自汗과 盜汗의 기전에 대한 고찰

A Study on the Mechanism of Spontaneous Sweating and Night Sweating

Objectives : 自汗과 盜汗에 대한 역대 논설을 수집, 검토함으로써 두 증상의 기전 설명의 변화와 각각의 기전, 그리고 두 증상의 관계에 대해서 살펴보는 것이다. Methods : 四庫全書 등 검색 DB에서 나온 自汗과 盜汗의 기전을 언급한 역대 의서의 내용을 분석하고, 自汗과 盜汗의 각각의 기전과 둘의 관계에 대해서 살펴보았다. Results ＆ conclusion : 盜汗의 원인을 陰虛로 보기 시작한 이유는 朱丹溪의 滋陰 중시, 當歸六黃湯의 처방구성, 金元이후 火熱病機의 발전을 들 수 있다. 傷寒盜汗은 邪氣가 半表半裏에 있는데, 이미 손상된 表의 衛氣가 더욱 虛해지거나, 衛氣와 함께 들어간 邪氣가 陰을 흔들거나, 衛氣가 안으로 갈 때 正邪抗爭으로 熱이 나서 땀이 난다고 볼 수 있다. 雜病盜汗은 陰虛함을 틈타 衛氣가 과도하게 들어와 表가 虛하거나, 들어온 衛氣가 상대적으로 陰보다 많아 熱이 나서 땀이 난다고 볼 수 있다. 밤에 陰이 길러지지 않고 소모되면서 밤에 길러져야 할 衛氣가 더욱 虛해져서 땀이 난다고도 볼 수 있다. 自汗의 범주에 盜汗이 포함되는 경우 自汗은 衛氣 자체가 虛한 것으로 盜汗보다 衛氣의 운행 체계가 무너진 것으로 이해할 수 있다.

Objectives : The aim of this paper is to examine the mechanisms of spontaneous sweating and night sweating, their relationship and how the explanations of their mechanisms have changed over the course of time, through examination of past discussions on spontaneous sweating and night sweating. Methods : Contents in classical medical texts that mention the mechanisms of spontaneous sweating and night sweating among search results from databases such as the Siku Quanshu were analyzed, followed by examination of each of their mechanisms, and their relationship with each other. Results & Conclusions : The cause of night sweating before the 『Danxixinfa』 was seen to be caused by yang deficiency in relation to problems of Exterior Qi and the theory of Heart governs perspiration , as the focus was on the phenomenon of sweating. However, it seems that yin deficiency came to be seen as playing a more fundamental role in the process of determining the root cause of night sweating. Moreover, Zhu Danxi s emphasis on nurturing yin, the composition of Dangguiliuhuangtang, and the development of the fire-heat pathology since the Jin Yuan period added to this shift in perspective. Night sweating from Shanghan could be seen as a sign of the already damaged Exterior Qi becoming more deficient while the pathogenic qi is in the half-exterior-half-interior zone, or as the pathogenic qi which entered with the Exterior Qi unsettling yin, or as a result of heat that is produced in the struggle between healthy qi and pathogenic qi that happens when Exterior Qi enters. Night sweating from miscellaneous disease could be seen as a sign of a deficient exterior that resulted from excessive entering of the Exterior Qi during yin deficiency, or resulting from relatively excessive Exterior Qi to deficient yin, producing heat that leads to sweating. If yin is not cultivated during the night but rather consumed leading to deficiency of Exterior Qi which also needs to be cultivated during night time, it could result in sweating.