RECORD OF FIRST VISIT
Date of first visit: 1/Aug/2008
Name: ***Lee Gender: male
Date of birth: 19/Oct/1964
Chief complains: over weight for several years
Descriptions (4 diagnostic methods)
A) Asking
Present illness history: A 44 year old man came to my clinic because of being overweight.
He wanted to lose weight. He was always chubby as far as he could remember. After he came to NZ 5years ago, he developed the habit of eating sweets after dinner. Recently he feels easily tired and heavy. He refused to talk about how much he weighed and told me his BMI was 27.
He easily feels tired after physical or mental work.
He likes spicy and salty food. He prefers red meat and white meat instead of vegetables. His appetite is excessive and he becomes easily hungry. When he is hungry, he becomes very irritable. Also, when his stomach is empty, it is really hard for him to go to bed. Therefore he eats some snack.
He tried to exercise so he used to go to a gym twice a week. But now he only walks for 30 minutes once or twice per week
His stool is loose and urination is normal.
Past illness history: Allergic rhinitis- almost 5years after he came to NZ
Life style: Full time job, busy- frequently works on weekend.
No smoking and alcohol
Family history: Mother- passed away because of liver cancer
He is the youngest of the family-
His eldest sister: chubby, healthy
His other two siblings: slim
Menstruation, marital& obstetrical history; Married with 2children
General : Vitality 7/10, dim facial complextion
Tongue: Thick pink white coating, teeth mark on the margin, red tongue tip
Sound: N-C
Odours: N-C
D) Palpation
Pulse: Both Chi- weak
Body area: Not palpable mass
E) Physical Examination
N-C
CASE SUMMAY
B) Syndrome Differentiation: Damp-heat retention underlying spleen and kidney qi deficiency
C) Explanation:
Over consumption of heavy, greasy and spicy foods facilitate production of heat evils in the stomach. Meanwhile, inadequate exercise after eating these types of foods damages the spleen function. The over-heated stomach will digest an excessive amount of food. Therefore, the stomach will digest food easier and make an individual feel hungry, but the spleen cannot handle an excessive food load causing it to under function and be unable to carry out its transformation and transportation functions properly. As a result, the spare metabolic products turn into turbid fluid and phlegm which intermix with blood and qi (vital energy) filling up the organs, bones and muscles. Also, he has underlying spleen qi and kidney qi deficiency that aggravate the damp- retention.
TREATMENT
Remove damp-heat first and then tonify spleen and kidney
B) Treatment Methods:
Remove heat from stomach-Nei ting (ST44)
Remove dampness- Shei fen (Ren9)
Shui dao(ST28)
Hua rou men (ST24) especially for increase appetite
Local points - Zhong wan (Ren12),Qi hai(Ren6)
Tian shu(ST25), Xia wan(Ren10) , Guan yuan (Ren4)
Life style advice
Eat regularly and small amount.
Try to avoid the supper and desserts
Carry water bottle and drink plenty of water
Drink coffee with skimmed milk instead of three in one coffee
Exercise: walking, running, and cycling
OBESITY (TCM)
Definition;
TCM does not treat "excess weight" per se; rather it deals with the underlying body condition that may have led to the excess weight. Once the body's balance is restored, the metabolism will process food properly and excess weight should no longer be a problem . Specifically, TCM holds that fat or adipose tissue is mostly due to phlegm and dampness evils. The spleen is said to be at the root of all phlegm production and is involved in the transportation and transformation of body fluids and foods. If the spleen becomes damaged by eating too many sweet foods and getting too little exercise, it will fail in its duty to move and transform waste fluids and foods. Instead these metabolic wastes will gather, collect and transform into dampness evils. If dampness evils endure over time, they will congeal into phlegm, and become fat tissue.
Aetiology and pathogenesis
TCM takes a holistic approach to obesity by focusing on the underlying changes in the body. According to TCM principles, development of obesity is due to the following pathological changes.
1. Over consumption of greasy food causes stomach heat and poor spleen functioning: the spare metabolic products turn into turbid fluid and phlegm.
2. Exogenous evils giving rise to obesity: When dampness and turbid fat enters the water passages, they are further distributed by the lungs, allowing penetration into all the organs internally.
3. Qi (vital energy) stagnation causes turbid phlegm accumulation: The liver can fail to regulate qi (vital energy) flow that in turn affects digestion and blood flow. The resulting sluggish qi (vital energy) and blood flow tend to block the meridians
4. Kidney essence exhaustion leads to disharmony: Kidney essence exhaustion leads to disharmony; the vaporization processes are impaired causing more fluid accumulation.
In short, the fundamental causes of obesity are spleen and kidney deficiencies, which manifest as an overflow of body fluids, accumulation of dampness and phlegm evils and stagnation in blood flow. Sometimes stomach heat and qi (vital energy) stagnation are associated. Moreover, improper vaporization of body fluids by the triple burner may also appear. All of these factors play an important role in the development of obesity.
Syndrome differentiations
1. Excessive Internal Phlegm and dampness
| |
| |
When the spleen becomes damaged, such as eating too many sweet foods and getting too little exercise, it will fail in its duty to move and transform waste fluids and foods. Instead these metabolic wastes will gather, collect and transform into evil dampness. If dampness evils endure, over time they will congeal into phlegm, and become fat tissue. The excessive internal phlegm manifests itself as excess weight, accompanied by tiredness, body heaviness, chest and /or stomach distension, and in some cases poor appetite.
The tongue has a slimy covering of fur, while there is a rolling, taut pulse. This type of obesity is generally due to an eating disorder, or secondarily by some other illness.
Treatment involves that removing phlegm and stagnation. Once the phlegm is swept away, the qi can move smoothly and easily. This promotes the movement of phlegm and reduction of fat .
2. Stagnation of Qi (vital energy) and Blood
Patients exhibiting this condition may suffer from irritability or low motivation, chest or breast fullness, insomnia, a dreamy state, menstrual disorder or amenorrhea and infertility. Some patients may complain of headaches. There may be dizziness and numbness of the four extremities.
The tongue is dark red with a white thin fur or a thin and greasy fur. The pulse is thready and rolling. This is because the movement of blood is not smooth or easily flowing. Stasis obstructs the vessels and inhibits the qi mechanism. Therefore, fat and dampness collect and accumulate within the vessels, making the blood more viscous. If this continues over time, obesity and arteriosclerosis (thickening and hardening of the arteries) will result.
The principle treatment is to speed up the blood flow and remove stagnation.
3. Yang Deficiency of Spleen and Kidney
. People in this category often feel exhausted or fatigued. They may experience lower back and knee weakness, shortness of breath, impotence or low libido.
The tongue is pale and without any fur covering and the pulse is deep and fine, the. Genetic factors can play a part in this condition. It may also be the result of other illnesses, stress or an unhealthy lifestyle.
The spleen-yang's role in digestion can be likened to a process of fermentation and distillation in cooking. However, it's controlling force, the kidney-yang, is the root of all the physiological activities in the body. The two interact: spleen-yang deficiency may lead to kidney-yang deficiency and kidney-yang deficiency may lead to spleen-yang deficiency. Whatever the case, if the kidney becomes deficient, the spleen will be unable to effectively produce nutrient essence for the body's needs. In the case of yang deficiency of spleen and kidney, there is not enough qi to transform or melt the phlegm.
Treatment involves fortifying the spleen and rectifying the kidney deficiency.
4. Liver Stagnation
Liver stagnation caused by prolonged strong emotions or depression leads to disharmony between the spleen and the liver and gives rise to fluid retention. Due to the liver being depressed, the gall bladder is also depressed and exhausted; the flow of these organs become unbalanced, and the qi mechanism does not flow freely. Hence fat turbidity is difficult to be transformed and over time it leads to obesity.
| |
| |
People in this category tend to have excessive fatty material deposited in the abdomen. The physique is bloated and individuals feel drained of energy. Individuals may also experience excess sputum secretion, dizziness, vertigo, retching, a dry mouth, lack of desire for food or drink and discomfort in chest and abdomen. A white glossy or greasy coating usually covers their tongues. The pulse is rolling.
Treatment involves improving liver functioning, unblocking the gallbladder and moving stagnation.
Treatment:
Different acu-points are selected depending on the types of disharmony pattern:
| 1. | Excited liver-yang |
| | |
| 2. | Dampness accumulation due to spleen deficiency |
| | |
| 3. | Heat stagnation in the stomach |
| | |
| 4. | Constipation due to intestinal dryness |
| | |
| 5. | Qi (vital energy) insufficiency in the spleen and lungs |
| | |
| 6. | Yang deficiency in the spleen and kidney |
In case of excessive appetite add nei-ting; for heart palpitations and shortness of breath add shen-men and nei-guan; for constipation add tian-shu and zhi-gou and for scanty urine add shui-fen and yin-ling-quan. (See graphics for references.)
OBESITY (WMS)
Definition: Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight.
Overweight and obesity are major risk factors for a number of chronic diseases, including diabetes, cardiovascular diseases and cancer.
Evidence is emerging to suggest that the prevalence of overweight and obesity is increasing worldwide at an alarming rate. New Zealand
Management
The main treatment for obesity consists of dieting and physical exercise. Diet programs may produce weight loss over the short term, but keeping this weight off can be a problem. It often requires making exercise and a lower calorie diet a permanent part of a person's lifestyle. In the general population only 20% are successful at long-term weight loss maintenance. In a more structured setting, however, 67% of people who lost greater then 10% of their body mass maintained or continued to lose weight one year later. An average maintained weight loss of more then
Diet:Diets to promote weight loss are generally divided into four categories: low-fat, low-carbohydrate, low-calorie, and very low calorie. A meta-analysis of six randomized controlled trials found no difference between the main diet types (low calorie, low carbohydrate, and low fat), with a 2–4 kilogram weight loss in all studies.
Exercise:With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running, and cycling are the most effective means of exercise to reduce body fat.
Medication:Medication used for obesity. Orlistat (Xenical) and sibutramine (Meridia).There are two commonly prescribed medications for obesity. One is orlistat, which reduces intestinal fat absorption by inhibiting pancreatic lipase; the other is sibutramine, which is a specific inhibitor of the neurotransmitters norepinephrine, serotonin, and dopamine in the brain (very similar to some anti-depressants), therefore decreasing appetite. Rimonabant, a third drug, works via a specific blockade of the endocannabinoid system. It has been approved in Europe for the treatment of obesity but has not yet received approval in the
Bariatric surgery:Bariatric surgery ("weight loss surgery") is the use of surgical interventions in the treatment of obesity. As every operation may have complications, surgery is only recommended for severely obese people (BMI >40) who have failed to lose weight with dietary modification and pharmacological treatment. Weight loss surgery relies on various principles; the most common approaches are reducing the volume of the stomach, producing an earlier sense of satiation (e.g. by adjustable gastric banding and vertical banded gastroplasty) while others also reduce the length of bowel that food will be in contact with, directly reducing absorption (gastric bypass surgery). Band surgery is reversible, while bowel shortening operations are not. Some procedures can be performed laparoscopically. Complications from weight loss surgery are frequent. The effects of liposuction however are less well determined, with some small studies showing benefits and others showing none.
Patient name ** Lee Treatment Number:2
TCM disease: Overweight
TCM type/pattern: Damp-heat retention underlying spleen and kidney qi deficiency
Date:13/oct/2008
Current condition/change: While getting acupuncture treatments, he is taking herbal medicine as well because of easy fatigability.
His appetite has slightly decreased. He does not feel hungry easily.
Treatment principle: remove dampness
Prescription: same
Remove Nei ting
Add Da heng (SP15)
Explanation: His appetite has decreased. So I decided to focus more on removing dampness . Therefore I remove Nei ting and add Da heng
Da heng (SP15) Moves qi and regulates the intestines, remove dampness
Nei ting(ST44) Clears heat from the Stomach channel and alleviates pain
Harmonizes the intestines and clears damp-heat
CASE CONCLUSION
A 44 year old man came to my clinic because of being overweight.
The actual weight loss to be expected is about 1
Now he is on the 2nd week .He refuses to check his body weight but he told me that his excessive appetite has decreased. Before, he would carry on eating after he was full, but now he is able to stop eating when he is full. Also, He used to have loose stool but now his defecation has become good. Generally he feels much better. He has more energy to exercise.
Many people know that diet and exercise are helpful in any program of weight loss. Most people who come for acupuncture treatments, however, have been given diets and exercise practices before. They might have good understanding of what their diet should be like, but they feel depressed or irritable when they try to stay on a diet. Acupuncturist should significantly relieve such problems and improve will power along with helping weight loss.
