Hand and foot dancing refers to spasms of the hands and feet, increased movements, varied and uncontrollable, resembling a dance. It can also resemble a puppet on strings due to rapid twitching, and in severe cases, the face may also exhibit actions such as pouting, blinking, and tongue protrusion, or manifest as hemibody dancing.

Suwen. Zhizhenyao Da Lun states: "All wind with vertigo and shaking is ascribed to the liver," and "All sudden muscular spasm and rigidity is ascribed to wind." Therefore, this condition is often classified under liver wind in classical medical texts. However, the spasms (or convulsions) of liver wind involve alternating flexion and extension of the hands and feet, with stereotyped movements, which are distinctly different from hand and foot dancing. Clinically, they should be differentiated.

Epileptic seizures also involve spasms of the hands and feet, but they often start with rigidity of the limbs, followed by alternating flexion and extension, unconsciousness, stiff collapse, frothing at the mouth, and rapid recovery, with recurrent episodes, returning to normal after the episode ends. This condition, however, involves continuous dancing while awake, with all movements ceasing upon falling asleep.

bubble_chart Pattern Analysis

1. External Contraction Wind Evil︰Fever is characterized by sudden onset of involuntary movements in the limbs and torso, with constant twisting, turning, and restlessness. The movements are rapid and uncontrollable, often leading to self-inflicted scratches or injuries to the hands and feet. Due to these movements, the hands cannot grasp, and the feet cannot stand, making walking difficult. Accompanying symptoms include twitching of the head, face, eyes, nose, and corners of the mouth, resembling "grimacing," difficulty eating, slurred speech, and cessation of symptoms only during sleep, resuming upon waking. The tongue texture is red, with a thin white or slightly yellow coating, and the pulse is floating-rapid or rapid and forceful. This condition often arises in children due to inadequate postnatal care, leading to insufficient healthy qi, or in adults with constitutional weakness, compounded by invasion of wind-cold or wind-heat through the mouth, nose, or meridians. Over time, heat transforms and stirs liver wind, triggering the onset of chorea. In cases of liver-kidney yin deficiency, prolonged fatigue or chronic illness depletes yin-blood in the liver and kidneys, or external contraction of pathogenic heat damages yin fluids. Yin deficiency with internal heat, or insufficient yin-blood failing to nourish the sinews, results in muscular tension and subsequently stirs liver wind, causing head twitching and chorea. External contraction of wind pathogens typically begins with fever and chills, headache, body pain, and a floating pulse, followed by chorea. Liver-kidney yin deficiency, however, develops after prolonged internal damage or external contraction of pathogenic heat depleting yin fluids, accompanied by symptoms of yin deficiency with internal heat (vexing heat in the chest, palms, and soles; tidal fever; night sweats; restlessness and insomnia; dry mouth; flushed cheeks; scanty dark urine; a bright red tongue with scant coating; and a deep-thin-rapid pulse) as well as liver-kidney deficiency symptoms (vertigo, tinnitus, blurred vision, muscular tension and numbness, sore lower back and weak legs, seminal emission, premature ejaculation, etc.). Chorea caused by liver-kidney yin deficiency and that caused by external contraction of wind pathogens are both highly typical. Treatment: For chorea due to external contraction of wind pathogens, the approach is to dispel wind pathogens and nourish blood to extinguish wind. The modified Four Ingredients Decoction can be used, reflecting the principle that "to treat wind, first treat blood; when blood circulates, wind dissipates." For wind-cold, add Cinnamon Twig, Saposhnikovia Root, and Schizonepeta; for wind-heat, add Chrysanthemum Flower, Skullcap Root, and Coptis Rhizome. For severe twitching, consider adding Uncaria, raw Fossil Bone, raw Oyster Shell, Earthworm, whole Scorpion, Stiff Silkworm, and Centipede.
2. Liver-kidney Yin Deficiency︰The limbs dance, the head and neck twist, with frequent grimacing and eye movements, and the sinews and vessels are mostly tense, the cheeks are red and flushed, vertigo and tinnitus, blurred vision, soreness in the waist and weakness in the legs, feverish feeling in the palms and soles, restlessness and insomnia, scanty dark urine, dry stool accumulation, a red tongue with scant coating, and a wiry, thin, and rapid or wiry and thin pulse. The method of nourishing water to moisten wood and calming the liver to extinguish wind should be employed, using the Wolfberry and Chrysanthemum Rehmannia Pill with modifications, such as adding Cicada Slough, Earthworm, and Scorpion, etc. **Liver depression with blood deficiency** and **liver-kidney yin deficiency** can both manifest as involuntary dancing movements! From the perspective of disease causation, **liver depression with blood deficiency** is primarily caused by emotional injuries, such as excessive worry, anger, or resentment leading to liver qi stagnation. The wood fails to flourish, and the liver loses its free-flowing function, accompanied by blood deficiency (heart and liver blood deficiency). Blood deficiency then leads to malnourishment of the sinews, and liver qi stagnation. When provoked by anger, liver qi surges upward into the chest, causing qi and blood to fail in distribution, resulting in involuntary dancing movements. **Liver-kidney yin deficiency**, on the other hand, arises from external contraction of pathogenic heat consuming yin essence, or prolonged illness and overexertion damaging liver and kidney yin, leading to malnourishment of the sinews and vessels, thus causing involuntary dancing movements. Patients with **liver depression and blood deficiency** may exhibit symptoms of visceral agitation in daily life, as described in Jingui Yaolue·"Women's Miscellaneous Diseases: Pulse Patterns and Treatments": "Women with visceral agitation are prone to sadness, weeping, and behaving as if possessed by spirits." Such patients are often sentimental, easily agitated, prone to weeping or uncontrollable laughter, and their limb movements are highly susceptible to external influence, resembling various imitated dance-like motions that are ever-changing. Those with **liver-kidney yin deficiency**, in addition to involuntary dancing movements, also exhibit symptoms of **yin deficiency with internal heat** and liver-kidney depletion. The method of **nourishing water to moisten wood** should be employed. As the ancients said: "Emotional injuries cannot be cured by medicine alone."
3. Deficiency of Both Qi and Blood︰Mental fatigue and burnout, shortage of qi leading to reluctance to speak, faint and timid voice, pale complexion, pale lips and nails, aversion to wind with spontaneous sweating. Gradually develops into involuntary movements, progressively worsening, with slackening of the sinews and vessels in the limbs, numbness and weakness, eventually leading to inability to care for oneself. Pale tongue, weak or thin and feeble pulse. This is often seen in the elderly with declining strength, yin-yang disharmony, malnutrition of the sinews and vessels in the limbs, and internal stirring of liver wind causing involuntary movements. Kidney essence insufficiency is often seen in those with weak constitution, congenital deficiency, or poor maternal care during pregnancy leading to fetal malnutrition, and lack of timely postnatal nourishment, resulting in kidney essence insufficiency and liver essence deficiency, leading to malnutrition of the sinews and involuntary limb movements. Cases caused by qi-blood deficiency are more common in the elderly, with gradual onset of convulsions in the hands and feet, slowly progressing to involuntary limb movements, accompanied by symptoms of qi-blood deficiency (pale complexion, aversion to wind with spontaneous sweating, faint and low voice, vertigo, numbness, pale lips and nails, pale tongue, deep wiry and thin pulse). In contrast, involuntary movements due to kidney essence insufficiency have an earlier onset, typically seen in individuals aged 30–40. In addition to involuntary movements, patients also exhibit symptoms of kidney essence insufficiency (forgetfulness, dementia, depressive-like states, soreness in the waist and legs, tinnitus, vertigo, etc.). For qi-blood deficiency, treatment should focus on tonifying and replenishing qi and blood, pacifying the liver and extinguishing wind, using Eight Precious Ingredients Decoction supplemented with liver-pacifying and wind-extinguishing medicinals. For kidney essence insufficiency, the method of enriching and tonifying kidney essence is used, with Great Life-Endowing Pill as the base formula, modified as needed.
4. Liver Depressionblood Deficiency︰It is commonly seen in women, often characterized by irritability, emotional depression, chest tightness, frequent sighing, sentimentality, and a tendency to become easily agitated and tearful. When faced with worry, grief, or anger, they may exhibit uncontrollable laughter or incessant weeping, accompanied by dancing movements, intense emotions, and behavior resembling that of an actor, alternating between episodes of activity and rest, insomnia, dreamfulness, and easy fright. The tongue appears pale, and the pulse is wiry and thin. From the perspective of disease etiology, it is primarily caused by emotional disturbances, such as worry, grief, or anger, leading to liver qi depression, failure of wood to flourish, and impaired liver dispersion, often accompanied by blood deficiency (heart and liver blood deficiency). Blood deficiency results in the tendons losing their nourishment, while liver qi stagnation, when provoked, causes liver qi to surge upward into the chest, preventing the proper distribution of qi and blood, thus triggering dancing movements. Liver-kidney yin deficiency arises from external contraction of pathogenic heat, which damages yin essence, or prolonged illness and overexertion, leading to insufficient liver and kidney yin and subsequent malnourishment of the tendons, resulting in dancing movements. Those with liver depression and blood deficiency may exhibit symptoms of visceral agitation in daily life, as described in Jingui Yaolue: "Women with visceral agitation are prone to sadness and weeping, as if influenced by spirits." Hence, patients are often sentimental, easily agitated, prone to weeping or uncontrollable laughter, and their limb movements are highly susceptible to external influence, closely resembling various imitated dance-like motions that are highly variable. For those with liver-kidney yin deficiency, in addition to dancing movements, symptoms of yin deficiency with internal heat and liver-kidney deficiency are also present. The former is treated with methods such as soothing the liver and nourishing blood, pacifying the liver and extinguishing wind, using Peripatetic Powder supplemented with wind-extinguishing herbs. Additionally, attention must be paid to regulating emotions.
5. Kidney Essence Insufficiency︰It is commonly seen in adults, initially presenting with localized convulsions that gradually progress, eventually leading to involuntary movements of the limbs, often accompanied by forgetfulness. Over time, the patient may appear dull, taciturn, and mentally impaired, along with symptoms such as tinnitus, vertigo, soreness and weakness in the lower back and legs, lack of strength in the lower limbs, difficulty walking, a pale tongue, and a deep, weak pulse at the chi position. **Qi-blood deficiency and kidney essence insufficiency causing involuntary movements!** From the perspective of disease etiology: - **Qi-blood deficiency** is often seen in the elderly or those with weakened vitality, resulting from yin-yang disharmony, malnutrition of the tendons and vessels, and internal stirring of liver wind, leading to involuntary movements. - **Kidney essence insufficiency** is typically due to congenital weakness, inadequate prenatal nourishment, or poor maternal health during pregnancy, resulting in fetal malnutrition and lack of postnatal replenishment. This leads to kidney essence insufficiency, liver essence deficiency, and malnutrition of the tendons, causing limb movements. **Clinical manifestations:** - **Qi-blood deficiency** mostly occurs in the elderly, with convulsions developing gradually in the hands and feet, progressing slowly to involuntary limb movements. It is accompanied by symptoms of qi-blood deficiency (pale complexion, aversion to wind, spontaneous sweating, faint and low voice, vertigo, numbness, pale lips and nails, pale tongue, deep, wiry, and thin pulse). - **Kidney essence insufficiency** presents with earlier onset, typically between 30–40 years of age. In addition to involuntary movements, patients exhibit symptoms of kidney essence insufficiency (forgetfulness, dullness, mental impairment, soreness in the lower back and legs, tinnitus, vertigo, etc.). **Treatment:** - For **qi-blood deficiency**, the approach involves tonifying and replenishing qi and blood, pacifying the liver and extinguishing wind, using Eight Precious Ingredients Decoction supplemented with liver-pacifying and wind-extinguishing herbs. - For **kidney essence insufficiency**, the method focuses on enriching and tonifying kidney essence, using Great Life-Endowing Pill with modifications.
6. Pregnancy in Women︰The limbs move involuntarily, and the head and face can also twist, with manifestations similar to the various symptoms of chorea described above. The tongue appears pale, and the pulse is slippery or wiry and slippery. During pregnancy, those with liver and kidney deficiency or insufficient qi and blood are prone to worsening conditions, leading to malnutrition of the tendons and vessels and internal stirring of liver wind, resulting in chorea. The key distinguishing feature is that this type occurs only during pregnancy. It is more common in young first-time pregnant women and during the first three months of pregnancy, and the symptoms cease once the pregnancy is terminated.

bubble_chart Documentation

1. Rumen Shiqin．Wind form: "The old man Ma from Xinzai, aged fifty-nine, was beaten sixty times by officials due to unpaid autumn taxes, which caused him to develop a wind convulsion that has lasted for three years. During severe episodes, his hands and feet tremble uncontrollably, making it impossible for him to hold objects, and he needs others to feed him. His mouth and eyes remain wide open, and his lips and tongue are chewed raw. The shaking is so intense that it resembles a puppet being jerked by strings. Every time he has an episode, crowds gather to watch. At night, he lies in fever, throwing off all his clothes and blankets, feeling itchy and hot all over, yet paradoxically cold externally. He has long wished to end his life but cannot even hold a rope. He has spent all his wealth seeking medical treatment, to the point of impoverishment, yet his illness persists. His son, a former minor official in the town, consulted Dai Ren about his father's condition. Dai Ren said: 'This illness is very easy to treat. If it were the height of summer, one or two purges would suffice to cure him. Now that it is autumn and cold, three purges may be necessary. If that doesn't work, then acupuncture at specific points will surely cure him.' First, he was given Tong Sheng San to induce sweating, followed by a purgative, which caused him to expel one or two liters of phlegm. By evening, he had five to seven bowel movements, and his condition slightly improved. After five days, another purge was administered, expelling three to four liters of phlegm, which was yellow and clotted like egg yolk, and hot like soup. The old man, unable to probe his own throat due to trembling hands, had his wife do it for him, resulting in a swollen and injured throat. He was delirious as if drunk for about one or two hours before gradually regaining consciousness. After several more bowel movements, he immediately felt lighter on his feet, with reduced trembling and no fever. He was able to walk, use a comb, and hold a spoon and chopsticks. Before the third purge, his illness was completely washed away. After the illness, he only felt extremely cold. Dai Ren said: 'He should be nourished with food, and the cold will naturally recede over time. Since a major illness has been expelled, his defensive qi will gradually recover. Therefore, he should be given medicine to disperse wind and guide qi, and must not be treated with hot medicines, as this could lead to other illnesses.'"