Developing a traditional chinese medicine diagnostic structure for post-traumatic stress disorder.
BACKGROUND
Post-traumatic stress disorder (PTSD) is a common, disabling condition with many diverse symptoms including anxiety, depression, insomnia, and body pain. These symptoms are likely to be helped by treatment with Traditional Chinese Medicine (TCM); however, PTSD is not yet a recognized disorder (bing ming) in Chinese medicine. In preparation for a phase II clinical trial comparing TCM and cognitive behavioral therapy (CBT) treatment of PTSD symptoms, a TCM diagnostic pattern framework for persons who meet the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) definition of PTSD was sought.


METHODS
Three approaches were used to identify the most likely TCM pattern differentiations for PTSD: an English-language TCM textbook review on the conditions "depression," "anxiety," and "insomnia"; a survey of 20 experienced practitioners of TCM; and TCM assessments of 21 individuals affected by PTSD. Two TCM practitioners synthesized the information into a list of pattern differentiations.


RESULTS
The most likely pattern differentiations for PTSD were Heart Shen disturbance caused by Heat, Fire, or a constitutional deficiency; Liver Qi stagnation; and Kidney deficiency. Secondary patterns identified were outcomes of long-term Liver Qi stagnation-Liver overacting on Spleen/Stomach, Liver Fire, Phlegm Fire, Phlegm-Damp, and Heart Fire-and constitutional deficiencies in the Heart, Kidney, and Spleen organ systems.


CONCLUSIONS
The use of extant literature, expert knowledge, and clinical TCM diagnoses contributed to the development of a TCM diagnostic structure for PTSD. The results can inform the clinical practice of TCM. The method can be used to guide research design involving different diagnostic systems.
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM, USA. nlian@salud.unm.edu
Nityamo
N
Sinclair-Lian
Michael
M
Hollifield
Margaret
M
Menache
Teddy
T
Warner
Jenna
J
Viscaya
Richard
R
Hammerschlag
D001007:Anxiety / Q000150:complications / Q000175:diagnosis; D003863:Depression / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008516:Medicine, Chinese Traditional; D010146:Pain / Q000150:complications / Q000175:diagnosis; D011594:Psychometrics; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000175:diagnosis; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000175:diagnosis*