Introduction

Hyperhidrosis is a disorder that interferes with daily life, characterized by sweating in excess of physiological requirements. Alcohol consumption, medication use, psychiatric illness, metabolic disorders, and psychological factors have all been implicated in its onset.1 This condition is reported to affect approximately 4–5% of the general population;2 however, its pathophysiology remains incompletely understood. Given that the eccrine glands—densely distributed on the palms, soles, forehead, and axillae—are innervated by sympathetic cholinergic fibers, the development of hyperhidrosis is presumed to be closely related to autonomic dysregulation. Hyperhidrosis is broadly classified into primary and secondary forms. Primary hyperhidrosis typically occurs without an identifiable underlying cause, whereas secondary hyperhidrosis is caused by systemic conditions including metabolic–endocrine disorders, cardiovascular diseases, or respiratory illnesses.1

Hyperhidrosis can be treated using topical aluminum chloride, botulinum toxin injection, or surgical interventions. However, these conventional treatments are limited by the potential for various side effects and a frequent tendency for hyperhidrosis to recur even after treatment.1 In addition, hyperhidrosis substantially impairs daily and social functioning; in particular, craniofacial or palmar hyperhidrosis may affect not only patients themselves but also those around them, thereby exacerbating psychological distress.3

Samhwangsasim-tang, a classical formula recorded in the Chinese medical classic Sanghanron,4 exhibits anti-inflammatory5 and metabolic-modulatory activities,6 and has been applied to treat conditions such as hypertension,7 inflammatory gastrointestinal diseases,8 and cardiac disorders.7 Jin et al9 previously reported that Samhwangsasim-tang exerts vasodilatory effects by reducing phosphorylation of the myosin phosphatase target subunit, whereas Pak et al4 demonstrated its neuroprotective effects through attenuation of neuronal apoptosis and oxidative stress.

Based on these anti-inflammatory, metabolic-modulatory, and vasodilatory effects of Samhwangsasim-tang, it has been hypothesized to be beneficial in alleviating heat-related sweating disorders, given that body temperature regulation and sweating are influenced by the autonomic nervous system, inflammatory, and metabolic pathways.

Despite the growing interest in the pharmacological properties of Samhwangsasim-tang, no clinical reports, to our knowledge, have evaluated its use as the treatment of hyperhidrosis. Herein, we describe a patient with hyperhidrosis in whom spontaneous sweating and flushing improved following administration of Samhwangsasim-tang, thereby addressing an existing gap in the literature and presenting a potentially novel therapeutic observation.

Case Presentation

The patient (Table 1) was a 66-year-old man. His chief complaints at first visit were sweating and flushing. His disease showed a chronic course with exacerbation between February and March 2025. The patient had a past history of gastric cancer diagnosed in 2022 and treated surgically. He had no relevant family history.

Table 1 Systematic Examination of the Patient’s Condition

The patient, who had a long-standing tendency to excessive sweating, presented to our clinic on May 22, 2025, reporting worsening hyperhidrosis from February to March 2025 without any identifiable precipitating event. The patient’s excessive craniofacial sweating occurred repeatedly during work and impaired daily functioning. No specific antecedent symptoms or diseases that could explain hyperhidrosis were identified. Based on these findings, the patient was diagnosed with hyperhidrosis. No systemic, endocrine, neurologic, or infectious abnormalities suggestive of secondary hyperhidrosis were identified on history taking or physical examination. Previous clinical guidelines indicate that laboratory testing is not necessary unless findings explicitly point toward a secondary cause.1 Accordingly, no additional laboratory investigations were performed for this patient.

Regarding the Korean medicine diagnosis and rationale for formula selection, the patient reported heat intolerance and warm hands and feet, with worsening of symptoms under conditions of increased body heat (eg, hot weather and physical activity). We therefore inferred that the sweating was related to elevation of deep/core body temperature and selected Samhwangsasim-tang as the therapeutic intervention, given its described anti-inflammatory,5 metabolic-modulatory,6 and body-heat–reducing (“heat-clearing”) properties.10

Outcome measures (Table 2) included the following: (1) Numeric Rating Scale (NRS), at each visit, the severities of spontaneous sweating and flushing were quantified using an integer 0–10 scale; (2) Hyperhidrosis Disease Severity Scale (HDSS), the HDSS questionnaire was administered to assess the severity and impact of hyperhidrosis.

Table 2 The Symptom Evaluation Index

Subsequently, interventions (Table 3) included Samhwangsasim-tang extract granules (Hanpoong Pharm. Co., Seoul, Republic of Korea), dosed at two sachets per dose, taken orally thrice daily, 30 minutes after meals. No concomitant treatments (acupuncture, cupping, or conventional pharmacotherapy) were provided.

Table 3 Prescription of Samhwangsasim-Tang

During the treatment period (Figure 1) of 42 days (2025.05.22–2025.07.02), the patient reportedly ingested a total of 156 sachets.

Figure 1 Treatment Timeline.

The patient’s clinical course (Table 4) was as follows:

Table 4 Hyperhidrosis Symptom Progression

(1) May 22, 2025: The patient reported that even mild activity provoked flushing (NRS score 10) and marked craniofacial sweating (NRS score 10). Sweating occurred and worsened with physical exertion and hot weather. The patient did not perceive a relationship between mental tension, stress, and sweating.

(2) May 29, 2025: Sweating decreased and flushing modestly improved (spontaneous sweating NRS 10 → 6; flushing NRS 10 → 6). His stools became slightly loose without diarrhea, and no other adverse effects related to the medication were reported.

(3) June 10, 2025: Further improvement was noted (spontaneous sweating NRS 6 → 4; flushing NRS 6 → 4).

(4) June 17, 2025: Symptoms improved to approximately 20–30% of the exacerbation level (spontaneous sweating NRS 4 → 2–3; flushing NRS 4 → 2–3). Despite the transition to summer and hotter weather, sweating continued to decline.

(5) July 2, 2025: Spontaneous sweating resolved (NRS 0), and flushing remained improved (previously NRS 2–3).

Discussion

Hyperhidrosis is characterized by sweating that exceeds physiological needs.1 In many cases, a diagnosis can be established clinically based on history and symptom characterization, and additional testing is often unnecessary when the presentation is typical.11,12 Therapeutic options are broadly classified into nonsurgical and surgical modalities. Nonsurgical approaches include topical and systemic pharmacotherapy, iontophoresis, and botulinum toxin injections, whereas surgical options include local cutaneous procedures and sympathectomies.11

Complementary and alternative approaches for the treatment of hyperhidrosis have previously been explored. Sidek et al13 reported that Curcuma xanthorrhiza Roxb. exhibits antimicrobial and anhidrotic properties, and may mitigate hyperhidrosis and associated bromhidrosis. Further, Zhu et al14 described significant improvement of hyperhidrosis in a 16-year-old boy with acupuncture combined with Cupressus Leaf Tea administration.

Samhwangsasim-tang—composed of Coptis japonica Makino, Scutellaria baicalensis Georgi, and Rheum palmatum Linné —is a classical prescription applied to various conditions, including hypertension7 and inflammatory gastrointestinal disorders.8 Coptis japonica Makino has been described as exerting anti-inflammatory15 and metabolic-modulatory effects16 and is used for fever, inflammation, and abdominal pain.17 Scutellaria baicalensis Georgi is traditionally employed for gastrointestinal complaints, and has been ascribed antitumor, antiviral, antibacterial, anti-inflammatory, antioxidant, and neuroprotective activities.10,18 Conversely, Rheum palmatum Linné is frequently used for gastrointestinal disorders accompanied by constipation and has been associated with antiallergic19 and vasorelaxant properties.20 Considering these pharmacological profiles, Samhwangsasim-tang may act as a multi-component formulation with anti-inflammatory, metabolic-modulatory, vasodilatory, and heat-reducing (“heat-clearing”) effects.

The patient was a 66-year-old man with a stocky body habitus who presented with hyperhidrosis that worsened without a clear precipitate between February and March 2025. Even mild activity provoked profuse craniofacial sweating that interfered with daily life (NRS score, 10), accompanied by subjective flushing. He reported heat intolerance and warm extremities, with sweating aggravated by conditions associated with increased body heat (eg, physical activity and hot weather). On this basis, the condition was interpreted as hyperhidrosis related to elevated core temperature, and Samhwangsasim-tang was prescribed for its putative deep-temperature–lowering and metabolic-modulatory effects. In this case, we used a Samhwangsasim-tang granule containing Rehmannia glutinosa (Gaertn.) DC. in addition to Coptis japonica Makino, Scutellaria baicalensis Georgi, and Rheum palmatum Linné. This reflects the general tendency of modern herbal pharmaceutical preparations to add supplementary herbs to broaden clinical indications.

Approximately 42 days after initiating treatment, sweating improved to within the normal range, and flushing decreased to 20–30% of the baseline level (spontaneous sweating NRS 10 → 0; flushing NRS 10 → 2–3; HDSS 4 → 1). The patient reported that, even during activity in hot weather, sweating was limited, and the heat sensations that previously accompanied sweating diminished to two or three brief episodes per day. The patient expressed satisfaction, stating that after treatment, sweating and flushing were relieved, allowing him to lead a smooth daily life, even during hot seasons.

This single-patient case report has inherent limitations, as the mechanism underlying the improvement of hyperhidrosis observed in this case cannot be elucidated solely by a single case report. Although Samhwangsasim-tang exhibits properties such as anti-inflammatory, metabolic-regulating, and vasodilatory effects, these characteristics do not establish a causal link between these properties and symptom improvement. The mechanistic explanations presented in this study should be regarded as hypothetical and exploratory, and should not be prematurely generalized.

Furthermore, this study has the limitation of lacking objective sweat measurement methods, such as gravimetry, minor starch-iodine testing, or thermoregulatory sweat testing. Since the symptom evaluation in this study relied solely on subjective scales (NRS and HDSS), it limits the objectivity and quantitative nature of the results.

Several confounding factors should also be considered. The patient’s age and history of gastric cancer surgery showed no temporal or symptomatic correlation with the sweating symptoms. Although the treatment was conducted during the hot and humid summer months, when sweating generally worsens, the potential influence of environmental factors, placebo effects, or spontaneous remission cannot be entirely excluded.

Consequently, this case should be interpreted as hypothesis-generating, and further research is warranted to delineate the therapeutic scope of Samhwangsasim-tang, ideally through prospective studies with standardized outcome measures and appropriate controls.

However, this report is notable in that, to our knowledge, it is the first case of hyperhidrosis that improved with Samhwangsasim-tang monotherapy. Concurrent improvement in spontaneous sweating and flushing after administration of Samhwangsasim-tang suggests that its anti-inflammatory, heat-reducing, and metabolic-modulatory actions may favorably influence cutaneous metabolism and peripheral circulation. Hyperhidrosis is a difficult condition to treat, and achieving complete resolution often requires a long treatment period. In this case, symptom improvement was observed in a patient with hyperhidrosis following the administration of Samhwangsasim-tang granules for a relatively short duration (42 days). These findings suggest that this alternative therapeutic approach may represent a feasible adjunctive option for the alleviation and management of hyperhidrosis. Given the observed improvements, this raises the possibility that Samhwangsasim-tang could be considered for treating the symptoms or conditions hypothesized to arise from elevated body heat or metabolic dysregulation.

Conclusions

In this single-patient case, clinically meaningful improvement in hyperhidrosis was observed following administration of Samhwangsasim-tang. After approximately 42 days of treatment, spontaneous sweating resolved (NRS 10 → 0; HDSS 4 → 1), and flushing decreased to about 20–30% of the baseline level (NRS 10 → 2–3).

Acknowledgments

We would like to thank Editage (www.editage.co.kr) for English language editing.

Ethical Considerations

This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. The research protocol was reviewed and approved by the Institutional Review Board of Wonkwang University (IRB No. WKIRB-202510-BM-090). According to the IRB determination, this case report involving de-identified patient information was considered ethically appropriate for publication. Written informed consent for publication of this case was obtained from the patient. All patient information was anonymized to ensure patient confidentiality.

Disclosure

The authors report no conflicts of interest in this work.

References

1. Mcconaghy JR, Fosselman D. Hyperhidrosis: management options. Am Fam Physician. 2018;97(11):729–734.

2. Doolittle J, Walker P, Mills T, Thurston J. Hyperhidrosis: an update on prevalence and severity in the United States. Arch Dermatol Res. 2016;308(10):743–749. doi:10.1007/s00403-016-1697-9

3. Hamm H. Impact of hyperhidrosis on quality of life and its assessment. Dermatol Clin. 2014;32(4):467–476. doi:10.1016/j.det.2014.06.004

4. Pak ME, Park YJ, Yang HJ, Hwang YH, Li W, Go Y. Samhwangsasim-tang attenuates neuronal apoptosis and cognitive decline through BDNF-mediated activation of tyrosin kinase B and p75-neurotrophin receptors. Phytomedicine. 2022;99:153997. doi:10.1016/j.phymed.2022.153997

5. Lee MJ, Choi JH, Lee SJ, Cho IH. Oriental medicine Samhwangsasim-tang alleviates experimental autoimmune encephalomyelitis by suppressing Th1 cell responses and upregulating Treg cell responses. Front Pharmacol. 2017;8:192. doi:10.3389/fphar.2017.00192

6. Fang P, Sun Y, Gu X, et al. San-Huang-Tang protects obesity/diabetes induced NAFLD by upregulating PGC-1α/PEPCK signaling in obese and galr1 knockout mice models. J Ethnopharmacol. 2020;250(250):112483. doi:10.1016/j.jep.2019.112483

7. Iijima OT, Takeda H, Matsumiya T. Effects of San’o-shashin-to on the antioxidative mechanism in spontaneous familial hypercholesterolaemic rabbits. Pharmacol Res. 2000;41(2):137–141. doi:10.1006/phrs.1999.0577

8. Shih YT, Wu DC, Liu CM, Yang YC, Chen IJ, Lo YC. San-Huang-Xie-Xin-Tang inhibits Helicobacter pylori-induced inflammation in human gastric epithelial AGS cells. J Ethnopharmacol. 2007;112(3):537–544. doi:10.1016/j.jep.2007.04.015

9. Jin F, Shin HM, Jeon SB, et al. Vasorelaxation by Samhwangsasim-tang, an herb medicine, is associated with decreased phosphorylation of the myosin phosphatase target subunit. Environ Toxicol Pharmacol. 2007;24(3):199–205. doi:10.1016/j.etap.2007.05.004

10. Zhao T, Tang H, Xie L, et al. Scutellaria baicalensis Georgi. (Lamiaceae): a review of its traditional uses, botany, phytochemistry, pharmacology and toxicology. J Pharm Pharmacol. 2019;71(9):1353–1369. doi:10.1111/jphp.13129

11. Walling HW, Swick BL. Treatment options for hyperhidrosis. Am J Clin Dermatol. 2011;12(5):285–295. doi:10.2165/11587870-000000000-00000

12. Walling HW. Primary hyperhidrosis increases the risk of cutaneous infection: a case-control study of 387 patients. J Am Acad Dermatol. 2009;61(2):242–246. doi:10.1016/j.jaad.2009.02.038

13. Sidek NAM, Husain K, Buang F, Mohd Said MM. Antiperspirant and antibacterial activities of Curcuma Xanthorrhiza extract as a potential alternative treatment for hyperhidrosis. Separations. 2023;10(6):324. doi:10.3390/separations10060324

14. Zhu J, Arsovska B, Kozovska K. Case report: acupuncture and herbal treatment with Yunnan Baiyao for hyperhidrosis. IOSR JDMS. 2017;16(2):80–81. doi:10.9790/0853-1602028081

15. Kwon OJ, Noh JW, Lee BC. Mechanisms and effect of Coptidis rhizoma on obesity-induced inflammation: in silico and in vivo approaches. Int J Mol Sci. 2021;22(15):8075. doi:10.3390/ijms22158075

16. Ran Q, Wang J, Wang L, Zeng HR, Yang XB, Huang QW. Rhizoma coptidis as a potential treatment agent for type 2 diabetes mellitus and the underlying mechanisms: a review. Front Pharmacol. 2019;10:805. doi:10.3389/fphar.2019.00805

17. Wang J, Wang L, Lou GH, et al. Coptidis rhizoma: a comprehensive review of its traditional uses, botany, phytochemistry, pharmacology and toxicology. Pharm Biol. 2019;57(1):193–225. doi:10.1080/13880209.2019.1577466

18. Wang ZL, Wang S, Kuang Y, Hu ZM, Qiao X, Ye M. A comprehensive review on phytochemistry, pharmacology, and flavonoid biosynthesis of Scutellaria baicalensis. Pharm Biol. 2018;56(1):465–484. doi:10.1080/13880209.2018.1492620

19. Matsuda H, Tewtrakul S, Morikawa T, Yoshikawa M. Anti-allergic activity of stilbenes from Korean rhubarb (Rheum undulatum L.): structure requirements for inhibition of antigen-induced degranulation and their effects on the release of TNF-alpha and IL-4 in RBL-2H3 cells. Bioorg Med Chem. 2004;12(18):4871–4876. doi:10.1016/j.bmc.2004.07.007

20. Yoo MY, Oh KS, Lee JW, et al. Vasorelaxant effect of stilbenes from rhizome extract of rhubarb (Rheum undulatum) on the contractility of rat aorta. Phytother Res. 2007;21(2):186–189. doi:10.1002/ptr.2042