Vol.10 No.2,  June, 2000

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Acupuncture Education

Lectures on Acupuncture  

Part I: Clinical Acupuncture

Lecture Eighteen: OBESITY

by Shang Xiukui(Liang Chun/yuHu /Minghai(Tianjin Traditional Chinese Medicine College, 300193, China)

If the food intake is more than the food consumption, the extra food will be stored in the body in the form of fat. And if the fatty degree is over 20% of weight, it is called obesity. Over weight means the fatty degree is 10% over the nor mal body weight. When the weight (quality) index is over 24 ［weight(kg)/height 2 (m2)��? obesity can appear. According to the standard of WHO and countries like the USA and Great Britain, obesity means the male index is over 27 and the female index is over 25. Obesity can be divided into simple obesity, secondary obesity and other types of obesity according to the endocrine metabolic etiology. In ancient medical records, obesity was seldom mentioned. Now, there are more and more people with obesity because of the development of society. Doctors eng aging in TCM use acupuncture and moxibustion to treat obesity in China. Etiology and Pathogenesis Obesity has a relationship with constitution, inheritance, age, die t, emotions and life style. In TCM, doctors believe that the etiology can be divided into deficiency and excess. The excess type is due to over intake of fatty food, or excessive consumption of alcohol. All of these can cause stagnation of food essence and fat. Fat people having excessive phlegm and dampness means that fat is most likely to produce phlegm and dampness which may turn into h eat. The deficiency type is referred to spleen Qi deficiency, or kidney Qi deficiency. Qi deficiency leads to yin excess and yin governs the body figure. Fat people are usually with deficiency of Qi. In a word, obesity has a relation to the hypofunction of the spleen and stomach. In addition, there are congenital causes and natural obesity.

1. Excess of the Spleen and Stomach (Simple Obesity)

Main manifestations: Fat body figure, especially over the lumbar area, or fat from an early age or with strong muscles

Accompanying symptoms and signs: Strong desire for food, excessive eating, flushed face, sweating and aversion to heat, fullness of abdomen and constipation. Tongue and pulse diagnosis: Normal or slightly red tongue with thin and yellowish coating, forceful and slippery pulse

Syndrome analysis: The spleen nourishes the muscles and has the function of transporting food. The function of the stomach is to receive and digest food. So excessive food intake can cause obesity. Flushed face, aversion to heat and sweating are due to excessive heat in the Middle-Jiao. Constipation and abdominal fullness are due to heat in the stomach and intestine.

2. Spleen Deficiency and Excessive Dampness (Secondary Obesity)

Main manifestations: Obvious obesity in the face, neck and abdomen, loose muscles.

Accompanying symptoms and signs: Pale face, tiredness, weak extremities, aversion to cold, excessive sleeps, anorexia, abdominal fullness, constipation, short ness of breath on exertion, or slight edema.

Tongue and pulse diagnosis: Pale tongue with thin and white coating, deep, thready and slow pulse.

Syndrome analysis:. Spleen Yang deficiency cause an excessive dampness, so the body becomes fat and the muscles loose, pale face, lassitude and aversion to cold are due to stagnation of middle Yang by damp-cold. Sleepiness or anorexia, fullness of abdomen and shortness of breath are due to deficiency of spleen Yang. Fullness of abdomen and edema are due to deficiency of Yang, causing stagnation of water. Yang deficiency results in failing to transport Qi, leading to constipation.

3. Primary Qi Deficiency

Main manifestations: Obesity with obvious fat inglutaea, loose leg muscles.

Accompanying symptoms and signs: There may be tiredness, desire to be quiet and aversion to move, pale complexion, normal or poor appetite, shortness of breath on exertion, aversion to cold, scanty urine and edema. Female patients can have these symptoms before or after menstrual cycle, and impotence and praecox ejaculation may appear in males.

Tongue and pulse diagnosis. Pale tongue with idented margins, thin and white coating, deep thready and slow pulse.

Syndrome analysis: Deficiency of kidney Yang cause coldness in the Lower-Jiao. Cold dampness will stagnate in the lower extremities, causing loose muscles. Deficiency of Yang Qi will lead to lassitude, preference for quiet and aversion to move. Pale face, anorexia, shortness of breath, aversion to cold, scanty urine and edema symptoms in female patients can happen during the menstrual period. Impotence and praecox ejaculation in males are due to kidney Yang deficiency and disorder of bladder Qi in transformation. Clinical doctors should differentiate deficiency and excess, apply principles of invigorating the spleen and nourishing the kidney to treat deficiency syndrome, and employ the method of resolving dampness and stagnation to treat excess syndrome.

1. Deficiency Syndrome (No.2 and No.3 Above-mentioned Differentiation)

Treatment principle: Reinforcing Qi and resolving dampness, invigorating the spleen and nourishing the kidney

Acupoint selection: Pishu (BL 20), Weishu (BL 21),Shenshu (BL 23), Zusanli (ST 36), Qihai (CV 6),Guanyuan (CV 4), Sanyinjiao (SP 6), Taixi (KI 3),Yinlingquan (SP 9).

Explanation: Pishu, Weishu and Zusanli are used for improving the stomach, invigorating the spleen to remove dampness and phlegm. Shenshu, Qihai, Guanyuan and Weishu are used for warming the kidney, reinforcing the kidney Yang to invigorate the spleen. Sanyinjiao, Taixi and Yinlingquan are used for eliminating water and dampness. Zhongwan and Daheng can be used to treat abdominal fullness and anorexia. Baihui can be used to treat sleepiness and heavy feeling in the head.

Method: Puncture Pishu and Weishu obliquely downward 1.5 cun. Puncture Zusanli, Qihai and Yinlingquan perpendicularly 1.5 cun. Puncture Guanyuan, Sanyinjiao and Taixi perpendicularly 1.0 cun. Apply the reinforcing method with warming needles. Retain the needles for 30 minutes.2.Excess Syndrome.

Treatment principle: Resolving stagnation, clearing and quenching fire.

Acupoint selection: Hegu (LI 4), Neiting (ST 44),Quchi (LI 11), Weishu (BL 21 ), Pishu (BL 20), Zhongwan (CV 12), Tianshu (ST 25), Shuidao (ST 28), Fenglong (ST 40), Yinlingquan (SP 9)

Explanation: Hegu, Neiting and Quchi can be used together to clear away fire of Yangming meridian, inhibite the hyperfunction of the stomach and intestine. Pishu, Weishu, Zhongwan and Tianshu can be used to eliminate stagnation in the stomach and intestine. Shuidao, Zhongwan and Tianshu can be used to resolve turbid phlegm. Add Zhigou (TE 6) for constipation, Liangqiu(ST 34) for hunger, and Yanglingquan and Taichong (LR 3) for liver-Qi stagnation.

Method: Puncture Hegu, Neiting and Quchi perpendicularly 1.0 cun. Puncture Pishu and Weishu obliquely downward 1.0 cun. Puncture Shuidao, Fenglong and Yinlingquan perpendicularly 1.5 cun. Apply the reducing method with strong stimulation. Retain the needles for 20 minutes. Give strong stimulation time and again when the needles are retained.

Other Therapies

1: Ear Acupuncture Otopoint. Lung, Large Intestine, Triple Energy, Hunger point, Thirst point. Method: Put Wangbuliuxing (Semen Vaccariae) on these points and fix them with plaster, then press them .Change the seeds every 3 days. Two months constitute one course of treatment. 2. Chinese Medicine: "Qingtong Yin"( Decoction for Clearing Away Heat from the Spleen and Stomach) and "Fangfeng Tongsheng San"(Radix Ledebouriellae Powder for Dispersing Pathogenic Wind and Retention of lnternal Heat) are used for treating spleen and stomach excess. Fangji HuangQi Tang (Deconction of Radix Stephaniae Tetrandrae and Radix Astragali seu Hedysari) is used for treating spleen Qi deficiency and excessive dampness. Jisheng ShenQi Wan (  Jisheng Pill for Invigorating Kidney Qi) is used for treating kidney Yang deficiency.

Notes

1. In addition to herbal and acupuncture treatment, exercise and healthy diet are also important. Exercise is the most important way in treating obesity. 

2. In recent years, doctors often use ear acupuncture to treat obesity because it is quite convenient. The stimulation on the ear points may lead to a change in the Hunger point, and may affect the nutritional state in order to control the appetite, reduce the appetite, reduce the food absorption and reduce fat.

　

Part II: Example Cases

by Meng Hong( Wang Wei /Liu lu(Tianjin Traditional Chinese Medicine College, 300193, China)

Case 1:

Ms Li, 28 years old,156 cm high. Her weight was 48 kilos two years ago. She became heavier after childbirth, and the weight increased to 71 kilos. Symptoms: Strong desire for food, sleepiness, constipation, tiredness, red tongue with dry and yellowish coating, rapid and slippery pulse. Differentiation: Excess heat in the stomach: Treatment principle: Regulate the functions of spleen and stomach, hold back the abnormal desire for food and remove dampness and phlegm. Regulate the functional activity of internal secretion. Acupoint selection: Select Zhongwan (CV 12 ), Tianshu (ST 25), Guanyuan (CV 4), Yinlingquan (SP 9) , LiangQiu (ST 34), Fenglong (ST 40),Qimen (LR 14), Weishu(BL21), Ganshu(BL 18) and Danshu (BL 19) as the main points, and Spleen, Lung, Small Intestine, Large Intestine, Hunger point, Thirst point as the main otopoints. After the 1st course o f treatment, her weight decreased to 65.4kilos. She had weak desire for food, drank less water than before, and expelled more excrement and urine. Finally, her weight was 60 kilos after another courses of treatment.

Case 2:

Ms He, 48 years old,166 cm high. Her weight was 74 kilos before visiting doctor. Symptoms: Normal appetite, sleepiness, shortness of breath on exertion, fullness in the chest and hypochondria, diarrhea, tiredness, pale tongue with idented margins, greasy and yellowish coating, slippery pulse. Differentiation: Deficiency of both spleen and stomach. Treatment principle: Invigorate the spleen and stomach, regulate the circulation of Qi, remove dampness and resolve phlegm, regulate the function of internal secretion. Acupoint selection: Select Zhongwan (CV 12) , Tianshu (ST 25), Guanyuan (CV 4), Yinlingquan (SP 9), LiangQiu (ST 34), Fenglong (ST 40), Qimen (LR 14), Weishu (BL 21), Ganshu (BL 18) and Danshu (BL 19) as the main acupoints, and Spleen, Lung, Small Intestine, Large Intestine, Hunger point and Thirst point as the main otopoints. Her weight decreased to 64 kilos after two courses of treatment. She felt vigorous and relaxed thereafter.

Questions　

1. How many types does obesity have in the differentiation?

2. How is obesity treated by acupuncture? Questions and Answers in Lecture 17

1. What is the etiology and pathogenesis of AIDS?

1). The kidney deficiency fails to store the energy due to excessive sexual activity. Most patients who suffer from AIDS are between 20-50 years old, and especially between 20-39. The sexual intemperance of the innocent youngster injure s the kidney energy, causing the kidney to fail storing the essence, and manifested as a series of deficient symptoms.

2). The spleen's function is injured by predilection for alcohol. Most of the AIDS patients have a history of alcoholic hobby. The injured spleen and stomach fail to produce energy and blood. The pathologic factors attack the body to produce functional disorder when the vital energy is insufficient.

3). In case of deficiency of the congenital energy, the virus may be transmitted from the infected mother to the child.

2. What is the prognosis of AIDS and how to take good care of patients with AIDS ?

1). It is still at the researching phase in treatment ADIS with acupuncture and moxibustion according to the related reports. Acupuncture and moxibustion therapies have a certain effect in improving symptoms and prolonging life-span.

2). In treatment of ADIS with acupuncture and moxibustion, the single-used needles should be applied in the clinic. The strict routine sterilization should be applied and the doctor should wear rubber sterilized gloves.

3). Prevent ADIS from propagation by sexual activity, the average infection percentage is up to 70% for person who makes sexual activity with person carrying ADIS virus. However, the more frequent sexual activity, the higher the infection percentage.

It is the important measure to get rid of abnormal sexual activity in order to prevent AIDS from propagation.

4). In order to prevent AIDS from infection by blood transfusion and blood products, the suspected person must be forbidden to offer blood and prohibit importing blood products.

5). Prevent mother from infection by ADIS virus to body directly. Contraception should be carried out, either father or mother carries ADIS virus. Once the mother is pregnant, she should be actively to have a miscarriage.

6). In the aspect of professional prevention, pay much attention to medical care and safe guard to person who works in laboratory. For example, avoid dam aging skin with polluted apparatus, avoid skin wound contacting patient, put on gloves when contacting blood specimen, polluted apparatus ,body fluid, drainage and secretion before leaving the ward. Take off job-clothes and gloves and wash hands seriously, put all of polluted articles by blood into sealed bags and burn them.