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Key learning points for this page on ADD/ADHD
You may wonder why I’ve written this page on ADD/ADHD! After all, isn’t ADD/ADHD a Western phenomenon and hasn’t Western Medicine got effective treatments for it? Also, if you know a little about Chinese medicine, what help can ‘yin and yang’ offer that modern (Western) research, psychology and psychiatry can’t surpass?
As you’ll read, ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactive Disorder) now affect a huge number of people, starting in childhood, and their families, friends and colleagues. People begin drugs for them as infants then continue to take them well into adulthood. It’s an expensive matter and generates good profits for pharmaceutical firms!
Of course, please realise these are my thoughts, not those of ‘official Chinese medicine’ (assuming there is such a thing!) Also, this is somewhat discursive because I’m interested in a range of aspects of the conditions.
Oh! And I claim no originality for these thoughts! (And although I checked all the references, there’s bound to be a mistake.)
If you read the criteria for diagnosis of ADD/ADHD (see ICD-aa, code 6A05), you may be surprised to find that you fit!
Nearly everyone does if you look hard enough.
For example, one of the signs of hyperactivity and impulsiveness is inability to sit still, especially in quiet surroundings – so, unless asleep, meditating or praying, how many of us can stay completely still? What? You don’t even move your fingers or scratch yourself? Or how many of us do several things at once or in quick succession, roving between them like a searchlight probing the sky for enemy planes?
And what about the constant ramblings of your computer mouse?
Of course, one symptom is not enough for a diagnosis! There are many other symptoms in ADHD and the condition is diagnosed when there are enough of them. But you can understand why so many children are diagnosed with it!
Children haven’t grown bodies big enough – not enough yin – to stabilise their yang. So they are restless, noisy, always asking questions, fidgeting, easily distracted and bored, frequently interrupting you and they don’t look ahead to any consequences of their impulsivity! You could say that a healthy child has ADD/ADHD!
Yet, bear with me. I think Chinese medicine may have insights into the causes of ADD/ADHD, and possibly has ways to ameliorate their symptoms. Along the way you may discover some facts that the industry doesn’t want you to notice!
In the following, it will help if you have some idea of what Chinese medicine means when talking about yin and yang and Blood. For a quick primer, click the links to those words!
And before we dive in, just a mention of how many people are diagnosed with ADD/ADHD! Apparently, about 1 in 9 children in USA have been diagnosed with ADHD, or 7.1 million children, up by 1 million on the number so diagnosed in 2016, when the ratio was 1 in 10. (https://www.newscientist.com/article/2432684-about-1-in-9-children-in-the-us-have-been-diagnosed-with-adhd/).
There’s much more about the reasons for the increase in cases in Caroline Williams’ article: – https://www.newscientist.com/article/mg25834372-000-adhd-whats-behind-the-recent-explosion-in-diagnoses/.
Not all countries are as generous with their diagnoses! As of 2019, 7.77 per cent of children in the US take stimulant medications, while in France the figure is only 0.46 per cent. (https://www.newscientist.com/letter/mg25834400-300-france-takes-a-different-line-over-adhd-drugs/)
In my opinion ‘ADHD’ – Attention Deficit Hyperactive disorder takes two conditions and conflates them. I think that Attention Deficit disorder ADD is one condition and Hyperactive disorder another, although they often are described as occurring together as ADHD.
Distinguishing between them may help us understand how to treat them.
Attention deficit implies there is something lacking.
In Western medicine this is seen to be a lack of mental acuity, or a lack of mental energy. Such a lack of mental energy would normally be seen in Chinese medicine as a lack of yang energy.
However, while it’s true that you can have a lack of yang energy, more common is a lack of both yang and yin energy, with one or other being more apparent at any one time.
For example, take my car, which has a nice old petrol-fuelled internal combustion engine.
Driving along one day, I look at the engine coolant temperature gauge and see, to my alarm, that the engine is over-heating. Then I remember that I’m driving across the Sahara desert in the middle of summer on a hot day at midday … in which case it’s not perhaps surprising that my ancient jalopy’s engine is over-heating! – yang excess.
But on another day, in mid-winter, in Scotland, on a cold night, the gauge also shows the engine is over-heating. What now? Well, perhaps I should have noticed the trail of engine coolant drips following us, showing that I have a leak: there is now NO coolant left in my car’s engine which is now getting too warm for its health! – yin deficiency.
In the first example, there is too much yang, blazing down on us. The car’s cooling system is working but overcome by the external heat.
In the second example, the over-heating occurs because there is not enough cooling, moisturising fluid and so the engine over-heats because of not enough yin.
So the first difference with Western medicine (WM), from the point of view of Chinese medicine (CM), is that this attention deficit is most likely to come from a yin deficiency, not from yang excess. In this case I think that the attention deficit arises mainly from what is called ‘Blood deficiency’. Let me explain.
Blood – in Chinese medicine – is where your Mind resides. To be more specific, in Chinese medicine, the Mind rests in Heart Blood. Like a grandchild nestling in its much-loved grandparent’s arms – a comfortable place – the child can settle, calm down and even sleep. Likewise, the Mind rests in what is called Heart Blood, (assuming Blood is healthy and uncontaminated).
Hyperactivity may arise from this kind of internal Blood deficiency, just as hunger and tiredness, signs of deficiency, makes me (you too?) more irritable: and this certainly applies, when they are tired and hungry, to my grandchildren!
Of course, hyperactivity can also be triggered by something external, just as a big gust of wind, or accidental nudge, may trigger your car’s alarm.
Just so, hyperactivity is usually an expression of excess Yang but it can also arise from deficient Blood, just as poor sleepers may toss around for hours anxiously expecting the alarm to sound, to the point where they don’t really need the alarm clock at all! (Funnily enough, after the alarm goes off, they can often sleep better for a little while because they no longer need to worry about the alarm going off!)
So I see ADD as mostly Yin deficiency in the form of Blood deficiency, specifically Heart Blood deficiency. This (Yin) deficiency manifests as inability to rest, to sleep, to concentrate, to be calm, to remember. If we understand ADD it becomes easier to understand ADHD because the ‘hyperactive’ part doesn’t seem to occur without the underlying ADD. (Without ADD, the hyperactive element might instead be regarded as tending towards being bipolar in origin. If so, we might be much more suspicious of stimulants in the patient’s life and cautious of prescribing more of them.)
If this argument is right, the main treatment for ADD should be to strengthen the body’s ability to create healthy Blood. As you may have seen on the page explaining Blood, there is a graphic there of how Blood is made. It requires the correct (healthy) food and drinks, a healthy Stomach energy that prepares the food you’ve swallowed for digestion, a Spleen energy which transforms it, extracting the food’s ‘essence’.
This food essence is then oxygenated by the Lungs and despatched onwards by your Heart at which point, and only then, does it become Blood with a capital B (differentiating it from the red stuff not yet despatched by your Heart). Finally!
So along the way, it depends on not just the food and drinks you swallow but also on a healthy digestion, effective Lungs and Heart. But if you look at the diagram, you’ll see several other factors which contribute to its formation, being Kidney Ming Men Fire and Kidney Jing Essence.
Jing Essence comes in your genes from your parents. (Choose your parents carefully!) Take care with the health of your Stomach, Spleen, Lungs and Heart. Then, given healthy food and drinks and a conservative upbringing with good life habits and you’ll get healthy Blood.
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From the point of view of Chinese medicine, factors either inherited or congenital contributing to formation of ADD (I add some of the Western-based research that supports this) include:
These are called ‘pre-Heaven’ causes in Chinese medicine.
Chinese medicine calls these ‘post-Heaven’ causes.
After birth, further causes might include:
Expanding on some of the above, this would mean avoiding foods that lack nutrition:
I suspect that the drugs mainly used for ADD/ADHD, mostly amphetamine-based like methylphenidate, work best with ADD patients whose diets and digestion are already better. Like coffee for someone disorientated and confused by lack of sleep (yin deficiency) these drugs can, for a while, wake you up and help maintain better attention.
Of course, as anyone who uses coffee regularly for sleep deprivation knows, using it too often means:
Similarly, it seems that drugs like Ritalin work only short-term. They become less effective after 3 months and beyond 14 months they should be stopped. (J Am Acad Child Adolesc Psychiatry, 2009; 48: 240-8). Indeed, these medications helped only 1 in 10 children diagnosed with ADD/ADHD, meaning 9 out of 10 were not so helped! (Source: Journal of the American Academy of Child & Adolescent Psychiatry, 2013; doi: 10.1016/j.jaac.2012.12.007).
The Cochrane Collaboration, an independent review group, looked at 20 years of Ritalin use, consisting of over 185 trials and 12,245 children.
They reported that the low quality of the underpinning evidence meant that they could not be certain how much the drug improved the lives of the children and adolescents with ADHD. (Source: Cochrane Collaboration, The Cochrane Library, 2015; issue 11). (Ritalin, they also found, had various unpleasant side-effects, including insomnia. Much more on this at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340974/#:~:text=A%20recent%20meta-analysis%20of,2014. Chinese medicine would also agree that this kind of stimulant would readily reduce sleep quality.)
So from this point of view, for ADD it is more important to nourish and enable the body to nourish itself with better digestion and food, calmness and rest: all of these strengthen yin. Yin-enhancing treatments (eg acupuncture and herbs) should help. (This action alone may render stimulant drugs unnecessary.)
Of the Western drugs mostly used, a recent addition, atomoxetine, seems more suitable. This increases noradrenaline and is, supposedly, not addictive. By increasing noradrenaline, atomoxetine (among other actions) increases and maintains blood pressure. In terms of Chinese medicine this means the drug temporarily ‘increases’ Blood which, as explained, is probably deficient in children with ADD. If it does this it would help with their attention.
But atomoxetine probably has side effects, as yet not fully apparent: Chinese medicine may be preferable for some.
Chinese medicine here would aim to improve digestion and to steady the Mind. Mainly this would be with herbs and acupuncture but also gentle massage and, as the child improves, help with slowing and steadying movements. Acupuncture has very few side-effects, unlike most drugs and even most herbal prescriptions. (However, herbal prescriptions use much lower doses than drugs. Herbal prescriptions are also easily altered to improve their underlying action and reduce side-effects.)
However, I admit that acupuncture may not suit some children either from fear of needles or from restlessness.
Many tests show that coordination is difficult for ADHD children but slowing and steadying them is known to help: see https://www.wddty.com/features/simple-moves-to-beat-adhd/ and SLOW! www.anatbanielmethod.com/abm-free-chapters-and-videos
(Interestingly, concerning the question of steadying movements, there was an experiment in Germany, admittedly done with ‘healthy’ children aged 13-16 – in other words they displayed no signs of ADHD. They split them into two groups, one of which, the control group, exercised as usual, and the other did what were called ‘bilateral coordinated exercises’, consisting of bouncing a basketball with one hand and a volleyball with the other. After about 10 minutes they re-assessed both groups and the coordinated exercise group had far better concentration and attention.)
Another insight from Chinese medicine is that, although irritating for others, fidgeting may be a way of dispersing excess yang energy, in which case it would help concentration. (https://www.newscientist.com/article/mg23631510-300-state-of-unrest-can-fidgeting-really-help-you-concentrate/). If so I would say this applies to a far wider range of people than just those diagnosed with ADHD! (See also https://www.newscientist.com/article/dn27706-let-them-fidget-squirming-around-helps-children-with-adhd-focus/)
Returning to the underlying deficiency, we cannot assume these days that the Blood in our veins is as pure as in times of yore!
Sadly, there are many contaminating factors that influence the health of our children and later that of our adult population. Some are poisons, and other environmental and food additives can lead to inflammation.
Inflammation is a sign of heat, an important cause of disease in Chinese medicine and increasingly recognised as such also by Western Medicine.
From its symptoms, ADHD may or may not have Heart Blood deficiency but certainly displays Excess Yang. (Yang is most noticeable in the form of excess Movement or Heat.) Movement can be restlessness – running around, for example, or fidgeting, or impulsivity, and Heat appears as redness, inflammation, dryness, a short temper, impatience, and difficulty sleeping.
For excess yang, the Chinese medicine theory would I think suggest that amphetamine-stimulus may be too much, being highly ‘exciting’. Ideally, they need milder drugs, possibly sedative. First remove possible triggers for excess yang behaviour and over-sensitivity, like environmental pollutants and heavy metal exposure – as from lead and mercury; then remove high sugar and additive enhanced foods, junk foods and the like, which are low nutrient foods and interfere with brain processing thought. Try to teach slower eating habits with more chewing.
I support the notion that ADHD is to some extent a sleep disorder because good sleep strengthens Yin energy and Blood. If so, an underlying problem is deficient yin, as argued above for ADD.
Some ADHD sufferers have brain fog, something like narcolepsy. Lacking Yin (because of poor sleep) they appear more active but the activity has no internal regulation (yin supplies a steadying regulation and if yin is deficient, life becomes chaotic, like a class of small children when the teacher leaves the room), so Western medicine prescribes a stimulant (to yank the children into line!) Experience in France may support this (https://www.newscientist.com/article/mg23431283-100-is-adhd-a-sleep-disorder-stimulant-drug-improves-symptoms/).
Interestingly, there is doubt about the long-term effectiveness of methylphenidate drugs such as Ritalin and Adderral. And when the FDA originally approved their use, almost none of the initial trials focused on safety, and 7 of the 20 drugs approved by FDA weren’t even designed to treat ADHD, but other problems like obesity. (Source: PLoS ONE, 2014; 9(7): e102249) Obesity is usually an excess of flesh, ie a form of excess yin. For this, a yang-type medication might be appropriate in some cases to stimlulate greater activity, so to ‘burn off’ the fat.
Chinese medicine would probably lump the overall effect of the various causes of ADD and ADHD listed above into what are called the symptoms of ‘Damp’ and/or ‘Phlegm’. As such, a bit like mist or fog, they impair an otherwise healthy response to disease and life. With Chinese medicine, there are acupuncture treatments and herbal prescriptions which clear the Damp and Phlegm without being stimulating.
Mental Dampness causes a heavy, dull feeling, making it difficult to concentrate or focus. It is like trying to think during an influenza attack, making it hard to organize events and often leading to forgetfulness and carelessness. This makes it hard to remember instructions, let alone follow them. It often causes a form of depression. It can make you clumsy, perhaps dyspraxic.
‘Phlegm’, especially when there is ‘Heat’ around (for more on the more physical symptoms of Phlegm-Heat, click on Phlegm-Heat), leads additionally to a condition approaching mania, with anxiety and disruptive behaviour, sometimes with dizziness and headache. Many symptoms of hyperactivity come under Damp and Phlegm with Heat.
In Chinese medicine, Damp and Phlegm mainly arise from deficient action of the Spleen energy organ. But Phlegm can also affect the Heart energy organ, making the Mind unstable, unable to focus: as explained, Phlegm with Heat provokes restless behaviour, even a bit ‘crazy’.
Heat mainly upsets two energy organs, Liver and Heart. In the Liver energy organ, Heat produces impulsivity, restlessness, and confrontational behaviour – signs of what is called ‘Wind’. In the Heart Heat produces racing heartbeat, great anxiety, restlessness, manic laughter and inability to sleep (“Heat”).
How might Chinese medicine treat these conditions?
Treating ADD and ADHD patients with Chinese medicine revolves around clearing Heat, Damp and Phlegm, mainly from Liver, Heart and Spleen energy organs.
From the point of view of Chinese medicine, there is an additional factor. These conditions often cause considerable stress amongst those so diagnosed. Stress leads to Qi stagnation which is itself another source of Wind and Heat, affecting all three energy organs, Liver, Heart and Spleen. Chinese medicine can often help with the symptoms of stress.
Unlike sedatives from Western Medicine which sometimes feel like a heavy weight on one’s mind, clearing Qi stagnation, say with acupuncture, leaves most people often feeling wonderfully relaxed. (I have even had patients who found this calm and relaxed state foreign to their experience! They hardly knew how to take it!)
After that, the aim is to strengthen yin, more specifically the form of yin known as Blood. Together these actions start to clear the excess yang of hyperactivity and resolve the deficient yin of attention deficit disorder.
What this means is much greater emphasis on yin-enhancing factors, plus good nutrition and sleep, avoiding whatever exacerbates yang (for example, besides stimulants like Ritalin some Hot foods exacerbate Yang). Treatment then aims to ‘resolve’ or clear the patient’s body’s tendency towards inflammation, and to calm the mind.
Many children aged 0 – 6 continue with ADHD medication well into their teens. Adults with patience, persistence and good acupuncture may be able to reduce and eventually stop their medications. Perhaps they succeed because their level of yin (including Blood) has increased with age as their body mass increases, whereas young children have small body mass hence limited yin and Blood resources, as against their bountiful supplies of yang energy, which all healthy children normally exhibit.
Of course, this would not apply to adults with yin deficiency: ideally, they would need to have their yin deficiency treated successfully before embarking on drug withdrawal. (For more about yin deficiency click on Yin Deficiency: Exhausted – Stress and Apathy – Acupuncture Points (acupuncture-points.org)
Why do some ADHD patients apparently definitely benefit from methylphenidate drugs like Ritalin and Adderral?
Based on the previous discussion, one might assume that ADHD patients would become overly hyperactive from these medications—but in reality, they don’t!
I’ve argued that their main problem is deficient yin. But in some adults at least, there appear to be none of the usual signs of yin-deficiency. So how to explain this?
Until I’ve seen more ADHD adults I’m not sure, but I suspect that they lack both yin and yang, in the form of Blood (yin) and Kidney yang. Here methylphenidate would enhance the yang, bringing balance because in health, yang can improve yin. (How? Go back to the page on Blood showing how Kidney Yang energy is necessary to enable the Spleen to function properly.
Without that yang energy, the Spleen fails to ‘transform’ food and extract its essence meaning that the originating substance for Blood cannot be supplied.) If so, in Chinese medicine they should be given prescriptions to enhance Kidney yang: the exact prescription would be adapted to fit the exact symptoms of the individual and would almost certainly fit better than methylphenidate.
Acupuncture is based on a workable theory well over 2000 years old – probably very much older. It has helped an enormous range of conditions.
One acupuncture treatment is seldom enough and in chronic conditions a course of treatments may be necessary. There may be food advice. As it works, the patient gradually begins to feel calmer and more ‘collected’; sleeps better; feels less restless; has more stable resilient energy and becomes easier to live with!
With ADD and ADHD it would probably be combined with herbs, and advice on food and lifestyle would be offered.
You are trying to wean yourself off medication, and replace it with food or herbs?
To wean yourself off medication means – almost certainly – having acupuncture to help while you reduce medication. Probably herbs too, for which you’ll need to see an experienced practitioner.
Obviously, if you’ve read this far, you’ll know about a range of substances to avoid (heavy metals …) and what to avoid is probably as important if not more important than what’s best to eat.
First read our page on Nutrition to get an idea of how Chinese medicine approaches the question of food.
Blood-building foods will be important whereas stimulant foods are best avoided (eg those containing caffeine), and many ‘hot foods‘, being yang, may be too stimulating.
That doesn’t mean you should only eat foods listed under ‘Cold foods‘: many of them will be more yin than yang but eating them too often may damage your Stomach yang energy, a bad idea!
Digestive enzymes may help, likewise pre- and pro-biotics (regarding probiotics, read our page on antibiotics).
We know Omega-3 fish oils help children, but really, for children, it is a broad range of nutritious foods, with 3 meals a day, that helps most. Just giving children a proper breakfast helps them enormously.
Proper? Proper breakfast means no sugar or salt or potato/crisp snacks, no cola, no caffeine, no chocolate, no flavourings, no colourings. (I expect I’ve left out something!)
Instead try porridge made with oats and milk, or wholemeal bread with butter/olive oil and tahini or almond butter filling. Or rice congee as on our page on clogstoun congee or clogstoun porridgee for resilience.
Or boiled eggs with toast, butter and cress on top? Why not add some miso paste?
And try to slow them down! Teach them to chew what they eat before swallowing: very important!
Good luck! Oh! – you can leave a comment (preferably positive!) or reply in the box at the bottom of this page.
Why You get Nervous Stomach Anxiety and How to Handle It. Acupuncture has great ways to help.
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If you are interested in understanding how Traditional Chinese Medicine can improve your life sign up to my newsletter for the latest updates.
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If you are interested in understanding how Traditional Chinese Medicine can improve your life sign up to my newsletter for the latest updates.