Bob Flaws, Dipl. Ac. & C.H., FNAAOM

Zhang Yi-mei and Zhang Xiao-ling, writing in Hu Nan Zhong Yi Za Zhi (Hunan Journal of Chinese Medicine), #9, 2000, p. 22-23, describe their treatment of 41 cases of pediatric attention deficit hyperactivity disorder with a combination of acupuncture and internally administered Chinese herbal medicine as compared to 46 cases of ADHD who received acupuncture alone.

Cohort description:

Of the 41 children in the treatment group, 34 were male and seven were female. The youngest was four and half years old and the oldest was 15. In the comparison group, there were 37 males and nine females who ranged in age from 4-12 years. All had been diagnosed as suffering from ADHD based on the criteria set forth in the DSM-IV. In addition, neurological diseases resulting in disturbances of intelligence were excluded.

Treatment method:

The so-called comparison group received the following acupuncture treatment. The main or ruling points consisted of several named groups of points. Zhi San Zhen (Intelligence Three Needles) was comprised of Qian Ding (GV 21) located on the midline and unnamed points located three cun to either side. Zhu Yi Li San Zhen (Attention Power Three Needles) consisted of Yin Tang (M-HN-3) and Tai Yang (M-HN-9) needled bilaterally. The last group of ruling points was Si Shen Cong (M-HN-1). Auxiliary points included: He Gu (LI 4), Shou Zhi Zhen (Hand Intelligence Needles, i.e., Nei Guan, Per 6, Shen Men, Ht, and Lao Gong, Per 8), Zu San Zhen (Foot Three Needles, i.e., Zu San Li, St 36, San Yin Jiao, Sp 6, and Tai Chong, Liv 3), Shen Mai (Bl 62), and Zhao Hai (Ki 6). One cun 30 gauge fine needles were used. Needles on the head were needled transversely approximately one cun. The Si Shen Cong were needled towards Bai Hui (GV 20). Points on the four extremities were needled perpendicularly to standard depths. Even supplementing-even draining hand technique was used with the needles being twirled once every 10 minutes. The needles were retained for a total of 30 minutes per treatment, with one treatment per day.

The treatment group received the same acupuncture treatment as the comparison group. However, in addition, they were orally administered Jing Ling Kou Fu Jin (Stilling, Magically [Effective] Orally Administered Fluid), a ready made medicine. Patients 3-5 years old received 5ml of this medicine two times per day. Those 6-14 got 10ml two times per day, and those 14 or over were administered 10ml three times per day. Jing Ling Kou Fu Jin was comprised of: cooked Radix Rehmanniae (Shu Di), Radix Dioscoreae Oppositae (Shan Yao), Fructus Corni Officinalis (Shan Zhu Yu), Fructus Ligustri Lucidi (NuZhen Zi), Fructus Schisandrae Chinensis (Wu Wei Zi), Sclerotium Poriae Cocos (Fu Ling), Sclerotium Pararadicis Poriae Cocos (Fu Shen), Radix Polygalae Tenuifoliae (Yuan Zhi), Os Draconis (Long Gu), Concha Ostreae (Mu Li), and Rhizoma Alismatis (Ze Xie). This medicine was chosen based on the opinion that the main disease mechanisms of pediatric ADHD are kidney water insufficiency with liver yang hyperactivity and exuberance resulting in a loss of regulation between yin and yang and thus lack of calm of the heart spirit.

All the patients in both groups were treated for three months which equaled one course of therapy.

Treatment outcomes:

Clinical cure was defined as the basic disappearance of the 18 symptoms of ADHD described in the DSM-IV. Marked effect meant that five or more of these 18 symptoms decreased from before to after treatment. Some effect meant that two or more of these symptoms decreased. No effect meant that there was no improvement.

Based on these criteria, eight cases in the treatment group were judged cured, 21 got a marked effect, 10 got some effect, and two got no effect, for a total amelioration rate of 95.12%. In the comparison group, five cases were deemed cured, 20 got a marked effect, 14 got some effect, and seven got no effect, for a total amelioration rate of 84.78%.

In terms of three month follow-up, six cases in the treatment group were still considered cured three months after the completion of the therapy, 18 cases were still considered markedly effective, 14 cases still had some effect, and three cases had no effect. Hence the three month follow-up amelioration rate for the treatment group was 92.68%. In the comparison group, the numbers were respectively three, 12, 21, 10, and 78.26%.

Conclusion:

I think there are several conclusions that Western practitioners can draw from this study. First, both acupuncture alone and acupuncture plus Chinese herbal medicinals can be effective for the treatment of pediatric ADHD. Secondly, the combination of acupuncture and orally administered Chinese medicinals appears to achieve better therapeutic effects than acupuncture alone. Third, even better results may have been achieved if the authors of this study had treated based on individual patients’ pattern discriminations. In this study, except for the auxiliary acupoints whose selection was not explained, all the patients were treated for yin vacuity with yang hyperactivity and restlessness of the heart spirit. Other Chinese literature (see James Lake’s and my Chinese Medical Psychiatry) suggests that there are several different Chinese disease mechanisms which might result in ADHD, each of which requires its own treatment principles and protocols. Therefore, both the cure rate and the total amelioration rates, especially in the treatment group, might have been higher if more individualized Chinese medicinal formulas had been used. However, even without such individualized treatment, Zhang and Zhang’s results are, I think, encouraging. And fourth, it is possible that using this or similar Chinese medical protocols in tandem with Western medicine might allow for smaller doses of Western drugs with less adverse side effects and even better overall treatment outcomes.

Copyright © 2000, Blue Poppy Press. All rights reserved.

For more information on the Chinese medical treatment of pediatric hyperactivity and/or ADHD, please see Bob Flaws’ A Handbook of TCM Pediatrics (Blue Poppy Press); Bob Flaws & James Lake’s Chinese Medical Psychiatry (Blue Poppy Press); and Blue Poppy Seminars’ The Treatment of Mental-emotional Disorders with Chinese Medicine and TCM Pediatrics Certification Program.