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ADDADHD Wake Forest University Baptist Medical Center Ranked

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ADDADHD Wake Forest University Baptist Medical Center Ranked Powered By Docstoc
					ADD/ADHD: TCM Perspectives

      Roy Upton, Herbalist
                       Western Paradigm
   Most prevalent behavioral disorder in children
   1.5 million children taking methylphenidate (Ritalin)
   4 million diagnosed
   Cluster of neuropsychiatric symptoms
     Restlessness
     Inability to focus
     Mood swings
     Temper tantrums
     Problems completing tasks
     Disorganization
     Inability to cope with stress
     Impulsivity
     Oppositional conduct
     Depression
       Etiology of a Disease: 1845

Dr. Heinrich Hoffman
  “The Story of Fidgety Phil”
  Described symptoms of ADHD
          Etiology of a Disease: 1902

 Initially reported in medical literature in 1902 (Sir George
  Still)
 Published series of lectures describing impulsive children
  with behavior problems due to “genetic dysfunction” not
  child-rearing.

   “…the control of activity in conformity with moral consciousness is
   markedly defective…”

   Stoll suggested the capacity to exercise good judgment might be
   imperfectly developed.
        Etiology of a Disease: 1940

Condition identified with “minimal brain damage
 or dysfunction”

Resulting from brain or head trauma, infection, or
 toxic damage.
       Etiology of a Disease: 1970

Hyperactivity becomes focus of syndrome more
 than other symptoms
         Etiology of a Disease: 1980

American Psychiatric Association defines:
   “Hyperkinetic reaction of childhood” evolving into
   “hyperkinetic syndrome” and “hyperactive child
   syndrome” to “attention deficit disorder” with or without
   “hyperactivity”.

   Symptomology focused on inattention with impulsivity.
  Etiology of a Disease: 1994-Present

ADHD (3 patterns)
   Predominantly hyperactive-impulsive type (Hyper)
   Predominantly inattentive type (ADD)
   Combination type (ADHD)
                 Symptoms & Diagnosis
 Hyperactivity-Impulsivity              Inattention
    Restless, fidgety, squirming in          Easily distracted by irrelevant
     seat                                      sights and sounds
    Running, climbing, or leaving            Failing to pay attention to
     a seat where sitting or quiet             details
     behavior is expected                     Easily bored (but if doing
    Blurting out answers before a             something they really enjoy,
     question is fully asked                   no problem)
    Having difficulty waiting                Rarely follow instructions,
     one’s turn.                               forget or lose things
                                              Often skipping from one
                                               uncompleted task to another.
In children 6 or more symptoms must appear prior to age 7 an continue for at
least 6 months. When symptoms affect school performance, social
relationships, or behavior at home, syndrome is suspected.
                  Must Rule Out

 Major life change: death of loved one
 Change in parental relationship
 Depressive disorder
 Middle ear infection causing hearing impairment
 Brain disorders
 Other learning disabilities
 Anxiety or depression
 Normal developmental activity
              Confounding Factors

 Learning disabilities
 Oppositional defiant disorder
 Conduct disorder
 Anxiety and/or depression
         Treatment: Pharmacological &
                  Behavioral
 Pharmacological
     Amphetamine (Adderall), dextroapmphetamin (Dexedrine),
      methylphenidate (Concerta, Metadate, Ritalin)
 Behavioral: Group behavioral therapy, school visits, student aid, 8-
  week summer camp, etc.
 Combination therapy better results than either alone.
 Less medication needed when combined with behavioral therapy
 Primarily work on dopamine modulation
 Atomoxetine (Straterra): Norepinephrine reuptake inhibitor (70%
  improvement of symptoms)
                              Side Effects
 Amphetamines, methylphenidate
       Decreased appetite
       Insomnia
       Increased anxiety or irritability
       Mild stomach ache
       Headaches
 Strattera
       Nausea
       Vomiting
       Sleeplessness
       Suicidal thoughts (4 of every 1000 patients; higher incidence in treatment
        group over controls)
       Severe liver damage
       Sudden death in those with heart problems
       New psychotic symptoms (hearing voices, mania, paranoia)
       Has not been studied in children less than 6 years old
                     Cause: Western

 Neurobiological disorders
 Genetics
 Smaller “brains”
 Environment may affect but not considered a cause.
    Cigarette and alcohol use during pregnancy
    Lead
    Sugar not generally considered a major factor
             NIH Consensus Report

“ We do not have an independent, valid test for ADHD,
  and there are no data to indicate that ADHD is due to a
  brain malfunction…and finallly, after years of clinical
  research and experience with ADHD, our knowledge
  about the cause or causes of ADHD remains
  speculative.”
     Physiological Considerations: TCM

   Yin: Reflects quietness, contemplativeness, ease, comfort, stability.
   Yang: Rules fire, animation, vitality.
   Jing: Rules growth,vitality, the senses.
   Kidney: Rules growth & development, willpower; fear.
   Liver: Rules the even patency of emotion, creativity, decision making,
    anger.
   Heart: Houses the shen, rules consciousness & thinking; joy.
   Spleen: Rules digestion & assimilation, nourishment; quality of
    thought.
   Fire: Causes dryness, agitation, thickens phlegm, causes irritability,
    anger.
   Phlegm: Obstructs the channels, blocks the orifices, impairs mental
    function, clouds the mind and dulls the senses.
           Emotions, Qualities, Spirits

 Organ        Emotion        Quality           Spirit
 Heart        Joy            Compassion        Shen
 Spleen       Reflection     Sympathy          Thoughts
 Lung         Grief          Acceptance        Body spirit
 Kidney       Fear           Willpower         Jing
 Liver        Anger          Creativity        Soul

 Bad emotional states all negatively affect the heart and
  thus organs; the heart is the root of the seven emotions.
             Emotions and Mind

Excess grief, reflection, oppression and fear:
 Injure the heart

Excess anger and joy: Scatter the mind
        Heart (Fire): TCM Physiology

The Heart governs, and controls
     Flow of blood through the vessels
     Houses the Shen
     Rules consciousness
     Governs speaking
        Patterns of Heart Disharmony
 Anxiety
 Dream disturbed sleep
 Dulled senses
 Excessive mental activity
 Excessive talking
 Fidgeting
 Heart palpitations
 Inability to articulate
 Inability to concentrate
 Vivid dreaming
 Sleeplessness
 Stress
     Spleen (Earth): TCM Physiology

Governs digestion and assimilation (nourishment)
Transports nutrients
Produces blood
Regulates blood
     Patterns of Spleen Disharmony

Gas
Indigestion
Bubbly sputum
Food allergies
Mucus accumulation, generation of phlegm
       Kidney (Water): TCM Physiology

 Genetics ruled through kidneys (base intelligence)
 Governs water metabolism
 Houses & governs the essence, rules the senses (jing)
      Jing of heart rules tongue, speech, consciousness, intelligence
      Jing of spleen rules taste, development of flesh
      Jing of lung rules smell, acceptance
      Jing of kidneys rules hearing (listening), willpower (discipline)
      Jing of liver rules vision, creativity, decision making
 Rules growth & development
 Seat of marrow (brain)
     Patterns of Kidney Disharmony

Lower back pain
Frequent urination (bedwetting)
Ringing in the ear
Lack of hearing acuity/deafness
Excessive fear
Lack of willpower
      Liver (Wood): TCM Physiology

 Governs "Smooth Flow of Qi and Blood”.
 Stores the blood.
 Rules the nervous system.
 Governs the emotions.
 ”Commander of an army”.
 Liver is anger
 Regulates vision
 Rules creativity.
 "Houses the Soul."
        Patterns of Liver Disharmony

 Depression
 Emotional ups and downs
 Energy highs and lows
 Excessive anger
 Inability to make decisions
 Lack of creativity
 Vision problems
        Five Element Considerations

 Fire (Heart-Shen) feeds Earth (Spleen-Nourishment-
  Reflection), controls Metal (Lung-Grief-Acceptance);
 Earth feeds Metal, controls Water (Kidneys-Fear-
  Willpower);
 Metal feeds Water, controls Wood (Liver-Anger-
  Creativity-Decision Making);
 Water feeds Wood, controls Fire;
 Wood feeds Fire, controls Earth
             Therapeutic Strategies

 Nourish qi
 Nourish blood
 Nourish kidney yin-jing
 Quiet agitated kidney yang
 Nourish heart (shen)
 Open orifices
 Clear pathogenic fire
 Clear pathogenic phlegm
      Patterns of Disharmony: ADHD

 Kidney Jing Deficiency
 Kidney Yin Deficiency
 Over exuberance of kidney yang
 Phlegm obstruction of heart
 Kidney-Liver deficiency
 Deficiency Fire
 Excessive Fire
 Excessive Liver Fire rising
 Qi, Blood, Fluid Deficiency
                 Tonify Yin

Calm the Spirit
Cool
Counter ascendant yang
Moisten
Nourish
Nurture
Strengthen foundation
Heart, Kidneys, Liver, Lungs
                       Yin Tonics: Herbs
   American ginseng: Yin deficiency w/heat signs; generates fluids;
    w/ophiopogon for yin deficiency and injured fluids.
   Asparagus root: Nourishes kidneys, generates fluids; w/rehmania &
    scrophularia for irritability
   Ophiopogon: Clears heart eliminates irritability.
   Dendrobium: Nourishes yin, clears heat, brightens vision.
   Lily bulb (Lillium brownii): Clears heat and heart, calms spirit,
    restlessness, and irritability; w/rehmania for irritability w/insomnia.
   Ligustrum: Nourishes liver and kidneys, clears heat, improves vision;
    w/lycii bark & moutan for deficiency fire.
   Tortoise shell: Nourishes yin, anchors yang, clears heat; slow
    development; clears heat from blood, nourishes blood, tonifies heart;
    w/dragon bone & polygala for anxiety and insomnia.
                 Resolve Phlegm

 Phlegm obstructs the    Acorus
  channels                Alpinia
 Clouds mind             Citrus peel
 Dulls senses            Turmeric
 Slows reaction times    Pinellia
 Makes one sluggish      Polygala
                    Nourish Blood

 Dang gui                  Blood transports nutrients
 Donkey hide gel           Feeds heart (shen)
 He shou wu                Nourishes and moistens
 Peony                      liver (feeds emotional
 Rehmania                   well-being)
                            Softens
                            Moistens
            Open Orifices

 Acorus            Enliven sensory orifices
 Alpinia           Invigorate qi & blood
 Benzoin           Treat branch of disease no
                     root
         Clear Heat, Reduce Liver Fire

Rehmania and tortoise shell.
Nourishes yin, clears heat
Reduces rising liver yang
      Rehmania
      Tortoise shell
      Phellodendron
      Anemerrhena
           Kidney Yin Formulas

Liu wei di huang wan: Rehmania, dioscorea,
 moutan, alisma, cornus, fu ling.
Ba wei di huang wan: + Aconite & cinnamon.
Chih bai di huang wan: + Phellodendron &
 anemerrhena.
Ming mu di huang wan: + Lycii, chrysanthemum
   Astragalus & Zizyphus Compound
            (Yang Xin Tang)
 Nourish Heart          Transform Phlegm
 Nourish Blood          Quiet Spirit

       Astragalus      Schisandra
       Poria           Polygala
       Dang gui        Ginseng
       Ligusticum      Cinnamon bark
       Pinellia
                        Licorice
       Zizyphus
                        Ginger
       Biota
                       Gambir Formula
                       (Gou Teng San)
   Gypsum                     Regulates liver
   Ginger (fresh)
                               Clears liver fire rising
   Gambir
   Chen pi                    Extinguishes wind
   Pinellia                   Nourishes yin
   Ophiopogon
                               Clears mental cloudiness
   Poria (fu ling/fu shen)
   Ginseng                    Treats insomnia
   Chrysanthemum
   Siler
   Licorice
          Ginseng & Longan Compound
                 (Gui Pi Tang)
   Ginseng               Tonifies qi
   Longan                Nourishes blood
   Atractylodes          Fortifies spleen
   Poria                 Nourishes heart
   Zizyphus
                          Quiets the spirit
   Astragalus
                          Excessive thinking
   Dang gui
   Polygala              Inability to concentrate
   Ginger (fresh)        Fright
   Jujube                Forgetfulness
   Saussurea             Insomnia
   Licorice
  Dioscorea & Achyranthes Compound
           (Jian Ling Tang)
 Dioscorea        Excessive liver fire rising
 Achyranthes      Extinguishes liver wind
 Hematite         Nourishes Blood
 Dragon bone      Nourishes yin
 Oyster shell     Quiets spirit
 Rehmania         Settles disturbed sleep
 Peony            Forgetfulness
 Biota
      Cyathula & Rehmania Formula
             (Zuo Gui Wan)
 Rehmania           Enriches yin
 Dioscorea          Tonifies kidneys
 Lycii fruit        Nourishes jing
 Cornus             Nourishes marrow
 Cuscuta
 Donkey hide gel    W/salvia & polygala for
 Tortoise shell      sleeplessness and memory
 Cyathula            disorders
             Ginseng & Zizyphus Formula
              (Tian Wang Bu Xin Tang)


    Ginseng
    Rehmania (fresh)
                               Enriches yin
   Zizyphus                   Nourishes blood
   Poria (fu ling/fu shen)
   Polygala                   Quiets spirit
   Acorus                     Nourishes spirit
   Scrophularia
   Biota                      Lassitude
   Platycodon
   Asparagus
   Salvia
   Stemona
   Ophiopogon
   Eucommia
   Dang gui
   Schisandra
           Zizyphus Combination
           (Suan Zao Ren Tang)
 Suan zao ren        Insomnia
 Fu ling             Excessive dreaming
 Ligusticum          Disturbed shen
 Licorice            Nourishes heart
 Anemerrhena         Nourishes blood
                 Poria & Bamboo
                (Wen Dang Tang)
 Citrus peel (chen pi)      Regulate qi
 Bamboo shavings            Transform phlegm
                             Harmonize stomach
 Pinellia
                             Quiet spirit
 Citrus aurantium           Insomnia
 Poria                      Phlegm obstructing the heart
 Licorice                   Schizophrenia
 Ginger (fresh)             Mania
                             Depression
 Jujube
                             Fright
                       Sanjia Fumai Tang
   Rehmania                     Nourishes yin
   Ophiopogon
                                 Nourishes blood
   Tortoise shell
   Peony                        Clears deficiency heat
   Pseudostellaria              Quiets heart
   Gelatin
                                 Quiets liver
   Licorice (baked)
   Curcuma
   Polygala
   Dendrobium
   Oyster shell
   Acorus
   Dragon bone
 Acorus          Calms spirit
 Polygala        Opens orifices
 Dragon bone     Vaporizes & expels
 Oyster shell     phlegm
                  Quiets heart & spirit
                  Treats irritability &
                   insomnia
            Alpinia-Acorus Syrup

 Alpinia                Prevents phlegm accumulation
 He shou wu             Astringes Kidney Essence
                         Nourishes blood
 Lycium berries
                         Nourishes yin
 Dragon bone            Quiets spirit
 Oyster shell           Treats insomnia
 Acorus                 Opens orifices
 Curcuma                Promotes blood circulation

 Salvia
 Antler
                     Martial Arts

Cultivates
     Discipline
     Focus
     Listening
     Introspectiveness
     Healthy expenditure of energy
     Breathing

				
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