Summary of "Progress of Traditional Chinese Medicine on ADHD Treatment Based on Syndrome Differentiation

Summary of "Progress of Traditional Chinese Medicine on ADHD Treatment Based on Syndrome Differentiation"

The article, authored by Ying-Ying Zhang and Ya-Ping Li from the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, reviews the application of Traditional Chinese Medicine (TCM) in treating Attention-Deficit Hyperactivity Disorder (ADHD), a prevalent neurodevelopmental disorder in children characterized by hyperactivity, inattention, impulsivity, emotional instability, and learning difficulties. Published in *Drug Combination Therapy* (2021;3(3):11), it addresses the lack of standardized syndrome differentiation in TCM for ADHD and proposes a unified framework based on visceral differentiation supplemented by the eight principal syndromes. By synthesizing recent literature, the authors classify ADHD into seven syndrome types and recommend corresponding herbal compounds, emphasizing harmonization of yin and yang while avoiding spleen injury in pediatric patients.

Background and Etiology

ADHD's etiology remains multifaceted in modern medicine, involving genetic, neurobiochemical (e.g., dopamine, norepinephrine, serotonin imbalances), and psychosocial factors such as improper parenting and academic stress. In TCM, absent from ancient texts, it aligns with categories like "hysteria" or "forgetfulness and dementia," attributed to congenital deficiencies, birth injuries, emotional trauma, or improper nurturing, leading to organ dysfunction (primarily heart, liver, spleen, kidney) and yin-yang imbalance. The disease essence is deficiency with excess features, commonly involving phlegm and blood stasis.

Syndrome differentiation standardizes etiology, visceral location, disease nature, and pathogenesis using an "eight-character" nomenclature for precision. Despite varied naming in literature, the authors unify syndromes into common types for targeted prescribing.

Principles of TCM Compound Treatment and Seven Syndrome Types

TCM compounds aim to "compensate bias and remedy maladies" through yin-yang balance, nourishing without overtaxing the spleen. The seven types, their locations, etiologies, symptoms, and treatments are outlined below:

1. Kidney Deficiency and Liver Hyperactivity, Yin Deficiency and Hyperactivity Syndrome (Liver/kidney; yin deficiency with liver-yang hyperactivity): Symptoms include irritability, impulsivity, restlessness, night sweats, dry stool. Classical: Qi Ju Di Huang Wan; modern: Jingling Oral Liquid (nourishes yin/kidney, calms mind). Adjuncts like acupuncture or Bushen Yizhi Decoction suppress yang and soothe nerves.

2. Heart and Spleen Deficiency, Deprivation of Nourishment Syndrome. (Heart/spleen; qi/blood deficiency): Features emotional instability, fatigue, forgetfulness, sallow complexion. Classical: Gui Pi Tang; modern: Shenqi Guipi Syrup (invigorates qi/blood, strengthens spleen). Acupuncture variants balance yin-yang; Long Mu Qingxin Mixture calms yang.

3. Phlegm Fire Disturbs the Heart, Damp-Heat Internal Syndrome. (Heart; damp-heat breeding phlegm-fire): Manifests as excitability, phlegm in throat, constipation, yellow urine. Huang Lian Wen Dan Tang clears heat/phlegm; adjunct ear acupoint therapy (e.g., wangbuliuxing seeds) nourishes mind, though limited on damp-heat.

4. Heart and Liver Fire Prosperous, Phlegm Obsessed Mind and Spirit Syndrome. (Heart/liver; phlegm-dampness engendering fire): Involves anger, sticky phlegm, dry stool. Xiaoyao San soothes liver; Xiexin Ningshen Decoction clears fire/phlegm, calms wind/mind. Pingtou Decoction strengthens spleen/liver; methods reflect syndrome diversity.

5. Kidney Deficiency and Essence Deficiency, Dystrophy of Marrow Sea Syndrome. (Kidney; kidney-qi deficiency impairing marrow): Linked to delayed marrow development, yin-yang imbalance. Yizhi Ningshen Granule tonifies kidney/essence; acupuncture regulates Du channel for qi unblocking.

6. Deficiency of Heart and Kidney, Deficiency of Both Qi and Yin. (Heart/kidney; yin deficiency): Symptoms: fatigue, dry mouth, weak pulse. Kong Sheng Zhen Zhong Dan replenishes qi/yin; Jingning Decoction variants calm heart, communicate heart-kidney.

7. Syndromeless Differentiation Type (No specific signs; often remission): Lacks classification; treat akin to kidney-liver types with broad-spectrum therapy to avoid blind interventions.

Summary and Outlook

TCM syndrome differentiation aligns with clinical realities, offering targeted, safer alternatives to Western stimulants like methylphenidate, which risk nausea, insomnia, and growth suppression. TCM shows superior efficacy with fewer adverse effects. Challenges include complex, overlapping syndromes not fitting eight-character naming and limited patent drugs for certain types. Future research should refine classifications for atypical cases, enhancing TCM's integration with modern medicine.

This synthesis provides clinicians with a standardized reference, underscoring TCM's holistic approach to ADHD pathogenesis and treatment.