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.
Sinclair-Lian
Nityamo
N
University of New Mexico, Department of Family and Community Medicine, Albuquerque, NM, USA. nlian@salud.unm.edu
Hollifield
Michael
M
Menache
Margaret
M
Warner
Teddy
T
Viscaya
Jenna
J
Hammerschlag
Richard
R
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*