Can Acupuncture and TCM Treat Essential Tremors?

Tremors are a common movement disorder that cause areas of our body to move involuntarily. Essential tremors are one specific type of tremor that don’t have a known cause from a conventional medicine perspective, like an existing disease, brain damage or as a side effect of a medication. Essential tremors often get worse over time and can affect our ability to perform daily tasks, reduce quality of life, and can be embarrassing for people when the tremors disrupt activities they were previously able to perform without difficulty. While there are conventional medical treatments to manage essential tremors, Traditional Chinese Medicine can also help reduce disruptive tremors with acupuncture and herbal medicine treatments.

TL;DR - Summary

Essential tremors affect almost 6% of people over the age of 65 worldwide, up to 20% in some areas, and do not have a clear cause from a conventional medicine perspective.
Conventional treatments can involve lifestyle modifications, medication, or surgical intervention in severe cases.
In Traditional Chinese Medicine, tremors are a form of internal wind causing involuntary movements; Addressing the root problem that is generating internal wind as well as appropriate scalp acupuncture can reduce the severity of essential tremors in many cases.
Research shows that acupuncture and herbal medicine are useful treatment options for essential tremors when used alone but can also improve the effect of tremor medications and reduce their side effects.
If you are looking for treatment options for your tremors, it may be worth the time to talk to a local, licensed Acupuncturist or Traditional Chinese Medicine Practitioner about your case and see what they recommend.

Conventional Medicine Sees Tremors as a Nervous System Condition

The most recent review of the research (1) found that essential tremors appear in 1.33% of the population worldwide. However, in people aged 65 years and older this increases to 5.79%, with the oldest age groups studied showing an average of 9.3% and multiple studies showing a 20% or greater prevalence. That’s up to 1 in 5 people! In about 50% of cases, essential tremors run in families (2).

Broadly, a “tremor” is any shaking movement of a body part that is involuntary and rhythmic. They’re a result of muscles repeatedly contracting and relaxing, and commonly appear in the hands, head, and legs, but they can happen in other areas of the body.

Tremors are classified in a variety of ways, including by:

When they happen - at rest or when doing an activity
What causes them - damage to part of the brain, a drug, another existing health issue, psychologic factors, or hereditary disorder
How they present in day-to-day life - speed of the shaking, how big the movements are, whether they’re all the time or only sometimes, how quickly they appear (gradual or sudden), and what kinds of tasks/activities they disrupt

Essential tremors are specifically those that happen without any clear cause, although they tend to run in families. While essential tremors do reflect some kind of problem with the nervous system, it is rare for other neurologic symptoms (pain, numbness, tingling) to be present.

This type of tremor often starts mildly but can worsen over time, happens in the hands, arms, and sometimes the head, and is more noticeable with the arms outstretched or with an activity like writing or holding a cup. To differentiate essential tremors from other types of tremor, a doctor will look in the patient's medical history for potential causes (medications, other health conditions) and do a variety of tests to see when, how, and in what ways the tremors manifest, as well as possibly doing blood tests and brain imaging (3).

Treatment for essential tremors can include some diet or lifestyle modifications (like reducing caffeine intake) if they are mild, while in more severe cases your doctor may prescribe medications like propranolol (beta-blocker) or certain anti-seizure medication (primidone, topiramate, or gabapentin). If medications don’t help or cause too many side effects, there are also surgical options like deep brain stimulation (4).

TCM Sees Tremors as a Imbalance of the Body Causing Internal Wind

In Traditional Chinese Medicine the disease category for involuntary movements of the body is tic and tremors or chàn zhèng 颤证 (5).

“Internal Wind is a chaotic and unpredictable movement of energy inside the body that often causes involuntary movements.”

Tics and tremors are both types of involuntary body movement, but are slightly different. A tic doesn’t usually follow a consistent pattern and can happen suddenly like tensing or spasms in small muscles, blinking, clearing the throat, shrugging, head movement, sniffing, or involuntarily saying words. Tremors on the other hand are more rhythmic and consistent, and commonly affect the arms, legs, head, vocal cords, or eyes.

In TCM, tics and tremors are caused by the stirring of Internal Wind. When treating essential tremors, TCM practitioners will focus on extinguishing Wind and adjusting the internal imbalance that caused Wind to be generated it in the first place.

Now, Internal Wind isn’t gas. Internal Wind is a chaotic and unpredictable movement of energy inside the body that often causes involuntary movements. Internal wind is generated by a number of physiological imbalances (learn more about those here) that, when corrected, should reduce or stop essential tremors, spasms, tics, or the sensation of involuntary muscle contractions.

TCM Treatment for Tremors

To expel internal wind and reduce tremors there are a few different modalities that a TCM trained Acupuncturist or TCM Practitioner may use including acupuncture, scalp acupuncture, herbal medicine, and electrical stimulation.

Acupuncture can help balance the root cause of the internal wind, regulate qi and blood flow to nourish the tendons, ligaments, and muscles, while also addressing any emotional or physical factors that are contributing to the issue. When we use scalp acupuncture, certain lines or areas on the scalp are needled transversely and then mildly stimulated with electricity (similar to a TENS machine) to regulate specific areas of the brain related to the development of tremors. Herbal medicine is often combined with acupuncture to reinforce the effect of treatment, especially in cases where the patients’ energy is weak or if their progress with acupuncture is very slow.

“Using acupuncture in combination with certain tremor medications can improve outcomes by almost 34% compared with people who were on medication alone. ”

Tremors can be improved with TCM treatment but progress may be tricky. Acute or fairly recent tremors are usually easier to treat than those that have been around for many years or that run in families. If you’re wondering whether TCM can help your case specifically, talk to a local TCM Practitioner or Acupuncturist for more information.

Acupuncture is also a useful addition to other tremor treatments like medications. Some studies, which I cover in more detail in the next section, show that using acupuncture in combination with certain tremor medications can improve outcomes by almost 34% compared with people who were on medication alone.

What Does Current Research Tell Us?

Can acupuncture or traditional chinese herbal medicine get rid of tremors?

To the ire of many Traditional Chinese Medicine Practitioners and acupuncturists, there is still very little high quality research about the effectiveness of acupuncture or herbal medicine for the wide variety of medical conditions we learn how to treat. “High quality research” means randomized controlled trials or “RCTs”, made even better if they are double blinded and have large sample sizes looking at thousands or tens of thousands of people. There are unfortunately no studies of this quality and size about acupuncture for tremors.

Available research shows that acupuncture is a useful treatment option for people with essential tremors. One study found that the combination of propranolol (tremor medication) and acupuncture was effective in reducing tremors in 90.0% of patients, while propranolol alone was effective for only 56.7% of patients (6). A meta analysis of articles from 2003-2016 found that acupuncture was an effective treatment option whether it was used as the only treatment method or in combination with a commonly prescribed essential tremor medication (7). This study also found that acupuncture was able to reduce the side effects of propranolol. Several case studies also came to similar conclusions: that acupuncture can help reduce the severity of tremors and/or can improve the outcomes for patients taking tremor medications (8-11).

Unfortunately these studies are pretty small, so in most of them the researchers still recommend that more well-designed clinical studies with a larger scale be done in the future to further improve the quality of their results.

“...acupuncture can help reduce the severity of tremors and/or can improve the outcomes for patients taking tremor medications... researchers still recommend that more well-designed clinical studies with a larger scale be done in the future to further improve the quality of their results.”

Conclusions

As an Acupuncturist and Traditional Chinses Medicine Practitioner, I think it’s always worth the time to talk to a local practitioner about your case and see what they think. Most of us offer free consultations, which can be a great way of getting more information before deciding to do TCM treatment. Tremors can be difficult to treat, and the longer they’ve been around untreated the longer it’s probably going to take to see results. At the same time, because TCM treatment addresses the condition of the whole body, there are likely other related symptoms that will improve over the course of your treatment for tremors.

Thanks for reading! For more information about Traditional Chinese Medicine treatments

check out my other blog articles or my Instagram @alina.acupuncture.

BONUS STUFF: Research Article Summaries

If you want to dig into the research a little more, I summarized several papers about Traditional Chinese Medicine for tremors below. I’ve also tried to order these clinical trials, research studies, and case studies in a rough order from highest quality and/or most important to lowest quality. Finally, here are a few important notes about this section:

I am not currently a researcher, so my ability to evaluate the quality of each of these studies is limited by not being directly involved in academia anymore.
Many of these studies require a lot of specific knowledge about acupuncture, the brain, and other physiological mechanisms to understand what they’re saying in a useful way. Understanding the nuance of this jargon is difficult unless we have recent academic training. I’ve tried to translate that kind of stuff as best I can without oversimplifying the conclusions.
Some of these texts are only available in Chinese. For those, I relied on Google Translate to read them which invites a host of translation issues. Be aware of this if your reading the original article.
For some I could only find abstracts, which makes the quality of the study hard to verify.
Citations for each study are at the bottom if you want to check out any of these studies in full.

Clinical Observation on Acupuncture Combined With Medication for Treatment of Essential Tremor - Sui & Li, 2010 (6)

This randomized control trial is listed in the Cochrane Library, which hosts many of the highest quality studies available. Here, researchers looked at how well propranolol (one of the most common drugs used to treat tremors) performed alone and when combined with acupuncture. The study of 60 participants found that the combination of propranolol and acupuncture was effective in reducing tremors in 90.0% (27/30) of patients, while propranolol alone was effective for only 56.7% (17/30) of patient in the study group. Overall tremor scores of the combined acupuncture and medication group were also obviously better than that of the medication group.

A Meta-analysis of the Effectiveness of Acupuncture for the Treatment of Essential Tremors - Sohn et al, 2017 (7)

A meta-analysis looks at all of the existing studies about one topic and reviews their collective data to find trends. Often, meta-analyses also evaluate how good the data from each study is and will include that assessment in their conclusions. If there are many high-quality studies included in the meta-analysis, the overall trends will be strong and robust. If there aren’t very many studies or the studies were of lower quality, then the trends will be less certain.

In this meta-analysis from 2017 about acupuncture treatment for essential tremors, 8 studies met the inclusion criteria (which is very few). Of those 8 studies, the data show that acupuncture was an effective treatment option whether it was used as the only treatment method or used in combination with commonly prescribed essential tremor medication. Researchers also found that acupuncture was able to reduce the side effects of propranolol in cases where both treatments were used concurrently.

The caveat however, is that the total sample size (ie. the number of patients included in these studies) was still too small to make strong conclusions, so “in the future, well-designed clinical studies such as double-blind studies or large-scale RCT (randomized control trial) studies are considered to be necessary”.

A Review on Treatment of Essential Tremor in Traditional Chinese Medicine - Shin et al, 2017 (14)

This is another meta-analysis that reviewed papers from 2007~2016 looking at TCM treatments for essential tremors. Thirteen total studies were selected and of those, nine showed that acupuncture combined with Western medicine was significantly more effective than Western medicine alone, or that electro-acupuncture and Chinese herbal medicine was significantly more effective than Western medicine.

This study was originally published in Korean so I had to wade through the not-great English translation, but the main conclusion was: “Treatment of essential tremor in Traditional Chinese Medicine may be more effective and safe than in Western medicine. Therefore, we hope this study will lead to further clinical research on treatment of essential tremor in Korean medicine.”

Case Report of Essential Tremor Treated with GwiBiTang and Gagambang - Oh et al, 2012 (8)

This is a case study report about 6 patients treated for essential tremors at Sangji University’s Oriental Medicine Hospital in Korea. The treatments used a combination of acupuncture, herbal medicine, and moxibustion for about 1 month. Of the 6 patients with essential tremors, the symptoms of 2 were “markedly improved”, 3 were “moderately improved” and 1 saw almost no change. This study was originally published in Korean and no English version was available at the time of this writing.

A Case Report of Early Onset Essential Tremor - Ryu & Chae, 2013 (9)

Another study out of Korea, this paper is a case report about a child patient with essential tremors who was treated with herbal medicine and acupuncture. During the 4 months of treatment, the patient's hand tremors were relieved, but came back after about a year and a half. Lifestyle factors seem to play a role in this gradual return of symptoms, and the researchers concluded that “More cases and long-term observation in relation to early onset of tremor are required.”

Observation on the Effect of Scalp Acupuncture Cluster Needling on Essential Tremor - Wang & Zheng, 2017 (12)

Originally published in Chinese, I couldn’t find the full text of this study to read but did find an English description of it on the NCCAOM’s (National Certification Commission for Acupuncture and Oriental Medicine, the national licensing board in the US) website, here: https://www.nccaom.org/wp-content/uploads/pdf/Acupuncture%20Soothes%20Essential%20Tremor.pdf

This study looked at the effectiveness of scalp acupuncture and conventional acupuncture for essential tremors using 60 patients split into two groups. Because these were patients in a hospital, the treatment protocol was 6 days per week for about 30 days, with a follow-up check after 3 months. Their conclusions were that “the total effective rate of the scalp acupuncture treatment group was 96.7% and the conventional acupuncture group was 73.3% (P<0.05).... And the relapse rate [after 3 months] of the scalp acupuncture group was 13.81% and 45.5% for the conventional acupuncture group (P<0.05).”

While I couldn’t find exactly what criteria they were using to qualify “effective” because I didn’t have access to the original text, I thought it was interesting that treatment frequency was so high. Typically in Canada most people can only afford treatment 1-2x/week, despite our TCM training recommending more clustered treatments for maximum effect, especially for chronic conditions like essential tremors. Being able to treat someone for 6 days every week for a month would result in dramatically different treatment outcomes than what most Canadian practitioners see on a regular basis. An outline of the actual acupuncture points used was also provided, and apart from the standard scalp lines, they used a cluster pattern on top of the head that I had never seen before. If you’re a practitioner reading this, check out the link above for the full protocol, it may be a useful clinical option for your patients.

Case Study of Benign Hand Tremors - Fan et al. (11)

This case study looked at a single patient with lifelong tremors (since age 8) who’s mother and three other male siblings also experienced tremors. The patient reported improvements after each acupuncture session (which were twice a week for an unspecified amount of time). Tremors would return at a certain point after these sessions, but the patient found theirs were less severe overall than their other family members and attributed it to the acupuncture.

Acupuncture for Refractory Epilepsy: Role of Thalamus - Chen at al, 2014 (13)

This study looked at how the thalamus, a region of the brain, affects the generation of epileptic seizures and what therapies can be used to change the disruptive signals in the brain that may cause them. Researchers found that “pathological oscillation within the thalamus and the cortex [were] attributable to seizure generation and propagation. Thus, it is rational to conclude that acupuncture could work as a promising therapy, or at least a screening tool, to select suitable candidates for these invasive modalities in the management of refractory epilepsy.

While this doesn’t directly talk about essential tremors, I found it interesting that they recommended acupuncture as a screening tool/treatment option before other invasive procedures. Acupuncture has few to no side effects, so I think using it as a first line treatment option is a great idea and may reduce the need for people to undergo surgical procedures like deep brain stimulation.

For the Acupuncturists & TCM folk: The points they used in this study were DU-14, LI-4, GB-34 with high frequency EA.

Cerebellar Oscillations Driven by Synaptic Pruning Deficits of Cerebellar Climbing Fibers Contribute to Tremor Pathophysiology - Pan et al, 2020 (15)

Full disclosure: this study is very difficult to read unless you’re familiar with the details of brain physiology, which I am not. I’m including it because the main conclusion was that the pathomechanism of essential tremors may be too much electrical activity in the cerebellum. The cause of this was found to be a loss of the brain protein GluRδ2, which results in an overgrowth of the cerebellar fibers and thus excessive oscillations of cerebellar neurons.

While that may not seem very helpful for our clinical practice (apart from knowing that correcting GluRδ2 may be a future conventional treatment strategy for essential tremor) , it offers another avenue to explore for our patients with essential tremors: using scalp lines that relate to regulating function in the cerebellum.

INFOGRAPHIC: Causes of Internal Wind

Works Cited

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Gonzalez-Usigli HA. Tremor. Merck Manuals Professional Edition. Published May 4, 2020. Accessed November 2, 2021. https://www.merckmanuals.com/en-ca/professional/neurologic-disorders/movement-and-cerebellar-disorders/tremor‌
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Fan J, Xu B, Chen Y, Krapf A, Mccarthy R. Case Study of Benign Hand Tremors. New York College of Traditional Chinese Medicine https://www.nyctcm.edu/Portals/0/assets/hand%20tremors_Fan.pdf
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Alina RehkopfNovember 29, 2021