Hot palms and soles is a common clinical symptom, belonging to the category of internal injury fever. Hot palms and soles is not only an active symptom but also a subjective symptom with objective indicators. Hot palms and soles are commonly seen in Yin deficiency with fire excess, but they can also be observed in other internal injury fevers where the patient actively feels feverish but the body temperature is not significantly high, i.e., not only common in虚 fire but also in real heat, as applied in traditional Chinese medicine.

1. TCM differential diagnosis and treatment

1. Fever with Yin deficiency and hot palms and soles

This syndrome is characterized by hyperactivity of Yang, uncontrolled fire by water, and internal disturbance of虚 heat as the key for differential diagnosis and treatment. Yin deficiency with Yang excess leads to internal heat, which causes fever in the afternoon or evening, hot palms and soles, or spleen deficiency with dampness. Exuberant fire ascending internally disturbs the heart and soul, resulting in restless sleep with frequent dreams and flushed cheeks; internal fire forces body fluids to leak, leading to night sweats; Yin deficiency with fire excess and fluid deficiency results in dry mouth and throat, dry and hard stool, and yellow and reduced urine; the tongue is dry and thin, with a color resembling dry red wine or cracks, thin or no coating, and a thin and rapid pulse, all indicating Yin deficiency with fire excess. This syndrome is primarily characterized by intermittent fever in the afternoon or evening, restless sleep with a dry mouth and throat, a tongue with a dry and red wine-like color or cracks, thin or no coating, and a thin and rapid pulse as the key points for differential diagnosis. Treatment should focus on nourishing Yin and clearing heat, with Qing Gu San as the formula.

2. Internal blood stasis (Qi stagnation leading to fever) heat in the palms and soles of the hands and feet

This syndrome is mainly differentiated and treated based on emotional imbalance and Qi stagnation leading to fire. The liver governs the release of Qi, stores blood, likes to be unobstructed, and its meridians are distributed in the ribs, pass through the diaphragm, and reach the breasts. Emotional depression, the liver loses its unobstructed state, Qi stagnation leads to fire, or anger is excessive, internal heat of the liver fire, hence fever; due to emotional injury, fever fluctuates with mood changes; Qi stagnation and Qi flow disorder, depression and unhappiness, chest and rib distension and pain, breast distension and pain; sighing and groaning temporarily relieves the Qi, hence the preference for sighing and groaning; Qi flow disorder and blood circulation obstruction, hence irregular menstruation in women, abdominal pain during menstruation; restlessness and irritability are due to the liver fire transforming Yin into fire; the liver fire consumes body fluid, the gastrointestinal tract has heat, hence bitter taste in the mouth and dry throat, dry and hard stools; red tongue or red tongue edge, yellow fur, deep and rapid pulse are signs of Qi stagnation and fire. This syndrome is characterized by low fever or sweating, the symptoms often fluctuate with mood changes, depression and unhappiness, preference for sighing and groaning, restlessness and irritability, red tongue, yellow fur, deep and rapid pulse are key points for differentiation. Treatment is to soothe the liver and regulate Qi, clear the liver fire and relieve heat, using the formula of Dan-Zhi Xiang-Yao Powder.

2. New viewpoints of modern traditional Chinese medicine on heat in the palms and soles of the hands and feet

Regarding the differentiation and treatment of heat in the palms and soles of the hands and feet, ancient books have discussed it from kidney Yin deficiency and blood stasis, while modern traditional Chinese medicine, based on clinical care and observation, believes that heat in the palms and soles of the hands and feet is commonly seen in people with Yin deficiency and fire excess, but many other causes can also lead to this disease, belonging to internal injury fever. The actual differentiation and treatment is as follows:

1. Blood stasis blocking the meridians, after a long time, the generation of fire can lead to heat in the palms and soles of the hands and feet

Blood stasis within the body, long-term depression leading to the generation of fire, this has long been a conclusion in the basic theory of traditional Chinese medicine. However, it is not known whether the heat caused by this is heat in the palms and soles of the hands and feet, and there are few discussions on this. The example of Cheng’s treatment of blood stasis blocking the meridians can be said to be a new enlightenment for the understanding of the clinical manifestation of heat in the palms and soles of the hands and feet in traditional Chinese medicine. Treatment with活血通脉, one can use the Decoction for Removing Blood Stasis Below the Diaphragm.

2. Insufficient temperament, deficiency in the middle-jiao can lead to heat in the palms and soles of the hands and feet

Deficiency of Qi leading to fever has been one of the issues in the academic debate of traditional Chinese medicine for many years. The focal point of the debate is mainly centered around why Qi deficiency can cause fever? Although opinions on this issue can vary from person to person, wise or benevolent, each expressing their own views. However, it is not known that there is a basic consensus on the understanding that Qi deficiency can cause fever, and from clinical nursing, it is also known that Qi deficiency can indeed lead to fever, with intermittent fever not fixed, including low fever, high fever, afternoon fever, and heat in the palms and soles of the hands and feet. But no matter what kind of intermittent fever, they all have their own characteristics, that is, ‘when fever is active, it manifests’. And fever usually occurs with deficiency of the spleen and stomach, and malaise in digestion and transportation. In treatment, based on invigorating Qi, using acrid and warm herbs to remove heat, not only promotes the repair of gastrointestinal function, but also the symptoms of fever are cured accordingly, which can be treated with the formula of replenishing the middle and invigorating Qi, such as the Decoction for Invigorating the Middle and Qi.