Dr. Hu Anbang's Clinical Experience in Treating Night Sweats in Malignant Lymphoma Patients

Patients with malignant lymphoma often develop night sweats: profuse sweating begins as soon as they fall asleep, day or night, and stops the moment they wake. Night sweats seriously disturb sleep; many lymphoma patients have recurrent episodes lasting months at a time, severely impairing quality of life.

Following the TCM principle of pattern differentiation and treatment, Dr. Hu Anbang divided night sweats in malignant lymphoma patients into four types: 1) yin deficiency with exuberant fire; 2) Yangming internal heat; 3) construction-defense disharmony; 4) yang deficiency with spontaneous sweating.

Yin-deficiency, fire-exuberant patients present with vexation, dry mouth, night sweats covering the whole body as soon as they fall asleep, or steaming sweat over the center of the chest, dark urine, a red tongue, and a fine pulse. This type can be treated with Huanglian Ejiao Tang; those with heart-yin depletion can use Tianwang Buxin Dan to nourish the heart and quiet the spirit.

Patients with night sweats of the Yangming internal-heat type sweat in a steaming manner, even breaking into a sweat all over the head while eating during the day; they have a dry mouth, irritability, and a slippery pulse. Such patients can be treated with Baihu Tang or Baihu plus Renshen Tang. Dr. Hu Anbang often uses Huaixiaomai (processed wheat) instead of Jingmi (rice) in Baihu Tang, to generate fluids, clear heat, and stop sweating.

Patients with night sweats of the construction-defense disharmony type often feel wind-aversion after sweating and have a soft, forceless pulse; they are suited to Guizhi Tang. In Dr. Hu's experience, if sweating is profuse and the pulse is weak and soft, Longgu (Dragon Bone) and Muli (Oyster Shell) may be added to Guizhi Tang to secure astringency and prevent desertion.

Yang-deficiency spontaneous-sweating patients present with heart vexation and palpitations, night sweats with aversion to cold. Dr. Hu Anbang considered this due to deficiency of heart fire and insecurity of defensive yang; it should be treated with Muli San to boost qi, secure the exterior, astringe sweat, and subdue yang.

Dr. Hu Anbang's analysis of 16 lymphoma patients with night sweats he treated found that yin deficiency with exuberant fire was the largest group, at 54%; Yangming internal heat accounted for 37%; construction-defense disharmony and yang-deficiency spontaneous sweating each accounted for 4.5%. On average, these patients' night sweats were substantially reduced after 3–4 doses of Chinese herbs and resolved after about 10–20 doses.

Chemotherapy is a common treatment for malignant lymphoma patients, and night sweats easily appear after chemotherapy, so night sweats in lymphoma patients tend to recur. Following TCM pattern differentiation, according to the specific clinical symptoms presented, one can usually resolve this complication in lymphoma patients.

But the four types summarized by Dr. Hu Anbang are only a rough framework; in my own practice I have seen many patients who do not fit any of the four.

For example, a patient I saw today had not only night sweats but also generalized aching pain as if wrapped in something, fatigue, a bitter taste in the mouth, dry stools, pain around the eye sockets, and symptoms of conjunctivitis. Such a case is very hard to fit into any of the four types summarized by Dr. Hu Anbang; the physician can only rely on his own clinical experience to judge the pattern.