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Spontaneous sweating refers to the natural occurrence of sweating without the use of diaphoretic (sweat-inducing) medications. Wei Qi (Defensive Qi) functions to protect the skin, ensure the density and solidity of the Cou Li (skin texture and pores), secure body fluids, and prevent their uncontrolled leakage. The heat-toxin of smallpox/rash spreads from the interior to the exterior, interfering with the normal operation of Wei Qi, causing the skin to become lax and the Cou Li to open, leading to the external leakage of body fluids and thus spontaneous sweating. In general diseases, spontaneous sweating should be stopped immediately. However, during the initial eruption of rashes, spontaneous sweating is actually a favorable sign, indicating that Yin and Yang Qi are harmonious, Ying Qi (Nutritive Qi) and Wei Qi are flowing smoothly, pathogenic factors cannot remain stagnant, and it facilitates the eruption and resolution of the rash. Furthermore, the Heart governs sweat, and all sores and ulcers belong to the Heart; spontaneous sweating indicates the external discharge of toxic heat. Although severe heat can also be relieved through sweating, resulting in the body becoming cool again, this signifies the dispersion of toxins. If sweating continues incessantly and fever worsens, it indicates that pathogenic factors have merged into the Yang aspect, leading to Yang deficiency. Treatment should focus on astringing sweat, consolidating the exterior, clearing heat, and detoxifying, to replenish Wei Qi and prevent complications such as itching, collapse, or ulceration. In such cases, Baoyuan Decoction (used for major principles) or Danggui Liu Huang Tang (Cinnamon Twig and Rehmannia Six-Huang Decoction, used for night sweats) may be administered. If the rash has crusted over and scabs fall off, accompanied by spontaneous sweating, this is due to Qi deficiency. Treatment should aim to tonify Yang and rescue Yin, preventing Qi loss, using Shiquan Dabu Decoction (Ten Complete Great Tonifying Decoction, used for sweating disorders). If sweating persists, it can be taken together with Bai Pu San (Decoction of Rotten Cattail Powder), and externally, the Wen Fen Pu Method (Powder Dusting Method) can be applied. Xue Ji stated: After the crusts form, careful differentiation and treatment are essential. If caused by Blood deficiency, Danggui Buxue Tang (Angelica Sinensis and Astragalus Tonifying Blood Decoction, used for deficient heat) should be used; if caused by Qi deficiency, Sijunzi Tang (Four Gentlemen Decoction) plus Huangqi (Astragalus Root) should be used; if caused by both Qi and Blood deficiency, Shiquan Dabu Decoction is appropriate. For spontaneous sweating caused by dietary irregularities, Xiaoyigong San (Minor Extra-merit Powder, used for vomiting and diarrhea) plus Huanglian (Coptis Rhizome), Wuweizi (Schisandra Fruit), and Wumei Rou (Mume Seed Flesh) should be used. Sweating during sleep is caused by Heat in the Heart. If sweat extends from the head to the neck but does not reach the chest, this is spontaneous sweating due to deficiency of the Qi of the Six Yang channels, which requires no specific treatment. If sweat extends from the neck to the umbilicus, this is due to Stomach Qi deficiency, treated with Baoyuan Decoction (equivalent to Shen Yin, see Major Principles); if ineffective, take together with Bai Pu San. Spontaneous sweating is transformed from Blood; when Yin Qi fails to consolidate, sweating occurs during sleep. Patients with smallpox/rash should primarily focus on nourishing Blood. Formulas such as Danggui Buxue Tang, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Bazhen Tang (Eight-Treasure Decoction), and Renshen Yangrong Tang (Ginseng Nourishing Spirit Decoction) can be prescribed according to the syndrome. Spontaneous sweating accompanied by facial redness, thirst, and excessive sweating on the hands and feet indicates Stomach Heat, treated with Xiehuang San (Drain Yellow Powder, used for Spleen heat) or Renshen Baihu Tang (Ginseng White Tiger Decoction, used for fever) plus Huanglian. After various symptoms subside, regulation can be achieved with Xiaoyigong San plus Zhiren (Gardenia Seed) and Maidong (Ophiopogon Tuber). Spontaneous sweating caused by food stagnation and internal heat is treated with Sijunzi Tang plus Qu (Medicated Leaven). Spontaneous sweating accompanied by convulsions and salivation indicates Liver Wood insulting Spleen Earth, treated with Xiaoyigong San plus Gouteng (Uncaria Ramulus). When convulsions decrease, remove Gouteng and add Chaihu (Bupleurum Root). Zhu Danxi stated that spontaneous sweating is not harmful, referring only to the initial eruption and cases where sweating is mild. However, excessive sweating easily causes debility. Before the crusts form, there is a risk that Qi and Blood deficiency will prevent scabbing; after the crusts form, one must guard against Blood depletion and Yin deficiency, leaving Yang without attachment. If sweat flows like oil, hair is wet as if washed, and panting is ceaseless, this is a sign of Lung Qi exhaustion, representing a fatal condition that is difficult to treat.

Fumai San (Floating Wheat Powder)
Floating wheat, any amount, stir-fried until fragrant. Take 3–5 qian per dose, decocted in water, to treat spontaneous sweating due to Stomach deficiency.

Baipu San (Rotten Cattail Powder, also known as Zhihan San/Stop-Sweat Powder)
Burn old cattail fans to ash. Take 3 qian per dose, mixed with warm wine, to be taken at any time.

Wenfen Pu Method (Warm Powder Dusting Method)
Huanglian (Coptis Rhizome), Moli Fen (Oyster Shell Powder), Beimu (Fritillaria Bulb) (each half liang), Jingmi Fen (Rice Flour) (one sheng).
Grind all ingredients into fine powder. Apply/dust onto the body.