Q I am a 52-year-old woman and I have trembling hands.

This problem runs in my family, affecting a few of my sisters and my two sons. We have tested negative for thyroid disorder.

The trembling is very frustrating, especially when I hold a cup and saucer or use a laser pointer when giving presentations.

Can traditional Chinese medicine (TCM) help?

A Trembling hands are commonly referred to as hand tremors.

Besides hyperthyroidism, the condition can be caused by essential tremor, Parkinson's disease, multiple sclerosis as well as other diseases.

It can also be a side effect of medications or lifestyle habits like drinking too much caffeine or alcohol.

Essential tremor, a nervous system disorder that causes involuntary and rhythmic shaking, is the most common cause of abnormal trembling, primarily of the hands.

It runs in families and is most common among those aged 40 and above. It tends to worsen over time, though it is usually not dangerous.

If the tremors become severe, you might find it hard to eat normally, put on make-up or write legibly. If the voice box or tongue is affected, you may also have trouble with speech.

Symptoms may be aggravated by emotional stress, fatigue, caffeine or extreme temperatures.

In TCM, essential tremor stems from deficiencies linked to the brain, liver, spleen and kidneys. A lack of qi (vital energy) and blood, or poor blood circulation, may play a part too.

Heat and phlegm, known as pathogenic factors in TCM, are another possible cause. Based on TCM theory, the liver stores blood, controls the tendons of the body and harmonises emotions.

When liver yin (the element res- ponsible for cooling organs) is lacking, internal wind may be created in the body. This triggers uncontrolled tremors of the hands, feet or head. One may also feel dizzy and suffer from a dry mouth or a stiff neck.

If one's liver yin stays at a low level for a prolonged period, it can "dry up" the blood, creating blood stasis with internal wind. This condition will follow the meridian (channels through which qi travels) to reach the brain.

The person may then experience hand or feet tremors. His muscles may feel rigid and his movements may be sluggish.

According to TCM, the spleen transforms and transports nutrients around the body in the form of qi and blood. But a weak spleen will transform nutrients into phlegm and dampness instead.

Phlegm and dampness that accumulate over time create heat in the body. When the heat travels to the brain via the meridians, the person will suffer from body tremors.

As the body's tendons, fascia and ligaments are nourished by blood, a lack of qi and blood can also lead to tremors of the hands, feet and head.

Another possible cause for tremors is weak kidneys.

In TCM, the kidneys play a role in blood production. Deficiency in the kidneys would mean the brain lacks blood. This results in hand tremors that may be accompanied by forgetfulness and confusion. One may also feel sleepy during the day, but alert at night.

CUT BACK ON CAFFEINE

Try to resolve your problem by making lifestyle changes, taking Chinese herbal medicine and doing acupoint massages. Massaging on certain acupoints can improve your muscle strength, control and coordination of the affected area.

Make lifestyle changes such as:

•Eliminating caffeine from your diet. If you are a smoker, quit smoking. If you are taking medication, check whether tremors could be a side effect.

•Practising relaxation techniques to help ease any anxiety issues.

•Cutting back on spicy and oily food to strengthen your spleen as well as boost your body's production of qi and blood.

Some Chinese herbs can address the underlying problems:

•To dispel internal wind, try tall gastrodia tuber, gambir plant or cape jasmine fruit. Blood circulation can be enhanced with red peony root, szechwan lovage rhizome and peach seed.

•If you have too much heat and phlegm, take pinellia tuber, jack-in-the-pulpit tuber and red tangerine peel.

•Processed rehmannia root, white peony root and Chinese angelica can increase qi and blood. For kidney-related problems, take barbary wolfberry fruit and ginseng.

Lim Lay Beng

Traditional Chinese medicine practitioner at YS Healthcare TCM Clinic

Doc Says: Oral medication can treat tremor condition

Tremors affecting the hands can have multiple causes. Aside from thyroid disorders, they can be a manifestation of Parkinson's disease or even strokes.

However, in view of your family history, it could be something called essential tremors.

This is a neurological disorder that usually affects the hands, although it can affect the head and legs as well.

Unlike the tremors caused by Parkinson's disease, the shaking caused by essential tremors does not occur at rest but when one is doing something, for instance, eating, using tools or shaving.

Hand tremors can make it difficult for the patient to do these tasks. The tremors do not affect his health but they can be very disabling for him.

This form of tremors is usually genetic and runs in families.

The good news is that it is amenable to treatment. Oral medications are used to treat the condition.

It is better that you consult your doctor to ascertain the cause of your hand tremors and to seek treatment for it.

Dr Charles Siow

Neurologist, Mount Elizabeth Novena Hospital