Understanding Liver Wind agitating Internally due to Liver Blood Deficiency
The Liver stores Blood and governs the sinews. When Liver Blood is insufficient, the sinews are described as undernourished and lose their steadiness, and the resulting involuntary movement is called internal Wind.
The signs are trembling or twitching of the hands and feet, numbness, dizziness and a pale or sallow complexion. Vision may blur and the eyes feel dry.
The tongue is pale and thin, sometimes trembling, with a thin white coat. The pulse is fine and wiry.
It follows chronic blood loss, a weak Spleen that does not produce enough Blood, chronic illness, or Kidney Essence deficiency failing to nourish Liver Blood.
Treatment nourishes Liver Blood and settles the Wind. Unlike external Wind, this is not treated by dispersing; the underlying deficiency is the target.
Signs and symptoms
Key signs
- Trembling or twitching of the hands and feet
- Numbness of the limbs
- Dizziness
- Pale or sallow complexion
Also seen
- Dry eyes and blurred vision
- Cramps in the muscles
- Brittle nails
- Scanty periods
- Poor sleep with light dreaming
- A pale, trembling tongue
Variations
- A sensation of crawling under the skin
- Difficulty holding objects steady
- Pins and needles in the fingers
Worse with
- Physical exertion
- Prolonged eye strain or screen use
- Emotional stress or anger
- Menstrual blood loss
Better with
- Rest and sleep
- Blood-nourishing food such as dark greens, liver and dates
- Gentle exercise such as walking or tai chi
- Warm regular meals
Timing
- It builds over months, with tremor and numbness worsening when tired.
- It may worsen around menstruation in women with heavy periods.
Practitioner notes
- The tongue is pale and thin, sometimes visibly trembling, with a thin white coat. A red tongue would point to a different internal Wind pattern.
- The pulse is fine and wiry, showing deficiency with the Wind quality.
- The distinction from internal Wind from Yang rising is the absence of heat and forceful pulse; here the pulse is empty.
- The distinction from external Wind is that there is no acute cold, no fever and no surface signs.
Causes
Common causes
- Chronic blood loss or heavy bleeding
- Weak Spleen and Stomach failing to produce Blood
- Chronic illness consuming Liver Blood
- Kidney Essence deficiency failing to nourish Liver Blood
How it develops
- It develops slowly from chronic deficiency.
- If the deficiency deepens, the tremor and numbness become more marked, and other deficiency signs appear.
Diagnosis
Diagnosis rests on internal Wind signs with clear Blood deficiency, and a pale tongue.
Tongue
- Body: Pale and thin, sometimes trembling.
- Coating: Thin white.
- Note: A red tongue would suggest Heat rather than Blood deficiency.
Pulse
Fine, Wiry
Fine shows Blood deficiency; wiry shows the Wind quality without Heat.
Observation
- Pale complexion
- Fine tremor of the hands
- Dry eyes
- A tired bearing
Listening
- A quiet voice
Palpation
- Abdomen: Soft and weak, without masses.
- Channels: The skin is dry; SP-10 and BL-17 may feel empty, and the limbs may be cool.
Questions that separate it from look-alikes
- Any tremor, twitching or numbness?
- How are the periods, and is there heavy bleeding?
- Any dizziness or blurred vision?
- How is the diet and the energy?
Treatment
Principles
- Nourish Liver Blood
- Settle internal Wind
- Support the Spleen so Blood is produced
- Avoid dispersing herbs, which would deplete further
Herbs
Formulas
- Si Wu Tang - The foundational Blood tonic, the base for this pattern.
- Bu Gan Tang - Nourishes Liver Blood specifically, used for dry eyes and blurred vision with tremor.
- Dang Gui Bu Xue Tang - The Huang Qi and Dang Gui pair, for deficiency with poor circulation.
- Ba Zhen Tang - The combined Qi and Blood tonic, used when fatigue is also prominent.
Acupoints
- BL-17 (Geshu) - The influential point for Blood, used to nourish it.
- SP-10 (Xuehai) - Regulates Blood and is used where periods are heavy.
- ST-36 (Zusanli) - Builds Qi so Blood can be produced from food.
- LR-3 (Taichong) - Settles the Liver and is used for tremor and dizziness.
- GB-20 (Fengchi) - The Wind point, used for internal as well as external Wind.
- DU-20 (Baihui) - Raises clear Qi to the head, used for dizziness.
Personalising the plan
- If tremor dominates, Wind-settling herbs are increased.
- If there is ongoing blood loss, the cause is addressed first.
- If the Spleen is weak, digestive support is added so the tonics are absorbed.
- If Heat appears, cooling herbs are added - but dispersing is still avoided.
Self-care
Diet
- Blood-nourishing food: dark leafy greens, black beans, dates, small amounts of liver
- Warm cooked meals at regular times
- Avoid excessive caffeine and alcohol
- Adequate protein
Lifestyle
- Rest and sleep, especially after eye strain
- Gentle exercise rather than exhausting activity
- Reduce screen time where possible
- Address heavy periods with a doctor
Qigong and movement
- Slow, steady practice with an emphasis on balance and softness.
How it differs from look-alikes
Patterns that can be mistaken for liver wind agitating internally due to liver blood deficiency, and the contrast that separates them.
Liver Wind agitating Internally due to Liver Blood Deficiency
This page itself; listed because the reference distinguishes it from the two excess Wind patterns below.
Liver Wind agitating Internally due to Liver Yang Rising
Yang rising gives dizziness and headache with a forceful pulse and heat signs; here the pulse is empty and the picture pale.
Liver Wind agitating Internally due to Liver Fire
Fire gives red eyes, bitter taste and a forceful pulse, with convulsion in severe cases. Here there is deficiency without Heat.
Liver Blood Deficiency
The deficiency without the Wind: pale, dry eyes and scanty periods but no tremor or numbness.
Where it appears
Skin conditions in which this pattern is commonly seen.
Safety and when to get help
For anything severe, sudden or spreading quickly, read when a skin problem needs urgent care.
This page describes a TCM pattern, not a diagnosis, and a pattern can accompany more than one skin condition. Get urgent medical help for a rash with fever, confusion or feeling very unwell; skin that is blistering, peeling or spreading quickly; swelling of the face, lips or throat, or difficulty breathing; or a lesion with increasing pain, warmth, red streaks or pus. For anything persistent, severe or changing, have it assessed by a clinician before treating it yourself.
Read the skin condition pages for the red flags that belong to a specific presentation.
Urgent-sign guidance is based on standard sources: NHS anaphylaxis, NHS cellulitis, NHS Stevens-Johnson syndrome, NHS melanoma.
Evidence note
No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.
Common questions
Why is it called internal Wind?
Because the movement comes from inside the body rather than from an external cold. The tradition calls any involuntary movement Wind.
Why not use dispersing herbs?
External Wind is dispersed outward. Here the Wind comes from deficiency, so dispersing would deplete the person further; the treatment nourishes.
Why do the eyes and tremor appear together?
The Liver opens to the eyes and governs the sinews. When Liver Blood is low, both are affected.
When should I see a doctor?
Sudden numbness or weakness, speech difficulty, or progressive tremor needs urgent medical assessment.