SWEATING

SWEATING

Chapter contents

INTRODUCTION

Excessive sweating is always considered a symptom requiring the doctor’s attention in Chinese medicine. In order to define ‘excessive sweating’ we should bear in mind that under certain circumstances sweating is a normal physiological process. For example, it is normal to sweat during exercise, after eating spicy foods, in very hot weather and when under emotional strain.

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.).

WHEN WE ASK

I ask about daytime sweating mostly to confirm a diagnosis of Lung-Qi deficiency and about night sweating to confirm a diagnosis of Yin deficiency. If night-time sweating appears without any manifestation of Yin deficiency, then we need to think again and check whether this symptom is being caused by Damp-Heat or other less common patterns.

HOW WE ASK

When asking about daytime sweating, I generally ask, ‘Do you tend to sweat abnormally even in the absence of exercise?’ In the case of night-time sweating, the question is easier and I simply ask, ‘Do you tend to sweat at night sometimes?’ We should, however, exclude night sweating that is simply caused by too heavy a blanket and too hot a bedroom.

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.

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Tags: Diagnosis in Chinese Medicine A Comprehensive Guide

Apr 15, 2017 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off

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