CN113288958B - Pharmaceutical composition for treating epilepsy - Google Patents

Pharmaceutical composition for treating epilepsy Download PDF

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CN113288958B
CN113288958B CN202110546869.6A CN202110546869A CN113288958B CN 113288958 B CN113288958 B CN 113288958B CN 202110546869 A CN202110546869 A CN 202110546869A CN 113288958 B CN113288958 B CN 113288958B
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pharmaceutical composition
epilepsy
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CN113288958A (en
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杨旭红
郑丽君
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Teaching Hospital of Chengdu University of TCM
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18Magnoliophyta (angiosperms)
    • A61K36/185Magnoliopsida (dicotyledons)
    • A61K36/23Apiaceae or Umbelliferae (Carrot family), e.g. dill, chervil, coriander or cumin
    • A61K36/233Bupleurum
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/02Medicinal preparations containing materials or reaction products thereof with undetermined constitution from inanimate materials
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/56Materials from animals other than mammals
    • A61K35/618Molluscs, e.g. fresh-water molluscs, oysters, clams, squids, octopus, cuttlefish, snails or slugs
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/56Materials from animals other than mammals
    • A61K35/62Leeches; Worms, e.g. cestodes, tapeworms, nematodes, roundworms, earth worms, ascarids, filarias, hookworms, trichinella or taenia
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K35/00Medicinal preparations containing materials or reaction products thereof with undetermined constitution
    • A61K35/56Materials from animals other than mammals
    • A61K35/63Arthropods
    • A61K35/64Insects, e.g. bees, wasps or fleas
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18Magnoliophyta (angiosperms)
    • A61K36/185Magnoliopsida (dicotyledons)
    • A61K36/23Apiaceae or Umbelliferae (Carrot family), e.g. dill, chervil, coriander or cumin
    • A61K36/238Saposhnikovia
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18Magnoliophyta (angiosperms)
    • A61K36/185Magnoliopsida (dicotyledons)
    • A61K36/48Fabaceae or Leguminosae (Pea or Legume family); Caesalpiniaceae; Mimosaceae; Papilionaceae
    • A61K36/484Glycyrrhiza (licorice)
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18Magnoliophyta (angiosperms)
    • A61K36/185Magnoliopsida (dicotyledons)
    • A61K36/65Paeoniaceae (Peony family), e.g. Chinese peony
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18Magnoliophyta (angiosperms)
    • A61K36/185Magnoliopsida (dicotyledons)
    • A61K36/71Ranunculaceae (Buttercup family), e.g. larkspur, hepatica, hydrastis, columbine or goldenseal
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18Magnoliophyta (angiosperms)
    • A61K36/185Magnoliopsida (dicotyledons)
    • A61K36/74Rubiaceae (Madder family)
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K36/00Medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicines
    • A61K36/18Magnoliophyta (angiosperms)
    • A61K36/88Liliopsida (monocotyledons)
    • A61K36/888Araceae (Arum family), e.g. caladium, calla lily or skunk cabbage
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P21/00Drugs for disorders of the muscular or neuromuscular system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00Drugs for disorders of the nervous system
    • A61P25/08Antiepileptics; Anticonvulsants
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00Drugs for disorders of the nervous system
    • A61P25/14Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2236/00Isolation or extraction methods of medicinal preparations of undetermined constitution containing material from algae, lichens, fungi or plants, or derivatives thereof, e.g. traditional herbal medicine
    • A61K2236/30Extraction of the material
    • A61K2236/33Extraction of the material involving extraction with hydrophilic solvents, e.g. lower alcohols, esters or ketones
    • A61K2236/331Extraction of the material involving extraction with hydrophilic solvents, e.g. lower alcohols, esters or ketones using water, e.g. cold water, infusion, tea, steam distillation, decoction
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02ATECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
    • Y02A50/00TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
    • Y02A50/30Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Abstract

The invention discloses a pharmaceutical composition for treating epilepsy, which is prepared from the following raw materials in parts by weight: 10-20 parts of radix bupleuri, 14-26 parts of rhizoma acori graminei, 21-39 parts of uncaria, 21-39 parts of keel, 21-39 parts of oyster, 21-39 parts of radix paeoniae alba, 7-13 parts of radix sileris, 10-20 parts of fried stiff silkworm, 10-20 parts of earthworm and 3-7 parts of liquorice. The composition has a remarkable effect on treating epilepsy, has the effects of improving symptoms and reducing or controlling attack on part of intractable epilepsy, can exert a synergistic effect with anti-epilepsy western medicines when being used for the status epilepticus, and simultaneously promotes the recovery of patients. Compared with western medicines, the composition is safer, has no obvious toxic or side effect in long-term clinical application, has no side effects such as cognitive impairment, language dysfluencies, dizziness and the like, has no teratogenic effect, and has a clinical application prospect.

Description

Pharmaceutical composition for treating epilepsy
Technical Field
The invention particularly relates to a pharmaceutical composition for treating epilepsy.
Background
Epilepsy (epilepsy), commonly known as epilepsy, "epilepsy", is a chronic disease with repeated attacks, and needs to be treated by taking medicines for a long time, common antiepileptic medicines have more side effects, common side effects include gastrointestinal tract reaction, dizziness, headache, somnolence, double shadows of visual objects, ataxia of limb activities and the like, for example, the side effect of valproic acid is weight gain, chronic cognition, memory and behavior change, a few have serious hepatotoxicity, pancreatitis may occur, the interaction of medicines is obvious, chronic tissue and cognitive toxicity exist, and teratogenic effect exists; phenobarbital has sedative side effect, can occasionally cause connective tissue damage, has withdrawal reaction and has teratogenic effect; ethosuximide occasionally has gastrointestinal reactions; initial doses of carbamazepine are prone to neurotoxic effects, have microsomal enzyme induction, can cause exacerbations, and have potential cognitive toxicity, while exfoliative dermatitis is the most serious side effect of carbamazepine. The side effects of phenytoin sodium can cause neurotoxicity, connective tissue abnormality, gastrointestinal tract reaction and teratogenesis. The side effects of the novel antiepileptic drug are obviously reduced, but still have a plurality of side effects, for example, oxcarbazepine still has serious adverse reactions such as exfoliative dermatitis and the like, topiramate influences cognition and causes weight loss, and the common side effect of lamotrigine is rash and the like.
According to epidemiological data, the incidence rate of epilepsy in people is about 50-70/10 ten thousand, the prevalence rate is about 5% -7%, and according to the ratio, about 65-70 ten thousand patients with epilepsy occur each year in China, more than 600 patients with epilepsy exist in China, wherein about 25% -30% of patients have poor response to drugs, and the epilepsy is called drug-resistant epilepsy (also called refractory epilepsy). The treatment of drug-resistant epilepsy is a worldwide problem, and the curative effect of the original first-line medicine or the existing novel antiepileptic medicine is not good enough, so that the search for a new antiepileptic medicine and a treatment target becomes necessary.
Disclosure of Invention
In order to solve the problems, the invention provides a pharmaceutical composition for treating epilepsy, which is prepared from the following raw materials in parts by weight: 10-20 parts of radix bupleuri, 14-26 parts of rhizoma acori graminei, 21-39 parts of uncaria, 21-39 parts of keel, 21-39 parts of oyster, 21-39 parts of radix paeoniae alba, 7-13 parts of radix sileris, 10-20 parts of stiff silkworm, 10-20 parts of earthworm and 3-7 parts of liquorice.
Further, the traditional Chinese medicine is prepared from the following raw material medicines in parts by weight:
15 parts of bupleurum, 20 parts of acorus gramineus, 20 parts of uncaria, 30 parts of dragon bone, 30 parts of oyster, 20 parts of white paeony root, 10 parts of divaricate saposhnikovia root, 15 parts of stiff silkworm, 15 parts of earthworm and 5 parts of liquorice.
Furthermore, the bupleurum root is the bupleurum root of bamboo leaves; the Bombyx Batryticatus is parched Bombyx Batryticatus.
Furthermore, the traditional Chinese medicine preparation is a preparation prepared by taking medicinal powder of raw material medicines or water or organic solvent extracts of the raw material medicines as active ingredients and adding pharmaceutically acceptable auxiliary materials.
Still further, the formulation is an oral formulation.
Further, the oral preparation is granules, powder, pills or solution.
The invention also provides a preparation method of the pharmaceutical composition, which comprises the following steps:
(1) weighing the raw material medicines according to the mixture ratio;
(2) grinding the raw materials into powder, or extracting with water or organic solvent, and adding pharmaceutically-acceptable adjuvants or auxiliary components.
The invention also provides application of the pharmaceutical composition in preparing a medicament for treating epilepsy.
Further, the medicine is a medicine for calming wind and arresting convulsion.
The invention finally provides the use of the aforementioned pharmaceutical composition for the preparation of a medicament for the treatment of tic disorders.
The invention is improved from a hospital preparation Qinggan Ningxian tablet which is applied for decades by neurology of subsidiary hospitals of Chengdu Chinese medicine university. When the liver-clearing epilepsy-relieving tablet is clinically used, the product is found to have increased seizure risk for partial epilepsy patients. Meanwhile, animal experiments prove that the natural indigo which is one of the main components of the preparation increases the death and seizure risks of animals, therefore, the preparation is improved, the natural indigo is removed, and the components such as the acorus calamus, the uncaria and the like are added to form a new prescription, so that the preparation has better curative effect in clinical application, and the risk of increasing the seizure is obviously reduced.
In the pharmaceutical composition, the radix bupleuri, the rhizoma acori graminei and the uncaria rhynchophylla are used as main medicines, the pharmaceutical composition has the effects of clearing fire, reducing phlegm, inducing resuscitation and stopping wind, the dragon bone and the oyster are used for suppressing hyperactive yang and stopping wind, the stiff silkworm and the earthworm are used for reducing phlegm, dredging collaterals and stopping wind, the radix paeoniae alba and the liquorice are used for relieving spasm and preventing convulsion, the effects of inducing resuscitation, reducing phlegm, dredging collaterals and stopping wind, stopping wind and arresting convulsion are achieved, and the rhizoma acori graminei can open the blood brain barrier and lead the medicines to the brain to directly reach the disease. The composition disclosed by the invention is a pure traditional Chinese medicine formula, has an obvious effect on treating epilepsy, has the effects of improving symptoms and reducing or controlling seizures on part of intractable epilepsy, and can play a synergistic effect with antiepileptic western medicines when being used for status epilepticus, and meanwhile, can promote the awakening of a patient. Compared with western medicines, the composition is safer, has no side effects such as cognitive disorder, language disfluency, dizziness and the like in long-term clinical application in treating epilepsy and tic disorder, has no teratogenic effect, and has a clinical application prospect.
It will be apparent that various other modifications, substitutions and alterations can be made in the present invention without departing from the basic technical concept of the invention as described above, according to the common technical knowledge and common practice in the field.
The present invention will be described in further detail with reference to the following examples. This should not be understood as limiting the scope of the above-described subject matter of the present invention to the following examples. All the technologies realized based on the above contents of the present invention belong to the scope of the present invention.
Detailed Description
Example 1 preparation of the medicament of the invention
The formula is as follows: 10g of bupleurum bambusicola, 14g of acorus gramineus, 21g of uncaria, 21g of dragon bone, 21g of oyster, 21g of white paeony root, 7g of divaricate saposhnikovia root, 10g of fried stiff silkworm, 10g of earthworm and 3g of liquorice.
The preparation method comprises the following steps: decocting the above materials in water for 2 times, adding 12 times v/w and ml/g of water for each time, decocting for 2h, and mixing the decoctions.
Example 2 preparation of the inventive medicament
The formula is as follows: 20g of bupleurum chinense, 26g of acorus gramineus, 39g of uncaria, 39g of keel, 39g of oyster, 39g of white paeony root, 13g of divaricate saposhnikovia root, 20g of fried stiff silkworm, 20g of earthworm and 7g of liquorice.
The preparation method comprises the following steps: decocting the above materials in water for 3 times, adding 6 times v/w and ml/g of water for each time, decocting for 1h, and mixing the decoctions.
Example 3 preparation of the inventive Agents
The formula is as follows: 15g of bupleurum chinense, 20g of acorus gramineus, 20g of uncaria, 30g of keel, 30g of oyster, 20g of white paeony root, 10g of divaricate saposhnikovia root, 15g of fried stiff silkworm, 15g of earthworm and 5g of liquorice.
The preparation method comprises the following steps: decocting the above materials in water for 2 times, adding 8 times v/w (volume) and ml/g (volume) of raw materials, decocting for 1.5 hr, and mixing decoctions.
The advantageous effects of the present invention will be described below by way of test examples.
Test example 1 clinical test
1 data and method
1.1 clinical data
60 newly diagnosed primary epilepsy (tonic-clonic seizures) patients who received treatment in subsidiary hospitals of Chengdu traditional Chinese medicine university from 1 month to 2019 month in 2017 were selected as study objects and divided into an experimental group (n ═ 30) and a control group (n ═ 30) according to a random digital table method. In the experimental group, 14 males and 16 females are selected; age 18-63 years, mean age (39.21 ± 6.58) years; the course of disease is 3-23 months, and the average course of disease (10.34 +/-2.17) months. In the control group, 17 men and 13 women; age 19-65 years, mean age (41.02 ± 5.67) years; the course of the disease is 2-26 months, and the average course of the disease (11.05 +/-2.2-74) months. The clinical baseline data of two groups of patients were compared, and the difference was not statistically significant (P > 0.05). All patients gave informed consent and the study was approved by the ethical committee.
Inclusion criteria were: the symptoms, physical signs and the like all accord with the diagnosis standard in 'latest clinical diagnosis and treatment guidelines for epilepsy, opportunity and challenge coexistence'; ② the first diagnosis is primary epilepsy (forced-clonic attack); and the number of attacks per month is not less than 2.
Exclusion criteria: firstly, the symptoms of a focal nervous system and the dysfunction of liver and kidney are accompanied; ② the major diseases or malignant tumors of organs such as heart and kidney, blood and immune system; there are contraindications or allergies to the drugs involved in this study; patients in pregnancy or lactation; fifthly, the medicine has cognitive disorder or mental disease.
1.2 methods of treatment
The control group is orally administered with sodium valproate sustained release tablet (Xenoffy pharmaceutical Co., Ltd., national drug Standard H20010595) at a dose of 500mg/d, 1 time/d, 500mg/d every 7d, and the maximum dose is no more than 1500 mg/d. Experimental group for the treatment of Bupleurum, acorus calamus and uncaria decoction, the prescription composition is as follows: 15g of bupleurum chinense, 20g of acorus gramineus, 20g of uncaria, 30g of dragon bone, 30g of oyster, 20g of white paeony root, 10g of divaricate saposhnikovia root, 15g of fried stiff silkworm, 15g of earthworm and 5g of liquorice are decocted with water for administration, and the decoction is taken 1 dose/d in the morning and evening for 2 times. Both groups continued for 24 weeks.
1.3 Observation index
The clinical curative effect, the effective rate of treatment and the incidence rate of adverse reaction of two groups of patients are compared. The clinical curative effect is as follows: the effect is shown: the frequency of epileptic seizures is reduced by over 75%; the method has the following advantages: the seizure frequency is reduced by 50 to 75 percent; and (4) invalidation: the frequency of epileptic seizures is reduced by less than 50%. Effective rate (%) is (effective + effective)/total number of cases.
1.4 statistical methods
Statistical analysis of the data from this study was performed using software SPSS 18.0. The data are measured as mean + -standard deviation
Figure BDA0003073831620000041
Representing, adopting t test analysis; count data are expressed as% and analyzed using the x2 test. Statistical results in P<0.05 indicates that the comparison difference is statistically significant.
2 results
2.1 comparison of clinical efficacy
The effective rate of the treatment in the experimental group is 73.33% (significant effect and effective effect are respectively 9 cases and 13 cases), the effective rate of the treatment in the control group is 76.67% (significant effect and effective effect are respectively 12 cases and 11 cases), and the difference between the two groups has no statistical significance (P is more than 0.05), which is shown in table 1.
TABLE 1 comparison of clinical and effective treatment rates of two groups of patients
Figure BDA0003073831620000042
2.2 incidence of adverse reactions
2 cases of mild diarrhea are observed in the experimental group, the diarrhea occurs 2-3 times per day, the tolerance is realized, the medicine is not stopped taking, and the incidence rate of adverse reactions is 6.67%; in the control group, nausea was observed in 4 cases, liver function was slightly damaged in 1 case, sleepiness was observed in 1 case during the day, and memory was decreased in 2 cases, which were all tolerated without stopping taking the drug, and the incidence rate of adverse reactions including side effects such as cognitive impairment, language dysfluencies, dizziness and the like was 26.67%. The difference between the two groups was statistically significant (P < 0.05).
In conclusion, the composition has a remarkable effect in treating epilepsy, has the effects of improving symptoms and reducing or controlling seizures on part of intractable epilepsy, and can play a synergistic effect with antiepileptic western medicines when being used for the status epilepticus and simultaneously promote the awakening of patients. Compared with western medicines, the composition is safer, has no side effects such as cognitive disorder, language dysfluencies, dizziness and the like in long-term clinical application in treating epilepsy and tic disorder, has no teratogenic effect, and has a clinical application prospect.

Claims (7)

1. A pharmaceutical composition for treating epilepsy, comprising: the traditional Chinese medicine is prepared from the following raw materials in parts by weight: 10-20 parts of bupleurum falcatum, 14-26 parts of acorus gramineus, 21-39 parts of uncaria, 21-39 parts of keel, 21-39 parts of oyster, 21-39 parts of white peony root, 7-13 parts of divaricate saposhnikovia root, 10-20 parts of fried stiff silkworm, 10-20 parts of earthworm and 3-7 parts of liquorice.
2. The pharmaceutical composition of claim 1, wherein: the traditional Chinese medicine is prepared from the following raw materials in parts by weight:
15 parts of bupleurum, 20 parts of grassleaf sweelflag rhizome, 20 parts of uncaria, 30 parts of dragon bone, 30 parts of oyster, 20 parts of white paeony root, 10 parts of divaricate saposhnikovia root, 15 parts of fried stiff silkworm, 15 parts of earthworm and 5 parts of liquorice.
3. The pharmaceutical composition according to claim 1 or 2, characterized in that: the preparation is prepared by taking medicinal powder of raw material medicines, or water or organic solvent extracts of the raw material medicines as active ingredients and adding pharmaceutically acceptable auxiliary materials.
4. The pharmaceutical composition of claim 3, wherein: the preparation is an oral preparation.
5. The pharmaceutical composition of claim 4, wherein: the oral preparation is granules, powder, pills or solution.
6. A process for preparing a pharmaceutical composition according to any one of claims 1 to 5, characterized in that: it comprises the following steps:
(1) weighing the raw material medicines according to the proportion of claim 1;
(2) grinding the raw materials into powder, or extracting with water or organic solvent, and adding pharmaceutically-acceptable adjuvants or auxiliary components.
7. Use of a pharmaceutical composition according to any one of claims 1 to 5 in the manufacture of a medicament for the treatment of epilepsy.
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