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Tremor (Chan) refers to swaying, and vibration (Zhen) refers to shaking. This occurs because the sinews and vessels cannot restrain or maintain control, presenting the manifestation of Wind. The *Neijing* states: "All wind diseases causing tremors and dizziness belong to Liver Wood." The Liver governs Wind; Wind is Yang Qi, and Yang is active. This indicates that excessive Wood Qi overacts on Spleen Earth. The Spleen governs the four limbs, which are the extremities of all Yang meridians. The movement arises from the stirring of Wood Qi, as stated in the classics: "Wind excess leads to diseases of the extremities." There are cases where only the head trembles while the hands and feet remain still. This is because the head is the summit of all Yang meridians; when Wood Qi rushes upward, only the head trembles while the limbs do not. If the pathogen disperses to the four extremities, then the hands and feet tremble while the head remains still. These conditions result from excessive Wood Qi combined with Fire transformation. Metal controls Wood, but Metal is the child of Earth. Since Earth is controlled by Wood, it has no spare capacity to generate Metal. The *Suwen* says: "The Liver is one Yang, the Heart is two Yangs, and the Kidney is a solitary Zang organ; a small amount of Water cannot overcome two fires." Consequently, Wood carries the momentum of Fire and lacks fear (of Metal), instead counter-rebelling against what it cannot conquer (Metal), attacking directly without restraint. The *Nanjing* describes this as "Wood transverse and invading Metal." This disease is rare in young adults, appearing after middle age, and is especially common in the elderly. The elderly suffer from insufficient Yin blood, where scant Water fails to control abundant Fire, making it extremely difficult to treat. Previous sages rarely discussed this. Only Zhang Dairen successfully treated an old man named Ma from Xinzhai by diagnosing it as a combination of Wood-Fire and Phlegm. Those encountering this syndrome should refer to his principles and apply profound thought.

Ma, the old man from Xinzhai, was 59 years old. Because he failed to pay taxes in autumn, he was subjected to sixty strokes of the heavy bamboo by officials. The shock caused Qi disorder leading to wind convulsions, which persisted for three years. During severe attacks, his hands and feet trembled so much that he could not hold objects; eating required others to feed him; his mouth and eyes would open wide, and his lips and tongue would be chewed raw. His body shook like a marionette pulled by strings. Every time he had an attack, people in the market would gather to watch. At night, he felt feverish, kicking off his blankets; his whole body was dry and itchy; he felt internal heat but external coldness. He longed to commit suicide but lacked the strength to even tie a rope. He exhausted his wealth seeking medical help, going bankrupt, yet his illness became more stubborn. Ma's son, a former minor clerk in the county, asked Dairen about his parents' condition. Dairen said, "This disease is easy to treat. If it were midsummer, two emetic treatments would suffice to purge the phlegm and cure him. Now that it is autumn cold, three emetic treatments can be used. If not cured, acupuncture points must be needled, and he will surely recover. First, use Fangfeng Tongsheng San to induce sweating, followed by emetics. He vomited one to two sheng of phlegm. By evening, he had five or six bowel movements, and the disease improved slightly. Wait five days and perform another emesis. He vomited three to four sheng of phlegm, resembling chicken yolks in clumps, hot to the touch. Because Ma's hand tremors prevented him from inducing vomiting himself, his wife assisted, causing swelling and injury to his throat. He fell into a coma, intoxicated-like, and after about one to two hours, gradually regained consciousness. He had several more bowel movements, immediately feeling lighter legs, reduced tremors, cessation of fever, ability to walk, comb, dress, and hold chopsticks and spoons himself. Before the third emesis, the disease was completely eradicated. After the illness, he felt extreme cold. Dairen said, 'It should be supplemented with food; it will recede naturally.' When major diseases depart, Wei Qi has not yet recovered, so it is appropriate to use herbs that disperse wind and guide Qi. One must absolutely avoid warming agents with hot properties, lest they cause other diseases." Sun Yikui commented: "Based on Dairen's treatment, only those who truly understand this as excess Phlegm-Fire would dare to treat it thus. Excess Wood results from deficient Metal. Since the disease has lasted long, there may be similarities at the start but differences at the end. Moreover, after emesis, sweating, and purgation, how can one say supplementation is absolutely unnecessary? For milder cases, methods such as tonifying Metal, calming Wood, clearing Phlegm, and regulating Qi might be applicable, depending on the practitioner's judgment. For stroke causing dragging limbs, Xingfu San, Du Huo San, and Jinya Jiu are suitable for those without heat. Cui Gan Wan calms Fire, soothes the Liver, resolves Phlegm, and stops tremors, suitable for those with heat. For tremors due to Qi deficiency, Shen Zhu Tang tonifies. For tremors due to Heart deficiency, Buxin Wan nourishes. If accompanied by Phlegm, Daotan Tang with Zhuli (Bamboo Juice) is used. For trembling and shaking in the elderly, Dingzhen Wan is appropriate."