1. Case Analysis: The Dilemma of Spleen Deficiency and Damp-Heat Behind Excessive Sweating

In July 2024, a 5-year-old child was treated, presenting with fever symptoms, with a temperature fluctuating between 37 and 40 degrees. The child typically sweats a lot, requiring two clothing changes before bed each night, is active, and prone to catching colds and indigestion, showing poor digestive function, thin physique, and slow growth in height and weight. Examination revealed a grade 2 tonsil enlargement. The parents mistakenly thought the child had “excessive internal heat,” but traditional Chinese medicine (TCM) diagnosis showed a white and greasy tongue coating and a deep and slippery pulse, indicating a condition of spleen deficiency with damp-heat and liver depression turning into fire.

[Initial Prescription] Honey-fried Ephedra 3g, Processed Bitter Apricot Kernel 8g, Astragalus 15g, Sterculia Seed 5g, Fried Arctium Fruit 10g, Fried Perilla Seed 10g, Gleditsia Spine 10g, Pinellia Tuber 10g, Ginger Magnolia Bark 15g, Rhubarb 1g, Uncaria 10g (added later), Gastrodia 10g, Scutellaria 10g, Moutan Bark 10g, Angelica 10g, Chuanxiong 6g, Poria 15g, Fried Alisma 10g, 6 doses

Core Pathogenesis Analysis:

It is common for children to be active and sweat easily. Due to their activity, especially kicking off blankets at night, their pores open, making them susceptible to catching colds.

From the perspective of TCM pathogenesis, the root cause lies in poor digestive function of the spleen and stomach, which easily generates accumulated heat. The spleen and stomach are the foundation of acquired constitution; when their function is impaired, food cannot be properly digested and absorbed, leading to internal stagnation and turning into heat. Additionally, it is common for children to have excessive liver fire, as the liver governs the free flow of qi, and excessive liver fire makes it difficult for emotions to settle, resulting in hyperactivity in children.

When liver qi stagnates, and spleen and stomach damp-heat affect the three burners, it disrupts the normal metabolism of body fluids, causing damp-heat to linger and further aggravating symptoms like excessive sweating and susceptibility to colds.

1. ​Spleen and Stomach Cold Deficiency: Long-term indigestion leads to impaired spleen and stomach function, with internal retention of dampness (spleen and lung qi deficiency)
2. ​Internal Damp-Heat: Dampness turns into heat, obstructing the three burners and affecting fluid metabolism (pathogenesis of damp-heat syndrome)
3. ​Liver Depression Turning into Fire: Liver fire disturbs the mind, causing hyperactivity and restless sleep (theory of emotional disorders)

[Comparison of Tongue Coating Before and After]
The comparison shows a significant reduction in the greasy coating in the middle of the tongue, indicating a clear decrease in dampness, but the tongue body remains slightly red, requiring further adjustment. After one week of treatment, back sweating decreased, and head sweating reduced. After another week, sweating returned to normal.

Symptom Comparison Table:

​2. Three Core Strategies for TCM Adjustment

1. ​Clearing and Resolving Damp-Heat
   • ​Medication: Fried Arctium Fruit, Scutellaria, Gleditsia Spine (clearing lung and stomach damp-heat)
   • ​Principle: Targeting red and swollen tonsils and yellow and greasy tongue coating in damp-heat syndrome, such as using Ganlu Xiaodu Pill to treat hand, foot, and mouth disease damp-heat syndrome
2. ​Strengthening the Spleen and Resolving Dampness
   • ​Medication: Astragalus, Poria, Fried Alisma (strengthening the spleen and resolving dampness)
   • ​Topical Application: Angelica Dahurica + Gleditsia Spine powder mixed with vinegar, applied to the skin to remove dampness (external treatment method)
3. ​Soothe the Liver and Clear Heat
   • ​Medication: Uncaria, Gastrodia, Moutan Bark (calming the liver and extinguishing wind, clearing heat from the blood)
   • ​Diagnosis: The child’s hyperactivity and poor sleep confirm the pathogenesis of “liver depression turning into fire disturbing the mind”

​3. Four Key Insights for Mothers

1. ​Beware of “Pseudo-Heat Symptoms”
   • If a child has excessive sweating + thick and greasy tongue coating + sticky stools, it is more likely damp-heat rather than true heat; avoid using cold and cooling herbs like Isatis Root
2. ​Contraindications for Topical Medications
   • Angelica Dahurica, Gleditsia Spine, and other herbs with warm and pungent properties are contraindicated on broken skin to avoid irritation and worsening inflammation
3. ​Key Points for Treatment Course Management
   • This child’s condition prolonged due to not taking medication on time, confirming the clinical experience that “spleen deficiency requires a 2-month treatment cycle”
4. ​Warning Signs of Developmental Delay
   • Excessive sweating → depletion of qi and blood → reduced growth hormone secretion

Mothers must pay attention to the issue of children being active and sweating easily. Early adjustment of the child’s constitution can help with growth and weight gain.

Essentially, it is closely related to the spleen, stomach, and three burners.

From a TCM perspective, the following aspects can be addressed:

Diet: The diet should be light and easy to digest, following the principle of “grains for nourishment, fruits for assistance, meats for benefit, and vegetables for fullness.” Give children more millet porridge, yam porridge, and pumpkin porridge to strengthen the spleen and stomach. Avoid greasy, spicy, and cold foods to prevent burdening the spleen and stomach, such as fried chicken, chili peppers, and ice cream, which should be eaten sparingly.

Sleep: Ensuring adequate sleep for children is crucial. TCM believes that “when a person lies down, blood returns to the liver.” Good sleep aids in liver repair and the nourishment of qi and blood. Encourage children to develop a habit of going to bed early and waking up early, creating a quiet and comfortable sleep environment. Avoid overstimulating children before bed; use gentle music or reading picture books to help them relax and fall asleep.

Emotions: Pay attention to managing the child’s emotions, avoiding prolonged states of tension, anxiety, or irritability. Use parent-child games and outdoor activities to keep the child’s mood cheerful, allowing for normal liver qi flow.

If these aspects are addressed but symptoms do not significantly improve, it is still recommended to seek TCM adjustment. Generally, without special circumstances, improvement can be achieved within 1-2 months.

​4. Guide to Choosing Chinese Patent Medicines

​5. Advanced Guide for TCM Enthusiasts

For this child experiencing both colds and fever and excessive sweating, a deeper analysis from TCM theory is necessary, beyond just looking at surface symptoms.

Colds and fever stem from damp-heat steaming in the stomach, not true heat, so using only heat-clearing herbs is not the best approach.

Excessive sweating is due to heat in the liver and gallbladder, but the key issue lies in the three burners. The three burners are the channels for the body’s qi and fluid circulation; if their function is impaired, it can lead to many problems.

Clearing and regulating the three burners, strengthening the spleen, and resolving dampness are key treatment strategies.

The spleen governs the transformation of water and dampness. When the spleen and stomach function strongly, water and dampness are properly transformed, and the heat attached to dampness dissipates. Clearing and regulating the three burners allows for smooth qi flow and normal fluid metabolism. This approach addresses both the colds and fever and improves excessive sweating. By doing so, it avoids the potential drawbacks of using astringent herbs to stop sweating and treats the child’s condition from the root, achieving a comprehensive effect.