Treating attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) with Chinese and Western medicine alike can be a challenge if proper diagnostics are not applied. News about the increasing number of children diagnosed with ADHD and behavioral disorders is readily available, and all too often, children are put on mind-altering pharmaceuticals that might impact their brains' development. Let's discuss the late Alex Tiberi's breakdown of four different variations of ADD and ADHD from a Western perspective, and their individual correlations to Chinese diagnoses and respective treatments.
Alex Tiberi, a renowned acupuncturist and Chinese herbalist who was one of the founders of PCOM, passed away in 2014. Tiberi had taught classes on a myriad of subjects relating to Chinese medicine, and was particularly respected for his teachings on pediatric acupuncture. In his pediatric courses, he taught about a wide breadth of ailments, including ADHD.
Tiberi analyzed four separate diagnoses in TCM that describe different patterns in children who are all diagnosed with the umbrella diagnosis of ADHD, but may in fact have differing cerebral patterns according to images produced using a single-photon emission computerized tomography (SPECT) scan. Therefore, each pattern requires different treatment protocols, whether one is using Western medicine, TCM or a combination of the two.1
Pattern #1
In the first pattern, Tiberi talks about what is termed "frontal lobe turn-off." If a person is presented with a problem to solve while connected to a SPECT scan, the prefrontal cortex should light up as circulation increases to this area of the brain. In children with this pattern of ADD, the prefrontal cortex becomes less active. A child with this pattern cannot concentrate on a task. These children also experience forgetfulness and sleepiness.
From a TCM perspective, we might say this person is lacking the spleen qi necessary to address cognitive challenges and that spleen yang energy isn't rising vigorously enough to increase circulation to the prefrontal cortex, an action necessary to perform thoughtful tasks. A child with spleen qi deficiency ADD may be an overthinker, distracted by their own ruminations.
These patients respond well to stimulants such as Ritalin, as a lack of energy is the source of their symptoms, and therefore stimulants seem to effectively treat their distraction, as it increases blood circulation to the brain.
TCM Treatment: Likewise, herbal formulas that are tonifying in nature, such as Gui Pi Tang, are useful to treat this pattern of ADD. Point selection should include points that raise clear yang energy, such as SP 3 and SP 2, according to Tiberi.2 Based on my clinical experience, I also recommend the combination of Du 24, GB 15 and ST 8, as this combination brings blood directly to the frontal lobe.
Pattern #2
In the second pattern of ADHD discussed by Tiberi, during a SPECT scan, unlike the first pattern in which the prefrontal cortex shuts off, the prefrontal cortex does light up as it is supposed to, but so does every other area of the brain. This is described as "Ring of Fire ADD," and is associated with symptoms such as oppositional behavior, periods of increased impulsivity, racing thoughts, irritability, inflexible and rigid thinking, sensitivity to noise, and cyclic mood change.3
In TCM, we would call this liver fire ADD or ADHD. These children become more fidgety with challenges and consequentially act out during moments in which they are asked to focus, due to cerebral overstimulation.
TCM Treatment: Unlike the spleen qi deficiency pattern, this patient does not do well on stimulants, as they are already overstimulated. This child might concentrate slightly better with stimulants; however, they will feel uncomfortable on them and will still exhibit an inability to control themselves.2
Regarding herbs, Tiberi recommends the use of formulas that will descend liver fire, such as Chai Hu Jia Long Gu Mu Li Tang. Point selection should also descend liver fire, such as LV 2 and GB 43.
Pattern #3
In the third pattern of ADD, the limbic system in the brain is always overactive. Dr. Amen of Amen Clinics, who is renowned for his treatment of ADD / ADHD, says, "in Limbic ADD, the prefrontal cortex is underactive during concentration while the deep limbic area – which sets your emotional tone, controlling how happy or sad you are – is overactive."3 This type of ADD is akin to heart presentation in Chinese medicine, and Tiberi explains it is most likely heart fire, but possibly heart yin xu.2 These children may suffer from sleep disturbances, and are hyper-emotional, likely bothered by comments made by their teachers, as in, they take things very personally. In general, these children are very emotional and cry easily.
TCM Treatment: This pattern is not well-suited for treatment with stimulants, as they do not address the ailment, which is hypersensitivity. A child with limbic ADD might respond better to Chinese herbal medicine, such as Huang Lian Jie Gu Tang for heart fire or Tian Wang Bu Xin Dang for HT yin xu, as suggested by Tiberi.2
For these children, a practitioner's bedside manner is particularly important, as they are sensitive and will be subconsciously seeking a sense of safety and acceptance with you.
Pattern #4
The fourth and final type of ADD discussed by Tiberi involves an area of the brain called the "reticular activating system." The RAS is an area of brain matter located at the very top of the spine. It receives and sorts all of the sensory information, aside from smell, that one's brain receives, and decides which pieces are relevant and should be brought forth to one's consciousness.4
In children who have this type of ADD, the RAS is underdeveloped and therefore incapable of sorting the various stimuli coming in. Consequentially, this child needs their environment to be just so, in order to avoid overwhelm and to achieve concentration. Extra stimuli that may be disturbing for these children are temperature variations, other kids' behaviors, noises outside of the subject, uncomfortable physical sensations, and outside distractions.3
Also of note, according to Tiberi, this type of child is likely to choose to sit under a table when doing group work, for example, as this environment is very enclosing and comfortable, as it blocks out other distractions. Similarly, they may listen to loud music to block out other distractions.
This pattern closely resembles kidney yin deficiency, as with a depletion of yin, it is difficult to mask stimulus, i.e., yang.
TCM Treatment: Tiberi recommended the formula Zhi Bai Di Huang Wan and the points KD 3, KD 6 and KD 10.1
References
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