Donguibogam identifying depressed stagnation of the mind as the fundamental root of binging and vomiting is remarkably insightful from the perspective of modern neuroscience and gastroenterology. When we experience stress or feel anxiety, stress hormones such as cortisol are excessively secreted from the brain, disrupting the balance of neurotransmitters such as serotonin, known as the happiness hormone, and dopamine, which manages the reward circuit. These neurotransmitters are richly distributed not only in the brain but also in the gut. Our gut possesses its own neural network and neurotransmitter system to the extent that it is called the second brain. This connection is known as the gut-brain axis.
When eating behaviors are disrupted, as in bulimia nervosa, the appetite regulation center located in the hypothalamus fails to function properly. When psychological pressure or anxiety peaks, our body develops strong cravings for carbohydrates or high-fat foods to stimulate the brain's pleasure-inducing reward circuit through the stress response. While this connects to dopamine release and provides immediate gratification, the surging guilt and shame that follow immediately stimulate stress hormones again. These emotions subsequently affect the gut, inhibiting digestive enzyme secretion and making intestinal motility abnormal. This corresponds directly to what Donguibogam describes as qi stagnation, which can be interpreted as abnormal flow or hypofunction of intestinal motility.
Frequent vomiting causes even more serious problems. Gastric acid is strongly acidic, causing severe damage to the esophagus, pharynx and larynx, oral cavity, and teeth during vomiting. It can cause not only esophagitis and acid reflux, but also enamel erosion, salivary gland enlargement, and voice changes. Furthermore, because vomiting disrupts the body's electrolyte balance, it can lead to life-threatening complications such as arrhythmia or a heart attack in severe cases. As essential electrolytes such as potassium and sodium are expelled from the body, strain is placed on the heart, and muscle spasms or weakness may occur.
Ultimately, the repeated cycle of binging and vomiting worsens the vicious cycle of the gut-brain axis. Every time the brain experiences stress, it seeks a reward through food, and the gut falls into a chronic inflammatory state due to repeated digestive burdens and acid reflux. This interferes with nutrient absorption, disrupts the balance of beneficial bacteria in the gut, and can lead to decreased immunity. Moreover, psychological suffering such as anxiety and depression deepens, further solidifying this entire process. As such, bulimia nervosa is not a simple dietary habit issue, but a serious medical condition where the brain, gut, and our emotions are intricately intertwined, which is why professional help is absolutely necessary.
