治小儿虚汗、盗汗。然心血液盛，亦发为汗，故宜收敛心气。
人参 当归（炒，各二钱） 共锉散，用雄猪心一个，切三片，每服二钱，猜心一
片，井水同煎，食远服。一方加黄 ，二钱蜜炙。
治小儿自汗。
牡蛎（ ） 黄 （蜜炙） 生地黄 入浮麦、麻黄根同煎，食前服。
人参 白术 茯苓 黄 （蜜炙） 当归 甘草（炙，各一钱） 用生姜一片，入
麦麸同煎，食前服。
牡蛎 麻黄根（各一两） 赤石脂 糯米粉 龙骨各五钱） 为轻细末，绵包药，扑于身上。
自汗属气虚，阳虚血虚湿痰，宜人参黄 ，少佐桂枝，阳虚制附子亦可少用，火气
上蒸胃中之湿，亦能作汗，凉膈散主之。自汗盗汗，并忌生姜，以其开腠理也。盗汗属
血虚阴虚，小儿不须治，当归大黄汤甚效，但药性寒而人虚者，兼用黄 、甘草补气之
味，麻黄根治盗汗甚捷，盖其性能行周身之表，引诸药至卫分而固腠理也。盗汗发热，
因阴虚者四物加黄柏，兼气虚加参 白术。盗汗者表里汗出，非任自汗而自出也，多因
心虚所致，宜敛心气益肾水，使阴阳调和，水之升降，其汗自止。《经》曰∶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；惊惶恐惧，汗出于肝；摇体劳苦，汗出于脾。然肥人多自汗，以其
多气虚也。瘦人多盗汗，以其多阴虚有火也。但脏腑尽有津液，一经劳倦所伤，皆足
以致汗出，然血之与汗，异名同类，故夺血者无汗，夺汗者无血。
五脏六腑表里之阳，皆心主之，以行其变化，随时升降，所在之处而生津；亦随其
火扰，所在之处泄而为汗，是汗尽由心出也。醒而出汗曰自汗，属阳虚。睡而出汗曰
盗汗，属阴虚。汗者心之阳，寝者肾之阴，一则阳虚不能固表，一则阴虚不能闭脏也。
有胃腑旁达于外为手足汗者，有胃热熏蒸头颅自汗而属实者，故外感初症多自汗。海藏
曰∶与寒脉散三黄丸，三日病已，盖肾主五液，化为五湿，肾水上行，乘心之虚，心火
上炎而入肺，欺其不胜皮毛以是而开，为汗出也。先以凉膈散泻胸中相火，次以三黄丸
泻心火以助阴，则肾水退舍而还本脏，玄府固闭而汗自己矣。此可以证初起实热为汗之
一见，然非概可以有余之法治不足也。
《经》曰∶心之液为汗。东垣曰∶坤土主湿，在人为脾胃，夫人之汗，犹天地之阴
气，为雾为雨也。《内经》独主于心，东垣又指脾胃而言，盖心属火主热，脾胃为土主
湿，湿热相搏，为汗明矣。如天气下降，地湿上升，乃成霖雨。又如甑中烧酒，非汤火
熏淘，则不能成涓滴也。然人身清阳之气上行达表，实腠理而固皮毛，谓之卫气，卫气
象天，天包地外，一气统摄，犹卫气包护一身。《经》云，阳密乃固，阳密者即腠理密
也。此气主于肺，而本于胃，故胃充则卫实。自汗、盗汗之症，为病虽一，其源不
同。自汗者乃阳虚气虚有湿，盖阳气虚则不能卫护肌表，故醒时津律然而汗出。盗汗
者，乃阴虚血虚有火也，阴血虚，则不能荣养于中，故睡里凑凑然而汗出也，肾多主
之，以其闭藏之令失守也。然自汗阳虚，古今之定论，但真阴衰弱，亦令自汗，盖阴虚
则火动乘于阴位，阴精被火煎熬而出，犹干竹而以火燃之，亦有油也，不可概用参术黄
与桂枝敛之，但补其阴，则火自潜伏而汗自止矣。当兼以脉候辨之。
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，人心为汗；又云∶汗者，心之液，此言汗为心之液，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，
和调于五脏，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，则津液而为汗，是汗乃身之阳气所化，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，冬天腠里闭密，汗不外溢，小便频多，此更可见汗属津液，
而非可血类也更明矣。况人之一身有涕、泪、涎睡、便溺，皆属一水之化，而发于九
窍之中。故鼻之所出曰涕，目之所出曰泪、口之所出曰唾、曰涎，二阴之所出曰便溺，
而皮肤之所泄则曰汗，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。
夫自汗属阳虚有湿，盗汗属阴虚有火，古哲之定论，然《经》曰∶阳者卫外而为固
也，但火与元气势不两立，故火盛则阳衰，阳衰则卫虚，其所虚之卫行阴，当瞑目之
时，正气无力，以固其表，故腠理开，津液泄而为汗，迨寤则目张，其行阴之气复还于
表而汗止矣。谓之盗汗，《经》名寝汗也。自汗盗汗，虽分阴虚阳虚，然悉属于卫，且
卫气者，实由谷气之所由化，肺脏之所分布，即天真之阳，必得是而后充大，无是则
衰微，变症百出，岂止汗乎。
汗由血化，血自气生，在内为血，在外为汗，然汗者心之液也，而肾又主五液，故
汗证未有不由心肾虚而得者。心阳虚不能卫外而为固，则外伤而自汗，不分寤寐，不因
劳动，而自能出也，肾阴衰，不能内营而退藏，则内伤而盗汗，睡则汗出，醒则倏收。
《经》曰∶津脱者，腠里开，汗大泄也。然二者之汗，各有冷热之分，因寒气乘阳气而
发者，所出之汗必冷，因热气乘阴虚而发者，所出之汗必热，虽然，亦有热火过极，
亢则害承乃制，反兼胜已之化，而为冷者有之，此又不可不察也。较而论之，则自汗为
甚，盖盗汗真元犹未尽虚，自汗则真元耗散，腠里皆开，肺失统气之权，不能固表，
故毫窍疏豁，任其溃泄，势必阳亡阴竭而后己，故自汗阳虚，治当补气，以卫外，盗汗
阴虚，治当滋阴以荣内，一以温热补益，一以清凉滋补，总不外收敛固密为主。至若肺
虚未固其皮毛，脾虚者收其中气，心虚者益其血脉，肝虚者禁其疏泄，肾虚者。助其
封藏，更当观五脏，宜温宜补，或润或燥，不得胶乎一定也。
仲景曰∶汗多则亡阳，阳去则阴胜也，重虚其表，阳虚极矣。甚为寒中，有服止汗
固表药不应，愈敛愈出，止当理心血，盖汗乃心之液，心无所养，不能摄血，故溢而为
汗也，宜大补黄 汤，加酸枣仁也。有微热者加石斛。凡治自汗，既用人参、黄 ，当
必少佐桂枝、防风，以助其达表之力。阳虚甚者，更必少加附子，以翼参 之助。内伤
虚损，总用补中益气汤，少加麻黄根制附子为佐助，但升柴须少用，而必蜜炙以抑其升
发暴悍之性，又欲其引参 至表，复不可缺。食滞中宫，热气聚胃而上炎，则头汗
出，然在病后产后，悉属阳虚，误治必死。当心汗出，名心汗，乃思虑伤脾，以生脉散
或补心丹治之。至阴之处，或两腿挟中，行走劳动，汗出腥秽，此下焦湿热不行也，以
渗湿热为主。遇饮食汤饭，鼻上多汗，此肺虚乘热也，宜益肺凉血。两胁之下动辄有
汗，此肝虚乘热也，宜补肝养血。饮食汗出如洗，日久心虚液耗，令人消渴偏风，宜及
早治之。脾经湿热，淫于四肢，使手足心常有汗，宜抑阳流湿。平人半身出汗，夏月半
身有汗，此皆气血不足所致，夭之兆也。凡衄血吐血，头额汗多，而身上无汗，为阳亡
阴竭，及汗出不至足者死。汗出发润，如油之粘，如珠之缀，及淋漓如雨，揩拭不逮
者，即三阳绝汗也，不治。脉不为汗衰者，死。额汗如雨，喘促弄色，四肢厥冷，
汤药俱呕者，死。大如贯珠，转出不流者，六阳气绝也死。
治疗小儿虚汗、盗汗。然而心主血液，血盛亦能化为汗，因此适宜收敛心气。
人参、当归（炒制，各二钱），共同锉成散剂，取雄猪心一个，切成三片，每次服用二钱药散，配合一片猪心，用井水同煎，在饭后较远时服用。另一配方加入黄芩（此处原文“黄”后缺字，结合语境及常见配伍，多指黄芪或黄芩，但下文有蜜炙黄芪，且治自汗多用黄芪，然此处未明，暂按原文保留或推测为黄芪/黄芩，鉴于下文有明确黄芪，此处若为黄芩则清热，若为黄芪则补气。根据冯氏锦囊原书，此处多为黄芪。但严格按原文“黄 ”，通常指黄芪或黄芩。考虑到治虚汗盗汗，黄芪可能性大，但为了严谨，翻译时保留“黄[芪/芩]”或根据下文推断。注：冯氏锦囊中此方常加黄芪。此处依文意译为“黄[芪]”或仅译“黄”，但要求准确，故译为“黄[芪]”并备注，或直接译为“黄[芪]”。*修正：原文“黄 ”后有空格，通常指黄芪。*）二钱，蜜炙。
治疗小儿自汗。
牡蛎（煅）、黄[芪]（蜜炙）、生地黄，加入浮小麦、麻黄根同煎，饭前服用。
人参、白术、茯苓、黄[芪]（蜜炙）、当归、甘草（炙，各一钱），用生姜一片，加入麦麸同煎，饭前服用。
牡蛎、麻黄根（各一两）、赤石脂、糯米粉、龙骨（各五钱），研成轻细粉末，用绵布包裹药物，扑撒在身上。
自汗属于气虚，阳虚、血虚、湿痰也可导致，适宜用人参、黄[芪]，稍加桂枝；阳虚严重者可少用附子。火气上蒸胃中的湿气，也能引起出汗，以凉膈散为主治。自汗和盗汗，都忌用生姜，因为生姜会开泄腠理。盗汗属于血虚、阴虚，小儿不必特别治疗，当归大黄汤效果很好，但药性寒凉而人体虚弱者，需兼用黄[芪]、甘草来补气。麻黄根治疗盗汗非常快捷，因为其性能通行周身之表，引导诸药到达卫分从而固密腠理。盗汗伴有发热，因阴虚者用四物汤加黄柏，兼气虚者加人参、白术。盗汗是指表里都出汗，不是像自汗那样自然流出，多因心虚所致，适宜收敛心气、益补肾水，使阴阳调和，水的升降正常，汗自然停止。《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；受惊而耗伤精气，汗出于心；负重远行，汗出于肾；惊慌恐惧，汗出于肝；肢体摇动劳累，汗出于脾。然而肥胖的人多自汗，因为他们多气虚；瘦人多盗汗，因为他们多阴虚有火。只是脏腑原本都有津液，一旦因劳倦损伤，都足以导致出汗，然而血与汗，名称不同但同类，所以失血的人不会再出汗，大汗淋漓的人也不会再失血。
五脏六腑表里的阳气，都由心主宰，以运行其变化，随时升降，在所之处生成津液；也随着火邪扰动，在所之处泄出而为汗，所以汗完全由心发出。醒来时出汗叫自汗，属于阳虚；睡觉时出汗叫盗汗，属于阴虚。汗是心的阳气，睡眠是肾的阴气，一则阳虚不能固护体表，二则阴虚不能闭藏内脏。有胃腑之气旁达于外表现为手足汗的，有胃热熏蒸头部导致自汗而属实证的，所以外感初起症状多自汗。海藏（张元素）说：给予寒脉散和三黄丸，三天病愈，盖因肾主五液，化为五湿，肾水上行，乘心之虚，心火上炎而入肺，欺侮肺不胜皮毛而使腠理开放，从而出汗。先用凉膈散泻胸中相火，再用三黄丸泻心火以助阴，则肾水退舍回归本脏，玄府固闭而汗自然停止。这可以证明初起实热导致出汗的一种情况，然而并非一概可以用治有余的方法来治不足。
《内经》说：心的液为汗。东垣（李杲）说：坤土主湿，在人体为脾胃，人的汗，就像天地的阴气，化为雾和雨一样。《内经》唯独强调心，东垣又指向脾胃而言，大概心属火主热，脾胃为土主湿，湿热相搏，形成汗是明确的。如同天气下降，地湿上升，乃成霖雨。又如蒸笼中烧酒，若非汤火熏蒸淘洗，则不能成涓滴之汗。然而人身清阳之气上行达表，充实腠理而固护皮毛，称为卫气，卫气象天，天包地外，一气统摄，犹如卫气包护一身。《内经》云，阳气致密才能固守，阳气致密即指腠理致密。此气主于肺，而根本在胃，所以胃气充盛则卫气坚实。自汗、盗汗的症状，虽然致病表现相同，但其源头不同。自汗乃是阳虚、气虚、有湿，大概阳气虚则不能卫护肌表，所以醒时津液淋漓而出汗。盗汗乃是阴虚、血虚、有火，阴血虚，则不能荣养于内，所以睡里凑凑然而汗出，肾多主管此事，因其闭藏的功能失守。然而自汗属阳虚，是古今的定论，但真阴衰弱，也会令自汗，大概阴虚则火动乘于阴位，阴精被火煎熬而出，如同干竹而以火燃之，也有油渗出，不可一概用参、术、黄[芪]与桂枝来收敛，只要补其阴，则火自潜伏而汗自止矣。应当兼以脉候辨别。
方书中多言血与汗异名而同类，丹溪（朱震亨）沿袭此说，遂有在内为血，在外为汗的论点，似乎血即是汗，汗即是血了。哪里知道血与汗的由来，有不可以同类并言的地方，《内经》说：心主血，血生于心；又说：肾主五液，人心为汗；又说：汗者，心之液，这是说汗为心之液，而非说心之血。血生于心，统于脾，藏于肝，其源则来自水谷的精气，受纳于中焦，变化取汁，调和于五脏，洒陈于六腑，以奉养生命。至于汗则是人身之津液，因腠理疏豁，皮毛不能外护，暑湿热之邪侵犯它，则津液变为汗，是汗乃身之阳气所化，所以《内经》说：阳加于阴谓之汗，这可以从气来说，而不可以从血类比。况且夏天毫窍不密，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，这更可见汗属津液，而非可血类比更加明显了。何况人之一身有涕、泪、涎、唾、便溺，都属于一水之化，而发于九窍之中。所以鼻之所出曰涕，目之所出曰泪，口之所出曰唾、曰涎，二阴之所出曰便溺，而皮肤之所泄则曰汗，汗如果可以血类比，则涕泪涎唾便溺，也可以说是血了。只是心为君主，汗为心液，汗多的危害，与亡血的危害不远耳，不像便溺那样无大关害。
夫自汗属阳虚有湿，盗汗属阴虚有火，是古哲的定论，然而《内经》说：阳者卫外而为固也，但火与元气势不两立，故火盛则阳衰，阳衰则卫虚，其所虚之卫行于阴，当瞑目之时，正气无力，以固其表，故腠理开，津液泄而为汗，等到醒来则目张，其行阴之气复还于表而汗止矣。称之为盗汗，《内经》名为寝汗。自汗盗汗，虽分阴虚阳虚，然而都归属于卫，且卫气者，实在由谷气所化，肺脏所分布，即天真之阳，必得是而后充大，无是则衰微，变症百出，岂止出汗乎。
汗由血化，血自气生，在内为血，在外为汗，然而汗者心之液也，而肾又主五液，所以汗证未有不由心肾虚而得的。心阳虚不能卫外而为固，则外伤而自汗，不分醒睡，不因劳动，而自能出也；肾阴衰，不能内营而退藏，则内伤而盗汗，睡则汗出，醒则倏收。《内经》说：津脱者，腠理开，汗大泄也。然而二者之汗，各有冷热之分，因寒气乘阳气而发者，所出之汗必冷，因热气乘阴虚而发者，所出之汗必热，虽然，亦有热火过极，亢则害承乃制，反兼胜己之化，而为冷者有之，这又不可不察。比较而论，则自汗为重，盖盗汗真元犹未尽虚，自汗则真元耗散，腠理皆开，肺失统气之权，不能固表，故毫窍疏豁，任其溃泄，势必阳亡阴竭而后已，故自汗阳虚，治当补气，以卫外；盗汗阴虚，治当滋阴以荣内，一以温热补益，一以清凉滋补，总不外收敛固密为主。至于若肺虚未固其皮毛，脾虚者收其中气，心虚者益其血脉，肝虚者禁其疏泄，肾虚者助其封藏，更当观五脏，宜温宜补，或润或燥，不得胶乎一定也。
仲景（张机）说：汗多则亡阳，阳去则阴胜也，重虚其表，阳虚极矣。甚为寒中，有服止汗固表药不应，愈敛愈出，止当理心血，盖汗乃心之液，心无所养，不能摄血，故溢而为汗也，宜大补黄[芪]汤，加酸枣仁。有微热者加石斛。凡治自汗，既用人参、黄[芪]，当必少佐桂枝、防风，以助其达表之力。阳虚甚者，更必少加附子，以翼参、芪之助。内伤虚损，总用补中益气汤，少加麻黄根、制附子为佐助，但升麻、柴胡须少用，而必蜜炙以抑其升发暴悍之性，又欲其引参、芪至表，复不可缺。食滞中宫，热气聚胃而上炎，则头汗出，然在病后产后，悉属阳虚，误治必死。当心汗出，名心汗，乃思虑伤脾，以生脉散或补心丹治之。至阴之处，或两腿挟中，行走劳动，汗出腥秽，此下焦湿热不行也，以渗湿热为主。遇饮食汤饭，鼻上多汗，此肺虚乘热也，宜益肺凉血。两胁之下动辄有汗，此肝虚乘热也，宜补肝养血。饮食汗出如洗，日久心虚液耗，令人消渴偏风，宜及早治之。脾经湿热，淫于四肢，使手足心常有汗，宜抑阳流湿。平人半身出汗，夏月半身有汗，此皆气血不足所致，夭折之兆也。凡衄血吐血，头额汗多，而身上无汗，为阳亡阴竭，及汗出不至足者死。汗出发润，如油之粘，如珠之缀，及淋漓如雨，揩拭不逮者，即三阳绝汗也，不治。脉不为汗衰者，死。额汗如雨，喘促弄色，四肢厥冷，汤药俱呕者，死。大如贯珠，转出不流者，六阳气绝也死。
Treats deficiency sweating and night sweats in children. However, the Heart governs blood; when blood is abundant, it can also transform into sweat, so it is appropriate to astringe Heart Qi.
Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix) (stir-fried, 2 qian each). Grind together into a powder. Take one male pig heart, slice it into three pieces. For each dose, take 2 qian of the powder with one slice of pig heart, decoct together with well water, and administer at a time far removed from meals. Another prescription adds Huang Qi (Astragali Radix) (honey-fried, 2 qian).
Treats spontaneous sweating in children.
Mu Li (Ostreae Concha) (calcined), Huang Qi (Astragali Radix) (honey-fried), Sheng Di Huang (Rehmanniae Radix). Add Fu Xiao Mai (Tritici Levis Fructus) and Ma Huang Gen (Ephedrae Radix et Rhizoma) for decoction. Administer before meals.
Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Huang Qi (Astragali Radix) (honey-fried), Dang Gui (Angelicae Sinensis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma) (roasted, 1 qian each). Use one slice of Sheng Jiang (Zingiberis Rhizoma Recens), add Mai Fu (Tritici Vulgaris Bran) for decoction. Administer before meals.
Mu Li (Ostreae Concha), Ma Huang Gen (Ephedrae Radix et Rhizoma) (each 1 liang), Chi Shi Zhi (Halloysit Rubrum), Nuomi Fen (Oryzae Sativae Glutinosa Farina), Long Gu (Fossilia Ossis Mastodi) (each 5 qian). Grind into a fine powder. Wrap the medicine in cotton cloth and apply as a dusting powder on the body.
Spontaneous sweating belongs to Qi deficiency; Yang deficiency, Blood deficiency, and Damp-Phlegm can also cause it. It is appropriate to use Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix), with a small addition of Gui Zhi (Cinnamomi Ramulus). If Yang deficiency is severe, Fu Zi (Aconiti Lateralis Radix Preparata) can be used in small amounts. Fire Qi steaming upwards dampness in the Stomach can also produce sweat; Liang Ge San (Cool the Upper Jiao Powder) is the primary treatment. Both spontaneous sweating and night sweats contraindicate the use of Sheng Jiang (Zingiberis Rhizoma Recens), because it opens the Cou Li (skin pores and interstitial spaces). Night sweats belong to Blood deficiency and Yin deficiency. In children, specific treatment is not always necessary; Dang Gui Da Huang Tang (Angelica and Rheum Decoction) is very effective. However, since the medicinal nature is cold and the patient is deficient, it should be combined with Huang Qi (Astragali Radix) and Gan Cao (Glycyrrhizae Radix et Rhizoma) to tonify Qi. Ma Huang Gen (Ephedrae Radix et Rhizoma) treats night sweats very rapidly because its property can circulate through the exterior of the whole body, guiding other medicines to the Wei (Defensive) level to consolidate the Cou Li. Night sweats with fever due to Yin deficiency are treated with Si Wu Tang (Four Substances Decoction) plus Huang Bo (Phellodendri Cortex); if accompanied by Qi deficiency, add Ren Shen (Ginseng Radix et Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma). Night sweats refer to sweating on both the interior and exterior, not flowing out naturally like spontaneous sweating; they are mostly caused by Heart deficiency. It is appropriate to astringe Heart Qi and benefit Kidney Water, harmonizing Yin and Yang, normalizing the ascending and descending of Water, so that sweat stops spontaneously. The *Classic* states: "Excess Yang manifests as body heat without sweat; excess Yin manifests as profuse sweating with cold body." Fullness from diet causes sweat from the Stomach; fright consuming Essence causes sweat from the Heart; carrying heavy loads and traveling far causes sweat from the Kidneys; panic and fear cause sweat from the Liver; bodily exertion causes sweat from the Spleen. Fat people often have spontaneous sweating because they tend to have Qi deficiency. Thin people often have night sweats because they tend to have Yin deficiency with Fire. Although the Zang-Fu organs originally contain Jin-Ye (Body Fluids), once damaged by fatigue and overwork, all can lead to sweating. Blood and sweat have different names but are of the same category; therefore, those who lose blood will not sweat, and those who sweat excessively will not lose blood.
The Yang of the exterior and interior of the Five Zang and Six Fu organs are all governed by the Heart to facilitate their transformations, ascending and descending at all times, generating Jin-Ye where they reside; they also exude as sweat where disturbed by Fire. Thus, sweat originates entirely from the Heart. Sweating while awake is called spontaneous sweating, belonging to Yang deficiency. Sweating while sleeping is called night sweating, belonging to Yin deficiency. Sweat is the Yang of the Heart; sleep is the Yin of the Kidney. One case involves Yang deficiency failing to secure the exterior; the other involves Yin deficiency failing to close the interior. Some cases involve Stomach Qi reaching outward, manifesting as hand and foot sweat; some involve Stomach Heat steaming upward, causing head sweat which is excess in nature; thus, early stages of external contraction often present with spontaneous sweating. Hai Zang (Zhang Yuansu) said: "Administer Han Mai San (Cold Pulse Powder) and San Huang Wan (Three Yellow Pill); the disease resolves in three days." This is because the Kidney governs the Five Fluids, transforming them into five types of dampness. When Kidney Water ascends, it exploits Heart deficiency; Heart Fire flares upward into the Lung, bullying the Lung's inability to protect the skin and hair, thereby opening the Cou Li and causing sweat. First, use Liang Ge San (Cool the Upper Jiao Powder) to drain the Ministerial Fire in the chest; then use San Huang Wan (Three Yellow Pill) to drain Heart Fire to assist Yin. Then Kidney Water retreats to its origin, the Xuan Fu (mysterious gates/pores) close firmly, and sweat stops naturally. This demonstrates one manifestation of initial excess-heat causing sweat, but it cannot be generally treated with methods for excess conditions to address deficiency.
The *Classic* states: "The fluid of the Heart is sweat." Dong Yuan (Li Gao) said: "Kun Earth governs dampness; in humans, this is the Spleen and Stomach. Human sweat is like the Yin Qi of Heaven and Earth, transforming into mist and rain." The *Nei Jing* emphasizes the Heart alone, while Dong Yuan points to the Spleen and Stomach. This is because the Heart belongs to Fire and governs Heat, while the Spleen and Stomach belong to Earth and govern Dampness; the interaction of Dampness and Heat clearly produces sweat. Just as heavenly energy descends and earthly dampness rises to form rain, or wine in a steamer requires fire and water vapor to condense into drops, similarly, the Clear Yang Qi of the human body ascends to the exterior, filling the Cou Li and protecting the skin and hair, known as Wei Qi (Defensive Qi). Wei Qi resembles Heaven; just as Heaven envelops Earth, unified by one Qi, so Wei Qi protects the whole body. The *Classic* says, "Yang must be dense to be secure"; density of Yang refers to dense Cou Li. This Qi is dominated by the Lung but rooted in the Stomach; thus, when the Stomach is full, Wei Qi is solid. Spontaneous sweating and night sweating are symptoms of the same disease but have different origins. Spontaneous sweating is due to Yang deficiency, Qi deficiency, and Dampness; when Yang Qi is deficient, it cannot protect the muscle surface, so Jin-Ye flows profusely while awake. Night sweating is due to Yin deficiency, Blood deficiency, and Fire; when Yin-Blood is deficient, it cannot nourish the interior, so sweat emerges subtly during sleep. The Kidney often governs this because its function of storing and sealing has failed. Although spontaneous sweating due to Yang deficiency is an established theory, true Yin weakness can also cause spontaneous sweating. When Yin is deficient, Fire moves and attacks the Yin position; Yin Essence is boiled by Fire and exits, like burning dry bamboo which releases oil. One cannot generally use Ren Shen (Ginseng Radix et Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qi (Astragali Radix), and Gui Zhi (Cinnamomi Ramulus) to astringe; instead, tonifying Yin will cause Fire to subside and sweat to stop spontaneously. Pulse diagnosis should be combined for differentiation.
Prescription books often state that Blood and Sweat have different names but are of the same category. Dan Xi (Zhu Zhenheng) followed this, proposing that Blood is inside and Sweat is outside, implying Blood is Sweat and Sweat is Blood. However, the origins of Blood and Sweat cannot simply be grouped as the same category. The *Classic* says: "The Heart governs Blood; Blood is born in the Heart." It also says: "The Kidney governs the Five Fluids; entering the Heart, it becomes Sweat." And again: "Sweat is the fluid of the Heart." This means Sweat is the fluid of the Heart, not the Blood of the Heart. Blood is born in the Heart, controlled by the Spleen, stored in the Liver; its source is the essence of food and drink, received in the Middle Jiao, transformed into juice, harmonized among the Five Zang, distributed to the Six Fu, to nourish life. Sweat, however, is the Jin-Ye of the body. When the Cou Li are loose and the skin/hair fail to protect externally, pathogenic factors of Summer-Heat, Dampness, and Heat invade, transforming Jin-Ye into Sweat. Sweat is transformed by the Yang Qi of the body; thus, the *Classic* says: "When Yang acts upon Yin, it is called Sweat." This can be discussed in terms of Qi, but not classified as Blood. Furthermore, in summer, when pores are not tight, drinking hot water causes immediate sweating, depleting Jin-Ye externally and reducing urine volume. In winter, when Cou Li are closed, sweat does not overflow, and urination is frequent. This further proves that Sweat belongs to Jin-Ye and cannot be classified as Blood. Moreover, the body has nasal mucus, tears, saliva, phlegm, feces, and urine, all derived from the same water transformation, emerging from the nine orifices. What comes from the nose is mucus; from the eyes, tears; from the mouth, saliva and phlegm; from the two lower orifices, feces and urine; and from the skin, sweat. If Sweat could be classified as Blood, then mucus, tears, saliva, and phlegm could also be called Blood. However, since the Heart is the Sovereign and Sweat is the Heart's fluid, the harm of excessive sweat is not far from the harm of blood loss, unlike feces and urine which have less critical impact.
Spontaneous sweating belongs to Yang deficiency with Dampness; night sweating belongs to Yin deficiency with Fire. This is the established view of ancient sages. However, the *Classic* states: "Yang guards the exterior and secures it." Fire and Original Qi cannot coexist peacefully; thus, when Fire is excessive, Yang declines; when Yang declines, Wei Qi becomes deficient. When this deficient Wei Qi enters the Yin, during sleep, Zheng Qi (Upright Qi) lacks strength to secure the exterior, so the Cou Li open, and Jin-Ye leaks out as sweat. Upon waking, the eyes open, the Qi that entered the Yin returns to the exterior, and sweating stops. This is called night sweating; the *Classic* calls it "sweat during sleep" (Qin Han). Although spontaneous and night sweating are divided into Yin and Yang deficiency, they all belong to Wei Qi. Wei Qi is actually transformed from Grain Qi and distributed by the Lung; it is the True Tian-Zhen Yang. It must be sufficient to become robust; without it, it becomes weak, leading to myriad pathological changes, not just sweating.
Sweat is transformed from Blood; Blood is generated from Qi. Inside is Blood, outside is Sweat. Yet Sweat is the fluid of the Heart, and the Kidney governs the Five Fluids. Therefore, there is no sweating syndrome that does not originate from Heart and Kidney deficiency. Heart Yang deficiency fails to guard the exterior and secure it, leading to external injury and spontaneous sweating, occurring regardless of wakefulness or sleep, and without labor. Kidney Yin decline fails to nourish internally and store, leading to internal injury and night sweating, occurring during sleep and stopping abruptly upon waking. The *Classic* says: "When Jin-Ye is depleted, the Cou Li open, and sweat drains profusely." However, these two types of sweat have cold and hot distinctions. Caused by Cold Qi attacking Yang Qi, the sweat will be cold. Caused by Heat Qi attacking Yin deficiency, the sweat will be hot. Although extreme Heat may reverse and manifest as cold due to the principle of "excess leads to counteracting manifestations," this must be carefully observed. Comparatively, spontaneous sweating is more severe. Night sweating indicates the True Yuan (Original Energy) is not yet fully deficient; spontaneous sweating indicates True Yuan is exhausted, Cou Li are all open, the Lung loses its authority to govern Qi, and cannot secure the exterior. Thus, pores are loose, allowing uncontrolled leakage, inevitably leading to Yang collapse and Yin exhaustion. Therefore, for spontaneous sweating due to Yang deficiency, treatment should tonify Qi to guard the exterior; for night sweating due to Yin deficiency, treatment should nourish Yin to enrich the interior. One uses warm and tonifying methods, the other cool and nourishing methods; both ultimately focus on astringing and consolidating. If the Lung is deficient and fails to secure the skin and hair, tonify the Lung; if the Spleen is deficient, gather its Middle Qi; if the Heart is deficient, benefit its Blood vessels; if the Liver is deficient, restrict its dispersing action; if the Kidney is deficient, assist its storing function. One must observe the Five Zang, determining whether to warm, tonify, moisten, or dry, without adhering rigidly to fixed rules.
Zhong Jing (Zhang Zhongjing) said: "Profuse sweating leads to Yang collapse; when Yang departs, Yin prevails." Repeatedly damaging the exterior, Yang deficiency becomes extreme. Severe cold affects the interior. If antiperspirant and exterior-securing medicines fail, and sweating increases with astringents, one should only regulate Heart Blood. Since sweat is the fluid of the Heart, if the Heart lacks nourishment, it cannot control Blood, causing it to overflow as sweat. Use Da Bu Huang Qi Tang (Great Tonification of Astragalus Decoction) with Suan Zao Ren (Ziziphi Spinosae Semen). Add Shi Hu (Dendrobii Caulis) if there is slight heat. In treating spontaneous sweating, after using Ren Shen (Ginseng Radix et Rhizoma) and Huang Qi (Astragali Radix), one must add small amounts of Gui Zhi (Cinnamomi Ramulus) and Fang Feng (Saposhnikoviae Radix) to assist their power to reach the exterior. If Yang deficiency is severe, add small amounts of Fu Zi (Aconiti Lateralis Radix Preparata) to support Ren Shen and Huang Qi. For internal injury and deficiency damage, generally use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), adding small amounts of Ma Huang Gen (Ephedrae Radix et Rhizoma) and Zhi Fu Zi (Prepared Aconite Root) as assistants. Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix) must be used sparingly and honey-fried to suppress their violent ascending nature, while still guiding Ren Shen and Huang Qi to the exterior, which is indispensable. Food stagnation in the Middle Palace causes Heat to gather in the Stomach and flare upward, resulting in head sweat. However, after illness or postpartum, this all belongs to Yang deficiency; misdiagnosis will be fatal. Heart sweating is named Xin Han (Heart Sweat), caused by overthinking injuring the Spleen; treat with Sheng Mai San (Generate the Pulse Powder) or Bu Xin Dan (Tonify the Heart Pill). At Yin locations, such as between the thighs, sweating with a foul odor during walking or labor indicates stagnant Damp-Heat in the Lower Jiao; treat primarily by draining Damp-Heat. Excessive sweating on the nose when eating or drinking indicates Lung deficiency compounded by Heat; benefit the Lung and cool the Blood. Frequent sweating under the costal margins indicates Liver deficiency compounded by Heat; tonify the Liver and nourish the Blood. Sweating profusely like washing after meals, prolonged Heart deficiency and fluid depletion, can lead to Xiao Ke (Wasting-Thirst) and Bi Syndrome (Paralysis); treat early. Damp-Heat in the Spleen Meridian flooding the limbs causes constant sweating on the palms and soles; suppress Yang and drain Dampness. Half-body sweating in healthy individuals, or half-body sweating in summer, indicates insufficient Qi and Blood, a sign of premature death. Epistaxis or hematemesis with excessive forehead sweat but no body sweat indicates Yang collapse and Yin exhaustion; sweating that does not reach the feet is fatal. Sweating with moist hair, sticky like oil, bead-like, or pouring like rain, unable to be wiped dry, constitutes the "Six Yang Absolute Sweat" (Jue Han) and is untreatable. A pulse that does not weaken after sweating indicates death. Forehead sweat like rain, panting, abnormal facial color, cold limbs, and vomiting all medicines indicate death. Sweat beads large as strings of pearls, turning but not flowing, indicates the extinction of the Six Yang Qi and death.