Epilepsy
Xian Bing
痫 病
concept
etiology
pathogenesis
symptoms
diagnosis
differentiation of syndromes
treatment
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Concept:
mental disorder,
paroxysmal
episodic loss of consciousness
spitting foam,
staring upward,
convulsion of limbs, and
screaming like a pig or goat.
Consciousness recovery very soon, and the patient behaves like ordinary people.
Etiology / pathogenesis
Seven emotions
Congenital factors
Brain trauma
Diagnosis
Acute onset
proceeding symptoms: dizziness, suffocation of the chest, yawning
typical symptoms: above
family history
congenital history
triggered factors: fear,
over exertion,
emotional irritations,
improper diet, or
brain trauma, or
too much mental or sexual activities
differentiation of syndromes
severity?
excess / deficiency ?
Principle of treatments
Acute stage: open the orifices and awake the mind
Chronic stage: eliminate the pathogens and tonify APF
Treatments
Acute stage
Yang epilepsy
Clinical manifestations:
falling down suddenly,
loss of consciousness,
complexion changes from red, dark red to blue purple or pale
purple lips,
jaw clenched,
starring upward,
stiffness of the neck and the back,
convulsion of limb,
saliva discharge, or
wheezing in the throat, or
screaming with unusual sound, or
even incontinence of urine and stool,
consciousness recovery very soon,
only with slight tiredness after regain the consciousness,
red tongue,
white and sticky or yellow and sticky coating,
string and rapid or string and slippery pulse
Principle of treatment:
open the orifices awake the mind during seizure, and then
clear heat, purge phlegm and stop wind
formulas:
Acupuncture: Du 26 Renzhong, shi xuan, and LI 4 Hegu
Huang lian jie du tang (stomach tube)
Huang lian
Huang qin
Huang bai
Zhi zi
Analysis:
Huang lian, huang qin, huang bai and zhi zi clear fire of the san jiao.
Yin epilepsy
Clinical manifestations:
dull, grey and yellow complexion during the seizure,
cold and hands and feet,
eyes half open and half closed,
semi coma or coma, or
convulsion,
saliva discharge,
no screaming or screaming with lower sound,
several seizures a day or even more than ten seizure a day,
feeling of fatigue after recovery,
pale tongue,
white and sticky coating,
deep and thready or deep and slow pulse
Principle of treatment:
open the orifices awake the mind during seizure, and then
warm to resolve phlegm
The formulas
Acupuncture Du 26 Renzhong, shi xuan, and LI 4 Hegu
Shen fu tang by using the stomach tube
Ren shen
Fu zi
Chronic stage
a.Phlegm and fire disturbing the shen
Clinical manifestations:
irritability,
easy to be angry,
insomnia,
cough with sputum which is difficult to expectorate,
bitter taste, dry mouth,
constipation,
yellow urine,
the above symptoms aggravated after seizures, or
even could not fall into sleep for whole night,
red eyes,
red tongue,
yellow and sticky coating,
deep, string, slippery and rapid pulse
Principle of treatment:
clear and purge the liver fire,
resolve phlegm and calm the shen
formula: dang gui lu hui wan
Long dan cao
Qing dai
Lu hui
Da huang
Huang lian
Huang qin
Huang bai
Zhi zi
Mu xiang
She xiang
Dang gui
Analysis:
Long dan cao, qing dai and lu hui: purge the liver fire
Da huang, huang lian, huang qin, huang bai and zhi zi: purge fire of san jiao
Mu xiang and she xiang: regulate qi and open orifices
Dang gui: harmonizes the blood and nourishes the liver.
b.Wind and phlegm blockage
Clinical manifestations:
dizziness,
fullness in the chest,
fatigue,
lots of sputum,
red tongue,
white and sticky coating,
string, slippery and forceful pulse
Principle of treatment: eliminate sputum,
subdue wind and calm epilepsy
formula: ding jian wan
Tian ma
Quan xie
Jiang can
Chuan bei mu
Dan nan xing
Ban xia
Zhu ru
Shi chang pu
Hu po
Fu shen
Yuan zhi
Chen sha
Fu ling
Chen pi
Dan shen
Mai dong
Jiang zhen
Gan cao
Analysis of the formulas
Tian ma, quan xie and jiang-- subdue the liver wind
Chuan bei mu, dan nan xing, ban xia, zhu ru and shi chang pu -- resolve phlegm and open orifices and send adverse flow qi downward
Hu po, fu shen, yuan zhi and chen sha -- calm the heart mind
Fu ling and chen pi -- Strengthen the spleen and benefit qi and resolve phlegm
Dan she-- promotes blood circulation
Mai dong -- clear the lung and tonify the heart
Jiang zhen and gan cao -- warm the middle jiao and harmonize the stomach
Heart and spleen deficiency
Clinical manifestations:
repeated seizures,
fatigue,
pale complexion,
thin body build,
poor appetite,
loose stool,
pale tongue,
white and sticky coating, and
deep and weak pulse
Principle of treatment: tonify the spleen and the heart
formulas: liu jun zi tang and wen dan tang
Liu jun zi tang
Chen pi
Ban xai
Ren shen
Fu ling
Bai zhu
Gan cao
Wen dan tang
Ban xia
Zhu re
Zhi shi
Chen pi
Zhi gan cao
Fu ling
Analysis of the formulas
Liu jun zi tang resolve phlegm and benefit the heart
Wen dan tang regulate qi and resolve phlegm, clear heat in the gallbladder and harmonize the stomach
Liver and kidney deficiency
Clinical manifestations: repeated seizures, dull complexion, dizziness, blurred vision, dry eyes, poor memory, insomnia, sore and weakness of the lower back and knees, dry constipation, red tongue, thin and yellow coating, deep thready and rapid pulse
Principle of treatment: tonify the liver and the kidney
The formula: Da bu yuan jian
Ren shen
Zhi gan cao
Shu di huang
Gou qi zi
Shan yao
Dang gui
Shan zhu yu
Du zhong
Lu jiao jiao
Gui ban jiao
Mu li
Bie jia
Analysis of the formulas:
Ren shen, zhi gan cao, shu di huang, gou qi zi, shan yao, dang gui, shan zhu yu and du zhong tonify qi and benefit the heart and tonify the liver and the kidney
Lu jiao jiao and gui ban jiao nourish yin and benefit the marrow
Mu li and bie jia nourish yin and subdue yang
Prognosis
Constitution
The condition of APF and severity of PF
Diets
Emotions
Proper treatments
Prevention and general advices
Control the trigger factors such as emotions, diets and over exertion
Avoid doing certain jobs such as driving, jobs close to fire or water
2.10Summary
3.Self tests
What are the common symptoms of epilepsy?
Discuss the differentiation of syndrome of epilepsy.
Describe the treatment of epilepsy.
Depressive syndromes in psychosis
Dian Bing
癫 病
Concept:
reticence,
mental dullness,
incoherent speech,
silent and
often happy
(schizophrenia or depression in Weston medicine)
Etiology and pathogenesis
Emotional irritations
Phlegm and qi stagnation
Heredity and constitution
Diagnosis
More adult female
Symptoms: above
differentiation of syndromes
acute and chronic
deficiency and excess
Differential diagnosis
Dian bing and depression
Dian bing and dementia
treatments: regulate qi to relieve stagnation,
restore the shen’s activities
Treatments
1Liver qi stagnation
Clinical manifestations: depression, indifference, dullness, incoherent speech or muttering to oneself, changeable moods, distension and fullness in the chest, pale tongue, thin and white coating, string pulse
Principle of treatment: promote the liver qi circulation to relieve stagnation
The formula: Chai hu shu gan san柴胡疏肝散
Chai hu
Zhi ke
Xiang fu
Hou pu
Bai shao yao
Shi chang pu
Yuan zhi
Yu jing
Analysis of the formula
Chai hu, zhi ke, xiang fu and hou pu promote the liver qi circulation to relieve stagnation
Bai shao yao soothes the liver
Shi chang pu, yuan zhi and yu jing open the orifice of the heart
2Phlegmand qi stagnation
Clinical manifestations: depression, indifference, dullness, incoherent speech or muttering to oneself, changeable moods, poor appetite, red tongue, white and sticky coating, and string and rapid pulse
Principle of treatment:regulate qi to relieve stagnation, resolve phlegm and awake the shen
The formula: shun qi dao tan tang
Ban xia
Chen pi
Fu ling
Zhi shi
Dan nan xing
Xiang fu
Mu xiang
Analysis of the formulas
Ban xia, chen pi, dan nan xing and zhi shi resolve phlegm
Fu ling strengthen the spleen and eliminate the dampness
Mu xiang and xiang fu regulate qi
3The heart and spleen deficiency
Clinical manifestations: absent – mindedness, dream disturbed sleep, palpitation, fright, grief, weeping, fatigue, poor appetite, pale tongue, sticky coating, and a deep, thready and weak pulse
Principle of treatment: regulate qi, strengthen the spleen andnourish the heart
The formulas: yang xin tang and yue ju wan
Yang xin tang
Ren shen
Huang qi
Gan cao
Chuan xiong
Dang gui
Fu ling
Yuan zhi
Bai zi ren
Suan zao ren
Wu wei zi
Rou gui
Yue ju wan
Cang zhu
Xiang fu
Chuan xiong
Shen qu
Zhi zi
Analysis of the formulas
Yang xin tang strengthen the spleen, nourishes the heart and calm the shen
Yue ju wan regulate qi’s activities
4Qi and yin deficiency
Clinical manifestations: repeated attacks, absent mindedness, talkative, fright, irritability, insomnia, red face, thin body build, dry mouth and tongue, red tongue and less coating or no coating, deep, thready and rapid pulse
Principle of treatment: benefit qi and nourish yin
The formulas: si jun zi tang and da bu yin wan
Si jun zi tang
Ren shen
Bai zhu
Fu ling
Gan cao
Da bu yin wan
Huang bai
Shi di huang
Zhi mu
Gui ban
Zhu ji sui
Analysis of the formulas
Si jun zi tang strengthen the spleen and benefit qi
Da bu yin wan nourishes yin and subdues deficiency fire
Prognosis
The prognosis is good in general, but may be triggered the emotion irritations again.
2.9Prevention and general advices
Emotions
Diets
Jobs and rest
Exercise
Summary
3.Self tests
Describe the etiology and pathogenesis of Dian bing
Describe the common syndromes in Dian bing
Describe the common treatment method of Dian bing.
Mania
Kuang Bing
狂病
1.Objectives
Upon complexion of this chapter, you should be able to:
1.1understand the concept of mania in TCM, and
1.2master etiology, pathogenesis, diagnosis, differentiation of syndrome and treatments of mania.
2.Important points
2.1Introduction
Mania is characterized by shouting, restlessness, irritability, and violent behavior.
2.2.Etiology and pathogenesis
2.2.1Emotional irritations
2.2.2Diets
2.2.3Heredity and constitution
2.3Diagnosis
Has history of emotional irritations or family history
Symptoms are shouting, restlessness, irritability, and violent behavior
2.4Key points for differentiation of syndromes
2.5Steps of differentiation of syndromes
2.6Principle of treatments: purge fire and eliminate phlegm, regulate yin and yang, and restore the shen
2.7Treatments
2.7.1Phlegm and fire upward disturbing the mind
Clinical manifestations: sudden onset with symptoms like irritability, headache, insomnia, staring angrily, flushed face and red eyes, following by violent behaviors such as climbing over walls and houses, shouting, smashing, hitting people, refuse to eat and sleep, red and purple tongue body, yellow and sticky coating ore dry and yellow coating, string, large, slippery and rapid pulse
Principle of treatment: clear and purge the liver fire, eliminate sputum and awake the shen
The formula: cheng shi sheng tie luo yin
Sheng tie luo
Gou teng
Dan nan xing
Bei mu
Ju hong
Shi chang pu
Yuan zhi
Fu shen
Cheng sha
Tian men dong
Mai men dong
Xuan shen
Lian qiao
Analysis of the formulas
Sheng tie luo is heavy to send adverse flow of qi downward and purges fire
Gou teng clear heat in the heart and calms the liver wind
Dan nan xing, bei mu, ju hong eliminate phlegm and dampness
Shi chang pu, yuan zhi, fu shen and chen sha open the orifices, calm the mind and restore the shen
Tian men dong, mai men dong, xuan shen and lian qiao nourish yin, clear heat, remove the stasis
2.7.2Excessive fire damaging yin
Clinical manifestations: mania gradually lessen, followed by fatigue, easy to be frightened, irritability, thin body, flushed face, a red tongue, and a thready and rapid pulse
Principle of treatment: nourish yin, reduce fire, calm the mind and stabilize emotion
The formula: er yin jian
Sheng di huang
Mai dong
Xuan shen
Huang lian
Mu tong
Zhu ye
Deng xi cao
Fu shen
Suan zao ren
Gan cao
Analysis of the formula:
Sheng di huang, mai men dong and xuan shen nourish yin, clear heat and remove stasis
Huang lian, mu tong, zhu ye and deng xin cao clear the heart fire and calm the shen
Fu shen, suan zao ren and gan cao nourish the heart and the shen
2.7.3Phlegm and blood stagnation
Clinical manifestations: mania for long period of time, dull complexion, irritability, hallucination, uncommon behaviors, headache, palpitation, dark purple tongue withpetechia, less coating or thin, yellow and dry coating, string and thready or thready and choppy pulse
Principle of treatment: purge phlegm andremove stasis
The formula: dian kuang meng xing tang
Tao ren
Chi shao yao
Chai hu
Da fu pi
Chen pi
Qing pi
Su zi
Sang bai pi
Ban xia
Gan cao
Xiang fu
Mu tong
Analysis of the formulas
Tao ren and chi shao yao remove blood stasis.
Chai hu and xiang fu regulate qi and blood
Da fu pi sends qi downward
Chen pi eliminate phlegm and stagnation
Sang bai pi purge the lung fire
Ban xia resolvespledge
Gan cao balances the other herbs
2.7.4Blood stasis blocking the orifices
Clinical manifestations: insomnia, easy to be frightened, anxiety, hallucination, dull complexion, dark blue tongue, or withpetechia, thin and slippery coating, small and string or thready and choppy pulse
Principle of treatment: remove stasis and resolve phlegm
The formula: hu yu tong qiao tong
Dan shen
Chi shao yao
Tao ren
Hong hua
Hu po
Da huang
Shi chang pu
Yu jing
Chai hu
Xiang fu
Analysis of the formula
Dan shen, chi shao yao, tao ren, hong hua, hu po and da huang remove stasis and obstruction in the collaterals
Shi chang pu and yu jing open orifices
Chai hu and xiang fu relieve stagnation
2.7.5Disharmony between the heart and the kidney
Clinical manifestations: mania for long period of time, repeated attacks, hallucination, could not control themselves, insomnia, irritability, dry mouth, constipation, red tip of the tongue with cracks, thready and rapid pulse
Principle of treatment: nourish yin and subdue yang, connect the heart and the kidney
The formulas: Huang lian e jiao tang and hu po yang xin tang
Huang lian e jiao tang
Huang lian
E jiao
Huang qin
Ji zi huang
Bai shao yao
Analysis of the formulas
Huang lian e jiao tang clears heat and nourishes yin
Hu po yang xin dan calms the heart and connects the heart and kidney
2.8Prognosis. Varies
2.9Prevention and general advices
Emotions
Personal care
2.10Summary
Mania is often caused by emotional irritations and congenital factors. The heart, the liver, the spleen and gallbladder are often affected.
3.Self tests
What are the difference among epilepsy, dian and kuang bing
Describe the etiology and pathogenesis of mania.