| Research objectiveIn daily clinical practice of child psychiatry Tourette syndrome (TS) and attention deficit hyperactivity disorder (ADHD) as well as their co-existence are common and need careful evidence-based approaches in differential diagnostics and treatment choice. Hence, their relationship at different levels (e.g. psychopathology, pathogenesis, traditional chinese medicine differentiation, treatment) needs to be elucidated in more detail. The articles of this is to discuss characteristics of syndrome differentiation of traditional Chinese medicine(TCM) and pathogenesis of children with comorbidity of Tourette syndrome(TS)and attention deficit hyperactivity disorder (ADHD). Using the theory of "five zang-organs hidden five mind" to explain the pathogenesis of liver and spleen disorder, as well as the corresponding changes of mind in children suffering from comorbidity of TS and ADHD. Through pathogenesis of liver and spleen disorder and using of "five zang-organs hidden five mind" to prove the effectiveness of clinical treatment principle of supporting earth to inhibit wood, furthermore, to provide clinical basis for using of Jian pi zhi dong decoction. During clinical treatment and observation, use the Yale global tic severity scale (YGTSS) and the traditional Chinese medicine(TCM) symptom classifying standard as well as self-made ADHD scale to evaluate children with behavior changes and TCM symptoms before and after treatment, and to evaluate clinical symptoms and improvement of ADHD symptoms in children with comorbidity of TS and ADHD.MethodsTo investigate parents and children with comorbidity of TS and ADHD using the Yale global tic severity scale (YGTSS), the TCM symptom classifying standard and self-made ADHD scale. Verify the past history of children, conduct clinical specialized examination by a professor for the first time, then give a score by the researchers and professor together. Make the secondary objective evaluation of the change of clinical symptoms after 30 days’ treatment. Make the third objective evaluation of the change of clinical symptoms after 60 days’ treatment. After 90 day’s, when the children come back to attend the clinic, ask the symptom changes, and give a final score. Finally, make attention tests for children with comorbidity of TS and ADHD before and after to make a comparison.Results1. Relation between Comorbidity of TS and ADHD and gender There are 50 cases in children with comorbidities,44 cases of male, and 6 for female. Boys outnumbered girls in the ratio of 7.33 to 1.2. Relation between Comorbidity of TS and ADHD and age of onset In 50 cases of children with comorbidities, the minimum age for the onset is 4 years old, the maximum is 14 years old, and average age is (6.85±2.18),30 cases are in 3 to 7 years old period (60%),20 cases are in 7 to 18 years old period (40%). The highest incidence is onset when one is in preschool-age from 3 to 7 years old.3. Relation between Comorbidity of TS and ADHD and the course of the disease In this group, the longest duration of children is 8 years and the shortest is less than one year. The average durations (2.24±1.04) years.4. Curative effect4.1 Situation of tic disorder improvement:after treatment for 12 weeks, 50 patients with 7 cases (14%) markedly effective,27 cases (54%) effective and 16 cases invalid (32%). Function damage score after treatment (16.82±9.61), motor tics degree score (8.22±1.56), vocal tics degree score (4.04±3.81); Function damage score before treatment (37.78±11.41), motor tics degree score (11.14±1.69), vocal tics degree score (7.24±3.81). After treatment, both motor tics and vocal tics significantly reduced in type, frequency, intensity, complexity and function damage than before. (P < 0.01).4.2 Situation of TCM symptoms improvement:after treatment for 12 weeks, 50 patients with 37 (74%)effective, and 13 cases invalid(26%). Degree of TCM symptom score before treatment (10.28±2.11), after treatment (6.16±2.00). A significant reduction can be seen in the TCM symptoms after treatment (P < 0.01).4.3 Situation of ADHD symptoms improvement:Degree of ADHD symptoms score before treatment (13.28±2.87), after treatment (9.88±3.35). The ADHD symptoms total score after treatment significantly decreased than before. (P<0.01).Conclusions1. Comorbidity of TS and ADHD has the highest incidence in preschool-age 3 to 7 years old.2. Incidence in boys is higher than girls.3. As for children with Comorbidity of TS and ADHD, the syndrome differentiation of Traditional Chinese medicine mainly focuses on zang-fu and yin yang syndrome differentiation. While the pathogenesis is spleen deficiency and liver hyperactivity. Liver-wind stirring internally and phlegm confusing body and mind are the pathological factors during the process of the disease. Syndrome differentiation and disease differentiation should be combined together in Clinical diagnosis.4. Tests results:4.1 Before and after treatment in children with YGTSS rating scale. There are significant difference statistically both in motor tics, vocal tics and motor+vocal tics damage. Indicated that children with tic symptoms can be obviously improved through taking Jian pi zhi dong decoction for 12 weeks.4.2 Before and after treatment in children with the TCM symptom classifying standard. There are significant difference statistically in TCM symptoms before and after treatment. Indicated that symptoms like inattention, hyperactivity and impulsion can be obviously improved by taking Jian pi zhi dong decoction.4.3 Before and after treatment in children with self-made ADHD scale There are significant difference in ADHD scale before and after the treatment, which show that taking Jian pi zhi dong decoction can obviously improve patient’s spirit, complexion, appetite, sleep, urine, etc.4.4 Before and after treatment in children with attention tests There are significant difference statistically in attention tests before and after treatment, which shows that attention is better than previous after taking Jian pi zhi dong decoction for 12 weeks.5. It is unclear which component of the comorbidity (TS and ADHD) is most important in case of co-existence with respect to accompanying problems like emotional disturbances. This editorial gives a short overview of the essential research topics concerning live and spleen from the aspect of "five zang-organs hidden five mind" of TCM, consider that the onset of Children with Comorbidity of TS and ADHD is closely related to the disorder of liver and spleen as well as unbalance of mind. Disorder of the function of liver and spleen and the change of deficiency and excess will all lead to abnormal change of the mind. While at the same time, emotional extremity or persistent negative emotion will also bring an disorder of the function of liver and spleen, thus result in unbalance of qi and yin yang, which manifests as hyperactivity, impulsivity, the distraction, and tic disorders and lead to the occurrence of comorbidity of TS and ADHD. In clinic, emphasis should be focused on liver and spleen differentiation. Set up the treatment principle of support earth to inhibit wood, combining psychological counseling and mood cultivate, which are the ways to benefit spleen, suppress the liver, and harmonize Yin and Yang together. Probably, the identification of separate or would help to sort out the complexities and this supplement may nurture such a perspective of future research for a better understanding and treatment of youths with TD+ADHD and their families. |
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