Qingre Gubiao Decoction for Post-Infectious Spontaneous Sweating and Night Sweats

Qingre Gubiao Decoction (Heat-Clearing and Exterior-Securing Decoction) is an empirical formula of the modern TCM physician Wang Jiru, from his work Wenbing Chuyan. It is composed as follows: Sheng Shigao (Gypsum Fibrosum, raw) 30 g, Digupi (Cortex Lycii) 12 g, Fuxiaomai (Fructus Tritici Levis) 30 g, Nuodaogen (Radix Oryzae Glutinosae) 30 g, Zhimu (Rhizoma Anemarrhenae) 10 g. Decoct in water, strain, and take warm, twice daily. When decocting, Sheng Shigao should be boiled first for 15–30 minutes so that its active ingredients extract better.

This formula clears heat, secures the exterior, and stops sweating. It is indicated for internal heat with disharmony of the exterior, leading to spontaneous sweating and night sweats. In the formula, Sheng Shigao and Zhimu clear heat in the qi aspect; Digupi eliminates steaming bone syndrome and drains deficiency heat; Nuodaogen and Fuxiaomai are famous TCM herbs for stopping sweating, serving as symptomatic medicines.

Wang Jiru's formula evolved from Zhang Zhongjing's Baihu Decoction (White Tiger Decoction). Baihu Decoction treats exuberant heat in the yangming qi aspect, presenting with high fever, flushed face, polydipsia with a craving for drink, sweating with aversion to heat, and a large, surging, forceful pulse. Baihu Decoction consists of Sheng Shigao, Zhimu, Jingmi (round-grain rice), and Zhigancao (honey-fried Radix Glycyrrhizae); the present formula takes Sheng Shigao and Zhimu from Baihu Decoction to forcefully clear heat from the qi aspect.

In the middle-to-late stage of warm disease (infectious disease), some patients, although their fever has subsided and the thermometer shows no abnormal temperature, still feel internally hot that will not clear; if this drags on, symptoms such as dry mouth and thirst appear. At such times one must use the approach of Baihu Decoction to clear heat from the qi aspect.

When heat evil lingers, it often passes from the qi aspect into the blood aspect. Some patients feel heat steaming outward as if from the bones; TCM holds this to be heat evil entering the interior, and requires herbs such as Digupi, Mudanpi (Cortex Moutan), Yinchaihu (Radix Stellariae), Qinjiao (Radix Gentianae Macrophyllae), Biejia (Carapax Trionycis), and Qinghao (Herba Artemisiae Annuae) to drain deficiency heat; the present formula uses Digupi.

Internal heat evil forces sweat outward, so the patient's most prominent symptom is unstoppable spontaneous sweating or night sweats. Heat-clearing herbs alone are slightly insufficient in force; this formula adds the sweat-stopping herbs Fuxiaomai and Nuodaogen, both in large doses, to address the branch simultaneously. The logic is clear: root and branch are treated together, and the formula is worth learning from.

When using this formula, note: if the patient does not aversion to heat but instead feels cold, this formula should be used with caution.