herbal medicine and treatments for adhd

7/28/2019 Herbal Medicine and Treatments for ADHD

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http://www.healing-arts.org/children/ADHD/herbal.htm

Herbal Medicine and Treatments for ADHD

Herbal Medicine and Treatments for Attention-Deficit / Hyperactivity Disorder (ADHD)

Overview:

Parents and professionals faced with the challenging task of treating ADD and ADHD in childrencommonly face an unfortunate situation in which behavior problems at home and/or school haveplaced yet another pressure to opt for medication as the primary treatment.

There is little doubt that the majority of these 'medicated' children will have benefits in theirattention span, behavior, and other components of their disorder. And yet, the benefits ofmedication come with built-in risks from misdiagnosis, side effects, abuse, and unforeseen long-term complications.

Although complementary and alternative therapies have shown promise in treating ADD andADHD, the task of matching the patient to the most appropriate of these therapies remains elusiveto many parents who have explored the options, as well as professionals. Many treating physiciansare waiting for better studies, and conventional standards, to help establish appropriate treatmentprotocols.

This article will explore the potential of herbal medicine as a component of a complementarytreatment plan for ADD /ADHD (please see our complete list of othertreatments for ADHD).

Herbal Treatments & the Alarming Increased Medical Use of Stimulants:

The use of herbal medicine in the treatment of ADHD is of high interest to the many families andprofessionals looking for alternatives to drug therapy. This interest has no doubt heightened inrecent years due to problematic and near epidemic-proportion use of stimulants in children. Thefollowing review of an alarming trend to medicate ever-increasing numbers of school- and pre-school age children will help serve to emphasize the need for greater research into naturalalternative treatments.

Conventional pharmaceutical treatment for ADD/ADHD commonly includes methylphenidate(Ritalin) or amphetamine (primarilyAdderall and Dexedrine). Both of the substances are powerfulstimulants that have been in the Drug Enforcement Administration's (DEA) Schedule II of theControlled Substances Act (CSA) since 1971. Schedule II of the CSA contains those substancesthat have the highest abuse potential and dependence profile of all drugs that have medical utility.

According to the DEA's own records, the production of methylphenidate by the drug manufacturersin this country has increased by more than 500 percent since 1991. The production ofamphetamine has increased by over 2,000 percent in the same nine-year period of time. Morethan 50 percent of the methylphenidate and amphetamine prescriptions are written bypediatritions.

Their data indicate that the number precriptions written for ADHD has increased by a factor of 5

since 1991. In 1998 alone, over 4,000 prescriptions for methylphenidate were written forchildren 2years of age or less. (It should be noted that this drug is not approved for use in children under sixyears of age because safety and efficacy has not been established.)

The use of these medications varies widely from one region and community to another, with someregions identifying up to 20% of the student population receiving stimulants for ADHD.
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For a complete text of the information that has been summarized immediately above, please seethe"Statement of Terrance Woodworth, Deputy Director, Office of Diversion Control, DrugEnforcement Administration: Before the Committee on Education and the WorkforceSubcommittee on Early Childhood, Youth and Families".

Related Links:

Ritalin Use Among Youth: Examining the Issues and Concerns

Why are Stimulants Useful in ADD and ADHD?:

There appear to be biological differences in the brains of children appropriately diagnosed withADD and ADHD. Although diagnosis appears to be fraught with problematic issues forprofessionals, there does seem to be a general agreement that stimulants will generate significantimprovements in many symptom-parameters of ADD/ADHD patients.

A less well known fact is that these stimulants tend to improve most everyone's performance, childor adult - ADHD or not. The potential for the abuse of stimulants is not a new issue. A drug abuse

problem now includes college kids, who are, for example, abusing Ritalin to help them in theirstudies. What may be specific to the ADHD patient however, is their apparent difficulty in achievingand maintaining the type of brain activity normally associated with alert, focused, states ofconcentrated analytical learning.

This difference can be demonstrated in brain-maps using quantitative electroencephalographic(QEEG) measurements of brain wave activity in the various lobes of the brain. In the frontal lobe,where focused, analytical thinking occurs, ADD/ADHD patients tend to produce an abnormally highamount of alpha-, and/or theta- waves (normally associated with dreamy, eyes-closed states,) andless beta-waves (associated with focused, analytical thinking).

When given an 'eyes-open' challenge involving focused mental calculation or reading, most peoplewill produce less alpha (or theta), and more beta wave. This state of brain functioning appears tobe necessary for optimal focused attention and linear problem-solving. When given the samechallenge, patients with ADHD appear to be unable to make the appropriate shift into this focusedtype of brain functioning. Stimulant drugs and EEG Biofeedback Therapy have been shown tobring brain wave activity, reflected in EEG and brain-map data, closer to normal. The patient oftenexperiences a dramatic improvement in the ability to focus thought and pay attention for longerperiods of time.

Specific changes in brain function associated with ADD and ADHD have been reported in the

literature (see study below). Diminished perfusion (blood flow) and cortical activity are associatedwith ADHD. Herbal, nutritional and pharmaceutical interventions may be designed to improve suchfunctional parameters of the condition.

RELATED STUDIES:

High-Resolution Brain SPECT Imaging in ADHD

Amen DG, Carmichael BDAmen Clinic for Behavioral Medicine, Fairfield, California 94585, USAAnn Clin Psychiatry 1997 Jun;9(2):81-6

Children and adolescents with ADHD were evaluated with high-resolution brain SPECT imaging to
http://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/woodworth.htmhttp://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/woodworth.htmhttp://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/wl51600.htmhttp://www.healing-arts.org/children/ADHD/biofeedback.htmhttp://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/woodworth.htmhttp://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/wl51600.htmhttp://www.healing-arts.org/children/ADHD/biofeedback.htm


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determine if there were similarities between reported PET and QEEG findings.

Fifty-four children and adolescents with ADHD by DSM-III-R and Conners Rating Scale criteriawere evaluated. A non-ADHD control group was also studied with SPECT. Two brain SPECTstudies were done on each group, a resting study and an intellectual stress study done whileparticipants were doing a concentration task.

Sixty-fiver percent of the ADHD group revealed decreased perfusion in the prefrontal cortex withintellectual stress, compared to only 5% of the control group. These are findings consistent withPET and QEEG findings. Of the ADHD group who did not show decreased perfusion, two-thirdshad markedly decreased activity in the prefrontal cortices at rest.

Herbal medicines have demonstrated effectivenss in their ability to improve blood perfusion to thebrain and learning capacity. (See references to specific herbals below, notably Ginkgo andBacopa). Studies such as the one above may provide indicators and possible mechanisms for

herbal therapeutics.

RELATED STUDIES:

Sensitivity and Specificity of QEEG in Children with Attention Deficit or SpecificDevelopmental Learning Disorders

Chabot RJ, Merkin H, Wood LM, Davenport TL, Serfontein GDepartment of Psychiatry, New York University School of Medicine, New York, USAClin Electroencephalogr 1996 Jan;27(1):26-34

The sensitivity and specificity of QEEG-based discriminant functions were evaluated in populationsof children diagnosed with specific developmental learning disorders and those with attention deficitdisorders.

Both populations of children could be distinguished from each other, and from the normalpopulation, with high levels of accuracy. Pretreatment QEEG could be utilized to distinguishADD/ADHD children who responded to dextroamphetamine from those who responded tomethylphenidate, again with high levels of accuracy.

This paper provides a replication of all presented discriminant functions, and should provide the

research basis for the generalized utilization of QEEG in the initial evaluation of children withlearning and/or attention disorders.

As demonstrated in the above study, the effectiveness of stimulant therapy, including indicationsfor specific medication, could be predicted based on QEEG determinations.

It may be important to keep such biological implications in mind when using herbal remedies,because any medication with exclusively sedative or hypnotic actions may fail to produce thedesired effects. The effects of herbal medicines in ADHD remains somewhat speculative,especially since practitioners rarely rely on the herbal treatment alone, and very few studies have

been published on the prevailing herbal formulas. Research into functional and biological effects ofherbal medicine is greatly needed and will help to clarify some of the questions about theirappropriate use in ADHD.


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The Use of Herbal Stimulants in ADD/ADHD:

Caffeine, as found in coffee and other herbal stimulants has been proposed as an alternative tostimulant drugs in the treatment of ADD/ADHD. Although herbal practitioners rarely use caffeine orcaffeine-containing herbs alone, many of the most popular formulas do contain stimulatingcomponents.

The benefit of caffeine stimulation has been addressed in several studies in this population. In

general, these studies have demonstrated significant benefits with the administration of caffeine tochildren with ADD/ADHD. The benefits however have not been without side effects, and havefailed to match or exceed those derived from the conventional stimulant medication regimes.

RELATED STUDIES:

Objectively Measured Hyperactivity--II: Caffeine and Amphetamine Effects

Schechter MD, Timmons GDJ Clin Pharmacol 1985 May-Jun;25(4):276-80

Errors of commission and omission, chair movements, and reaction times were assessed in fifteenpreviously diagnosed hyperactive children on a Continuous Performance Test after four drugregimens: amphetamine at doses of 1.6 and 5.0 mg twice a day, as well as 300 mg caffeineadministered alone and with 1.6 mg amphetamine twice a day, and produced significant reductionsin errors of commission and increased reaction times in those children scoring 24 or more on theConner's Abbreviated Parent Questionnaire.

In addition, subjective symptoms on this questionnaire were significantly reduced by all drugtreatments. The high (600 mg) daily dose of caffeine was observed to significantly controlhyperactive symptoms, however, it also produced a number of side effects as well.

It has even been suggested that many ADHD children who go into remission as adults may havelearned to self-medicate with regular coffee consumption. In such cases, elimination of caffeinefrom their diet may actually unmask the underlying ADHD condition. (Dalby JT)

RELATED STUDIES:

Will Population Decreases in Caffeine Consumption Unveil Attention Deficit Disorders inAdults?

Dalby JTDepartment of Psychology, Calgary General Hospital, Alberta, CanadaMed Hypotheses 1985 Oct;18(2):163-7

Attention deficit disorders (ADD) represent the commonest behavior disorder observed in childrenbut only recently has the persistence of these disorders into adulthood been acknowledged. Asindividuals with ADD enter adolescence and then adulthood some behavioral symptoms appear tocease, others become muted. This change has usually been attributed to physiological maturation.

One environmental factor which may also contribute to the altered clinical picture is the regular

ingestion of caffeine beginning in late adolescence. Caffeine has been found to alter the behaviorof ADD children in a manner resembling more widely prescribed stimulant medications.

If some adults with ADD have responded positively to caffeine ingestion then it would be predicted


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that increases in reports of ADD symptoms will escalate with the rapid decline in caffeineconsumption in North America.

The following studies comparing caffeine therapy to Ritalin (methylphenidate) showed similarbenefits using low-dose caffeine, and even better results when the two stimulants were combined.It may be important to note that the benefits of caffeine were negated using higher doses.

RELATED STUDIES:

Responses to Methylphenidate and Varied Doses of Caffeine in Children with AttentionDeficit Disorder

Garfinkel BD, Webster CD, Sloman LCan J Psychiatry 1981 Oct;26(6):395-401

Six children with the diagnosis of Attention Deficit Disorder were treated as day hospital patients,using different stimulant medication. They were studied in a double-blind crossover experiment inwhich they received caffeine in low dose or in a high dose. Methylphenidate was added to bothdosages, as well as administered alone.

Results indicated that caffeine in low dosage when added to methylphenidate was superior to allother treatment conditions. Caffeine in low dosage could not be differentiated from 10 mg ofmethylphenidate.

High dosage caffeine was not different from placebo or no-drug conditions. This study offersevidence to support a curvilinear pattern of dose-response for caffeine, in attenuating the

behavioural manifestations of this syndrome.

Individual Responses to Methylphenidate and Caffeine in Children with Minimal BrainDysfunction

Garfinkel BD, Webster CD, Sloman LCan Med Assoc J 1975 Oct 18;113(8):729-32

Eight children with minimal brain dysfunction were studied for their individual responses to twostimulant medications - methylphenidate hydrochloride and caffeine citrate. Four types of

behavioural responses were observed in the double-blind crossover experiment: four childrenresponded favourably to both psychostimulants, one responded to methylphenidate alone and tworesponded to the placebo. The behaviour of one child deteriorated while he was takingmethylphenidate and caffeine.

In general, methylphenidate was superior to caffeine in diminishing hyperactive and aggressivebehaviour. It is apparent that such stimulantmedication exerts... therapeutic effects... and wouldtherefore be useful as one aspect of a complete treatment program for children with this syndrome.

In the following study caffeine failed to show significant benefits compared to conventional

stimulant drugs. Herbalists have maintained that use of isolated active ingredients from medicinalplants (in this case, caffeine) risks loss of synergistic benefits of the whole plant or herb.

NEGATIVE CAFFEINE STUDIES:


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Caffeine Versus Methylphenidate and D-Amphetamine in Minimal Brain Dysfunction: aDouble-Blind Comparison

Huestis RD, Arnold LE, Smeltzer DJAm J Psychiatry 1975 Aug;132(8):868-70

The authors compared the efficacy of caffeine, methylphenidate, and d-amphetamine in children

with minimal brain dysfunction using a double-blind crossover design.

The slight improvement with caffeine was not significantly better than placebo. Both prescriptiondrugs resulted in significant improvement and were significantly superior to caffeine.

The authors suggest that the discrepancy between these results and an earlier, more optimisticreport may stem from the use in this study of pure caffeine rather than whole coffee.

[Editor's note: At the time of some of these earlier studies, the terms "Attention Deficit Disorder(ADD)" or "Attention-Deficit/Hyperactivity Disorder (ADHD)" had not been included in the DSM. Theterm "Minimal Brain Dysfunction" was one of the diagnostic distinctions that we have now come todescribe as ADD (DSM-III) or one of the forms of ADHD (DSM-IV)].

Other studies on caffeine therapy for ADHD have also failed to show clear benefits compared tostimulant drugs or even placebo. (Arnold, LE) (Garfinkel, BD).

Considering the failure of caffeine to demonstrate consistent and reliable benefits, combined withthe incidence of caffeine-related side-effects, alternative and herbal practitioners are more likely torecommend herbal formulas designed to provide mild stimulating effects along with other indicatedand synergistic actions.

Several herbal formulas that have been used to treat ADHD will be discussed below.

Other (Caffeine-free) Herbal Stimulants, Brain Antioxidants, and Nerve Tonics:

Studies on the physiological effects of herbs point to potential benefits for several brain,neurological , and performance parameters. Many of these benefits may well extend to ADHDpatinets. Several herbal remedies for the nervous system are known for their stimulating effects.Frances Brinker, ND, classifies this category of herbs as 'alertness enhancers', due to theirdocumented effects on nervous system function (Brinker): None of the following herbs containcaffeine.

Ginkgo(Ginkgo biloba)

Ginkgo leaves are remarkable for their ability of their ginkgolide and flavone glycoside-containing extracts to increase local blood flow to brain, bringing greater oxygenation to thetissues, while acting as a neural antoixidant. Ginkgo also improvies brain glucosemetabolism, and positively affects levels of amine neurotransmitter substances in the brain.These benefits become more pronounced after prolonged use.

For more information, please see theAlternative Medicine Review, Monograph: Ginko

Biloba

Brahmi(Bacopa monniera)

This Ayurvedic herb has a long history of use as a cognitive enhancer. Research shows that
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it the protects brain from free radical damage even better than the cognitive-enhancing drugdeprenyl (Battacharya), while stimulating improved learning and cognitive function (Kidd).

Siberian Ginseng(Eleutherococcus senticosis)

Adaptogenic; helps to modulate stress reactions by normalizing physiological function. Theextract stimulates brain activity and causes a more economical release of body energywhich results in increased work output. It contains a mixture of eleutherosides A-E,including syriingin (B) and syringaresinol diglucoside (E), which have been shown todiminish stress-caused reductions of strength and memory retrieval. It also benefits growth

rates.

The anti-stress effect seems to derive from its antioxidant and steroid metabolism activity onthe hypothalamus-pituitary-adrenal endocrine function. It improves adaptation to dimishedblood flow to the brain. Siberian ginseng also produces an increase of amine nervetransmitter substances in the brain and adrenal gland.

Gotu Kola(Centella asiatica, also Hydrocotyle asiatica)

These herbs are not to be confused with the caffeine-containg Kola nut. Their triterpenoidglycosides - asiaticoside, madecassoside, and brahmoside - reduce adrenal corticosterone

blood levels during stress. They have also been found to be useful for cognitive andnervous disorders and vascular problems of the brain. Green Oats(Avena sativa)

The fresh green seeds have been used as a mild antispasmotic and nourishing nerve tonic.Its tonic effects are not immediatly stimulating as with caffeine, but are cummulative andresotorative over time with continued use.

Various combinations of sedative and stimulating herbs have been widely used in naturopathic andherbal practice as one aspect of treatment for ADHD. The following herbal formula is similar tomany of those being recommended for the treatment of ADHD. It includes both stimulant andsedative herbs. In this study it was used to test effectiveness in the treatment of adult adjustment

disorder with anxiety. The formula demonstrated significant benefits in the treatment of anxiety, aninteresting finding in that it made use of stimulant herbs.

RELATED STUDIES:

A Combination of Plant Extracts in the Treatment of Outpatients with Adjustment Disorderwith Anxious Mood: Controlled Study Versus Placebo

Bourin M, Bougerol T, Guitton B, Broutin EGIS Medicament, Faculte de Medecine, Unite de Psychopharmacologie, Nantes, France

Fundam Clin Pharmacol 1997;11(2):127-32

Euphytose (EUP) is a combination of six extracts: Crataegus, Ballota, Passiflora and Valeriana,which have mild sedative effects, and Cola and Paullinia, which mainly act as mild stimulants.

This multicenter, double-blind, placebo-controlled general practice study was carried outpatientswith adjustment disorder with anxious mood. The study was coordinated by psychiatrists. Ninety-one patients were included in the EUP group and 91 patients in the placebo group. They allreceived two tablets three times a day over 28 days (D).

Evaluation using the Hamilton-anxiety (HAM-A) rating scale were carried out on D0, D7, D14 and

on D28. Comparing the two groups, 42.9% of the patients (EUP group) had a HAM-A score of lessthan 10 at D28 versus 25.3% in the placebo group (P = 0.012).

From D7 to D28 there was a statistically significant difference (P = 0.042) between the two


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treatments, indicating that EUP is better than placebo in the treatment of adjustment disorder withanxious mood.

Herbal Formulas for ADHD:

Herbal tonics and nervines designed for the treatment ADHD are used frequently in the practice ofherbal medicine. The herbal formulas presented here reflect both the medical literature, whenavailable, and popular usage, based on the experience and recommendations of authorities in thefield.

Chinese Herbs and the Treatment of ADHD:

In the system of traditional Chinese medicine, herbal formulas are used in synergistic combinationto nourish and balance the systems of the body. The philosophy of 'restoring balance' lends itselfin particular to ADD/ADHD, in which the affected individual suffers from multiple biochemical,

neurological, and behavioral symptoms for which there is no clear-cut etiology.

Chinese herbal preparations are traditionally compounded for the individual patient, based on theirparticular symptom picture.

A chinese herbal formula, called Tiaoshen Liquor, was used to treat children with hyperactivity.Results were very favorable, as summarized below. The authors offered a probable mechanism,based on previous animal studies, suggesting that the improvements noted could be due toimproved cholinergic neurotransmitter function, as well as increased tolerance to brainoxygenation problems.

RELATED STUDIES:

Hypothesis : Clinical and Experimental Studies on Tiaoshen Liquor for Infantile HyperkineticSyndrome

Wang LH, Li CS, Li GZPediatric Dept. of the Affiliated Hospital of Shandong College of TCM, JinanChung Kuo Chung Hsi I Chieh Ho Tsa Chih 1995 Jun;15(6):337-40

One hundred children with hyperkinetic syndrome were treated by using Tiaoshen Liquor (TL)

consisting of Chinese herbal drugs. After the treatment, the behavior[al problems] grading loweredgreatly, their attention was improved, and their academic records raised. The total effective ratereached 94%.

The results of the animal experiments showed that TL could reduce the spontaneous activities ofthe healthy mice, thus lowering remarkably the spontaneous activities in the mice with hyperkineticbehavior caused by taking scopolamine; reinforce the learning memory in the healthy mice; andimprove in different degrees the learning memory of the mice with dysmnesia caused byadministering scopolamine, sodium nitrite and alcohol respectively.

This indicates that the therapeutic mechanism of TL for this syndrome was probably related to the

improvement of information transfer function of the cholinergic neuron synapses of central nervoussystem and to the enhancement of hypoxia tolerence of the cerebral tissues.


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Additional evidence of neurotransmitter stimulation with herbs was demonstrated in this study ofChinese herbal treatment of ADHD.

RELATED STUDIES:

Hypothesis : Clinical Observation and Treatment of Hyperkinesia in Children by TraditionalChinese Medicine

Sun Y, Wang Y, Qu X, Wang J, Fang J, Zhang LShaanxi College of Traditional Chinese Medicine, XianyangJ Tradit Chin Med 1994 Jun;14(2):105-

Sixty-six children with hyperkinesia were treated with the Yizhi (wit-increasing) syrup, after whichtheir scores on behavior[al problems] dropped, their school records improved, and the rate ofappearance of soft neurotic signs lowered, all three changes being significant, giving a totaleffectiveness rate of 84.8%.

After the treatment, examination of the 24-hour urine showed significant increases in its content ofnorepinephrine (NE), dopamine (DA), 3-4 dihydroxy phenylacetic acid (DOPAC), cyclic adenosinemonophosphate (cAMP), and creatinine (Cr).

In the following study a Chinese herbal formula was compared to a western medicine approach(Ritalin) in a side-by-side clinical trial. The herbal formula performed as well as Ritalin in this trial,with fewer side-effects.

RELATED STUDIES:

Hypothesis : Preliminary Study of Traditional Chinese Medicine Treatment of Minimal Brain

Dysfunction: Analysis of 100 Cases

Zhang H, Huang JAffiliated Hospital of Guangzhou College of TCMChung Hsi I Chieh Ho Tsa Chih 1990 May;10(5):278-9, 260

This paper reports the clinical treatment of 100 patients with minimal brain dysfunction (MBD), theirage ranged from 7-14.2 years, and the average age was 10.5. Patients were divided into TCM[Traditional Chinese Medicine] and WM [Western Medicine] group[s] randomly.

The TCM group (80 cases) were treated withm the therapy of subduing hyperactivity of the Liverand invigorating the function of the spleen by using: Bupleurum chinense, Scutellaria baicalensis,Astragalus membranaceus, Codonopsis pilosula, Ligustrum lucidum, Lophatherum gracile andthread of ivory. The WM group (20 cases) were treated with Ritalin 5-15 mg twice daily. Onecourse of treatment lasted one month, and effects were evaluated after 1-3 courses of treatment.

The results were as follows: In the TCM group, 23 cases were cured (clinical symptom and sign[s]disappeared, 10 IQ units were raised in their intelligence, abnormal electroencephalogram wasrecovered and there was no recurrence during the first six months after recovery). 46 cases wereimproved (clinical symptom and sign[s] markedly improved, 4 IQ units raised in intelligence andelectroencephalogram improved), and 11 cases ineffective. The effective rate was 86.25%.

In the WM group, 6 cases were cured, 12 cases improved and 2 cases ineffective, the clinicaleffective rate being 90.0%.


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There was no significant difference between the two groups in this study, but, the side-effects ofthe TCM group were less than the WM group, and the TCM group had more beneficial effects toimprove intelligence, enuresis and the black of orbits.

The study showed that the Verbal Scale in [the] Wechsler Intelligence Scale for children is one ofthe indications of diagnosis of MBD and evaluating the curative effects on this disorder.

Regarding the availability of Chinese herbs, the Chinese herbal formulas tested in the abovementioned studies were not 'traditional' Chinese patent formulas, and therefore would be difficult toreproduce or purchase commercially. It is nevertheless encouraging that several different formulasbased on Traditional Chinese herbal system have all demonstrated effectiveness in ADHD.

Although more research is necessary to confirm these findings and generalize them to other herbalformulas, similar Chinese herbal formulas are available or may be compounded by knowledgeablehealth practitioners.

The following Chinese herbal formulas have been recommended for ADHD by master Chineseherbalists, and are based on available herbal products that are generally recognized as safe.

Recommended Chinese Herbal Formulas:

Dr. Yong Deng, OMD, L Ac, Department Chair of Oriental Medicine at Southwest College ofNaturopathic Medicine, has recommended the following formula for the treatment of ADHD withChinese herbs:

Calm Dragon Formula(K'an Herbs)

Bupleurum plus Dragon Bone and Oyster Shell DecoctionChai hu jai long gu mu li tang

o Components:

Chinese thorowax root (Bupleurum Chinense) chai hu

Skullcap root (Scutellaria) huang qin

Pinellia rhizome ban xia

Oriental white ginseng root ji lin bai ren shen

Calcined oyster shell mu li

Dragon bone long gu

Cinnamon twig (cassia) gui zhi

Poria sclerotium fu ling

Red jujube fruit hong zao

Hematite dai zhe shi

Gardenia fruit zhi zi

This formula may be used alone or in combination with other herbs or formulas as may beprescribed by a trained practitioner of Chinese herbal medicine.

Formulas are generally available through licensed practitioners, and may be prescribed as herbaldecoctions, or in convenient tablets and fluid extracts. Problems with taste may be overcome byadding the extract to a honey or syrup base, or by mixing with fruit juices.


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For information on obtaining the Calm Dragon Formula, please contact K'an Herbs at 800-543-5233. Although K'an Herbs does not sell to the public, they can direct you to a professionalpractitioner who can provide you these products.

Other Commonly Recommended Herbal Formulas for ADHD:

Herbal treatment for ADHD is varied amongst western herbal practitioners, who commonly

recommend dietary changes and nutritional supplements along with combination herbal formulas.Although the effectiveness of the herbal formulas have yet to be evaluated in clinical trials, areview of prevailing recommendations based on authoritative sources reveals some interestingsimilarities in treatment strategies.

What follows is a sampling of expert recommendations. Note that many formulas contain bothrelaxing and stimulating components along with synergistic nervines.

1. Sharol Tilgner, N.D. (Author of: Herbal Medicine from the Heart of the Earth):

The following formula has been recommended for AD/HD. Marketed as 'Liquid Serenity', Dr.

Tilgner refers to this as 'antidepressive formula' in her book.

o Components of This Formula:

St. John's Wort(Hypericum perforatum) 25 - 40 %

Kava Kava(Piper methysticum) 15 -30 %

Oats(Avena sativa) fresh milky seed 10 -20 %

Siberian ginseng(Eleutherococcus senticosus) 15 -30 %

Skullcap(Scutellaria lateriflora) 5 -10 %

Chamomile(Matricaria recutita) 5 -10 %

Schisandra(Schisandra chinensis) 5 -10 %Lavender essential oil(Lavandula officinalis) to taste

Orange essential oil(Citrus aurantium) to taste

o Dosage for Children:

30 drops 2-3 times per day.

o Profile of Herbs Used in This Formula (Tilgner):

St. John's Wort, Hypericum perforatum, is a nervine, anti-inflammatory, sedative,and trophorestorative (nourishing). It is used for depression, fear, insomnia, anxietyor feelings of worthlessness, nerve pain and night terrors. St. John's Wort should beused long term for these effects.

Kava Kava, Piper methisticum, is a sedative, hypnotic, antispasmostic, analgesic,anti-inflammatory and mild anticonvulsant. It is used to relieve anxiety, stress,insomnia, tension headaches, attention deficit and hyperactivity disorder, andgeneral pain from muscle spasms or inflammation. Research has shown thatindividuals are able to maintain cognitive effects when using kava kava, unlike mostsedative or hypnotic drugs.

Siberian Ginseng, Elutherococcus senticosus, is an adaptogen. It helps the body toadapt to stressful situations of many types whether from internal or external causes.It increases endurance and concentration and enhances oxygen metabolism intissues and organs. This herb strengthens disgestion, kidneys, and enhances overallresistance to disease. It is supportive to the adrenal gland and other bodily functions.
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Skullcap, Scutellaria lateriflora, is a sedative, antispasmotic, hypotensive, nervoussytem trophorestorative and cerebral vasodilator. It is used for insomnia, restlesssleep, agitation, nervous exhaution, and nervous system weakness after prolongedillness. Skullcap is indicated for nervous irritation of the cerebrospinal nervoussystem.

Chamomile, Matricaria recutitia, is anti-inflamatory, antispasmotic, analgesic,carminative, sedative, and stomachic. It is a restorative tonic for the nervous system.Chamomile isused as a mild sedative for nervousness and nightmares and is

especially nice for infants and children that are restless when attempting to sleep.

Oat,Avena sativa, is a slow-acting nourishing nervine. Green oat extracts have beenused in breaking addictive habits with substances like morphine, opium, alcohol,nicotine, and coffee. It is also used for insomnia, nervousness, and an irritatednervous system from exhaustion or stress.

Schisandra, Schisandra chinensis, is a hepatoprotective, immunomodulator,adaptogen, and cholagogue. It increases brain efficiency, work capacity, and buildsstrength. It is used in this formula for its multi-system support. It is useful in insomnia,night sweats, prolonged diarrhea, and immunodeficient states.

Lavender essential oil, Lavandula officinalis, is a spasmolytic, anti-inflammatory,

and carminative. It is used for nervous excitement, exhaustion, and insomnia.Orange essential oil, Citrus aurantium, has an aroma that is relaxing and uplifting.The aroma is taken into the body by the olfactory nerve and affects the limbic systemof the brain.

For more information on the availability of this product, please contact:

Wise Woman HerbalsPO Box 279Creswell, Oregon, 97426

(800) 532-5219

2. David Winston, Herbalist AHG & Ethnobotanist (Author of: Herbal Therapeutics: SpecificIndications for Herbs and Herbal Formulas):

Focus Formula:

o Components of This Formula:

Oats(Avena sativa) fresh milky seed

Lemon Balm(Melissa officinalis) fresh herbHawthorne(Crataegus monogyna) fruit, leaf and flower

Ginkgo(Ginkgo biloba) leaf

Scullcap(Scutellaria lateriflora) herb

o Indications:

A gentle, yet useful formula for children with hyperactive behavior and attentiondeficit disorder (ADHD/ADD). Also indicated for general irritability, poorconcentration, and restless sleep patterns. Adults can use this formula for poor

concentration and restlessness.

o Activity:


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Oats, Lemon Balm, and Scullcap are 'nerve tonics' that nourish and normalize thenervous system.

Hawthorne strengthens the heart and circulatory system and in Chinese medicinecalms the Shen (Mind).

Ginkgo increases vascular circulation to the brain, improving memory andconcentration.

o Suggested Use::

Use 10 -20 drops of the tincture 2 -4 times per day taken in warm milk orchamomile/lemon balm tea. Let the tea sit for 5-10 minutes to evaporate the alcohol.

3. Mary Bove, N.D. (Author of:An Encyclopedia of Natural Healing for Children and Infants):

The following formula - Compounded Melissa ~ A Children's Hyperactivity Compound(same as 'Melissa Supreme' ) - has been recommended for ADHD by herbalist, MaryBove, N.D.:

o Components:

Lemon Balm(Melissa officinalis)

Chamomile flowers(Matricaria chamomilla)

Passionflower(Passiflora incarnata)

Skullcap herb(Scutellaria lateriflora)

Wild oat seed, fresh (Avena sativa)

Gotu Kola(Centella asiatica)

Mineral salts extracted from kelp, Irish moss, and other seaweeds

o Therapeutic Actions:

This compound contains both nervine and tonic principles which both relax andrestore stimulating balance to the functions of the brain and nrevous system. It quietsdown the agitation and over-excitability of the nervous system without causingdrowsiness.

o Indications:

Authors claim this compound is effective in the treatment of childrens hyperactivity,

anxiety, nervous sensitivity, excitability, and attention deficit disorders. As arestorative tonic, this compound may be taken during the daytime to reducehyperactivity and at bedtime to promote restful sleep. The compound may also beused by adults who exhibit similar difficulties, excessive mental chatter and nervousmental irritation.

o Uses/Dosage:

Add 20-30 drops of the extract to water or juice and take 3-4 times per day betweenmeals. For best results take the fomula over an extended period of several months orlonger.

For more information on the availability of this product, please see Gaia Herbs.

Herb-Drug Interactions:
http://www.amazon.com/exec/obidos/ASIN/087983692X/thehealingcenterhttp://www.healing-arts.org/children/ADHD/herbal.htm#Melissa%23Melissahttp://gaiaherbs.com/http://www.amazon.com/exec/obidos/ASIN/087983692X/thehealingcenterhttp://www.healing-arts.org/children/ADHD/herbal.htm#Melissa%23Melissahttp://gaiaherbs.com/


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Herbal remedies are generally well-tolerated and safe when used according to informed practiceguidelines. It is important, nevertheless, that parents, patients and professionals who employherbal therapies be aware of the potential for side-effects and drug interactions.

The use of tonic and stimulating herbs for ADHD may potentiate the effects of stimulant medicationcausing side-effects, or necessitate a reduction in the effective dose. The list below includes somecommon precautions (Brinker):

1. Coffee (caffeine):o Possible contraindications (aggravated by excessive dosing):

High-grade inflammation Restless insomnia Heart palpitations Anxiety states

o Drug interactions (aggravated by excessive dosing):

Ephedrine (drug, or herbal ephedra: ma huang) with excessive caffeine maycause:

weight loss

agitation tremors insomnia

Monoamine oxidase inhibitors (MAOIs): may cause hypertensive crisis (when combined with excessive

caffeine)2. Ginseng:

o Drug interactions:

Phenelzine: Concurrent use of phenelzine has resulted in manic-like symptoms

3. Kava-Kava:

o Possible contraindication:

Endogenous depression (due to its sedative activities)


Sedatives, Tranquilizers: May potentiate CNS depressant action

4. Ma Huang:

o Possible contraindications:

Anorrhexia (due to its appetite suppressing effects) Insomnia

Suicidal tendencies (may aggravate anxiety, tension, and apprehension) High blood pressure Diabetes (due to its hyperglycemic effects)


Coffee, tea, stimulants (caffeine, methylxanthines, theophylline): potentiates stimulating effects may accelerate undesired weight loss and loss of appetite

Monoamine oxidase inhibitors (MAOIs): toxicity in combination wait two weeks after discontinuing MAOI drugs before considering Ma

Huang

Precautions about Discontinuing Stimulant Drugs:


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Physicians frequently advise against discontinuing Ritalin and other amphetamines abruptly.Withdrawal may cause aggravation of ADHD symptoms, including depression, irritabilty,exhaution, hyperactivity, excitability, psychosis, and suicidal feelings. It is commonlyrecommended that the medication dose be gradually reduced over the course of several weeks(Breggin).

When embarking on a treatment that incorporates or substitutes herbal medicine it is advised thatparents and patients consult with professionals knowledgeable in these approaches as well as in

the management of aggravations during the weaning process.

In his book, Talking Back to Ritalin, Peter Breggin reminds us that it may be normal for a child toexhibit heightened behavioral symptoms during the withdrawal phase.

Use of herbal, nutritional and other complementary therapies may help reduce these risks. It isimportant to provide a child with a sensitive network of support.

Finding a Practitioner Familiar with Herbal Therapies:

Although a number of medical doctors are being educated in alternative therapies and hospitalsare opening centers for complementary and integrative medicine at a rapid rate, it still may bedifficult for you to find a physician or licensed professional who is familiar with herbal treatments forADHD or Traditional Chinese Medicine.

Here are a few resources that may assist you in your search:

Find a Naturopathic Physician:

Use this search engine to locate an N.D. near you. Physicians in this database aremembers of the American Association of Naturopathic Physicians.

Practitioner Reference Guide:This is a listing from the Institute for Traditional Medicine of practitioners who practiceChinese medicine and prescribe herbs as part of their practice. It is also a very goodresource on Traditional Chinese Medicine and how to choose a practitioner.

Find an Integrative Medicine Practitioner Near You:

This multifaceted search resource allows you to search for practitioners from a greatnumber of alternative therapies. The practitioners' list currently available is provided byAmerican WholeHealth Networks, which is continually expanding their database. At thistime [07/20/00], they have a limited directory and may not have a listing for a therapist inyour area, but you might want to keep checking for updates and additions

If you have a comprehensive resource list or search engine for practitioners of alternative

medicine and wish to have your site included on this page, please write to ourWebmaster.

Summary:

There is a great need to explore alternative treatments for ADHD. As the use of Ritalin andamphetamine in children have increased to alarming proportions, parents and professionals alikeare searching for effective alternatives to stimulant drugs. Herbal medicines may offer a safealternative, especially in combination with complementary therapies.

Although more research is necessary to confirm the implied benefits of commercially availableherbal formulas, there are at least a few clinical trials of herbs and herbal extracts, notably Chineseherbal formulas, that have shown promising results in this arena.
http://www.amazon.com/exec/obidos/ASIN/1567511295/thehealingcenterhttp://www.naturopathic.org/aanpsearch.htmhttp://www.itmonline.org/pract.htmhttp://www.wholehealthmd.com/about/practitioners/mailto:[email protected]://www.amazon.com/exec/obidos/ASIN/1567511295/thehealingcenterhttp://www.naturopathic.org/aanpsearch.htmhttp://www.itmonline.org/pract.htmhttp://www.wholehealthmd.com/about/practitioners/mailto:[email protected]


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References:

Arnold LE, Christopher J, Huestis R, Smeltzer DJ; Methylphenidate vs Dextroamphetamine vsCaffeine in Minimal Brain Dysfunction: Controlled Comparison by Placebo Washout Design withBayes' Aanalysis. Arch Gen Psychiatry 1978 Apr;35(4):463-73

Amen DG, Carmichael BD; High-Resolution Brain SPECT Imaging in ADHD. Ann Clin Psychiatry1997 Jun;9(2):81-6

Bhattacharya SK, Bhattacharya A, Kumar A, Ghosal S;Antioxidant Activity of Bacopa monniera inRat Frontal Cortex, Striatum, and Hippocampus. Phytother Res 2000 May;14(3):174-9

Bove, Mary;An Encyclopedia of Natural Healing for Children and Infants; 1996, Keats Pub

Breggin, Peter;Talking Back to Ritalin; Common Courage Pr; 1998

Brinker, F; Formulas For Healthful Living; Eclectic Medical Publications, 1995; pp 115-18

Brinker, F; Herb Contraindications And Drug Interactions, Second Edition; Eclectic Medical

Publications, 1998

Chabot RJ, Merkin H, Wood LM, Davenport TL, Serfontein G; Sensitivity and Specificity of QEEGin Children with Attention Deficit or Specific Developmental Learning Disorders.ClinElectroencephalogr 1996 Jan;27(1):26-34

Dalby JT; Will Population Decreases in Caffeine Consumption Unveil Attention Deficit Disorders inAdults? Med Hypotheses 1985 Oct;18(2):163-7

Garfinkel BD, Webster CD, Sloman L; Individual Responses to Methylphenidate and Caffeine inChildren with Minimal Brain Dysfunction. Can Med Assoc J 1975 Oct 18;113(8):729-32

Garfinkel BD, Webster CD, Sloman L; Responses to Methylphenidate and Varied Doses ofCaffeine in Children with Attention Deficit Disorder. Can J Psychiatry 1981 Oct;26(6):395-401

Huestis RD, Arnold LE, Smeltzer DJ; Caffeine Versus Methylphenidate and D-Amphetamine inMinimal Brain Dysfunction: a Double-Blind Comparison. Am J Psychiatry 1975 Aug;132(8):868-70

Kidd PM;A Review of Nutrients and Botanicals in the Integrative Management of CognitiveDysfunction. Altern Med Rev. 1999 Jun;4(3):144-61. Review.

Schechter MD, Timmons GD; Objectively Measured Hyperactivity - II: Caffeine and AmphetamineEffects. J Clin Pharmacol 1985 May-Jun;25(4):276-80

Sun Y, Wang Y, Qu X, Wang J, Fang J, Zhang L; Clinical Observation and Treatment ofHyperkinesia in Children by Traditional Chinese Medicine. J Tradit Chin Med 1994 Jun;14(2):105-9

Tilgner, S; Herbal Medicine from the Heart of the Earth; 1999; Wise Acres Press; pp 216-17.

Wang LH, Li CS, Li GZ; Clinical and Experimental Studies on Tiaoshen Liquor for InfantileHyperkinetic Syndrome. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1995 Jun;15(6):337-

Winston, David; Herbal Therapeutics, Specific Indications for Herbs and Herbal Formulas, 6th ed. ;Herbal Therapeutics Library; 1999; pp14-15
http://www.amazon.com/exec/obidos/ASIN/087983692X/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1567511295/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1888483016/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1888483067/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1888483067/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1881517020/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/087983692X/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1567511295/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1888483016/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1888483067/thehealingcenterhttp://www.amazon.com/exec/obidos/ASIN/1881517020/thehealingcenter


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Woodworth, T (DEA rep) ; Committee on Educ and Workforce, 106th Congress, 2nd session; Sub-committee on early Childhood, Youth, and Families Hearings, "Ritalin Use Among Youth:Examining the Issues and Concerns" May 16, 2000

Zhang H, Huang J; Preliminary Study of Traditional Chinese Medicine Treatment of Minimal BrainDysfunction: Analysis of 100 Cases. Chung Hsi I Chieh Ho Tsa Chih 1990 May;10(5):278-9, 260
http://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/wl51600.htmhttp://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/wl51600.htmhttp://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/wl51600.htmhttp://edworkforce.house.gov/hearings/106th/ecyf/ritalin51600/wl51600.htm

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