总括 小儿自汗症多端，切莫将为一例看，要识阴阳虚实候，勤勤调理自平安。
脉法 脉大而虚浮而濡者，在尺为自汗，在寸为盗汗。伤寒脉阴阳俱紧当无汗，若自汗为亡阳之症，不治。
《内经》曰∶心之液为汗。《原病式》曰∶心热则汗出。东垣云∶西南坤土也，在人为脾胃。夫人之汗，犹天地之
雨，阴滋其湿则为雾露为雨也。按《内经》独主于心，而东垣又指脾胃而言，何也？盖心为君火主热，脾胃属土主湿，
湿热相搏为汗明矣，亦如地之湿气为云雾，而上升于天，若不下降则不成霖雨也。夫五脏皆令人出汗，独心与脾胃主其
湿热，此乃总司耳。故《经》曰∶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。若自汗与盗汗者，病虽似而实不同也，细详于后。
（凡汗出发润，一不治也；汗出如油，二不治也；汗凝如珠，三不治也。通身出汗谓之热越，热气越于四体也。睡
熟汗出，醒而收者为盗汗。丹溪云∶自汗属气虚，人参黄 ，少佐以桂枝汤，虚甚附子汤亦可。盗汗属血虚，当归六黄
汤神效。火气上蒸，胃中之湿亦然作汗，凉膈散主之。）
小儿脾虚自汗，多出额上，沾黏人手，速救胃气，服全蝎观音散。
脾虚泻自汗，遍身冷，而出有时，遇泻则无，泻过则有，此候大虚，急当以参苓白术散服之。
肺虚自汗，右脸色多 白，肺脉按之无力，久因咳嗽连声不已，乃肺经虚气上壅致令汗出，宜补肺散为治，及以藿
香饮调脾，此又益母救子之义也。
慢惊自汗，遍体俱有，其冷如冰，此症已危，详慢惊论内。
有实症自汗，外因感受风邪发热，无问昏醒，浸浸自汗出，当用百解散，或间投五苓散。
有小儿无疾，睡中汗出如水，觉而经久不干，此名积症盗汗，脾冷所致，用三棱散。
有时时冷汗微出，发根如贯珠，而额上 然，此为惊汗，宜抱龙丸及茯神汤加麻黄根服。
有睡中汗自出者，曰盗汗，此阳虚所致，久不已，令人羸脊枯瘦，心气不足，津液妄出故也，用茯神汤加黄 煎服。
〔附方〕
当归六黄汤 当归 生地 熟地 黄 黄连 黄芩 黄柏
凉膈散 桔梗 薄荷 甘草 栀子 连翘 大黄 芒硝
全蝎观音散 莲肉 人参 扁豆 天麻 防风 全蝎 羌活 白芷 木香 黄 茯苓 神曲 甘草
参苓白术散 见霍乱症内。
补肺散 阿胶 茯苓 铃 糯米 杏仁 甘草
藿香饮 人参 半夏 赤茯 甘草 苍术 陈皮 藿香 浓朴
百解散 见热症内（一方加升麻）
五苓散 见惊风症内。
三棱散 见诸吐症内。
抱龙丸 见惊风症内。
茯神汤 茯神 人参 当归 甘草
总括：小儿自汗的症状表现多种多样，切勿将其视为同一种情况看待。必须辨识阴阳虚实的证候，精心调理自然能够平安无事。
脉法：脉象大而虚浮且濡软的，尺部出现多为自汗，寸部出现多为盗汗。伤寒病中，若脉象阴阳两部都紧，应当无汗；如果此时出现自汗，则是亡阳的危重证候，难以治愈。
《内经》说：心的体液是汗。《原病式》说：心热则汗出。李东垣说：西南方属坤土，在人体对应脾胃。人的汗液，就像天地的雨水一样，阴气滋润湿气就形成雾露和雨水。按照《内经》的观点，出汗主要与心有关，而李东垣又指出与脾胃有关，这是为什么呢？因为心属君火主热，脾胃属土主湿，湿热相互搏结形成汗液是很明显的道理，也如同地上的湿气变成云雾，上升于天空，如果不能下降就不能形成霖雨。五脏都能导致出汗，只有心和脾胃主管湿热，这是总的概括。所以《内经》说：饮食过饱，汗出于胃；受惊耗伤精气，汗出于心；负重远行，汗出于肾；奔跑恐惧，汗出于肝；身体摇动劳累，汗出于脾。至于自汗和盗汗，病症虽然相似但实际上不同，详细论述在后面。
（凡是汗出后头发湿润，是一不治；汗出如油，是二不治；汗凝滞如珠状，是三不治。全身出汗称为“热越”，即热气发散到四肢。熟睡时出汗，醒来后停止的称为盗汗。朱丹溪说：自汗属于气虚，用人参、黄芪，稍微佐以桂枝汤，虚损严重的也可以用附子汤。盗汗属于血虚，用当归六黄汤效果极佳。火气上蒸，胃中的湿气也随之化为汗液，用凉膈散主治。）
小儿脾虚导致的自汗，多从额头冒出，汗水黏腻沾手，需迅速挽救胃气，服用全蝎观音散。
脾虚泄泻伴随自汗，全身发冷，出汗有定时，腹泻时不出汗，腹泻过后才出汗，这种证候属于大虚，急需服用参苓白术散。
肺虚自汗，右侧脸色多苍白，肺脉按之无力，长期因咳嗽不止，这是肺经虚气上壅导致出汗，宜用补肺散治疗，并用藿香饮调理脾胃，这又是“益母救子”的道理。
慢惊风伴随自汗，全身都有，身体冷如冰，此症已经危险，详见慢惊风的论述。
有实证自汗，外感风邪发热，无论昏睡还是清醒，浸渍般地自汗出，当用百解散，或者间歇投服五苓散。
有的小儿没有疾病，睡觉时出汗如水，醒来后很久不干，这叫积症盗汗，由脾冷引起，用三棱散。
有时冷汗微微渗出，发根像串珠一样，额头光亮，这叫惊汗，宜用抱龙丸及加麻黄根的茯神汤服用。
有睡觉时汗自动流出的，叫盗汗，这是阳虚所致，久治不愈，使人脊背消瘦枯瘦，心气不足，津液妄出，因此用茯神汤加黄芪煎服。
〔附方〕
当归六黄汤：当归、生地、熟地、黄芪、黄连、黄芩、黄柏
凉膈散：桔梗、薄荷、甘草、栀子、连翘、大黄、芒硝
全蝎观音散：莲肉、人参、扁豆、天麻、防风、全蝎、羌活、白芷、木香、黄芪、茯苓、神曲、甘草
参苓白术散：见霍乱症章节。
补肺散：阿胶、茯苓、铃兰（注：原文“铃”通常指麦冬或百合等润肺药，此处依原文保留“铃”，但在中医古籍中常指代特定药材，结合上下文补肺，可能指麦冬或百合，但严格按原文提取为“铃”）、糯米、杏仁、甘草
藿香饮：人参、半夏、赤茯苓、甘草、苍术、陈皮、藿香、厚朴
百解散：见热症章节（一方加升麻）
五苓散：见惊风症章节。
三棱散：见诸吐症章节。
抱龙丸：见惊风症章节。
茯神汤：茯神、人参、当归、甘草
General Overview: The manifestations of spontaneous sweating in children are diverse; do not treat them as a single uniform condition. One must distinguish between yin and yang, deficiency and excess patterns, and with diligent regulation, peace and health will naturally be restored.
Pulse Diagnosis: A pulse that is large, deficient, floating, and soggy indicates spontaneous sweating when felt at the chi position, and night sweating when felt at the cun position. In cold damage diseases, if the pulse is tight in both yin and yang positions, there should be no sweating; if spontaneous sweating occurs instead, it is a sign of Yang collapse (Wang Yang), which is difficult to cure.
The *Neijing* states: "The fluid of the Heart is sweat." The *Yuanbing Shi* states: "When the Heart is hot, sweat is produced." Li Dongyuan said: "The southwest corresponds to Kun Earth, which in humans relates to the Spleen and Stomach." Human sweat is like rain in heaven and earth; when Yin nourishes dampness, it forms mist, dew, and rain. According to the *Neijing*, sweating is primarily governed by the Heart, while Li Dongyuan points to the Spleen and Stomach. Why? Because the Heart belongs to Minister Fire and governs heat, while the Spleen and Stomach belong to Earth and govern dampness. It is clear that the interaction of Damp-Heat produces sweat, just as earthly moisture rises as clouds and mist into the sky; without descending, it does not become heavy rain. All five Zang organs can cause sweating, but only the Heart and Spleen/Stomach govern Damp-Heat; this is the general principle. Thus, the Classics state: "After eating to fullness, sweat comes from the Stomach; after fright depletes Essence, sweat comes from the Heart; carrying heavy loads and traveling far, sweat comes from the Kidney; running fast and fearing, sweat comes from the Liver; bodily movement and toil, sweat comes from the Spleen." As for spontaneous sweating and night sweating, although the symptoms appear similar, they are fundamentally different, as detailed below.
(If hair becomes wet with sweat after sweating, this is the first untreatable condition; if sweat is oily, this is the second; if sweat coagulates into bead-like drops, this is the third. Sweating over the entire body is called "Heat Wandering" (Re Yue), meaning heat dissipates into the four limbs. Night sweating refers to sweating during deep sleep that stops upon waking. Zhu Danxi said: Spontaneous sweating belongs to Qi deficiency; use Ren Shen (Ginseng) and Huang Qi (Astragalus), slightly supplemented with Guizhi Tang (Cinnamon Twig Decoction). If deficiency is severe, Fuzi Tang (Aconite Decoction) may also be used. Night sweating belongs to Blood deficiency; Danggui Liu Huang Tang (Angelica Six-Huang Decoction) is extremely effective. When Fire Qi steams upward, dampness in the Stomach also transforms into sweat, treated with Liang Ge San (Cooling the Diaphragm Powder).)
For children with spontaneous sweating due to Spleen deficiency, sweat often emerges on the forehead, sticky and clinging to hands. One must quickly rescue Stomach Qi and administer Quanxie Guanyin San (Scorpion Guanyin Powder).
For spontaneous sweating accompanied by Spleen deficiency diarrhea, where the whole body feels cold and sweating occurs intermittently—absent during diarrhea but present after—it indicates severe deficiency. Urgently administer Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder).
For spontaneous sweating due to Lung deficiency, the right side of the face is often pale, and the Lung pulse is weak upon pressure. Long-term incessant coughing causes Lung Qi deficiency to rise and obstruct, leading to sweating. Treat with Bufei San (Tonify Lung Powder) and regulate the Spleen with Huoxiang Yin (Agastache Drink), following the principle of "nourishing the mother to save the child."
Spontaneous sweating associated with slow convulsions occurs all over the body, with the body cold as ice. This condition is critical; see the discussion on slow convulsions.
There are cases of spontaneous sweating due to excess syndromes, caused by external wind-pathogen invasion and fever. Regardless of whether the child is unconscious or awake, profuse spontaneous sweating occurs. Use Baisan Jie (Hundred-Dispersal Powder) or administer Wuling San (Five-Ingredient Powder with Poria) intermittently.
Some children have no disease but sweat like water during sleep, remaining wet long after waking. This is called accumulation-type night sweating (Ji Zheng Dao Han), caused by Cold in the Spleen. Use San Leng San (Curcuma Powder).
Occasional slight leakage of cold sweat, with hair roots resembling beads and a shiny forehead, is called fright-sweat. Use Baolong Wan (Dragon-Holding Pill) and Fushen Tang (Poria Spirit Decoction) added with Mahuang Gen (Ephedra Root).
Sweating automatically during sleep is called night sweating, caused by Yang deficiency. If prolonged, it leads to emaciation of the spine and thinness, insufficiency of Heart Qi, and reckless loss of Jin Ye (Body Fluids). Therefore, use Fushen Tang added with Huang Qi (Astragalus) for decoction and administration.
[Attached Formulas]
Danggui Liu Huang Tang (Angelica Six-Huang Decoction): Dang Gui (Angelicae Sinensis Radix), Sheng Di (Rehmanniae Radix), Shu Di (Prepared Rehmanniae Radix), Huang Qi (Astragali Radix), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex).
Liang Ge San (Cooling the Diaphragm Powder): Jie Geng (Platycodonis Radix), Bo He (Menthae Haplocalycis Herba), Gan Cao (Glycyrrhizae Radix et Rhizoma), Zhi Zi (Gardeniae Fructus), Lian Qiao (Forsythiae Fructus), Da Huang (Rhei Radix et Rhizoma), Mang Xiao (Natrii Sulfas).
Quanxie Guanyin San (Scorpion Guanyin Powder): Lian Rou (Nelumbinis Semen), Ren Shen (Ginseng Radix et Rhizoma), Bian Dou (Dolichoris Lablab Semen), Tian Ma (Gastrodiae Rhizoma), Fang Feng (Saposhnikoviae Radix), Quan Xie (Scorpio), Qiang Huo (Notopterygii Rhizoma et Radix), Bai Zhi (Angelicae Dahuricae Radix), Mu Xiang (Aucklandiae Radix), Huang Qi (Astragali Radix), Fu Ling (Poria), Shen Qu (Massa Medicata Fermentata), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder): See Cholera Syndrome section.
Bufei San (Tonify Lung Powder): E Jiao (Colla Corii Asini), Fu Ling (Poria), Ling [Note: Text says 'Ling', likely referring to Mai Dong or Bai He in context, but extracted as is], Nuo Mi (Oryza Glutinosa Semen), Xing Ren (Armeniacae Semen Amarum), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Huoxiang Yin (Agastache Drink): Ren Shen (Ginseng Radix et Rhizoma), Ban Xia (Pinelliae Rhizoma), Chi Fu Ling (Red Poria), Gan Cao (Glycyrrhizae Radix et Rhizoma), Cang Zhu (Atractylodis Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Huoxiang (Agastaches Herba), Hou Po (Magnoliae Officinalis Cortex).
Baisan Jie (Hundred-Dispersal Powder): See Heat Syndrome section (One formula adds Sheng Ma).
Wuling San (Five-Ingredient Powder with Poria): See Convulsive Disease section.
San Leng San (Curcuma Powder): See Various Vomiting Syndromes section.
Baolong Wan (Dragon-Holding Pill): See Convulsive Disease section.
Fushen Tang (Poria Spirit Decoction): Fu Shen (Poria cum Radice), Ren Shen (Ginseng Radix et Rhizoma), Dang Gui (Angelicae Sinensis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma).