Review Article

Traditional Oriental Herbal Medicine for Children and Adolescents with ADHD: A Systematic Review

Table 1

Selected studies characteristics.

Study Method ParticipantsInterventionOutcomes

Cheng et al. 2006
[19]
Randomized Control TrialTreatment group  
Number: 50, male/female: 39/11  
Age range: mean 8.7 ± 1.5    
Control group  
Number: 50, male/female: 40/10   
Age range: mean 8.9 ± 1.4      
Country: China  
Diagnostic criteria: DSM-IV
Baseline characteristic: not described
Treatment group  
Yizhiyidong decoction 30 mL each time, 3 times a day for 12 weeks    
Control group  
Ritalin 5 mg–10 mg each time, twice a day for 12 weeks
The study defined treatment effect as follows:   
(i) Showing effectiveness—disappearance of symptoms, Conners index decrease ≥80%: treatment/control: 16/23  
(ii) Showing improvement—improvement of symptoms, Conners index decrease 80%–50%: treatment/control: 21/18  
(iii) Ineffective—no improvement or worsening in core symptoms, Conners index and studying: treatment/control: 13/9

Kong et al. 2007 [20]Randomized Control TrialTreatment group  
Number: 60, male/female: 44/16  
Age range: mean 8.4 ± 1.42    
Control group  
Number: 60, male/female: 48/12  
Age range: mean 8.40 ± 1.40      
Country: China  
Diagnostic criteria: DSM-IV  
Baseline characteristic: homogeneity for gender, age, and IQ
Treatment group  
Qijudihuang pill, 3 pills, 3 times a day for 3 months    
Control group  
Ritalin starting from 5mg and adjusted to 10 mg–20 mg for 3 months
There was no significant difference of treatment effectiveness between treatment group and control group. Followup 6 months and 12 months after treatment indicated that treatment had significantly more sustainable effect than control, and statistics showed that treatment group has significantly less side effects compared to control group.

Lai and Li 2006 [21]Randomized Control TrialTreatment/control: 21/19  
Male/female: 24/16
Age range: 6–14 (mean 8.437 ± 2.061)       
Country: China  
Diagnostic criteria: DSM-IV  
Baseline characteristic: homogeneity for gender, age, and course of disease
Treatment group  
Oriental herbal medicine decoction 150 mL
a day, 5 days a week for 8 weeks    
Control group  
Ritalin 0.3–0.5 mg/kg a day, 5 days a week for 8 weeks
The study defined treatment effect as follows:   
(i) Recovery—disappearance of core symptoms, Conners index decrease >80%, obvious improvement in studying, effectiveness sustains after stopping medication for 6 months: treatment/control: 2/1  
(ii) Showing effectiveness—obvious alleviation of core symptoms, Conners index decrease >50%, improvement in studying: treatment/control: 10/9  
(iii) Showing improvement—improvement of core symptoms, Conners index decrease >30%, improvement in studying but not stable: treatment/control: 7/6   
(iv) Ineffective—no improvement or worsening in core symptoms, Conners index and studying: treatment/control: 3/3

Li and Chen 1999 [22]Randomized Control TrialTreatment group  
Number: 37, male/female: 37/0  
Age range: mean 10.7 ± 4.2      
    Control group  
Number: 33, male/female: 33/0   
Age range: mean 10.3 ± 3.9      
Country: China  
Diagnostic criteria: DSM-IV and Conners Rating Scale  
Baseline characteristic: Homogeneity for gender, age, course of disease, and IQ
Treatment group  
Duodongning granule 3 g for age <8, 6 g for age ≥8 daily with placebo that resembles Ritalin, 1 tablet each day, 6 days a week for
4 weeks     
  Control group  
Ritalin 10 mg daily, with placebo that resembles Duodongning granule and same dosage as treatment group, 6 days a week
for 4 weeks
The study defined treatment effect as follows:   
(i) Showing effectiveness—disappearance of core symptoms, Conners index <1.2, obvious improvement in studying, normal social function: treatment/control: 17/15  
(ii) Showing improvement—improvement of core symptoms, Conners index decrease but still >1.5, improvement in studying and social function but not stable: treatment/control: 16/14  
(iii) Ineffective—no evident improvement in core symptoms, Conners index, studying, and social function: treatment/control: 4/4     
3 subjects in treatment group reported mild loss of appetite, while 7 subjects in control group reported evident loss of appetite and 1 subject reported sleeplessness.

Li et al. 2004
[23]
Randomized Control TrialTreatment/control: 58/48  
Male/female: 84/22  
Age range: 7–15       
Country: China  
Diagnostic criteria: DSM-IV  
Baseline characteristic: Homogeneity for age, gender, and course of disease      
There were 114 subjects originally, 3 excluded and 5 attrited. 4 were attrited due to adverse effect caused by methylphenidate but attrition/exclusion reason for other subjects was not indicated.
Treatment group  
Yizhiningshen granules 1 dose for age 7–10, 2 doses for age 10–15, twice a day for 6 weeks    
Control group  
Ritalin 5 mg per day for age 7–8, 10 mg per days for age 8–15, twice a day, 5 days a week for 6 weeks
The study defined treatment effect as follows:   
(i) Recovery—disappearance of core symptoms, Conners index decrease >80%, obvious improvement in studying, effectiveness sustains after stopping medication for 6 months, Chinese medicine therapeutic index ≥90%: treatment/control: 6/2  
(ii) Showing effectiveness—obvious alleviation of core symptoms, Conners index decrease ≤80% and >50%, improvement in studying, Chinese medicine therapeutic index <90% and ≥60%: treatment/control: 20/18  
(iii) Showing improvement—improvement of core symptoms, Conners index decrease ≤50% and >30%, improvement in studying but not stable, Chinese medicine therapeutic index <60% and ≥10%: treatment/control: 26/22  
(iv) Ineffective—no improvement or worsening in core symptoms and studying, Conners index decrease ≤30%, Chinese medicine therapeutic index <10%: treatment/control: 6/6

Lin et al.2007 [24]Randomized Control TrialTreatment group  
Number: 40, male/female: 32/8   
Age range: 6.5–13, mean 8.7 ± 2.7    
Control group 1 (Ritalin)   
Number: 40, male/female: 31/9   
Age range: 7–12, mean 8.5 ± 2.5    
Control group 2 (treatment + Ritalin)  
Number: 40, male/female: 32/8  
Age range: 7–11, mean 8.2 ± 2.1      
Country: China  
Diagnostic criteria: DSM-IV  
Baseline characteristic: Homogeneity for gender, age, and course of disease
Treatment group  
Ningshen oral liquid 30–60 mL per day for 12 weeks    
Control group 1  
Ritalin 5 mg–40 mg per day for 12 weeks    
Control group 2  
Ningshen oral liquid 30–60 mL plus Ritalin 5 mg–40 mg per day for 12 weeks
The study defined treatment effect as follows:   
(i) Near recovery—disappearance of core symptoms, Conners index decrease >80%, obvious improvement in studying: treatment/control 1/control 2: 4/3/7  
(ii) Showing effectiveness—obvious alleviation of core symptoms, Conners index decrease ≤80% and >50%, improvement in studying: treatment/control 1/control 2: 7/7/10  
(iii) Showing improvement—improvement of core symptoms, Conners index decrease ≤50% and >30%, improvement in studying but not stable: treatment/control 1/control 2: 16/19/17  
(iv) Ineffective—no improvement or worsening in core symptoms and studying, Conners index decrease ≤30%: treatment/control 1/control 2: 13/11/6    
Assessment of Conners index 12 weeks after stopping medication reported that there was significant drop in effectiveness in Ritalin control group but not in treatment group and combined treatment group.

Ma 2007 [16]Randomized Control TrialTreatment group  
Number: 22, male/female: 15/7     
Control group  
Number: 20, male/female: 20/16       
Age range: 6–13      
Country: China  
Diagnostic criteria: DSM-IV  
Baseline characteristic: not described      
There were originally 49 subjects in the study and 7 cases were attrited, but there was no indication of whether they belonged to treatment group and control group.
Reasons for attrition were also not sufficiently presented
Treatment group  
Duodongting decoction 150 mL each time for age 4–7, 200 mL each time for age 8–12, twice a day for 28 days, and break for 2 days (1 treatment cycle) before starting another treatment cycle, for 2 cycles + behavioral therapy    
Control group  
Ritalin 0.45 mg/kg for 28 days and break for 2 days (1 treatment cycle) before starting another treatment cycle, for 2 cycles + behavioral therapy
The study defined treatment effect as follows:   
(i) Showing effectiveness—hyperactivity, and inattention alleviated by 2/3: treatment/control: 7/6  
(ii) Showing improvement—obvious symptomatic improvement, hyperactivity and inattention alleviated by 1/2: treatment/control: 11/10  
(iii) Ineffective—no symptomatic relief after 2 treatment cycles treatment/control: 4/4

Ma et al. 2007
[25]
Randomized Control TrialTreatment group/control group-Chinese medicine/control group-Ritalin: 55/53/51      
Country: China  
Diagnostic criteria: DSM-IV  
Baseline characteristic: homogeneity for age, gender, and course of disease      
Attrition criteria was mentioned but there was no indication if any subject was attrited because initial number of subjects randomized was not stated
Treatment group  
YIzhiningshen granules 10 g each time for age 6–10, 15 g each time for age 11–18,
twice a day for 24 weeks    
Control group 1-Chinese medicine   
Jingning oral liquid 10 mL each time,
twice a day, 5 days per week for 24 weeks    
Control group 2-Ritalin  
Ritalin 5 mg each time for age 6–8, and 10 mg each time for age 9–18, twice a day,
5 days per week for 24 weeks
The study defined treatment effect as follows:  
(i) Recovery—disappearance of core symptoms, Conners index decrease >80%, obvious improvement in studying and social function, Chinese medicine therapeutic index ≥90%: treatment/control 1/control 2: 6/3/3  
(ii) Showing effectiveness—obvious alleviation of core symptoms, Conners index decrease ≤80% and >50%, improvement in studying and social function, Chinese medicine therapeutic index <90% and ≥60%: treatment/control 1/control 2: 29/18/19  
(iii) Showing improvement—improvement of core symptoms, Conners index decrease ≤50% and >30%, improvement in studying but not stable, Chinese medicine therapeutic index <60% and ≥10%: treatment/control 1/control 2: 15/27/22  
(iv) Ineffective—no improvement or worsening in core symptoms and studying, Conners index decrease ≤30%, Chinese medicine therapeutic index <10%: treatment/control 1/control 2: 5/5/7

Wang and Shi 2003 [26]Randomized Control TrialTreatment group  
Number: 58, male/female: 49/9
Age range: mean 9.3 ± 2.9    
Control group  
Number: 50, male/female: 42/8  
Age range: mean 9.5 ± 3.2      
Country: China  
Diagnostic criteria: DSM-IV and Conners index >1.5  
Baseline characteristic: homogeneity for
age, gender, course of disease, and IQ
Treatment group  
Jingning oral liquid 10 mL each time, twice a day for 4 weeks    
Control group  
Ritalin 10 mg in the morning and 5 mg at night for 4 weeks
The study defined treatment effect as follows:
(i) Showing effectiveness—disappearance of symptoms, obvious improvement in social function and studying, Conners index < 1.2: treatment/control: 27/23  
(ii) Showing improvement—improvement of symptoms, improvement in social function and studying but improvement not stable, decrease in Conners index but still >1.5: treatment/control: 26/22  
(iii) Ineffective—no improvement or worsening in symptoms, Conners index and studying: treatment/control: 5/5    
No side effects observed in treatment group but 10 subjects in control group reported nausea and loss in appetite, 2 subjects reported dizziness, and 1 subject reported sleeplessness.

Xu 2005 [27]Randomized Control TrialTreatment group  
Number: 100, male/female: 87/13  
Age range: mean 9.3 ± 2.4    
Control group  
Number: 50, male/female: 43/7  
Age range: mean 9.1 ± 2.3      
Country: China  
Diagnostic criteria: DSM-IV criteria of combined type ADHD  
Baseline characteristic: homogeneity for
age, gender, course of disease, and IQ
Treatment group  
Jingningzhidong granules 1 g/kg/day, maximum 50 g, for
12 weeks    
Control group  
Ritalin 0.3 mg/kg/day, increase dosage gradually to maximum 0.6 mg/kg/day, for 12 weeks
The study defined treatment effect as follows:   
(i) Showing effectiveness—decrease in Conners index by ≥66%: treatment/control: 56/26  
(ii) Showing improvement—decrease in Conners index ≥33% and <66%: treatment/control: 22/14   
(iii) Ineffective—decrease in Conners index < 33%: treatment/control: 22/10    
There was almost no side effect reported in treatment group but subjects in control group reported more obvious and persistent side effects. Assessment of Conners index 4 weeks after stopping medication reported that there was significant drop in effectiveness in control group but not in treatment group.

L. Yang and J. Yang 2005 [28]Randomized Control TrialTreatment group  
Number: 48, male/female: 40/8   
Age range: 6–12 (mean 8.3)     
Control group  
Number: 38, male/female: 31/7  
Age range: 6.5–13 (mean 8.6)       
Country: China  
Diagnostic criteria: DSM-IV  
Baseline characteristic: Homogeneity for gender, age, course of disease, and coexisting symptoms
Treatment group  
Yizhiningshen oral liquid 2 × 10 mL, 3 times a day for 3 months + behavioral therapy    
Control group  
Ritalin 10 mg, once per day for 3 months, no medication during weekend and holiday + behavioral therapy
The study defined treatment effect as follows:   
(i) Recovery—disappearance of core symptoms, Conners index decrease >80%, obvious improvement in studying, effectiveness sustains after stopping medication for 6 months: treatment/control: 6/2  
(ii) Showing effectiveness—obvious alleviation of core symptoms, Conners index decrease >50%, improvement in studying: treatment/control: 16/15  
(iii) Showing improvement—improvement of core symptoms, Conners index decrease >30%, improvement in studying but not stable: treatment/control: 20/17  
(iv) Ineffective—no improvement or worsening in core symptoms, Conners index and studying: treatment/control: 6/4    
Treatment group showed improvements in co-existing symptoms such as loss in appetite, recurrent flu, but no evident improvement in control group.

Yu and Wang 2005 [29]Randomized Control TrialTreatment group  
Number: 68, male/female: 54/14  
Age range: mean 9.1 ± 2.8    
Control group  
Number: 20, male/female: 15/5  
Age range: mean 9.3 ± 2.7      
Country: China  
Diagnostic criteria: DSM-IV and Conners index > 1.5  
Baseline characteristic: homogeneity for
age, gender, and course of disease
Treatment group  
Jingning decoction one dose per day for 3 months    
Control group  
Ritalin 0.2–0.5 mg/kg/day for 3 months
The study defined treatment effect as follows:   
(i) Showing effectiveness—disappearance of symptoms, obvious improvement in social function and studying, Conners index < 1.2: treatment/control: 42/15  
(ii) Showing improvement—improvement of symptoms, improvement in social function and studying but improvement not stable, decrease in Conners index but still >1.5: treatment/control: 19/3  
(iii) Ineffective—no improvement in symptoms, Conners index and studying: treatment/control: 7/2