经义
阳之汗，以天地之雨名之。○在心为汗。○阳加于阴谓之汗。○阴虚者，阳必凑之，故少气时热而汗出也。
○魄汗未藏，四逆而起。○汗出偏沮，使人偏枯。○人所以汗出者，皆生于谷，谷生于精。今邪气交争于骨肉而
得汗者，是邪却而精胜也。○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。○炅则腠理开，营卫通，汗大泄，故气泄矣。○劳则喘息汗出，内外皆越，故气
耗矣。○阳气有余为身热无汗，阴气有余为多汗身寒，阴阳有余则无汗而寒。○肾病者，寝汗出，憎风。（《素问》）
哲言
食梅津生，食芥泪堕，此液之自外夺者也；悲则涕生，愧则汗发，此液之自内致者也。（《医参》）
三阳实，三阴虚，汗不出；三阴实，三阳虚，汗不止。（《仁斋直指》）
真气已亏，胃中火盛，则汗出不休；真气已竭，阴火已衰，则无汗反躁；阴阳俱衰，四时无汗，其形不久。（李东垣）
卫气虚则多汗，营血虚则无汗。（娄全善）
阳者，卫外而为固也。阳虚不能卫外，故津液不固而汗易泄且畏风也。此与伤风自汗不同。彼责之邪实，
此责之表虚，故补、散各异。（《医方集解》）
汗出虽由卫气不固，胃中之津液外泄，而实关乎脏腑之蒸发使然。心之阳不能外卫而为固，则自汗出，包
络之火蒸发也；肾之阴不能退藏于密，则盗汗出，阴火乘虚蒸发也。（《张氏医通》）
腠理之疏密，卫实司之，故自汗多责之表虚。然《要略》曰∶腠者，三焦通会元真之处；理者，五脏六腑
之文理也。以此观之，卫外之阳不足，皆当责之于中。根于中者，命曰神机。故治法不离营卫、阴阳、中气之
间，不徒从腠理也。（程郊倩）
汗出一证，有自汗者，有盗汗者。自汗者， 然无时而动作则益甚；盗汗者，寐中通身汗出，觉来渐收。
古云∶自汗属阳虚。腠理者，卫气之所司也。人以卫气固其表，卫气不固，则表虚自汗而津液为之发泄也。治
宜实表补阳。盗汗属阴虚。阴虚阳必凑之，故阳蒸阴分则血热，血热则液泄而为盗汗也。治宜清火补阴。然以
余观之，则自汗亦有阴虚，盗汗亦多阳虚也。如烦劳大热，最多自汗，或以饮食之火起于胃，劳倦之火起于脾，
酒色之火起于肾，皆能令人自汗。若此者谓非阳盛阴衰而何？又若人之寤寐，总由卫气之出入，卫气者，阳气
也，人于寐时，则卫气入于阴分，此其时非阳虚于表而何？所以自汗、盗汗，亦各有阴阳之证，不得谓自汗必
属阳虚，盗汗必属阴虚也。然则阴阳有
异，何以辨之？曰∶但察其有火无火，则或阴或阳自可知矣。盖有火而汗出者，以火盛灼阴，阴虚可知也；无
火而汗出者，以表气不固，阳虚可知也。知斯二者，则汗出之要无余义，而治法亦可得其纲领矣。○病后多汗，
若伤寒、疟疾，凡系外感寒邪，汗出热退，而有汗不即止者，此以表邪初解，必由腠理，卫气开泄，其汗宜然。
即数日旬日，亦自无妨，卫气渐实，汗必自止，无足虑也。若其他杂证，本非外感之解，而自汗、盗汗者，乃
非所宜，不容不治。○汗证有阴阳∶阳汗者，热汗也；阴汗者，冷汗也。人但知热能致汗，而不知寒亦致汗。
所谓寒者，非曰外寒，正以阳气内虚，则寒生于中，阴中无阳，则阴无所主而汗随气泄。故凡大惊大恐，皆能
令人汗出，是皆阳气顿消，真元失守之兆。至其甚者，则如病后产后，或吐泻失血之后，必多有汗出者，岂非
气去而然乎？故《经》曰∶阴胜则身寒，汗出，身常清。仲景曰∶极寒反汗出，身必冷如冰。是皆阴汗之谓也。
故凡治阴汗者，但当察气虚之微甚。微虚者，略扶正气，其汗自收；甚虚者，非速救元气不可。（《景岳全书》）
方书多言血与汗异名而同类，丹溪因之，遂有在内为血，在外为汗之论，似乎血即是汗，汗即是血矣。奚
知血与汗之由来，有不可以同类并言者。《经》云∶心主血，血生于心。又云∶肾主五液，入心为汗。又云∶
汗者，心之液。而非曰心之血。血生于心，统于脾，藏于肝，其源则自水谷之精气，受于中焦，变化取汁，调
和于五脏，洒陈于六腑，以奉生身者也。若夫汗则为人身之津液。因腠理疏豁，皮毛不能外护，暑、湿、热之
邪干之，则津泄而为汗，是汗乃身中之阳气所化。故《经》曰∶阳加于阴谓之汗。此可以气言，而不可以血类
也。且夏天毫窍不密，汤水入胃，汗即流溢，津液外耗，小便短少；冬天腠理闭密，汗不外溢，小便频多，此
更可见汗属津液，而非可以血类也更明矣。况人之一身，有涕、泪、涎、唾、便、溺，皆属一水之化，而发
于九窍之中，汗若可以血类之，则涕、泪、涎、唾、便、溺亦可以血言之矣。但心为君主，汗为心液，汗多之
害，与亡血之害不甚远耳，非若便、溺之无大关害也。（《冯氏锦囊》）
心为君火，脾胃属土，此湿热相搏为汗明矣。如甑中烧酒，若非汤火熏蒸，则不能成汁液。（《医学正传》）
多汗身软者，湿也。心主热，脾主湿，湿热相搏，如地之蒸气为云、雨、雾、露。（《医学入门》）
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；痰证自汗，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。○凡汗出发润，汗出如油，汗出如珠，
汗多喘满，汗雨淋漓，皆属败证。（《证治汇补》）
病患汗出脐胸而止者，皆险证也。至腰稍可，至足方佳。（查了吾）
补编
汗由血液，本乎阴也。《经》曰∶阳之汗，以天地之雨名之。其义可知。然汗发于阴而出于阳，此其根本
则由阴中之营气，而其启闭则由阳中之卫气。故凡欲疏汗而不知营卫之盛衰，欲止汗而不知橐 之牝牡，吾知
其不败不已也。（张景岳）
汗出于心，热之所致；汗出于脾，湿气上腾；汗泄于肤，卫气不固。所以清心则液荣于内而为血；和胃则
液周流而不腾；实腠理则卫气充而液不泄。知斯三者，治汗之能事毕矣。（李东垣）
元阴之气衰弱，亦有自汗之证。盖阴虚则火动，乘于阴位，阴精被火煎熬，故汗自出也。是犹干竹以火燃
之而有油耳。不
可用参、 补气，但补其阴，则火自伏而汗自止。若相火乘于阴血而然者，宜补阴药中加知、柏。如阴血被湿
热熏蒸而然者，用当归六黄汤。○自汗宜补阳调卫，盗汗宜滋阴降火。阳虚冷汗自出者，宜补心，益火之原，以
消阴翳也；阴虚热汗盗出者，当补肾，壮水之主，以镇阳光也。汗乃心之液。阳虚阴必乘，故发厥而自汗，治
用四君子汤加黄 、肉桂以补阳；阴虚阳必凑，故发热而盗汗，治用四物汤加黄柏、知母以滋阴。○黄 、白术，
乃止汗之圣药。麻黄发汗，根节又能止汗。有用龙骨、牡蛎止汗者，取其收涩也。有湿胜自汗者，须用渗湿之
剂；有自汗不任风寒者，须用逐风之剂；有因房劳所致者，须用补肾之剂。桂枝汤，治外感风邪自汗之剂；黄
建中汤，治外感气虚自汗之剂；补中益气汤，治伤寒气虚自汗之剂。凡内伤诸证，自汗不止者，俱用补中益
气汤，少加附子、麻黄根、浮小麦，效如影响。但升、柴须蜜制炒，以杀其升发勇悍之性，又欲其引参、 至
肌表，故不可缺。（罗赤诚）
阳虚自汗宜补阳，然有扶阳而不愈者，乃表虚无以外卫也，当敛表以实之；心虚自汗宜补心，然有补心而
不愈者，乃营虚无以内藏也，当养血以调之。汗出于脾，湿气盛也，当燥之，然有补脾燥湿而不愈者，乃火气
蒸腾也，当清其热；汗出于肾，阳加于阴也，当清之，然有凉血养血而不愈者，乃相火作强也，当滋其阴。肝
主疏泄而自汗者，当调血清火；胃经气滞而自汗者，宜导气通滞。此治杂病自汗之法也。若伤风伤湿而自汗者，
当解其外；温病热病而自汗者，当清其中。又非前法并论也。（《证治汇补》）
六阳之脉，上循于头；三阴之经，剂颈而还。阴虚阳浮，故汗出头面，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，有胃热上蒸者，随证施治。惟关格
小便不通而头汗者难治，阳脱而头汗者不治。（《医统》）
伤寒头汗属少阳，小柴胡汤和之。食滞中宫，热气上蒸，亦令头汗，保和丸加姜汁炒川连。○脾胃湿蒸，
旁达四肢，则手足多汗。热者，二陈汤加川连、白芍；冷者，理中汤加乌梅；弱者，十全大补汤去川芎加五味
子。○夏月半身出汗，由气血不充，内挟痰饮所致，偏枯之兆也。《经》云∶汗出偏沮，使人偏枯。十全大补
汤、养营汤加行经豁痰药治之。○别处无汗，独心胸一片有汗，此思虑伤心所致，名曰心汗，归脾汤合生脉散、
猪心汤煎服。○阴汗属下焦湿热，龙胆泻肝汤加风药一、二味，风能胜湿故也。若因酒色过度者，用六味地黄汤。
（《张氏医通》）
余尝病怔忡、盗汗，补心肾无功，乃加猪心数片引之，遗已。药贵向导，不可不审。（王宇泰）
脉候
尺涩脉滑，谓之多汗。（《素问》）
男子平人脉虚弱细微者，善盗汗出。（《金匮》）
浮而濡者为汗。在寸为自汗，在尺为盗汗。（《证治汇补》）
选案
一妇在产后，头汗甚多，诊脉虽洪而缓。余曰∶头汗咸谓亡阳，然产后阴虚，喜其亡阳，与阴齐等，可勿
药也。主人疑之，更医峻用温补，乃暴注下泻，完谷不化，益认为阳虚，重用参、附，其泻愈甚，数日之间，
肌削神困。复诊脉洪弦数甚，此真阴竭矣。主人及医谓∶温补尚尔完谷不化，岂非阳虚之至乎？余曰∶产后头
汗，乃阴虚虚火上蒸，孤阳上迫，液不秘藏。误加温补燥热之气，暴注下趋而为完谷，乃火性急速，不及变化，
更加温药迫之，焚灼之势，必力穷乃止。《经》曰∶阴平阳秘，精神乃治。今阴气不能和平，阳气自难秘密，
精神离决，不待言矣。（冯楚瞻）
朱御章弟，劳倦发热，上半身自汗如雨，三昼夜不止。敛汗方法，并无一应。其岳陆右文邀予，诊脉浮细沉
洪，软弱无力，
面白无神，舌胖嫩白滑。意此必肺气大虚，腠理不固。初以黄 汤加五味子、附子各二钱，自子至卯，连进三
剂，其汗如故。思之良久，更用蜜炙黄 二两，人参五钱，白术一两，蜜炙升、柴、陈皮各一钱，归身、炙草、
黑姜各二钱，白芍、五味子、附子各三钱，大枣五枚，一剂而敛。右文曰∶连服补敛之剂，汗俱不止，乃用升、
柴、炮姜等，辛以散之，而汗反止，其故何也？予曰∶证本劳伤，脾肺中藏之阳陷而不升，卫外之阳虚而不固，
以致阴气不降，乘虚外溢，故特用升、柴以升提下陷之气，黑姜以收固卫外之阳，使阳得在外而为阴之卫，斯
阴得在内而为阳之守也。后用生金滋水等剂培养而愈。（《潜村医案》）
一少年上身汗出，三年不愈。用棉花子炒焦泡汤，服四、五日，汗出至足，后用归脾等汤调养而愈。（周慎斋）
附方
止汗方 治汗出不止。用五倍子为末，唾津调贴脐中，外用帛缚定，过宿即止。
又方 治盗汗，用冬桑叶一味，焙干为末，空心米饮下二钱，神效。
扑粉法 用牡蛎、龙骨、麻黄根、赤石脂等分研末，绢包扑之，效。
【经典论述】
阳气之汗，以天地间的雨水来命名。○汗由心所主。○阳气作用于阴液，便形成汗。○阴虚之人，阳气必然凑集于内，所以会出现气短、阵发性发热并出汗的症状。
○魄汗（夜间睡眠时出汗）未能潜藏，会导致四肢逆冷。○身体一侧出汗而另一侧无汗，会使人发生半身不遂。○人之所以出汗，都是源于水谷精微，而水谷精微又生于肾精。如今邪气在骨肉之间交争而得出汗的，这是邪气退却而精气胜出的表现。○饮食过饱，汗出于胃；受惊导致精气耗夺，汗出于心；负重远行，汗出于肾；奔跑恐惧，汗出于肝；肢体摇动劳苦，汗出于脾。○天气炎热则腠理开泄，营卫之气通畅，大汗淋漓，因此正气也会随之泄散。○过度劳累则喘息出汗，体内的气机内外都向外越出，因此元气耗损。○阳气有余表现为身体发热而无汗，阴气有余表现为多汗且身体发寒，阴阳俱有余则既无汗又感到寒冷。○肾病的人，睡觉时出汗，且怕风。（《素问》）
【哲人言论】
吃梅子生津液，吃芥末流泪，这是津液从外部刺激而引发的；悲伤则流鼻涕，羞愧则出汗，这是津液从内部情志变化而产生的。（《医参》）
三阳经实证、三阴经虚证，则不出汗；三阴经实证、三阳经虚证，则汗出不止。（《仁斋直指方》）
真气已经亏损，胃中火气旺盛，则汗出不止；真气已经枯竭，阴火已经衰退，则无汗反而烦躁；阴阳俱衰，四季都不出汗，其生命不会长久。（李东垣）
卫气虚弱则多汗，营血虚弱则无汗。（娄全善）
阳气的作用是护卫体表并使其固密。阳虚不能护卫体表，所以津液不固而容易出汗且怕风。这与伤风引起的自汗不同。伤风责之于邪气实，此症责之于表虚，所以治疗方法一个是发散，一个是补益，各不相同。（《医方集解》）
出汗虽然是因为卫气不固，导致胃中的津液外泄，但实际上关乎脏腑的气化蒸腾作用。心的阳气不能在外护卫固密，就会自汗，这是包络之火蒸发的结果；肾的阴液不能在内部潜藏固守，就会盗汗，这是阴火乘虚蒸发所致。（《张氏医通》）
腠理的疏密，由卫气主要掌管，所以自汗多责之于表虚。然而《金匮要略》说：腠，是三焦通会元真之气所在的地方；理，是五脏六腑的纹理。由此看来，卫外之阳气不足，都应该归咎于中焦脾胃。根植于内部的，叫做神机。所以治法离不开调和营卫、阴阳和中气，不仅仅局限于腠理。（程郊倩）
出汗这一症状，有自汗和盗汗之分。自汗，是指清醒时无时无刻不在出汗，活动时更加严重；盗汗，是指睡眠中通身出汗，醒来后逐渐停止。
古人说：自汗属于阳虚。腠理由卫气所主管。人靠卫气来固护体表，卫气不固，则表虚自汗，津液随之发泄。治疗应当实表补阳。盗汗属于阴虚。阴虚则阳气必凑集于内，所以阳气蒸腾阴分导致血热，血热则津液外泄成为盗汗。治疗应当清火补阴。然而依我观察，自汗也有阴虚的，盗汗也多见阳虚的。比如烦劳大热，最多出现自汗，有的是因为饮食之火起于胃，劳倦之火起于脾，酒色之火起于肾，都能让人自汗。像这种情况，能说不是阳盛阴衰吗？另外人的醒与睡，总由卫气的出入决定，卫气就是阳气，人在睡眠时，卫气进入阴分，这个时候难道不是表阳虚吗？所以自汗、盗汗，也各有阴阳的证候，不能说自汗一定属阳虚，盗汗一定属阴虚。那么阴阳既然有差异，如何辨别呢？回答说：只要观察有火还是无火，那么或阴或阳自然可以知道了。大概有火而出汗的，是因为火盛灼伤阴液，可知是阴虚；无火而出汗的，是因为表气不固，可知是阳虚。懂得这两点，那么出汗的要旨就没有遗漏了，治疗方法也可以掌握纲领了。○病后多汗，如果是伤寒、疟疾等外感寒邪，出汗后热退，但汗没有立即停止的，这是因为表邪刚刚解除，腠理和卫气开泄，出汗是正常的。即使持续数日或旬日，也无妨，卫气逐渐充实，汗自然会停止，不必担忧。如果是其他杂病，本来就不是外感初解，而出现自汗、盗汗的，就不适宜这样，不容不治疗。○汗证有阴阳之分：阳汗，是热汗；阴汗，是冷汗。人们只知道热能致汗，却不知道寒也能致汗。所说的寒，不是说外寒，而是因为阳气内虚，寒从内生，阴中无阳，阴无所主而汗随气泄。所以凡是大惊大恐，都能令人出汗，这都是阳气骤然消减，真元失守的征兆。到了严重的程度，就像病后产后，或者吐泻失血之后，必定有很多出汗的情况，这难道不是气脱导致的吗？所以《内经》说：阴胜则身寒，汗出，身体常觉清冷。张仲景说：极寒反而出汗，身体必定冷如冰。这些都是阴汗的说法。所以凡是治疗阴汗，只应当察看病人气虚的程度。轻微气虚的，稍微扶助正气，汗自然收敛；严重气虚的，非迅速挽救元气不可。（《景岳全书》）
方书大多说血与汗异名同类，朱丹溪沿袭此说，于是有了“在内为血，在外为汗”的理论，似乎血就是汗，汗就是血了。哪里知道血与汗的来源，有不可以用同类来谈论的。《内经》说：心主血，血生于心。又说：肾主五液，入心为汗。又说：汗是心之液。而不是说心之血。血生于心，统摄于脾，贮藏于肝，其源头来自水谷的精气，受纳于中焦，经过变化取汁，调和于五脏，布散于六腑，以供养全身。至于汗，则是人身上的津液。因为腠理疏阔，皮毛不能在外护卫，暑、湿、热邪侵犯它，则津液外泄成为汗，这是汗乃由身中之阳气所化生。所以《内经》说：阳加于阴谓之汗。这可以从气来解释，而不能归类为血。况且夏天毫窍不紧密，汤水入胃，汗就流溢，津液外耗，小便短少；冬天腠理闭密，汗不外溢，小便频多，这更可见汗属于津液，而非可以归类为血的道理更加明确了。何况人的一身，有涕、泪、涎、唾、大便、小便，都属于同一水源的变化，而发于九窍之中，如果汗可以归类为血，那么涕、泪、涎、唾、大便、小便也可以说是血了。只是心为君主，汗为心液，汗多的危害，与亡血的危害不相上下罢了，不像大小便那样关系不大。（《冯氏锦囊秘录》）
心为君火，脾胃属土，湿热相搏导致出汗是很明显的。就像蒸笼中烧酒，如果不是汤火熏蒸，就不能变成汁液。（《医学正传》）
多汗且身体软弱的，是湿邪。心主热，脾主湿，湿热相搏，就像大地上的蒸气形成云、雨、雾、露。（《医学入门》）
阳虚自汗必定怕冷，火热自汗必定烦躁发热。伤湿自汗，困倦身体沉重，阴天加重，声音像从瓮中发出；伤风自汗，头痛身热，咳嗽烦闷，鼻塞流涕；伤暑自汗，身热口渴，烦躁面色垢浊；痰证自汗，头晕目眩呕吐逆气，胸满吐痰；心虚自汗，心悸恍惚；肝热自汗，口苦多眠；肾虚自汗，潮热咳嗽；脾虚自汗，倦怠少食。○凡是头发湿润如油，汗出如油珠，汗出如豆大颗粒，汗多伴喘满，汗如雨下淋漓，都属于败证。（《证治汇补》）
病人出汗到脐部或胸部就停止的，都是险证。出汗到腰部稍好，出汗到脚部才好。（查了吾）
【补编】
汗由血液化生，根本在于阴。《内经》说：阳气之汗，以天地间的雨水命名。其中的含义可以推知。然而汗发于阴而出于阳，其根本在于阴中之营气，而其开启关闭则由阳中之卫气控制。所以凡是想要发汗而不知道营卫盛衰，想要止汗而不知道橐龠（指呼吸或气机升降）的开合，我知道他如果不失败是不会停止的。（张景岳）
汗出于心，是热所致；汗出于脾，是湿气上腾；汗泄于皮肤，是卫气不固。所以清心则津液荣养于内而化为血；和胃则津液周流而不升腾；充实腠理则卫气充盛而津液不泄。懂得这三点，治疗汗病的能事就完成了。（李东垣）
元阴之气衰弱，也有自汗的证候。大概阴虚则火动，火乘于阴位，阴精被火煎熬，所以汗自出。这就像干竹用火燃烧而有油流出一样。不能用人参、黄芪补气，只需补其阴，则火自伏而汗自止。如果是相火乘于阴血而导致的，宜在补阴药中加入知母、黄柏。如果是阴血被湿热熏蒸而导致的，用当归六黄汤。○自汗宜补阳调卫，盗汗宜滋阴降火。阳虚冷汗自出的，宜补心，益火之原，以消阴翳；阴虚热汗盗出的，当补肾，壮水之主，以镇阳光。汗是心之液。阳虚阴必乘，所以发厥而自汗，治疗用四君子汤加黄芪、肉桂以补阳；阴虚阳必凑，所以发热而盗汗，治疗用四物汤加黄柏、知母以滋阴。○黄芪、白术，是止汗的圣药。麻黄发汗，根节又能止汗。有用龙骨、牡蛎止汗的，取其收涩作用。有湿胜自汗的，须用渗湿的药剂；有自汗不耐风寒的，须用祛风的药剂；有因房劳所致的，须用补肾的药剂。桂枝汤，治疗外感风邪自汗的方剂；黄芪建中汤，治疗外感气虚自汗的方剂；补中益气汤，治疗伤寒气虚自汗的方剂。凡是内伤诸证，自汗不止的，都用补中益气汤，少加附子、麻黄根、浮小麦，效果立竿见影。但升麻、柴胡必须蜜制炒，以削弱其升发勇悍之性，又想它们引导人参、黄芪到达肌表，所以不可缺少。（罗赤诚）
阳虚自汗宜补阳，但有扶阳而不愈的，是表虚无以外卫，应当敛表以实之；心虚自汗宜补心，但有补心而不愈的，是营虚无以内藏，应当养血以调之。汗出于脾，是湿气盛，应当燥湿，但有补脾燥湿而不愈的，是火气蒸腾，应当清热；汗出于肾，是阳加于阴，应当清之，但有凉血养血而不愈的，是相火作强，应当滋阴。肝主疏泄而自汗的，当调血清火；胃经气滞而自汗的，宜导气通滞。这是治疗杂病自汗的方法。如果是伤风伤湿而自汗的，当解其外；温病热病而自汗的，当清其中。这又不是前面方法所能一概而论的。（《证治汇补》）
六阳经脉，上行至头；三阴经脉，至颈部即还。阴虚阳浮，所以汗出头面，不能遍及周身。有相火逼迫肾水上行至心之分野的，有阳气失所依附飞越于高巅的，有寒湿相搏的，有瘀血内蓄的，有胃热上蒸的，随证施治。只有关格病小便不通而头汗的难治，阳脱而头汗的不治。（《医统》）
伤寒头汗属少阳，用小柴胡汤和解。食滞中宫，热气上蒸，也会导致头汗，用保和丸加姜汁炒黄连。○脾胃湿蒸，旁达四肢，则手足多汗。热的，用二陈汤加黄连、白芍；冷的，用理中汤加乌梅；弱的，用十全大补汤去川芎加五味子。○夏季半身出汗，由气血不充，内挟痰饮所致，是偏枯的先兆。《内经》说：汗出偏沮，使人偏枯。用十全大补汤、养营汤加行经豁痰药治疗。○别处无汗，独心胸一片有汗，这是思虑伤心所致，名叫心汗，用归脾汤合生脉散、猪心汤煎服。○阴汗属下焦湿热，用龙胆泻肝汤加一两种风药，风能胜湿的缘故。如果是因酒色过度导致的，用六味地黄汤。（《张氏医通》）
我曾经患心悸、盗汗，补心肾无效，于是加入几片猪心作为引药，病就好了。药物贵在向导，不可不审慎。（王宇泰）
【脉候】
尺脉涩而寸脉滑，称为多汗。（《素问》）
男子平人脉象虚弱细微的，容易盗汗。（《金匮要略》）
脉浮而濡的是汗证。在寸口是自汗，在尺部是盗汗。（《证治汇补》）
【选案】
一位妇女在产后，头部出汗很多，诊脉虽洪大但缓。我说：头部出汗常说亡阳，但产后阴虚，喜欢这种亡阳，与阴气相等，可以不用药。主人怀疑，换医生峻用温补，于是暴注下泻，完谷不化，更加认为是阳虚，重用参、附，腹泻更甚，几天之间，肌肉消瘦精神困顿。复诊脉洪弦数甚，这是真阴竭尽了。主人及医生说：温补尚且完谷不化，岂不是阳虚至极吗？我说：产后头汗，是阴虚虚火上蒸，孤阳上迫，津液不秘藏。误加温补燥热之气，暴注下趋而为完谷，这是火性急速，来不及变化，再加温药逼迫，焚灼之势，必定力穷才停止。《内经》说：阴平阳秘，精神乃治。现在阴气不能和平，阳气自然难秘密，精神离决，不用说也知道。（冯楚瞻）
朱御章的弟弟，劳倦发热，上半身自汗如雨，三昼夜不止。收敛汗液的方法，都没有反应。他的岳父陆右文邀请我去，诊脉浮细沉洪，软弱无力，面白无神，舌胖嫩白滑。心想这一定是肺气大虚，腠理不固。起初用黄芪汤加五味子、附子各二钱，从子时至卯时，连进三剂，汗依然如故。思考良久，改用蜜炙黄芪二两，人参五钱，白术一两，蜜炙升麻、柴胡、陈皮各一钱，当归身、炙甘草、黑姜各二钱，白芍、五味子、附子各三钱，大枣五枚，一剂而汗止。右文说：连续服用补敛的药剂，汗都不止，竟然用升麻、柴胡、炮姜等辛散的药物，汗反而停止了，这是什么缘故？我说：证本劳伤，脾肺中脏之阳陷而不升，卫外之阳虚而不固，以致阴气不降，乘虚外溢，所以特别用升麻、柴胡以升提下陷之气，黑姜以收固卫外之阳，使阳得在外而为阴之卫，这样阴得在内而为阳之守。后用生金滋水等药剂培养而痊愈。（《潜村医案》）
一个少年上身出汗，三年不愈。用棉花子炒焦泡汤，服用四五天，汗出至足，后用归脾汤等调养而痊愈。（周慎斋）
【附方】
止汗方 治疗汗出不止。用五倍子研末，用唾液调匀贴敷脐中，外用帛带缚定，过一夜即止。
又方 治疗盗汗，用冬桑叶一味，焙干研末，空腹米饮送服二钱，神效。
扑粉法 用牡蛎、龙骨、麻黄根、赤石脂等分研末，绢包扑撒患处，有效。
[Classic Discourse]
Sweat of Yang Qi is named after the rain of heaven and earth. ○ Sweat is governed by the Heart. ○ When Yang Qi acts upon Yin fluids, sweat is formed. ○ In cases of Yin deficiency, Yang Qi inevitably congregates internally, thus resulting in shortness of breath, intermittent fever, and sweating. ○ "Po" sweat (night sweats) failing to be concealed leads to cold extremities. ○ Sweating on only one side of the body causes hemiplegia. ○ The reason humans sweat is all derived from grain essence, which in turn is generated from Kidney essence. Now, when pathogens struggle between the muscles and bones and sweat ensues, it indicates that the pathogen is retreating and the essence is prevailing. ○ Excessive fullness from food leads to sweat from the Stomach; fright depleting essence leads to sweat from the Heart; carrying heavy loads over long distances leads to sweat from the Kidneys; running and fear lead to sweat from the Liver; bodily shaking and toil lead to sweat from the Spleen. ○ Heat opens the interstices (Cou Li), allows Ying and Wei Qi to flow freely, causing profuse sweating, thereby leaking Qi. ○ Labor causes panting and sweating, with internal and external Qi escaping outward, thus depleting Yuan Qi. ○ Excess Yang manifests as body heat without sweat; excess Yin manifests as profuse sweating with cold body; excess of both Yin and Yang manifests as no sweat with coldness. ○ Kidney disease presents with night sweats and aversion to wind. (*Su Wen*)
[Philosophical Remarks]
Eating plums generates saliva; eating mustard makes one weep; these are fluids drawn out from external stimuli. Grief produces tears; shame produces sweat; these are fluids generated from internal emotional changes. (*Yi Can*)
Excess in the Three Yang meridians and deficiency in the Three Yin meridians result in no sweat; excess in the Three Yin meridians and deficiency in the Three Yang meridians result in unceasing sweat. (*Ren Zhi Zhi Zhi Fang*)
When True Qi is already deficient and Stomach fire is flourishing, sweat flows incessantly; when True Qi is exhausted and Yin fire has declined, there is no sweat but rather restlessness; when both Yin and Yang decline, there is no sweat in any season, and life will not be long. (Li Dongyuan)
Deficiency of Wei Qi leads to excessive sweating; deficiency of Ying Blood leads to absence of sweat. (Lou Quanshan)
Yang's function is to protect the exterior and maintain solidity. Yang deficiency fails to protect the exterior, so Jing Ye (body fluids) are not secured, leading to easy sweating and aversion to wind. This differs from spontaneous sweating due to wind-cold invasion. The latter is attributed to excess pathogen, while this is attributed to exterior deficiency; thus, treatments differ—one disperses, the other tonifies. (*Yi Fang Ji Jie*)
Although sweating occurs due to insecure Wei Qi causing Stomach Jing Ye to leak externally, it essentially relates to the evaporative transformation of the Zang-Fu organs. If Heart Yang cannot protect and secure the exterior, spontaneous sweating occurs, driven by the evaporation of Fire in the Pericardium; if Kidney Yin cannot remain hidden and secure internally, night sweats occur, driven by Yin fire evaporating due to deficiency. (*Zhang Shi Yi Tong*)
The density of Cou Li (interstices) is primarily managed by Wei Qi, so spontaneous sweating is often blamed on exterior deficiency. However, *Jin Gui Yao Lue* states: "Cou" is where the San Jiao connects with Yuan Zhen Qi; "Li" refers to the textures of the Five Zang and Six Fu organs. From this perspective, insufficiency of exterior-protecting Yang should be traced back to the Middle Jiao. What is rooted internally is called Shen Ji (Spirit Mechanism). Therefore, treatment methods must not depart from regulating Ying and Wei, Yin and Yang, and Middle Qi, nor focus solely on Cou Li. (Cheng Jiaoqian)
Sweating symptoms include spontaneous sweating (Zi Han) and night sweating (Dao Han). Spontaneous sweating occurs continuously while awake, worsening with activity; night sweating occurs throughout the body during sleep and gradually stops upon waking.
Ancients said: Spontaneous sweating belongs to Yang deficiency. Cou Li is governed by Wei Qi. Humans rely on Wei Qi to secure the exterior; if Wei Qi is insecure, exterior deficiency leads to spontaneous sweating and fluid leakage. Treatment should solidify the exterior and tonify Yang. Night sweating belongs to Yin deficiency. Yin deficiency causes Yang to congregate internally, so Yang steams the Yin branch, causing blood heat; blood heat causes fluid leakage into night sweating. Treatment should clear fire and tonify Yin. However, in my observation, spontaneous sweating can also stem from Yin deficiency, and night sweating often involves Yang deficiency. For instance, great fatigue and heat often cause spontaneous sweating; some arise from dietary fire in the Stomach, labor fire in the Spleen, or wine/sex fire in the Kidneys, all causing spontaneous sweating. Are these not cases of Yang excess and Yin deficiency? Furthermore, wakefulness and sleep depend on the movement of Wei Qi, which is Yang Qi. During sleep, Wei Qi enters the Yin branch; at this time, is it not a case of exterior Yang deficiency? Thus, spontaneous and night sweating each have Yin-Yang patterns; one cannot say spontaneous sweating is always Yang deficiency or night sweating is always Yin deficiency. How to distinguish them? Answer: Observe the presence or absence of Fire. Sweating with fire indicates fire flourishing and scorching Yin, revealing Yin deficiency; sweating without fire indicates insecure exterior Qi, revealing Yang deficiency. Knowing these two points grasps the essence of sweating and the general principles of treatment. ○ Post-illness excessive sweating, such as in Shang Han or Malaria caused by exogenous cold, where heat subsides after sweating but sweating does not stop immediately, is because the exterior pathogen has just resolved, and Cou Li and Wei Qi are open and泄 (leaking); this sweating is normal. Even if it lasts days or ten days, it is harmless; as Wei Qi gradually solidifies, sweating will stop naturally, requiring no worry. If other miscellaneous diseases, not resolving from exogenous pathogens, present with spontaneous or night sweating, this is inappropriate and requires treatment. ○ Sweating patterns have Yin and Yang: Yang sweat is hot sweat; Yin sweat is cold sweat. People know heat causes sweating but do not know cold can also cause it. The "cold" referred to here is not exogenous cold, but rather internal Yang deficiency generating cold from within; without Yang in Yin, Yin lacks mastery and sweat leaks with Qi. Thus, great fright or terror can cause sweating, signaling sudden consumption of Yang Qi and loss of True Yuan. In severe cases, such as post-illness, postpartum, or after vomiting/diarrhea/blood loss, profuse sweating occurs; is this not due to Qi departure? Hence, *Jing* says: "Yin excess causes cold body, sweating, and constant feeling of coolness." Zhang Zhongjing said: "Extreme cold reversely causes sweating, and the body becomes cold as ice." These refer to Yin sweat. Therefore, treating Yin sweat requires assessing the degree of Qi deficiency. Mild deficiency: slightly support Zheng Qi, and sweat will cease; severe deficiency: urgent rescue of Yuan Qi is necessary. (*Jing Yue Quan Shu*)
Formulary books often state that Blood and Sweat are different names but same category. Zhu Danxi followed this, proposing "internally Blood, externally Sweat," implying Blood is Sweat and Sweat is Blood. Yet the origins of Blood and Sweat cannot be discussed as the same category. *Jing* says: "Heart governs Blood, Blood is born from Heart." Also: "Kidney governs Five Fluids, entering Heart becomes Sweat." Also: "Sweat is the fluid of the Heart," not "Blood of the Heart." Blood is born from Heart, governed by Spleen, stored in Liver, originating from Essence-Qi of Grain and Water, received in Middle Jiao, transformed into juice, harmonized among Five Zang, distributed in Six Fu, to nourish the body. Sweat, however, is the Jing Ye of the human body. Due to open Cou Li and failure of skin/hair to protect externally, Summerheat, Dampness, and Heat pathogens invade, causing Jing Ye to leak as sweat; thus, sweat is transformed by Yang Qi within the body. Hence, *Jing* says: "Yang acting on Yin is called Sweat." This can be explained via Qi, not classified as Blood. Moreover, in summer, pores are not tight; water entering the stomach causes immediate sweating, consuming Jing Ye and reducing urine; in winter, Cou Li are closed, sweat does not overflow, and urine is frequent. This clearly shows sweat belongs to Jing Ye, not Blood. Furthermore, the body has nasal mucus, tears, saliva, phlegm, feces, and urine, all transformations of one water source emerging from the nine orifices. If sweat could be classified as Blood, then mucus, tears, saliva, phlegm, feces, and urine could also be called Blood. Only because Heart is the Monarch and Sweat is its fluid is the harm of excessive sweating comparable to blood loss, unlike feces and urine which are less critical. (*Feng Shi Jin Nang*)
Heart is Minister Fire, Spleen and Stomach belong to Earth; damp-heat clashing causing sweating is evident. Like distilling wine in a steamer, without soup-fire steaming, liquid cannot form. (*Yi Xue Zheng Chuan*)
Profuse sweating with soft body indicates Dampness. Heart governs Heat, Spleen governs Dampness; damp-heat clashing is like earth vapor forming clouds, rain, fog, and dew. (*Yi Xue Ru Men*)
Yang deficiency spontaneous sweating implies aversion to cold; Fire-heat spontaneous sweating implies irritability and heat. Dampness-injury spontaneous sweating brings fatigue and heaviness, worsening on cloudy days, voice sounding muffled; Wind-injury spontaneous sweating brings headache, body heat, cough, irritability, nasal congestion, and runny nose; Summerheat-injury spontaneous sweating brings body heat, thirst, irritability, and greasy face; Phlegm-pattern spontaneous sweating brings dizziness, nausea, chest fullness, and expectoration; Heart-deficiency spontaneous sweating brings palpitations and confusion; Liver-heat spontaneous sweating brings bitter taste and hypersomnia; Kidney-deficiency spontaneous sweating brings tidal fever and cough; Spleen-deficiency spontaneous sweating brings fatigue and poor appetite. ○ Hair wet like oil, sweat like oil beads, sweat like large pearls, profuse sweating with panting/fullness, and sweat pouring like rain all indicate defeat syndromes. (*Zheng Zhi Hui Bu*)
Patients whose sweating stops at the navel or chest present dangerous conditions. Sweating reaching the waist is slightly better; reaching the feet is good. (Cha Liaowu)
[Supplement]
Sweat originates from Blood, fundamentally rooted in Yin. *Jing* says: "Sweat of Yang is named after heavenly rain." The meaning is clear. However, sweat emerges from Yin but exits through Yang; its root lies in Ying Qi within Yin, while its opening and closing are controlled by Wei Qi within Yang. Thus, those who wish to induce sweating without knowing the rise and fall of Ying and Wei, or wish to stop sweating without understanding the bellows-like mechanism (Tuo Yue), I know they will not cease until they fail. (Zhang Jingyue)
Sweat from Heart is caused by Heat; sweat from Spleen is caused by rising Dampness; sweat leaking from skin is due to insecure Wei Qi. Therefore, clearing Heart makes fluids nourish internally and become Blood; harmonizing Stomach makes fluids circulate without rising; solidifying Cou Li makes Wei Qi abundant and prevents fluid leakage. Knowing these three completes the art of treating sweating. (Li Dongyuan)
Decline of Primordial Yin Qi also presents with spontaneous sweating. Generally, Yin deficiency causes Fire to move, attacking Yin positions; Yin Essence is boiled by Fire, causing spontaneous sweat. This is like burning dry bamboo producing oil. Do not use Ginseng or Astragalus to tonify Qi; only tonify Yin, then Fire settles and sweat stops. If caused by Minister Fire attacking Yin Blood, add Anemarrhena and Phellodendron to Yin-tonifying herbs. If caused by Yin Blood steamed by Damp-Heat, use Dang Gui Liu Huang Tang. ○ Spontaneous sweating should be treated by tonifying Yang and regulating Wei; night sweating by nourishing Yin and descending Fire. Cold spontaneous sweating from Yang deficiency should tonify Heart, benefit the origin of Fire to dispel Yin shadows; hot night sweating from Yin deficiency should tonify Kidney, strengthen the master of Water to suppress Yang brilliance. Sweat is the fluid of the Heart. Yang deficiency allows Yin to attack, causing collapse and spontaneous sweating; treat with Si Jun Zi Tang plus Huang Qi and Cinnamon Bark to tonify Yang. Yin deficiency allows Yang to congregate, causing fever and night sweating; treat with Si Wu Tang plus Huang Bai and Zhi Mu to nourish Yin. ○ Huang Qi and Bai Zhu are holy medicines for stopping sweat. Ma Huang induces sweating, but its root nodes stop sweating. Long Gu and Mu Li are used for their astringent properties. Damp-excess spontaneous sweating requires diaphoretic-damp-draining formulas; spontaneous sweating intolerant to wind-cold requires wind-dispelling formulas; sexual exhaustion-induced sweating requires Kidney-tonifying formulas. Gui Zhi Tang treats spontaneous sweating from exogenous wind; Huang Qi Jian Zhong Tang treats spontaneous sweating from exogenous Qi deficiency; Bu Zhong Yi Qi Tang treats spontaneous sweating from injury-cold Qi deficiency. For all internal injury disorders with unceasing spontaneous sweating, use Bu Zhong Yi Qi Tang with minor additions of Fu Zi, Ma Huang Gen, and Xiao Mai, with effect like an echo. But Sheng Ma and Chai Hu must be honey-fried to mitigate their vigorous ascending nature, and to guide Ren Shen and Huang Qi to the muscle surface; thus they are indispensable. (Luo Chicheng)
Yang deficiency spontaneous sweating should be treated by tonifying Yang, but if supporting Yang fails, it is due to exterior deficiency lacking exterior protection; consolidate the exterior to solidify it. Heart deficiency spontaneous sweating should be treated by tonifying Heart, but if tonifying Heart fails, it is due to Ying deficiency lacking internal storage; nourish Blood to regulate it. Sweat from Spleen indicates Dampness excess; dry it. But if tonifying Spleen and drying Dampness fails, it is due to Fire steaming; clear the Heat. Sweat from Kidney involves Yang acting on Yin; clear it. But if cooling Blood and nourishing Blood fails, it is due to Minister Fire exerting strength; nourish its Yin. Liver governing dispersion and causing spontaneous sweating requires regulating Blood and clearing Fire; Stomach meridian Qi stagnation causing spontaneous sweating requires guiding Qi and unblocking stagnation. These are methods for treating miscellaneous disease spontaneous sweating. For wind-damp spontaneous sweating, resolve the exterior; for warm-heat disease spontaneous sweating, clear the interior. These are not discussed together with the previous methods. (*Zheng Zhi Hui Bu*)
Six Yang meridians ascend to the head; Three Yin meridians return at the neck. Yin deficiency with Yang floating causes sweating only on the head and face, not the whole body. Cases include Minister Fire forcing Kidney Water up to the Heart's domain; Yang Qi losing attachment and flying to the high vertex; Cold-Damp clashing; internal Blood stasis; Stomach Heat steaming upward. Treat according to syndrome. Only Guan Ge syndrome with urinary obstruction and head sweating is difficult to treat; Yang collapse with head sweating is untreatable. (*Yi Tong*)
Shang Han head sweating belongs to Shaoyang; treat with Xiao Chai Hu Tang to harmonize. Food stagnation in the Middle Palace, with Heat steaming upward, also causes head sweating; treat with Bao He Wan plus Jiang Zhi fried Chuan Lian Zi. ○ Spleen-Stomach Damp-Steaming spreading to limbs causes hand-foot hyperhidrosis. Hot type: Er Chen Tang plus Chuan Lian Zi and Bai Shao; Cold type: Li Zhong Tang plus Wu Mei; Weak type: Shi Quan Da Bu Tang minus Chuan Xiong plus Wu Zi. ○ Summer half-body sweating is caused by insufficient Qi and Blood, internal Phlegm-Fluid retention, a sign of hemiplegia. *Jing* says: "Sweating on one side causes hemiplegia." Treat with Shi Quan Da Bu Tang or Yang Ying Tang plus channel-unblocking and phlegm-resolving herbs. ○ No sweating elsewhere, only sweating on the chest and heart area, caused by overthinking damaging the Heart, named Heart Sweat; treat with Gui Pi Tang combined with Sheng Mai San and Pig Heart Decoction. ○ Yin sweat (genital sweating) belongs to Lower Jiao Damp-Heat; use Long Dan Xie Gan Tang plus one or two wind-dispelling herbs, as Wind conquers Damp. If caused by excessive wine/sex, use Liu Wei Di Huang Tang. (*Zhang Shi Yi Tong*)
I once suffered from palpitations and night sweats; tonifying Heart and Kidney was ineffective, so I added several slices of Pig Heart as a guide, and the illness ceased. Medicines value guides; this must be considered carefully. (Wang Yutai)
[Pulse Signs]
Chi pulse choppy, Cun pulse slippery, indicates excessive sweating. (*Su Wen*)
In healthy men, weak, fine, and minute pulses predispose to night sweating. (*Jin Gui Yao Lue*)
Floating and soggy pulses indicate sweating syndromes. At Cun: spontaneous sweating; at Chi: night sweating. (*Zheng Zhi Hui Bu*)
[Selected Cases]
A woman postpartum had excessive head sweating. Pulse was surging yet slow. I said: Head sweating is often called Yang collapse, but postpartum involves Yin deficiency; preferring this Yang collapse balances the Yin, so no medicine is needed. The owner doubted, changed doctors who used harsh warming tonics, leading to violent diarrhea with undigested food, further confirming Yang deficiency; they heavily used Ren Shen and Fu Zi, worsening diarrhea. Within days, emaciation and mental fatigue ensued. Re-pulse: surging, wiry, rapid—True Yin was exhausted. Owner and doctor said: Warming tonics still cause undigested stool, isn't this extreme Yang deficiency? I said: Postpartum head sweating is Yin deficiency with deficient Fire steaming upward, solitary Yang pressing up, fluids not sealed. Mistakenly adding warming/drying qi caused violent downward flow as undigested food; Fire nature is swift, leaving no time for transformation; adding more warm medicine forces burning intensity until power is exhausted. *Jing* says: "When Yin is peaceful and Yang is secret, Spirit is regulated." Now Yin cannot be peaceful, Yang cannot be secret; Spirit separation is evident. (Feng Chuzhan)
Zhu Yuzhang's brother suffered fatigue-fever, upper body spontaneous sweating like rain for three days/nights. Astringent methods failed. His father-in-law Lu Youwen invited me. Pulse: floating/fine superficially, surging deep, weak/powerless. Face pale/lusterless, tongue fat/tender/white/slippery. I thought: Lung Qi severely deficient, Cou Li insecure. Initially used Huang Qi Tang plus Wu Zi and Fu Zi (2 qian each). From Zi to Mao hours, three doses given, sweat unchanged. After long thought, switched to Honey-fried Huang Qi (2 liang), Ren Shen (5 qian), Bai Zhu (1 liang), Honey-fried Sheng Ma, Chai Hu, Chen Pi (1 qian each), Dang Gui Shen, Zhi Gan Cao, Hei Jiang (2 qian each), Bai Shao, Wu Zi, Fu Zi (3 qian each), Da Zao (5 pieces). One dose stopped sweat. Youwen asked: Continuous astringent/tonic doses failed, yet Sheng Ma, Chai Hu, Pao Jiang (acrid-dispersing) stopped it? Why? I said: Syndrome is labor-injury; Yang of Spleen/Lung Zang sinks and fails to ascend; Exterior-protecting Yang is deficient and insecure, causing Yin Qi to fail descending and overflow externally due to deficiency. Specifically used Sheng Ma/Chai Hu to lift sinking Qi, Hei Jiang to secure exterior Yang, allowing Yang to protect Yin externally, so Yin can guard Yang internally. Later used Sheng Jin Zi Shui agents to cultivate and cure. (*Qian Cun Yi An*)
A youth had upper body sweating for three years, uncured. Used roasted cotton seeds soaked in water, taken for 4-5 days, sweat reached feet, then cured with Gui Pi Tang etc. for maintenance. (Zhou Shenzhai)
[Attached Formulas]
Stop Sweat Formula: Treats unceasing sweating. Use Wu Bei Zi powder, mix with saliva, apply to umbilicus, bind with cloth overnight; stops immediately.
Another Formula: Treats night sweats. Use Dong Sang Ye (Winter Mulberry Leaf) alone, roast dry, powder. Take 2 qian with rice water on empty stomach; miraculous effect.
Powder Method: Use equal parts Mu Li, Long Gu, Ma Huang Gen, Chi Shi Zhi, grind to powder, pack in silk, dust on affected area; effective.