before we talk about abnormal sweating um we certainly want to understand what normal sweating is right um and I think a lot of people just think that the way they sweat is normal sweating and that may be some people are are very well aware that the way they sweat is abnormal that they sweat a ton um and very few people will tell you that you know oh I don't sweat but we do find those people too where it's like I don't sweat enough you know I know that there's some people where um I've used herbs to help them um adjust their spleen actually and they started sweating more and then afterwards they're like I didn't realize it but being able to sweat a little bit really helps my body feel better so they they reported post facto that um regulating their spleen in this case by working with some of their damp issues helped their sweat Express themselves more and then their body felt better because of it because it brought yongi to the surface I think so that's really what sweat is right so the yongi and the the Wei are are thought of as um producing normal sweat um do you do you all remember what what organ system the sweat is said to belong to I will tell you sweat belongs to the heart the sweat is considered this refined Essence from the blood and the reason we bring this up is because excessive sweating is thought of as um not just Dam not just making you thirsty but actually damaging the fluids that help your heart right so um anybody who engages in activities that sweat too much um are opening opening the door for some pathologies and you know and in the East Bay this is probably most common with people that have anxiety and uh go to a lot of Bick roomm yoga classes and so you have to explain to them this relationship between heart blood and sweat and sweating a lot which is really you know the main thing about this hot yoga stuff but the idea is there's this relationship between the Wei and the Yi where the Yi is supposed to go to the surface and then the Wei opens or closes these interes to regulate and when we need to release heat when we need to release some extra fluids then we're supposed to sweat and then we when we don't the interstices are supposed to close down and protect the surface right um this activity of the wein and the interes that so is really this it's this shimmering membrane between you and the external environment you know our heat exchange with the external environment so we do want this to be really really really normal if at all possible um we'll talk about sweating excessively we'll also talk about not sweating um if the sweat is really balanced and this is actually a token of um the balance between yin and yang and the body so um when we talked about wind cold uh exterior deficiency we said that the treatment principle and maybe I should actually share make some notes so for instance when we talked about wind cold exterior deficiency tyion pattern we said that one of the signs of This was um chills more than fever with sweating and the sweating the origin of the sweating was described as a Ying way disharmony so the ying and the way the nutritive level and the protective level we not in harmony so um it said that the protective level the wayi is undernourished by the Ying right so the way is undernourished or unregulated and that's why we're sweating right because this defensive ches is a little bit weak and isn't isn't sufficiently attached to the nutritive level so if we're going to use um uh traditional metaphors that were often used in Chinese medicine describing this as a battle between the evil and the righteous Chi um the way Chi are the soldiers but they don't have enough sandwiches so they're getting tired they're not doing things quite the right way so we need to bring more nutritive Chi to them and one of the main ways we do this is with gager right so gager is said to harmonize the Ying in the way and so when we get to um a treatment principle the treatment principle for this be harmonized ying and way with herbs like gager so gager is a mirical herb um used for Millennia Now by humans to help them out we know that it's warming in proper property but the other thing it does is it actually works right in the energetic layer between the ying and the Whey to get them to talk more so if there is nutrition in the Ying layer it can get to the Wei layer and then you can better fight something off um we said that the um the heart is sweat which we want to think about as refined blood we have a few different um we have a few different areas where refined blood forms a fluid so this is also true of um breast milk breast milk is considered refined blood right so um it said that while in utero the the the fetus actually eats the mother's blood and then after it leaves and enters the post Heaven realm it still eats the mother's blood but processed through the breast but it's still considered like standing right next to blood which is why if you are nursing um blood deficiency is a common thing so we need to make sure that there's lots of blood nourishment going on or else um this uh loss of blood through the milk um can lead to blood deficiency signs and symptoms um so we said that um heart fluid is is is sweat but we also say that the lung governs the exterior right so that's the wayi so there's also this intimate relationship of the lungs with sweat too and it's important to kind of um kind of emphasize that that the the lung don't forget governs the entire Wei exterior as well it is considered the most exterior of the the yin organs right um so what's normal sweat normal sweat it's in response to heat exercise sometimes spicy food doesn't do much for you right um and also emotional strain so all of these are are normal reasons to sweat so if our patient you know if you say you sweaty and they say well I sweat when I work out then that's fine right um abnormal sweat would be too much quantity or not in response to one of these things just sweating for no reason right um and that usually points to something um that's not regulated about the fluids of the system so we also have to say oh maybe this spleen because the spleen transforms and transports all the fluids of the body right um so we can say Earth is the mother of fluids this is the earth phase producing all the fluids so there may be situations where there's a spleen issue that can also contribute to why we're not sweating well so or sweating appropriately is really what I should say um let me see how much more I want to cover before so if the chi and the Yang fail to manage the fluids then we may have abnormal sweating if the way Chi fails to regulate the interes we may have abnormal sweating um other reasons that we might have abnormal sweating um so Yi reduced wayi reduced then any kind of internal heat can also give us abnormal sotic so we did a long list of different Zang Fu patterns that can create heat um uh and sometimes this is called hyperactivity and then we know that deficient heat can also create sweating just because it's heat and there was a couple different kinds of heat that we we expected to see with Y deficiency five Palm heat night Heat this kind of stuff um and the last one we'll just mention is that there is also a sweating due to blood deficiency which we'll talk about a little bit um but this is more usually more pronounced blood deficiency um we'll get into the weeds here a little bit about different kinds of sweating that um you know we're interested in when and where basically the sweating occurs and that's going to give us some information about potential underlying patterns so if we can categorize the differences in sweating by time amount characteristics location that's going to help us out a little bit um and we'll start here at the top so spontaneous sweat and spontaneous sweat is usually categorized in the same place of spontaneous sweat or sweat with light exertion this basically means sweating without with without much reason to sweat right um and there's a couple different reasons why we might have this right so spontaneous sweating can be due to um cheat deficiency and this would be especially if somebody um is very cheat efficient and the exercise and The Sweat Just pours out of them we can think about this as being sort of analogous to wind cold um exterior deficiency that we just talked about some disregulation of the Ying in the way weight te is a little bit weak maybe the lung system would be the first place we'd ask about do you have shortness of breath are you fatigued to try to see if this um light sweating or quick sweating due to light exertion um is that is that the caused by cheat deficiency um there's also a chance that any kind of sweat spontaneous sweating or sweating with light um light exertion could be from Full heat and full heat when we say full heat we just mean excess heat and any of those excess heat patterns that we talked about um they can be existing in various degrees it could be in liver and gallbladder Heat could be stomach stomach heat it could be um yanging uh yanging Channel heat any of these excess heat conditions can lead to a place where um you sweat more than you think you should um I can think about um a few of my martial arts friends that I used to do a lot of contact sports with and it seems like um these guys would would be uh really sweaty really quick and they were all usually bigger bigger dudes that were sort of excess heat conditioned so stomach heat would be sort of something that they would might have maybe some damp heat as well so um we we'll see this this is often that same body type that's very very warm all year round tank tops and shorts even in the middle of winter right the next category I think is really important for us to focus on because um it ties in this idea that uh especially certain kinds of sweat steal our vitality and are are actually somewhat somewhat urgent I mean it's not urgent care urgent but you definitely want want to pay attention to them and um nighttime sweating is also sometimes known as Thief sweating um not only because thieves come at the night in the night but they come and they take something valuable from you so the idea here is that if somebody's really sweating a lot at night and they're losing lots of fluids and I've talked to patients where this is the case where they soak through two or three shirts a night you know um just at night they're sweating so much or they wake up in their bed clothes are all soaked and everything and they have to put a towel underneath them and things like this um and for them it's an inconvenience but for the Chinese medicine practition this continues for a long period of time that you're losing this really really valuable um Yin essence of the body you know this thin you know gin it's a gin the Jin or thin uh part of the yin Essence and if it continues then it could actually exacerbate some of these night heat signs or symptoms that might may be caused by Yin deficiency so you have Yin deficiency you get night sweats you lose more fluid you get more night you get more un deficiency it becomes an unver virtuous cycle right so we can think mostly of some sort of cheat deficiency some sort of full heat may cause a um either spontaneous sweat or sweating with very very very light exercise and then for nighttime Thief sweat we've already talked about Yin deficiency as being a big big potential here and then one that people don't think about is damp heat especially stomach and spleen damp Heat so I'm hoping by the time that you're out in the clinic room right here um you don't automatically go to Yin deficiency for a reason that somebody has night sweats um for some reason we we forget that dampness and heat can also cause night sweats and um one of the instructors I trained with for my doctor at suzan roido an advanced shanan Lan six syndromes practitioner um her big thing was that Yin deficiency sweats are way less common than damp heat sweats if occurring at night so I want you all to look for the dampness and heat not just for the Y deficiency if you do find these nighttime sweats um in addition to that we may have um uh cold sweating I'm gonna Feld Maya's question right now was there was there a question are the four on the right no completely separate sorry two columns um so there is we can also get a cold sweat right and cold sweat often will come with uh Yang deficiency uh it can be potentially also from fleem which is less common with the idea that this um fleem in the big picture and so we have to remember that there's substantial fleem which is respiratory fleem that you could actually put into a tissue or cough out of your lungs this is called substantial Flem right but then we have this insubstantial flim which is almost much more like energetic Gunk and that's any kind of um fluid accumulation in the body that is the result of irregular energetic flow and so cold sweat can can be caused by that too so insubstantial flim sometimes you can feel it nodules Under the Skin these are often insubstantial FL but sometimes this insubstantial flim can be more vague than that you don't actually have anything to to point to physically but you have maybe a slippery pulse a thicker tongue coat um and maybe you have cold sweating at random times maybe they uh talk about numbness in C certain parts of their body or dizziness and all of this kind of points towards this more insubstantial FL which we we're certainly going to get into much greater detail uh later on in the in the semester but now we'll just mention that sometimes cold cold sweating can be caused by fleem as well although I would say that young Vu is the first place that we actually go um we may need to ask some questions about you know are your limbs C but your body hot and then that might lead us to some different ideas of patterns it might not just be young deficiency a category that we're unlikely to encounter frequently unless we work in in a hospital inpatient with terminal patients or in hospice is this expiry sweat sometimes called desertion sweat and the basic idea of desertion sweat is that when people's Yin or yangong is very very very close to the end of the Rope you may end up with some sort of XY sweat which is a sweating that happens very close to the end of your life um not to say that you will necessarily die from here but if you see this kind of XPR it's because the yin or the Yang are very very deeply compromised um so Yin XPR um we say it's like oil drops and yang exer is supposed to be like pearls so we're going to say that this one is more heat this one is more cold so the way we describe um the end of life in Chinese medicine is a separation of yin and yang right that the yin and yang are no longer clinging together creating this Dynamic interchange of energies from the sky and the earth that is actually our entire experience um when we get to the point in our lives where one or of the other of these is so um so compromised that they start to separate we may see actually um different kinds of sweating manifest and uh it's not surprising what we actually see with this manifestation if the yin is really really really really compromised they'll say that the body surface will be very hot the person will look hot and the and the sweat will trickle like drops of oil especially on their brow um if the Yang is actually expiring then we say that this is Young XPR sweat and we expect cold signs and symptoms in this cold sweat to be manifested um so they say that this is not a really really really good sign um if it is y deficiency this um uh uh we expect more cold if it's deficiency we expect more heat um I put these on the other side just as some some other um sort of body location ideas about sweat um half body sweat I can't say clinically I've seen it very much but this is described as either heat um sorry sweating signs on the upper body or body or sweating signs on the left side of the body or the other side of the on the right side of the body and this is often associated with wind the erratic movement of energy and obstructions due to wind so we might actually expect this more along on perhaps uh things like wind stroke which is actually a lot like a traditional Chinese description of a stroke what we would call the sort of um acute neurological event of a stroke they described it as a wind stroke a sudden change in the body and the wind obstructs the channels and there's a sort of footnote that this could create a hemilateral which means half body sweat um so wind stroke sometimes also associated with wind flam for our purposes right now I don't really want to get deep into the analysis of windstrong or wind Flem but I do just want to point to the fact that a few of these irregular sweating patterns can be due to a combination of FL maybe with wind uh heart sweat is another specific area where we can actually get get sweat and some people have described to me in clinic that you know the area of their chests gets hot um and you know this gives us a little bit of information umang I'm just seeing uh we may think that this is some sort of uh over emotion affecting the function of of maybe the heart right um and I'll just bring your attention that when we talk about uh heart sweat we're actually talking about the whole chest region including the epigastrium so the region just below the heart is considered the heart area also um so some sort of excessive emotion affecting the heart and you may need to do a dangu diagnosis to figure out well what exactly is going on here you know are have they worried so much that it's now reduced their spleen so their blood is low so it's actually what we're treating is heart blood deficiency and that's why they're getting the sweat um is it because they're uh uh maybe their their heart excess they have heart fire maybe they've been doing all sorts of Lifestyle things that are very um uh provocative of the heart emotions and now their heart fire is out of control and they have actually heart heat and so we might expect palpitation we might expect restlessness anxiety that sort of stuff when we look at the next area of sweat we look at Yin sweat and we talked about the two lower Yin but this is really a genital region um so if somebody does have you know a generally damp uh genital region um we can often think about the liver channel here um we might also think about um kidney y deficiency potentially it's idea that the kidney has this reproductive aspect and if the Yong is decreased then maybe the fluids in the area but I would say liver is the first place that we go and we have Yin sweat of the genital region and probably some sort of dampness in heat is the most common clinical thing that we see sorry that says DH which is damp heat um I will say that I have had a couple patients in my practice whose Main and complain is that they have too much sweating from their hands um and I have heard anecdotal evidence that some acupuncture practitioners have had success with this that wasn't my experience I didn't have a lot of success with this um but there are people who um do sweat excessively from their palms um it's usually related to some sort of liver condition or perhaps to spleen and stomach which is what cam says cam says that it's spleen and stomach dampness steaming to the steaming the the extremities so the picture of ety we have here is that you have a warm and damp middle and this warm and damp middle is pushing out warmth and dampness to the hands and feet which is then creating the sweaty hands and feet um this was you know when when I had this one patient that saw me for two or three visits with excessive sweating of the Palms um I looked for splain and stomach dampness signs or symptoms and I sure didn't find them um and it seemed that like it was much more of a liver heat kind of thing because she would get it when she was very nervous and it would make her antsy and irritable um so I gave her a couple of liver treatments but we only got two treatments in and she decided it wasn't working so I I can't give you a personal anecdote about having success with that but I certainly recommend in your clinical practice if you do have success with it reach out to me so I can know about it I'd love to have better results with that um so we've kind of gone through the major um the major sweat pattern uh sweat types here and gestured towards the patterns but let's go ahead and take a look at some of the patterns just so we can be sure that we have a good review of these um and this is straight from dung when dung details the um excessive sweat patterns he names wind cold exterior Invasion so taang um wind strike so this would be the exterior deficiency that we talked about and the sweating is from a we deficiency um we talked about windw heat exterior pattern so this is another wey pattern that we've talked about in the past um wind heat wind warm Invasion can also create sweat then internal replete heat any kind of excess heat of any organ could potentially create sweat and then he names out damp heat on the chi level we've talked a little bit about that but we'll just say from the four levels we could represent this with the damp heat on the chi level pattern and then this lower lower Jou damp heat and I I indicated that probably liver and kid liver and gallbladder damp heat is really the main area that we're talking about here when we talk about lower ja damp heat um in the in the bigger picture of lower jaia we certainly could say well that also includes urinary bladder that also includes the kidney but clinically I would say liver gallbladder is where you're going to go with this um and interestingly we can put the liver in a couple different JS depending on what what emphasis we want to put on in the liver function when we talk about vacuity sweat patterns we I think we've talked about each of these um we said cheve Acuity this is going to be spontaneous sweating sweating with light heavy sweating with light exertion or sweating without exertion this often gestures towards CH Acuity um young vacuity often this is going to be our Cold Sweat Right invuity This is often going to be our night heat our night sweat um or often accompanied by five Palm heat so Yin deficiency heat and then Yong collapse Yin collapse collapse is another word for expiry so these are two indications of uh sweating that can happen in in more usually more terminal cases and uh the clinical pearls there for you are recognizing the oily sweat of the um Yin collapse versus The Sweat likee pearls from Yang collapse and then dual dual Acuity of heart and spleen maybe we should talk about this one a little bit more just because dung mentions it and it is a pattern that actually we see frequently so let's so this is a combination pattern and before I go into it I want to just see if anyone recalls from your om class and your diagnosis one class what this dual of Acuity is so these are this is a combination of two dang Fu patterns the basic idea here is that it's a spleen Chi deficiency that then leads to yes Maya exactly a heart blood deficiency um and the reason I want to pull this out is because it's very yeah exactly the spleen produces the blood and this is really important because we see this a lot in clinic we see a lot of combination people that have um weak digestion and also low blood levels right um and when we take out our acupuncture needles and we want to say what do we actually want to treat with this with acupuncture herbs separate question it turns out to get to this Blood deficiency really the only way is via the spleen right um because it is the spleen that produces blood so if there's not enough blood the way to do that is to stimulate you know it's not important that you know them but you know points like spleen six stomach 36 which is a spleen and a stomach Point um you can think about spleen three as well um all these spleen points where we're basically saying to the body let's move the energy to the digestion so that the digestion can assimilate more nutrient and turn that into blood there's not really any way to get to the blood with an AC function needle without going through the spleen right um we can encourage more blood to go to the Heart by using points you know maybe we use points like heart seven or heart eight or Heart Six and these all kind of encourage more blood to go to the heart but you're only working with the amount of blood that you have in the system right so if you want more blood the only way to do it is via the spleen which is also the latter Heaven root call back of engenderment so this means after you're born the way that you engender stuff is via your spleen right if you want more blood you get it from food that's where it comes from right and breathing to a certain extent so um we can encourage the spleen to make better blood but it's very difficult to actually put blood try to put blood in the system with needles which is why a lot of acupuncturist will tell you um if you want to nourish you really need to use the herbs or food right that's how you're really going to get more blood into somebody is by herbs or food as opposed to acupuncture um so this is an important pattern because it's very very clinically common and we actually talked about it earlier um the straight formula for this is gu Tong as long as you don't have liver involvement but this gu Tong if you look at the ingredients it will show you a lot of really really good ways to support the liver I mean support the the spleen to make more blood and it gives it blood nourishing herbs that the spleen can then transform um okay so I I don't find sweating the most thrilling topic to talk about with my patients but um it often does give us a little bit of um information that that we can feed into sort of our eight principles diagnosis um I will say though that in so far as sweating relates to hot and cold in the body it is a very important thing to ask our patients and it's Al something that you will notice when you touch them you'll notice the the you know how how moist their skin is and if they're very very dry or very very wet that's interesting information you know um we can often especially the very very wet we might start to think oh why is this person sweating so much do they have heat inside do they have wey deficiency we might ask some questions about this to try to get to to the root of the issue it does beg the P the question though we're going to talk about um why somebody sweats too much we do have to briefly answer the question you know why would you not sweat and so the the phrase for this is sweat block and we'll remind ourselves that even though we describe sweat as being this thing that is potentially a thief that steals our Vitality it's also an essential part of regulating our internal and external environment so we do want to be able to sweat appropriately and if we're not sweating appropriate it generally points to some sort of disorder of the Yang or Wei and a good example that would be wind cold exterior Invasion cold damage and we we described how the actual environmental cold can get in and block the yangi from the surface and so there's no sweat and then our actual medicine would be promote sweat diaphoresis right diaphoresis means promote sweat and we can have some you know Common or uncommon uh uh patterns like true cold false heat things like that where you might not be sweating but there's heat trapped inside that's really it for sweat block there's not a whole lot to say um you know if the if the Yang is very damaged and we're just not warm then we don't expect there to be any sweat we've also seen that Yang deficiency can flip over and cause sweat as well so I I don't think it's terribly diagnostic for in young for young deficiency in this case whether somebody's sweating or not sweating with certain times we will encourage diaphoresis and so that herb class will be called diaphoretics things that make you sweat and you know the chief among this would be mahang but you know caffeine is in there too right caffeine makes people sweat so you you can use um you can use black tea or coffee as a diaphoretic