Treatment Of Attention Deficit Hyperactivity Disorder With Antithetical Drugs

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Li Liang and Han Fei

[Abstract] Attention deficit hyperactivity disorder (ADHD) is a common psychobehavioral disorder in childhood. Its pathogenesis is complex and its manifestations are diverse

The authors believe that the treatment of this disease should be based on tonifying the kidney and filling the essence, invigorating the spleen and removing dampness, clearing phlegm and opening the mouth, and the flexible use of the right medicine on the basis of the combination of disease and syndrome differentiation. Among them, Radix Rehmanniae Rehmanniae and Cornus officinalis nourish kidney yin and liver blood, Cistanche deserticola and Zhiren warm kidney yang and benefit essence and qi, Codonopsis pilosula, and Astragalus membranaceus replenish spleen, nourish the source of energy, Atractylodes macrocephala and Poria cocos restore spleen circulation and remove dampness, Acorus calamus, and Polygala tenuifolia clear phlegm and open and close pathogenic factors. The use of drugs can play the role of outlining and simplifying to complex, and the clinical effect is significant, which provides certain guidance and reference for the treatment of this disease.

[Key words] Attention deficit hyperactivity disorder; Drug control; Rehmannia glutinosa; Cornus officinalis; Cistanche deserticola; Yizhiren; Atractylodes macrocephala; Poria cocos; Codonopsis pilosula; Astragalus; Gladiolus; high aspiration

Desert ginseng

Paired drugs are called "drug pairs", also known as "sister drugs", which means that the prescription of Chinese medicine for clinical treatment often uses two Chinese medicines together to promote, inhibit, coordinate, and interact with each other, so as to achieve the purpose of increasing efficiency, reducing toxicity, connecting or transforming into other uses. It is an invisible bridge between single medicine and compound Chinese medicine [1]. Attention deficit hyperactivity disorder (ADHD), commonly known as "hyperactivity disorder", is a relatively common psychological and behavioral disorder syndrome in childhood, which is characterized by inattention, short attention, hyperactivity impulse, and is often accompanied by learning difficulties, misbehavior and other problems that do not match the actual age or development level [2]. According to its clinical manifestations, it can be classified into the categories of "forgetfulness", "agitation", "deafness", "dirtiness" and so on. The author believes that the disease is located in the heart, spleen, and kidney. The basic pathogenesis is qi deficiency and essence deficiency, phlegm-dampness block, divine mechanism failure, and laxity. The main causes of the disease are insufficient fetal endowment, acquired dystrophy, improper education, and an inappropriate environment. The main pathological factor is a deficiency, with phlegm and dampness, and blood stasis for a long time. Therefore, in the treatment, we should pay attention to the relationship between the spleen and kidney, eliminate the cause of disease, and take tonifying the kidney and fill the essence, strengthening the spleen and removing dampness, and clearing phlegm to open the mouth as the basic method. The commonly used drugs for the treatment of ADHD are introduced as follows in order to help the treatment of this disease.

1. Nourishing kidney yin and liver blood-prepared Rehmannia and Cornus officinalis

Children are the body of childish yin and childish yang. The essence, blood, and body fluid are not yet full, the viscera function is not mature, and the physiological particularity has also become the internal factor of ADHD. The kidney is a strong official. It is skillful and skillful. It mainly stores essence, generates marrow, and fills the brain. If the kidney is full of energy, the kidney is full of energy, the sea of marrow is full, and the brain is fed, then the sense, movement, and memory functions are normal. The Direct Determination of Pediatric Drug Syndrome [3] said: "Kidney governs deficiency, and there is no substance." Children with ADHD often have congenital abnormalities, such as deficiency of kidney essence and kidney qi, lack of source of marrow production, and loss of nourishment in the brain, which are manifested by poor memory and sensory disorders. Deficiency of kidney qi, weakness or strength, deficiency of kidney essence, loss of marrow sea, and loss of nourishment of brain can lead to clumsy actions, poor coordination, and decreased memory; Deficiency of kidney yin, disharmony of heart and kidney, and hyperactivity of heart yang can lead to attention deficit and restlessness.

Rehmannia glutinosa has a sweet taste, and warm nature, and belongs to the liver and kidney. Sweet and warm, nourishing yin and blood, replenishing essence and filling marrow. "Herbal Summary": "It is the medicine for yin division to enter the Shaoyin kidney meridian All syndromes should be replenished with the agent of nourishing blood and yin, tonifying kidney and filling essence, and Rehmannia glutinosa should be prepared to replenish it. " Cornus officinalis has a sour taste, a mild nature, and belongs to the liver and kidney. Acid and warm astringent, tonifying liver and kidney, astringent and solid. According to the Record of Meditation and Reference to the West, "Cornus officinalis can greatly astringe vitality, invigorate the spirit, and be stubborn and slippery."

Rehmannia glutinosa and cornus officinalis are commonly used medicines for tonifying essence and marrow. Rehmannia glutinosa is thick in taste and thin in qi. It can greatly nourish vitality, essence, and marrow, and its function is more beneficial. Cornus officinalis is warm but not dry, and it can benefit the liver and kidney, help the kidney to store essence, and its function is more convergent. Because the essence and blood are homologous, nourishing liver blood can also promote the metaplasia of kidney essence. The two drugs are compatible, one is replenishing and the other is astringent, which restricts and promotes each other, and the power of replenishing the liver and kidney and benefiting blood essence is especially increased. Yuan Haixia et al. [4] found that prepared Rehmannia can improve the memory and learning ability of ADHD model rats, and reduce their hyperactivity, impulsivity, and other behavioral manifestations. Wang Aimei et al. [5] have found that cornus officinalis can improve the learning and memory function of rats, which may be related to the fact that the polysaccharides contained in Cornus officinalis can significantly improve the synaptic plasticity and promote the expression of brain-derived neurotrophic factor and tyrosine kinase receptor B in the hippocampus. In addition, Zhao Min [6] found that cornus officinalis - Rehmannia officinalis has a certain regulatory effect on the intestinal flora.

2. Warm kidney yang, benefits essence, and qi - Cistanche deserticola, Yizhiren

Desert living cistanche

Yin and Yang are mutually fundamental and mutually transforming. The deficiency of kidney qi and yin for a long time will inevitably affect kidney yang. Kidney yang is the essence of yang, just as Zhang Jingyue said: "Five viscera You can't release the yang without it. " Kidney yang has the function of stimulating, promoting, warming, and promoting. Only when the kidney yang is full, warming the viscera, meridians, body, organs, and orifices, and promoting and promoting its functional activities, can the blood essence and body fluid be normalized and distributed. Therefore, when tonifying the kidney essence and kidney qi, we should also pay attention to warming the kidney and helping the yang. This is the meaning of seeking yin in the yang. 

Cistanche deserticola is sweet and salty in taste, warm in nature, and belongs to the kidney and large intestine. It tastes heavy and moistens the body. It can not only warm the kidney, help the yang, and replenish the blood essence, but also moisten the intestines and relieve constipation. The Classic of Materia Medica calls it "the essential medicine for nourishing kidney and blood essence". Yizhiren has a pungent taste, warm nature, and two meridians of the spleen and kidney. It is spicy, warm, and dry. It is good at warming the spleen and stopping diarrhea, absorbing saliva, and has the effect of consolidating essence and shrinking urine. Materia Medica Mu called it "a medicine for promoting yang and removing yin". 

Cistanche deserticola ma and Alpinia oxyphylla are commonly used drugs for warming and tonifying the spleen and kidney. Cistanche deserticola is nourishing, nourishing but not severe, warm but not dry, Alpinia oxyphylla is fragrant, warming the spleen and stomach, warming the kidney and cold, and astringing the qi. The two drugs are compatible and complement each other. They can warm the kidney and warm the spleen. They are especially suitable for children with ADHD accompanied by enuresis and spitting. In addition, Cistanche deserticola can also help Rehmannia glutinosa and Cornus officinalis to replenish liver and kidney essence and blood, and the combination of yang warming drugs for the treatment of this disease still has the meaning of seeking yin in the yang.

Cstanche deserticola

Hu Yuming et al. [7] found that the effective components in Cistanche deserticola can significantly improve the function of the cholinergic nerve by regulating the activity of cholinesterase Learning and memory ability. Ma Junqiao et al. [8] carried out a study on Alpinia heterophylla and found that it has a similar effect with Cistanche deserticola. Xie Jihong et al. [9] found that the content of norepinephrine and 5-hydroxy indole acetic acid in the hypothalamus increased, the ratio of dopamine to dihydroxyphenylacetic acid increased, and the content of dihydroxyphenylacetic acid in the striatum also increased after the rats were given the ethanol extract of Cistanche deserticola by gavage.

Superman herbs cistanche

3. Replenishment of spleen and resources - Codonopsis pilosula and Astragalus membranaceus

The spleen is thought for the purpose, and the body is combined with the flesh and dominates the limbs. Children's intestines and stomachs are fragile and thin, and their spleen is often insufficient. They are easy to be injured by milk food, resulting in insufficient temper. Spleen deficiency is lost in tranquility The speech is bold and capricious; Spleen deficiency is not good at thinking, but poor logic, lack of organization, regardless of consequences, regardless of risks; Spleen deficiency leads to limb loss, which is difficult to control, while more hands and feet, more small movements. In addition, the kidney is the innate foundation, and the spleen is the acquired foundation. The two are mutually supporting and promoting each other. The innate essence stored in the kidney also depends on the continuous replenishment of the essence of the water and grain. Spleen deficiency will lead to loss of health, water, and grain will not be distributed, and the biochemical source of qi and blood will not be sufficient to support the congenital disease, which will also aggravate the disease.

Codonopsis pilosula is sweet and mild and has two channels: spleen and lung. It can nourish the spleen and lungs, replenish qi and generate fluid. "Materia Medica Justice," said that its "origin is not very similar to ginseng Far. Astragalus is sweet and warm and belongs to the lung and spleen. It is sweet, warm, and moderate, and has a light smell. It is good at supplementing qi and strengthening the surface, supporting poison and generating muscle, and is also beneficial to the effect of water and detumescence. "Tang Ye Ben Cao," said that it has the function of softening the spleen and stomach, and is the medicine of Zhongzhou.

The compatibility of Codonopsis pilosula and Radix Astragali is derived from the Spleen and Stomach Theory. It is a commonly used medicine for tonifying qi and strengthening the spleen. Codonopsis pilosula is a kind of yin and can nourish qi, nourish the central state, harmonize the spleen and stomach, promote healthy circulation, and produce fluid Partial complement; Astragalus membranaceus is light and floating, replenishing the spleen and lungs, invigorating the vital energy, elevating the yang qi, and benefiting the water and dampness. It belongs to the yang but is partial to the solid surface. Both are essential drugs for invigorating qi, and both have the function of invigorating the spleen. The two drugs are combined, one yin and one yang, one exterior and one interior, and the other are necessary for use. The power of invigorating qi and invigorating the spleen is greater.

Zhang Zhendong et al. [10] found that Codonopsis pilosula can antagonize memory acquisition, memory consolidation, and memory reproduction in mice. Liu Dongmei et al. In addition, Codonopsis pilosula and Radix Astragali also have the effects of anti-tumor, anti-fatigue, anti-aging, regulating immunity, improving circulation, and enhancing gastrointestinal motility [12-13].

4. Restore spleen circulation and remove dampness - Atractylodes macrocephala and Poria cocos

The spleen is responsible for the transportation of water, likes dryness but hates dampness, and has a vigorous temper. Only when the water can be transported normally without stopping gathering, and the drying of the spleen is the prerequisite to ensure its normal transportation and chemical function One is that if the spleen is deficient and the water and liquid are transported abnormally, it will produce phlegm and water dampness, which will, in turn, trap the spleen and further aggravate the spleen deficiency, that is, phlegm and water dampness trap the spleen. Wet, turbid, and sticky, blocking the gas flow, you can see that you prefer to lie down and do things slowly. In addition, people usually eat fatty, sweet, thick, and greasy products, resulting in the spleen losing its health, the water being wet and not spreading, and gathering into phlegm, or the body with spleen deficiency and phlegm being wet, or the body with spleen deficiency and phlegm being wet and wet due to the preference for spicy and hot materials, resulting in phlegm, dampness and phlegm heat, which can be used to clear the body and disturb the mind.

Atractylodes macrocephala tastes sweet and bitter and has a warm nature. It can return to the spleen and stomach. Gan Wen is good at tonifying the spleen and replenishing qi, and bitter Wen is good at dryness to benefit water and dryness. It also has the function of stopping sweat and preventing pregnancy. Materia Medica

Xuan said: "Atractylodes macrocephala is a medicine for invigorating the spleen and stomach." Poria cocos are sweet and light and have a flat nature. It can be returned to the four channels of the heart, spleen, lung, and kidney. Sweet, light, penetrating, and beneficial, and can also replenish the deficiency. It can not only benefit the water and moisture, strengthen the spleen and stomach, but also calm the heart and mind. The Medication Mind Method says that it "tastes sweet and smooth, replenishes yang, benefits spleen and expels water".

The compatibility of Atractylodes macrocephala and Poria cocos is derived from Jingyue Quanshu, which is a commonly used medicine for invigorating the spleen and removing dampness; Poria Ling Gan is light and flat, replenishing but not stagnating, and sharp but not severe. It is important to be light and moist. The combination of the two drugs, one for replenishing and one for infiltrating, can restore the spleen, remove water and moisture, and allow the normal distribution of water and liquid, which also helps to dissipate phlegm.

Ji Zhihong et al. [14] found that atractylodes macrocephala can improve memory and learning ability. Xu Yubin et al. [15] found that Poria cocos not only can improve learning and memory but also has sedative and hypnotic effects. In addition, Atractylodes macrocephala and Poria cocos also have anti-inflammatory, anticancer, antidepressant, hypoglycemic, and promoting gastric motility [16-17].

5. Typical medical records

The patient, a male, 9 years old, was initially diagnosed on August 15, 2019. The chief complaint is that he can't concentrate and listen carefully in class for more than half a year. He was diagnosed with ADHD in a local hospital. His symptoms improved slightly after treatment with oral oselta, but he stopped taking the medicine because of insomnia, anorexia, and other adverse reactions after taking the medicine. So he came to our hospital for treatment with traditional Chinese medicine. Engraving: inattention, poor memory, reduced learning performance, more small movements, poor coordination, often self-conscious fatigue, rash speech, good sleep, two-tone, light tongue, white and greasy fur, and smooth pulse. Western medicine diagnosis: ADHD, TCM syndrome differentiation: deficiency of spleen and kidney, loss of heart and mind, phlegm, and dampness blocking the orifices. Prescription: 12 g of cooked rehmannia, 12 g of Chinese yam, 12 g of cornus officinalis, 12 g of poria cocos, 12 g of ligustrum lucidum, 12 g of radix pseudostellariae, 15 g of codonopsis pilosula, 9 g of Pueraria lobata, 9 g of acorus tatarinowii, 9 g of prepared radix polygala, 9 g of semen ziziphi spinosae, 9 g of cypress seed, 15 g of fried atractylodes macrocephala, 12 g of astragalus, 9 g of cistanche, 9 g of fructus oxyphylli, 6 g of pinellia, 28 doses, 1 dose per day, 300 mL of water decoction, two warm drinks in the morning and evening. At the second visit on September 12, 2019, the parents complained that the above symptoms had improved to varying degrees after taking the medicine, but there were still many small movements, and the coordination was still poor. Recently, nasal congestion occurred due to cold, especially at night, the tongue was light red, the fur was white and greasy, and the pulse was floating. Add 9 g of Angelica dahurica and 9 g of Magnolia magnolia to the upper part, 28 doses, 1 dose per day, and decoct with water. On October 10, 2019, during the third visit, the parents complained that the children had been able to listen to the lectures in class, their academic performance had improved, their small movements had decreased, they were easy to wake up during sleep, their tongue was light red, their fur was thin and white, and their pulse was stringy, and they removed Spinelli ternate, aconite, angelica dahurica, and magnolia from the upper part, and added 15 g28 doses of the calcined keel, one dose per day, and decocted in water. After that, the above prescriptions are still added or subtracted to consolidate the curative effect.

Cistanche powder

Click here to view Cistanche deserticola  products

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According to this case, the child has been ill for more than half a year, and its symptoms include inattention, careless speech, greasy fur, and slippery pulse, which are manifested by phlegm and dampness, and loss of consciousness. Poor memory and clumsy actions are the symptoms of kidney deficiency, essence deficiency, marrow sea insufficiency, and weakness. Many small movements and self-conscious fatigue are the symptoms of deficiency of temper and loss of limbs. This disease is based on kidney deficiency and essence deficiency, spleen deficiency, and dampness stagnation, and the target is turbid phlegm and loss of heart and mind. Therefore, it should be treated by tonifying the kidney and replenishing essence, nourishing the heart and calming the nerves, strengthening the spleen and removing dampness, clearing phlegm, and opening the orifices. The prescription is composed of Liuwei Dihuang Pill plus or minus Ligustrum lucidum, Atractylodes macrocephala, Codonopsis pilosula, Radix Astragali, and Radix Pseudostellariae, which can replenish the kidney and essence, strengthen the spleen and remove dampness; Sour jujube kernel and cypress kernel nourish the mind and calm the nerves; Acorus calamus and Polygala tenuifolia can clear phlegm and open the mind, and communicate with heart and kidney; Pinellia ternate and Su Zi enhance the power of eliminating dampness and phlegm; Cistanche deserticola and Yizhiren warm the kidney and benefit the essence, implying the meaning of seeking yin in yang; Pueraria lobata can lift and clear the yang, stimulate the qi of the spleen and stomach, and help ginseng, Ling, Shu, and Qi to restore the spleen. The symptoms of the children in the second diagnosis were relieved, but the nasal congestion occurred due to an external infection. Therefore, Angelica dahurica and Magnolia magnolia were added to disperse the external pathogenic factors and clear the nose. The symptoms of the children with the third diagnosis have improved significantly, they have been able to listen to the lectures, and their academic performance has also improved. According to the tongue and pulse, their phlegm and dampness have gradually increased, and their spleen and kidney have gradually increased, but they are easy to wake up during sleep. Therefore, Spinelli ternata, Suzi, angelica dahurica, and magnolia have been removed, and the keel has been calcined to calm the heart and calm the nerves.

6. Conclusion

The special physiological and pathological characteristics of children, such as delicate viscera, unfilled shape and qi, deficiency of spleen, and deficiency of the kidney, are the internal basis of ADHD. Therefore, the age of 7 to 12 years is the high incidence age of ADHD. In clinical treatment, we should pay attention to the overall concept, and emphasize the combination of disease differentiation and syndrome differentiation. According to the etiology and pathogenesis of the disease, combined with its pathological characteristics of deficiency, phlegm and dampness, and blood stasis for a long time, we should pay equal attention to the treatment of congenital and acquired diseases, and apply such treatment methods as tonifying the kidney and filling the essence, strengthening the spleen and removing dampness, clearing the phlegm and opening the orifices, and combine with syndrome differentiation to match the products of calming the nerves and invigorating the mind, regulating qi and activating blood circulation. Given the complex etiology and pathogenesis of the disease, various pathological factors, and diverse clinical manifestations, the taste of the medicine should also be increased correspondingly when dispensing the prescription, and the use of the medicine can achieve the purpose of outlining and simplifying the complexity, which also contributes to the improvement of clinical efficacy.

reference

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