bubble_chart Concept

Back heat refers to a symptom where the back feels feverish.

Suwen. Qijiaobian Da Lun states

"When the year's fire is excessive, scorching heat prevails, and the lung metal is afflicted by evil. People suffer from malaria, ... shoulder and back heat." Later generations have referred to it as chest and back heat or neck and back heat. Yixue Rumen refers to it as back heat.

Clinically, it is quite rare for back heat to appear alone; this symptom often coexists with body heat and chest heat. This section only discusses cases where back heat is the primary symptom.

bubble_chart Pattern Analysis

1. Lung Fire︰Back fever, worsening in the afternoon, throat dry cough, coughing up yellow phlegm, chest and back distending pain, severe constipation, flushed face and red tongue with yellow coating, rapid pulse. The lungs reside in the upper energizer, and the back is the domain of the lungs. When lung fire is intense, it causes back fever; pathogenic heat stagnating in the lungs leads to disturbance of qi movement, resulting in chest and back distending pain. Failure of the lungs to descend and purify manifests as cough, while heat scorching lung fluids causes throat dryness and yellow phlegm. In the afternoon, when yang qi is abundant, the heat intensifies and symptoms worsen. The lungs and large intestine are externally-internally related, so lung heat damaging fluids leads to severe constipation. A flushed face, red tongue with yellow coating, and rapid pulse are all signs of excessive heat. The characteristic symptoms are back fever with cough and chest and back distending pain. Treatment should focus on clearing and descending lung fire, using the family secret White-Draining Powder. This is a case of excess, as pathogenic heat invades the lungs, causing chest and back distending pain, back fever accompanied by cough.
2. Yin Deficiency︰There is a sensation of heat in the back, which increases in the evening, with aching pain in the lower back and spine, feverish feeling in the palms and soles, night sweat during sleep, a red tongue with scant coating, and a pulse manifestation that is thin and rapid. This is a deficiency pattern, primarily due to yin deficiency. Kidney deficiency leads to aching pain in the lower back and spine, feverish feeling in the palms and soles, night sweat during sleep, a red tongue with scant coating, and a pulse manifestation that is thin and rapid. The treatment should focus on enriching yin and clearing heat, using the formula Anemarrhena, Phelloendron and Rehmannia Pill. The key points for differentiation between the two lie in the fact that it is often caused by kidney yin deficiency and frequently accompanied by aching pain in the lower back and spine, as well as feverish feeling in the palms and soles.

Back heat syndrome is rarely seen in clinical practice. Ancient medical texts seldom mention it. Cases of back gangrene with heat are often found in elderly patients with yin deficiency, occurring at night and alleviating during the day. During an episode, patients do not prefer cold but find slight relief by washing with warm water.

bubble_chart Documentation

1. Zabing Zhengzhi Zhunsheng-Fever: "The lungs are located in the chest and back, lung heat causes the chest and back to also become hot."
2. Chishui Xuanzhu-Fire Heat Section: The heat in the shoulders and back, as well as the outer side of the small toe, the armpit, the shin, and the back of the ankle, all indicate heat in the foot taiyang."
3. Yixue Rumen: "Back heat is associated with the lungs, as the lungs reside in the upper energizer, hence the heat is felt in the back." (Cited from "Dongyi Shijian-External Form Chapter")