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ADHD and ADD in Chinese medicine.

Keywords: Chinese medicine, Chinese herbal medicine, attention deficit hyperactivity disorder (ADHD), attention deficit disorder (ADD)

Attention deficit hyperactivity disorder (ADHD) and simple attention deficit disorder (ADD) are relatively recent Western medical diagnostic categories (especially in China), and there is no simple one-to-one correspondence between either of these and a single traditional Chinese medical disease category. However, by understanding the main clinical manifestations of ADHD or ADD, one can reframe these modern Western medical disease categories into their constituent traditional Chinese medical categories and, from there, erect rational Chinese medical diagnostic and treatment protocols. In fact, this is exactly what has been done in modern Chinese medicine as practiced in the People's Republic of China (PRC) over the last dozen or so years. It is not uncommon to see cohort studies or randomized clinical trails on Chinese medical treatments for ADHD in Chinese medical journals from the PRC. While it is hard to assess the prevalence of ADHD in the PRC, it is clear from these articles that this diagnosis is being made and Chinese doctors are attempting to treat it, primarily with Chinese herbal medicine.

Chinese Medical Disease Categorization

The main clinical symptoms of ADHD as described in the Chinese medical literature correspond to the traditional Chinese medical disease categories of irritability ([TEXT NOT REPRODUCIBLE IN ASCII] yi nu, easy anger, and [TEXT NOT REPRODUCIBLE IN ASCII] duo nu, excessive anger), insomnia ([TEXT NOT REPRODUCIBLE IN ASCII] bu mian), profuse dreams ([TEXT NOT REPRODUCIBLE IN ASCII] duo meng), oppressive ghost dreams ([TEXT NOT REPRODUCIBLE IN ASCII]meng yan, i.e., nightmares), vexation and agitation ([TEXT NOT REPRODUCIBLE IN ASCII] fan zao), and impaired memory ([TEXT NOT REPRODUCIBLE IN ASCII] jian wang). Based on these correspondences, the Chinese medical disease causes and pathomechanisms of ADHD are nothing other than the pathomechanisms of these traditional Chinese medical diseases.

Chinese Medical Disease Causes and Mechanisms

In Chinese medicine, hyperactivity ([TEXT NOT REPRODUCIBLE IN ASCII]duo dong, excessive stirring) is primarily related to the health or disease of the spirit ([TEXT NOT REPRODUCIBLE IN ASCII]shen) residing in the heart ([TEXT NOT REPRODUCIBLE IN ASCII]xin). The heart spirit is the ruler of the entire bodymind, and the state of this spirit abiding internally is reflected in the outward appearance and activity of the body externally. If the spirit is healthy, then it is calm ([TEXT NOT REPRODUCIBLE IN ASCII]an). In that case, the mind is not agitated and, likewise, the body does not stir or move about excessively, i.e., there is no fidgeting. Hyperactivity, on the other hand, is described as the heart spirit ([TEXT NOT REPRODUCIBLE IN ASCII]xin shen) stirring restlessly ([TEXT NOT REPRODUCIBLE IN ASCII]dong wang). Because the mind is agitated, the body is also restless, and therefore, there is agitation ([TEXT NOT REPRODUCIBLE IN ASCII]zao), which refers clinically to the inability to sit peacefully or fidgeting. According to Chinese medical theory, there are three basic mechanisms that may result in pediatric hyperactivity: either 1) the spirit is insufficiently constructed and nourished, 2) some sort of heat evils are harassing the spirit, or 3) some sort of evil qi, such as phlegm turbidity or blood stasis, is blocking the orifices of the heart.

In terms of the causes of these three basic pathomechanisms, insufficient nourishment and construction may be due to a congenital insufficiency (as in the case of Down's syndrome) or may be due to improper diet. Heat evils may be 1) inherited from the parents at conception, 2) engendered during gestation due to the mother's diet and emotions, 3) caused by improper diet after birth, 4) caused by frustration, anger, and other emotional excesses, 5) caused by too much stimulation (such as violent TV and videogames), and 6) caused by the external contraction of heat evils (possibly via inoculations). Phlegm turbidity is caused by improper diet and too little exercise, while blood stasis is the result of either prolonged mental-emotional stress or traumatic injury (including injury during delivery).

The Chinese medical disease causes and mechanisms of ADD are basically the same as those of hyperactivity. Either there is insufficient qi and blood to nourish and construct the spirit mind, there are some heat evils harassing the heart spirit making it disquieted, or there is some evil qi blocking the heart orifices, thus misting and confounding the heart spirit. In addition, in Chinese medicine, an inability to remember is also mostly due to insufficient nourishment and construction of the heart spirit.

The Chinese Medical Treatment of ADHD and ADD

The Chinese doctor begins his or her treatment of ADHD/ADD by first determining what Chinese medical patterns the patient presents. This is called basing treatment on the discrimination or identification of patterns ([TEXT NOT REPRODUCIBLE IN ASCII]bian zheng lun zhi) and is the hallmark of professional Chinese medicine. These patterns are agreed upon combinations of A) generalized signs and symptoms, B) tongue signs, and C), pulse signs. Each pattern or combination of patterns implies a certain imbalance within the functioning of the bodymind. Having identified which pattern or patterns are present, the Chinese doctor then posits the treatment principles necessary to rebalance the imbalance implied in the name of the pattern(s). Once stating these principles, the Chinese doctor then immediately knows what he or she should do in order to concretely rebalance that/those imbalance(s). In particular, most cases of ADHD and ADD involve some sort of evil heat. The main types of evil heat present in this condition are depressive heat ([TEXT NOT REPRODUCIBLE IN ASCII]yu re), phlegm heat ([TEXT NOT REPRODUCIBLE IN ASCII]tan re), and vacuity heat ([TEXT NOT REPRODUCIBLE IN ASCII]xu re). Therefore, clearing heat is almost always some part of the Chinese medical treatment plan for ADHD/ADD.

An Example of How Chinese Medicine Treats ADHD/ADD Due to Vacuity Heat

From "The Treatment of 36 Cases of Pediatric ADHD (Attention Deficit Hyperactivity Disorder) by Integrated Chinese-Western Medicine" by Yang Hong (Fu Jian Zhong Yi Yao [Fu Jian Chinese Medicine & Medicinals]. August, 2005:34).

Cohort Description

There were 56 patients in this two-wing comparison study, including 38 males and 18 females. All patients were between the ages of five and 11 years old, and the course of disease was from six months to three years in length. The disease appeared before the age of seven years old in all patients. The individual patient IQ ranged between 85-117 points.

These participants were randomly divided into two groups. The treatment group (who received both Chinese and Western medicine) included 36 patients: 24 males and 12 females. In this group, the average age was six years, and the course of disease was between eight months and three years in length, with an average duration of 1.8 years. The average IQ of these children was 95. The comparison group (who only received Western medicine) included 20 patients: 14 males and six females. In this group, the average age was five years and eight months old, and the course of disease was between six months and 2.7 years in length, with an average duration of 1.65 years. The average IQ of these children was 90. Thus, there were no significant statistical differences between these two groups.

Treatment Method

The treatment group took five milligrams of methylphenidate (Ritalin[R]) two times per day in the morning and evening. [Note: In clinical practice, the usual dosage for this medication ranges from 0.3-0.8mg/kg depending upon body weight. Prescribing physicians usually begin with a dosage of 0.3 mg/kg (i.e., a 5-10mg pill in the morning) and, based on the response to treatment, may add a second late morning or early afternoon dose. This dose may then be increased by five milligrams per week until either the desired beneficial effect or undesirable side effects occur.] In addition to Ritalin, the treatment group was administered Chinese herbal medicine. The formula used was Liu Wei Di Huang Tang He Gan Mai Da Zao Tang (Six Flavors Rehmannia Decoction plus Licorice, Wheat, & Red Date Decoction):
Shu Di Huang (cooked Radix Rehmanniae), 12 grams
Shan Zhu Yu (Fructus Corni), 9 grams
Dan Pi (Cortex Moutan), 6 grams
Shan Yao (Radix Dioscoreae), 12 grams
Fu Ling (Poria), 10 grams
Ze Xie (Rhizoma Alismatis), 6 grams
Da Zao (Fructus Jujubae), 6 grams
Xiao Mai (Fructus Tritici), 30 grams
Gan Cao (Radix Glycyrrhizae), 3 grams

One packet of these medicinals was taken per day by adding 600 milliliters of water to the above and boiling until reducing the fluid to 200 milliliters. The resulting liquid was divided into two doses and taken in the morning and evening.

The comparison group took Ritalin at the same dosage and intervals as the treatment group. In both groups, one course of treatment equaled one month, and all patients in the study continued treatment for three courses (i.e., three months).

Study Outcomes

Cure meant that the patient's concentration, focus, and mood had stabilized and that his or her grades in school had improved substantially. Improvement meant that the child's movement was less and he or she could sit for a longer period of time and concentration, focus, and school grades had also improved. No improvement meant that there was no difference in the child's health from before to after treatment. Based on these criteria, 26 cases in the treatment group were cured, eight cases improved, and two cases did not improve. Therefore, the cure rate for this group was 72.2%, and the total amelioration rate was 94.4%. In the comparison group, 12 cases were cured, four cases improved, and four cases did not improve. Thus the cure rate for this group was 60%, and the total amelioration rate was 80%.

Follow-up visits six months later showed that symptoms had reappeared in 70% (14/20 cases) of the patients in the comparison group, while symptoms reappeared in only 13.9% (5/36 cases) of the patients in the treatment group. In addition, only eight children in the treatment group had side effects (which included poor appetite and slight difficulty sleeping), whereas, in the comparison group, 12 cases (60%) had side effects that had a tendency to be more severe than the treatment group and included decreased appetite, insomnia, abdominal pain, and rapid heartbeat.

Chinese Author's Discussion

A child's body belongs to pure yang. In children, yang is often in surplus and yin is often insufficient. Due to these tendencies, it is easy to see how children manifest signs of yang stirring having a surplus and yin tranquility being insufficient. Attention deficit hyperactivity disorder easily develops, because yin cannot control yang and yang qi stirring frenetically results in the heart spirit not being settled, therefore causing the child's attention span to be lax ([TEXT NOT REPRODUCIBLE IN ASCII]huan san, literally lax and scattered). To address these disease mechanisms, the doctor in this article used Liu Wei Di Huang Tang to enrich yin and supplement the kidneys, combined with Can Mai Da Zao Tang to nourish the heart and quiet the spirit. [Readers should note that Liu Wei Di Huang Wan has been in constant use in Chinese medicine since the Song dynasty (approximately 1,200 years) and was created by the greatest premodern Chinese medical pediatrician, Qian Yi, while Can Mai Da Zao Tang is five hundred years older still (approximately 1,700 years) and was created by the greatest of all premodern Chinese herbalists, Zhang Zhong-jing.]

Based on my many years of clinical experience and many similar studies published in China, I believe that Chinese medicine, with or without Western medicine, is effective for the treatment of ADHD/ADD. This is especially so when Chinese herbal medicine is combined with the proper diet and lifestyle modifications to address the underlying causes of these conditions. Properly prescribed Chinese herbal medicine is without side effects and can also reduce the dosage and the side effects of Western pharmaceuticals at the same time as making those drugs clinically even more effective. Therefore, I believe that Chinese medicine should be considered as an option and/or complement to modern Western psychiatry for the treatment of these conditions.

Copyright [c] Blue Poppy Press, 2007. All rights reserved.

by Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

COPYRIGHT 2008 The Townsend Letter Group
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Title Annotation:Chinese Medicine; attention deficit hyperactivity disorder; attention deficit disorder
Author:Flaws, Bob
Publication:Townsend Letter
Geographic Code:1USA
Date:Apr 1, 2008
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