The Herb and Acupuncture Treatment of ADHD
Chief Complaint: anger management
Western Diagnosis: ADHD with Oppositional Disorder Defiant Disorder
Medical History: Patient is 13-year-old male student, 108 lbs., 5’6″, whose only other medical history was a case of asthma two years prior and pneumonia four years prior to first visit. Patient is only son/child of and resides with his parents and has two older step-sisters from mother’s previous marriage (one of whom is still at home). Family had relocated from urban to rural area approximately 4 years prior and patient held resentment and had grieving issues over leaving his home and friends behind.
Patient experienced episodes of anger (sometimes violent) which had increased in frequency and intensity both at school and at home, had difficulty maintaining focus/attention in the classroom and in studying and remembering, and had progressed to almost daily in-school suspensions and detention at school. One recent extreme incident at school had lead to patient being subject to adjudication and patient was on probation. Patient was in court-ordered counseling at a behavioral center and was medicated with three separate drugs (Depakote, Clonidine, and Aderol). Appetite was described as “good” with cravings for pizza and ice cream, a desire for cold drinks consisting daily of 1-2 sodas, 3-4 glasses of juice, and 2-3 glasses of milk. Patient admitted heat in hands but cold in feet, itchiness on back, and dandruff; heavy sleeper with active dreams; and one bowel movement daily.
Questioning exam: Patient described himself as agitated and angry. He was unhappy with how his medications made him feel and he told parents he wanted to try something “natural.” Under neurophysiological on the intake, patient admitted to a history of emotional problems, anxiety, confusion/foggy, moody, hyper, grieving, irritability, joyful, over-thinking, easily stressed, easy to anger, restlessness, bad-tempered, talkative, and poor memory. Patient admitted to excessive and intense playing of video games and listening to music. Parents stated that patient would become nearly entranced with the video games and played loud violent music, which frequently ended in a verbal altercation with family members. Patient admitted to having difficulty in taking turns or waiting his turn and having interruptive or impulsive behavior. Patient also admitted to finding the behavior of others as being unreasonable or “not fair” to him and that he would justifiably act or react accordingly with temper outbursts. Patient admitted that issues of power and control caused feelings of anger and often a struggle between himself and those in authority.
Pulse exam: Wiry pulse, occasionally slightly rapid.
Tongue exam: Tongue was short/reluctant, peeled and red at the tip and with thin white coat, often slightly wet and quivering. Patient was extremely fidgety, especially the hands, and the degree of agitation often almost to the point of not being able to stay seated in chair. Very dark-reddish circles were obvious around the eyes and the lips appeared to be somewhat enlarged and very red. Slender, weak body with little muscle mass, fine reddish hair, little body hair.
OM Diagnosis: Pediatric Hyperactivity and Anger due to Kidney Deficiency (insufficiency of pre-natal Kidney Essence which failed to nourish Liver Wood).
Treatment Principle: Release constrained Qi and promote free-flow of the emotions. Calm the spirit, clear heat, nourish yin.
Point Prescription: GV 13, DU 20, DU 24 used in combination:
GV 13 to settle the Ethereal Soul and to send Essence to the Brain
DU 20 to clear Spirit, discharge Heat, and send Yin upward
DU 24 to calm Mind, quiet the Heart and Spirit
Auricular NADA Points:
Shenmen for tension, anxiety, depression
Sympathetic for the Sympathetic nerve system
Liver to settle the Ethereal Soul and promote the free-flow of Qi
Kidney to tonify Kidney Essence and Yin
Heart to Quiet the Heart and Spirit
Herbal Formula: Acorus Tablets, 2 300-mg tablets 3x daily reduced to 1 bid after 8 months (ITM, Portland, OR, formula to calm spirit, resolve phlegm, and clear heat due to Kidney Yin Deficiency)
Gui Pi Wan, 8 3x daily reduced to 6 3x daily after eight months (standard Chinese formula to tonify Qi and Blood as well as for over-work, over-thinking, over-studying)
Xiao Yao Wan, 8 3x daily added in second month and discontinued end of fourth month (to promote free-flow of Qi, Blood, and the emotions)
Suan Zao Ren Wan, 3 3x daily added end of fourth month and reduced to 2 3x daily in eighth month (to nourish Liver, calm Heart, and clear Liver Heat)
Lifestyle Prescription: Patient and family members were initially counseled to become more observant of dietary habits, especially to control consumption of ice cream, soda, cheese, and other snacks. Approximately two months into treatments, patient had what is best described as a total “meltdown” in behavior during a school vacation week. Patient had been at a “sleep-over” with friends, playing video games and staying up most of the night, eating junk food and sodas or not eating at all, and flew into a total violent rage upon arriving home. Father had to subdue patient physically after patient tore bedroom door off hinges. Patient was seen for treatment the following day and an agreement was made between parents and patient to better control diet and eliminate as much high carbohydrate foods as possible, to include snacks and sodas. Family made commitment to prepare a nutritious breakfast each morning for the patient and to eat more balanced meals.
Results: Patient was seen for treatment with weekly visits for the first two months. Two weeks into treatment, patient felt less agitated, had fewer cravings, exhibited less heat signs (obvious less redness around eye area), exhibited better temperament, but had little improvement in appetite (which actually had been quite poor outside of junk food).
By end of second month, sleep was improved and patient was doing homework assignments on his own and catching up on his late assignments.
Treatment was extended to every two weeks at the beginning of third month and patient was taken off both the Depakote and Clonidine by his counselor. Patient reported being very busy, not as agitated or as easily annoyed as before. During treatment, patient exhibited very little fidgeting. A week later, patient was taken off third/last drug, Aderol. School was going very well and there had been no more home incidents of anger. Patient’s tongue was not moving around as much and there was a visible sparkle in his eyes.
At end of third month, patient weighed 112 pounds and was not eating snack foods. His Shen was very good. School work had improved and, although anticipated, he would not have to go to summer school. A month later, patient’s weight was up to 120.
At the end of the sixth month, patient reported that his summer vacation was uneventful. Parents gave good report that patient was making better decisions and keeping his balance. Patient reported that he handled irritations well and his appetite and sleep were both good. At the end of the summer, patient’s weight was up to 130 pounds.
Ten months after commencing treatment, patient is doing well in school and reports feeling good about himself. Acupuncture treatment will continue on a bi-monthly basis until the one-year anniversary; herbal treatment will continue as stated. Patient’s case will then be re-evaluated.
Synopsis: Although the patient’s father was reluctant to admit that his son might have delayed development (Kidney Essence Deficiency) in any way, he whole-heartedly joined in his son’s treatment. It was and needed to be a team effort. At this time, the patient’s parents and family brag upon the fact that the patient is truly a totally different person.