EATING DISORDERS AND TRADITIONAL CHINESE MEDICINE

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EATING DISORDERS AND TRADITIONAL CHINESE MEDICINE

• Sarah Fogarty
• Dr Andrew J McAinch
• Dr Chris Zaslawski
• Associate Professor David Harris
• Professor Lily Stojanoska

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BackgroundWhat is an Eating Disorder?

• Four types of eating disorders are looked at in
  this study
• Binge Eating Disorder (BED),
• Bulimia Nervosa (BN),
• Anorexia Nervosa (AN),
• Eating Disorders Not Otherwise Specified (EDNOS).
  

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• Anorexia Nervosa

• Bulimia Nervosa

• EDNOS

• Binge Eating Disorder

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WM Relationship of ED to each other
This process, although less common, can occur
in the opposite direction from recovery (e.g. no
eating disorder) to either AN or BN (Agras 2009)
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Eating Disorders and Chinese Medicine

• Eating disorders are a modern concept
• Critical reviewed research
• Anecdotal evidence

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Aim

• To determine
• The patterns of disharmony involved in eating
  disorders
• To develop a treatment model based on these
  findings to help guide practitioners to treat
  those with an eating disorder

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Methodology- PSI

• Data is obtained from two surveys
• Both surveys had questions on
• Individuals age and gender
• General health
• For those with an eating disorder additional
  questions on
• Diagnosis and treatment of their eating disorder
• Specific signs

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Survey

• 333 respondents, 137 excluded remaining
  respondents, all female
• Age 18-71
• 13 BED (6.6)
• 26 EDNOS (13.3)
• 36 BN (18.4)
• 67 AN (34.2)
• 54 No ED ((21.4)
• 67.6 had a formal diagnosis

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Survey Analysis

• We identified the Patterns of disharmony relevant
  to Eating Disorders
• Pattern allocation according to the three
  references WHO (2007), Deng (2000) and Wiseman
  (1998)
• Symptoms matched to a checklist according to
  Berle et al methodology.
• The check list symptoms are counted (as a
  percentage)
• Berle, C., Cobin, D., Smith, N., Zaslawski, C. A
  novel methodological approach to evaluate
  Traditional Chinese Medicine treatment outcomes
  using pattern identification. Draft Not yet
  published Nov 2008

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Stomach Heat
Thirst
Foul Breath
Hyperorexia
Oliguria with dark urine
Constipation
Ulceration of the mouth or gingivitis
Scorching pain of the Stomach that refuses pressure
Preference for cold fluids
Acid up flow
Rapid hungering
Swelling and pain of the teeth
Scorched lips
Total


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Stomach Heat
Thirst X
Foul Breath
Hyperorexia
Oliguria with dark urine
Constipation X
Ulceration of the mouth or gingivitis X
Scorching pain of the Stomach that refuses pressure
Preference for cold fluids X
Acid up flow
Rapid hungering X
Swelling and pain of the teeth X
Scorched lips
Total 6/12


Conversion to 6/12 x 100 0.50
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Results

• Table 1 has the mean PSI's for each of the
  specific patterns separately for each eating
  disorder and those with no eating disorder.
• For those without an eating disorder, the most
  strongly expressed patterns were
• Liver Qi Depression
• Spleen and Kidney Yang Deficiency
• Liver Qi invading the Stomach

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Results

• For those with an eating disorder of any type,
• Liver Qi Depression,
• followed by Spleen and Stomach Deficiency Cold,
• are the two most strongly expressed TCM patterns
  
• Figures 1-21 shows the mean PSI for each
  pattern.

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Results Spleen Qi Deficiency
PSI
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Results Comparing those with and eating disorder
to no eating disorder

• The top three patterns for which the differences
  in mean PSI's are largest are
• AN Spleen Qi deficiency, Spleen and Stomach
  Deficiency Cold, Heart Qi Deficiency
• BN Liver Qi Stagnation and Stomach Heat, Spleen
  Qi Deficiency, and Heart Qi Deficiency

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Results Comparing those with and eating disorder
to no eating disorder

• The top three patterns for which the differences
  in mean PSI's are largest are
• EDNOS Spleen and Stomach Deficiency Cold, Liver
  Qi Stagnation and Stomach Heat and Spleen Qi
  Deficiency.
• BED Stomach Yin Deficiency, Liver Qi Depression
  and Heart Qi Deficiency

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Application to treatment

• Proposed treatment model
• Combining
• The sufferers top PSI patterns
• And the patterns that in general present with the
  greatest difference in mean from those with no
  eating disorder.

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Application to treatment continued..

• Liver Qi Stagnation and Spleen Qi deficiency

• Spleen Qi deficiency, Spleen and Stomach
  Deficiency cold and Heart Qi deficiency

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Benefit for this treatment protocol

• Method to focus treatment.
• Individual treatment.
• Easy to administer
• Doesnt require extensive experience or
  understanding of eating disorders.

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Understanding Eating Disorders from a TCM
perspective

• Eating disorders can be identified as an
  autonomous TCM category.
• Liver Qi stagnation and Spleen and Stomach
  Deficiency cold are strongly exhibited by
  sufferers of eating disorders of any type

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Specifically to AN

• Evidence that
• Spleen Qi deficiency and
• Heart Qi deficiency are involved in AN.
• (1st and 3rd highest deviations from those with
  no eating disorder)
• Involvement of Spleen and Stomach Deficient Cold

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Specifically to BN

• AN and BN present broadly similarly but
• Liver greater role in BN
• Spleen and stomach greater role in AN
• Stomach heat anecdotal pattern theory partially
  confirmed.

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Specifically to EDNOS and BED

• EDNOS
• Evidence supports WM theory that EDNOS is a way
  station from BN or AN to recovery
• This could inform how treatment could help
  prevent relapses.
• BED
• BED separate syndrome to EDNOS, BN and AN.

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Further Research

• Validating the survey
• An evaluation of the proposed treatment protocol
• Prevention of relapse
• Effect of emotional component

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Conclusion

• Added to knowledge on how eating disorders
  categories present in TCM.
• Support for the WM theory.
• Development of a treatment guide for eating
  disorder treatment.
• Support anecdotal evidence Spleen Qi Deficiency
  in AN
• Adds others patterns not previously mentioned
  (Spleen and Stomach Deficiency Cold)

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Acknowledgements

• British Acupuncture Council- Particularly Nigel
• Acupuncture Research Resource Centre-
  Particularly Mark Bovey