Anorexia+Nervosa


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Definition:
An eating disorder characterized by a perverted sense of body image; an obsessive fixation on thinness and dread of weight gain; significant weight loss; and amenorrhea in women.

Etiology:
The disorder primarily affects females, with only 5% of patients being male. Onset is usually during adolescence or young adulthood (rarely after the middle twenties), and chiefly in middle-to-upper class white women. It is rarely seen in lower socioeconomic levels or in Blacks or Asians. The incidence of eating disorders is increasing in America, with estimates of up to 18-25% of college women having either anorexia or bulimia (binge and purge: see "bulimia"). Anorexia is a disorder where the sufferer radically restricts caloric intake, based on an obsession to be thin: the end result is emaciation. Although pure forms of both anorexia and bulimia exist, it is not infrequent for a sufferer to overlap the two diseases.

The cause for anorexia nervosa is unknown, although possible factors include a hypothalamic disorder; psychiatric disorder (such as depression); peer pressure; and reactions to cultural or familiar attitudes towards the body.

Consider: pancreatic or liver hypoglycemia with sympathetic nervous system compensation affecting the bile duct, pyloric and ileocecal valves as well as enzyme availability (Easley).

Somatic Therapies:
• qigong • tai qi chuan

Nutrition:
therapeutic foods: • increase foods that calm the Shen (Spirit), tonify the Heart, harmonize the Stomach and Spleen • bell pepper, cilantro, mustard greens, green onion, garlic, cinnamon, ginger, pumpkin, yam, beans, corn, barley, rice, persimmons, potatoes (Ni, 102.)

specific remedies: • tea from green onions, garlic, cinnamon or ginger (Ni, 102.) • soup from pumpkin, yam, beans, potatoes, corn, barley or vegetables (Ni, 102.) • soupy rice (Ni, 102.)

Botanicals
• Acorus calamus (toxic): tonic (Sherman) • Angelica archangelica (root): with Chamamaelum nobilis (chamomile) (British Herbal Pharmacopoeia, p. 27) • Arctium lappa (root): (British Herbal Pharmacopoeia, p. 128) • Centaurium erythraea: with Chamomilla spp. and Arctium lappa (root) (British Herbal Pharmacopoeia, p. 56) • Chamomilla spp.: anorexia; with Humulus lupulus to allay pain, anxiety (British Herbal Pharmacopoeia, p. 61) • Humulus lupulus: sedative, bitter; stimulates digestion (Sherman)

consider: nutritives • Avena sativa • Medicago sativa • Nepeta cataria • Taraxacum officinale (root)

Chinese Formulae
• Pinellia and Magnolia C. (Ban Xia Hou Po Tang); Cyperus 18 (patent): Liver Qi Stagnation: plum-pit Qi, neurosis, vomiting, depression (Hsu, 1980, p. 395; Yeung, p. 42; Dharmananda, 1986, p. 226; Bensky and Barolet, p. 291; Cyperus 18: Dharmananda, 1990, p. 45) • Four Major Herbs C. (Si Jun Zi Tang): Spleen Qi Xu (Deficiency): pallid complexion, low soft voice, reduced appetite, loose stools, weak limbs, pale tongue (Hsu, 1980, p. 264; Yeung, p. 214; Dharmananda, 1986, p. 103; Bensky and Barolet, p. 236) • Ginseng and Tang Kuei Ten C. (Shi Guan Da Bu Tang): Spleen Qi Xu (Deficiency) with Xue Xu (Blood Deficiency): reduced appetite, weakness of lower extremities, feeling of coldness (Hsu, 1980, p. 262; Yeung, p. 209; Dharmananda, 1986, p. 107; Bensky and Barolet, p. 260) • Ginseng Nutritive C. (Ren Shen Yang Ying Tang): Xue Xu (Blood Deficiency) with Qi Xu (Deficiency) and Shen Disturbance: reduced appetite, fatigue, weight loss, dry skin, dry mouth and throat, palpitations, forgetfulness (Hsu, 1980, p. 239; Yeung, p. 182; Dharmananda, 1986, p. 407; Bensky and Barolet, p. 260) • Fu-shen 16 (patent): Shen Disturbance (Dharmananda, 1990, p. 68)

Acupuncture
after assessing the person and palpating, consider these patterns: Stomach Shi (Excess): sanguine; Stomach Xu (Deficiency): phlegmatic; Shen Disturbance; Spleen Qi Xu (Deficiency); Stagnant Liver Qi; Liver Invading Spleen; Cold and Yang Xu (Deficient) Spleen; Cold and Yang Xu (Deficient) Kidney; Shi (Excess) of the Du Mai (Governing Vessel)

» illustrative combinations: • consider treatment for "Internal Dragons" or "External Dragons"; External Dragons: GV-20, UB-11, UB-23, UB-61; Internal Dragons: Master point 1/4" below CV-15, St-25, St-32, St-41; In both treatments, sedate first. If the person and the pulses change, fine. If no change with sedation, then tonify. (Worsley) • Sp-4 and PC-6: activate and harmonize the Chong Mai (Penetrating Vessel); facilitate circulation of Qi in the Middle Warmer; access deepest aspects of nourishment; Master point and Couple point of the Chong Mai (Penetrating Vessel) • SI-3 and UB-62: open the Du Mai (Governing Vessel) for which Shen disorders are a symptom of Shi (Excess) • Sp-4 and CV-12: harmonize the Center and treat lack of appetite (Finkelstein, p. 26) • Ht-7 and Sp-6 for Shen Disturbance, Spleen Qi Xu (Deficiency), and/or Stagnant Liver Qi (Eisen) • UB-18 (-); UB-20 (+), Lv-3 and Sp-6 for Liver Invading Spleen (Eisen) • UB-20 (+ and ind. D), UB-23 (+ and ind. D), PC-6, Sp-4 and Kd-2 for Cold and Yang Xu (Deficiency) of Spleen and/or Kidney contributing to anorexia nervosa (Eisen) • UB-17, UB-18, UB-19, CV-6, St-39, St-45 and Lv-4 for "anorexia" (Mann, p. 96) • CV-12 and Sp-4 treat lack of appetite (Finkelstein, p. 89) • CV-12, CV-11, CV-10 and CV-9 (+): regulate the Stomach Qi; strengthen the Spleen; transform Rebellious Qi; eliminate Food Stagnation; harmonize digestion • CV-22, CV-12, CV-4 and GV-9: Reunion points of the Yin and Yang, needled when there is conflict between Yin and Yang, according to Su Wen (Finkelstein, p. 78)

Homeopathy
• Aconitum napellus: less appetite after fright • Arsenicum album: very restless, exhaustion, vomits; < after eating; fear of being poisoned • Cinchona: flatulence gives no relief of pain; may have been bulimic first; indolent, theorizing; extremely sensitive; periodical • Cyclamen: great weakness in morning, restless in afternoon, prefers being alone • Folliculinum: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • Gelsemium: weakness; quiet; dullness; apathy; insomnia; no thirst • Ignatia: fear of getting fat, rejection; obsessed with perfect weight; extreme headaches • Lac Humanum: history of difficult mother-daughter relationship; issues of nourishment and addiction • Myrica cerifera: depressed; discouraged; desperate; does not want to eat; irritable • Natrum muriaticum: fear of rejection; dry lips and skin; constipated • Phosphoric acid: grief with loss of appetite, apathetic to self and food • Platina: obsessed with their appearance, egocentric; tied up with sexuality • Sepia: hepatic; irritable, indifferent to everything; desire to be alone; disgust for food, abnormal odors, though of food nauseating • Veratrum album: many gastrointestinal problems; certain foods cause diarrhea; often workaholics; hysterical people; thirst for large quantities

Subtle Support
• Mi (Gardner, p. 72, 78) • Fa# (Gardner, p. 82, 87)

mental/emotional: • rhythmic folk songs • County Derry • songs of Steven Foster • Spanish tangos • Brahms' Hungarian dances • Sousa's marches • Strauss' waltzes • Gilbert and Sullivan • Indian Love Call • My Wild Irish Rose • Wishing • Estrellita (Heline, p.18)

Mind/Body
• Immunological assessment study: The profiles of patients with anorexia deviated from the reported typical profile of significantly depressed cell-mediated immunity (CMI), demonstrating normal T-lymphocyte populations and unimpaired proliferative lymphocyte responsiveness. In fact, mitogen responsiveness was significantly elevated above the controls; but with nutritional repletion, this enhanced responsiveness regressed toward control values. Maintenance of relatively intact CMI may be an important factor separating the malnourished anorexia nervosa patient from other protein-calorie malnourished patients. (Locke, 1983, p. 167) • Conflicts about growing up. (Epstein, p. 58) • Denying the self-life. Extreme fear, self-hatred, and rejection. (Hay, 1984, p. 152) • To explain the paradoxical illnesses of anorexia or bulimia, one has to drop the distinction between mind and body. In anorexics, the distorted idea, 'I must be thinner,' takes over the bodymind like a malevolent and elusive phantom. Even after long hospitalization and exhaustive psychiatric treatment, the patient rarely eats like a normal person. In the binging and vomiting of bulimia, the distortion goes beyond, 'I have to be thin,' to 'I can never be thin enough.' Thus, in similar ways, obsession with an unrealistic body image takes over as 'a ghost of memory', a memory picked up and stored in the body. These patients do not feel they have a disease, they are the disease, and to heal, they must reach the level where the 'ghost lives.' (Chopra, p. 79-81) • Anorexics and bulimics have an exaggeration of an ascetic ideal, and resist their own femininity and sexuality in an aim to free themselves of bodily needs, to be pure and spiritual renunciates. "Asceticism generally throws a shadow, and the name of that shadow is 'greed'. Thus, anorexics never succeed in finding a happy medium in the conflict between greed and asceticism, between hunger and renunciation, between self-centeredness and self-sacrifice. These patients have to discover and accept their own greed, their craving for love and sex, their egocentricity and their femininity, with all the instinctiveness and corporeality that this entails." (Dethlefsen, p. 142-5) • "Extreme states are not purely random and meaningless pathological behaviors. Each has a highly ordered, almost mathematical, predictability. One goal of process paradigm has been to demonstrate that the cause-and-effect, illness-and-cure philosophy governing much of psychiatric research and treatment is not the only useful way of either observing or treating the effects of these syndromes. A process paradigm which studies the various channels of human expression and which deals concretely with both individual and collective issues, normal and extreme states, is sorely needed." (Mindell, 1988, p. 162)

Chinese psychophysiology: • Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; opens into the tongue; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Stomach ~ Wei is the Sea of Nourishment and origin of all fluids; it transforms and digests food so that the Spleen can separate the distilled food essences; with the Spleen, is the root of post-natal Qi; and as Earth, it relates to ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, and nurturance. » Weakness, dysfunction, and illness are associated with worry, anxiety, and overthinking. Worry will cause Stagnation of Qi in the Stomach and will manifest as a niggling, burning pain, belching, and nausea. Excessive mental work over a period of years leads to Deficiency of Stomach Qi. Anger, frustration, and resentment affect the Stomach indirectly through Liver Qi Stagnation which invades the Stomach. (Maciocia, p. 267) » Stomach Xu (Deficiency) signs include slow digestion; vomiting after meals; painful eyebrows; emotionality; teariness; sadness; cold feet (Seem, p. 28); cold and shivering in the abdominal area; abdomen swollen and full; gastritis; loss of appetite; diarrhea; nausea; and leg weakness.

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); and relates to the ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, deep thinking, and reminiscence; » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; memory failure; pale lips; loose stools; and muscular weakness. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; maintains smooth flow of Qi and Xue (Blood); and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc., and a tendency to "invade" the Spleen and Stomach.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).