Attention+Deficit+Hyperactivity+Disorder+(ADHD)

A problem usually diagnosed in children but can last throughout adolescence and into adulthood. As its name implies, it is characterized by poor attention span and easy distractability and by hyperactivity and impulsivity

Relevant TCM Diseases: Irritability (Yi Nu, Duo Nu), Insomnia (Bu Mian), Profuse Dreams (Duo Meng), Oppressive Ghost Dreams (Meng Yan), Vexation and Agitation (Fan Zao), Impaired Memory (Jian Wang)

Symptom Patterns in Western Psychiatry: 1. Difficulty sustaining attention 2. Does not follow through the instructions 3. Difficulty organizing tasks 4. Easily DistractedAvoids tasks that require sustained mental effort 1. Often restless or fidgets with hands when sitting 2. Runs or climbs excessively or when inappropriate to do so 3. Often blurts out answers inappropriately 4. Has difficulty waiting turn 5. Often interrupts or intrudes on others
 * Inattentive Subtype:**
 * Hyperactive Subtype:**

Differential Diagnosis: Medical Disorders: A. Seizure disorders B. Diseases of the CNS C. Toxic Exposure D. Metabolic Diseases Effects of Substances: A. Alcohol or illicit substance intoxication or withdrawal B. Side effects of medications (e.g., bronchodilators) Psychiatric Disorders: A. Attention Deficit Hyperactivity Disorder (ADHD) B. Generalized Anxiety Disorder (GAD) C. Seperation anxiety D. Oppositional-defiant disorder E. Conduct disorder F. Learning disorders G. Perceptual or cognitive processing deficits

TCM Etiology and Pathogenesis: “In Chinese medicine, hyperactivity has mainly to do with the Chinese spirit residing in the heart. If the spirit is healthy, then it is, ipso facto, calm. If the spirit is calm, the mind is not agitated nor the body restless. Therefore, according to Chinese medicine, there are three basic mechanisms which may result in pediatric hyperactivity. Either the spirit is not nourished sufficiently, some sort of evil Qi, such as heat or wind, harasses the heart spirit, or some sort of evil Qi, such as phlegm turbidity or blood stasis, block the rifices of the heart… Chinese causes and mechanisms of Attention Deficit Disorder (ADD) are very similar to those of hyperactivity”1

TCM Pattern Differentiation: Spleen Vacuity, Liver Hyperactivity 1 Uncontrollable fidgeting, emotional tension, easy anger, poor sleep, fatigue, diminishe appetite, diarrhea due to stress Scattered concentration: + GV-20, Si Shen Cong, PC-7 Hyperactive stirring: + BL-15, Ding Shen, An Mian Labile emotions w/ vexation and agitation: + GV-24, CV-17, KI-6 [Chai Hu(3-10g.), Gou Teng(6-12g.), Dang Gui(4-10g.), Chuan Xiong(6-12g.), Bai Zhu(6-10g.), Fu Ling(6-12g.), Gan Cao(3-10g.)] Pronounced disquieted spirit: + He Huan Pi, Ye Jiao Teng or Long Gu, Mu Li Depressive heat: + Huang Qin and/or Huang Lian Pronounced fatigue due to spleen vacuity: + Dang Shen Phlegm Turbidity: + Ban Xia, Shi Chang Pu, Chen Pi
 * Tongue:** thin white coat
 * Pulse:** bowstring
 * Treatment Principles:** Fortify the spleen and harmonize the liver
 * Acupuncture Treatment:** LR-3, LI-4, ST-36, HT-7. Even technique
 * Acupuncture Modifications:**
 * Herbal Treatment:** //Yi Gan San// 1
 * Modifications:**

Heart-Spleen Dual Vacuity 1 Sallow yellow or somber white facial complexion, pale nails and lips, fatigue, insomnia, profuse dreams, heart palpitations, shortness of breath, poor appetite, tendency to loose stool, impaired memory [Tai Zi Shen (6-10g.), Bai Zhu (6-10g.), Fu Shen (6-12g.), Huang Qi (6-12g.), Gan Cao (3-10g.), Dang Gui (4.5-10g.), Suan Zao Ren (6-12g.), Yuan Zhi (4.5-10g.), Shi Chang Pu (3-10g.), Wu Wei Zi (6-10g.), Da Zao (2-5 pieces)], Huai Xiao Mai (12-25g.)]
 * Tongue:** fat pale tongue with teeth marks, thin white coat
 * Pulse:** fine, weak
 * Treatment Principles:** Fortify the spleen and supplement the heart, boost the Qi and nourish the blood
 * Acupuncture Treatment:** BL-15, BL-17, BL-47, BL-20. Tonifying technique
 * Acupuncture Modifications:** //Same as above pattern//
 * Herbal Treatment:** //Gui Pi Tang He Gan Mai Da Zao Tang Jia Jian// 1

Yin Vacuity-Yang Hyperactivity 1 Children tend to be thin, poor concentration, insomnia, heart palpitations, easy agitation, easy anger, excessive movement and speech, dizziness, tinnitus, possible low back pain, possible enuresis, flushed cheeks, dry mouth and throat, night sweats [Shu Di Huang (6-12g.), Shan Zhu Yu (6-10g.), Gou Qi Zi (6-10g.), Fu Ling (6-10g.), Shan Yao (6-10g.), Gan Cao (3-6g.), Zhi Mu (6-10g.), Huang Bai (6-10g.), Gui Ban (10-15g.), Nu Zhen Zi (6-10g.), Long Gu (10-15g.), Mu Li (10-15g.), Shi Chang Pu (6-10g.)] Scattered concentration, poor memory: Yi Zhi Ren, Wu Yao Disquieted sleep w/ spasms and contractions of hands and feet: + Suan Zao Ren, Ye Jiao Teng, Gou Teng, Bai Shao
 * Tongue:** red tongue, red tip, scanty coat
 * Pulse:** fine, rapid
 * Treatment Principles:** Enrich and nourish kidney Yin, Level the liver and subdue Yang, calm the heart and boost intelligence
 * Acupuncture Treatment:** Tonify: KI-3, SP-6; Drain: PC-6, GV-14, LI-11
 * Acupuncture Modifications:** //Same as first pattern//
 * Herbal Treatment:** //Zuo Gui Yin Jia Wei// 1
 * Modifications:**

Phlegm Heat Harassing Internally 1 Excessive movement and speech, difficulty controlling oneself, lack of concentration, easy anger, pronounced irritability, vexation and agitation, possible nausea, profuse phlegm, chest and abdominal fullness and oppression, torpid intake, possible bad breath, bitter taste in mouth, yellow-red urination [Ban Xia (6-10g.), Chen Pi (6-10g.), Fu Ling (6-10g.), Huo Po (6-10g.), Yu Jin (6-10g.), Shi Chang Pu (6-10g.), Hua Shi (6-10g.), Zhi Ke (6-10g.), Lian Qiao (6-10g.), Huang Lian (1.5-6g.), Gan Cao (1.5-3g.)] With Yin vacuity: + Shu Di Huang, Bai He, Shi Hu Constipation due to heat: + Da Huang, Huang Qin, Zhi Zi Severe phlegm and chest oppression: + Meng Shi, Chen Xiang Very little or no heat: Use //Chang Zhi Long Mu Tong//
 * Tongue:** red tongue edges, slimy yellow coat
 * Pulse:** slippery, rapid, bowstring
 * Treatment Principles:** Clear heat and disinhibit dampness, transform phlegm and calm the heart
 * Acupuncture Treatment:** ST-40, CV-12, PC-6, GV-14, LI-11. Draining technique
 * Acupuncture Modifications:** //Same as first pattern//
 * Herbal Treatment:** //Huang Lian Wen Dan Tang Jia Jian// 1
 * Modifications:**

Static Blood Obstructing Internally 1 Poor concentration, difficulty studying, easy anger over nothing, excessive movement and restlessness, dry withered hair, scaly skin, prominent veins, possible history of birth trauma with intracranial hemorrhage, blue green/dull dark complexion [Tao Ren (6-10g.), Hong Hua (6-10g.), Chuan Xiong (3-6g.), Chi Shao (3-6g.), Shi Chang Pu (6-10g.), Yi Zhi Ren (6-10g.), Shan Zu Yu (6-10g.), Shu Di Huang (6-12g.), Huang Jing (6-10g.)] Excessive movement and restless fidgeting: + Long Gu, Mu Li Essence spirit lassitude, fatigue, shortness of breath, palpitations: + Huang Qi, Dang Gui Torpid intake, sallow complexion, weak limbs: + Dang Shen, Bai Zhu, Fu Ling, Shan Yao 5-palm heat, insomnia, profuse dreams, emaciation, and red tongue: + Gui Ban, Sheng Di Huang, Zhi Mu, Huang Bai
 * Tongue:** dark and/or purple tongue, static spots or macules, engorged tortuous sublingual veins
 * Pulse:** deep, choppy, fine or bound, regularly intermittent
 * Treatment Principles:** Quicken the blood, transform stasis, nourish blood, engender essence, calm spirit, boost intelligence
 * Acupuncture Treatment:** Drain: SP-10, LI-4, BL-15;Tonify: BL-17, BL-23
 * Acupuncture Modifications:** //Same as first pattern//
 * Herbal Treatment:** //Huo Xue An Shen Tang// 1
 * Modifications:**

Yang Qi Insufficiency 1 Poor concentration, excessive movement nut not overexcitement, lassitude of the spirit, somber wite complexion, torpid intake, loose stools, low back and knee soreness and limpness, cold body and chilled limbs [Shu Di Huang (6-10g.), Shan Zhu Yu (6-10g.), Shan Yao (6-10g.), Fu Ling (6-10g.), Ze Xie (6-10g.), Dan Pi (3-6g.), Fu Zi (3-6g.), Rou Gui (3-6g.), Yi Zhi Ren (6-10g.), Shi Chang Pu (6-10g.)]
 * Tongue:** pale tongue, moist coat
 * Pulse:** deep, weak
 * Treatment Principles:** Supplement the kidneys and boost the Qi, strengthen the will (or mind) and quiet the spirit
 * Acupuncture Treatment:** BL-23, GV-4, BL-51, CV-4, ST-36. Moxa
 * Herbal Treatment:** //Shen Qi Wan Jia Wei// 1

=
=====================================================================
 * IBIS:**

Definition:
Two related but presumably distinctive conditions are discussed in the literature: Attention-deficit disorder without hyperactivity (ADD) and Attention-deficit disorder with hyperactivity (ADHD). In some sources a third, derivative variant is also delineated. The characteristics of each of these will be discussed below in an attempt to integrate several perspectives on this rather slippery topic and hopefully provide us with some insight that is clinically applicable.

Developmentally inappropriate inattention and impulsivity, with or without hyperactivity. This definition conforms to the American Psychiatric Association's Diagnostic and Statistical Manual, Third Edition -Revised (DSM-III-R), shifting the focus of the disorder from excessive physical activity. ADD is implicated in learning disorders and, except for moderate to profound mental retardation, can influence the behavior of children at any cognitive level. The central feature of ADHD is trouble getting things done, both at home and at school, and trouble getting along with adults and other children. Although many parents of energetic children ask their doctors about hyperactivity, it is not a common disorder. According to an article in the British Journal of Psychiatry only 3 percent of children are actually diagnosed with an attention deficit hyperactive disorder. Nevertheless, according to many other sources, ADD is estimated to affect 10% of boys and 3% of girls from 4 to 11 years old, a total of 5 to 10% of school-aged children, precipitating half of the childhood referrals to diagnostic clinics. Most authorities agree that ADD is seen 10 times more common in boys than girls.

Despite its frequent use as a diagnosis, there is a strong argument that attention-deficit disorder (with or without the hyperactivity component) is a collection of symptoms or criteria, an administrative category, rather than a true diagnostic entity. A simple tour though the several recent volumes of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders reveals the uncertainty surrounding the diagnosis of attention-deficit hyperactivity disorder (ADHD). During the past 20-30 years we have seen this condition labeled minimal brain damage, minimal brain dysfunction, behavior and learning disorder; hyperkinetic-impulsive disorder; hyperkinetic syndrome, developmental hyperactivity, and finally attention-deficit hyperactivity disorder. Hence while this diagnosis is frequently resorted to and is commonly used, and perhaps excessively relied upon, by parents, teachers and school officials, caution and circumspection are recommended in making the decision to label a child with the diagnosis of ADHD. In many cases, once the parents and child have accepted the label of "ADD" the element of determinism seems to predominate and no one seems to accept the possibility of improvement through observation, initiative and change; the label provides too easy an excuse for every difficult situation.

Etiology:
The exact cause or causes of attention-deficit disorder are unknown. Several theories advocating biochemical, sensory and motor, physiologic, and behavioral correlates and manifestations have been proposed. The conventional medical community theorizes that the disorder may result from genetic factors; chemical imbalance; injury or disease at or after birth; or a defect in the brain or central nervous system, with the result that the mechanism responsible for controlling attention capabilities and filtering out extraneous stimuli does not work properly. Less than 5% of children with ADD have evidence of neurologic damage, but CT scans and EEGs have not shown structural abnormalities. Recent research indicates neurotransmitter abnormalities, e.g., decreased activity or stimulation in upper brainstem and frontal-midbrain tracts. Food sensitivities, toxins, neurologic immaturity, and environmental problems have also been hypothesized. As many as half of all hyperactive children have fewer behavior problems when put on a diet free of such substances as artificial flavorings, food colorings, preservatives, monosodium glutamate, caffeine, sugar, and chocolate. Poor diet and subclinical hypoglycemia are also contributing factors in many cases. In every case, the family dynamics must be examined, especially if the child has already been diagnosed with ADD so that attitudes and behaviors have been shaped around this label.

Nutritional and Environmental Factors: • Food additive sensitivities - "Feingold hypothesis"- Benjamin Feingold, M.D. estimated that 40-50% of hyperactive children are sensitive to artificial food colors, flavors, and preservatives as well as naturally occurring salicylates and phenolic compounds. His claims were based on over 1,200 cases in which food additives were linked to learning and behavior disorders. He presented his findings to the AMA in 1973. Researchers focused on only 10 of the food dyes versus the 3,000 additives with which Feingold was concerned. A negative correlation was found and the National Advisory Committee on Hyperkinesis and Food Additives to the USA Nutrition Foundation in 1980 filed a negative report about the role of food additives and hyperactivity.

• Most of the research refuting Feingold's hypothesis comes from C. Keith Conner's book, Food Additives and Hyperactive Children. Rippere has reviewed much of the work done by Conner and has placed criticism in 6 areas: a) The placebo used was a chocolate cookie. Conner even admits in a follow-up two years later that 21% of the mothers mentioned that chocolate adversely affected their children's behavior. b) Only 26 mgs worth of additives were used compared with 76.5 mg average and 150 mg 90th percentile. c) The dose interval was relatively long. d) Conner used the cytotoxic test for determining allergies. This test has many false positives and negatives. e) Evaluation was not done on a daily basis and the evaluations were very subjective. f) Conner consistently minimizes and discounts findings which support Feingold's findings. (Feingold; Conner; Swanson and Kinsbourne, 1980; Egger, 1985)

• Food allergy/sensitivities • Food and inhalant allergies, especially salicylates, phenolic food components and traditional antigens (Swain, 41-2; McGovern, 1983) • Hypoglycemia (Langseth and Dowd, 1978) • Nutrient deficiencies: Many nutrient deficiencies can cause impaired CNS function. Iron is the most common nutrient deficiency in American children. Most research has been done with vitamin B-6, vitamin B-3, and calcium. (Brenner,1982) • Lead toxicity: It has been estimated that the human body can tolerate about 1 mg of lead without suffering from toxic side effects. In an urban environment the average person ingests, with solid foods, 1 mg/wk. Another 0.1 mg/wk comes from beverages. The World Health Organization estimates only 10% of the lead ingested is actually absorbed. Typical airborne inhalation of lead in an urban environment is about 0.2 mg/day. Researchers have demonstrated that children absorb and retain much higher amounts of lead than adults. Abnormal lighting: TV and fluorescent lighting

ADHD in Chinese Medicine: In the psychophysiologic theory of traditional Chinese medicine, pediatric hyperactivity primarily centers around the concept of the Shen (Mind or Spirit) which resides in the Heart. If the Shen is healthy, then the child will be calm, their mind will not be agitated nor their body restless.

According to traditional Chinese medical pathology, there are three basic causes which can disturb the Shen residing in the Heart: Heat, Phlegm and/or Xu (Deficiency). If the Shen is not nourished sufficiently the child will not feel grounded and their Shen will flutter around nervously, like an agitated flame; this situation will be aggravated if further Heat develops and rises, or if excessive Phlegm develops and obstructs the portals or orifices of the Heart to cause confusion and poor judgment. In advanced cases, Xue Ye (Blood Stasis) may obstruct the channels causing malnourishment of the Orifices and complicate any of the three above patterns. Further, because the Spleen tends to be weak in children and the Liver tends to excess, there is often a combination of insufficient spirit, due to Qi Xu (Deficiency) with Liver depression transforming Wind due to malnourishment by the Xue (Blood). According to Bob Flaws, this last pattern is the most commonly seen in clinical practice. (Flaws, p. 256)

Chinese Patterns and Etiology: Julian Scott has described four primary patterns and their origins: » Heat Shi (Excess): these children may have suffered from "womb heat" due to the mother's consumption of Hot foods or herbs, an illness involving fever or exposure to excessive hot weather while in utero; other common causes include the child's consumption of foods that cause heat in the system, such as curries, spicy foods, or shellfish; food additives, artificial coloring and flavors; febrile diseases; adverse reactions to immunization; and, accumulation disorders due to overeating and/or food retention. » Heat and Phlegm Shi (Excess): this pattern includes the elements described in the Heat pattern above, but has the strong influence of excessive Phlegm aggravating the condition due to a hereditary predisposition to Phlegm, a diet high containing Phlegm-producing foods such as dairy, peanut butter, excessive sweets, and an intolerance to gluten; ultimately the combination of the Heat and the Phlegm clouds the Heart and impinges upon the ability to discern right and wrong. » Middle Warmer Xu (Deficiency), including Spleen Qi Xu (Deficiency): these children usually have a constitutional Spleen Qi Xu (Deficiency); they have poor boundaries at home, have difficulty nourishing themselves, and frequently drain Qi from their parent(s) excessively or inappropriately; "love does not flow in family;" frequently they have a history of becoming weakened by illness; they are inclined to be thin, they usually have a poor appetite, and poor sleep habits, together with their strong thirst and inclination to excessive consumption of fruit juice and cold drinks, their habits and lifestyle further weaken their Spleen; this is aggravated by their aversion to exercise and inclination to retreat into intellectual activities. » Kidney Qi Xu (Deficiency): they have constitutional Kidney Xu (Deficiency), and/or a history of long-term or severe illness; the Water does not adequately control the Fire in these children and overstimulation causes the Fire to flare and rush up

Somatic Therapies:
• gentle exercise • Eurhythmy • yoga

Nutrition:
therapeutic foods: • whole-foods diet, high in protein and complex carbohydrates; reduce sugar and simple carbohydrates. (Zametkin, Nordahl, et al, 1990; Langseth, Dowd, 1978.) • increase foods that calm the Shen (Spirit), tonify the Heart, harmonize the Stomach and Spleen • increase foods rich in Vitamin B-complex • longan, oyster, rice, rosemary, wheat, wheat germ, mushroom

Chinese: » Heart Xue Xu (Blood Deficiency), Spleen Qi Xu (Deficiency), and also in Yin Xu (Deficiency), Yang hyperactivity: • nourishing, cooked, warm, clear bland diet, with slightly increased animal protein to help manufacture sufficient blood, for example, soups with black beans, chicken or beef broth, and plentiful root and leafy green vegetables (Flaws, 1997, p. 262)

specific remedies: • 2 oz. fresh walnuts, 2 oz black sesame seeds, crush together and eat three times daily (Butt and Bloomfield, 149.) • for nervous tension: 3 oz. fresh oysters, 3 oz. peanuts, 2 oz. celery. Boil in 2 pt water until reduced to half. Divide into 2 halves and eat and drink twice daily for 7-14 days (Butt and Bloomfield, 149.) • if indications of lead toxicity, via hair analysis, use foods that will chelate: pectin (apples), alginate (seaweed) methionine, cysteine and cystine-foods such as beans, eggs, onions, and garlic (Marz, 314-315.)

avoid: • avoid food additive sensitivities - eliminate processed foods that contain artificial colors, flavors, sweeteners, and preservatives, commonly listed as benzoates, nitrates, and sulfites; common food additives also include calcium silicate, BHT, BHA, benzoyl peroxide, emulsifiers, thickeners, stabilizers, vegetable gums, and food starch. (McGovern, 1983; Egger J, et al. Lancet. 1985 Mar 9;1(8428):540-545; Egger, et al, 1992; Rowe KS, Rowe KJ. J Pediatr. 1994 Nov;125(5 Pt 1):691-698.) • "Feingold hypothesis"- Benjamin Feingold, M.D. estimated that 40-50% of hyperactive children are sensitive to artificial food colors, flavors, and preservatives as well as naturally occurring salicylates and phenolic compounds. His claims were based on over 1,200 cases in which food additives were linked to learning and behavior disorders. (Feingold) • avoid salicylate-containing foods: - Fruits-almonds, apples, apricots, cherries, currants, nectarines, peaches, plums and prunes - Berries-blackberries, boysenberries, gooseberries, raspberries, strawberries - Grapes and raisins or any product made with grapes - wine, wine vinegar, jellies, foods containing fruit juice sweeteners - Oranges (note: grapefruit, lemon and lime are permitted) - also, many spices: cardamom, cinnamon, cloves, curry, oregano, paprika, pepper, rosemary, sage, turmeric (Swain, Soutter, et al., 1985.) In a study of hyperkinetic children and behavioral changes associated with diet, acetyl salicylate was the phenolic compound provoking the greatest frequency of responses (80%), while from foods, sugar, corn, beef and egg were the next most common offenders at 30%. (McGovern, 1983.) • avoid additives and phenolics: The Hyperactive Children's Support Group of Great Britain recommends avoiding the following: Tartrazine, Sunset Yellow, Benzoic acid, amaranth, Red 2G, Brilliant Blue FCF, Carmine, Quinoline Yellow, FCF, Carmoiic acid, Sulfur dioxide, Potassium nitrate, BHT, Caramel, Cochineal, Sodium benzoate, Sodium nitrate, BHA, Indigo, (Swanson, Kinsbourne, 1980; Brown, 276.) • minimize food sensitivities: eliminate or reduce the intake of cow's milk, soy, eggs, wheat, citrus, and other potential allergenic foods (McGovern, 1983; Egger, et al, 1992.) • minimize sugars and simple carbohydrates to reduce risk of hypoglycemic reactions: 75% of criminals were hyperactive children and more than 50% have abnormal GTT's. Hypoglycemia can stimulate increased catecholamine secretion. (Langseth, Dowd, 1978.) • avoid meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar

» Chinese: • Phlegm Obstructing the Heart Orifices: avoid Sweet, Cold and Damp foods which either weaken the Spleen, such as chilled, cold, raw foods or sugar and sweets, or foods which cause Dampness and Phlegm, such as sugar and sweets, dairy foods, and fatty, greasy, fried foods (Flaws, 1997, 262.) • Heat Shi (Excess): eliminate all food additives, colorings and flavorings; avoid oranges, sugar and red meat, as well as Hot foods such as hot spices, shellfish and curries (Scott) • Heat and Phlegm Shi (Excess): eliminate Phlegm-producing foods such as dairy and peanut butter; high freequency of gluten intolerance which causes green phlegm and nasal congestion; avoid Sweet and Damp foods (Scott) • Middle Jiao Xu (Deficiency), including Spleen Qi Xu (Deficiency): limit sweets and fruit juices, especially restrict cold food and drinks; no ice (Scott) • Kidney Qi Xu (Deficiency): limit sweets and cold food; no ice (Scott)

Botanicals
• Avena sativa (Wild oat): calms the nervous system; one dose daily for one month (Zand, et al, p. 268); 100 g to a full bath (Schilcher, p. 100) • Anemone pulsatilla (toxic ): morbid mental excitement (Felter and Lloyd, p. 1592) • Atropa belladonna (toxic): in 3x attenuation: nervous excitement with wild and furious delirium, hysteria (Felter and Lloyd, p. 339) • Ferula asafoetida: hysteria, emotional attacks associated with flatulent distention of the abdomen (Felter, p. 221) • Gelsemium sempervirens (toxic): flushed face, bright eyes, increased heat of head, great restlessness and excitation (Felter, p. 387) • Chamomile: effective and time-proven relaxant; one cup of tea at bedtime, as needed. • Cimicifuga racemosa: puerperal, suicidal despondency (Harper-Shove, p. 30) • Conium maculatum (toxic): mild maniacal excitement (Felter, p. 320) • Datura stramonium (toxic): with alternate fits of weeping and laughter (Harper-Shove, p. 30) • Eleutherococcus senticosus (Siberian ginseng): modulates blood sugar metabolism and aids adrenal function; 300-400 mg daily of concentrated, standardized extract of roots and rhizomes or 2-3 g of dry, powdered roots and rhizomes, in 2-3 divided doses; for children use one-half the adult dose (Brown, p. 275, 278) • Eschscholtzia californica (California poppy): sedative and anxiety-reducing effects • Evening primrose oil: corrects the essential fatty acid deficiency noted in some ADHD children; 2 to 3 grams daily; recommended by the Hyperactive Children's Support Group of Great Britain. (Colquhoun and Bunday, 1981) • Ferula asafoetida: hysteria, emotional attacks associated with flatulent distention of the abdomen (Felter, p. 221) • Gelsemium sempervirens (toxic): flushed face, bright eyes, increased heat of head, great restlessness and excitation (Felter, p. 387) • Humulus lupulus (hops): nervous excitability in fevers, sedates, produces sleep (Felter, p. 408); especially indicated with restlessness and anxiety states, sleep disorders; infuse 1 tablespoonful of hop strobiles with 1/4 liter of boiling water; leave for 10 minutes, for 1 cup of hop tea; 1 cup per day for children up to 3 years old is usually sufficient; with older children, the dose may be increased to 1 cup, three times daily; a pillow containing hops strobiles can also be effective (Schilcher, p. 60 - 61) • Hyoscyamus niger (toxic): acute or recurrent mania, epileptic mania, puerperal mania, delusional insanity (Felter and Lloyd, p. 1036) • Hypericum perforatum (St. Johns wort): for sedative action, especially with nervous restlessness and sleep disorders; infusion of 1 teaspoonful of the cut-up herb (with minimal stems) with 200 ml of boiling water on to; leave for 10 minutes; daily dosage of 1 one cup for young children, 2 - 3 cups for children above 3 years old; fluidextract: 5 drops twice daily for young children, 10 drops up to three times daily for schoolchildren (Schilcher, p. 61, 118) • Lavandula angustifolia (lavender flowers): especially indicated with restlessness, problems going to sleep, functional epigastric symptoms, nervous stomach and intestinal symptoms due to nerves". Dosage: Pour 150 ml of boiling water on to teaspoonful of lavender flowers, cover, and leave to infuse for 10 minutes. (Schilcher, p. 60) • Melissa officinalis (Balm leaves): especially indicated with "problems going to sleep of nervous origin, functional gastrointestinal disorders;" infuse 1 tablespoonful of cut-up balm leaves with about 150 ml of boiling water for 1 cup of balm tea, cover the container and leave for about 10 minutes; infants are given 1 cup in divided doses over the day, young children up to 3 cups daily (Schilcher, p. 60) • Passiflora incarnata (passion flower herb): specific for "nervous restlessness". Dosage: infuse 1 tablespoonful of the cut-up herb with 150 - 200 ml of boiling water, leave on a low flame for 5 minutes; young children are given 1 cup per day, children of 3 years and over, up to 3 cups daily. (Schilcher, p. 60; Ellingwood, p. 107)) • Scutellaria (Skullcap): a relaxant and calms the mind; one dose, three times a week, for three months. Note: This herb should not be given to a child less than six years old. (Zand, et al, p. 268) • Valeriana spp.: hysteria (Felter, p. 685)

Chinese Formulae
• Acorus Tablets (patent): calm Shen, resolve Phlegm, clear Heat for hyperactivity, poor memory and concentration (Dharmananda, p. 96) • Minor Bupleurum C.: relaxes the nervous system and can help relieve stress.; for children, one dose daily for one month, followed by wild oat for one month; Note: Minor bupleurum should not be given to a child who has a fever or any other sign of an acute infection. (Zand, et al, p. 268) • Bupleurum F. (Yi Gan San): with Spleen Xu (Deficiency) and Liver hyperactivity, to fortify the spleen and harmonize the liver; emotional tension, irritability, easy anger, uncontrollable fidgeting, poor sleep, fatigue, reduced appetite, loose stools or diarrhea in response to emotional stress, thin, white tongue fur, a wiry pulse (Flaws, 1997, p. 256-257) • Cinnamon C. (Gui Zhi Tang): with Spleen Xu (Deficiency) and Liver hyperactivity, to fortify the spleen and harmonize the liver; emotional tension, irritability, easy anger, uncontrollable fidgeting, poor sleep, fatigue, diminished appetite, easily developing diarrhea in response to emotional stress, thin, white tongue fur, a wiry pulse (Flaws, 1997, p. 256-257) • Nourish the Heart and Boost the Spleen Decoction (Yang Xin Yi Pi Tang): with Heart and Spleen Xu (Deficiency), to fortify the Spleen and supplement the Heart, supplement Qi and nourish Xue (Blood); A sallow yellow or somber white facial complexion, pale nails and pale lips, fatigue, insomnia, heart palpitations, shortness of breath, a poor appetite, a tendency to loose stools, poor memory, a fat, pale tongue with thin, white fur, a fine, weak pulse (Flaws, 1997, p. 256-257) • Ginseng and Longan C. (Gui Pi Tang) plus Licorice, Triticus and Red Date Decoction (Gan Mai Da Zao Tang) with additions and subtractions: Heart Xue Xu (Blood Deficiency) and Spleen Qi Xu (Deficiency); A sallow yellow or somber white facial complexion, pale nails and pale lips, fatigue, insomnia, heart palpitations, shortness of breath, a poor appetite, a tendency to loose stools, poor memory, a fat, pale tongue with thin, white fur, a fine, weak pulse (Flaws, 1997, p. 256-257) Pseudostellariae (tai zi shen) poria center (fu shen) white atractylodes (bai zhu) Chinese angelica (dang gui) astragalus (huang qi) polygala (yuan zhi) zizyphus (suan zao ren) acorus (shi chang pu) schizandra (wu wei zi) jujube (da zao) triticum (fu xiao mai) licorice (gan cao) ª with sleepwalking, profuse dreaming, or nightmares, add uncaria (gou teng), dragon teeth (long chi), and mother-of-pearl (zhen zhu mu); ª if there is impaired memory, add polygala (yuan zhi), dragon bone (long gu), and acorus (shi chang pu) (Flaws, 1997, p. 256-257) The following are all for Yin Xu (Deficiency), Yang hyperactivity, to supplement the Kidney and enrich Yin, subdue Yang and quiet the Shen (Mind); Main symptoms: Besides tending to be thin, children with this pattern also have a red tongue with diminished furor a pale tongue with a red tip. Their pulses are fiiie and rapid and they tend to sutfer from insomnia, heart palpitations, agitation, dizziness, ringing in the ears, possible low back pain, possible bed-wetting at night, flushed cheeks, and possible night sweats. (Flaws, 1997, p. 258-260) • You Yin Qian Yang Wan (Foster Yin and Subdue Yang Pills) • Qing Nao Yi Zhi Tong (Clear the Brain and Boost the Intelligence Decoction) • Sheng Mai Yin (Generate the Pulse Drink) • Bu Shen Yi Zhi Tang (Supplement the Kidneys & Boost the Intelligence Decoction) • Bu Shen Huo Xue Tang (Supplement the Kidneys & Quicken the Blood Decoction) • Bu Shen Er Xian Tang (Supplement the Kidneys Two Immortals Decoction) • Chang Pu Wu Wei San (Acorus & Schisandra Powder) • Restore the Left [Kidney] Pills (Zuo Gui Wan Jia Jian) with additions & subtractions prepared rehmannia (shu di huang) dioscorea (shan yao) moutan (mu dan pi) tortoise plastron (gui ban) white peony (bai shao yao) dragon bone (long gu) oyster shell (mu li) polygala (yuan zhi) acorus (shi chang pu) schizandra (wu wei zi) alpinia (yi zhi ren) lycium fruit (gou qi zi) licorice (gan cao) ª If there is bed-wetting add cuscuta (tu si zi), mantis egg-case (sang piao xiao), and rosa fruit (jing ying zi)

• Huang Lian Wen Dan Tang Jia Jian (Coptis Warm the Gall Bladder Decoction with Additions & Subtractions): Heart Agitated by Phlegm Fire (Phlegm confounding the portals of the Heart & Heat harassing the Heart Shen) Main symptoms: Easy angered, very irritable, easily vexed, restless, possible nausea, possible profuse phlegm, chest fullness and oppression, a bitter taste in the mouth when waking up in the morning, a tongue with red edges and slimy, yellow fur, a wiry, slippery, rapid pulse • Chang Zhi Long Mu Tang (Acorus, Polygala, Dragon Bone and Oyster Shell Decoction): when Phlegm confounding the Heart Orifices but with no or minor heat ª If there is heat, add coptis (huang lian), gentiana (long dan cao), and lophatherum (dan zhu ye). ª If there is Yin Xu (Deficiency), add prepared rehmannia (shu di huang), lily bulb (bai he), and dendrobium (shi hi). ª If there is Yang Xu (Deficiency), add aconite (fu zi), antelope horn (lu jiao), and astragalus (huang qi). ª Xue Yu (Blood Stasis) Obstructing the Channels and (causing) malnourishment of the portals, to Quicken the Xue (Blood) and dispel Yu (Stasis): for hyperactivity plus a history of birth trauma with intracranial hemorrhage, a dull, dark facial complexion, easily angered over nothing, a dark red tongue, a choppy pulse Guiding formula: Since this pattern merely complicates one of the three above patterns, one should choose from among the above formulas and then add red peony (chi shao yao), salvia (dan shen), and carthamus (hong hua).

Acupuncture
after assessing the person and palpating, consider these patterns: Shen Disturbance; Heart Fire Blazing, causing Shen Disturbance; Heart Agitated by Phlegm Fire; Heart Misted by Cold Phlegm; Liver Fire Blazing Upward; Liver Wind Arising From Liver Yang Rising; Heat Shi (Excess); Heat and Phlegm Shi (Excess); Heart and Spleen Xu (Deficiency); Middle Jiao Xu (Deficiency), including Spleen Qi Xu (Deficiency); Spleen Xu (Deficiency) with Liver Shi (Excess); Kidney Qi Xu (Deficiency); Yin Xu (Deficiency) with Yang Shi (Excess); Shi (Excess) of the Du Mai (Governing Vessel); Shi (Excess) symptom of the Yang Qiao Mai (Yang Motility Vessel); Xu (Deficiency) of the Yin Qiao Mai (Yin Motility Vessel)

» pattern discrimination: more on differential in Diagnoses sections

» illustrative combinations: • Ht-7, Lv-2 and St-44, with strong reducing technique, to clear Heat and calm the Shen, in cases of Heat Shi (Excess); needles not usually retained; can also add LI-4 and Lv-3; substitute Ht-8 for Ht-7 when more Heat is present; note: children will scream with treatment, mainly from anger, not from fear or pain; treatment course usually 10-15 sessions with one, or preferably two, treatments each week (Scott) • Ht-7, Ht-8, Lv-2, St-40, GB-34 and PC-5, with strong reducing technique, to clear Heat, resolve Phlegm, and calm the Shen, in cases of Heat and Phlegm Shi (Excess); may also moxa CV-12 if Cold has developed in the abdomen; note: child will usually discharge of Phlegm and often can go berserk temporarily in reaction to effective treatment; such discharges are a beneficial sign and the child will usually become more childlike and well-behaved afterward; course of treatment anywhere from 10-30 sessions with observable change after 8-10 treatments (Scott) • Sp-6, St-36 and Ht-7, and, on most occasions, Lv-3 also, with tonifying technique, to strengthen the Middle Warmer and tonify the Spleen, in cases of Middle Warmer Xu (Deficiency) and Spleen Qi Xu (Deficiency): these children will scream and try to manipulate the parents to abort the treatment, keeping parents out of the room during the treatment may preclude this situation; course of treatment anywhere from 10-30 and the prognosis is variable; key factor as are dietary and parents setting up boundaries (Scott) • Bl-23 (ind. D) and Kd-1 (ind. D), with indirect moxa, and NO needles, to tonify the Kidney and calm the Shen, in cases of Kidney Qi Xu (Deficiency); the moxa treatment will bring down false Fire and restore balance between the Upper and Lower Warmers; always use indirect moxa in children below the age of 6 or 7 or with any child who wont stay still; needles will frighten these children overexcite them, and further weaken the Kidney Qi; these children usually have constitutional Kidney Xu (Deficiency) and/or a history of long-term illness or a very severe illness; they respond slowly to treatment and need to be treated for several months (Scott) • GV-20, si shen cong, PC-6, Ht-7, Lv-8, Lv-3 and Sp-6 for childhood hyperactivity due to Internal Liver Wind and Heart Yin Xu (Deficiency) (Jirui and Wang, p. 282) • Kd-4 (listed as "Kd-5") and Lu-9 for screaming fits of children (Mann, p. 154) consider treatment for "Internal Dragons" or "External Dragons" External Dragons: GV-20, • UB-11, UB-23, UB-61; Internal Dragons: Master point 1/4" below CV-15, St-25, St-32, St-41; In both treatments, sedate first. If the person and the pulses change, fine. If no change with sedation, then tonify. (Worsley) • UB-15 and CV-14 for neurasthenia; remove Obstruction of Heart Qi circulation in Chest Bi (Fullness) to reduce Fire and ease the mind (Shanghai, p. 202; Finkelstein, p. 40; Flaws, 1989, p. 78) • UB-15 and Ht-7: calm the Heart Spirit, remove Obstruction from the Orifices of the Heart, calm the emotions, and treat insomnia due to Xu (Deficiency) of the Heart and Spleen (Flaws, 1989, p. 78; Finkelstein, p. 40) • UB-15 and PC-8: suppress Heart Fire to calm the Spirit and ease the Mind (Flaws, 1989, p. 78; Finkelstein, p. 40) • Ht-3, PC-5, Ht-7, LI-4, SI-3, Kd-7 and TW-3 for mania (Lee and Cheung, p. 325) • GV-26, Lu-11, Sp-1, PC-7, UB-62, GV-16, St-6, CV-24, PC-8, GV-23, CV-1 and LI-11 for mania and melancholia (Lee and Cheung, p. 325) • UB-58, St-23 and St-24 for melancholia and mania with protrusion of the tongue (Lee and Cheung, p. 325) • CV-13 and Ht-7: treat "manic running amok" (Ellis, et al, 1988, p. 357) • PC-6, Ht-7, GV-26 and SI-3 (also consider LI-4, Lv-3, Lu-11, PC-7, Kd-1, Kd-4, Sp-6, LI-11, GB-34, GB-30, yi long, TW-21, TW-17, CV-22, UB-1, TW-23, GV-20 and Kd-6) for hysteria (Lee and Cheung, p. 322) • UB-15, UB-11, UB-13, UB-17, UB-18, UB-20 and UB-23: disperse Yang Shi (Excess) in the organs (Finkelstein, p. 40) • GV-23, GV-16 and UB-62: tranquilize the mind and calm the emotions (Finkelstein, p. 82) • CV-11 and PC-6: reduce Heart Fire to ease the Mind (Finkelstein, p. 88); "sweep away bitterness in the chest" (Ellis, et al, 1988, p. 356) • CV-14, TW-10 and UB-15: treat mental instability (Shanghai, p. 178) • Lv-5 and CV-3: reduce Fire of the Liver (Finkelstein, p. 74) • GV-20 and Kd-3: subdue Yang (Finkelstein, p. 81) • Lu-11, GV-26 and Sp-1: clear the Brain, regain mental clarity; release Heat and stabilize nerves (Finkelstein, p. 5) • Kd-3, UB-23 and UB-15: adjust disharmony of Heart and Kidney (Finkelstein, p. 53) • Kd-3, Sp-6, LI-4, GB-20 and Lv-2: reinforce Kidney and nourishes Yin (Finkelstein, p. 53) • Kd-3 and UB-23: nourish Kidney Yin and facilitates Jing (Essence) (Finkelstein, p. 53) • SI-3 and UB-62: open the Du Mai (Governing Vessel) for which Shen disorders are a symptom of Shi (Excess) • UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and for which restlessness is a Shi (Excess) symptom • Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which restlessness is a Xu (Deficiency) symptom

Homeopathy
• Aconite: often have strange and irrational fears, e.g., cotton balls, fear of a light plastic ball but not of a football; babies must nurse in a particular place; fears and sweating at night; tendency to fevers, croup, thirst. • Anacardium: feels put down, isolated, separated from the world; pathological inferiority; feels need to prove him/herself; experience test-taking anxiety, go blank; antagonism within him/herself; of two wills, two minds; devils speaking in one ear; angels in the other; Jekyl and Hyde; can be cruel and malicious, often after a history of being abused or belittled; swearing; acts as if lacks conscience • Argentum nitricum: is thin, excited, and anxious child, always in a hurry, moving, touching; premiere remedy for obsessive-compulsive behavior in children; afraid of crowds and dislikes going to any public places, including school, prefers being outdoors; hyperactive but with a quality of innocence; usually not malicious, though may have short bursts of anger; hypoglycemic: better from eating, craves sweets, which adversely affect her/his behavior; may be susceptible to conjunctivitis and tonsillitis • Aranea ixabola: excessive teasing, especially teasing and manipulating by acting cute; mischievous leader - gets others to disobey; fascinated with spiders • Arnica: child in shock, or never well since shock or trauma, can be due to difficult birth; often confused with Sulphur • Aurum met.: little adults; want affection, don't know how to express emotional needs; can be cold to family, have a hard time making friends; perfectionist, can be bitter and negative; try hard, don't want to fail; tend to sinus problems, nasal congestion, moaning in sleep; feel better from music • Baryta carbonica: can be sweet, timid and fearful or be the class clown, goofy and acting out; apparent arrested or delayed mental, physical or social development; shy, self-conscious, with self-limitation, feels defective; fear of looking bad, being laughed at, criticized; feels incompetent, incapable; feels s/he is being laughed at, mocked or criticized; timid due to fears, especially fear of making a mistake; feels s/he is being watched; dares not look up; acts childish and immature; difficulty with schoolwork; backward or behind; often teachers pet; tend to tics and glandular swellings • Baryta iodatum: irritable, hurried, restless, and nervous; difficulty concentrating; canine appetite • Belladonna: forgetful, slow, poor learning ability; sensitive to noise and light; night terrors, fear of ghosts; looks wild when angry; large heads, with bright red cheeks; look well, even when sick; tend to otitis media; complain of hot and throbbing discomfort; often crave cold drinks, lemons and oranges • Bismuthum subnitricum: these children cling desperately to their mothers and are terrified when alone; tend to be thirsty for cold water, but can have acute stomach pain in which even water is vomited as soon as it reaches the stomach • Bufo: difficulty relating well to others; narrow focus; don't understand danger; associated with seizures or autism; slow, coarse appearance; can hug or bite you; masturbation or premature interest in sex; rely on basic instincts and instant gratification; upset when not understood; music or bright objects can be intolerable; often present with eczema, nail biting, and may have protruded tongue or a gaunt face with stupid expression • Calcarea bromatum: restlessness in flaccid, chubby children • Calcarea carb: feels unsafe; afraid of robbers, dogs, heights. airplanes - any situation with potential risk to physical safety; cautious, protective; fear that other will perceive her/his confusion and think s/he's insane; feeling as if everything is horrible; stubborn and methodical; obstinate and strong-willed; can be slow, hesitating; chunky build; sweat on head as infant • Calcarea phosphorica: feels frustrated, dissatisfied; acts fussy, peevish; can be a devilish young child, who is restless, shy, and fearful, but who loves to take chances and play tricks, a daredevil; feels as if s/he is away from home and must get home; athletic; loves travel, change, new experiences; complain of growing pains, especially in the bones; desire smoked meats; tends to have abdominal gas, colic, slightly swollen abdomen; often have tonsillar hypertrophy. • Cannabis indica: feels isolated, disconnected; feelings of anguish, terror, ecstasy; spacy, confused, inattentive; time and space feel disoriented; fear of going insane; everything feels like a dream, even familiar things seem strange or unreal; acts as if in a dream or off in space; can't pay attention for long; good at science projects but can theorize until lose touch with reality; absent-minded; can be obsessive-compulsive; as if on drugs, stoned look in eyes; parents may have used marijuana excessively; three common variations: (1) laughing, giggling, clowning around; (2) ethereal, airy; (3) brassy, loquacious, like to dress up in olden day clothes • Capsicum: intensely homesick, discontented, brooding, irritable, absent-minded, disobedient, and angry; appear extremely obstinate; contrary, even against something they want if suggested by someone else; fear being censured and easily offended; restless, clumsy, and run into everything; difficulty sleeping at night, but yawn during the day; can wake in a fright, screaming, or full of fear; worse form any draft, even warm air; often seen in child at daycare with frequent otitis and bright red ears; can have pale face and puffiness under eyes, but rashes and red ears • Carcinosinum: fearful, timid, unhappy, worried, and obstinate, yet sensitive to reprimand and music; appear dull of mind, disinterested, and averse to conversation; can be very sympathetic to others; can be very tidy or very messy; love to travel and will over-extend themselves; frequently suffer from insomnia; strongly crave or dislike salt, milk, eggs, fat meat, and/or fruit; onset of symptoms often after severe reaction to a vaccination; frequently a family history of cancer; may have brownish cafe-au-lait complexion, many pigmented moles, and bizarre tics or blinking eyes • Chamomilla: bad temper, very irritable and impatient; complaining, frustrated, restless, and thirsty; contrary - do not know what they want; demands one thing than want something else; fidgety child quiets down once he has attracted attention; wants to be carried everywhere or will whine and scream but will settle down if carried and jiggled or rocked; aversion to be touched with a hypersensitivity to pain; feels pain is unbearable; everything is intolerable; can become so hyperactive that he will get exhausted and begin to cry; dullness of the senses with a diminished power of comprehension, as if they were hard of hearing; all symptoms worse at night • Cina: cross, contrary, disobedient with very difficult behavior; child does not want to be touched or even looked at and turns away when approached; nothing satisfies them for long; restless, fidgety and fretful, especially during sleep; grind their teeth at night and wet the bed; often agitated by parasites, such as pinworms; sleep is very restless, accompanied by jerking, frequent swallowing and coughing; often sleep on their abdomen or the hands and knees during sleep (Medorrhinum); irritated nose causing a constant desire to rub, pick, or bore into it until it bleeds; ears can be itchy; often show twitching of face muscles and eyelids, even inclined to seizures; appetite can be ravenous, strong thirst, and much craving of sweets; children often have large bellies • Colocynthis: easily offended, especially by feeling unappreciated, insults, or humiliation; moody and overly sensitive; want to be alone; tend to abdominal cramp and sciatic pain, may bend forward for relief • Cornus circinatus: don't want to think, read or work; inability to concentrate on thoughts; don't understand what they are reading; tend to aphthous stomatitis, flatulence, and weakness upon waking • Crotalus horridus: intense, animated, hurried, restless, and talkative; many fears, especially that someone might be following them or that they hear footsteps behind them; fear of being alone, spirits, ghosts, snakes; can strike out in fits of rage; resent and blame other children for supposedly getting them into trouble; report dreams of hairy spiders; tend to hives and epistaxis • Cuprum metallicum: anxiety at night; fears of kidnappers or house catching fire; known for sticking their tongues out • Ferrum metallicum: strong-willed and persistent; fight for their beliefs; sluggish mind with difficulty collecting thoughts; tend to anemia and headaches; often obese, with aversion to eggs; can crave or detest tomatoes • Gallic acidum: will hurt loved ones; wild at home but can be controlled elsewhere; fear being alone, day or night; want attention and need to win; can be sweet or manipulate others to fight; repeats same things over and over; touches things; tend to excessive mucous in nose and throat; often complain of photophobia; uncommon remedy with limited duration of action • Helleborus: feel stupid, that they cannot deal with things, and that their mind is sluggish; appear dull and unresponsive; often a history of encephalitis or a head injury; difficulty memorizing anything or articulating thoughts; tendency to despair and a strong aversion to making any effort, yet easily angered; observed to bite their spoon when eating without being aware of it; history of fever and/or head injury; often need to follow quickly with Hyoscyamus; easily confused with Sulphur and Med. • Hyoscyamus: difficult children with poor impulse control, even though engage in premeditated actions; talk excessively with episodes of mania and rage that might include hitting and screaming, also inclined to depression after manic phase; can be manipulative, lying, and violent; seem unable to think; unresponsive to questions or cannot bear anyone talking to them; intense and violent excitability with fear, delirium, and the delusion of being poisoned; feelings of abandonment, jealousy, suspicion; fears of dark, dogs, water; delirious; delusions of animals, of being pursued by enemies, as if s/he might be injured by surroundings; sees ghosts, specters; very animated, seeming silly and foolish; smiling and laughing at everything, often inappropriately; talks nonsense; acts out ridiculous gestures like a dancing clown or monkeys, trying to be center of attention, often with sexual overtones; giddy; love to run around naked, can be a totally shameless exhibitionist with bizarre behaviors for shock value, including cursing; tries to embarrass parents; jealous of their siblings, often may injure them; cannot tolerate being covered up. • Kali bromatum: restless child, always have to be doing something, especially with his hands - throwing a ball, shooting marbles, flying an airplane, even cracking his knuckles. • Lachesis: loquacious, agitated and hyperactive; restless and moody with strong emotions; very jealous of siblings, or even same sex parent; tend to be vengeful, sarcastic and nasty, especially hurtful (and intuitively accurate) with insults; can have a self-destructive personality, with a marked lack of confidence and a tendency to severe depression, withdrawal, and hopelessness; hate any kind of physical or behavioral restriction, like tight clothing or being "grounded; cant bear authority and run away from home; tend to self-criticism and irritability; often reproach themselves severely; may also show aggression which surfaces easily and makes them difficult to live and work with; known for suspicion with a marked preoccupation about others; frequently feel that others are often criticizing them and putting them on the defensive; all symptoms worse upon waking, when they are typically unrefreshed and even more agitated, often complain of a suffocative feeling. • Lycopodium: insecure, may act like bullies, being cocky and boastful, often with overcompensation; marked lack of confidence and many fears, often really cowards; can be dictatorial and bossy at home where they feel safe; delusion that s/he is a great person; fear of looking bad, needs to cover up; afraid of failure; afraid to try anything new or to try again if fail once; fear that s/he will be injured; sees phantoms, images; displays both fear and bravado; usually intelligent and may look older than his years, but often suffers from dyslexia, confuses words or letters; performance anxiety; prefers younger friends; want to please authority figures; tends to abdominal gas; more tired, more restless, or more irritable between 4 and 8 p.m.; child doesn't want to sit down at the dinner table, but prefers to run around • Lyssinum: bite, growl, snarl, scratch, act rabid; torment followed by rage, unprovoked rage; angry but repent quickly, has remorse; feels tormented, abandoned, as if has suffered some wrong; feel as if has been injured or abused; often history of abuse, children of violent parents; strike out at presumed tormentor; self-destructive, impulse to cut self; defensive, as if being attacked or insulted; possible history of dog bite; animal-like behavior; aggravated by sound of running water; fears of water or reflected water, dogs, small rooms; crave chocolate and salt; enuresis • Mancinella: fear of evil, devils, being possessed; may develop fears or obsession with evil after seeing a scary movie; delusion that soul has been surgically removed; child says someone is taking things away; often associated with asthma or bronchitis • Medorrhinum: irritable, agitated, and in a hurry; racing mind; lust for experience, especially sensual; feels a need to hide her/himself, because s/he has a defect or is somehow flawed; anticipation anxiety; delusion that someone is behind him/her or that someone is touching their head; fear that something dreadful has happened; sense that everything is strange or unreal; fear of going insane; terrible memory, forgetful, mentally dull; unstable emotionally; has fits; can be reckless and impulsive; obsessive-compulsive, rigid; cruel or loving to animals; wants to stay up late at night, feels better at night, yet can fear dark and monsters;. may have a history of diaper rash as a baby, and later skin rashes and asthma; nail biting; hot feet; sleep with knees to chest • Natrum muriaticum: little adults; extreme watchfulness; known for sitting in mothers lap during interview; often tidy, don't want to lose control; sweet, except in family; silent grief or may have shrieking tantrums; may be confidante to one parent and nasty to other; ADD with concomitant anorexia; shyness with urination, especially in public place; crave salt, aggravated by sun, and dislike slimy foods and fat • Natrum sulphuricum: specific for depression after a head injury; often seen with grief after parents divorce; strong sense of duty to family; can be suicidal; suffer existential anxiety and may have a nihilistic attitude toward life; sadness relieved by music; often experiment with drugs; born older; tend to asthma and warts • Nux moschata: child passes out with slightest injury or no obvious provocation; giddy, spacy, mental confusion; can be perfect child - cooperates with parents, shares, does chores, goes to bed on time; tend to sleepiness, constipation and dryness of eyes, mouth and tongue • Opium: difficulty concentrating; spacy; painlessness of obviously painful complaint; out of touch; complaints from fright or after head injury; constipation; sleep apnea; mother often given drugs during pregnancy or labor • Phosphorus: fear of being unloved, isolated, having lost all friends; psychic; sees ghosts, spirits, specters; sense of being on a distant island; concern that has an incurable disease; gregarious, bubbly, good-natured; sensitive, sympathetic, kind; sweet, compassionate; can be spacy • Platina: insecure, volatile, flirtatious, arrogant and contemptuous, usually girls; forsaken and unloved with a need to reconnect to people, but have the illusion that others are physically and mentally inferior; underneath there are often feelings of failure, rejection, and a lack of confidence; want to look good; very forward, even young girls will put out a sexual messages and tend to be jealous of other women; emotionally stuck, tend to live in and dwell on the past; can have strong feelings of anger, indignation and paranoia; may have overwhelming and aggressive impulses that provoke the most severe depression and confused states, alternatingly indescribably happy and can laugh at the saddest thing, then insufferably sad, hopeless and terrified by any serious thought; needs excitement or melodrama; very restless children who cannot remain in one spot and may experience marked anxiety with trembling, as well as oppressed breathing and violent palpitations • Rhus toxicodendron: always on the move, both body and mind; hyperactive with focus; restless; silly, irritable; can be malicious; move to relieve pressure, better from motion; known for grinding teeth and sweating at night; crave bacon, milk and dairy products; often confused with Calc Phos, Calc carb and Tub • Scorpion: violent if provoked or just for the fun of it, even parents fear being harmed by child; lack of conscience and compassion for the suffering of others; detached, likes solitude, can attack if bothered; indifferent to pain or pleasure • Stramonium: violent or fearful; severe hyperactivity, easily terrified, and inclined to violent agitation and fits of rage; speech is loud, fast, and possibly incoherent; feelings of terror, abandonment; afraid of the dark, dogs, evil, suffocation and abandonment; thirst is great, yet they dread water; fears of death; believes s/he is always alone, especially afraid to be alone at night, become overly vigilant to combat these fears and become violent if controlled; nightmares and night terrors that become increasingly worse between midnight and 2 a.m., they often wake screaming; see ghosts, specters, spirits; horror of glistening objects; delusions of animals, of danger; clinging; aggressive; bites, kicks, strikes; uses threatening language; can have seizures or personality change after a head injury, frightful episode, or trauma (especially being chased by dogs); can be useful in autism or Tourettes; child can be sweet all day and have terrors at night; introverted Stram can look like Nat mur or Staph • Sulphur: egotistical; tries to control feeling with mind; hates being scared; feels as if being scorned; delusions that s/he has been disgraced; messy and tattered but thinks looks fine; can be lost in thought, absent-minded, spacy; forgetful, loses things; has visions; full of theories and dreams, loves science fiction; can be a loner with limited social skills; prefers computers, reading, mechanical things • Tarentula hispania: frenzy, > music; acts wild and crazy; loves to sing and dance; feels as if never enough time; feels as if s/he has been insulted; sense of a stranger in the room; sees faces on closing eyes; episodes of raving delirium; mischievous and sneaky; teases and hides; cuts things; hurried, always restless. • Tuberculinum: revolts against restriction and need to feel free; always desires and seeks change, travel and new experiences; always feels dissatisfied; feels as if there is never enough time; afraid of (and often torments) dogs, cats; delusions that s/he can fly, that someone is following her/him, that he is surrounded by animals; feels everything is strange; compulsive and uncontrollable; destructive; throws tantrums; breaks things; precocious; often malicious • Tuberculinum aviare: extreme restlessness with great weakness; diminished appetite of long duration; tendency to otitis. • Veratrum album: inconsolable after fancied misfortune; racing mind, agitated actions; driven to act on impulses; religious mania; overly religious; feels s/he is in communication with God; delusions that s/he is a great person or somehow distinguished; delusions of animals; always busy but often fruitlessly so; has impulses to kiss or touch others; hurried and restless, fidgeting, poking others; precocious. • Zincum metallicum: fidgety and restless, especially known for restless feet and legs; overactive nervous system; twitching, jerking, and even convulsions; sensitive, irritable, and prone to rage; often make mistakes in writing and speaking; feel like they have committed a crime; can have tendency to lick everything; may look like little old people

Subtle Support
• Mi (Gardner, p. 72, 78) • Fa# (Gardner, p. 82, 87)

mental/emotional: • rhythmic folk songs • County Derry • songs of Steven Foster • Spanish tangos • Brahms' Hungarian dances • Sousa's marches • Strauss' waltzes • Gilbert and Sullivan • Indian Love Call • My Wild Irish Rose • Wishing • Estrellita (Heline, p.18)

Integrative Therapies
Hyperactivity is a childhood disorder characterized by inability to concentrate, impulsiveness, and the need for constant movement. It is frequently accompanied by learning and behavioral problems in school.

Other symptoms of hyperactivity may include poor memory, lack of coordination, inability to finish projects, speech or hearing problems, headaches, stomach aches, and frequent temper tantrums.

The major causes of hyperactivity are often traced to food additives, food allergies, and sugar in the diet. Nutritional deficiencies, middle ear infections, and heavy metal contamination, such as lead poisoning, can also be the cause.

Since emotional problems, family stress, and learning disabilities usually accompany hyperactivity, it is important to seek the help of a counseling professional and to involve the whole family in the treatment. Consult a physician if there are symptoms that indicate a possible ear infection, such as hearing loss, fevers, and swollen and aching ears.

THE FOLLOWING SUPPLEMENTS ARE USED FOR HYPERACTIVITY AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Daily multivitamin and mineral supplement – consult the product label for age-appropriate dosage. Be sure to use a brand free of sugar and artificial additives. It should include chromium, vitamin B6, and magnesium to help prevent sugar cravings. 2. Daily iron supplement – liquid varieties usually work best for children. See the product label for age-appropriate dosage. 3. Vitamin C – 100 milligrams times the age of the child per day, given in divided doses.

REGARDING THE PROPER DIET FOR HYPERACTIVITY: 1. Food allergies may be causing or adding to the problem. Certain foods seem to be more likely to cause hyperactivity. Eliminating these foods from the diet is a good way to determine if one or several of them are responsible for the problem. The main problem foods are dairy products (including milk, cheese, ice cream) and eggs, wheat, corn, and sugar.

After eliminating all of those foods from your child's diet, and the symptoms have gone away, one food at a time can be reintroduced to see if the symptoms reoccur. A new food would be introduced each week. For more information about the elimination diet and food allergies, refer to the article on Food sensitivities.

2. Eliminate or greatly reduce sugar foods such as candy, cake, cookies, soda pop, and refined carbohydrates, including white flour products and white rice.

3. Maintain an overall healthy diet. A healthy diet includes daily servings of leafy green vegetables, whole grains, fruit, and proteins with a minimum of animal fat.

Use as many fresh, whole foods as possible. Avoid processed and prepackaged foods. It is essential to read product labels to rule out allergic food ingredients as well as artificial colorings, bleaching agents, preservatives, and other additives. A rule of thumb is that if you don't recognize a listed additive, don't use the product until you find out more about the additive's possible effects.

HERBS USED FOR HYPERACTIVITY: 1. Add oatstraw to the child's bath water. Heat 2 pounds of oatstraw in 3 quarts of water. Boil for 30 minutes. Cool, strain, and pour the liquid into the bath water. Remember to readjust the temperature for comfort. 2. Oatstraw tea – 1 cup before or with breakfast and 1 warm cup before bedtime. Use 2 teaspoons of the dried herb per cup. 3. Herbs for sugar cravings – Devils Club and Gymnema are 2 herbs that decrease craving for sweets. Add 15 drops of the tincture, which is a liquid herbal extract, to a small amount of water or juice twice daily. Or, 1 capsule 3 times a day can be taken if the child can swallow it.

ANOTHER CONSIDERATION INCLUDES THE FOLLOWING: Hair analysis is a way to detect heavy metal toxicity. If implicated, make an effort to reduce exposure to heavy metals such as lead, cadmium, arsenic, mercury, and aluminum. Sources of these metals include eating from soldered tin cans, pesticides, cooking utensils, cigarette smoke, and industrial waste and pollutants.

Consult a health care practitioner to have a hair analysis done.

HOMEOPATHY: From the following homeopathic medicines chose the one that best matches the symptoms. Dissolve 2 pellets under the tongue twice a day. • Tarentula 12c: For the child who can't sit still and must keep in constant motion. • Chamomile 12c: For the irritable child who wants constant attention or to be constantly held. Note: A wide range of homeopathic medicines can be helpful for individuals with this condition. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.