I have two questions about how this heat manifests differently than excess heat. Why does the heat go specifically to the palms, soles, and chest? And why only malar flush, as opposed to flushed complexion?
Generally that is just the most common areas, people can technically have yin deficiency and have heat throughout their body. Generally it will range based on the degree of the underlying deficiency and what other patterns they hold (i.e. there is often more than one thing happening).
Yin deficiency is in many ways what we term “tired and wired” in the west - so you are deficient, ultimately, but then functionally locked into an adrenal/stress state which generates heat and anxiety in many cases. Part of the stress response that the body is locked in is part of the hands and feet (for example, sweaty palms and feet with anxiety).
I just had a new thought as I read your first sentence. I read it incorrectly, without the comma. “Generally that is just the most common areas people can technically have yin deficiency…”
If one had kidney yin def, there could be insufficient cooling to reach the extremeties, and with heart yin def, it could be insufficient cooling in the chest area. What are your thoughts about that?
I’m still trying to figure out the malar flush…
So you know, I’m learning about TCM, and I’m working on an essay about def heat vs excess heat. Excess heat is much easier for me to understand. I’m trying to absorb every symptom, and understand why they happen, as opposed to merely memorizing them. I think it will make diagnosis easier in the long run.
The malar flush is a pretty strait forward explanation: yang (heat) rises and the chest and head are at the top. The hands and feet are furthest away from the interior they are more likely to be affected by a disruption of the flow of the blood and/or qi. Also the limbs are further down the line of importance than the internal organs so when circulation is weakened the body will naturally protect the interior first. Look at what happens during hypothermia for example. Hope that helps.
I would like to offer a sort of image to your question. Say in an ideal body the amount of yin and yang are optimal. But for any number of reasons something causes the yin to be less than it should be. The yang is still at its “normal” level so to speak, so it will gain entrance into more of the yin spaces - but there is not more yang or heat. Therefore, one can have minimal heat symptoms. On the other hand, if the yin remains optimal, but the yang is increased, there is, of course MORE heat available to stimulate and fill the body, which the yin will have a harder time balancing and also become more consumed by the excessive yang heat, cause in time excessive yang with yin deficiency. Hope this was helpful.
Just to clarify yin deficiency, like almost everything else actually, has a scale to it. A very mild yin deficiency may produce no symptoms at all whereas a very severe yin deficiency can lead to extreme sensations of heat such as steaming bone syndrome. The level of yang is not necessarily related - so you can have mild to severe yin deficiency with the same level of yang in both cases.
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