bubble_chart Concept

Spontaneous sweating refers to the natural perspiration of the human body without factors such as fatigue, natural conditions, wearing overly warm clothing, or taking diaphoretic drugs.

This symptom was first mentioned in the "Treatise on Cold Damage Diseases: Differentiation of Taiyang Disease Pulse Patterns and Treatment," referred to as "spontaneous sweating." The "Sanyin Fang" records: "Regardless of being awake or asleep, if one sweats profusely on their own, it is called spontaneous sweating."

This discussion only covers generalized spontaneous sweating; localized spontaneous sweating (such as "head sweating," "sweating of hands and feet," etc.) and "expiry sweating" are addressed in separate sections.

bubble_chart Pattern Analysis

1. Disharmony between Nutrient and Defensive Qi︰Sweating with aversion to wind, generalized soreness and pain, alternating chills and fever, thin white tongue coating, and a moderate pulse. Due to constitutional exterior deficiency, the defense qi is not consolidated, and the striae and interstices lose their tightness. Additionally, because of insufficient nutrient yin, there is susceptibility to wind pathogens, leading to yin-yang disharmony and dysfunction of opening and closing. Hence, after sweating, aversion to wind becomes pronounced, along with generalized soreness and pain and alternating chills and fever. The thin white tongue coating and moderate pulse are signs of disharmony between nutrient and defensive qi. The treatment should focus on harmonizing the nutrient and defensive aspects, and the formula chosen is Cinnamon Twig Decoction.
2. Wind-dampness Attacking the Exterior︰Intermittent spontaneous sweating with scanty sweat, aversion to wind and fear of cold, heaviness and numbness of limbs, scanty urine, thin white tongue coating, floating and moderate or soggy and slippery pulse. Commonly seen in cases of common cold with dampness or arthralgia syndrome. As stated in Leizheng Zhicai on sweating syndromes: "If wind and dampness contend with each other, there may be intermittent spontaneous sweating with aversion to wind." When wind-dampness pathogens invade the body surface and impair defensive yang, or when a constitutionally weak body is further attacked by external wind-dampness, the striae and interstices become alternately open and closed, leading to intermittent spontaneous sweating with scanty sweat, aversion to wind and fear of cold, and a floating, moderate pulse. When wind-dampness obstructs the meridians and collaterals, causing blockage of the passageways, symptoms such as heaviness and numbness of limbs and a soggy, slippery pulse may appear. Dampness pathogens tend to disrupt the free flow of the triple energizer, leading to dysfunction of the bladder and scanty urine. A thin white tongue coating indicates wind-dampness invading the body surface without heat manifestations. The treatment should focus on dispelling wind and overcoming dampness, replenishing qi and consolidating the exterior, using modified Stephania and Astragalus Decoction.
3. Exuberant Heat in Yangming︰Spontaneous sweating occurs frequently, with profuse sweating, high fever and flushed face, extreme thirst and desire for drinks, yellow and dry tongue coating, and a surging, forceful pulse. This is a symptom of cold-damage disease where pathogenic factors transmit to the Yangming channel, and the onset is not limited to summer. The key points for differentiation are: profuse sweating without resolution of fever, accompanied by high fever, extreme thirst, a surging and forceful pulse, and other symptoms. Treatment should focus on clearing heat and purging fire, using formulas such as White Tiger Decoction.
4. Summerheat Damaging Qi and Yin︰Frequent spontaneous sweating with profuse sweating, excessive thirst with a desire to drink, chest and diaphragm stuffiness and oppression, red tongue texture, yellow and dry coating, surging and weak pulse. It is a syndrome of summerheat injury with qi and yin depletion, occurring in summer. The key points for pattern identification are: both signs of summerheat (fever and sweating) and symptoms of qi and yin deficiency (thirst, red tongue, surging but weak pulse). The treatment should focus on clearing summerheat and draining heat, tonifying qi and promoting fluid production. The prescription is Wang's Summerheat-Clearing Qi-Replenishing Decoction.
5. Qi Deficiency︰Spontaneous sweating occurs frequently, worsening with activity, accompanied by constant fear of cold, shortness of breath, fatigue, reluctance to speak, pale complexion, usual intolerance to wind-cold, and susceptibility to common cold. The tongue texture is pale with thin white coating, and the pulse is slow and weak. The main responsibility lies with the heart and lungs. As the heart governs sweat and the lungs govern the qi of the whole body and are externally associated with the skin and hair. Due to heart and lung qi deficiency, the defensive exterior is not firm, the striae and interstices are not dense, leading to the outward leakage of body fluids, hence frequent spontaneous sweating. The key points of pattern identification are: spontaneous sweating, worsening with slight activity, usual intolerance to wind-cold, susceptibility to common cold, constant fear of cold, shortness of breath, fatigue, reluctance to speak, pale complexion, and a slow, slippery, and weak pulse. The treatment should focus on tonifying qi, consolidating the exterior, and stopping sweating. The recommended formulas are Middle-Tonifying Qi-Replenishing Decoction and Jade Screen Powder with modifications.
6. Yang Deficiency︰Spontaneous sweating worsens with activity, accompanied by cold body and limbs, poor appetite, abdominal distension and fullness, preference for hot drinks, loose stools, complexion shallow yellow or pale, pale tongue with white coating, and weak pulse. The main cause is attributed to the spleen and kidneys. As the spleen is the source of qi and blood generation and transformation, and the kidneys store true yin and house primordial yang, they should only be consolidated and secured. Suwen．Yinyang Yingxiang Da Lun states: "Yang resides on the exterior, serving as the envoy of yin." If spleen and kidney yang qi is deficient and weak, yang fails to restrain yin, leading to spontaneous sweating. The key diagnostic points are: besides spontaneous sweating, there are also signs of spleen-kidney yang deficiency such as cold body and limbs, anorexia, loose stools, soreness and weakness of the waist and knees, etc. Treatment should focus on warming yang and astringing yin. The recommended formulas are Kidney Qi Pill combined with Middle-Tonifying Qi-Replenishing Decoction, supplemented with calcined Longgu and Muli (dragon bone and oyster shell), Schisandra Fruit, and other astringent and yin-consolidating herbs.

The symptom of spontaneous sweating can manifest in exterior pattern, interior pattern, deficiency pattern, and excess pattern. As pointed out in the "Mingli Lun of Cold-Damage Disease": "Spontaneous sweating... also has its own yin-yang syndromes, and it cannot be said that spontaneous sweating must belong to yang deficiency." Therefore, in clinical practice, it is first necessary to distinguish the different natures of external contraction seasonal disease and internal damage Zabing. The former is mostly an excess pattern, while the latter is mostly a deficiency pattern, with deficiency pattern being more common. There are also cases of deficiency and excess combined, and it is important to differentiate the root and branch, weigh the primary and secondary aspects, and apply pattern differentiation and treatment.

bubble_chart Documentation

1. Suwen-Yinyang Bie Lun: "Yang added to yin is called sweat."
2. Suwen-Jingmai Bie Lun: "Fear depletes the essence, and sweat comes from the heart; carrying heavy loads and traveling long distances cause sweat to come from the kidneys; running fast and being frightened cause sweat to come from the liver; shaking the body and laboring hard cause sweat to come from the spleen."
3. Danxi Xinfa．spontaneous sweating: "Spontaneous sweating is attributed to qi deficiency, blood deficiency, dampness, yang deficiency, and phlegm. The condition of spontaneous sweating is always due to the deficiency of both the heart and kidneys. Therefore, when yin is deficient, yang will inevitably intrude, causing fever and spontaneous sweating; when yang is deficient, yin will inevitably dominate, causing fainting and spontaneous sweating. Thus, it is caused by the imbalance of yin and yang." "Spontaneous sweating is strongly contraindicated with Fresh Ginger Rhizome, as it opens the striae and interstices."
4. Zhangshi Yitong．Miscellaneous Section: "Although spontaneous sweating is due to the failure of defense qi to consolidate, leading to the leakage of body fluids from the stomach, it is actually related to the evaporation caused by the internal organs. When the yang of the heart cannot protect the exterior and consolidate, spontaneous sweating occurs."