Fan Zao  烦燥  Vexation and Agitation

Fan, vexation describes a subjective feeling of heat, pressure, and uneasiness in the chest.Zao, agitation is where the limbs feel restless, with a local sensation of heat, that can be objectively felt.

They often occur together. The main etiology is heat unsettling the shen. Hence it is sometimes referred to as xin fan, heart vexation.

Clinical Manifestations
-heat in the chest
-chest oppression
-choking sensation
-restless and warm feeling in the limbs
-restless urge to move the legs  (restless leg syndrome)
-general malaise
-mental agitation
-anxiety, worry, anguish
-panic attacks

Common Etiological Factors
-external cold and internal heat
-repletion heat in the yang ming
-depressive heat in the shao yang
-heat entering the ying and the blood aspects
-residual heat
-phlegm fire
-yin vacuity exuberant fire
-heart blood stasis

In mood disorders the two most common of these factors are;

1. Phlegm fire
Phlegm fire has two common points of origin.
Firstly, spleen vacuity caused by poor eating habits, excessive worry, intellectual overwork, mental rumination, that is unexamined and believed meantation, lack of physical exercise, or chronic disease results in the poor transformation and transportation of fluids, leading to the accumulation of damp phlegm.
Here poor eating habits would include, over consumption of dairy products and sweet, fatty, cold, iced, or raw food.
If damp and phlegm linger, they can transforms into heat.
Secondly, if the liver qi stagnates as a result of frustration, anger, humiliation, resentment, or excessive emotional stimulation. The liver may attack the spleen, which leads to the above scenario, or liver qi depression and stasis may transform into fire. Fire burns and coagulates fluids, which produces phlegm-heat. Phlegm with heat tends to rise and obstruct the chest and the orifices of the heart, causing restlessness of the shen. Anxiety, anguish, excitability, and mental restlessness, as well as a sensation of oppression and heat in the chest, and/or restless legs syndrome then occurs.
Clinically this is more common in younger patients with strong constitutions.

2. Yin vacuity & fire hyperactivity
Chronic diseases, long standing emotional confusion, excessive sex, old age, overwork, long-term spleen vacuity, consumption of certain drugs, can damage kidney yin.
This can lead to yin failing to control yang, which causes rising vacuity fire which disturbs the shen, resulting in agitation, poor sleep and memory, restlessness, vexation and agitation. True yin vacuity heat can also disturb the ministerial fire which can further ascend, leaving its house, also causing agitation of the shen, such as, mental restlessness, anxiety, and anguish, as well as a heat feeling and a sense of oppression in the chest, and/or restless legs with sensation of heat in the legs.
Clinically this pattern is more common in elderly people, particularly in menopausal disorders.
This can be similar to panic attacks.