Progress of traditional Chinese Medicine on ADHD Treatment Based on Syndrome Differentiation

Ying-Ying Zhang,Ya-Ping Li

Abstract—Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in childhood.Syndrome differentiation for ADHD in traditional Chinese medicine is complex without common uniform,it is important to propose unified standards.Based on the principle of syndrome differentiation,this article focused on the different names of different syndrome differentiation methods but the same essence,and summarized Chinese medicine compounds according to syndrome factors.By collecting relevant literature on ADHD treatment with Chinese herbal compound in recent years,ADHD is classified into 7 different syndrome types,and Chinese herbal compound is classified correspondingly for reference and selection of clinical treatment of ADHD.

Keywords—ADHD，Treatment based on syndrome differentiation，Chinese herbal compound，differentiation standard，dialectical system

I.BACKGROUND

Attention deficit hyperactivity disorder[1](ADHD),is a com-mon neurodevelopmental disorder in childhood.Its clinical manifestations are hyperactivity,inattention,emotional instability,impulsive willfulness,learning difficulties and comorbidities that may occur with certain diseases.

ADHD has not been recorded in ancient medical classics.According to its hyperactivity and impulsive symptoms,it belongs to the category of hysteria,"forgetfulness and dementia".The latest TCM syndrome assessment scale divides ADHD into five syndrome types:yin deficiency of liver and kidney,deficiency of both heart and spleen,type of phlegmheat internal disturbance,liver fire flaming,heart and kidney deficiency.

The common syndrome differentiation types of ADHD correspond to different manifestations.Kidney Deficiency And Liver Hyperactivity,Yin Deficiency And Hyperactivity Syndrome shows as distracted mind,irritability,hyperactivity,impulsiveness,difficulty in self-control,restlessness in sleep,forgetfulness when things happen,vexation,hot mouth,red lips,thin body,red cheekbones,night sweats,dry stool,red tongue with little fluid,little moss and thin pulse strings.Heart And Spleen Deficiency,Deprivation of Nourishment Syndrome shows as distracted,restless,clumsy,emotional instability,dizziness,forgetfulness,slow thinking,sallow complexion,fatigue,dreaminess,lack of sleep,loss of appetite,loose stool,pale tongue with white fur and weak pulse.The Phlegm Fire Disturbs the Heart,Damp-heat Internal Syndrome shows as distracted thoughts,multilingual crying,capricious and hyperactive,easy to get excited,chest tightness,excessive phlegm in throat,restless sleep at night,red eyes,bitter taste,Huang Chi urine,constipation,red tongue,yellow and greasy fur,and slippery pulse.Heart And Liver Fire Prosperous,Phlegm Obsessed Mind And Spirit Syndrome shows as phlegm fire disturbs the heart,phlegm sticks to the throat,irritation turns into anger,urine is yellow,and stool is dry.Yellow greasy tongue coating,red tongue,pulse string number.And Deficiency of Heart And Kidney,Deficiency of Both Qi and Yin shows as tiredness,sweating,shortness of breath,dry cough,scanty phlegm,anorexia,dry mouth,sore throat,dizziness,hot flashes,hot hands and feet,soreness of the waist,tinnitus,painful urination,red and purple tongue,little moss,and weak pulse.

A.Etiology and Pathogenesis

The etiology and pathogenesis of ADHD are not yet been fully clarified.Modern medicine thinks that its pathogenic factors are multi-source,which is usually the result of biologicalpsychological-social factors.Genetic factors,neurobiochemical factors,social psychological factors and other factors are related to the incidence of ADHD.Modern studies believe that the neurotransmitters related to ADHD are mainly norepinephrine,5-hydroxytryptamine and dopamine.Electroencephalogram examination indicates that ADHD children have more slow waves of insufficient brain awareness than normal children,and these slow waves will be treated by drugs,EEG biofeedback,etc,or gradually decrease or even disappear with age.In the aspect of social psychology,improper parenting methods,such as corporal punishment,abuse and suppression education,put too high demands on children,resulting in increased psychological pressure of children,which usually leads to ADHD.At the same time,the quickening pace of social life and work,the aggravation of mental work,the fierce academic competition,the increase of study pressure and the temptation of electronic products can all increase children’s social psychological pressure and mental stress,and cause psychological and behavioral disorders.

The etiology of ADHD in traditional medicine is related to the dysfunction of the internal organs and the imbalance of Yin and Yang caused by factors such as congenital deficiency,birth injury and trauma,acquired atrophy,emotional injury and other factors.Prenatal factors,including pregnant women physical weakness,lack of vitality,or premature exertion after labor,exhaustion of gas,insufficient kidney essence in parents with weak parents,early birth,advanced age,emotional discomfort,prenatal depression,and unrestrained life,Eating disorder,lack of nutrition,disease,etc.Injuries during childbirth,including premature rupture of membranes,dryness of amniotic fluid,weakening of qi and blood,abnormal delivery,excessive tension during labor,fear of fear,poor circulation of qi and blood,stasis of qi and blood,hindering the fetus from going out,causing hypoxia in the fetus.Injuries during labor,premature rupture of the afterbirth or prolonged labor,multiple vaginal examinations increase the risk of infection.Improper parenting and inadequate nursing will also aggravate the condition of ADHD.Traditional Chinese medicine theory believes that the main lesions of ADHD were heart,liver,spleen and kidney ;The essence of the disease is deficiency,and there are also symptoms of excess.Phlegm and blood stasis are common,and deficiency and excess are common situations in clinical practice.

B.Syndrome differentiation and Syndromes of ADHD

Syndrome differentiation[2] is mainly to standardize the etiology of the disease,the location of the viscera,the nature of the disease,and the main pathogenesis at different stages of the disease evolution.In order to better standardize the name of the syndrome,the syndrome and its name are standardized.Shen Chunti[3] believes that according to clinical practice,the ’four-character’ syndrome name can hardly reflect the disease,disease location,and pathology of the disease.In order to clarify the definition of each syndrome name and its connotation and extension,it is necessary to follow the disease location,etiology,disease,and disease of the organs,the principle of the pathogenesis.Adopt the’eight Chinese characters’to standardize the name of the syndrome,and then establish the concept and definition of each syndrome.

Based on the principle of syndrome differentiation,though the names of the various syndrome differentiation methods are different,the essence is the same[4].All or part of these syndromes are combined to form a common name,namely ’syndrome name’.As the same type of syndrome can make prescriptions and medications more symptomatic and targeted.On the basis of the above-mentioned syndrome differentiation,the author combined with ’Diagnosis and Efficacy Criteria for Diseases and Syndromes of TCM,Standards for Diagnosis and Efficacy of TCM Pediatric Diseases and Hyperactivity’ and ’Practical Pediatrics of Traditional Chinese Medicine[5] and various physicians’records of ADHD-like symptoms and diseases,mostly based on viscera differentiation,supplemented by eight cardinal syndrome differentiation,and summarized its syndrome types.ADHD is a kind of disease mixed with deficiency and excess,which often appears in clinic.Syndrome differentiation and treatment of syndrome elements will more clearly reflect the etiology and pathogenesis of the disease in the name of the disease,making the treatment more symp-tomatic.

II.PRINCIPLES OF TRADITIONAL CHINESE MEDICINE COMPOUND TREATMENT AND SYNDROME TYPES

Traditional Chinese medicine compounds mainly play the role of’compensating the bias and remedying the maladies’in the treatment of ADHD.The treatment principle of ADHD is to harmonize yin and yang.Due to the internal organs of children are delicate and easy to be deficiency and easy to be adequate,it is necessary to pay attention to nourishing yin and not hurting the spleen,removing evil,and not hurting the spleen,and do not use bitter cold.

A.Kidney Deficiency and Liver Hyperactivity,Yin Deficiency and Hyperactivity Syndrome

Kidney deficiency and hyperactivity of the liver,yin deficiency and hyperactivity are located in the liver and kidney.The etiology is due to liver and kidney yin deficiency and liveryang hyperactivity.There are Qi Ju Dihuang Pills as theclassical prescriptions,and Zhibai Dihuang Pills are used to treat the combined syndrome of deficiency and fire.Shen Huijuan,Han Xinmin,etc[6].treat this syndrome with Jingling Oral Liquid.Rehmannia glutinosa,Moutan Bark,Poria,Polygala,etc.can nourish yin,nourish the kidney,calm the mind and nourish the mind.He Shanwei[7] believes that ADHD is mainly due to the imbalance of Yin and Yang balance,insufficient Yin and calm,and Yin does not control Yang.Chinese medicine and acupuncture with auricular pressure are used to treat this syndrome.Chen Hongyan[8] uses Di Mu Ningshen Oral Liquid to treat this syndrome,and the prescription is used to refresh the brain and invigorate the kidney.Lv Xiaojing[9]treats the syndrome with nourishing yin and suppressing yang,soothing the mind and nourishing the mind,and using Bushen Yizhi Decoction to treat this syndrome.The combined prescription nourishes the kidney and suppresses the yang,nourishes the heart and calms the mind,and has achieved certain effects in the prognosis and prevention of ADHD.Liu Qian[10] treats this syndrome by nourishing the liver and kidney,calming the liver and suppressing yang,and mimicking Ping Dong Decoction to treat this syndrome.The prescription is based on nourishing the liver and kidney to treat yin deficiency,calming the liver and suppressing yang and relieving yang hyperactivity.Luo Xiaorong[11]and others believe that the syndrome of kidney deficiency and hyperactivity of the liver is the most common type in ADHD.Yizhi Ningshen Liquid is used to treat this syndrome,and the prescription is used to soothe the nerves,nourish the mind,and resuscitate.The above-mentioned methods all start with nourishing the liver and kidney,calming the liver and suppressing yang,and the treatment methods are similar.

Liu Xin[12] believes that“Heart disease must be treated with the same principles of medicine and the Book of Changes.”He combineds the theory of Chinese medicine with the Book of Changes and treated the syndrome through“sandbox games”,presenting the intangible psychological content in a symbolic way and obtaining treatment With healing,creation and development,and self-experience,it regulates the five senses,harmonizes the five viscera,calms yin and yang,and improves emotions in general.This method mainly regulates yin and yang,which is different from the treatment of this syndrome under syndrome differentiation,and cannot be included in the syndrome differentiation treatment system.

B.Heart and Spleen Deficiency,Deprivation of Nourishment Syndrome

The heart and spleen are both insufficiency,and the heart and spleen are the disease location of the syndrome.The cause is the deficiency of the heart and the spleen.The classic prescriptions are Guipi Decoction and Gan Mai Dazao Decoction.Commonly used classic prescriptions are Renshen Guipi Pills.Baizi Yangxin Pills,etc.Li Wenlong[13] used Shenqiguipi syrup to treat this syndrome,invigorating qi and nourishing blood,invigorating the spleen and soothing the nerves.Zhang Chaoqun,Jiang Zhiyan[14] believes that children deficiency of heart and nourishment,mental,the heart and spleen are both weak and the liver is prosperous.Long Mu Qingxin Mixture is used to treat this syndrome,which is intended to nourish the heart and strengthen the spleen,and calm the yang.Liao Fengyan[15]believes that ADHD is a heart-related encephalopathy,and the heart and spleen are exhausted due to excessive worry and fear.Insufficient qi and blood,insufficient heart,spleen,qi and yin lead to insufficiency of the brain and mind,the main treatment of this syndrome is acupuncture plus traditional Chinese medicine.The choice of acupuncture scalp acupuncture and body acupuncture can balance the heart and spleen,balance the yin and yang.Gan Mai Dazao Decoction,nourishes the lungs and invigorates the spleen,nourishes the heart and blood,calms the mind and sleeps at night,and balances yin and yang.Most of the above methods start with the heart and spleen,the treatment is to nourish the heart and calm the nerves,replenish qi and invigorate the spleen.Some of the treatment methods have added the treatment of liver vigor and sedative yang,and lung qi weakness to invigorate the lung.The syndrome type is based on the syndrome differentiation.There is no deviation from the general treatment of the disease,and clinical treatment does not have to be confined to it excessively,which meets the requirements of the syndrome differentiation system for the syndrome type.

C.Phlegm Fire Disturbs the Heart,Damp-heat Internal Syndrome

Phlegm fire disturbs the heart,damp-heat inherent disease is located in the heart,the cause is damp-heat inter-growth,and the concurrent syndrome is phlegm fire.Luo Bin[16]used Huanglian Wendan Decoction to treat this syndrome.The above method clears away heat and relieves fire,resolves phlegm and calms the heart,which is in line with the treatment rule of the syndrome type under syndrome differentiation.Zhang Baoli[17] uses traditional Chinese medicine to soothe the nerves and remove phlegm in combination with ear acupoint burying in the treatment of this syndrome.

The soothing and resolving phlegm method has the effects of strengthening the spleen,nourishing intelligence,soothing the mind and calming the heart.Mind is nourished,emotionally stable,and ears are closely related to meridians.They are gathered by the ancestral meridians,and all the twelve meridians reach the ear directly or indirectly.Use wangbuliuxing seeds to press the ear points.Chinese medicine treatment and ear points Buried beans cooperate with each other,complement each other and complement each other.The method uses phlegm-resolving and calming the nerves as the treatment method,whereas no treatment is added to the internal elements of damp-heat,from which the method has some limitations.

D.Heart And Liver Fire Prosperous,Phlegm Obsessed Mind And Spirit Syndrome

Heart and liver fire,phlegm and heart disease are located in the heart and liver,the cause of phlegm dampness endogenous,heart and liver fire,and both syndromes are phlegm,also,set Xiaoyao San as the classic prescription.Zhang Fan[18]etc.used the method that Legislation on the characteristics of heart and liver fire,using ’the spleen to hide the meaning and thinking of the will’to treat this syndrome,combined with the prescription to invigorate the spleen and eliminate phlegm,clear the heart and cool the liver.Wang Xiafang[19,20]believes that ADHD dividing into the heart and liver,and disturb the phlegm heat type,liver and kidney yin deficiency,hyperactivity of liver yang type,deficiency of both heart and spleen,loss of nourishment of mind and spirit type.The types are often mixed and change with each other.It is difficult to separate completely.The central liver-fire and phlegm-heat disturbance are the initial stage of ADHD.It is a sign of yangheat restlessness,so it is established that the treatment of clearing the heart,purging fire and eliminating phlegm,and calming the liver to relieve wind and calming the mind,treat this syndrome with the addition and subtraction of Xiexin Ningshen Decoction,which aims to reconcile the qi and yin.And the qi of heart is self-generation.the heart is open and the mental is self-nerving,so it can clear the heart to purify the fire and eliminate the phlegm,calm the liver and quench the wind and calm the mind.Miao Jing,Liu Chengquan,Ma Xigui,etc[21].use Pingtou Decoction to treat this syndrome,combined with a prescription for clearing the heart and calming the liver,resuscitating and immobilizing.The Shang method is mostly based on strengthening the spleen and liver,soothing the liver and relieving depression.The above methods are complementary applications,which fully reflect the significance of syndrome differentiation,the system is unified,the treatment methods are diverse,and thetreatment is adequate.

E.Kidney Deficiency And Essence Deficiency,Dystrophy of Marrow Sea Syndrome

Kidney deficiency and essence deficiency,dystrophy of the marrow sea type located in the kidney,and the cause is deficiency of kidney qi,and dystrophy of the marrow sea.Ma Rong[22-24]et al.believe that ’slow development of the marrow sea’leads to ADHD.The key is’deficiency of kidney essence,delayed development of marrow sea,imbalance of yin and yang,excess yang movement,insufficient yin and tranquility’.Based on this,the method of tonifying the kidney and filling essence was established,and ’YizhiNingshen Granule was developed to treat this syndrome.Sa Cuihua25 believes that by regulating the qi in the governor channel of the child,the qi is unobstructed,the kidney essence is replenishing,and the kidney’s qi is continuously injected into brain,and the marrow sea is filled,then the brain orifice function will be restored,and the kidney can be regulated by acupuncture.Acupuncture treatment of this syndrome.The method of replenishing the kidney and tranquilizing the nerves,filling the essence and filling the marrow,is in line with the treatment of the syndrome type based on syndrome differentiation,highlighting the ’sickness,regulating the mind,and invigorating the brain’.This method conforms to syndrome differentiation of syndrome elements and can be used as adjuvant therapy .

F.Deficiency of Heart and Kidney,Deficiency of Both Qi and Yin

Insufficiency of the heart and kidney,the deficiency of both qi and yin lies in the heart and the kidneys.The main cause is the deficiency of heart and kidney yin.The Classic prescription named KongShengZhenZhongDan.Wang Junhong[26,27]uses the method of replenishing qi,nourishing yin and calming the heart,and using the addition and subtraction of Jingning decoction to treat this syndrome.The combined prescription is used to nourish qi and nourish yin,calm the mind and calm mind,reconcile yin and yang,and communicate the heart and kidney.Lin Jianyao[28] always uses To replenish qi and nourish yin,use Kongsheng Zhenzhong Dan to treat this syndrome,and at the same time pay attention to nourishing qi and nourish yin,and use more soothing and nourishing herb to play the effects of nourishing qi,nourishing yin,soothing the nerves,and nourishing the mind.Kidney yin,calming mind,and depriving liver yang,with the effect to calming mind,flourishing intelligence and disappearing restlessness.The method is based on replenishing qi and nourishing yin,calming the heart and replenishing the kidney,which is in line with the syndrome differentiation under the syndrome elements.

G.Syndromeless Differentiation type

The syndromeless differentiation type is characterized by no other symptoms or signs after the diagnosis,and cannot be classified specifically,and because the clinical type is not rare,the characteristics of no other clinical manifestations are summarized as ’syndromeless differentiation type’.Li Yaping[29]believes that the diagnosis of clinical syndromes starts with the kidney system.ADHD can be subdivided into three types:syndromeless differentiation type and distinguishable,insufficient kidney essence,dystrophic brain,kidney deficiency,liver vigor,and yin deficiency hypertrophy.The two types of kidney deficiency and liver hyperactivity,yin deficiency and yang hyperactivity are the same as the aforementioned two types of kidney deficiency and essence deficiency,marrow sea dystrophy,kidney deficiency and liver hyperactivity,and yin deficiency and fire hyperactivity,but there are still a large number of visible syndromeless differentiation types.In addition,this type of syndrome often appears in the remission or recovery period of the disease.The specific treatment plan is not stated.It is privately believed that it has similarities with the disease of kidney deficiency and liver hyperactivity,Yin deficiency and fire and fire.This type of clinicaltreatment conforms to the syndrome differentiation system.After the disease is differentiated,the classification is classified as syndromeless,so it can reduce blind treatment and incurable treatment.Broad-spectrum adjuvant therapy or other similar types of treatment can be used.

III.SUMMARY AND OUTLOOK

The traditional Chinese medicine compound treatment of ADHD based on syndrome differentiation is in line with the actual situation of TCM disease differentiation and syndrome differentiation;under syndrome differentiation,most of the disease locations and disease properties frequently used in clinical diagnosis have corresponding treatment methods and medicines,and each disease location and disease nature Each syndrome element has a specific symptom.The correct understanding of the location and nature of the disease is related to the determination of the treatment method.The unified syndrome differentiation of different physicians under the syndrome differentiation system has practical guiding significance for clinical diagnosis and treatment.This treatment compound can be used for clinical reference and selection.

ADHD based on syndrome differentiation has the advantages of standardized syndrome differentiation and complete syndrome information,so the prescription is more targeted.Clinicians often treat ADHD by differentiation of diseases and syndromes[30].The main academic viewpoints are divided into treatment from deficiency and treatment from reality.Syndrome differentiation can be combed from both pathogen-esis and disease nature.Modern medical treatment of ADHD often uses western medicine plus psychological counseling,and most of the commonly used western medicines are central nervous excitants,such as methylphenidate.Chemical drugs have certain adverse reactions[31],which easily lead to nausea,dizziness,anorexia,insomnia and other discomforts,and even affect children’s normal growth and development in severe cases.However,the adverse reactions of traditional Chinese medicine compound treatment are relatively few and havehigh safety.Studies have shown that TCM syndrome differentiation is superior to Western medicine in treating ADHD[32],which provides a basis for further research on syndrome differentia-tion.

The comprehensive,refined,and standardized syndrome differentiation of various physicians can accurately reveal the pathological nature of the current stage of the disease.The ’syndrome’ strives to summarize all clinical manifestations by the name of the syndrome type,while clinically simple and typical syndromes are few,and most of the syndrome types are combined with several syndromes.In the form of folder and compound,the name of the clinical syndrome differenti-ation type needs to be summarized in eight words;however the clinical syndrome differentiation situation is diverse and complex,and cannot be completely confined to the general syndrome type in eight words.Therefore,there are irregular syndromes that are not named according to eight words.

Syndrome types that are not strictly named according to the four syndromes:1)syndromeless differentiation type,2)heart and spleen deficiency type,3)phlegm-fire internal disturbance type,4)Qi and Yin deficiency type.The possible reasons are as follows:In addition to the main symptoms required for disease differentiation,patients with undifferentiated types have no other physical symptoms or signs,and cannot summarize the symptoms with traditional disease location,disease nature,etiology and pathogenesis,or because of this type The syndrome is between the two stages of disease development,and it is not in line with the actual situation to belong to any stage,and it is easy to be mistaken and untreated.The heart and spleen deficiency type only involves the location and disease,and the etiology and pathogenesis are not matched.According to the pathogenesis analysis and the treatment and medication discussed by the author of this type,it can be known that the etiology and pathogenesis are the deficiency of spleen qi,the spleen is the foundation of acquired nature,the source of qi and blood biochemistry,the lack of qi and blood biochemistry,the function of heart governing blood circulation and mind governing mind Injury,so this type is classified as the heart and spleen deficiency.The type of mental loss of nourishment,the phlegm-fire internal disturbance type did not mention the disease position,but the term internal disturbance usually refers to the heart disturbance,so the disease is in the heart,and the etiology and pathogenesis are sputum fire,phlegm and heat are inter-growth,damp-heat is added,’phlegm-fire internal disturbance’ can be understood as a rough abbreviation of phlegm-fire disturbing heart,dampheat internal type.Qi and Yin deficiency type involves disease,unknown disease location,or disease location.According to its treatment method of replenishing qi,nourishing yin,calming the heart,reconciling yin and yang,and communicating the heart and kidney,it can be known that the disease is located in the heart and kidney,so it can be attributed to the deficiency of heart and kidney,and deficiency of both qi and yin.

For those who have not systematically understood ADHD,this type It is difficult to understand;ADHD commonly used patent drugs focus on kidney deficiency and liver hyperactivity,yin deficiency and fire,heart and spleen deficiency,and deprivation type.Most of the patent drugs have the effects of nourishing liver and kidney,strengthening spleen and heart,regulating heart and kidney[33].There are fewer medicines for the heart and liver fire,phlegm obsessing the mind,phlegm fire disturbing the heart,damp-heat internal type,heart and kidney deficiency,and Qi and Yin deficiency types with relatively narrow options.

Competing interests:

The authors declare no conflicts of interest.

Acknowledgment:

National Key R&Program"Research on Prevention and Control of Major Chronic Non-communicable Diseases"；Study on the interaction of biological markers and risk factors in the diagnosis of attention deficit hyperactivity disorder.(Subject No.:2016YFC1306103.)

Citation:

Zhang YY,Li YP.Progress of traditional Chinese Medicine on ADHD Treatment Based on Syndrome Differentiation.DrugCombTher.2021;3(3):11.doi:10.53388/DCT2021080501.

Executive editor:Na Liu.

Submitted:15 November 2020,Accepted:14 April 2021,Online:27 April 2021.

© 2021 By Authors.Published by TMR Publishing Group Limited.This is an open access article under the CC-BY lice nse(http://creativecommons.org/licenses/BY/4.0/).