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.
Damp-phlegmDamp-phlegm
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
Damp-phlegmDamp-phlegm
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
Damp-phlegmDamp-phlegm
Liver Qi StagnationLiver Qi Stagnation
EtiologyDrug StressEmotional Stress
Liver Qi Stagnation
Phlegm under the skin
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
Liver Qi StagnationLiver Qi Stagnation
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
Liver Qi StagnationLiver Qi Stagnation
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
Blood StagnationBlood Stagnation
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
Blood StagnationBlood Stagnation
Move Qi & Blood
Spleen Qi DeficiencySpleen Qi Deficiency
Etiology Water/dampfrom food orenvironment
Chronic illnessOverwork
Spleen Qi Deficiency
Phlegm under the skin
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
Spleen Qi DeficiencySpleen Qi Deficiency
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
Spleen Qi DeficiencySpleen Qi Deficiency
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
Kidney Qi DeficiencyKidney Qi Deficiency
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
Kidney Qi DeficiencyKidney Qi Deficiency
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
Kidney Qi DeficiencyKidney Qi Deficiency
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