The Heart controls sweat
Blood and Body Fluids have a common origin. Sweat is
one of the Body Fluids that come from the space
between skin and muscles. As we have seen, Blood and
Body Fluids mutually interchange (Fig. 6.4). When
Blood is too thick, Body Fluids enter the blood vessels
and thin it down. The ‘Classic of the Jade Letter of the
Golden Shrine’ says: ‘Body fluids enter the blood vessels
and change into Blood.’23
Since the Heart governs Blood and this has a relation
of mutual interchange with Body Fluids, of which
sweat is part, the Heart is related to sweat. A deficiency
of Heart-Qi or Heart-Yang may often cause spontaneous
sweating, while a deficiency of Heart-Yin may
often cause night sweating and the treatment should
be aimed at tonifying Heart-Yang in the former case
and Heart-Yin in the latter. On the other hand, excessive
sweating, such as happens in hot weather or hot
living conditions, may injure Heart-Yang.
Because of the relationship of interchange between
Body Fluids and Blood, a patient who is haemorrhaging
should not be subjected to sweating, and a patient
who is sweating profusely should not have drying
herbs, nor should a bleeding technique in acupuncture
be used. As the ‘Spiritual Axis’ in chapter 18 advises:
‘Big bleeding, do not cause sweat; big sweat, do not cause
bleeding.’24
Furthermore any profuse and continuous sweating
in a patient with Heart deficiency should be treated
without delay, as a loss of sweat implies loss of Body
Fluids, which, in turn, will lead to a deficiency of Blood
because of the interchange between Blood and Body
Fluids.Of course, it should be noted that excessive sweating
may also be due to organs other than the Heart. In
particular, deficiency of Lung-Qi may cause spontaneous
sweating. Excess sweating may also be caused by
Heat or Damp-Heat, especially of the Stomach. Generally
speaking excessive sweating is related to the Heart,
especially when it is associated with emotional tension.
Heat injures the Heart also because it causes sweating:
as sweat is a fluid related to the Heart, excessive
sweating may weaken Heart-Yang.
Besides Qi, the Lungs also diffuse Body Fluids to the
skin and to the space between the skin and muscles
(cou li space) in the form of a fine ‘mist’. This is one
reason why the Upper Burner is compared to ‘Mist’.
The fine mist of Body Fluids moistens the skin and
regulates the opening and closing of pores and sweating.
When this function is normal, the pores open and
close normally, and there is a normal, physiological,
amount of sweating: in such a case, the space between
skin and muscles is said to be well regulated. When this
function is impaired, and the condition is one of Excess,
the pores become blocked and there is no sweating: in
this case, the space between the skin and muscles is
said to be too ‘tight’. If the condition is one of Deficiency,
the pores are over-relaxed and remain open so
that there is spontaneous sweating: in such a case, the
space between the skin and muscles is said to be too
‘loose’.
If the Lung’s function of diffusing body fluids is
impaired, fluids may accumulate under the skin,
causing oedema (usually of the face).
The diffusing of Lung-Qi can be stimulated by LU-7 Lieque
The Lungs control the skin and the
space between skin and muscles
(Cou li space)
This function is closely related to the previous two
functions. The Lungs receive fluids from the Spleen and
spreads them to the skin and the space between skin
and muscles all over the body. This nourishes and moistens
the skin. If the Lungs diffuse fluids normally, the
skin will have lustre, the opening and closing of the
pores is well regulated and sweating will be normal. If
this function is impaired, the skin will be deprived of
nourishment and moisture, and the skin may be rough
and dry (Fig. 8.8).
When Qi and fluids in the space between skin and
muscles (cou li) are harmonized, the space is properly
regulated, sweating is normal and the person has a
good resistance to pathogenic factors. In pathology,
the space between skin and muscles may be either
too ‘slack’ or ‘open’, in which case the person sweats
abnormally and external pathogenic factors penetrate
easily, or too ‘tight’ or ‘closed’, in which case there is
not enough sweating and, if pathogenic factors do
invade the body, the person will usually react strongly
with a fever.
The space between skin and muscles (cou li)
• When Qi and fluids in the space between skin and muscles
(cou li) are harmonized, the space is properly regulated,
sweating is normal and the person has a good resistance to
pathogenic factors
• When the space between skin and muscles is too ‘open’,
the
person sweats abnormally and external pathogenic factors
penetrate easily. To ‘tighten’ the space, reinforce LU-9
Taiyuan
and BL-13 Feishu with direct moxa cones
• When the space between skin and muscles is too ‘closed’,
there is not enough sweating and, if pathogenic factors do
invade the body, the person will usually react strongly with
a
fever. To ‘relax’ the space, needle LU-7 Lieque and L.I.-4
Hegu
The Lungs influence Defensive Qi, which flows in the
space between skin and muscles. If Lung-Qi is strong,
Defensive Qi will be strong and the person will have a
good resistance to attack by exterior pathogenic factors.
If Lung Qi is weak, the Defensive Qi will also be weakand,
because the pores will be open, there may be spontaneous
sweating; the person will also be prone to
attack by exterior pathogenic factors. When this kind
of sweating occurs, a certain amount of Defensive Qi
is lost with the sweat. For this reason, the ‘Simple
Questions’
in chapter 3 calls the pores ‘doors of Qi’.11
Conversely, if an exterior pathogenic factor does
invade the exterior portions of the body, that is, the
space between skin and muscles (which can happen
even if the Defensive Qi is relatively strong), it will
obstruct this space and therefore the circulation of
Defensive Qi, which, in turn, will impair the Lung diffusing
function, causing aversion to cold, sneezing, etc.
(Fig. 8.9).
The ‘Simple Questions’ in chapter 10 says: ‘The Lungs
control the skin and manifest on the hair. ’12 In chapter 9
it says: ‘The Lungs are the root of Qi, the residence of the
Corporeal Soul (Po), they manifest in the hair, they fill up
the skin, they represent Yin within the Yang and pertain to
Autumn.’13 entering and exiting of Qi and fluids in the joint capsules:
this contributes to irrigating and lubricating the
The relationship between Lungs and synovial membranes.
Kidneys with regard to fluids
In terms of fluids, the Lungs control the Water passages In adults, however, fear and chronic anxiety more
and send fluids down to the Kidneys; the often cause deficiency of Kidney-Yin and rising of
Kidneys respond by evaporating some of the fluids and Empty-Heat within the Heart, with a feeling of heat in
sending them back up to the Lungs to keep them moist the face, night sweating, palpitations and a dry mouth
(Fig. 12.13). This is why it is said in Chinese medicine and throat.
that the ‘Kidneys govern Water and the Lungs are the
Upper Source of Water’. If the Heart is strong, it will cause Qi to descend, but
If Lung-Qi is deficient, it cannot send fluids downwards if the Heart is weak, it will cause Qi to rise in the form
and the Lungs cannot communicate with the of Empty-Heat. This is more common in old people and
Kidneys and Bladder, causing incontinence or retention in women as fear and anxiety weaken Kidney-Yin and
of urine. If Kidney-Yang is deficient and cannottransform give rise to Empty-Heat of the Heart with such symptoms
and excrete the fluids in the Lower Burner, as palpitations, insomnia, night sweating, a dry
they may accumulate to cause oedema, which will mouth, a malar flush and a Rapid pulse.
impair the descending and diffusing of Lung-Qi. Deficiency There are other causes of fear, not related to the
of Kidney-Yin results in deficiency of fluids in Kidneys. Liver-Blood deficiency and a Gall Bladder deficiency
the Lower Burner. The consequence of this is that fluids can also make the person fearful.
fail to rise to keep the Lungs moist, thus causing deficiency
of Lung-Yin. The symptoms of this are a dry The discussion that follows will often list the clinical
throat at night, a dry cough, night sweating and a significance of a given symptom (e.g. ‘night-sweating
feeling of heat in the palms and soles of feet. indicates Yin deficiency’ or ‘thirst indicates Heat’). It
Box 12.9 summarizes the interrelationship between should be pointed out that this approach actually contradicts
the Lungs and the Kidney the very essence of Chinese diagnosis and patterns
sBox 12.9 Lungs and Kidneys according to which it is the picture formed by a
• Relationship between Lungs and Kidneys with regard to Qi number of symptoms and signs, rather than individual
• The Lungs send Qi down to the Kidneys, which ‘hold’ it: symptoms, that matters. No symptom or sign can be
this makes breathing normal seen in isolation from the pattern of which it forms
• Gathering Qi of the chest (related to the Lungs) part: it is the landscape that counts, not individual features.
communicates with Original Qi in the abdomen (related Thus it is wrong to say ‘night-sweating indicates
to the Kidneys) Yin deficiency’: we should say ‘in the presence of malar
• Relationship between Lungs and Kidneys with regard to flush, a Red tongue without coating and a dry throat
fluids at night, night sweating indicates Yin deficiency, while
• Lung-Qi sends fluids down to the Kidneys in the presence of a feeling of heaviness, a sticky taste,
• Kidney-Yang evaporates some and sends resulting a bitter taste, epigastric fullness, night sweating indicates
‘vapour’ back up to the Lungs to moisten them Damp-Heat’. It is only for didactic purposes that
we need to list symptoms and signs in isolation with
The end result of the complex process of transformation, their possible diagnostic significance.
transportation and excretion of fluids leads to the
formation of various Body Fluids in each of the three 10. Sweating
Burners. The fluids of the Upper Burner are primarilysweat, Evaluation of symptoms of sweating must be made by
which flows in the space between skin and considering if it is part of an exterior or interior pattern.
muscles; those of the Middle Burner are the fluids produced In the context of exterior conditions, sweating indicates
by the Stomach, which moisten the body and a relatively deficient condition. I say ‘relatively’
integrate Blood; those of the Lower Burner are primarily because an invasion of an external pathogenic factor
urine and the small amount of fluids in the stools is a Full condition by definition. However, in some
cases, if the Upright Qi is particularly deficient, there
The best points to influence the Triple Burner’s may be sweating: indeed, sweating is a sign that the
transformation Upright Qi is deficient.
and excretion of fluids are not on the Triple Burner channel Box 24.25 summarizes causes of sweating.
itself but on the Directing Vessel (Ren Mai): i.e. Ren-17 In invasions of Wind-Cold, there are two types of
Shanzhong for the Upper, Ren-9 Shuifen for the Middle and pattern, one characterized by predominance of Cold,
Ren-5 Shimen for the Lower Burner the other by predominance of Wind: in the latter, there
is some sweating, which indicates that the Upright Qi
In the chest cavity, the Triple Burner controls the is somewhat deficient.
entering and exiting of Qi, which is governed by the In the context of interior conditions, sweating may
Gathering Qi. In the abdominal and pelvic cavity, be caused either by a Full condition of Heat (or Damp-
the Triple Burner controls the transportation and Heat) or by a Deficient condition, which may be of
transformation of Qi in the Membranes. In the space Yang or Yin.
between skin and muscles, the Triple Burner controlsthe The pathology of sweating in Full and Empty conditions
diffusing of Defensive Qi and the entering and is different. In Full conditions of Heat, sweating
exiting of Qi in and out of that space. This function of is caused by evaporation of Body Fluids by Heat. In
the Triple Burner regulates the flow of Defensive Qi in Empty conditions, sweating is caused by the deficient
this space, the opening and closing of pores and sweating. Yang or Yin Qi not holding fluids, in the space betweenthe
In the joint cavities, the Triple Burner controls the skin and muscles in the former case and in the
‘bones’ in the latter. Empty-Heat
One must distinguish sweating by the area of body, Manifestations
time of day, conditions and quality of sweat. • A feeling of heat in the afternoon or evening, a dry mouth
The areas and with desire to drink in small sips, a dry throat at night, night
Area of body sweating, a feeling of heat in the chest, palms and soles
• Only on head: Heat in the Stomach or Damp-Heat (five-palm heat), dry stools, scanty dark urine, Floating-
• Oily sweat on forehead: collapse of Yang Empty and Rapid pulse, Red tongue without coating
• Only on arms and legs: Stomach and Spleen Aetiology
deficiency • Overwork (in the sense of working long hours)
• Only on hands: Lung-Qi or Heart-Qi deficiency • Irregular eating
• Whole body: Lung-Qi deficiency • Excessive sexual activity
• On palms, soles and chest: Yin deficiency (called • Persistent, heavy blood loss (such as in menorrhagia)
‘five-palm sweat’)
Box 24.26 summarizes patterns in sweating. Empty Yin
Time of day The main manifestations of Emptiness of Yin are a
• In daytime: Yang deficiency feeling of heat in the afternoon or evening, a dry throat
• At night-time: Yin deficiency (in some cases it can at night, night sweating, thin body, a Floating-Empty
also be from Damp-Heat) pulse and a tongue without coating.
Condition of illness Again, the above are only the general symptoms of
• Profuse cold sweat during a severe illness: collapse Emptiness of Yin, other symptoms depending on which
of Yang organ is mostly involved. The organs most likely to
• Oily sweat on forehead, like pearls, not flowing: collapse suffer from Yin Emptiness are the Kidneys, Lung, Heart,
of Yang, danger of imminent death Liver and Stomach.
Quality of sweat Other symptoms also depend on whether there is
• Oily: severe Yang deficiency Empty-Heat or not. If the Yin deficiency is severe, after
• Yellow: Damp-Heat some time, Empty-Heat will develop, causing (in addition
to the above symptoms of Yin deficiency) the following
Box 24.25 Causes of sweating symptoms: a low-grade fever, a feeling of heat
Full in the evening, five-palm heat and a Red tongue.
• Heat Yin also moistens, hence the symptoms of dryness
• Damp-Heat such as dry throat and tongue.
Empty
• Deficiency of Yang
• Deficiency of Yin Ren-4, Ren-6 and Ren-8 rescue Yang Qi and stop
sweating if indirect moxibustion on ginger or
Box 24.26 Sweating aconite is applied.
Area of body It is important to stop sweating because profuse
• Only on head: Heat in the Stomach or Damp-Heat sweating will further weaken the Heart in two ways.
• Oily sweat on forehead: collapse of Yang Firstly, a loss of sweat implies loss of Defensive Qi,
• Only on arms and legs: Stomach and Spleen deficiency which represents a further loss of Yang. Secondly, a
• Only on hands: Lung-Qi or Heart-Qi deficiency loss of fluids from sweating leads to a deficiency of
• Whole body: Lung-Qi deficiency Blood because of the interchange relation between
• On palms, soles and chest: Yin deficiency (called ‘five- Body Fluids and Blood. The resulting deficiency of
palm Blood will further weaken the Heart.
sweat’).
Time of day HE-6 nourishes Heart-Yin and, in combination
• In daytime: Yang deficiency with KI-7, stops night sweating
• At night-time: Yin deficiency (in some cases it can also be
from Damp-Heat) Box 35.4 Lung-Yin deficiency
Condition of illness Clinical manifestations
• Profuse cold sweat during a severe illness: collapse of Cough which is dry or with scanty sticky sputum, weak and/
Yang hoarse voice, dry mouth and throat, tickly throat, tiredness,
• Oily sweat on forehead, like pearls, not flowing: collapse dislike of speaking, thin body or thin chest, night sweating,
of normal-coloured tongue, dry without coating (or with
Yang, danger of imminent death rootless
Quality of sweat coating) in the front part, Floating-Empty pulse
• Oily: severe Yang deficiency Treatment
• Yellow: Damp-Heat LU-9 Taiyuan, Ren-17 Shanzhong, BL-43 Gaohuangshu, BL-
13
Sweat Feishu, Du-12 Shenzhu, Ren-4 Guanyuan, KI-6 Zhaohai,
The smell of sweat is often related to Dampness Ren-12
because the fluids forming sweat come from the space Zhongwan, SP-6 Sanyinjiao, LU-10 Yuji, L.I.-11 Quchi
between the skin and muscles where Dampness often
accumulates. Any strong-smelling sweat often indicates Box 35.15 Heart- and Lung-Qi deficiency
Damp-Heat. Putrid-smelling sweat may indicate Clinical manifestations
a disease of the lungs, liver or kidneys. Slight shortness of breath, slight cough, weak voice, dislike
of
speaking, bright-white complexion, propensity to catch
colds,
tiredness, palpitations, shortness of breath on exertion,
depression, spontaneous sweating, sighing, Pale tongue,
Empty pulse
Treatment
LU-9 Taiyuan, LU-7 Lieque, Ren-6 Qihai, BL-13 Feishu, Du-
12
Shenzhu, ST-36 Zusanli, Ren-12 Zhongwan, HE-5 Tongli, P-
6 Box 37.4 summarizes Kidney-Yin deficiency.
Neiguan, BL-15 Xinshu, Ren-17 Shanzhong
This pattern is characterized by deficiency of Yin and
also Essence of the Kidneys, as Essence is part of
Kidney-Yin.
Deficient Kidney-Yin fails to produce enough Marrow
to fill the brain, resulting in dizziness, tinnitus, vertigo
and poor memory. The dizziness would be slight and
the tinnitus would be of gradual and slow onset with
a sound like rushing water.
The deficiency of Kidney-Yin leads to lack of Body
Fluids and ensuing dryness, resulting in a dry mouth
at night, constipation and scanty dark urine.
Night sweating is due to Yin being deficient and
failing to hold Defensive Qi (Wei Qi) in the body at night
(Defensive Qi retires into the Yin at night), so that the
precious Yin nutritive essences come out with the
sweat. Thus night sweating is very different from
daytime sweating as, with the former, the Yin nutritive
essences are lost, whilst with the latter, Yang fluids are
lost. Night sweating is also called ‘evaporation from the
bones’, whilst daytime sweating is called ‘evaporation
from the muscles’. The term for night sweating is also
‘rob sweating’, probably to indicate that with it the
body is robbed of precious Yin essences.
Kidney-Yin deficiency often causes night sweating, which
represents a loss of Yin fluids. Night sweating is
‘evaporation
from the bones’, i.e. a loss of deep, precious fluids. It was
called
‘rob sweating’ because it robs the body of precious Yin
essences
Treatment
Principle of treatment: nourish Kidney-Yin.
Acupuncture
Points: Ren-4 Guanyuan, KI-3 Taixi, KI-6 Zhaohai,
KI-10 Yingu, KI-9 Zhubin, SP-6 Sanyinjiao, Ren-7Yinjiao, LU-
7 Lieque and KI-6 Zhaohai in
combination (opening points of the Directing
Vessel).
Method: reinforcing method, no moxa.
Explanation
– Ren-4 without moxa tonifies Kidney-Yin and
Kidney Essence (with moxa it can tonify
Kidney-Yang).
– KI-3 tonifies the Kidneys.
– KI-6 is specific to tonify Kidney-Yin and it
benefits the throat (particularly indicated for dry
mouth at night).
– KI-10 is specific to tonify Kidney-Yin.
– KI-9 tonifies Kidney-Yin, particularly useful in
case of anxiety and emotional tension of Kidney
origin.
– SP-6 tonifies Liver- and Kidney-Yin and calms
the mind.
– Ren-7 nourishes Yin.
– LU-7 and KI-6 in combination open the
Directing Vessel (Ren Mai) and nourish
Kidney-Yin.
Herbal fomula
Zuo Gui Wan Restoring the Left [Kidney] Pill.
Liu Wei Di Huang Wan Six-Ingredient Rehmannia Pill.
Three Treasures
Nourish the Root (variation of Zuo Gui Wan).
Box 37.4 Kidney-Yin deficiency
Clinical manifestations
Dizziness, tinnitus, vertigo, poor memory, hardness of
hearing,
night sweating, dry mouth and throat at night, lower
backache, ache in bones, nocturnal emissions, constipation,
dark scanty urine, infertility, premature ejaculation,
tiredness,
lassitude, depression, slight anxiety, normal-coloured
tongue
without coating, Floating-Empty pulse
Treatment
Ren-4 Guanyuan, KI-3 Taixi, KI-6 Zhaohai, KI-10 Yingu, KI-
9
Zhubin, SP-6 Sanyinjiao, Ren-7 Yinjiao, LU-7 Lieque and KI-
6
Zhaohai in combination (opening points of the Directing
Vessel).
Kidney-Yin deficiency, Empty-Heat
blazing
Clinical manifestations
Malar flush, mental restlessness, insomnia, night sweating,
low-grade fever, afternoon fever, five-palm heat, feeling of
heat in the afternoon and/or evening, scanty dark urine,
blood
in the urine, dry throat especially at night, thirst with desire
to
drink in small sips, dizziness, tinnitus, hardness of hearing,
lower backache, nocturnal emissions with dreams, excessive
sexual desire, dry stools
Tongue: Red, cracked with a red tip, without coating
Pulse: Floating-Empty and Rapid
Treatment
KI-3 Taixi, KI-6 Zhaohai, KI-10 Yingu, KI-9 Zhubin, Ren-4
Guanyuan, KI-2 Rangu, SP-6 Sanyinjiao, HE-5 Tongli, LU-7
Lieque, LU-10 Yuji, HE-6 Yinxi, Du-24 Shenting, L.I.-11
Quchi
Treatment
Principle of treatment: nourish Kidney- and Heart-Yin,
clear Heart Empty-Heat, calm the Mind.
Acupuncture
Points: HE-7 Shenmen, HE-6 Yinxi, HE-5 Tongli,
Yintang extra point, BL-15 Xinshu, Ren-15 Jiuwei,
Du-24 Shenting, KI-3 Taixi, KI-10 Yingu, KI-9
Zhubin, KI-6 Zhaohai, Ren-4 Guanyuan, SP-6
Sanyinjiao.
Method: reinforcing on the points to nourish Kidney-
Yin (KI-3, -6, -9, 10, Ren-4, SP-6), reducing
method on the points to clear Heart Empty-Heat
(HE-5, -6, -7, BL-15), even method on the others
(Yintang, Ren-15, Du-24).
Explanation
– HE-7 calms the Mind.
– HE-6 clears Empty-Heat and nourishes Heart-
Yin (it is specific for night sweating combined
with KI-7 Fuliu).
– HE-5 clears Heart Empty-Heat and conducts
Heat downwards away from the head.
– Yintang calms the Mind.
– BL-15 clears Heart-Heat.
– Ren-15 calms the Mind and nourishes
Heart-Yin.
– Du-24 calms the Mind.
– KI-3, KI-9 and KI-10 tonify Kidney-Yin. KI-9, in
particular, calms the Mind.
 KI-6 nourishes Kidney-Yin.
 37.12 Kidney- and Lung-Yin deficiency
Clinical manifestations
Dry cough which is worse in the evening, dry throat and
mouth, thin body, breathlessness on exertion, lower
backache,
night sweating, dizziness, tinnitus, hardness of hearing,
scanty
urination, normal-coloured tongue without coating or with
rootless coating, Floating-Empty pulse
Treatment
KI-3 Taixi, KI-6 Zhaohai, LU-7 Lieque and KI-6 Zhaohai in
combination (opening points of the Directing Vessel), Ren-4
Guanyuan, KI-13 Qixue, LU-9 Taiyuan, LU-1 Zhongfu, SP-6
Sanyinjiao, BL-43 Gaohuangshu