Observation

Tremor of the head consists of shaking of the head, with the head usually moving back and forth. The tremor ranges from the very slight with small amplitude to the very pronounced with large amplitude.

Clinical significance

A tremor of the head always indicates internal Wind, which itself stems from the Liver. Liver-Wind may be of the Full or Empty type: the Full type develops from Liver-Yang rising or Liver-Fire while the Empty type develops from Liver- and Kidney-Yin or Liver-Blood deficiency. The tremor of the head is pronounced in the Full type and slight in the Empty type. In a few cases, the cause may be exhaustion of Heart-Yin, in which case the tremor will usually be a fine one.

Observation

‘Rigidity of the neck’ indicates that the patient finds it difficult to bend the head forwards or backwards and to turn the head from side to side.

Clinical significance

In acute situations, rigidity of the neck may indicate an invasion of external Wind, in which case it will be accompanied by all the typical manifestations of an exterior invasion such as aversion to cold, fever, headache and a Floating pulse. Both Wind-Cold and Wind-Heat may cause rigidity of the neck but it is more likely to occur with an invasion of Wind-Cold (in fact, it is one of the chief symptoms of invasion of Wind-Cold as listed in the ‘Discussion of Cold-induced Diseases’ – see Bibliography, p. 1067). Another possible acute condition causing stiffness of the neck occurs when external Cold and Dampness invade the muscles of the neck, in which case there is also pronounced neck pain; this is a case of acute Painful Obstruction Syndrome and it is relatively common.

In chronic cases, stiffness of the neck is due either to a weakness of the Bladder channel in the neck occurring against a background of Kidney deficiency or to internal Wind, both of which are more common in the elderly.

Box 4.1 summarizes patterns underlying neck rigidity.

Observation

Deviation of eyes and mouth consists in the mouth’s being pulled towards the healthy side and an inability to close or open the eye completely; in addition, the patient finds it difficult to grimace, to bulge the cheeks, grin and whistle.

Clinical significance

Deviation of eye and mouth is a consequence of Wind-stroke and is usually seen in middle-aged or elderly people; it always indicates internal Wind affecting the muscles of the face.

When deviation of eyes and mouth follows a stroke, it is called central facial paralysis in Western medicine, as it arises from the central nervous system. In facial paralysis following Wind-stroke, the nerves above the eyes are not affected, that is, the movement of the eyebrows and furrowing of the forehead are normal. By contrast, in peripheral facial paralysis (Bell’s palsy), the patient will be unable to raise the eyebrow or furrow the forehead on the paralysed side. Figure 4.1 shows the deviation of eye and mouth.

Observation

Facial paralysis is characterized by deviation of the mouth, incomplete closure of one eye and inability to grimace, grin, bulge the cheeks, whistle, or raise the eyebrow and furrow the forehead on the affected side (see Plate 4.1 on p. P8).

Clinical significance

Facial paralysis is due to invasion of external Wind in the muscles of the face and primarily in the Bright-Yang channels.

Observation

Tic consists in an involuntary twitching of the face muscles.

Clinical significance

In Chinese medicine a facial tic may be due to various patterns, among which are Liver-Qi stagnation, Liver-Blood deficiency, Liver-Wind, Liver-Wind with Phlegm and external Wind.

When due to Liver-Qi stagnation, facial tic will be accompanied by irritability, depression, tendency to crying, abdominal distension, headache and a Wiry pulse.

Liver-Blood deficiency causes facial paralysis by failing to nourish the muscles of the face and giving rise to Empty-Wind; other symptoms may include dizziness, blurred vision, dull-pale complexion and a Choppy pulse.

Liver-Wind may lead to facial tic because it is in the nature of internal Wind to cause involuntary movements. Facial tic caused by Liver-Wind is more common in the elderly and is accompanied by vertigo, headache, loss of balance and a Wiry pulse.

In the elderly, Liver-Wind frequently combines with Phlegm, both of which may lead to facial tic. Other symptoms include vertigo, nausea, headache, a feeling of oppression of the chest, a tendency to being overweight, a Swollen tongue and a Wiry-Slippery pulse.

External Wind may cause a temporary facial tic.

Box 4.2 summarizes patterns underlying facial tic.

BOX 4.2   FACIAL TIC

• Tic and irritability, depression, Wiry pulse: Liver-Qi stagnation

• Tic and dizziness, blurred vision, Choppy pulse: Liver-Blood deficiency

• Tic and vertigo, Wiry pulse: Liver-Wind

• Tic and vertigo, nausea, Wiry-Slippery pulse: Liver-Wind with Phlegm

• Temporary tic: external Wind

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