Hand Tremors

63 year old male with sudden onset of right hand tremor. Extremely spastic, intermittent, but comes on every few minutes. No numbness, no tingling, no pain.

Was tested by GP who thought it might be a pinched nerve. Also was tested by neurologist for parkinsons and given MRI, with nothing remarkable. Does have arthritic neck, which after a few treatments started feeling fine.

Cold and Stress are what seem to trigger the most spasms. Tho he has a big aversion to heat.

He is on 'uasoretic'? hi BP meds. Has a puffy tongue, pale red to red, thin white to thin yellowish at times coating. Scallops. Darker with some petechia on liver area. Plulse is around 60bpm (meds? keeping it down?), weak, but present yin and yang pulses. Slippery liver pulse. Weak spleen pulse, sometimes slippery too.

First treated for wind/internal wind. Gave 4 back treatments for his neck including points like LI10 and SJ5 to bring more qi and blood to the hand. GB20 every time. Then started doing more damp heat treatments, as I thought he exhibited some of those symptoms. 

Nothing in 7 treatments, including first giving Tian Ma Gou Teng Yin and later Long Dan Xie Gan Tang modified with Gou Teng and another wind clearing herb (as per Bensky for tremors)- nothing has worked.

His doctors are stumped, and one says it may be 'essential tremors' while the neurologist said to see an acupuncturist :)

He is on a break from treatments, in hope that I can find some answers for him. Anyone?

 

Hi

Nanci Simari


Comments

Chad Dupuis's picture

This generally comes from

 

This generally comes from the neck, so continuing to work on that area would be appropriate.  Tremors also have some motor cortex involvement so points such as GV 20 are often quite helpful.  Cupping on the upper back would also be appropriate particularly if you are not getting response from the treatment.

Our protocol for tremors (which is the same whether we are doing acupuncture, tong ren and/or tuina) is as follows:

  • Huatuo of C1 (best with tuina as opposed to needling)
  • TH 16 (same as above)
  • SI 16 (same as above)
  • UB 9 (cerebellum)
  • GV 20 (motor cortex)
  • Tiandong (click name for location, a sky window point we use, best with deep tuina)
  • GV 19 (sensory cortex)
  • Local Points and Appropriate Descending points such as UB 62 (perhaps with SI 3 which is good for the neck, a local point, and an extraordinary vessel point w/UB 62)

So a treatment using our approach would go roughly as follows:  1) deep tuina on the sky windows points and appropriate huatuo points in the neck, 2) needling all appropriate points listed above along with those related to their constitution overall and local "ashi" points, 3) finish with more tuina - sky window, neck, down into arm, 4) adjunctive techniques if necessary - cupping...

nancisimari's picture

great!

These are definitely not points I had thought of- and the use of tui na on some sounds like a great idea. I really appreciate it, as I was looking for some alternative type points. I will let you know how it works out. 

nancisimari's picture

ps on tremor tx

Of course it will depend upon the patient himself, but roughly how long would you continue this protocol before expecting to see results?

Chad Dupuis's picture

In all but relatively serious

In all but relatively serious chronic conditions I generally expect some sort of noticeable change within 4-7 treatments.  We treat 1/x weekly and very, very rarely more than that.  

A noticeable change is something that the patient can comment on.  Not necessarily gone but not the same either - just a change.  Initially even a mild worsening of the symptoms would be considered positive vs. nothing...

nancisimari's picture

ok

thanks a lot! if you have any herbal suggestions, that would be good to hear too.