EpilepsyEpilepsy TCM Diagnoses and Treatments

Suddenly falling on the ground, unconsciousness, spitting saliva, staring upwards, clonic convulsion, or shouting as bleat or pig yell, and regaining consciousness some time later

Etiology & Pathology:1. Mental disorder1. Mental disorder2. Congenital factors2. Congenital factors3. Miscellaneous 3. Miscellaneous

Main Points for differentiationMain Points for differentiation A) Def. or ExcessA) Def. or ExcessExcess:Excess:

Wind-phlegmWind-phlegmInternal phlegm-fireInternal phlegm-fireInternal blockage of blood stasisInternal blockage of blood stasis

Def.Def.Heart & Kidney def.Heart & Kidney def.Liver & kid. Yin def.Liver & kid. Yin def.

B) Attacking & Remission periodB) Attacking & Remission periodAttacking: eliminating phlegm & regulating QiAttacking: eliminating phlegm & regulating QiRemission: Tonify the liver & kid. YinRemission: Tonify the liver & kid. Yin

C) Yang type & Yin TypeC) Yang type & Yin TypeYang Type: Syndrome of excess heatYang Type: Syndrome of excess heatYin Type: Syndrome of deficient coldYin Type: Syndrome of deficient cold

Yang Type Yin type

Good constitution Constitution is not very good, Vital Qi is gradually exhausted

Sudden attack, falling down & shout, clonic convulsion & spitting, lockjaw, looking upwards with taut,

Suffered from frequent attack of epilepsy, pale complexion, dull-witted, unconsciousness, reticent, dumb-struck

Rapid or wiry slippery Deep, wiry or deep & slippery

Principles of the treatmentPrinciples of the treatmentTreatment must be according to the stage of the disease:

Attacking or

Intervals

TCM treatment PrinciplesTCM treatment Principles

1. Wake up mind & Open the orifice2. Promoting Blood circulation & resolve the blood stasis3. Resolving the food stagnation & clear the heat4. Eliminate phlegm & arrest convulsion5. Suppress wind & arrest convulsion6. Calm emotions & tranquilize mind7. Nourish Liver & Kidney8. Nourish Spleen & tonify Qi

TreatmentTreatmentAttacking StageAttacking Stage

1). Yang Type epilepsy Signs & Symptoms:

– Main Sym. : headache, dizziness, fullness in chest, then falling down on the ground unconsciously, looking upwards, dark lips, lockjaw, rigidity of neck, clonic convulsion, or rale of sputum in the air passage, or splitting saliva

– Concurrent sym.: shouting as bleat or pig yell, even fecal & urinary incontinence, be conscious gradually after the attack stops, daily life goes on as usual except that the patient feels tired.

– Tongue: whitish & greasy or yellow & greasy fur,

– Pulse: wiry & slippery & rapid

• Treatment Protocol:

– Removing phlegm-heat– Suppress wind– Calm mind & arrest convulsion

Formula:

Modifications:Arrest convulsion:

-- Bai Jiang Can, Quan Xie (scorpion), Calm mind

-- Fu Shen, Long Gu, Mu Li, Ci ShiHeat

-- Huang Lian, Ling Yang Jiao Powder

Qin Re Zheng Jing Tang

Shi Jue Ming Zi Shi Yin Gan Jiang San Zhi Zi Mu Tong Da Huang

Long Dan Cao Cai Hu Mai dong Tian Zhu Huang Dan Nan Xin Yuan Zhi

Shi Chang Pu Tian ma Gou Teng

An Gong Niu Huang Wan

Su he Xiang Wan

TreatmentTreatmentAttacking StageAttacking Stage

2). Yin Type epilepsy Signs & Symptoms:

– Main Sym. : dim & sallow complexion, cold limbs, unconsciousness, eyes slightly open, with spasm of muscles, clonic convulsion

– Concurrent sym.: generally no shouting or only making a little sound, some transfixed or dumb-struck, looking but seeing not, listening but hearing not, no moving, no speaking, recurring frequently, tired all over after wake, recovered gradually

– Tongue: light tongue body, whitish and greasy fur,

– Pulse: deep thready or thready slippery

• Treatment Protocol:

– Eliminating phlegm– Warm up Yang Qi– Arrest convulsion

Formula:

Modifications:

Eliminate phlegm:

-- Dan nan xing, chuan wu, bai fu zi, Hei Dou,

Calm mind

-- Fu Shen, Long Gu, Mu Li, Ci Shi

Er Chen Tang

Chen Pi Ban Xia Fu Ling Zhi Gan Cao

Su he Xiang Wan

TreatmentTreatmentIntermittent StageIntermittent Stage

1). Spleen Def. with abundant sputumSigns & Symptoms:

– Main Sym. : tiredness, asthenia, thin of stature & weakness, frequent dizziness, dim complexion, loss of appetite, loose stools

– Concurrent sym.: nausea, vomiting, or feeling of fullness in stomach, and stuffiness in hypochondrium, or spitting whitish sputum

– Tongue: light tongue body, whitish and greasy fur,

– Pulse: wiry sleppery or soft slippery

• Treatment Protocol:

– Eliminating phlegm– Nourish Spleen

Formula:

Modifications:Eliminate phlegm:

-- Dan nan xing, Gua LouVomiting

-- Zu Ru, Xuan Fu Hualoose stools

-- Yi Ni Ren, Bai Bian DouCalm mind

-- Shi Chang Pu, Yuan ZhiYellow sputum with yellow greasy fur

-- Wen Dan Tang

Liu Jun Zi Tang

Dang Shen Bai Zhu Fu Ling Gan Cao Ban Xia Chen Pi

Su he Xiang Wan

TreatmentTreatmentIntermittent StageIntermittent Stage

2). Obstruction of wind-phlegmSigns & Symptoms:

– Main Sym. : Premonitory sym. as dizziness, headache, fullness feeling in chest, asthenia before onset, no premonitory sym. In some of the patients, suddenly falling down, unconsciousness, clonic convulsion & spitting saliva when attacking, some of the patients are unconscious for a while, or absentminded without clonic convulsion

– Concurrent sym.: maybe screaming when attacking, urinary and fecal incontinence, expectorating

– Tongue: red or dark red with greasy fur

– Pulse: wiry sleppery

• Treatment Protocol:

– Eliminating phlegm– Suppress wind– Arrest convulsion

Formula:

Modifications:Arrest convulsion:

-- Quan Xie, Jiang Caneliminate phlegm

-- Zu li, Shi Chang PuStrength Spleen

-- Chen Pi, Fu LingCalm mind

-- Hu Po, Yuan Zhi, Fu ShenHarmonize middle Jiao

-- Sheng Jiang, Gan Cao

Ding Jian Wan

Tian Ma Chuan Bei Dan Nan Xing Ban Xia

Su he Xiang Wan

TreatmentTreatmentIntermittent StageIntermittent Stage

3). Liver & Kidney Yin def.Signs & Symptoms:

– Main Sym. : Frequent recurrence, absent-mindedness, dizziness, dry eyes, dark complexion, dry and lusterless helix, amnesia, insomnia

– Concurrent sym.: soreness & weakness in the lumbar region & knees, dry & hard stools, constipation

– Tongue: red body with less fur

– Pulse: thready & rapid

• Treatment Protocol:

– Tonify liver & Kidney– Nourishing heart– Calm mind

Formula:

Modifications:Nourish Yin:

-- Gui Ban, Bie JiaEliminate phlegm-heat

-- Zu Ru, Bei Mu, Tian Zhu HuangIrritability

-- Zu Ye, San Zhi zi, Lian Zi Calm mind

-- Po Zi Ren, Yuan Zhi, Fu Shen, Ci shiDry stools

-- Dang Gui, Yuan Shen, Huo Ma Ren

Zuo Gui Wan

Shu Di Shan Yao Shan Zu Yu Gou Qi Zi Du Zhong Tu Si Zi

Fu Zi Rou Gui Dang Gui Lu Jiao Jiao

Case History

1. male 14 years Medical history:Medical history: patient suffered from epilepsy as a child, onset at intervals of one or several months, often caused by terror or nervousness, feels fullness in chest & dizziness when attacking, then shouting, falling down on the ground, unconscious, clonic convulsive, lock jaw, even biting the tongue, spitting saliva. Attack sustained 5-6 minutes, awake gradually & medication on many occasions. No curative effects were obtained. First visiting:First visiting:

Main complain: Epilepsy Memory was failing, school record decreased, felt tired and sluggish. Tongue: whitish greasyPulse: wiry & slippery

TCM diagnose: obstruction of wind-phlegm

Treatment protocol:-- Eliminating phlegm-- suppress wind--arrest consvulsive

Formula: Dan nan xing 10, Tian Zhu Huang 10, Yuan Zhi 10, Shi chang Pu 6,

Shi jue ming 30, Zi Shi Yin 15, Tian Ma 10, Gou Teng 30, Fu Ling 30 + Ding Xian Wan

Stomach-acheStomach-ache

TCM Diagnoses and Treatments

Pain in the gastric cavity caused by impairment of the spleen & stomach and by derangement of qi & blood

various kind of pain in the stomach, often accompanied with fullness and distention in the stomach, eructation, regurgitation of acid and food from the stomach, hypochondriac & abdominal distention, and other symptoms.

Etiology & Pathology:1. 1. External pathogenic factorsExternal pathogenic factors

Cold DampnessCold Dampness2. Diet2. Diet

Quantity of foodQuantity of foodNatural of foodNatural of foodConditions of eatingConditions of eating

3. Emotional problems3. Emotional problems

AngerAngerPensiveness & worryPensiveness & worry

4. Over-exertion4. Over-exertion5. Over work5. Over work6. constitutional weakness6. constitutional weakness7. Wrong Treatment 7. Wrong Treatment

Main Points for differentiationMain Points for differentiation A) Def. or ExcessA) Def. or Excess

Excess: (most at initial stage)Excess: (most at initial stage)sudden & serious pain, tenderness, sever after meal, repeat pain, sudden & serious pain, tenderness, sever after meal, repeat pain, Cold invading St.Cold invading St.Retention of foodRetention of foodLiv. Qi invading St.Liv. Qi invading St.St.-heatSt.-heatSt.-FireSt.-FireSt.-Phlegm fireSt.-Phlegm fireSt.-Damp-heatSt.-Damp-heatSt. & Liv. HeatSt. & Liv. HeatBlood stasis in St.Blood stasis in St.Phlegm in St.Phlegm in St.

Def.: (aged)Def.: (aged)chronic pain or repeated attack, preference for pressing, relieving chronic pain or repeated attack, preference for pressing, relieving

after meal or deterioration after tiredness, relieving after rest,after meal or deterioration after tiredness, relieving after rest,St. & Sp. Def. and coldSt. & Sp. Def. and coldSt. Yin Def.St. Yin Def.

Pain in the morning--Pain in the afternoon--pain at Pain in the morning--Pain in the afternoon--pain at

nightnight

B) Cold or HeatB) Cold or Heat

C) Qi or BloodC) Qi or Blood

Qi: distending pain with belching; moving pain; early Qi: distending pain with belching; moving pain; early stage diseasestage disease

Blood: needling-like or cutting-like pain; fixed pain; Blood: needling-like or cutting-like pain; fixed pain; chronic diseasechronic disease

D) St. Liver or SpD) St. Liver or SpSt. Sp. Liv.

Caused by Exo-pathogenic factors Emotional problem

sym,. Distending pain in the chest & abdomen, belching, continuous pain, dyschesia,

Protracted disease, vague pain in the st. sever when hungry & relieving after meal & rest, sallow complexion, fatigue, weakness, loose stool

Distention pain involved in hypochondriac region, moving pain, wiry pulse

TreatmentTreatmentExcessExcess

1). Cold invading the stomachSigns & Symptoms:

– Main Sym. : Acute epigastric pain with sudden onset, chilliness, desire for application of warmth on the stomach area, pain not alleviated by pressure

– Concurrent sym.: aversion to cold, no thirst, preference for hot drink, nausea, vomiting,

– Tongue: thick-white coating

– Pulse: full & tight

• Treatment Protocol:

– Expel cold– Warm Stomach– Stop Pain

Formula:

Modifications:Severe sym. of cold:

-- Gan Jiang, Wu Zhu YuDistension of Qi

-- Chen Pi, Mu XiangExterior sym.

-- Xiang Fu, Zi Su Ye, Chen pi, Gan Cao Oppression of stomach area, no appetite, belching &

vomiting-- Zhi Shi, Shen Qu, Ji Nei Jin, Ban Xia, Sheng

Jiang

Liang Fu Wan

Gao Liang Jiang Xiang Fu

Fu Zi Li Zhong Wan

Fresh Ginger + one teaspoon of Barbados sugar

TreatmentTreatmentExcessExcess

2). Food RetentionSigns & Symptoms:

– Main Sym. : Dull epigastric pain which is worse with pressure, feeling of distention & fullness, belching, sour regurgitation, foul breath, vomiting of undigested food, epigastric pain relieved after vomiting

– Concurrent sym.: loose stools or constipation – Tongue:

thick-sticky coating in the centre & root– Pulse:

slippery• Treatment Protocol:

– Resolve food stag.– Restore the descending of St. Qi– Stop Pain

Formula:

Modifications:Feeling of distension:

-- Zhi shi, Sha Renconstipation

-- Da Huang, Hou Pu, Zhi Shi, Severe pain which is worse with pressure,

constipation, dry yellow coating-- Da Chen Qi Tang

Promotes digestion-- Ji Nei Jin, Mai Ya

Bao He Wan

Shan Zha Shen Qu Lai Fu zi Ban xia Chen Pi Fu Ling

Lian Qiao

TreatmentTreatmentExcessExcess

3). Liver Qi invading St.Signs & Symptoms:

– Main Sym. : Epigastric distention & pain radiating towards the right or left hypochondrium, belching, uncomfortable feeling of hunger, the pain comes in bouts clearly related to emotional tension.

– Concurrent sym.: sighing, irritability – Tongue:

normal body color or slightly red sides– Pulse:

wiry• Treatment Protocol:

– Soothe the liver – Regular the Qi– Stop Pain

Formula:

Modifications:Severe pain:

-- Yan Hu SuoBelching, hiccup, nausea

-- Fu Shou, Chen Xiang, Xuan Fu Hua Stag. Of liv. Qi leads to Liv. Fire

-- Mu dan pi, Shan Zhi Zi, Chai Hu, Bai shaoLiv. Fire damage yin

-- Shen Di huang, mai meng dongAcid regurgitation

-- Wa Leng Zi, Wu Zei GuPhlegm sighs

-- bai jie zidistension soon after eating

-- Mai Ya, Lai Fu zi

Cai Hu Shu Gan San

Cai Hu Bai Shao Zhi Ke Zhi Gan Cao Chen Pi Xiang Fu

Chuan Xiong

TreatmentTreatmentExcessExcess

4). Stomach heatSigns & Symptoms:

– Main Sym. : burning epigastric pain– Concurrent sym.: thirst, irritability, sour regurgitation, bitter

taste, prefer cold drinking

– Tongue: dry yellow coating, red body

– Pulse: slightly rapid

• Treatment Protocol:

– Clear Stomach-heat – Restore the descending of st. Qi

Formula:

Modifications:

severe epigastric pain:

-- Bai Shao, Gan Cao

Severe st. heat

-- Pu gong Yin, Lian Qiao, Jin Yin Hua

Bai Hu Tang

Shi gao Zhi Mu Geng Mi Gan Cao

TreatmentTreatmentExcessExcess

5). Stasis of blood in the stomachSigns & Symptoms:

– Main Sym. : stabbing epigastric pain which is worse with pressure & after eating

– Concurrent sym.: palpable masses in the epigastrium, vomiting of dark blood sometimes looking like coffee-grounds, dark complexion. The pain may be worse at night. There may be blood in the stools.

– Tongue: purple, possible only in the centre

– Pulse: choppy or wiry or firm

• Treatment Protocol:

– Move blood & eliminate stasis– Harmonize the stomach, stop pain

Formula:

Modifications:severe epigastric pain:

-- Yan Hu Suo Stag. Of Qi

-- Zhi Ke, Qing PiRetention of cold in St.

-- Gui Zhi, Gan JiangBleeding

-- San Qi, Bai Jiacidity or sore regurgitation

-- Wu Zei Gu

Shi Xiao San

Pu huang Wu Ling Zhi

Dan Shen Yin

Dan Shen Tan xiang Sha Ren

TreatmentTreatmentDeficiencyDeficiency

1). St. & Sp. Def. & coldSigns & Symptoms:

– Main Sym. : dull stomach-ache which improves with pressure, after eating, and with the application of heat

– Concurrent sym.: vomiting of thin fluids, tiredness, poor appetite, chilliness, loose stools, pale complexion

– Tongue: pale, white coating

– Pulse: deep weak

• Treatment Protocol:

– Strengthen the Sp. & St.

Formula:

Modifications:sore regurgitation:

-- wu zei gu (- Yi tang) vomiting of thin fluid

-- Gan Jiang, Chen Pi, Ban Xia, Fu lingempty cold sym.

-- Da Jian Zhong TangConfusing signs of both cold & heat

-- Gan Cao Xie Xing Tang ( Ban Xia, Gan Jiang, Huang Qin, Huang lian, Zhi gan Cao, Da Zhao)

Huang Qi Jian Zhong Tang

Huang Qi Bai Shao Gui Zhi Zhi Gan Cao Sheng Jiang Da Zao

Yi Tang

TreatmentTreatmentDeficiencyDeficiency

2). St. Yin Def. Signs & Symptoms:

– Main Sym. : dull stomach-ache– Concurrent sym.: dry mouth, desire to sip liquids, dry throat, dry

stools, slight nausea

– Tongue: normal color, dry, no coating, scattered cracks or a central wide stomach-type crack

– Pulse: floating empty in the right middle position

• Treatment Protocol:

– Nourish Yin– Benefit the St.– Stop pain

Formula:

Modifications:acid regurgitation:

-- Huang Lian, Wu Zu Yu Stag. Of Qi

-- Fu Shou, Dry stools.

-- Huo ma renThirst

-- Lu Geng, Tian Hua feng, Wu mei

Yi Guan Jian

Bei Sha Shen Mai Men Dong Sheng di Dang Gui Chuan Lian zi

Bai Shao Gan Cao Tang

Bai Shao Zhi Gan Cao

Case History

1. Female 45 years Medical history:Medical history:. Stomach pain for 2 yearsFirst visiting:First visiting:

Main complain: Epigastric Pain The pain was dull, worse lying down, aggravated by pressing on

the area, and accompanied by a slight nausea and acidity. When the pain was bad she also became constipated and her appetite decreased. Slight feeling of fullness.

Slight bleeding in between periods with light-fresh blood for 4 month

Tongue: Pale with a slight Bluish-Purple tinge, teeth-mark & a sticky-white coating

Pulse: slippery on the whole and weak on the right side

TCM diagnose: Sp. Qi Def. + Food retention

Treatment protocol:-- Tonify Sp-- Resolve retention of food

Formula: Shan Zha 6, Shen Qu 6, Lai Fu Zi 4, Ban Xia 6, Chen Pi 3,

Fu Ling 6, mai Ya 4, Zhi Shi 4, Bai Shao 9, Zhi Gan Cao 4, Bai Zhu 6,

Case History

1. Female 38 years Medical history:Medical history:. Stomach pain for 5 yearsFirst visiting:First visiting:

Main complain: Epigastric Pain pain radiated from epigastrium to the right hypochondrium & was

accompanied by a pronounced feeling of distension & belching. She also suffered from difficult bowel movements and the stools were often like small pebbles. She felt often depressed and irritable & found it difficult to establish permanent relationships with the opposite sex. Her periods were regular & normal in all ways, except that she suffered from premenstrual irritability & distension.

Slight bleeding in between periods with light-fresh blood for 4 month Tongue: unremarkable, being only slightly red on the sidesPulse: slightly slippery on left side

TCM diagnose: Stagnation of Liver Qi

Treatment protocol:-- Move Liver qi-- promote the descending of St. Qi-- Calm mind

Formula: Chai Hu 4, Bai Shao 9, Zhi Ke 6, Zhi Gan Cao 4.5, Chen Pi 4, Xiang

Fu 4, Chuan Xiong 4.5, Mu xiang 3, He Huan Pi 6, Dang Shen 6

Case History

1. Male 45 years Medical history:Medical history:. Stomach pain for 22 yearsFirst visiting:First visiting:

Main complain: Epigastric Pain Pain radiated from the epigastrium to the right hypochondrial

region. It was worse at night and better after eating. He belched a lot, his stools were slightly dry & he felt very tired.

Tongue: red on the sides, stiff and with a slightly rootless coating

Pulse: Fine, slightly empty at the deep level in general, and floating empty and very slightly wiry on the right middle position.

TCM diagnose: Stag. Of Liver Qi invading the St. + St. Yin Def.

Treatment protocol:-- Move Liver qi-- Tonify St. Yin

Formula: Chai Hu 4, Bai Shao 9, Zhi Ke 4, Zhi Gan Cao 4.5, Chen pi 3,

Xiang Fu 4, Chuan Xiong 3, Mei Gui Hua 4.5, Fu Shou 3, Tai Zi Shen 6, Shan Yao 6, Mai men Dong 6, Yu Zhu 4,

Case History

1. Male 45 years Medical history:Medical history:. Patient was diagnosed by western doctor as duodenal ulceration in 3 years ago. First visiting:First visiting:

Main complain: Stomach-ache Patient feel dizziness & tiredness sometime, bad appetite, chilliness, pain

from the epigastrium to the right hypochondrium region. sour regurgitation, heart burning sensation.

Before he came here, he asked for another TCM doctor, the doctor diagnosed as Sp & St. def. cold and gave him 6 bags of Huang Qi Jian Zhong Tang. After he drunk the herb tea, the dizziness was even worse, the stomach-ache & hypochondrial pain also got worse, thirsty like to drinking water, dry stools.

Tongue: white greasy coating with dark spots on the tip of the tonguePulse: deep fine

TCM diagnose: Blood stasis in the Stomach + Liver Qi Stag.

Treatment protocol:-- Move blood stasis-- Harmonize Shao Yaong & Yang Ming

Formula: Chai Hu 4, zhi shi 3, Huang Qin 3, Ban Xia 3, Chi Shao 3, Gui Zhi 3,

Tao Ren 3, Sheng Jiang 3, Da Zhao 3pc, Da Huang 2