RLS is a sign of poor blood circulation in the legs, and a history of smoking, lack of exercise, or diabetes could be contributing factors. A lack of iron in one’s diet is thought to exaggerate symptoms of RLS. Traditional Chinese medicine believes that the cause of Restless Leg Syndrome is heat in the Heart, which is thought to cause agitation in one’s spirit, and can lead to restlessness during sleep.

In TCM, the spirit is referred to as the Shen, and it is believed to be stored in the Heart. In traditional Chinese medicine, each organ is believed to be sensitive to one unique type of weather: while the Heart wants to feel warm, it should not feel hot. The theory of Zang-Fu (“internal organs”) holds that the Kidneys are the source of yin and yang in the body. When Kidney yin is low, it means that the body is susceptible to heat, contributing to the Heart’s discomfort (and therefore the Shen’s), and can lead to restless legs.

Herbal remedies can be recommended to help the Kidneys, Heart, and Shen, and this can in turn relieve the uncomfortable sensations of Restless Leg Syndrome. Two of the more common herb formulas that are recommended are RopinoHerb RLS and RopinoHerb PLMD. Nutritional supplements that include Vitamin E, calcium, magnesium, and folic acid have also been proven to improve symptoms of RLS.

Another TCM treatment for restless legs is acupuncture. Acupuncture treatments have proven effective in patients with arthritis, and are believed to also stimulate those parts of the brain that are involved in RLS. Moxibustion, an ancient TCM practice, can also help to control RLS symptoms. Moxibustion is the utilization of the mugwort herb, or “moxa,” to stimulate the points on the body used during acupuncture. Stimulating these points can help to energize or align one’s qi, and also can induce a smoother blood flow, which will reduce the urges of Restless Leg Syndrome.

For more information on how TCM can alleviate Restless Leg Syndrome, please visit Pacific College of Oriental Medicine at http://www.PacificCollege.edu.

A:Restless legs syndrome afflicts between 1-10 per cent of people (usually middle aged or older people) in varying degrees. It is characterized by itching, tiredness and uneasiness deep in the muscles of the leg, usually in the lower part and, in a fifth of cases, the arms. Sufferers may experience twitching and sometimes pain, burning (a feeling akin to having insects crawling over you) or aching.

One of the biggest difficulties is often convincing your doctor that you have the condition. No simple laboratory test exists to confirm the syndrome, and symptoms disappear during the daytime, when you’re likely to visit the doctor (although your wife may suffer from involuntary movements in the day termed “dyskinesias while awake”, or DWA). A diagnosis is usually made by interviewing the patient about symptoms.

However, the best way to tell if you have the problem is to work out when it occurs; in true RLS, the symptoms usually occur an hour after you settle down to rest or sleep, with the peak incidence in the evening, between 6pm and 4am. Not surprisingly, those suffering from RLS also have trouble sleeping.

Medicine believes the condition is linked to nervous system disorders and that it is hereditary, frequently appearing in first degree relatives. It can also be a complication of alcoholism, iron deficiency or anemia, diabetes and even pregnancy, and can be linked to neuropathy or the kidney condition uremia (although in these instances, it is not considered true RLS).

Because medicine considers RLS a nervous system disorder, it treats it as a relative to Parkinson’s disease. The primary drug of choice is dopaminergic agents, such as levodopa. Although it does appear to stop the feelings and involuntary movements, this relief comes with a heavy price the plethora of possible side effects noted by those with Parkinsonism: nausea or vomiting, postural hypotension, (feeling faint on standing), psychotic symptoms, delusions, hallucinations, confusion, motor difficulties and involuntary movements the very problems you are attempting to solve. But with RLS, L-dopa also tends to cause symptoms to occur late at night, interrupting sleep or causing “rebound” symptoms which develop earlier in the day and are more severe than those you might have had before you started drug treatment.

Other possibilities are dopamine agonists, such as bromocriptine and pergolide, which have fewer rebound effects but don’t have a long track record of working very well.

Medicine has also turned to opioids, such as codeine, propoxyphene (Darvon), oxycodone (Percodan), or pentazocine and even methadone, in an attempt to drug the victim into relaxing his limbs. Although some studies of Percodan and Darvon show that it may work (Sleep, 1993; 16: 327-32; and 717-23), other studies show that only some patients with a full range of symptoms respond (Neuropeptides, 1988; 11: 181-4). Furthermore, the biggest problem is the potential for addiction that exists with all opiates.

This problem also exists with the third type of medicine, the benzodiazepines, or tranquillizers, which work by forcing the patient to sleep.

In one study, conducted at the Sleep Disorders Center at Johns Hopkins University School of Medicine, in Baltimore, Maryland, 32 per cent found relief with carbidopa levadopa, 28 per cent with pergolide and 5 to 6 per cent with opiods (hydrocodone or propoxyphene). In this particular study none found relief with bromocriptine. However, with the carbidopa levodopa combination, more than three quarters suffered from rebound symptoms.

This armament of drugs is even more ridiculous in light of the evidence that RLS could be nothing more than a nutritional deficiency. Several studies have showed that iron deficiency is associated with RLS; in one study, a quarter of patients were found to have low blood levels of iron; conversely, one quarter of patients with low iron stores had RLS (Neurology, 1960; 10: 868-73). In at least one study of patients with RLS who were iron deficient, iron supplements cured the problem (Acta Med Scand, 1953; 145: 453).

Another possibility is folic acid deficiency (M I Boutez, and E H Reynolds, Eds, Folic Acid in Neurology, Psychiatry and Internal Medicine, Raven Press, 1979; Can Med Association J, 1976; 15: 217-22). Vitamin E has also been shown to alleviate symptoms. In one study, of nine patients receiving vitamin E, seven had symptoms eliminated completely and the other two had more than half of symptoms controlled (J Appl Nutr, 1973; 25: 8-15).

WDDTY panellist Melvyn Werbach, nutritional doctor and professor of the University of California, Los Angeles, recommends that patients avoid caffeine, cola, tea and cocoa, which has been shown to help symptoms (J Clin Psychiatry, September 1978), and consume a sugar free, high protein diet, since symptoms often are caused by hypoglycemia. In one study of over 350 patients with RLS, all of them also had typical symptoms of recurrent hypoglycemia. As soon as they were started on a sugar free, high protein diet with frequent snacks and one night feed, symptoms resolved or were strikingly alleviated in the vast majority (J Fla Med Assoc, 1973; 60: 29-31).

Your wife may wish to pursue the nutritional route (with a qualified practitioner) to see if it sorts out both problems, which may well be related.

A-It sounds as though you are suffering from what is usually called restless legs syndrome. There are two types of RLS. The first is the variety you experience, with shooting pain in your lower limbs and often numbness. The other variety only affects motor control, with no cramping or pain, but the legs go into periodic spasms and sometimes seem to have a life of their own. The cramping variety is often worse at night, and is alleviated by massage or movement. The other strange feature of RLS is that it doesn’t always affect the legs. Patients can experience problems with the lower back, the upper thighs or even the hands.

WDDTY is not a fan of so called magic bullets single substances or devices which claim to offer a magical cure. Although magnetotherapy has tremendous success in treating a variety of problems, there are many simpler solutions to your problem.

RLS is usually due to a biochemical imbalance something you’re eating that you shouldn’t be or a vital nutrient that you’re not getting.

A classic cause is a folic acid deficiency (Botez MI, Reynolds EH, eds. Folic Acid in Neurology, Psychiatry and Internal Medicine, New York: Raven Press, 1979). The first area to investigate is whether any drugs you are taking are interfering with your levels of this vital nutrient, as many do deplete levels of folic acid. These include stomach drugs like H2-blockers, bile acid type drugs like cholestyramine and colestipol, oral contraceptives, certain antibiotics, steroids, and even painkillers and anti inflammatories like indomethacin, suphasalazine or common aspirin (see Alternatives, p 6-7). So, if you are taking aspirin or another painkiller to alleviate the pain of your leg cramps, you could be making the problem worse.

In a case report of three women with mild RLS and decreased sensation in the legs, all three recovered after treatment with folic acid. A similar result was seen in another three women with RLS and general muscle pain in response to folic acid treatment (Can Med Assoc J, 1976; 15: 217-22).

Although the optimal dose of folic acid is ordinarily between 400-800 mcg, in your case, WDDTY panel member Dr Melvyn Werbach warns, you may need to take doses as high as 5 mg three times per day. Such high dose levels should only be taken under medical supervision from an experienced qualified nutritionist.

Another classic cause of RLS as well as a related problem sponta neous leg cramps (SLC) is reactive hypoglycaemia, indicative of poor sugar control. In one study of more than 350 patients with RLS, SLC, or both, almost all had other symptoms of low blood sugar and tested positively for hypoglycaemia on glucose tolerance testing. During the test, the researchers also found that the low blood sugar brought on an episode of RLS pain.

In the study, the participants were put on a sugar free, high protein diet with small frequent meals and one small meal at night. Shortly after this, all symptoms were cleared or strikingly alleviated in the vast majority of patients. Recurrences of the problem were usually traced back to cheating on the diet within the past 12 hours (J Fla Med Assoc, 1973; 60: 29-31).

In light of these results, it’s worth having yourself tested for hypoglycaemia (London’s Biolab do such a test; tel: 002 7636 5959). If the glucose tolerance test shows that you have the condition, you may wish to work with a nutritionist, who will devise an appropriate diet and eating plan.

It’s also a good idea to avoid caffeine and xanthine derivatives of any variety, which includes coffee, tea, all cocoa products and cola. One study of patients with RLS found that their symptoms improved markedly once they eliminated all caffeine products from their diet (J Clin Psych, 1978; Sept: 693-8).

Dr Werbach has evidence that RLS may also be caused by a deficiency of iron or an abnormal iron metabolism. In one study, one quarter of patients with RLS were shown to have low blood levels of iron (Neurology, 1960; 10: 868-73). In another study, simple iron supplementation resolved the problem (Acta Med Scand, 1953; 145: 453. Again, you need to make sure that any drugs you’re taking aren’t interfering with your iron intake these include cholestyramine, tetracycline, indomethacin and aspirin.

Another found that regular running helped and, if that’s not possible, at least do the leg stretches that athletes perform during the warm-up period. Another exercise is to stand with your back against a wall, and then slide down until you’re sitting with your thighs perpendicular to the floor. Hold the position for a minute or so, and then repeat several times each day.

On the dietary front, raw greens can help, as can nuts and seeds, but soak them overnight first. If the symptoms are worse at night, check the bedsheets, says one reader. Use cotton sheets, and not polycotton ones. Reflexology also helped one reader. Zinc is another deficiency that may be causing the problem, so try supplementing along with magnesium.

Another pattern consists of a disagreeable leg sensation and sense of restlessness that is brought on by rest and often relieved by movement. It is not uncommon for your bed partner to be very aware that your legs are kicking much of the night or are constantly moving. You may or may not be aware of your own movements, however. Although the cause of RLS is not clear, experts suspect it comes from a deficiency of the neurotransmitter called dopamine. RLS can also be aggravated by iron deficiency (having blood ferritin levels less than 50, even though over 9 is considered normal), nerve injuries, vitamin B12 and folic acid deficiency, hypothyroidism, and other problems. In some people, RLS may be associated with hypoglycemia. Some medications (especially Elavil and perhaps lithium) can aggravate RLS.

Diagnosing RLS

If you tend to scatter your sheets and blankets, and especially if you tend to kick your bed partner or if you note that your legs tend to feel jumpy and uncomfortable at rest at night, you probably have RLS. You can also have a sleep study done to look for leg muscle contractions. If contractions occur every twenty to forty seconds and last for about one-half to five seconds each, you have RLS. The sleep study will determine if these leg movements are associated with waking from deep sleep into light sleep to a degree that would be expected to cause daytime fatigue. Leg movements are not considered significant unless one has associated daytime sleepiness.

Treating RLS

There are both natural and prescription approaches to treating RLS. Following are summaries of those that have been found to be most successful.

Natural Treatments

Natural remedies for RLS focus on diet and nutritional supplementation. Avoiding caffeine is important. Because RLS may be associated with hypoglycemia, eating a sugar-free, high-protein diet with a protein snack at night may decrease episodes of cramping and RLS at night.

An estimated 25 percent of RLS patients have low serum iron levels. As noted above, if your serum ferritin score is under 50, I would take an iron supplement. I recommend the prescription iron supplement Chromagen FA because it also contains folic acid and combines iron and vitamin C, which helps the iron to be absorbed. Take iron supplements on an empty stomach. Vitamin E can also be very helpful, although it takes six to ten weeks of treatment to help. Take 400 international units a day. If you have RLS in which pain, numbness, and lightning stabs of pain are relieved by movement or local massage, taking 5 milligrams of folic acid three times a day (available by prescription) is helpful. However, folic acid does not help cases of RLS where there is no discomfort.

Finally, a few case reports have suggested that taking the amino acid L-tryptophan can be effective. I recommend using the related compound 5-HTP

Prescription Treatments

Ambien,Neurontin, and Klonopin are the medications that are highly effective in the treatment of RLS. I tell patients to adjust the dose to not only get adequate sleep, but to also keep the bedcovers in place and to avoid kicking their partners. Opioids can also be effective, but carry a greater risk addiction.

Sixteen-year-old Sherrie was referred to us by her family practice physician because of a five-year history of ADD. She had been on Ritalin since the sixth grade. In kindergarten Sherrie was sent out of the classroom for talking too much. An aunt and a cousin on both sides of the family had also been diagnosed as hyperactive. Her father and maternal aunt suffered from manic depression. Without her Ritalin, she was unable to focus. Easily distracted by noise or movement, Sherrie found it very difficult to concentrate while taking tests. Paying attention in conversation was also a challenge. Sherrie complained of talking without listening and often found herself staring off into space in mid-sentence. No matter how much she told herself to be quiet, she blurted out her thoughts or feelings anyway. It was embarrassing at times, though much of the time she had little, if any, awareness of how she affected other people. Sherrie was used to her friends asking her to be quiet. She had a reputation among her friends of acting immaturely and of being the last one to catch on to a joke. While driving, she often daydreamed. She would become confused when she saw a car in another lane, as if she did not
believe she was seeing it.

Sherrie was very antsy, always fidgeting and fiddling. Clicking her nails against her teeth and tapping her fingers was a perpetual occupation. Sherrie’s poking, hugging, and pulling at other people was a constant annoyance to them, but she could not keep her hands to herself. Sherrie was always moving some part of her body. She would skip down the hall to release her pent-up energy. Without having a way to let it out, she felt that she would scream. “The energy is trapped inside of me and has to be pushed out. It’s all out of control,” she explained.

Ritalin gave Sherrie hives and made her feel like she did not know herself. Her habit of being “a major procrastinator” was not affected by the Ritalin. With or without medication, she asked lots of “dumb questions” even though she maintained a 3.8 grade-point average.

Sherrie had a passion for pickles. She ate them straight from the jar. She also liked to suck on ice. Her fingers and toes became extremely cold when she skied.

Sherrie’s defining features were her extreme restlessness and ceaseless activity. We gave her Veratrum album, mentioned earlier in Jill’s case of adult ADD. Again notice the strong desire for sour foods. These people are generally good-natured and helpful but overexuberant. Their energy oozes out around the edges. As is frequently the case in treating children, we gave Sherrie a single dose of the medicine and asked her to return in five weeks.

When we saw her again, she was very happy with her progress. She had informed her psychiatrist that she wanted to discontinue the Ritalin before taking the homeopathic medicine. When she came for her followup visit, Sherrie found our parking lot without directions, something she could normally do only with the help of Ritalin. Her grades were better, in contrast to her previous efforts to discontinue Ritalin, when her grades plummeted to all F’s.

Her parents also reported that Sherrie’s behavior had drastically improved. She no longer stared blankly. Her friends told her that she “wasn’t as crazy” as she used to be. No longer antsy, she felt a lot more controlled. The urge to poke, hug, and pull at other people had stopped plaguing her. Sherrie’s leg no longer moved restlessly, nor was she clicking her nails against her teeth. Sherrie remarked that she was not as depressed as she had been, although she had not actually described herself that way previously.

Sherrie now had “a real appetite” instead of sporadic urges. She no longer experienced “that special taste for pickles.” Sherrie needed two doses of the
Veratrum over the next year and a half, then discontinued treatment because she felt well. She did not resume taking Ritalin. As her treatment progressed, Sherrie was able to notice whenever she felt even a little hyperactive and could stop it by telling herself to relax. Before beginning homeopathic treatment, Sherrie had been unable to notice or control her behavior patterns. Now she became fidgety only once in a while instead of all the time. When her voice became loud, she quieted down, which was also impossible in the past. “It’s like somebody opened the curtains and let me see.”

The Dijeridu Kid from Down Under

Angela’s mother brought her to see us when she was twenty-two months old. The Australian family was visiting the United States during Angela’s father’s didgeridoo concert tour. The didgeridoo is a rhythmic Aboriginal instrument. Angela had a red rash on her face. She had not gotten one good night’s sleep (nor had her parents!) since birth. When her mother weaned her at seven months, Angela refused cow’s milk. Angela had a pattern of waking in the middle of the night crying, distressed, and disoriented. Her parents tried to soothe her despair by letting her sleep with them; otherwise she woke repeatedly crying for her mother. She fought for hours against going to sleep. Her mother described her as being “in a frenzy every night.” Angela’s exhausted parents had even resorted unsuccessfully to giving their little darling sleeping pills.

Angela was extremely willful. It was extremely nerve wracking to travel with her, which was a conflict with her father’s entertainment career. Angela screamed at the top of her lungs during most of our interview with her. She became inconsolable. Even when her mother offered her a bottle of her favorite juice, she refused. She had the habit of throwing herself on the floor when unhappy.

Angela loved people. She was a very lively baby and did not want to nap. She lived in a busy household where friends and family members were always coming and going. She had walked at nine months and ran at ten. She climbed fearlessly on anything within her reach. She loved playing with animals and putting on her mother’s lipstick. When we inquired about Angela’s musical affinity, her mother told us that as soon as the music came on, Angela squirmed and danced. Even at her very young age, she sat at the piano bench and tried to bang on the keys. She loved to play her father’s guitar when he held her on his knee. Family friends often commented on the child’s rhythmical talents.

Angela had been diagnosed with an unusual skin condition called dermatomyositis, which showed up as purplish, red, scarred areas on her fingers resembling tiny splinters.

We gave Angela one dose of homeopathic Tarentula. This medicine, made from the Spanish spider, is for overactive children who are extremely lively, love to be the center of attention, climb like little spiders, and love dancing and rhythmic music. They can have tantrums and fits and often have a mischievous, manipulative quality. It is understandable that Angela, raised in an environment of music and dance, needed this lively medicine. A well respected Italian homeopathic physician, Massimo Mangialavori, recounts a story of a small southern village in

Tarentula hispanica (tarantula spider)

Tarentula children have rhythm. Their active, climbing, jumping restlessness mimics animal behavior. They love music and rhythmic activities like dancing, tapping, or drumming, and it soothes them. Cunning and mischievous, they play tricks on their parents and other children, tell lies, and love to hide. They are very hurried and impatient. Often destructive, they have to be watched very closely, as they are capable of breaking anything they get their hands on. They are very impulsive and distractible. Twitching and jerking of the muscles is a common symptom. They are often attracted to bright colors.

Italy near the seaport of Tarent. A group of girls in the village suffered from a hysterical type of insanity which was only relieved when they danced in a type of frenzy and cut with knives or swords.3 Although it did not come up in Angela’s case, many children needing Tarentula do have an urge to wildly
cut clothing and other things during their rages.

Angela’s mother called from Australia five weeks after she took the medicine. Angela had no further tantrums or extreme moodiness; “just the odd two-yearold stuff.” Her mother had no complaints about Angela’s behavior compared to before she took the Tarentula. Now she was much more easily managed when she became upset. She jumped up and down occasionally when her mother said no, but would settle down. Angela was much more easily entertained. It was much easier for her to sit in a car, which had been a major problem previously. Her teeth grinding, which her mother forgot to mention in the first interview, was 90 percent improved. The redness and scarring on her hands were also better. Angela’s mother added that prior to the homeopathy, her daughter was forever tapping, teasing, and getting into mischief. These behaviors had also improved. “Looks like Miss Spider’s working,” her mother exclaimed.

Angela needed one more dose of the Tarentula five months later because some of her symptoms had returned, though to a much lesser degree than before the homeopathic treatment. Angela’s dermatologist was quite surprised that the redness and inflammation of her fingers had improved significantly.
3 Pelt, M., “Spiders in Nature and Homeopathy: Mangialavore in Wageningen, Autumn 1993 and 1994,” Homeopathic Links, 8(3), 1995, p. 45-46.

The Little Girl Who Couldn’t Sit Still

Six-year-old Sumi was a very cute little girl with honeycolored hair, green eyes, and gold skin. Her striking features resulted from her Japanese and Northern European heritage. We first interviewed Sumi and her family at a poolside table at a California hotel where we were speaking at a conference on homeopathy. What was most notable about Sumi was that she could not sit still for more than five minutes. She ran around the table, became easily distracted by the children in the swimming pool, or whispered something into her mother’s ear. It seemed literally impossible for her to stay in one place.

Sumi was calm and sweet when she was an infant. She had suffered from ear infections, debilitating diarrhea, profuse perspiration, and lethargy. Sumi’s speech was delayed. Her mother sought out homeopathic treatment for her now because of her restlessness. Sumi kissed, poked, prodded, and pulled. She was very affectionate. She blurted things out loudly. School was a struggle because of her difficulty concentrating, following directions, and staying at her desk. She wandered around and was always busy. Her verbal skills lagged far behind the other children at her grade level. It was particularly hard for her to remember words.

This sweet child seemed to lack any awareness of how her behavior affected others. She often came on too strongly, but did not realize it. She bit her nails down to the quick and even nibbled her toenails. Sumi loved cucumbers and liked to chew on ice.

Sumi may sound very similar to Sherrie and Jill, because of her relentless motion. They all needed the same medicine, Veratrum album. We first treated Sumi two and a half years ago. She is literally a different child now. Just weeks after starting homeopathy, Sumi began making excellent progress with her speech. She spent less time searching for words and her focus was greatly improved. She did not stumble or rush so much. Before she could only color one page at a time in a coloring book; within three weeks of taking the Veratrum, she was completing eight pages.

Over time, Sumi’s progress continued. Her nailbiting diminished. She no longer kissed all the time. Her actions became more purposeful and centered and she became more aware of her impact on others. Sumi’s teachers no longer complained about her disruptive behavior. Rather than the word-salad she used to communicate previously, now she could connect phrases and her vocabulary was growing. She remembered the names of her classmates whereas before she had been oblivious to such details. Sumi’s parents were pleasantly surprised that she could handle kindergarten so well. During the next year, she grew five inches. Growth spurts often occur soon after a child takes a homeopathic medicine.

One curious aspect of homeopathic treatment is what is called a return of old symptoms. This means that a particular symptom that an individual had in the past may briefly reappear in the process of healing. This occurred with Sumi. She briefly developed a small swelling in her breast just as she did at two months of age when she developed a breast bud. Her mother reported that it was at this time that her health problems originally began. During the course of homeopathic treatment, Sumi also broke out once in large blisters on her right ribs and back. They looked a lot like shingles. Sumi’s mother had had herpes during her pregnancy. Both of these skin eruptions might seem like coincidence to the average person, but to the homeopath they are recognizable as a return of old symptoms, which is often necessary for deep and lasting healing.