Floating-rapid pulse indicates exterior pathogen needing sweating. Purging damages fluids/stomach Qi. Choppy Chi pulse confirms interior deficiency without interior pathogen transmission. Restore fluids for spontaneous cure. Use Mahuang Tang, Guizhi Jia Baizhu Fuling Gancao Tang, or Xiashi Guizhi Jia Shaoyao Tang.)
Taiyang should have aversion to cold/fever; now sweating without aversion, fine-rapid Guan pulse indicates error of vomiting (see Fever).
Taiyang slow Cun, floating Guan, weak Chi with fever, sweating, aversion to cold, no vomiting, but epigastric fullness indicates error of purgation. If no purgation needed but patient has thirst, it transfers to Yangming; give small water or Wuling San.
Severe vomiting/purging causing extreme deficiency and massive sweating, followed by water-induced sweating and hiccups, indicates cold stomach (see Hiccups).

Yang Collapse:
Cold damage floating pulse, fire coercion causes Yang collapse with惊狂 (panic/madness), restlessness. Gui Zhi Qu Shaoyao Jia Shu Ki Mu Li Long Gu Jiu Ni Tang (Guizhi Tang minus Peony plus Schizonepeta, Oyster Shell, Dragon Bone, Rescue Decoction) is indicated.
Taiyang excessive sweating causes leakage, aversion to cold, dysuria, limb stiffness. Guizhi Jia Fuzi Tang (Guizhi Tang with Aconite Decoction) is indicated.
Excessive sweating or re-sweating causes Yang collapse, delirium. Short pulse indicates death; harmonious pulse indicates survival. (Short pulse: fluid exhaustion, untreatable; Harmonious: righteous Qi intact, treatable. Use Xiaochaihu Jia Guizhi.)
Yang pulse micro with little sweating indicates harmony; profuse sweating indicates excess. Solid Yang pulse with excessive sweating causes Yang isolation and fluid loss, leading to hard stool.
Shaoyin micro pulse prohibits sweating (Yang collapse). Weak-choppy Chi pulse prohibits purgation (Yin deficiency). Use Guizhi Shaoyao Gancao Tang or Sini Tang.
Patient with tight Yin-Yang pulses but sweating indicates Yang collapse, belonging to Shaoyin, likely with sore throat, vomiting, diarrhea (use Guizhi Jia Ganjiang Tang or Sini Tang).

Night Sweats:
Night sweats occur during sleep and stop upon waking. (Sleep moves Qi inward, releasing fluids; waking moves Qi outward, stopping sweat.) Miscellaneous disease night sweats indicate Yin deficiency; cold damage night sweats indicate pathogens in half-exterior/half-interior. Exterior pathogens cause spontaneous sweating. Text says: "Slight night sweating with aversion to cold indicates unresolved exterior." Yangming interior excess with floating pulse indicates residual exterior pathogen. Three-Yang concurrent disease with sweating upon closing eyes indicates pathogens between exterior/interior, requiring harmonization, unlike spontaneous sweating which has clear exterior/interior/deficiency/excess distinctions.
Taiyang floating-numerous pulse, headache, fever, slight night sweating, aversion to cold: exterior unresolved (see Phlegm-Rheum).
Yangming floating-tight pulse with tidal fever; floating pulse alone indicates night sweating (*Liuren Shu*: Huangqin Tang, Chaihu Jianggui Tang, or Guizhi Fuling Baizhu Tang).
Three-Yang concurrent disease: floating-large pulse at Guan, somnolence, sweating upon closing eyes. (Cheng Wuji: Guan pulse monitors Shaoyang. Taiyang floats, Yangming is large. Floating-large at Guan indicates Three-Yang concurrent disease with Gallbladder heat causing somnolence and sweating. Shaoyin somnolence has no sweating. Use Xiaochaihu Tang or Xiexin Tang.)
Zhang Yuansu: Can Xiaochaihu Tang be used for Shaoyang-like symptoms? Yes. Three-Yang concurrent disease shows Taiyang (floating), Yangming (large), Shaoyang (Guan). Somnolence and eye-closing sweat indicate Gallbladder heat. Since Gallbladder is half-exterior/half-interior, Xiaochaihu Tang is appropriate.

Head Sweat:
The head is the meeting point of all Yang meridians. Heat steaming Yang causes head-only sweating. Three-Yin meridians do not reach the head, so they do not cause head sweating. Whole-body sweating is called "Heat Venting"; head-only sweating with no body sweat indicates heat...