Pediatric Epilepsy in Traditional Chinese Medicine (TCM): Overview & Treatments

Definition & Overview

Pediatric epilepsy (痫证) is a common, convulsive neurological condition in children. It is characterized by sudden collapse, loss of consciousness, drooling, upward eye movements, and limb convulsions, with recovery after the episode often returning the child to near-normal state. Epilepsy most often begins after age 4–5, with a prevalence of around 0.3%–0.5%. Persistent episodes can negatively impact long-term prognosis and may lead to cognitive delays.

Source: zysj.com.cn

Etiology & Pathogenesis (病因病机)

From a TCM perspective, pediatric epilepsy can arise from both congenital and acquired factors:

Congenital factors:

• Weak prenatal constitution
• Maternal malnutrition
• Prenatal fright

These factors may disrupt vital Qi and blood flow, predisposing the child to seizures.

Acquired factors:

• Head injuries
• Infections or toxins
• Emotional trauma
• Poor digestion leading to damp-phlegm

Epilepsy involves multiple organs, including the heart, liver, spleen, and kidney, with a common interplay between pathogenic excess (wind, phlegm, stasis) and constitutional deficiency (Qi, Yin). Symptoms appear when wind and phlegm obstruct internal orifices, while remission often reflects underlying organ weakness and phlegm accumulation returning.

Clinical Diagnosis

Seizure types:

• Generalized convulsions: Whole-body spasms, unconsciousness, drooling, tongue biting, incontinence; postictal fatigue and confusion
• Absence (petit mal): Brief loss of awareness without convulsions, lasting seconds
• Psychogenic seizures: Emotional disturbances such as laughing, crying, sleepwalking, temporary dementia-like states
• Focal seizures: Localized muscle contractions

Additional diagnostic clues: family history, brain imaging, EEG.

Differential diagnosis: Distinguish from “Jingfeng” (惊风) “Fright Wind” — febrile convulsions that are not typical epilepsy unless recurrent, though they may evolve into epilepsy over time.

TCM Differentiation & Treatment (辨证论治)

Core Principles

• During seizures: Address pathogenic excess—wind, phlegm, stasis—using treatments to pacify wind, dissolve phlegm, and open orifices.
• Post-seizure recovery: Build constitutional deficiency—nurture spleen, heart, kidney, Qi, and Yin to consolidate health.

Four TCM Patterns & Treatments

1. 惊痫 (Fright-type epilepsy): Caused by shock/fright. Treat with calming formulas such as 镇惊丸 and herbs like fu shen, pearl, zhensha.
2. 痰痈 (Phlegm-congested type): Excess phlegm obstructing orifices. Treat with formulas like 涤痰汤 and herbs like banxia, chenpi.
3. 风痫 (Wind-type epilepsy): Internal wind and liver issues. Treat with wind-extinguishing formulas such as 定痫丸 and herbs like tianma, gou teng.
4. 瘀痫 (Stasis-type epilepsy): From trauma or injury causing blood stasis. Treat with blood-activating formulas like 通窍活血汤 with herbs such as peach kernel, chuanxiong.

During remission, herbal formulations focus on strengthening the child according to dominant deficiency patterns—spleen, heart, liver, kidney.

Other Treatments & Modern Support

Patent medicines:

• 朱砂安神丸 for fright-type
• 癇痫白金丸 for phlegm-type
• 镇痈片 for phlegm-related spasms

Non-pharmacological treatments:

• Acupuncture: Different points and techniques for acute attacks vs. remission
• Ear acupuncture: Stimulating brain and heart points
• Tuina massage: Specific zones and maneuvers, e.g., “推三关”, “退六腑”

Western medical interventions: For acute seizures, include airway protection, oxygen, anticonvulsants (e.g., diazepam, phenobarbital, phenytoin), management of electrolytes, and prevention of hypoglycemia or cerebral edema.

Preventive Care & Nursing

Prevention:

• Ensure maternal and perinatal health
• Avoid trauma and infections
• Treat febrile convulsions promptly
• Maintain safety to prevent head injury
• Support emotional well-being

During seizure:

• Do not restrain limbs
• Turn the child’s head to the side
• Protect teeth and airway
• Suction phlegm if necessary

Ongoing care:

• Manage diet and emotions
• Avoid seizure triggers
• Ensure consistent medication
• Supervise activities to prevent accidents

Research & Evidence

Clinical studies from the 1990s reported positive outcomes with TCM formulas:

• 105 cases treated with TCM, over 85% efficacy
• Capsule medicine treatment reported ~97% effectiveness

While these studies are dated, they provide historical evidence supporting TCM interventions alongside modern care.

Summary & Context

This post outlines traditional Chinese medical views and therapies for pediatric epilepsy, combining classical TCM theory, herbal prescriptions, manual therapies, and integration with Western emergency treatments. The approach emphasizes a holistic, phase-based method: managing acute attacks while later strengthening the child’s constitution to prevent recurrence and improve long-term outcomes.