bubble_chart Concept

The condition of blisters on the palms and metatarsus refers to the appearance of dense pustules or blisters of varying sizes on the palms and soles. Initially, there is a burning or itching sensation on the palms and metatarsus, followed by the emergence of pustules or blisters as small as needle tips. Some pustules may merge into patches, with surfaces that may become eroded or dry and flaky. Some blisters have thicker walls and can also merge into larger blisters that are not easily ruptured. Both pustules and blisters can recur repeatedly. Waike Zhengzong mentions "river snail blisters," Yizong Jinjian refers to "foot dampness qi (tinea pedis)," both of which fall under the scope of this condition.

bubble_chart Common Symptoms and Signs

1. Dampness-heat accumulation leading to blisters: Dense blisters or pustules as small as needle tips appear on the palms and metatarsus, mainly blisters, some of which may merge into patches. After rupture, the surface becomes wet and eroded, drying into large flakes of peeling skin, with herpetic eruptions that may recur.
2. Intense toxic heat causing blisters: Initially, the skin on the fingers, palms, or metatarsus becomes red, rapidly developing dense pustules as small as needle tips, which may later merge into patches. In severe cases, it can spread to other parts of the body. Accompanied by fever and chills, dry mouth, constipation, and dark urine, with a red tongue, yellow coating, and a rapid or fine pulse.
3. Spleen deficiency with excessive dampness causing blisters: Deep-seated blisters appear on the palms and metatarsus, either clustered or merged into large blisters with thick walls that are not easily ruptured, accompanied by intense itching. The skin is generally not red, and the blister fluid is white. If blisters rupture, they reveal an eroded base; if they dry and absorb, the surface may peel. Often accompanied by fatigue, drowsiness, abdominal distension, and loose stools, with a slow pulse, swollen tongue, and greasy coating.
4. Dampness toxin infiltration causing blisters: Often occurs on the thenar eminence of the palm or the arch of the foot, presenting as superficial blisters or small pustules with intense itching, worsening with heat. After rupture, they exude fluid and gradually expand, later drying into keratinized peeling skin. Often accompanied by wet erosion or fungal nails between the fingers and toes.

1. Dampness-heat accumulation blisters vs. intense toxic heat blisters: Both are caused by internal dampness-heat. The former is often due to dampness-heat affecting the spleen, leading to dysfunction in transportation and water retention in the skin. The latter is usually due to dampness-heat accumulating into toxins or combined with external toxins, causing dampness toxin stagnation and heat interaction, leading to intense toxic heat or blazing of both qi and blood. Clinically, both present with blisters and pustules, but the former is mainly blisters, while the latter is mainly pustules. The former is mostly localized to the palms and soles, while the latter can spread to other parts of the body. The former generally lacks significant systemic symptoms, while the latter is often accompanied by fever and chills. The former has a slow onset, while the latter can erupt suddenly. Treatment for the former involves clearing heat and draining dampness, commonly using clearing heat and dispelling dampness decoction. The latter requires clearing heat, cooling blood, and removing toxins, commonly using removing toxin cooling blood decoction.
2. Spleen deficiency with excessive dampness causing blisters and dampness toxin spreading causing blisters: The former is mostly due to improper diet, damaging the spleen and stomach, dysfunction of the spleen in transportation, dampness evil stagnating between the skin striae and interstice, unable to be discharged, thus forming blisters. The latter is mostly caused by prolonged residence in damp environments, exposure to rain, wading in water, or working in water, leading to dampness soaking and causing blisters. Therefore, the former has a slower onset, with deep-seated blisters, either clustered or fused into large blisters, with thicker walls that are not easily broken. Treatment focuses on strengthening the spleen and removing dampness, commonly using the Spleen-Strengthening Dampness-Removing Decoction. The latter often occurs on the thenar eminence of the palm or the metatarsal arch of the foot, with rashes mostly being superficial small blisters that are easily broken. The commonly used formula is the Toxin-Removing Dampness-Removing Decoction with modifications.

1. Waike Zhengzong: River snail sores often appear on the hands and feet, suddenly burning like fire, followed by the appearance of purple, white, and yellow blisters. This is due to the spleen meridian's wind-dampness attacking and infusing. If not treated, they gradually enlarge, causing swelling, pain, and discomfort. Use a thread needle to puncture and drain the toxic fluid, then cover with Taiyi ointment. If the sores reappear after puncturing, internal administration of the Detoxifying Spleen-Purging Decoction can cure them.