SWEATING

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Chapter 76

SWEATING

Chapter contents

SPONTANEOUS SWEATING

Interrogation, Chapter 41

Lung-Qi deficiency

Spontaneous sweating which is worse on exercise, slight shortness of breath, slight cough, weak voice, dislike of speaking, bright-white complexion, tendency to catch colds, tiredness, a dislike of cold, Pale tongue, Empty pulse.

Lung-Yang deficiency

NIGHT SWEATING

Interrogation, Chapter 41

Night sweating is called in Chinese dao han, which literally means ‘thief sweating’; this name probably refers to the fact that night-time sweating is very depleting of the body’s energies and it ‘robs’ the body of its Qi. Both daytime and night-time sweating deplete the body’s energy: the former depletes Qi and Yang, and the latter Yin. Thus both daytime and night-time sweating start a pathological vicious circle because they can derive from a deficiency but they also aggravate that deficiency.

Yin deficiency

Night sweating, dry mouth with a desire to drink in small sips, dry throat in the evening, scanty dark urine, dry stools, normal-coloured tongue without coating, Floating-Empty pulse.

This may be Yin deficiency of several different organs: the Lungs, Heart, Stomach, Liver, Kidneys or Spleen.

Yin deficiency with Empty-Heat

Profuse night sweating, five-palm heat, feeling of heat in the evening, dry mouth at night with a desire to drink in small sips, malar flush, Red tongue without coating, Floating-Empty and Rapid pulse.

Damp-Heat in Stomach and Spleen

Night sweating, a feeling of fullness and pain of the epigastrium and lower abdomen, poor appetite, a feeling of heaviness, thirst without a desire to drink, nausea, loose stools with an offensive odour, a feeling of heat, dull-yellow complexion, sticky taste, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Deficiency of Qi and Blood of the Heart

Night sweating, palpitations, shortness of breath on exertion, pale face, tiredness, slight depression, spontaneous sweating, dizziness, insomnia, dream-disturbed sleep, poor memory, anxiety, tendency to be easily startled, dull-pale complexion, pale lips, Pale and Thin tongue, Choppy or Fine pulse.

This is less common than the night sweating from Yin deficiency and it usually occurs in women.

Lesser-Yang pattern

Night sweating, bitter taste, hypochondrial discomfort, dry throat, alternation of hot and cold feeling, irritability, unilateral coating on the tongue, Wiry pulse.

This can be either the Lesser-Yang pattern within the Six Stages identification of patterns (in which there is a prevalence of cold feeling) or the Gall-Bladder Heat pattern within the Four Levels identification of patterns (in which there is a prevalence of hot feeling). This type of night sweating usually follows a febrile disease.

Clinical note

• Remember: night sweating is not always caused by Yin deficiency!

SWEATING FROM COLLAPSE

Interrogation, Chapter 41

Collapse of Qi and Yin

Profuse sweating like oil drops, a feeling of heat, body hot to the touch, thirst, collapse, Red tongue without coating, Deep-Minute-Rapid pulse.

Collapse of Yang

Profuse sweating like pearls, watery sweat, body cold to the touch, a feeling of cold, cold limbs, unconsciousness, pale face, weak breathing, Pale tongue, Hidden pulse.

YELLOW SWEAT

Observation, Chapter 20; Interrogation, Chapter 41

Yellow sweat was first mentioned in the ‘Synopsis of Prescriptions from the Golden Cabinet’ (Jin Gui Yao Lue, c. AD200). In Chapter 14, where yellow sweat is mentioned three times, it says: ‘With Yellow Sweat disease there is swelling, fever, thirst and yellow sweat like Phellodendron sap [i.e. bright-yellow]’.¹

Damp-HEAT

Yellow sweat like Phellodendron sap all over the body, fever, swelling, a feeling of heaviness, sticky/bitter taste, sticky yellow tongue coating, Slippery pulse.

Other symptoms and signs depend on the organ involved, which may be the Stomach, Spleen, Liver or Gall-Bladder.

Nutritive and Defensive Qi obstructed

Fever, sweat like Phellodendron sap, swelling, a feeling of heaviness of the body, a feeling as if there were insects crawling under the skin, thirst, difficult urination, white tongue coating, Deep pulse.

This pattern is characterized by a deficiency of the Defensive Qi and a stagnation of the Nutritive Qi (this is the exact opposite of the Greater-Yang Wind pattern); fluids are retained, Qi is obstructed and the Bladder’s function is impaired. This cause of yellow sweat is less frequent than the previous one.

Stagnant Liver-Qi turned into Heat

Yellow sweat which stains the clothing particularly in the axilla, hypochondrium or genital region, hypochondrial or epigastric distension, a slight feeling of oppression of the chest, irritability, premenstrual tension, irregular periods, premenstrual breast distension, a feeling of a lump in the throat, a feeling of heat, red face, thirst, propensity to outbursts of anger, heavy periods, tongue Red on the sides, Wiry and slightly Rapid pulse.

Spleen- and Lung-Qi deficiency

Yellow sweat in the upper back, hypochondrium or head worse after exertion, slight shortness of breath, weak voice, spontaneous daytime sweating, dislike of speaking, bright-white complexion, tendency to catch colds, tiredness, poor appetite, slight abdominal distension after eating, weakness of the limbs, loose stools, Pale tongue, Empty pulse.

This pattern is more common in the elderly.

Yin deficiency with Empty-Heat and Dampness

Yellow sweat that stains the clothing in the axilla or genital region, greasy skin, dry throat at night, a feeling of heat in the evening, night sweating, five-palm heat, malar flush, insomnia, anxiety, dry mouth with a desire to drink in small sips, excessive vaginal discharge, a feeling of heaviness, Red tongue without coating, Floating-Empty and slightly Slippery pulse.

LOCALIZED SWEATING

Unilateral sweating

Unilateral sweating can occur on the left or the right side of the body. From an acupuncture perspective, this symptom is often due to an imbalance within the Yin or Yang Heel vessels. Unilateral sweating was mentioned in the ‘Yellow Emperor’s Classic of Internal Medicine ’ Simple Questions’ (Huang Di Nei Jing Su Wen), which says in Chapter 3: ‘Unilateral sweating is due to a withering of the channels on that side of the body’.² A ‘withering’ or weakness of the channels on one side of the body may occur as a result of an accident to that side or after a high fever which injures the Yin fluids and leads to malnourishment of the channel of that side.

Wind-Phlegm

Unilateral sweating, severe dizziness, blurred vision, tremors, unilateral numbness or tingling of a limb, tinnitus, nausea, sputum in the throat, a feeling of oppression of the chest, Stiff or Deviated and Swollen tongue, Wiry-Slippery pulse.

Phlegm with Blood stasis

Unilateral sweating, unilateral numbness of a limb, dizziness, nausea, phlegm in the throat, a feeling of oppression of the chest, pain in the limbs, Purple and Swollen tongue, Slippery-Wiry pulse.

Deficiency of Qi and Blood

Unilateral sweating, poor appetite, loose stools, weak voice, tiredness, blurred vision, dizziness, numbness/ tingling of limbs, palpitations, dull-pale complexion, Pale tongue, Weak or Choppy pulse.

Cold-Dampness

Unilateral sweating, contraction of tendons, contraction of hands, a feeling of heaviness of the limbs, epigastric fullness, a feeling of heaviness of the head and body, a feeling of cold, cold limbs, sticky white tongue coating, Slippery-Slow pulse.

Nutritive- and Defensive-Qi not harmonized

Unilateral sweating, fever, occipital headache, aversion to cold, stiff neck, Floating-Slow pulse.

Wind-Dampness in the Girdle Vessel

Sweating of the upper or lower half of the body, numbness of the legs, a feeling of heaviness of the abdomen and legs, cold feet, pulse that is Wiry on both Middle positions.

Sweating on the head

Observation, Chapter 20; Interrogation, Chapter 41

Stomach Damp-Heat steaming upwards

Sweating on the head, facial pain, stuffed nose or thick, sticky nasal discharge, a feeling of fullness and pain of the epigastrium, a feeling of heaviness, thirst without a desire to drink, nausea, a feeling of heat, dull-yellow complexion, sticky taste, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

In this case, Dampness does not accumulate in the limbs but ‘steams’ upwards to the head; this is more likely to happen when Heat is pronounced.

Liver-Fire

Sweating on the head, headache, red face, dizziness, tinnitus, irritability, propensity to outbursts of anger, thirst, bitter taste, constipation, dark urine, Red tongue with redder sides and dry yellow coating, Wiry-Rapid pulse.

Deficient Yang floating upwards

Sweating on the head, pale complexion, cold limbs, shortness of breath, a feeling of cold, tiredness, Weak-Deep pulse.

Retention of food with Stomach-Heat in children

Sweating on the head at night, restless sleep, waking up with crying during the night, vomiting, fullness, pain and distension of the epigastrium which are relieved by vomiting, nausea, vomiting of sour fluids, foul breath, sour regurgitation, belching, loose stools or constipation, poor appetite, thirst, a feeling of heat, thick, sticky yellow tongue coating, Slippery-Rapid pulse.

Sweating on the chest

Observation, Chapter 20; Interrogation, Chapter 41

Sweating on the chest is also called ‘heart region sweating’.

Heart- and Spleen-Qi deficiency

Sweating on the chest, palpitations, shortness of breath on exertion, pale face, tiredness, slight depression, spontaneous sweating, poor appetite, slight abdominal distension after eating, weakness of the limbs, loose stools, Pale tongue, Empty pulse.

Heart- and Kidney-Yin deficiency

Sweating on the chest especially in the evening or night, palpitations, insomnia, dream-disturbed sleep, anxiety, poor memory, dizziness, tinnitus, hardness of hearing, lower backache, night sweating, scanty dark urine, normal-coloured tongue without coating, Floating-Empty pulse.

This is a common cause of sweating in the chest area.

Sweating of hands and feet

Observation, Chapters 14 and 20; Interrogation, Chapter 41

Damp-Heat in Stomach and Spleen

Sweating of hands and feet, hot hands, swollen fingers and toes, a feeling of fullness and pain of the epigastrium and lower abdomen, poor appetite, a feeling of heaviness, thirst without a desire to drink, nausea, loose stools with an offensive odour, a feeling of heat, dull-yellow complexion, sticky taste, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Stomach- and Spleen-Qi deficiency

Sweating of hands and feet, cold hands, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, uncomfortable feeling in the epigastrium, loss of sense of taste, Pale tongue, Empty pulse.

Stomach- and Spleen-Yin deficiency

Sweating of hands and feet, dry mouth that is worse after sleep, dry lips, no appetite or slight hunger but no desire to eat, constipation (dry stools), dull or slightly burning epigastric pain, dry mouth and throat especially in the afternoon, thirst but with no desire to drink, or a desire to drink in small sips, slight feeling of fullness after eating, normal-coloured tongue without coating, or without coating in the centre, Floating-Empty pulse.

Sweating of the palms

Observation, Chapters 14 and 20; Interrogation, Chapter 41

Lung-Qi deficiency

Sweating of the hands, slight shortness of breath, slight cough, weak voice, spontaneous daytime sweating, dislike of speaking, bright-white complexion, tendency to catch colds, tiredness, dislike of cold, Pale tongue, Empty pulse.

Lung-Yin deficiency

Sweating of the hands in the afternoon, cough which is dry or with scanty, sticky sputum, weak/hoarse voice, dry mouth and throat, tickly throat, tiredness, dislike of speaking, thin body or thin chest, night sweating, normal-coloured tongue without coating (or with rootless coating) in the front part, Floating-Empty pulse.

Heart-Qi deficiency

Sweating of the hands, palpitations, shortness of breath on exertion, pale face, tiredness, slight depression, spontaneous sweating, Pale tongue, Empty pulse.

Heart-Yang deficiency

Profuse sweating of the hands, cold hands, palpitations, shortness of breath on exertion, tiredness, spontaneous sweating, a slight feeling of discomfort or stuffiness in the heart region, a feeling of cold, cold hands, bright-pale face, slightly dark lips, Pale tongue, Deep-Weak pulse.

Heart-Yin deficiency

Sweating of the hands in the evening, palpitations, insomnia, dream-disturbed sleep, poor memory, anxiety, tendency to be easily startled, mental restlessness, uneasiness, ‘feeling hot and bothered’, dry mouth and throat, night sweating, normal-coloured tongue without coating or with rootless coating, Floating-Empty pulse, especially on the left Front position.

Sweating in the axillae

The Liver and Heart channels influence the axilla.

Liver-Yin deficiency with Empty-Heat

Sweating in axillae, dizziness, numbness/tingling of limbs, insomnia, blurred vision, floaters, dry eyes, scanty menstruation or heavy bleeding (if Empty-Heat is severe), malar flush, cramps, withered and brittle nails, dry hair and skin, a feeling of heat in the evening, night sweating, five-palm heat, thirst with a desire to drink in small sips, Red tongue without coating, Floating-Empty and slightly Rapid pulse.

Damp-Heat in Liver and Gall-Bladder

Smelly sweating in axillae, fullness/pain of the hypochondrium, abdomen or epigastrium, bitter taste, poor appetite, nausea, a feeling of heaviness of the body, yellow vaginal discharge, vaginal itching, mid-cycle bleeding/pain, burning on urination, dark urine, yellow complexion and eyes, vomiting, Red tongue with redder sides and unilateral or bilateral sticky yellow coating, Wiry-Slippery-Rapid pulse.

Heart-Yin deficiency with Empty-Heat

Sweating in axillae, palpitations, insomnia, dream-disturbed sleep, poor memory, anxiety, tendency to be easily startled, mental restlessness, dry mouth and throat, thirst with a desire to sip fluids, a feeling of heat in the evening, malar flush, night sweating, five-palm heat, Red tongue, redder on the tip with no coating, Floating-Empty and Rapid pulse.

Heart-Fire

Sweating in axillae, palpitations, thirst, mouth and tongue ulcers, mental restlessness, a feeling of agitation, insomnia, dream-disturbed sleep, a feeling of heat, red face, bitter taste, Red tongue with redder tip and yellow coating, Overflowing-Rapid pulse.

ABSENCE OF SWEATING

Interrogation, Chapter 41

In exterior invasions of Wind, it is always important to ask about sweating, as 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). Thus, it is very important in the initial stages of invasion of external Wind to ask about the presence or absence of sweating, especially if herbal medicine is used because there are two quite distinct prescriptions depending on whether there is a prevalence of Cold or Wind. These are Gui Zhi Tang Ramulus Cinnamomi Decoction for prevalence of Wind and Ma Huang Tang Ephedra Decoction for prevalence of Cold.

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).

Invasion of Wind-Cold

Absence of sweating, aversion to cold, fever, cough, itchy throat, slight breathlessness, stuffed or runny nose with clear watery discharge, sneezing, occipital headache, body aches, thin white tongue coating, Floating-Tight pulse.

Cold on the Exterior, Heat in the Interior

Absence of sweating in any part of the body, aversion to cold, fever, restless legs, mental restlessness, thirst, sore throat, cough with yellow sputum.

Cold-Dampness on the Exterior

Absence of sweating, headache, a feeling of heaviness of the head and limbs, muscle ache, painful joints, dislike of cold.

NOTES

1. Ren, He. A New Explanation of the Synopsis of Prescriptions from the Golden Cabinet Jin Gui Yao Lue Xin Jie ). Zhejiang: Zhejiang Science Publishing House, 1981; 120.

2. The Yellow Emperor’s Classic of Internal Medicine – Simple Questions (Huang Di Nei Jing Su Wen ). People’s Health Publishing House: Beijing, 1979:17 First published c. 100BC

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