People suffering with RLS have difficulty in trying to depict their symptoms; they may report sensations such as an almost irresistible urge to move the legs, which are not painful but are distinctly bothersome; this can lead to significant physical and emotional disability. The sensations usually are worse during inactivity and often interfere with sleep, leading to walking discomfort, chronic sleep deprivation, and stress. Once correctly diagnosed, RLS can usually be treated effectively by relieving symptoms; in some secondary cases, it can even be cured.

Many people tap their feet or shake their legs resulting from a nervous tic, consumption of stimulants, drug side-effects or other factors; this is usually innocuous, unnoticed, and does not interfere with daily life. People with Restless Leg Syndrome the nervous tics are very noticeable; they feel an indescribable sensation in their legs that can most closely be compared to a burning, itching sensation in the muscles of the legs or arms.

Restless Leg Syndrome at a Glance:

• Restless Leg Syndrome is a condition marked by unpleasant leg sensations at bedtime.
• Restless Leg Syndrome frequency leads to insomnia.
• The cause of Restless Leg Syndrome is unknown in most patients, but many conditions have been associated with it.
• Treatment of Restless Leg Syndrome is directed toward any underlying illness, if known.
• Medications are available for Restless Leg Syndrome.

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Modern findings can also contribute to the Chinese medical understanding. The possibility of a brain metabolism defect may suggest deficiency of the kidney (since the brain is considered an outgrowth of the kidney system in the Chinese understanding) and a deficiency of the heart, which influences brain activities. The correlation of Restless Legs Syndrome with poor circulation suggests that blood stasis is affecting the legs. The deficiency of iron and folate in the blood may correspond to a blood deficiency syndrome (usually depicted as liver blood deficiency).

Therefore, the Chinese medical therapy would primarily involve tonifying the deficiencies and promoting blood circulation. The deficiency syndrome appears to mainly involve the liver and kidney (possibly also the heart), and the stasis mainly involves the legs. Certain herbs immediately come to mind, such as: rehmannia and cornus for nourishing liver and kidney; tang-kuei and peony for nourishing blood of liver and heart; millettia and achyranthes for nourishing and vitalizing blood (achyranthes is also relied upon to direct the blood flow to the lower body). Chaenomeles is often included Chinese formulas for contracture of the leg muscles, and is especially used in deficiency syndromes; the traditional pair of peony and licorice is typically given to reduce spastic activity, also in deficiency syndromes. In China, these deficiency syndromes would also be treated by consuming organ meats (such as liver), thus providing iron and folate.

Restless Legs Syndrome does not appear frequently in the modern Chinese literature. However, a small number of clinical trials have been reported. For example, in one study involving 21 patients (6), the formula given was a modified Peony and Licorice Combination (Shaoyao Gancao Tang). The basic pair of herbs (usually in equal quantities) was modified by adding three herbs for vitalizing blood circulation: achyranthes, salvia, and pueraria (use of pueraria as a blood vitalizer is an application developed during the past 30 years), and adding chaenomeles for the spastic movement. Another report of similar nature (7) involved the same treatment-except for the herb pueraria-for 18 patients. In both cases, all the patients were said to have improved (restless legs no longer a consistent problem), with only one case recurring after a year. Chinese therapeutic massage, acupuncture, and other therapies might also be utilized in the clinics.

In response to a question about treating Restless Legs Syndrome, Lin Zongguang (a clinician at the Shidong Hospital in Shanghai) reported on his experience treating more than 20 such cases (8). He said that he found the disorder related to “the deficiency and injury of the heart, liver, and kidney.” For cases dominated by deficiency of liver and kidney, he suggested a modified version of Rehmannia Six Formula (Liuwei Dihuang Wan), adding ligustrum and tang-kuei. In cases of heat syndrome, he would use the standard modification of Rehmannia Six Formula that adds phellodendron and anemarrhena. For cases in which heart and liver deficiency dominated, he suggested a modified Ginseng and Longan Formula (Guipi Tang), adding rehmannia.

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References

1. Lin Zongguang, How to treat Restless Legs Syndrome with Traditional Chinese medicine, Journal of Traditional Chinese Medicine 23(4): 305-307.
2. Shan Yipu, Treatment of 21 cases of Restless Legs Syndrome with modified Shaoyao Gancao Tang, Shandong Journal of Traditional Chinese Medicine 1986; (2): 17-18.
3. Fruehauf H and Dharmananda S, Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs, 1997 ITM, Portland, OR.
4. Subhuti Dharmananda, Restless Legs Syndrome and Chinese Medicine

“Restless legs syndrome is underdiagnosed in kids,” says Suresh Kotagal, M.D., chair of Mayo Clinic pediatric neurology and a sleep specialist. “If you look at children with difficulty falling asleep, you’ll see a fair number have restless legs. Thus far, there have been sporadic case reports, but nobody has studied a larger group of children, looking at children with insomnia complaints as a whole to see how many had restless legs syndrome.”

Dr. Kotagal and his colleague Michael Silber, M.B.Ch.B., Mayo Clinic neurologist and sleep specialist, indicate that restless legs syndrome may account for some of the age-old notion of “growing pains.”

“It’s been known for decades that children have ‘growing pains,’” says Dr. Kotagal. “Studies by other investigators have now shown that growing pains in some children may actually be restless legs syndrome.”

Dr. Kotagal says that while infrequent “growing pains” may be immaterial, parents and children should be alert for a habitual pattern of discomfort in the limbs around bedtime.

“Occasional growing pains are nothing to worry about, but growing pains every night may be restless legs syndrome,” he says. “It’s like the fact that somebody might snore one or two days a month, but if it happens every night, it may be something that needs medical attention.”

The study examined the records of 538 children who had been seen in the pediatric sleep disorders program at Mayo Clinic between Jan. 2000 and March 2004. New, rigidly defined diagnostic criteria established by a consensus conference of the National Institutes of Health and the International Restless Legs Syndrome Foundation in 2003 allowed the Mayo Clinic researchers to classify their 32 patients as having probable restless legs in nine cases and definite restless legs syndrome in 23 cases. Those in the probable restless legs syndrome group were more likely to be younger. The most common symptoms were trouble getting to sleep or staying asleep, which affected 87.5 percent. One commonality in the restless legs syndrome patients was a low iron level in the blood (as measured by serum ferritin) seen in 83 percent of the patients, the explanation for which is unknown, according to Dr. Kotagal.

“With regard to the iron deficiency, we don’t know if it’s the diet or a genetic predisposition to low iron levels,” says Dr. Kotagal. Drs. Kotagal and Silber also found family history of restless legs syndrome in 23 out of 32 patients identified to have restless legs syndrome in the study, or 72 percent. The child’s mother was three times more likely to be the parent affected with restless legs syndrome.

“There seems to be a strong genetic component in restless legs syndrome,” says Dr. Kotagal. “Very often when taking the medical history with the child, the parents say they have a similar condition.”

An additional characteristic seen in 25 percent of the patients was inattentiveness.

The researchers note that the symptoms of restless legs occur most often in the evening or around bedtime. Symptoms include discomfort or needing to move the legs, which is alleviated by moving around.

“Children very often describe it as ‘creepy crawlies,’ as ‘ouchies’ or ‘owies,’” says Dr. Kotagal. “It feels like bugs crawling on the legs. One child described it as feeling like he was walking though snow. There is also an uncontrollable urge to move the legs.”

Dr. Kotagal believes that it is important to recognize and treat this condition, as it hampers a child’s lifestyle. “If affects the quality of life,” he says. “They wake up frequently in the night. They wake up tired. They may also be inattentive during the day.” The long-term outcome of childhood restless legs syndrome is not known, according to Dr. Kotagal, but it is treatable using medications that increase the levels of dopamine in the central nervous system. Dr. Kotagal notes that there is evidence that iron seems to be very important to the synthesis of dopamine in the body. He says that there is not yet sufficient evidence, however, that treatment with iron helps relieve restless legs syndrome in children.

Dr. Kotagal indicates that there may be connections between restless legs syndrome and attention deficit hyperactivity disorder. The treatments for both conditions address somewhat the same chemical imbalance, he notes.

“When we look at kids who have decreased attention span, over one-third of them will have sleep apnea or restless legs syndrome,” he says. “We can say that it goes to further affirm the fact that inattentiveness is multifactorial — due to depression, anxiety, stressors in the child’s life, obstruction of breathing passageways, sleep apnea or restless legs. We need to look at all of these possibilities.”

Adapted from materials provided by Mayo Clinic.

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