Identifying Sweating Patterns: A Common Symptom Guide

Both externally contracted febrile diseases and internal damage miscellaneous disorders can present with generalized sweating. In externally contracted febrile diseases, invasion by external pathogens such as wind and cold leads to dysfunction of the ying (nutritive) and wei (defensive) systems, or exuberant heat forces body fluids to leak outward — both can cause sweating. In internal damage miscellaneous disorders, sweating is caused by yin-yang imbalance.

Generalized Sweating

• Sweating with small amounts of sweat, accompanied by fever, aversion to cold, body aches, and a floating, relaxed pulse: this is Taiyang wind-stroke syndrome. It is caused by wind-cold pathogens attacking the exterior, leading to disharmony between the ying and wei.
• Profuse sweating accompanied by high fever, aversion to heat, irritability, thirst with a desire for cold drinks, flushed face, red tongue with yellow coating, and a flooding, large pulse: this is Yangming channel syndrome or qi-level heat exuberance syndrome. It is caused by intense internal heat forcing body fluids to leak outward.
• Excessive sweating, aversion to cold, scanty urine or difficulty urinating, slight rigidity of the limbs, and difficulty flexing and extending the joints: this is yang deficiency leaking sweat syndrome. It is caused by excessive sweating during treatment, leading to exterior yang deficiency and weakened containment and securing function.
• Profuse, dripping perspiration, or sweat with an oily appearance, accompanied by rapid, labored breathing, pale complexion, cold extremities, and a faint, barely perceptible pulse: this is yang collapse syndrome. It is caused by severe yang qi deficiency on the verge of collapse.
• Initial aversion to cold with shivering, restlessness and agitation, followed by fever and sweating: this is shiver sweating (zhan han). It is caused by the struggle between pathogenic and antipathogenic qi.
• Profuse, continuous sweating accompanied by irritability, thirst, high fever, oppression and fullness in the chest and epigastrium, red tongue with yellow coating, and a flooding, large, forceful pulse, occurring in the summer season: this is summer-heat syndrome. It is caused by exuberant heat forcing body fluids to leak outward.
• Sweating during sleep that stops upon waking, accompanied by soreness and weakness of the lower back and knees, back pain, or nocturnal emissions and seminal efflux, five-center heat and vexation, red tongue with scant coating, and a thin, rapid pulse: this is yin deficiency night sweating syndrome. It is caused by yin deficiency failing to secure the ying internally.
• Sweating upon the slightest exertion, accompanied by mental fatigue, lack of strength, shortness of breath, disinclination to speak, pale complexion, pale tongue, and a vacuous pulse: this is qi deficiency spontaneous sweating syndrome. It is caused by spleen qi weakness and middle qi insufficiency.

Localized Sweating

This refers to uneven distribution of sweating, where some areas have sweat while others do not.

1. Head Sweating: Sweating only on the head, with the rest of the body having no sweat or only minimal sweat.

• Head sweating with no sweat elsewhere, accompanied by fever, heavy body sensation, fatigue, chest oppression, red tongue with yellow coating, and a rapid pulse: this is heat exuberance sweating syndrome. It is caused by internal heat steaming upward with inhibited qi dynamic.
• Head sweating with no sweat elsewhere, accompanied by yellowing of the body and eyes, difficult urination, abdominal fullness, red tongue with yellow, slimy coating, and a rapid pulse: this is damp-heat sweating syndrome. It is caused by damp-heat in the liver and gallbladder steaming upward with inhibited qi dynamic.
• Head sweating accompanied by pale complexion, slightly cold extremities, shortness of breath, disinclination to speak, mental fatigue, lack of strength, pale tongue, and a weak pulse: this is qi deficiency spontaneous sweating syndrome. It is caused by spleen qi weakness and middle qi insufficiency.

2. Palmoplantar Sweating: Sweating only in the palms and soles, with the rest of the body without sweat.

• Palmoplantar sweating accompanied by slightly cold extremities, mental fatigue, lack of strength, poor appetite, loose stools, pale tongue, and a vacuous pulse: this is spleen deficiency sweating syndrome. It is caused by spleen qi weakness with impaired transportation and transformation, leading to leakage of body fluids.
• Palmoplantar sweating accompanied by heat sensation in the palms and soles, dry throat and mouth, red tongue with scant coating, and a thin, rapid pulse: this is yin deficiency sweating syndrome. It is caused by yin deficiency with internal heat, leading to leakage of body fluids.

3. Hemilateral Sweating: Sweating on one side of the body (upper or lower, left or right), with the opposite side without sweat.

• Hemilateral sweating (left or right), accompanied by pale complexion, mental fatigue, lack of strength, heart palpitations, pale tongue, and a vacuous pulse: this is qi and blood insufficiency with inhibited qi dynamic, leading to failure in distributing body fluids throughout the body.
• Sweating on the upper body with no sweat on the lower body, accompanied by pale complexion, slightly cold extremities, aversion to cold, pale tongue with white coating: this is yang qi deficiency syndrome. Yang qi is deficient, and body fluids escape upward.
• Sweating on the lower body, accompanied by soreness and weakness of the lower back and knees, nocturnal emissions and seminal efflux, five-center heat and vexation, red tongue with scant coating, and a thin, rapid pulse: this is yin deficiency internal heat syndrome. Yin deficiency with internal heat and inhibited qi dynamic leads to leakage of body fluids.
• Hemilateral sweating (left or right), accompanied by hemiplegia, dark tongue with stasis macules: this is stroke syndrome. Internal obstruction by blood stasis and impaired meridian circulation lead to failure in distributing body fluids.