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1 Original article J of Oriental Neuropsychiatry 2013:24(1): ADHD 의한약물치료에대한최신임상연구동향 년부터 2012 년까지중국논문을중심으로 - 유춘길, 조아람, 서주희, 정성식 *, 이지수, 성우용 국립중앙의료원한방신경정신과, 한방내과 *, 침구과, 부산대학교한의학전문대학원한방신경정신과교실 The Current State of Studies for Herbal Medicine of Attention Deficit Hyperactivity Disorder (ADHD) -Focusing on Chinese Journals- Chun-Gil Ryu, A-Ram Cho, Joo-Hee Seo, Seong-Sik Jeong*, Ji-Su Lee, Woo-Yong Sung Departments of Oriental Neuropsychiatry, *Oriental Internal Medicine, Oriental Acupucture and Moxibustion, National Medical Center, Department of Oriental Neuropsychiatry, Pusan National University School of Korea Medicine Abstract Objectives : The purpose of this study was to take around herbal medicine for Attention Deficit Hyperactivity Disorder in China. Methods : A journal search was performed using China National Knowledge Infrastructure (CNKI) from 2007 to Key words searched were 'ADHD'. Results : 25 studies were selected. Case control studies showed that herbal medicine treatment reported better results than the western medicine treatment group. 12 case reports reported a significant improvement in herbal medicine treatment for patients with ADHD. Frequently used herbal materials were Rhizome of Polygalae Radix and Rhizome of Acori Gramineri Rhizoma (16 times), Root of Glycyrrhiza uralensis Fisch (14 times), Root of Rehmanniae Radix et Rhizoma Preparata and Sclerotium of Poria cocos Wolf (12 times). Conclusions : There have been many studies regarding herbal medicine for Attention Deficit Hyperactivity Disorder in China, and these studies can be applied to the clinical practices in Korea. Key Words: ADHD, Herbal medicine, CNKI, study. Received : February 25, 2013; Revised : March 19, 2013; Accepted : March 19, 2013 Correspondence : Joo-Hee Seo, Department of Oriental Neuropsychiatry, National Medical Center, 243, Ulgiro, Jung-gu, Seoul, Korea. Tel : , Fax : , herb9848@naver.com

2 2 The Current State of Studies for Herbal Medicine of Attention Deficit Hyperactivity Disorder (ADHD) I. 서론 주의력결핍과잉행동장애 (Attention Deficit Hyperactivity Disorder, ADHD) 는아동의발달상흔히볼수있는행동장애의하나로써, 주의집중력이짧고충동적인행동, 그리고과잉행동성향등을주된양상으로한다 1). 미국아동에서는아동의약 3~7% 가주의력결핍-과잉행동장애로진단될수있다고보고있으며. 우리나라의경우에도 2008년서울시환경보건진흥원이 44개교초등학교 1학년과 4학년을대상으로조사한결과유병율이 3.8% 로나타났고, 서울과대전지역을대상으로한국내역학조사결과에서는이보다더높은 7.6% 의유병율을나타냈다 2). ADHD 아동의서양의학적치료개입으로는약물치료와비약물치료로서의부모교육훈련, 인지행동치료, 사회적기술훈련, 놀이치료를비롯한심리치료등이사용되며, 2004년부터 2008년까지국내 ADHD 아동에대한치료를분석한결과약물치료가 67.3% 로가장많았다고보고되었다. 이러한약물치료는즉각적이고단기적인효과를보이기는하나우리나라의부모들이아동에게약물을사용하는것에대한부담감이있고, 아동에게적절한대처행동을습득시키는데한계가있으며 3), 가장흔히사용되는 Methylphenidate ( 상품명-Ritalin) 의경우맥박의증가, 혈압의증가와같은심혈관계부작용과불면, 식욕감소, 두통, 위통, 낮시간졸림, 짜증, 불안등의부작용이발생하기때문에비약물치료등의개입이요구되어왔다 4). 한의학의고대문헌중에서정확히일치하는병증과개념에대한논술은없으나임상증상을근거로볼때, 風, 躁動, 失聰, 健忘 등의범주에속한다고할수있으며, 소아는神氣가怯弱하여잘놀래고화도잘내고, 기뻐하기도잘함으로, 섭생부족등이있을때이러한증후가쉽게발생한다고보고있다 5). 국내에서한약물을사용한임상연구로는 Byun 6), Kim 7) 등소수의증례보고만이발표되었고, 문헌적고찰역시 2006년이전 ADHD 치료법에대해서만 포괄적으로이루어져왔다 8-10). 이에본연구에서는 ADHD 연구가보다더활발히진행되고있는중국에서 2007년이후발표된임상논문의고찰을통해 ADHD의한약물치료에대한최신동향을파악하여임상적접근에도움을주고자한다. II. 연구방법 1. 논문의검색 인터넷중국논문검색사이트인 CNKI (China National Knowledge Infrastructure; 中國知識基礎施設工程 ) 에서제공하는 CAJ (China Academic Journals; 中国学术期刊全文数据 ) 를이용하여 2007 년에서 2012 년까지의 ADHD 관련논문을검색하였다. 검색범위는醫藥衛生 (Medicine/Hygiene) 의 中医学, 中药学, 中西医结合 으로검색어 注意力缺陷多动障碍, 小儿多动症, ADHD, 兒童多動症 을이용하여검색하였다. 논문의검색은 2013년 1월에시행하였다. 2. 논문의선별논문의선정기준은사람을대상으로한연구이면서대상자는 ADHD 환자이고, 복합장애일경우주진단이 ADHD인경우, 복합치료를한경우주치료방법이한약물인경우로하였다. 동물대상연구, ADHD가주진단이아닌경우, 한약물치료가주치료방법이아닌경우, 종설논문인경우는제외하였다. 본연구의선정기준을바탕으로 2명의연구자가의견합의를이룬논문을포함시켰다. 또한비교임상연구에대해서는 Jadad Quality Assessment Scale을이용하여논문의질을평가하였다 11).

3 CG Ryu, AR Cho, JH Seo, SS Jeong, JS Lee, WY Sung 3 IV. 고찰 1. 연구의설계 모든비교임상연구에서선정기준, 제외기준은제시하였으나, 무작위배정의과정및맹검에관련한자세한기술은없었고, Kǒng 24) 의연구에서만탈락자의수와이유에대한언급이있었다. Jadad Quality Assessment Scale 점수는모두 1점이하로논문의질은낮은편이었다. 하지만국내연구에비해서연구의규모나수가비교적앞서있기때문에임상적으로참고할가치가있는것으로보인다. Fig. 1. Flow diagram preferred reporting items for review. III. 결과 1. 대상연구의선정 검색어를통한 1차검색을통하여중복된논문을제외한총 142 편이검색되었다. 그중문헌적고찰등비임상연구논문 35편을제외하고, 제목과초록을통해 ADHD 와관련없는논문 17편, 동물실험 18편을제외한임상논문 72편을선별하였다. 그후 72편논문의전문을분석하여한약물이주치료법이아닌논문 33편, 증례가 1편인논문 ( 증례 3예를단순나열한 1편포함 ) 7편, 구성약물의기재없이처방이름만언급된논문 7편을제외한후, 단일임상연구 12편, 비교임상연구 13편등총 25편의논문을선정하였다 (Fig. 1). 2. 임상연구의개요연구의설계방법, 연구대상의특징, 평가기준, 결과등을정리하였다 (Table 1, 2). 2. 진단기준진단기준으로는 를사용한논문이 11편으로가장많았고, ICD-10, DSM-III를사용한논문이각각 2편, 中国精神疾病分类与诊断标准 (CCMD-3:3 편, CCMD-2R:1편 ) 을사용한논문이 4편이었고, 나머지에서는임상증상에의해진단했다고기재하거나특별한언급이없었다. 3. 평가기준치료효과및부작용평가에서는특별한척도없이임상증상의변화에따라평가한경우가 13편이었다. (Conners Rating Scale) 를이용하여평가한논문은 6편,, IVA-CPT (Integrated Visual and Auditory Continuous Performance Test), 지능검사를함께사용한연구, 와 C-WISC (Chinese-Wechsler Intelligence for Children Scale) 를함께사용한연구,, Cancellation test, Safety test (AST, ALT, Cr, ECG) 를함께사용한연구,, Achenbach (Child Behavior Checklist-CBCL), CGI, TESS (Toxic Exposure Surveillance System) 를함께사용한연구, TESS, C-WISC, 를함께사용한연구, 와 Lab 검사를한연구가각각 1편이었다. (Conners Rating

4 4 The Current State of Studies for Herbal Medicine of Attention Deficit Hyperactivity Disorder (ADHD) Table 1. Case-Control Studies of Treatment on Patients with ADHD in China First author (year) Wāng CX 12) (2012) Chén XG 13) (2012) Wang YJ 14) (2011) Huáng D 15) (2011) Lóng H 16) (2010) Li XZ 17) (2009) Yú T 18) (2008) Liú FQ 19) (2008) Lǐ D 20) Wú D 21) Yáng JF 22) Zhāng SH 23) Sample size (age) Onset years 17 (6~11) 6 months~2 yrs 6~15 3 months~8 yrs (2.9 yrs) Case study 39 (7.35±2.84) 3 months 42 (5~16) 1~8 months 76 (5~15) 6 months~8 yrs Diagnostic criteria Psychiatry 20 (6.5~ ±1.6) 76 (5~13) 6 months~6 yrs 47 (5~) 6 months+ 51 (9~12) 2 months~13 months 36 (3~14) ICD (7~14) DSM-III 198 (~17) Treatments Gammaekdaejo-tang (Ganmaidazao-tang, GDT) 3 times/day, 1~3 months Ikjiryungbang (Yìzhìníngfāng) 2 times/day, 150 ml/once, 3~12 months Soajiryukdangjang (Xiaoerzhili Tangjiang) 10 ml/once, 3 times/day, 3 months Ikjigaegyu-tang (Yìzhìkāiqiào-tāng) 60 days Traditional Chinese Medicine (according to Mechanism of Disease) 1 time/day, 6 times/week, 3 months Ikjieungsin-granule (Yizhiningshen-granule) 6~10 yrs: 10 g/once 11~18 yrs: 15 g/once 2 times/d, 6 weeks. SosihotanghapChunmagudung-um gagam (Xiǎocháihútānghétiānmágōuténg-yǐnjiājiǎn) 2 times/day, 8 weeks Jakyakgamcho-tang (Sháoyaogāncǎo-tāng) 2 times/day+auricular Acupuncturing 3 times+/day, 30 days Ikjiansingubokak (Yìzhìānshénkǒufúyè) 1~3 yrs: 2.5 ml/once 3~5 yrs: 5 ml/once 5 yrs~: 10~15 ml/once 3~4 times/day, 1~2 months Chungyuldoche-tang (Qīngrèdǎozhì-tāng) 3 times/day, 15 days. Gammaekdaejo-tang (Ganmaidazao-tang, GDT) 1 volume/day+psychotherapy Bokbangsukjihwang-tang (Fùfāngshúdìhuáng-tāng) 2 times/day, 90 days+ psychotherapy Outcomes measurements adverse events measurements Results The total effective rate was 88.2%. IVA CPT Intelligence tests Effect manifested time 4.5 weeks. After 1 year follow-up, total effective rate was 73.2%. The children s morality, hyperactivity and attention deficit were improved after treatment with significant difference (p<0.01). The total effective rate was 71.4%. The total effective rate was 89.5%. C-WISC The score of behavior factor, learning factor and index in Conners Scale decreased significantly (p<0.05). Other index had no significant change. The total effective rate was 86.8%. The total effective rate was %. The total effective rate was %. The total effective rate was 86%, improved rate 83%. The total effective rate was 92.1%. After 1 year follow-up, the total effective rate was 94.9%. IVA CPT: Integrated Visual and Auditory Continuous Performance Test, : Conners Rating Scale, C-WISC: Chinese-Wechsler Intelligence for Children Scale, TESS: Toxic Exposure Surveillance System, CCMD: the Chinese Classification of Mental Disorders, ICD: International Classification of Diseases, CGI: Global Impressions.

5 CG Ryu, AR Cho, JH Seo, SS Jeong, JS Lee, WY Sung 5 Scales) 는전세계적으로아동기문제행동측정을위해가장광범위하게사용된평가도구들중하나로볼수있으며, 또한 ADHD 아동을대상으로 ADHD 증상및이와관련된문제행동들을조사하기위해임상과연구에서널리사용되고있는척도이다. 는 3~17 세사이의아동을대상으로과잉행동과기타다른문제행동들을평가하기위한간편한도구로써부모용평가척도와교사용평가척도의두가지형식으로되어있다 37). 객관적척도를사용하지않은논문이절반이상으로연구결과의해석에제한점을가지며, 추후국내연구에서는이에대한고려가필요하다고하겠다. 4. 치료결과단일임상연구는총 12편으로변증에따라다른처방을사용한연구는 2편이었고 ( 心肝陽亢型 / 脾虛肝旺型 / 腎虛肝亢型 -Lóng 16), 滯熱內停, 心火上炎 / 滯熱內停, 引動肝風 -Wú 21) ), 다른연구에서는변증에대해언급하지않았다. 한약물만을치료에사용한연구가 9편, 耳鍼치료결합 1편, 심리치료결합 2편이었고 Ritalin 을함께사용한경우는없었다. 耳鍼治療를함께시행한연구 18) 에서는芍藥甘草湯과腎, 心, 皮質下, 神門, 枕등의耳穴에王不留行을붙여자극하는방법을함께사용하였다. 심리치료로는 Zhāng 23) 은부모에대한심리지지와아이를교육하는방법과순서를교육하고, 의사가아이의상태를평가하고격려및심리암시를시행하였고, Yáng 22) 은부모를통해아이의자신감을불어넣어주고존중하도록하며, 병을치료할수있다는믿음을주어자제력을강화시키는동시에, 부모와선생은아이의작은발전에도격려와지지를보내고거친행동을기억하여서로공유하도록하였다. 인지기능을함께평가한연구 16) 에서인지기능은치료전후의큰변화가없었다. 12편의논문에서적어도 71.4% 이상의유효율을나타냈다. 비교임상연구는총 13편으로 1편을제외한나머지 12편에서 Ritalin 복용군을대조군으로설정하여연구를진행했다. 나머지한편에서는전정기능훈련을위 주로감각통합훈련을시행한집단을대조군으로설정하였다. 변증이언급된 ( 또는치법이표기되어변증을유추할수있는경우 ) 연구는 7편 ( 滋水涵木法 - Qian 27), 腎陰不足, 肝陽偏亢 -Wang 28), 腎陰不足, 肝陽偏旺 / 心脾氣虛, 神失所養 / 濕熱內蘊, 痰火擾心 / 瘀血內阻, 腦絡失養 -Lín 30), 腎虛肝旺 -Zhèng 32), 益腎塡精 - MA 34), 肝腎陰虛 -Kǒng 24), 平肝熄風, 淸熱化痰 -Shí 36) ) 이었다. 치료수단으로한약만을사용한연구가 7편, Ritalin을함께사용한연구가 2편, 심리치료를함께시행한연구 2편, 감각통합훈련을시행한연구, 바이오피드백을시행한연구가각각 1편이었다. Zhāng 31) 은한약물과전정기능을중심으로한감각통합치료와심리치료, 행동치료를병행한치료조와감각통합치료 (60~100 m 2 의공간안에스케이트보드, 미끄럼틀, 드럼등을두고, 전문가의지도하에아동이가볍고즐겁게참여하고훈련하도록유도하여 1~1.15 시간시행 ) 와심리치료, 행동치료를병행한대조군으로시행한연구를통해유의한치료율의차이와빠른치료효과를얻었다고보고했다. Lǐ 35) 는静灵口服液복용과함께바이오피드백을시행한치료군과 Ritalin 과바이오피드백을함께실시한대조군으로시행한연구를통해유의한차이의치료율과낮은재발율, 부작용발생율의결과를보고했다. 이상의치료결과를통해, ADHD 에대한한약물치료가유효함을알수있었고, 이를국내임상연구에응용할수있을것으로생각된다. 다만, 앞서연구의설계에서언급했듯이논문의질이낮은편이므로이에대한고려가필요할것이다. 5. 변증및관련장부변증이언급된연구는총 9편으로, 그중腎陰虛와관련된변증이 7편으로가장많았고, 心火, 痰등으로도질환을바라보았다. 장부로는腎, 肝, 心등과관련이있는것으로보았다. 陰虛변증이많은것은소아가純陽之體인데다가稚陰稚陽한생리적특징때문인것으로사료되며 5), ADHD 환자를치료함에있어서陰虛변증을우선적으로고려해볼수있겠다.

6 6 The Current State of Studies for Herbal Medicine of Attention Deficit Hyperactivity Disorder (ADHD) Table 2. Case Reports of Treatments on Patients with ADHD in China First author (year) Sample size (age) Onset years Diagnostic criteria Treatments Kǒng DR 24) Zōu WQ 25) (2011) Huáng F 26) (2010) (8.40±1.42) 60 (8.40±1.40) 112 A. 56 (5~13) 6 months~6 yrs B. 56 (7~13) 7 months~6 yrs A. 10 (6~10) B. 10 (6~10) at least 6 month C-WISC Chinese Academy of Pediatrics CCMD-3 A. Gigukjihwang-huan (Qiju Dihuang-wan) 3 pills/once, 3 times/day. 3 months B. Ritalin 5 mg/day 10~20 mg/day (depending on the needs) 2 times (am, md)/day, 3 months A. Gamigonsungchimjung-dan (Jiāwèikǒngkǒngzhěnzhōng-dān) Traditional Chinese Medicine 2 times/day, 3 months B. Ritalin 5 mg/once, 2 times/day, 3 months A. Bosin-tanggami (Baoshen-tānggami) 1 time (pm)/day, 100 ml/once+ritalin 0.3~0.6 mg/kg 2 times (am, md)/day, 5 times/week, 3 month B. Ritalin 0.3~0.6 mg/kg 2 times (am, md)/day, 5 times/week, 3 month Qian J 27) (2010) A. 35 (6~ ±3.32) 8 months~6 yrs B. 35 (7~13 8.2±2.67) 7 months~7 yrs ICD-10 A. Traditional Chinese Medicine B. Ritalin 6~8 yrs old: 5 mg 9~14 yrs old: 10 mg 2 times/day, 150 ml/once, 3 month Wang L 28) (2010) Lù FY 29) (2009) 85 (5~15) A. 60 B (5~15) A. 30 B. 30 A. Jibakjihwang-huan (Zhibai Dihuang-wan) 2 times/day, 30 day B. Ritalin 30 day A. Iksingunnoi-tang (Yìshènjiànnǎo-tāng) Preschoolers 1/2 days schoolers 1/day+psychotherapy, 12 weeks. B. Ritalin 0.3~0.6 mg/kg, 2 times/day, 5 times/week+psychotherapy, 12 weeks. Outcomes measurements adverse events measurements TESS C-WISC Cancellation test Safety test (AST, ALT, Cr, ECG) Results The score of behavior factor, learning factor and hyperactivity factor index in Conners Scale decreased significantly (p<0.01) The clinical total effective rate was 87.5% in the treatment group and that was 67.9% in the control group. The score of learning factor in Conners Scale of Group A decreased significantly, had fewer side effect than B. The clinical total effective rate was 74.3% in the treatment group and that was 77.1% in the control group, without significant difference (p>0.05). The total effective rate of TCM syndrome effect in the treatment group was 91. 4% and that was 65.7% in the control group, with a significant difference (p<0.05). In the cancellation test, the cancellation score, mistaken rate, and hyperactivity index of both groups were not significantly different, but two weeks after medication, the hyperactivity index of the treatment group was significantly better than that of the control group (p<0.05). There was no obvious untoward reaction found in the treatment group (p> 0.05), whilst in the control group, 34% of cases had nausea and poor appetite. Total effective ratio A: 93.3%, B: 64.0%, (p<0.01). Group A showed more significant improvement than group B. (Total effective ratio-a: 100, B: 80) Group A had rapid effects.

7 CG Ryu, AR Cho, JH Seo, SS Jeong, JS Lee, WY Sung 7 Lín YB 30) (2008) Zhāng GS 31) (2008) Zhèng X 32) (2008) Zhāng H 33) (2008) MA Rong 34) Lǐ FH 35) Shí SX 36) 75 A. 43 (6~12) 6 months+ B. 32 (6~11) 6 months+ 45 A. 25 (7.5) 10 month~ 3 yrs B. 20 (8.5) 6 months~ 4 yrs A. 50 (9.21±2.83) 3.12±0.85 B. 45 (9.17±3.15) 3.81± (6~13) 6.5 month~5.5 yrs A. 30 B (6~18) A. 55 B. 53 C A. 46 B (6~17) 42 (6~12) CCMD-2R CCMD-3 CCMD-3 DSM-III A. Traditional Chinese Medicine (according to Mechanism of Disease) Samgapbokmak-tang (Sānjiǎfùmài-tāngjiājiǎn) Guibi-tanggagam (Guipi-tang) Ondam-tanggami (Wendan-tang) Boyanghwano-Tanghwajae (Bǔyángháiwǔ-tānghuācái) 2 times/day, 4 months B. Ritalin 5 mg/once, 2 times (am, md)/day, 5 times/week, 4 months A. Dadongjungan-tang (Duōdòngjìngān-tāng) 3 times/day+sensory integration therapy 1~1.5 h/day, (vestibula function-40 min)+psychotherapy, Behavioral therapy, 80 days B. Sensory integration therapy 1~1.5 h/day, (vestibula function-40 min)+ Psychotherapy, Behavioral therapy, 80 days A. Soajiryukdangjang (Xiaoerzhili Tangjiang) 5~9 yrs: 10 ml 3 10~14 yrs: 15 ml 3, 1 month B. Ritalin 3~5 yrs: 5 ml 2 6~14 yrs: 10 ml 2, 1 month A. Traditional Chinese medicine 9 yrs: 25 ml 9 yrs: 40 ml 3 times/day+ Ritalin 5 mg, 2 times/day, 2 months B. Ritalin 5~15 mg, 2 times/day, 2 months A. Ikjieungsin-granule (Yizhiningshen-granule) 6~10 yrs: 10 g/once 11~18 yrs: 15 g/once, 2 times/day, 5 times/weeks. B. Jungryunggubokak (Jìnglíngkǒufúyè) 10 ml/once, 2 times/day. 5 times/weeks. C. Ritalin 6~8 yrs: 5 mg/once 9~18 yrs: 10 mg/once, 2 times (am, md)/day, 5 times/weeks. 24 weeks. A. Jungryunggubokak (Jìnglíngkǒufúyè) 10 ml/once, 2 times/day+brain function biofeedback 30 min/once 3 times/week+psychotherapy, 12 weeks B. Ritalin 10~20 mg/day, 2 times (am, md)/day+ Brain function biofeedback 30 min/once, 3 times/week+ psychotherapy, psychological and behavioral therapy, 12 weeks A. Chunmagudung-um (Tiānmágōuténgyǐnjiā-wèi) 50 ml/once, 2 times/day, 6 months B. Ritalin 5 mg 2 times/day, 5 times/week+psychotherapy, Comprehensive behavioral therapy, Cognitive Behavioral Therapy, Social training, 6 months CCMD-III Lab CBCL CGI TESS There are significant improvements on both groups after the treatment. Between Group A and B, there was no significant difference, but Group A had no side effect. Group A showed more significant improvement than group B. (p<0.01) (Total effective ratio-a: 96, B: 70) Group A had rapid effects. Total effective ratio A: 86.00, B: (p<0.05) Group A showed more significant improvement and less side effect than Group B. The total effective rate and excellent rate of Group A was 90.91% and 63.64%. The total effective rate and excellent rate of treatment group was obviously higher than that of Group Aand Group B. Total effective rate (A: 84.5 B: 65.6) Excellent rate (A: 78.3 B: 58.9) Side effective rate (A: 21.6 B: 57.1) Relapse rate (A: 11.6 B: 33.9) (p<0.01) Total effective ratio A: 82% B: 78.5%

8 8 The Current State of Studies for Herbal Medicine of Attention Deficit Hyperactivity Disorder (ADHD) Table 3. Frequency of Herbal Materials that Constitute the Intervention Pre Scrptions Frequency Herbal materials 16 Rhizome of Polygalae Radix, Rhizome of Acori Gramineri Rhizoma 14 Root of Glycyrrhiza uralensis Fisch 12 Root of Rehmanniae Radix et Rhizoma Preparata, Sclerotium of Poria cocos Wolf 9 Root of Paeonia japonica (Makino) Miyabe & Takeda 8 Sternum of Testudinis Plastrum 7 Seed of Ziyzyphus jujuba Miller, Root of Bupleuri Radix 6 Seed of Cornus officinalis Siebold et Zucc, Tuberous root of Dioscorea batatas, Shell of Ostrea gigas, Root of Rehmaniae Radix 6. 사용된한약물분석 7. 부작용분석 25편의논문에서총 31개의처방을사용하였고, 증상에따라가감한약물을제외한 94종의약재가사용되었다. 熟地黃, 龜板, 鱉甲등의補陰劑와遠志, 石菖蒲, 茯笭, 酸棗仁등心, 脾經에작용하며安神, 開竅醒神하는약물들의빈도가높았다. 그중遠志와石菖蒲가 16회로가장많이사용되었다 (Table 3). 遠志는心陽을보조하고痰濕을去하며, 心氣를보익하여腎氣로하여금상부의心과교통케함으로써交通心腎, 安神益智의효능이있다. 그러므로心腎不交로나타나는心腎不安, 驚悸, 失眠, 健忘등을치료한다. 石菖蒲는淸陽의氣를振暢시키므로醒神健腦하고, 和中開胃하므로淸陽의氣가不升하여나타나는記憶模糊, 癲狂, 痴呆등證에상용된다. 甘草는대부분의경우佐使藥으로쓰였고, 甘麥大棗湯에서는甘平和中緩急하는성질을이용해君藥으로쓰였다. 熟地黃은補血, 滋潤시키며, 또한生精益髓시키는효능이있어서肝, 腎二經을補益시키는要藥이되어, 肝腎不足과心肝血虛諸證에사용한다. 茯笭은平甘淡하여心, 脾, 腎經에작용하여健脾寧心하며, 心神不安, 驚悸失眠등의證에응용한다 38). 상기약물은腎陰虛, 痰, 腎心과관련된변증이많음에따라고빈도로사용된것으로보이며, 기존처방에가미하거나, 신약개발을위한실험연구에응용할가치가있는것으로생각된다. 한약물과 Ritalin 을함께복용한치료군과 Ritalin 만을복용한대조군과의비교에서 Huáng 25) 는치료군이대조군에비해유의하게낮은부작용이발생했음을보고했고, Zhāng 32) 는치료군에서식욕하강 7예 (23.3%), 구건 3예 (10.0%), 오심 9예 (30.0%), 변비 6 예 (20.0%), 대조군에서각각 26예 (96.3%), 14예 (51.9%), 20예 (74.1%), 17예 (63.0%) 로유의한차이가있음을보고하였다. Ritalin 을복용하지않은한약물치료군과 Ritalin 을복용한대조군과의비교에서 Qian 26) 는 Safety test (AST, ALT, Cr, ECG) 를시행하여대조군의 34% 에서오심, 식욕저하가발생하였고, 치료군에서는부작용이없었음을보고하였다. Lín 29) 의연구에서는대조군에서만 32예의식욕저하, 17예의입면장애, 2예의두통이발생하였고, TESS를이용한 Lǐ 34) 의연구에서는치료조 21.6%, 대조조 57.1% 로부작용발생율의유의한차이가나타났다. Kǒng 24) 의 TESS 를이용한평가에서도치료조에서유의하게부작용발생율이낮았다. 결과적으로한약물을단독복용했을때뿐만아니라한약물과 Ritain을함께복용한경우에도 Ritalin 단독투여시보다부작용이낮았다. 이를통해한약물이부작용이적은 ADHD 의치료방법일뿐만아니라, Ritalin 과의겸복을통해 Ritain 부작용을해결할대안이될수도있을것이라고생각되며, 이에대한추가적인연구가필요할것으로보인다.

9 CG Ryu, AR Cho, JH Seo, SS Jeong, JS Lee, WY Sung 9 V. 결론 CNKI에서제공하는 CAJ의검색을통해 2007년부터 2012년까지발표된 ADHD 의한약물치료에대한최신임상연구동향을분석해다음과같은결론을얻었다. 1. 진단기준으로는 를사용한연구가 11 편으로가장많았고, 치료효과평가기준으로는임상증상의호전에따라평가한연구가 13 편, 척도로 를사용한경우가 12편이었다. 부작용평가를위해 TESS를척도로사용한연구는 2편이었다. 2. 변증및관련장부는腎陰虛와관련된변증이가장많았고, 장부로는腎, 肝, 心등과관련이있는것으로보았다. 3. 빈용한약물은遠志, 石菖蒲 16회, 甘草 14회, 熟地黃, 茯笭 12회, 芍藥 9회, 龜板 8회, 酸棗仁, 柴胡 7회였다. 처방의선정이나가감에있어상기약물을우선적으로고려해볼수있을것이다. 4. 단일임상연구에서유의하게높은효과를나타냈으며, 비교대조군연구에서도 Ritalin 대조군과유사하거나유의하게높은치료율을보였다. 뿐만아니라부작용발생율도유의하게낮으므로현재치료목적으로가장많이사용되는 Ritalin을보완, 대체할가능성이있는치료방법중하나임을알수있었다. References 1. Choi H, Kim JS, Lee EH. Study for Visual Application of Circle Pattern with 3G Color on Attention Deficit/Hyperactivity Disorder Patients. J Korean Oriental Med. 2010;31(1): Choi MO. A Study on the Strengths Model-based Parenting Experience of the Children with ADHD. Korean Journal of Social Welfare. 2012;64(1): Choi JA. Literature Review of Play Therapy Intervention for Children with ADHD. Journal of the Korean Home Economics Association. 2012;50(5): Kim JS, Kim BN, Cho SC, et al. The Side Effects and Correlates of OROS-Methylphenidate in the Treatment of Children and Adolescents with ADHD. J Kor Acad Child Adolesc Psychiatry. 2010;21(2): Lee SG. A Study of the Children with Mental Disorders in Oriental Medicine. J of Oriental Neuropsychiatry. 2003;14(2): Byun KW, Kim JH, Kim JW, Chung SY. Effects of Oriental Medical Treatment on ADHD - A Retrospective Survey -. J Korean Oriental Med. 2011;32(4): Kim LH, Song BY, Yu G. 3 Case Reports of ADHD Childrem Treated with Acupuncture and Herbal Medicine. J of Oriental Neuropsychiatry. 2004; 15(1): Kim HE, Kim JH. The Literature Study for Attention Defict Hyperactivity Disorder (ADHD) in Traditional Chinese Medical Journals. J Korean Oriental Pediatrics. 2006;20(2): Lee TH, Kim LH, Jang IS, et al. A Review of Attention Defict Hyperactivity Disorder in Traditional Chinese Medical Journals. J of Oriental Neuropsychiatry. 2003;14(1): Park HC, Kang MS, Kim LH. A review of Attention Defict Hyperactivity Disorder in Traditional Chinese Medical Journals. J of Oriental Neuropsychiatry. 2007;18(2): Jadad AR, Moore RA, Carroll D, et al. Assessing the Quality of Reports of Randomized Trials: Is Blinding Necessary? Controlled Trials 1996;17(1): Wāng CX. 17 Cases of Children with ADHD Treated by Gofanmaidazao-tang. Journal of Practical Traditional Chinese Medicine. 2012; 28(10): Gāng XC, Tán LL, Xǔ SH, et al. Analysis about Treatment by Yìzhìníngfāng of Children with ADHD. Journal of New Chinese Medicine. 2012;44(7): Wang YJ, Lu Y, Zheng Q, et al. Effect of the Xiaoerzhili Tangjiang to the Children of Attention

10 10 The Current State of Studies for Herbal Medicine of Attention Deficit Hyperactivity Disorder (ADHD) Deficit/hyperactivity Disorder. Chin J Mod Drug Appl. 2011;5(18): Huáng D, Tāng ZZ. 42 Cases of Children with ADHD Treated by Yìzhìkāiqiàotāng. Chinese Community Doctors. 2011;33: Lóng H. Traditional Chinese Medicine Treatment according to Mechanism of Disease of ADHD. Chin J Mod Drug Appl. 2010;4(6): Lǐ XZ, Mǎ R, Lǐ YP. Effect of Yizhiningshen Granule on Symptoms and Cognitive function of Children with Attention Deficit Hyperactivity Disorder. Journal of Tianjin University of Traditional Chinese Medicine. 2009;28(4): Yú T, Liú L. 76 Cases of Children with ADHD Treated by Xiǎocháihútānghétiānmágōuténgyǐnjiājiǎn. TCM Res. 2008;21(4): Liú FQ. 47 Cases of Children with ADHD Treated by Sháoyaogāncǎotāng with Auricular Acupuncturing. Gansu Journal of TCM. 2008;21(7): Lǐ D. 51 Cases of ADHD Treated by Yìzhìānshénkǒufúyè. Strait Pharmaceutical Journal. 2007; 19(3): Wú D. 36 Cases of Children with ADHD Treated by Qīngrèdǎozhì-tāng. Chinese Journal for Clinicians. 2007;35(6): Yáng JF. 38 Cases of Children with ADHD Treated by Ganmaidazao-tang with P2ychotherapy. Chinese Journal of GMTCM. 2007;22(5): Zhāng SH. Chinese Medicine Treatment of 198 Cases of Children with ADHD. Journal of Traditional Chinese Medicine in Liáoníng. 2007; 34(5): Kǒng DR, Huò J, Fù HP, et al. 38 Cases of Children with ADHD Treated by Qiju Dihuang Wan. Shandong Journal of Traditional Chinese Medicine. 2007;7: Zōu WQ. 56 Cases of Children with ADHD Treated by Jiāwèikǒngkǒngzhěnzhōngdān. TCM Res. 2011;24(6): Huáng F. Observation of Integrative Medicine to Treat Children with Attention Deficit Hyperactivity Disorder. Medical Journal of Chinese People's Health. 2010;22(10): Qian J. Observation on the Effect of Nourishing the Liver and Kidney on Children with Attention Deficit Hyperactivity Disorder: A Report of 35 Cases. Journal of Traditional Chinese Medicine. 2010;51(1): Wang L. ZhibaiDihuangPill Treating 60 Cases of ADD of Deficiency of Yin Leading to Hyperactivity of Yang Type. China Journal of Chinese medicine. 2010;25(147): Lù FY, Mǎ FF, Féng SW. Observation of Integrative Medicine with Psychotherapy to Treat Children with Attention Deficit Hyperactivity Disorder. Modern Journal of Integrated Traditional Chinese and Western Medicine. 2009;18(29): Lín YB. Traditional Chinese Medicine Treatment according to Mechanism of Children with Attention Deficit Hyperactivity Disorder in 43 Cases. Fujian Journal of TCM 36 February. 2008;39(1): Zhāng GS. Observation of Integrative Medicineto Treat Children with Attention Deficit Hyperactivity Disorder. Journal of Sichuan of Traditional Chinese Medicine. 2008;26(10): Zhèng X, Zhū KJ, Liú TS, et al. 38 Cases of Children with ADHD Treated by Xiaoerzhili Tangjiang. Human Journal of Traditional Chinese medicine. 2008;24(5): Zhāng H, Zhōu XF. 30 Cases of Integrative Medicineto Treat Children with Attention Deficit Hyperactivity Disorder. Journal of Practical Traditional Chinese Medicine. 2008;24(3): MA Rong, Lǐ XM, Wèi XW, et al. Observation of Yishentianjing Method on Treating Fifty-five with Children Attention Deficit Hyper Activity Disorder. Journal of Tianjin University of Traditional Chinese Medicine. 2007;26(3): Lǐ FH, Wáng YS, Yuán J. Observation of Jìnglíngkǒufúyè with Biofeedback to Treat Children with Attention Deficit Hyperactivity Disorder. Tianjin Journal of Traditional Chinese Medicine. 2007;24(4): Shí SX. 50 Cases of Children with ADHD Treated by Tiānmágōuténgyǐnjiāwèi. Traditional Chinese

11 CG Ryu, AR Cho, JH Seo, SS Jeong, JS Lee, WY Sung 11 Medicine Information Magazine. 2007;14(10): Conners CK. Conners Rating Scales Manual. North Tonawanda, NY: Multi-Health Systems; The Compilation Committee of Herbalogy. Herbology. 1st ed. Seoul: Younlimsa; 2004;535-6, 565-6, 586-8, 635-8,

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