Anorexia: Highlights in Traditional Persian medicine and conventional medicine

Document Type: Mini Review Article


1 Department of Traditional Persian Medicine, School of Medicine, Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Department of Phytopharmaceuticals (Traditional pharmacy), School of Pharmacy; Medicinal Plants Processing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran


Objective: Anorexia and impaired appetite (Dysorexia) are common symptoms with varying causes, and often need no serious medical intervention. Anorexia nervosa (AN) is a chronic psychiatric disease with a high mortality rate. In Traditional Persian Medicine (TPM), anorexia is a condition in which anorexic patients lose appetite due to dystemperament. This review aims to discuss the common points of traditional and conventional approaches rather than introducing Persian medical recommendations suitable for nowadays use.
Materialsand Methods: For this purpose, Avicenna's Canon of Medicine, main TPM resources and important databases were reviewed using the related keywords.
Results: Despite complex hormonal explanation, etiology of AN in conventional approach is not completely understood. In TPM approach, the etiology and recommended interventions are thoroughly defined based on humoral pathophysiology. In TPM approach, disease states are regarded as the result of imbalances in organs’ temperament and humors. In anorexia with simple dystemperament, the physician should attempt to balance the temperament using foods and medicaments which have opposite quality of temperament. Lifestyle, spiritual diseases (neuro – psychological) and gastrointestinal worms are the other causes for reducing appetite. Also, medicines and foods with warm temperaments (such as Pea soup and Mustard) are useful for these patients (cold temperament).
Conclusion: Although the pathophysiology of AN in TPM is different in comparison with conventional views, TPM criteria for treatment this disorder is similar to those of current medicine. Recommending to have spiritual support and a healthy lifestyle are common in both views. Simple safe interventions recommended by TPM may be considered as alternative medical modalities after being confirmed by well-designed clinical trials.


Main Subjects

Aghili M. 2006. Kholase al hekmah. Vol. 1, pp. 35-42, Quom, Iran, Esmailian Press.

Avena NM, Bocarsly ME. 2012. Dysregulation of brain reward systems in eating disorders: neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa. Neuropharmacology, 63: 87-96.

Bellodi L, Martoni RM, Galimberti E, Cavallini MC. 2013. Low baseline startle in anorexia nervosa patients. Prog Neuropsychopharmacol Biol Psychiatry, 40: 26-29.

Bloch M, Ish-Shalom S, Greenman Y, Klein E, Latzer Y. 2012. Dehydroepiandrosterone treatment effects on weight, bone density, bone metabolism and mood in women suffering from anorexia nervosa-a pilot study. Psychiatry Res, 200: 544-549.

Bolton JG, Patel S. 2001. Osteoporosis in anorexia nervosa. J Psychosom Res, 50: 177-178.

Bouquegneau A, Dubois BE, Krzesinski JM, Delanaye P. 2012. Anorexia nervosa and the kidney. Am J Kidney Dis. 60: 299-307.

Brockmeyer T, Bents H, Holtforth MG, Pfeiffer N, Herzog W, Friederich HC. 2012. Specific emotion regulation impairments in major depression and anorexia nervosa. Psychiatry Res, 200: 550-553.

Brockmeyer T, Grosse Holtforth M, Bents H, Herzog W, Friederich H-C. 2013. Lower body weight is associated with less negative emotions in sad autobiographical memories of patients with anorexia nervosa. Psychiatry Res, 210: 548-552.

Bulik CM, Sullivan PF, Tozzi F, Furberg H, Lichtenstein P, Pedersen NL. 2006. Prevalence, heritability, and prospective risk factors for anorexia nervosa. Arch Gen Psychiatry, 63: 305-312.

Bulik CM, Thornton LM, Root TL, Pisetsky EM, Lichtenstein P, Pedersen NL. 2010. Understanding the relation between anorexia nervosa and bulimia nervosa in a Swedish national twin sample. Biol Psychiatry, 67: 71-77.

Casper RC. 2006. The 'drive for activity' and "restlessness" in anorexia nervosa: potential pathways. J Affect Disord, 92: 99-107.

Cavedini P, Zorzi C, Bassi T, Gorini A, Baraldi C, Ubbiali A, Bellodi L. 2006. Decision-making functioning as a predictor of treatment outcome in anorexia nervosa. Psychiatry Res, 145: 179-187.

Chapman IM. 2004. Endocrinology of anorexia of ageing. Best Pract Res Clin Endocrinol Metab, 18: 437-452.

Connan F, Campbell IC, Katzman M, Lightman SL, Treasure J. 2003. A neurodevelopmental model for anorexia nervosa. Physiol Behav, 79: 13-24.

Cowdrey FA, Park RJ, Harmer CJ, McCabe C. 2011. Increased neural processing of rewarding and aversive food stimuli in recovered anorexia nervosa. Biol Psychiatry, 70: 736-743.

Darzi J, Frost G, Montaser R, Yap J, Robertson, M. 2014. Influence of the tolerability of vinegar as an oral source of short-chain fatty acids on appetite control and food intake. Int J Obes, 38: 675-681.

Emaratkar E, Namdar H, Ghaffari F, Fallahi F, Gooshehgir S, Nazem E, Minaee M, Nikbakht A, Mosaddegh M, Mohammadi FG. 2012. Factors and Drugs that influence appetite and its relation with humors from the perspective of Persian Traditional Medicine. Medical history, 3: 39-54.

Fauci AS. 2008. Harrison's principles of internal medicine. McGraw-Hill Medical New York, USA.

Favaro A, Santonastaso P, Manara R, Bosello R, Bommarito G, Tenconi E, Di Salle F. 2012. Disruption of Visuospatial and Somatosensory Functional Connectivity in Anorexia Nervosa. Biol Psychiatry,72: 864-870.

Galusca B, Costes N, Zito NG, Peyron R, Bossu C, Lang F, Le Bars D, Estour B. 2008. Organic background of restrictive-type anorexia nervosa suggested by increased serotonin 1A receptor binding in right frontotemporal cortex of both lean and recovered patients: [18F]MPPF PET scan study. Biol Psychiatry, 64: 1009-1013.

Gentile MG, Pastorelli P, Ciceri R, Manna GM, Collimedaglia S. 2010. Specialized refeeding treatment for anorexia nervosa patients suffering from extreme undernutrition. Clin Nutr, 29: 627-632.

Godart N, Berthoz S, Curt F, Perdereau F, Rein Z, Wallier J, Horreard A-S, Kaganski I, Lucet R, Atger F. 2012. A randomized controlled trial of adjunctive family therapy and treatment as usual following inpatient treatment for anorexia nervosa adolescents. PloS one 7, e28249.

Hambrook D, Brown G, Tchanturia K. 2012. Emotional intelligence in anorexia nervosa: is anxiety a missing piece of the puzzle? Psychiatry Res, 200: 12-19.

Hanachi M, Melchior JC, Crenn P. 2013. Hypertransaminasemia in severely malnourished adult anorexia nervosa patients: risk factors and evolution under enteral nutrition. Clin Nutr. 32: 391-395.

Heaner MK, Walsh BT. 2013. A history of the identification of the characteristic eating disturbances of Bulimia Nervosa, Binge Eating Disorder and Anorexia Nervosa. Appetite, 65: 185-188.

Hebebrand J, Exner C, Hebebrand K, Holtkamp C, Casper RC, Remschmidt H, Herpertz-Dahlmann B, Klingenspor M. 2003. Hyperactivity in patients with anorexia nervosa and in semistarved rats: evidence for a pivotal role of hypoleptinemia. Physiol Behav, 79: 25-37.

Heilbronn LK, Milner K-L, Kriketos A, Russell J, Campbell LV. 2007. Metabolic dysfunction in anorexia nervosa. Obes Res Clin Pract, 1: 139-146.

Johansen JE, Fetissov SO, Bergstrom U, Nilsson I. Fay C, Ranscht B, Hokfelt T, Schalling M. 2007. Evidence for hypothalamic dysregulation in mouse models of anorexia as well as in humans. Physiol Behav, 92: 278-282.

Jorjani SE. 2002. Zakhireh kharazmshahi In: Moharrari M (Ed). Tehran, The academy of Medical Science Islamic Republic of Iran.

Kaye W. 2008. Neurobiology of anorexia and bulimia nervosa. Physiol Behav, 94: 121-135.

Kaye WH, Frank GK, Bailer UF, Henry SE, Meltzer CC, Price JC, Mathis CA, Wagner A. 2005. Serotonin alterations in anorexia and bulimia nervosa: new insights from imaging studies. Physiol Behav, 85: 73-81.

Kaye WH, Nagata T, Weltzin TE, Hsu L, Sokol MS, McConaha C, Plotnicov KH, Weise J, Deep D. 2001. Double-blind placebo-controlled administration of fluoxetine in restricting-and restricting-purging-type anorexia nervosa. Biol Psychiatry, 49: 644-652.

Kaye WH, Wierenga CE, Bailer UF, Simmons AN, Bischoff-Grethe A. 2013a. Nothing tastes as good as skinny feels: the neurobiology of anorexia nervosa. Trends Neurosci. 36: 110-120.

Kaye WH, Wierenga CE, Bailer UF, Simmons AN, Wagner A, Bischoff-Grethe A. 2013b. Does a shared neurobiology for foods and drugs of abuse contribute to extremes of food ingestion in anorexia and bulimia nervosa? Biol Psychiatry, 73: 836-842.

Keating C. 2010. Theoretical perspective on anorexia nervosa: the conflict of reward. Neurosci Biobehav Rev, 34: 73-79.

Kells M, Davidson K, Hitchko L, O'Neil K, Schubert-Bob P, McCabe M. 2013. Examining supervised meals in patients with restrictive eating disorders. Appl Nurs Res, 26: 76-79.

Kowalska I, Karczewska-Kupczewska M, Strączkowski M. 2011. Adipocytokines, gut hormones and growth factors in anorexia nervosa. Clinica Chimica Acta, 412: 1702-1711.

Lebow J, Sim L. 2013. The influence of estrogen therapies on bone mineral density in premenopausal women with anorexia nervosa and amenorrhea. Vitam Horm,92: 243-257.

Legroux-Gerot I, Vignau J, Collier F, Cortet B. 2005. Bone loss associated with anorexia nervosa. Joint Bone Spine, 72: 489-495.

Madsen SK, Bohon C, Feusner JD. 2013. Visual processing in anorexia nervosa and body dysmorphic disorder: Similarities, differences, and future research directions. J Psychiatr Res, 47: 1483-1491.

Markey O, McClean CM, Medlow P, Davison GW. Trinick TR, Duly E, Shafat A. 2011. Effect of cinnamon on gastric emptying, arterial stiffness, postprandial lipemia, glycemia, and appetite responses to high-fat breakfast. Cardiovasc Diabetol, 10, 78.

Mas S, Plana MT, Castro-Fornieles J, Gasso P, Lafuente A, Moreno E, Martinez E, Mila M, Lazaro L. 2013. Common genetic background in anorexia nervosa and obsessive compulsive disorder: preliminary results from an association study. J Psychiatr Res, 47: 747-754.

Miotto P, Pollini B, Restaneo A, Favaretto G, Sisti D, Rocchi MB, Preti A. 2010. Symptoms of psychosis in anorexia and bulimia nervosa. Psychiatry Res, 175: 237-243.

Mitan LA. 2004. Menstrual dysfunction in anorexia nervosa. J Pediatr Adolesc Gynecol, 17: 81-85.

Mousavi SH, Naghizade B, Pourgonabadi S, Ghorbani A. 2016. Protective effect of Viola tricolor and Viola odorata extracts on serum/glucose deprivation-induced neurotoxicity: role of reactive oxygen species. Avicenna J Phytomed, 6, 434-441.

Ng L, Ng D, Wong W. 2012. Is supervised exercise training safe in patients with anorexia nervosa? A meta-analysis. Physiotherapy, 99: 1-11.

Nimrouzi M, Borzoo S, Salehi A. 2015. Management of anorexia from the viewpoint of Arzani in Mizan-al-Teb. Journal of Islamic and Iranian Medicine. 6: 43-52.

Nimrouzi M, Sadeghpour O, Imanieh M-H, Shams-Ardekani M, Zarshenas MM, Salehi A, Minaei M-B. 2014. Remedies for children constipation in medieval Persia. J Evid Based Complementary Altern Med. 19: 137-143.

Nimrouzi M, Zare M. 2014. Principles of Nutrition in Islamic and Traditional Persian Medicine. J Evid Based Complementary Altern Med. 19: 267-270.

Nimrouzi M, Zarshenas MM. 2015a. Functional constipation in children: non-pharmacological approach. J Integr Med. 13: 69-71.

Nimrouzi M, Zarshenas MM. 2015b. Management of anorexia in elderly as remarked by medieval Persian physicians. Acta Med Hist Adriat. 2: 115-128.

Oldershaw A, Hambrook D, Stahl D, Tchanturia K, Treasure J, Schmidt U. 2011. The socio-emotional processing stream in Anorexia Nervosa. Neurosci Biobehav Rev, 35: 970-988.

Östman E, Granfeldt Y, Persson L, Björck I. 2005. Vinegar supplementation lowers glucose and insulin responses and increases satiety after a bread meal in healthy subjects. Eur J Clin Nutr. 59: 983-988.

Ramoz N, Versini A, Gorwood P. 2012. Anorexia nervosa and estrogen receptors. Vitam Horm, 92: 141-163.

Rask-Andersen M, Olszewski PK, Levine AS, Schioth HB. 2010. Molecular mechanisms underlying anorexia nervosa: focus on human gene association studies and systems controlling food intake. Brain Res Rev, 62: 147-164.

Rolls A, Borg JS, de Lecea L. 2010. Sleep and metabolism: Role of hypothalamic neuronal circuitry. Best Pract Res Clin Endocrinol Metab.24: 817-828.

Santel S, Baving L, Krauel K, Munte TF, Rotte M. 2006. Hunger and satiety in anorexia nervosa: fMRI during cognitive processing of food pictures. Brain Res, 1114: 138-148.

Scacchi M, Ida Pincelli A, Cavagnini F. 2003. Nutritional status in the neuroendocrine control of growth hormone secretion: the model of anorexia nervosa. Front Neuroendocrinol, 24: 200-224.

Scheurink AJ, Boersma GJ, Nergardh R, Sodersten P. 2010. Neurobiology of hyperactivity and reward: agreeable restlessness in anorexia nervosa. Physiol Behav. 100: 490-495.

Shah-Arzani M-A. 2008. Tib-e-Akbari. Quom, Jalal-ed-Din press, p. 879.

Shāh Arzānī M. Mīzān al-ṭibb. Quom, Ehyay-e-tabiei press, p. 221.

Shayeghian Z, Aguilar-Vafaie ME, Tabatabae KR. 2011. Core maladaptive schemas and parental bonding among female adolescent with normal weight, overweight and anorexia symptoms. Pajoohandeh Journal. 16: 30-38.

Shibuya I, Nagamitsu S, Okamura H, Komatsu H, Ozono S, Yamashita Y, Matsuishi T. 2011. Changes in salivary cortisol levels as a prognostic predictor in children with anorexia nervosa. Int J Psychophysiol. 82: 196-201.

Södersten P, Bergh C, Ammar A. 2003. Anorexia nervosa: towards a neurobiologically based therapy. Eur J Pharmacol. 480: 67-74.

Sodersten P, Nergardh R, Bergh C, Zandian M, Scheurink A. 2008. Behavioral neuroendocrinology and treatment of anorexia nervosa. Front Neuroendocrinol. 29: 445-462.

Stoving RK, Andries A, Brixen K, Flyvbjerg A, Horder K, Frystyk J. 2009. Leptin, ghrelin, and endocannabinoids: potential therapeutic targets in anorexia nervosa. J Psychiatr Res. 43: 671-679.

Tanaka M, Nakahara T, Kojima S, Nakano T, Muranaga T, Nagai N, Ueno H, Nakazato M, Nozoe S, Naruo T. 2004. Effect of nutritional rehabilitation on circulating ghrelin and growth hormone levels in patients with anorexia nervosa. Regul Pept. 122: 163-168.

Tipu M, Akhtar M, Anjum M, Raja M. 2006. New dimension of medicinal plants as animal feed. Pak Vet J. 26: 144-148.

Titova OE, Hjorth OC, Schiöth HB. Brooks SJ. 2013. Anorexia nervosa is linked to reduced brain structure in reward and somatosensory regions: a meta-analysis of VBM studies. BMC psychiatry. 13: 110.

van Kuyck K, Gerard N, Van Laere K, Casteels, C, Pieters G, Gabriels L, Nuttin B. 2009. Towards a neurocircuitry in anorexia nervosa: evidence from functional neuroimaging studies. J Psychiatr Res. 43: 1133-1145.

Venkatramalingam K, Christopher JG, Citarasu T. 2007. Zingiber officinale an herbal appetizer in the tiger shrimp Penaeus monodon (Fabricius) larviculture. Aquaculture Nutrition 13: 439-443.

Yoshida NM, Yoshiuchi K, Kumano H, Sasaki T, Kuboki T. 2006. Changes in heart rate with refeeding in anorexia nervosa: a pilot study. J Psychosom Res. 61: 571-575.

Young JK. 2010. Anorexia nervosa and estrogen: current status of the hypothesis. Neurosci Biobehav Rev. 34: 1195-1200.

Zandian M, Ioakimidis I, Bergh C, Sodersten P. 2007. Cause and treatment of anorexia nervosa. Physiol Behav. 92: 283-290.

Zarshenas MM, Zargaran A, Abolhassanzadeh Z, Vessal K. 2012. Jorjani (1042-1137). J Neurol. 259: 2764-2765.

Zerwas S, Lund BC, Von Holle A, Thornton LM, Berrettini WH, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, La Via M, Mitchell J, Rotondo A, Strober M, Woodside DB, Kaye WH, Bulik CM. 2013. Factors associated with recovery from anorexia nervosa. J Psychiatr Res. 47: 972-979.