AUTISM

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Autism is characterized by profound disturbance in the emergence of social

relations, apparent as early as the first months of life and almost always by age
three years (1). Disturbances in brain maturation appear to be a cause of this
syndrome, which may be exacerbated by deficiencies in certain nutrients (e.g.,
vitamin B6, magnesium, glycine, glutamine), by allergies to foods, and other
factors. The severity of symptoms can vary markedly between individuals and in
response to treatment.
The relationship of serotonin to autism has been investigated extensively, but
the implications remain unclear due to conflicting findings. Serotonin levels in
autistic individuals tend to be elevated (2, 3, 8), as are the levels of the serotonin
precursor tryptophan (11), with apparent increase in symptom severity correlated
with the tryptophan levels. In fact, a hypothesis has been put forward (2)
suggesting that there is a maturation defect in the monaminergic systems in
autism. Alternatively, however, it may be that the defect in serotonin metabolism
is a marker for tendency to experience autism but is not a cause of the
disorder. Relatives of autistic children are found to have a variety of serotoninmetabolism disorders, but not the mental disorder (9). A serotonin lowering
drug, fenfluramine, was tested (10) in a double-blind placebo-controlled trial, but
no obvious therapeutic effect was noted. On the other hand, a test (12) of both
the dopaminergic antagonist (amisulpride) and the dopaminergic agonist
(bromocriptine) did show some effects that might indicate a role of the
monoamines in autism symptoms. The evidence thus far points to a role of
monoamines in the severity of autism symptoms but it appears that the
biochemical imbalance is not the sole disorder leading to autism.
Autism has been correlated with other childhood disorders that are related to
brain function, such as attention deficit disorder (ADD), mental retardation,
epilepsy, and learning disabilities (4). While the specific mechanisms and
manifestation of these disorders differ significantly, there is a relatively high
incidence of one or more such disorders occurring simultaneously and a similar

benefit is claimed to using certain nutritional approaches, such as administering

nutritional supplements and avoiding allergens.
Chinese books on pediatrics do not mention autism, and this subject does not
appear in the modern Chinese medical journal literature either. In the
book Clinical Experiences (5), a condition is described as follows: disturbance in
mental development, apathy, tardiness of speaking... which is described as a
syndrome of heart blood deficiency and the suggested treatment is an herbal
formula given as a decoction, consisting of 10 grams each ginseng, ophiopogon,
and acorus, 6 grams each of tang-kuei and polygala, 5 grams of frankincense, 3
grams of cnidium, and 1.5 grams of cinnabar. This formula nourishes the heart qi,
yin, and blood, vitalizes the heart blood, removes phlegm obstructing the orifices
of the heart, and calms the agitation of the heart spirit (shen). This prescription
might be compared with the formula recommended in the pediatrics volume of
the Encyclopedia of Traditional Chinese Medicine (6) for treatment of
hyperkinetic syndrome in patients who display symptoms of changeable interests,
divided attention, amnesia, dreaminess, stutter, or problems in formation of phrases
and sentences.... The formula is as follows: 12 grams each of pseudostellaria and
astragalus, 9 grams each of hoelen, atractylodes, tang-kuei, polygala, acorus, and
schizandra, with 15 grams of wheat, 6 grams of licorice, and 10 pieces of
jujube. This is basically a combination of Licorice and Jujube Combination (Gan
Mai Da Zao Tang), and Astragalus and Zizyphus Combination (Yang Xin Tang),
two traditional formulas used for mental disturbance. The new formula tonifies
the qi and blood, removes phlegm obstruction of the orifices, and calms the spirit.
In an article (7) reviewing basic Chinese medical treatments for mental
syndromes, the classical division of mental disorders into dian and kuan
types is made. The dian type refers to taciturn and uncommunicative behavior,
dementia, lack of sympathy, apathy, and soliloquy; it refers to the person who
turns inward. This is closest to the autistic condition. The kuan type, by
contrast, is very aggressive; it refers to the person who acts out, loudly and
sometimes violently. The famous physician Zhou Danxi stated Dian belongs to
yin and kuan to yang...both conditions are caused by the entanglement of phlegm
in the heart... The ancient texts also attribute the dian and kuan states to
congestion of the seven emotions which generate phlegm and mask and obstruct
the orifice of the heart. A general formula for alleviating the phlegm obstruction
is made by combining pinellia, magnolia bark, perilla fruit, hoelen, arisaema,

curcuma, acorus, polygala, perilla leaf, sinapis, raphanus, bamboo juice, and
styrax (liquid). Deficiency of qi and blood also gives rise to the dian condition;
for symptoms and signs that include spiritlessness, suspiciousness, melancholy
mood, refusal of food, soliloquy, and tendency to cry, the formula recommended
contains codonopsis, atractylodes, astragalus, tang-kuei, licorice, polygala, fushen, saussurea, ginger, jujube, wheat, nardostachys, fu-shou, citrus, zizyphus,
albizzia, polygonum stem, and dragon bone. In the book Clinic of Traditional
Chinese Medicine (13), a formula for dian type condition (stagnancy of phlegm
and qi), the indications include apathy, dementia, muttering to oneself, and the
treatment is 12 grams of curcuma, 10 grams each of citrus, pinellia, hoelen,
arisaema, chih-shih, polygala, acorus, and cyperus, and 6 grams of licorice.
In the review article (15) on the classification and treatment of mental
disorders, early Chinese writings about various mental syndromes are
mentioned. Among them is this commentary attributed to Li Peng in the Ming
Dynasty book Entering the Door of Medicine:
The mental disorders is described in but one word: phlegm. These
diseases are mostly caused by internal injury and only extremely rarely
due to external pathogenic influences. The internal trauma, excessive
wetness, inappropriate diet, food stagnation, could produce phlegm
fire. Then uprising phlegm fire masks the heart orifices. When the
person was frightened or fearful or worried or thinking too much, the
fire will become more vigorous and then the spirit will not be able to
reside in its house. Then the phlegm would suffocate the empty house.
The formulas described above clear out the accumulated phlegm and help
prevent formation of additional pathological phlegm. It is important to
recognize, however, that adverse dietary practices can overcome the impact of
the herbs.
Discussing specifically the dian type of mental condition, it is said (13, 15)
that it is mostly caused by traumatic injury to the seven emotions. The injured
emotion will lead to heart fire, obstruction of liver qi, and failure of the ascending
of the spleen qi. When qi becomes stagnated, the body fluid will accumulate and
condense to form phlegm. The uprising of phlegm will interfere with and cloud
the spirit. As an example of a specific treatment, the following herbs are

suggested: 12 grams of hoelen, 9 grams each of pinellia, citrus, chih-shih,

bamboo, cyperus, and polygala, 6 grams each of curcuma, acorus, saussurea, and
licorice, plus 3 slices of fresh ginger.
To what extent might these theories and treatments for a yin-type mental
disorder apply to the autistic child or adult? Many of the discourses on mental
disorders by Chinese doctors refer to people who develop the mental syndrome
after being relatively normal, but are then influenced by some events. While this
may be the case in some autistic children, current Western investigations suggest
that there is a physical and biochemical disorder present at birth. However, the
severity of symptoms can be modulated in many children by diet, nutrition, and
drugs, and therefore Chinese medical treatments for similar symptoms acquired
in individuals through various experiences (which would affect the biochemistry
rather than the physical structures of the brain) may be applicable.
Which particular combination of herbs, though, might work best for an
autistic child? One can not know until something has been tried. The only report
available to us on treatment of autism with Chinese herbs is an informal
communication from a medical doctor in Belgium who had studied with this
Institute. He claimed that he had obtained a notable favorable response in several
autistic children using the prepared Bamboo and Ginseng Combination (Zhu Ru
Wen Dan Tang). This formula contains bamboo, licorice, coptis, bupleurum,
hoelen, ginger, pinellia, ginseng, cyperus, citrus, and chih-shih. As with the
formulas mentioned above, it includes digestion-promoting, phlegm-resolving,
and sedative herbs. Unlike some of the above, it contains none of the blood tonic
herbs. The report of effectiveness was made several years ago, and the Institute
does not have current contact with this physician.
More recently, a formula for treatment of ADD was developed by ITM, called
Acorus Tablets (21), and several informal reports of effectiveness were obtained
from practitioners who gave it to their patients. This formula contains acorus,
polygala, fu-shen, alpinia, curcuma, rehmannia, dragon bone, dragon teeth, oyster
shell, bamboo sap, tortoise shell, and succinum. Like the above formulas, it
contains herbs for resolving phlegm, sedatives, and blood tonics, but it contains
only one herb for promoting digestive functions (alpinia). This formula was
based on the claimed effective use of similar combinations for the treatment of
ADD in China. In the treatment of epilepsy in children, similar formulations are

used, with an emphasis on resolving phlegm obstruction. Another combination

(21) produced by ITM, Cyperus 18, was designed to treat mental depression that
arose from the syndrome of heart fire, liver qi stagnation, and poor conductance
of food essence by the spleen, with resultant phlegm obstruction. This formula
contains cyperus, perilla leaf, bamboo, uncaria, saussurea, bupleurum, aurantium,
fu-shen, pinellia, chih-shih, coptis, ginseng, ophiopogon, tang-kuei, cnidium,
ginger, arisaema, and licorice. Informal reports have indicated that it is often
successful. As an example, a patient at our own clinical facility (under treatment
for multiple sclerosis) had used antidepressive drugs for eight years, but was able
to discontinue the drugs after use of this formula for less than six months.
Given the limited experience thus far and the commentaries from ancient and
modern writers about treatment of mental disorders, including childhood
problems such as ADD, mental retardation, and epilepsy, it would appear that the
most likely approach to prove helpful is to utilize the phlegm-resolving herb
compounds. It is possible that the digestion-promoting and qi and blood tonic
therapies used in China accomplish a function similar to the use of vitamin and
amino acid therapies in the West. Since the latter have been tested and appear
safe and somewhat effective, one may decide to utilize the Western nutritional
approach and the Chinese method of removing phlegm obstruction.
The most frequently used herbs for treating phlegm obstruction that causes
mental disturbance are polygala and acorus. Polygala has a long-standing
reputation in China for improving mental conditions. According to British
doctors (16) who visited China during the previous century, polygala is
supposed to have a special effect upon the will and mental powers, giving
strength and character, improving the understanding, strengthening the memory,
and increasing the physical powers. Acorus is reported (17) to be effective in
the treatment of epilepsy of the phlegm-dampness and phlegm-heat types, being
of benefit in 80% and 55% of cases respectively. It is similarly reported that if
acorus is added to a basic sedative formula, it is effective in treating melancholia
and that patients abandon the idea of suicide by taking about 7 doses of the
decoction. In a book (18) reviewing the current uses of commonly prescribed
Chinese herbs, both acorus and polygala are mentioned as treatments for epilepsy
and mental disorders, with acorus specifically mentioned as valuable in the
treatment of children. In another book (19) reviewing the modern use of herbal

formulas, it is mentioned that the combination of arisaema, polygala, and acorus

are added to other formulas for the symptomatic treatment of spiritual inertia.
Of course, when a skilled practitioner is available to access the needs of the
autistic child, it might be determined that qi and/or blood tonics, or other herbs
are needed. These would especially be suggested if the child is growing slowly,
is pale, or has a weak pulse. A suggested herbal combination based on the above
considerations would be comprised of ginseng, hoelen, pinellia, citrus, ginger,
jujube, licorice, acorus, polygala, tang-kuei, fu-shen, and bamboo. For
convenience of obtaining herb supplies and administering herbs in pill form (if
desired), this combination could be approximated by using Er Chen
Wan (traditional formula made as a patent medicine) plus Acorus Tablets (child
size tablets).
Some Chinese herbs have been shown to reduce serotonin levels or inhibit the
action of serotonin (20). Serotonin is a mediator of pain signals, and analgesic
herbs sometimes function via reducing the signal transmission. Diterpene
alkaloids, such as aconitine (from aconite) and methysergide, block the effects of
serotonin. Rauwolfia alkaloids, such as reserpine and rhynchophylline (from
uncaria), deplete serotonin. Volatile oils from asarum and acorus also lower
serotonin levels (the active constituent in acorus is asarone). Of these herbs, only
acorus is frequently mentioned in the formulas above, though uncaria is often
used in treating mental disorders (included in Cyperus 18), and is used in
childrens remedies. A formula comprised of aconite, dry ginger, cinnamon bark,
and licorice was utilized (14) in treating dian-type schizophrenia characterized by
little change in facial expressions, dull eyes, decrease in self-initiated
movements, inability to love, talking little and having sentences with little
content or unfinished, and lack of interest in socializing. the recommended
dosage of aconite was quite high. It is possible that the serotonin-inhibitors
reduce the symptoms of the dian type mental disorders. To obtain a serotonininhibiting action, the dosage of the herbs may need to be higher than is often
recommended for treating other disorders. The need to use high dosages is also
the situation with nutritional supplements applied in Western studies of autism.
In a review of vitamin B6 and magnesium supplementation trials provided by
the Autism Research Institute, the dosage of the vitamin administered covered a
wide range, but was typically 30 mg/kg/day up to about one gram per day, and

magnesium dosage was typically 1015 mg/kg/day, up to about 500 mg. These
levels far exceed what is available from dietary sources. Glycine, in the form of
dimethylglycine, is recommended in dosages of 125500 mg/day, starting with a
low dose and increasing gradually to minimize the occurrence of hyperactivity in
response to initial dosing.
Due to the lack of familiarity of most Westerners with Chinese herbs, leading
to questions about their safety, efficacy, method of application, and duration of
use, it can not be expected that Chinese herb formulas will be widely utilized in
the treatment of autism, especially in young children. However, there is
sufficient evidence that Chinese physicians have had experience and some
success in treating mental disorders similar to autism (perhaps sometimes autism
itself), so that it is a method that should be pursued with due caution along with
the recommended dietary and nutritional approaches. There are several herbal
formulas which have been used extensively in the West without significant
adverse effect that can be used as the starting point for experimental treatments.
References
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17. Dong ZL and Yu SF, Modern Study and Application of Materia Medica,
1990, China Ocean Press, Beijing.
18. Ou Ming, editor, Chinese-English Manual of Commonly Used Herbs in
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Medicine, 1990, China Ocean Press, Beijing.
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21. Dharmananda S, A Bag of Pearls, 1994 Institute for Traditional Medicine,
Portland, OR.

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