Obesity
Obesity
肥胖
By Prof Engin CAN (Enqin Zhang)
Contact e-mail: prof.engincan@hotmail.co.uk
Tel: 0044 078 461 93488
Website: http://sites.google.com/site/drcantreat/home
Obesity refers to an excess accumulation of fat in the body. Generally speaking, obesity can be diagnosed by the body weight which exceeds the standard body weight by 20%. The fat may be equally distributed throughout the whole body; or mostly in the abdominal area (apple-shaped) often seen in men; or in the hips and thighs (pear-shaped) mostly seen in women. In the U.K. adult obesity rates have almost quadrupled in the last 25 years with 22% of British people currently diagnosed as obese; in children the numbers have tripled over the last 20 years, of which 10% of six-year-olds and a rising 17% of 15-year-olds are suffering with obesity. Over 30,000 deaths a year in England are caused by obesity alone. Clinically, obesity can be classified into two categories, namely, simple obesity and secondary obesity. Simple obesity has no obvious endocrine-metabolic disturbances; while, secondary obesity has the symptoms of primary diseases, such as hypothalamic syndrome, Cushing’s syndrome and others. Additionally, it is important to note that obesity is different from being overweight, the latter which refers to excess weight due to muscle, bone or body water rather than body fat.
Chinese western medicine gives obesity the same name as western doctors in the U.K. While in TCM, obesity is named ‘Fei Pang’ (fatness) or ‘Tan Yin’ (phlegm stagnation). In the Huangdi Neijing (The Yellow Emperor’s Canon of Internal Medicine), the earliest medical classical text in China (B.C. 475-221 - unknown authorship), obesity was described as "Fei Gui Ren" (the fat aristocrats). Today, we are using many TCM therapies, such as body acupuncture, ear acupuncture, herbal medicines or herbal teas, as well as diet combined with exercise to treat simple obesity, of which most patients can lose 5-10 kilos per month. However, for secondary obesity patients, their primary diseases must first be addressed before obesity can be treated, of which is oftentimes more difficult to treat than simple obesity.
Aetiology and Pathology
For most people, obesity is caused by excess calorie intake. But, there are many other factors that contribute to the cause of obesity. For example: 1) Physical inactivity: Today many people spend 8-10 hours at their desks, or long hours in front of the television or computer, while devoting only a few hours or even minutes to physical activity. Some studies have shown that television viewing for more than 2 hours a day has been linked to obesity; 2) Living environment: Some people live in neighbourhoods without pavements, trails, parks, or even supermarkets where they can buy fresh fruit, vegetables and other healthy foods. So, their lifestyle is very limited to the house and eating fast foods every day; 3) Genes and family factor: Some studies have shown genes to have a strong influence on the body weight, as many cases of clinical obesity are often found within the family; 4) Hormonal problems: Hypothyroidism is a disorder of the thyroid glands producing insufficient thyroid hormones and thus, slowing down metabolism and leading to weight gain; Cushing’s syndrome is another hormonal disorder due to the body‘s adrenal glands making excess cortisol hormone and thus, also causing weight gain; 5) Emotional factors: Some studies have shown people tend to eat more than normal whenever they are bored, angry or stressed; 6) Age factors: Older people tend to lose muscle mass as they age and gain weight due to their retarded metabolism rate at which their body burns calories; women tend to gain weight in their middle age due to their change in lifestyle, as well as the onset of menopause; 7) Pregnancy factor: During pregnancy women tend to eat a lot more for the healthy nourishment and development of the foetus and thus, gain weight; many women also find it very difficult to lose the weight after giving birth, especially after two or more pregnancies.
In TCM theory, obesity is believed to be the result of many factors. For example: 1) Congenital constitution, such as qi-deficiency of the kidney and spleen, which can lead to stagnation of phlegm in the body, and then develop to obesity. This type of obesity often occurs within the same family; 2) Long term intake of excessive fatty foods or alcoholic drinks may cause dysfunction of the spleen-qi, which leads to stagnation of phlegm in the body and eventually leads to obesity. This type of obesity is seen mostly in people with a luxurious or higher standard of living; 3) Prolonged sitting or lying that can cause stagnation of qi and blood, which leads to accumulation of phlegm and results in obesity. This type of obesity mostly affects a category of managers, computer operators, accountants, housewives and others with a sedentary lifestyle; 4) Emotional disturbances, such as sadness, depression or loneliness which may cause stagnation of qi, and then develop into an accumulation of phlegm that leads to obesity. This type of obesity mostly occurs in the young or middle-aged women.
Thus, from the above factors it is evident the main pathology of obesity in TCM includes two aspects: 1) stagnation of phlegm or heat-phlegm; and 2) dysfunction of the spleen-qi and kidney-qi.
Differential Diagnosis
- Stagnation of phlegm: Fat physique, heaviness of the body, more sputum, dizziness, nausea, dry mouth with no desire for drinking, preference for greasy fatty foods or excessive alcohol consumption, listlessness and somnolence, white and greasy fur of the tongue, and slippery pulse.
- Stagnation of heat-phlegm: Fat physique, hyperorexia, dry mouth, preference for drinking cold water, aversion to heat and profuse sweating, restlessness, constipation, yellow and scanty urine, red tongue with yellow and greasy fur, and slippery and rapid pulse.
- Deficiency of the spleen-qi: Fat physique, pale complexion, abdominal distension after meals, spiritual lassitude and fatigue, shortness of breath, and somnolence and no desire to talk and walk, loose stool, scanty urine, or light dropsy, pale tongue with tooth prints on the margins, thin and white fur, and weak pulse.
- Deficiency of the kidney-qi: Fat physique, bright-white complexion, preference for quietness and aversion to activity, shortness of breath with more difficulty inhaling, dizziness and aching loins or afternoon fever, irregular menstruation in women and impotence in men, light-coloured tongue with tender texture, less fur, and deep, thin and weak pulse.
Diagnosis in Western Medicine
- Common Method
(1) Standard Weight(kg) = [height(cm)-100] x 0.9
Note: If the actual body weight exceeds the standard weight by 20% with the exclusion of muscle weight and water retention, this condition can be diagnosed as obesity.
(2) Fat accumulation: The average thickness of subscapular skin fold in a normal person aged 25 years old is 14.2mm; the average thickness of skin fold in the deltoid region of a 25-year-old male is 10.4mm and 17.5m in a 25-year-old female.
- BMI Method
BMI, or body mass index, is a simple and widely used method for estimating body fat. The method was developed by the Belgian Statistician and anthropometrist Adolphe Quetelet. BMI is calculated by dividing the subject’s weight by the square of his/her height, typically expressed either in metric or US ‘Customary’ unit.
Metric: BMI = kg/m2
Note: In this formula, kg refers to the subject’s weight in kilograms and m is the subject’s height in metres.
The current weight definitions in use establish the following BMI values, agreed in the year 1997 and published in the year 2000.
A BMI less than 18.5 is underweight;
A BMI of 18.5 -24.9 is normal weight;
A BMI of 25.0-29.9 is overweight;
A BMI of 30.0-39.9 is obese;
A BMI of 40.0 or higher is severe (or morbid) obese;
TCM Treatment
- Body acupuncture
Basic acupoints:
Zusanli (St 36)
Tianshu (St 25)
Sanyinjiao (Sp 6)
Zhongwan (Ren 12)
Pishu (B 20)
Weishu (B 21)
Fenglong (St 40)
Supplementary acupoints:
For stagnation of phlegm, add Neiguan (P 6), Yinlingquan (Sp 9).
For stagnation of heat-phlegm, add Hegu (LI 4), Quichi (LI 11).
For deficiency of the spleen-qi, add Dabao (Sp 21), Qihai (Ren 6).
For deficiency of the kidney-qi, add Taixi (K 3), Shenshu (B 23).
Method: Use filiform needles to puncture the acupoints selected. For the patients with stagnation of phlegm, and stagnation of heat-phlegm, the reducing method should be applied; while, for those with deficient spleen-qi and deficient kidney-qi, the reinforcing method and the even movement method should be used.
- Ear acupuncture
Ear points: Pt. Shenmen, Pt. Stomach, Pt. Large Intestine, Pt. Spleen, Pt. Mouth, Pt. Hunger, Pt. Endocrine.
Method: Select 3-5 ear points for each session, the auricular-seed-pressing therapy can be applied on the points, and replace the seeds every 3-5 days, continue the treatment for 2-3 months.
- Herbal therapy
(1) Stagnation of phlegm
Therapeutic principle: Regulating qi and eliminating phlegm.
Recipe: Modified Er Chen Tang and Zexie Tang/Decoction.
Ingredients:
Chenpi (Pericarpium citri reticulatae) 10g
Zhibanxia (Rhizoma pinelliae praeparatae) 9g
Shichangpu (Rhizoma acori talarinowii) 9g
Dongguapi (Exocarpium benincasae) 15g
Gualoupi (Pericarpium trichosanthis) 15g
Administration: All the above herbs should first be soaked in a pot of water for 2 hours or more, and then placed over a high fire until boiling, and then simmered over a low fire for 25-30 minutes. Finally, strain the herbal liquid from the boiled herbs to obtain the decoction for oral use. Drink half in the morning and the other half in the evening.
(2) Stagnation of heat-phlegm
Therapeutic principle: Clearing away heat and eliminating phlegm.
Recipe: Wen Dan Tang/Decoction with additional ingredients.
Ingredients:
Chenpi (Pericarpium citri reticulatae) 9g
Zhuru (Caulis bambusae in taeniam) 6g
Zhishi (Fructus aurantii imaturus) 9g
Zhigancao (Radix glycyrrhizae praeparatae) 3g
Dafupi (Pericarpium arecae) 15g
Dahuang (Radix et rhizoma rhei) 3-6g
Administration: All the above herbs should first be soaked in a pot of water for 2 hours or more, and then placed over a high fire until boiling, and then simmered over a low fire for 25-30 minutes. Finally, strain the herbal liquid from the boiled herbs to obtain the decoction for oral use. Drink half in the morning and the other half in the evening.
(3) Deficiency of the spleen-qi
Therapeutic principle: Tonifying the spleen-qi to treat obesity.
Recipe: Xiang Sha Liu Jun Zi Tang/Decoction with additional ingredients.
Ingredients:
Baizhu (Rhizoma atractylodis macrocephalae) 9g
Zhigancao (Radix glycyrrhizae praeparatae) 3g
Chenpi (Pericarpium citri reticulatae) 9g
Muxiang (Radix aucklandiae) 9g
Administration: All the above herbs should first be soaked in a pot of water for 2 hours or more, and then placed over a high fire until boiling, and then simmered over a low fire for 25-30 minutes. Finally, strain the herbal liquid from the boiled herbs to obtain the decoction for oral use. Drink half in the morning and the other half in the evening.
(4) Deficiency of the kidney-qi
Therapeutic principle: Tonifying the kidney-qi to treat obesity.
Recipe: Liu Wei Dihuang Wan/Decoction with additional ingredients.
Ingredients:
Shudihuang (Rhizoma rehmanniae praeparatae) 9g
Shanyao (Rhizoma dioscoreae) 9g
Mudanpi (Cortex moutan radicis) 9g
Xianmao (Rhizoma curculiginis) 10g
Yinyanghuo (Herba epimedii) 10g
Administration: All the above herbs should first be soaked in a pot of water for 2 hours or more, and then placed over a high fire until boiling, and then simmered over a low fire for 25-30 minutes. Finally, strain the herbal liquid from the boiled herbs to obtain the decoction for oral use. Drink half in the morning and the other half in the evening.
Lifestyle and Dietary Advice
- For patients with secondary obesity, it is necessary to first consult with a G.P. or a specialist for an exact diagnosis before beginning treatment of obesity. For example, if obesity is caused by the primary condition of hormonal imbalance, the patient should first seek an endocrinologist before starting other treatments, including TCM therapies.
- Diet is the most important factor for treating obesity. Common belief is that without dieting, weight can never be lost. There are many diet formulas available today, but the basic principles of most diets are to eat more fresh or half-cooked vegetables and less meat and fat/greasy foods; drink more warm water before or after dinners to assist the gastric juices and reduce the absor
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