See

discussions, stats, and author profiles for this publication at: http://www.researchgate.net/publication/266857846

A Case Series: How Do Patients With An Eating

Disorder, Seeking Acupuncture Treatment
Present (Patterns of Disharmony), And How Are
They Treated?
ARTICLE DECEMBER 2014
DOI: 10.1016/j.arthe.2014.08.002

CITATIONS

READS

22

3 AUTHORS, INCLUDING:
Sarah Fogarty
Western Sydney University
8 PUBLICATIONS 23 CITATIONS
SEE PROFILE

Available from: Sarah Fogarty

Retrieved on: 05 October 2015

Accepted Manuscript
Title: A Case Series: How Do Patients With An Eating
Disorder, Seeking Acupuncture Treatment Present (Patterns of
Disharmony), And How Are They Treated?
Author: Sarah Fogarty Debra Clydesdale Waldron Norah
McIntire
PII:
DOI:
Reference:

S2211-7660(14)00017-6
http://dx.doi.org/doi:10.1016/j.arthe.2014.08.002
ARTHE 26

To appear in:
Received date:
Accepted date:

3-8-2014
22-8-2014

Please cite this article as: Fogarty S, Waldron DC, McIntire N, A Case Series:
How Do Patients With An Eating Disorder, Seeking Acupuncture Treatment Present
(Patterns of Disharmony), And How Are They Treated?, Acupunct. Rel. Ther. (2014),
http://dx.doi.org/10.1016/j.arthe.2014.08.002
This is a PDF file of an unedited manuscript that has been accepted for publication.
As a service to our customers we are providing this early version of the manuscript.
The manuscript will undergo copyediting, typesetting, and review of the resulting proof
before it is published in its final form. Please note that during the production process
errors may be discovered which could affect the content, and all legal disclaimers that
apply to the journal pertain.

A Case Series: How Do Patients With An Eating Disorder, Seeking

Acupuncture Treatment Present (Patterns of Disharmony), And How Are

ip
t

They Treated?

cr

Sarah Fogarty, PhD

us

Trial coordinator, National Institute for Complementary Medicine, University of Western

Sydney, Australia
Debra Clydesdale Waldron, B Sc

an

Acupuncturist at OM Vitality Center - Inner Body Knowing, Los Angeles, California, United
States of America
Norah McIntire, M TCM

Acupuncturist at Acuadvantage, Los Angeles, California, United States of America

ed

Correspondence: Locked Bag 1797. Penrith, NSW 2751 Australia Phone: + 61 2 4629 3290,
Fax: + 61 2 4629 3291 email: s.fogarty@uws.edu.au

ABSTRACT:

pt

(Received: Mar 10th 2014; Accepted with revisions: June 22nd, 2014)

Ac
ce

Acupuncture is an emerging therapy being utilized by those with eating disorders.

Little is known about acupuncture and eating disorders. The aim of this paper is to
present some TCM insight into the eating disordered patient who seeks
acupuncture treatment such as how they present according to TCM principles and
how acupuncturists are treating these patients. Three experienced acupuncturists
contributed 46 cases studies (eighteen outpatients, twenty six inpatients) of patients
with eating disorders who sought acupuncture treatment. Help with their eating
disorder was not what the majority of patients in this study sought acupuncture for.
The majority of in-patients wanted help for digestive and mood concerns. Our
collective cases provide an insight into how eating disorders present and how they
are treated by TCM acupuncture. How these insights may help clinicians and
researchers is discussed.
Key words: Eating Disorders; acupuncture; anorexia nervosa; bulimia nervosa;
Traditional Chinese Medicine.

Word Count:

Page 1 of 20

INTORDUCTION
Eating disorders are a major health problem commonly affecting women of early
teenage years to young adulthood [1, 2]. According to the new DSM-5 categorisation of
eating disorders Anorexia Nervosa (AN) is now characterized as persistent restriction of
energy leading to significantly low body weight, disturbances in the way ones body shape is
experienced and intense fear of gaining weight or becoming fat[3]. Bulimia Nervosa (BN)

ip
t

is characterized by recurrent episodes of binge eating with inappropriate weight

compensatory behaviours and self-evaluation unduly influenced by body shape and

eating without compensatory behaviours [4].

cr

weight[4]. Binge eating disorder (BED) is characterized by recurrent episodes of binge

Eating disorders not otherwise specified

us

(EDNOS), which was the presentation of an eating disorder that did not meet the criteria for
anorexia nervosa or bulimia nervosa [5], has been replaced by Other Specified Feeding or

an

Eating Disorders (OSFED)[4].

In 2012 there were more than 913,000 people in Australia with an eating disorder (ED)

at a cost of $69.7 billion (AUD) and an estimated 1,828 deaths due to EDs [6]. In the US it
is estimated that 8 million Americans have an ED with 9% of women struggling with AN in
their lifetime, 1.5% of women with BN and 3.5% of women with binge eating [7, 8]. It is

ed

reported that 5 10% of anorexics die within 10 years after contracting the disease; 18-20%
of anorexics will be dead after 20 years and only 30 40% ever fully recover[8]. Treatment

pt

for those with AN and BN can be challenging, and a multidisciplinary approach is the most
commonly prescribed form of treatment [9-11]. Some of many modalities and therapies used

Ac
ce

include nutritional supplementation, cognitive behavioural therapy (CBT), medication, family

counselling, dietary advice, counselling and/or health monitoring among others [6].
Individuals with an ED are known to seek help from complementary and alternative therapies
(CAM)[12].

Acupuncture is characterized by the insertion of needles into specific body points to

impact the flow of qi (vital energy), a therapeutic relationship, individualized treatment and
active engagement of patients in self care or management [13]. The acupuncture consultation
is a complex therapeutic intervention involving not just needling but a more holistic
experience [14]. There is emerging evidence identifying an adjunctive role for the use of
acupuncture to treat EDs however the research is in its infancy. EDs are a relatively recent
mental health diagnosis[15], and the Chinese classical texts do not have a satisfactory

Page 2 of 20

comparable diagnosis. Despite the lack of EDs in Traditional Chine Medicine (TCM)
history, the authors believe that EDs can be helped by classical acupuncture, and this offers a
unique intersection of ancient treatment for a modern illness.
The evidence on which patterns of disharmony are relevant for eating disorders is
limited and of mixed quality [16-20]. These current theories, however, give an idea of the

ip
t

patterns that are being used to define eating disorders (most commonly Zang Fu patterns
involving the Spleen, Stomach, Liver, Heart and Kidney). The patterns of disharmony put

cr

forward by authors, academics and respected practitioners of eating disorders (BN, AN and
AN and BN collectively) have been identified in Table 1.

us

While there are a number of theoretical research papers/theses investigating the use of
acupuncture for the treatment of EDs [21-25], there is little information about the

an

practical/clinical presentation of the ED sufferer seeking acupuncture treatment [25, 26].

Utilising the collective cases of acupuncturists, experienced in treating those with EDs, may

provide a better understanding of how EDs present in TCM practice and how they are
treated which may, in turn, inform clinicians and guide further research questions. The aim
of this paper is to present a TCM insight into the eating disordered patient who seeks

ed

acupuncture treatment, specifically addressing the motivations of the eating disordered

patient who seeks acupuncture treatment, how they present according to TCM principles and

Ac
ce

pt

how acupuncturists are treating these patients.

MATERIALS AND METHODS

Participants

Two practitioners from the United States and one from Australia, with experience
treating EDs contributed cases to this study.

Forty-three individuals with an ED sought

treatment with the three different practitioners from 2002 to 2012. Patients were either
private patients of the acupuncture clinicians or undertaking acupuncture treatment as part of
a research project. The major difference for patients in the research setting was the clinical
outcome forms they filled in at baseline and at the end of the treatment intervention and that
their treatment was free. There was a mixture of in and out patients. The major difference
between inpatient and outpatient care was the level of continuous supervised care with
inpatients receiving up to 24 hours a day supervised care and outpatients from none to 8

Page 3 of 20

hours a day. The other major difference was the severity of the ED with inpatients often
presenting as more severe or medically unwell on the ED spectrum than those who are
outpatients.
The inclusion criteria for the cases included
1. having an ED and
2. seeking treatment for either their ED specifically or for a symptom associated with

ip
t

their ED.

Cases were also included when a patient had had an ED and was seeking treatment to

cr

avoid a full blown relapse. A minimum of 3 visits was required to be an eligible case. There
were no exclusion criteria. Excluding co-morbid conditions could invalidate or alter the

us

presentation of patients with EDs seeking acupuncture treatment and thus any conclusions
drawn from the cases. This case series aims to capture the lived presentation of those with an

an

ED seeking acupuncture.
Study Design

This is a retrospective case series designed study. It is a descriptive study with the
purpose of following a group of patients who are undergoing the same procedure over time to
present some TCM insights.

ed

Treatment

Acupuncture: Type of Acupuncture: TCM style manual acupuncture was most commonly

pt

used in these cases.

TCM diagnosis: The TCM diagnosis was primarily based on viscera and bowel pattern

Ac
ce

identification[27] however channel diagnosis and Five Element theory was used by one
practitioner for two patients and Balance Method was used by one practitioner for six
patients. There is no peer reviewed research or historical context to guide the style of
acupuncture in the treatment of EDs. However, TCM acupuncture is useful in the treatment
of complex diseases[27].

Examination: The method of examination to determine the patterns involved (in all methods)
included the techniques of inquiry and inspection[27].
Point selection: The treatment method and point selection for each individual was based on
the identification of the pattern most predominately involved each session.
Needling:

Page 4 of 20

Needles- Fine disposable needles (Australia-Serin or Viva brand, either 0.22 or 0.25
gauge, America-typically 34-38 gauge needles) were used. The majority of points
were needled bilaterally.
Insertion depth and Stimulation- Shallow and light manual stimulation was used given
the extreme thinness and sensitivity of the participants,[28] and thus de Qi was not
obligatory. Acupuncture needles were typically inserted between and inch.

ip
t

Typically the needles were manipulated using a combination of lift and thrust
and rotation, which, according to Chinese acupuncture theory, is believed to have a

cr

supplementing effect [29]. This was done following insertion and once midway
during the treatment.

us

Duration: The needles were left in situ on average for 30 minutes after which they
were removed.

an

Other TCM interventions- Some patients receiving acupuncture at a private clinic

setting received myofascial release, Chinese herbs, structural bodywork, body mind therapies,
touch therapy, personal training and/or Qi Gong. Some participants in the in-patient research

setting received acupressure instead of needles and light massage treatment.

The acupuncture treatment, both in private practice and in the research setting, was

ed

pragmatic, i.e., individualised to each patient.

Treatment was administered by three of the authors (SF, DW or NM), all experienced
acupuncture practitioners, with a combined 32 years in practice.

pt

Co-interventions: All participants in the inpatient group received conventional inpatient

Ac
ce

treatment which consisted of a multidisciplinary team comprised of a consultant psychiatrist,

clinical psychologists, intern clinical psychologists, dietician, occupational therapist and
specially trained nursing staff. Patients attended group therapy for several hours each day
with a cognitive behavioural focus. All meals and snacks were supervised by members of the
clinical team.

The outpatients received a mixture of co-interventions ranging from no other

treatment to regular medical support such as psychiatry, Western medication, nutrition, group
therapy and utilising the services of a specialised ED outpatient clinic.
Analysis
The age and duration of ED are expressed as the mean and standard deviations (SD).
The descriptive statistics were calculated using Excel (Microsoft Office 2007).

Page 5 of 20

RESULTS
The characteristics of the inpatients seeking acupuncture are: majority female
(96.2%), aged in their early twenties, suffering from a co-morbid disease, single, and living
with their parents. Almost a quarter of participants had previously used complementary
medicine or therapies [21]. The characteristics of the outpatient group are: female (100%),

studying. See Table 2 for a summary of demographic characteristics.

ip
t

aged in their early twenties, single, suffering from a co-morbid disease and many were

cr

Help with their ED was not what the majority of patients in this study sought
acupuncture for. The majority of inpatients wanted help for digestive and mood concerns.

us

The majority of outpatients wanted help with sleep and digestive concerns. Table 3 lists what

an

patients wanted acupuncture treatment for.

Table 4-7 lists the patterns of disharmony presented in the cases and the most

DISCUSSION

ed

commonly used points. Appendix 1 has a list of all the points used.

The primary objective of the case series is to inform/educate clinicians and to guide

how they are treated.

pt

future research by providing a better understanding of how ED present in TCM practice and

Ac
ce

Conditions versus Symptoms for Treatment

Our case series indicates that sufferers receiving acupuncture treatment are not

seeking treatment specifically for their ED, but for aspects related to their eating disorder
such as mood, digestion issues, sleep and general health. Our findings mirror Clarkes 2009
thesis results which also found that ED sufferers sought acupuncture treatment for symptoms
or side effects of their ED such as mental/emotional issues (including stress and depression),
menstrual irregularities and digestive complaints rather than the ED directly [26]. This
knowledge may help future researchers design their studies focusing on outcome measures
and study methodologies that address mood issues for inpatients, and sleep issues for
outpatients. Relapse rates are high in those with an ED, and helping ED patients with their
specific needs/complaints during in-patient or out-patient care such as sleep, mood and/or
digestion might help them preserve with their ED treatment [30].

Page 6 of 20

Our findings also reiterate that acupuncture is being used as a complementary therapy
not a primary treatment for ED.

Future research designs should reflect this finding.

Acupuncture practitioners who see patients with an ED privately, and acupuncture

associations, should ensure that any promotion or advertising regarding treatment of EDs
reflects acupunctures use and evidence as a complementary therapy.

ip
t

Patterns

The top three presenting patterns for the AN inpatients in our case series are Liver Qi

cr

depression, Spleen Yang deficiency and Spleen Qi deficiency. In Fogartys (2012) study the
patterns seen in AN sufferers involved Liver Qi depression, Spleen Qi deficiency, Spleen and

us

Stomach Deficiency Cold and Heart Qi deficiency [23]. The top three patterns in both cases
are very similar with both including Liver Qi depression and Spleen Qi deficiency. Spleen

an

Yang deficiency and Spleen and Stomach Deficiency Cold have very similar features sharing
6 symptoms (75% of Spleen and Stomach Deficiency Colds symptoms and 50% of Spleen
Yang deficiencys symptoms) [27, 31]. Spleen Yang deficiency has a greater number of

symptoms than Spleen and Stomach Deficiency Cold indicating perhaps a more developed
longstanding systemic pattern. It is hypothesised that the difference between Spleen Yang

ed

deficiency and Spleen and Stomach Deficiency Cold may reflect the difference in the severity
in presentation of AN with Spleen Yang Deficiency reflecting the more severe state of AN
and the progression of AN according TCM pathology. If this is the case then Spleen and

pt

Stomach Deficiency Cold developing into Spleen Yang Deficiency might indicate a worsening

Ac
ce

of AN which may act as a trigger or safety guard to clinicians that acute allopathic
intervention is needed.

Future research may examine more specific aspects of pattern

presentation such as if specific behaviours are correlated with specific patterns, for instance if
laxative abuse leads to a presentation of Yang deficiency rather than Qi deficiency.
Liver Qi depression was highly prevalent in both the 2012 study and in our cases [23].
There are a number of theories for the higher levels of Liver Qi depression seen in EDs.
These include Liver Qi depression reflecting the difficulty of living with and suffering from
an ED (forced hospitalisation, in-patient stays etc [32]) and/or the role of trauma (such as
childhood sexual abuse, neglect, abuse in general, post-traumatic stress[33]).

A better

understanding of the role of Liver Qi depression in those with an ED may help clinicians
tailor their treatment for greater therapeutic benefit. Given the proposed hypothesis for the
role of Liver Qi depression in EDs, acupuncture may have a role in the prevention of ED

Page 7 of 20

onset and/or relapses. Future research investigating the specific role of Liver Qi depression
within the field of ED would be of interest.

The list of patterns seen in the presented cases (both inpatient and outpatient) does not
substantially reflect or reproduce what was seen in the summary of patterns from the
literature (Table 1). Our presented cases reflect a greater diversity of patterns seen in those

ip
t

with an ED than those in Table 1 involving heat, excess, stagnation and deficiency patterns.
More evidence-based research is needed to corroborate (or replace) the anecdotal theories of

cr

practitioners and authors.

us

Points

Point selection is a vital part of the effectiveness of the TCM treatment. Difficulties

an

in determining the points to use in treatment can arise when treating complex cases as
patients present with multiple patterns of disharmony, rendering it impossible to pick points
to treat all areas of disharmony. The top ten points most commonly used in our case series

were similar for both out and in patients and thus will be grouped together for discussion.
The points include 4 heavenly star points, 3 command, shu-stream and yuan source points, 2

ed

he-sea, confluent and four sea points, and 1 luo connection, front-mu and hui-meeting points
[31]. EDs are systemic, affecting many areas of the body. Our point selection reflects the
above mentioned range of dysfunction affecting many areas of the body such as qi, blood,

pt

yin/yang, external pathogens, the extra ordinary channels, multiple TCM organs and channels
[31, 34]. They also address the issues that patients requested treatment for such as SP 6, KI

Ac
ce

3, PC 6, LR 3, CV 6, yintang for sleep; LI 4 and LR 3, SP 6, PC 6, GB 34, yintang for mood;

ST 25, ST 36, SP 6, PC 6, TE 5, GB 34, LR 3, CV 6 for digestive complaints. It is of interest
that the ancient texts state that he-sea points (Stomach 36 and Gall Bladder 34) are for disease
of the Stomach and disorders resulting from irregular eating and drinking [31]. The lists of
points give clinicians unfamiliar with treating EDs a reference of possible points to use.
Researchers have a list of points used in clinical practice addressing ED patients area of
concerns.

Future research might implement some of these listed points in their study

protocol.

Clinical observations

Page 8 of 20

Treating patients with an ED can be difficult, and the encounter may present unique
patient care issues. To help clinicians, the authors have provided some observations based on
their experiences.
-

ED patients, particularly those with AN, are prone to becoming chilled. The use
of a heating blanket (electric blanket) on the treatment table will help keep the
patient warm.
Lower gauge thin needles were used by all the practitioners because:

ip
t

o deep needling is contraindicated for those with AN due to the thinness of

cr

this population and

o heavy needling or heavy stimulation, including electrical stimulation may

us

trigger anxiety and/or a worsening of co-morbid conditions including

anxiety and/or depression.

Anorexics may struggle with lying still for long periods as underlying blood

an

and/or yin deficiencies can cause them to be restless and/or they feel the lack of
movement will lead to weight gain (lack of movement equals fewer calories

burnt).

All three authors, independently of each other, administered the same needle
All authors felt that longer retention times

ed

retention times (25-30 minutes).

depleted the patients and lead to poorer outcomes. This is supported by Kraft
(2003) [28].

This population can benefit from a therapist who understands EDs and some of

pt

Ac
ce

the issues patients are going through. The therapeutic relationship is a very
important aspect of the acupuncture consultation, and the cultivation of the
therapeutic relationship is central to successful treatment [24].

Safety at the clinic is very important; it needs to be a safe place for the eating
disordered patient to attend.

Know your duty of care obligations and any

mandatory reporting of abuse or mandatory reporting of self-harm.

Issues for

those with an ED amongst others include, unsecured scales (patients weighing

themselves while you are out of the room) and magazines extolling the virtues of
being thin and weight loss and denouncing being overweight.

Future acupuncture and ED research may wish to consider the clinical observations
when designing study protocols.

Page 9 of 20

Limitations
Limitations in the case series presented are that only one practitioner treated all the
inpatients and thus the patterns and point locations might be a characteristic of the
practitioner not a trend reflected in clinical practice.

A possible reason for the higher predominance of Liver Qi depression seen in our cases

ip
t

may be that those with high Liver Qi depression are more likely to self select acupuncture

cr

treatment and thus be more susceptible to its benefits.

Conclusion

us

Our collective cases provide an insight into how EDs present and how they are
treated by TCM acupuncture. This insight may help clinicians better understand and treat

an

clients with ED and provide some guidance/resources for researchers designing their study

protocols.

REFERENCES

Ac
ce

pt

ed

1.
Birmingham CL, Beumont P. Medical Management of Eating Disorders. Cambridge:
Cambridge University Press; 2004.
2.
Grilo CM. Eating and weight disorders. London: Psychology Press; 2006.
3.
DSM-5 Proposed Diagnostic Criteria for Anorexia Nervosa [database on the Internet].
American Psychiatric Association. 2010 [cited 27th April 2010]. Available from:
www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=24.
4.
DSM-5 DaSMoMD. Feeding and Eating Disoders. The American Psychiatric
Association (APA); 2103 [cited 2013 6th September]; Available from:
http://www.dsm5.org/Documents/Eating%20Disorders%20Fact%20Sheet.pdf.
5.
American Psychiatric Association. Diagnostic and statistical manual of mental
disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2009.
6.
Butterfly Foundation for Eating Disorders. Paying the Price: The economic and social
impact of eating disorders in Australia. Melbourne, Australia: The Butterfly Foundation2012.
7.
Merikangas K, He J, Burstein M, Swanson S, Avenevoli S, Cui L, et al. Lifetime
prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity
Survey Replication. J Am Acad Child Adolesc Psychiatry. 2010;Oct;49(10):980-9.
8.
South Carolina Department of Mental Health. Eating Disorder Statistics 2006 [cited
2013 10th September]; Available from: http://www.state.sc.us/dmh/anorexia/statistics.htm.
9.
Fairburn C, Harrison P. Eating Disorders. Lancet. 2003;361(February 1):407-16.
10.
Andersen AE, Mehler PS. Eating disorders : a guide to medical care and
complications. Baltimore: Johns Hopkins University Press; 1999.
11.
Anorexia Nervosa and Related Eating Disorders Inc. Treatment and Recovery. 2005
[cited 2013 14th October]; Available from: http://www.anred.com/tx.html.
12.
Hay P, Mond J, Paxton S, Rodgers B, Darby A, Owen C. What are the effects of
providing evidence-based information on eating disorders and their treatments? A

Page 10 of 20

Ac
ce

pt

ed

an

us

cr

ip
t

randomized controlled trial in a symptomatic community sample. Early Interv Psychiatry.

2007;1:31624.
13.
(NCCAM). NCfCaAM. Acupuncture: An Introduction. NCCAM; August 2011
[updated August 2011; cited 2013 12 March ]; NCCAM Pub No:D404].
14.
Shi G-X, Yang X-M, Liu C-Z, Wang L-P. Factors contributing to therapeutic effects
evaluated in acupuncture clinical trials. Trials. 2012;13(42):1-5.
15.
Gull W. Anorexia nervosa (apepsia hysterica, anorexia husteria). Trans R Soc Lond
1874;7:22-8.
16.
Deadman P. Eating Disorders. In: Fogarty S, editor. Email ed2007. p. 1.
17.
Flaws B. Eating Disorders. In: Fogarty S, editor. Email ed. USA2007. p. 1.
18.
Maciocia G. Eating Disorders. In: Fogarty S, editor.2007. p. 1.
19.
Ross J. Acupuncture and Anorexia Nervosa. In: Fogarty S, editor.2006. p. 1.
20.
Scott J. Eating Disorders. In: Fogarty S, editor. UK2007. p. 1.
21.
Smith C, Fogarty S, Touyz S, Madden S, Buckett G, Hay P. Acupuncture and
acupressure health outcomes for patients with anorexia nervosa: findings from a pilot
randomised controlled trial and patient interviews 2013.
22.
Fogarty S, Harris D, Zaslawski C, McAinch AJ, Stojanovska L. Acupuncture as an
Adjunct Therapy in the Treatment of Eating Disorders: A Pilot Study. Complement Ther
Med. 2010;18(6):227-76.
23.
Fogarty S, Harris D, Zaslawski C, McAinch AJ, Stojanovska L. Development of a
Chinese Medicine Pattern Severity Index for Understanding Eating Disorders. The Journal of
Alternative and Complementary Medicine. 2012;18(6):597-606.
24.
Fogarty S, Smih C, Touyz S, Madden S, Buckett G, Hay P. Patients with anorexia
nervosa receiving acupuncture or acupressure; their view of the therapeutic encounter.
Complement Ther Med. 2013.
25.
Fogarty S, Stojanovsak L, Harris D, Zaslawski C, Mathai ML, McAinch AJ. Does
Acupuncture promote weight loss and mental health in overweight and obese individuals
participating in a weight loss program? A randomised cross-over pilot study. 2014.
26.
Clarke L. Exploring the basis for Acupuncture Treatment of Eating Disorders; A
Mixed Methods Study: Northern College of Acupuncture (NCA); 2009.
27.
Deng T. Practical Diagnosis in Traditional Chinese Medicine. Edinburgh: Churchill
Livingstone; 2000.
28.
Kraft N. Anorexia Nervosa. Oriental Medicine Journal. 2003;11(1):19-23.
29.
Deng L, Gan Y, He S, Ji X, Li Y, Wang R, et al. Chinese Acupuncture and
Moxibustion. Cheng Y, Huang X, Jia W, Li S, Qui M, Yang J, editors. Beijing, China:
Foreign Languages Press; 1996.
30.
Lowe B, Zipfel S, Buchholz C, al e. Long-term outcome of anorexia nervosa in a
prospective 21-year follow up study. Psychol Med. 2001;31:881-90.
31.
Deadman P, Al-Khafaji M, Baker K. A Manual of Acupuncture. East Sussex: Journal
of Chinese Medicine Publications; 1998.
32.
Ramjan LM, Gill B. An Inpatient Program for Adolescents with Anorexia
Experienced as a Metaphoric Prison. Australian Journal of Nursing. 2012;112(8, August):2433.
33.
Mitchell KS, Mazzeo SE, Schlesinger MR, Brewerton TD, Smith BN. Comorbidity of
Partial and Subthreshold PTSD among Men and Women with Eating Disorders in the
National Comorbidity Survey-Replication Study. Int J Eat Disord. 2012;April; 45(3):307-15.
34.
Lade A. Acupuncture Points; Images and Functions. Seattle: Eastland Press; 1989.
35.
Wimmer R. Treating the Femal Athlete Triad: Eating Disorders, Part One2003; 4(9):
Available from: http://www.acupuncturetoday.com/mpacms/at/article.php?id=28296.

Page 11 of 20

ed

an

us

cr

ip
t

36.
Flaws B. Bulimia and Chinese Medicine. Blue Poppy Press; 2001 [cited 2006 13th
September]; Available from:
http://chinesemedicalpsychiatry.com/articles/article_bulimia.html.
37.
MacLean W, Lyttleton J. Clinical Handbook of Internal Medicine. Australia: Interest
of Western Sydney; 2002.
38.
Fletcher M. Fight Eating Disorders with Chinese Medicine. Pacific College of
Oriental Medicine [serial on the Internet]. 2002-2005: Available from:
http://www.pacificcollege.edu/acupuncture-massage-news/articles/571-fight-eatingdisorders-with-chinese-medicine.html.
39.
Munir NE. Anorexia and Bulimia. [Article]: Healing Centre An alternative healing
method; 2007 [updated 27th February 2007]; Available from:
http://www.healthphone.com/consump_english/a_healing_centre/em...
40.
Eating Disorders. Global Information Hub for Integrated Medicine; 2003 [cited 2007
27th February]; Available from:
http://content.nhiondemand.com/moh/media/TCMHC1.asp?objID=....
41.
Flaws B, Lake J. Chinese Medical Psychiatry. 2nd ed. Boulder: Blue Poppy Press;
2003.
42.
Smith RD. Anorexia nervosa : west meets east a study of collateral damage:
Acupuncture Colleges (Australia),; 1993.
43.
Gasgcoigne S. The Manual Of Conventional Medicine for Alternative Practitioners.
Chippenham: Dorking, Jigme Press; 1994.
44.
Ross J. Acupuncture Point Combinations- The Key to Clinical Success. Edinburgh:
Churchill Livingstone; 1995.
45.
Mahoney H. Sexual Abuse/Incest and the Resulting Patterns of Energetic Disharmony
in the Young Female:- Can Traditional Chinese Medicine Play a Role in Understanding
These Patterns? Melbourne: Australian Acupuncture College of Melbourne; 1989.

pt

Table 1. Summary of patterns of disharmony according to eating disorder type.

Ac
ce

Bulimia Nervosa
Liver Qi stagnation leading to yin deficiency fire [35]
Evil Heat or yang hyperactivity of the Stomach [36]
Stomach Heat type regurgitation [37]
Liver qi Stagnation and Stomach Heat [23]
Spleen Qi deficiency [23]
Heart Qi deficiency [23]
Anorexia Nervosa
Deficiency of Heart and Spleen [38, 39]
Spleen and Stomach Qi deficiency [40]
Spleen Qi deficiency, Yang deficient and heart deficient fire [35]
Fear (Kidney deficiency) misting Shen leading to Spleen deficient involvement [28]
Heart spirit malnourished [41]
Spleen Qi deficiency [23]
Earth deficiency [23, 42]
Spleen and Stomach Deficiency Cold [23]
Heart Qi Deficiency [23]
Liver Qi depression [23]
Eating Disorder Not Otherwise Specified (EDNOS)
Spleen and Stomach Deficiency Cold [23]
Liver Qi stagnation and Stomach heat [23]

Page 12 of 20

ip
t
cr

Ac
ce

pt

ed

an

us

Spleen Qi deficiency [23]

Binge Eating Disorder (BED)
Stomach Yin deficiency [23]
Liver Qi depression [23]
Heart Qi deficiency [23]
Eating Disorders in general (BN, AN collectively)
Spleen Qi deficiency with Liver stagnation [43]
Spleen and Stomach deficiency (excess or deficiency pattern) [16, 40]
Spleen Qi deficiency and deficient Heart fire [44]
Flaring up of Liver Fire [38, 39]
Stagnation of Qi and heat in the Stomach [38, 39]
Liver Qi stagnation [38, 39]
Fear, fright, and anxiety and thinking [41]
Earth dry, heart unkindled, metal brutal [20]
Earth failing to nourish metal [45]
Liver Qi depression [23]
Spleen and Stomach Deficiency Cold [23]

Page 13 of 20

Table 2. Demographic information for cases presented.

Inpatients
n=26
n

Outpatients
n=17

%/SD

%/SD

25

(96.2)

17

(100)

22

(SD 5.3)

25.2

(SD 9.7)

Female
Age
Duration of ED

5.2 years

(SD 6.2)

7.5 years

Eating Disorder
26 (100)

Bulimia Nervosa

(41.2)

(17.6)

(92.3.0)

(47.0)

us
an

Co-morbid conditions
24

(41.2)

Eating Disorder Not otherwise

Specified
Anxiety

(SD 7.5)a

cr

Anorexia Nervosa

ip
t

Gender

17

(65.4)

(47.0)

OCD

14

(53.8)

(17.6)

IBS

(0.0)

(5.9)

Body Dysmorphic Disorder

(3.8)

(11.8)

ed
5

(19.2)

(5.9)

(0.0)

(5.9)

(15.4)

(0.0)

(7.8)

(0.0)

Single

20

(76.9)

(52.9)

Married

(7.7)

(11.8)

Other

(15.4)

(23.5)

(38.5)

11

(64.7)

Chronic fatigue
Phobias
ADHD

Ac
ce

Relationship

pt

PTSD

Depression

Occupation
Student
a

Missing data for 6 of the 17 individuals

Page 14 of 20

Table 3. Issues/concerns that patients sought benefit from with acupuncture.

Out--Patients (n =17)

3.8

4
0
5
3
8
0

15.4
0
19.2
11.5
30.8
0

3 11.5

35.3

5
2

29.4
11.8

ip
t

76.9
3.8

cr

20
1

us

46.2

Digestive- IBS, abdominal/epigastric

pain, constipation, diarrhoea, stomach
aches, bloating
Mood- anxiety, stress, tension,
depression, crying
Womens Health- amenorrhea
Eating disorder specificbinging/purging, nocturnal eating,
sugar cravings, addiction
Extremities- cold hands/feet,
numbness in extremities
Sleep- insomnia, night sweats,
bedwetting
Energy- tiredness
Pain- lower back, hip, shoulder
Headaches
General Health
Dizziness
Other- cold all the time, dry skin,
edema

an

12

17.6

11.8

8
2
4
4
2
1
0

47.1
11.8
23.5
23.5
11.8
5.9
0

Ac
ce

pt

ed

In-Patients (n =26)
Digestive- IBS, abdominal/epigastric
pain, constipation, diarrhoea, stomach
aches, bloating, nauseous, cramps
Mood- anxiety, stress, tension,
depression, crying
Womens Health- amenorrhea
Eating disorder specificbinging/purging, obsession with food,
self-control
Extremities- cold hands/feet,
numbness in extremities
Sleep- insomnia, night sweats,
bedwetting
Energy- tiredness
Pain- lower back, hip, shoulder
Headaches
General Health
Dizziness
Other- cold all the time, dry skin,
edema

Page 15 of 20

Table 4. List of patterns of disharmony presenting in the in-patient cases

In-Patients (n =26) Primary
Condition

46.2
15.4
11.5

Spleen Yang deficiency

Spleen Qi deficiency
Liver Qi depression

9
8
6

34.6
30.8
23.1

2
1
1
1
1

7.7
3.8
3.8
3.8
3.8

Heart Qi deficiency
Heart Blood deficiency
Liver Qi stagnation and Stomach Heat
Liver Qi invading the Stomach
Food accumulation
Stomach-Spleen Disharmony
Heart Yin deficiency
Liver fire Flaming upwards
Heart Yang deficiency

2
2
1
1
1
1
1
1
1

7.7
7.7
3.8
3.8
3.8
3.8
3.8
3.8
3.8

cr

ip
t

12
4
3

Ac
ce

pt

ed

an

us

Liver Qi depression
Spleen Yang deficiency
Spleen Qi deficiency
Liver Qi stagnation and Stomach
Heat
Heart Qi and Blood deficiency
Heart Qi deficiency
Spleen and Kidney Yang deficiency
Heart Blood deficiency

In-Patients Secondary Conditions

Page 16 of 20

Table 5. List of patterns of disharmony presenting in the out-patient cases

%
47.1
5.9
5.9
5.9
5.9

1
1
1
1
1
1

5.9
5.9
5.9
5.9
5.9
5.9

Spleen Qi deficiency
Qi depression/Liver Qi depression
Liver Qi Stagnation and Stomach Heat
Stomach Spleen Disharmony

4
3
3
2

23.5
17.6
17.6
11.8

Chanel Diagnosis UB
Damp
Damp heat in the intestines
depressive heat liver and heart
Heart Qi deficiency
Heart Yin deficiency
Heart yang xu/Blood xu
Liver Qi stagnation invading the spleen
Liver yin deficiency and depression
Heart blood xue fire blazing
Kidney Yang deficiency
Lung and Spleen qi deficiency
Spleen and Lung Deficiency
Spleen and Stomach deficiency Cold
Sp qi Xu and St Qi xu
xue deficiency

1
1
1

5.9
5.9
5.9

1
1
1

5.9
5.9
5.9

1
1
1
1
1
1

5.9
5.9
5.9
5.9
5.9
5.9

1
1

5.9
5.9

1
1

5.9
5.9

ip
t

8
1
1
1
1

cr

Ac
ce

pt

ed

an

Liver Qi depression
Blood deficiency
Chanel Diagnosis UB
Heart Yang deficiency
Kidney yin deficiecny with
empty heat & wind
Liver blood Xu
Liver yin deficiency
SI xu & cold
Spleen Yang deficiency
Stomach Heat
UB and GB

Out-Patients Secondary Condition

us

Out-Patients (n =17)
Primary Condition

Page 17 of 20

Table 6. Top 10 points used in treatment.

In-patients
n=26
1

Out-patients
n=17

LI 4 and St 36 (100)

Lr 3 (88.2)

Lr 3

(88.5)

Sp 6 (76.5)

Sp 6

(76.9)

St 36 and LI 4 (70.6)

Pc 6

(61.5)

P 6 and Ki 3 (52.9)

Ki 3 (50)

Lu 7 and TE 5 (47.1)

GB 34 and SI 3 (30.8)

GB 34 (41.2)

St 25 (26.9)

10

10

CV 6 (23.1)

Extra Point

cr

ip
t

Ki 6 (35.3)

Ac
ce

pt

ed

an

us

Yintang (29.4)

Page 18 of 20

Table 7. Point combinations used

Out-Patients

Points

Used n (%)

Three Emperors

Sp 6, Sp 7.5, Sp 9

1 (5.9)

Four Gates

LI 4 and Lr 3

12 (70.6)

Four Gates

LI 4 and Lr 3

22

(84.6)

Ac
ce

pt

ed

an

us

cr

ip
t

In-Patients

Combination

Page 19 of 20

ip
t

Table

cr

Case series: Acupuncture and eating disorders

Appendix 1.

LI

St

Sp

PC

TE

UB

KI

HT

SI

GB

4
11
1

36
8
29

9
6
4

6
3
7

5
10
3

65
60
59

9
2
5

4
5
6

5
4
3

34
41
13

2
5
3

40
42
45
44
41
43
25
38

3
10
12
15

4
9

4
6

58
10
11
15
18
20
21
23

3
7
4
6
25

Lr

CV

GV

Extra

Ear

Other

8
3
1

6
4

24
3
20

Yintang

Shenmen
Lv
Sp

Lingku
da bai
zhong bai
yao
(dorsum of
hand)

39
40
21

5
4
2

Ki
Stomach
Hungry

Point combinations
Three emperors
(SP6, SP 7.5?, SP 9)
Four gates

ep
te

an

Lu

us

List of all the points used in the out-patient treatment

Ac
c

List of all the points used in the in-patient setting

Lu

LI

St

Sp

PC

TE

UB

KI

HT

SI

GB

Lr

CV

GV

Extra

Point combinations

4
11

36
1
25
40

6
10
3
4

23
31
34

1
3
24
13

7
3

34
21
20

3
2

4
12
6

EX-B8
Yntng

Four gates

Page 20 of 20