The pattern of internal stirring of liver wind generally refers to liver yang transforming into wind and disturbing the upper body, or liver wind carrying phlegm-fire rushing upward, with qi and blood moving upward together, or extreme liver yin and blood deficiency generating dryness and wind, resulting in a series of symptoms characterized by rapid changes and shaking or trembling of the head, including the obstruction of the seven orifices and abnormal movements of the limbs. The causes of this symptom and sign disease are complex, often due to factors such as advanced age with kidney deficiency, overstrain from sexual activity, internal damage from the seven emotions, or dietary imbalances. It can also occur due to warm disease entering the lower energizer, leading to the exhaustion of yin and blood.

The main clinical manifestations include: vertigo, headache, tinnitus, facial deviation, severe cases may involve fainting, loss of speech, unconsciousness, or numbness, tremors, hemiplegia of the hands and feet, or convulsions. The tongue is often deep red and dry, and the pulse is usually wiry and rapid, or slippery and long. In cases of extreme yin and blood deficiency generating wind, the pulse is often thin, rapid, and weak, or thin, wiry, and feeble.

This syndrome is commonly seen in diseases such as "vertigo," "headache," "apoplexy," "hemiplegia," "syncope," and "warm disease."

This syndrome should be differentiated from the "pattern of ascendant hyperactivity of liver yang," "pattern of extreme heat generating wind," "liver excess with qi stagnation stirring wind pattern," "wind apoplexy involving meridians and vessels syndrome," and "pattern of liver heat stirring wind."

The clinical manifestations and specific treatments of this syndrome vary across different diseases:

1. seen in vertigo and headache, commonly referred to as liver yang transforming into wind, often results from a constitutional yin deficiency with yang exuberance. This can be exacerbated by overwork or anger, causing qi and fire to rise and stir wind yang, or from prolonged emotional depression transforming into fire, leading to excessive consumption of liver yin and the rise of fire and stirring of wind. The main symptoms include dizziness, blurred vision, a sensation of being on a boat or car, or headache accompanied by dizziness, eye soreness, and photophobia. Associated symptoms include irritability, facial redness, dry and bitter mouth, or numbness and twitching of limbs, unsteady walking, or insomnia and dreamfulness. These symptoms often worsen with overwork or anger. The tongue is red with a yellow coating, and the pulse is wiry and rapid. The treatment should focus on nourishing yin and subduing yang, pacifying the liver and extinguishing wind. Commonly used formulas include Liver-Settling Wind-Extinguishing Decoction (Yixue Zhongzhong Canxilu) or Antelope Horn and Uncaria Decoction (Tongsu Shanghan Lun), removing fresh Unprocessed Rehmannia Root, Tendrilleaf Fritillary Bulb, Mulberry Leaf, Bamboo Shavings, and adding raw Shijueming, raw oyster shell, Nacre, Tuber Fleeceflower Stem, and Albizia flower.
2. In cases of apoplexy or major syncope, this represents a severe form of liver yang transforming into wind, with syndromes of obstruction or collapse affecting the seven orifices, and convulsions or paralysis affecting the limbs. For detailed treatment, refer to the section on apoplexy.
3. The pattern of internal stirring of liver wind seen in hemiplegia is often a mild form within the category of internal wind. The patient's consciousness remains clear, but the meridians and collaterals are obstructed by wind yang and phlegm turbidity, leading to symptoms such as deviation of the eye and mouth, stiff tongue and slurred speech, heavy and numb limbs, and hemiplegia. The tongue is red with a greasy coating, and the pulse is wiry, slippery, and rapid. The treatment should focus on subduing yang and extinguishing wind, regulating qi and reducing fire, while also resolving phlegm and clearing heat, and dredging the meridians and collaterals. Commonly used formulas include Gastrodia and Uncaria Drink (Zabing New Meanings in Syndrome Treatment) with additions such as Earthworm, Stiff Silkworm, whole scorpion, centipede, Bamboo Juice, Sichuan Fritillary Bulb, Red Peony Root, Stephania Tetrandra, and Chinese Clematis Root.
4. The pattern of internal stirring of liver wind can also be seen in patients with residual hemiplegia within the category of internal wind. In this case, the meridians and collaterals are not yet fully cleared, and wind yang has not completely extinguished or may re-emerge, often accompanied by symptoms of wind yang such as vertigo, headache, muscle twitching, and spasms. The treatment can use Gastrodia and Uncaria Drink with modifications to pacify the liver and subdue yang, extinguishing wind, while also addressing the characteristics of qi deficiency and phlegm turbidity obstructing the meridians and collaterals in hemiplegia, emphasizing Yang-Tonifying Five-Returning Decoction (Yilin Gaicuo) to tonify qi, dispel stasis, and dredge the collaterals. If wind yang has been extinguished and phlegm stasis has been cleared after treatment, and the limbs can move, but there is still soreness in the waist and legs, dizziness, fatigue, and mental dullness, indicating a deficiency of marrow and essence, the treatment should shift to tonifying and replenishing marrow and essence to achieve complete recovery.
5. The pattern of internal stirring of liver wind, seen in lower energizer warm disease, is called "extreme yin blood deficiency generating wind." It is caused by repeated sweating and purging, loss of blood, and depletion of yin, leading to the exhaustion of liver and kidney yin and blood in the lower energizer. This results in the inability to nourish the orifices and limbs, leading to malnourishment of the liver meridian and internal stirring of deficient wind. Symptoms include wriggling of limbs, and in severe cases, convulsions, trembling of the corners of the mouth, and a strong, restless sensation in the heart. There are also signs of severe damage to the true yin of the liver and kidney, such as emaciation, internal heat, hotter palms and soles, flushed cheeks, dry mouth, dry tongue, night sweats, deafness, slurred speech, red and crimson edges and tip of the tongue, tooth scum, chapped lips, and a pulse that is weak, thin, rapid, or thin, wiry, and weak. These signs differ from those of liver yang transforming into wind, where although there are signs of wind yang moving through the limbs and meridians, the main manifestation is wind yang carrying phlegm fire to the vertex, unlike this syndrome where the prominent symptom is limb shaking. The pattern of liver yang transforming into wind is characterized by lower deficiency and upper excess or root deficiency and branch excess, with the branch being more urgent than the root. The treatment focuses on addressing the branch first and then the root. In contrast, the pattern of internal stirring of liver wind is characterized by mild evil and severe deficiency, with deficiency being the main aspect. The treatment always focuses on supporting the right, starting with nourishing blood and stabilizing wind, and enriching yin. Representative formulas include Three-Carapace Pulse-Restoring Decoction (Wenbing Tiaobian), 大, and Minor Wind-Stabilizing Pearl (Wenbing Tiaobian).

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Since this syndrome often arises from liver qi transforming into fire and generating wind, and is frequently accompanied by phlegm-fire rushing upward, it often involves complications such as liver excess attacking the spleen and stomach, middle energizer deficiency-cold, counterflow lung metal, and phlegm-fire.

1. For cases involving spleen and stomach invasion with qi stagnation, symptoms include hypochondriac and abdominal distension, fullness, pain, belching, nausea, and vomiting. In addition to liver-pacifying and wind-extinguishing medicinals, consider adding soothing and descending herbs such as Puncturevine Caltrop Fruit, Germinated Barley, Pinellia, Nardostachys Root, and Citron Fruit.
2. For cases with middle energizer deficiency, symptoms include reduced appetite, lack of taste, abdominal distension, fullness, and loose stools. Consider adding spleen-strengthening and stomach-tonifying herbs such as Tangshen, White Atractylodes Rhizome, Chinese Yam, Lotus Seed, Nardostachys Root, Dried Ginger, Sichuan Fritillaria (stir-fried until yellow), and Dried Tangerine Peel.
3. For cases involving counterflow lung metal with liver qi rushing upward to the lungs, symptoms often include hypochondriac pain, abnormal rising of qi, and panting. Consider adding lung-clearing and liver-suppressing herbs such as Evodia Fruit (stir-fried), Mulberry Twig, Bitter Apricot Seed, Perilla Stem, Red Tangerine Exocarp, and Cultivated Purple Perilla Fruit.
4. For cases involving phlegm-fire, there is a certain relationship with body constitution: obese individuals often have excess body but deficient qi, with dampness and stagnation, leading to obstructed qi pathways and phlegm stagnation. This exacerbates wind-yang tendencies, and treatment should include qi-regulating and phlegm-resolving herbs such as Er Chen Tang, Magnolia Bark, Submature Bitter Orange, Inula, Radish Seed, and Cultivated Purple Perilla Fruit. Thin individuals often have excess heat and dryness, prone to wind generation from heat. If combined with habits like smoking and drinking, dampness and phlegm accumulate, leading to symptoms such as phlegm cough, stuffiness, belching, nausea, vertigo, and palpitations. Once wind-yang stirs, it often carries phlegm-fire upward, blocking the seven orifices. In such cases, add phlegm-resolving and resuscitation herbs such as Arisaema with Bile, Tabasheer, Bamboo Juice, Milkwort Root, Acorus, and Curcuma Root. Before wind movement, focus on clearing qi and resolving phlegm, using Qi-Clearing and Phlegm-Resolving Pill (Yifangkao) or Fire-Clearing and Phlegm-Resolving Pill (from "Ancient and Modern Medical Mirror") with modifications.
5. Additionally, the pattern of internal stirring of liver wind caused by external wind-cold often presents with exterior symptoms such as chills, fever, headache, and body aches. In such cases, consider adding wind-dispersing herbs such as Schizonepeta, Saposhnikovia Root, Dahurian Angelica, Cicada Slough, Stiff Silkworm, Silkworm Feces, Gastrodia Tuber, and Gentian, combined with internal wind-pacifying herbs.

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bubble_chart Differentiation of Similar Patterns

1. Pattern of ascendant hyperactivity of liver yang and pattern of internal stirring of liver wind: Although both are caused by yin deficiency with yang hyperactivity in the liver, leading to symptoms and signs, there are significant differences in the mechanism of disease and clinical manifestations between the conditions of wind transformation and non-wind transformation, and between wind stirring and non-wind stirring. In terms of the mechanism of disease, the pattern of internal stirring of liver wind has significantly worsened compared to the pattern of ascendant hyperactivity of liver yang, undergoing a qualitative change: the original condition of water failing to nourish wood leading to wood excess has developed into a more severe kidney deficiency, with yang hyperactivity transforming into fire and wind; the original condition of improper diet leading to phlegm and heat has developed into extreme heat transforming into fire, with wind arising from fire; the original condition of internal damage from seven emotions has developed into five minds transforming into fire, with fire stirring liver wind. These qualitative changes in the mechanism of disease inevitably lead to changes in clinical manifestations; the pattern of ascendant hyperactivity of liver yang only presents with symptoms of yang qi floating in the upper part, such as headache, dizziness, facial redness, dizzy vision, tinnitus, dry mouth and tongue, etc.; the pattern of liver yang transforming into wind presents with symptoms such as blurred vision, dizziness, numbness and twitching of limbs, palpitation and insomnia, vomiting and loss of appetite, spontaneous sweating, and a tendency to collapse; the internal wind category presents with symptoms such as facial distortion, head shaking, tongue wagging, stiff tongue and inability to speak, unconsciousness, etc., which are symptoms of liver wind rising to the vertex, and symptoms such as heavy and sluggish limbs, hand and foot spasms, hemiplegia, etc., which are symptoms of liver wind spreading to the limbs; at the same time, the tongue may be numb, stiff, or short, and the pulse manifestation is no longer the wiry and rough or wiry and rapid pulse of yang hyperactivity, but a wiry and long and forceful pulse. If there are typical symptoms of the pattern of obstruction or the pattern of collapse, the distinction from the pattern of ascendant hyperactivity of liver yang can be even clearer.
2. Pattern of extreme heat generating wind and pattern of internal stirring of liver wind: Compared to the pattern of internal stirring of liver wind, which arises internally, the pattern of extreme heat generating wind, although similar in wind stirring, differs in the mechanism of disease and manifestations. First, in terms of the disease cause mechanism, the pattern of extreme heat generating wind is caused by warm pathogens attacking from above, entering through the mouth and nose, and its clinical manifestations of wind stirring are all due to the warm, heat, summerheat, and fire pathogens entering from the exterior to the interior, attracting ministerial fire, with fire stirring wind and wind and fire fanning each other, for example, wood and fire transforming together, leading to malnutrition of tendons and vessels, resulting in hand and foot convulsions; external spreading to the meridians leading to spasms; internal pressing on the pericardium leading to syncope; reversed transmission to the pericardium leading to unconsciousness. These clinical manifestations of stirring liver wind are all due to pathogenic heat transmitting to the interior as the pathogen, and once the pathogenic heat is cleared, the liver wind naturally subsides, which is completely different from the pattern of internal stirring of liver wind that arises internally. Second, in terms of clinical manifestations, the pattern of extreme heat generating wind must have symptoms of external contraction seasonal pathogens coexisting with wind stirring symptoms, which can be used for differentiation. For example, the panting due to summerheat scorching and lung qi deficiency must be accompanied by spontaneous sweating without phlegm sounds, which is very different from the pattern of internal stirring of liver wind, which is often accompanied by phlegm turbidity obstructing the seven orifices and phlegm rising with snoring sounds; summerheat disease with wind stirring must be accompanied by high fever, and also by signs of dampness such as dirty face, dry teeth, constipation or diarrhea with difficulty, etc., which is also different from the dryness and wind generated by internal stirring of wind and yang; high fever with convulsive syncope must have signs of excess heat, such as high fever, mental confusion, eye rolling, stiff neck, limb spasms, opisthotonos, red tongue, yellow coating, wiry and rapid pulse, etc., which is also different from the signs of deficient wind due to warm disease transmitting to the lower energizer, extreme deficiency of yin blood, and internal stirring of liver wind, such as limb numbness, wriggling of limbs, red cheeks, shoulder cracking, tidal fever, night sweat, aphtha, dry and crimson tongue, thin and rapid or thin and wiry and weak pulse, etc.
3. In the context of wind pattern and the pattern of internal stirring of liver wind: among syncope cases, apart from the major syncope, sudden syncope, and emotional syncope mentioned in the Neijing, which inherently belong to the category of internal wind and are essentially the pattern of internal stirring of liver wind, there is no need for differential diagnosis. Other types of syncope differ significantly from the pattern of internal stirring of liver wind and do not require differential diagnosis. Only qi syncope, often caused by excessive liver qi leading to blood counterflow, may exhibit wind-like characteristics such as rapid changes and abnormal limb movements or postures during onset, which can easily be confused with the pattern of internal stirring of liver wind. The key point of differentiation lies in the fact that qi syncope involves chaotic qi and blood counterflow, with yin-yang failing to connect smoothly, unlike the pattern of internal stirring of liver wind where qi, blood, phlegm, and fire surge upward together. The clinical manifestations of qi syncope are: initially, a feeling of chest tightness and rapid, labored breathing, almost suffocating; followed by lockjaw and inability to speak, abnormal limb movements, such as grasping at air, clenching fists, convulsions, rigidity, or paralysis of the hands and feet; in severe cases, sudden mental confusion and loss of consciousness. However, the unconsciousness in this syndrome is intermittent, with alternating periods of clarity and confusion, unlike the continuous unconsciousness seen in the pattern of internal stirring of liver wind. Additionally, during qi syncope, the face may appear bluish-yellow, and the extremities may feel cool, without signs of phlegm congestion or snoring; whereas in the pattern of internal stirring of liver wind, the face is red, the body is warm, and there is profuse phlegm and loud snoring. In qi syncope, the tongue coating is often thin and white, and the pulse is deep and hidden, turning to deep and wiry upon recovery; in contrast, the tongue coating in the pattern of internal stirring of liver wind is often yellow and greasy, and the pulse is wiry, long, slippery, and large.
4. Wind apoplexy involving meridians and the pattern of internal stirring of liver wind: External wind invading the meridians or blood vessels can be easily confused with the pattern of internal stirring of liver wind, which includes symptoms such as numbness of the skin, facial paralysis, sluggish speech, and hemiplegia. However, they can be differentiated in the following aspects: (1) The constitutional basis before the onset of the disease is different. External wind is prone to attack those with qi deficiency and weak defensive qi, while internal wind is more likely to occur in those with liver-kidney yin deficiency and hyperactivity of yang due to water deficiency. (2) The mechanism of disease is different. External wind is caused by wind evil combined with phlegm-dampness, cold-dampness, or dead blood obstructing the meridians, or wind invading the blood vessels. For example, facial paralysis caused by external wind is due to the relaxation of the yangming and taiyang meridians on the affected side, while the healthy side becomes tense. Internal wind, on the other hand, is caused by liver wind combined with phlegm-fire and turbid pathogens rising and blocking the meridians and blood vessels, leading to malnutrition of the orifices and sinews. (3) The clinical manifestations are different. The meridian pattern of external wind may be accompanied by headache, fever, aversion to wind and cold, floating and slow or floating and wiry pulse, and other signs of the six meridians, without involving the internal zang-fu organs. The pattern of internal stirring of liver wind does not have the signs of the six meridians. Although there are symptoms of the meridians and blood vessels, they often appear as precursors or sequelae of internal organ symptoms and signs, and are often accompanied by sudden collapse, loss of speech, and unconsciousness, along with internal zang-fu organ syndromes.
5. Pattern of liver heat stirring wind and pattern of internal stirring of liver wind: The syndrome of liver heat stirring wind manifests as sudden unconsciousness, collapse, stiff neck, staring eyes, convulsions of the hands and feet, and facial twitching, characterized by rapid onset and physical shaking, which can easily be confused with the pattern of internal stirring of liver wind. The key points for differentiation are: (1) The pattern of liver heat stirring wind is often caused by phlegm-heat and fright, while the pattern of internal stirring of liver wind is often caused by overstrain, depletion of kidney essence, and yin deficiency with yang hyperactivity transforming into wind. (2) The pattern of liver heat stirring wind often recurs, with episodes occurring daily or multiple times a day, and the patient quickly returns to normal after the episode, which is different from the pattern of internal stirring of liver wind. (3) The pattern of liver heat stirring wind is more common in adolescents, while internal wind is more common in middle-aged or constitutionally obese individuals. (4) The pattern of liver heat stirring wind belongs to yang epilepsy, with general characteristics of epilepsy. During an epileptic episode, phlegm-heat rises, causing frothing at the mouth, animal-like cries, dilated and unresponsive pupils, and involuntary urination and defecation. The patient wakes up naturally after a while, just like a normal person. This can be distinguished from the collapse of internal stirring of liver wind, which is silent, without frothing at the mouth, and often accompanied by facial paralysis and hemiplegia.

bubble_chart Documentation

1. "Apoplexy: A Comprehensive Discussion on Apoplexy": "Suwen discusses apoplexy, and while it is not unclear, it primarily refers to diseases caused by external factors. Jingyue's so-called wind pathogens affecting people are fundamentally exterior pattern. Neijing mentions various winds, all referring to external pathogens, hence there are no symptoms such as mental confusion, phlegm obstruction, rigidity, paralysis, or convulsions. ... As for internal causes of sudden fainting and collapse, Suwen has entries for major syncope and emotional syncope, but these are not referred to as apoplexy. ... It is not that Jiayi Jing refers to hemiplegia and sudden death as being caused by partial wind pathogens, and the chapter on apoplexy in "Jingui" also attributes symptoms such as facial distortion, heavy body numbness, unconsciousness, and tongue stiffness with drooling to thief pathogens affecting the meridians, collaterals, organs, and viscera. Thus, diseases caused by internal wind are all attributed to external contraction of pathogenic wind, disrupting the examples in Suwen. ... By this point, the term apoplexy specifically refers to symptoms of facial distortion, sudden collapse, and unconsciousness. ... However, based on recent observations of sudden fainting and collapse, most cases involve sudden liver yang hyperactivity, rising qi and fire, and phlegm-heat surging upward, with coarse breathing and high respiration, which is completely opposite to the ancient view of deficiency-cold. ... Only internal heat and internal wind, with sudden liver yang hyperactivity forcing qi and blood to rush upward into the brain, can cause sudden facial distortion, heavy body numbness, unconsciousness, tongue stiffness, and drooling. Externally, there must be signs of liver yang hyperactivity, such as a red face, flushed shoulders, coarse breathing, and high respiration. The pulse is often floating, large, turbid, rapid, and hurried, and not solely floating and tight. Although there are occasional cases of true yang decline, where a slight stir of deficiency wind leads to collapse pattern, with a pale face, cold limbs, and sticky sweat, resembling the cold-deficiency interaction described in "Jingui," ... this is not external cold, and the pulse should be slow, thin, deep, and hidden, certainly not floating and tight."