The Trembling Hand is a vital component required to summon the Echo of Varshan, a formidable enemy that drops valuable loot when defeated. To embark on this journey, you'll need to gather the Trembling Hand along with three other Malignant Body Parts: the Gurgling Head, the Blackened Femur and the Malignant Heart. 

Getting Trembling Hand

The Trembling Hand, like the other Malignant Body Parts (Gurgling Head, Blackened Femur, and Malignant Heart), can be obtained from various sources. Here are the ways to obtain the Trembling Hand in Diablo 4:

Tree of Whispers Cache (from World Tier 3):

• Progress through the game until you reach World Tier 3.
• Complete Whispers of the Dead objectives, which are small tasks marked on the map to collect Grim Favors.
• Gather 10 Grim Favors, and then visit the Tree of Whispers.
• Open the Tree of Whispers Cache, which contains a random Malignant Body Part, possibly including the Trembling Hand.

Grotesque Debtor Drop:

• Defeat the Grotesque Debtor monster, which guarantees a random Malignant Body Part drop.
• Debtors may spawn around areas with active Whispers of the Dead or during the Bloody Harvest event.

Transmutation at the Alchemist:

• You can use 1 other Malignant Body Part (not the Trembling Hand), along with 5 Veiled Crystals and 1 of the following, depending on the Body Part used: Abstruse Sigil, Baleful Fragment, or Coiling Ward.
• This process creates a Malignant Body Cache with a random drop. Using 1 Malignant Heart, 4 Baleful Fragments, and 15 Veiled Crystals guarantees a Trembling Hand.

It's important to note that while you can obtain Trembling Hand through different means, your best chance is to acquire it from a Tree of Whispers Cache starting at World Tier 3. However, if you already have the other necessary components, you can consider transmuting them at the Alchemist for a chance to obtain the Trembling Hand. Keep in mind that transmutation requires rare resources, so use it judiciously.

Trembling Hand Using

The Trembling Hand is just one part of the Ritual of Hatred. To summon the Echo of Varshan, you'll need the following components:

• Trembling Hand
• Gurgling Head
• Blackened Femur

These items will be consumed at a Malignant Altar as part of the ritual. Once the Echo of Varshan is summoned, you can engage in battle with this formidable foe. Defeating the Echo of Varshan is rewarding, as it yields valuable loot.

It's important to note that Trembling Hands on their own have no use. You must combine them with the Gurgling Head and Blackened Femur to summon the Echo of Varshan. Therefore, it's advisable to save your Trembling Hands until you have all the necessary components.

While you can use other Malignant Body Parts to create Malignant Body Caches at the Alchemist, it's generally better to save these parts for later, as you will ultimately obtain all the required parts through gameplay.

You can carry multiple Trembling Hands in your inventory, which allows you to farm them and the other necessary items until you are fully prepared to face the Echo of Varshan.