一人气喘自汗，昼夜不眠不食。医以外感治之，益甚。仲淳曰∶此肾虚气不归原，故火上浮，喘汗
交作，脾虚故不思食。亟以麦冬、枸杞、五味滋阴敛肺，苏子、橘红降气消痰，茯苓、白术、枣仁补脾敛
汗，不数剂而愈。
汗症有自汗、盗汗之不同。自汗者，无时自出，动则为甚。此由卫气亏而不能固卫于外，以致津
液自渗泻而出，属气虚者多。然亦有服参、 而自汗如故者，此为阴虚，水不制火，心液自泻。《原病
式》所云∶病心热则汗出是也。盗汗者，睡中盗出，至醒方知。盖阴虚之人，睡去则卫外之阳，乘虚陷入阴
中，表液失其固卫而盗出，觉则阳复用事，卫气复出于表，表实而汗自止。此属阴虚。丹溪亦曰∶自汗
属气虚，盗汗属血与阴虚。外有痰症自汗者，所谓痰饮内动，身必有汗也。有湿热自汗者，譬之土气，湿
热蒸为雨露，故湿无热不作汗，湿得热而蒸之，则自汗矣。若止心空孔一片，因暑有汗名曰心汗。良由
思虑过度，致伤心血而然。考
《内经》之论，五脏皆能令人汗。故士材云∶肺虚者，固其皮毛，黄 六一汤之属∶脾虚者补其
中气，玉屏风散之属；心虚者，益其血脉，天王补心丹之属，肝虚者，禁其疏泻，白芍、枣仁之属；
肾虚者，助其封藏，八仙长寿丸之属。至若因外感六淫所致者，自有本门治法可遵。故致汗之因甚
多，宜各随其兼症而理之，不可胶执。按沈氏云∶汗为心之液，凡汗出无有不从心液而来。故治诸
汗，皆宜养心液，固表气为主。亦知要之言也。
玉屏风散
白术〔补中气，止自汗。二两。〕黄 〔益卫气，实皮毛。〕防风〔取其达于表，又
得防风，其功愈大。各一两。〕加麻黄根、浮小麦。〔止诸汗必愈。〕或再加人参。如因湿热自汗
者，本方加芩、连、柏，苓之属。
此气虚自汗之方也。如糯米、圆肉、枣仁、白芍、龙骨、牡蛎之属，皆可采用。若果气虚阳衰者，
方可参用参附汤、 附汤、黄 建中汤〔即桂枝汤加黄 ，倍饴糖。〕之属。本草云∶凡服固表药
而汗不止者，用炒枣仁一两，同地、冬、白芍、五味、圆肉、竹叶大剂多服自效。
加味生脉散
生脉数加黄 甘草〔用参、 补气实表。纳五味，甘草用钱许。余各三、五钱。〕白
芍〔同五味，收阴敛气汗。〕枣仁 圆肉〔同麦冬，清心养液，〕如肺有热者，去参、 合六味汤。
此治盗汗之神药也。一妇幼患此症，仲淳以二剂投之，二十余年不发。〔方中有制香附二钱。〕
当归六黄汤
当归 生地黄 熟地黄〔滋阴养血。〕黄连 黄芩 黄柏〔去火各等分。〕黄 〔实
表倍用。〕
此亦治盗汗之方也。余谓阴虚有火，非苦寒之品所宜。按沈氏云∶若外感症中盗汗，宜用此方，
阴虚盗汗，则宜六味、左归方中，加滋阴收敛之属。
止汗红粉
炒糯米〔半斤。〕龙骨 牡蛎 麻黄根 赤石脂〔各一两，为末，绢包扑之。〕
此外治之法，汗出不止者，急用此闭塞其汗孔，乃卫外之兵也。
若汗，出如胶之粘，如珠之流，或淋漓如雨，揩拭不逮者皆难治。
【汗证举例】
有一人出现气喘、自汗，昼夜无法入睡和进食。医生按外感病治疗，病情反而加重。张遂辰（字仲淳）说：这是肾虚导致气不归元，因此虚火上浮，气喘与出汗同时发作；脾虚所以不想吃东西。立即使用麦冬、枸杞、五味子来滋阴敛肺，苏子、橘红降气化痰，茯苓、白术、酸枣仁补脾止汗，没吃几副药就好了。
汗症有自汗和盗汗的不同。自汗是指没有特定时间自然出汗，活动后加重。这是由于卫气亏虚不能固护肌表，导致津液自行渗漏而出，多属于气虚。然而也有服用参、芪等补气药后自汗依旧的，这属于阴虚，水不制火，心液自行外泄。《原病式》所说：“心脏有热则出汗”就是这种情况。盗汗是指在睡眠中偷偷出汗，醒来才知道。大概是阴虚的人，睡着时卫外的阳气乘虚陷入阴分，体表津液失去固护而盗出，醒来后阳气重新发挥作用，卫气复出到体表，表实而汗自止。这属于阴虚。朱丹溪也说：自汗属于气虚，盗汗属于血虚与阴虚。还有因痰饮导致的自汗，所谓痰饮内动，身体必然有汗。有湿热导致的自汗，好比土地之气，湿热蒸腾化为雨露，所以湿无热不能作汗，湿得热蒸腾，就会自汗。如果只在心口一片区域出汗，因暑天出汗称为心汗。大多是由于思虑过度，损伤心血所致。考察《内经》的论述，五脏都能让人出汗。所以士材说：肺虚者，固护皮毛，用黄耆六一汤之类；脾虚者，补其中气，用玉屏风散之类；心虚者，益其血脉，用天王补心丹之类；肝虚者，禁止疏泄太过，用白芍、酸枣仁之类；肾虚者，助其封藏，用八仙长寿丸之类。至于因外感六淫所致的，自有本门的治法可遵循。所以导致出汗的原因很多，应当根据伴随症状分别调理，不可固执拘泥。据沈氏说：汗是心的体液，凡是出汗无不来自心液。所以治疗各种汗症，都以养心液、固表气为主。这也是抓住要领的话。
玉屏风散
白术〔补中气，止自汗。二两。〕黄耆〔益卫气，实皮毛。〕防风〔取其通达肌表，又得防风，功效更大。各一两。〕加麻黄根、浮小麦。〔止各种汗症必愈。〕或者再加人参。如果是湿热自汗者，本方加黄芩、黄连、黄柏、茯苓之类。
这是气虚自汗的方子。如糯米、桂圆肉、酸枣仁、白芍、龙骨、牡蛎之类，都可以采用。如果确实是气虚阳衰者，才可以参考使用参附汤、四逆汤、黄耆建中汤〔即桂枝汤加黄耆，倍用饴糖。〕之类。本草说：凡服用固表药而汗不止的，用炒酸枣仁一两，同地黄、麦冬、白芍、五味子、桂圆肉、竹叶大剂量多服自有效验。
加味生脉散
生脉散加黄耆、甘草〔用人参、黄耆补气实表。纳五味子、甘草用一钱左右。其余各三、五钱。〕白芍〔同五味子，收敛阴气止汗。〕酸枣仁、桂圆肉〔同麦冬，清心养液。〕如肺有热者，去人参、黄耆合六味地黄汤。
这是治疗盗汗的神效药。一个幼女患此症，张仲淳用两剂投药，二十多年未复发。〔方中有制香附二钱。〕
当归六黄汤
当归 生地黄 熟地黄〔滋阴养血。〕黄连 黄芩 黄柏〔去火各等分。〕黄耆〔实表倍用。〕
这也是治疗盗汗的方子。我认为阴虚有火，不适合用苦寒之品。据沈氏说：如果在感冒症中出现盗汗，宜用此方；阴虚盗汗，则宜在六味地黄丸、左归丸中加入滋阴收敛之品。
止汗红粉
炒糯米〔半斤。〕龙骨 牡蛎 麻黄根 赤石脂〔各一两，研为末，用绢包扑擦。〕
这是外治的方法，汗出不止的，急用此法闭塞汗孔，这是保卫体表的兵将。
如果汗出如胶般粘稠，如珠滴流，或淋漓如雨，擦拭不及的都难治。
[Examples of Sweating Syndromes]
A patient presented with panting, spontaneous sweating (Zihan), and inability to sleep or eat day or night. The physician treated it as an external contraction (Waigan), which exacerbated the condition. Zhang Zhunchun said: This is Kidney deficiency causing Qi to fail to return to its root, thus floating fire rises upward, resulting in simultaneous panting and sweating; Spleen deficiency causes lack of appetite. Immediately administer Ophiopogonis Radix (Maidong), Lycii Fructus (Gouqi), and Schisandrae Fructus (Wuweizi) to nourish Yin and astringe Lung Qi; Perillae Fructus (Suzi) and Citri Reticulatae Pericarpium (Juhong) to descend Qi and resolve phlegm; Poria (Fuling), Atractylodis Macrocephalae Rhizoma (Baizhu), and Ziziphi Spinosae Semen (Suanzaoren) to tonify Spleen and stop sweating. After several doses, he recovered.
Sweating syndromes differ between spontaneous sweating (Zihan) and night sweats (Daohan). Spontaneous sweating refers to sweating at any time without specific occasion, worsening with movement. This is due to deficient Wei Qi (Defensive Qi) failing to secure the exterior, leading to leakage of body fluids, mostly belonging to Qi deficiency. However, there are cases where spontaneous sweating persists despite administering Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi); this belongs to Yin deficiency, where Water fails to control Fire, causing Heart fluids to leak out. As stated in *Yuan Bing Shi*: "When the Heart has heat, sweat is produced." Night sweats refer to sweating secretly during sleep, known only upon waking. It is generally that in persons with Yin deficiency, when asleep, the Yang defending the exterior falls into the Yin aspect due to deficiency; surface fluids lose their securing power and sweat out. Upon waking, Yang resumes its function, Wei Qi returns to the exterior, the exterior becomes solid, and sweating stops naturally. This belongs to Yin deficiency. Danxi also said: Spontaneous sweating belongs to Qi deficiency; night sweats belong to Blood and Yin deficiency. There are also cases of spontaneous sweating due to Phlegm-Fluids (Tan Yin), where internal movement of Phlegm-Fluids inevitably causes sweating. There are cases of spontaneous sweating due to Damp-Heat, analogous to earth qi steaming into rain and dew; thus, Dampness without Heat does not produce sweat, but when Dampness is steamed by Heat, spontaneous sweating occurs. If sweating occurs only in a patch over the heart region due to summer heat, it is called Heart Sweat (Xinhan). This is largely caused by excessive worry damaging Heart Blood. Examining the discussions in *Neijing*, all five Zang organs can cause sweating. Therefore, Shitai said: For Lung deficiency, secure the skin and hair using formulas like Huangqi Liuyin Tang; for Spleen deficiency, tonify Middle Qi using formulas like Yupingfeng San; for Heart deficiency, benefit blood vessels using formulas like Tianwang Buxin Dan; for Liver deficiency, restrict excessive dispersal using herbs like White Peony Root (Baishao) and Ziziphi Spinosae Semen (Suanzaoren); for Kidney deficiency, assist in sealing and storing using formulas like Baxian Changshou Wan. As for those caused by external contraction of the Six Excesses (Liuyin), there are specific treatment methods to follow. Thus, the causes of sweating are numerous; one should treat according to accompanying symptoms and not be rigid. According to Shen Shi: Sweat is the fluid of the Heart; all sweating originates from Heart fluids. Therefore, treating various sweating syndromes should primarily focus on nourishing Heart fluids and securing the exterior Qi. This is indeed grasping the essential point.
**Yupingfeng San (Jade Windscreen Powder)**
Atractylodis Macrocephalae Rhizoma (Baizhu) [Tonifies Middle Qi, stops spontaneous sweating. Two liang.] Astragali Radix (Huangqi) [Benefits Wei Qi, solidifies skin and hair.] Saposhnikoviae Radix (Fangfeng) [Takes advantage of reaching the exterior; with Fangfeng, the efficacy increases. Each one liang.] Add Ephedrae Radix et Rhizoma Root (Mahuanggen) and Triticum Levis Fructus (Fuxiaomai). [Must cure all types of sweating.] Or add additional Ginseng Radix et Rhizoma (Renshen). If it is spontaneous sweating due to Damp-Heat, add Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Phellodendri Cortex (Huangbai), and Poria (Fuling) to this formula.
This is a formula for Qi-deficiency spontaneous sweating. Herbs such as Glutinous Rice (Nuomi), Dimocarpus Longan Aril (Yuanyrou), Ziziphi Spinosae Semen (Suanzaoren), White Peony Root (Baishao), Dragon Bone (Longgu), and Oyster Shell (Muli) can all be adopted. If it is truly Qi deficiency with Yang collapse, one may consider using Shenfu Tang (Ginseng and Aconite Decoction), Sini Tang (Frigid Extremities Decoction), or Huangqi Jianzhong Tang [which is Guizhi Tang plus Huangqi, double the amount of Yitang/Malt Sugar]. Materia Medica states: For those taking exterior-securing medicines but sweating continues, use one liang of stir-fried Ziziphi Spinosae Semen (Suanzaoren), taken in large doses with Rehmanniae Radix (Dihuang), Ophiopogonis Radix (Maidong), White Peony Root (Baishao), Schisandrae Fructus (Wuweizi), Dimocarpus Longan Aril (Yuanyrou), and Bambusae Folium (Zhuyedan) for self-efficacy.
**Jiawei Shengmai San (Modified Pulse-Nourishing Powder)**
Shengmai San plus Astragali Radix (Huangqi) and Glycyrrhizae Radix et Rhizoma (Gancao) [Use Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) to tonify Qi and solidify the exterior. Use Schisandrae Fructus (Wuweizi) and Glycyrrhizae Radix et Rhizoma (Gancao) about one qian. Others three to five qian.] White Peony Root (Baishao) [Together with Schisandrae Fructus (Wuweizi),收 Yin and astringe Qi to stop sweat.] Ziziphi Spinosae Semen (Suanzaoren) and Dimocarpus Longan Aril (Yuanyrou) [Together with Ophiopogonis Radix (Maidong), clear Heart and nourish fluids.] If there is heat in the Lung, remove Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi), combine with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).
This is a miraculous medicine for treating night sweats. A young girl suffered from this syndrome; Zhang Zhunchun administered two doses, and she did not relapse for over twenty years. [The formula contains processed Cyperi Rhizoma (Xiangfu) two qian.]
**Danggui Liuhuang Tang (Angelica Six-Yellow Decoction)**
Angelicae Sinensis Radix (Danggui) Rehmanniae Radix Preparata (Shengdihuang) Rehmanniae Radix Preparata (Shudihuang) [Nourish Yin and tonify Blood.] Coptidis Rhizoma (Huanglian) Scutellariae Radix (Huangqin) Phellodendri Cortex (Huangbai) [Remove fire, equal parts.] Astragali Radix (Huangqi) [Solidify exterior, use double dose.]
This is also a formula for treating night sweats. I believe that for Yin deficiency with fire, bitter-cold substances are not suitable. According to Shen Shi: If night sweats occur in external contraction syndromes, this formula should be used; for Yin deficiency night sweats, one should use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) or Zuogui Wan (Left Restoring Pill) adding Yin-nourishing and astringent herbs.
**Zhihan Hongfen (Stop-Sweat Red Powder)**
Glutinous Rice (Chao Nuomi) [Half jin.] Dragon Bone (Longgu) Oyster Shell (Muli) Ephedrae Radix et Rhizoma Root (Mahuanggen) Halloysit Rubrum (Chishizhi) [Each one liang, ground into powder, packed in silk cloth and applied/patted.]
This is an external treatment method. For uncontrollable sweating, urgently use this to close the sweat pores; it acts as the soldiers guarding the exterior.
If sweat is sticky like glue, flowing like beads, or dripping like rain, unable to be wiped dry, these are difficult to treat.