Attention deficit hyperactivity disorder is characterized by an ongoing pattern of inattention, hyperactivity, unfocused motor activity and impulsivity that interferes with functioning or development, according to the National Institute of Mental Health. It is often diagnosed in childhood and lasts into adulthood. ADHD is a chronic condition that can have a serious and long-lasting impact on a person's life. While there is no cure for ADHD, it is possible to reduce symptomatology with the currently available treatments, which include medication, psychotherapy, training or a combination approach.
Case Presentation
A 30-year-old female patient presents with ADHD diagnosed in childhood. She reports frequent procrastination, inattentiveness and inability to focus. The patient reports she has difficulty processing one thing at a time and prioritizing tasks. She makes careless mistakes often because of this. She complains of poor short-term memory recall and needs to write things down or else she will forget. Only creative work seems to summon her focus.
She also complains of emotional dysregulation and occasional irritability, which manifests as a clogged sensation in the throat, palpitations, and a rising sensation of energy. She also reports social anxiety, hypersensitivity to sounds and stimuli, vivid dreams, and occasional night sweats.
Her medical history includes asthma since early childhood, and she has secondary complaints of sinus congestion, fatigue, nausea, occasional bloating and constipation. Most significantly, the patient has a history of trauma at age 11 which was left unresolved for 10 years until she began psychotherapy.
She self-medicated with CBD extract, but declined all psychiatric medication until two weeks ago when she started Provigil (modafinil), a medication that promotes wakefulness. This medication is thought to work by altering the natural chemicals (neurotransmitters) in the brain, according to Drugs.com. Since starting this prescription, the patient complains of the side effects of this medication, which include lowered appetite, nervousness, and increased body temperature.
The patient's physical presentation is robust. She presents with moderate bodily activity and weighs 298 lbs. at 6 feet tall. She has a clear, high-toned voice and makes eye contact; she does not appear as a mentally deficient constitution from a classical Chinese medicine perspective. She has a very present demeanor and an easygoing attitude during her treatments with us. However, when discussing her personal history of trauma, her voice tends to become relatively quiet and her facial emotions flatten.
Using TCM diagnosis, the patient's tongue presents as pink, swollen, and geographic with deep midline and horizontal cracks, and a dry coat. Her pulses are rapid overall and deep in the chi positions. Her left pulses are weak and thready in the cun and guan positions, and her right pulses are forceful and slippery in the guan position.
TCM Diagnosis
Shen evaluation according to classical ben shen diagnosis is a three-level diagnostic system. It is comprised of dian kuang pattern differentiation, shen qi pattern differentiation and five shen pattern differentiation. These diagnostics patterns are based on Nei Jing Inner Classics and several classical texts. This is the major diagnostic system for mental disorders in classical Chinese medicine, and it is entirely rooted in the foundational texts upon which Chinese medicine is founded.
Case Analysis
From a TCM point of view, the patient has clear signs of the heart not storing the shen, causing the shen to "float," which manifests as ADHD symptoms. In addition, she has moodiness and irritability also due to the heart shen dysregulation. She is also suffering the medication's side effects, which weakens her shen and mental energy further.
After the shen evaluation, we evaluated her mental energy pattern with the three-level diagnosis following the classical ben shen system. According to our diagnosis system, the mental energy pattern of shen qi is the core concept for all mental disorders. The first-level diagnosis is of a mild yin pattern or "dian" disorder; the second level is shen qi irritability; and the third level is heart shen irritability.
Our treatment focuses on this main mental energy pattern, although the patient also falls into the diagnostic pattern of shen qi oversensitivity secondarily. Her TCM zang fu organ pattern is heart fire with spleen qi deficiency and damp phlegm obstruction; her body weight, nasal congestion and clogged sensation in the throat are all signs of damp phlegm accumulation in her body.
Editor's Note: Part 2 of this article (May issue) presents the authors' six-day acupuncture and herbal medicine treatment protocol and the patient's response / improvement.
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