Many cultural factors are implicated in the etiology of eating disorders. Although these may be central to the development of a disorder, Chinese medicine identifies an underlying Spleen weakness, which may manifest as obsessive behaviour, digestive discomfort, or both, as instigator of the pathological behaviour (Ryan & McLaughlin, 1998).

It is commonly accepted that eating disorders such as anorexia can only exist in a society with an emphasis on slenderness. Except among the upper middle classes of Japan and Hong Kong, anorexia is thought to be nonexistent in Asia, as well as in western culture during historical periods with different emphases on physique (Kleinman, 1991). Although the diagnosis is generally limited to the contemporary western world (Kleinman, 1991), appetite disturbances complicated by psycho-emotional factors are addressed by the materia medica of classical Chinese medicine (Hammer, 1990).

The Spleen rules cognitive capacity, concentration and memorising (Tierra, 1988). Indulgence in these pursuits or excess rumination is considered detrimental to Spleen functioning, responsible for digestive harmony. Its implication in eating disorder on physical and emotional levels according to Chinese thought is echoed by the western association between these disorders and neurotic perfectionism (Minarik & Aherns, 1986). Herbs that reestablish harmonious digestion as well as acupuncture have been successfully applied to eating disorders (Apostolopoulos & Karavi 1996).

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