Infantile convulsions is a disorder mostly seen in children under five years of age. It is characterized by paroxysms of involuntary muscular contractions of the limbs, stiffness of the neck or even opisthotonus, and it may be accompanied by disturbance of consciousness.

Convulsions occurring in high fever, epidemic cerebrospinal meningitis, encephalitis B, dysentery, pneumonia and measles complicated by toxic encephalopathy may be differentiated and treated with the principles mentioned in this section.

Etiology and Pathogenesis

Infantile convulsions may be classified into acute and chronic types.

A. The acute type is usually due to the invasion of exogenous evils such as wind, summer-heat, dampness, epidemic pestilent evil, etc., which cause the formation of heat and fire and the production of phlegm and wind or the stagnation of food with the formation of phlegm-fire attacking the heart and inducing liver-wind. In short, accumulation of phlegm-heat causing hyperactivity of liver-wind and disturbance of the pericardium are responsible for the pathogenesis, and the positions involved are the heart and liver meridians.

B. The chronic type is often caused by long-term vomiting and diarrhea or overuse of bitter-cold drugs leading to the deficiency of the spleen and stomach, hyperactivity of liver-yang and exhaustion of kidney-yang and, consequently, the dysfunction of the spleen. It may also result from the consumption of body fluids and kidney-yin after a long period of fever, leading to insufficiency of liver-blood and irritation of endogenous wind. Hence, the positions involved are the liver, spleen and kidney meridians.

ACUTE INFANTILE CONVULSIONS

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) The prodromal symptom: Fever, irritability, muscular twitching, tightening of the mouth, teeth grinding, somnolence, etc., are common to acute infantile convulsions.  

(b) The characteristics of symptoms: All symptoms are attributable to yang, sthenia, and heat-syndrome, such as sudden onset of high fever, loss of consciousness, abundant expectoration, muscular spasms, stiffness of neck, lockjaw, etc., which have been summarized as four categories, i.e., phlegm, heat, spasm and wind.

(c) Differentiation between interior and superficies syndrome: A superficies-syndrome manifests as fever, headache, no or little sweating, nasal stuffiness, runny nose, red tongue with thin, white coating and floating and rapid pulse. An interior-syndrome appears as high fever, irritability, sweating, thirst, discharge of foul stool or constipation, red tongue with dry yellow coating and rapid pulse. In the syndrome involving both the superficies and the interior, symptoms include high fever, no or little sweating, irritability, thirst, yellow urine, red tongue with yellowish coating and floating and rapid pulse.

(d) Identification of the severity of the disease: The case is mild when the convulsive seizures are not frequent, mild and last for a short time, and the loss of consciousness, if present, is transient. In serious cases, the seizures are frequent, last for a long period occur abruptly, and they are accompanied by high fever, loss of consciousness and wheezing sounds in the throat. In critical cases, there may appear deadly cold limbs, dyspnea, abundant expectoration, gray complexion and feeble and thready pulse. In general, those with superficies-syndrome are mostly mild cases, while those with interior-syndrome, especially those with involvement of yingfen and xuefen, are serious.

B. Therapeutic principles

The therapy of clearing away heat, eliminating phlegm, relieving convulsion and suppressing wind are the general principles for the disorder.

Classification and Treatment

A. Disease of exogenous wind

Manifestations: Fever, headache, nasal stuffiness, runny nose, cough, redness of the throat, loss of consciousness, convulsions, upward staring of the eyes, lockjaw, red tongue with thin and white or yellowish coating and floating and rapid pulse.

Therapeutic principles: Expel wind-heat, relieve convulsion, and suppress wind.

Prescription: The Modified Powder of Forsythiae and Lonicerae

Flos Lonicerae 10 g
Fructus Forsythiae 10 g
Herba Menthae (decocted) 3 g
Spica Schizonepetae 6 g
Fructus Arctii 10 g
Radix Platycodi 6 g
Herba Lophatheri 10 g
Rhizoma Phragmitis 15 g
Ramulus Uncariae cum Uncis 10 g
Bombyx Batryticatus 6 g
Periostracum Cicadae 3 g

Remarks: Add Radix Scutellariae (6 g) and Gypsum Fibrosum (decocted, 30 g) for cases with high fever. Add Rhizoma Arisaema cum Bile (5 g) for those with profuse sputum. Add Caulis Bambusae in Taeniam (10 g) and Pericarpium Citri Reticulatae (6 g) for those with vomiting. Add Radix et Rhizoma Rhei (10 g) for those with constipation. Add Cornu Saigae Tataricae powder (1 g) and Pulvis Cornu Rhinocerotis (2 g) for cases with ecchymoses or petechiae.

B. Disease of summer-heat

Manifestations: Fever, sweating, somnolence, stiffness of neck, nausea, vomiting, headache, aversion to wind followed by loss of consciousness and convulsions, red tongue with yellow, greasy coating and floating-soft pulse.

Therapeutic principles: Clear away summer-heat and superficial evils, relieve convulsions, and suppress wind.

Prescription: The Modification of Elsholtziae seu Moslae Decoction with Additions

Herba Elsholtziae seu Moslae 6 g
Cortex Magnoliae Officinalis 6 g
Semen Dolichoris 10 g
Flos Lonicerae 10 g
Fructus Forsythiae 10 g
Folium Isatidis 10 g
Rhizoma Acori Graminei 10 g
Ramulus Uncariae cum Uncis 10 g
Polvis Cornu Saigae Tataricae (mixed with the decoction) 1.5 g

Remarks: Add Radix et Rhizoma Rhei (5 g, decocted) and Natrii Sulfas Exsiccatus (5 g, mixed with the decoction) for those with constipation and dry, yellow tongue coating. Add Bolus of Precious Drugs (half bolus twice a day) for those with loss of consciousness.

C. Disease of dampness-heat and pestilent evil

Manifestations: Sudden onset of high fever, coma, irritability or delirium, frequent episodes of convulsions, vomiting, abdominal pain, discharge of thin odorous stool or purulent and bloody stool, red tongue with yellow coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat and toxic materials, eliminate dampness, and suppress wind.

Prescription: The Modification of Coptidis Decoction for Detoxification

Rhizoma Coptidis 1 g
Radix Scutellariae 10 g
Cortex Phellodendri 6 g
Fructus Gardeniae 6 g
Ramulus Uncariae cum Uncis 10 g
Scorpio 1.5 g

Remarks: Add Pill of the Jade Pivot (0.5 to 1.0 gram twice a day) for cases with vomiting. Add Radix Pulsatillae (10 g), Cortex Fraxini (10 g), Herba Portulacae (10 g) and Radix Aucklandiae (3 g) for those with bloody and purulent stool. Add Radix Ginseng (10 g) and Radix Aconiti Lateralis Praeparata (10 g) for those with collapse-syndrome, i.e., pale complexion, dyspnea, coldness of limbs and feeble and thready pulse.

D. Accumulation of phlegm and stagnation of food

Manifestations: Poor appetite, vomiting, abdominal pain and distention, discharge of odorous stool or constipation at the onset, followed by fever, loss of consciousness, convulsions, wheezing sounds in the throat, noisy breathing, red tongue with yellow, greasy coating and wiry and smooth pulse.

Therapeutic principles: Relieve dyspepsia, clear away phlegm, and relieve convulsions.

Prescription: The Modified Pill of Promoting Digestion

Fructus Crataegi 10 g
Massa Fermentata Medicinalis 10 g
Fructus Hordei Germinatus 10 g
Semen Raphani 6 g
Pericarpium Citri Reticulatae 6 g
Rhizoma Pinelliae 10 g
Fructus Forsythiae 10 g
Poria 10 g
Rhizoma Coptidis 1 g
Rhizoma Arisaema cum Bile 5 g
Radix Curcumae 6 g
Ramulus Uncariae cum Uncis 10 g
Scorpio 1.5 g

Remarks: Add Pill of Jade Pivot for cases with vomiting. Add Radix et Rhizoma Rhei (5 g, decocted), Natrii Sulfas (5 g, mixed with the decoction) for those with wheezing sounds in the throat, abdominal pain and distention and constipation.

CHRONIC INFANTILE CONVULSIONS

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

As a whole, chronic infantile convulsions are characterized by insidious onset and convulsive seizures of mild degree occurring at intervals, or it is manifested as head staggering, muscular twitching of the face or muscular spasms of a single limb. The cases associated with low fever, restlessness, flushed cheeks, thirst, dryness of lips and throat and smooth and uncoated tongue are attributed to the consumption of yin. Those accompanied by pale complexion, coldness of limbs, loose stool, clear urine and pale tongue with white coating are attributed to the impairment of yang. In short, the disorder is generally attributable to a cold and an asthenia syndrome. However, some cases complicated by heat and phlegm may manifest themselves as an asthenia-syndrome associated with sthenia-syndrome.

B. Therapeutic principles

Warming middle-jiao and strengthening the spleen are the basic therapeutic principles. For cases with yang deficiency, the therapies of warming yang and dispelling cold are recommended, and for those with yin deficiency, those of nourishing yin, suppressing yang, softening the liver and calming the wind should be adopted. As for those cases with asthenia-syndrome complicated by sthenia-syndrome, those of supporting healthy qi and expelling evil ought to be employed.

Classification and Treatment

A. Spleen deficiency with liver hyperactivity

Manifestations: Mental fatigue, sallow complexion, eye opening during sleep, loose stool, cold limbs, intermittent weak convulsive seizures, pale tongue with white coating and feeble and thready pulse.

Therapeutic principles: Warm and strengthen spleen-yang, support the spleen, and suppress the liver.

Prescription: The Modified Decoction for Regulating the Middle-Jiao

Radix Ginseng 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Rhizoma Zingiberis Praeparata 5 g
Ramulus Uncariae cum Uncis 10 g
Rhizoma Gastrodiae 6 g
Os Draconis 15 g
Concha Ostreae 15 g
Radix Glycyrrhizae Praeparata 3 g

B. Deficiency of spleen-yang and kidney-yang

Manifestations: Mental fatigue, pale complexion, sweating, cold limbs, eye opening during sleep, involuntary movement of hands and feet, loose stool, pale tongue with white coating and deep and thready weak pulse.

Therapeutic principles: Warm and tonify the spleen and kidneys, recuperate the depleted yang, and rescue the patient from danger.

Prescription: The Modified Decoction for Strengthening Kidney-Yang

Radix Ginseng 10 g
Poria 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae Praeparata 6 g
Radix Astragali 15 g
Rhizoma Dioscoreae 15 g
Cortex Cinnamomi 6 g
Radix Aconiti Lateralis Praeparata 15 g
Os Draconis (decocted) 15 g
Concha Ostreae (decocted) 15 g

C. Consumption of liver-yin and kidney-yin

Manifestations: Low fever, emaciation, flushed face, fatigue, restlessness, feverish sensation over palms, soles and the chest, tremors and clonic convulsions of the limbs, constipation, crimson, smooth and dry tongue and thready and rapid pulse.

Therapeutic principles: Nourish yin, suppress yang, soften the liver, and calm the wind.

Prescription: The Modified Bolus for Serious Endogenous Wind-Syndrome

Radix Rehmanniae 10 g
Colla Corii Asini 10 g
Radix Ophiopogonis 10 g
Radix Paeoniae Alba 15 g
Radix Glycyrrhizae Praeparata 6 g
Fructus Cannabis 10 g
Plastrum Testudinis 10 g
Carapax Trionycis 10 g
Concha Ostreae 15 g
Fructus Schisandrae 6 g
Egg yolk 1 pcs

Remarks: Add Radix Stellariae (10 g) and Cortex Lycii Radicis for cases with hectic fever.

D. Asthenia syndrome complicated by phlegm-heat

Manifestations: Intermittent fever, restlessness, loss of consciousness, strabismus, tremors and spasms of the limbs, profuse expectoration, salivation, noisy breathing, red tongue with yellow coating and wiry, thready and rapid pulse.

Therapeutic principles: Clear heart-fire, and eliminate phlegm.

Prescription: The Modified Decoction for Clearing Heart-Fire and Dispersing Phlegm

Rhizoma Coptidis 1 g
Rhizoma Arisaema cum Bile 5 g
Rhizoma Acori Graminei 10 g
Rhizoma Pinelliae 6 g
Poria 10 g
Caulis Bambusae in Taeniam 6 g
Radix Ophiopogonis 10 g
Ramulus Uncariae cum Uncis 10 g
Radix Ginseng 10 g
Semen Ziziphi Spinosae 10 g
Rhizoma Gastrodiae 5 g

Experiential Prescriptions

A. One piece of Fructus Mume for rubbing the teeth; applicable to cases with lockjaw.

B. Fresh Lumbricus; ground to form a paste and mixed with honey or sugar; applied on the fontanelle; applicable during convulsive seizures.

Copyright 1995 Hopkins Technology