A seizure, or more formally an epileptic seizure, is an involuntary attack in which there is spasmodic clonic-tonic movement of a part or the whole of the body. The attack may last anywhere from a few seconds to many hours. During the attack there may be complete loss of consciousness.
A seizure may be part of many illnesses. This chapter presents those illnesses in which Wind stirs in the interior or Wind poisons injure the meridians.
Etiology and Pathology
The location of seizure is the tendons and muscles. A seizure may result when there is failure to nourish the tendons and muscles and dysfunction of the Du Meridian. Since the nourishment of the tendons and muscles depend upon the normal functioning of the visceral organs, especially the heart, the liver and the kidney, they have an important role. Of the visceral organs the liver is the key organ since endogenous Wind stirs readily when liver-Yang is hyperactive.
When exogenous pathogenic evils invade and accumulate in the interior, they may transform into Heat. This occurs most readily in a patient in whom Yang is exuberant. If strong Heat enters the Yangming Meridian it damages the body fluids. As a result the tendons and muscles lose their nourishment and enter into spasmodic contractions. Alternately, if the Heat evil transmits into the Nutritive or Blood Level, it scorches the Liver Meridian. As Heat becomes intense it gives rise to internal Wind, and the stirring of Wind leads to the seizure.
In a patient with constitutionally exuberant Yang-Qi and accumulation of Phlegm and Dampness in the interior, strong passions or improper diet may excite Yang to become hyperactive and transform into Fire. This may give rise to endogenous Wind or pull Phlegm and Heat upward to disturb the orifices and block the meridians and channels. As a result, the tendons and muscles lose their nourishment and seizure may ensue.
If Heat evil lodges in the interior over a long time, it damages liver-blood and kidney-essence. In such circumstances of deficiency endogenous Wind arises readily. Similarly, chronic deficiency of Qi and blood, massive blood loss, severe vomiting or diarrhea, or unrestrained sweating all can damage Yin and blood, and lead to loss of nourishment for the tendons and muscles.
Trauma can impair the body’s resistance to attack by exogenous pathogenic evils. If following trauma Wind attacks and its poisons enter the meridians and channels, the distribution of Qi and blood in the Nutritive Level become impaired. This leads to impaired nourishment of the tendons and muscles and precipitates a seizure.
Sometimes exogenous Wind, Cold and Dampness attack the body in concert. When they do so they cause impedance of flow in the meridians and channels so that Qi and blood in the Defensive and Nutritive Levels become disharmonious and fluids lose their proper distribution. This leads to loss of nourishment of the tendons and muscles.
Clinical Manifestation and Key Points for Diagnosis
A seizure is an attack of involuntary spasmodic tonic-clonic movement of a part of the whole of the body. It may involve only that region of the tendons and muscles relating to one particular visceral organ or meridian, or several regions, or the entire body. In addition to the tonic-clonic spasmodic movements there may be opisthotonos, loss of consciousness, deviation of the eyes upward or sideways, trismus, foaming at the mouth, and urinary or fecal incontinence. Associated symptoms of illnesses that cause seizure may include high fever, mental confusion, delirium, headache, vomiting and mania.
A seizure appearing in the course of Heat illness is mostly due to strong exogenous pathogenic evil. If it appears suddenly in a patient with a history of exuberant liver-Yang it is mostly due to internal injury.
In general, paroxysmal or continual seizure involving all four limbs and accompanied by high fever, loss of consciousness or delirium, and opisthotonos is a strength illness. If the seizure involves a small region of the body or consists of chorea-like movements of a hand or foot, with mild fever, lassitude or mental confusion, it is a deficiency illness.
The specific causes of seizures often have distinctive patterns of symptoms. Thus, in strong Heat in the interior giving rise to liver-Wind, the seizure involves all four limbs, with high fever, profuse sweating, thirst with desire for cold drinks and loss of consciousness. In the late stage of an acute Heat illness, with lingering Heat consuming Yin and blood and giving rise to deficiency Wind, the seizure involves chorea-like movements of the hands or feet, with low grade fever, restlessness, dry mouth and tongue, and lassitude. If pestilential poisons attack the brain or Wind poisons enter through a traumatic wound to attack the Liver Meridian, the seizure involves tonic-clonic movement of all limbs, opisthotonos, loss of consciousness and dyspnea. If liver-Yang ascends abnormally with internal stirring of liver-Wind, the seizure is associated with intense headache, vomiting, delirium, hemiplegia, flushed face and coarse respiration.
Several prepared formulas are convenient for emergency treatment of convulsions.
Zhi Jing San (Spasm-Relieving Powder): 3 g three times daily for seizures involving all four limbs. It has the following composition: quanxie (Buthus) and wugong (Scolopendra).
An Gong Niuhuang Wan (Gallstone Palace-Calming Pill): one pill three times daily for seizures due to extreme Heat giving rise to Wind.
Zi Xue Dan (Purple-Snow Pill): 3 g three times daily, also for seizures due to extreme Heat giving rise to Wind.
Hupo Bao Long Wan (Amber Dragon-Embracing Pill): one pill three or four times daily. This formula has the ability to extinguish Wind, stop convulsion, dissipate Phlegm and cool Heat. Hupo Bao Long Wan has the following composition: niuhuang (Bos taurus domesticus, gallstone), renshen (Panax), gouteng (Uncaria), hupo (amber), xionghuang (realgar), tianzhuhuang (Bambusa textilis), shexiang (Moschus), baijiangcan (Bombyx mori), fuling (Poria), zhusha (cinnabar), and bile-treated nanxing (Arisaema erubescens).
Extreme Heat Giving Rise to Wind
Main Symptoms. In addition to convulsion, there are opisthotonos, trismus, teeth-grinding, eyes rolling upward, high fever, thirst with desire for cold drinks, restlessness, abdominal distention and constipation. The tongue is red, with yellow coating. The pulse is taut and rapid.
Therapeutic Principle. Purge Heat and preserve Yin.
Treatment. Xi Ling Bai Hu Tang (Rhinoceros-Antelope White Tiger Decoction). This is Bai Hu Tang (White Tiger Decoction) augmented with the following herbs: shuiniujiao (Bubalus bubalis) 10 g, lingyangjiao (Saiga tatarica) 10 g, gouteng (Uncaria) 10 g, and juhua (Chrysanthemum) 10 g. [The original composition of this formula used rhinoceros horn, hence the name. This is now replaced by the horn of the water buffalo, which is equally efficacious.]
For trismus and gurgling in the throat from sputum, add bile-treated nanxing (Arisaema consanguineum).
For loss of consciousness or delirium, prescribe An Gong Niuhuang Wan (Gallstone Palace-Calming Pill) to open orifices and resuscitate.
For constipation and abdominal distention and pain, add dahuang (Rheum palmatum), mangxiao (Mirabilite) and zhishi (Citrus aurantium) to facilitate defecation of Heat-purging.
If Heat attacks the Nutritive and Blood Levels, with eruption of macular rash, add shengdihuang (Rehmannia) and mudanpi (Paeonia suffruticosa) to help cool blood and purge Heat.
Hyperactive Yang Transforming into Wind
Main Symptoms. A patient with constitutional hyperactivity of liver-Yang suddenly develops headache and vomiting, followed by loss of consciousness and seizure. In addition, the face is flushed and there may be loud snoring. The tongue is red, with yellow coating. The pulse is taut, tight and forceful.
Therapeutic Principle. Nourish Yin, subdue Yang, calm the liver and extinguish Wind.
Treatment. Zhen Gan Xi Feng Tang (Liver-Sedating and Wind-Extinguishing Decoction). Since their purpose is to unblock the liver yinchenhao and maiya may be removed from this formula.
To enhance the formula’s ability to calm the liver and extinguish Wind, add tianma (Gastrodia) and gouteng (Uncaria).
For intense headache, add lingyangjiao (Saiga tatarica), xiakucao (Prunella) and kudingcha (Ilex cornuta, latifolia).
If there is gurgling in the throat from sputum, add Zhejiang beimu (Fritillaria), tianzhuhuang (Bambusa textilis), zhuru (Phyllostachys nigra) and bile-treated nanxing (Arisaema consanguineum) to dissipate Phlegm.
Wind Stirring due to Yin Deficiency
Main Symptoms. Chorea-like movements of the hands and feet; low fever, flushed cheeks; dry mouth, dry tongue; lassitude; and shortness of breath. The tongue is crimson and denuded. The pulse is threadlike and rapid, or depletive and rapid.
Therapeutic Principle. Nourish Yin and extinguish Wind.
Treatment. Da Ding Feng Zhu (Major Wind-Extinguishing Pearls).
If there is insufficiency of Qi and blood as well, add huangqi (Astragalus), dangshen (Codonopsis) and danggui (Angelica) to augment Qi and nourish blood. Alternately, prescribe Ba Zhen Tang (Eight Treasures Decoction).
Interior Invasion by Wind Poisons
Main Symptoms. Following physical trauma the patient develops headache, dizziness, restlessness, grimacing, opisthotonos, and recurrent seizures involving all four limbs. The tongue coating is greasy, and the pulse taut and tight.
Therapeutic Principle. Dispel Wind, detoxify poisons and relieve convulsion.
Treatment. Yu Zhen San (Fairy Powder). It has the following composition: tianma (Gastrodia) 10 g, baiprocessed processed fuzi (Typhonium giganteum) 10 g, nanxing (Arisaema erubescens) 10 g, fangfeng (Saposhnikovia) 10 g, baizhi (Angelica dahurica) 9 g, and qianghuo (Notopterygium) 9 g.
To enhance the ability to relieve convulsion, quanxie (Buthus), wugong (Scolo-pendra) and baijiangcan (Bombyx) may be added.
Exogenous Evils Blocking Meridians
Main Symptoms. Convulsion involving all four limbs; opisthotonos; trismus, inability to speak; chills, fever; no or slight sweating; headache; and heaviness of limbs. The tongue is pale red, with thin white coating. The pulse is floating and tight.
Therapeutic Principle. Dispel Wind, disperse Cold, dry Dampness and harmonize the Nutritive Level.
Treatment. Modified Qianghuo Sheng Shi Tang (Notopterygium Dampness-Defeating Decoction). It has the following modified composition: qianghuo (Notopterygium) 10 g, duhuo (Angelica pubescens) 10 g, gaoben (Ligusticum sinense) 10 g, fangfeng (Saposhnikovia) 10 g, gancao (Glycyrrhiza) 6 g, chuanxiong (Ligusticum) 10 g and manjingzi (Vitex trifolia) 9 g.
If Cold is stronger than the other exogenous evils, with headache, no sweating and tense pulse, release the exterior and induce sweating with Gegen Tang (Pueraria Decoction). It has the following composition: gegen (Pueraria), mahuang (Ephedra), guizhi (Cinnamomum), baishaoyao (Paeonia) and gancao (Glycyrrhiza).
Sometimes Dampness and Heat enter the channels and produce such symptoms as muscle spasm, fever, epigastric fullness, thirst without desire to drink, dark urine, yellow and greasy tongue coating and slippery and rapid pulse. For this illness, prescribe San Ren Tang (Three-Seed Decoction) augmented with dilong (Pheretima), sigualuo (Luffa cylindrica) and weilingxian (Clematis) to enhance its ability to unblock channels.