EATING DISORDERS AND EATING DISORDERS AND TRADITIONAL CHINESE MEDICINETRADITIONAL CHINESE MEDICINE

Sarah FogartyDr Andrew J McAinch

Dr Chris ZaslawskiAssociate Professor David Harris

Professor Lily Stojanoska

Background:Background:What is an Eating Disorder?What 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).

Anorexia

Nervosa

Bulimia Nervosa

EDNOSBinge Eating Disorder

WM Relationship of ED to each other

BED

Stand alone Eating Disorder

* 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)

•Eating disorders are a modern concept

•Critical reviewed research

•Anecdotal evidence

Eating Disorders and Chinese MedicineEating Disorders and Chinese Medicine

AimTo 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

Methodology- PSI

Data is obtained from two surveys

Both surveys had questions on:• Individual’s age and gender• General health

For those with an eating disorder additional questions on:• Diagnosis and treatment of their eating disorder• Specific signs

•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

Survey

•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

Survey Analysis

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

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

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:1.Liver Qi Depression2.Spleen and Kidney Yang Deficiency3.Liver Qi invading the Stomach

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.

Results

Results Spleen Qi Deficiency

PSI

Results: Comparing those with and eating disorder to no eating

disorderThe 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

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

Application to treatment

Proposed treatment model:

Combining

• The sufferer’s top PSI patterns

• And the patterns that in general present with the greatest difference in mean from those with no eating disorder.

Application to treatment continued..

• Liver Qi Stagnation and Spleen Qi deficiency

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

Benefit for this treatment protocol

• Method to focus treatment.

• Individual treatment.

• Easy to administer

• Doesn’t require extensive experience or understanding of eating disorders.

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

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

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.

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.

Further Research

• Validating the survey

• An evaluation of the proposed treatment protocol

• Prevention of relapse

• Effect of emotional component

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)

Acknowledgements

• British Acupuncture Council- Particularly Nigel

• Acupuncture Research Resource Centre- Particularly Mark Bovey