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Clinical Research on Attention-Deficit Hyperactivity Disorder (ADHD) Treatment with XNKQ Acupuncture Therapy

Introduction

Over the course of more than twenty years of clinical practice and research, I developed the Five-Step Acupuncture Method for Infertility. Traditionally, classical acupuncture treatment for infertility followed a four-step framework. However, modern patients present new challenges: many women are found to have poor endometrial quality upon examination, and experience dark brown discharge or blood clots at the beginning and end of their menstrual cycles.

To address these issues, I introduced a Five-Step, the second-step applied during the final one to two days of menstruation. This step serves a unique purpose—helping the body to “clear out the old and welcome the new,” thereby improving uterine lining health and creating a more receptive environment for conception. Given today’s lifestyle, environmental, and social factors, I believe the classical four-step method is no longer sufficient.

The Five-Step Method thus represents both an innovation and an extension of the classical tradition, tailored to modern needs. It integrates the wisdom of Traditional Chinese Medicine with contemporary clinical realities, offering a more comprehensive and effective acupuncture protocol for infertility treatment.

Author: Liu Jing
Arizona, USA
Published in: Tianjin University of Traditional Chinese Medicine, June 2011

Dr. Jing Liu

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common pediatric neuropsychiatric disorders, clinically characterized by inattention and hyperactivity. In modern biomedicine the etiology remains incompletely defined. In Traditional Chinese Medicine (TCM), the core pathomechanism is viewed as yin deficiency with yang hyperactivity and yin–yang disharmony, with the Heart, Liver, Spleen, and Kidney chiefly involved. First-line Western treatment uses central nervous system stimulants, which often require prolonged courses and may cause notable adverse effects with a tendency to relapse. TCM therapy aims to restore yin–yang balance and, according to pattern differentiation, applies strategies such as strengthening the Spleen, tonifying the Kidney, soothing the Liver, nourishing the Heart, opening the orifices, calming the Shen, and dispelling stasis. These approaches are noted for stable efficacy and minimal side effects, with broad prospects.

Rationale: The Xing Nao Kai Qiao (XNKQ) acupuncture method was developed by Academician Shi Xuemin in the early 1970s for stroke, targeting pathologies such as blood stasis, Liver wind, and phlegm turbidity that obscure the clear orifices, leading to “closure of the orifices and sequestration of the spirit,” wherein the spirit fails to guide qi. Through appropriate point selection, XNKQ nourishes the Heart and Kidney, calms Liver yang, arouses and tranquilizes the spirit, strengthens the brain, and harmonizes yin and yang. This approach accords well with the basic TCM pathogenesis of ADHD; therefore, rational application of XNKQ may achieve therapeutic benefit for ADHD.

Objective:
To observe the clinical efficacy of XNKQ acupuncture in ADHD and, from theoretical and clinical perspectives, to explore its mechanisms of action.

Methods:
From July 2009 to January 2011, 200 outpatients at the Eastern Medicine Center (USA) diagnosed with ADHD were enrolled. By order of presentation and a random-number table, patients were assigned to an acupuncture group (n = 120) or a medication group (n = 80). The groups were comparable in sex, age, and disease status (P > 0.05).
• Acupuncture group: XNKQ acupuncture, three sessions per week.
• Medication group: oral methylphenidate (Ritalin) 5–10 mg, twice daily, 30 minutes before breakfast and lunch.
Both groups were treated for three months per course with outpatient follow-up every three weeks. Using a predesigned clinical observation form and clinic records, we documented baseline data, medication adherence, and changes before and after treatment in the DSM-IV ADHD 18-item symptom scores and the Hyperactivity Index and then evaluated efficacy.

Results:

  1. The overall response rate was 89.2% in the acupuncture group and 78.8% in the medication group; statistical analysis showed a significant difference between groups (P < 0.01).
  2. Both groups showed significant improvement in Hyperactivity Index scores from baseline (P < 0.01). Between-group comparison demonstrated superiority of the acupuncture group (P < 0.01).

Conclusions:
The study suggests that XNKQ acupuncture is an effective treatment for ADHD, achieving therapeutic effects comparable to Western pharmacotherapy and improving symptoms of inattention and hyperactivity. Compared with medication, XNKQ showed a higher response rate and favorable safety with minimal side effects, warranting wider clinical application and further research.

Keywords: Attention-Deficit/Hyperactivity Disorder (ADHD); Xing Nao Kai Qiao (XNKQ); acupuncture therapy.

Preface

Attention-Deficit/Hyperactivity Disorder (ADHD), also called childhood attention deficit disorder or childhood hyperkinetic syndrome, is a common neuropsychiatric condition. While cases are most frequently seen in children, adults can also be affected. The prevalence among children under seven years of age is approximately 3%–5%. Core clinical manifestations include distractibility or difficulty sustaining attention, excessive activity, and poor self-control, often accompanied by learning difficulties or cognitive impairment; intelligence is normal or near normal.

In recent years, with the quickened pace of life, heightened parental expectations, and environmental pollution, the incidence of ADHD has shown a yearly upward trend. The condition not only directly affects an individual’s life, study, and prospects, but also brings burdens to society, parents, and families. According to the 2004 annual report of the U.S. National Health Interview Survey by the Centers for Disease Control and Prevention (CDC), roughly four million children under 18 in the United States had been diagnosed with ADHD. More than one million adults and children in the U.S. are currently taking prescription medications for this condition.

Although ADHD is not recorded by name in classical Traditional Chinese Medicine (TCM) texts, based on its clinical manifestations it may be categorized under “agitation/restlessness (躁动),” “impaired listening/attending (失聪),” and “forgetfulness (健忘).” Children are “pure yang” by nature—yang tends to be in excess and yin relatively insufficient—so they are physiologically prone to hyperactivity of yang and insufficiency of yin, leading to unsettled shen (mind/spirit) and distractibility, and thus to the pathological hyperactivity syndrome. In Western medicine, central nervous system stimulants are considered the most effective treatment; although they act quickly, they often require long-term administration, have notable side effects, and relapse is common. By contrast, TCM therapies characterized by sustained action, durable efficacy, and minimal adverse reactions are attracting increasing attention. TCM shows unique advantages and confirmed efficacy in treating ADHD, particularly with acupuncture, which can effectively reduce the harms associated with ADHD.

This paper collects clinical cases to observe the efficacy of the Xing Nao Kai Qiao (XNKQ) acupuncture method in ADHD. It also reviews the literature on ADHD and on XNKQ acupuncture, summarizing etiologies and pathomechanisms, pattern-based treatments, and the clinical application and mechanisms of XNKQ.

Part I. Review

1. Advances in TCM Research on ADHD

ADHD is a relatively common behavioral disorder of childhood. It is mainly characterized by inattention, poor self-control, hyperactivity, emotional instability, and impulsivity, and is often accompanied by cognitive impairment and learning difficulties; intelligence is normal or near normal. Based on differing emphases in clinical presentation, ADHD is generally divided into three types: predominantly inattentive, predominantly hyperactive/impulsive (poor self-control), and combined type.

According to the DSM-IV published by the American Psychiatric Association, the prevalence is 3%–7%, with a male-to-female ratio of 4–9:1. In China, reported prevalence among school-age children ranges from 1.3% to 13.4%. Current medical research holds that the etiology remains unclear; onset is related to multiple biological and genetic factors as well as social, psychological, environmental, and perinatal/traumatic factors. Some studies suggest close associations with altered levels of trace elements such as lead, zinc, and magnesium; others propose insufficiency of central dopaminergic function; still others implicate abnormalities in monoamine neurotransmitters (NE, DA, 5-HT) and their metabolism in the central nervous system [1]. The prognosis is generally good: the vast majority of children gradually improve and recover in adolescence.

Most scholars consider ADHD a major interdisciplinary topic spanning pediatrics, neuropsychiatry, psychology, and education; comprehensive treatment psychosocial interventions plus medication is recommended. In recent years, TCM has shown definite efficacy for ADHD. Below is a summary of literature from roughly the past five years.

1) Etiology and Pathomechanism

Although not named explicitly in ancient texts, based on its manifestations of scattered shen, excessive speech and movement, and restlessness/impulsivity, ADHD can be classified under “zang zao” (visceral agitation) and “zao dong” (restless agitation); because affected children have normal/near-normal intelligence yet excessive activity and difficulty focusing, leading to learning problems, it is also related to “jian wang” (forgetfulness) and “shi cong” (impaired listening/attending).

Major causes include congenital endowment insufficiency; improper postnatal care; trauma; post-illness debility; and emotional dysregulation. The principal affected organs are the Heart, Liver, Spleen, and Kidney. Emotional activity in humans is intimately linked with the viscera and requires the essence and qi of the five organs as its material basis; dysfunction of the five organs inevitably disturbs emotional activity. The Suwen (“Plain Questions”), “Explication of the Five Qi,” states: “The five viscera store: the Heart stores shen, the Lung stores po, the Liver stores hun, the Spleen stores yi, and the Kidney stores zhi.” If Heart qi is insufficient and the Heart lacks nourishment, the shen loses containment, causing emotional lability and poor attention; if Kidney essence is deficient and the “sea of marrow” is not filled, the brain lacks clarity; if Kidney yin is insufficient and water fails to restrain wood, Liver yang may rise, leading to hyperactivity and irritability; if the Spleen is deficient and fails to nourish, quietude is lacking, interests are inconsistent, impulsive speech occurs, and forgetfulness results; Spleen deficiency with Liver excess further aggravates hyperactivity and impulsivity. Yin governs quiescence and yang governs activity; harmony of yin and yang allows balanced movement and stillness—“When yin is balanced and yang is secured, spirit and mind are governed” (Suwen, On the Great Treatise of Life). If organ yin–yang is disrupted, disorders of emotion and movement arise, with yin failing to contain internally and yang becoming overactive externally.

2) Pharmacotherapy

(2.1) Pattern-Differentiated Herbal Treatment
  • Lin Yuebin [2] divided ADHD into four patterns:
    • Kidney-yin deficiency with Liver-yang hyperactivity strategy: nourish yin and subdue yang, calm the spirit and enhance cognition; prescription: Sanjia Fumai Tang (Three-Shell Restore Pulse Decoction) with modifications.
    • Heart–Spleen qi deficiency with malnourished shen strategy: strengthen Spleen and tonify qi, nourish Heart and calm the shen; prescription: Guipi Tang with modifications.
    • Internal damp-heat with phlegm-fire disturbing the Heart strategy: transform phlegm, clear heat, calm the shen and enhance cognition; prescription: Wendan Tang with modifications.
    • Blood stasis obstructing brain collaterals strategy: invigorate blood, transform stasis, calm the shen and enhance cognition; prescription: Buyang Huanwu Tang with adaptations.
      In a controlled trial (TCM group, n=43 vs. methylphenidate group, n=32), overall efficacy did not differ significantly, but the TCM group reported no side effects, whereas the control group had decreased appetite and insomnia in 17 cases and headache in 2 cases.
  • Pu Chengluo [3] categorized three patterns:
    • Kidney-yin deficiency with Liver-yang hyperactivity: nourish Kidney yin, pacify Liver and subdue yang; Liuwei Dihuang Tang with modifications.
    • Heart–Spleen deficiency:strengthen Spleen and qi, nourish blood and Heart; Buzhong Yiqi Tang: combined with Guipi Tang with modifications.
    • Internal damp-heat with phlegm-fire harassing the Heart:clear heat, transform phlegm, resolve dampness and relieve vexation; Huanglian Wendan Tang with modifications.
  • Zhang Li [4] studied ADHD with concomitant anorexia, dividing into four patterns and using Tiao Nao Ling (Regulate Brain Spirit) as the base prescription with pattern-specific additions. Treatment group (n=60) vs. control group (Tiao Nao Ling alone, n=60): total effective rate 93.33% vs. 73.33% (P < 0.05).
    Tiao Nao Ling ingredients included (Chinese names as provided): 石菖蒲、远志、龟板、龙齿、益智仁、生地、熟地、炙首乌、山茱萸、白芍、太子参、陈皮、百合、黄精, etc.
  • Wu Dong [5] posited close ties to the Heart and Liver channels, often due to yang hyperactivity arising from prolonged food stagnation transforming into heat/fire. He used a self-devised Qingre Daozhi Tang (Clear Heat and Guide Stagnation Decoction) with two patterns:
    • Stagnant heat with Heart fire flaming upward: disperse food, resolve stagnation, clear Heart and guide heat; herbs: 生石膏、焦三仙、炒莱菔子、枳壳、知母、生地、丹皮、淡竹叶、炒栀子、豆豉.
    • Stagnant heat stirring Liver wind: clear heat and stagnation, pacify Liver and extinguish wind; herbs: 生石膏、焦三仙、炒莱菔子、枳壳、知母、钩藤、僵蚕、白芍、白蒺藜、菊花、熟军.
      Among 36 cases, the cure rate was 86%.
  • He Yimin [6] divided ADHD into four patterns:
    • Kidney deficiency with hyperactive Liver: enrich water to restrain wood, calm and focus the spirit; Liuwei Dihuang Tang adaptations.
    • Spleen deficiency with exuberant Liver: strengthen Spleen, soothe Liver,   warm Gallbladder and calm the shen; Yinshao Longmu Tang (银芍龙牡汤).
    • Heart–Spleen qi deficiency with malnourished shen:strengthen Spleen and qi, nourish Heart and calm the shen; Guizhi Jia Longgu Muli Tang with additions.
    • Internal damp-heat with phlegm-fire disturbing the Heart:warm Gallbladder, calm the shen, clear phlegm-heat; Huanglian Wendan Tang with additions.

He emphasized comprehensive management physiological, psychological, and social with cooperation among patients, guardians, teachers, and physicians.

(2.2) Disease-Specific Prescriptions
  • Wang Ling [7] treated the yin-deficient, yang-hyperactive type (often due to congenital insufficiency or post-illness depletion) with Zhibai Dihuang Wan modifications in 60 children; controls (n=50) received methylphenidate. After 30 days: treatment group 93.3% effective (51 cured, 3 markedly effective, 2 improved, 4 ineffective) vs. control 64.0% significant difference (P < 0.01).
  • Luo Zhengbao [8] used Zishen Yanggan Fang (滋肾养肝方: 熟地黄、生龟板、生龙牡、茯苓、黄柏、五味子、石菖蒲、炙甘草) for 52 children with the TCM pattern of Liver–Kidney yin deficiency with internal wind; controls (n=52) took methylphenidate. After 1–3 months (one month per course), both groups improved significantly (p < 0.01), with total effective rate 86.5% vs. 68.0% (P < 0.05) favoring the herbal group.
  • Zhang Shuhe et al. [9] treated 198 moderate-to-severe combined-type ADHD cases (from over 1,000 screened) with Compound Shudihuang Decoction (熟地黄、白芍、龙骨、牡蛎、石菖蒲、枸杞子、五味子), plus positive reinforcement, parental counseling, and education strategies; 30-day courses:
    • 15–30 days (n=38): 2 cured, 16 markedly effective, 10 improved, 10 ineffective.
    • 30–60 days (n=108): 76 cured, 24 markedly effective, 8 improved, 0 ineffective.
    • 60–90 days (n=52): 40 cured, 9 markedly effective, 3 improved, 0 ineffective.
  • Yang Juanfang [10] viewed poor self-control as the most prominent feature i.e., disorder of the shen. Based on the dictum “For Heart disease, eat wheat” (Lingshu, Five Flavors), she used Ganmai Dazao Tang to regulate the Heart shen, adding Acori tatarinowii (Shi Chang Pu) to open the orifices and enhance cognition and Polygala (Yuan Zhi) to calm the shen, relieve constraint, and transform phlegm, with individualized modifications plus psychological nursing. Among 38 cases: 19 markedly effective, 16 improved, 3 ineffective; total effective rate 92.1%.
  • Shi Shuxiang [11] attributed many cases to improper diet and rich, greasy foods damaging Spleen and Stomach, generating heat and phlegm; phlegm-heat unsettles the Heart shen and stirs Liver wind. She applied a strategy of pacifying Liver and extinguishing wind, clearing heat and transforming phlegm, calming and settling the Heart, using Tianma Gouteng Yin with additions; controls received methylphenidate. Among 50 treated cases: 16 markedly effective, 25 improved, 9 ineffective; relapse at 6-month follow-up in 10 cases. Controls (n=42): 14 markedly effective, 19 improved, 9 ineffective; relapse in 15 cases. Treatment outperformed control (P < 0.05).
  • Zhao Lijie [12] used Anshen Yizhi San (熟地黄12 g，山药10 g，山茱萸10 g，当归15 g，白芍10 g，石菖蒲12 g，远志12 g，茯神12 g，酸枣仁12 g，生龙骨15 g，生牡蛎15 g，麦芽12 g), powdered and taken with honey, for six months per course, in 68 children: 46 markedly effective, 18 improved, 4 ineffective; total effective rate 94.1%.
(2.3) Chinese Patent Medicines
  • Ma Rong [13] argued that although the disease locus is in the brain, its root lies in the Kidney “Kidney essence deficiency, yin–yang disharmony, excess movement of yang and insufficiency of yin, with visceral dysfunction leading to malnourished brain marrow.” On this basis he formulated Yizhi Ning Shen Granules (主要药物：紫河车、熟地黄、石菖蒲、远志、泽泻、黄连). In clinical studies using Jingling oral solution and methylphenidate as comparators in 159 children, Yizhi Ning Shen showed: control-significant rate 63.64%; TCM-pattern control-significant rate 85.45%; significantly superior to Jingling and methylphenidate. Improvement in primary symptom scores was comparable to methylphenidate and better than Jingling; for TCM pattern scores, no significant differences among the three drugs on primary symptoms, but Yizhi Ning Shen and Jingling were superior to methylphenidate on secondary symptoms and tongue/pulse findings reflecting TCM’s holistic regulatory advantage. All three improved hyperactivity index and neurological soft signs; differences among them were not significant. Follow-up and safety testing of cases with ≥marked efficacy indicated stable long-term efficacy and good safety. Animal studies suggested that high-dose Yizhi Ning Shen reduces brain DA and NE while modulating catecholamine imbalance possibly a key mechanism for suppressing hyperactivity and exploratory behavior and improving cognition in model rats [14].
  • Jiang Yongzhong et al. [15] approached the Kidney–Liver–Heart tri-organ axis, positing a main mechanism of Kidney-yin deficiency, Liver-yang rising, and unsettled Heart shen. They treated 40 children with Shudihuang Mixture(熟地、山茱萸、山药、远志、石菖蒲、龙骨、牡蛎、龟板、五味子、地骨皮、云苓、白术、陈皮、泽泻、钩藤、龙胆草、川芎等); controls (n=40) received methylphenidate. Total effective rates: treatment group 10% at week 1, 40% at week 4, 65% at week 12; control group 77.5% at week 1, 72.5% at week 4, 72.5% at week 12. Thus methylphenidate acted faster at weeks 1 and 4 (P < 0.05), but by week 12 no significant differences remained in total effective rate or PSQ hyperactivity index (P > 0.05). Adverse effects: mild appetite loss in 1 case (treatment) vs 9 cases (control). The mixture thus showed slower onset, gentler action, and fewer side effects.
  • Shao Jianjun [16] used an in-house preparation, Zishen Yangxue Wan (main components: 山萸肉、益智仁、龟板、熟地、当归, etc.) in 70 children; controls (n=55) used methylphenidate. After four weeks: treatment group 48 markedly effective, 14 improved, 8 ineffective; total effective rate 88.6%. Control group 30 markedly effective, 10 improved, 15 ineffective; total effective rate 72.7%. The difference was statistically significant (P < 0.05).
(2.3) Chinese Patent Medicines (continued)
  • Zhang Biao et al. [17], drawing on pediatric physiology and long-term clinical experience, proposed that the susceptibility to pediatric ADHD arises from the constitutional basis of soft/immature viscera, tender yin–yang, and timid/feeble shen that is easily disturbed. The syndrome features are “insufficient yin-quiescence, excess floating yang,” and “root-deficiency with branch-excess,” with clinical manifestations summarized under shen (mind), qing (emotion), xing (temperament), and zhi (will). The core pathomechanism centers on Kidney-yin deficiency, Liver-yang hyperactivity, and unsettled Heart shen; thus the basic therapeutic principles are nourish Kidney and pacify Liver, nourish Heart and enhance cognition, calm the spirit and settle the will. Based on this, the authors treated 73 children with Duodong’an Oral Solution (多动安口服液: 熟地黄、制首乌、白芍、白蒺藜、珍珠母、钩藤、知母、川柏、当归、炙远志、柏子仁、五味子、甘草等) and achieved a total effective rate of 90.4% after 8 weeks. Preliminary biochemical studies suggested the formula increases CNS monoamines (NE, DA, 5-HT) and their metabolites and rebalances these transmitters, which may underlie its effect in ADHD.
  • Ding Zhengxiang [18] treated 50 cases of the Kidney-deficiency/yang-exuberance type with Pediatric Intelligence Syrup (小儿智力糖浆: 龟板、龙骨、远志、石菖蒲、雄鸡汁) and used Jingling Oral Solution as the comparator. The total effective rates were 86.00% (treatment) vs 75.56% (control), with the treatment group showing superior score reductions and better improvement in TCM cardinal symptoms—especially dry mouth–throat and five-center heat.
  • Mei Qixia et al. [19] conducted a clinical comparison of Pediatric Intelligence Syrup vs methylphenidate in ADHD. After 4 months, for mild-to-moderate cases there was no significant difference the syrup was comparable to methylphenidate. Although methylphenidate acted faster and outperformed the syrup in severe cases, the syrup had higher safety and better adherence.

Other TCM Therapies

  • Meng Jianguo et al. [20] performed acupuncture at Dazhui (GV14), Changqiang (GV1), Jiuwei (CV15) with strong stimulation, no retention, once weekly for 6 weeks in 60 children: cured 40, markedly effective 12, effective 7, ineffective 1; total effective rate 98.33%. The authors attributed efficacy to regulating Ren–Du vesselsand the Heart/Liver/Kidney axis.
  • Zhong Tianping et al. [21] randomized 120 patients to acupuncture + psychotherapy (self-control, PMR, supportive therapy) vs controlled-release methylphenidate for 12 weeks. On Conners index at weeks 8 and 12, the acupuncture+psychotherapy group improved more than medication alone. Technique: nourish yin/tonify Kidney, pacify Liver/subdue yang, calm the Heart/settle will, harmonize yin–yang. Main points: Baihui (GV20) through Sishencong (EX-HN1), Shenshu (BL23), Taixi (KI3), Guanyuan (CV4), Sanyinjiao (SP6), Taichong (LR3), Neiguan (PC6), Shenmen (HT7), Xinshu (BL15), Ganshu (BL18), Pishu (BL20).
  • Liu Min [22] used auricular acupressure (Kidney, Heart, Brainstem, Shenmen, Excitatory point) for 40 cases vs 20 on methylphenidate/amphetamine. After three 10-session courses: treatment cure 80%, total effective 95% vs control cure 60%, total 85% (P < 0.05).
  • Liu Hongjiao [23] used catgut embedding at Shousanli (LI10) and Zusanli (ST36) (hand–foot “sanli”) in 73 children: markedly effective 64, effective 8, ineffective 1; total effective 98.6%; effects maintained at 18-monthfollow-up.

Comprehensive Therapies

  • Zhou Zheng [24] combined Jingan Yizhi Decoction (静安益智汤: 熟地10 g、山药10 g、益智仁10 g、龟板10 g、石菖蒲10 g、山萸肉10 g、茯苓10 g、枸杞子10 g、菊花6 g、远志6 g、龙骨10 g) with sensory integration training and psychological correction in 68 children. Total effective rates: 80.88% after the first course and 83.88% after the second, with no adverse reactions.
  • Li Jianlong et al. [25] randomized 64 children: observation group (n=31) received “Thirteen Ghost Points”acupuncture (per Qianjin Yaofang) plus Jingshuai-kang Capsules (酸枣仁、白芍、甘草酸、天麻、郁金等) and Congnao Yizhi Capsules (人参、鹿角胶、干姜、肉桂、远志、石菖蒲等); control (n=33) received CNS stimulants and tricyclic antidepressants. Both had behavioral–cognitive training. After 3 months, by Conners scale the effective rates were 94% (29/31) vs 91% (30/33), with a statistically significant difference (P < 0.01). Points included Renzhong (GV26), Shaoshang (LU11), Yinbai (SP1), Daling (PC7), Shenmai (BL62), Fengfu (GV16), Jiaoche (ST6), Chengjiang (CV24), Laogong (PC8), Shangxing (GV23), Huiyin (CV1), Quchi (LI11), Guifeng (EX); specific needling details provided (e.g., GV26 oblique upward 0.5 cm with pecking to lacrimation; BL62 straight 0.5–1 cm with strong “volcano-fire” style; Guifeng pricking to bleed).
  • Wang Meiying et al. [26] used filiform acupuncture + Wang-buliu-xing seed ear-pressing + psychological intervention in 38 cases vs methylphenidate controls (n=20). Total effective rates: 92% vs 65% (significant). Body points: Baihui, Shenting, Shenmen, Sanyinjiao, Fengchi, Taichong; ear points: Heart, Kidney, Brainstem, Brain point, Subcortex, Shenmen, Adrenal, Sympathetic, Sanjiao.
  • Huang Ling [27] treated 62 cases with abdominal acupuncture at Zhongwan, Xiawan, Qihai, Guanyuan, Huaro-men, Wailing, Daheng plus an herbal formula (熟地、益智仁、枸杞子、桑椹子、五味子、柏子仁、夜交藤、茯苓、太子参、红枣、莲子、竹叶、天竺黄、钩藤、牡蛎、龙骨、甘草). Outcomes: cured 30, markedly effective 21, effective 9, ineffective 2; total effective 96.8%, cure+marked 82.3%.
  • Chen Xuezhi [28] compared tuina + herbs (n=50) vs tuina alone (n=30). Results: treatment total effective 96%(cured 30, markedly effective 9, improved 9, ineffective 2) vs control 80%—significant (P < 0.05). Tuina protocol detailed (cranial, facial, Ren/Du, Back-Shu, extremities). Herbal formula: 熟地黄、生地各24 g；山茱萸、山药、天麻各12 g；丹皮、茯苓、泽泻、牡蛎、龙齿、钩藤各10 g.
  • Liu Fangqin [29] used Shaoyao Gancao Tang plus auricular acupressure (Kidney, Heart, Subcortex, Shenmen, Occiput) in 47 cases: cured 39, markedly effective 6, ineffective 2; cure 82.97%, total effective 95.74%.
  • Wang Rui et al. [30] combined Jingling Oral Solution + acupuncture (n=58) vs methylphenidate (n=50). Total effective: 91.4% vs 90.0% (P > 0.05). Points: Neiguan, Taichong, Taixi, Quchi; add Baihui, Shenmen, Sishencong for inattention; add Lieque, Xinshu, Dingshen for hyperactivity; add Shenting, Zhaohai, Tanzhong for agitation; add Xinshu, Zusanli, Sanyinjiao for Heart–Spleen deficiency.

Conclusion

In 1902, George Still first provided a detailed description of children with excessive activity. In 1994, the DSM-IV re-classified the disorder as attention-deficit disorder with or without hyperactivity. Clinically, stimulants, tricyclic antidepressants, α-2 agonists, and non-tricyclic antidepressants are commonly used; however, adverse effects and high relapse after discontinuation limit acceptance by children and families. TCM therapies for pediatric ADHD have achieved notable efficacy with fewer side effects. Yet challenges remain: (1) non-uniform TCM etiology/pathomechanism frameworks and pattern classifications, and lack of unified efficacy criteria, reducing cross-study comparability; (2) small sample sizes and limited long-term follow-up; (3) non-standardized acupuncture point selection, lacking consensus on point sets with confirmed efficacy. Future work should strengthen clinical and experimental research, establish standardized outcome criteria, screen effective formulas, and define high-performing, reproducible acupoint sets/combos to improve outcomes.

II. Advances in Research on the “Xing Nao Kai Qiao (XNKQ)” Acupuncture Method

XNKQ was established by Academician Shi Xuemin in the early 1970s for stroke, addressing pathologies such as blood stasis, Liver wind, and phlegm turbidity that obscure the clear orifices, leading to “closure of the orifices and sequestration of the spirit, with the spirit failing to guide qi.” It emphasizes yin-channel and Du-vessel points and standardized manipulation/quantitative dosing, distinct from traditional selection and techniques. With 30+ years of clinical application, XNKQ has shown remarkable efficacy in stroke and its complications and has been widely promoted nationwide. Recent studies over roughly the past three years are summarized below.

1) Conceptual Overview of XNKQ

Drawing from extensive clinical and teaching practice and classical theory e.g., “If the ruler is unclear, the twelve officials are endangered,” “Blood congesting above causes syncope,” “Blood and qi surge upward”, Shi Xuemin localized the lesion of stroke to the brain and advanced a new pathogenesis of “orifice closure with spirit sequestration—the spirit fails to conduct qi.” He posited that upward transformation of yang generates wind; blood follows qi counterflow to the vertex; with phlegm, fire, blood, and qi harassing the orifices, the clear orifices are obstructed and the spirit cannot guide qi, resulting in stroke. Targeting disturbed consciousness and motor deficits, he proposed treatment centered on “arousing the brain and opening the orifices, nourishing Liver–Kidney, and unblocking channels”, and created the XNKQ method [1]. Core points: Renzhong (GV26), Neiguan (PC6), Sanyinjiao (SP6) as principal, with Jiquan (HT1), Chize (LU5), Weizhong (BL40) as auxiliaries; point selection is closely aligned with meridian affiliation and functions. Over two decades, he verified and refined point prescriptions and standardized needle direction, depth, manipulation, and stimulation dose, including variations by condition, forming a quantitative, systematic, and standardized technique for stroke.

2) Point Selection and Operation in XNKQ

XNKQ comprises Principal Formula I and Principal Formula II.

  • Principal I: Neiguan (PC6) and Renzhong (GV26), primarily for clouded spirit states (stroke collapse/closure syndromes, palpitations, hysteria, psychosis, heatstroke, toxic coma, etc.). Add auxiliaries by pattern to integrate holism with pattern-based treatment.
  • Principal II: Shangxing (GV23), Yintang (EX-HN3), Baihui (GV20), Neiguan (PC6), Sanyinjiao (SP6) for recovery-phase stroke and certain non-organic conditions (palpitations, enuresis, impotence, seminal emission). This set calms the spirit and reduces pain from repeated GV26 needling.
  • Complication-based additions: e.g., dysphagia add Fengchi (GB20), Yifeng (SJ17), Wanggu (GB12); finger flexion add Hegu (LI4); aphasia add Lianquan (CV23) + bleeding Jinjin/Yuye; equinovarus add Qiuxu (GB40) through-needling to Zhaohai (KI6); constipation needle Waishuidao (ST28), Waiguilai (ST29), Fenglong (ST40); respiratory failure Qishe (ST11) bilaterally; urinary incontinence/retention Zhongji (CV3), Qugu (CV2), Guanyuan (CV4) with moxa/massage/hot compress; ataxia Fengfu (GV16), Yamen (GV15), cervical Jiaji; diplopia Tianzhu (BL10), Jingming (BL1), retrobulbar; epilepsy Daling (PC7), Jiuwei (CV15); periarthritis Jianzhen (SI9), Jianzhongshu (SI15), Jianwaishu (SI14) with bleeding/cupping at tender points; vascular dementia Baihui, Sishencong, Sibai, Taichong; sleep-wake reversal Shangxing, Shenmen.

 

Standard manipulation: disinfect; first needle bilateral Neiguan, straight insertion with combined lift-thrust + rotation reducing method for 1 minute. Then Renzhong oblique toward the nasal septum with pecking reduction to tearing or ocular moistening. Then needle ipsilateral Sanyinjiao, oblique 45° along tibial border to the original SP6 location; then lift-thrust tonifying to elicit 3 twitches in the affected limb. Next Jiquan (HT1) (located 1 cun inferior to original) avoiding axillary hair, straight insertion with reducing to elicit one upper-limb twitch. Retention 30 min. Because GV26 stimulation is strong, prolonged use increases discomfort; it may be replaced by Yintang, Shangxing, Baihui (straight at Yintang; Shangxing through-needling to Baihui). Alternate the two sets if consciousness clears but voluntary movement has not appeared. If only mild weakness or fine-motor deficits remain, use Yintang, Shangxing, Baihui [31].

Clinical Applications of XNKQ

3.1 Stroke and Its Complications

  • Cui Xinhua et al. [32] randomized 830 stroke patients to XNKQ vs traditional (415 each). Post-treatment marked-efficacy favored XNKQ (P < 0.05). Efficacy was greater in first-ever stroke than recurrent (P < 0.05). Cure rates were significantly higher in acute/subacute (2 h–10 d) than in stable (11–20 d), recovery (21–90 d), or sequelae (3–12 mo) groups; stable vs recovery did not differ; all groups differed significantly from the sequelae group (P < 0.05). Results indicate earlier is better, with the optimal treatment window ≈ 3 months. XNKQ rapidly improved speech and limb function; mild–moderate cases largely normalized after 4–8 weeks; moderate–severe achieved independent living after 12 weeks.
  • Zhou Junding [33] studied 330 stroke cases: marked-efficacy 84.35% (XNKQ) vs 62.61% (traditional). Cure rates within 10 days (acute/subacute) were significantly higher than later stages; stable vs recovery not different; all exceeded sequelae (P < 0.05). Cure rate declined with longer course—again supporting early needling.
  • Zhang Zhongyuan [34] randomized 180 acute ischemic cerebrovascular disease patients to XNKQ vs traditional acupuncture; after 4 weeks, CSS and NIHSS scores decreased more with XNKQ (P < 0.01).
  • Lin Xiaoling [35] randomized 200 acute cerebral infarction patients to XNKQ + standard meds/rehab vs traditional acupuncture + meds/rehab for two 2-week courses. Total effective: 92% vs 78% (significant).
  • Jiang Yan et al. [36] in 60 basal-ganglia intracerebral hemorrhage (subacute) cases: XNKQ + standard care vs standard care for 3 weeks. CSS and ADL improved more with XNKQ; clinical efficacy (cure+marked progress) 90%vs 60% (significant), with motor recovery notably better in XNKQ.
  • Luo Ping [37] in 246 pseudobulbar palsy patients: both groups received routine infusions; 10-day courses. Symptom/sign scores improved in both (P < 0.01) but more in XNKQ; Kubota water-swallow test effective rate 98.4%vs 74.8% (P < 0.05); fewer unremoved nasogastric tubes after 2 courses (P < 0.05).
  • Duan Hongtao [38]: 80 pseudobulbar palsy, both groups standard neuro + rehab; treatment group also XNKQ. After 2 courses, total effective 95% vs 80% (P < 0.05).
  • Zhang Aina [39]: XNKQ (n=143) vs traditional limb-meridian acupuncture (n=76) for post-stroke hemiplegia: cured 32%, marked 45%, total 77% vs cured 24%, marked 42%, total 66%; P < 0.01. Tang Weidong et al. [40]: 42 hemiplegic post-stroke; FMA and neuro-deficit scores showed XNKQ > traditional.
  • Mou Jiao et al. [41]: 90 motor aphasia due to cerebral infarction randomized to XNKQ + speech therapy, XNKQ alone, speech therapy alone. Using WAB and CADL, all improved; combined therapy showed advantages in spontaneous speech, repetition, naming, and daily communication.
  • Cui Lisheng [42]: 60 post-stroke depression randomized to fluoxetine vs fluoxetine + XNKQ for 6 weeks. Response rates 83.33% vs 46.67%; HAMD declined significantly in both (P < 0.01), with greater decline in XNKQ. Adverse effects were mild and similar.
  • Fan Li et al. [43]: 100 acute cerebral infarction with dysphagia: Eight-Confluent points + XNKQ vs XNKQ + local glossopharyngeal needling for 3 weeks. Effective rates 92.31% vs 76% (P < 0.05).

3.2 Other Indications

  • Coma: Wan Jun [44], 32 cases; GCS increased post-XNKQ (P < 0.05); arousal rate 78.13%, total effective 84.38% at 6-month evaluation.
  • Cerebral vasospasm after head injury: Wan Jianbin et al. [45], 60 cases randomized; both improved VMCA/VICA (P < 0.01), with XNKQ superior to control (P < 0.05).
  • Vascular dementia: Leng Enrong [46], 28 cases with XNKQ + electroacupuncture: markedly effective 13, effective 7, improved 5, ineffective 3; overall improvement 89% after 2–5 courses.
  • Vasoneurotic headache: Hu Haimin [47], Xiongju Teiao San (Chuanxiong Tea Blend) plus XNKQ in 48 cases: cured 33, marked 10, effective 4; total 97.9% (4–40 days).
  • Cervical spondylosis: Guo Jingxian [48], vertebral-artery type, 86 cases randomized: XNKQ total effective 97.7% vs 76.7% (P < 0.05). Wang Ping [49], cervicogenic vertigo, 56 cases: cured 40, marked 12, effective 4 (4 relapsed); total 92.86% with XNKQ + supine three-traction maneuvers.
  • Refractory insomnia: Zhu Shanpo [50], 118 cases with XNKQ + “Head Three Needles” (Sishencong, Shenting, Benshen): cured 41, improved 67, unhealed 10; total 92%.
  • Depression: Su Ping [51], 63 cases randomized: XNKQ + psychotherapy vs fluoxetine + psychotherapy for 6 weeks. HAMD/HAMA outcomes: overall efficacy similar; HAMA differed significantly favoring acupuncture. Some relapse and side effects (dry mouth, constipation, dizziness) occurred with fluoxetine; acupuncture had minimal AEs.
  • Case reports: XNKQ applied with adjuncts for MSA-C [52], progressive spinal muscular atrophy [53], Parkinson’s disease [54], ageusia [55], hysterical lower-limb numbness [56], and central pontine myelinolysis[57].

3.3 Combination with Other Modalities

3.3.1 With traditional acupuncture: Zhong Ling [58], 60 first-ever cerebral infarction randomized: control traditional acupuncture; treatment traditional + XNKQ + Naoxintong capsules; 4 weeks. Neuro-deficit, FMA, MBI all improved (P < 0.01), with treatment > control (P < 0.01).

3.3.2 With abdominal acupuncture: Yuan Fengguo et al. [59], 120 stroke and sequelae randomized: XNKQ + abdominal acupuncture + rehab vs XNKQ + abdominal acupuncture. Treatment had higher basic cure and total effective rates (P < 0.05).

3.3.3 With encircling needling (围刺法): Li Aihong et al. [60], 60 post-stroke aphasia randomized: XNKQ + CT-guided encircling vs routine care; both had speech therapy. Speech function improved more with combination (P < 0.01); total efective 96.7%.

3.3.4 With electroacupuncture: Peng Zhilian et al. [61], 90 limb paralysis post stroke: traditional acupuncture, XNKQ, XNKQ + electroacupuncture. Cure/total effective: 16.67%/76.67%, 33.33%/93.33%, 43.33%/96.67%, respectively. Both XNKQ groups > traditional (P < 0.05); XNKQ+EA cure rate > XNKQ alone(P < 0.05).

3.3.5 With acupoint catgut embedding: Zhao Yuehong [62], 120 stroke-recovery patients randomized: control Western conventional + TCM syndrome-based treatment; treatment + XNKQ + catgut embedding. Total effective 100% vs 73.3% (P < 0.05); long-term efficacy also favored the combination (P < 0.05).

 3.3.6 Combination with Tuina/Massage

Peng Zhilian [63] randomized 70 post-stroke hemiplegia patients into an observation group (n=35) and a control group (n=35). The observation group received XNKQ acupuncture plus tuina and functional training; the control group received XNKQ acupuncture alone. Both groups also received conventional therapy for the primary disease. Cure rate and total effective rate were higher in the observation group, which also showed greater improvements in limb motor function and activities of daily living (ADL).

Luo Xuemei [64] randomized 360 stroke patients into three groups (A, B, C; n=120 each). All received routine clinical care and rehabilitative nursing. Group A additionally received XNKQ acupuncture + meridian-guided massage; group B received traditional acupuncture + meridian massage. Before/after treatment, limb function and ADL were assessed using Fugl-Meyer Assessment (FMA) and Barthel Index (BI). After 60 days, all three groups improved significantly vs baseline; between-group comparisons showed A > B > C (all P < 0.01).

3.3.7 Combination with Heat-Sensitive Moxibustion (duplicate numbering in source)

Gao Yang [65] treated 42 cases of post-stroke urinary incontinence using XNKQ acupuncture combined with heat-sensitive moxibustion at acupoints. Outcomes: cured 24, markedly effective 7, improved 4, ineffective 7; total effective rate 83.3%.

4. Mechanistic Studies

  • Xiao Deyi et al. [66] enrolled 60 acute cerebral infarction patients into conventional therapy (n=30) vs XNKQ + conventional (n=30), with 30 healthy examinees as controls. Plasma BNP was significantly elevated in acute infarction vs controls (P < 0.01). By day 15, BNP levels declined in both patient groups (P < 0.01), but declined further in the XNKQ group, approaching control levels (P < 0.05 vs conventional). XNKQ thus significantly lowers BNP in early cerebral infarction.
  • Shen Pengfei [67] studied 18 acute basal ganglia infarction cases randomized to meridian-point needling (basic care + XNKQ main points), non-meridian/non-acupoint needling + basic care, and basic care only (n=6 each). Using 18F-FDG PET-CT to evaluate cerebral glucose metabolism (whole brain, infarct core, peri-infarct edema), the XNKQ group showed marked activation in breadth and intensity vs both comparators, indicating a specific effect of meridian-point XNKQ on improving cerebral metabolism.
  • Wei Huifang et al. [68], in an ischemia-reperfusion rat model, found plasma ET and Ang II increased while CGRP decreased after injury. XNKQ reduced ET and significantly increased CGRP, suggesting regulation beyond endothelial vasoactive substances inhibiting inflammatory cascade initiation after reperfusion and engaging endogenous protection.
  • Guo Lin et al. [69] randomized 45 SD rats into normal, model, sham, XNKQ, and non-acupoint needling groups (n=10 per treatment group; normal n=5). MCAO reperfusion models were created (except normal). Pathology of ischemic-side brain tissue at 6 h and 24 h showed extensive neuronal degeneration/necrosis and leukocyte infiltration in the model group. XNKQ markedly reduced lesion severity at both time points vs model; non-acupoint needling showed no improvement vs model. XNKQ thus ameliorates brain injury across ischemic phases.
  • Zhang Lufen et al. [70] randomized adult male SD rats into sham, model control, XNKQ, and drug (Xiangdan injection) groups in an MCAO-reperfusion model. After treatment (XNKQ at 3 h; drug at 5 h), serum/brain SOD activityand MDA were assessed 2 h later. XNKQ at 3 h increased serum SOD vs model, indicating free-radical scavenging, inhibition of lipid peroxidation, and neuroprotection.
  • Shi Huiyan et al. [71–72] used MCAO rats and western blotting to assess Peroxiredoxin VI and UCH-L1 expression in XNKQ, traditional acupuncture, model, and sham groups. At 6 h, Peroxiredoxin VI increased in XNKQ vs model; UCH-L1 decreased in XNKQ/traditional/sham vs model, with greatest decrease in XNKQ. At 24 h, both XNKQ and traditional showed higher Peroxiredoxin VI and lower UCH-L1 vs model. XNKQ thus enhances antioxidant capacityand may be superior in early phases.
  • Wang Guang’an et al. [73] randomized adult male Wistar rats into XNKQ (GV26, PC6), acupuncture control (LI11, ST36), sham, and model groups, with 6 h and 24 h time points. Western blotting for 14-3-3 tau in basal ganglia showed no significant differences between groups/time points. The authors suggest 14-3-3 tau may not be centrally involved in basal-ganglia neurodegeneration under these conditions or is expressed at low levels requiring more sensitive detection.
  • Wang Shu et al. [74] compared PC6 (Neiguan, main XNKQ point) vs non-acupoint (lateral thoracoabdominal)and no-acupuncture in an MCAO model. Light microscopy showed no significant change in neuronal necrosis for non-acupoint/no-acupuncture vs model (P > 0.05), but PC6 significantly reduced necrosis (P < 0.05). Electron microscopy showed near-normal ultrastructure in PC6 vs severe edema/organelle damage in non-acupoint/no-acupuncture supporting acupoint specificity and neuronal protection by PC6.

5. Conclusion

Overall, the clinical applications of XNKQ are extensive, and basic research now reaches the molecular level. Strengths in China include abundant case sources, solid TCM theoretical foundations, and advanced equipment. However, issues remain:

  1. Repetition > innovation: many studies ask “is it effective” with statistical comparisons, but fewer explore dose–response of needling, time-effect relationships, and interactions among acupoints.
  2. Outcome evaluation systems: WHO classifies post-stroke states as impairment, disability, and handicap, with corresponding metrics; domestic studies often rely on neurological deficit scales and ADL but seldom include quality of life, late survival, or mortality.
  3. Methodology: a lack of high-quality randomized, controlled, blinded, multicenter, large-sample evidence-based trials.
  4. Publication bias: over-emphasis on positive results hinders balanced re-appraisal; negative findings are also valuable and should be reported.
  5. Beyond stroke (large samples), many indications have small, scattered reports lacking robust RCTs.

Future directions: deepen TCM brain theory; expand XNKQ indications, especially conditions with limited biomedical options yet promising XNKQ signals (e.g., Parkinson’s disease, dementias, ADHD, cerebral palsy, CO poisoning, narcolepsy, traumatic brain injury sequelae, progressive bulbar palsy, moyamoya disease, neuromyelitis optica, and other degenerative/demyelinating and intractable disorders); and pursue mechanistic studies alongside standardized, reproducible acupoint combinations.

Part II. Theoretical Exploration of XNKQ in Treating ADHD

I. Fundamental TCM Understanding of ADHD

1) Etiology and Pathomechanism

1.1 Congenital endowment insufficiency. Parental frailty and Kidney-qi deficiency, or poor mental regulation during pregnancy, may lead to insufficient fetal endowment, Liver–Kidney deficiency, inadequate essence and blood, malnourished brain marrow, and unanchored yuan-shen.

1.2 Birth/traumatic stasis. Birth injury or other trauma causes qi-blood stasis, impaired meridian flow, malnourished Heart/Liver, and unsettled hun/shen.

1.3 Improper postnatal care. Over-consumption of pungent/hot foods stokes Heart/Liver fire; greasy, rich foods generate damp-heat and phlegm-turbidity; cold/raw foods injure Spleen–Stomach; post-illness debility damages viscera and depletes qi/blood leading to malnourished shen and yin–yang disequilibrium (distractibility, hyperactivity).

1.4 Emotional dysregulation. Children are tender yin/yang with unfilled Kidney essence; rapid growth creates relative yin insufficiency, failing to restrain yang → hyperactivity. Immature Heart–Spleen, improper upbringing (overindulgence, lack of boundaries), and frustrated desires lead to restless shen, uncontained yi, agitation, impulsivity, and forgetfulness.

2) Disease Location

The primary viscera are the Heart, Liver, Spleen, and Kidney. Emotional activity depends on the essence and qi of the five organs; dysfunction disturbs emotion. As stated in Suwen, Explication of the Five Qi: “The Heart stores shen, Lung stores po, Liver stores hun, Spleen stores yi, Kidney stores zhi.” Heart-qi/yin deficiency leads to emotional lability and inattention; Kidney essence deficiency empties the sea of marrow, obscuring clarity; Kidney-yin deficiency fails to restrain wood → Liver-yang rising (hyperactivity/irritability); Spleen deficiency yields poor quietude, fickle interests, impulsive speech, forgetfulness; Spleen deficiency with Liver excess aggravates hyperactivity/impulsivity.

3) Pathogenesis

3.1 Excess movement of yang with insufficiency of yin quiescence. Suwen, Great Treatise on the Correspondence of Yin–Yang: “Yin is quiescent; yang is agitated.” Suwen, On the Great Treatise of Life: “When yin is balanced and yang secured, the spirit is governed.” Children are pure yang—yang in relative excess with insufficient blood/essence/fluids, leading to yin deficiency and yang hyperactivity: apparent “high energy” but actually vacuous yang floating, with scattered shen, forgetfulness, clumsiness root deficiency with branch excess.

3.2 Visceral dysfunction as the main pathological change. The disorder centers on mind, thought, and emotion, with Heart, Liver, Spleen, Kidney most involved; the Heart is pivotal (“Heart stores shen”). Heart-qi/yin deficiency causes unsettled shen, inattention, dull reactions, forgetfulness; Heart fire easily flares in children. The Liver, storing hun and of dynamic nature, when yin-deficient with yang rising, produces obstinacy, impulsivity, rough movements, agitation; Liver-blood deficiency yields restless hun (e.g., somniloquy, somnambulism). The Spleen (stillness, storing yi) is often weak in children; improper feeding or illness leads to damp/phlegm (possibly transforming into heat) that disturbs the Heart. The Kidney stores essence, governs marrow and brain; Kidney-qi deficiency yields clumsiness, poor auditory discrimination, enuresis; failure of Kidney water to restrain wood and fire amplifies Liver-yang and Heart fire. Overall patterns: Heart excess/Kidney deficiency, Liver excess/Spleen deficiency, yang excess/yin deficiency, expressing as instability of shen, zhi, qing, xing (mind, will, emotion, temperament). 

4. Treatment Principles and Methods

Primary principle: harmonize yin and yang.

  • Heart-shen insufficiency: tonify Heart–Kidney.
  • Kidney deficiency with Liver hyperactivity: nourish Kidney and pacify Liver.
  • Heart–Spleen qi deficiency: tonify Heart and Spleen.
    When phlegm-turbidity, phlegm-fire, or blood stasis are present, add transform phlegm, clear heat, and invigorate blood strategies.

II. XNKQ Acupuncture and ADHD

1. The Shen and Its Relationship to ADHD

“Shen” denotes the governing capacity of life activities. Suwen, Explication of the Five Qi states: “The five viscera store—Heart stores shen, Lung stores po, Liver stores hun, Spleen stores yi, Kidney stores zhi.” The five aspects of shen are unified yet distinct, each with specific physiological roles and mutual regulation. Lingshu, Ben Shen elaborates: “That which manages affairs is called Heart; when the Heart recalls, it is yi; where yi abides is zhi; from zhi arises si(rumination); from si arises lü (consideration); from lü arises zhi (wisdom).”
When shen functions normally, the spirit is vigorous, consciousness clear, thought agile, responses quick, memory sound. When shen is impaired, abnormalities of spirit, consciousness, and thought ensue.

Because Heart-shen, Liver-hun, Lung-po, Spleen-yi, and Kidney-zhi are facets of shen, and shen also orchestrates visceral balance, emotions are regulated via the five viscera. Shen harmonizes yin–yang (movement vs stillness, excitation vs inhibition, joy/anger/sorrow/pleasure, firmness vs gentleness, etc.), maintaining dynamic equilibrium. Shenalso coordinates form and function “form gives rise to shen; shen governs form.” Thus, ADHD marked by poor attention, hyperactivity, emotional instability, impulsivity, cognitive/learning difficulties relates closely to dysfunction of shen in children whose viscera and facets of shen are still immature.

2. Theoretical Basis for Treating ADHD with XNKQ

XNKQ, created by Academician Shi Xuemin in the early 1970s to address stroke mechanisms (“blood stasis, Liver wind, phlegm turbidity” obscuring clear orifices → “orifice closure, spirit sequestered, shen fails to guide qi”), emphasizes yin-channel and Du-vessel points.

  • Principal Formula I: Neiguan (PC6), Renzhong (GV26), Sanyinjiao (SP6).
    • PC6 (a Confluent Point of the Yin Linking Vessel; Luo-Connecting of the Pericardium): nourishes Heart, calms shen, and courses qi and blood.
    • GV26 (meeting of Du with the hand/foot yin–yang): Du rises to the brain and vertex; reducing at GV26regulates Du and opens the orifices to arouse and calm the mind.
    • SP6 (meeting of Spleen, Liver, Kidney): supplements Kidney, nourishes yin and marrow; marrow relates to essence and brain (“brain is the sea of marrow”).
    • Auxiliaries: Weizhong (BL40), Jiquan (HT1), Chize (LU5) to open orifices, arouse spirit, and free channels.

Principal Formula II: Shangxing (GV23), Yintang (EX-HN3), Baihui (GV20), plus PC6 and SP6.

  • Yintang (extra point on the Du line) clears orifices and rouses shen.
  • Shangxing and Baihui, both on the Du vessel and intersecting multiple yang and Liver channels as well as Ren/Chong relationships, allow through-needling (GV23→GV20) to harmonize yin–yang, calm Liver wind, supplement essence/marrow, nourish qi/blood, and open the orifices.

Synthesis: By selecting and combining these points, XNKQ can nourish Heart and Kidney, pacify Liver, arouse and tranquilize shen, strengthen the brain, and harmonize yin–yang—precisely addressing the core TCM pathogenesis of ADHD. Therefore, rational application of XNKQ can achieve therapeutic benefit in ADHD.

Part III. Clinical Study on the XNKQ Acupuncture Method for the Treatment of ADHD

I. General Information

1. Subjects and Methods

1.1 Case Sources

Outpatients were recruited from the Eastern Medicine Center (USA) between July 2009 and January 2011.

1.2 Diagnostic Criteria

Diagnosis was primarily based on DSM-IV criteria for Attention-Deficit/Hyperactivity Disorder (ADHD) (see Appendix 1):

  1. Symptoms meet DSM-IV criteria for ADHD;
  2. Symptoms occur in two or more settings (e.g., home and school);
  3. Onset before age 7;
  4. Marked impairment in academic and/or social functioning;
  5. Exclusion of other developmental or psychiatric disorders.

1.3 Eligibility Criteria

1.3.1 Inclusion

(1) Cases satisfying the above diagnostic criteria, with intellectual disability excluded;
(2) Age 6–14 years;
(3) Consent to receive treatment and examinations per protocol.

1.3.2 Exclusion

(1) Not meeting diagnostic or inclusion criteria;
(2) Unable to complete required treatment/exams;
(3) Non-adherent or lost to follow-up;
(4) Severe psychiatric illness or severe primary heart, lung, liver, or kidney disease.

1.3.3 Discontinuation/Withdrawal

(1) Poor efficacy or worsening prompting discontinuation;
(2) Serious adverse events requiring cessation;
(3) Intercurrent serious somatic illness during the trial;
(4) Addition/change of medications likely to affect outcomes;
(5) Inability to persist with therapy and request to withdraw.

1.3.4 TCM Pattern Differentiation

Following Wang Shouchuan (ed.), Pediatrics of Traditional Chinese Medicine, three patterns were identified:

(1) Kidney deficiency with Liver hyperactivity: hyperkinesia and restlessness, irritability, impulsivity, poor self-control, scattered thinking, inattention, inability to sit still; possibly poor memory/grades, clumsiness; five-center heat, night sweating, constipation; red tongue with scant or no coat, thin-wiry pulse.
(2) Heart–Spleen deficiency: limited sustained attention, fatigue, thin or puffy body habitus, hyperactivity without aggression, impulsive speech, tasks left unfinished, poor sleep, poor memory, spontaneous sweating, picky eating, pale complexion, poor appetite; pale tongue with thin-white coat, deficient or thin-weak pulse.
(3) Phlegm-fire harassing inwardly: talkative hyperactivity, irritability, impulsivity, capricious interests, inattention, chest vexation with heat, insomnia; red tongue with yellow-greasy coat, slippery-rapid pulse.

1.4 Study Methods

1.4.1 Trial Design

Randomized, single-blind design. Randomization used a random number table to ensure balance. 200 patients were assigned to acupuncture (n=120) or medication (n=80).

1.4.2 Treatments

  • Acupuncture group: XNKQ acupuncture per standardized protocol.
  • Medication group: Oral methylphenidate (Ritalin).

1.4.3 Points/Manipulation and Medication Dosing

(1) Acupuncture

  • Principal points: Neiguan (PC6), Renzhong (GV26), Sanyinjiao (SP6), Baihui (GV20), Yintang (EX-HN3), Shangxing (GV23), Shenmen (HT7), Daling (PC7), Sishencong (EX-HN1).
  • Additions by pattern:
    • Kidney deficiency with Liver hyperactivity: Taixi (KI3), Taichong (LR3).
    • Heart–Spleen deficiency: Xinshu (BL15), Pishu (BL20), Qihai (CV6).
    • Phlegm-fire harassing inwardly: Fenglong (ST40).
  • Symptom-based additions:
    • Constipation: Tianshu (ST25), Zhigou (SJ6).
    • Slowed responses: Hegu (LI4), Taichong (LR3).
    • Loose stools: Tianshu (ST25), Guanyuan (CV4).

Manipulation: Tonifying at SP6; even method at other principal points. In pattern-based points, apply reducing at LR3, ST40, PC7; tonifying at others.

Course: Stainless steel filiform needles (No. 30, 1-inch). After deqi, retain 20 min, with one repeat manipulation at 10 min. 3 sessions/week; 3 months = 1 course.

(2) Medication

Methylphenidate (chemical name; trade name Ritalin).
Dose: 5–10 mg per dose, twice daily, 30 min before breakfast and lunch, for 3 months (one course).

2. Treatment Course and Outcome Measures

Both groups received 3 months of treatment with follow-up every 3 weeks. A pre-designed case report form plus chart data captured demographics, medication use, and changes in DSM-IV 18 ADHD symptoms and Hyperactivity Index (HI) before/after treatment to assess efficacy. CBC, urinalysis, stool routine, and ECG were obtained pre/post as safety indices. No concomitant ADHD-related drugs or therapies were permitted.

3. Efficacy Criteria

Adopted the National TCM Theory Committee, ADHD Specialty Committee standard, combined with Conners score reduction:

  • Clinical cure: DSM-IV all 18 symptoms essentially resolved.
  • Markedly effective: ≥ 5 symptoms reduced vs baseline.
  • Effective: ≥ 2 symptoms reduced.
  • Ineffective: no improvement.

Conners’ Children’s Behavior Rating Scale: see Appendix 2.

Indices:

  • Efficacy index = (Pre-score, Post-score) / Pre-score × 100%
  • HI improvement rate = (Pre-HI − Post-HI) / Pre-HI × 100%

4. Data Collection and Statistical Analysis

Upon trial completion, case report forms were checked for completeness. All observation forms were aggregated for analysis.

Statistics: Categorical data χ² tests; ordinal data two-sample rank-sum (with correction); continuous data two-sample t-tests; within-group pre/post paired t-test or paired rank-sum. Analyses used SPSS 13.0.

II. Results and Analysis

1. Case Analysis

200 eligible cases met inclusion/exclusion criteria and were randomized: acupuncture n=120, medication n=80. Baseline characteristics:

1.1 Sex Distribution (Pre-treatment)

Table 1. Sex Distribution Before Treatment

Group n Male Female χ2 P
Acupuncture
120
79
41
0.015
0.903
Medication
80
52
28
–
–

Note: χ² test P>0.05; no significant difference groups comparable.

1.2 Age Distribution (Years)

Table 2. Age Distribution (Years)

Group n 6-10 10-14 χ2 P
Acupuncture
120
70
50
0.055
0.814
Medication
80
48
32
–
–

Note: χ² P>0.05; no significant difference groups comparable.

1.3 Baseline Inattention and Hyperactivity

Table 3. Baseline Inattention (items per DSM-IV)
Table 4. Baseline Hyperactivity/Impulsivity

(For both domains, between-group comparisons at baseline e.g., careless mistakes, difficulty sustaining attention, seeming not to listen, failure to follow through, disorganization, avoidance of sustained mental effort, losing things, distractibility, forgetfulness; and hyperactivity/impulsivity items such as fidgeting, leaving seat, difficulty playing quietly, running/climbing inappropriately or subjective restlessness, “on the go,” talking excessively, blurting answers, difficulty awaiting turn, interrupting/intruding all showed no significant differences.)

2. Outcomes and Analysis

No mid-trial withdrawals; symptom datasets were complete.

2.1 Overall Efficacy After 3 Months

Table 5. Overall Efficacy at 3 Months

Group n Cure Marked Effective Ineffective Total Effective
Acupuncture
120
22
61
24
13
89.2%
Medication
80
11
25
27
17
78.8%

Rank-sum Z=2.972, P=0.003: significant difference.

2.2 Resolution Rates of Inattention and Hyperactivity/Impulsivity Symptoms

Tables 6–7. Post-treatment resolution rates were compared for each DSM-IV item in the inattention and hyperactivity/impulsivity domains.

  • In inattention, most items showed no significant between-group differences, except: “Often fails to follow through on instructions… (not due to oppositional behavior or failure to understand)”, where the difference was significant (P<0.05) favoring acupuncture.
  • In hyperactivity/impulsivity, no significant differences were found across items between groups.

2.3 Hyperactivity Index (HI) Improvement

Table 8. Hyperactivity Index (Conners’)

  • Within-group:
    • Acupuncture: 12.68±1.20 → 5.76±1.13; Δ 6.91±1.53; t=49.34, P=0.000.
    • Medication: 12.91±1.06 → 8.18±1.22; Δ 4.74±1.38; t=30.60, P=0.000.
      Both groups improved (P<0.01).
  • Between-group: P<0.05, indicating greater HI improvement with acupuncture.

2.4 Efficacy vs Age (Acupuncture Group)

Table 9. Age-Related Efficacy (Acupuncture)

Age (years) n Cure Marked Effective Ineffective Total Effective
6-10
70
13
36
14
7
90.0%
11-14
50
9
25
10
6
88.0%

Rank-sum Z=0.245, P=0.807: no correlation between age and efficacy.

2.5 Adverse Reactions

  • Acupuncture: no abnormalities in CBC/UA/stool, liver/kidney function, or ECG pre/post; no adverse reactions observed.

  • Medication: Labs/ECG unremarkable pre/post; however, 15 cases experienced nausea, dry mouth, constipation, decreased appetite during treatment.

III. Summary

  1. Baseline sex, age, inattention, and hyperactivity showed no significant differences between groups comparable.

  2. Total effective rate: acupuncture 89.2% vs medication 78.8%; significant difference (P<0.01).

  3. Both groups showed significant HI score improvement (P<0.01); between-group difference significant, with acupuncture superior (P<0.01).

  4. For the 18 DSM-IV symptoms, the resolution rate of “failure to follow through on instructions” favored acupuncture (P<0.05); other items showed no significant differences. No age-efficacy correlation was found within the acupuncture group.

  5. Safety: acupuncture no notable adverse events; medication GI and appetite-related side effects occurred.

IV. Representative Cases

Case 1. W.M., male, 11, first visit Aug 5, 2009. Inattention (can sit still only 10 min), grade average 54. T: pale-red, thin-white coat; P: normal.
Treatment: XNKQ principal points (PC6, GV26, SP6, GV20, EX-HN3, GV23, HT7, PC7, EX-HN1), 3×/week. Caffeine/high-sugar drinks stopped.
Results: 3 weeks → sits 30 min, grade 78. At 12 weeks → focused in class/homework, grade 90.

Case 2. Jenny, female, 12, Aug 27, 2009. Cheer captain; talkative in class, leaves seat; grades 70s. UA/ BM essentially normal.
Treatment: As Case 1 + SJ6, ST25, 3×/week. Increase water; avoid caffeine/sugary drinks.
Results: 1 month → attentive, grades 90; 2 more months → cured.

Case 3. Zhang, male, 13, Sep 19, 2009. Should be Grade 8 but in Grade 1; isolates, dismantles bicycles; normal growth.
Treatment: As Case 1 + LR3, SI3, 3×/week for 3 months.
Results: After 3 sessions, initiated conversation; after 9 sessions, advanced to second semester of Grade 1; at 3 months, passed Grade 1.

Case 4. Rhys, male, 11, Oct 12, 2009. ADHD since 8; obesity (+31 lb), junk-food diet, grades 52; T: pale, P: normal.
Treatment: Morning XNKQ; afternoon Spleen-fortifying/transform phlegm set (CV6, CV4, ST36, ST25, CV12, ST40, ST34, CV17), each 3×/week. Diet/exercise counseling.
Results: Week 5 → −25 lb, grades 72; at 3 months → attentive in class.

Case 5. Julie, female, 13, Nov 28, 2009. ADHD ×4 years on meds; grades B; mood became withdrawn/depressed.
Treatment: XNKQ + BL15, BL20, CV6, 3×/week.
Results: 2 weeks → calmer/brighter; weeks 5–6 → reduce to 2×/week; week 8 → essentially recovered; then weekly ×4 → cured.

Case 6. Max, male, 15, Dec 7, 2009. Taciturn, irritable, oppositional; meds ineffective; T: pale; C: white; P: wiry-slippery.
Treatment: XNKQ + ST40, LI4, LR3, 3×/week.
Results: Week 1 → URI/rhinitis resolved; week 2 → conversant at meals; week 4 → homework “easy,” grades up; 8 weeks → near normal.

Case 7. Rhys, male, 6, Dec 23, 2009. Leaves group in preschool, poor intake at lunch → thin; on ADHD meds 3 weeks with reduced appetite (½ normal).
Treatment: XNKQ + SJ6, ST25, 3×/week.
Results: Week 4 → appetite/BM normal; can stay in class; week 9 → completes full lessons and eats quietly; +3 weeks → cured.

Case 8. Jenny, female, 9, Jan 12, 2010. Strong-willed, avoids group activities; listens in class, spends 3–4 h/night on homework; grades ~50, IQ good.
Treatment: XNKQ + LR3, KI3, 3×/week.
Results: Week 6 → grades ~70, joined soccer; week 12 → B+.

Case 9. Luis, male, 13, Jan 26, 2010. Distracted, gaming/internet after school; grades 45; high-sugar drinks.
Treatment: XNKQ + LI4, LR3, 3×/week. Diet advice; remove console/computer.
Results: Week 5 → major improvement; all recent tests A+; +7 weeks → essentially recovered.

Case 10. Tina, female, 10, Feb 10, 2010. Trauma history; explosive crying when feeling unfair; IBS with ADHD; alternating constipation/loose stools; P: wiry-slippery.
Treatment: XNKQ + ST25, SJ6, LR3, LI4, 3×/week.
Results: 2 weeks → normal BM, steadier mood; 4 weeks → good emotional control and better grades; 8 weeks → near recovery.

Case 11. Jason, male, 9, Feb 21, 2010. Forgetful, bullying peers; grades 35; BM constipated; T: red, scant coat; P: wiry-slippery.

Treatment: XNKQ + SJ6, ST25, LR3, LI4, 3×/week.
Results: Week 5 → hyperactivity largely resolved, grades improved; week 12 → cured.

Case 12. Mike, male, 8, Mar 3, 2010. Never completed homework since school start; stares blankly; breathy sighing; thin, poor appetite, loose stools.
Treatment: XNKQ + ST25, CV4, BL15, BL20, CV6, 3×/week.
Results: Week 3 → appetite up, complexion improved; week 5 → attentive, on-time homework; +7 weeks → cured.

Case 13. Mina, female, 7, Mar 18, 2010. Near end of preschool yet cannot write her name; solitary doodling; C-section birth; IQ A.
Treatment: XNKQ, 3×/week.
Results: Week 6 → listens well, spells her name, reads 10 min; +6 more weeks → cured.

Case 14. Amy, female, 10, Mar 26, 2010. Mirrors herself repeatedly in class/homework; dislikes study; otherwise healthy.
Treatment: XNKQ + LR3, KI3, LI4, 3×/week; 5 weeks/course. Remove makeup/mirror; limit calls.
Results: Week 5 → behavior controlled, grades improved; +7 weeks → cured.

Case 15. Tom, male, 12, Apr 11, 2010. Brooding, distractible, dislikes sports.
Treatment: XNKQ + LR3, KI3, 3×/week.
Results: 12 weeks → marked improvement.

Case 16. Scott, male, 11, Apr 24, 2010. Difficult birth, neonatal pneumonia; frequent colds/fever/rhinitis; grade average <60.
Treatment: XNKQ + BL15, BL20, CV6, 3×/week.
Results: After 1 course, more energetic; completes homework quickly.

Case 17. Sam, male, 7, May 6, 2010. Obese; naps/dazes in class.
Treatment: XNKQ + BL15, BL20, CV6, 3×/week; diet/exercise.
Results: Week 4 → −5 lb, attentive; +8 weeks → cured.

Case 18. Ellie, female, 11, May 16, 2010. Fights with younger brother; talks in class; thin; T: red, scant coat; P: wiry-thin.
Treatment: XNKQ + LR3, LI4, 3×/week.
Results: 1 course → calmer, self-controlled, grades improved, follows rules.

Case 19. Renee, female, 8, Jun 15, 2010. Quiet; inattentive; slow/inefficient with tasks; C-section; fright history.
Treatment: XNKQ + LR3, LI4, 3×/week. Encourage interaction/group activities.
Results: 1 course → more lively, joined dance class.

Case 20. Bob, male, 6, Jun 26, 2010. Provokes peers; spills tableware intentionally; head strike at age 3; ADHD dx.
Treatment: XNKQ + LR3, LI4, 3×/week.
Results: 1 course → marked relief.

Case 21. Gary, male, 8, Jul 3, 2010. Appears attentive but not listening; seasonal sneezing/rhinitis.
Treatment: XNKQ, 3×/week.
Results: 1 course → rhinitis and ADHD essentially cured.

Case 22. Maddie, male, 9, Jul 18, 2010. Scribbles on desks; grade ~50; thin; constipation; on ADHD meds >1 year with low appetite (½ normal).
Treatment: XNKQ + SJ6, ST25, 3×/week.
Results: Week 7 → appetite/BM normal; stopped desk damage; week 12 → attentive, grades 75; near cure.

Case 23. Alice, female, 8, Aug 4, 2010. Quiet; does homework but slow; grades ~50.
Treatment: XNKQ + LI4, LR3, 3×/week.
Results: Week 6 → grades ~70, joined soccer; week 12 → B+, near cure.

Case 24. Clara, male, 12, Aug 21, 2010. Daytime somnolence; poor sleep; high-sugar beverages; grades 55.
Treatment: XNKQ + LR3, LI4, 3×/week; increase produce; avoid sugary drinks; remove gaming/computer.
Results: Week 3 → 75; 1 course → marked relief.

Case 25. Cody, male, 9, Sep 11, 2010. Frequent quarrels; disruptive; ADHD dx.
Treatment: XNKQ + LR3, LI4, 3×/week.
Results: Week 4 → grades improved; week 8 → symptom relief.

Case 26. Lisa, female, 10, Sep 22, 2010. URI unresponsive to antibiotics; anxious about falling grades; ADHD dx since 8.
Treatment: XNKQ, 3×/week; 3 weeks/course.
Results: Week 1 → URI resolved; week 3 → grades up; week 12 → good academic performance, near cure.

Case 27. Danny, male, 10, Oct 12, 2010. Taciturn, irritable, defiant; thin, picky eater; P: wiry-slippery.
Treatment: XNKQ + LI4, LR3, ST40, BL15, BL20, CV6, 3×/week.
Results: Week 2 → appetite improved, +5 lb; week 4 → grades up, steadier mood; week 8 → symptoms reduced.

V. Discussion

1. Clinical Efficacy of XNKQ for ADHD

This randomized, single-blind study showed total effective rate 89.2% for acupuncture vs 78.8% for methylphenidate, with a significant difference. Both treatments significantly improved the Hyperactivity Index, but acupuncture showed greater improvement. For the 9 inattention and 9 hyperactivity/impulsivity DSM-IV items, most resolution rates did not differ between groups; only “failure to follow through on instructions” showed a significant advantage for acupuncture (P<0.05). Age (6–10 vs 11–14) did not influence efficacy within the acupuncture group. Safety favored acupuncture, with no notable adverse events vs GI/appetite side effects on medication.

Overall, XNKQ demonstrates definite efficacy for ADHD, with higher total effectiveness than methylphenidate, comparable symptom resolution across most DSM-IV items, age-independent benefits, and better tolerability.

2. Mechanistic Considerations

2.1 TCM Perspective

ADHD is a common pediatric neurobehavioral disorder with unclear biomedical etiology. In TCM it aligns with categories such as zang sao, restlessness, forgetfulness, etc. Core pathogenesis: yin deficiency with yang hyperactivityand yin-yang disharmony, involving the Heart, Liver, Spleen, and Kidney. Treatment aims to harmonize yin–yang with pattern-based strategies: strengthen Spleen, tonify Kidney, soothe Liver, nourish Heart, open the orifices, calm the spirit, invigorate blood.

2.2 Rationale for the XNKQ Prescription

Principal points: PC6, GV26, SP6, GV20, EX-HN3, GV23, HT7, PC7; additions per pattern (KI3, LR3; BL15, BL20; ST40).

PC6 (Yin Linking Vessel, Luo of Pericardium) nourishes Heart and calms Shen;

GV26 (Du/hand-foot yin-yang meeting) regulates Du and opens orifices.

SP6 (meeting of Spleen–Liver–Kidney) supplements Kidney, nourishes yin/marrow, benefits brain.

Yintang, Shangxing → Baihui along Du open the orifices, pacify Liver wind, supplement essence/marrow, and harmonize yin–yang.

For XNKQ’s adaptation to ADHD (no hemiplegic side), bilateral HT7 and PC7 substitute for side-specific HT1, LU5 in stroke protocols.

Combined, these points nourish Heart/Kidney, pacify Liver, arouse and tranquilize shen, strengthen the brain, and harmonize yin–yang, matching ADHD’s TCM pathogenesis.

3. Limitations and Future Work

Sample size was relatively limited; future studies should expand to multicenter, large-sample trials. Elements of data collection/design were individual-led, possibly introducing limitations/subjectivity; future work should form a team-based research group. Diagnostic/efficacy criteria in the field lack uniform standards; studies on mechanisms remain relatively few. Future research should optimize point prescriptions, clarify effective point rules, manipulation, timing, and stimulation dose, to establish best-practice protocols.

Recent TCM work in ADHD shows promise, but standardization of diagnosis, efficacy criteria, and pattern classification is needed; many studies remain at observational levels. Addressing these gaps will elevate ADHD research to a new level.

Conclusion

Drawing on the mentor’s clinical experience with XNKQ, this study observed clinical efficacy in ADHD: the acupuncture group achieved a total effective rate of 89.2% with a significant HI improvement vs baseline and significantly better overall efficacy than methylphenidate. This supports XNKQ as an effective clinical option for ADHD.

Additionally, by reviewing literature on ADHD and XNKQ, we summarized pathogenesis, treatments, clinical applications, and mechanisms. Findings suggest that, consistent with pattern-based TCM thinking, when pathomechanism aligns, XNKQ can be applied to multiple clinical conditions with favorable outcomes. Promotion of XNKQ in modern practice on the basis of pathomechanistic concordance and expansion of its clinical indications may better guide care.

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附录

附录1

附录

美国精神病协会制定的《精神障碍诊断和统计手册》第四版 (DSM-IV)对注意力缺陷多动症的诊断 标准:

A.(1)或(2)

(1)注意分散:以下症状>6条，持续6个月以上且达到与发育水平不相适应和不一致的程度:

a)常常不注意细节问题或经常在作业，工作或其他活动中犯一些粗心大意的错误;

b)在工作或游戏中难以保持注意集中;

c)别人和他说话时常似听非听;

d)常不能按别人的指示完成作业，家务或工作(不是由于违抗行为或未能理解所致);

e)常难以组织工作和游戏;

f)常逃避、讨厌或不愿做要求保持注意集中的工作(如学校作业或家庭作业);

g)常常丢失学习和活动要用的物品(如玩具、学校指定的作业、铅笔、书本或工具);

h)常容易受外界刺激而分散注意力;

i)日常活动中容易忘事;

(2)多动/冲动:以下症状>6条持续6个月以上且达到与发育水平不相适应和不一致的程度;

a)常常手或脚动个不停或在座位上不停扭动;

b)在教室或其他要求保持坐位的环境中常离开座位;

c)常难以安静地玩耍或从事闲暇活动;

d)常在不恰当的情况下乱跑或乱爬(成人或青少年仅限于主观感觉坐立不安);

e)经常忙个不停或常像“被摩托驱赶着”活动;

《Conners儿童行为量表》项目评分

1.不安宁或活动过多()

2.易激惹，好冲动()

3.时常打扰其他儿童()

4.难于完成已开始的工作，注意力短暂()

5.经常地坐立不安()

6.注意力不集中，易于分心()

7.要求必须即刻得到满足，易于受挫折()

8.常常容易哭()

9.情绪变化迅速且激烈()

10.易于发脾气，暴躁和不可预测的行为()

总分()

备:服用本药后有何不适，请填写在右侧相应括号内。如没有，请填“无”() 上述各项按活动程度分为四级:分别填写0(没有)、1(偶有)、2(较常见)、

3(很多)。