Editor's Note: Part 1 of this digital exclusive appeared in the April issue. This case study involves a 30-year-old female patient with ADHD diagnosed in childhood. Pt. 1 covered TCM diagnosis and case analysis.
The Six-Visit Treatment Protocol
First Visit (07/20/2021):
We began the first treatment after the initial mental and physical evaluations performed at her first visit. Acupuncture treatments require mental shen preparation, which we do with shen communication techniques to guide the patient's shen when we are performing acupuncture treatment. The techniques used are based on the patient's shen qi pattern and the four levels of examination.
Second Visit (07/26/2021):
The patient reports that her symptoms have improved. Within an hour after the last treatment, she released many repressed tears and experienced lightness and relief from this release. She reports feeling more "dialed in," focused and settled since last week, and experiences increased motivation.
Due to the medication, she has almost no hunger, increased body temperature, and sweating. She is on day two of her menstruation and feels slightly irritable. She mentions her throat can feel stuck when she gets anxious.
She enjoys her new nutritional and lifestyle habits ,and attributes better digestion and respiration to these changes. Her tongue and pulse remain unchanged since her first treatment.
Third Treatment (08/02/2021):
The patient reports improvement and that she felt "great" after her last treatment. Today only she feels slightly more "stuck," as she just got offered a new job position and is unsure whether to take it. She feels frozen toward making the decision and slightly anxious about it.
Her stools are looser than usual, but still somewhat formed. She is tired and feels that her body is holding the stress. Her eyes are dry due to the medication.
Fourth Treatment (08/16/2021):
The patient reports feeling better; she feels more focused and able to prioritize things, and does tasks more quickly throughout the day than before. Since she ran out of the herbal prescription, she notices some more sinus congestion and slower digestion, and asked us to refill herbs, as they were very effective in sustaining her results.
She decided to take the new part=time job. At her current job, she discovered some undesirable news and became irritable about it. She managed to catch herself almost immediately and decided to choose to feel calm about it instead. She said she had never self-regulated like this before, and she was pleased to feel calmer and in control of her emotions.
Fifth Treatment (08/23/21):
The patient reports feeling calmer and more "grounded" than ever, and more able to focus on tasks. She is prioritizing better and feels her motivation has been stable. She reports that her PMS this month is much milder than usual.
She mentions that recently her sleep has been deeper than normal and that it is difficult for her to wake up in the morning. She thinks this is due to the medication over-stimulating her and burning her out, leaving her exhausted by the end of the day. She started a second part-time job this week, and she is still getting acclimated but feels positive about it.
We added a custom herbal prescription on her fifth treatment, which is indicated both to calm her shen and transform the damp phlegm. This is a customized formula that has been combined according to the ben shen mental health theories and principles.
Sixth Treatment (09/13/21) and Case Summary:
The patient's ADHD symptoms continue to improve. She reports feeling more grounded, focused and attentive. She feels significantly less irritable, and emotionally lighter after having let go of many harbored emotions throughout the course of this treatment. She experiences improved motivation, and she is eating healthier, meditating more regularly and managing her tasks more effectively. Her "dian" disorder has improved and her shen qi mental energy is much more regulated.
The patient discontinued use of her ADHD medication two weeks ago, much to our surprise. She experienced some fatigue with the withdrawal. We have continued her treatments since completing this study, and she reports continued improvement in her symptoms and good-quality sleep. She reports that her nasal congestion and digestive function are significantly improved and "normal" now, and she only experiences discomfort when she eats dairy or forgets to take her herbal prescription.
She is pleased with the improvement of her condition, and now that she feels more emotionally and physically regulated, she intends to prepare her body for pregnancy in the near future.
Commentary / Clinical Pearls
It must be noted that this patient is not just a psychiatric ADHD patient, but that she also experiences dysregulation on the physical and energetic levels. The all-encompassing nature of Chinese medicine can be used to treat her holistically, by considering her physiology and her personal history to create effective treatment that includes traditional lifestyle support as an important adjunct to her psychological treatment.
Based on this classical system, we treat the root of imbalance (shen disharmony) to address the branch symptomatology (ADHD, the chemical imbalance triggered by the shen disharmony). While modern psychiatry is a tool for addressing the mental level, real healing takes place on all levels of the human being that are simultaneously part of the disharmony. This is where the patient-oriented approach and time-tested efficacy of classical Chinese medicine can be of great value in the clinic.
After six consecutive acupuncture and herbal medicine treatments, our patient's mental energy, i.e., shen qi, is regulated. Her heart shen is "returning to its house" in TCM terms. In TCM, the shen is the psyche, mind, spirit and monarchy of our life and qi is the root of life; thus shen qi is the energy of our life and psychospiritual state. We have achieved great results with our diagnosis and treatment system based on this traditional philosophy and wisdom.
The results indicate that the ben shen concept and theory from the inner classics have significant implications for the treatment of mental health with traditional Chinese medicine.
Over my almost 30 years in clinical practice, I have used Chai Hu Long Gu Mu Li Tang extensively for a wide array of clinical presentations ranging from chronic headaches to anxiety, insomnia, and prescription drug withdrawal symptoms if these situations fit the appropriate patterns – all with extremely positive clinical outcomes.
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