obesity: a tcvm approach

Obesity: a TCVM Obesity: a TCVM ApproachApproach

CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA

ObesityObesity• Body weight is 20% over idealBody weight is 20% over ideal

• An intake of total dietary energy above that needed for An intake of total dietary energy above that needed for maintenance and production or exercise over a long period of maintenance and production or exercise over a long period of timetime

• Energy in is based uponEnergy in is based upon• Food intakeFood intake• AbsorptionAbsorption

• Energy used isEnergy used is• Basic metabolic rate Basic metabolic rate (thermoneutral condition)(thermoneutral condition)• ExerciseExercise• LactattionLactattion• PregnancyPregnancy• GrowthGrowth

In > > Out

Obesity: TCVM Classical StrategyObesity: TCVM Classical Strategy

(1) Yin Tonic Herbs (Remannia, Lycium etc)

Decrease in appetiteDecrease in food intake

(2) Purgative herbs (Rheum, Cannabis Ma Zi Ren etc)

Passing food faster through SILess time to absorb nutrientsDecrease in absorption

(3) Qi Tonic Herbs (Ginseng, codonopsis etc)

Energy boostingPatient more willing to exerciseBurning down Fat tissue

•Damp-phlegm

•Liver Stagnation

•Blood Stagnation

•Spleen Deficiency

•Kidney Deficiency

Obesity: TCVM Etiology and PatternObesity: TCVM Etiology and Pattern

Excess

Deficiency

Damp-phlegmDamp-phlegm

Etiology

Spleen Qi Deficiency

Water/dampfrom food orenvironment

Other pathogenic factors

Stagnation of Water-damp

Phlegm under the skin

Obesity

Symptoms . Overweight. Swelling neck or belly. fast respiratory rate, or cough or asthma. Pulse: Fast, deep or slippery. Tongue: pale or red with thick coating. In people: obese smoker. Overall: not weak

Treatment Strategy: Transform damp and resolve phlegm Acupuncture treatment

1) needling: ST-36/40, BL-13, SP-6/9or Electro-acupuncture (F=30 Hz) for local swelling area

2) Message: Abdomen and back, twice a day.


Herbal Formula

Citrus Chen Pi 8%Pinellia Ban Xia 8%Poria Fu Ling 10%Coix Yi Yi Ren 20%Atractylodes Cang Zhu 8%Areca Da Fu Pi 10%Benincasa Dong Gua Pi 8%Alisma Ze Xie 10%Plantago Che Qian Cao 10%Cyperus Xiang Fu 8%

Phlegm Fat Formula (Citrus-Pinellia Compound)

Er Chen Tang

Resolve Damp

Liver Qi Master


Fritillaria Zhe Bei Mu Soften hardness and clear nodules

Ostrea Mu Li Soften hardness and clear mass

Prunella Xia Ku Cao Clear Liver Heat and resolve nodules

Scrophularia Xuan Shen Clear Heat and cool Blood

Trichosanthes Tian Hua Fen Clear Heat and promote body fluids

Platycodon Jie Geng Open the Upper Jiao and transform phlegm

Rhubarb Da Huang Clear stagnation/stasis and clear Heat

Angelica Bai Zhi Clear Wind-Cold and relieve pain

Max Formula For lipomas


Liver Qi StagnationLiver Qi Stagnation

EtiologyDrug StressEmotional Stress

Liver Qi Stagnation


Obesity

Liver over-control SpleenSpleen fails to transform Damp

Symptoms:

Treatment strategy:

Acupuncture:

. Overweight

. Aggressive, or restlessness

. Hypertension

. irregular estrous cycling

. exercise intolerance, lassitude

. Pulse: Wiry and deep

. Tongue: purple or pale with coating or without coating

Sp-6/9, ST-40Liv-3, GB-20 and GB-34

Regulate liver, clear Fire and transform damp


Herbal formula:

Picrorrhiza Hu Huang Lian 18%Prunella Xia Ku Cao 19%Cassia Jue Ming Zi 18%Rehmannia Sheng Di Huang 15%Rheum Da Huang 15%Cassia Pang Xie Ye 15%

Picrorrhiza Compound*

Clear Liver

Purge LI

Clear LiverNourish Yin/Blood


Blood StagnationBlood Stagnation

Etiology Other factors

Qi stagnation

Stress

Blood Stagnation

Water/Damp retention in the body

Obesity

Qi-blood stagnation

Symptoms:

Treatment strategy:

Acupuncture:

. Overweight

. lump in the body surface

. exercise intolerance, lassitude

. Pulse: slow and deep

. Tongue: purple with coating or without coating

Invigorate Blood and transform damp

BL-17/SP-10LIV-3, GB-34, LI-4ST-40/BL-40


Carthamus Hong Hua 22%Ligusticum Chuang Xiong 22%Olibanum Ru Xiang 19%Typha Pu Huang 1 9%Rheum Da Huang 18%

Stagnation RelieverHerbal Formula:

Move Blood, resolve stasis

Purge LI


Move Qi & Blood

Spleen Qi DeficiencySpleen Qi Deficiency

Etiology Water/dampfrom food orenvironment

Chronic illnessOverwork

Spleen Qi Deficiency


Obesity

Symptoms:

Treatment strategy:

• Overweight• Diarrhea, or dry feces• Hyperlipemia• Eexercise intolerance, lassitude • Pulse: Weak and deep • Tongue: pale with coating or without coating

tonify spleen qi and transform damp

Acupuncture: ST-36/40/41, SP-2/3, and BL-20/21


Herbal Formula:

Astragalus Huang Qi 34%Atractylodes Cang Zhu 33%Lycium Gou Qi Zi 33%

Herbal formula:

Astragalus-atractylodes-lycium

Nelumbo He Ye (Lotus) 13%Alisma Ze Xie 13%Poria Fu Ling 13%Coix Yi Yi Ren 13%*Atractylodes Cang Zhu 13%Atractylodes Bai Zhu 12%Citrus Chen Pi 10%Cassia Jue Ming Zi 13%

Nelumbo Compound*

Eliminate Damp, Strengthen SP

Drain Damp

Resolve stagnation, clear Liver


Kidney Qi DeficiencyKidney Qi Deficiency

Etiology Other factorsAgeingChronic illness

Kidney Qi Deficiency

Water retention

Obesity

Phlegm

Symptoms:

Treatment strategy:

Acupuncture:

. Overweight

. Often occurs in the aged patient

. Difficulty in walking or standing, or chronic back pain

. Bone degeneration or osteoporosis

. Pulse: Weak and deep

. Tongue: pale with coating or without coating

tonify Kidney qi and transform damp

Bai-hui, Shen-shu, Shen-peng, Shen-jiaoBl-23/26, SP-6 and Kid-3


Herbal formula: Psoralea Pill

Psoralea Bu Gu Zi 32%Notoginseng Tian Qi 9%Rheum Da Huang 30%Cassia Fan Xie Ye 29%

Purge LI

Move BloodTonify Kid Qi/Yang


9 yr MC Siamese9 yr MC Siamese

Obesity (14 lb)Obesity (14 lb)

Less playful and less activity Less playful and less activity after moving to a new place 3 after moving to a new place 3 weeks agoweeks ago

Warm-seekingWarm-seeking

Tongue: pale & swollenTongue: pale & swollen

Pulse: deep & weakPulse: deep & weak

KobeKobe


Rx: Psoralea PillRx: Psoralea Pill

HenriettaHenrietta

12 yo FS Dachshund12 yo FS Dachshund

OverweightOverweight

Able to get around with Able to get around with supportsupport

Pants a lot with slight Pants a lot with slight coughcough

Pulse: Fast & deepPulse: Fast & deep

Tongue: redTongue: redDamp-PhlegmDamp-Phlegm

Rx: Phlegm Fat Rx: Phlegm Fat FormulaFormula

Constipation: a TCVM Constipation: a TCVM ApproachApproach

CAPT R.M. Clemmons, DVM, PhD, CVACAPT R.M. Clemmons, DVM, PhD, CVA

Regulation of Colon FunctionRegulation of Colon Function•Colon is like the urinary Colon is like the urinary bladderbladder

•Innervation byInnervation by•Sympathetics from L2-3Sympathetics from L2-3

•Parasympathetics from Parasympathetics from S1-3S1-3

•Filling PhaseFilling Phase•SympatheticsSympathetics

•YinYin

•Emptying PhaseEmptying Phase•ParasympatheticsParasympathetics

•YangYang

Propranolol @ 0.25-0.5 Propranolol @ 0.25-0.5 mg/kg TIDmg/kg TID

ConstipationConstipation•Definition:Definition:

•ConstipationConstipation•Infrequent or Infrequent or incomplete bowel incomplete bowel movementsmovements•Feces are drier or Feces are drier or harderharder

•ObstipationObstipation•Intractable Intractable constipationconstipation•Impossible defecationImpossible defecation

•PatternsPatterns

•HeatHeat•Qi StagnationQi Stagnation•Qi DeficiencyQi Deficiency•Yin/Blood DeficiencyYin/Blood Deficiency

Stomach HeatStomach Heat

Stomach HeatStomach Heat

Pathogenic HeatPathogenic HeatYin DeficiencyYin Deficiency

channelchannel

GumsGums organorgan

UlcerUlcer

childchild

ColitisColitisoror

ConstipationConstipation

grandchildgrandchild

CystitisCystitis

DifferentiationDifferentiationHEATHEAT Qi StagnationQi Stagnation Qi DeficiencyQi Deficiency Blood/Yin Blood/Yin

DeficiencyDeficiency

OnsetOnset Acute Wood Person. Chronic Chronic

StoolStool Dry On/Off Small/Thin Dry

MucusMucus Yes No No No/Yes

ThirstThirst Yes No No Yes

UrinationUrination Short Normal Long Short

Abdm. PainAbdm. Pain No Flank No No

Mouth odorMouth odor Foul No No Slight

PreferencePreference Cool None Warm Cool

Tongue colorTongue color Red Purple Pale Pale/Red

T. MoistureT. Moisture Dry Normal Wet Dry

T. CoatingT. Coating Yellow Normal No No

PulsePulse Fast/Wiry Wiry Weak Weak/Thready

Constipation/MegacolonConstipation/MegacolonHeatHeat •Acute onset of colicAcute onset of colic

•Hot ear & noseHot ear & nose•Cool seekingCool seeking•ThirstyThirsty•Foul breath Foul breath •Swollen upper palateSwollen upper palate•Red & dry tongueRed & dry tongue•Fast pulseFast pulse

Da Chang Qi TangDa Chang Qi Tang

Qi StagnationQi Stagnation •Sub-acute onset of colicSub-acute onset of colic•Bloat & abdominal fullnessBloat & abdominal fullness•Gaseous bowel movementsGaseous bowel movements•AnorexiaAnorexia•Purple or red tonguePurple or red tongue•Wiry, fast pulseWiry, fast pulse

Xiao Zhang SanXiao Zhang San

Qi DeficiencyQi Deficiency •Chronic constipation or colicChronic constipation or colic•AnorexiaAnorexia•Loss of body massLoss of body mass•WeaknessWeakness•Pale tonguePale tongue•Deep & weak pulseDeep & weak pulse

Fan Xie YeFan Xie Ye

Yin/Blood Yin/Blood DeficiencyDeficiency

•Very chronic megacolon with impactionVery chronic megacolon with impaction•Dry flaky skinDry flaky skin•Weak or geriatric patientWeak or geriatric patient•Pale or red, dry tonguePale or red, dry tongue•Fast, weak & thready pulseFast, weak & thready pulse

Dang Gui Cong Dang Gui Cong RongRong

AcupunctureAcupuncture

HeatHeat Qi Qi StagnationStagnation

Qi Qi DeficiencyDeficiency

Blood/Yin Blood/Yin DeficiencyDeficiency

PointsPoints LI-4

LI-10

GV-1

BL-21

ST-37

LIV-3

GV-1

GB-34

ST-36

SP-6

B-21

BL-15

SP-6

SP-10

GV-1

MethodMethod q d 3d

1-3 times

q wk

2-4 times

q wk

2-5 times

q wk

3-7 times

Kitty LittleKitty Little

15 yr FS Persian15 yr FS Persian

Chronic constipation with Chronic constipation with impactionimpaction

Dry flaky skin with dandruffDry flaky skin with dandruff

General weaknessGeneral weakness

Tongue: Tongue: red & dry red & dry

Pulse: deep, weak & threadyPulse: deep, weak & thready

Yin/Blood DeficiencyYin/Blood Deficiency

Rx: Dang Gui Cong Rx: Dang Gui Cong RongRong

MollyMolly

13 yr FS Maine Coon13 yr FS Maine Coon

Earth personalityEarth personality

Frequent constipation with Frequent constipation with impactionimpaction

Colon cleaning under Colon cleaning under anesthesia 5 times in past 2 anesthesia 5 times in past 2 yearsyears

Recent inappetenceRecent inappetence

Vomits undigested food with Vomits undigested food with impacted impacted

Rx: Lactulose & CisaprideRx: Lactulose & Cisapride

First visit:First visit:

No BM for 5 dayNo BM for 5 dayAbdomen filled with fecal Abdomen filled with fecal ballsballs

Dry haircoatDry haircoatWarm seekingWarm seekingTongue: red & dryTongue: red & dryPulse: weakPulse: weak

Molly DxMolly DxEarth personalityEarth personalityNo BMNo BM

Earth element Earth element (SP/ST)(SP/ST)

DrynessDrynessRed & dry tongueRed & dry tongue

Yin DeficiencyYin Deficiency

Weak pulseWeak pulseAnorexiaAnorexiaDecreased thirstDecreased thirst

Qi DeficiencyQi Deficiency

TCVM Dx: SP/ST (LI) Yin & Qi DeficiencyTCVM Dx: SP/ST (LI) Yin & Qi Deficiency

Molly RxMolly Rx

Acupuncture:Acupuncture:

DN: GV-20, CV-12, ST-25DN: GV-20, CV-12, ST-25EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz)EA: (10 minutes @ 20 Hz & 10 minutes @ 80-120 Hz) BL-21, BL-25, ST-36- -ST-37 (bilaterally)BL-21, BL-25, ST-36- -ST-37 (bilaterally)

Owner reported that Molly defecated a long firm stool 10-16 Owner reported that Molly defecated a long firm stool 10-16 hours after acupuncture and continued to have BMs every 2-3 hours after acupuncture and continued to have BMs every 2-3 days. Stool still dry & still warm seeking.days. Stool still dry & still warm seeking.

TCM Herbal:TCM Herbal:

Ma Zi Ren Wan + Fan Xie YeMa Zi Ren Wan + Fan Xie Ye

obesity: a tcvm approach

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