经云。寒气客于皮肤。阴气盛。阳气虚。故为振寒寒栗。深师曰。振乃阴气争胜。故为战。
栗则阳气不复。故为颤。骨者髓之府。不能久立。行则振掉。骨将惫矣。颤振与螈 相类。螈
则手足牵引。而或伸或屈。颤振则但振动而不屈也。亦有头动而手不动者。盖木盛则生风生火。
上冲于头。故头为颤振。若散于四末。则手足动而头不动也。经曰。诸风掉眩。皆属于肝。若肝
木实热。泻青丸。肝木虚热。六味丸。肝木虚弱。逍遥散加参、术、钩藤。挟痰。导痰汤加竹沥。
脾胃虚弱。六君子汤加芎、归、钩藤。卫虚多汗恶寒。加黄 二钱。附子五分。脾虚。补中益气
加钩藤。心血虚少而振。平补正心丹。心气虚热而振。本方去肉桂、山药、麦冬、五味。加琥珀、
牛黄、黄连。名琥珀养心丹。心虚挟痰而振。本方去龙齿、肉桂、山药、麦冬、五味。加琥珀、
川芎、胆星、麝香、甘草。为秘方补心丹。心虚挟血而振。龙齿清魂散。肾虚而行步振掉者。八
味丸、十补丸选用。实热积滞。可用汗吐下法。戴人治马叟。手足振掉。若线提傀儡。用涌法。
出痰数升而愈。此必痰证痰脉。而壮盛气实者。不可不知。
〔诊〕颤振之脉。小弱缓滑者可治。虚大急疾者不治。间有沉伏涩难者。必痰湿结滞于中之象。
凡久病脉虚。宜于温补。暴病脉实。宜于峻攻。若久病而脉反实大。暴病而脉反虚弱。决无收功
之理也。
The *Classic of Medicine* (*Huangdi Neijing*) states: "When cold pathogenic qi lodges in the skin, yin qi becomes excessive while yang qi is deficient, resulting in aversion to cold with shivering and tremors." Shen Shi (an ancient physician) stated: "Shivering occurs when yin qi contends and gains the upper hand, manifesting as rigors; trembling occurs when yang qi fails to recover, manifesting as tremors." The bones are the residence of marrow. If the bones are failing, one cannot stand for long, and walking causes shaking and instability, indicating that the skeletal system is deteriorating. Tremor and convulsion are similar conditions. Convulsion involves traction of the limbs, with extension or flexion alternating; whereas tremor involves only vibration without flexion or extension. There are cases where only the head moves while the hands remain still. This is because excessive Wood qi generates wind and fire, which rush upward to the head, causing head tremors. If the wind scatters to the four extremities, it causes movement of the hands and feet while the head remains still. The *Classic* states: "All wind diseases characterized by shaking and dizziness belong to the Liver." For Liver Wood excess-heat syndrome, use *Xieqing Wan* (Drain the Green Pill); for Liver Wood deficiency-heat syndrome, use *Liujun Wan* (Six-Ingredient Pill with Rehmannia); for Liver Wood deficiency, use *Xiaoyao San* (Free and Easy Wanderer Powder) added with Ginseng (*Renshen*), Atractylodes Macrocephala (*Baizhu*), and Uncaria (*Gouteng*); if complicated by phlegm, use *Daotan Tang* (Major Phlegm Decoction) added with Bamboo Juice (*Zhuli*); for Spleen-Stomach deficiency, use *Liujunzi Tang* (Six Gentlemen Decoction) added with Ligusticum (*Chuanxiong*), Angelica Sinensis (*Danggui*), and Uncaria (*Gouteng*); for Defensive Qi deficiency with profuse sweating and aversion to cold, add Astragalus (*Huangqi*) 2 qian and Aconite (*Fuzi*) 5 fen; for Spleen deficiency, use *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) added with Uncaria (*Gouteng*); for tremors due to Heart Blood deficiency, use *Pingbu Zhengxin Dan* (Leveling and Tonifying the Heart Pill); for tremors due to Heart Qi deficiency with heat, remove Cinnamon Twig (*Rougui*), Dioscorea (*Shanyao*), Ophiopogon (*Maidong*), and Schisandra (*Wuweizi*) from this formula, and add Amber (*Hupo*), Calculus Bovis (*Niuhuang*), and Coptis (*Huanglian*), naming it *Hupo Yangxin Dan* (Amber Nourishing Heart Pill); for tremors due to Heart deficiency complicated by phlegm, remove Dragon Bone (*Longgu*), Cinnamon Twig (*Rougui*), Dioscorea (*Shanyao*), Ophiopogon (*Maidong*), and Schisandra (*Wuweizi*) from this formula, and add Amber (*Hupo*), Ligusticum (*Chuanxiong*), Arisaema with Bile (*Danning*), Musk (*Shexiang*), and Licorice (*Gancao*), calling it *Mifang Buxin Dan* (Secret Recipe Tonifying Heart Pill); for tremors due to Heart deficiency complicated by blood stasis, use *Longqing Qinghun San* (Dragon Bone Clearing Soul Powder); for tremors during walking due to Kidney deficiency, select *Bawei Wan* (Eight-Ingredient Pill) or *Shibu Wan* (Ten-Nourishing Pill). If caused by excess-heat and accumulation stagnation, diaphoretic, emetic, or purgative methods may be used. Dairen (Zhang Congzheng) treated an old man named Ma, whose hands and feet trembled like a puppet on strings. He employed the emetic method, expelling several sheng of phlegm, after which the patient recovered. This situation must involve phlegm signs and phlegm pulses, occurring in individuals with robust constitution and strong qi; this point must not be overlooked.
[Diagnosis] Regarding the pulse of tremor: a small, weak, slow, and slippery pulse indicates a treatable condition; a deficient, large, rapid, and hurried pulse indicates an untreatable condition. Occasionally, a deep, hidden, and choppy pulse may appear, which is a sign of phlegm-dampness congealing and obstructing internally. For chronic diseases with a deficient pulse, warm tonification is appropriate; for acute diseases with an excess pulse, vigorous attacking methods are appropriate. If a chronic disease presents with an unexpectedly excess-large pulse, or an acute disease presents with an unexpectedly deficient pulse, there is no hope for recovery.