Convulsions,+Involuntary+Shaking+and+Twitching+(Chou+Chu)

In Chinese medicine, convulsions include various tics, spasms, and sudden uncontrollable, commonly jerky movements, including tremors

Relevant Western Diseases: Parkinson’s disease, Huntington’s disease, Athetosis, Torsion spams chronic progressive chorea, Sydanham’s Chorea, Gille de la tourette’s syndrome, hereditary ataxia, Hepatolenicular degeneration, hysteria

Diagnosis: A. In general, gradually starts woth shaking or twitching and reduced activities B. Involuntary shaking or twitching, may have twitching at rest C. Body movements slow down and aily activity is decreased D. Flattened facial emotion expression dull eyes, looks like a mask E. Difficulty handwriting or doing detailed work with fingers (decreased dexterity) F. Walks slowly, wavering or cannot walk properly G. Shen condition is weak, numb or disturbed Should have A, B and refer others to confirm diagnosis

Prognosis: For elderly with severe liver and kidney essence deficiency, treatment commonly takes a long time to control and sedate the symptoms. Patients with brain injury or severe pre-heaven disharmonies also have poor prognosis. Patient with good Zang Fu function and good Shen have a much better prognosis and may fully recover.

Differential Diagnosis: Medical Disorders: A. Tic Disorders B. Parkinson’s Disease C. Parkinsonism D. Huntington’s Disease E. Multiple Sclerosis F. Other degenerative disorders of the CNS Psychiatric Disorders: A. Somatoform disorders (including conversion disorder) B. Hypochondriasis C. Major depressive episode with somatization D.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Scizophrenia with somatic delusions E.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Generalized Anxiety Disorder (GAD) F.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Panic Attack G.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Obsessive-Compulsive Disorder H.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Malingering I.<span style="font-family: "Times New Roman"; font-size-adjust: none; font-size: 7pt; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal;"> Fatitious Disorders

TCM Etiology & Pathogenesis: “The two main mechanisms of convulsions in Chinese medicine are malnourishment of the sinews and stirring of wind. The sinews only maintain their proper extention and remain relaxed when they receive proper moistening and nourishment. If, for any reason, the sinews lack proper moistening and nourishment, they dry out and contract. When they contract they may cause convulsions or tugging and slackening. The sinews may be deprived of proper nourishment if an evil Qi congests in and obstructs the channels and network vessels or if Yin blood is insufficient. The common evils which may congest and obstruct the channels and network vessels are wind, cold, and dampness. In addition, Qi stagnation, blood stasis, and phlegm may all also hinder and obstruct the free flow of the channels and network vessels, thus depriving the sinews of proper moistening and nourishment.”1

“Emotional disharmony causing Liver Qi stagnation, aging and overexertion causing Liver blood and Kidney essence deficiency, blood or Yin fluid deficiency, internal phlegm or blood stagnation, as well as heat or fire affecting the Liver can all generate wind and cause involuntary movement situations. Liver is a wind organ and is easily injured by heat, fire and stagnation which lead to Liver Qi stagnation and body Yin blood deficiency. Liver blood and Yin are the resources which nourish all of the sinews of the human body; this described by the statement “liver is governing sinews”. In addition, Liver is a ‘moving’ organ because of its wind property, so the shaking, twitching and contractions are due to Liver disharmony”2

TCM Pattern Differentiation: Liver Depression Transforming Heat with Blood Vacuity 1,2 Facial tics which typically occur during episodes of stress or anger, shaky or twitchy joints, fingers and muscles, irritability, easy anger, chest, breat, rib-side and/or abdominal distention and fullness, low appetite, abdomen bloated, dislikes socializing people, hypersensitive, suspicious and moody, possible PMS or early or excessive menstruation in females -LR-3, LI-4, GB-20, BL-17, BL-18. Even technique1 -LR-3, LR-6, LR-14, LI-4, GB-20, GB-21, BL-10, GV-20, GB-15, GV-23, GV-242 More obvious Liver heat: + LR-2 Tics of the eyes: + Taiyang, BL-2, GB-1 Tics of the lips: + ST-4, GV-26 (upper lip) or CV-24 (lower lip) Tics of the jaws: + ST-3, ST-6, SI-18 Tics of the shoulder: + LI-15, SI-9, TW-14 Tics of the arms: + TW-5, LI-11 Tics of the neck: + GV-14, BL-10 -Dan Zhi Xiao Yao San Jia Wei - [Dan Pi (10g.), Zhi Zi (10g.), Chai Hu (3-10g.), Dang Gui (10g.), Bai Shai (10-18g.), Bai Zhu (10g.), Fu Ling (10g.), Gan Cao (6g.), Gou Teng (10-15g.), Chan Tui (10g.)] 1 -[Chai Hu, Qing Pi, Yu Jin, Xiang Fu, Long Gu, Mu Li, Zhen Zhu Mu, Di Long, Chuan Xiong, Yuan Zhi, Huang Qin]2 No obvious depressive heat: - Dan Pi, Zhi Zi Marked blood vacuity: + Ji Xue Teng, He Shou Wu Red, itchy eyes: + Ju Hua, Mu Zei Cao
 * Tongue:** dark red or pale tongue with red and/or inflated tongue edges with white or yellow coat
 * Pulse:** fine, bowstring, possibly rapid
 * Treatment Principles:** Course the Liver and rectify the Qi, clear heat and resolve depression, nourish the blood and extinguish wind
 * Acupuncture Treatment:**
 * Acupuncture Modifications**1**:**
 * Herbal Treatment:**
 * Modifications:**

Liver Blood Vacuity 1,2 Slight tics often associated with the menses in females, weak and numbness sensations, low energy and tired quickly, pale white complexion, pale lips and nails, dizziness, vertigo, insomnia, por memory, depression, possible blurred vision or night blindness, scanty menstruation, dry brittle nails, dry eyes, hair and skin -BL-17, BL-18, BL-23, LR-8, SP-6, LI-4, GB-20. Even technique; modify according to above pattern1 -LR-3, LR-8, SP-6, SP-10, ST-36, CV-6, CV-15, HT-7, GV-20, Yintang -[Dang Gui, Bai Shao, Ji Xue Teng, Chai Hu, Zhen Zhu Mu, Huang Qin, Yuan Zhi, He Huan Pi, Gou Qi Zi]2 Constipation1: + Huo Ma Ren Static blood obstructing network vessels1: + Quan Xie, Wu Gong Accompanying Qi vacuity1: + Huang Qi, Dang Shen Loose stools due to spleen vacuity1: + Shan Yao, Bai Zhu Dizziness, vacuity vexation, and insomnia1: + Zhi Zi, Dan Zhu Ye, Ju Hua, Ye Jiao Teng Torpid intake and abdominal fullness1: + Sha Ren, Ji Nei Jin, Chen Pi
 * Tongue:** pale tongue, possibly dry white coat
 * Pulse:** fine, bowstring, weak
 * Treatment Principles:** Supplement the liver and nourish the blood, relax the sinews and extinguish wind
 * Acupuncture Treatment:**
 * Herbal Treatment:**
 * -**Si Wu Tang He Da Ding Feng Zhu Jia Jian - [Shu Di (12g.), Dang Gui (10g.), Bai Shao (10g.), Chuan Xiong (10g.), E Jiao (10g.), Wu Wei Zi (10g.), Mai Dong (12g.), Gui Ban (12g.), Bie Jia (12g.), Mu Li (12g.)]1
 * Modifications:**

Liver Wind Internal Stirring 1 Tics occasioned or aggravated by bouts of stress and/or anger, headache and distention, dizziness, tinnitus, heaviness or a feeling of unsteadiness in the lower limbs [Tian Ma (12g.), Gou Teng (12-15g.), Shi Jue Ming (15g.), Zhi Zi (10g.), Huang Qin (10g.), Niu Xi (12g.), Du Zhong (10g.), Quan Xie (6g.), Chuan Xiong (6g.)] Pronounced Yin and blood vacuity: + Dang Gui, Bai Shao, Suh Di, Gou Qi Zi; + KI-3, SP-6
 * Tongue:** dark red tongue, yellow possibly dry coat
 * Pulse:** fine, bowstring, forceful, possibly rapid
 * Treatment Principles:** Level or calm the liver and extinguish wind
 * Acupuncture Treatment:** LR-3, LI-4, GB-20, GV-20. Draining or even technique; modify according to above pattern
 * Herbal Treatment:** Tian Ma Gou Teng Yin Jia Jian1
 * Modifications:**

Extreme Heat Stirring Wind 1 Repeated, numerous, strong tics and spasms, red complexion, red eyes, easy anger, abdominal distention, constipation, dry throat, oral thirst, heart vexation, tension and agitation; if severe possible spirit clouding and deranged speech [Xuan Shen (15-30g.), Mai Dong (12-24g.), Sheng Di (12-24g.), Da Huang (6-10g.), Mang Xiao (4.5g.), Di Long (6g.), Quan Xie (6g.), Ju Hua (10g.), Gou Teng (10-15g.)] Severe vexation & agitation1: + Dan Zhu Ye, Zhi Zi If extreme heat has damaged Qi & fluids: Use Bai Hu Jia Ren Shen Tang Jia Jian1 [Shi Gao (30g.), Zhi Mu (10g.), Gan Cao (3-6g.), Ren Shen (6g.), Di Long (6g.), Quan Xie (6g.), Ju Hua (10g.), Gou Teng (10-15g.)]
 * Tongue:** red tongue, yellow slimy possibly dry coat
 * Pulse:** bowstring, rapid
 * Treatment Principles:** Discharge fire and assist fluids, nourish Yin and increase humors, extinguish wind & resolve tetany
 * Acupuncture Treatment:** ST-44, LI-11, GB-34, GV-14, GB-20. Draining technique; modify according to above pattern
 * Herbal Treatment:** Zeng Ye Cheng Qi Tang Jia Wei1
 * Modifications:**

Liver & Kidney Yin Deficiency, Wind Moving Within 2 Frequent very mild shaking and twitching, dry mouth and eyes, thirsty, lower back sore and aching, hot flashes, night sweats, constipation, irritability, scanty or frequent urination, moody, talkative, depressed, suspicious, insomnia, excess dreaming at night, 5-palm heat
 * Tongue:** red tongue, thin or without coat
 * Pulse:** rapid, thready
 * Acupuncture Treatment:** LR-3, LR-8, KI-3, KI-6, CV-4, CV-6, ST-36, SP-6, HT-7, LI-4, LI-11, Yintang
 * Herbal Treatment:** [Shu Di Huang, Mai Men Dong, E Jiao, Bai Shao, He Shou Wu, Gui Ban, Bie Jia, Gou Teng, Ji Xue Teng]

Phlegm Qi Stagnation Obstructing Meridian, Wind Moving 2 Shaking and twitching w/ puffiness or swelling, nodules or scrofula, feeling of body tenderness, abdominal bloating, nausea, vomiting, overweight, phlegm sound when talking and snoring during sleep, heavy sensation of the body and head, Shen numbness and flattened emotions
 * Tongue:** swollen tongue, dusky greasy coat
 * Pulse:** wiry, slippery
 * Acupuncture Treatment:** LI-4, LR-3, ST-40, TW-6, Ashi, GB-20, GB-34, Yintang
 * Herbal Treatment:** [Ban Xia, Chen Pi, Jiu Hong, Nan Xing, Di Lng, Jiang Chan, Shi Chang Pu, Bai Zhu, Cang Zhu, Chuan Bei Mu]

Qi Blood Stagnation Obstructing Meridian, Wind Moving 2 Shaking and twitching w/ pain and stiffness, cyanosis of lips, fingers, palms, toes and face, spider veins on the body, complaint of body pain, stiffness, fullness and distention, can be very severe shaking & twitching w/ stagnation signs, may have headaches and history of injury Phlegm Qi Stagnation Obstructing Meridian, Wind Moving 2 Shaking and twitching w/ puffiness or swelling, nodules or scrofula, feeling of body tenderness, abdominal bloating, nausea, vomiting, overweight, phlegm sound when talking and snoring during sleep, heavy sensation of the body and head, Shen numbness and flattened emotions
 * Tongue:** purplish tongue, dark spots, white coat
 * Pulse:** wiry, tense, choppy
 * Acupuncture Treatment:** LI-4, LR-3, SP-6, SP-10, Ashi, CV-17, GV-20, Yintang, Taiyang
 * Herbal Treatment:** [Chuan Xiong, Chi Shao, Bai Shao, Hong Hua, Tao Ren, Gou Teng, Quan Xie, Jiang Chan, Ge Gen]
 * Tongue:** swollen tongue, dusky greasy coat
 * Pulse:** wiry, slippery
 * Acupuncture Treatment:** LI-4, LR-3, ST-40, TW-6, Ashi, GB-20, GB-34, Yintang
 * Herbal Treatment:** [Ban Xia, Chen Pi, Jiu Hong, Nan Xing, Di Lng, Jiang Chan, Shi Chang Pu, Bai Zhu, Cang Zhu, Chuan Bei Mu]

Liver Fire Phlegm Heat, Wind Moving Within 2 Shaking and twitching w/ hot and burning sensation, frequent and severe, worse w/ heat, red face and chest, feeling like burning up, irritable, occasional delirium and incoherent speech, quick and jumping topics, busy mind, anger easily and ca make symptoms worse, dry and bitter taste in mouth
 * Tongue:** red tongue, thick yellow coat
 * Pulse:** wiry, rapid
 * Acupuncture Treatment:** LR-2, LR-6, ST-25, ST-40, ST-44, LI-4, LI-11, HT-6, PC-7, GV-14, GV-20, Yintang
 * Herbal Treatment:** [Long Dan Cao,Zhi Zi,Huang Qin, Chai Hu, Fu Ling, Ze Xie, Che Qian Cao,Dang Gui,Gou Teng,Dan Nan Xing]

Spleen and Kidney Yang Deficiency, Wind Moving Within 2 Shaking and twitching w/ weak and cold sensations, pale complexion, feeling cold of the body, especially on the extremities, feeling worse with cold and better with warmth, Shen is weak and sensitive, low appetite and energy, sluggish, may have swollen and puffiness, no motivation and retardation
 * Tongue:** puffy tongue, watery white coat
 * Pulse:** deep, slow
 * Acupuncture Treatment:** SP-3, SP-6, KI-3, KI-7, CV-4, CV-6, CV-12, GV-4, BL-20, BL-23, GV-20
 * Herbal Treatment:** [Zhi Fu Zi, Fu Ling, Bai Zhu, Gan Jiang, Gui Zhi, Zhe Xie, Di Long, Yi Yi Ren, Shao Yao, Huang Qi]

Kidney Essence Deficiency, Wind Moving Within 2 Shaking and twitching w/ sensations of weakness and soreness, almost always occurring in elderly, commonly starts gradually from both hands and then affects whole body. Accompanied by premature grey hair, other signs of aging, poor memory, sore joints, restricted and slow body movement and speech, may have re-heaven deficiency conditions including premature birth or other deficiencies or defects
 * Tongue:** pale, thin tongue, thin coat
 * Pulse:** deep, weak, especially the proximal positions
 * Acupuncture Treatment:** KI-3, KI-6, LR-3, LR-6, LI-4, GB-21, PC-8, Yintang, GV-20, CV-4

Wind Phlegm Obstructing the Meridian, Wind Moving 2 Shaking and twitching w/ a sudden onset. Eyelids and facial muscles are twitchy and numb, painful or prolapsed, may affect other areas of the body; patient may be overweight or have phlegm accumulation, headaches, dizziness, vertigo or nausea
 * Tongue:** puffy tongue, thick white foamy coat
 * Pulse:** slippery, wiry
 * Acupuncture Treatment:** LI-4, TW-5, LI-11, TW-17, GB-20, GB-21, GB-41, ST-40, SP-9, GB-13, GV-23
 * Herbal Treatment:** [Zhi Nan Xing, Bai Fu Zi, Bai Jiang Cao, Fang Feng, Jing Jie, Ban Xia, Chen Pi, Fu Ling, Bai Zhu]