脉经云。前部左右弹者。阳跷也。动则苦腰痛癫痫。恶风偏枯。僵仆羊鸣。身强皮痹。从少
阳斜至太阳者。阳维也。动则苦癫痫。僵仆羊鸣。手足相引。甚者失音不能言。从少阴斜至厥阴
者。阴维也。动则苦癫痫。尺寸俱浮。直上直下。此为督脉。腰背强痛。不得俯仰。大人癫病。
小儿风痫。脉来中央浮。直上直下者。督脉也。动则苦腰背膝寒。夫癫。小儿痫也。巢氏妄立五
痫之说。曰阳痫。曰阴痫。曰风痫。曰湿痫。曰马痫。证治杂出。殊不知癫痫之发。皆由肝肾龙
雷上冲所致也。
痫病与卒中痉病相似。但痫病发时昏不知人。卒然眩仆倒地。甚则螈 抽搐。目上视。或口
眼斜。或口作六畜声。将醒时吐涎沫。醒后又复发。有连日发者。有一日三五次发者。若中风
中寒中暑中热。则仆时无声。醒时无涎沫。醒后不复发也。刚痉柔痉亦屡发。然身体强直。角弓
反张。不似痫之身软。或为六畜声也。痫证之发。由肾中龙火上
升。而肝家雷火相从挟助也。惟有肝风。故作搐搦。搐搦则通身之脂液逼迫而上。随逆气而吐出
于口也。阴气虚。不能宁谧于内。则附阳而上升。故上热而下寒。阳气虚。不能周卫于身。则随
阴而下陷。故下热而上寒。
丹溪主痰与热。以星、半、芩、连为主。热多者。凉膈散加川连、麦冬以泄之。痰多者。戴
人三圣散以吐之。如惊者。东垣安神丸以平之。可下。以承气汤下之。然后用安神平肝之剂。归、
地、牛黄、朱砂、青黛、柴胡、川芎之类。心热痰迷心窍者。清神汤。病久而成窠囊。窠囊日久。
必至生虫。妙功丸神效。既与行痰涤热。痫证已愈。然须防其再发。宜十全大补加枣仁、远志、
麦冬。禀气素虚者。鹿角胶经年常服。六味丸加远志、沉香。亦不可缺。风痫骤发。项强直视。
不省人事。此肝经有热也。或有切牙者。泻青丸合导赤散治之。如病发者。可用轻粉、白矾、代
赭石。发过米饮调下。重剂以镇之也。若起于郁者。四七汤加木香、南星。发时用前药下灵砂丹。
不得卧。用养正丹。多呕。下黑锡丹。痰多者。导痰汤加木香、竹沥。痫病昼发。灸阳跷。宜补
中益气加益智。夜发。灸阴跷。宜六味丸加鹿角胶。丹矾丸治五痫诸证。方用黄丹一两。白矾二
两。银罐中 通红为末。入腊茶一两。不落水猪心血为丸。绿豆大。朱砂为衣。每服三十丸。茶
清送下。久服其涎自便出。服一月后。更以安神药调之。久患气虚。痰气壅塞。须防卒变。不可
妄许以治也。凡见目瞪如愚者不治。治之亦必无功。
石顽曰。痫证往往生于郁闷之人。多缘病后本虚。或复感六淫。气虚痰积之故。盖以肾水本
虚不能制火。火气上乘。痰壅脏腑。经脉闭遏。故卒然倒仆。手足搐捻。口目牵掣。乃是热盛生
风之候。斯时阴阳相薄。气不得越。故迸作诸声。证状非一。古人虽分五痫。治法要以补肾为本。
豁痰为标。随经见证用药。但其脉急实。及虚散者不治。细缓者虽久
剧可治。
〔诊〕脉浮滑洪数为风痫。细弦微缓为虚痫。浮为阳痫。沉为阴痫。虚弦为惊。沉数为实热。
沉实弦急者不治。
《脉经》记载：寸关尺前部（腕侧）左右弹指有力的，是阳跷脉。若此脉动，患者会苦于腰痛、癫痫，怕风，半身不遂，突然僵倒并发出羊叫声，身体僵硬，皮肤麻木。从少阳脉斜向太阳脉的，是阳维脉。若此脉动，患者会苦于癫痫，突然僵倒并发出羊叫声，手足相互牵引，严重的失音不能说话。从少阴脉斜向厥阴脉的，是阴维脉。若此脉动，患者会苦于癫痫。如果寸部和尺部脉象都浮，且脉势直上直下，这是督脉脉象。患者会苦于腰背强痛，不能俯仰。这是大人的癫病，小儿的风痫。脉来在中央部位浮取即得，直上直下的，也是督脉。此脉动则苦于腰背膝盖寒冷。所谓“癫”，是指小儿的痫病。巢元方错误地创立了五痫的说法，称为阳痫、阴痫、风痫、湿痫、马痫，证候和治疗杂乱无章。殊不知癫痫发作，都是由肝肾中的龙雷之火上冲所致。
痫病与卒中、痉病相似，但痫病发作时昏迷不知人事，突然眩晕仆倒在地，严重时出现抽搐，眼睛上翻，或者口眼歪斜，或者口中发出六畜的叫声，将要清醒时吐出涎沫，醒后又会再次发作。有的连日发作，有的一天发作三五次。如果是中风、中寒、中暑、中热，则仆倒时没有声音，清醒时没有涎沫，清醒后不再复发。刚痉和柔痉也会多次发作，但是身体强直，角弓反张，不像痫病那样身体柔软，或者发出六畜的声音。痫证的发作，是由于肾中龙火上升，而肝家雷火相从挟助所致。只有肝风内动，所以发生抽搐。抽搐导致全身脂液被逼迫而上行，随着逆气从口中吐出。阴气虚弱，不能在内部宁静安谧，就会依附阳气而上升，所以上面热下面寒。阳气虚弱，不能在周身卫护，就会随着阴气而下陷，所以下面热上面寒。
朱丹溪主张痰与热致病，以天南星、半夏、黄芩、黄连为主药。热多的，用凉膈散加川黄连、麦冬来清泄；痰多的，用戴人三圣散来催吐。如果有惊恐症状的，用东垣安神丸来平定。可以攻下的，用承气汤攻下，然后用安神平肝的药剂，如当归、地黄、牛黄、朱砂、青黛、柴胡、川芎之类。心热痰迷心窍的，用清神汤。病久形成窠囊，窠囊日久，必定生虫，妙功丸效果神奇。既然已经行痰涤热，痫证已愈，然而必须防止其再发，宜用十全大补汤加酸枣仁、远志、麦冬。禀赋素来虚弱的，鹿角胶常年常服，六味丸加远志、沉香，也不可缺少。风痫突然发作，项强直视，不省人事，这是肝经有热。或者有咬牙的，用泻青丸合导赤散治疗。如病发作时，可用轻粉、白矾、代赭石，发作后用米饮调下，用重剂来镇摄。如果是因郁结引起的，用四七汤加木香、天南星，发作时用前面的药下灵砂丹。不得安卧的，用养正丹。多呕吐的，用黑锡丹。痰多的，用导痰汤加木香、竹沥。痫病白天发作的，灸阳跷穴，宜用补中益气汤加益智仁；夜间发作的，灸阴跷穴，宜用六味丸加鹿角胶。丹矾丸治疗五痫各种证候，方用黄丹一两，白矾二两，在银罐中烧红研为末，加入腊茶一两，用不落水的猪心血泛丸，如绿豆大，朱砂为衣。每服三十丸，茶清送下。久服其涎自然排出。服药一个月后，再用安神药调理。久患气虚，痰气壅塞，须防备突然变化，不可妄许能治愈。凡是见到眼睛瞪大像傻子一样的，属于不治之症，治疗也必然无功。
石顽说：痫证往往生于郁闷之人，多因为病后本元虚弱，或者又感受六淫邪气，是气虚痰积的缘故。大概是因为肾水本虚不能制约火势，火气上乘，痰壅塞脏腑，经脉闭阻遏抑，所以突然倒仆，手足抽搐捻转，口目牵掣，这是热盛生风的征候。此时阴阳相互搏击，气机不能宣越，所以迸发出各种声音，证状不一。古人虽然分为五痫，治法要以补肾为本，豁痰为标，随经络见证用药。但是脉象急实，以及虚散的，属于不治之症。脉象细缓的，虽然病久且剧烈，也可以治疗。
〔诊〕脉浮滑洪数为风痫。脉细弦微缓为虚痫。脉浮为阳痫，脉沉为阴痫。脉虚弦为惊痫，脉沉数为实热。脉沉实弦急的，属于不治之症。
The *Mai Jing* (Pulse Classic) states: When the pulse at the anterior portion (distal aspect) of both left and right sides is elastic and palpable, it indicates the Yang Qiao Mai (Yang Heel Vessel). If this vessel is active, the patient suffers from lower back pain, epilepsy (*Xian Bing*), aversion to wind, hemiplegia, sudden stiff collapse accompanied by bleating like a sheep, body stiffness, and skin numbness. When the pulse slants from the Shaoyang channel to the Taiyang channel, it indicates the Yang Wei Mai (Yang Linking Vessel). If this vessel is active, the patient suffers from epilepsy, sudden stiff collapse with sheep-like bleating, mutual traction of hands and feet, and in severe cases, aphonia and inability to speak. When the pulse slants from the Shaoyin channel to the Jueyin channel, it indicates the Yin Wei Mai (Yin Linking Vessel). If this vessel is active, the patient suffers from epilepsy. If both the Cun (inch) and Chi (cubit) positions are floating, and the pulse moves straight up and down, this is the pulse of the Du Mai (Governing Vessel). The patient suffers from stiffness and pain in the waist and back, unable to bend or extend. This corresponds to Dian disease (*Dian Bing*) in adults and Wind Epilepsy (*Feng Xian*) in children. If the pulse comes floating at the central position, moving straight up and down, it also indicates the Du Mai. Activity of this pulse causes suffering from coldness in the waist, back, and knees. "Dian" refers to pediatric epilepsy. Chao Yuanfang erroneously established the theory of Five Types of Epilepsy, naming them Yang Epilepsy, Yin Epilepsy, Wind Epilepsy, Dampness Epilepsy, and Horse Epilepsy, resulting in chaotic syndromes and treatments. It is unknown that the onset of epilepsy is caused by the upward rush of Dragon Fire and Thunder Fire from the Liver and Kidney.
Epilepsy resembles stroke (*Zhong Feng*) and tetanus/spasm (*Jing Bing*), but during an epileptic attack, the patient loses consciousness, suddenly faints and falls due to dizziness, and may experience convulsions, upward deviation of the eyes, facial paralysis, or emit sounds resembling domestic animals. Before regaining consciousness, the patient salivates; after waking, the attack may recur. Attacks may occur on consecutive days or three to five times a day. In contrast, if one suffers from stroke, cold strike, heat stroke, or summerheat strike, there is no sound upon falling, no saliva upon waking, and no recurrence after waking. Both Gang Jing (Stiff Tetanus) and Rou Jing (Flaccid Tetanus) may recur frequently, but the body remains rigid with opisthotonos, unlike epilepsy where the body is soft or produces animal-like sounds. The onset of epilepsy is caused by the ascent of Dragon Fire from the Kidney, assisted by Thunder Fire from the Liver. Only when Liver Wind arises do convulsions occur. Convulsions force bodily lipids upward, which are then vomited out through the mouth along with rebellious Qi. When Yin Qi is deficient, it cannot remain tranquil internally, so it attaches to Yang Qi and ascends, resulting in upper heat and lower cold. When Yang Qi is deficient, it cannot circulate and protect the body, so it sinks with Yin Qi, resulting in lower heat and upper cold.
Zhu Danxi attributes the pathology to Phlegm and Heat, using Tian Nan Xing (Arisaematis Rhizoma), Ban Xia (Pinelliae Rhizoma), Huang Qin (Scutellariae Radix), and Lian Zi (Coptidis Rhizoma) as primary herbs. For excessive heat, Liang Ge San (Cool the Upper Jiao Powder) is modified with Chuan Lian Zi (Coptidis Rhizoma) and Mai Dong (Ophiopogonis Radix) to drain heat. For excessive phlegm, Dai Ren's San Sheng San (Three Sages Powder) is used to induce vomiting. For cases involving fright, Dongyuan An Shen Wan (Calming the Spirit Pill) is used to pacify. If purgation is indicated, Cheng Qi Tang (Order the Qi Decoction) is used for purgation, followed by formulas to calm the spirit and soothe the liver, such as Dang Gui (Angelicae Sinensis Radix), Di Huang (Rehmanniae Radix), Niu Huang (Bovis Calculus), Zhu Sha (Cinnabaris), Qing Dai (Indici Folium), Chai Hu (Bupleuri Radix), and Chuan Xiong (Ligustici Chuanxiong Rhizoma). For heart heat and phlegm confusing the orifices of the Heart, Qing Shen Tang (Clear the Spirit Decoction) is used. Chronic illness forms "nest sacs" (chronic pathological accumulations); over time, these may generate parasites. Miao Gong Wan (Miraculous Merit Pill) is highly effective. Once phlegm is moved and heat is cleared, and epilepsy is cured, prevention of recurrence is essential. One should use Shi Quan Da Bu Tang (Great Tonifying Ten Substances Decoction) modified with Suan Zao Ren (Ziziphi Spinosae Semen), Yuan Zhi (Polygalae Radix), and Mai Dong. For those with inherent constitutional deficiency, Lu Jiao Jiao (Deer Antler Glue) should be taken regularly for years, along with Liu Wei Wan (Six-Ingredient Rehmannia Pill) modified with Yuan Zhi and Chen Xiang (Aquilariae Lignum Resinatum). For acute Wind Epilepsy presenting with neck stiffness, fixed gaze, and unconsciousness, indicating Liver Heat, or with teeth grinding, Xie Qing Wan (Drain the Green Pill) combined with Dao Chi San (Direct the Flow Powder) is used. During an attack, Qing Fen (Calomel), Bai Fan (Alumen), and Dai Zhe Shi (Haematitum) can be administered, taken with rice water after the attack subsides, using heavy sedatives to suppress it. If caused by stagnation, Si Qi Tang (Four Perfections Decoction) modified with Mu Xiang (Aucklandiae Radix) and Nan Xing (Arisomatis Rhizoma) is used; during attacks, Ling Sha Dan (Spirit Cinnabar Pellet) is administered via purgation. For insomnia, Yang Zheng Dan (Nourish Righteousness Pellet) is used. For frequent vomiting, Hei Xi Dan (Black Lead Pellet) is used. For excessive phlegm, Dao Tan Tang (Guide Out Phlegm Decoction) modified with Mu Xiang and Zhu Li (Bambusae Succus) is used. For daytime epilepsy, moxa is applied to Yang Qiao; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) modified with Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) is prescribed. For nighttime epilepsy, moxa is applied to Yin Qiao; Liu Wei Wan modified with Lu Jiao Jiao is prescribed. Dan Fan Wan (Lead and Alum Pill) treats all types of epilepsy. The formula uses 1 liang of Huang Dan (Minii Oxidum Rubrum), 2 liang of Bai Fan, calcined red-hot in a silver crucible and powdered, mixed with 1 liang of La Cha (aged tea), and formed into pills the size of mung beans using pig heart blood (from pigs not exposed to rainwater), coated with Zhu Sha. Take 30 pills per dose with clear tea. Long-term use naturally expels phlegm. After one month, regulate with calming-spirit medicines. For chronic Qi deficiency with phlegm-Qi obstruction, beware of sudden changes; do not falsely promise a cure. Cases presenting with staring eyes like a fool are incurable; treatment will be futile.
Shi Wen stated: Epilepsy often arises in individuals prone to depression, usually due to root deficiency after illness or secondary contraction of the Six Exogenous Pathogens, resulting in Qi deficiency and phlegm accumulation. Essentially, Kidney Water is deficient and fails to control Fire; Fire qi surges upward, phlegm obstructs the Zang-Fu organs, and meridians are blocked, causing sudden collapse, convulsions of hands and feet, and pulling of the mouth and eyes. This is a sign of Wind generated by excessive Heat. At this moment, Yin and Yang clash, and Qi cannot disperse freely, thus producing various sounds and varied symptoms. Although ancients divided epilepsy into five types, treatment must focus on tonifying the Kidney as the root and resolving phlegm as the branch, prescribing according to the affected meridian and syndrome. However, if the pulse is rapid and solid, or deficient and scattered, the condition is incurable. If the pulse is fine and slow, even if chronic and severe, it is treatable.
[Diagnosis] A floating, slippery, full, and rapid pulse indicates Wind Epilepsy. A fine, wiry, and slightly slow pulse indicates Deficiency Epilepsy. A floating pulse indicates Yang Epilepsy; a sinking pulse indicates Yin Epilepsy. A deficient and wiry pulse indicates Fright Epilepsy; a sinking and rapid pulse indicates Excess Heat. A sinking, solid, wiry, and rapid pulse indicates an incurable condition.