卫气至夜行于阴，或遇天之六淫在于表，或遇人气兴衰所变，如天之五邪六淫
者，相乘于里，或脏腑经脉之阴阳，自相胜负，则皆有以致阳气之不足。然而非惟寒湿燥同其阴者，
能伤其阳而已，至若风火热同其阳者，则亦伤之，而相火出肾肝表里四经者尤甚。夫火与元气不两立，
故火盛则阳衰。卫与阳一也，阳衰则卫虚，所虚之卫行阴，当瞑目之时，则更无气以固其表，故腠理
开津液泄而为汗。迨寤则目张，其行阴之气复散于表，则汗止矣。夫如是者，谓之盗汗，即《内经》
之寝汗也。《内经》谓肾病者，腹大胫肿，喘咳，寝汗，憎风。又岁水太过，甚则土气乘之者，病亦
若是。注曰∶肾邪攻肺，心内微，心液为汗，故寝汗。仲景《伤寒论》中名盗汗，谓阳明病当作里实
而脉浮者，必盗汗。又三阳合病，目合则汗。成无己谓伤寒盗汗，非若杂病者之责其阳虚而已，是由
邪在半表半里使然也。何者，若邪气一切在表，干于卫则自汗出，此则邪气侵行于里，外连于表邪，
及睡则卫气行于里，乘表中阳气不致，津液得泄而为盗汗，亦非若自汗，有为之虚者，有为之实者，
其于盗汗，悉当和表而已。今观仲景二论，似若不同，究其微旨，则一而已矣。何则？《内经》论其
源，则心肾者乃阴阳之主。所以论汗必自心之阳，论寝必自肾之阴。仲景之云，从其邪之所在之阴阳，
便成盗汗，是指阴阳之流者耳。抑究其源流，悉
是卫气之为用。卫气者，由谷气之所化，肺脏之所布。然天真之阳必得是而后充大，无是则衰微。故
生气通天论所言，阳气者，如苍天之气，顺之则阳固，与阳因而上，卫外者之类，皆指卫气也。所以
王注以卫气合天地之阳气。若夫成无己之释仲景者固善矣，抑亦未为至当，虚劳杂病之人，岂可独责
其阳虚，而不有阴虚之可责者乎。予每察杂病之盗汗，有冷有热，岂无其故哉。因热邪乘阴虚而发者，
所出之汗必热。因寒邪乘阳虚而发者，所出之汗必冷。其汗冷之义，即《内经》所谓阴胜则身寒，汗
出，身上清也。非独为自汗，虽盗汗亦然。其温汗之义，殆以所乘之热，将同于伤寒，郁热在表里而
汗者也。虽然邪乘之重者，亢则害，承乃制，兼化水为冷者有之，相火出于肾挟水化而为冷者有之，
此又不可不审也。盖成无己因《金匮要略》叙杂病云∶平人脉虚弱微细，善盗汗。又以《巢氏病源》
以虚劳之人盗汗，有阳虚所致，因即谓杂病之盗汗，悉由于阳虚也。且以《金匮要略》言之，脉虚弱
者，乃阳气之虚，细弱者，乃阴气之虚。何独举阳而遗其阴，亦智士之一失也。然虚劳之病，或得于
大病后阴气未复，遗热尚留，或得之劳役七情色欲之火，衰耗阴精，或得之饮食药味，积成内热，皆
有以伤损阴血，衰惫形气。阴气既虚，不能配阳，于
是阳气内蒸，外为盗汗，灼而不已，阳能久存而不破散乎。当归六黄汤治盗汗之圣药。宜润剂者，六
黄汤。宜燥剂者，正气汤。无内热者，防风散、白术散。肝火，当归龙荟丸。虚者，黄 连翘汤。实
者，三黄连翘汤。身热，加地骨皮、柴胡、黄芩、秦艽。肝虚，加酸枣仁。肝实，加龙胆草。右尺实
大，黄柏、知母。烦心，黄连、生地黄、当归、辰砂、麦门冬。脾虚，人参、白术、白芍药、干山药、
白扁豆、浮麦。亦可用山药一味为末，临卧酒调下三钱。经霜桑叶末，茶调服。豆豉微炒，酒渍服。外
用五倍子或何首乌为末，津唾调填脐中，以帛缚定。脏腑盗汗皆属肾。经云∶肾病者，寝汗出，憎风
是也。运气盗汗皆属寒水。经云∶岁水太过，寒气流行，甚则劳汗出，憎风。又云∶太阳所至，为寝
汗痉是也。
卫气在夜间运行于阴分，如果遇到外界的天之六淫邪气停留在体表，或者遇到人气兴衰变化所导致的类似天之五邪六淫的邪气，这些邪气相互侵犯体内；或者是脏腑经脉的阴阳之气自相胜负，这些都可能导致阳气不足。然而，不仅仅是寒、湿、燥这些属性为阴的邪气能损伤阳气，像风、热、火这些属性为阳的邪气也会损伤阳气，尤其是从肾、肝以及它们的表里经（胆、三焦）发出的相火，损伤更为严重。因为火与元气不能并存，所以火盛则阳气衰微。卫气与阳气本质相同，阳气衰微则卫气虚弱，虚弱的卫气行于阴分，当人闭目入睡时，就没有足够的气来固护肌表，所以腠理（皮肤纹理及汗孔）张开，津液外泄而形成盗汗。等到醒来睁眼时，原本行于阴分的卫气重新散布到体表，汗也就停止了。像这样的情况，称为盗汗，也就是《内经》所说的“寝汗”。《内经》说：肾病的人，腹部胀大，小腿浮肿，气喘咳嗽，睡中出汗，怕风。又岁运水气太过，严重时土气被乘克，病症也类似如此。注解说：肾邪攻击肺脏，心中微痛，心液化为汗，所以睡中出汗。张仲景《伤寒论》中称为盗汗，说阳明病本应表现为里实证却出现脉浮的，必定有盗汗。又有三阳合病，闭目即出汗的情况。成无己认为伤寒引起的盗汗，不像杂病那样只责之于阳气虚弱，而是由邪气在半表半里之间所致。为什么呢？如果邪气完全在体表，干扰卫气就会自汗出；这里是邪气侵入运行于里，外部连接表邪，等到睡觉时卫气行于里，乘表中阳气不固，津液得以泄出而成为盗汗，这也不像自汗那样，有的属于虚证，有的属于实证，对于盗汗，都应当调和表气而已。现在看张仲景的两个论述，似乎不同，探究其精微旨意，其实是一致的。为什么呢？《内经》论述其本源，心肾是阴阳的主宰。所以论汗必然联系心的阳气，论寝必然联系肾的阴气。张仲景所说，是根据邪气所在的阴阳部位，便形成盗汗，这是指阴阳之气的流变而言。再探究其源流，都是卫气的作用。卫气，是由谷气所化生，由肺脏所布散。然而先天的真阳必须依赖它才能充盛壮大，没有它则衰微。所以《生气通天论》中所说的“阳气者，如苍天之气，顺之则阳固，与阳因而上，卫外者”之类，都是指卫气。所以王冰注解说卫气合于天地的阳气。至于成无己解释张仲景的观点固然好，但也未必是最恰当的，虚劳杂病患者，难道可以只责之于阳气虚弱，而没有阴虚可责的吗？我每次观察杂病的盗汗，有冷的也有热的，难道没有原因吗？因热邪乘阴虚而发作的，所出的汗必然是热的。因寒邪乘阳虚而发作的，所出的汗必然是冷的。所谓汗冷，就是《内经》所说的阴胜则身寒，汗出，身上清冷。不仅自汗如此，盗汗也是这样。所谓温汗，大概是因为所乘的热邪，如同伤寒一样，郁热在表里之间而出汗。虽然如此，邪气侵袭严重的，亢盛则为害，必须有制约，兼化水为冷的情况是有的，相火出于肾脏挟带水气化为冷的情况也是有的，这又不可不仔细审察。大概成无己因为《金匮要略》叙述杂病时说：平时人脉象虚弱微细，容易盗汗。又以《巢氏病源》说虚劳之人盗汗，有因阳气虚弱导致的，于是认为杂病的盗汗，全部由于阳气虚弱。且以《金匮要略》来说，脉虚弱，是阳气之虚；脉细弱，是阴气之虚。为何只举阳气而遗漏阴气，这也是明智之士的一个失误。然而虚劳之病，有的是在大病后阴气未恢复，余热尚留；有的是因劳役、七情、色欲之火，衰耗阴精；有的是因饮食药味，积成内热，都有损伤阴血，使形气衰惫的原因。阴气既然虚弱，不能配纳阳气，于是阳气在内蒸腾，外在表现为盗汗，灼热不已，阳气能长久存在而不破散吗？当归六黄汤是治疗盗汗的神药。适宜用润剂的，用六黄汤。适宜用燥剂的，用正气汤。没有内热的，用防风散、白术散。肝火盛的，用当归龙荟丸。虚证的，用黄芪连翘汤。实证的，用三黄连翘汤。身体发热的，加地骨皮、柴胡、黄芩、秦艽。肝虚的，加酸枣仁。肝实的，加龙胆草。右尺脉实大的，用黄柏、知母。心烦的，用黄连、生地黄、当归、辰砂、麦门冬。脾虚的，用人参、白术、白芍药、干山药、白扁豆、浮小麦。也可以用山药一味研末，临睡前用酒调服三钱。经霜桑叶研末，茶调服。豆豉微炒，酒浸服。外用五倍子或何首乌研末，用唾液调匀填敷脐中，用帛带缚定。脏腑盗汗都属于肾。经文说：肾病的人，睡中出汗，怕风，就是这个道理。运气盗汗都属于寒水。经文说：岁运水气太过，寒气流行，严重时导致劳汗出，怕风。又说：太阳之气所至，表现为睡中出汗、痉病，就是这个道理。
Wei Qi (Defensive Qi) travels through the Yin meridians at night. If it encounters the Six Excesses (Six Pathogenic Factors: Wind, Cold, Summer-heat, Dampness, Dryness, Fire) of Heaven remaining on the exterior, or if it encounters changes caused by the rise and fall of human Qi, similar to the Five Evils and Six Excesses, which invade the interior mutually; or if the Yin and Yang of the Zang-Fu organs and meridians contend with each other, all these can lead to a deficiency of Yang Qi. However, it is not only the Yin-natured pathogens such as Cold, Dampness, and Dryness that damage Yang Qi; even the Yang-natured pathogens such as Wind, Heat, and Fire also damage it, especially the Ministerial Fire (Xiang Huo) originating from the Kidney, Liver, and their respective exterior-interior meridaries (Gallbladder and Sanjiao), which causes even more severe damage. Since Fire and Original Qi cannot coexist, when Fire is excessive, Yang Qi declines. Wei Qi is identical in nature to Yang Qi; when Yang Qi declines, Wei Qi becomes deficient. This deficient Wei Qi travels within the Yin. When one closes the eyes to sleep, there is insufficient Qi to secure the exterior, causing the Cou Li (skin pores and interstices) to open and body fluids to leak out as sweat. Upon waking and opening the eyes, the Wei Qi that was traveling in the Yin redistributes to the exterior, and the sweating stops. Such cases are called "Sweating during Sleep" (Dao Han), which is referred to as "Sweating during Slumber" (Qin Han) in the *Nei Jing* (Inner Canon). The *Nei Jing* states: In Kidney disease, there is abdominal distension, swelling of the calves, wheezing and coughing, sweating during slumber, and aversion to wind. Furthermore, when the Water phase of the annual cycle is excessive, and Earth Qi is overacted upon severely, the pathology is similar. The commentary notes: Kidney pathogen attacks the Lung, causing slight pain in the heart; Heart fluid transforms into sweat, hence sweating during slumber. Zhang Zhongjing's *Shanghan Lun* (Treatise on Cold Damage) calls this Dao Han, stating that in Yangming disease, which should present as an interior excess pattern but presents with a floating pulse, there must be sweating during sleep. There is also the case of combined illness of the Three Yang meridians, where sweating occurs upon closing the eyes. Cheng Wuji stated that Dao Han in cold damage is not merely due to Yang deficiency as in miscellaneous diseases, but results from pathogenic factors residing between the exterior and interior. Why? If pathogenic factors are entirely on the exterior and interfere with Wei Qi, spontaneous sweating occurs. Here, pathogenic factors invade and travel within, connecting externally with exterior pathogens. When sleeping, Wei Qi travels inward; taking advantage of the failure of Yang Qi in the middle and exterior to consolidate, body fluids are released as Dao Han. This differs from spontaneous sweating, which can be either deficiency or excess; for Dao Han, one should harmonize the exterior. Observing Zhang Zhongjing's two discussions, they seem different, but investigating their subtle purport reveals they are essentially one. Why? The *Nei Jing* discusses the source: Heart and Kidney are the masters of Yin and Yang. Therefore, discussing sweat necessarily relates to the Yang of the Heart, and discussing slumber necessarily relates to the Yin of the Kidney. Zhang Zhongjing's statement refers to the flow of Yin and Yang based on where the pathogen resides, forming Dao Han. Investigating the source and flow, it is all the function of Wei Qi. Wei Qi is transformed from Grain Qi and distributed by the Lung. However, innate True Yang must rely on it to become robust; without it, it declines. Thus, what is said in the *Shengqi Tongtian Lun* regarding "Yang Qi is like the Qi of the vast sky; following it ensures Yang is solid... guarding the exterior," all refers to Wei Qi. Hence, Wang Bing's commentary states that Wei Qi combines with the Yang Qi of Heaven and Earth. Although Cheng Wuji's explanation of Zhang Zhongjing is good, it may not be entirely adequate. Can patients with consumptive miscellaneous diseases be blamed solely for Yang deficiency, ignoring possible Yin deficiency? In my observation of Dao Han in miscellaneous diseases, some sweat is cold and some is hot; there must be reasons for this. When triggered by Heat pathogen acting on Yin deficiency, the sweat emitted is necessarily hot. When triggered by Cold pathogen acting on Yang deficiency, the sweat emitted is necessarily cold. The meaning of cold sweat corresponds to what the *Nei Jing* says: "Yin excess leads to body coldness, sweating, and a feeling of coolness on the body." This applies not only to spontaneous sweating but also to Dao Han. The meaning of warm sweat likely arises because the acting heat pathogen, similar to cold damage, causes damp-heat to stagnate in the interior and exterior, leading to sweating. Nevertheless, when pathogenic invasion is severe, excessive conditions cause harm until controlled by counteracting forces; cases where water transforms into cold exist, and cases where Ministerial Fire from the Kidney carries water energy to transform into cold also exist, which requires careful examination. Cheng Wuji, citing the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) which describes miscellaneous diseases: "Normally, a weak, fine, and thin pulse indicates susceptibility to Dao Han," and citing the *Chao Shi Bing Yuan* (Source Book of Diseases) which states that Dao Han in consumptive disease can be caused by Yang deficiency, concluded that all Dao Han in miscellaneous diseases stems from Yang deficiency. However, according to the *Jin Gui Yao Lue*, a weak pulse indicates Yang deficiency, while a fine and weak pulse indicates Yin deficiency. Why mention only Yang and omit Yin? This is a lapse even by wise scholars. Consumptive diseases may arise after major illnesses where Yin has not recovered and residual heat remains; or from labor, emotional disturbances, and sexual indulgence consuming Yin essence; or from diet and medication accumulating internal heat. All these damage Yin blood and exhaust physical Qi. Once Yin is deficient, it cannot balance Yang, causing Yang to steam internally and manifest externally as Dao Han. If burning continues unabated, can Yang remain intact without dissipating? Danggui Liu Huang Tang (Cinnamon Twig and Rehmannia Decoction with Six Ingredients) is the divine medicine for treating Dao Han. For those requiring moistening agents, use Liu Huang Tang. For those requiring drying agents, use Zhengqi Tang. For those without internal heat, use Fangfeng San (Saposhnikovia Powder) or Baizhu San (Atractylodes Macrocephala Powder). For Liver Fire, use Danggui Longhui Wan (Corydalis and Gardenia Pill). For deficiency patterns, use Huanglian Qiaotou Tang (Scutellaria and Forsythia Decoction - Note: Text says 'Huang Lian Qiao Tou', likely referring to a specific formula involving Scutellaria/Forsythia for deficiency, often interpreted as Huanglian Yujie Tang variant or similar, but strictly translating text: Huanglian Qiaotou Tang). For excess patterns, use Sanhuang Qiaotou Tang (Three Yellows and Forsythia Decoction). For body heat, add Digupi (Groundcherry Root Bark), Chaihu (Bupleurum), Huangqin (Scutellaria), and Qinjiao (Gentiana Macrophylla). For Liver deficiency, add Suanzaoren (Ziziphus Seed). For Liver excess, add Longdancao (Gentiana Root). For fullness and enlargement of the Right Chi pulse, use Huangbai (Phellodendron) and Zhimu (Anemarrhena). For vexation of the heart, use Huanglian (Coptis), Shengdihuang (Rehmannia Root), Danggui (Angelica Sinensis), Chen Sha (Cinnabar), and Maidong (Ophiopogon). For Spleen deficiency, use Renshen (Ginseng), Baizhu (Atractylodes), Baishao (White Peony), Ganshanyao (Dried Yam), Baibian Dou (Hyacinth Bean), and Fumai (Floating Wheat). One may also use single-shan yao (Dried Yam) powdered, taken with wine before bed, three qian. Powdered leaves of mulberry that have endured frost, taken with tea. Fermented soybeans (Douchi) lightly fried and soaked in wine. Externally, powder of Wubeizi (Chinese Gall) or Heshouwu (Polygonum Multiflorum) mixed with saliva, applied to the umbilicus, and bound securely with cloth. Dao Han of the Zang-Fu organs belongs to the Kidney. The Classic states: "Kidney disease involves sweating during slumber and aversion to wind." Dao Han related to climatic cycles belongs to Cold Water. The Classic states: "When the Water phase is excessive, Cold Qi prevails, leading to profuse sweating and aversion to wind." It also states: "When Taiyang Qi arrives, it manifests as sweating during slumber and spasms."