There are many reasons for hand tremors in patients with chronic alcoholic liver disease, which need to be carefully analyzed. First, the patient has a clear history of alcoholic cirrhosis, is currently in the decompensated stage, and has been checked several times for elevated blood ammonia. For such a patient, if sudden unexplained hand tremor occurs, we need to first consider the possibility of early hepatic encephalopathy, which is medically known as “fluttering tremor” or “hepatic tremor”. Hepatic encephalopathy occurs mainly due to the impairment of the detoxification function of the liver, and a large amount of toxic substances, such as blood ammonia, enter the brain through the blood circulation, interfering with the energy metabolism and nerve conduction of the brain, resulting in psychoneurological symptoms. Before the onset of symptoms, some patients may have triggers such as constipation, high-protein eating and gastrointestinal bleeding. Hepatic encephalopathy is an important complication in patients with cirrhotic decompensation and has a high mortality rate; therefore, it is recommended that this patient seek prompt medical examination. Second, it is important to know whether the patient is still addicted to alcohol. For alcoholics, they are also prone to symptoms of hand tremors because the ethanol contained in alcohol excites the central nervous system, causing reduced control of movement; excessive alcohol consumption, in addition to damage to the liver, also has adverse effects on the nervous system, especially the reduction in vitamin intake, producing alcoholic myopathy, etc. Clinically, there will also be terminal sensory disorders of the limbs, weakness, hand trembling, and weakened tendon reflexes; similarly, if a large amount of alcohol is consumed in the fasting state, there will also be hypoglycemic reactions such as panic, hand trembling, sweating and pallor due to increased insulin secretion and decreased blood glucose concentration; for long-term alcohol dependents, a series of neuropsychiatric symptoms such as delirium, hallucinations and shaking of the four skills will also occur if alcohol is suddenly cut off, which we call “alcohol withdrawal syndrome”. Finally, for elderly patients, we also need to rule out the possibility of concurrent cerebrovascular disease, or Parkinson’s disease causing hand tremors.