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。
表虚自汗玉屏风,甚者桂枝加附从,里实自汗用白虎,便秘调胃承气攻。
【注】表虚 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 (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 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
调胃承气汤
心虚盗汗睡多惊,酸枣仁汤服即宁,心火伤阴必烦热,当归六黄汤奏功。
【注】盗汗有二,虚实两分。心虚者,阴气不敛也,睡则多惊,以酸枣仁汤主之;心
热者,火伤于阴也,身多烦热,以当归六黄汤主之。
酸枣仁汤
当归 白芍(炒) 生地 茯苓 酸枣仁(炒) 知母(炒) 黄柏(炒) 五味子 人参 黄
(炙)
水煎服。
【方歌】酸枣仁汤治盗汗,阳不能藏阴本虚,归芍生地茯苓枣,知柏五味共参
当归六黄汤
当归 生地黄 熟地黄 黄芩 黄柏 黄连 黄 (炙)
引用浮麦,水煎服。
【方歌】当归六黄治盗汗,阳盛阴伤液自流,生熟二地芩连柏,归 浮麦汗能收。
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,有的因为体表卫气虚弱。睡中出汗称为盗汗,属于阴分不足(阴虚),多因心气虚弱、血分有热所致,治疗需根据具体证候进行辨证施治。
【注释】汗是人体津液的一部分,存在于体表阳气层面的称为“津”,存在于体内阴气层面的称为“液”,发泄于体外的称为“汗”。如果汗液无故流出,是因为阴阳失衡偏盛所致。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,有虚证和实证的区分。虚证表现为汗出时感觉皮肤温热(翕翕发热),伴有发热和怕冷,这是表虚;实证表现为汗出时感觉热气蒸腾(蒸蒸发热),发热但不怕冷,这是里热。对于表虚者,治疗方法应当固护肌表;对于里实热者,治疗方法应当清泻里热。又有睡觉时出汗,醒来后汗止的情况,称为盗汗。盗汗主要主病为阴虚,但需要区分是心气虚弱不能固摄,还是心火亢盛损伤阴液。心气虚弱应当补益心气,心火亢盛应当凉血清热。医者应当仔细辨别,以免出现诊断错误。
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;里实热引起的自汗,使用白虎汤;若伴有便秘,则用调胃承气汤攻下通便。
【注释】表虚导致的自汗,以玉屏风散为主治方。如果恶寒严重,说明阳气虚弱,可用桂枝汤加附子来固护阳气。阳明经里实热证,表现为蒸蒸自汗,用白虎汤清热。若伴有便秘,用调胃承气汤攻下。
【方歌】表气虚弱时常自汗,玉屏风散治疗很适宜,黄芪、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)
引用生姜、大枣,水煎服。
心气虚弱导致的盗汗常伴有多梦易惊,服用酸枣仁汤即可安宁;心火亢盛损伤阴液必然导致烦热,服用当归六黄汤可奏效。
【注释】盗汗有两种,分为虚证和实证。心气虚弱者,阴气不能收敛,睡觉时容易惊醒,以酸枣仁汤主治;心热者,火热损伤阴液,身体多有烦热感,以当归六黄汤主治。
酸枣仁汤
当归 白芍(炒) 生地 茯苓 酸枣仁(炒) 知母(炒) 黄柏(炒) 五味子 人参 黄芪(炙)
水煎服。
【方歌】酸枣仁汤治盗汗,阳不能藏阴本虚,归芍生地茯苓枣,知柏五味共参芪。
Self-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 (Wei Qi deficiency). Night sweating during sleep is attributed to Yin deficiency, often resulting from Heart Qi deficiency and Heat in the Blood level; treatment should be based on syndrome differentiation.
[Note] Sweat is a part of body fluids. Those existing at the exterior Yang level are called "Jin" (thin fluid), those existing at the interior Yin level are called "Ye" (thick fluid), and those excreted to the outside are called "Han" (sweat). If sweat flows out without cause, it is due to an imbalance and excess of Yin or Yang. For example, when children sweat spontaneously without obvious cause, it is called self-sweating. Self-sweating belongs to Yang syndromes and has deficiency and excess distinctions. Deficiency type presents with mild warmth upon sweating (Xi Xi fever), accompanied by fever and aversion to cold, indicating exterior deficiency; Excess type presents with steaming heat upon sweating (Zheng Zheng fever), with fever but no aversion to cold, indicating interior heat. For exterior deficiency, the treatment method is to consolidate the exterior; for interior excess-heat, the treatment method is to purge interior heat. Another condition is sweating during sleep that stops upon waking, known as night sweating (Dao Han). Night sweating primarily indicates Yin deficiency, but one must distinguish between Heart Qi deficiency failing to secure the exterior and Heart Fire injuring Yin. Heart Qi deficiency requires tonifying the Heart, while Heart Fire requires cooling the blood and clearing heat. Practitioners should differentiate carefully to avoid errors.
For self-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). For self-sweating due to interior excess-heat, use Bai Hu Tang (White Tiger Decoction); if accompanied by constipation, use Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) to purge.
[Note] Self-sweating due to exterior deficiency is primarily treated with Yu Ping Feng San. If there is severe aversion to cold, it indicates Yang Qi deficiency, and Gui Zhi Tang (Cinnamon Twig Decoction) with added Fu Zi (Prepared Aconite Root) can be used to secure Yang Qi. Yangming interior excess-heat presents with steaming self-sweating, treated with Bai Hu Tang (White Tiger Decoction) to clear heat. If accompanied by constipation, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) is used to purge.
Yu Ping Feng San (Jade Windscreen Powder)
Huang Qi (Honey-fried Astragali Radix) Fang Feng (Saposhnikoviae Radix) Bai Zhu (Earth-fried Atractylodis Macrocephalae Rhizoma)
Decoct in water and take orally.
[Prescription Song] When exterior Qi is weak and spontaneous sweating occurs frequently, Yu Ping Feng San is very suitable; Huang Qi, Fang Feng, and fried Bai Zhu, decocted in water and taken warm, at any time.
Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction with Added Prepared Aconite Root)
Bai Shao Yao (White Peony Root) Gui Zhi (Cinnamon Twig) Gan Cao (Honey-fried Licorice Root) Fu Zi (Prepared Aconite Lateral Root)
Add fresh ginger and jujube, decoct in water and take orally.
[Prescription Song] When exterior Qi deficiency is severe, Gui Zhi Tang is best; Bai Shao Yao, Gui Zhi, and Gan Cao, adding Fu Zi leads to gradual recovery.
Bai Hu Tang (White Tiger Decoction)
Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction)
Heart Qi deficiency leading to night sweating often involves frequent dreaming and fright; taking Suan Zao Ren Tang (Ziziphus Seed Decoction) brings calmness. Heart Fire injuring Yin inevitably causes irritability and heat; taking Dang Gui Liu Huang Tang (Angelica Hexa-Huang Decoction) achieves efficacy.
[Note] Night sweating has two types, divided into deficiency and excess. Heart Qi deficiency means Yin Qi fails to gather; sleeping involves much fright, primarily treated with Suan Zao Ren Tang (Ziziphus Seed Decoction). Heart heat means fire injures Yin; the body experiences much irritability and heat, primarily treated with Dang Gui Liu Huang Tang (Angelica Hexa-Huang Decoction).
Suan Zao Ren Tang (Ziziphus Seed Decoction)
Dang Gui (Angelica Sinensis Radix) Bai Shao (Fried White Peony Root) Sheng Di Huang (Rehmanniae Radix Preparata) Fu Ling (Poria) Suan Zao Ren (Fried Ziziphi Spinosae Semen) Zhi Mu (Anemarrhenae Rhizoma) Huang Bo (Fried Phellodendri Cortex) Wu Wei Zi (Schisandrae Chinensis Fructus) Ren Shen (Ginseng Radix et Rhizoma) Huang Qi (Honey-fried Astragali Radix)
Decoct in water and take orally.
[Prescription Song] Suan Zao Ren Tang treats night sweating, where Yang cannot store Yin due to original deficiency; Dang Gui, Bai Shao, Sheng Di Huang, Fu Ling, and Zao Ren, along with Zhi Mu, Huang Bo, Wu Wei Zi, Ren Shen, and Huang Qi.
Dang Gui Liu Huang Tang (Angelica Hexa-Huang Decoction)
Dang Gui (Angelica Sinensis Radix) Sheng Di Huang (Rehmanniae Radix) Shu Di Huang (Rehmanniae Radix Preparata) Huang Qin (Scutellariae Radix) Huang Bo (Phellodendri Cortex) Huang Lian (Coptidis Rhizoma) Huang Qi (Honey-fried Astragali Radix)
Add Fu Mai Xiao (Floating Wheat), decoct in water and take orally.
[Prescription Song] Dang Gui Liu Huang Tang treats night sweating, where Yang excess and Yin injury cause fluids to flow freely; Sheng Di Huang, Shu Di Huang, Huang Qin, Huang Lian, Huang Bo, Dang Gui, Huang Qi, and Fu Mai Xiao can stop sweating.