自汗属阳有虚实,或因胃热或表虚,睡中盗汗为阴弱,心虚血热随证医。
[注]
汗乃人之津液,存于阳者为津,存于阴者为液,发泄于外者为汗,
若汗无故而出者,乃因阴阳偏胜也,
如小儿无因而汗自出者,谓之自汗,
自汗属阳有虚实之别,
虚者汗出翕翕,发热恶寒,乃表虚也,
汗出蒸蒸,发热不恶寒,乃里热也,
表虚者,法当固表,里实者,法当攻热,
又有睡则汗出,觉则汗止,谓之盗汗,
盗汗主阴虚,然当分心虚不固,心火伤阴也,
心虚当补心,心热当凉血,治者宜详辨之,庶无差谬。
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汗证门
表虚自汗玉屏风,甚者桂枝加附从,裹实自汗用白虎,便秘调胃承气攻。
[注]
表虚濈濈自汗,玉屏风散主之,
若恶寒冷,阳气虚也,桂枝汤加附子固之,
阳明里实,蒸蒸自汗,用白虎汤清之,
便秘者,以调胃承气汤攻之。
(玉屏风散) 黄耆蜜炙 防风 白术土炒 水煎服。
(方歌)
表气虚弱时自汗,玉屏风治颇相宜,黄耆防风炒白术,水煎温服不拘时。
(桂枝加附子汤) 白芍药 桂枝 甘草炙 附子制 引用姜枣水煎服。
(方歌)表气虚弱甚,桂枝汤最良,芍药桂枝草,加附病渐康。
(白虎汤)方见里热
(调胃承气汤)方见里热。
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汗证门
自汗属于阳证,分为虚证和实证两种情况。有的因为胃中有热,有的因为体表虚弱;睡中出汗称为盗汗,属于阴分虚弱,多因心气不足、血分有热,需根据具体证候进行治疗。
[注释]
汗是人的津液,存在于体表属阳的称为“津”,存在于体内属阴的称为“液”,发泄于体外的称为“汗”。如果汗液无故而出,是因为阴阳偏盛所致。例如小儿没有明显原因而自然出汗,称为自汗。自汗属于阳证,有虚证和实证的分别:虚证表现为汗出时感觉轻微发热(翕翕发热),伴有怕冷,这是表虚;实证表现为汗出时感觉热气蒸腾(蒸蒸汗出),发热但不怕冷,这是里热。表虚者,治疗原则应当固护肌表;里实者,治疗原则应当攻逐热邪。又有睡觉时出汗,醒来后汗止的情况,称为盗汗。盗汗主要主阴虚,但应当区分是心气虚弱不能固摄,还是心火旺盛损伤阴液。心气虚弱当补益心气,心火亢盛当凉血清热,医者应当仔细辨别,以免出现差错。
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汗证门
对于表虚引起的自汗,使用玉屏风散;病情严重的,在桂枝汤基础上加附子以增强固表作用;对于里实热引起的自汗,使用白虎汤清泄里热;如果伴有便秘,则用调胃承气汤攻下实热。
[注释]
表虚导致持续不断(濈濈)的自汗,由玉屏风散主治。
如果伴有恶寒,说明阳气虚弱,可用桂枝汤加入附子以固护阳气。
阳明经里实热证,表现为热气蒸腾的自汗,用白虎汤清解。
伴有便秘者,用调胃承气汤攻下。
(玉屏风散) 黄耆蜜炙,防风,白术土炒,水煎服。
(方歌)
表气虚弱时常自汗,玉屏风治疗很适宜,黄耆防风炒白术,水煎温服不拘时间。
(桂枝加附子汤) 白芍药,桂枝,甘草炙,附子制,引用姜枣水煎服。
(方歌)表气虚弱甚,桂枝汤最良,芍药桂枝草,加附病渐康。
(白虎汤)方见里热
(调胃承气汤)方见里热。
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汗证门
Spontaneous sweating belongs to Yang syndromes and is divided into deficiency (Xu) and excess (Shi) types. It may be caused by stomach heat or exterior deficiency; night sweats (Dao Han) belong to Yin deficiency, often due to Heart Qi deficiency and blood heat, and should be treated according to the specific syndrome.
[Note]
Sweat is the body's Jin-Ye (body fluids). Those existing in the Yang aspect are called "Jin" (thin fluid), those in the Yin aspect are called "Ye" (thick fluid), and those excreted on the exterior are called "Han" (sweat). If sweat occurs without an obvious cause, it is due to an imbalance of Yin and Yang. For example, when children sweat spontaneously without a clear reason, it is called spontaneous sweating. Spontaneous sweating belongs to Yang syndromes and has distinctions between deficiency and excess: Deficiency type presents with mild fever (Xi Xi Fa Re) accompanied by aversion to cold, indicating Exterior Deficiency; Excess type presents with steaming sweat (Zheng Zheng Zi Han) and fever without aversion to cold, indicating Interior Heat. For Exterior Deficiency, the treatment principle is to consolidate the exterior; for Interior Excess, the principle is to purge the heat. Another condition is sweating during sleep and stopping upon waking, known as night sweats (Dao Han). Night sweats primarily indicate Yin deficiency, but one must distinguish whether it is due to Heart Qi deficiency failing to secure the exterior or Heart Fire damaging the Yin. Heart Qi deficiency requires tonifying the Heart, while Heart heat requires cooling the blood. Physicians should differentiate carefully to avoid errors.
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Chapter on Sweating Disorders
For spontaneous sweating due to exterior deficiency, use Yu Ping Feng San (Jade Windscreen Powder); if severe, add Fu Zi (Prepared Aconite Root) to Gui Zhi Tang (Cinnamon Twig Decoction) to strengthen consolidation; for interior excess heat causing sweating, use Bai Hu Tang (White Tiger Decoction) to clear interior heat; if accompanied by constipation, use Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) to purge excess heat.
[Note]
Continuous (Ji Ji) spontaneous sweating due to exterior deficiency is mainly treated with Yu Ping Feng San (Jade Windscreen Powder).
If accompanied by aversion to cold, it indicates Yang Qi deficiency; Gui Zhi Tang (Cinnamon Twig Decoction) with added Fu Zi (Prepared Aconite Root) can be used to secure the Yang.
Yangming Interior Excess Heat, presenting with steaming spontaneous sweating, is treated with Bai Hu Tang (White Tiger Decoction) to clear.
Those with constipation are treated with Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) to purge.
(Yu Ping Feng San / Jade Windscreen Powder) Huang Qi (Astragali Radix, honey-fried), Fang Feng (Saposhnikoviae Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma, soil-fried). Decoct in water and take orally.
(Fang Ge / Formula Verse)
Exterior Qi weakness causes frequent spontaneous sweating,
Yu Ping Feng San is quite suitable for treatment.
Huang Qi, Fang Feng, and stir-fried Bai Zhu,
Decoct in water, take warm, at any time.
(Gui Zhi Jia Fu Zi Tang / Cinnamon Twig Decoction plus Prepared Aconite Root) Bai Shao Yao (Paeoniae Radix Alba), Gui Zhi (Cinnamomi Ramulus), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried), Zhi Fu Zi (Aconiti Lateralis Radix Praeparata). Use fresh ginger and jujube as guides, decoct in water, and take orally.
(Fang Ge / Formula Verse)
When exterior Qi weakness is severe,
Gui Zhi Tang is best.
Bai Shao Yao, Gui Zhi, and Gan Cao,
Add Fu Zi, and the illness gradually recovers.
(Bai Hu Tang / White Tiger Decoction) See Interior Heat section.
(Tiao Wei Cheng Qi Tang / Regulate the Stomach and Direct Downward Decoction) See Interior Heat section.
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Chapter on Sweating Disorders