典藏书目

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

Wei Qi (Defensive Qi) protects the skin, fills the interstices (Cou Li), and secures body fluids to prevent their abnormal leakage. When pathogenic factors invade, causing Wei Qi to fail in its external protection, body fluids will leak abnormally. However, this moist sweating occurs spontaneously, not as a result of diaphoretic treatment. Wind-strike causes fever and spontaneous sweating; Taiyang disease (Taiyang Syndrome) presents with sweating, aversion to wind, and thirst; severe Wind-Dampness results in profuse sweating and dampness on the body. Both Wind and Summerheat-Dampness pathogens can cause spontaneous sweating. Only Cold pathogens damage Ying Qi (Nutritive Qi) without affecting Wei Qi, thereby keeping the skin and interstices closed and preventing sweating. Initially, there is no sweat, but if the pathogen transmits inward and transforms into heat, Ying and Wei flow freely, the interstices open, and spontaneous sweating occurs.

Spontaneous sweating also differs between exterior and interior syndromes, and between deficiency and excess patterns. 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 belongs to Exterior Deficiency, and warming methods are suitable. These cases involve pathogens at the exterior. If sweating occurs without aversion to wind or cold, the exterior has resolved, indicating an interior syndrome treatable by purgation. For example, Yangming disease with fever and sweating indicates heat venting outward; urgent purgation is required for Yangming fever with profuse sweating. Although spontaneous sweating is common, if the skin becomes moist like oil or beads sticking to the body without flowing, it is a sign of untreatable conditions. Conversely, if the whole body is uniformly moist and the fever subsides with cooling after sweating, it is a favorable omen.

Fever, sweating, and aversion to cold belong to the exterior syndrome.
When a patient frequently sweats spontaneously, it is because Ying Qi is harmonious internally but disharmonious externally, due to Wei Qi failing to coordinate with Ying Qi. Ying Qi circulates within the vessels, while Wei Qi circulates outside. Re-inducing sweating will restore harmony between Ying and Wei, curing the condition. Guizhi Tang (Cinnamon Twig Decoction) is indicated. Wind damages Wei, Cold damages Ying. When Wei is affected by Wind but Ying remains healthy, it is called "Ying Harmony." Once Wei is invaded by pathogens, it cannot harmonize with Ying nor protect the skin and interstices, leading to frequent spontaneous sweating. Guizhi Tang disperses Wind and harmonizes Ying and Wei. (See Taiyang Disease section for details). If accompanied by stiffness of the neck and back, Guizhi Jia Gegen Tang (Cinnamon Twig Decoction with Kudzu Root) is used. If accompanied by painful joints, inability to flex and extend, and dysuria, Gancao Fuzi Tang (Licorice and Aconite Decoction) is used (see Wind-Damp Fever section).

If sweating leaks incessantly with aversion to wind after diaphoresis, Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction) is indicated (see later sections). If sweating is accompanied by thirst, Wuling San (Polyporus Powder) is used; if without thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is used.

The *Huo Ren Shu* states: For wind-strike with spontaneous sweating, Guizhi Tang must be used with caution. If the pulse is floating and weak, and although Guizhi Tang is indicated, the patient becomes irritable after taking it without resolving the pulse and symptoms, it should not be taken again. If wind-strike spontaneous sweating is accompanied by frequent urination, Guizhi Tang must strictly be avoided. Furthermore, in Taiyang disease with spontaneous sweating, limb spasms, and difficulty moving, if dysuria is present, Aconite may be added to Guizhi Tang. If urination is frequent, Guizhi Fuzi Tang must strictly be avoided; Shaoyao Gancao Tang (Peony and Licorice Decoction) is preferred. If Guizhi Fuzi Tang is mistakenly used to attack the exterior, causing dry throat, irritability, cold limbs, and vomiting, Gancao Ganjiang Tang (Licorice and Ginger Decoction) should be given first to restore Yang Qi. Once limbs warm, Shaoyao Gancao Tang restores leg extension.

Zhao noted that post-sweating leaking sweat with difficult urination resembles spontaneous sweating with frequent urination. Zhang Zhongjing repeated these chapters to clarify distinctions. The first case: Taiyang disease after excessive sweating leads to leaking sweat, aversion to wind, difficult urination, and slight limb stiffness. Guizhi Fuzi Tang is indicated. This is due to excessive sweating medication, not spontaneous sweating. Aversion to wind indicates residual pathogens. Difficult urination and limb stiffness indicate fluid loss and lack of nourishment to tendons. This is Yang depletion from excessive sweating, exterior deficiency with pathogenic retention, not interior. Thus, Aconite warms the meridians, Guizhi releases the exterior, and Shaoyao nourishes blood and relaxes tendons.

The second case: Floating pulse indicates deficiency. Spontaneous sweating and slight aversion to cold indicate Yang deficiency failing to defend the exterior. Frequent urination indicates lower jiao deficiency-cold failing to control water. Heart irritability indicates Yin deficiency and blood shortage. Leg cramps indicate blood loss from sweating failing to nourish tendons. This initial presentation involves both exterior and interior deficiency, without exterior Yang signs. It should not be treated with Guizhi Tang. Mistaken use leads to cold limbs, dry throat, irritability, and vomiting due to Yang depletion and cold stagnation. Ganjiang warms the interior and restores Yang; Gancao and Shaoyao replenish blood. After leg extension, if delirium occurs due to prior fluid loss and dry ginger's dryness causing Yangming internal binding, Tiaowei Chengqi Tang (Regulating the Stomach and Purging Down Decoction) should be used sparingly.

Shaoyao Gancao Tang is specifically for calf cramps after recovery from cold limbs, not for floating pulse, spontaneous sweating, and frequent urination. The *Huo Ren Shu* incorrectly applies it here. Analyzing Zhang Zhongjing's logic: The concern is not the dryness of Ganjiang but the deficiency of Zheng Qi (Upright Qi). Restoring Yin-Yang balance via Ganjiang, Shaoyao, and Gancao is crucial. Once upright Qi is restored, even if delirium persists due to dry stool, Dahuang and Mangxiao can safely purge without damaging Qi. This sequence of hot then cold, tonifying then purging, appears reverse but is actually correct, demonstrating Zhang Zhongjing's brilliance.

For summerstroke with spontaneous sweating, fever, aversion to cold, weak pulse, thirst, and cold feet, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated.

Fever, sweating, and absence of aversion to cold belong to the interior, characteristic of Yangming disease.
Q: What are the exterior signs of Yangming? A: Fever, spontaneous sweating, absence of aversion to cold, and aversion to heat. (Da Chengqi Tang, Major Order the Qi Decoction).
Q: Why does one-day onset present with aversion to cold but no fever? A: Aversion to cold will cease spontaneously, followed by sweating and aversion to heat.
Q: Why does aversion to cold cease? A: Yangming belongs to Earth, the destination of all pathogens, with no further transmission. Initial aversion to cold stops by the second day, confirming Yangming disease.
In cold damage transferring to Yangming, continuous slight sweating occurs. (Wind-strike causes sweating; cold damage does not, except when entering Yangming).

If accompanied by hard stool and delirium, purgation is required.
Fever, sweating, absence of aversion to cold, hard stool, and delirium indicate Chengqi Tang. Urgent purgation with Da Chengqi Tang is needed for Yangming fever with profuse sweating.

Xu recorded a case: Cold damage with eye pain, dry nose, insomnia, constipation, and large pulses throughout. After night sweating, Dachaihu Tang (Major Bupleurum Decoction) was urgently administered despite objections about fluid depletion. The physician argued for honey suppositories, but Xu insisted on Dachaihu Tang based on Zhang Zhongjing's hidden principles, resulting in cure. Critics question purging in spontaneous sweating or early dryness. Zhang Zhongjing's "urgent purgation" parallels "urgent rescue of exterior/interior." Early purgation prevents fluid exhaustion. Understanding the pathology prevents error; otherwise, honey suppositories are safer.

If accompanied by floating-tight pulse and bitter taste, avoid sweating and acupuncture; use harmonizing methods.
Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness, panting, fever, sweating, absence of aversion to cold, 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 diaphragm, causing vexation with tongue coating. Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is indicated. For thirst and dry mouth, Baihu Jia Renshen Tang. For floating pulse, fever, thirst, and dysuria, Zhu Ling Tang (Poria Decoction) is indicated. (Note: Floating pulse/bitter taste indicates exterior pathogen; tight pulse/sweating/abdominal fullness indicates interior pathogen. Harmonizing is required).

If accompanied by dysuria, distinguish appetite.
Yangming patients desiring food but with dysuria and normal stool, experiencing joint pain, mild heat sensation, sudden madness, and steady sweating, resolve as Water fails to overcome Grain Qi. Pulse tightening indicates recovery (use Guizhi Tang or Qianghuo Tang). Cold-damage Yangming unable to eat, with dysuria and steady hand/foot sweating, suggests chronic mass formation and loose stool due to cold water in the stomach separating grain and water (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 upon pressure with aversion to cold requires Fuzi Xiexin Tang (Aconite Decoction for Draining the Epigastrium); hard upon pressure with rib pain and no aversion to cold requires Shi Zao Tang (Ten Jujubes Decoction).

If accompanied by diarrhea:
Sweating, diarrhea, persistent heat, cold limbs, and aversion to cold require Sini Tang (Counterflow Decoction). Diarrhea with undigested food requires Tongmai Sini Tang (Pulse-Restoring Counterflow Decoction). Sweating, diarrhea, slight heat, and rapid pulse indicate self-recovery; tight pulse indicates non-recovery. Fever, diarrhea, and incessant sweating after six days indicate death.

If accompanied by vomiting and diarrhea:
Tight pulse, sweating, sore throat, vomiting, and diarrhea indicate Shaoyin Yang depletion. 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 Jia Zhuyedan Tang (Pulse-Restoring Counterflow Decoction plus Porcine Bile).

Haizang summarizes: Taiyang spontaneous sweating uses Guizhi Tang; Yangming uses Baihu Tang; Shaoyin uses Sini Tang.
Yangming syndrome with fever, eye/nose pain, insomnia, spontaneous sweating, or aversion to heat with floating pulses uses Baihu Tang. Cold damage with long pulses, profuse sweating, cold skin, and thin interior pulses, or malaria with chills only, indicates Yangming transmitting to Shaoyin; Baihu Jia Guizhi Tang is used. Pulse speed distinguishes this pattern.

*Huo Ren Shu*: If sweating induces movement of Qi to the left, do not sweat; dizziness, sweating, and muscle twitching result. Treat first with Fangfeng Baizhu Muli San (Saposhnikovia, Atractylodes, and Oyster Shell Powder), then Jianzhong Tang. Formula: Equal parts Saposhnikovia, roasted Oyster Shell, and Atractylodes. Take 2 qian with wine or rice drink, 2-3 times daily. After sweating stops, take Xiao Jianzhong Tang.

Ji Yan Fang: For excessive sweating, reduce Neiting, Hegu, and Fuliu acupoints.

Resembling Yangming exterior signs:
Post-vomit sweating without aversion to cold/fever with fine-rapid Guan pulse is minor deviation. Fever and sweating without aversion to cold indicate Soft Spasm. Post-sweat burning heat indicates Wind-Warmth (pulse floating, sweating, heaviness, somnolence).

Post-sweat/vomit/purge spontaneous sweating:
Two-Yang concurrent disease: Incomplete sweating initially transfers to Yangming with continued slight sweating and no aversion to cold. If Taiyang signs persist, do not purge; use mild sweating. Persistent red face indicates stagnant Yang at the exterior; fumigation helps. Incomplete sweating causes restlessness, wandering pain, shortness of breath. Pulse choppy confirms incomplete sweating. (Cheng Wuji commentary explains concurrent disease dynamics). Do not use Guizhi Tang after purgation. Sweating, wheezing, and no significant heat require Mahuang Xingren Gancao Shigao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction).

After Guizhi Tang, if massive sweating and large pulse persist, continue Guizhi Tang. If malarial-like recurrence twice daily, sweating resolves it; use Guizhi Er Mahuang Yi Tang (Two Parts Cinnamon Twig to One Part Ephedra Decoction). Post-sweat dry stomach and insomnia require small sips of water. Floating pulse, dysuria, mild fever, and thirst require Wuling San. Chaihu syndrome persisting after mistaken purgation resolves with Chaihu Tang. Taiyang Guizhi syndrome mistreated with purgation causing diarrhea, rapid pulse (exterior unresolved), and wheezing with sweating requires Gegen Huanglian Huangqin Tang (Kudzu, Scutellaria, and Phellodendron Decoction). Floating-numerous pulse indicates sweating resolution; purgation causing heaviness and palpitations requires waiting for spontaneous sweating due to interior deficiency (weak Chi pulse). Taiyang disease presenting with sweating instead of aversion to cold/fever and fine-rapid Guan pulse results from mistaken vomiting. Floating-Huan Cun, Floating Guan, Weak Chi with fever, sweating, aversion to cold, and epigastric fullness results from mistaken purgation. Thirst indicates transfer to Yangming; Wuling San is appropriate. Massive vomiting/purgation causing extreme deficiency and sweating with hiccups indicates cold stomach.

Yang Depletion:
Fire therapy forcing sweating in floating pulse cold damage causes Yang depletion,惊狂 (panic/madness), and restlessness. Guizhi Qu Shaoyao Jia Shuqi Muli Longgu Jiuni Tang (Cinnamon Twig Decoction without Peony plus Clamshell, Oyster Shell, and Dragon Bone to Save from Emergency) is indicated. Leaking sweat after Taiyang sweating with aversion to wind, dysuria, and limb stiffness requires Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction plus Aconite). Excessive sweating causing Yang depletion and delirium with short pulse is fatal; harmonious pulse indicates survival. Weak Yang pulse with little sweating is harmonious; excessive sweating is excessive. Solid Yang pulse with excessive sweating causes interior Yang extinction and fluid loss, leading to hard stool. Shaoyin disease with weak pulse forbids sweating (Yang depletion). Weak-Chi pulse forbids purgation (Yin deficiency). Tight pulses with sweating indicate Yang depletion in Shaoyin, likely with sore throat, vomiting, and diarrhea (use Guizhi Jia Ganjiang Tang or Sini Tang).

Night Sweats:
Night sweats occur during sleep and stop upon waking. Sleep moves Qi inward, allowing fluid leakage; waking moves Qi outward, stopping sweat. In miscellaneous diseases, night sweats indicate Yin deficiency; in cold damage, they indicate pathogens in the half-exterior/half-interior. Pathogens at the exterior cause spontaneous sweating. "Slight night sweating with aversion to cold" indicates unresolved exterior. Floating pulse in Yangming with night sweating indicates residual exterior pathogen. Three-Yang concurrent disease with sweating upon closing eyes indicates pathogens between exterior and interior, requiring harmonizing methods.
Taiyang disease with floating-numerous pulse, headache, fever, slight night sweating, and aversion to cold indicates unresolved exterior.
Yangming disease with floating-tight pulse, tidal fever, and floating pulse alone indicates night sweating (use Huangqin Tang, Chaihu Jianggui Tang, or Guizhi Fuling Baizhu Tang).
Three-Yang concurrent disease with floating-large pulse rising to Guan, somnolence, and sweating upon closing eyes indicates Gallbladder heat (use Xiao Chaihu Tang or Xiexin Tang). Zhang Yuansu confirms Xiao Chaihu Tang is appropriate for this pattern.

Head Sweat:
The head is the meeting point of all Yang meridians. Heat steaming upward causes head-only sweating. Three Yin meridians do not reach the head, so they do not cause head sweating. Whole-body sweating is "Heat Venting"; head-only sweating indicates trapped heat...