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    Epilepsy page 1 1. Epilepsy: A Case Study Comparing Western and

    Traditional Chinese Treatment Procedures

    2. by Hila Ravid, Shai Ravid and Reuven Ravid

3. Abstract

    4. Epilepsy is the world’s most common neurological

    1disease. Western medicine treats epilepsy primarily

    with medication and, infrequently, surgery.

    Traditional Chinese medicine uses a combination of

    acupuncture and herbal formulas. A case study

    describes the successful treatment of a 24-year-old

    woman by traditional Chinese medicine (TCM).

5. Keywords

    6. Epilepsy, Dian Xian, traditional Chinese medicine,

    Western medicine, Acupuncture, Phlegm, Wind, Fire,

    Yin deficiency, Liver, Spleen, Heart, Kidney.

7. Introduction

    8. Throughout the centuries, in different cultures,

    certain superstitions grew up regarding epilepsy.

    The ancient Greeks for example, called epilepsy the

    sacred disease, and even in Martin Luther’s time

    epilepsy was referred to as a demonic illness. In

    the Middle Ages and into the modern era, the common

    belief was that devils and ghosts were responsible

    for epilepsy. According to the Talmud, one of the

    holy books of Judaism, epilepsy was regarded as a

    disease of (demonic) possession. It was only at the

    thend of the 19 century, when western medicine began

    to provide neurological clues as to the disease

    process, that the prejudices against epilepsy

    gradually begin to recede.

    Epilepsy page 2

    art One: Epilepsy as understood by Western 9. P

    medicine

    210. Definition of epilepsy

    11. Epilepsy is a brain disorder marked by electrical disturbances in brain wave frequency, which results in a seizure.

     312. Varieties of epilepsy

    13. Seizures are classified as either generalised or partial and may be primary (idiopathic) or secondary. Where the electrical disturbances are spread throughout the entire brain the disease is called general epilepsy; when they are restricted to a particular area of the brain it is called partial or focal epilepsy.

14. Primary (idiopathic) epilepsy

    15. In this case the cause of the seizures is unknown and there is no indication of previous brain damage. In about five to ten percent of cases there is a genetic basis. Even an electro encephalogram (EEG) may not provide a clear-cut indication that a

    4problem exists.

    16. There are two major types of idiopathic epilepsy:

    517. Tonic-clonic (grand mal)

    i. In the tonic phase of the seizure,

    breathing stops due to contractions of the

    air passages, and in the clonic phase

    there are convulsions. The patient may

    vomit, and after regaining consciousness

    can experience such symptoms as headache,

    Epilepsy page 3

    muscle pains and a desire to sleep. These

    seizures can vary as to frequency and

    length. This type of epilepsy usually

    begins between the ages of four and 20

    years and often ceases naturally as the

    patient gets older. Seizures, which begin

    after 25 years of age, are generally of

    the secondary variety.

    618. Absence (petit mal)

    a. These seizures are very brief, lasting only

    five to ten seconds. During this time the

    patient is unresponsive and immobile although

    there may be tremors of the eyelids or

    shoulders. This particular seizure returns

    several times daily, and after the seizure the

    patient has no conscious recollection of what

    happened. This type of epilepsy usually ceases

    naturally.

    719. Secondary epilepsy

    20. This type of epilepsy results from damage to the brain cortex and may be due to viral infections, tumours, foreign objects, metabolic disease such as hypoglycaemia, anorexia nervosa, calcium deficiency, genetic diseases, vascular accidents etc. Seizures can appear either days or years after the injury to the brain.

    821. Treatment

    22. Management of the symptoms is aimed at improving the patient’s quality of life by reducing or eliminating seizures. Treatment can be drug based or involve a surgical procedure.

    Epilepsy page 4 Antiepileptics/anticonvulsants are generally efficient in treating most seizures, however side effects and toxicity can be a problem. Surgical procedures can be used for the prevention of seizures but this is only undertaken where the patient has not responded to conventional treatment and is considered to be at high risk.

    923. Drug Treatment

    24. Name of 25. Type 26. Us27. Opti28. Selected

    drug of ual mal side effects

    seizures adult (Therapeut

    daily ic) level

    dose of drug in

    (mg/kg) the blood

    (μg/ml)

    29. Phenytoin 30. Toni31. 4-32. 10-33. Nystagmu

    c-clonic, 8 20 s, ataxia,

    focal dysarthria,

    sedation,

    confusion,

    etc.

    34. Carbamazep35. Toni36. 5-37. 4-8 38. Nystagmu

    ine c-clonic, 25 s, dysarthria,

    focal diplopia,

    ataxia,

    drowsiness,

    etc.

    39. Valproic 40. Toni41. 1042. 50-43. Nausea,

    acid c-clonic, -60 100 vomiting,

    focal, diarrhea,

    absence drowsiness,

    alopecia, etc.

    44. Phenobarbi45. Toni46. 2-47. 10-48. Drowsine

    tal c-clonic, 5 40 ss, nystagmus,

    focal ataxia, skin

    rushes,

    learning

    Epilepsy page 5

    difficulties,

    etc. 49. Primidone 50. Toni51. 5-52. 5-15 53. Sedation

    c-clonic, 20 , nystagmus,

    focal ataxia,

    vertigo,

    nausea, etc. 54. Ethosuximi55. abse56. 2057. 40-58. Nausea,

    de nce -35 100 vomiting,

    anorexia,

    headache,

    lethargy, etc. 59. Clonazepam 60. abse61. 0.62. 20-63. Drowsine

    nce 05-0.2 80 ss, ataxia,

    irritability,

    behavioral

    changes,

    exacerbation

    of tonic-

    clonic

    seizures.

    1064. Surgical Treatment

    65. Surgery can involve partial removal of the

    temporal lobe or implantation of electrodes in the

    brain after the corpus callosum has been separated.

66. Summary

    67. The cause of epilepsy is unknown and not every

    patient can become seizure free with Western medical

    treatment. Many patients suffer additional problems

    due to the side effects of their medication.

    68. Part Two: epilepsy as understood by Chinese

    11medicine

    69. Epilepsy, known as Dian Xian, was identified in

    the Chinese medicine classics over 2000 years ago.

    Epilepsy page 6

    1270. According to Xin-ming epilepsy is due to a

    disruption of the Heart, Liver, Kidney and Spleen

    energy, with loss of consciousness due to blocking

    of the Heart orifices by internal phlegm.

    71. Management of epilepsy is holistic; it not only

    aims to mitigate the acute disorder but also

    addresses the chronic underlying weakness.

72. Chinese Medicine classifies Epilepsy according to shi & xu patterns,

    rather than tonic-clonic or absences, in which the most important

    causative factor of its appearance is Phlegm in the upper part of the

    body (the Upper Jiao) which causes the disturbance of mind and

    manifests as the epileptic seizure.

    1373. Aetiology and pathogenesis

    a. The major aetiological factors are:

    74. Liver wind and turbid phlegm obstructing the

    mind.

    75. Liver fire with phlegm heat.

    76. Liver and Kidney yin deficiency.

    77. 4. Spleen and Stomach deficiency

    78. Differential diagnosis and treatment according

    14 to patterns

    79. Liver wind and turbid phlegm obstructing the

    mind

80. Clinical manifestations

    81. Before the seizure: dizziness, vertigo,

    stiffness of the neck, oppression in the chest,

    general malaise.

    Epilepsy page 7

    82. During the seizure: sudden collapse, locked jaw,

    upward staring eyes, convulsions, salivation,

    shouting, crying, loss of consciousness without

    convulsions, loose stool and urine. The tongue will

    have a thin (white or yellow) sticky coating and the

    pulse will be either rapid (shu) and slippery (hua)

    or tight (jin) and slippery.

     Pathology 83.

    84. Liver wind stirs up internal phlegm causing it

    to rise upward and mist the Heart and mind. If this

    results in convulsions then Liver wind is

    predominant; if there is a loss of consciousness

    without convulsions, phlegm predominates over Liver

    wind.

85. Treatment principle

    86. Extinguish wind and resolve phlegm, unblock the

    Heart orifices and strengthen the Spleen.

87. Main acupuncture points

    88. Baihui DU-20, Renzhong DU-26, Jianshi P-5,

    Taichong LIV-3, Fengchi GB-20, Fenglong ST-40, Yaoqi

    (M-BW-29- an extra point located under the S2 spine.

    Needling Method: Insert the needle slanted upwards

    2-2 1/2 Cun). Use reducing method and treat daily.

    Retain needles for 40 minutes to one hour.

89. Main herbal formula

    90. Ding Xian Wan (Arrest Seizure Pill).

91. Liver fire with phlegm heat

    Epilepsy page 8

    92. Clinical manifestations

    93. Epileptic seizure, Irritability, restlessness,

    insomnia, bitter taste in the mouth, thirst,

    difficult expectoration of yellow phlegm. The tongue

    will be red with a yellow coating and the pulse will

    be wiry (xian), rapid (shu) and slippery (hua). 94. Pathology

    95. Heat from Liver fire condenses body fluids into

    phlegm which then causes the phlegm to rise and

    block the Heart orifices.

96. Treatment principle

    97. Purge Liver fire, resolve phlegm, unblock the

    Heart orifices.

98. Main acupuncture points

    99. Renzhong DU-26, Laogong P-8, Xingjian LIV-2,

    Benshen GB-13, Fenglong ST-40, Shenmen HE-7,

    Yongquan KID-1. Use reducing method and treat daily.

    Retain needles for 40 minutes to one hour.

100. Main herbal formulas

    101. Long Dan Xie Gan Tang (Drain the Liver

    Decoction) or Di Tan Tang (Scour Phlegm Decoction).

102. 3. Liver and Kidney yin deficiency

    103. Clinical manifestations

    104. Mild seizures, insomnia, poor memory, pain and

    weakness of the lower back and knees, dizziness,

    constipation, vertigo. The tongue will be red with

    scanty coating or without coating and the pulse will

    be rapid (shu) and fine (xi).

    Epilepsy page 9 105. Pathology

    106. Liver and Kidney yin and jing deficiency lead

    both to both Liver yang rising and to malnourishment

    of the mind. Liver yang rising will further harass

    the mind and lead to an epileptic seizure*.

107. Treatment principle

    108. Nourish Liver and Kidney yin, subdue Liver yang

    and calm the mind.

     Main acupuncture points 109.

    110. Baihui DU-20, Ganshu BL-18, Shenshu BL-23,

    Jinsuo DU-8, Tongli HE-5, Yanglingquan GB-34, Jiuwei

    REN-15, Taixi KID-3, Sanyinjiao SP-6, Yaoqi (M-BW-

    29). Use even method and treat daily. Retain needles

    for 30 minutes.

111. Main herbal formulas

    112. Zuo Gui Wan (Restore The Left (Kidney) Pill) or

    Tian Ma Gou Teng Yin (Gastrodia And Uncaria

    Decoction).

113. 4. Spleen and Stomach deficiency

    114. Clinical manifestations

    115. Prolonged Epilepsy accompanied by Lassitude,

    poor memory, low appetite, nausea, yellow and

    lustreless complexion, loose stools, fatigue, thin

    body to the point of fragility, vertigo and

    dizziness. The tongue will be pale and the pulse

    will be soft (ruan) and fine (xi) or soft and weak

    (xu).

    Epilepsy page 10 116. Pathology

    117. Qi and blood production are reduced due to

    weakness of the Spleen and Stomach. Spleen

    deficiency leads to the production of phlegm. The

    mind is not nourished as the clear qi is unable to

    rise due to phlegm accumulation and lack of qi and

    blood.

     Treatment principle 118.

    119. Strengthen the Spleen, harmonise the Stomach,

    resolve phlegm and increase qi production in order

    to nourish Heart blood.

120. Main acupuncture points

    121. Baihui DU-20, Xinshu BL-15, Juque REN-14,

    Zhongwan REN-12, Zusanli ST-36, Qihai REN-6, Daling

    P-7, Fenglong ST-40, Taichong LIV-3, Pishu BL-20.

    Use even or reinforcing method. Treat daily or every

    other day. Retain needles for 30 minutes.

122. Main herbal formula

    123. Liu Jun Zi Tang (Six Gentleman Decoction).

124. Case study

    125. The patient was a 24-year-old female with a

    history of epileptic seizures from the age of 13.

126. Main clinical manifestations

    127. The epileptic seizures were of the tonic-clonic

    type and included the following symptoms: blurred

    vision that led to dizziness, shouting, collapse and

    loss of consciousness, convulsions, salivation and

    incontinence of urine. The seizures lasted from one

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