A 35-year-old woman with severe spontaneous sweating, night sweats, and palpitations induced by work stress was managed using an herbal strategy to tonify Qi and harmonize Ying and Wei.

Case ID: CHC-0027

Case Summary

This case describes a 35-year-old woman who presented with frequent, severe spontaneous sweating and night sweats triggered by chronic work stress and sleep deprivation. The original report documented a conventional diagnosis of autonomic nervous system dysfunction and a TCM assessment of Sweating Syndrome (Han Zheng) driven by Qi and Blood deficiency with an insecure defensive exterior. The patient was managed through a dynamic herbal approach that initially secured the exterior to stop the severe sweating, then pivoted to move Qi and rebuild her foundational energy.

Patient Presentation

• Patient: 35-year-old female.
• Main Complaint: Frequent spontaneous sweating and night sweats, accompanied by palpitations and fatigue.
• History: The patient reported that recent high work stress and insufficient sleep led to an onset of continuous spontaneous sweating and severe night sweats. The episodes of sweating were often followed by heart palpitations and shortness of breath, which further deteriorated her sleep quality. She had attempted lifestyle adjustments and took over-the-counter vitamins, but experienced no significant improvement. At the time of consultation, she presented with a notably pale complexion and profound mental fatigue.

Examination and Diagnosis

• Conventional Diagnosis: Autonomic nervous system dysfunction.
• TCM Tongue and Pulse: The tongue was pale red with a thin, white coating. The pulse was fine and weak (脉细弱).

TCM Assessment

The original practitioner interpreted the presentation as Sweating Syndrome driven by Qi and Blood deficiency and an Insecure Defensive Exterior (汗证 – 气血不足，卫表不固).

According to the principles of yin and yang Chinese Medicine, normal sweating is regulated by the Wei (Defensive) Qi at the body’s surface, which acts as a barrier to control the opening and closing of the pores. The original report noted that the patient’s chronic work stress and sleep deprivation had severely exhausted her foundational Qi and Blood.

Without sufficient Qi to anchor and secure the exterior, her pores remained loosely open, resulting in spontaneous daytime sweating. Furthermore, because TCM views sweat as sharing a common physiological origin with blood (“sweat is the fluid of the Heart”), the constant loss of fluids further deprived her Heart of nourishment. This secondary depletion directly caused her subsequent symptoms of palpitations, shortness of breath, and ongoing fatigue.

Treatment Approach

The primary treatment principle was to tonify Qi, secure the exterior, and harmonize the Ying (Nutrient) and Wei (Defensive) levels (益气固表，调和营卫). The strategy aimed to physically close the pores using astringent minerals while rebuilding the underlying Spleen and Lung Qi to restore the body’s natural autonomous regulation.

Herbal Formulas and Modifications

• Initial Formula (April 25, 2023): A 13-herb decoction focused heavily on boosting Qi and anchoring fluids.
  • Tonifying Qi and Securing the Exterior: Huang Qi (Astragalus, 30g) at a heavy dose, Bai Zhu (Atractylodes, 15g), and Fu Ling (Poria, 20g) were utilized to strongly fortify Spleen and Lung Qi, reinforcing the body’s defensive barrier.
  • Harmonizing Ying and Wei: Chao Bai Shao (Stir-baked White Peony, 15g) nourished the blood and softened the Liver. Bei Chai Hu (Bupleurum, 15g) and Huang Qin (Scutellaria, 10g) were added to gently soothe Liver stagnation caused by stress.
  • Astringing Sweat and Calming the Spirit: Duan Long Gu (Calcined Dragon Bone, 30g) and Duan Mu Li (Calcined Oyster Shell, 30g) are heavy, mineral-based medicinals. They were decocted first to extract their active components, serving to strongly anchor the floating spirit (stopping palpitations) and physically astringe the pores to halt the severe fluid loss.
  • Balancing the Formula: Cang Zhu, Jie Geng, Ze Xie, and Fang Feng were included to dispel wind, regulate fluid metabolism, and ensure the tonics did not create stagnation. Gan Cao Pian harmonized the herbs.
• Modification (May 9, 2023): At the second visit, the sweating and palpitations had improved, but the patient developed abdominal bloating. The practitioner immediately removed the heavy, astringent minerals (Duan Long Gu, Duan Mu Li), which can be hard on digestion. Instead, Dang Shen and Shan Yu Rou were added to deeply nourish Qi and Yin. To address the new bloating, Qi-moving herbs Zhi Shi, Jiang Hou Po, and Mu Xiang were introduced to stimulate gastrointestinal motility.

Follow-Up

• May 9, 2023 (Second Visit): After the initial course of the decoction, the source reported that the spontaneous sweating and night sweats were notably reduced, and her palpitations and shortness of breath were alleviated. The formula was subsequently adjusted to manage her residual fatigue and a new onset of mild abdominal distension.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the dynamic, highly responsive management of autonomic dysfunction. In highly stressed modern professionals, chronic exhaustion often manifests as unregulated sweating and a racing heart.

The original practitioner recognized that simply prescribing heavy astringents would trap the pathology, while solely prescribing tonics could overwhelm a weak digestive system. The clinical reasoning shines in the second visit: heavy astringents (Dragon Bone and Oyster Shell) were used strictly as an acute intervention to stop the immediate leakage of sweat. As soon as the sweating stabilized, these dense minerals were removed to prevent them from causing digestive stagnation (bloating), and the formula was seamlessly pivoted to Qi-moving and Yin-nourishing herbs. This demonstrates the core TCM tenet of constantly adapting the prescription to the patient’s real-time metabolic capacity.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：气虚不固汗频流，营卫不和病难休]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 15, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation