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Obesity: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA.

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Presentation on theme: "Obesity: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA."— Presentation transcript:

1 Obesity: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

2 Obesity Body weight is 20% over idealBody weight is 20% over ideal An intake of total dietary energy above that needed for maintenance and production or exercise over a long period of timeAn intake of total dietary energy above that needed for maintenance and production or exercise over a long period of time Energy in is based uponEnergy in is based upon Food intakeFood intake AbsorptionAbsorption Energy used isEnergy used is Basic metabolic rate (thermoneutral condition)Basic metabolic rate (thermoneutral condition) ExerciseExercise LactattionLactattion PregnancyPregnancy GrowthGrowth In > Out

3 Obesity: TCVM Classical Strategy (1)Yin Tonic Herbs (Remannia, Lycium etc) Decrease in appetite Decrease in food intake (2) Purgative herbs (Rheum, Cannabis Ma Zi Ren etc) Passing food faster through SI Less time to absorb nutrients Decrease in absorption (3) Qi Tonic Herbs (Ginseng, codonopsis etc) Energy boosting Patient more willing to exercise Burning down Fat tissue

4 Damp-phlegm Liver Stagnation Blood Stagnation Spleen Deficiency Kidney Deficiency Obesity: TCVM Etiology and Pattern Excess Deficiency

5 Damp-phlegm Etiology Spleen Qi Deficiency Water/damp from food or environment Other pathogenic factors Stagnation of Water-damp Phlegm under the skin Obesity

6 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-6/9 or Electro-acupuncture (F=30 Hz) for local swelling area 2) Message: Abdomen and back, twice a day. Damp-phlegm

7 Herbal Formula Citrus Chen Pi8% Pinellia Ban Xia8% Poria Fu Ling10% Coix Yi Yi Ren20% Atractylodes Cang Zhu8% Areca Da Fu Pi10% Benincasa Dong Gua Pi8% Alisma Ze Xie10% Plantago Che Qian Cao10% Cyperus Xiang Fu8% Phlegm Fat Formula (Citrus-Pinellia Compound) Er Chen Tang Resolve Damp Liver Qi Master Damp-phlegm

8 FritillariaZhe Bei MuSoften hardness and clear nodules OstreaMu LiSoften hardness and clear mass PrunellaXia Ku CaoClear Liver Heat and resolve nodules ScrophulariaXuan ShenClear Heat and cool Blood TrichosanthesTian Hua FenClear Heat and promote body fluids PlatycodonJie GengOpen the Upper Jiao and transform phlegm RhubarbDa HuangClear stagnation/stasis and clear Heat AngelicaBai ZhiClear Wind-Cold and relieve pain Max FormulaFor lipomas Damp-phlegm

9 Liver Qi Stagnation Etiology Drug Stress Emotional Stress Liver Qi Stagnation Phlegm under the skin Obesity Liver over-control Spleen Spleen fails to transform Damp

10 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-40 Liv-3, GB-20 and GB-34 Regulate liver, clear Fire and transform damp Liver Qi Stagnation

11 Herbal formula: Picrorrhiza Hu Huang Lian18% Prunella Xia Ku Cao19% Cassia Jue Ming Zi18% Rehmannia Sheng Di Huang15% Rheum Da Huang15% Cassia Pang Xie Ye15% Picrorrhiza Compound* Clear Liver Purge LI Clear Liver Nourish Yin/Blood Liver Qi Stagnation

12 Blood Stagnation EtiologyOther factors Qi stagnation Stress Blood Stagnation Water/Damp retention in the body Obesity Qi-blood stagnation

13 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-10 LIV-3, GB-34, LI-4 ST-40/BL-40 Blood Stagnation

14 Carthamus Hong Hua 22% Ligusticum Chuang Xiong22% Olibanum Ru Xiang19% Typha Pu Huang1 9% Rheum Da Huang18% Stagnation Reliever Herbal Formula: Move Blood, resolve stasis Purge LI Blood Stagnation Move Qi & Blood

15 Spleen Qi Deficiency Etiology Water/damp from food or environment Chronic illness Overwork Spleen Qi Deficiency Phlegm under the skin Obesity

16 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 Deficiency

17 Herbal Formula: Astragalus Huang Qi 34% Atractylodes Cang Zhu33% Lycium Gou Qi Zi33% Herbal formula: Astragalus-atractylodes-lycium Nelumbo He Ye (Lotus)13% Alisma Ze Xie13% Poria Fu Ling13% Coix Yi Yi Ren13% *Atractylodes Cang Zhu 13% Atractylodes Bai Zhu12% Citrus Chen Pi10% Cassia Jue Ming Zi13% Nelumbo Compound* Eliminate Damp, Strengthen SP Drain Damp Resolve stagnation, clear Liver Spleen Qi Deficiency

18 Kidney Qi Deficiency EtiologyOther factors Ageing Chronic illness Kidney Qi Deficiency Water retention Obesity Phlegm

19 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-jiao Bl-23/26, SP-6 and Kid-3 Kidney Qi Deficiency

20 Herbal formula: Psoralea Pill Psoralea Bu Gu Zi32% Notoginseng Tian Qi9% Rheum Da Huang30% Cassia Fan Xie Ye29% Purge LI Move Blood Tonify Kid Qi/Yang Kidney Qi Deficiency

21 9 yr MC Siamese Obesity (14 lb) Less playful and less activity after moving to a new place 3 weeks ago Warm-seeking Tongue: pale & swollen Pulse: deep & weak Kobe Kidney Qi Deficiency Rx: Psoralea Pill

22 Henrietta 12 yo FS Dachshund Overweight Able to get around with support Pants a lot with slight cough Pulse: Fast & deep Tongue: red Damp-Phlegm Rx: Phlegm Fat Formula

23 Constipation: a TCVM Approach CAPT R.M. Clemmons, DVM, PhD, CVA

24 Regulation of Colon Function Colon is like the urinary bladderColon is like the urinary bladder Innervation byInnervation by Sympathetics from L2-3Sympathetics from L2-3 Parasympathetics from S1-3Parasympathetics from S1-3 Filling PhaseFilling Phase SympatheticsSympathetics YinYin Emptying PhaseEmptying Phase ParasympatheticsParasympathetics YangYang Propranolol @ 0.25-0.5 mg/kg TID

25 Constipation Definition:Definition: ConstipationConstipation Infrequent or incomplete bowel movementsInfrequent or incomplete bowel movements Feces are drier or harderFeces are drier or harder ObstipationObstipation Intractable constipationIntractable constipation Impossible defecationImpossible defecation Patterns Heat Qi Stagnation Qi Deficiency Yin/Blood Deficiency

26 Stomach Heat Pathogenic Heat Yin Deficiency channel Gums organ Ulcer child ColitisorConstipation grandchild Cystitis

27 Differentiation HEAT Qi Stagnation Qi Deficiency Blood/Yin Deficiency Onset AcuteWood Person.Chronic Stool DryOn/OffSmall/ThinDry Mucus YesNo No/Yes Thirst YesNo Yes Urination ShortNormalLongShort Abdm. Pain NoFlankNo Mouth odor FoulNo Slight Preference CoolNoneWarmCool Tongue color RedPurplePalePale/Red T. Moisture DryNormalWetDry T. Coating YellowNormalNo Pulse Fast/WiryWiryWeakWeak/Thready

28 Constipation/Megacolon Heat Acute onset of colicAcute onset of colic Hot ear & noseHot ear & nose Cool seekingCool seeking ThirstyThirsty Foul breathFoul breath Swollen upper palateSwollen upper palate Red & dry tongueRed & dry tongue Fast pulseFast pulse Da Chang Qi Tang Qi 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 San Qi 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 Ye Yin/Blood Deficiency 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 Rong

29 Acupuncture Heat Qi Stagnation Qi Deficiency Blood/Yin Deficiency Points 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 Method q d 3d 1-3 times q wk 2-4 times q wk 2-5 times q wk 3-7 times

30 Kitty Little 15 yr FS Persian Chronic constipation with impaction Dry flaky skin with dandruff General weakness Tongue: red & dry Pulse: deep, weak & thready Yin/Blood Deficiency Rx: Dang Gui Cong Rong

31 Molly 13 yr FS Maine Coon Earth personality Frequent constipation with impaction Colon cleaning under anesthesia 5 times in past 2 years Recent inappetence Vomits undigested food with impacted Rx: Lactulose & Cisapride First visit: No BM for 5 day Abdomen filled with fecal balls Dry haircoat Warm seeking Tongue: red & dry Pulse: weak

32 Molly Dx Earth personality No BM Earth element (SP/ST) Dryness Red & dry tongue Yin Deficiency Weak pulse Anorexia Decreased thirst Qi Deficiency TCVM Dx: SP/ST (LI) Yin & Qi Deficiency

33 Molly Rx Acupuncture: DN: GV-20, CV-12, ST-25 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 hours after acupuncture and continued to have BMs every 2-3 days. Stool still dry & still warm seeking. TCM Herbal: Ma Zi Ren Wan + Fan Xie Ye

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