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.

By Shang Xiukui,  Liang Chunyu, Hu Minghai