Epilepsy TCM Diagnoses and Treatments Suddenly falling on

Epilepsy 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 disorder 2. Congenital factors 3. Miscellaneous

Main Points for differentiation A) Def. or Excess: Wind-phlegm Internal phlegm-fire Internal blockage of blood stasis Def. Heart & Kidney def. Liver & kid. Yin def. B) Attacking & Remission period Attacking: eliminating phlegm & regulating Qi Remission: Tonify the liver & kid. Yin C) Yang type & Yin Type Yang Type: Syndrome of excess heat Yin 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, dullwitted, unconsciousness, reticent, dumb-struck Rapid or wiry slippery Deep, wiry or deep & slippery

Principles of the treatment Treatment must be according to the stage of the disease: Attacking or Intervals

TCM treatment Principles 1. Wake up mind & Open the orifice 2. Promoting Blood circulation & resolve the blood stasis 3. Resolving the food stagnation & clear the heat 4. Eliminate phlegm & arrest convulsion 5. Suppress wind & arrest convulsion 6. Calm emotions & tranquilize mind 7. Nourish Liver & Kidney 8. Nourish Spleen & tonify Qi

Treatment Attacking 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: 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 Modifications: Arrest convulsion: -- Bai Jiang Can, Quan Xie (scorpion), Calm mind -- Fu Shen, Long Gu, Mu Li, Ci Shi Heat -- Huang Lian, Ling Yang Jiao Powder

Treatment Attacking 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: Er Chen Tang Chen Pi Ban Xia Fu Ling Zhi Gan Cao Su he Xiang Wan Modifications: Eliminate phlegm: -- Dan nan xing, chuan wu, bai fu zi, Hei Dou, Calm mind -- Fu Shen, Long Gu, Mu Li, Ci Shi

Treatment Intermittent Stage 1). Spleen Def. with abundant sputum Signs & 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: Liu Jun Zi Tang Dang Shen Bai Zhu Fu Ling Gan Cao Ban Xia Su he Xiang Wan Modifications: Eliminate phlegm: -- Dan nan xing, Gua Lou Vomiting -- Zu Ru, Xuan Fu Hua loose stools -- Yi Ni Ren, Bai Bian Dou Calm mind -- Shi Chang Pu, Yuan Zhi Yellow sputum with yellow greasy fur -- Wen Dan Tang Chen Pi

Treatment Intermittent Stage 2). Obstruction of wind-phlegm Signs & 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: Ding Jian Wan Tian Ma Chuan Bei Dan Nan Xing Ban Xia Su he Xiang Wan Modifications: Arrest convulsion: -- Quan Xie, Jiang Can eliminate phlegm -- Zu li, Shi Chang Pu Strength Spleen -- Chen Pi, Fu Ling Calm mind -- Hu Po, Yuan Zhi, Fu Shen Harmonize middle Jiao -- Sheng Jiang, Gan Cao

Treatment Intermittent 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: Zuo Gui Wan Shu Di Shan Yao Shan Zu Yu Gou Qi Zi Fu Zi Rou Gui Dang Gui Lu Jiao Du Zhong Modifications: Nourish Yin: -- Gui Ban, Bie Jia Eliminate phlegm-heat -- Zu Ru, Bei Mu, Tian Zhu Huang Irritability -- Zu Ye, San Zhi zi, Lian Zi Calm mind -- Po Zi Ren, Yuan Zhi, Fu Shen, Ci shi Dry stools -- Dang Gui, Yuan Shen, Huo Ma Ren Tu Si Zi

Case History 1. male 14 years 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: Main complain: Epilepsy Memory was failing, school record decreased, felt tired and sluggish. Tongue: whitish greasy Pulse: 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-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. External pathogenic factors Cold Dampness 2. Diet Quantity of food Natural of food Conditions of eating 3. Emotional problems Anger Pensiveness & worry 4. Over-exertion 5. Over work 6. constitutional weakness 7. Wrong Treatment

Main Points for differentiation A) Def. or Excess: (most at initial stage) sudden & serious pain, tenderness, sever after meal, repeat pain, Cold invading St. Retention of food Liv. Qi invading St. -heat St. -Fire St. -Phlegm fire St. -Damp-heat St. & Liv. Heat Blood stasis in St. Phlegm in St. Def. : (aged) chronic pain or repeated attack, preference for pressing, relieving after meal or deterioration after tiredness, relieving after rest, St. & Sp. Def. and cold St. Yin Def.

Pain in the morning--Pain in the afternoon--pain at night B) Cold or Heat C) Qi or Blood Qi: distending pain with belching; moving pain; early stage disease Blood: needling-like or cutting-like pain; fixed pain; chronic disease D) St. Liver or Sp St. Caused by Exo-pathogenic factors sym, . Distending pain in the chest & abdomen, belching, continuous pain, dyschesia, Sp. Liv. Emotional problem 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

Treatment Excess 1). Cold invading the stomach Signs & 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: Liang Fu Wan Gao Liang Jiang Xiang Fu Fu Zi Li Zhong Wan Fresh Ginger + one teaspoon of Barbados sugar Modifications: Severe sym. of cold: -- Gan Jiang, Wu Zhu Yu Distension of Qi -- Chen Pi, Mu Xiang Exterior 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

Treatment Excess 2). Food Retention Signs & 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: Bao He Wan Shan Zha Shen Qu Lai Fu zi Ban xia Chen Pi Fu Ling Lian Qiao Modifications: Feeling of distension: -- Zhi shi, Sha Ren constipation -- 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

Treatment Excess 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 liver – Regular the Qi – Stop Pain

Formula: Cai Hu Shu Gan San Cai Hu Bai Shao Zhi Ke Zhi Gan Cao Chen Pi Xiang Fu Chuan Xiong Modifications: Severe pain: -- Yan Hu Suo Belching, 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 shao Liv. Fire damage yin -- Shen Di huang, mai meng dong Acid regurgitation -- Wa Leng Zi, Wu Zei Gu Phlegm sighs -- bai jie zi distension soon after eating -- Mai Ya, Lai Fu zi

Treatment Excess 4). Stomach heat Signs & 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: Bai Hu Tang Shi gao Zhi Mu Geng Mi Gan Cao Modifications: severe epigastric pain: -- Bai Shao, Gan Cao Severe st. heat -- Pu gong Yin, Lian Qiao, Jin Yin Hua

Treatment Excess 5). Stasis of blood in the stomach Signs & 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: Shi Xiao San Pu huang Wu Ling Zhi Dan Shen Yin Dan Shen Tan xiang Sha Ren Modifications: severe epigastric pain: -- Yan Hu Suo Stag. Of Qi -- Zhi Ke, Qing Pi Retention of cold in St. -- Gui Zhi, Gan Jiang Bleeding -- San Qi, Bai Ji acidity or sore regurgitation -- Wu Zei Gu

Treatment Deficiency 1). St. & Sp. Def. & cold Signs & 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: Huang Qi Jian Zhong Tang Huang Qi Bai Shao Gui Zhi Gan Cao Sheng Jiang Da Zao Yi Tang Modifications: sore regurgitation: -- wu zei gu (- Yi tang) vomiting of thin fluid -- Gan Jiang, Chen Pi, Ban Xia, Fu ling empty cold sym. -- Da Jian Zhong Tang Confusing signs of both cold & heat -- Gan Cao Xie Xing Tang ( Ban Xia, Gan Jiang, Huang Qin, Huang lian, Zhi gan Cao, Da Zhao)

Treatment Deficiency 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: 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 Modifications: acid regurgitation: -- Huang Lian, Wu Zu Yu Stag. Of Qi -- Fu Shou, Dry stools. -- Huo ma ren Thirst -- Lu Geng, Tian Hua feng, Wu mei

Case History 1. Female 45 years Medical history: Stomach pain for 2 years 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

Case History 1. Female 38 years Medical history: Stomach pain for 5 years 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 sides Pulse: 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: Stomach pain for 22 years First visiting: Main complain: Epigastric 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: Patient was diagnosed by western doctor as duodenal ulceration in 3 years ago. 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 stomachache & hypochondrial pain also got worse, thirsty like to drinking water, dry stools. Tongue: white greasy coating with dark spots on the tip of the tongue Pulse: 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 3 pc, Da Huang 2