Liver wind stirring internally

Description: Dizziness; convulsions, tremor, other forms of spasm; hemiplegia, facial paralysis.

Biomedical correspondence: Observed in numerous diseases characterized by paralysis or spasm, such as stroke, Parkinson’s disease, and encephalitis.

Pathogenesis: Liver wind stirring internally is attributed to the following factors:

• ascendant hyperactivity of liver yáng (a vacuity-repletion complex);
• high fever in repletion heat patterns;
• liver blood vacuity; or
• liver yīn vacuity.

Plain Questions (素问 sù wèn) states, All wind with shaking and [visual] dizziness is ascribed to liver. Usually, the pulse is stringlike, the tongue is red, and the tongue fur is dry. However, the signs are quite distinct depending on the cause. Hence, liver wind stirring internally is divided into sub-patterns:

• liver yáng transforming into wind (肝阳化风 gān yáng huà fēng)
• extreme heat engendering wind (热极生风 rè jí shēng fēng)
• blood vacuity engendering wind (血虚生风 xuè xū shēng fēng)
• yīn vacuity stirring wind (阴虚动风 yīn xū dòng fēng)

These are detailed below.

Liver Yáng Transforming into Wind

A disease pattern chiefly characterized by dizziness; headache; distension in the head; numbness of the limbs; tremor of the limbs; unsteady gait; red face; in severe cases (wind stroke), sudden clouding collapse, deviated eyes and mouth, and hemiplegia.

Description: Dizziness that threatens balance; unsteady gait; headache and distension in the head; impatience, agitation, and irascibility; insomnia with profuse dreaming; tinnitus; stiff nape; shaking of the head; unsteady gait; numbness of the limbs; limp aching lumbus and knees; tremor of the extremities; sluggish speech; red face; a red tongue, in some cases with a slimy fur; and a pulse that is stringlike, fine, and forceful. In severe cases, there is wind stroke marked by sudden clouding collapse, leaving the patient with deviated eyes and mouth, sluggish speech, hemiplegia, and phlegm rale in the throat.

Diseases: Dizziness; headache; wind stroke.

Pathogenesis: Yīn-humor depletion causing ascendant hyperactivity of liver yáng, in turn giving rise to wind, which can combine with phlegm to cloud the clear orifices and obstruct the network vessels.

Analysis of signs

• Internal wind: Dizziness and loss of balance, headache, shaking of the head or tremor of the limbs, and unsteady gait.
• Wind stroke: Especially when wind combines with phlegm, it can cause wind stroke, which is typically marked by sudden clouding collapse and loss of consciousness, leaving the patient with deviated eyes and mouth, hemiplegia, sluggish speech, and phlegm rale in the throat. Clouding collapse is explained by wind-yáng suddenly stirring, causing derangement of qì and blood flow and carrying phlegm upward to cloud the clear orifices. Hemiplegia, deviated eyes and mouth, and sluggish speech are attributed to wind-phlegm obstructing the network vessels. Phlegm rale is caused by wind carrying phlegm up into the throat.
• Tongue: Red and often slimy, reflecting the presence of phlegm.
• Pulse: Stringlike, fine, and forceful.

Treatment:

Medicinal therapy: Enrich yīn, calm the liver, and extinguish wind. Use Liver-Settling Wind-Extinguishing Decoction (镇肝熄风汤 zhèn gān xī fēng tāng).

Acumoxatherapy: Base treatment mainly on LR, GB, and KI. Drain GV-20 (Hundred Convergences, 百会 bǎi huì), GB-20 (Wind Pool, 风池 fēng chí), and LR-3 (Supreme Surge, 太冲 tài chōng), and supplement SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), GB-43 (Pinched Ravine, 侠溪 xiá xī), KI-3 (Great Ravine, 太溪 tài xī), and KI-1 (Gushing Spring, 湧泉 yǒng quán).

Extreme Heat Engendering Wind

A disease pattern chiefly characterized by vigorous heat effusion (high fever); clouded spirit; convulsions.

Description: Clenched jaw, convulsion of the limbs, and in severe cases, arched-back rigidity (opisthotonos), upward-staring eyes, with manic agitation, clouding of the spirit (tetanic reversal), red or crimson tongue with dry yellow fur, and a pulse that is stringlike and rapid. When this pattern occurs in infants and children, as is often the case, it constitutes acute fright wind disease, which may be observed in influenza or encephalitis B.

Diseases: Fright wind; tetany.

Pathogenesis: Warm-heat evil penetrating the heart and liver, causing liver wind to stir. The warm-heat gives rise to intense heat, which then stirs wind. The warm-heat is of external origin, while the wind is of internal origin. In terms of four-aspect pattern identification, this is a blood-aspect pattern.

Analysis of signs

• Internal wind: Convulsions of the limbs, clenched jaw, upward-staring eyes starting, and in severe cases arched-back rigidity all involve hypertonicity of the sinews, which is associated with internal wind.
• Heat evil clouding the spirit: Manic agitation or clouded spirit due to heat passing into the pericardium.
• Tongue: Red or crimson with a dry yellow fur.
• Pulse: Stringlike and rapid. The stringlike quality reflects liver involvement, while the rapid quality reflects the heat.

Treatment

Medicinal therapy: Clear heat, cool the liver, and extinguish wind. Use Antelope Horn and Uncaria Decoction (羚角钩藤汤 líng jiǎo gōu téng tāng) or Peaceful Palace Bovine Bezoar Pill (安宫牛黄丸 ān gōng niú huáng wán).

Acumoxatherapy: Base treatment mainly on GV, GB, LR, PC, and HT. Select GV-20 (Hundred Convergences, 百会 bǎi huì), GB-20 (Wind Pool, 风池 fēng chí), LR-3 (Supreme Surge, 太冲 tài chōng), GV-14 (Great Hammer, 大椎 dà zhuī), LI-11 (Pool at the Bend, 曲池 qū chí), PC-8 (Palace of Toil, 劳宫 láo gōng), and HT-8 (Lesser Mansion, 少府 shào fǔ); needle with drainage and prick Twelve Well Points (十二井穴 shí èr jǐng xué) to bleed.

Blood Vacuity Engendering Wind

A disease pattern chiefly characterized by tremor of the extremities; twitching of the flesh; hypertonicity of the joints; dizziness; numbness; and blood vacuity signs.

Description: Tremor of the extremities; jerking sinews and twitching flesh; hypertonicity of the joints; dizziness; tinnitus; lusterless nails; lusterless white facial complexion; pale tongue; a pulse that is fine or weak.

Diseases: Dizziness.

Pathogenesis: Blood vacuity depriving the sinews of nourishment and encouraging wind to arise. This stems from:

• blood loss or
• blood vacuity due to enduring illness.

Analysis of signs

• Internal wind: Dizziness; tremor of the limbs; numbness of the limbs; hypertonicity of the extremities; jerking sinews and twitching flesh, itchy skin.
• Blood vacuity: Lusterless white facial complexion.
• Tongue: Red with scant fur and little liquid.
• Pulse: Fine and weak.

Variant: Blood dryness engendering wind (血燥生风 xuè zào shēng fēng), characterized by itchy and scaling skin.

Treatment

Medicinal therapy: Nourish the blood and extinguish wind. Use Tremor-Stabilizing Pill (定振丸 dìng zhèn wán).

Acumoxatherapy: Base treatment mainly on GV, GB, LR, SP, ST, and KI. Drain GV-20 (Hundred Convergences, 百会 bǎi huì), GB-20 (Wind Pool, 风池 fēng chí), and LR-3 (Supreme Surge, 太冲 tài chōng), and supplement SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), KI-6 (Shining Sea, 照海 zhào hǎi), BL-20 (Spleen Transport, 脾俞 pí shù), and LR-8 (Spring at the Bend, 曲泉 qū quán).