ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD), Chinese Medicine view

This syndrome is most commonly seen in children between the ages of 5

and 15 and is characterized by distractibility, short attention span, impulsive

behavior, hyperactivity, and learning and behavior disabilities. In biomedicine,

improper functioning of neurotransmitter systems has been proposed

as a possible cause. Pharmaceutical treatment most commonly involves

central nervous system stimulants such as amphetamine, dextroamphetamine,

and methamphetamine, or similar drugs such as methylphenidate

(Ritalin). These tend to allow the child to focus while also, paradoxically,

calming hyperactivity. Most children, however, are not cured by pharmaceutical

treatment.

APPLIED CHANNELS IN CHINESE MEDICINE

The perspective of Chinese medicine

Chinese medicine views the pattern to be rooted in a generalized imbalance

in the inter-regulation of the organs. Although the pattern might

be broken down into ascendant liver yang, liver-kidney yin deficiency, and

spleen qi deficiency types, there will likely be fairly rapid changes from one

to another symptom pattern during the course of treatment. The internal

organs of children are delicate and thus easily disturbed by irregularities in

diet, environment, or emotional situation. Therefore, this pattern in children

is not the same as it might be in adults, where a particular pathodynamic

(e.g., spleen qi deficiency) may be fairly stable throughout the course of

treatment. In children, because the cause is fundamentally one of imbalance

and not a case of pure deficiency, manifestations are changeable.

In all of its forms, the condition is ultimately rooted in a deficiency of

pre-natal qi and is generally not caused by any of the six externally-contracted

excesses (wind, cold, summer heat, dampness, dryness, and fire).

Etiology

Children with congenital deficiencies of pre-natal qi do not necessarily

develop this pattern. Children with prenatal qi deficiency who go on to develop

this pattern generally also experience one of the following:

• Emotional stressors such as increased pressure in school or socially.

This also includes emotional issues related to family life.

• Severe fear or traumatic experiences.

• Irregular diet, especially one where the child eats only certain foods

without sufficient variety (especially an excess of sweets).

Symptomatology

There are five basic symptom categories. A child experiencing this pattern

may not necessarily have all of the symptoms below:

1. Difficulty concentrating

The child is easily distracted, has problems in school, wants to move

about, tries to do too many things at once and/ or has difficulties with

memory.

2. Emotional problems

Affected children are often irritable and difficult to control. They are

often unconcerned about the results of their actions or their effects on

others. They may also be easily angered.


Appendix 5 The Liver and Attention Deficit Hyperactivity Disorder (ADHD)

3. Sleep disorders

Symptoms may include waking easily, sleepwalking, or talking during

sleep.

4. Muscular changes

These may include twitching or tightness of the muscles, usually in the

neck or face.

5. Difficulties with balance

The child may be clumsier than others and may fall often or have an

unusual gait.

Channel diagnosis

The pattern most often includes palpable changes on the jue yin liver

channel, jue yin pericardium channel, tai yin spleen channel, or tai yin lung

channel. There may also be changes along the shao yin channel or the du

vessel. Palpation of these channels is helpful in the differential diagnosis.

Differentiation

In most cases, patterns will involve an intermingling of yin deficiency,

phlegm, and fire.

Exuberant liver fire/liver fire harassing and stirring (Jff X tftll giin hu6 rao

dong)

In this pattern, irritability and constant movement will be most obvious.

The child may talk excessively and will have difficulty getting to sleep

(yin deficiency). Palpation may reveal small nodules along the jue yin pericardium

channel, especially in the area between PC-3 (qu ze) and PC-4 (xi

men).

The treatment principle, in this case, is to clear heat, transform phlegm

stasis, calm the liver and extinguish wind.

Acupuncture

A helpful point pair for this pattern is PC-7 (da ling) and LR-2 (xingjiiin),

which clears and transforms heat from the jue yin channel. KI-7 (fit liu) may

also be added to benefit the yin (mother point of the kidney channel).

Herbs

Gastrodia and Uncaria Drink (tiiin ma gou teng yin), with modifications

Gastrodiae Rhizoma (tiiin ma)

Uncariae Ramulus cum Uncis (gou teng)


APPLIED CHANNELS IN CHINESE MEDICINE

Paeoniae Radix alba (bai shao)- with a higher dose of up to 30g

Perillae Folium (zi su ye)

Lonicerae Flos (jin yin hua)

Ziziphi spinosae Semen (suan zao ren)

Anemarrhenae Rhizoma (zhi mu)

Angelicae sinensis Radix (dang gui)

Rehmanniae Radix (sheng di huang)

Fossilia Dentis Mastodi (long chi) - if sleep problems are pronounced

Puerariae Radix (ge gen) - if neck stiffness is pronounced

Elements of Warm the Gallbladder Decoction (wen dan tang) maybe

added as well to transform phlegm and open the collaterals.

Liver and kidney yin deficiency Attention problems are often most pronounced

is this pattern. The child may also have dry eyes, warm palms and/ or abdomen

(five-center heat), a red tongue, and a thin, rapid, or frail pulse. The child will

often wake easily during the night. Palpation may reveal changes along the

shiw yin channel, especially the area around HT-5 (tong li) to HT-7 (shen

men) and KI-6 (zhiw hili). Palpable channel changes in children are often

very small, and differentiation is a skill that will only be gained with practice

over time. In this type of case, the changes may feel like very small, crunchy

thickening along the shiw yin channel.

The treatment principle is to benefit the kidney and liver yin.

Acupuncture

The point pair HT-6 (yin xi) and KI-7 (fit liu) is most often used in combination

with LR-3 (tai chong). This pair benefits the kidney yin, as HT-6

(yin xi), the cleft point of the heart channel provides qi from the heart to

facilitate the yin-strengthening action of KI-7 (fit liu). This is an instance

of regulating the shao yin qi transformation to facilitate communication

between the heart and kidney. LR-3 (tai chong), the source point of the liver

channel, benefits the liver yin.

Herbs

Six-Ingredient Pill with Rehmannia (liu wei di huang wan), with modifications

Consider adding Anemarrhenae Rhizoma (zhi mu), Nelumbinis Semen

(lian zi), Platycladi Semen (bai zi ren), and/or Testudinis Plastrum (gui

ban).

Heart and spleen deficiency A child with this pattern will likely present as

more generally deficient, as there is a coexisting deficiency of both heart and


The Liver and Attention Deficit Hyperactivity Disorder (ADHD)

spleen qi. In the case of the spleen, however, the pattern will also include what

may be termed spleen yin deficiency. This can be understood as yang ming

yin deficiency affecting the spleen, thus leading to the common complaint of

constipation. The child will also often be tired, have a low appetite, have excessive

dreams, and will be easily scared. The pulse will often be slow, and the tongue

pale with a dry coating. Palpation often reveals soft nodules or a decrease in

muscle tone along both the lung and spleen tai yin channels, and occasionally

on the shao yin channels as well.

The treatment principle is to benefit the qi.

Acupuncture

The point pair LU-9 (tai yuan) and SP-3 (tai bai) is most commonly used

together with the pair CV-11 (jian U) and ST-36 (zu siin li). Both pairs are

used to benefit the qi throughout the body. Source points on the tai yin

channel stimulate the production of post-natal qi. The CV-11 (jian U) and

ST-36 (zu siin li) pair fortifies the spleen-stomach, primarily by stimulating

yang movement.

Herbs

Emperor of Heaven's Special Pill to Tonify the Heart (tiiin wang bu xin

diin), with modifications

Ziziphi spinosae Semen (suiin zao ren) - higher dose

Platycladi Semen (bai zi ren) - higher dose

Asparagi Radix (tiiin men dong)

Ophiopogonis Radix (mai men dong)

Rehmanniae Radix (sheng di huang)

Polygalae Radix (yuan zhi)

with the addition of Four-Gentleman Decoction (si jun zi tang)

to support the spleen

Conclusion

In all ADD/ ADHD patients, it should be remembered that wind, phlegm,

fire, and qi stasis may always be part of the presentation. Because the pattern

may change fairly quickly during a course of treatment, the diagnosis

should often be re-evaluated. The operative concept for these patients is a

general loss of inter-regulation among the organs.

Other acupuncture points that may be considered include GB-20 (Jeng

chi), TB-18 ( qi mai), and BL-10 ( tiiin zhit) if neck complaints are present.

Also du vessel points such as GV-21 (hou ding) and GV-24 (shen ting) can

[ 655]

APPLIED CHANNELS IN CHINESE MEDICINE

be used to bring clear qi up to the head/brain. Finally, the spleen, liver, and

heart back transporting points (BL-20, BL-18, and BL-15) as well as the

point pair CV-12 (zhang wan) and ST-40 (Jeng long) can also be used to

facilitate phlegm transformation.

Because of the tendency of these patients to also present with phlegm

(sometimes 'formless' or unseen phlegm), formulas should often include

variations of Warm the Gallbladder Decoction (wen dlm tang) and TwoCured

Decoction (er chen tang). These formulas can open shiw yang! jue

yin, transform phlegm, and unblock the collaterals of the brain.

If the patient is older and the condition more long-standing, it may be

advisable to consider herbs that more strongly calm wind and transform

phlegm, such as Bombyx batryticatus (bdi jiang can) and Scolopendra (wu

gong); or herbs that strongly move blood, such as Carthami Flos (hong

hua).

In general, the Liver is an important part of most ADHD patterns in

the sense that inter-regulation is compromised. Many of the treatment

principles outlined above involve clearing and regulating to facilitate jue

yin function (via not only the jue yin channel, but also by using tai yin and

shao yin to clear and stimulate). Only in the case of a more 'pure' deficiency

of post-natal qi does the liver play a less important role in treatment. In the

most commonly seen patterns, the liver function of dredging and draining

the pathways of qi is at the center of this syndrome


Wang Ju-Yi

Jason D. Robertson

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