THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 12, Number 7, 2006, pp. 673–677

© Mary Ann Liebert, Inc.

CASE REPORT

Traditional Chinese Medicine Treatment of Epilepsy

YASUYO HIJIKATA, M.D., Ph.D.,1 AKIHIRO YASUHARA, M.D., Ph.D.,2 YUKA YOSHIDA, M.D.,2
and SEISHIRO SENTO, M.D., Ph.D.3

ABSTRACT

Objectives: To evaluate the effectiveness of traditional Chinese medicine, specifically the traditional herbal
formulation Bu-yang-huan-wu-tang, for treating epilepsy stemming from cerebrovascular dysfunction.
Subjects: Three adult patients with epilepsy refractory to standard antiepileptic medications were involved.
Results: All three showed substantial improvement in the frequency and severity of seizures after Bu-yang-
huan-wu-tang was added to conventional medical treatment.
Conclusions: Decrease of seizure frequency and severity in three epileptic patients was achieved by adding
Bu-yang-huan-wu-tang to conventional therapy according to the principles of Traditional Chinese Medicine
(TCM) theory. This treatment mainly relied on the resolution of blood stagnation in cerebrovascular systems.
Blood stagnation is an important underlying pathology of many disease processes according to TCM theory.

INTRODUCTION treat patients with epilepsy who were diagnosed according

to the four diagnostic procedures of TCM: Interrogation, In-

C onventional medical treatments for epilepsy are not uni-

formly effective and can cause unpleasant side effects.1
The Traditional Chinese Medicine (TCM), Bu-yang-huan-
wu-tang, (BYHWT), has been used in China for more than
100 years to treat strokes and their sequelae.2 The origina-
tor of BYHWT, Wang Qing-Ren, believed hemiplegic pa-
tients suffering a stroke lose five-tenths of the body’s yang
qi, and BYHWT would improve their condition. Accord-
ingly, the Chinese name actually means “Fortify the yang
to restore the five-tenths decoction.”
According to TCM theory, BYHWT is qi-tonic, acts to in-
vigorate blood circulation and eliminate blood stasis, and
promotes movement in channels and collaterals.2,3 Because
we thought patients with epilepsy might have similar patho-
physiology, “so-called Blood Stagnation in TCM theory,”
we used BYHWT, or a modified version of this formula, to
spection (includes tongue diagnosis), Auscultation/Olfac-
tion, and Pulse/Palpation (4).
BYHWT formula contains Angelica sinensis-radix
(dang gui) 3.5 g, Paeonia veitchii-radix (chi shao yao) 3
g, Ligusticum chuanxiong-radix (chuan xiong) 3 g, Prunus
persica-semen (tao ren) 4 g, and Carthamus tinctorius-
flos (hong hua) 2 g, which invigorate blood to eliminate
stasis. Pheretima aspergillum (di long) 1.5 g is also a com-
ponent to promote movement in channels and collaterals.
Finally, a qi-tonic herb, Astragalus membranaceus-radix
(Huang Qi) 9 g, which corrects qi deficiency, is also in-
cluded (numerals designate grams of intake per day).5,6,7,8
P. aspergillum (di long)—earthworm—has a long tradi-
tion of use for treating epilepsy, particularly in the Heibei
district in China, and has traditionally been used as an-
tifebrile agent in Japan.

1Toyodo Hijikata Clinic, Osaka, Japan.

2Department of Pediatrics, Kansai Medical University Kohri Hospital, Osaka, Japan.
3Sento Clinic, Tokyo, Japan.

673
674
CASE 1
A 24-year-old woman was born with Moyamoya disease,
a cerebrovascular occlusive disorder, which required angio-
plasty at 1 year of age. Antiepileptic drugs given after age
17 years generally provided seizure control except around
the time of menses, during which seizure frequency in-
creased dramatically in spite of good drug compliance. At
age 24, when she went abroad, she had severe uncontrol-
lable exacerbation of tonic seizures. She was hospitalized in
a local emergency hospital for 2 weeks. She came back to
Japan and suffered from status epilepticus again. She was
hospitalized and treated with lidocaine, sodium valproate
(VPA), phenytoin (PHT), and zonisamide (ZNS) with reso-
lution of generalized seizures. However, the tonic seizures
of her limbs continued for almost a week until BYHWT was
added. She was diagnosed as suffering from Blood stasis, a
TCM diagnosis based on catamenial seizure and presenta-
tion of a dark vena sublingualis. Further complications ac-
cording to TCM diagnosis were yang and qi-deficiency
(Spleen and Kidney) based on her intolerance of cold, pale
tongue body color, appetite loss, nausea, constipation, and
a thready, weak pulse. In addition, Blood deficiency was
also diagnosed, based on her presentation of a pale face and
tongue body color at the time of hospitalization.9 The sever-
ity level of her tonic seizures was expressed as symptom
score in the footnote of Figure 1 (4: very severe, 3: severe,
2: moderately severe, 1: mild based on duration and fre-
quency of tonic seizures). Figure 1 shows her prompt im-
provement in the severity level of tonic seizures except
4 brain
3
Symptom score
0
November December
2000
Antiepileptic drugs
Menstruation
Buyang-hai-wu-tang
Symptom Score: 4, very severe; 3, severe; 2, moderately severe; 1, mild
FIG. 1.
HIJIKATA ET AL.
around the time of menses (January 2001) after treatment
with BYHWT was initiated. Catamenial seizure exacerbation
had been slower to respond to all treatments until initiation
of BYHWT. Soon after initiation of BYHWT intake, catame-
nial seizure decreased dramatically. Although not shown in
Figure 1, a large part of the patient’s 76-day hospital course
was complicated by stomach upset with nausea and
anorexia. After approximately 2 months of BYHWT treat-
ment, her appetite improved substantially. This was attrib-
uted to the spleen qi-tonic effects of A. membranaceus-radix
(huang qi). According to TCM, spleen qi is responsible for
the capacity to digest food and fluid. Since hospital dis-
charge, the patient has been well and seizure-free even dur-
ing menstruation using the combination of conventional
therapy and BYHWT.
CASE 2
A 37-year-old woman was diagnosed with hemiplegia–
hemiconvulsion–epilepsia syndrome based on electroen-
cephalography (EEG) and magnetic resonance imaging
(MRI) result in the second year of life. Her seizures were
accompanied periodically by sudden collapse. She also suf-
fered from left hemiplegia and mild retardation. EEG
showed left low amplitude with rare sporadic spike and fre-
quent spikes in both frontal lobes. MRI demonstrated left
cerebral ventricular enlargement, prominent left cerebral
lobe atrophy, and a poorly branched middle cerebral artery.
Conventional drug therapy was effective initially, although
after bathing
Tonic seizure
January February March
2001
Change in scores for tonic seizures (Case 1).
CHINESE MEDICINE TREATMENT OF EPILEPSY
fatigue and stress caused increased seizure frequency. Ulti-
mately, however, she was experiencing several seizures a
day even when feeling well and compliant with multiple
antiepileptic drugs, including VPA, ZNS, clorazepate
dipotassium (a kind of benzodiazepine), PHT, and potas-
sium bromide. BYHWT was added to her conventional drugs
because she was diagnosed as having Blood Stagnation by
virtue of her cerebrovascular abnormality, dark vena sub-
lingualis, and her intolerance to Cold. Loss of smooth liver
qi flow was diagnosed because her condition was aggravated
by stress. Figure 2 demonstrates the dramatic decrease in
seizure frequency within 2 months of initiating BYHWT, al-
though severe stress continued to induce seizures for some
time. One (1) year after combining BYHWT with conven-
tional drug therapy, she was seizure-free. Her EEG also im-
proved, showing a gradual decline in frontal lobe spikes af-
ter BYHWT was added to her treatment.
CASE 3
A 30-year-old man had an 8-year history of apparent loss
of consciousness with fatigue and stress. Directly before a
seizure, he experienced pallor, cold extremities, sickness,
nausea, and temple pain.
Several evaluations including an EEG ultimately resulted
in a diagnosis of temporal-lobe epilepsy. He was treated with
PHT for more than 2 years, but his consciousness disorder
70
Bu-yang-huan-wu-tang
60
50
40
Seizure
30
20
10
0
January March May
2002
FIG. 2. Change in seizure frequency (Case 2).
675
recurred. According to TCM theory, he was diagnosed to
have Blood Stagnation. This diagnosis was based on his pre-
sentation of shoulder stiffness, temporal pain at the time of
seizures, the dark color of his tongue body, and his intoler-
ance to cold. An additional diagnosis of pathogenic Damp-
ness was based on intake of much water sometimes followed
by nausea. Stagnation of Liver qi was diagnosed with fre-
quent seizures after hard stressful work.
BYHWT was combined with several other herbs appro-
priate for his condition. These were Bupleurum chinensis
(chai hu) (spreads depressed Liver qi), Cinnamomum cas-
sia (Rou Gui) (fortifies yang), Aconitum carmichaeli (fu zi)
(disperses cold and warms channels), Arisaema consan-
guineum (tian nan xing), and Pinellia ternata (ban xia) (both
dry dampness and transform phlegm), Poria cocos (fu ling)
(leaches out Dampness and strengthens the Spleen), and Rhi-
zoma Atractylodis (bai zhu) (tonifying Spleen qi). This mod-
ified version of the traditional formula BYHWT combined
with PHT resulted in almost complete resolution of his com-
plaints. He was disease free for more than 2 years, after
which time he stopped taking modified BYHWT.
DISCUSSION
According to TCM theory, perimenstrual aggravation of
symptoms often signifies Blood stasis. Case 1 demonstrated
resolution of catamenial seizure exacerbations after adequate
July September November January
2003
676 HIJIKATA ET AL.

Tremor
3
2
1
3 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3
Myalgia

3
2
1
3 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3
1993 1994 1995
Air-conditioner Air-conditioner
in classroom in classroom
A + Chinemys reevesii (3 g/day) A

B Liver yin-tonic

C Dry Dampness, expel Phlegm

D Disperse Cold and alleviate pain

Symptom Score: 3, severe beyond endurance; 2, between 3 and 1; 1, moderate; 0, no symptoms

FIG. 3. Clinical course of a patient with porencephaly treated with modified Bu-yang-huan-wu-tang.

treatment with BYHWT. Deterioration in tonic seizures with
menstruation, evacuation, bathing, and brain scintigram may
be due to acute local blood flow disturbances such as tran-
sient microemboli, thrombi, or vasospasm and so on.
In case 2, fatigue and stress aggravated the seizure dis-
order. According to TCM, this indicates that qi deficiency
(fatigue) and stagnated Liver qi (stress) both enhanced the
underlying Blood Stagnation. The addition of BYHWT to
conventional therapy dramatically decreased seizures in
these cases because of its ability to supplement qi and im-
prove blood flow, especially to the brain.
The first two cases were much improved by prescribing
the classic formula BYHWT without modification. This
would appear to indicate that the main underlying cause of
the epilepsy was the Blood Stagnation diagnosed according
to the four diagnostic procedures of TCM as explained
above.
The reason we added various herbs to BYHWT in the third
case was that the patient demonstrated pathogenic symptoms
and signs of phlegm and dampness as well as Blood Stag-
nation, which were not observable in the first two cases that
were mainly aggravated by Blood Stagnation.

TABLE 1. CONSTITUENTS OF HERB GROUP A, B, C, D

Formula A (BYHT added with herbs: numerals designate g/day)
Invigorate channels, tonify Spatholobus suberectus (JiXueTeng) 1
Blood, and promote circulation
Spread depressed Liver qi Bupleurum Chinese (ChaiHu) 1.5
and relieve constraint
Calm and extinguish Wind Gastrodia elata (Tian Ma) 2
Formula B: Yin-tonic Scrophularia ningpoensis (Xuan Shen) 3
Nourish liver Asparagus cochinchinensis (Tian Men Dong) 3
Paeonia lactiflora (Bai Shao Yao) 4
Rehmannia glutinosa (Sheng Di Huang) 3
Amyda sinensis—Carapax (Bie Jia) 4
Formula C: Dry Dampness and transform Arisaema consanguineum (Tian Nan Xing) 2
Phlegm Pinellia ternata (Ban Xia) 3
Poria cocos (Fu Ling) 3
Formula D: Disperse Cold and Alleviate Cinnamomum cassia (Rou Gui)
pain Aconitum carmichaeli (Fu Zi)

BYHT, Bu-yang-huan-wu-tang.
CHINESE MEDICINE TREATMENT OF EPILEPSY
Although another 19-year-old Japanese man with poren-
cephaly did not have epilepsy as in the previous three cases,
he had pain and tremors of his four extremities after exer-
cise or bathing. He also had headache, vomiting, and cold-
ness without abnormal EEG except for porencephaly. This
led to exhaustion followed by hospitalization.
In this case, the patient’s tremor may be considered a side
effect of the conventional therapy. Because two other Japan-
ese siblings with epilepsy (19-year-old man and a 23-year-
old woman) both had similar hand tremor that was treated
with the same conventional therapies and that disappeared
when treated with modified BYHWT (data not shown).
According to TCM diagnosis, the patient with poren-
cephaly had qi deficiency signified by a slightly thready pulse,
perspiration on slight exertion, and aggravation of symptoms
under stressful conditions. He also had Blood Stagnation
marked by a pale purple tongue body, dark vena sublingualis,
and symptoms aggravated by cold. He also displayed an un-
derlying yin deficiency marked by increased dreaming, malar
flush, and perspiration in his palms and underarms. In addi-
tion this patient showed signs of Liver yang rising signified
by a wiry pulse, and an increased tremor when under tension.
The clinical course is shown in Figure 3. As shown in Table
1 formula A:modified BYHWT added with Chinemys reevesi
(gui ban) 3 g to nourish yin and anchor yang tended to de-
crease symptoms, except when the patient was exposed to air
conditioning that cooled his body, making it more prone to
Blood Stagnation. The addition of yin tonic group B to A
C. reevesii seemed to make the patient worse. Finally, For-
mula A added to group C to dry Dampness and transform
Phlegm and group D to disperse cold and alleviate pain seemed
to work dramatically. For this particular patient, the yin-tonic
group including C. reevesii (gui ban) 3 g obviously made the
Blood Stagnation worse because yin tonics are sticky in na-
ture whereas the drying of dampness and dispersing of cold
herbs worked to remove blood stagnation.
Intake of this combination for approximately 1 year ren-
dered this patient completely symptom free, after which he
ceased taking the herbal medicine. To date he remains
well.
CONCLUSIONS
According to TCM theory, epilepsy is often said to be
caused by Liver wind, Heart fire, phlegm, and phlegm with
blood stagnation.10
If we prescribe BYHWT to people with epilepsy caused
by Heart fire, Liver wind, or with much phlegm, the condi-
tion would likely become worse because of the nature of rais-
ing the qi of A. membranaceus-radix (Huang Qi) or of sticky-
natured Angelica sinensis-radix (dang gui).
677
BYHWT should be specifically prescribed to epileptic pa-
tients displaying clinical signs of Blood Stagnation in order
to to improve blood flow, as in the cases we report here.
This is likely to result in amelioration of unpleasant symp-
toms and an improvement in the quality of life in seizure
patients for whom conventional therapy does not provide
satisfactory stabilization of the condition.
TCM theory may be an excellent tool in diagnosis and
treatment to help patients with epilepsy unresponsive to con-
ventional therapies and/or subject to unpleasant side effects
of conventional therapies.
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Address reprint requests to:
Yasuyo Hijikata, M.D., Ph.D.
Toyodo Hijikata Clinic
3-11-29 Kasuga, Ibaraki-shi, Osaka, 567-0031
Japan
E-mail: Hijikata@osb.att.ne.jp