May 12, 2013

Going beyond conventional medicine......

Dr. Jayashree Joshi
                    M.D., D.C.H     
Consultant Pediatrician.
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      Holistic treatment of ADHD disorders.

WHAT IS HYPERACTIVITY?
Hyperactivity is the clinical manifestation of a build-up of excess energy in a person's neuro-muscular system.
Hyperactivity is most intense in early childhood, declining gradually over the years, so that it becomes progressively less apparent in later childhood and adolescence. 

Hyperactivity is less frequently seen when an erstwhile hyperactive child enters adulthood, because such an adult becomes hyperactive only during periods of nervous excitement or stress. 


Hyperactivity of the MIND leads to ATTENTION DEFICIT.


The pattern of hyperactivity seen most commonly is physical hyperactivity accompanied by an attention deficit (due to a hyperactive mind), so we hear the label ADHD being used more commonly than just plain Hyperactivity.


WHEN DO WE LABEL A CHILD HYPERACTIVE
We say a child has a Hyperactivity Disorder when the child :
* Cannot sit still without constantly fidgeting, or even stand still for a little while.
* Squirms and keeps getting up from his chair, and twists and turns all the time.
* Is restless and likes to run and climb all the time, often over furniture in the house.
* Has trouble playing quietly or engaging in a leisure activity ( such as playing with one toy for any length of time when a toddler, or playing a game of chess with any interest as he grows up ).
* Appears to be 'driven' and 'on the go' all the time.
* Talks excessively and loudly.
* Answers questions before they’ve been completely asked.
* Has trouble waiting turns and never stands in a line for anything. Waiting is not an acceptable behaviour for him.* Interrupts or intrudes on others, and is very annoying to others. 

* The child is always driven by impulse rather than thought. 
(A child should have at least six of these symptoms, for it to be labelled hyperactive).

The Causes of Hyperacivity and ADHD

Why hyperactivity is seen only in some children and not all, can best be understood by looking at Ayurveda, the Indian System of Medicine. 
Ayurveda attributes hyperactive states to the excessive accumalation of vaata dosha in the body.

Vaata is formed from the air and ether elements of our Universe and so is naturally associated with intense motion and kinetic energy.

Hyperactive children have a predominently vaata type of Prakriti (Constitution) because of which they are prone to remain in constant motion, leading to hyperactivity.

Natal and pre-natal factors such as prematurity, a low birth weight, maternal problems affecting the foetus in its formative stages, trauma and other problems during birth and many other related conditions often give rise to hyperactivity, with or without other associated conditions such as poor cognitive function, a degree of mental retardation and other neurological abnormalities. When such associated problems are

present, they need to be treated concurrently.

VAATA DOSHA & HYPERACTIVITY

The three doshas of vaata, pitta and kapha that one is born with can also bemodified by external factors such as diet, exercise and sleep.

A suitable alteration of the diet along with a prescribed change in the exercise and sleep pattern can help reduce hyperactivity in many cases. 

Activity:Children with hyperactivity have a predominently vaata prakriti ( Constitution ).
They, therefore, respond to their environment in the 'vaata way', which obviously involves a lot of motion and physical activity.
Hyperactive children should be encouraged to play in the shade and should never be allowed to over-exert or tire themselves out.
They should always be adequately hydrated and should avoid getting dehydrated, especially during and after playing.
They should be given small and frequent meals.
These two simple measures help to prevent a build-up of excessive vaata in a child's body.

Sleep: Children with hyperactive behaviour should be allowed and encouraged to take a nap once or twice a day, in addition to ensuring that they sleep well at night. This will prevent an excessive build-up of kinetic energy in their body.
We should aim not to let them 'over-do' anything - they should play within limit, talk within limit (even laugh within limit!) in order to maintain a better harmony of the three doshas. 

Diet:
A hyperactive child should not be given food that is dry, very cold, too spicy, or predominently raw.
Wafers, biscuits, puffed rice, farsan, curd (yoghurt), ice-cream, carbonated drinks are snacks best avoided.



The Various therapies available for treating Hyperactivity and ADHD:

There are a number of therapies which complement each other, which we can use to treat hyperactivity and modify hyperactive behaviour.
Not all children need all these methods however, and some may respond well enough to just one type of therapy and they will not need a second type of therapy at all, but for the most part, we find that combining the use of two or three of the following therapies often gives the best result.

1. HERBAL HOMEOPATHY

2. BACH FLOWER THERAPY
3. AYURVEDA
4. PLANETARY REMEDIES 
5. YOGA & MUDRA
6. RITALIN & other ALLOPATHIC MEDICINES

HERBAL HOMEOPATHY


We can use certain well-known herbs in their potentised form, making use of their biological effects, rather than their subtle effects. The potencies used are usually 6X and 30X. Higher potencies are not needed.

Herbs which have a calming effect on the neuro-muscular system, such aschamomilla, passiflora, valeriana, nux vomica .................can be used with great benefit. They act by scaling down excitability at neruo-muscular junctions leading to reduced muscle stimulation and voluntary movement. It helps if even these herbs are chosen according to a person's Prakriti.

BACH FLOWERS THERAPY


Many hyperactive children have an emotional component to their hyperactivity.

Whether the emotional imbalance is a cause or an effect of their hyperactivity is often difficult to determine.
In any case, treatment would focus on restoring their emotional balance to an extent as much as possible.

The commonest emotional problems seen in hyperactive children are: a demanding nature, an insistence on being heard all the time, a perpetual extreme impatience and the desire to impose their will on others.

They can get angry very fast and very easily, yet their tempers cool down fast, too. They have frequent mood swings and do not care much about the effect of their moods on others.

In their scheme of things, they feel it is only right that others should accept their behaviour, because they are just being their normal selves!

Their behaviour is erratic on many occassions.
It is apparent that they are often dictated to by their moods and they are not in command of themselves.
Quite apart from their hyperactivity, their moody behaviour makes them difficult to handle and in some cases to live with, as well.
Hence they are often a source of disruption in family life.

Bach flower remedies such as Chicory, Impatiens, Heather, Vine, Vervain, Beech and a host of others can be judiciously used to control temperamental and erratic behaviour.


Once a child's behaviour improves with Bach flower therapy, the flower remedies may be discontinued. The fact that they need not be given forever, is an advantage.


AYURVEDA, the Indian System of Medicine :

Ayurveda has a lot to offer us in containing hyperactivity.
The three pillars of Ayurveda are DIET - ACTIVITY - SLEEP. Each of these can be modified to help reduce hyperactivity. 
THE DIET : It should contain less of vaata-causing food
So it should not be too dry or too cold. It should contain sweet, sour and salty 'rasas' rather then the bitter and spicy 'rasas', as the former reduce and the latter, increasethe 'vaata' content of food. Accordingly, the diet can be suitably modified, depending upon local customs in different parts of the world. 
An empty Stomach increases 'vaata' so it is best for these children to have small, frequent meals. Hyperactive kids are fussy eaters with irregular appetites, which increases their food problems. They prefer to eat snack foods rather than healthy foods, but snack foods often cause 'vaata' and should be discouraged. With some imagination, even home-cooked foods can be altered a little and offered as snacks, rather than as meals, when they will have a greater chance of being happily accepted and eaten!

ACTIVITY: ( This is called 'vihar' in Ayurveda ).

'Vihar' includes physical, mental and spiritual activity. As would be obvious, physical over-activity of all types should be curtailed.
Excessive travelling, watching fast action scenes on TV, talking excessively all the while and other similar actions can cause a high input of 'vaata'. 

Frequent breaks should be used, during which only minimal physical activity is allowed. The number and frequency of such compulsory breaks differ according to individual needs. Children can be asked to lie down / sit down in a comfortble place, and just 'tune off' from whatever they have been doing. During a break, they can do something that has a much lower scale of activity : for instance, if a child has been playing a game, he can sit down and watch others play, for a while, before joining in the play again. Loud, noisy places and loud, noisy music also increase 'vaata' and should be avoided, whenever possible. Violent games and violent activity in general, are to be guarded against. This includes violent thoughts as well, so even watching a movie showing a lot of violence is bad for a hyperactive child! Classical music, soothing music are beneficial. So are repetetive chants, such as catechism, because they serve to make the mind less hyperactive. 
SLEEP :
Sleep performs a very important function in our lives. Our Inner Body takes over when we are asleep. The seven chakras and all the nadis in our body work unhindered while we are asleep. They perform the vital functions of repair and maintenance of the body during this time. Our body decides how much of what it requires ( hormones, enzymes, etc ) and instructions are given accordingly. This system needs to function smoothly for proper balance and harmony to be maintained in our body.
Children with hyperactivity have a poor sleep pattern and wake up easily at the slightest noise. They also have an excessive amount of dreams. Often, they fly, jump or fall from great heights in their dreams. They need to be encouraged to sleep properly, sometimes with the help of mild herbs like valeriana, avena sativa, chamomilla, eclipta, skullcap, betony, mint, sage, zizyphus. A good sleep goes a long way in reducing hyperactivity. 
Ayurvedic remedies that may be used to treat Hyperactivity:
Herbs which reduce 'vaata dosha', of which there are many, can be used either singly or in combination. Some popular preparations described in ancient Ayurvedic texts that reduce 'vaata dosha' are: 
Maharasnadi kadha Triphala guggul Erand-haritaki churna Saraswatarishta
Ashwagandharishta, Shatavari, Brahmi, Shankpushpi, Jyotishmati and Jatamansi may also be used with good results in some cases, depending ofcourse, upon the child's Prakriti.
Ayurveda gives a lot of importance to OIL APPLICATION in treating vaata dosha. Important oils are : Til oil, Shatavari oil, Mahanarayan oil, Bala oil.
Oil must be applied all over the body before a bath and massaged gently, from below upwards. Ideally, an oil massage should be done every day but if this is not possible, it should be done at least once a week. Slightly warm oil should be used.

DIET and AYURVEDA: Ayurveda gives tremendous importance to one's diet. The following is a general outline of the type of diet that will suit or harm each type of Prakriti.

Diet for VATA PRAKRITI 
The qualities of vata are cold, dry, light, hard, and rough.So the food eaten must have opposite qualities.
VATA PACIFYING FOODS:General : excess vata can be counterbalanced with nutritive and tissue-building foods that are warm, moist, heavy, soft and oily, as well as foods with a sweet, sour and salty taste.Vata pacifying foods include ghee, soft dairy products, wheat, rice, corn and bananas.A person with a vata constitution should favor foods like hot cereal with ghee, hearty soups and vegetables, and whole cooked grains and chapatis. Spicy foods are generally okay for vata.Vegetables : Asparagus, beets, carrots, cucumber, green beans, okra (bhindi), onions and garlic , radishes, sweet potatoes, turnips.Fruits : Bananas, coconuts, dates, mangoes, melons, peaches, all sweet fruits in general.Grains : Oats, rice and wheat
VATA AGGRAVATING FOODS:General : Foods with the vata qualities, such as crackers, frozen desserts, and large amounts of raw vegetables and salads, will aggravate vata. Also, refined foods such as white flour and sugar, have light and dry qualities and would be best avoided by people with vata constitutions.Pungent, bitter, astringent; light, dry, cold foods,stimulants like smoking, alcohol, junk food, sugar, tea (esp. long leaf teas and green tea), brown rice.Vegetables : Cabbage, cauliflower, celery, brinjal, leafy green vegetables, mushrooms, peas, peppers (simla mirch) potatoes, sprouts, tomatoes, zucchini (tori). If you do have these vegetables cook them in pure desi ghee or unrefined til oil. Tomatoes are best avoided except as a small addition to salads.Fruits : Apples, pears, pomegranates.Spices: Vatas can have almost all spices and herbs in moderation When there is aggravated Vata, the following are to be taken with caution : coriander seeds (dhaniya powder), fenugreek (methi seeds), saffron, turmeric, parsley. Avoid too much hot, dry spices such as dried chili, which will aggravate dryness. 

Diet for PITTA PRAKRITI
Pitta is hot, sharp, oily and light.So the food eaten should have opposite properties.
PITTA PACIFYING FOODS:
General : you can balance excess pitta with foods that are cool, dry and heavy with a mild, naturally sweet, bitter or astringent taste. For example, milk, rice, beans, steamed vegetables and fruit are good for pitta people. Mild spices like cumin, coriander and cilantro are particularly beneficial for pitta. Sweet, bitter, astringent; cold, heavy, dry. Moderation, coolness, ghee, coconut oil, olive oil, green coriander (dhaniya), coriander seeds, cardamom, sprouts and raw foods.Vegetables & Fruits: can eat most vegetables and fruits. Exceptions are given below.Grains : Barley, oats, wheat, parboiled rice.
PITTA AGGRAVATING FOODS:
General : pungent and oily foods such as curry, fried foods and spicy condiments, as well as spices such as cayenne, garlic and dry ginger, should be avoided by pitta constitutions. Pungent, sour, salty, hot, light, oily. Stimulants like smoking, alcohol, coffee, pickles, vinegar, fried foods, spicy foods, fermented foods, curds, almond, corn, til, mustard oil.Vegetables : Beets, carrots, brinjal, garlic, hot peppers, onions, spinach, tomatoes.Fruit : Sour and unripe fruits. If there is aggravated Pitta avoid grapefruit, papayas, peaches, bananas, apricots.Grains : Brown rice, corn, millet, rye. 

Diet for KAPHA PRAKRITI :
The qualities of kapha dosha are cold, heavy, liquid and unctuous.So the food eaten should be opposite of this.
KAPHA PACIFYING FOODS:
General : To balance kapha dominance, eat smaller amounts of food and emphasize food with vata properties of light and dry. Also, foods which are dry, hot or sharp are recommended, so look for foods with pungent, bitter or astringent tastes. Examples include puffed cereals such as puffed rice or corn; small, astringent grains, such as millet, amaranth, and quinoa; and light, bitter vegetables such as leafy greens. Spices like ginger, turmeric and chilli are generally good for kapha people.Favour : Warm light food, dry food cooked without much water, minimum of butter, oil and sugar, stimulating foods (ginger, chillies, pickles), raw foods, salads, fruits.Vegetables : Generally all vegetables are good, but if you are suffering from any kapha disorder like lung congestion, congestive asthma, sinuses, obesity, heart disease, diabetes, high cholestrol, then avoid all sweet juicy vegetables such as cucumbers, pumpkin family, sweet potatoes, tomatoes, tori, ghiya etc.Fruits : Apples, apricots, pears, pomegranates, dried fruits in general (apricots, figs, prunes, raisins)Lentils & Legumes : If the dosha is not aggravated all except tofu and kidney beans are acceptable.Spices : All are good - ginger is best for improving digestion, turmeric is excellent for drying out the mucous, chillies are excellent for removing mucous.
KAPHA AGGRAVATING FOODS :
General : Foods such as dairy products, wheat, avocados and oils have these qualities and will increase kapha in the body. Sweet, sour, salty; heavy, oily, cold. Desserts, sweets, ice cream, deep fried foods, possessiveness, miserliness, laziness.Vegetables : all sweet juicy vegetables such as cucumbers, pumpkin family, sweet potatoes, tomatoes, tori, ghiya etc.Fruits : All sweet juicy fruits in general.Lentils & Legumes : Tofu and kidney beans.Spices : excess salt. 


PLANETARY REMEDIES

We can use herbs based upon the planetary configuration seen in the natal horoscope, as described in Vedic astrology. Herbal baths (called Aushadhi snaan) for a badly placed Mercury or Moon often help to reduce hyperactivity.

YOGA and MUDRAS

There are many ways in which practice of Yoga and Mudras can help :
They help to bring discipline in the Muscular System of the Body as well as in the ConsciousMind. They help by calming the Mind, so reduce Hyperactivity and help increase the attention span. They help by reducing the negative influence of Planets. They reduce the jerkiness seen in the movement of hyperactive persons. They also reduce the 'jerkiness' of their minds. They instill a smoothness in movements of the limbs. They help by pausing an abnormal onset of both, physical and mental activity, automatically.
Yoga has to be learned from a Teacher. All the 'asanas' ( specific stretching exercises ) should be initially done under supervision, because they will not give the desired effect if they are done wrongly.
Even children as young as three years can be taught basic 'asanas' but the breathing exercises ( pranayam ) which give control over the Mind, should not be taught to a child less than eight years of age.
Yoga should be done on a regular basis, else it will have no meaning.
So it is better done as a Group activity, with more than one family member participating daily.

Mudras is another form of Yoga, in which the fingers of one's hands are folded in particular ways. Some of the Mudras are very easy to do, and help in improving digestion and mental hyperactivity and so learning to do Mudras can be of great help in ADHD.


RITALIN and other ALLOPATHIC MEDICINES

I would leave these to the last, to be used only in desperate cases, where all else has failed.
The best known drug today in the management of ADHD is without a doubt, Ritalin or methylphenidate.
It has, in the last few years, been widely used and abused, all over the world.
Methylphenidate acts by amplifying the amount of dopamine secreted in the Brain.
It is classified as a Central Nervous System stimulant, with an action more potent than caffiene but less than the amphetamines. It seems to stimulate the Brain just enough to widen the attention span of a person, thus helping him focus on the activity on hand.

Clinically, it has been shown to increase the self-esteem, cognition, and social skills of children with ADHD. It reduces locomotor activity as well as frequent bursts of impulsive behaviour and thus has a 'calming' effect on them.

This is what makes Ritalin a highly popular drug among parents, who often root for it with unqualified approval. Thus, Parents and sometimes Doctors too, tend to overlook the common side effects of Ritalin, such as appetite suppression, a paradoxically abnormal and extreme amount of focus on mundane issues, wakefulness and rarely, euphoria.
The possibility of a forced addiction-like state, complete with distressing withdrawal effects after discontinuance of therapy, does not deter parents in putting their wayward children on Ritalin, if only to buy peace in the family.
Other drugs with Ritalin-like activity prescribed for ADHD are amphetamine and dextroamphetamine ( sometimes in combination ) dexmethylphenidate hydrochloride. Strattera : this is the only drug for ADHD that is not a stimulant

The ARGUMENT FOR Ritalin group of drugs can be best summarised as follows:

The drug begins to act very soon and you can notice the difference in the child within a few days. Often the difference is dramatic. The child, who finally learns to sit still and pay attention in class, stops getting into trouble all the time in school and his grades begin to improve. There is less yelling and more peace in the house. It is almost as if the child has turned over a new leaf. The child's self-esteem goes up, he is able to make and keep friends, and does not feel left out of activities in school and on the playground anymore.
Over and inspite of all this, however, one cannot ignore the insistent whisper of warning in one's ear, about these drugs : there have been sudden and unexplained deaths in children on Ritalin and the amphetamines, which are suspected to have been caused by a drug-induced arrythmia in the heart beat, or of other major side effects such as irreversible liver failure, and even a sudden worsening of ADHD, for which the drug has been started, in the first place....there are legions of complaints pouring in from all over the world from parents who have been too hasty, perhaps, in taking succour in Ritalin, sometimes giving it to two or even three of their children at a time, all in the name of 'Definitive Treatment' of a supposed 'Disorder'.
The use of Ritalin has alarmed Governments across the world, who have finally woken up to the hazards posed by its widespread and indiscriminate use. Most Governments are busy issuing warnings to Doctors to be more careful and less hasty while prescribing medicines like Ritalin.And yet, there is an unabated and a surging demand for these drugs, from patients and their families. 

Perhaps it is time to pause for a while, and think.What really is Hyperactivity?What would you call an Attention Deficit?
There is no barometer for measuring either of these. They are relative terms, subject to one's perception. But they are related to the functions of the bdy and mind, definitely. A wider understanding of how a person functions, therefore, can help us understand this very vexatious problem, better. And when we gain a deeper understanding of ourselves, we become empowered to make a better choice in treating the faults that we have.
Dr. Jayashree Joshi (M.D. Pediatrics)
Holistic Health Consultant and Herbalist 
Telephone 91 - 9545890611 
Email herbaltradition@yahoo.com

About Me

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I am an India-based Doctor. Though primarily qualified in Allopathy, I use many time-tested herbal remedies in my practice. I offer tele-consultation as well as consultation through Online Chat.
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