children with ADHD herbal therapy for attention deficit hyperactivity disorder
herbal medicine and Traditional Chinese Herbs for ADHD

By John M. Dye, ND herbal therapy, Traditional Chinese Medicine, natural treatments for children with attention-deficit hyperactivity disorder (ADHD):

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  Herbal Medicine and Treatments for ADHD

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Herbal Medicine and Treatments for Attention-Deficit / Hyperactivity Disorder (ADHD)


Parents and professionals faced with the challenging task of treating ADD and ADHD in children commonly face an unfortunate situation in which behavior problems at home and/or school have placed yet another pressure to opt for medication as the primary treatment.

There is little doubt that the majority of these 'medicated' children will have benefits in their attention span, behavior, and other components of their disorder. And yet, the benefits of medication come with built-in risks from misdiagnosis, side effects, abuse, and unforeseen long-term complications.

Although complementary and alternative therapies have shown promise in treating ADD and ADHD, the task of matching the patient to the most appropriate of these therapies remains elusive to many parents who have explored the options, as well as professionals. Many treating physicians are waiting for better studies, and conventional standards, to help establish appropriate treatment protocols.

This article will explore the potential of herbal medicine as a component of a complementary treatment plan for ADD /ADHD (please see our complete list of other treatments for ADHD).

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Herbal Treatments & the Alarming Increased Medical Use of Stimulants:

The use of herbal medicine in the treatment of ADHD is of high interest to the many families and professionals looking for alternatives to drug therapy. This interest has no doubt heightened in recent years due to problematic and near epidemic-proportion use of stimulants in children. The following review of an alarming trend to medicate ever-increasing numbers of school- and pre-school age children will help serve to emphasize the need for greater research into natural alternative treatments.

Conventional pharmaceutical treatment for ADD/ADHD commonly includes methylphenidate (Ritalin) or amphetamine (primarily Adderall and Dexedrine). Both of the substances are powerful stimulants that have been in the Drug Enforcement Administration's (DEA) Schedule II of the Controlled Substances Act (CSA) since 1971. Schedule II of the CSA contains those substances that have the highest abuse potential and dependence profile of all drugs that have medical utility.

According to the DEA's own records, the production of methylphenidate by the drug manufacturers in this country has increased by more than 500 percent since 1991. The production of amphetamine has increased by over 2,000 percent in the same nine-year period of time. More than 50 percent of the methylphenidate and amphetamine prescriptions are written by pediatritions.

Their data indicate that the number precriptions written for ADHD has increased by a factor of 5 since 1991. In 1998 alone, over 4,000 prescriptions for methylphenidate were written for children 2 years of age or less. (It should be noted that this drug is not approved for use in children under six years of age because safety and efficacy has not been established.)

The use of these medications varies widely from one region and community to another, with some regions identifying up to 20% of the student population receiving stimulants for ADHD.

For a complete text of the information that has been summarized immediately above, please see the "Statement of Terrance Woodworth, Deputy Director, Office of Diversion Control, Drug Enforcement Administration: Before the Committee on Education and the Workforce Subcommittee on Early Childhood, Youth and Families".

Related Links:

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Why are Stimulants Useful in ADD and ADHD?:

There appear to be biological differences in the brains of children appropriately diagnosed with ADD and ADHD. Although diagnosis appears to be fraught with problematic issues for professionals, there does seem to be a general agreement that stimulants will generate significant improvements in many symptom-parameters of ADD/ADHD patients.

A less well known fact is that these stimulants tend to improve most everyone's performance, child or adult - ADHD or not. The potential for the abuse of stimulants is not a new issue. A drug abuse problem now includes college kids, who are, for example, abusing Ritalin to help them in their studies. What may be specific to the ADHD patient however, is their apparent difficulty in achieving and maintaining the type of brain activity normally associated with alert, focused, states of concentrated analytical learning.

This difference can be demonstrated in brain-maps using quantitative electroencephalographic (QEEG) measurements of brain wave activity in the various lobes of the brain. In the frontal lobe, where focused, analytical thinking occurs, ADD/ADHD patients tend to produce an abnormally high amount of alpha-, and/or theta- waves (normally associated with dreamy, eyes-closed states,) and less beta-waves (associated with focused, analytical thinking).

When given an 'eyes-open' challenge involving focused mental calculation or reading, most people will produce less alpha (or theta), and more beta wave. This state of brain functioning appears to be necessary for optimal focused attention and linear problem-solving. When given the same challenge, patients with ADHD appear to be unable to make the appropriate shift into this focused type of brain functioning. Stimulant drugs and EEG Biofeedback Therapy have been shown to bring brain wave activity, reflected in EEG and brain-map data, closer to normal. The patient often experiences a dramatic improvement in the ability to focus thought and pay attention for longer periods of time.

Specific changes in brain function associated with ADD and ADHD have been reported in the literature (see study below). Diminished perfusion (blood flow) and cortical activity are associated with ADHD. Herbal, nutritional and pharmaceutical interventions may be designed to improve such functional parameters of the condition.


High-Resolution Brain SPECT Imaging in ADHD

Amen DG, Carmichael BD
Amen Clinic for Behavioral Medicine, Fairfield, California 94585, USA
Ann Clin Psychiatry 1997 Jun;9(2):81-6

Children and adolescents with ADHD were evaluated with high-resolution brain SPECT imaging to determine if there were similarities between reported PET and QEEG findings.

Fifty-four children and adolescents with ADHD by DSM-III-R and Conners Rating Scale criteria were evaluated. A non-ADHD control group was also studied with SPECT. Two brain SPECT studies were done on each group, a resting study and an intellectual stress study done while participants were doing a concentration task.

Sixty-fiver percent of the ADHD group revealed decreased perfusion in the prefrontal cortex with intellectual stress, compared to only 5% of the control group. These are findings consistent with PET and QEEG findings. Of the ADHD group who did not show decreased perfusion, two-thirds had markedly decreased activity in the prefrontal cortices at rest.

Herbal medicines have demonstrated effectivenss in their ability to improve blood perfusion to the brain and learning capacity. (See references to specific herbals below, notably Ginkgo and Bacopa). Studies such as the one above may provide indicators and possible mechanisms for herbal therapeutics.


Sensitivity and Specificity of QEEG in Children with Attention Deficit or Specific Developmental Learning Disorders

Chabot RJ, Merkin H, Wood LM, Davenport TL, Serfontein G
Department of Psychiatry, New York University School of Medicine, New York, USA
Clin Electroencephalogr 1996 Jan;27(1):26-34

The sensitivity and specificity of QEEG-based discriminant functions were evaluated in populations of children diagnosed with specific developmental learning disorders and those with attention deficit disorders.

Both populations of children could be distinguished from each other, and from the normal population, with high levels of accuracy. Pretreatment QEEG could be utilized to distinguish ADD/ADHD children who responded to dextroamphetamine from those who responded to methylphenidate, again with high levels of accuracy.

This paper provides a replication of all presented discriminant functions, and should provide the research basis for the generalized utilization of QEEG in the initial evaluation of children with learning and/or attention disorders.

As demonstrated in the above study, the effectiveness of stimulant therapy, including indications for specific medication, could be predicted based on QEEG determinations.

It may be important to keep such biological implications in mind when using herbal remedies, because any medication with exclusively sedative or hypnotic actions may fail to produce the desired effects. The effects of herbal medicines in ADHD remains somewhat speculative, especially since practitioners rarely rely on the herbal treatment alone, and very few studies have been published on the prevailing herbal formulas. Research into functional and biological effects of herbal medicine is greatly needed and will help to clarify some of the questions about their appropriate use in ADHD.

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The Use of Herbal Stimulants in ADD/ADHD:

Caffeine, as found in coffee and other herbal stimulants has been proposed as an alternative to stimulant drugs in the treatment of ADD/ADHD. Although herbal practitioners rarely use caffeine or caffeine-containing herbs alone, many of the most popular formulas do contain stimulating components.

The benefit of caffeine stimulation has been addressed in several studies in this population. In general, these studies have demonstrated significant benefits with the administration of caffeine to children with ADD/ADHD. The benefits however have not been without side effects, and have failed to match or exceed those derived from the conventional stimulant medication regimes.


Objectively Measured Hyperactivity--II: Caffeine and Amphetamine Effects

Schechter MD, Timmons GD
J Clin Pharmacol 1985 May-Jun;25(4):276-80

Errors of commission and omission, chair movements, and reaction times were assessed in fifteen previously diagnosed hyperactive children on a Continuous Performance Test after four drug regimens: amphetamine at doses of 1.6 and 5.0 mg twice a day, as well as 300 mg caffeine administered alone and with 1.6 mg amphetamine twice a day, and produced significant reductions in errors of commission and increased reaction times in those children scoring 24 or more on the Conner's Abbreviated Parent Questionnaire.

In addition, subjective symptoms on this questionnaire were significantly reduced by all drug treatments. The high (600 mg) daily dose of caffeine was observed to significantly control hyperactive symptoms, however, it also produced a number of side effects as well.

It has even been suggested that many ADHD children who go into remission as adults may have learned to self-medicate with regular coffee consumption. In such cases, elimination of caffeine from their diet may actually unmask the underlying ADHD condition. (Dalby JT)


Will Population Decreases in Caffeine Consumption Unveil Attention Deficit Disorders in Adults?

Dalby JT
Department of Psychology, Calgary General Hospital, Alberta, Canada
Med Hypotheses 1985 Oct;18(2):163-7

Attention deficit disorders (ADD) represent the commonest behavior disorder observed in children but only recently has the persistence of these disorders into adulthood been acknowledged. As individuals with ADD enter adolescence and then adulthood some behavioral symptoms appear to cease, others become muted. This change has usually been attributed to physiological maturation.

One environmental factor which may also contribute to the altered clinical picture is the regular ingestion of caffeine beginning in late adolescence. Caffeine has been found to alter the behavior of ADD children in a manner resembling more widely prescribed stimulant medications.

If some adults with ADD have responded positively to caffeine ingestion then it would be predicted that increases in reports of ADD symptoms will escalate with the rapid decline in caffeine consumption in North America.

The following studies comparing caffeine therapy to Ritalin (methylphenidate) showed similar benefits using low-dose caffeine, and even better results when the two stimulants were combined. It may be important to note that the benefits of caffeine were negated using higher doses.


Responses to Methylphenidate and Varied Doses of Caffeine in Children with Attention Deficit Disorder

Garfinkel BD, Webster CD, Sloman L
Can J Psychiatry 1981 Oct;26(6):395-401

Six children with the diagnosis of Attention Deficit Disorder were treated as day hospital patients, using different stimulant medication. They were studied in a double-blind crossover experiment in which they received caffeine in low dose or in a high dose. Methylphenidate was added to both dosages, as well as administered alone.

Results indicated that caffeine in low dosage when added to methylphenidate was superior to all other treatment conditions. Caffeine in low dosage could not be differentiated from 10 mg of methylphenidate.

High dosage caffeine was not different from placebo or no-drug conditions. This study offers evidence to support a curvilinear pattern of dose-response for caffeine, in attenuating the behavioural manifestations of this syndrome.


Individual Responses to Methylphenidate and Caffeine in Children with Minimal Brain Dysfunction

Garfinkel BD, Webster CD, Sloman L
Can Med Assoc J 1975 Oct 18;113(8):729-32

Eight children with minimal brain dysfunction were studied for their individual responses to two stimulant medications - methylphenidate hydrochloride and caffeine citrate. Four types of behavioural responses were observed in the double-blind crossover experiment: four children responded favourably to both psychostimulants, one responded to methylphenidate alone and two responded to the placebo. The behaviour of one child deteriorated while he was taking methylphenidate and caffeine.

In general, methylphenidate was superior to caffeine in diminishing hyperactive and aggressive behaviour. It is apparent that such stimulantmedication exerts... therapeutic effects... and would therefore be useful as one aspect of a complete treatment program for children with this syndrome.

In the following study caffeine failed to show significant benefits compared to conventional stimulant drugs. Herbalists have maintained that use of isolated active ingredients from medicinal plants (in this case, caffeine) risks loss of synergistic benefits of the whole plant or herb.


Caffeine Versus Methylphenidate and D-Amphetamine in Minimal Brain Dysfunction: a Double-Blind Comparison

Huestis RD, Arnold LE, Smeltzer DJ
Am J Psychiatry 1975 Aug;132(8):868-70

The authors compared the efficacy of caffeine, methylphenidate, and d-amphetamine in children with minimal brain dysfunction using a double-blind crossover design.

The slight improvement with caffeine was not significantly better than placebo. Both prescription drugs resulted in significant improvement and were significantly superior to caffeine.

The authors suggest that the discrepancy between these results and an earlier, more optimistic report may stem from the use in this study of pure caffeine rather than whole coffee.

[Editor's note: At the time of some of these earlier studies, the terms "Attention Deficit Disorder (ADD)" or "Attention-Deficit/Hyperactivity Disorder (ADHD)" had not been included in the DSM. The term "Minimal Brain Dysfunction" was one of the diagnostic distinctions that we have now come to describe as ADD (DSM-III) or one of the forms of ADHD (DSM-IV)].

Other studies on caffeine therapy for ADHD have also failed to show clear benefits compared to stimulant drugs or even placebo. (Arnold, LE) (Garfinkel, BD).

Considering the failure of caffeine to demonstrate consistent and reliable benefits, combined with the incidence of caffeine-related side-effects, alternative and herbal practitioners are more likely to recommend herbal formulas designed to provide mild stimulating effects along with other indicated and synergistic actions.

Several herbal formulas that have been used to treat ADHD will be discussed below.

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Other (Caffeine-free) Herbal Stimulants, Brain Antioxidants, and Nerve Tonics:

Studies on the physiological effects of herbs point to potential benefits for several brain, neurological , and performance parameters. Many of these benefits may well extend to ADHD patinets. Several herbal remedies for the nervous system are known for their stimulating effects. Frances Brinker, ND, classifies this category of herbs as 'alertness enhancers', due to their documented effects on nervous system function (Brinker): None of the following herbs contain caffeine.

  • Ginkgo (Ginkgo biloba)

    Ginkgo leaves are remarkable for their ability of their ginkgolide and flavone glycoside-containing extracts to increase local blood flow to brain, bringing greater oxygenation to the tissues, while acting as a neural antoixidant. Ginkgo also improvies brain glucose metabolism, and positively affects levels of amine neurotransmitter substances in the brain. These benefits become more pronounced after prolonged use.

    For more information, please see the Alternative Medicine Review, Monograph: Ginko Biloba

  • Brahmi (Bacopa monniera)

    This Ayurvedic herb has a long history of use as a cognitive enhancer. Research shows that it the protects brain from free radical damage even better than the cognitive-enhancing drug deprenyl (Battacharya), while stimulating improved learning and cognitive function (Kidd).

  • Siberian Ginseng (Eleutherococcus senticosis)

    Adaptogenic; helps to modulate stress reactions by normalizing physiological function. The extract stimulates brain activity and causes a more economical release of body energy which results in increased work output. It contains a mixture of eleutherosides A-E, including syriingin (B) and syringaresinol diglucoside (E), which have been shown to diminish stress-caused reductions of strength and memory retrieval. It also benefits growth rates.

    The anti-stress effect seems to derive from its antioxidant and steroid metabolism activity on the hypothalamus-pituitary-adrenal endocrine function. It improves adaptation to dimished blood flow to the brain. Siberian ginseng also produces an increase of amine nerve transmitter substances in the brain and adrenal gland.

  • Gotu Kola (Centella asiatica, also Hydrocotyle asiatica)

    These herbs are not to be confused with the caffeine-containg Kola nut. Their triterpenoid glycosides - asiaticoside, madecassoside, and brahmoside - reduce adrenal corticosterone blood levels during stress. They have also been found to be useful for cognitive and nervous disorders and vascular problems of the brain.

  • Green Oats (Avena sativa)

    The fresh green seeds have been used as a mild antispasmotic and nourishing nerve tonic. Its tonic effects are not immediatly stimulating as with caffeine, but are cummulative and resotorative over time with continued use.

Various combinations of sedative and stimulating herbs have been widely used in naturopathic and herbal practice as one aspect of treatment for ADHD. The following herbal formula is similar to many of those being recommended for the treatment of ADHD. It includes both stimulant and sedative herbs. In this study it was used to test effectiveness in the treatment of adult adjustment disorder with anxiety. The formula demonstrated significant benefits in the treatment of anxiety, an interesting finding in that it made use of stimulant herbs.


A Combination of Plant Extracts in the Treatment of Outpatients with Adjustment Disorder with Anxious Mood: Controlled Study Versus Placebo

Bourin M, Bougerol T, Guitton B, Broutin E
GIS Medicament, Faculte de Medecine, Unite de Psychopharmacologie, Nantes, France
Fundam Clin Pharmacol 1997;11(2):127-32

Euphytose (EUP) is a combination of six extracts: Crataegus, Ballota, Passiflora and Valeriana, which have mild sedative effects, and Cola and Paullinia, which mainly act as mild stimulants.

This multicenter, double-blind, placebo-controlled general practice study was carried outpatients with adjustment disorder with anxious mood. The study was coordinated by psychiatrists. Ninety-one patients were included in the EUP group and 91 patients in the placebo group. They all received two tablets three times a day over 28 days (D).

Evaluation using the Hamilton-anxiety (HAM-A) rating scale were carried out on D0, D7, D14 and on D28. Comparing the two groups, 42.9% of the patients (EUP group) had a HAM-A score of less than 10 at D28 versus 25.3% in the placebo group (P = 0.012).

From D7 to D28 there was a statistically significant difference (P = 0.042) between the two treatments, indicating that EUP is better than placebo in the treatment of adjustment disorder with anxious mood.

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Herbal Formulas for ADHD:

Herbal tonics and nervines designed for the treatment ADHD are used frequently in the practice of herbal medicine. The herbal formulas presented here reflect both the medical literature, when available, and popular usage, based on the experience and recommendations of authorities in the field.

  • Chinese Herbs and the Treatment of ADHD:

In the system of traditional Chinese medicine, herbal formulas are used in synergistic combination to nourish and balance the systems of the body. The philosophy of 'restoring balance' lends itself in particular to ADD/ADHD, in which the affected individual suffers from multiple biochemical, neurological, and behavioral symptoms for which there is no clear-cut etiology.

Chinese herbal preparations are traditionally compounded for the individual patient, based on their particular symptom picture.

A chinese herbal formula, called Tiaoshen Liquor, was used to treat children with hyperactivity. Results were very favorable, as summarized below. The authors offered a probable mechanism, based on previous animal studies, suggesting that the improvements noted could be due to improved cholinergic neurotransmitter function, as well as increased tolerance to brain oxygenation problems.


Hypothesis : Clinical and Experimental Studies on Tiaoshen Liquor for Infantile Hyperkinetic Syndrome

Wang LH, Li CS, Li GZ
Pediatric Dept. of the Affiliated Hospital of Shandong College of TCM, Jinan
Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1995 Jun;15(6):337-40

One hundred children with hyperkinetic syndrome were treated by using Tiaoshen Liquor (TL) consisting of Chinese herbal drugs. After the treatment, the behavior[al problems] grading lowered greatly, their attention was improved, and their academic records raised. The total effective rate reached 94%.

The results of the animal experiments showed that TL could reduce the spontaneous activities of the healthy mice, thus lowering remarkably the spontaneous activities in the mice with hyperkinetic behavior caused by taking scopolamine; reinforce the learning memory in the healthy mice; and improve in different degrees the learning memory of the mice with dysmnesia caused by administering scopolamine, sodium nitrite and alcohol respectively.

This indicates that the therapeutic mechanism of TL for this syndrome was probably related to the improvement of information transfer function of the cholinergic neuron synapses of central nervous system and to the enhancement of hypoxia tolerence of the cerebral tissues.

Additional evidence of neurotransmitter stimulation with herbs was demonstrated in this study of Chinese herbal treatment of ADHD.


Hypothesis : Clinical Observation and Treatment of Hyperkinesia in Children by Traditional Chinese Medicine

Sun Y, Wang Y, Qu X, Wang J, Fang J, Zhang L
Shaanxi College of Traditional Chinese Medicine, Xianyang
J Tradit Chin Med 1994 Jun;14(2):105-

Sixty-six children with hyperkinesia were treated with the Yizhi (wit-increasing) syrup, after which their scores on behavior[al problems] dropped, their school records improved, and the rate of appearance of soft neurotic signs lowered, all three changes being significant, giving a total effectiveness rate of 84.8%.

After the treatment, examination of the 24-hour urine showed significant increases in its content of norepinephrine (NE), dopamine (DA), 3-4 dihydroxy phenylacetic acid (DOPAC), cyclic adenosine monophosphate (cAMP), and creatinine (Cr).

In the following study a Chinese herbal formula was compared to a western medicine approach (Ritalin) in a side-by-side clinical trial. The herbal formula performed as well as Ritalin in this trial, with fewer side-effects.


Hypothesis : Preliminary Study of Traditional Chinese Medicine Treatment of Minimal Brain Dysfunction: Analysis of 100 Cases

Zhang H, Huang J
Affiliated Hospital of Guangzhou College of TCM
Chung Hsi I Chieh Ho Tsa Chih 1990 May;10(5):278-9, 260

This paper reports the clinical treatment of 100 patients with minimal brain dysfunction (MBD), their age ranged from 7-14.2 years, and the average age was 10.5. Patients were divided into TCM [Traditional Chinese Medicine] and WM [Western Medicine] group[s] randomly.

The TCM group (80 cases) were treated withm the therapy of subduing hyperactivity of the Liver and invigorating the function of the spleen by using: Bupleurum chinense, Scutellaria baicalensis, Astragalus membranaceus, Codonopsis pilosula, Ligustrum lucidum, Lophatherum gracile and thread of ivory. The WM group (20 cases) were treated with Ritalin 5-15 mg twice daily. One course of treatment lasted one month, and effects were evaluated after 1-3 courses of treatment.

The results were as follows: In the TCM group, 23 cases were cured (clinical symptom and sign[s] disappeared, 10 IQ units were raised in their intelligence, abnormal electroencephalogram was recovered and there was no recurrence during the first six months after recovery). 46 cases were improved (clinical symptom and sign[s] markedly improved, 4 IQ units raised in intelligence and electroencephalogram improved), and 11 cases ineffective. The effective rate was 86.25%.

In the WM group, 6 cases were cured, 12 cases improved and 2 cases ineffective, the clinical effective rate being 90.0%.

There was no significant difference between the two groups in this study, but, the side-effects of the TCM group were less than the WM group, and the TCM group had more beneficial effects to improve intelligence, enuresis and the black of orbits.

The study showed that the Verbal Scale in [the] Wechsler Intelligence Scale for children is one of the indications of diagnosis of MBD and evaluating the curative effects on this disorder.

Regarding the availability of Chinese herbs, the Chinese herbal formulas tested in the above mentioned studies were not 'traditional' Chinese patent formulas, and therefore would be difficult to reproduce or purchase commercially. It is nevertheless encouraging that several different formulas based on Traditional Chinese herbal system have all demonstrated effectiveness in ADHD.

Although more research is necessary to confirm these findings and generalize them to other herbal formulas, similar Chinese herbal formulas are available or may be compounded by knowledgeable health practitioners.

The following Chinese herbal formulas have been recommended for ADHD by master Chinese herbalists, and are based on available herbal products that are generally recognized as safe.

  • Recommended Chinese Herbal Formulas:

Dr. Yong Deng, OMD, L Ac, Department Chair of Oriental Medicine at Southwest College of Naturopathic Medicine, has recommended the following formula for the treatment of ADHD with Chinese herbs:

  • Calm Dragon Formula (K'an Herbs)
    Bupleurum plus Dragon Bone and Oyster Shell Decoction

    Chai hu jai long gu mu li tang

    • Components:

      Chinese thorowax root (Bupleurum Chinense)       chai hu

      Skullcap root (Scutellaria)       huang qin

      Pinellia rhizome       ban xia

      Oriental white ginseng root       ji lin bai ren shen

      Calcined oyster shell       mu li

      Dragon bone       long gu

      Cinnamon twig (cassia)       gui zhi

      Poria sclerotium       fu ling

      Red jujube fruit       hong zao

      Hematite       dai zhe shi

      Gardenia fruit      zhi zi

This formula may be used alone or in combination with other herbs or formulas as may be prescribed by a trained practitioner of Chinese herbal medicine.

Formulas are generally available through licensed practitioners, and may be prescribed as herbal decoctions, or in convenient tablets and fluid extracts. Problems with taste may be overcome by adding the extract to a honey or syrup base, or by mixing with fruit juices.

For information on obtaining the Calm Dragon Formula, please contact K'an Herbs at 800-543-5233. Although K'an Herbs does not sell to the public, they can direct you to a professional practitioner who can provide you these products.

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Other Commonly Recommended Herbal Formulas for ADHD:

Herbal treatment for ADHD is varied amongst western herbal practitioners, who commonly recommend dietary changes and nutritional supplements along with combination herbal formulas. Although the effectiveness of the herbal formulas have yet to be evaluated in clinical trials, a review of prevailing recommendations based on authoritative sources reveals some interesting similarities in treatment strategies.

What follows is a sampling of expert recommendations. Note that many formulas contain both relaxing and stimulating components along with synergistic nervines.

  1. Sharol Tilgner, N.D. (Author of: Herbal Medicine from the Heart of the Earth):

    The following formula has been recommended for AD/HD. Marketed as 'Liquid Serenity', Dr. Tilgner refers to this as 'antidepressive formula' in her book.

    • Components of This Formula:

      St. John's Wort (Hypericum perforatum) 25 - 40 %

      Kava Kava (Piper methysticum) 15 -30 %

      Oats (Avena sativa) fresh milky seed 10 -20 %

      Siberian ginseng (Eleutherococcus senticosus) 15 -30 %

      Skullcap (Scutellaria lateriflora) 5 -10 %

      Chamomile (Matricaria recutita) 5 -10 %

      Schisandra (Schisandra chinensis) 5 -10 %

      Lavender essential oil (Lavandula officinalis) to taste

      Orange essential oil (Citrus aurantium) to taste

    • Dosage for Children:

      30 drops 2-3 times per day.

    • Profile of Herbs Used in This Formula (Tilgner):

      St. John's Wort, Hypericum perforatum, is a nervine, anti-inflammatory, sedative, and trophorestorative (nourishing). It is used for depression, fear, insomnia, anxiety or feelings of worthlessness, nerve pain and night terrors. St. John's Wort should be used long term for these effects.

      Kava Kava, Piper methisticum, is a sedative, hypnotic, antispasmostic, analgesic, anti-inflammatory and mild anticonvulsant. It is used to relieve anxiety, stress, insomnia, tension headaches, attention deficit and hyperactivity disorder, and general pain from muscle spasms or inflammation. Research has shown that individuals are able to maintain cognitive effects when using kava kava, unlike most sedative or hypnotic drugs.

      Siberian Ginseng, Elutherococcus senticosus, is an adaptogen. It helps the body to adapt to stressful situations of many types whether from internal or external causes. It increases endurance and concentration and enhances oxygen metabolism in tissues and organs. This herb strengthens disgestion, kidneys, and enhances overall resistance to disease. It is supportive to the adrenal gland and other bodily functions.

      Skullcap, Scutellaria lateriflora, is a sedative, antispasmotic, hypotensive, nervous sytem trophorestorative and cerebral vasodilator. It is used for insomnia, restless sleep, agitation, nervous exhaution, and nervous system weakness after prolonged illness. Skullcap is indicated for nervous irritation of the cerebrospinal nervous system.

      Chamomile, Matricaria recutitia, is anti-inflamatory, antispasmotic, analgesic, carminative, sedative, and stomachic. It is a restorative tonic for the nervous system. Chamomile isused as a mild sedative for nervousness and nightmares and is especially nice for infants and children that are restless when attempting to sleep.

      Oat, Avena sativa, is a slow-acting nourishing nervine. Green oat extracts have been used in breaking addictive habits with substances like morphine, opium, alcohol, nicotine, and coffee. It is also used for insomnia, nervousness, and an irritated nervous system from exhaustion or stress.

      Schisandra, Schisandra chinensis, is a hepatoprotective, immunomodulator, adaptogen, and cholagogue. It increases brain efficiency, work capacity, and builds strength. It is used in this formula for its multi-system support. It is useful in insomnia, night sweats, prolonged diarrhea, and immunodeficient states.

      Lavender essential oil, Lavandula officinalis, is a spasmolytic, anti-inflammatory, and carminative. It is used for nervous excitement, exhaustion, and insomnia.

      Orange essential oil, Citrus aurantium, has an aroma that is relaxing and uplifting. The aroma is taken into the body by the olfactory nerve and affects the limbic system of the brain.

    For more information on the availability of this product, please contact:

    Wise Woman Herbals
    PO Box 279
    Creswell, Oregon, 97426
    (800) 532-5219

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  2. David Winston, Herbalist AHG & Ethnobotanist (Author of: Herbal Therapeutics: Specific Indications for Herbs and Herbal Formulas):

    Focus Formula:

    • Components of This Formula:

      Oats (Avena sativa) fresh milky seed

      Lemon Balm (Melissa officinalis) fresh herb

      Hawthorne (Crataegus monogyna) fruit, leaf and flower

      Ginkgo (Ginkgo biloba) leaf

      Scullcap (Scutellaria lateriflora) herb

    • Indications:

      A gentle, yet useful formula for children with hyperactive behavior and attention deficit disorder (ADHD/ADD). Also indicated for general irritability, poor concentration, and restless sleep patterns. Adults can use this formula for poor concentration and restlessness.

    • Activity:

      Oats, Lemon Balm, and Scullcap are 'nerve tonics' that nourish and normalize the nervous system.

      Hawthorne strengthens the heart and circulatory system and in Chinese medicine calms the Shen (Mind).

      Ginkgo increases vascular circulation to the brain, improving memory and concentration.

    • Suggested Use::

      Use 10 -20 drops of the tincture 2 -4 times per day taken in warm milk or chamomile/lemon balm tea. Let the tea sit for 5-10 minutes to evaporate the alcohol.

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  3. Mary Bove, N.D. (Author of: An Encyclopedia of Natural Healing for Children and Infants):

    The following formula - Compounded Melissa ~ A Children's Hyperactivity Compound (same as 'Melissa Supreme' ) - has been recommended for ADHD by herbalist, Mary Bove, N.D.:

    • Components:

      Lemon Balm (Melissa officinalis)

      Chamomile flowers (Matricaria chamomilla)

      Passionflower (Passiflora incarnata)

      Skullcap herb (Scutellaria lateriflora)

      Wild oat seed, fresh (Avena sativa)

      Gotu Kola (Centella asiatica)

      Mineral salts extracted from kelp, Irish moss, and other seaweeds

    • Therapeutic Actions:

      This compound contains both nervine and tonic principles which both relax and restore stimulating balance to the functions of the brain and nrevous system. It quiets down the agitation and over-excitability of the nervous system without causing drowsiness.

    • Indications:

      Authors claim this compound is effective in the treatment of childrens hyperactivity, anxiety, nervous sensitivity, excitability, and attention deficit disorders. As a restorative tonic, this compound may be taken during the daytime to reduce hyperactivity and at bedtime to promote restful sleep. The compound may also be used by adults who exhibit similar difficulties, excessive mental chatter and nervous mental irritation.

    • Uses/Dosage:

      Add 20-30 drops of the extract to water or juice and take 3-4 times per day between meals. For best results take the fomula over an extended period of several months or longer.

For more information on the availability of this product, please see Gaia Herbs.

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Herb-Drug Interactions:

Herbal remedies are generally well-tolerated and safe when used according to informed practice guidelines. It is important, nevertheless, that parents, patients and professionals who employ herbal therapies be aware of the potential for side-effects and drug interactions.

The use of tonic and stimulating herbs for ADHD may potentiate the effects of stimulant medication causing side-effects, or necessitate a reduction in the effective dose. The list below includes some common precautions (Brinker):

  1. Coffee (caffeine):

    • Possible contraindications (aggravated by excessive dosing):

      • High-grade inflammation
      • Restless insomnia
      • Heart palpitations
      • Anxiety states

    • Drug interactions (aggravated by excessive dosing):

      • Ephedrine (drug, or herbal ephedra: ma huang) with excessive caffeine may cause:
        • weight loss
        • agitation
        • tremors
        • insomnia

      • Monoamine oxidase inhibitors (MAOIs):
        • may cause hypertensive crisis (when combined with excessive caffeine)

  2. Ginseng:

    • Drug interactions:

      • Phenelzine:
        • Concurrent use of phenelzine has resulted in manic-like symptoms

  3. Kava-Kava:

    • Possible contraindication:

      • Endogenous depression (due to its sedative activities)

    • Drug interactions:

      • Sedatives, Tranquilizers:
        • May potentiate CNS depressant action

  4. Ma Huang:

    • Possible contraindications:

      • Anorrhexia (due to its appetite suppressing effects)
      • Insomnia
      • Suicidal tendencies (may aggravate anxiety, tension, and apprehension)
      • High blood pressure
      • Diabetes (due to its hyperglycemic effects)

    • Drug interactions:

      • Coffee, tea, stimulants (caffeine, methylxanthines, theophylline):
        • potentiates stimulating effects
        • may accelerate undesired weight loss and loss of appetite
      • Monoamine oxidase inhibitors (MAOIs):
        • toxicity in combination
        • wait two weeks after discontinuing MAOI drugs before considering Ma Huang

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Precautions about Discontinuing Stimulant Drugs:

Physicians frequently advise against discontinuing Ritalin and other amphetamines abruptly. Withdrawal may cause aggravation of ADHD symptoms, including depression, irritabilty, exhaution, hyperactivity, excitability, psychosis, and suicidal feelings. It is commonly recommended that the medication dose be gradually reduced over the course of several weeks (Breggin).

When embarking on a treatment that incorporates or substitutes herbal medicine it is advised that parents and patients consult with professionals knowledgeable in these approaches as well as in the management of aggravations during the weaning process.

In his book, Talking Back to Ritalin, Peter Breggin reminds us that it may be normal for a child to exhibit heightened behavioral symptoms during the withdrawal phase.

Use of herbal, nutritional and other complementary therapies may help reduce these risks. It is important to provide a child with a sensitive network of support.

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Finding a Practitioner Familiar with Herbal Therapies:

Although a number of medical doctors are being educated in alternative therapies and hospitals are opening centers for complementary and integrative medicine at a rapid rate, it still may be difficult for you to find a physician or licensed professional who is familiar with herbal treatments for ADHD or Traditional Chinese Medicine.

Here are a few resources that may assist you in your search:

  • Find a Naturopathic Physician:

    Use this search engine to locate an N.D. near you. Physicians in this database are members of the American Association of Naturopathic Physicians.

  • Practitioner Reference Guide:

    This is a listing from the Institute for Traditional Medicine of practitioners who practice Chinese medicine and prescribe herbs as part of their practice. It is also a very good resource on Traditional Chinese Medicine and how to choose a practitioner.

  • Find an Integrative Medicine Practitioner Near You:

    This multifaceted search resource allows you to search for practitioners from a great number of alternative therapies. The practitioners' list currently available is provided by American WholeHealth Networks, which is continually expanding their database. At this time [07/20/00], they have a limited directory and may not have a listing for a therapist in your area, but you might want to keep checking for updates and additions

  • If you have a comprehensive resource list or search engine for practitioners of alternative medicine and wish to have your site included on this page, please write to our Webmaster.

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There is a great need to explore alternative treatments for ADHD. As the use of Ritalin and amphetamine in children have increased to alarming proportions, parents and professionals alike are searching for effective alternatives to stimulant drugs. Herbal medicines may offer a safe alternative, especially in combination with complementary therapies.

Although more research is necessary to confirm the implied benefits of commercially available herbal formulas, there are at least a few clinical trials of herbs and herbal extracts, notably Chinese herbal formulas, that have shown promising results in this arena.


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Amen DG, Carmichael BD; High-Resolution Brain SPECT Imaging in ADHD. Ann Clin Psychiatry 1997 Jun;9(2):81-6

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Breggin, Peter;Talking Back to Ritalin; Common Courage Pr; 1998

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Garfinkel BD, Webster CD, Sloman L; Responses to Methylphenidate and Varied Doses of Caffeine in Children with Attention Deficit Disorder. Can J Psychiatry 1981 Oct;26(6):395-401

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Kidd PM; A Review of Nutrients and Botanicals in the Integrative Management of Cognitive Dysfunction. Altern Med Rev. 1999 Jun;4(3):144-61. Review.

Schechter MD, Timmons GD; Objectively Measured Hyperactivity - II: Caffeine and Amphetamine Effects. J Clin Pharmacol 1985 May-Jun;25(4):276-80

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Tilgner, S; Herbal Medicine from the Heart of the Earth; 1999; Wise Acres Press; pp 216-17.

Wang LH, Li CS, Li GZ; Clinical and Experimental Studies on Tiaoshen Liquor for Infantile Hyperkinetic Syndrome. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1995 Jun;15(6):337-

Winston, David; Herbal Therapeutics, Specific Indications for Herbs and Herbal Formulas, 6th ed.; Herbal Therapeutics Library; 1999; pp14-15

Woodworth, T (DEA rep) ; Committee on Educ and Workforce, 106th Congress, 2nd session; Sub-committee on early Childhood, Youth, and Families Hearings, "Ritalin Use Among Youth: Examining the Issues and Concerns" May 16, 2000

Zhang H, Huang J; Preliminary Study of Traditional Chinese Medicine Treatment of Minimal Brain Dysfunction: Analysis of 100 Cases. Chung Hsi I Chieh Ho Tsa Chih 1990 May;10(5):278-9, 260

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