Transcript Epilepsy

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
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 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
Excess: (most at initial stage)
sudden & serious pain, tenderness, sever after meal, repeat pain,
Cold invading St.
Retention of food
Liv. Qi invading St.
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 the 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
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
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 3pc, Da Huang 2