Epilepsy

1

• Epilepsy
• TCM Diagnoses and Treatments
• Suddenly falling on the ground,
  unconsciousness, spitting saliva, staring
  upwards, clonic convulsion, or shouting as bleat
  or pig yell, and regaining consciousness some
  time later
• Etiology Pathology
• 1. Mental disorder
• 2. Congenital factors
• 3. Miscellaneous

2

• Main Points for differentiation
• A) Def. or Excess
• Excess
• Wind-phlegm
• Internal phlegm-fire
• Internal blockage of blood stasis
• Def.
• Heart Kidney def.
• Liver kid. Yin def.
• B) Attacking Remission period
• Attacking eliminating phlegm regulating Qi
• Remission Tonify the liver kid. Yin
• C) Yang type Yin Type
• Yang Type Syndrome of excess heat
• Yin Type Syndrome of deficient cold

3
Yang Type Yin type
Good constitution Constitution is not very good, Vital Qi is gradually exhausted
Sudden attack, falling down shout, clonic convulsion spitting, lockjaw, looking upwards with taut, Suffered from frequent attack of epilepsy, pale complexion, dull-witted, unconsciousness, reticent, dumb-struck
Rapid or wiry slippery Deep, wiry or deep slippery
4

• Principles of the treatment
• Treatment must be according to the stage of the
  disease
• Attacking
• or
• Intervals

5

• TCM treatment Principles
• 1. Wake up mind Open the orifice
• 2. Promoting Blood circulation resolve the
  blood stasis
• 3. Resolving the food stagnation clear the
  heat
• 4. Eliminate phlegm arrest convulsion
• 5. Suppress wind arrest convulsion
• 6. Calm emotions tranquilize mind
• 7. Nourish Liver Kidney
• 8. Nourish Spleen tonify Qi

6

• Treatment
• Attacking Stage
• 1). Yang Type epilepsy
• Signs Symptoms
• Main Sym. headache, dizziness, fullness in
  chest, then falling down on the ground
  unconsciously, looking upwards, dark lips,
  lockjaw, rigidity of neck, clonic convulsion, or
  rale of sputum in the air passage, or splitting
  saliva
• Concurrent sym. shouting as bleat or pig yell,
  even fecal urinary incontinence, be conscious
  gradually after the attack stops, daily life goes
  on as usual except that the patient feels tired.
  
• Tongue whitish greasy or yellow
  greasy fur,
• Pulse wiry slippery rapid
• Treatment Protocol
• Removing phlegm-heat
• Suppress wind
• Calm mind arrest convulsion

7

• Formula
• Modifications
• Arrest convulsion
• -- Bai Jiang Can, Quan Xie
  (scorpion),
• Calm mind
• -- Fu Shen, Long Gu, Mu Li, Ci Shi
• Heat
• -- Huang Lian, Ling Yang Jiao Powder

Qin Re Zheng Jing Tang Qin Re Zheng Jing Tang Qin Re Zheng Jing Tang Qin Re Zheng Jing Tang Qin Re Zheng Jing Tang Qin Re Zheng Jing Tang
Shi Jue Ming Zi Shi Yin Gan Jiang San Zhi Zi Mu Tong Da Huang
Long Dan Cao Cai Hu Mai dong Tian Zhu Huang Dan Nan Xin Yuan Zhi
Shi Chang Pu Tian ma Gou Teng
An Gong Niu Huang Wan An Gong Niu Huang Wan An Gong Niu Huang Wan An Gong Niu Huang Wan An Gong Niu Huang Wan An Gong Niu Huang Wan
Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan
8

• Treatment
• Attacking Stage
• 2). Yin Type epilepsy
• Signs Symptoms
• Main Sym. dim sallow complexion, cold limbs,
  unconsciousness, eyes slightly open, with spasm
  of muscles, clonic convulsion
• Concurrent sym. generally no shouting or only
  making a little sound, some transfixed or
  dumb-struck, looking but seeing not, listening
  but hearing not, no moving, no speaking,
  recurring frequently, tired all over after wake,
  recovered gradually
• Tongue light tongue body, whitish and
  greasy fur,
• Pulse deep thready or thready slippery
  
• Treatment Protocol
• Eliminating phlegm
• Warm up Yang Qi
• Arrest convulsion

9

• Formula
• Modifications
• Eliminate phlegm
• -- Dan nan xing, chuan wu, bai fu
  zi, Hei Dou,
• Calm mind
• -- Fu Shen, Long Gu, Mu Li, Ci Shi

Er Chen Tang Er Chen Tang Er Chen Tang Er Chen Tang Er Chen Tang Er Chen Tang
Chen Pi Ban Xia Fu Ling Zhi Gan Cao
Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan
10

• Treatment
• Intermittent Stage
• 1). Spleen Def. with abundant sputum
• Signs Symptoms
• Main Sym. tiredness, asthenia, thin of stature
  weakness, frequent dizziness, dim complexion,
  loss of appetite, loose stools
• Concurrent sym. nausea, vomiting, or feeling of
  fullness in stomach, and stuffiness in
  hypochondrium, or spitting whitish sputum
• Tongue light tongue body, whitish and
  greasy fur,
• Pulse wiry sleppery or soft slippery
• Treatment Protocol
• Eliminating phlegm
• Nourish Spleen

11

• Formula
• Modifications
• Eliminate phlegm
• -- Dan nan xing, Gua Lou
• Vomiting
• -- Zu Ru, Xuan Fu Hua
• loose stools
• -- Yi Ni Ren, Bai Bian Dou
• Calm mind
• -- Shi Chang Pu, Yuan Zhi
• Yellow sputum with yellow greasy fur
• -- Wen Dan Tang

Liu Jun Zi Tang Liu Jun Zi Tang Liu Jun Zi Tang Liu Jun Zi Tang Liu Jun Zi Tang Liu Jun Zi Tang
Dang Shen Bai Zhu Fu Ling Gan Cao Ban Xia Chen Pi
Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan
12

• Treatment
• Intermittent Stage
• 2). Obstruction of wind-phlegm
• Signs Symptoms
• Main Sym. Premonitory sym. as dizziness,
  headache, fullness feeling in chest, asthenia
  before onset, no premonitory sym. In some of the
  patients, suddenly falling down, unconsciousness,
  clonic convulsion spitting saliva when
  attacking, some of the patients are unconscious
  for a while, or absentminded without clonic
  convulsion
• Concurrent sym. maybe screaming when attacking,
  urinary and fecal incontinence, expectorating
• Tongue red or dark red with greasy fur
• Pulse wiry sleppery
• Treatment Protocol
• Eliminating phlegm
• Suppress wind
• Arrest convulsion

13

• Formula
• Modifications
• Arrest convulsion
• -- Quan Xie, Jiang Can
• eliminate phlegm
• -- Zu li, Shi Chang Pu
• Strength Spleen
• -- Chen Pi, Fu Ling
• Calm mind
• -- Hu Po, Yuan Zhi, Fu Shen
• Harmonize middle Jiao
• -- Sheng Jiang, Gan Cao

Ding Jian Wan Ding Jian Wan Ding Jian Wan Ding Jian Wan Ding Jian Wan Ding Jian Wan
Tian Ma Chuan Bei Dan Nan Xing Ban Xia
Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan Su he Xiang Wan
14

• Treatment
• Intermittent Stage
• 3). Liver Kidney Yin def.
• Signs Symptoms
• Main Sym. Frequent recurrence,
  absent-mindedness, dizziness, dry eyes, dark
  complexion, dry and lusterless helix, amnesia,
  insomnia
• Concurrent sym. soreness weakness in the
  lumbar region knees, dry hard stools,
  constipation
• Tongue red body with less fur
• Pulse thready rapid
• Treatment Protocol
• Tonify liver Kidney
• Nourishing heart
• Calm mind

15

• Formula
• Modifications
• Nourish Yin
• -- Gui Ban, Bie Jia
• Eliminate phlegm-heat
• -- Zu Ru, Bei Mu, Tian Zhu Huang
• Irritability
• -- Zu Ye, San Zhi zi, Lian Zi
• Calm mind
• -- Po Zi Ren, Yuan Zhi, Fu Shen, Ci shi
• Dry stools
• -- Dang Gui, Yuan Shen, Huo Ma Ren

Zuo Gui Wan Zuo Gui Wan Zuo Gui Wan Zuo Gui Wan Zuo Gui Wan Zuo Gui Wan
Shu Di Shan Yao Shan Zu Yu Gou Qi Zi Du Zhong Tu Si Zi
Fu Zi Rou Gui Dang Gui Lu Jiao Jiao
16

• Case History
• 1. male 14 years
• Medical history patient suffered from epilepsy
  as a child, onset at intervals of one or several
  months, often caused by terror or nervousness,
  feels fullness in chest dizziness when
  attacking, then shouting, falling down on the
  ground, unconscious, clonic convulsive, lock jaw,
  even biting the tongue, spitting saliva. Attack
  sustained 5-6 minutes, awake gradually
  medication on many occasions. No curative effects
  were obtained.
• First visiting
• Main complain Epilepsy
• Memory was failing, school record decreased,
  felt tired and sluggish.
• Tongue whitish greasy
• Pulse wiry slippery
• TCM diagnose
• obstruction of wind-phlegm
• Treatment protocol
• -- Eliminating phlegm
• -- suppress wind
• --arrest consvulsive
• Formula
• Dan nan xing 10, Tian Zhu Huang 10, Yuan
  Zhi 10, Shi chang Pu 6, Shi jue ming 30, Zi Shi
  Yin 15, Tian Ma 10, Gou Teng 30, Fu Ling 30
• Ding Xian Wan

17

• Stomach-ache
• TCM Diagnoses and Treatments
• Pain in the gastric cavity caused by
  impairment of the spleen stomach and by
  derangement of qi blood
• various kind of pain in the stomach, often
  accompanied with fullness and distention in the
  stomach, eructation, regurgitation of acid and
  food from the stomach, hypochondriac abdominal
  distention, and other symptoms.
• Etiology Pathology
• 1. External pathogenic factors
• Cold Dampness
• 2. Diet
• Quantity of food
• Natural of food
• Conditions of eating
• 3. Emotional problems
• Anger
• Pensiveness worry
• 4. Over-exertion
• 5. Over work
• 6. constitutional weakness
• 7. Wrong Treatment

18

• Main Points for differentiation
• A) Def. or Excess
• Excess (most at initial stage)
• sudden serious pain, tenderness, sever after
  meal, repeat pain,
• Cold invading St.
• Retention of food
• Liv. Qi invading St.
• St.-heat
• St.-Fire
• St.-Phlegm fire
• St.-Damp-heat
• St. Liv. Heat
• Blood stasis in St.
• Phlegm in St.
• Def. (aged)
• chronic pain or repeated attack, preference for
  pressing, relieving after meal or deterioration
  after tiredness, relieving after rest,
• St. Sp. Def. and cold
• St. Yin Def.

19

• Pain in the morning--Pain in the
  afternoon--pain at night
• B) Cold or Heat
• C) Qi or Blood
• Qi distending pain with belching moving pain
  early stage disease
• Blood needling-like or cutting-like pain
  fixed pain chronic disease
• D) St. Liver or Sp

St. Sp. Liv.
Caused by Exo-pathogenic factors Emotional problem
sym,. Distending pain in the chest abdomen, belching, continuous pain, dyschesia, Protracted disease, vague pain in the st. sever when hungry relieving after meal rest, sallow complexion, fatigue, weakness, loose stool Distention pain involved in hypochondriac region, moving pain, wiry pulse
20

• Treatment
• Excess
• 1). Cold invading the stomach
• Signs Symptoms
• Main Sym. Acute epigastric pain with sudden
  onset, chilliness, desire for application of
  warmth on the stomach area, pain not alleviated
  by pressure
• Concurrent sym. aversion to cold, no thirst,
  preference for hot drink, nausea, vomiting,
• Tongue thick-white coating
• Pulse full tight
• Treatment Protocol
• Expel cold
• Warm Stomach
• Stop Pain

21

• Formula
• Modifications
• Severe sym. of cold
• -- Gan Jiang, Wu Zhu Yu
• Distension of Qi
• -- Chen Pi, Mu Xiang
• Exterior sym.
• -- Xiang Fu, Zi Su Ye, Chen pi, Gan Cao
• Oppression of stomach area, no appetite,
  belching vomiting
• -- Zhi Shi, Shen Qu, Ji Nei Jin, Ban Xia,
  Sheng Jiang

Liang Fu Wan Liang Fu Wan Liang Fu Wan Liang Fu Wan Liang Fu Wan Liang Fu Wan
Gao Liang Jiang Xiang Fu
Fu Zi Li Zhong Wan Fu Zi Li Zhong Wan Fu Zi Li Zhong Wan Fu Zi Li Zhong Wan Fu Zi Li Zhong Wan Fu Zi Li Zhong Wan
Fresh Ginger one teaspoon of Barbados sugar Fresh Ginger one teaspoon of Barbados sugar Fresh Ginger one teaspoon of Barbados sugar Fresh Ginger one teaspoon of Barbados sugar Fresh Ginger one teaspoon of Barbados sugar Fresh Ginger one teaspoon of Barbados sugar
22

• Treatment
• Excess
• 2). Food Retention
• Signs Symptoms
• Main Sym. Dull epigastric pain which is worse
  with pressure, feeling of distention fullness,
  belching, sour regurgitation, foul breath,
  vomiting of undigested food, epigastric pain
  relieved after vomiting
• Concurrent sym. loose stools or constipation
• Tongue thick-sticky coating in the
  centre root
• Pulse slippery
• Treatment Protocol
• Resolve food stag.
• Restore the descending of St. Qi
• Stop Pain

23

• Formula
• Modifications
• Feeling of distension
• -- Zhi shi, Sha Ren
• constipation
• -- Da Huang, Hou Pu, Zhi Shi,
• Severe pain which is worse with pressure,
  constipation, dry yellow coating
• -- Da Chen Qi Tang
• Promotes digestion
• -- Ji Nei Jin, Mai Ya

Bao He Wan Bao He Wan Bao He Wan Bao He Wan Bao He Wan Bao He Wan
Shan Zha Shen Qu Lai Fu zi Ban xia Chen Pi Fu Ling
Lian Qiao
24

• Treatment
• Excess
• 3). Liver Qi invading St.
• Signs Symptoms
• Main Sym. Epigastric distention pain
  radiating towards the right or left
  hypochondrium, belching, uncomfortable feeling of
  hunger, the pain comes in bouts clearly related
  to emotional tension.
• Concurrent sym. sighing, irritability
• Tongue normal body color or slightly
  red sides
• Pulse wiry
• Treatment Protocol
• Soothe the liver
• Regular the Qi
• Stop Pain

25

• Formula
• Modifications
• Severe pain
• -- Yan Hu Suo
• Belching, hiccup, nausea
• -- Fu Shou, Chen Xiang, Xuan Fu Hua
• Stag. Of liv. Qi leads to Liv. Fire
• -- Mu dan pi, Shan Zhi Zi, Chai Hu, Bai shao
• Liv. Fire damage yin
• -- Shen Di huang, mai meng dong
• Acid regurgitation
• -- Wa Leng Zi, Wu Zei Gu
• Phlegm sighs
• -- bai jie zi

Cai Hu Shu Gan San Cai Hu Shu Gan San Cai Hu Shu Gan San Cai Hu Shu Gan San Cai Hu Shu Gan San Cai Hu Shu Gan San
Cai Hu Bai Shao Zhi Ke Zhi Gan Cao Chen Pi Xiang Fu
Chuan Xiong
26

• Treatment
• Excess
• 4). Stomach heat
• Signs Symptoms
• Main Sym. burning epigastric pain
• Concurrent sym. thirst, irritability, sour
  regurgitation, bitter taste, prefer cold drinking
• Tongue dry yellow coating, red body
• Pulse slightly rapid
• Treatment Protocol
• Clear Stomach-heat
• Restore the descending of st. Qi

27

• Formula
• Modifications
• severe epigastric pain
• -- Bai Shao, Gan Cao
• Severe st. heat
• -- Pu gong Yin, Lian Qiao, Jin Yin Hua

Bai Hu Tang Bai Hu Tang Bai Hu Tang Bai Hu Tang Bai Hu Tang Bai Hu Tang
Shi gao Zhi Mu Geng Mi Gan Cao
28

• Treatment
• Excess
• 5). Stasis of blood in the stomach
• Signs Symptoms
• Main Sym. stabbing epigastric pain which is
  worse with pressure after eating
• Concurrent sym. palpable masses in the
  epigastrium, vomiting of dark blood sometimes
  looking like coffee-grounds, dark complexion. The
  pain may be worse at night. There may be blood in
  the stools.
• Tongue purple, possible only in the
  centre
• Pulse choppy or wiry or firm
• Treatment Protocol
• Move blood eliminate stasis
• Harmonize the stomach, stop pain

29

• Formula
• Modifications
• severe epigastric pain
• -- Yan Hu Suo
• Stag. Of Qi
• -- Zhi Ke, Qing Pi
• Retention of cold in St.
• -- Gui Zhi, Gan Jiang
• Bleeding
• -- San Qi, Bai Ji
• acidity or sore regurgitation
• -- Wu Zei Gu

Shi Xiao San Shi Xiao San Shi Xiao San Shi Xiao San Shi Xiao San Shi Xiao San
Pu huang Wu Ling Zhi
Dan Shen Yin Dan Shen Yin Dan Shen Yin Dan Shen Yin Dan Shen Yin Dan Shen Yin
Dan Shen Tan xiang Sha Ren
30

• Treatment
• Deficiency
• 1). St. Sp. Def. cold
• Signs Symptoms
• Main Sym. dull stomach-ache which improves with
  pressure, after eating, and with the application
  of heat
• Concurrent sym. vomiting of thin fluids,
  tiredness, poor appetite, chilliness, loose
  stools, pale complexion
• Tongue pale, white coating
• Pulse deep weak
• Treatment Protocol
• Strengthen the Sp. St.

31

• Formula
• Modifications
• sore regurgitation
• -- wu zei gu (- Yi tang)
• vomiting of thin fluid
• -- Gan Jiang, Chen Pi, Ban Xia, Fu ling
• empty cold sym.
• -- Da Jian Zhong Tang
• Confusing signs of both cold heat
• -- Gan Cao Xie Xing Tang ( Ban Xia, Gan Jiang,
  Huang Qin, Huang lian, Zhi gan Cao, Da Zhao)

Huang Qi Jian Zhong Tang Huang Qi Jian Zhong Tang Huang Qi Jian Zhong Tang Huang Qi Jian Zhong Tang Huang Qi Jian Zhong Tang Huang Qi Jian Zhong Tang
Huang Qi Bai Shao Gui Zhi Zhi Gan Cao Sheng Jiang Da Zao
Yi Tang
32

• Treatment
• Deficiency
• 2). St. Yin Def.
• Signs Symptoms
• Main Sym. dull stomach-ache
• Concurrent sym. dry mouth, desire to sip
  liquids, dry throat, dry stools, slight nausea
• Tongue normal color, dry, no coating,
  scattered cracks or a central wide stomach-type
  crack
• Pulse floating empty in the right
  middle position
• Treatment Protocol
• Nourish Yin
• Benefit the St.
• Stop pain

33

• Formula
• Modifications
• acid regurgitation
• -- Huang Lian, Wu Zu Yu
• Stag. Of Qi
• -- Fu Shou,
• Dry stools.
• -- Huo ma ren
• Thirst
• -- Lu Geng, Tian Hua feng, Wu mei

Yi Guan Jian Yi Guan Jian Yi Guan Jian Yi Guan Jian Yi Guan Jian Yi Guan Jian Yi Guan Jian Yi Guan Jian
Bei Sha Shen Mai Men Dong Mai Men Dong Sheng di Dang Gui Chuan Lian zi Chuan Lian zi
Bai Shao Gan Cao Tang Bai Shao Gan Cao Tang Bai Shao Gan Cao Tang Bai Shao Gan Cao Tang Bai Shao Gan Cao Tang Bai Shao Gan Cao Tang Bai Shao Gan Cao Tang Bai Shao Gan Cao Tang
Bai Shao Zhi Gan Cao
34

• Case History
• 1. Female 45 years
• Medical history. Stomach pain for 2 years
• First visiting
• Main complain Epigastric Pain
• The pain was dull, worse lying down,
  aggravated by pressing on the area, and
  accompanied by a slight nausea and acidity. When
  the pain was bad she also became constipated and
  her appetite decreased. Slight feeling of
  fullness.
• Slight bleeding in between periods with
  light-fresh blood for 4 month
• Tongue Pale with a slight Bluish-Purple
  tinge, teeth-mark a sticky-white coating
• Pulse slippery on the whole and weak on the
  right side
• TCM diagnose
• Sp. Qi Def. Food retention
• Treatment protocol
• -- Tonify Sp
• -- Resolve retention of food
• Formula
• Shan Zha 6, Shen Qu 6, Lai Fu Zi 4, Ban Xia
  6, Chen Pi 3, Fu Ling 6, mai Ya 4, Zhi Shi 4, Bai
  Shao 9, Zhi Gan Cao 4, Bai Zhu 6,

35

• Case History
• 1. Female 38 years
• Medical history. Stomach pain for 5 years
• First visiting
• Main complain Epigastric Pain
• pain radiated from epigastrium to the right
  hypochondrium was accompanied by a pronounced
  feeling of distension belching. She also
  suffered from difficult bowel movements and the
  stools were often like small pebbles. She felt
  often depressed and irritable found it
  difficult to establish permanent relationships
  with the opposite sex. Her periods were regular
  normal in all ways, except that she suffered
  from premenstrual irritability distension.
• Slight bleeding in between periods with
  light-fresh blood for 4 month
• Tongue unremarkable, being only slightly red
  on the sides
• Pulse slightly slippery on left side
• TCM diagnose
• Stagnation of Liver Qi
• Treatment protocol
• -- Move Liver qi
• -- promote the descending of St. Qi
• -- Calm mind
• Formula
• Chai Hu 4, Bai Shao 9, Zhi Ke 6, Zhi Gan
  Cao 4.5, Chen Pi 4, Xiang Fu 4, Chuan Xiong 4.5,
  Mu xiang 3, He Huan Pi 6, Dang Shen 6

36

• Case History
• 1. Male 45 years
• Medical history. Stomach pain for 22 years
• First visiting
• Main complain Epigastric Pain
• Pain radiated from the epigastrium to the
  right hypochondrial region. It was worse at night
  and better after eating. He belched a lot, his
  stools were slightly dry he felt very tired.
• Tongue red on the sides, stiff and with a
  slightly rootless coating
• Pulse Fine, slightly empty at the deep level
  in general, and floating empty and very slightly
  wiry on the right middle position.
• TCM diagnose
• Stag. Of Liver Qi invading the St. St. Yin
  Def.
• Treatment protocol
• -- Move Liver qi
• -- Tonify St. Yin
• Formula
• Chai Hu 4, Bai Shao 9, Zhi Ke 4, Zhi Gan Cao
  4.5, Chen pi 3, Xiang Fu 4, Chuan Xiong 3, Mei
  Gui Hua 4.5, Fu Shou 3, Tai Zi Shen 6, Shan Yao
  6, Mai men Dong 6, Yu Zhu 4,

37

• Case History
• 1. Male 45 years
• Medical history. Patient was diagnosed by
  western doctor as duodenal ulceration in 3 years
  ago.
• First visiting
• Main complain Stomach-ache
• Patient feel dizziness tiredness sometime,
  bad appetite, chilliness, pain from the
  epigastrium to the right hypochondrium region.
  sour regurgitation, heart burning sensation.
• Before he came here, he asked for another TCM
  doctor, the doctor diagnosed as Sp St. def.
  cold and gave him 6 bags of Huang Qi Jian Zhong
  Tang. After he drunk the herb tea, the dizziness
  was even worse, the stomach-ache hypochondrial
  pain also got worse, thirsty like to drinking
  water, dry stools.
• Tongue white greasy coating with dark spots
  on the tip of the tongue
• Pulse deep fine
• TCM diagnose
• Blood stasis in the Stomach Liver Qi Stag.
• Treatment protocol
• -- Move blood stasis
• -- Harmonize Shao Yaong Yang Ming
• Formula
• Chai Hu 4, zhi shi 3, Huang Qin 3, Ban Xia 3,
  Chi Shao 3, Gui Zhi 3, Tao Ren 3, Sheng Jiang 3,
  Da Zhao 3pc, Da Huang 2