bubble_chart Concept

Vexing heat in the chest, palms, and soles refers to a symptom of virtual fever characterized by feverish sensations in the palms of the hands and soles of the feet, along with a subjective feeling of heat and vexation in the chest. In some cases, the body temperature may rise, while in others, it may not.

The Suwen.Nitiao Lun mentions that "when yin qi is deficient and yang qi is abundant, it leads to heat and vexation" and "yin deficiency leads to internal heat," attributing the simultaneous occurrence of vexation and heat to yin deficiency.

If kidney deficiency causes dampness-heat to pour downward, resulting in heat in the soles of the feet accompanied by fever and pain in the lower legs, it does not fall within the scope of this discussion.

bubble_chart Pattern Analysis

1. Yin Deficiency︰vexing heat in chest, palms and soles, aggravated in the afternoon, often desiring to hold cold objects, preferring to extend hands and feet outside the covers when sleeping, night sweat, seminal emission, flushed cheeks, soreness and weakness in the lower back and knees, dry mouth and throat, tongue texture deep red with scant or peeled coating, pulse deep, thin, and rapid. Yin deficiency in all five zang-organs can manifest as vexing heat in chest, palms and soles, particularly common in yin deficiency of the lung, liver, and kidney. Among these,
   • lung yin deficiency often results from prolonged untreated "lung consumption," leading to depletion of lung yin. Symptoms include steaming bone fever, tidal fever, night sweat, cough with shortness of breath, or even hemoptysis, red tongue, and thin, rapid pulse. Treatment should focus on nourishing yin and blood, clearing heat and eliminating steaming, using Large Gentian and Turtle Shell Powder.
   • Liver yin deficiency arises from excessive overstrain or prolonged untreated liver disease, depleting blood and damaging yin. When liver yin is deficient, fire from the liver and gallbladder becomes excessive. Symptoms include heat in the palms and soles, vexing heat in the chest, thirst without desire to drink, poor sleep, physical weakness and fatigue, red tongue with scant coating, and wiry, thin, rapid pulse. Treatment should aim to nourish yin and blood while clearing heat, using Bone-Clearing Powder with modifications.
   • Kidney yin deficiency may result from yin deficiency in other organs spreading to the kidneys—known as "exhaustion inevitably reaching the kidneys"—or from excessive sexual activity depleting kidney essence, leading to kidney yin deficiency. Symptoms include vexing heat in the chest, palms and soles, tinnitus, seminal emission, night sweat, soreness and weakness in the lower back and knees (as the lower back is the "home" of the kidneys), and deep, thin, rapid pulse. Treatment should focus on nourishing kidney essence and clearing heat and steaming, using Left-Restoring Pill combined with Chinese Wolfberry Root-bark and Blackend Swallowwort Root, among others.
   Clinically, yin deficiency in the lung, liver, and kidney often coexists and mutually influences one another. The general approach is to nourish yin, clear heat, and relieve vexation, using Bone-Clearing Powder with modifications based on the specific syndrome.
2. Blood Deficiency︰In the afternoon, one feels heat in the palms of both hands and the soles of both feet, which worsens with slight exertion, accompanied by mental fatigue, physical lethargy, reduced appetite, reluctance to speak, palpitation, dizziness, blurred vision, a pale tongue texture, and a thin, weak or thin, choppy pulse. This condition often arises from deficiency of both the liver and spleen. The spleen, being the acquired foundation, disperses the essential qi of the five grains and transforms it into qi and blood. The liver, as the organ that stores blood, when impaired in its function of producing and storing blood, leads to blood deficiency. Externally, it fails to nourish the skin and hair, resulting in a pale complexion and skin; internally, liver fire becomes excessive, causing vexing heat in the chest, palms, and soles. When it fails to nourish the head and eyes, dizziness and a sensation of heat occur. Insufficiency of heart blood leads to palpitation, a pale tongue texture, and a thin, weak pulse. The liver is the "root of endurance," and liver deficiency cannot withstand fatigue, so even slight exertion triggers low-grade fever. The treatment should focus on regulating the liver and spleen, using Liver-Tonifying Decoction with the addition of Chinese Wolfberry Root-bark and other ingredients.
3. Latent Pathogens in Yin Phase︰Feverish feeling in palms and soles, irritability, poor sleep. There is low-grade fever, evening fever with morning coolness, fever subsides without sweating, good appetite but emaciation, tongue texture red with scant coating, pulse wiry-thin and slightly rapid. Mostly caused by improper or failed treatment of external contraction, leaving residual pathogens lurking in the nutrient yin. The key diagnostic points are night fever abating at dawn, fever subsiding without sweating, good appetite but emaciation. At night, Yingqi resists pathogens and reaches the yang aspect, causing fever; at dawn, the pathogens return to the yin aspect and fail to be expelled, hence the fever subsides without sweating. Lingering pathogens consume nutrient yin, which fails to nourish the muscles and skin, resulting in emaciation. Wenbing Tiaobian states: "Fever at night when moving in the yin aspect, coolness during the day when moving in the yang aspect—this shows the pathogenic qi is deeply lurking in the yin aspect. The fever subsides without sweating, indicating the pathogens do not exit to the exterior but return to the yin aspect, which further confirms this." Treatment should focus on enriching yin and expelling pathogens, using Sweet Wormwood and Turtle Shell Decoction.
4. Fire Stagnation︰vexing heat in chest, palms and soles，chest tightness，emotional discomfort，irritability and susceptibility to anger，head distension，bitter taste in mouth，dark urine，in women, irregular menstruation，red tongue with yellow coating，deep and rapid pulse. Mostly caused by dysfunction of the pivot mechanism, yang failing to reach, or unresolved external pathogens, excessive use of cold and cool herbs leading to congealing of pathogens, or overconsumption of cold foods suppressing {|###|}stomach yang{|###|}, preventing its dispersal. Symptoms include vexing heat in the chest, palms, and soles, heat in the limbs, dark urine, {|###|}dysphoria{|###|} and irritability, red tongue with yellow coating, wiry and rapid pulse. Treatment should clear the liver, dissipate fire, and resolve stagnation, using the modified Fire Stagnation Decoction. If {|###|}stomach yang{|###|} is constrained by cold foods, {|###|}yang qi{|###|} fails to spread, leading to stagnation and heat, symptoms include vexing heat in the chest, palms, and soles, limb fatigue, {|###|}restlessness without sweating{|###|}. Treatment should raise yang and dissipate fire, using the Yang-Raising and Fire-Dissipating Decoction.

Fire stagnation vexing heat in the chest, palms, and soles belongs to an excess pattern, which is different from the internal damage fever caused by yin deficiency or blood deficiency. In clinical practice, as long as one grasps the symptoms of vexing heat in the chest, palms, and soles, accompanied by fever in the limbs, head distension, bitter taste in the mouth, and dark urine, which are signs of liver depression and fire-heat, it can be differentiated.

The palms, soles, and chest in the human body belong to the interior and yin aspects. Yin deficiency leading to heat arises internally, hence manifesting as five-center fever. Internal heat stagnation is obstructed and cannot be vented externally, thus causing vexation. Clinically, although fever in both the palms and soles is often seen simultaneously, there are also cases where only the palms are hot while the soles are not very hot, or the soles are very hot while the palms are not noticeably hot. The general treatment principle is mainly to enrich yin and clear heat to relieve vexation. One should not hastily use bitter and cold substances to clear and vent upon seeing vexing heat.

bubble_chart Documentation

1. Jingui Yaolue．Blood Impediment Deficiency Fatigue Abnormal Pulse and Treatment Sixth: "Deficiency fatigue rectal urgency, palpitations and nosebleeds, abdominal pain, aching pain in the limbs, heat and vexation in the hands and feet, dry throat and mouth, Minor Center-Fortifying Decoction is the main treatment."
2. Shengji Zonglu Volume 43: "It is said that the disease of vexing heat in the heart is caused by excess in the Hand Shaoyin Meridian, but its deficiency can also cause virtual vexation."