（汗出不治 盗汗 头汗 手足汗 阴汗 半身汗出）
经云。阳气有余。为身热无汗。阴气有余。为多汗身寒。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。肾病者。寝汗出。
憎风。津脱者。汗大泄。汗出偏沮。使人偏枯。饮酒中风。则为漏风。入房汗出中风。则为内风。
景岳全书曰。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。诸古法云。自汗者属阳虚。腠理不固。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。盗汗者。属阴虚。阴虚者
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。此其大法。然自汗亦有
阴虚。盗汗亦多阳虚者。如遇烦劳大热之类。最多自汗。如饮食之火起于胃。劳倦之火起于脾。
酒色之火起于肾。皆能令人自汗。若此者。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。然则阴阳有异。何以辨
之。曰。但察其有火无火。则或阴或阳。自可见矣。盖火盛而汗出者。以火烁阴。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。无余义矣。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。欲禁汗而不知橐 之牝牡。吾知其不败
不已也。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。而阴中无阳。阴中无阳。则阴无所主。而汗
随气泄。故凡大惊大恐大惧。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。或大吐大泻失血之后。必多有汗出者。是岂非气怯而然乎。故经曰。阴胜则身寒。汗出
身常清。数栗而寒。寒则厥。厥则腹满死。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。非甘、姜、桂、附。
速救元气不可。
自汗虽由卫气不固。胃中之津液外泄。而实关乎脏腑蒸发使然。心之阳不能卫外而为固。则
自汗出。包络之火郁发也。肾之阴不能退藏于密。则盗汗出。阴火乘虚蒸发也。肺气衰则表不能
卫而自汗出。必喘乏少气。胃虚水谷气脱散者汗自出。必气虚少食。阴虚者。阳必凑。故发热自
汗。当归六黄汤。阳虚者。阴必乘。故发厥自汗。黄 建中汤。甚者少加附子。营血不足自汗。
黄建中加当归。甚者加熟地。卫外之阳不固而自汗。 附汤。脾中之阳衰微而自汗。术附汤。
肾中之阳浮游而自汗。参附汤。身冷自汗阴躁。欲坐泥水中。脉浮而数。按之如无。经云。脉至
而从。按之不鼓。诸阳皆然。此阴盛格阳。真武汤冷服。肺气虚者。固其皮毛。玉屏风散。脾虚
者。壮其中气。补中益气汤。心虚者。益其血脉。当归补血汤。肝虚者。理其疏泄。逍遥散。肾
虚者。助其封藏。都气丸。火气炎上。胃中之湿亦能作汗。可用凉膈散。脾胃不和。外挟风湿。
身重汗出。羌活胜湿汤。风湿相搏。时自汗出。防己黄 汤。恶风自汗。桂枝汤。又有漏风证。
一名酒风。不论冬夏。额上常有汗出。此醉后当风所致。经曰。有病身热懈惰。汗出如浴。恶风
少气。病名酒风。治之以泽泻、术各十分。麋衔五分。合以三指撮为后饭。又曰。饮酒中风。则
为漏风。漏风之状。多汗。常
不可以单衣。食则汗出。甚则身汗喘急。恶风衣常濡。口干善渴。不能劳事。先宜五苓散热服取
汗。后与黄 建中加白术、泽泻。汗出日久。用参、 、术、附等药不效。汗干仍热。此风邪伏
于经络。暂与参苏饮。病已止服。此反治也。汗出不止。名曰亡阳。以附子理中加黄 。外用温
粉扑之。痰证汗自出。痰消汗自止。二陈加桂枝、枳、桔、香附、贝母。多汗恶风。食则汗出如
油。久不治。必成消渴。玉屏风散。少加 牡蛎。病余气血俱虚而汗。服诸止汗药不应。用十全
大补汤半剂。加熟枣仁五钱。若胸膈烦闷。不能胜阴药者。生脉散加黄 二钱。当归六分。熟枣
仁三钱。一服即验。别处无汗。独心胸一片有汗。此思伤心也。其病在心。名曰心汗。归脾汤倍
黄。或生脉散加当归、枣仁。猪心汤煎服。
汗出不治证 汗出而喘甚者不治。汗出而脉脱者不治。汗出而身痛甚者不治。汗出发润至颠
者不治。汗出如油者不治。汗出如珠者不治。汗出如胶。胶粘如珠之凝。及淋漓如雨。揩拭不逮
者。皆不可治。
盗汗 金匮云。男子平人脉虚弱微细者。善盗汗出。盖平人脉虚弱微细。是卫虚不能鼓其脉
气于外。所以不能约束津液。当卫气行阴。目瞑之时。血气无以固其表。腠理开则汗。醒则行阳
之气复散于表。则汗止矣。名曰盗汗。亦名寝汗。此属本虚。与伤寒邪在半表不同。先与当归补
血汤加炒枣仁半两。数服后与都气丸调补之。酒客睡中多汗。此湿热外蒸也。二妙散加白术、防
风、牡蛎。血热盗汗。当归六黄汤为专药。虚人。多加参、 减芩、连。身热。加地骨皮。肝虚。
加枣仁。肝实。加龙胆草。烦心。加竹叶、辰砂、麦冬。脾虚。去芩、连加白术、芍药。伤寒阳
明少阳证盗汗。柴胡、葛根随证主治。温热三阳合病。目合则汗。白虎汤。
头汗 头为诸阳之会。额上多汗而他处无者。湿热上蒸使然。或蓄血结于胃口。迫其津液上
逆所致。蓄血头汗出。剂颈而还。犀角地黄汤。头汗小便不利。而渴不能饮。此瘀蓄膀胱也。桃
核承气汤。胃热上蒸。额汗发黄。小水不利者。五苓散加茵陈。甚则茵陈蒿汤微利之。伤寒胁痛
耳聋。寒热口苦。头上汗出。剂颈而还。属少阳。小柴胡加桂枝、苓、术和之。凡头汗。服和营
卫逐湿豁痰理气散瘀药。或发寒热。下体得汗者。为营卫气通。日渐向愈之机也。食滞中宫。热
气上炎。亦令头汗。生料保和丸。倍用姜汁炒川连。病后产后。悉属阳虚。误治必死。伤湿额上
汗出。下之微喘者死。下后小便不利者亦死。伤寒阴毒等证额汗。见绪论。
手足汗 脾胃湿蒸。傍达于四肢。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。十全大补去芎加五味子。
阴汗 阴间有汗。属下焦湿热。龙胆泻肝汤加风药一二味。风能胜湿也。或当归龙荟丸。及
二妙散俱效。阴囊湿者。以炉甘石 过扑之。密陀僧末亦佳。
半身汗出 夏月止半身出汗。皆气血不充。内挟寒饮所致。偏枯及夭之兆也。大剂十全大补、
人参养荣、大建中辈加行经豁痰药治之。若元气稍充。即间用小续命汤一剂以开发其表。或防己
黄汤加川乌以散其湿。此证虽属血虚。慎不可用四物阴药。以其闭滞经络故也。
石顽曰。汗之源不一。有因于卫气疏者。有因于营气热者。有因于营卫不和者。盖风邪干卫。
则腠理疏。营气乘表虚而外泄。则自汗。治当散邪为急。宜从仲景桂枝汤、小建中辈。迟则营气
外亡。邪气内入。必变府实潮热矣。又宜三承
气汤选用。此皆外感自汗也。若郁热内蒸。亦必从空窍发泄。或从肠胃下奔。或从皮毛外达。则
郁热得散。然外泄轻于下奔。蒸热胜于干热。以此验营卫之枯与不枯也。当从内伤虚损例治之。
至于邪正交加。非汗不解。故少阳挟热。或为盗汗。或腋汗胁汗。须知从阴阳交互时。及阴阳交
互处发泄者。皆阴阳不和。半表半里证。小柴胡、逍遥散。皆合剂也。及乎挟风邪痰湿之类。亦
多有之。至如头汗。或为湿热上攻。或为瘀血内结。亦属阴阳不和。其于阴汗股汗。又为肝家湿
热下渗之征验。岂可一概施治乎。
〔诊〕汗家腠理疏豁。其脉必缓。兼浮则为风。兼滑则为痰。兼大则为热。兼弱为卫虚。兼芤
为失血。兼迟为气虚。兼细为阴虚。经云。肺脉软而散者。当病灌汗。肺脉缓甚为多汗。尺涩脉
滑。谓之多汗。病风人脉紧数。浮沉有力。汗出不止。呼吸有声者死。不然。则主病气。
东垣治一人。二月阴雨寒湿。又因劳役所伤。病解之后。汗出不止。沾濡数日。恶寒重添浓
衣。心胸间时烦热。头目昏愦。上壅食少。此乃胃中阴火炽盛。与外天雨之湿气相合。而汗出不
休。遂用羌活胜湿汤。以风药去其湿。甘寒泻其热。一服而愈。
滑伯仁治一妇。暑月自汗。口干烦躁。欲坐水中。脉浮而数。按之豁然虚散。得之食生冷乘
凉所致。以真武汤。一进汗止。再进躁退。三进全安。
飞畴治陈子浓媳。八月间因产不顺。去血过多。产后恶露稀少。服益母草汤不行。身热汗出。
产科用发散行血更剧。自用焦糖酒一碗。遂周身络脉棰楚难堪。恶露大下。昏沉戴眼。汗出如浴。
但言心痛不可名状。此血去过多。心
失其养故痛。肝主筋。为藏血之地。肝失其荣。故络脉棰楚不堪。且汗为产后之大禁。若非急用
人参。恐难保其朝夕也。用四君合保元加白芍、五味。一剂汗止。因其语言如祟。疑为瘀血未尽。
更欲通利。予曰。声怯无神。此属郑声。且腹不疼痛。瘀何从有。此神气散乱不收之故。前方加
入枣仁、龙齿。诸证渐平。后服独参汤。至弥月而安。
《内经》说：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冷。饮食过饱，汗出于胃；受惊导致精气耗损，汗出于心；负重远行，汗出于肾；疾走并伴有恐惧，汗出于肝；肢体摇动过度劳累，汗出于脾。肾脏患病的人，睡觉时出汗，并且厌恶风邪。津液脱失的人，大汗淋漓；半身出汗，会导致半身不遂。饮酒后感受风邪，就会形成漏风证；房事后出汗又感受风邪，就会形成内风证。
《景岳全书》说：汗出一证，有自汗和盗汗之分。自汗是指没有固定时间，活动后更加严重；盗汗是指睡眠中全身出汗，醒来后逐渐停止。古代医法认为：自汗属于阳虚，腠理不固，是卫气所主管的。人依靠卫气来巩固体表，卫气不固，则表虚而自汗，津液因此外泄。治疗应当实表补阳。盗汗属于阴虚，阴虚则阳气必凑集于阴分，所以阳气蒸腾阴分则血热，血热则津液外泄而为盗汗。治疗应当清火补阴。这是大致法则。然而自汗也有阴虚的，盗汗也多见阳虚的。如果遇到烦劳大热的情况，最多出现自汗。如饮食之火起于胃，劳倦之火起于脾，酒色之火起于肾，都能使人自汗。像这种情况，难道不是阳盛阴衰吗？另外，人的清醒与睡眠，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？既然阴阳有差异，如何辨别呢？回答说：只要观察体内有火还是无火，那么或是阴虚或是阳虚，自然可以看清了。大概火势旺盛而汗出的，是因为火灼烧阴液，可知是阴虚；没有火势而汗出的，是因为表气不固，可知是阳虚。懂得这两点，那么汗出的关键就没有遗漏的了。汗由血液化生，根本在于阴。《内经》说：阳之汗，用天地的雨来命名。其中的道理可以知晓了。然而汗发源于阴而出于阳，其根本则由阴中的营气决定，而其开闭则由阳中的卫气决定。所以凡是想要止汗却不知道营卫的盛衰，想要发汗却不知道橐龠（指呼吸或气机升降）的牝牡（指阴阳开合），我知道他如果不失败就不会停止的。
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，而不知道寒也能致汗。所谓的寒，不是说外感寒邪，正是由于阳气内虚，则寒从中生，而阴中没有阳气。阴中没有阳气，则阴无所主，而汗随气外泄。所以凡是大惊、大恐、大惧，都能令人汗出。这都是阳气突然消亡、真元失守的征兆。到了严重的程度，就像病后、产后，或者大吐、大泻、失血之后，必定有很多汗出的。这难道不是气怯弱的表现吗？所以《内经》说：阴胜则身体寒冷，汗出且身体常觉清凉，频繁战栗而寒，寒极则四肢厥逆，厥逆则腹部胀满而死。张仲景说：极寒反而汗出，身体必定冷如冰。这些都是阴汗的说法。所以凡是治疗阴汗的，只应当考察气虚的程度。轻微虚弱的，稍微扶助正气，汗自然收敛；严重虚弱的，非用甘草、干姜、桂枝、附子迅速挽救元气不可。
自汗虽然由卫气不固、胃中津液外泄引起，但实际上关乎脏腑蒸发所致。心之阳不能卫外而为固，则自汗出，这是包络之火郁结而发。肾之阴不能退藏于密，则盗汗出，这是阴火乘虚蒸发所致。肺气衰弱则表不能卫而自汗出，必定伴有气喘、乏力、少气。胃虚导致水谷之气脱散者，汗自出，必定伴有气虚、食欲减退。阴虚者，阳必凑集，所以发热自汗，用当归六黄汤。阳虚者，阴必乘袭，所以发厥自汗，用小建中汤。严重的加附子。营血不足导致的自汗，用小建中汤加当归。严重的加熟地黄。卫外之阳不固而自汗，用附子汤。脾中之阳衰微而自汗，用术附汤。肾中之阳浮游而自汗，用参附汤。身体寒冷、自汗、阴躁，想坐在泥水中，脉浮而数，按之如无。《内经》说：脉象看似顺从，但按之不鼓指，诸阳皆如此。这是阴盛格阳，用真武汤冷服。肺气虚者，固护皮毛，用玉屏风散。脾虚者，壮其中气，用补中益气汤。心虚者，益其血脉，用当归补血汤。肝虚者，调理其疏泄，用逍遥散。肾虚者，助其封藏，用都气丸。火气炎上，胃中之湿也能作汗，可用凉膈散。脾胃不和，外挟风湿，身重汗出，用羌活胜湿汤。风湿相搏，时常自汗出，用防己黄芪汤。恶风自汗，用桂枝汤。又有漏风证，一名酒风，不论冬夏，额上常有汗出。这是醉后当风所致。《内经》说：有病身热懈怠，汗出如浴，恶风少气，病名酒风。治疗用泽泻、白术各十分，麋衔五分，合以三指撮为量，饭后服用。又说：饮酒中风，则为漏风。漏风的症状，多汗，常常不能穿单衣，进食则汗出，甚至身体出汗、喘急，恶风且衣服常湿，口干善渴，不能从事劳作。先宜五苓散热服取汗，后与黄耆建中汤加白术、泽泻。汗出日久，用人参、黄耆、白术、附子等药不效，汗干仍热，这是风邪伏于经络，暂与参苏饮，病已即停服。这是反治法。汗出不止，名叫亡阳，用附子理中汤加黄耆。外用温粉扑之。痰证汗自出，痰消汗自止，用二陈汤加桂枝、枳壳、桔梗、香附、贝母。多汗恶风，食则汗出如油，久不治，必成消渴，用玉屏风散，少加煅牡蛎。病余气血俱虚而汗，服诸止汗药不应，用十全大补汤半剂，加熟枣仁五钱。若胸膈烦闷，不能胜受阴药者，用生脉散加黄耆二钱，当归六分，熟枣仁三钱，一服即验。别处无汗，独心胸一片有汗，这是思虑伤心所致。其病在心，名叫心汗，用归脾汤倍用黄耆，或生脉散加当归、枣仁，猪心汤煎服。
汗出不治证：汗出而喘甚者不治。汗出而脉脱者不治。汗出而身痛甚者不治。汗出发润至头顶者不治。汗出如油者不治。汗出如珠者不治。汗出如胶，胶粘如珠之凝，及淋漓如雨，揩拭不及的，都不可治。
盗汗：《金匮要略》说：男子平人脉虚弱微细者，善于盗汗出。大概平人脉虚弱微细，是卫虚不能鼓动其脉气于外，所以不能约束津液。当卫气行于阴，眼睛闭合之时，血气无以固其表，腠理开则汗，醒则行阳之气复散于表，则汗止矣。名叫盗汗，也叫寝汗。这属于本虚，与伤寒邪在半表不同。先与当归补血汤加炒枣仁半两，数服后与都气丸调补之。酒客睡中多汗，这是湿热外蒸所致，用二妙散加白术、防风、牡蛎。血热盗汗，当归六黄汤为专药。虚人，多加人参、黄耆，减少黄芩、黄连。身热，加地骨皮。肝虚，加枣仁。肝实，加龙胆草。烦心，加竹叶、辰砂、麦冬。脾虚，去芩、连加白术、芍药。伤寒阳明少阳证盗汗，柴胡、葛根随证主治。温热三阳合病，目合则汗，用白虎汤。
头汗：头为诸阳之会。额上多汗而他处无者，是湿热上蒸所致。或者是蓄血结于胃口，迫其津液上逆所致。蓄血头汗出，仅到颈部而还，用犀角地黄汤。头汗小便不利，而渴不能饮，这是瘀蓄膀胱，用桃核承气汤。胃热上蒸，额汗发黄，小水不利者，用五苓散加茵陈。严重的用茵陈蒿汤微利之。伤寒胁痛耳聋，寒热口苦，头上汗出，仅到颈部而还，属少阳，用小柴胡汤加桂枝、茯苓、白术调和之。凡头汗，服和营卫逐湿豁痰理气散瘀药，或发寒热，下体得汗者，为营卫气通，日渐向愈之机也。食滞中宫，热气上炎，亦令头汗，用生料保和丸，倍用姜汁炒川连。病后产后，悉属阳虚，误治必死。伤湿额上汗出，下之微喘者死。下后小便不利者亦死。伤寒阴毒等证额汗，见绪论。
手足汗：脾胃湿蒸，旁达于四肢，则手足多汗。热者，用二陈汤加川连、白芍。冷者，用理中汤加乌梅。弱者，用十全大补汤去川芎加五味子。
阴汗：阴间有汗，属下焦湿热，用龙胆泻肝汤加风药一二味。风能胜湿也。或者用当归龙荟丸，及二妙散都有效。阴囊湿者，以炉甘石煅过扑之，密陀僧末亦佳。
半身汗出：夏月止半身出汗，皆气血不充，内挟寒饮所致。是偏枯及夭折的征兆。大剂十全大补、人参养荣、大建中类加行经豁痰药治之。若元气稍充，即间用小续命汤一剂以开发其表。或者用防己黄芪汤加川乌以散其湿。此证虽属血虚，慎不可用四物汤等阴药，以其闭滞经络故也。
石顽说：汗之源不一，有因于卫气疏者，有因于营气热者，有因于营卫不和者。盖风邪干卫，则腠理疏，营气乘表虚而外泄，则自汗。治疗应当散邪为急，宜从仲景桂枝汤、小建中汤之类。迟则营气外亡，邪气内入，必变府实潮热矣。又宜三承气汤选用。这都是外感自汗。若郁热内蒸，亦必从空窍发泄，或从肠胃下奔，或从皮毛外达，则郁热得散。然外泄轻于下奔，蒸热胜于干热，以此验证营卫的枯与不枯。应当从内伤虚损例治之。至于邪正交加，非汗不解。所以少阳挟热，或为盗汗，或腋汗胁汗。须知从阴阳交互时，及阴阳交互处发泄者，皆阴阳不和，半表半里证，小柴胡汤、逍遥散，都是合剂。以及挟风邪痰湿之类，也多有之。至如头汗，或为湿热上攻，或为瘀血内结，亦属阴阳不和。其于阴汗股汗，又为肝家湿热下渗之征验。岂可一概施治乎。
〔诊〕汗家腠理疏豁，其脉必缓。兼浮则为风。兼滑则为痰。兼大则为热。兼弱为卫虚。兼芤为失血。兼迟为气虚。兼细为阴虚。《内经》说：肺脉软而散者，当病灌汗。肺脉缓甚为多汗。尺涩脉滑，谓之多汗。病风人脉紧数，浮沉有力，汗出不止，呼吸有声者死。不然，则主病气。
东垣治一人。二月阴雨寒湿，又因劳役所伤，病解之后，汗出不止，沾濡数日，恶寒重添浓衣，心胸间时烦热，头目昏愦，上壅食少。此乃胃中阴火炽盛，与外天雨之湿气相合，而汗出不休。遂用羌活胜湿汤，以风药去其湿，甘寒泻其热，一服而愈。
滑伯仁治一妇。暑月自汗，口干烦躁，欲坐水中，脉浮而数，按之豁然虚散。得之食生冷乘凉所致。以真武汤，一进汗止，再进躁退，三进全安。
飞畴治陈子浓媳。八月间因产不顺，去血过多，产后恶露稀少，服益母草汤不行，身热汗出。产科用发散行血更剧。自用焦糖酒一碗，遂周身络脉棰楚难堪，恶露大下，昏沉戴眼，汗出如浴，但言心痛不可名状。此血去过多，心失其养故痛。肝主筋，为藏血之地，肝失其荣，故络脉棰楚不堪。且汗为产后之大禁，若非急用人参，恐难保其朝夕也。用四君合保元加白芍、五味，一剂汗止。因其语言如祟，疑为瘀血未尽，更欲通利。予曰：声怯无神，此属郑声。且腹不疼痛，瘀何从有。此神气散乱不收之故。前方加入枣仁、龙齿，诸证渐平。后服独参汤，至弥月而安。
(Unmanageable sweating, Night sweats, Head sweat, Hand and foot sweat, Genital sweat, Hemihidrosis)
The *Neijing* states: When Yang qi is in excess, it manifests as body heat without sweating; when Yin qi is in excess, it manifests as profuse sweating with a cold body. After overeating, sweat originates from the Stomach; after fright causing essence depletion, sweat originates from the Heart; after carrying heavy loads and traveling far, sweat originates from the Kidney; after running fast and feeling fear, sweat originates from the Liver; after excessive physical labor and fatigue, sweat originates from the Spleen. Patients with Kidney disease experience night sweats (sweating during sleep) and aversion to wind. Those with fluid exhaustion suffer from profuse sweating; hemihidrosis (sweating on only one side of the body) can lead to hemiplegia. Contracting wind after drinking alcohol results in "Leak Wind" syndrome; contracting wind while sweating after sexual intercourse results in "Internal Wind" syndrome.
The *Jingyue Quanshu* states: The symptom of sweating includes spontaneous sweating and night sweats. Spontaneous sweating occurs at any time without fixed schedule, worsening with activity. Night sweats refer to whole-body sweating during sleep, which gradually stops upon waking. Ancient medical methods state: Spontaneous sweating belongs to Yang deficiency, where the interstices are not secure, governed by Wei Qi (Defensive Qi). Humans rely on Wei Qi to consolidate the exterior; if Wei Qi is insecure, the exterior becomes deficient leading to spontaneous sweating, and body fluids are thereby released. Treatment should aim to consolidate the exterior and tonify Yang. Night sweats belong to Yin deficiency. In Yin deficiency, Yang inevitably congregates in the Yin aspect, so Yang steaming the Yin portion causes blood heat; blood heat leads to fluid leakage resulting in night sweats. Treatment should aim to clear fire and tonify Yin. This is the general principle. However, spontaneous sweating can also be due to Yin deficiency, and night sweats often involve Yang deficiency. For instance, in cases of mental fatigue and high fever, spontaneous sweating is most common. Fire from diet arises in the Stomach, fire from overwork arises in the Spleen, and fire from alcohol and sex arises in the Kidney; all can cause spontaneous sweating. Such cases indicate Yang excess and Yin deficiency. Furthermore, wakefulness and sleep are determined by the movement of Wei Qi. Wei Qi is Yang Qi. During sleep, Wei Qi enters the Yin aspect; this time indicates exterior Yang deficiency. Since Yin and Yang differ, how to distinguish them? Answer: Observe whether there is fire or not. If fire is abundant and sweating occurs, it is because fire scorches Yin, indicating Yin deficiency. If no fire is present but sweating occurs, it is because exterior Qi is insecure, indicating Yang deficiency. Understanding these two points covers the essentials of sweating. Sweat is derived from blood and fundamentally belongs to Yin. The *Neijing* says: "Yang's sweat is named after the rain of heaven and earth." The meaning is clear. Sweat originates from Yin and emerges from Yang; its root lies in Ying Qi (Nutritive Qi) within Yin, while its opening and closing are governed by Wei Qi within Yang. Therefore, those who wish to stop sweating but do not know the abundance or deficiency of Ying and Wei Qi, or those who wish to induce sweating but do not understand the yin-yang dynamics of the bellows (Qi mechanism), I know they will fail unless they cease.
Sweating syndromes have Yin and Yang distinctions. Yang sweat is hot sweat; Yin sweat is cold sweat. People know that heat causes sweating, but do not know that cold can also cause sweating. The "cold" referred to here is not external cold, but rather internal cold generated due to internal Yang deficiency. When there is no Yang within Yin, Yin has no master, and sweat leaks out with Qi. Thus, great fright, terror, or fear can all cause sweating. These are signs of sudden Yang consumption and loss of Yuan Yuan (Primordial Essence). In severe cases, such as after illness, postpartum, or after severe vomiting, diarrhea, or blood loss, profuse sweating is common. Is this not due to Qi timidity? Thus, the *Neijing* states: "Yin excess leads to cold body, sweating, constant coolness, frequent shivering and chills. Chills lead to cold extremities; cold extremities lead to abdominal fullness and death." Zhang Zhongjing said: "Extreme cold reversely causes sweating, and the body becomes cold as ice." These all refer to Yin sweat. Therefore, when treating Yin sweat, one must assess the degree of Qi deficiency. For mild deficiency, slightly supporting Zheng Qi will naturally stop the sweat. For severe deficiency, only quick rescue of Yuan Qi with Gancao (Licorice Root), Ganjiang (Dried Ginger), Guizhi (Cinnamon Twig), and Fuzi (Aconite Root) will suffice.
Although spontaneous sweating is caused by insecure Wei Qi and leakage of Stomach fluids, it is essentially due to organ evaporation. If Heart Yang cannot defend the exterior, spontaneous sweating occurs, caused by constrained fire in the Pericardium. If Kidney Yin cannot store tightly, night sweats occur, caused by Yin fire evaporating due to deficiency. If Lung Qi declines, the exterior cannot defend, leading to spontaneous sweating accompanied by asthma, fatigue, and shortness of breath. If Stomach Qi is weak and water-grain Qi scatters, spontaneous sweating occurs accompanied by Qi deficiency and poor appetite. In Yin deficiency, Yang congregates, causing fever and spontaneous sweating; use Danggui Liu Huang Tang (Six-Huang Decoction with Angelica). In Yang deficiency, Yin attacks, causing cold extremities and spontaneous sweating; use Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). In severe cases, add Fuzi. For spontaneous sweating due to insufficient Ying Blood, use Xiao Jian Zhong Tang plus Danggui. In severe cases, add Shudi (Prepared Rehmannia Root). For spontaneous sweating due to insecure exterior Yang, use Fuzi Tang (Aconite Decoction). For spontaneous sweating due to declining Spleen Yang, use Shu Fu Tang (Atractylodes and Aconite Decoction). For spontaneous sweating due to floating Kidney Yang, use Shen Fu Tang (Ginseng and Aconite Decoction). For cold body, spontaneous sweating, and Yin restlessness, desiring to sit in mud, with a floating and rapid pulse that feels empty upon pressure: The *Neijing* states, "Pulse seems compliant but does not drum under pressure; this applies to all Yang conditions." This is Yin excess repelling Yang; use Zhen Wu Tang (True Warrior Decoction) taken cold. For Lung Qi deficiency consolidating the skin and hair, use Yu Ping Feng San (Jade Windscreen Powder). For Spleen deficiency strengthening middle Qi, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). For Heart deficiency nourishing blood vessels, use Danggui Buxue Tang (Angelica Tonifying Blood Decoction). For Liver deficiency regulating dispersion and excretion, use Xiao Yao San (Free Wanderer Powder). For Kidney deficiency assisting sealing and storing, use Du Qi Wan (Duqi Pill). When Fire Qi flares upward, dampness in the Stomach can also cause sweating; use Liang Ge San (Cool the Diaphragm Powder). For Spleen-Stomach disharmony with external wind-dampness, causing heavy body and sweating, use Qiang Huo Sheng Shi Tang (Notopterygium Overcoming Dampness Decoction). For wind-dampness battling, causing occasional spontaneous sweating, use Fang Ji Huang Qi Tang (Stephania and Astragalus Decoction). For aversion to wind and spontaneous sweating, use Guizhi Tang (Cinnamon Twig Decoction). There is also Leak Wind syndrome, also called Wine Wind, characterized by constant sweating on the forehead regardless of season, caused by exposure to wind after drunkenness. The *Neijing* states: "Disease with body heat, lethargy, profuse sweating like bathing, aversion to wind, and shortness of breath is named Wine Wind. Treat with Zexie (Alisma Rhizome) and Baizhu (Atractylodes Macrocephala Rhizome) each 10 parts, and Lixian (Elatostema Lineolatum Herb) 5 parts, mixed into doses held by three fingers, taken after meals." It also says: "Contracting wind after drinking alcohol results in Leak Wind. Symptoms include profuse sweating, inability to wear single clothes, sweating upon eating, even body sweating and急促 breathing, aversion to wind with wet clothes, dry mouth with thirst, and inability to perform labor. First, use Wuling San (Five-Ling Powder) warm to induce sweating, then give Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction) plus Baizhu and Zexie. If long-term sweating does not respond to Renshen (Ginseng), Huangqi, Baizhu, and Fuzi, and sweating stops but heat remains, this is wind pathogen latent in meridians; temporarily give Renshen Su Yin (Ginseng and Perilla Drink), stopping when the disease resolves. This is contrary treatment. Unceasing sweating is named Wang Yang (Loss of Yang); use Fuzi Lizhong Tang (Aconite Regulate the Middle Decoction) plus Huangqi. Externally apply warm powder. For phlegm syndromes with spontaneous sweating, once phlegm clears, sweating stops; use Er Chen Tang (Two-Chen Decoction) plus Guizhi, Zhike (Bitter Orange), Jiegeng (Platycodon Root), Xiangfu (Cyperus Rhizome), and Beimu (Fritillaria Bulb). For profuse sweating with aversion to wind and oily sweating upon eating, if untreated long-term, it becomes Xiao Ke (Wasting-Thirst); use Yu Ping Feng San with added Mu Li (Oyster Shell). For residual Qi and Blood deficiency causing sweating unresponsive to various antiperspirants, use Shiquan Dabu Tang (Ten-Ingredient Great Supplement Decoction) half dose plus Shu Zaoren (Prepared Ziziphus Seed) 5 qian. If chest oppression prevents tolerating Yin tonics, use Sheng Mai San (Generate the Pulse Powder) plus Huangqi 2 qian, Danggui 6 fen, and Shu Zaoren 3 qian; effective after one dose. Sweating only on the heart and chest area, with no sweat elsewhere, is caused by worry injuring the Heart. The disease is in the Heart, named Xin Han (Heart Sweat); use Guipi Tang (Restore the Spleen Decoction) with doubled Huangqi, or Sheng Mai San plus Danggui and Zaoren, decocted with Zhu Xin (Pig Heart).
Unmanageable sweating signs: Unmanageable if accompanied by severe asthma. Unmanageable if pulse vanishes. Unmanageable if accompanied by severe body pain. Unmanageable if hair becomes moist up to the crown. Unmanageable if sweat is like oil. Unmanageable if sweat is like pearls. Unmanageable if sweat is like glue, sticky and clumping like pearls, or pouring down like rain, unable to be wiped dry.
Night sweats: The *Jingui Yaolue* states: In men, a normal pulse that is weak, fine, and subtle predisposes to night sweats. Generally, a weak, fine, and subtle pulse indicates Wei Qi deficiency failing to propel Qi outward, thus failing to constrain fluids. When Wei Qi travels through Yin and eyes close, Blood and Qi cannot consolidate the exterior; interstices open causing sweat. Upon waking, Yang Qi returns to scatter on the exterior, stopping sweat. This is named Night Sweat or Qin Han (Sleep Sweat). It belongs to root deficiency, differing from Shaoyang half-exterior/half-interior pathogens. First give Danggui Buxue Tang plus fried Zaoren 0.5 liang; after several doses, regulate and tonify with Duqi Wan. Alcohol drinkers sweating during sleep is due to external steaming of Damp-Heat; use Ermiao San (Two-Marvels Powder) plus Baizhu, Fangfeng, and Mu Li. For Blood Heat night sweats, Danggui Liu Huang Tang is the specific remedy. For deficient patients, increase Renshen and Huangqi, reduce Huangqin and Huanglian. With body heat, add Digupi (Groundcherry Bark). For Liver deficiency, add Zaoren. For Liver excess, add Longdancao (Gentian Root). For vexation, add Zhuye (Bamboo Leaf), Chen Sha (Cinnabar), and Maidong (Ophiopogon Tuber). For Spleen deficiency, remove Huangqin and Huanglian, add Baizhu and Shaoyao. For Shaoyang/Yangming night sweats in Cold Damage, treat according to syndrome with Chaihu (Bupleurum Root) and Gegen (Kudzu Root). For Warm Disease involving three Yang meridians, sweating upon closing eyes; use Baihu Tang (White Tiger Decoction).
Head sweat: The head is the meeting place of all Yang meridians. Excessive sweating on the forehead with none elsewhere is due to Damp-Heat steaming upward. Or it is caused by Blood stasis accumulating at the stomach gate, forcing fluids upward. For head sweat due to Blood stasis, stopping at the neck, use Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction). For head sweat with difficult urination and thirst unable to drink, this is Blood stasis in the Bladder; use Taohao Chengqi Tang (Peach Kernel and Rhubarb Decoction). For Stomach Heat steaming upward causing yellow forehead sweat and difficult urination, use Wuling San plus Yinchern (Coix Seed/Artemisia Capillaris - Note: Context implies Yinchen Hao for jaundice/damp-heat, usually Artemisiae Scopariae Herba). In severe cases, use Yinchen Hao Tang (Coir-Moss Decoction) to mildly purge. For Cold Damage with hypochondriac pain, deafness, alternating chills and fever, bitter taste, and head sweat stopping at the neck, it belongs to Shaoyang; use Xiaochaihu Tang (Minor Bupleurum Decoction) plus Guizhi, Fuling (Poria), and Baizhu to harmonize. For any head sweat, if taking herbs that harmonize Ying/Wei, expel dampness, resolve phlegm, regulate Qi, and dissipate stasis leads to chills/fever or sweating below the waist, it indicates Ying-Wei Qi connection and gradual recovery. Food stagnation in the center causing rising Heat also causes head sweat; use Shengliao Baohe Wan (Raw Material Harmonize the Stomach Pills) with doubled Jiangzhi fried Chuanlian (Sichuan Coptis Rhizome). Post-illness or postpartum cases all belong to Yang deficiency; misdiagnosis leads to death. Dampness injury with forehead sweat followed by purging causing slight asthma is fatal. Purging leading to difficult urination is also fatal. Forehead sweat in Cold Damage Yin Toxin syndromes is seen in the introduction.
Hand and foot sweat: Spleen-Stomach Damp-Heat steaming and reaching the four limbs causes hand and foot sweating. For Heat, use Er Chen Tang plus Chuanlian and Baishao (White Peony Root). For Cold, use Lizhong Tang (Regulate the Middle Decoction) plus Wumei (Mume Fruit). For Weakness, use Shiquan Dabu Tang removing Chuanxiong and adding Wuweizi (Schisandra Berry).
Genital sweat: Sweating in the genital region belongs to Lower Jiao Damp-Heat; use Longdan Xiegan Tang (Gentian Drain the Liver Decoction) plus one or two Wind-expelling herbs. Wind can overcome Dampness. Alternatively, Danggui Longhui Wan (Angelica Gardenia Pill) or Ermiao San are effective. For damp scrotum, dust with calcined Lucangshi (Calamine) or Miduoseng (Lead Monoxide powder).
Hemihidrosis: Sweating only on one side in summer is due to insufficient Qi and Blood, internally combined with Cold Fluid. It is a sign of hemiplegia or premature death. Treat with large doses of Shiquan Dabu, Renshen Yangrong (Ginseng Nourish Youth), or Dajianzhong (Great Construct the Middle) formulas plus herbs that move meridians and resolve phlegm. If Yuan Qi is slightly sufficient, occasionally use Xiaoxuming Tang (Minor Rescue Life Decoction) to open the exterior. Or use Fangji Huangqi Tang plus Chuanwu (Chuanwu Aconite) to disperse dampness. Although this syndrome belongs to Blood deficiency, strictly avoid Siwu Tang (Four-Substance Decoction) and other Yin tonics, as they obstruct meridians.
Shiwan stated: Sources of sweating vary. Some are due to loose Wei Qi, some to hot Ying Qi, some to disharmony between Ying and Wei. When Wind pathogen invades Wei, interstices loosen, and Ying Qi escapes due to exterior deficiency, causing spontaneous sweating. Treatment should urgently dispel pathogens, using Zhongjing's Guizhi Tang or Xiaojianzhong Tang. Delay leads to Ying Qi loss and pathogen entry, transforming into Fu organ excess with tidal fever; then select among San Chengqi Tangs. These are all external contraction spontaneous sweats. If constrained Heat steams internally, it must exit through orifices, either rushing down the intestines/stomach or reaching the skin. Then constrained Heat disperses. External release is lighter than downward rushing; steaming heat is stronger than dry heat. Use this to verify if Ying and Wei are withered or not. Treat according to internal injury deficiency examples. When pathogen and Righteous Qi interact, sweating is required to resolve. Thus, Shaoyang with Heat may cause night sweats or axillary/flank sweating. Know that sweating occurring during Yin-Yang interaction or at their interface indicates Yin-Yang disharmony, a half-exterior half-interior syndrome; Xiaochaihu Tang and Xiaoyao San are appropriate combinations. Cases involving Wind, Phlegm, and Dampness are also common. Head sweat may be due to Damp-Heat attacking upward or Blood stasis knotting internally, also belonging to Yin-Yang disharmony. Genital or thigh sweat is a sign of Liver Damp-Heat seeping downward. How can one treat all uniformly?
[Diagnosis] Patients prone to sweating have loose interstices; their pulse must be slow. Floating indicates Wind. Slippery indicates Phlegm. Large indicates Heat. Weak indicates Wei Qi deficiency. Choppy indicates Blood loss. Slow indicates Qi deficiency. Fine indicates Yin deficiency. The *Neijing* states: "If Lung pulse is soft and scattered, one suffers from Irrigation Sweat. If Lung pulse is very slow, there is profuse sweating. Scattered Chi pulse and Slippery Cun pulse indicate profuse sweating." In Wind diseases, if pulse is tight and rapid, forceful in floating and sinking, with unceasing sweating and audible respiration, death ensues. Otherwise, it indicates pathological Qi.
Dongyuan treated a man. In February, rainy and cold-damp weather, compounded by labor injury. After illness resolved, sweating continued unceasingly for days, soaking clothes. Severe aversion to cold requiring thick layers. Occasional vexation and heat in the chest/heart. Dizziness and confusion of head/eyes. Upper congestion, poor appetite. This was blazing Yin Fire in the Stomach combining with external rain dampness, causing continuous sweating. Used Qianghuo Shengshi Tang to remove dampness with Wind herbs and clear heat with Sweet-Cold herbs; cured after one dose.
Hu Bo Ren treated a woman. Summer spontaneous sweating, dry mouth, vexation, desiring to sit in water. Pulse floating and rapid, empty and scattered upon pressure. Caused by eating raw/cold food and seeking coolness. Used Zhenwu Tang; sweating stopped after first dose, restlessness retreated after second, fully recovered after third.
Feichou treated the daughter-in-law of Chen Zinong. In August, difficult childbirth with excessive blood loss. Postpartum lochia was scant. Yimucao Tang failed to promote flow. Body heat and sweating occurred. Obstetricians used dispersing and blood-moving herbs, worsening the condition. She drank a bowl of caramel wine, causing unbearable pain in collateral vessels throughout the body. Profuse lochia flow, coma with upward rolling eyes, profuse sweating like bathing. Only complained of indescribable heart pain. This was excessive blood loss causing Heart malnourishment and pain. Liver governs sinews and stores Blood; Liver lost nourishment, hence unbearable collateral pain. Moreover, sweating is a major contraindication postpartum. Without urgent Renshen, life could not be preserved day-to-day. Used Sijunzi Tang combined with Baoyuan Tang plus Baishao and Wuweizi; sweating stopped after one dose. Due to delirious speech resembling possession, suspecting residual Blood stasis, wishing to promote drainage. I said: Voice is timid and spiritless, this is Zhengsheng (feeble repetitive speech). Abdomen is not painful, how could there be stasis? This is scattered Spirit Qi failing to gather. Added Zaoren and Longchi (Dragon Bone) to previous formula; symptoms gradually stabilized. Later took Dushen Tang (Single Ginseng Decoction); safe until full term.