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When the hands tremble or shake, whether it occurs in one hand or both, it is referred to as hand tremor.

Suwen.Zhizhenyao Da Lun states: "All wind with vertigo and shaking is ascribed to the liver." Tremor refers to shaking, also known as vibration or oscillation. Zhengzhi Zhunsheng includes a specific entry on tremor within the category of wind disorders; however, tremor as a distinct disease category first appears in Zhangshi Yitong. Tremor includes head shaking, hand trembling, and body shaking. This article only discusses hand tremor, and other types of tremor will not be addressed.

This condition shares the characteristic of shaking with spasm and convulsion, but spasm and convulsion involve alternating extension and contraction of the limbs with continuous twitching, whereas hand tremor involves only vibration without spasm. Additionally, this condition differs from finger stiffness, which refers to the fingers being stiff and difficult to straighten, with limited movement, whereas hand tremor involves continuous shaking that is difficult to stop. Although both are hand disorders, their symptoms are distinctly different.

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1. Internal Stirring of Liver Wind︰The hand trembles incessantly, accompanied by dizziness, headache, dysphoria, and insomnia. The tongue is red with scant coating, and the pulse is wiry, rapid, and forceful, or deep, thin, and rapid. The cause lies in the liver, manifesting as an excess pattern, often seen in individuals with inherent liver yang exuberance. Since the liver governs the sinews, excessive liver yang stirs wind, and the hand trembles as it follows the movement of wind.
2. Wind Phlegm︰Hand tremors accompanied by numbness, chest and hypochondriac fullness, retching and nausea, sticky mouth, occasional irritability, white and greasy tongue coating, and wiry-slippery pulse indicate deep-seated phlegm-fluid retention in the meridians. The signs include obesity, facial puffiness, occasional numbness in the fingertips, or distension and discomfort in the limbs with restricted movement, or throat discomfort as if clogged with cotton, a swollen tongue with white and greasy coating. After onset, hand tremors are often accompanied by numbness, a condition commonly seen in the elderly. Treatment should focus on dispelling wind and resolving phlegm, and Phlegm-Guiding Decoction with bamboo juice can be selected. As the "spleen is the source of phlegm," spleen deficiency leading to dampness accumulation easily generates phlegm. When phlegm-fluid retention lurks internally and phlegm stirs wind, hand tremors manifest. Therefore, it can be said that the disease mechanisms of both conditions are the same, namely spleen qi deficiency. However, in spleen deficiency with wind-induced hand tremors, it is due to earth deficiency causing internal stirring of wind-wood, resulting in tremors. In wind-phlegm hand tremors, it is caused by the mutual binding of wind and phlegm, battling in the meridians, leading to the loss of restraint in the Jingmai. The differences in symptoms are as follows: - **Spleen deficiency with wind-induced hand tremors**: Tremors come and go, inability to hold objects, weak grip, fatigue, poor appetite, and bland taste in the mouth. - **Wind-phlegm hand tremors**: Accompanied by numbness, a crawling sensation like ants, distension in the fingers, as well as nausea, chest fullness, sticky mouth, and greasy tongue coating. For spleen deficiency with wind-induced hand tremors, treatment should focus on fortifying the spleen, strengthening earth, and calming wind. Six Gentlemen Decoction with Uncaria, Chinese Angelica, Peony Root, and Saposhnikovia Root can be used.
3. External Contractionwind-cold︰Hand tremors accompanied by pain, aversion to wind and cold, neck discomfort, sweating or without sweating, thin white tongue coating, floating or wiry-tight pulse. It is caused by disharmony between nutrient and defensive qi, with wind-cold directly invading the hands. There are usually obvious external climatic factors, and after onset, symptoms of wind-cold external contraction are present, with hand tremors and pain. This syndrome is more common in young people. Treatment should focus on dispelling wind and dispersing cold, and Astragalus and Cinnamon Twig Five Ingredients Decoction with Pueraria Root can be selected.
4. Spleen Deficiency with Wind Stirring︰Hand tremors with slowness, weakened grip strength, fatigue in the limbs, or accompanied by abdominal distension and fullness, diarrhea; a swollen tongue with a pale tongue texture, thin white coating, and a deep, slow, weak or wiry and slow pulse. It is caused by spleen deficiency stirring internal wind of the liver, leading to hand tremors; tremors occur intermittently, the hand cannot grasp objects, grip strength is weak, accompanied by fatigue and exhaustion, as well as poor appetite and a bland taste in the mouth. For treatment, it is advisable to strengthen the spleen, fortify the earth, and calm wind. Six Gentlemen Decoction can be used with additions such as Uncaria, Chinese Angelica, Peony Root, and Saposhnikovia Root.
5. Blood Deficiency with Wind Stirring︰Trembling and numbness of the hands, pale complexion without luster, dizziness, palpitation, insomnia, pale lips and tongue, thin white coating, weak and thready pulse. Mild hand tremors often occur in chronic deficiency diseases, mainly due to heart-liver blood deficiency, characterized by trembling and numbness of the hands, itchy skin, accompanied by dizziness, blurred vision, palpitation, insomnia, and other blood deficiency patterns. Treatment should focus on nourishing blood and extinguishing wind to stop tremors, with the recommended prescription being Ding Zhen Wan.
6. Stirring Wind Due to Yin Deficiency︰Fingers wriggling, mental fatigue palpitation, "dry throat, emaciated body, red and crimson tongue, scanty or no coating, thready and rapid pulse. The liver and kidneys are rooted in the same source, both located in the lower energizer. However, it is a deficiency pattern, which should be carefully differentiated in clinical practice. It is commonly seen in individuals with constitutional yin deficiency with internal heat or those with prolonged pathogenic heat lingering in the lower energizer. When liver and kidney yin are scorched, yin deficiency fails to subdue yang, leading to yang movement generating wind, which can also manifest as hand tremors. The distinguishing features between the two are: in excess patterns, hand tremors often occur suddenly and are more severe, accompanied by dizziness, headache, a forceful pulse, a relatively stiff tongue body, and a dark red tongue texture; in deficiency patterns, hand tremors mostly occur in the Rebing late stage [third stage], with milder tremors, described by Wu Ju-tong as: "fingers merely feel wriggling" (Wenbing Tiaobian), accompanied by listlessness, palpitations, dry throat and mouth, a thready and rapid pulse, and a dry crimson tongue with scant coating. For excess pattern hand tremors, it is appropriate to calm the liver and extinguish wind to stop tremors, using formulas such as Antelope Horn and Uncaria Decoction, or Gastrodia Tuber Uncaria Decoction; for deficiency pattern hand tremors, it is suitable to nourish yin and extinguish wind to stop tremors, using formulas like the two-shell Pulse-Restoring Decoction. $Blood deficiency wind-stirring hand tremors and stirring wind due to yin deficiency hand tremors! Both arise on the basis of insufficient yin and blood. However, compared to the latter, hand tremors are more severe. They mostly occur in the Rebing late stage [third stage], often due to liver-kidney yin deficiency, characterized by hand tremors accompanied by obvious internal heat patterns, such as dry throat and mouth, dry skin, a thready and rapid pulse, a red and crimson tongue, or even a curled tongue. For blood deficiency wind-stirring hand tremors, it is appropriate to nourish blood and extinguish wind to stop tremors, using the formula Ding Zhen Wan.

Hand tremors mostly occur in adults, but can also be seen in children. The cause is due to fear damaging the kidney, which affects the liver, leading to the loss of control over the tendons and vessels, hence causing hand tremors. Clinically, one may observe continuous hand tremors, which are more pronounced when the hands are held out flat, accompanied by a state of anxiety and fear, a weak pulse at the chi position, and a red tongue without coating. Treatment should focus on nourishing the kidney and liver, and one may choose Six-Ingredient Rehmannia Pill combined with Young Maid Pill plus Barbary Wolfberry Fruit, Chrysanthemum Flower, Ophiopogon Tuber, Schisandra Fruit, etc.

People who frequently consume alcohol are prone to hand tremors, which are more difficult to treat.

Although hand tremors are localized to the hands, they are often a sign of internal organ pathology, especially tremors caused by the internal stirring of liver wind combined with wind phlegm, which are often precursors to apoplexy. Yilin Gaicuo lists dozens of symptoms before the onset of apoplexy, including hand tremor disease, stating "some have one hand trembling for a long time, some have both hands trembling for a long time, some have the ring finger unable to extend for a period each day, and some have the thumb moving involuntarily without reason." Therefore, it is important to actively treat hand tremors to prevent the occurrence of apoplexy by addressing issues early on.

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1. Zhengzhi Zhunsheng. Tremor: "Tremor means shaking; vibration means movement. The tendons and vessels cannot restrain, and cannot hold, which is the image of wind. Neijing says: All wind-induced dizziness belongs to liver wood. The liver governs wind, wind is yang qi, yang governs movement, this excessive wood qi overcomes spleen earth, the spleen governs the four limbs, the four limbs are the ends of all yang, wood qi tympanites them, hence the movement. The scripture refers to wind-induced end diseases, this is it. There are also cases where the head moves but the hands and feet do not move, as the head is the leader of all yang, the rising of wood qi rushes, hence the head alone moves while the hands and feet do not move; scattered to the four ends, then the hands and feet move while the head does not move. All are due to excessive wood qi combined with the transformation of fire."