Pattern Differentiation and Treatment of Pediatric Night Sweats and Spontaneous Sweating

Both pediatric night sweats (daohan) and spontaneous sweating (zihan) belong to the pediatric sweat patterns of Chinese medicine. They are conditions in which abnormal discharge of sweat occurs in children due to imbalance of yin and yang; they mostly occur in children under five, with excessive sweating as the main clinical symptom.

From the Western medicine perspective, excessive sweating in children is generally caused by hyperthyroidism, autonomic nervous system dysfunction, or recurrent respiratory infections. Some children sweat profusely because of vitamin D-deficiency rickets, tuberculosis, or rheumatism; for such children, the primary disease must be treated.

The so-called night sweats mean the child sweats heavily while sleeping, even soaking the pillow and bedding. Night sweats are one of the common symptoms in pediatric patients; they occur whether or not the child has a tumor.

Night sweats must be distinguished from spontaneous sweating; both belong to excessive sweating. Unlike the transient sweating caused by fever, both night sweats and spontaneous sweating are chronic symptoms. Sweating during sleep that stops upon waking is night sweat; sweating easily whether asleep or awake is spontaneous sweating.

Night sweats and spontaneous sweating are divided into excess and deficiency patterns. They are generally caused by congenital insufficiency of constitution, inadequate postnatal care, lack of nourishment after illness, or excessive dispersal through medication.

Excess patterns are mostly caused by internal heat pressing outward; for example, if a child's undigested food accumulates and transforms into heat, it easily leads to spleen-stomach damp-heat or heart-spleen accumulated heat. Such children sweat excessively because internal heat steams upward and forces fluids outward, presenting as either spontaneous or night sweating.

Deficiency patterns are mostly caused by a weak child's body failing to close and retain, with fluids leaking outward. Children with exterior deficiency and failure to secure, decline of defensive yang, spleen deficiency with weak qi, or yin deficiency with effulgent fire easily develop spontaneous or night sweating.

Some children sweat profusely because of a mixed excess-deficiency condition with complex presentation.

Children have a fast metabolism and high activity, so sweating more than adults is normal; if there are no obvious accompanying signs, usually little treatment is needed. Most children improve after adjusting diet and routine; as they grow older, night sweats and spontaneous sweating naturally diminish.

Chinese medicine holds that during a child's growth there is a phenomenon called 'evolutionary steaming' (bian-zheng). At each stage of 'evolutionary steaming,' the child easily develops fever and spontaneous sweating, which improves greatly after the stage passes.

But if, apart from spontaneous and night sweating, the child also has other obvious symptoms, corresponding treatment is needed.

For example, if a child's spontaneous or night sweating is most pronounced on the head and limbs, with dry mouth, thirst, and bad breath, even mouth and tongue ulcers, thirst without desire to drink much, yellow urine, a red tongue, a yellow greasy coating, a purple and sluggish finger venule, and dry, lumpy, sheep-dung-like stools, this belongs to spleen-stomach damp-heat or heart-spleen accumulated heat; the treatment plan should clear the heart and drain the spleen, and clear and disinhibit damp-heat.

Representative formulas are Daochi San/Wan (Heart-Fire-releasing Powder/Pill) and Xiehuang San/Wan (Yellow-Draining Powder/Pill). The treatment principle is to clear the heart and drain fire; once stomach fire is cleared, the excess heat is removed, and once excess heat is removed, sweating stops of itself.

If a child presents mainly with night sweats, often accompanied by spontaneous sweating, sweating over the whole body, profuse sweating, fatigue, hot palms and soles, a pale tongue with little or mottled coating, and a thin, weak or thin, rapid pulse, this mostly belongs to yin deficiency with internal heat. It is often seen after warm-heat illnesses or in children with qi and yin damaged by chronic disease.

For such children, treatment should mainly supplement qi and nourish yin; representative formulas are Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Shengmai Yin (Generate the Pulse Drink), or Huangqi Shengmai Yin (Astragalus Generate the Pulse Drink). If the child can take decoctions, use Shengmai San (Generate the Pulse Powder) as the base, suitably adding floating wheat (fuxiaomai), calcined oyster shell (duan-muli), and rehmannia to strengthen the effect of nourishing yin and stopping sweating.

If, besides profuse sweating, the child also has aversion to wind, fatigue, sweating worse on movement, a pale complexion, and a usual tendency to catch colds, this should be attributed to decline of defensive yang and exterior deficiency with failure to secure. Such children mostly sweat most on the head or shoulders and back.

Treatment should harmonize yin and yang and harmonize the construction and defense; one may use Guizhi Tang (Cinnamon Twig Decoction), Guizhi Jia Gegen Tang (Cinnamon Twig plus Pueraria Decoction), or Huangqi Guizhi Tang (Astragalus Cinnamon Twig Decoction), followed up with Yupingfeng Granules (Jade Screen Powder) for consolidation.

Children with spleen deficiency, besides sweating easily, also show slow development, constant night crying, poor appetite, thin and lusterless hair, a pale or sallow complexion, irregular or dry unformed stools, fatigue and weakness, cold hands and feet or hot palms, and frequent colds and coughs. Such children often have low immunoglobulin, anemia, and trace-element deficiency.

Children with spleen deficiency have usually been ill for a long time and easily develop mixed excess and deficiency; treatment must address both. On one hand, fortify the spleen and boost qi, support the righteous and secure the exterior, boost qi and nourish yin, using Shengmai Yin, Guipi Wan (Spleen-Return Pill), or Huangqi Buxue Tang (Astragalus Blood-Tonifying Decoction) to support the righteous; on the other, spread and regulate the qi dynamic, using ready-made medicines such as Baohe Wan (Harmonize the Stomach Pill) or Jianwei Xiaoshi Pian (Stomach-Nourishing Digestive Tablets) to regulate digestion. Once the child's righteous qi recovers and the qi dynamic flows smoothly, both spontaneous and night sweating will diminish together.

Parents should also master some scientific child-rearing knowledge, strengthen the child's nutrition, have a balanced diet with meat and vegetables, and let the child eat more fruits and vegetables—many children with spleen-stomach accumulated heat have the condition from eating too much meat, so correcting the child's dietary habits is especially important.

At the same time, attention should be paid to letting the child exercise, arranging ball games, swimming, and running as appropriate, to promote digestion and boost immunity.

In addition, care should be taken to avoid infection; during outbreaks of epidemics, take the child as little as possible to crowded places to avoid catching epidemic diseases.

For pediatric diseases, tuina (pediatric massage) works well. Pediatric tuina treats various ailments with few side effects; it is just that the technique requires some skill. Conscientious parents can learn the techniques of pediatric tuina, or seek the help of a professional pediatric tuina therapist.

There are also some external treatment methods that can be used.

External formula one: equal parts of galla (wubeizi) powder, calcined oyster shell (duan-muli), and clove (dingxiang), ground into powder, mixed into a paste with warm water or vinegar, and applied externally to the child's navel or to the Yongquan (KI-1) point on the sole, fixed with a blank plaster patch (sold on Taobao) or adhesive tape; applied at night and removed in the morning. This can be used to treat night sweats.

External formula two: equal parts of galla (wubeizi) and curcuma (yujin), used as above; this can be used to treat both pediatric spontaneous and night sweating.

External formula three: galla (wubeizi), smoked plum (wumei), and mugwort leaf (aiye), decocted in water and used to soak the feet; this can be used to treat pediatric spontaneous and night sweating.