SWEATING

Published on 22/06/2015 by admin

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Chapter 41

imageSWEATING

WHY WE ASK

Daytime spontaneous sweating is not a crucial area of questioning for various reasons. First of all, it is a symptom that only Chinese patients are particularly aware of and which they therefore often report spontaneously. Western patients report this symptom quite rarely. In terms of clinical significance as part of a pattern, daytime spontaneous sweating is seldom a crucial manifestation that clinches a diagnosis.

An exception to this occurs when we see a patient during an acute invasion of Wind, in which case we should always ask whether there is sweating or not. The presence of sweating indicates that the pathogenic factor is either Wind-Heat or Wind-Cold but with the prevalence of Wind (Wind Attack Pattern of the Greater-Yang Pattern) and that the patient’s Upright Qi is relatively weak. Conversely, absence of sweating during an invasion of external Wind generally indicates that Cold predominates over Wind and that the patient’s Upright Qi is strong.

Night sweating is quite different in so far as Western patients are more aware of this symptom; in particular, in menopausal women this is a major symptom that is definitely reported by the patient. Night sweating is clinically significant to clinch the diagnosis of Yin deficiency (although it should be remembered that other patterns may cause night sweating, e.g. Damp-Heat, Stomach-Heat, etc.).

CLINICAL SIGNIFICANCE OF SWEATING

Evaluation of symptoms of sweating must be made by considering if it is part of an exterior or interior pattern.

Exterior patterns

In exterior patterns, spontaneous sweating indicates either invasion of Wind-Cold with the prevalence of Wind, which is due to a disharmony of Nutritive and Defensive Qi, or invasion of Wind-Heat. In invasion of Wind-Cold with the prevalence of Wind, the deficient Nutritive Qi fails to hold fluids in the space between skin and muscles, the pores are open and the patient sweats slightly. It is important to note that this is not a profuse, spontaneous sweating and the patient may not be aware of it unless we ask. In exterior patterns, slight sweating may also occur during invasions of Wind-Heat, Wind-Dampness or Summer-Heat.

In the course of acute febrile diseases, when the pathogenic factor penetrates into the Interior there is often profuse sweating, such as at the Bright-Yang stage of the Six Stages or the Qi level of the Four Levels.

Interior patterns

In interior patterns, spontaneous sweating is due to Qi or Yang deficiency, or to Full-Heat if it occurs in daytime and to Yin deficiency or Damp-Heat if it occurs at night. In Qi or Yang deficiency it is usually a deficiency of Lungs or Heart; in Full-Heat it is usually Heat (or Damp-Heat) in the Heart, Liver, Lungs or Stomach.

Night sweating is not always due to Yin deficiency.

Box 41.1 summarizes the patterns causing sweating in interior conditions.

BOX 41.1   SWEATING IN INTERIOR CONDITIONS

PATHOLOGY OF SWEATING

Daytime sweating involves loss of fluids from the space between skin and muscles where the Defensive Qi circulates; sweating at night (called Dao Han in Chinese, which literally means ‘thief sweating’) involves loss of fluids from the bone level and is often called ‘steaming from the bones’. Therefore the fluids lost during night sweating are more precious than those lost during daytime sweating: the fluids lost during daytime sweating are simply Body Fluids (Jin-Ye), whereas those lost during night sweating are nutritive Yin Essences. However, both daytime and night-time sweating start a pathological vicious circle because they can derive from a deficiency but also aggravate that deficiency. In fact, daytime sweating injures Qi (the pores are called ‘Qi holes’) while night sweating injures Yin.

Old Chinese books say that night-time sweat tastes sweet (because it is a Yin Essence), while sweat lost in daytime tastes salty.

Besides daytime and night-time sweating, there are two other types of sweating: sweating from collapse (Jue Han); and shiver sweating (Zhan Han).

Sweating from collapse occurs during collapse of Yang or collapse of Yin: the sweat from collapse of Yin is oily, whereas that from collapse of Yang pours out in watery and dilute drops.

Shiver sweating is seen usually in acute, febrile diseases and is characterized by a bout of shivering followed by sweating. If the fever abates after sweating, and the pulse is quiet and the body feels cold to the touch, this means that the pathogenic factor has been expelled and the Upright Qi has prevailed; but if after sweating there is restlessness and the pulse is Rapid it indicates that the pathogenic factor has prevailed and the Upright Qi has been severely weakened.

CLASSIFICATION OF SWEATING

Observation, Chapter 20; Symptoms and Signs, Chapter 76.

One must distinguish sweating according to the area of body, time of day, conditions and quality of sweat.

ABSENCE OF SWEATING

Symptoms and Signs, Chapter 76

Absence of sweating is also a symptom in Chinese medicine. In exterior invasions of Wind, it is always important to ask about sweating: the absence of sweating indicates invasion of Wind-Cold with the prevalence of Cold and this corresponds to the Greater-Yang stage within the Six Stages identification of patterns. The Greater-Yang stage is always caused by the invasion of Wind-Cold, of which there are two types: one with the prevalence of Cold (in which there is no sweating), the other with the prevalence of Wind (in which there is sweating).

In other exterior conditions, absence of sweating usually indicates Cold or Cold-Dampness in the superficial layers of the body (the space between skin and muscles).

In interior conditions, absence of sweating indicates a ‘tight’ and excessively closed state of the space between the skin and muscles (Cou Li). This renders the person more prone to fever when invaded by a pathogenic factor and it also indicates that the person is more prone to Full than Empty conditions.

For a more detailed description of various types of sweating, see Part 5, Chapter 76.

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