CLINICAL APPLICATIONS

* ADD (attention deficit disorder)

* ADHD (attention deficit hyperactivity disorder)  

* Hyperactivity, anxiety, impulsiveness, difficulty in focusing, inattentiveness, restlessness 

 

WESTERN THERAPEUTIC ACTIONS

* Cognitive effect to improve memory and treat learning impairment

* Neuroprotective effect to protect and prevent damages to the nerves and the brain

* Anxiolytic activity to relieve anxiety and hyperactivity

* Detoxifying effect to eliminate unwanted toxic compounds, chemical substances, and artificial food additives

 

CHINESE THERAPEUTIC ACTIONS

* Extinguishes Liver wind

* Nourishes Liver yin

* Tranquilizes the shen (spirit)

 

DOSAGE

For adults, take 3 to 4 capsules three times daily. For children, please refer to the Strategic Dosing Guidelines section to determine the proper dose based on age or body weight. For maximum effect, take the herbs on an empty stomach. The herbs should be taken for three months continuously prior to an evaluation on the progress of the individual.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Bie Jia (Carapax Trionycis)

Chuan Xiong (Rhizoma Chuanxiong)

Di Huang (Radix Rehmanniae)

Gou Teng (Ramulus Uncariae cum Uncis)

Gui Ban (Plastrum Testudinis)

Jue Ming Zi (Semen Cassiae)

Mai Dong (Radix Ophiopogonis)

Mu Li (Concha Ostreae)

Shi Chang Pu (Rhizoma Acori Tatarinowii)

Tai Zi Shen (Radix Pseudostellariae)

Yu Jin (Radix Curcumae)

Yuan Zhi (Radix Polygalae)

Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle)

 

BACKGROUND

Introduction: ADD/ADHD is a developmental condition in which the affected person is unable to concentrate and is easily distracted, with or without accompanying hyperactivity. Adults or children must have had an onset of symptoms before the age of seven that caused significant social or academic impairment. More recently, increasing attention has been focused on adult forms of ADHD, which have probably been under-diagnosed. The incidence is 3 to 7% in school-age children, and 2 to 7% in adults.

        Pathophysiology: The pathology of ADHD is not clear. Findings indicating that psychostimulants (which facilitate dopamine release) and noradrenergic tricyclics treat this condition have led to speculation that certain areas of the brain related to attention are deficient in neural transmission. The neurotransmitters dopamine and norepinephrine have been associated with ADD/ADHD.

        Mortality/Morbidity: There is no clear correlation with mortality in ADD/ADHD. However, studies suggest that childhood ADD/ADHD is a risk factor for subsequent conduct and substance abuse problems, which can carry significant mortality and morbidity. ADD/ADHD may lead to difficulties with academic or employment performance and social difficulties that can profoundly affect normal development. However, exact morbidity has not been established.

        Age and Gender Distribution: ADD/ADHD is a developmental disorder diagnosis that requires an onset of symptoms before age seven. After childhood, symptoms may persist into adolescence and adulthood, or they may ameliorate or disappear. The percentages in each group are not well established, but at least an estimated 15-20% of children with ADD/ADHD will maintain the full diagnosis in adulthood. Up to 65% of these children will have ADD/ADHD or some residual symptoms of ADD/ADHD as adults. In children, ADD/ADHD is three to five times more common in boys than girls. Some studies report incidences as high as 5:1. In adults, the gender ratio is closer to even.

        Treatment: Stimulants such as Ritalin (methylphenidate) and Dexedrine (dextroamphetamine), are generally prescribed for treatment of ADD/ADHD. Though they may be effective, there are certain risks involved. Common short-term side effects include significant insomnia, appetite suppression and weight loss, headaches, mood fluctuations (depression, irritability), and these substances can exacerbate tics in children. Long-term risks include possible growth retardation, especially with prolonged use. Furthermore, stimulants such as Ritalin (methylphenidate) and Dexedrine (dextroamphetamine) have significant abuse potential and must be used and regulated carefully.

 

FORMULA EXPLANATION

According to traditional Chinese medicine, ADD/ADHD is diagnosed as Liver wind rising with shen (spirit) disturbance arising from Liver yin deficiency. To treat these disorders, both calming and nourishing herbs must be used together to restore normal balance in the body.

        To extinguish Liver wind and calm down Liver yang rising (manifesting in muscle twitching or restlessness), Mu Li (Concha Ostreae), Jue Ming Zi (Semen Cassiae) and Gou Teng (Ramulus Uncariae cum Uncis) are used. These three herbs neutralize the mood, addressing the emotional aspects of ADD/ADHD such as irritability, hyperactivity and short temper. Bie Jia (Carapax Trionycis) and Gui Ban (Plastrum Testudinis) are used to tonify Liver yin and further assist the first three herbs in extinguishing Liver wind. To address yin deficiency, Bai Shao (Radix Paeoniae Alba), Di Huang (Radix Rehmanniae) and Mai Dong (Radix Ophiopogonis) are used. Bai Shao (Radix Paeoniae Alba) also softens the Liver to relieve spasms, cramps and stiffness that may be associated with anxiety or hyperactivity. Mai Dong (Radix Ophiopogonis) also sedates Heart fire to relieve shen (spirit) disturbance. Shi Chang Pu (Rhizoma Acori Tatarinowii) and Yuan Zhi (Radix Polygalae) are two aromatic herbs used to disperse phlegm obstructing the orifices and help restore cognitive and sensory functions. They are often used for forgetfulness and inability to concentrate. Yu Jin (Radix Curcumae) clears Heart heat, opens orifices and promotes consciousness. Tai Zi Shen (Radix Pseudostellariae) is neutral and tonifies both qi and yin. Chuan Xiong (Rhizoma Chuanxiong) promotes blood circulation and relieves stagnation and pain in the channels that may be caused by the long-term stiffening or twitching of the muscles. Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) nourishes the Heart and harmonizes the entire formula.

        In summary, Calm (Jr) is an effective and sophisticated formula with many herbs that address different aspects of ADD/ADHD. Herbs are used to tonify qi to treat the underlying deficiency, calm the shen (spirit) to improve focus and concentration, and sedate Liver wind and fire to reduce hyperactivity.

 

CAUTIONS & CONTRAINDICATIONS

* This formula should be discontinued once the condition is stabilized, or when the desired effects are achieved.

* This formula is contraindicated during pregnancy and nursing.

* This formula is contraindicated in individuals with yang deficiency or coldness.

 

CLINICAL NOTES

* It has been proposed that the environment is one of the major factors contributing to the cause of ADD/ADHD. In utero exposures to chemical and/or toxic substances, food additives or colorings, or allergens may increase the risk of the disorder. Environmental factors, such as diet, education and media influences (such as television), may also influence behavior in children.

* Proper treatment of ADD/ADHD is important to ensure proper academic performance, vocational success, and social-emotional development. Lack of or delayed treatment may contribute to incomplete development of such skills.

* There is great controversy on whether children with ADD/ADHD should receive drug treatment because of the possible risks and side effects. Herbs are a safe alternative as they restore the natural balance in the body without being addictive.

* It is important to educate and/or treat the parents who are over-anxious about the academic achievements of their children. If necessary, Calm or Calm (ES) can be used to calm the shen (spirit) of the parents.

* This formula should be used only as needed during school. However, use of this formula is not necessary during vacations, such as summer and winter vacations.

* Calm (Jr) is an herbal formula developed by Dr. Feng Bu-Zhen, a master of traditional Chinese medicine in Shanxi, China. It is commonly used to reduce hyperactivity, improve memory and increase attention span. According to one clinical trial published in Shanxi Medicine and Herbology in 1990, children with ADD/ADHD were treated daily for one month with herbs in Calm (Jr). At the end of the clinical trial, it was reported that out of 68 children, 61 showed no presentation of ADD/ADHD, three showed some improvement, and four had no response. No significant side effects were reported. Submitted by B.F., Shanxi, China.

 

SUPPLEMENTARY FORMULAS

* For poor memory or forgetfulness, use Enhance Memory.

* With anger and/or insomnia, add Calm (ES).

* For stress, add Calm.

* For stress and insomnia with underlying deficiency and weakness, add Calm ZZZ.

* For depression, add Shine or Shine (DS).

* With muscle stiffness, cramps and spasms, add Flex (SC).

* With acute headache, add Corydalin (AC).

* With chronic headache, add Corydalin (CR).

* With constipation, add Gentle Lax (Excess) or Gentle Lax (Deficient).

* With fatigue, excessive worrying and/or restless sleep due to blood deficiency, add Schisandra ZZZ.

* For Liver and Kidney yin deficiencies, add Nourish.

* For individuals with chronic exposure to chemical and/or toxic substances, add Herbal DTX.

* With blood stagnation, add Circulation (SJ).

* With hyperactivity and impulsivity due to excess heat in the body, add Gardenia Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Baihui (GV 20), Si Shen Cong

* Neiguan (PC 6), Taichong (LR 3), Dazhui (GV 14), Quchi (LI 11), Baihui (GV 20), Mingmen (GV 4), Daling (PC 7)

 

Classic Master Tung's Points:

* Zhenjing (T 1010.08), Tianhuangfu [Shenguan] (T 77.18), Huoying (T 66.03), Dizong (T 44.09), Dan (T 11.13), Yintang

 

Master Tung¡¦s Points by Dr. Chuan-Min Wang:

* ADD, ADHD: Zhenghui (T 1010.01), Zhengben (T 1010.12), Zhongbai (T 22.06)

 

Balance Method by Dr. Richard Tan:

* Left side: Taichong (LR 3), Ligou (LR 5), Ququan (LR 8), Houxi (SI 3), ear Shenmen

* Right side: Qiuxu (GB 40), Yanglingquan (GB 34), Shenmen (HT 7)

* Left and right sides can be alternated from treatment to treatment.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Attention deficit disorder: Shenmen, Occiput, Brain Stem, Brain, Nervous Subcortex, Neurasthenia Point. Bleed Ear Apex.

* Asperger syndrome: Brain, Forehead, Occiput, Shenmen, Nervous Subcortex, Neurasthenia Point, Anxious, Be Happy Point, Groove of Brain Posterior. Bleed Ear Apex.

* Epilepsy: Epilepsy Point, Brain, Brain Stem, Nervous Subcortex, Occiput, Shenmen, Kidney, Liver. Bleed Ear Apex.

* Autism in infants: Thalamus, Brain, Forehead, Exciting, Anxious, Be Happy, Endocrine.

* Convulsion and hyperactivity: Shenmen, Occiput, Nervous Subcortex, Lesser Occipital Nerve, Liver, Brain Stem, Brain. Bleed Ear Apex.

 

NUTRITION

* Make sure the diet has an adequate amount of calcium and magnesium, which have a calming effect.

* Cold-water fish, such as tuna, salmon, and herring, are great sources of docosahexaenenoic acid (DHA). This essential fatty acid is vital for proper development of the brain.

* Increase consumption of complex carbohydrates, such as fresh vegetables, fresh fruits, beans, and whole grains. Decrease consumption of simple carbohydrates, such as glucose, fructose, sugars, and processed grains.

* Avoid exposure to chemical and/or toxic substances, food additives or coloring, or allergens, which increase the risk of developing ADD/ADHD.

* Eliminate from the diet: sugar, candy, junk food, foods with artificial color and flavor, and fried foods. Also avoid antacids, cough drops, throat lozenges, and carbonated beverages.

* Warm and hot natured foods that damage qi and yin should be avoided, such as:

¡± certain fruits like mango and durian that produce heat.

¡± stimulants like coffee, alcohol, and energy drinks.

¡± spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

* Avoid food and drinks with artificial coloring.

* Consume as few meat products as possible. Do not eat processed meats, such as lunch meats, hot dogs and sausages, as they contain nitrites that are associated with inflammation and chronic disease.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Incorporate ¼ cup of either fresh or frozen blueberries into breakfast daily for two to four weeks.

 

LIFESTYLE INSTRUCTIONS

* Psychosocial support is extremely important for complete and long-term treatment of ADD/ADHD. Such approaches include contingency management (e.g., reward and timeout systems), parent training (educating the parent on child management skills), clinical behavior therapy (coordinated contingency management by both parents and teachers), and cognitive-behavioral treatment (e.g., self-monitoring, verbal self-instruction, problem-solving strategies, self-reinforcement).

* Encourage activities that foster calm and concentration, such as reading, meditation, qi gong and tai chi chuan [tai ji chuan].

* Discourage activities that impose disruption and short attention span, such as playing video games and watching television.

 

CASE STUDIES

* B.K., a 36-year-old male, presented with ADD along with poor memory. Pulse was rapid and wiry. The practitioner diagnosed this condition as Liver yin deficiency. Calm (Jr) was prescribed at 3 to 4 capsules three times per day. After taking the herbs for three months, the patient reported a calmer, more focused personality. His memory had also improved. Submitted by S.L., Yuma, Arizona.

* J.S., a 9-year-old male, presented with inability to complete tasks, inability to focus on school work, irritability and restlessness. He was easily angered and also had insomnia. He was skinny and had a pale complexion and dark circles under his eyes. Western diagnosis was ADHD. The TCM diagnosis was Liver wind rising, Liver yin deficiency, and shen (spirit) disturbance. Calm (Jr) was prescribed, and he showed great improvement in his ability to stay on tasks, with less irritability and fewer outbursts of anger. Sleep also improved. This patient continued to eat a diet high in simple carbohydrates and fats. His parents have not reached a point where they are willing to consider dietary changes. However, with Calm (Jr) and acupuncture, the child is improving. Submitted by J.S., Milwaukee, Oregon.

* S.A., a 5-year-old female, was diagnosed with her first seizure attack on May 2, 2002 and spent two days in the hospital. She was put on Tegretol (carbamazepine). Shortly after beginning the medication, the child started to have stomachaches and was not her usual self. The mother thought the seizure might have been caused by immunization shots the child had received earlier. The TCM diagnosis was Liver wind. While taking Calm (Jr), the child was able to decrease the dosage of Tegretol (carbamazepine). The mother noticed the seizures diminishing in frequency and intensity. The child was able to endure the seizures in a more relaxed manner. The patient also received cranio-sacral therapy. Submitted by M.C., Sarasota, Florida.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Calm (Jr) is formulated to treat and prevent ADD/ADHD. It contains herbs with cognitive effects to improve memory and treat learning impairment, neuroprotective effect to protect and prevent damages to the nerves and the brain, and anxiolytic activity to relieve anxiety and hyperactivity. Furthermore, Calm (Jr) also contains herbs with detoxifying effects to eliminate unwanted toxic compounds, chemical substances, and artificial food additives.

        Calm (Jr) contains many herbs that directly improve cognitive functions. Pharmacologically, utilization of the herbs has shown to improve cognition, treat aging-induced learning deficit, and ameliorate drug-induced memory impairment. In one laboratory study, administration of Shi Chang Pu (Rhizoma Acori Tatarinowii) is associated with a dose-dependent effect in improving memory.[1] Paeoniflorin, a compound from Bai Shao (Radix Paeoniae Alba), has been shown to enhance aging-induced learning deficit.[2] Jue Ming Zi (Semen Cassiae) contains numerous compounds, such as obtusifolin, that showed a marked effect to improve learning and attenuate scopolamine-induced memory impairment.[3] Gan Cao (Radix et Rhizoma Glycyrrhizae) also has a marked cognitive effect to efficiently ameliorate memory impairment.[4] Yuan Zhi (Radix Polygalae) is another herb with excellent neuroprotective and cognitive effects. It has a dose-dependent effect to protect the neurons from Abeta-induced neuronal damages.[5] It also inhibited acetylcholinesterase (AChE) activity in a dose-dependent and non-competitive manner.[6] Lastly, Yuan Zhi (Radix Polygalae) shows a beneficial cognitive effect on memory impairment induced by scopolamine or dysfunction of the cholinergic system in the brain.[7] Clinically, according to one study, 30 children with low IQ were treated, resulting in mild to moderate improvement in classroom performance using an herbal formula containing herbs such as Shi Chang Pu (Rhizoma Acori Tatarinowii) and Yuan Zhi (Radix Polygalae). The treatment protocol was to administer the formula twice daily for two weeks per course of treatment, for a total of three months of treatment.[8] According to another clinical trial, administration of 10 to 15 mL of a syrup made from Yuan Zhi (Radix Polygalae) and Shi Chang Pu (Rhizoma Acori Tatarinowii) three times daily was effective in managing 90 of 100 children with hyperactivity disorders.[9]

        In addition, Calm (Jr) has many herbs that indirectly improve cognitive functions by protecting the nerves and the brain. Shi Chang Pu (Rhizoma Acori Tatarinowii) contains beta-asarone, which has shown to have a neuroprotective effect by attenuating neuronal apoptosis in the hippocampus induced by beta-amyloid (Abeta).[10] Ferulic acid, a component present in both Dang Gui (Radix Angelicae Sinensis) and Chuan Xiong (Rhizoma Chuanxiong), exerts a marked effect to reduce the cerebral infarct area and minimize neurological deficit following transient focal cerebral ischemia.[11] According to one study, administration of Gou Teng (Ramulus Uncariae cum Uncis) demonstrates a neuroprotective effect against chemical-induced neuronal damages.[12] Gou Teng (Ramulus Uncariae cum Uncis) is also effective to protect and alleviate damage to hippocampal neurons induced by acute hypoxia.[13] Gou Teng (Ramulus Uncariae cum Uncis) also has a marked anxiolytic effect, and may be helpful to calm those who have anxiety or hyperactivity.[14] Clinically, Jue Ming Zi (Semen Cassiae) demonstrates a marked protective effect to prevent dopaminergic neurons against the toxicities involved in Parkinson's disease.[15] Di Huang (Radix Rehmanniae) shows a neuroprotective effect to ameliorate cognition deficits and attenuate oxidative damages in brain to treat senescence or neurodegenerative diseases, such as Alzheimer's and Parkinson's diseases.[16]

        According to the Merck Manual, the exposure to toxic substances and food additives or colorings is one of the main causes of ADD/ADHD. Therefore, the importance of eliminating environmental toxins cannot be over-emphasized. In Calm (Jr), herbs are added to specifically protect the liver and improve the detoxification of environmental toxins. Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) has been used successfully for thousands of years for detoxification. More recently, it has been documented that Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) has a marked detoxifying effect to treat a variety of poisonings, including but not limited to drug poisoning (chloral hydrate, urethane, cocaine, picrotoxin, caffeine, pilocarpine, nicotine, barbiturates, mercury and lead), food poisoning (tetrodotoxin, snake, and mushrooms), and others (enterotoxin, herbicides, pesticides).[17] Furthermore, Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) and Yu Jin (Radix Curcumae) have also been shown to have hepatoprotective effects against chemical- or tetrachloride-induced liver damage and liver cancer.[18]

        Since ADD/ADHD is characterized by an imbalance of neurotransmitters leading to a disharmony of the entire body, herbs that harmonize and balance the entire body have been used for treatment with good success. Mai Dong (Radix Ophiopogonis), Bai Shao (Radix Paeoniae Alba), Shi Chang Pu (Rhizoma Acori Tatarinowii) and Chuan Xiong (Rhizoma Chuanxiong) balance the central nervous system and calm hyperactivity. They have been used to effectively reverse drug-induced excitation.[19]^{,[20],[21],[22]} Mai Dong (Radix Ophiopogonis), Bai Shao (Radix Paeoniae Alba) and Chuan Xiong (Rhizoma Chuanxiong) harmonize the cardiovascular system and minimize the fluctuation of heart rate and blood pressure.[23]^{,[24],[25],[26]} Di Huang (Radix Rehmanniae) regulates the endocrine system to ensure normal production and release of endogenous hormones.[27]

        In summary, Calm (Jr) treats and prevents ADD/ADHD by improving memory and learning ability, relieving hyperactivity, and balancing the entire body. The effects of the formula have been documented with clinical trials, and the functions of the individual herbs have been shown by numerous clinical studies.

 

COMPARATIVE ANALYSIS

ADD/ADHD is a developmental condition in which the affected person is unable to concentrate and is easily distracted, with or without accompanying hyperactivity.

        Stimulants such as Ritalin (methylphenidate) and Dexedrine (dextroamphetamine) are generally prescribed for treatment of ADD/ADHD. Though they may be effective, there are certain risks involved. Common short-term side effects include significant insomnia, appetite suppression and weight loss, headaches, mood fluctuations (depression, irritability), and exacerbation of tics in children. Long-term risks include possible growth retardation, especially with prolonged use. Furthermore, stimulants such as Adderall (dextroamphetamine), Focalin (dexmethylphenidate), Concerta (methylphenidate), have significant abuse potentials and must be used and regulated carefully.

        From traditional Chinese medicine perspectives, ADD and ADHD are characterized by Liver wind rising with shen (spirit) disturbance arising from Liver yin deficiency. Therefore, herbs that calm the mind and nourish the underlying deficiencies are used. Many herbs in this formula have been shown via in vitro and in vivo studies to be effective in enhancing concentration and memory. Furthermore, these herbs are safe and natural, and do not have the harsh side effects of drugs.

        It is important to realize that though drugs may be effective, they have serious short- and long-term side effects. Furthermore, these drugs have significant abuse potentials, and their use must be monitored carefully. On the other hand, use of herbs is not only effective to improve focus and attention, they also improve memory and learning ability. Furthermore, herbs are much safer than drugs, both for short- and long-term uses. Lastly, practitioners and parents must both recognize that optimal treatment of ADD and ADHD requires more than just taking drugs or herbs, it also requires dietary, environmental and behavior changes. Combination of all these modalities ensures long-term success.