ADDADHD Wake Forest University Baptist Medical Center Ranked

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					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
     Inability to focus
     Mood swings
     Temper tantrums
     Problems completing tasks
     Inability to cope with stress
     Oppositional conduct
       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
 Published series of lectures describing impulsive children
  with behavior problems due to “genetic dysfunction” not

   “…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

   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 &
 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
     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,
   Heart: Houses the shen, rules consciousness & thinking; joy.
   Spleen: Rules digestion & assimilation, nourishment; quality of
   Fire: Causes dryness, agitation, thickens phlegm, causes irritability,
   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

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-
 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
Counter ascendant yang
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
         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 &
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)
    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 &
            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

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

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