Objective To investigate the effects of Tianma Zhixian Decoction combined with topiramate and carbamazepine on memory ability and galanin and iron exporter ferroportin 1（IREG1）in patients with epilepsy．Methods A total of 85 patients with epilepsy were admitted to our hospital from June 2019 to June 2022,including 21 patients treated with Tianma Zhixian Decoction combined with topiramate（Group A）,23 patients treated with Tianma Zhixian Decoction combined with carbamazepine（Group B）,22 patients treated with topiramate（Group C）,and 19 patients treated with carbamazepine（Group D）．The therapeutic effect,memory ability,galanin and IREG1 levels were compared among the four groups．Results There were no significant differences in the total treatment response rate and complete control rate between the four groups（P>0.05）．By pairwise comparison,the total response rate in Group A was significantly higher than those in Group C and Group D（P<0.05）,the rate in Group B was significantly higher than those in Group C and Group D（P<0.05）,there was no significant difference in the total response rate between group A and B（P>0.05）．In group A,the TCM syndrome score,seizure attacks and duration of seizure were significantly less than those of the other three groups（P<0.05）．In Group A,visual re-recognition,picture recall,visual regeneration,associative learning,understanding,numbers recitation forward or backward and MQ values were all significantly improved compared with those before treatment,which was significantly higher than that in the other three groups（P<0.05）．Galanin levels significantly increased in the four groups（P<0.05）after treatment,while IREG 1 protein expression decreased（P<0.05）．Galanin level in group A was significantly higher than the other three groups,IREG 1 protein expression was significantly lower than that in the other three groups（P<0.05）．There was no significant difference in the incidence of adverse reactions among the four groups（P>0.05）．Conclusions Tianma Zhixian Decoction combined with topiramate or carbamazepine is effective and safe in the treatment of epilepsy,with little effect on the memory ability of patients．Tianma Zhixian Decoction has more advantages in improving the complete control rate of epilepsy,improving epilepsy symptoms,reducing the number and duration of seizures,and inhibiting the abnormal expression of galanin and IREG1．