Chinese Translation Project
From the book of
The Clinical Chinese Medicine Series-by Pu Fu Zhou
By Diana Hester
Page 111

88. Spontaneous Sweating (1)

Liu _____, 60 years old, office worker, Feb 9, 1991 first visit. 

Patient’s statement:  At the end of the last fall, right around the rainy season, she visited Hu Nan for ten plus days, following this visit she felt heaviness and soreness of the body, sleepiness and lack of strength, heaviness of head (and headache?), she has edema and night sweats, her tastes are insensitive.  After taking western and Chinese medicine, there have been no effects.  She has traveled around both Guang areas (Guang Dong and Guang Xi), Fu Jian and other places, and back to Beijing at the start of winter; She felt slightly better, but in the last 2 months the night sweats have increased, primarily on the head and upper part of body, every night she has profuse sweating (as being washed) but no sweat on the legs, she feels cold on the back and warm on the abdomen after sweating, and there is also edema of the face and legs.  Her blood pressure is slightly high, often fluctuating between 150/90~184/100mmHg.  Sometimes she has dizziness, palpations, chest fullness, vexation, poor sleep, reduced appetite, lack of sensitivity tasting.  There is sticky phlegm, no coughing, normal bowel movements, scanty and dark urine(reddish yellow).  After being treated with Chinese medicine for several months the edema basically disappeared, but the night sweats have not stopped. 

On the right side the cun and chi position pulses are sinking and weak, guan position is wiry, and the left cun position is thin and rapid, the left guan position sinking and rapid.  The tongue body is dark, the fur is thick, dirty and greasy.

Basically her condition belongs to a Yin vacuity with liver heat (pattern), with externally contracted summer heat dampness also leading to illness.  Due to long-term use of yin tonic and astringent herbs, there is dampness congealed and transforming to heat, damp and heat accumulation, and the san jiao has lost regulation. Treatment should be to clear heat and drain dampness, focusing on dredging and opening yang ming and tai yin, while simultaneously soothing the liver heat.

Formula: Jie Hua 2 qian, Sang Ye 2 qian, Bai Ji Li 3 qian, Jiao Zhi Zi 1 qian, Xiang Dou Chi 3 qian, Dou Jun 3 qian, Xiang Ru 1 qian, Yu Jin 1 qian 5 fen, Jian Qu 2 qian, Xiang Mu gua 1 qian 5 fen, Shi Hu 3 qian, Bai Tong Cao 1qian.  Take 3 bags.

Feb 14 second visit:
 After taking the herbs the night sweats are greatly reduced, there is no sweating after falling sleep, the head slightly sweats after waking up, there is slight headache, she feels tired, her blood pressure is still fluctuating, there is poor appetite, lack of taste, normal bowel movement, urine darkness reduced but still scanty, the pulse has changed to wiry and moderate, the tongue coating is decreased, there is still lack of taste, but spleen and stomach have been long stranded (??), and are now just showing initial improvement, so it is better to continue regulating stomach qi and clearing damp heat.

Formula: Bai Ji Li 3 qian, Dou Juan 3 qian, Shi Hu 3 qian, Jian Qu 2 qian, Bai Tong Cao 1 qian, Xiang Mu Gra 2 qian, Guang Chen Pi 2 qian, Bei Yin chen 3 qian, Chi Xiao Dou 3 qian, Bian Dou Yi 2 qian, Dao Ya 2 qian, He Ye 2 qian.  5 bags.

On 22nd of the same month, third visit:
The upper body sweating was reduced after taking the herbs, the lower limbs can have slight sweating (not just limited on the head and upper part of the body), there is no more aversion to cold after sweating, she is sleeping better, the headache has basically disappeared, the appetite is still not ideal, the mouth is still lacking taste ,there is slightly sticky phlegm, bowel movement is normal, urine is still yellow, pulse has changed to be moderate, the tongue body is normal with a thin white coating.  Damp heat is gradually being cleared (transformed), San Jiao is gradually being harmonized, treatment should be primarily to harmonize the stomach, and again clear the remaining heat.

Formula:   Bai Ji Li 3 qian, Dou Juan 3 qian, Jian Qu 2 qian, Bian Dou Yi 3 qian, He Ye 2 qian, Yin chen 3 qian, Tong Cao 1qian, Hua Shi Kuai (wrapped) 3 qian, Shong Jie 3 qian, Yi Ren 4 qian, Fa Ban Xia 2 qian, Ju Hong 2 qian, Zhu Li 2 qian,  take 3 bags.

On the 27th of the same month, fourth visit:
After taking the herbs, there is slight sweating in the middle of the night, she can taste flavors now, the sticky phlegm is reduced, there is a stuffy, warm sensation in the chest and lumbar area in the afternoon, bowel movements are normal, there is still scanty and dark urine, the pulse is gradually moving towards normal, the tongue body is normal without coating.  Treatment should again be to clear the remaining heat, harmonize the stomach, and promote urination.  Subtract  Bai Ji Li,  Fa Ban Xia, Zhu Li, and add Shi Hu 3 qian, Zhu Ling 1 qian 5 fen, Da Fu Pi 1 qian 5 fen.  After taking 4 bags the sweat stopped, her appetite was increased, all other symptoms are normal and the patient is recovered. 

In this type of sweating case, the (patient’s) general body condition is Yin vacuity with liver heat.  In this case, she originally got sick due to traveling in the late fall to the damp and moist areas, around the rainy season, during a continually overcast time, and therefore contracted summer heat dampness, which congealed and transformed in to heat, and the damp heat was restrained for a long time, also the San Jiao lost its regularity (smooth flow), leading to Ying Wei irregularity.  Damp heat was suppressed and steamed up, forcing fluids to rise up, causing sweat on the upper body but not the lower.  The pulse and tongue signs were not purely Yin vacuity with liver heat patter.  The root condition was Yin vacuity with liver heat, but the branch was summer heat dampness stagnating.  From the treatment aspect, we gave up the root to take care of the branch, therefore using Xiang Ru, Dou Juan, Dou Chi, Sang Ye, Ju Hua, Hua Shi, Yin Chen; the herbs that clear summer heat, remove dampness, release both interior and exterior to primarily focus on eliminating summer heat and removing dampness.  We regulated the stomach as a secondary treatment, while concurrently caring for liver yin.  In this way the stagnated damp heat can be removed, congealed heat can be released, San Jiao smoothed and unblocked, stomach qi can be harmonized, Ying and Wei can be regulated, and sweating therefore will be restrained.  The reason that there was no effect when she first took nourishing Yin, augmenting Qi, and astringent herbs is that damp heat had not yet been eliminated.  As this case demonstrates, damp heat is sticky and stagnating, even at the end of winter it is still lurking (inside) and not being resolved.  Therefore (when) treating a disease, a (practitioner) must understand the cause of the disease; this is truly an important point of clinical practice.      




 
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