大意
痫病有阴有阳。大率属痰与热惊三者而已。不必分五等。（汇补）
内因
或因母腹受惊。或因卒然闻惊而得。惊则神出舍空。痰涎乘间而归之。或因饮食失节。脾胃亏损。积为痰
饮。以致涎潮上涌。均能发痫。大抵肥人多痰。瘦人多火。总不外因惊而得。（汇补）
外候
发则昏不知人。眩仆倒地。甚而螈 抽掣。手足搐搦。口眼相引。目睛上视。胸背强直。叫吼吐沫。食
顷乃醒。（三因）
五痫病状
病久必归五脏。肺痫。反折上窜。有类羊叫。心痫。目瞪吐舌。仿佛马鸣。脾痫。直视腹满。声如牛吼。肝痫。
惊跳反折。掣 。宛如鸡鸣。肾痫。直视如尸。吐沫。绝类猪叫犬吠。此五痫病状。偶类之耳。其实痰火惊三者。闭其
孔窍。鼓动涎潮。乱其主宰故也。（汇补）
痫分阴阳
先身热掣 。惊啼叫喊。而后发。脉浮洪者。为阳痫。病属六腑。易治。先身冷。无惊掣啼叫而病发。脉沉者。为
阴痫。病在五脏。难治。阳痫痰热客于心胃。闻惊而作。若痰热甚者。虽不闻惊。亦作也。宜用寒凉。阴痫亦本
于痰热。因用寒凉太过。损伤脾胃。变而成阴。法当燥湿温补祛痰。（汇补）
痫与卒中 病辨
三症相因。但痫病仆时。口作六畜声。将醒时吐涎沫。醒后复发。有连日发者。有一日三五发者。若中风中
寒中暑之类。则仆地无声。醒时无涎沫。亦不复发。惟 病。虽时发时止。然身体强直。反张如弓。不似痫病
身软作声也。（汇补）
死候
病后发痫者不治。神脱目瞪如愚者亦不治。发时遗尿者死。
脉法
脉虚弦为惊。又为风痫。
治法用药
大率行痰而兼清心降火。寻痰寻火。分多少治之。先以二陈加栝蒌、南星、黄连探吐。吐后服朱砂安神丸。
以降南方之火。当归龙荟丸以平东方之木。但化痰必先顺气。顺气必先调中。顽痰胶固。非辛温何以佐
其开导之功。故用之。（入门）
痫病选方
朱砂安神丸（方见惊悸） 泻青丸（方见火症） 加减通圣散（方见似中风）
葶苈苦酒汤 治痫病发时项强直视。不省人事。肝经热盛。或有切牙者。
苦酒（半斤） 葶苈（一合） 生艾汁（半斤） 煎作三服。吐后。泻青丸下之。
导赤散 治痫症切牙者。（方见火症）
粉黛汤
轻粉 代赭石 白矾（各等分）
发过。米饮调下。
杨氏五痫丸 治颠痫潮发。不论新久。
白附子（炮五钱） 半夏 皂角（各二两） 白矾（生用） 乌蛇（酒浸各一两） 白僵蚕
（一两半） 全蝎（二钱） 朱砂（二钱半） 蜈蚣（条半） 麝香（三字） 雄黄（一钱半）
为末。姜汁煮面糊丸。每服三十丸。食后姜汤下。
三痫丸 治一切惊痫。
荆芥穗（二两） 白矾（二两半半生半熟）
朱砂为衣。
当归龙荟丸（钱氏）
当归 龙胆草 栀子仁 黄连 黄柏 黄芩
芦荟 青黛 木香 麝香
共研细末。炼蜜为丸。如小豆大。每服二三十丸。生姜汤下。
General Principles
Epilepsy is categorized into Yin and Yang types. Generally, it primarily stems from Phlegm (Tan), Heat (Re), and Fright (Jing). There is no need to strictly divide it into five categories. (Source: *Zhengzhi Huibu*)
Internal Causes
Some cases arise from the mother experiencing fright during pregnancy, or from the patient suddenly hearing a startling noise. Fright causes the Shen (Spirit) to leave its residence, leaving the Heart empty, allowing Phlegm-Saliva to accumulate. Other cases result from irregular diet, damaging the Spleen and Stomach, leading to the accumulation of Phlegm-Fluids, which surge upward, triggering epilepsy. Broadly speaking, obese individuals tend to have excessive Phlegm, while thin individuals tend to have Fire. Ultimately, all are caused by Fright. (Source: *Zhengzhi Huibu*)
External Manifestations
Upon onset, the patient loses consciousness, feels dizzy, and falls to the ground. Severe cases involve convulsions and spasms, twitching of hands and feet, deviation of the mouth and eyes, upward staring of the eyeballs, rigidity of the chest and back, shouting, and foaming at the mouth. The patient typically regains consciousness after about the time it takes to eat a meal. (Source: *Sanyin Jiyi Bingzheng Fanglun*)
Symptoms of the Five Epilepsies
After prolonged illness, the pathogen resides in the Zang organs.
Lung Epilepsy: The body arches backward and moves upward, with sounds resembling a sheep's bleat.
Heart Epilepsy: The eyes stare wide, the tongue protrudes, with sounds resembling a horse's neigh.
Spleen Epilepsy: The eyes stare straight, the abdomen is full, with sounds resembling an ox's bellow.
Liver Epilepsy: The patient jumps in fright, the body arches backward, limbs twitch, with sounds resembling a chicken's crow.
Kidney Epilepsy: The eyes stare straight like a corpse, foaming at the mouth, with sounds resembling a pig's squeal or a dog's bark.
These descriptions for the five epilepsies are merely analogical comparisons. In reality, the root cause is that Phlegm, Fire, and Fright obstruct the orifices, agitate the Phlegm-Saliva, and disrupt the governing function of the Mind (Shen). (Source: *Zhengzhi Huibu*)
Differentiation of Yin and Yang Epilepsy
If the patient has fever, convulsions, fright, crying, and shouting before the onset, and the pulse is Floating-Hong (Surging), it is Yang Epilepsy. The pathology involves the Fu organs and is easier to treat.
If the patient has cold limbs, without fright, convulsions, or crying prior to onset, and the pulse is Deep, it is Yin Epilepsy. The pathology involves the Zang organs and is difficult to treat.
Yang Epilepsy is caused by Phlegm-Heat lodging in the Heart and Stomach, triggered by fright. If Phlegm-Heat is severe, it may occur even without a fright trigger. Cold-natured herbs should be used.
Yin Epilepsy also originates from Phlegm-Heat but transforms into Yin due to the excessive use of cold-natured herbs, which damages the Spleen and Stomach. The treatment method should focus on drying Dampness, warming and tonifying, and resolving Phlegm. (Source: *Zhengzhi Huibu*)
Differentiation between Epilepsy and Stroke
These conditions share similarities, but during an epileptic fall, the patient makes animal-like sounds, foams at the mouth upon waking, and may relapse, occurring multiple times a day or consecutively. In contrast, conditions like Wind-Stroke, Cold-Strike, or Heat-Stroke involve falling without sound, no foaming upon waking, and no recurrence. Only Jing Disease (Spasm Disorder) shares the intermittent nature, but the body remains rigid with opisthotonos (arching back like a bow), unlike epilepsy where the body is flaccid and noisy. (Source: *Zhengzhi Huibu*)
Incurable Signs (Prognosis)
Epilepsy recurring after recovery is incurable. Loss of Spirit with wide-eyed staring and dullness is incurable. Urinary incontinence during an attack indicates death.
Pulse Diagnosis
A Deficient-Wiry pulse indicates Fright or Wind-Epilepsy.
Treatment Principles and Medication
The general principle is to resolve Phlegm while clearing the Heart and descending Fire. Identify the source of Phlegm and Fire and treat according to their severity. Initially, use Er Chen Tang (Two-Aged Decoction) with Gua Lou (Trichosanthes Fruit), Nan Xing (Arisaema Rhizome), and Huang Lian (Coptis Rhizome) to induce vomiting. After vomiting, administer Zhu Sha An Shen Wan (Cinnabar Calming the Spirit Pill) to descend Heart-Fire, and Dang Gui Long Hui Wan (Angelica Dragon Ash Pill) to pacify Liver-Wood. However, to resolve Phlegm, one must first regulate Qi; to regulate Qi, one must first harmonize the Middle Jiao. For stubborn, tenacious Phlegm, acrid-warm herbs are necessary to assist in opening and guiding. Therefore, they are used. (Source: *Yixue Rumen*)
Selected Formulas for Epilepsy
Zhu Sha An Shen Wan (See "Palpitations" chapter)
Xie Qing Wan (See "Fire Syndromes" chapter)
Jiajian Tongsheng San (See "Wind-Stroke-like Syndromes" chapter)
Ting Li Ku Jiu Tang: Treats epilepsy with neck rigidity, upward staring, unconsciousness, indicating excess Heat in the Liver Meridian, possibly accompanied by teeth grinding.
Ingredients: Ku Jiu (Vinegar, half jin), Ting Li Zi (Descurainia Seed, one he), Sheng Ai Zhi (Fresh Mugwort Juice, half jin). Decoct and divide into three doses. After vomiting, follow with Xie Qing Wan.
Dao Chi San: Treats epilepsy with teeth grinding. (See "Fire Syndromes" chapter)
Fen Dai Tang
Ingredients: Qing Fen (Calomel), Dai Zhe Shi (Hematite), Bai Fan (Alum) in equal parts.
Administer after an episode, mixed with rice water.
Yang Shi Wu Xian Wan: Treats recurrent epilepsy, regardless of duration.
Ingredients: Bai Fu Zi (Typhonii Rhizoma, processed, five qian), Ban Xia (Pinelliae Rhizoma), Zao Jiao (Gleditsiae Spina) each two liang; Bai Fan (Alum, raw); Wu She (Zaocys, wine-soaked, one liang); Bai Jiang Can (Bombyx Batryticatus, one and a half liang); Quan Xie (Scorpio, two qian); Zhu Sha (Cinnabar, two and a half qian); Wu Gong (Scolopendra, one and a half strips); She Xiang (Musk, three zi); Xiong Huang (Realgar, one and a half qian).
Grind into powder, make pills with ginger juice and wheat paste. Take thirty pills per dose after meals, washed down with ginger soup.
San Xian Wan: Treats all types of fright-induced epilepsy.
Ingredients: Jing Jie Sui (Schizonepeta Spike, two liang); Bai Fan (Alum, two and a half liang, half raw, half calcined).
Coat with Zhu Sha (Cinnabar).
Dang Gui Long Hui Wan (Formula by Qian Yi)
Ingredients: Dang Gui (Angelica Sinensis), Long Dan Cao (Gentianae Radix), Zhi Zi Ren (Gardeniae Semen), Huang Lian (Coptidis Rhizoma), Huang Bo (Phellodendri Cortex), Huang Qin (Scutellariae Radix), Lu Hui (Aloe), Qing Dai (Indigo Naturalis), Mu Xiang (Aucklandiae Radix), She Xiang (Musk).
Grind into fine powder, form pills with refined honey, size of small beans. Take twenty to thirty pills per dose, washed down with ginger soup.