大意
汗乃心液。在内为血。在外为汗。肾复主液。在内为液。在外亦为汗。故自汗必由心肾虚而得之。（医圣）
内因
自汗者。卫气不固。荣血渗泄。（医鉴）饮食饱甚。汗出于胃。惊而夺精。汗出于心。持重远行。汗出于肾。疾走恐
惧。汗出于肝。摇体劳苦。汗出于脾。（素问）
外候
阳虚自汗必恶寒。火热自汗必躁热。伤湿自汗。困倦身重。天阴转甚。声如瓮出。伤风自汗。头疼身热。咳嗽
烦闷。鼻塞流涕。伤暑自汗。身热口渴。烦躁面垢。痰症自汗。头眩呕逆。胸满吐痰。心虚自汗。怔忡恍惚。肝热
自汗。口苦多眠。肾虚自汗。潮热咳嗽。脾虚自汗。倦怠少食。（汇补）
汗分冷热
自汗有冷有热。阴虚阳凑者。发热自汗。汗出必热。阳虚阴凑者。厥冷自汗。汗出必冷。然有火邪亢极。反兼
水化而汗冷者。又有相火出于肾中。挟水化而汗冷者。不可不审。（汇补）
汗多亡阳
气虚则外寒。虽见热中。蒸蒸为汗。终传大寒。（经文）此因汗多亡阳。重虚其表。阳虚极矣。故为寒中。凡病甚
虚极之人。多有头面汗出淋漓。口鼻皆冷。手足青色。气促不止。急欲温补以追欲绝之阳。并外用扑法。亦
有生者。迟则不及矣。（汇补）
脉法
浮而濡者为汗。在寸为自汗。在尺为盗汗。自汗之脉微而弱。为阳衰。盗汗之脉细而涩。为阴弱。（汇补）
治法
阳虚自汗。宜补肺。然有扶阳而不愈者。乃表虚汗无以外卫也。当敛表以实之。心虚自汗。宜安神。然有补
心而不愈者。乃血虚而汗无以退藏也。当养血以调之。汗出于脾。湿气盛也。当燥之。然有补脾胜湿而不
愈者。乃火气蒸腾也。当先清其热。汗出于肾。阳加阴也。当清之。然有凉血养血而不愈者。乃相火作汗也。
当滋其阴。肝主疏泄而自汗者。当调血清火。胃经气热而自汗。宜导痰通滞。此治杂病自汗之法也。若夫
伤风伤湿而汗者。当发汗以解外。温病热病而自汗者。当寒凉以清中。又非前法并论也。（汇补）
治分五脏
肺虚者。护其皮毛。脾虚者。壮其中气。心虚者。益其血脉。肝虚者。禁其疏泄。肾虚者。固其封藏。五脏之内。
酌其宜温宜清宜燥宜润而用之。惟存乎临症之顷也。（汇补）
死症
津脱者。腠理开。汗大泄。（灵枢）凡汗出发润。汗出如油。汗出如珠。汗多喘满。汗雨淋漓。皆不治也。（汇补）
用药
阳虚。用建中汤、参附汤。表虚。用桂枝加 术汤。心虚。用归脾汤。肝火。用逍遥散。肾虚。用地黄安肾丸。相
火。用当归六黄汤。湿胜。用羌活胜湿汤。痰病。用理气降痰汤。凡虚症服诸药汗不止者。重加枣仁。有微热者。
加石斛。劳役气虚。寒热倦怠。少食自汗。脉虚大。或沉细。补中益气汤。去升、柴。加五味、麻黄根。火气上蒸。胃
湿作汗者。凉膈散。湿热自汗。卫气虚弱。不任风寒者。调卫汤。痰实膈滞。寒热自汗。能食便秘。脉实者。大柴
胡汤下之。大抵气热汗出。多是有余之症。
【附盗汗】
盗汗者。睡则出汗。醒则渐收。因阴气空虚。睡则卫气乘虚陷入阴中。表无护卫。荣中之火。独旺于外。蒸热
而汗。醒则气周于表而汗止。此症多见于虚劳之人。阴气损伤。宜养荣清热。若大病之后。新产之余。及久
出盗汗不止。则阳气亦虚。宜补气固阳。固阳能生阴。气为水母。甘温化气。阴液斯敛。若拘泥济阴。乌能卫
外。故表而出之。（汇补）
【附头汗】
头汗者。以六阳之脉。上循于头。三阴之经。至颈而还。阴虚阳浮。故汗出头颈。不能周身。有相火迫其肾水
上行心之分野者。有阳气失所根据附飞越于高巅者。有寒湿相搏者。有瘀血内蓄者。若关格小便不通而
头汗者。难治。及阳脱唇舌口鼻清冷而头汗者。亦不治。（医统）
【附饮食汗】
饮食汗者。因正气空虚。反为饮食 悍之气所胜。故食入汗出。久不已。则心气耗散。令人消渴偏枯。宜安
胃汤敛之。（医统）又饮酒中风。头面多汗。食则汗甚。常不可单衣。身常濡。口干善渴。名曰漏风。盖头为诸阳
之会。酒性亦阳。所以饮必见面。醉后阳气升头。毛窍亦开。当风坐卧。风邪入之。故多汗。宜实表。（汇补）
【附心汗】
心汗者。圆圆一片。只在心膛。因忧思惊恐以伤其心。宜敛神益气。归脾汤主之。或用猪心一具。带血破开。
入人参、当归末一两。煮熟。去药食之。仍以艾煎汤。调茯苓末一钱服。
【附阴汗】
酒色过度。每多阴汗。用六味地黄汤。加山栀、柴胡。有房劳汗出中风。下体多汗。不能劳事。十味锉散。加黄
柏。（汇补）
汗病选方
黄 建中汤 治阳虚自汗。
黄 桂枝（各一钱半） 白芍（三钱） 甘草（一钱）
生姜、饴。水煎。
当归六黄汤 治阴虚盗汗。
当归 生地 熟地 黄柏 黄芩 黄连（各一钱） 黄 （二钱）
水煎。
玉屏风散 治虚炎自汗。
防风 黄 （各一钱） 白术（一钱）
水煎。
实表散（澹寮） 治腠虚冷汗。
附子（炮） 肉苁蓉 细辛 五味子（各一钱）
与黄 建中汤合用。加小麦。水煎。
羌活胜湿汤 治湿胜自汗。
炙甘草（三钱） 黄 （一钱） 生草（五分） 黄芩（生） 炒黄芩（各三分） 人参（三钱） 川芎 本 防
风（各三分） 独活（二分） 升麻 柴胡（各五分） 细辛 蔓荆（各三分） 薄荷（一分）
水煎服。
理气降痰汤 治痰病自汗。
桔梗 枳壳 橘红 半夏 茯苓 香附 贝母（各一钱二分） 甘草 桂枝（各五分）
防己黄 汤（仲景）
防己（五分） 黄 （钱半） 白术（七分） 甘草（五分）
姜、枣水煎。
安胃汤
黄连 五味子 乌梅肉 生甘草（各五分） 熟甘草（三分） 升麻梢（二分）
水煎。
归脾汤（方见中风）
封脐法 用五倍、明矾为末。津液调封脐中。一宿即止。女人津唾更佳。
扑粉法 用牡蛎、白术、麦麸、麻黄根、 本、糯米、防风、白芷等末。绢包。周身扑之。
快捷方式法 用青桑叶一味。乘露采。焙干为末。二钱。空心。温米汤饮下。
General Principles
Sweat is the fluid of the Heart. Internally, it manifests as Blood; externally, it manifests as sweat. The Kidney also governs fluids. Internally, it manifests as body fluids; externally, it also manifests as sweat. Therefore, spontaneous sweating (spontaneous sweating) must arise from deficiency of the Heart and Kidney. (Medical Sage)
Internal Causes
Spontaneous sweating occurs because Wei Qi (Defensive Qi) fails to secure the exterior, allowing Ying Blood (Nutritive Blood) to leak out. (Medical Mirror) Excessive fullness from diet causes sweat to issue from the Stomach; fright causing loss of Essence causes sweat to issue from the Heart; carrying heavy loads and traveling far causes sweat to issue from the Kidneys; running fast while fearful causes sweat to issue from the Liver; bodily movement and arduous labor cause sweat to issue from the Spleen. (Su Wen / Basic Questions)
External Manifestations
Spontaneous sweating due to Yang deficiency is invariably accompanied by aversion to cold. Spontaneous sweating due to fire-heat is invariably accompanied by restlessness and heat. Spontaneous sweating due to injury by dampness involves fatigue and heaviness of the body, worsening on cloudy days, with a voice sounding like it comes from an urn. Spontaneous sweating due to wind injury involves headache, feverish sensation in the body, cough, irritability, nasal congestion, and runny nose. Spontaneous sweating due to injury by summerheat involves fever, thirst, irritability, and a greasy appearance of the face. Spontaneous sweating due to phlegm-pattern involves dizziness, vomiting and rebellious qi, chest fullness, and expectoration. Spontaneous sweating due to Heart deficiency involves palpitations and mental confusion. Spontaneous sweating due to Liver heat involves bitter taste in the mouth and excessive sleepiness. Spontaneous sweating due to Kidney deficiency involves tidal fever and cough. Spontaneous sweating due to Spleen deficiency involves lassitude and poor appetite. (Hui Bu / Comprehensive Compilation)
Differentiation of Cold and Heat in Sweat
Spontaneous sweating can be cold or hot. In cases of Yin deficiency with Yang encroaching, there is feverish spontaneous sweating, and the sweat is hot. In cases of Yang deficiency with Yin encroaching, there is cold limbs with spontaneous sweating, and the sweat is cold. However, there are instances where pathogenic fire is extremely hyperactive and counteracts with water transformation, resulting in cold sweat. There are also instances where Ministerial Fire originates from the Kidneys and carries water transformation, resulting in cold sweat. These must not fail to be carefully examined. (Hui Bu / Comprehensive Compilation)
Excessive Sweating Leading to Collapse of Yang
Qi deficiency leads to external cold. Although internal heat may be seen, with steaming sweat, it ultimately transmits to severe cold. (Scripture) This is because excessive sweating leads to collapse of Yang, doubly weakening the exterior. When Yang deficiency is extreme, it results in interior cold. In patients who are extremely deficient, there is often profuse sweating on the head and face, coldness of the mouth and nose, cyanosis of the hands and feet, and unceasing shortness of breath. Urgent warming and tonification are needed to retrieve the nearly collapsed Yang, combined with external powder application methods. Survival is possible if treated promptly; delay renders it untreatable. (Hui Bu / Comprehensive Compilation)
Pulse Diagnosis
A floating and soggy pulse indicates sweat disease. If found at the Cun (inch) position, it is spontaneous sweating; if at the Chi (cubit) position, it is night sweating. The pulse for spontaneous sweating is faint and weak, indicating decline of Yang. The pulse for night sweating is fine and choppy, indicating weakness of Yin. (Hui Bu / Comprehensive Compilation)
Treatment Methods
For spontaneous sweating due to Yang deficiency, tonify the Lung. However, if supporting Yang does not cure it, it is because the exterior is deficient and sweat cannot guard outside; one should consolidate the exterior to strengthen it. For spontaneous sweating due to Heart deficiency, calm the Spirit. However, if tonifying the Heart does not cure it, it is because Blood is deficient and sweat cannot retreat and store; one should nourish Blood to regulate it. Sweat issuing from the Spleen indicates excess Dampness; one should dry it. However, if tonifying the Spleen and overcoming Dampness does not cure it, it is due to steaming of Fire; one should first clear the heat. Sweat issuing from the Kidneys indicates Yang adding to Yin; one should clear it. However, if cooling Blood and nourishing Blood does not cure it, it is due to Ministerial Fire causing sweat; one should nourish Yin. For spontaneous sweating due to Liver governing free flow and drainage, regulate Blood and clear Fire. For spontaneous sweating due to Qi-Heat in the Stomach Meridian, guide Phlegm and unblock stagnation. These are methods for treating spontaneous sweating in miscellaneous diseases. If sweating is due to Wind or Dampness injury, induce sweating to resolve the exterior. If spontaneous sweating is due to Warm Diseases or Heat Diseases, use cold-cooling herbs to clear the interior. These differ from the previous methods and should not be discussed together. (Hui Bu / Comprehensive Compilation)
Treatment According to the Five Zang Organs
For Lung deficiency, protect the skin and hair. For Spleen deficiency, strengthen Middle Qi. For Heart deficiency, benefit Blood vessels. For Liver deficiency, restrict free flow and drainage. For Kidney deficiency, secure storage and closure. Within the five Zang organs, choose appropriate warming, cooling, drying, or moistening methods based on clinical judgment. (Hui Bu / Comprehensive Compilation)
Fatal Signs
When Jin Ye (Body Fluids) escape, the cou li (pores) open, and sweat pours out profusely. (Ling Shu / Spiritual Pivot) Any case where sweat is oily, bead-like, accompanied by profuse sweating and panting/fullness, or raining down, is untreatable. (Hui Bu / Comprehensive Compilation)
Medication
For Yang deficiency, use Jian Zhong Tang (Middle-Jian Decoction) and Shen Fu Tang (Ginseng and Aconite Decoction). For exterior deficiency, use Gui Zhi Jia Zhu Tang (Cinnamon Twig Decoction plus Atractylodes). For Heart deficiency, use Gui Pi Tang (Restore the Spleen Decoction). For Liver Fire, use Xiao Yao San (Free and Easy Wanderer Powder). For Kidney deficiency, use Di Huang An Shen Wan (Rehmannia Pill to Calm the Kidney). For Ministerial Fire, use Dang Gui Liu Huang Tang (Angelica Six-Yellow Decoction). For Dampness excess, use Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome Dampness). For Phlegm disease, use Li Qi Jiang Tan Tang (Regulate Qi and Descend Phlegm Decoction). For deficiency patterns where various medicines fail to stop sweating, heavily add Suan Zao Ren (Ziziphus Seed). For slight heat, add Shi Hu (Dendrobium). For exhaustion-induced Qi deficiency with alternating chills and fever, lassitude, poor appetite, spontaneous sweating, and a large or deep-fine pulse, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), remove Sheng Ma and Chai Hu, add Wu Wei Zi and Ma Huang Gen. For Fire Qi steaming upward and Stomach Dampness causing sweat, use Liang Ge San (Cool the Diaphragm Powder). For damp-heat spontaneous sweating with weak Wei Qi unable to withstand wind-cold, use Tiao Wei Tang (Regulate Defensive Decoction). For Phlegm-excess and diaphragmatic stagnation with alternating chills/fever, spontaneous sweating, good appetite, constipation, and a forceful pulse, use Da Chai Hu Tang (Major Bupleurum Decoction) to purge. Generally, sweating due to Qi-Heat is mostly a syndrome of excess.
[Appendix: Night Sweating]
Night sweating refers to sweating during sleep, which gradually stops upon waking. It occurs because Yin Qi is empty; during sleep, Wei Qi falls into the Yin due to deficiency, leaving the exterior unprotected. The Fire within Ying circulates exclusively outside, steaming heat and causing sweat. Upon waking, Qi circulates on the exterior, and sweating stops. This pattern is common in consumptive disease patients with damaged Yin. It should be treated by nourishing Ying and clearing heat. After major illness, postpartum recovery, or prolonged uncontrollable night sweating, Yang Qi also becomes deficient. Tonify Qi and secure Yang. Securing Yang generates Yin; Qi is the mother of Water. Sweet-warm herbs transform Qi, allowing Yin fluids to converge. If one rigidly adheres to nourishing Yin, how can the exterior be guarded? Thus, treat by releasing from the exterior. (Hui Bu / Comprehensive Compilation)
[Appendix: Head Sweating]
Head sweating occurs because the six Yang meridians ascend to the head, while the three Yin meridians return at the neck. Yin deficiency with floating Yang causes sweat only on the head and neck, not the whole body. It may be caused by Ministerial Fire forcing Kidney Water up to the Heart's territory, or Yang Qi losing its foundation and flying away to the high peak (head). It may also result from cold-dampness combative interaction or internal accumulation of blood stasis. If head sweating occurs with Guan Ge (obstruction leading to urinary retention), it is difficult to treat. If head sweating occurs with Yang collapse, characterized by cold lips, tongue, mouth, and nose, it is untreatable. (Yi Tong / Medical Standards)
[Appendix: Dietary Sweating]
Dietary sweating occurs because righteous Qi is deficient and is overcome by the fierce Qi of food and drink, causing sweating upon eating. If prolonged, Heart Qi dissipates, leading to Xiao Ke (Wasting-Thirst) and hemiplegia. Use An Wei Tang (Stomach-Calming Decoction) to astringe. (Yi Tong / Medical Standards) Additionally, wind-strike after drinking alcohol causes much sweating on the head and face, worsening with eating. Patients dare not wear single layers, their bodies remain moist, and they have dry mouth with excessive thirst. This is named Lou Feng (Leaking Wind). Because the head is the meeting place of all Yang meridians, and wine is Yang in nature, drinking inevitably causes facial sweating. After drunkenness, Yang Qi rises to the head, pores open, and sitting/sleeping in the wind allows wind-pathogen invasion, causing much sweating. Secure the exterior. (Hui Bu / Comprehensive Compilation)
[Appendix: Heart Sweating]
Heart sweating appears as a round patch confined to the chest area. It is caused by worry, thought, fear, and fright injuring the Heart. Calm the Spirit and benefit Qi. Gui Pi Tang (Restore the Spleen Decoction) is the main formula. Alternatively, use one pig heart, cut open with blood, add one tael of powdered Ginseng and Angelica, boil until cooked, remove herbs, and eat the heart. Then decoct Mugwort, mix with one qian of Poria powder, and take orally.
[Appendix: Yin Sweating]
Excessive alcohol and sexual activity often lead to Yin sweating (sweating in the genital region). Use Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill) added with Gardenia and Bupleurum. For sweating after sexual exertion complicated by wind-strike, with much lower body sweating and inability to perform labor, use Shi Wei Cuo San (Ten-Ingredient Powder) added with Phellodendron Bark. (Hui Bu / Comprehensive Compilation)
Selected Formulas for Sweat Disease
Huang Qi Jian Zhong Tang (Astragalus Middle-Jian Decoction): Treats spontaneous sweating due to Yang deficiency.
Huang Qi, Gui Zhi (each 1.5 qian), Bai Shao (3 qian), Gan Cao (1 qian). Decoct with Sheng Jiang (Fresh Ginger) and Yi Tang (Maltose).
Dang Gui Liu Huang Tang (Angelica Six-Yellow Decoction): Treats night sweating due to Yin deficiency.
Dang Gui, Sheng Di, Shu Di, Huang Bo, Huang Qin, Huang Lian (each 1 qian), Huang Qi (2 qian). Decoct.
Yu Ping Feng San (Jade Windscreen Powder): Treats spontaneous sweating due to deficiency-fire.
Fang Feng, Huang Qi (each 1 qian), Bai Zhu (1 qian). Decoct.
Shi Biao San (Solidify Exterior Powder - Dan Liao): Treats cou li deficiency with cold sweat.
Fu Zi (Processed), Rou Cong Rong, Xi Xin, Wu Wei Zi (each 1 qian). Combine with Huang Qi Jian Zhong Tang, add Xiao Mai (Wheat), decoct.
Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome Dampness): Treats spontaneous sweating due to Dampness excess.
Zhi Gan Cao (3 qian), Huang Qi (1 qian), Sheng Cao (0.5 qian), Sheng Huang Qin, Chao Huang Qin (each 0.3 qian), Ren Shen (3 qian), Chuan Xiong, Gao Ben, Fang Feng (each 0.3 qian), Du Huo (0.2 qian), Sheng Ma, Chai Hu (each 0.5 qian), Xi Xin, Man Jing (each 0.3 qian), Bo He (0.1 qian). Decoct and take.
Li Qi Jiang Tan Tang (Regulate Qi and Descend Phlegm Decoction): Treats spontaneous sweating due to Phlegm.
Jie Geng, Zhi Ke, Ju Hong, Ban Xia, Fu Ling, Xiang Fu, Bei Mu (each 1.2 qian), Gan Cao, Gui Zhi (each 0.5 qian).
Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction - Zhang Zhongjing):
Fang Ji (0.5 qian), Huang Qi (1.5 qian), Bai Zhu (0.7 qian), Gan Cao (0.5 qian). Decoct with Sheng Jiang and Da Zao.
An Wei Tang (Stomach-Calming Decoction):
Huang Lian, Wu Wei Zi, Wu Mei Rou, Sheng Gan Cao (each 0.5 qian), Shu Gan Cao (0.3 qian), Sheng Ma Shao (0.2 qian). Decoct.
Gui Pi Tang (Restore the Spleen Decoction - see Stroke section):
Feng Qi Fa (Umbilical Sealing Method): Use Wu Bei Zi (Gallnut) and Ming Fan (Alum) as powder. Mix with saliva, apply to umbilicus overnight to stop sweating. Female saliva is better.
Pu Fen Fa (Powder Application Method): Use Mu Li, Bai Zhu, Mai Fu, Ma Huang Gen, Gao Ben, Nuomi, Fang Feng, Bai Zhi as powder. Wrap in silk, apply to the whole body.
Quick Method: Use Qing Sang Ye (Green Mulberry Leaf) alone. Harvest with dew, bake dry, make into powder. Take 2 qian on an empty stomach with warm rice soup.