Clinical Diary #04 — Shivering Body, Flowing Sweat
Clinical Diary #04 — Shivering Body, Flowing Sweat
Six in the morning. It is still dark outside. This is the time the patient wakes up. It is not because of the cold; it is because of the sweat.
While the body feels chilled, sweat is soaked into the back and chest. It is sticky and unpleasant. There is even a slight stinging sensation on the skin. They try to close their eyes to fall back asleep, but that marks the end of their rest for the day.
"I feel cold, yet I'm sweating. It happens when I eat, and also when I wake up in the morning."
In Traditional Korean Medicine (TKM), these symptoms are identified as a combination of Spontaneous Sweating (Jahan, 自汗) and Night Sweats (Dohan, 盜汗).
Spontaneous sweating refers to perspiring regardless of physical activity or heat. Night sweats, or "thieving sweats," are those that sneak up during sleep or in the early dawn. The simultaneous appearance of both symptoms is a signal that the body's protective barrier—known as Defensive Qi (Wei Qi, 衛氣) in TKM—has become compromised. The body fails to block external cold energy while internal heat leaks out. This creates the paradoxical situation of shivering while sweating.
The patient first noticed the night sweats two to three weeks ago. However, their struggle with poor sleep began two to three years ago.
Discussing their sleep history reveals a complex situation.
With medication, they can fall asleep within an hour, but they wake up frequently. Without medication, falling asleep is nearly impossible. They have used tranquilizers for over a year and have taken sleeping pills intermittently. Interestingly, the patient noticed that the sweating becomes more severe on the days they take sleeping pills.
"I think it got worse after I started taking sleeping pills."
This is not a mere coincidence. Tranquilizers and sedative-hypnotics affect the autonomic nervous system (ANS). The ANS is also responsible for thermoregulation and perspiration during sleep. After long-term use, the body may adapt to the drugs or, conversely, the system may become disrupted, causing both sleep quality and perspiration patterns to fluctuate.
There is another layer to this context. The patient recently left a long-term job. Following their resignation, lethargy set in, leading to a diagnosis of depression. They have been on antidepressants for two months. While the lethargy has improved slightly, the issues with sleep and sweating persist.
Observing this patient in the consultation room, I focused on one key factor:
The autonomic nervous system had been unstable for a long time.
The shock of leaving their job, the lethargy and depression, and years of relying on sleeping pills and tranquilizers—all of these factors gradually eroded the body's self-regulatory capacity. The result is the current dawn night sweats and daytime spontaneous sweating. In TKM terms, this is a state of Exterior Deficiency and Insecurity (Pyoheo-bulgo, 表虛不固) and Yin Deficiency with Internal Heat (Eumheo-naeyeol, 陰虛內熱), where internal heat is no longer controlled.
The prescription was Gyejiga-yonggol-moryeo-tang (Cinnamon Plus Dragon Bone and Oyster Shell Decoction).
This is a classic formula from the Shanghanlun (Treatise on Cold Damage). Cinnamon (Gyeji) and Ginger (Saenggang) warmly open the exterior to soothe the Defensive Qi, while Dragon Bone (Yonggol) and Oyster Shell (Moryeo)—fossilized bone and shells—astringe and calm the scattered energy. Rather than directly manipulating the autonomic nervous system, the medicine helps the body recover its own regulatory power.
I set the treatment direction in three stages:
First, reduce the night sweats that emerged 2–3 weeks ago. This is the symptom most clearly distressing the patient.
Second, gradually improve sleep quality. We aim to stabilize the pattern of frequent waking.
Third, recover from lethargy and restore vitality. This takes time. We will not rush this process.
Sweat, sleep, and vitality. These three are interconnected. As one improves, the others will gradually follow. Waiting for that natural progression is the philosophy behind this prescription.
Choi Yeon-seung, Chief Physician at Baekrokdam Clinic
