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。
大意
痫病有阴证和阳证之分。大体上主要属于痰、热、惊这三个病因罢了。不必强行分为五类。（出自《证治汇补》）
内因
有的因为母亲在怀孕期间受到惊吓，有的因为突然听到巨大的声响而患病。受惊则心神外越，心舍空虚，痰涎趁机积聚于心。有的因为饮食不节制，导致脾胃受损，积滞形成痰饮，致使痰涎潮涌上逆，这些都能引发痫病。大致来说，肥胖的人多痰湿，消瘦的人多虚火，总归都不外乎因惊恐而致病。（出自《证治汇补》）
外候（发作时的症状表现）
发作时神志昏迷，不知人事，头晕跌倒在地，甚至出现抽搐痉挛，手足拘挛抽动，口眼歪斜牵引，眼球向上凝视，胸背部僵硬挺直，发出叫声并口吐白沫，大约一顿饭的时间后才会苏醒。（出自《三因极一病证方论》）
五痫病状
病程久了，病邪必然归属于五脏。肺痫，身体反折向上窜动，声音类似羊叫；心痫，两眼瞪大，吐出舌头，声音仿佛马鸣；脾痫，两眼直视，腹部胀满，声音如牛吼；肝痫，受惊跳跃，身体反折，肢体掣动，声音宛如鸡鸣；肾痫，两眼直视如同尸体，口吐白沫，声音绝类猪叫或犬吠。这五种痫病的症状，只是偶然类比而已。其实质是因为痰、火、惊三者闭塞了孔窍，鼓动痰涎上涌，扰乱了心神的主宰功能所致。（出自《证治汇补》）
痫分阴阳
如果在发作前先有身热、抽搐、惊啼叫喊等症状，随后发病，且脉象浮洪的，称为阳痫。病位在六腑，容易治疗。如果在发作前先有身冷，没有惊跳、抽搐、啼叫等表现就发病，且脉象沉细的，称为阴痫。病位在五脏，难以治疗。阳痫是痰热客居在心胃，听到惊恐声而诱发；如果痰热严重，即使没有听到惊恐声，也会发病。适宜使用寒凉药物治疗。阴痫也本源于痰热，但因为之前过度使用寒凉药物，损伤了脾胃，从而转变为阴证。治疗方法应当采用燥湿、温补、祛痰的方法。（出自《证治汇补》）
痫与卒中病辨
这三种病症相互关联，但痫病仆倒时，口中会发出六畜的声音，将要苏醒时口吐涎沫，醒后可能再次发作，有的连日发作，有的一天发作三五次。如果是中风、中寒、中暑之类的疾病，则仆倒在地时没有声音，苏醒时没有涎沫，也不会再次复发。只有痉病，虽然也是时发时止，但身体强直，角弓反张如弓一样，不像痫病那样身体柔软并发出声音。（出自《证治汇补》）
死候（预后不良的症状）
病后再次发作痫病的，属于不治之症。神识涣散、两眼瞪大呆滞如愚者的，也不治。发作时遗尿的，主死。
治法用药
大体原则是行化痰浊兼清心降火。寻找痰源和火源，根据多少分别治疗。先用二陈汤加瓜蒌、胆南星、黄连进行探吐。吐完后服用朱砂安神丸，以降南方之心火；服用当归龙荟丸，以平东方之肝木。但是化痰必须先顺气，顺气必须先调理中焦脾胃。对于顽固胶固的痰浊，不用辛温药物怎么能辅助其开导之功呢？所以使用辛温药物。（出自《医宗必读·入门》）
痫病选方
朱砂安神丸（方剂见“惊悸”章节） 泻青丸（方剂见“火症”章节） 加减通圣散（方剂见“似中风”章节）
葶苈苦酒汤：治疗痫病发作时项部强直、两眼直视、不省人事。这是肝经热盛所致，或者伴有咬牙症状的。
组成：苦酒（半斤）、葶苈子（一合）、生艾汁（半斤）。煎煮后分三次服用。吐完后，用泻青丸送下。
粉黛汤
组成：轻粉、代赭石、白矾（各等分）。
发作过后，用米汤调服。
杨氏五痫丸：治疗癫痫潮发，不论新病久病。
组成：白附子（炮制五钱）、半夏、皂角（各二两）、白矾（生用）、乌梢蛇（酒浸各一两）、白僵蚕（一两半）、全蝎（二钱）、朱砂（二钱半）、蜈蚣（一条半）、麝香（三字）、雄黄（一钱半）。
研为细末，用姜汁煮面糊制成丸药。每次服用三十丸，饭后用姜汤送下。
三痫丸：治疗一切惊痫。
组成：荆芥穗（二两）、白矾（二两半，一半生用一半熟用）。
用朱砂为衣。
当归龙荟丸（钱乙方）
组成：当归、龙胆草、栀子仁、黄连、黄柏、黄芩、芦荟、青黛、木香、麝香。
共研为细末，炼蜜为丸，如小豆大小。每次服用二三十丸，生姜汤送下。
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.