In the clinical setting, diaphoresis is profuse sweating that is unrelated to the usual and normal stimuli. Two main types are of interest in this topic. Spontaneous sweating occurs while awake and is not influenced by environmental factors or physical activity. Night sweat occurs during sleep and stops upon waking.
Etiology and Pathology
There are five main types of illnesses that present diaphoresis as a prominent symptom.
Lung-Qi Deficiency. The lung governs the skin and hair and controls defensive Qi. Any deficiency of lung-Qi can result in deficiency of defensive Qi, and the latter in turn leads to the loosening of the interstices of the skin and muscles. Spontaneous sweating follows. In diaphoresis the most common causes of lung-Qi deficiency are a chronically weak constitution, weakness following an illness and protracted cough and dyspnea consuming lung-Qi.
Disharmony between Nutritive and Defensive Qi. Even mild attack by exogenous Wind in a state of weakness of the exterior or any imbalance between Yin and Yang may lead to disharmony between nutritive Qi and defensive Qi. When this happens, defensive Qi is unable to protect the exterior, thereby allowing abnormal spontaneous sweating to take place.
Insufficiency of Heart-Blood. Sweat is the fluid of the heart. Excessive brooding may injure the heart and the spleen, and significant blood loss may lead to depleted blood failing to nourish the heart. In either circumstance there is excessive discharge of heart-fluid. Spontaneous sweating may ensue.
Blazing Fire due to Yin Deficiency. Excessive strain, blood loss, excessive consumption of essence or strong exogenous Heat may injure Yin and cause its deficiency. When Yin is deficient endogenous Fire may arise. Such deficiency-Fire forces Yin-fluids outward as spontaneous or night sweat.
Heat Evaporating Fluids. Pent-up passions may cause liver-Qi to gel and transform into Fire. Overindulgence in acrid, spicy and strong-flavored foods may cause turbid Dampness to transform into Heat. In such circumstances, Liver-Fire or Dampness-Heat become strong in the interior and evaporate fluids, forcing them to disperse as sweat.
Clinical Manifestation
In diaphoresis illnesses sweating is unrelated to environmental factors. Sweating may be limited to regions, such as the head and face, the chest and abdomen, or the limbs, or it may be generalized over the entire body.
Spontaneous sweating occurs irrespective of the time of day or level of physical activity. It occurs while the person is awake, and is aggravated by physical exertion. It is often accompanied by such symptoms as cold-aversion, lassitude and weakness.
Night sweat occurs during sleep, stopping upon waking. It is often accompanied by such symptoms as recurrent fever and flushed cheeks.
Sometimes the sweat is yellow in color and stains the clothes; this is known as yellow sweat. Sometimes sweating is accompanied by such symptoms as stickiness and bitterness in the mouth, yellow and greasy tongue coating and slippery pulse. Sometimes the sweat leaves stickiness on the skin. When diaphoresis is protracted, there may be lassitude, anorexia and lumbar aches and weakness.
Occasionally, a patient may have both spontaneous sweating and night sweat.
Key Points of Diagnosis
Most illnesses with diaphoresis are of deficiency. Spontaneous sweating is mainly due to deficient Qi leaking outward, and night sweat is mainly due to Yin deficiency giving rise to endogenous Heat. On the other hand, diaphoresis due to Liver-Fire or Dampness-Heat consuming or evaporating fluids is of strength. Protracted spontaneous sweating may injure Yin. Protracted night sweat may injure Yang. In both circumstances deficiency of both Qi and Yin or of both Yin and Yang may ensue. If Heat evil evaporates fluids over a long period of time, it may injure Yin; in this case, the illness is of both deficiency and strength.
Shortness of breath, weakness and wind-aversion accompanying diaphoresis suggest insufficiency of lung-Qi and looseness of the interstices. Palpitation of the heart, insomnia, lusterless complexion and threadlike pulse accompanying diaphoresis suggest insufficiency of heart-blood and leakage of heart-fluid. Cold-intolerance, cold limbs, watery feces, white and smooth tongue coating and deep and feeble pulse accompanying diaphoresis suggest deficiency of Yang-Qi and weakened Yang unable to restrain Yin. Dry mouth and throat, red tongue with scant coating and threadlike and rapid pulse accompanying diaphoresis suggest blazing Fire in Yin deficiency and the Fire forcing Yin-fluid outward as sweat. Yellow sweat or sweat that leaves stickiness on the skin suggests accumulation of the Heat evil in the interior and evaporation of body fluids.
Herbal Treatment
Lung-Qi Deficiency
Main Symptoms. Sweating with wind-aversion, aggravated by any activity; high susceptibility to exogenous pathogenic evils; lusterless complexion; lassitude and weakness. The tongue coating is thin and white, and the pulse threadlike and feeble.
Therapeutic Principle. Augment Qi and firm the exterior.
Treatment. Yu Ping Feng San (Jade-Screen Powder).
If diaphoresis is profuse, add fuxiaomai (Triticum), mahuang root (Ephedra), muli (Ostrea) and nuodaogenxu (Oryza sativa) to strengthen the exterior and astringe sweat. (Note: do not use mahuang in place of mahuang root, as mahuang is diaphoretic.)
If Qi deficiency is marked, add dangshen (Codonopsis) and huangjing (Polygo-natum) to enhance Qi augmentation and astringency.
If there is Yang deficiency as well, add maimendong (Ophiopogon) and wuweizi (Schisandra) to nourish Yin and astringe sweat.
Disharmony between Nutritive and Defensive Qi
Main Symptoms. Sweating with wind-aversion, generalized aches and malaise, and periodic chills and fever; or, regional sweating. The tongue coating is thin and white, and the pulse is even.
Therapeutic Principle. Harmonize nutritive Qi and defensive Qi.
Treatment. Guizhi Tang (Cinnamomum Decoction).
If diaphoresis is profuse, add longgu (fossil bone) and muli (Ostrea) as clinically appropriate.
If profuse diaphoresis is accompanied by heaviness in the body, with white and greasy tongue coating, it is indicative of Dampness complicating nutritive-defensive disharmony. Add fangfeng (Saposhnikovia) and peilan (Eupatorium) to dispel Wind and dry Dampness.
If Yang is deficient, add renshen (Panax) to warm Yang and astringe sweat.
If diaphoresis affects half of the body or a smaller region, add Gan Mai Dazao Tang (Liquorice-Wheat-Date Decoction).
Insufficiency of Heart-Blood
Main Symptoms. Spontaneous sweating or night sweat; palpitation of the heart; insomnia; lassitude; shortness of breath; and lusterless complexion. The tongue is pale and the pulse threadlike.
Therapeutic Principle. Generate blood and nourish the heart.
Treatment. Gui Pi Tang (Spleen-Restoring Decoction).
If blood insufficiency is marked, add treated heshouwu (Polygonum), gouqizi (Lycium) and shudihuang (Rehmannia) to augment and restore essence and blood.
If diaphoresis is profuse, add calcined longgu (fossil bone) and muli (Ostrea), wuweizi (Schisandra) and fuxiaomai (Triticum) to astringe sweat.
Blazing Fire in Yin Deficiency
Main Symptoms. Night sweat; sometimes spontaneous sweating as well; hotness in the five centers; dry throat with thirst; flushed cheeks; and recurrent fever. The tongue is red, with little coating, and the pulse is threadlike and rapid.
Therapeutic Principle. Nourish Yin and suppress Fire.
Treatment. Danggui Liu Huang Tang (Angelica and Six Huang Decoction). It has the following basic composition: danggui (Angelica) 9g, shengdihuang (Rehmannia) 12 g, shudihuang (Rehmannia) 12 g, huanglian (Coptis) 12 g, huangqin (Scutellaria) 12 g, huangbai (Phellodendron) 12 g, and huangqi (Astragalus) 12 g.
If sweating is profuse, add muli (Ostrea), fuxiaomai (Triticum) and nuodaogenxu (Oryza sativa) to astringe sweat.
If recurrent fever is high, add Qinjiao (Gentiana), yinchaihu (Stellaria di-chotoma) and baiwei (Cynanchum atratum) to cool deficiency-Heat.
For constipation due to Heat accumulation, add dahuang (Rheum) and mangxiao (Mirabilite) to promote defecation.
For oliguria due to interior Heat, add yinchenhao (Artemisia).
Heat Evaporating Fluids
Main Symptoms. Sweat that is yellow in color and stains clothing; flushed complexion; restlessness; bitter taste in the mouth; and dark urine. The tongue coating is thin and yellow, and the pulse taut and rapid.
Therapeutic Principle. Cool the liver, purge Heat, eliminate Dampness and harmonize the Nutritive Level.
Treatment. Longdan Xie Gan Tang (Liver-Clearing Gentiana Decoction).
For Heat-induced constipation, add raw dahuang (Rheum palmatum) and mangx-iao (Mirabilite).
For strong Heat in the interior with dark oliguria, add yinchenhao (Artemisia).
Miscellaneous Types
If there is much sweating that is limited to the hands and feet, it is because the spleen governs the four limbs and deficient Qi is unable to reach the ends of the limbs. Use Huangqi Jian Zhong Tang (Astragalus Middle-Strengthening Decoction) to warm the middle-jiao, augment Qi, consolidate the exterior and stop sweating.
If chest discomfort, cyanotic tongue, purpuric spots and taut or impeded pulse accompany spontaneous or night sweat, the illness is due to blood stasis causing blockage. In this case, use Xue Fu Zhu Yu Tang (Decoction for Releasing Blood Stasis) to regulate Qi, mobilize blood, unblock the channels and harmonize nutritive and defensive Qi.
Acupuncture Treatment
Select the acupoints Hegu (LI-4), Houxi (SI-3) and Fuliu (KI-7). Use filiform needles and apply both reducing and reinforcing methods. In general, apply the reducing method to Hegu first, then the reinforcing method to Fuliu.
For lung-Qi deficiency, add Taiyuan (LU-9) and Zusanli (ST-36).
For disharmony between nutritive and defensive Qi, add Lieque (LU-7).
For insufficiency of heart-blood, add Xinshu (BL-15), Yingu (KI-10) and Sany-injiao (SP-6).
For blazing Fire in Yin deficiency, add Yingu (KI-10) and Zhaohai (KI-6).
Case Study
The patient was a 50-year old retired female worker. She presented with both spontaneous and night sweats that began following a common cold a month previously.
She had a 20-year history of Wind-induced injury to her heart, requiring her to take Western medication that strengthened her heart, promoted diuresis and dilated her arteries. On this regimen her condition stabilized. A month prior to admission she contracted the common cold, with fever, palpitations of the heart, worsened shortness of breath, and both spontaneous and night sweats.
On admission, she had spontaneous sweating, night sweats, palpitations of the heart, shortness of breath, impatience and irascibility, poor sleep with much dreaming and anorexia. Her tongue was dusky, with a thin and white coating. Her pulse was deep, threadlike, hesitant and intermittent.
Diagnosis. Deficiency of both Qi and Yin, with infirm exterior and Defensive Level.
Therapeutic Principle. Augment Qi, nourish Yin, firm the exterior and astringe sweat.
Treatment and Course. The prescribed formula had the following composition: calcined longgu (fossil bone) 24 g, calcined muli (Ostrea gigas) 24 g, roast huangqi (Astragalus membranaceus) 24 g, beishashen (Glehnia) 30 g, wuweizi (Schisandra chinensis) 10 g, fuxiaomai (Triticum aestivum) 30 g, tianzhu (Bambusa textilis) 20 g, fuling (Poria cocos) 20 g, yuanzhi (Polygala tenuifolia) 10 g, danshen (Salvia miltiorrhiza) 15 g, shengdihuang (Rehmannia glutinosa) 30 g, ejiao pellets (Equus asinus) 1 g. Note: longgu and muli were decocted first.
After seven daily doses, palpitation of the heart, shortness of breath, spontaneous sweating and night sweats all improved. She continued to sleep poorly, and her tongue and pulse configuration remained as before treatment. The same formula was continued but with seven kernels of dazao (Ziziphus jujuba) added. With the augmented formula, all her symptoms subsided.
