《素问》云∶阳气有余，为身热无汗，阴气有余，为多汗身寒，阴阳有余，则无汗而寒。又云∶
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。凡眠熟而汗出，醒则倏收者，曰盗汗，亦曰寝汗。不分
寤寐，不由发表而自然汗出者，曰自汗。若劳役因动汗出，非自汗也。伤寒脉紧，麻黄、葱、豉发之，
汗出于卫。伤寒脉缓，白术、桂枝止之，汗出于荣。往来寒热，眩，柴胡、连翘和之，汗出于少阳。
体若燔炭，地骨皮、秦艽解之，汗出于三焦。厥而抑郁，柴胡、麻黄发之，汗出于血。热聚于胃，大
黄、芒硝下之，汗出于足阳明。阴毒大汗，附子、干姜温之，汗出于三阳。
心之所脏在内者为血，发于外者为汗。汗者，乃心之液。而自汗之证，未有不由心肾俱虚而得之。
故阴阳虚必腠理发热自汗，此固阴阳偏胜而致。又有伤风、中暑、病湿，兼以惊怖、房室、劳极，则
历节、肠痈、痰饮、产蓐等证，亦能令人自汗。仲景谓肉极则自津脱，腠理开，汗大出。巢氏云∶虚
劳病，若阳气偏虚，则津发泄为汗。又云∶心脏热则腠理开，腠理开则汗出。诸家言汗出之义，
大约如此。
尝因是而究之，汗者、津之泄也，津与气同类，气之所至，津即有之，以故知《内经》之言心为汗者，
大矣哉。盖心是主阳之脏，阳乃火也，气也。故五脏六腑表里之阳，皆心脏主之，以行其变化。是故
津者，随其阳气所在之处而生，亦随其火扰所在之处泄出为汗，其汗尽由心出也。不然，何《内经》
言风、言劳动、言阳阴相争者，其汗各由其所在脏腑而出之乎。然五脏六腑，又必以十二经脉、荣卫
为要，因经脉是司其出入行气之隧道。荣行脉中以滋阴血，卫行脉外以固阳气，阳气固则腠理肥，玄
腑密，而脏腑经脉荣卫通贯若一。内之脏腑与表之经脉离居，则两者出入之机皆废，于是邪在于内则
玄府不密，而汗从腑脏出，邪在表则腠理不固，而汗从经脉出，所以自汗之由，不可胜计。至若脏腑
之阴拒格卫气浮散于外，无所根据从，或胃气虚衰，水谷气脱散者，或肺气微弱不能宣行荣卫而津脱者，
如是自汗，虽病重而尚有可治，独三阳之绝汗出者，则不可治矣。阴虚阳必凑，故发热自汗，当归六
黄汤加地骨皮。阳虚阴必乘，故发厥自汗，黄 建中汤，甚者加附子，或 附汤。滑伯仁治一妇，暑月
身冷自汗，口干烦躁欲卧泥水中，脉浮而数，按之豁然虚散。
曰∶《素问》云，脉至而从，按之不鼓，诸阳皆然，此为阴盛格阳。得之饮食生冷，坐卧当风，以真
武汤冷冻饮料之，一进汗止，再进躁去，三进全安。阴阳俱虚，热不甚，寒不甚，秋冬用桂枝，春夏用黄
。脉证无热者，亦用桂枝，脉证有热者，亦用黄 。或身温如常而汗出冷者，或身体冷而汗亦冷，
别无他病，并属本证。戴复庵用黄 建中汤，加浮麦少许煎，黄 六一汤，或玉屏风散。平人气象论
云∶尺涩脉滑，谓之多汗。王注∶谓尺肤涩而尺脉滑也。肤涩者，荣血内涸。又《针经》云∶腠理发
泄，汗出溱溱，是谓津。津脱者，腠理开，汗大泄。按此二经论自汗多而血涸津脱者，东垣周卫
汤，虽曰治湿胜自汗，内有血药，实润剂也，可以治此。湿胜自汗，以东垣法治之。东垣曰∶西南坤
土也，在人则为脾胃。阳之汗，以天地之雨名之。湿主淋淫，骤注者湿胜也。阴滋其湿，为露为雨，
此阴寒隔热火也。隔者解也，阴湿寒下行，地之气也。仲景云∶汗多则亡阳，阳去则阴胜也。重虚则
表阳虚极矣，甚为寒中。湿胜则音声如从瓮中出若中水也。相家有言，土音如居深瓮里，言其壅也、
远也、不出也，其为湿也审矣。又知此二者，亦为阴寒。《内经》云∶气虚则外
寒，虽见热中，蒸蒸为汗，终传大寒。知始为热中者，表虚无阳不任外寒，终传为寒中者，多成痹寒
矣。夫色以候天，脉以候地，形者乃候地之阴阳也。故以脉气候之，皆有形之可见者也。治张芸夫，
四月天寒，阴雨寒湿相杂，因官事饮食失节劳役所伤，病解之后，汗出不止，沾濡数日，恶寒重添浓
衣，心胸闷躁，时躁热，头目昏愦，壅塞食少减，此乃胃外阴火炽甚，与夫雨之湿气挟热，两气相合，
令湿热大作，汗出不休，兼见风邪以助东方甲乙，以风药去其湿，以甘药泻其热，羌活胜湿汤主之。
有痰证冷汗自出者，宜七气汤，或理气降痰汤，痰去则汗自止。火气上蒸胃中之湿，亦能作汗，可用
凉膈散。有气不顺而自汗不止，须理气使荣卫调和，小建中汤加木香。《素问》帝曰∶有病身热解惰，
汗出如浴，恶风少气，此为何病？岐伯曰∶病名酒风。帝曰∶治之奈何？岐伯曰∶以泽泻、术各十分，
麋衔五分，合以三指撮，为后饮。（麋衔，一名薇衔，俗名吴风草。）又云∶饮酒中风，则为漏风。
漏风之状，或多汗，常不可单衣，食则汗出，甚则身汗喘息，恶风，衣裳濡，口干善渴，不能
劳事。河间以白术散主之，此即酒风也。凡五脏风皆自汗恶风。因饮食汗出日久，
心中虚风虚邪，令人半身不遂，见偏风痿痹之病，先除其汗， 悍之气，按而收之，安胃汤。有病后
多汗，服正元散诸重剂不愈，唯八珍散宜之。有别处无汗，独心孔一片有汗，思虑多则汗亦多，病在
心，宜养心血。用 猪心一个，破开，带血入人参、当归二两缝之，煮熟去药，止吃猪心，仍以艾汤
调茯苓末服之。若服药汗仍出者，有热，牡蛎散。无热，小建中汤加熟附子一钱，不去皮，或正元散，
仍以温粉扑之。大汗不止，宜于诸药中入 牡蛎粉二钱半，并吞朱砂丹，或茸朱丹。常自汗出，经年
累月者，多用黑锡丹。久病及大病新愈汗出者，亦可用此。若不宜热补，须交济其阴阳自愈，当以灵
砂丹主之。凡此皆为无他病而独汗出者设，非谓有兼病者也。若服诸药欲止汗固表而并无效验，药愈
涩而汗愈不收止，可理心血。盖汗乃心之液，心无所养不能摄血，故溢而为汗，宜大补黄 汤加酸枣
仁。有微热者，更加石斛，兼下灵砂丹。汗出如胶之粘，如珠之凝，及淋漓如雨，揩拭不逮者，难治。
【诊】肺脉软而散者，当病灌汗，至今不复散发也。肺脉缓甚为多汗。
【头汗】阴阳俱虚，枯燥，头汗，亡津液也。热入血室，头汗。伤湿额上汗，因下之。微
喘者死。胃上热熏，额汗。发黄头汗，小便不利而渴，此瘀血在里也。心下懊 ，头汗。伤寒结胸，
无大热，以水结在胸胁间，头汗。往来寒热，头汗。海藏云∶头汗出，剂颈而还，血证也。额上偏多，
何谓也？曰∶首者六阳之所会也，故热熏蒸而汗出也。额上偏多以部分，左颊属肝，上颊属肺，鼻属
中州，颐属肾，额属心。三焦之火涸其肾水，沟渠之余迫而上入于心之分，故发为头汗，而额上偏多
者，属心之部，而为血证也。饮酒、饮食头汗出者，亦血证也。至于杂证，相火迫肾水上行，入于心
为盗汗，或自汗，传而为头汗出者，或心下痞者，俱同血证例治之。无问伤寒、杂病、酒积，下之而
心下痞者，血证也。何以然？曰∶下之亡阴，亡阴者则损脾胃而亡血，气在胸中，以亡其血陷之于心
之分也。故心下痞，世人以为血病，用气药导之则痞病愈甚，而又下之，故变而为中满鼓胀，非其治
也。然则当作何治？曰∶独益中州脾土，以血药治之，其法无以加矣。头汗出，胸胁满，小便不利，往
来寒热，心烦，呕而不渴，柴胡桂姜汤。身微热，表虚，头汗出不已，或因医者发汗以致表虚者，黄
汤。
【手足汗】一男子手足汗，医用芩、连、柏并补剂，皆不效。又足汗常多，后以八物、半、苓为君，白附、
川乌佐使，其汗即无。治脚汗，白矾、干葛各等分为末，每半两、水三碗，煎十数沸洗，日一次，三
五日自然无汗。
【阴汗】别见。
【无汗】经云∶夺血者无汗，夺汗者无血。束垣云∶真气已亏，胃中火盛，汗出不休，胃中真气已竭。若
阴火已衰，无汗反燥，乃阴中之阳，阳中之阳俱衰，四时无汗，其形不久，湿衰燥旺，理之常也。其
形不久者，秋气主杀，生气乃竭，生气者，胃之谷气也。乃春少阳生化之气也。丹溪云∶盛夏浴食无
汗为表实。治谢老夏月无汗久嗽，用半夏、紫苏二味为末，入莎末、枕流末、（蚬壳灰、蛤粉之属。）
仁陷末（神曲），以栝蒌穣、桃仁泥半两为丸，先服三拗汤三帖，却服此丸子。
《素问》说：阳气有余，表现为身体发热且无汗；阴气有余，表现为多汗且身体发冷；阴阳俱有余，则既无汗又身体发冷。又说：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；疾走恐惧，汗出于肝；肢体摇动劳苦，汗出于脾。凡是熟睡时出汗，醒来后汗液突然停止的，称为盗汗，也称为寝汗。不分醒着还是睡着，不因发汗治疗而自然出汗的，称为自汗。如果是因劳累活动而出汗，不属于自汗。伤寒脉紧，用麻黄、葱白、豆豉发汗，汗出于卫分；伤寒脉缓，用白术、桂枝止汗，汗出于营分。寒热往来、眩晕，用柴胡、连翘和解，汗出于少阳经；身体像燃烧的炭火一样热，用地骨皮、秦艽解表清热，汗出于三焦；四肢厥冷且情绪抑郁，用柴胡、麻黄发散，汗出于血分；热邪聚集于胃，用大黄、芒硝攻下，汗出于足阳明胃经；阴毒证大汗淋漓，用附子、干姜温阳，汗出于三阳经。
心在内贮藏血液，在外表现为汗液。汗，是心的津液。而自汗这一病症，没有不是由于心肾两虚引起的。所以阴阳虚弱必然导致腠理（皮肤毛孔）发热并自汗，这确实是阴阳偏盛偏衰所致。又有伤风、中暑、患湿病，兼有惊恐、房事过度、极度疲劳等情况，那么历节病、肠痈、痰饮、产后等病症，也能使人出现自汗。张仲景说肌肉极度虚弱则津液脱失，腠理开张，大汗淋漓。巢元方说：虚劳病，如果阳气偏虚，则津液外泄化为汗。又说：心脏有热则腠理开张，腠理开张则出汗。各家对汗出机理的说法，大致如此。
我曾经因此探究其原理，汗是津液的泄漏，津与气同类，气到达的地方，津也就随之存在，因此知道《内经》说“心为汗”的道理非常宏大。大概因为心是主宰阳气的脏腑，阳就是火，就是气。所以五脏六腑表里的阳气，都由心所主宰，以运行其变化。因此津液，随着阳气所在之处而产生，也随着火热扰动所在之处泄漏出来成为汗，这些汗最终都由心发出。不然的话，为什么《内经》说风邪、劳动、阴阳相争导致的汗，各自从其所在的脏腑而出呢？然而五脏六腑，又以十二经脉、营卫为关键，因为经脉是主管气出入运行的通道。营气在脉中运行以滋养阴血，卫气在脉外运行以固护阳气，阳气固护则腠理致密，玄府（汗孔）紧密，从而脏腑经脉营卫贯通如一。如果内部的脏腑与外部的经脉分离，那么两者出入的机制都会废弛，于是邪气在内部则玄府不密，汗从脏腑渗出；邪气在体表则腠理不固，汗从经脉渗出，所以自汗的原因，数不胜数。至于脏腑之阴排斥卫气浮散于外，无所依附，或者胃气虚衰，水谷之气涣散，或者肺气微弱不能宣通荣卫而导致津液脱失，这样的自汗，虽然病情严重但还有可治之机，唯独三阳经绝汗出的，就不可治了。阴虚则阳必凑集，所以发热自汗，用当归六黄汤加地骨皮。阳虚则阴必乘袭，所以发厥自汗，用黄芪建中汤，严重的加附子，或四逆汤。滑伯仁治疗一位妇人，暑天身体发冷自汗，口干烦躁想卧在泥水中，脉浮而数，重按豁然空虚散乱。他说：《素问》说，脉象表面顺从，重按却不鼓指，诸阳脉皆如此，这是阴盛格阳。因饮食生冷，坐卧当风所致，用真武汤冷冻后饮用，服一次汗止，服两次烦躁去除，服三次完全康复。阴阳都虚，热不明显，寒也不明显，秋冬季节用桂枝汤，春夏季节用黄芪建中汤。脉证没有热的，也用桂枝汤；脉证有热的，也用黄芪建中汤。或者身体温度正常但出汗冰冷，或者身体发冷且汗也冰冷，没有其他疾病，都属于本证。戴复庵用黄芪建中汤，加少许浮小麦煎煮，或用黄芪六一汤，或玉屏风散。《平人气象论》说：尺脉涩而脉滑，称为多汗。王冰注解说：是指尺部皮肤涩而尺部脉搏滑。皮肤涩，是因为营血在内枯竭。又《针经》说：腠理发泄，汗出溱溱（形容汗出连绵不断），这叫津。津液脱失，则腠理开张，大汗淋漓。看这两部经典论述自汗多因血涸津脱，东垣的周卫汤，虽然说是治疗湿胜自汗，内含血药，实际上是润剂，可以治疗这种情况。湿胜自汗，用东垣的方法治疗。东垣说：西南方属坤土，在人体对应脾胃。阳之汗，以天地之雨来命名。湿主淋淫骤注，这是湿胜。阴滋长其湿，化为露为雨，这是阴寒隔隔热火。隔者，解也，阴湿寒下行，是地之气。张仲景说：汗多则亡阳，阳去则阴胜。重虚则表阳虚极，甚则为寒中。湿胜则声音像从瓮中发出，如同中水邪。相家说，土音如居住在深瓮里，说的是壅滞、遥远、不出来的意思，这确是湿邪。又知这两种情况，也是阴寒。《内经》说：气虚则外寒，虽然见到热中症状，蒸蒸出汗，最终传变为大寒。知道开始为热中的，是因为表虚无阳不能抵御外寒，最终传变为寒中的，多形成痹寒。夫色用以候天，脉用以候地，形体乃用以候地的阴阳。所以用脉气候察，都有形可见。治疗张芸夫，四月天气寒冷，阴雨寒湿混杂，因公务饮食失节、劳役所伤，病解之后，汗出不止，沾湿数日，恶寒加重添穿厚衣，心胸闷躁，时而燥热，头目昏沉，壅塞食少减少，这是胃外阴火炽盛，加上雨的湿气挟带热气，两气相合，令湿热大作，汗出不休，兼见风邪助长东方甲乙木气，用风药去其湿，用甘药泻其热，以羌活胜湿汤为主。有痰证冷汗自出的，宜用七气汤，或理气降痰汤，痰去则汗自止。火气上蒸胃中之湿，也能作汗，可用凉膈散。有气不顺而自汗不止，须调理气机使荣卫调和，用小建中汤加木香。《素问》黄帝问：有病身热懈怠，汗出如浴，恶风少气，这是什么病？岐伯说：病名叫酒风。黄帝问：怎么治疗？岐伯说：用泽泻、白术各十分，麋衔五分，合在一起用三指撮取，饭后服用。（麋衔，一名薇衔，俗名吴风草。）又说：饮酒中风，则为漏风。漏风的症状，或多汗，常不能穿单衣，吃饭就出汗，甚至身体出汗喘息，恶风，衣裳湿透，口干善渴，不能从事劳作。河间用白术散主治，这就是酒风。凡五脏风皆自汗恶风。因饮食出汗日久，心中虚风虚邪，令人半身不遂，出现偏风痿痹的病，先除其汗，收敛悍戾之气，按而收之，用安胃汤。有病后多汗，服用正元散等重剂不愈，唯八珍散适宜。有别处无汗，独心口一片有汗，思虑多则汗也多，病在心，宜养心血。用一个猪心，剖开，带着血放入人参、当归二两缝合，煮熟去掉药渣，只吃猪心，仍以艾汤调服茯苓末。如果服药后汗仍出，有热的，用牡蛎散。无热的，用小建中汤加熟附子一钱，不去皮，或正元散，仍以温粉扑身。大汗不止，宜在诸药中加入牡蛎粉二钱半，并吞服朱砂丹，或茸朱丹。经常自汗，经年累月的，多用黑锡丹。久病及大病新愈汗出的，也可用此。若不宜热补，须交济其阴阳自愈，应当以灵砂丹主治。凡此皆为无他病而独汗出者设立，不是说有兼病的人。如果服用诸药想要止汗固表却无效验，药越收敛汗越不收止，可调理心血。盖汗乃心之液，心无所养不能摄血，故溢出而为汗，宜大补黄芪汤加酸枣仁。有微热的，再加石斛，兼服灵砂丹。汗出如胶般粘，如珠般凝，以及淋漓如雨，擦拭不及的，难治。
【诊法】肺脉软而散的，应当病灌汗，至今不再散发。肺脉缓甚为多汗。
【头汗】阴阳俱虚，枯燥，头汗，是亡津液。热入血室，头汗。伤湿额上汗，因误下所致。微喘者死。胃上热熏蒸，额汗。发黄头汗，小便不利而渴，这是瘀血在里。心下懊憹，头汗。伤寒结胸，无大热，因水结在胸胁间，头汗。寒热往来，头汗。海藏说：头汗出，仅到颈部而还，是血证。额上偏多，为什么呢？说：头部是六阳经交会之处，所以热熏蒸而汗出。额上偏多以部位划分，左颊属肝，右颊属肺，鼻属中州，颐属肾，额属心。三焦之火枯竭肾水，沟渠之余迫而上入于心之分野，所以发为头汗，而额上偏多的，属心之分野，而为血证。饮酒、饮食后头汗出，也是血证。至于杂证，相火迫使肾水上行，入于心为盗汗，或自汗，传变为头汗出的，或心下痞的，都同血证例治疗。不问伤寒、杂病、酒积，下之而心下痞的，是血证。为什么这样？说：下法亡阴，亡阴则损伤脾胃而亡血，气在胸中，因亡血陷于心之分野。所以心下痞，世人以为是血病，用气药导之则痞病更甚，而又下之，故变而为中满鼓胀，这不是正确的治法。然而应当如何治疗？说：独益中州脾土，用血药治疗，这种方法无以复加了。头汗出，胸胁满，小便不利，寒热往来，心烦，呕而不渴，用柴胡桂姜汤。身微热，表虚，头汗出不已，或因医生发汗以致表虚的，用黄芪汤。
【手足汗】一个男子手足出汗，医生用黄芩、黄连、黄柏并补剂，都不见效。又足汗常多，后来以八物汤、半夏、茯苓为主药，白附子、川乌为佐使药，其汗即止。治疗脚汗，白矾、干葛各等分为末，每半两，水三碗，煎煮十余沸后洗脚，每日一次，三五日自然无汗。
【阴汗】另见相关章节。
【无汗】经文说：夺血者无汗，夺汗者无血。束垣说：真气已亏，胃中火盛，汗出不休，胃中真气已竭。如果阴火已衰，无汗反燥，乃阴中之阳、阳中之阳俱衰，四季无汗，其寿命不长，湿衰燥旺，是治理的常理。其寿命不长者，秋气主杀，生气乃竭，生气者，胃之谷气也，乃春少阳生化之气。丹溪说：盛夏洗澡进食无汗为表实。治疗谢老夏月无汗久嗽，用半夏、紫苏二味为末，入莎草根末、枕流末（蚬壳灰、蛤粉之类）、神曲末，以瓜蒌瓤、桃仁泥半两为丸，先服三拗汤三帖，再服此丸子。
The *Suwen* (Basic Questions) states: When Yang qi is in excess, it manifests as body heat and anhidrosis; when Yin qi is in excess, it manifests as hyperhidrosis and coldness of the body; when both Yin and Yang are in excess, there is neither sweating nor heat. It further states: Excessive fullness from food leads to sweat originating from the Stomach; fright causing depletion of essence leads to sweat originating from the Heart; carrying heavy loads and traveling long distances leads to sweat originating from the Kidney; running fast and feeling fear leads to sweat originating from the Liver; bodily shaking and laborious work lead to sweat originating from the Spleen. Whenever sweat occurs during deep sleep and stops abruptly upon waking, it is called "stealing sweat" (Dao Han), also known as "sleeping sweat." Sweat that occurs regardless of being awake or asleep, without the use of diaphoretic treatments, is called "spontaneous sweat" (Zi Han). Sweat resulting from exertion and movement does not fall under the category of spontaneous sweat. In Taiyang disease with a tight pulse, using Ephedrae Herba (Mahuang), Allii Fistulosi Rhizoma (Congbai), and Fermented Soybean (Chidou) induces sweating, which originates from the Wei (Defensive) level. In Taiyang disease with a slow pulse, using Atractylodis Macrocephalae Rhizoma (Baizhu) and Cinnamomi Ramulus (Guizhi) arrests sweating, which originates from the Ying (Nutritive) level. Alternating chills and fever with dizziness are treated with Bupleuri Radix (Chaihu) and Lonicerae Japonicae Flos (Lianqiao) to harmonize, with sweat originating from the Shaoyang channel. If the body feels like burning charcoal, using Lycii Cortex (Digupi) and Gentianae Macrophyllae Radix (Qinjiao) resolves the condition, with sweat originating from the Sanjiao (Triple Burner). Cold extremities accompanied by depression are treated with Bupleuri Radix (Chaihu) and Ephedrae Herba (Mahuang) to disperse, with sweat originating from the Blood level. Heat aggregating in the Stomach is purged with Rhei Radix et Rhizoma (Dahuang) and Natrii Sulfas (Mangxiao), with sweat originating from the Foot-Yangming Stomach channel. Profuse sweating due to Yin toxicity is warmed with Aconiti Lateralis Radix Praeparata (Fuzi) and Zingiberis Rhizoma (Ganjiang), with sweat originating from the Three Yang channels.
The Heart stores blood internally and manifests sweat externally. Sweat is the fluid of the Heart. Spontaneous sweating arises invariably from deficiency of both the Heart and Kidney. Therefore, deficiency of Yin and Yang inevitably leads to heat in the Couli (skin pores) and spontaneous sweating, caused by the imbalance of Yin and Yang. Additionally, wind-stroke, summerheat, dampness, combined with fright, sexual exhaustion, or extreme fatigue, can lead to conditions such as Li Jie syndrome, intestinal abscess, phlegm-fluid retention, or postpartum disorders, all of which can cause spontaneous sweating. Zhang Zhongjing stated that extreme muscle weakness leads to loss of Jin-Ye (body fluids), opening of the Couli, and profuse sweating. Chao Yuanfang stated that in consumptive diseases, if Yang qi is deficient, Jin-Ye leaks out as sweat. He also stated that heat in the Heart opens the Couli, leading to sweating. The explanations of various schools regarding the mechanism of sweating are generally consistent.
I have investigated this principle: sweat is the leakage of Jin-Ye; Jin-Ye and Qi are of the same category. Wherever Qi reaches, Jin-Ye follows. Thus, the statement in the *Neijing* that "the Heart governs sweat" is profound. The Heart is the organ that governs Yang; Yang is Fire and Qi. Therefore, the Yang of the interior and exterior of the Five Zang and Six Fu organs is governed by the Heart to facilitate transformation. Consequently, Jin-Ye is generated where Yang Qi resides and leaks out as sweat where Fire disturbs. Ultimately, all sweat originates from the Heart. Otherwise, why does the *Neijing* state that sweat caused by wind, labor, or conflict between Yin and Yang originates from their respective organs? However, the Five Zang and Six Fu organs rely on the Twelve Meridians and Ying-Wei for regulation, as meridians are the tunnels governing the entry and exit of Qi. Ying Qi circulates within the vessels to nourish Yin and Blood, while Wei Qi circulates outside the vessels to secure Yang Qi. When Yang Qi is secured, the Couli are dense, and the Xuanfu (sweat pores) are tight, ensuring smooth communication among Zang-Fu organs, meridians, Ying, and Wei. If internal Zang-Fu organs and external meridians become disconnected, the mechanisms of entry and exit fail. Thus, pathogenic factors inside cause loose Xuanfu, leading to sweat from the Zang-Fu; pathogenic factors on the exterior cause insecure Couli, leading to sweat from the meridians. Hence, the causes of spontaneous sweating are countless. Regarding cases where Yin of the Zang-Fu repels floating Wei Qi outward without foundation, or where Stomach Qi is weak and Grain Qi dissipates, or Lung Qi is weak failing to circulate Ying-Wei leading to fluid loss, such spontaneous sweating, though severe, remains treatable. Only "Jue Han" (extreme sweat) of the Three Yang channels is untreatable. Yin deficiency leads to Yang encroachment, causing heat and spontaneous sweating; treat with Danggui Liu Huang Tang plus Digupi. Yang deficiency leads to Yin encroachment, causing cold extremities and spontaneous sweating; treat with Huangqi Jianzhong Tang, adding Fuzi for severe cases, or Sini Tang. Hua Borin treated a woman who, in midsummer, had cold body and spontaneous sweating, dry mouth, irritability, and a desire to lie in mud. Her pulse was floating and rapid but empty and scattered upon pressure. He said: The *Suwen* states that if the pulse appears compliant but is empty upon pressure, it indicates Yang deficiency due to Yin excess (Yin Cheng Ge Yang). This resulted from consuming cold foods and sitting/sleeping in drafts. Using Zhenwu Tang cooled before administration stopped the sweat after one dose, removed irritability after two doses, and restored health after three doses. For simultaneous deficiency of Yin and Yang with mild heat and cold, use Guizhi Tang in autumn/winter and Huangqi Jianzhong Tang in spring/summer. If pulse and symptoms show no heat, use Guizhi Tang; if heat is present, use Huangqi Jianzhong Tang. If the body temperature is normal but sweat is cold, or the body is cold and sweat is cold, with no other illness, these belong to this syndrome. Dai Fu'an used Huangqi Jianzhong Tang with a little Fumai (Floating Wheat), or Huangqi Liuyi Tang, or Yupingfeng San. The *Pingren Qixiang Lun* states: "Cun Cun position is choppy, Guan Guan position is slippery," indicating excessive sweating. Wang Bing noted: This means the skin at the Cun Cun position is rough while the pulse is slippery. Rough skin indicates depletion of Ying Blood internally. The *Zhenjing* states: "When Couli open and sweat flows profusely, this is Jin-Ye. Depletion of Jin-Ye leads to open Couli and massive sweating." These classics suggest that excessive sweating often results from depleted Blood and Jin-Ye. Dongyuan's Zhouwei Tang, although described as treating dampness-induced sweating, contains blood-nourishing herbs and acts as a moistening agent, suitable for this condition. Dampness-induced sweating should be treated according to Dongyuan's methods. Dongyuan stated: The southwest corresponds to Kun Earth, representing the Spleen and Stomach in the human body. Yang sweat is likened to rain in nature. Dampness causes profuse pouring, indicating dampness excess. Yin nourishes dampness, forming dew and rain; this is Yin-cold separating from Fire. Separation implies resolution; Yin-damp-cold descends, representing Earth Qi. Zhang Zhongjing said: "Excessive sweating leads to loss of Yang; when Yang departs, Yin prevails." Severe deficiency leads to extreme exterior Yang deficiency, resulting in interior cold. Dampness excess causes voice to sound as if coming from a jar, similar to water accumulation. Physiognomists say earth-toned voices resemble living in a deep jar, indicating obstruction, distance, and lack of emission, confirming dampness. These two conditions are also Yin-cold. The *Neijing* states: "Qi deficiency leads to exterior cold; even if heat in the interior is seen with steaming sweat, it eventually transmits to severe cold." Initial heat in the interior occurs because exterior emptiness lacks Yang to resist exterior cold; eventual transmission to interior cold often forms Bi-cold. Color reflects Heaven, pulse reflects Earth, and form reflects Earth's Yin and Yang. Thus, observing pulse and climate reveals visible forms. Treating Zhang Yunfu: In April, cold weather with rain and dampness, injured by official duties, irregular diet, and overwork. After recovery, continuous sweating soaked clothes for days, worsening aversion to cold requiring thick clothing, chest stuffiness and irritability, occasional hot flashes, dizziness, congestion, and reduced appetite. This is excessive Fire outside the Stomach combined with damp-heat from rain, causing intense damp-heat and unceasing sweating, aided by Wind evil supporting Wood Qi. Use Wind-dispelling herbs to remove dampness and Sweet herbs to drain heat, primarily using Qianghuo Shengshi Tang. For cold sweat due to Phlegm syndromes, use Qi Qi Tang or Liqi Jiangtan Tang; once Phlegm is resolved, sweating stops. Fire steaming upward into Stomach dampness can also cause sweating; use Liangge San. For spontaneous sweating due to stagnant Qi, regulate Qi to harmonize Ying-Wei, using Xiaojianzhong Tang plus Muxiang. In the *Suwen*, the Yellow Emperor asked: "A patient has body heat, lethargy, sweating like bathing, aversion to wind, and shortness of breath. What disease is this?" Qibo replied: "This is Jiufeng (Wine Wind)." The Emperor asked: "How to treat it?" Qibo replied: "Use Ze Xie and Bai Zhu in 10 parts each, and Xi Xian Cao in 5 parts. Mix and take three finger-pinches after meals. (Xi Xian Cao is also known as Wei Xian Cao or Wufeng Cao.)" It is also stated: "Drinking alcohol followed by wind exposure leads to Lou Feng (Leakage Wind)." Symptoms of Leakage Wind include excessive sweating, inability to wear single garments, sweating upon eating, sometimes whole-body sweating with panting, aversion to wind, wet clothes, dry mouth with thirst, and inability to perform labor. Hejian treated this with Baizhu San, which is essentially Jiufeng. Wind affecting any of the Five Zang causes spontaneous sweating and aversion to wind. Long-term sweating from diet creates empty wind and pathogens in the Heart, leading to hemiplegia and Bi-syndromes. First stop the sweating and gather the fierce Qi using Anwei Tang. For post-illness excessive sweating unresponsive to Zhengyuan San and other strong formulas, Bazhen San is appropriate. Localized sweating only on the heart region, increasing with mental effort, indicates Heart pathology; nourish Heart Blood. Use one pig heart, split open, insert 2 liang of Renshen and Danggui, sew up, boil, discard herbs, eat only the heart, and take Fuling powder mixed with Mugwort tea. If sweating persists despite medication, check for heat: use Musli San if heat is present; use Xiaojianzhong Tang plus 1 qian of Shu Fuzi (uncut) or Zhengyuan San if no heat, applying warm powder externally. For unceasing profuse sweating, add 2.5 qian of Muli powder to various formulas, or swallow Zhusha Dan or Rongzhu Dan. For chronic spontaneous sweating lasting years, use Heixi Dan. Also applicable for sweating after prolonged illness or recent recovery from major illness. If heat-tonifying is unsuitable, balance Yin and Yang to heal naturally using Lingsha Dan. These measures are for isolated sweating without other diseases, not for concurrent conditions. If astringent herbs fail to stop sweating and make it worse, regulate Heart Blood. Since sweat is the fluid of the Heart, Heart malnourishment fails to control Blood, causing overflow as sweat. Use Dahuangqi Tang plus Suanzaoren. Add Shibao for slight heat, and administer Lingsha Dan concurrently. Sweating like sticky glue, congealed pearls, or torrential rain that cannot be wiped dry is difficult to treat.
[Diagnosis] A soft and scattered Lung pulse indicates Guan Han (pouring sweat) that will not disperse. A very slow Lung pulse indicates excessive sweating.
[Head Sweat] Simultaneous deficiency of Yin and Yang, dryness, and head sweating indicate loss of Jin-Ye. Heat entering the Blood Chamber causes head sweating. Dampness injury with forehead sweating results from inappropriate purgation. Micro-panting indicates death. Heat steaming from the upper Stomach causes forehead sweating. Jaundice with head sweating, dysuria, and thirst indicate interior Blood stasis. Restlessness below the heart causes head sweating. Taiyang Jie Xiong (chest binding) with minimal heat and water accumulation in the chest/hypochondrium causes head sweating. Alternating chills and fever cause head sweating. Haizang stated: Head sweating stopping at the neck indicates Blood syndrome. Why is forehead sweating predominant? The head is the convergence of all Six Yang channels, so heat steams and causes sweating. Dividing by location: left cheek belongs to Liver, right cheek to Lung, nose to Central Earth, chin to Kidney, forehead to Heart. Sanjiao Fire depletes Kidney Water; residual fluid forces upward into the Heart region, causing head sweating. Forehead predominance belongs to the Heart region and indicates Blood syndrome. Head sweating after drinking or eating is also a Blood syndrome. In miscellaneous diseases, Ministerial Fire forcing Kidney Water upward into the Heart causes stealing sweat or spontaneous sweat, transmitting to head sweating or epigastric fullness; treat these as Blood syndromes. Regardless of Taiyang disease, miscellaneous diseases, or wine accumulation, epigastric fullness after purgation is a Blood syndrome. Why? Purgation depletes Yin; Yin depletion damages Spleen/Stomach and Blood. Qi in the chest sinks into the Heart region due to Blood loss. Thus, epigastric fullness is considered a Blood disease. Using Qi-regulating herbs worsens the fullness; subsequent purgation leads to abdominal distension. This is incorrect treatment. The correct treatment is to tonify the Central Earth (Spleen) and use Blood herbs. Head sweating with hypochondriac fullness, dysuria, alternating chills and fever, irritability, vomiting without thirst is treated with Chaihu Guijie Tang. Mild body heat, exterior deficiency, persistent head sweating, or exterior deficiency caused by excessive sweating by physicians is treated with Huangqi Tang.
[Hand and Foot Sweat] A man had hand and foot sweating; treatment with Huangqin, Huanglian, Huangbo, and tonics failed. Foot sweating was frequent. Later, using Babu Tang (Eight Substances Decoction) with Banxia and Fuling as chief herbs, and Baifu Zi and Chuanwu as assistant herbs, the sweating ceased. For foot sweating, equal parts Baifan (Alumen) and Gegen (Puerariae Lobatae Radix) powdered, half liang boiled in three bowls of water for ten boils, used to wash feet once daily; natural cessation occurs in three to five days.
[Yin Sweat] See separate section.
[Ahidrosis] The Classics state: "Those who lose Blood do not sweat; those who lose sweat do not lose Blood." Shuyuan stated: "If True Qi is depleted and Stomach Fire is abundant, unceasing sweating indicates Stomach True Qi is exhausted. If Yin Fire declines and anhidrosis with dryness occurs, it indicates decline of Yang within Yin and Yang within Yang. No sweating in four seasons indicates short life. Decline of dampness and rise of dryness is the normal order of governance. Short life is due to Autumn Qi dominating killing energy, exhausting Sheng Qi (generative Qi), which is Grain Qi of the Stomach, corresponding to Spring Shaoyang generative Qi. Danxi stated: Absence of sweating during bathing/eating in midsummer indicates Exterior Excess. To treat Xie Lao's chronic cough with anhidrosis in summer, use Banxia and Zisu powdered, mixed with Suo Chen Mo, Zhenliu Mo (Xianke Hui, Hafenn Fen), and Shenqu Mo. Form pills with Gualou Rang and Taoren paste (half liang). Administer San'ao Tang for three doses first, then these pills."