睡则汗出,寤则自收也。钱氏曰∶小儿睡而自汗出者,肌肉虚也,止汗散主之。
遍身汗出者,香瓜丸主之,上至胃下至脐,此胃虚也,当补脾,益黄散主之。〔薛〕
自汗属阳虚,盗汗属阴虚,盖阳为卫气,阴为荣血,血之所主心也,所脏肝也,热
搏于心,故液不能内敛而外泄于皮肤,人卧则静而为阴,觉则动而为阳,故曰自汗
属阳,盗汗属阴也,多因心肾不交,水火不能既济,肾虚则闭藏之令失守,故有是
证,宜用六味丸、十全大补汤。血虚内热者,当归六黄汤。心经有热者,导赤散。
肝经虚热者,六味地黄丸。血脱盗汗者,当归补血汤。肝胆风热者,柴胡清肝散。
食积内热者,二陈、枳实、山栀。胃气虚热者,六君子汤及浮麦散。血气俱虚者,
人参养荣汤。余证见自汗,当参览之。〔曾〕有夜睡中而汗自出者,名盗汗。此因
阳虚所致,久不已者令人羸瘠枯瘦,心气不足,津液妄出故也,用茯神汤加黄 ,
水姜枣烧盐汤服。
〔钱〕黄 散 治虚热盗汗。
牡蛎( ) 黄 生地黄(各等分)
上为末。煎服,不拘时。
白术散 治自汗、盗汗。
白术(三两) 小麦(一合,炒)
用水一钟半,煮干去麦为末。以绵黄 煎汤,量儿大小调服。忌萝卜辛辣
炙爆之类,乳母尤忌。又,团参汤亦治盗汗。
尝归六黄汤 治血虚盗汗,内热晡热者。
当归 熟地黄(各五分) 生地黄(炒,三钱) 黄连(炒黑) 黄柏(炒黑) 黄芩(炒黑。各三分)
黄(炒,五分)
上,水煎服。
沉香鳖甲丹 治潮热盗汗。
沉香 草龙胆 当归(洗,焙干) 鳖甲(童子小便浸一宿,去裙 ,酥炙黄) 绵黄 (锉。各一两) 川
黄连 川大黄(微炮。各半两)
上件捣,罗为细末,炼蜜和,如黍米大。每服十粒,用麦门冬去心煎汤下,量
儿大小加减。
苁蓉丹 治血少肌瘦盗汗。
肉苁蓉(酒浸一宿,刮去皱皮,火炙令干) 鳖甲(涂酥炙黄,去裙 。各一两) 当归 绵黄
何首乌(各半两)
上件捣,罗为细末,炼蜜和,如黍米大。每服十粒,温米饮下,食前,量儿大
小加减。
升麻汤 治肌热盗汗。
川升麻 绵黄 人参(去芦头。各一两) 熟干地黄(半两) 以上捣罗为细末。次用天
竺黄 牡蛎粉(各半两,研匀)
上件,通拌匀。每服半钱至一钱,煎竹叶汤调下。
牡蛎散 止盗汗。
牡蛎粉(二两) 麻黄根(为末) 赤石脂(细研) 糯米粉(各一两) 龙脑(一钱,研)
上件,再研,拌匀。每用一匙头,新绵包,每日及夜,常常扑身体头面有汗处。
虎杖散 治实热盗汗。虎杖 水煎服,量多少与之,无时。
〔海〕晋郎中子,自婴至童,盗汗凡七年矣,诸药不效。予与凉膈散、三黄丸,
三日病已。盖肾为五液,化为五湿,相火逼肾,肾水上行,乘心之虚,而入手少阴,
心火炎上而入肺,欺其不胜已也,皮毛以是而开,腠理玄府不闭,而为汗出也。出
于睡中者为盗汗,以其觉则无之,故经曰∶寝汗憎风是也。先以凉膈散泻胸中相火,
相火退,次以三黄丸泻心火以助阴,则肾水还本脏,玄府闭而汗为之自已。
〔曾〕有小儿,无疾睡中遍身汗出如水,觉而经久不干,此名积证盗汗,脾冷所
致,用三棱散,水煨姜煎服,次投益黄散、参苓白术散。
三棱散(癖积)
有时时冷汗微出,发根如贯珠,面额上 然,此为惊肝证,宜镇惊丸或琥珀
抱龙丸,及茯神汤加麻黄根,水煎服,取效。
镇惊丸 琥珀抱龙丸 茯神汤(三方并见惊搐)
睡觉时出汗,醒来后汗液自然停止。钱乙说:小儿睡觉时自然出汗的,是肌肉虚弱所致,用止汗散治疗。
全身出汗的,用香瓜丸治疗;从胃部到脐部出汗的,这是胃虚,应当补脾,用益黄散治疗。〔薛己〕
自汗属于阳虚,盗汗属于阴虚。因为阳气是卫气,阴血是营血,血液由心所主,肝脏是藏血的脏器。热邪搏结于心,导致津液不能内敛而外泄于皮肤。人躺下睡觉时身体静止属阴,醒来活动则属阳,所以说自汗属阳,盗汗属阴。这多因心肾不交,水火不能既济(协调),肾虚则闭藏的功能失守,所以出现这种症状,宜用六味丸、十全大补汤。血虚伴有内热的,用当归六黄汤。心经有热的,用导赤散。肝经虚热的,用六味地黄丸。血脱导致的盗汗,用当归补血汤。肝胆风热的,用柴胡清肝散。食积导致内热的,用二陈汤、枳实、山栀。胃气虚热的,用六君子汤及浮麦散。气血俱虚的,用人参养荣汤。其余证候参见自汗篇,应当参考查阅。〔曾世荣〕有夜间睡眠中汗液自行流出的,称为盗汗。这是因为阳虚所致,久治不愈会导致身体消瘦枯瘦,心气不足,津液妄出,因此使用茯神汤加黄芪,配合水、姜、枣、烧盐煎成的汤剂服用。
〔钱乙〕黄芪散治疗虚热盗汗。
牡蛎(煅) 黄芪 生地黄(各等分)
以上研为末。煎服,不拘时间。
白术散治疗自汗、盗汗。
白术(三两) 小麦(一合,炒)
用水一钟半,煮干后去掉小麦研为末。用绵黄芪煎汤,根据患儿大小调服。忌食萝卜、辛辣、炙烤爆炒之类食物,乳母尤其要忌口。另外,团参汤也治疗盗汗。
尝归六黄汤(注:原文误写为“尝”,应为“当”)治疗血虚盗汗,伴有内热和傍晚发热的。
当归 熟地黄(各五分) 生地黄(炒,三钱) 黄连(炒黑) 黄柏(炒黑) 黄芩(炒黑,各三分) 黄芪(炒,五分)
以上水煎服。
沉香鳖甲丹治疗潮热盗汗。
沉香 草龙胆 当归(洗,焙干) 鳖甲(童子小便浸泡一夜,去裙襕,酥炙黄) 绵黄芪(锉碎,各一两) 川黄连 川大黄(微炮,各半两)
以上捣碎,过筛为细末,炼蜜调和,如黍米大小。每服十粒,用麦门冬去心煎汤送下,根据患儿大小加减用量。
苁蓉丹治疗血少肌瘦盗汗。
肉苁蓉(酒浸一夜,刮去皱皮,火炙令干) 鳖甲(涂酥炙黄,去裙襕,各一两) 当归 绵黄芪 何首乌(各半两)
以上捣碎,过筛为细末,炼蜜调和,如黍米大小。每服十粒,温米饮送下,饭前服用,根据患儿大小加减用量。
升麻汤治疗肌热盗汗。
川升麻 绵黄芪 人参(去芦头,各一两) 熟干地黄(半两) 以上捣罗为细末。次用天竺黄 牡蛎粉(各半两,研匀)
以上混合拌匀。每服半钱至一钱,用竹叶汤调服。
牡蛎散止盗汗。
牡蛎粉(二两) 麻黄根(为末) 赤石脂(细研) 糯米粉(各一两) 龙脑(一钱,研)
以上再研,拌匀。每次取一匙头,用新棉包裹,日夜经常扑擦身体、头部、面部有汗处。
虎杖散治疗实热盗汗。虎杖水煎服,根据病情轻重给予适量,无固定时间。
〔王海〕晋朝郎中的儿子,从婴儿到儿童,盗汗长达七年,各种药物无效。我给他用凉膈散、三黄丸,三天病愈。因为肾对应五液,化为五湿,相火逼迫肾脏,肾水上行,乘心之虚,进入手少阴心经,心火炎上进入肺脏,欺侮肺金不胜心火,皮毛因此开张,腠理玄府不闭合,从而出汗。在睡中出汗的称为盗汗,因为醒来就没有了,所以经文说:寝汗憎风。先用凉膈散泻胸中相火,相火退去,再用三黄丸泻心火以助阴,则肾水回归本脏,玄府闭合,汗自然停止。
〔曾世荣〕有个小儿,无其他疾病,睡觉时全身出汗如水,醒来后很久不干,这叫积证盗汗,由脾冷所致,用三棱散,水煨姜煎服,接着投予益黄散、参苓白术散。
三棱散(癖积)
有时冷汗微微渗出,发根像贯珠一样,面额上隐隐作痛或变色,这是惊肝证,宜用镇惊丸或琥珀抱龙丸,以及茯神汤加麻黄根,水煎服,可获效。
Sweating during sleep, with spontaneous cessation upon waking. Qian Yi stated: When children sweat spontaneously during sleep, it is due to deficiency in the muscles; Zhihan San (Stop Sweat Powder) should be used.
For sweating over the entire body, Xianggua Wan (Melon Pill) is indicated. For sweating extending from the stomach region down to the umbilicus, this indicates Stomach deficiency; the Spleen should be tonified, and Yihuang San (Benefit Yellow Powder) is indicated. [Xue Ji]
Spontaneous sweating belongs to Yang deficiency, while night sweats belong to Yin deficiency. Yang constitutes Wei Qi (Defensive Qi), and Yin constitutes Ying Blood (Nutritive Blood). The Heart governs blood, and the Liver stores blood. Heat pathogen clashing with the Heart causes fluids to fail to remain internalized, leaking externally onto the skin. When lying down to sleep, the body is still and belongs to Yin; upon waking and moving, it belongs to Yang. Thus, spontaneous sweating is attributed to Yang, and night sweats to Yin. This often results from the failure of communication between the Heart and Kidney, where Water and Fire fail to interact harmoniously. Kidney deficiency leads to a loss of the closing and storing function, resulting in these symptoms. Liuwei Wan (Six-Ingredient Rehmannia Pill) and Shiquan Dabu Tang (Ten-Tonifying Decoction) are suitable. For blood deficiency with internal heat, Danggui Liuhuang Tang (Angelica and Honey-Fried Astragalus Decoction) is used. For heat in the Heart Meridian, Daochi San (Guide Out Redness Powder) is indicated. For deficiency heat in the Liver Meridian, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is used. For night sweats due to blood depletion, Danggui Buxue Tang (Angelica Tonify Blood Decoction) is indicated. For Wind-Heat in the Liver and Gallbladder, Chaihu Qinggan San (Bupleurum Clearing Liver Powder) is used. For internal heat due to food stagnation, Erchen Tang (Two-Aged Decoction), Zhishi (Immature Bitter Orange), and Shanzhi (Gardenia Fruit) are used. For deficiency heat of Stomach Qi, Liujunzi Tang (Six-Gentleman Decoction) and Fumai San (Floating Wheat Powder) are used. For combined Qi and Blood deficiency, Renshen Yangrong Tang (Ginseng Nourishing Grace Decoction) is indicated. For other syndromes, refer to the section on spontaneous sweating for consultation. [Zeng Shirong] Night sweats refer to sweating that occurs spontaneously during sleep. This is caused by Yang deficiency. If prolonged, it leads to emaciation and wasting. It results from insufficient Heart Qi and reckless discharge of body fluids. Fushen Tang (Poria Cocos Decoction) added with Huangqi (Astragalus Root) should be used, taken with a decoction of water, ginger, jujube, and burnt salt.
[Qian Yi] Huangqi San (Astragalus Powder) treats night sweats due to deficiency heat.
Muli (Oyster Shell, calcined), Huangqi (Astragalus Root), Shengdihuang (Rehmannia Root, fresh) (equal parts).
Grind into powder. Take as a decoction, at any time.
Baizhu San (Atractylodes Macrocephala Powder) treats spontaneous sweating and night sweats.
Baizhu (Atractylodes Macrocephala Rhizome, 3 liang), Xiaomai (Wheat Grain, 1 he, stir-fried).
Add 1.5 zhong of water, boil until dry, remove wheat, and grind into powder. Mix with a decoction of Mian Huangqi (Silky Milk Vetch Root) and administer according to the child's age. Avoid radish, spicy foods, roasted, fried, or baked items. Nursing mothers must strictly avoid these. Additionally, Tuanshen Tang (Ball-shaped Ginseng Decoction) also treats night sweats.
Danggui Liuhuang Tang (Angelica and Honey-Fried Astragalus Decoction) treats night sweats due to blood deficiency with internal heat and afternoon fever.
Danggui (Angelica Sinensis Root), Shudihuang (Rehmannia Root, prepared) (each 5 fen); Shengdihuang (Rehmannia Root, fresh, stir-fried, 3 qian); Huanglian (Coptis Rhizome, stir-fried black), Huangbai (Phellodendron Bark, stir-fried black), Huangqin (Scutellaria Root, stir-fried black) (each 3 fen); Huangqi (Astragalus Root, stir-fried, 5 fen).
Decoct in water and take orally.
Chenxiang Biejia Dan (Agarwood and Turtle Shell Pill) treats tidal fever and night sweats.
Chenxiang (Aquilaria Wood), Caolongdan (Gentiana Scabra Root), Danggui (Angelica Sinensis Root, washed and dried), Biejia (Turtle Shell, soaked overnight in urine of a young boy, remove skirt-like edges, stir-fried with butter until yellow), Mian Huangqi (Silky Milk Vetch Root, sliced) (each 1 liang); Chuan Huanglian (Coptis Rhizome), Chuan Dahuang (Rhubarb Root, lightly roasted) (each 0.5 liang).
Crush all ingredients, sieve into fine powder, mix with refined honey to form pills the size of millet seeds. Take 10 pills per dose, washed down with a decoction of Ophiopogon Japonicus Tuber (without heart), adjusting dosage according to the child's age.
Congrong Dan (Cistanche Pill) treats night sweats due to low blood volume and emaciation.
Roucongrou (Cistanche Stem, soaked in wine overnight, scraped clean, fire-dried), Biejia (Turtle Shell, coated with butter and stir-fried yellow, remove skirt-like edges) (each 1 liang); Danggui (Angelica Sinensis Root), Mian Huangqi (Silky Milk Vetch Root), Heshouwu (Polygonum Multiflorum Root) (each 0.5 liang).
Crush all ingredients, sieve into fine powder, mix with refined honey to form pills the size of millet seeds. Take 10 pills per dose, washed down with warm rice drink, before meals, adjusting dosage according to the child's age.
Shengma Tang (Cimicifuga Decoction) treats muscle heat and night sweats.
Chuan Shengma (Cimicifuga Rhizome), Mian Huangqi (Silky Milk Vetch Root), Renshen (Ginseng Root, remove rhizome) (each 1 liang); Shugan Dihuang (Prepared Rehmannia Root, 0.5 liang). Crush and sieve into fine powder above. Then add Tianzhuhuang (Calamus Tuber) and Musanfen (Oyster Shell Powder) (each 0.5 liang, ground evenly).
Mix all ingredients thoroughly. Take 0.5 qian to 1 qian per dose, mixed with a Bamboo Leaf Decoction.
Musan San (Oyster Shell Powder) stops night sweats.
Musanfen (Oyster Shell Powder, 2 liang), Mahuanggen (Ephedra Root, ground into powder), Chishizhi (Red Halloysite, finely ground), Nuomicifen (Glutinous Rice Flour) (each 1 liang); Longnao (Borneol, 1 qian, ground).
Grind again and mix evenly. Use one spoonful each time, wrap in new cotton, and frequently dust/powder the sweaty areas of the body, head, and face, day and night.
Huzhang San (Persicaria Polymorpha Powder) treats night sweats due to excess heat. Huzhang (Persicaria Polymorpha Root) decocted in water and administered according to severity, at any time.
[Wang Hai] The son of a Jin Dynasty Langzhong suffered from night sweats for seven years from infancy to childhood, unresponsive to various medicines. I prescribed Liangge San (Cooling Chest Powder) and Sanhuang Wan (Three-Yellow Pill), and the illness resolved in three days. The Kidney corresponds to the five fluids, transforming into five dampnesses. Ministerial Fire forces Kidney Water upward, exploiting Heart deficiency to enter the Hand-Shaoyin Heart Meridian. Heart Fire flares upward into the Lung, bullying the Lung Metal which cannot withstand it. Consequently, the skin pores open, and the Couli (interstices) and Xuanfu (pores) fail to close, leading to sweating. Sweating during sleep is called night sweats because it ceases upon waking. Hence, the classic states: "Night sweats cause aversion to wind." First, use Liangge San to drain the Ministerial Fire in the chest. Once the Ministerial Fire recedes, use Sanhuang Wan to drain Heart Fire to assist Yin, allowing Kidney Water to return to its home organ. The Xuanfu closes, and sweating stops naturally.
[Zeng Shirong] A child had no other disease but sweated profusely like water all over the body during sleep, remaining wet long after waking. This is called accumulation-syndrome night sweats, caused by Cold Spleen. Sanleng San (Sparganium Powder) was used, decocted with water-wrapped ginger, followed by Yihuang San (Benefit Yellow Powder) and Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder).
Sanleng San (for Pi Accumulation)
Occasional slight cold sweating, hair roots resembling beads, and visible discoloration or pain on the forehead indicate Liver Shock Syndrome. Zhenjing Wan (Settle Shock Pill) or Hubao Longwan (Amber Embracing Dragon Pill) should be used, along with Fushen Tang (Poria Cocos Decoction) added with Mahuanggen (Ephedra Root), decocted in water and taken orally for efficacy.
Zhenjing Wan (Settle Shock Pill), Hubao Longwan (Amber Embracing Dragon Pill), Fushen Tang (Poria Cocos Decoction) (All three formulas are described in the section on Convulsions).