tcm patterns of disharmony in eating disorders

Report
EATING DISORDERS AND
TRADITIONAL CHINESE MEDICINE
Sarah Fogarty
Dr Andrew J McAinch
Dr Chris Zaslawski
Associate Professor David Harris
Professor Lily Stojanoska
Background:
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
EDNOS
Binge
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 and Chinese Medicine
•Eating disorders are a modern concept
•Critical reviewed research
•Anecdotal evidence
To determine:
Aim
• 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
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
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
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
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:
1. Liver Qi Depression
2. Spleen and Kidney Yang Deficiency
3. 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 Spleen Qi Deficiency
PSI
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
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

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