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Obesity: a TCVM Approach

Obesity: a TCVM Approach. CAPT R.M. Clemmons, DVM, PhD, CVA. > >. Out. In. Obesity. Body 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 time Energy in is based upon Food intake Absorption

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Obesity: a TCVM Approach

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

  2. > > Out In Obesity • Body 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 time • Energy in is based upon • Food intake • Absorption • Energy used is • Basic metabolic rate (thermoneutral condition) • Exercise • Lactattion • Pregnancy • Growth

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

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

  6. Damp-phlegm 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.

  7. Damp-phlegm Herbal Formula Phlegm Fat Formula (Citrus-Pinellia Compound) 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% Er Chen Tang Resolve Damp Liver Qi Master

  8. Damp-phlegm Max Formula For lipomas

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

  10. Liver Qi Stagnation . Overweight . Aggressive, or restlessness . Hypertension . irregular estrous cycling . exercise intolerance, lassitude . Pulse: Wiry and deep . Tongue: purple or pale with coating or without coating Symptoms: Treatment strategy: Regulate liver, clear Fire and transform damp Acupuncture: Sp-6/9, ST-40 Liv-3, GB-20 and GB-34

  11. Liver Qi Stagnation Herbal formula: Picrorrhiza Compound* 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% Clear Liver Clear Liver Nourish Yin/Blood Purge LI

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

  13. Blood Stagnation Symptoms: . Overweight . lump in the body surface . exercise intolerance, lassitude . Pulse: slow and deep . Tongue: purple with coating or without coating Treatment strategy: Invigorate Blood and transform damp Acupuncture: BL-17/SP-10 LIV-3, GB-34, LI-4 ST-40/BL-40

  14. Blood Stagnation Herbal Formula: Stagnation Reliever Move Blood, resolve stasis Carthamus Hong Hua 22% Ligusticum Chuang Xiong 22% Olibanum Ru Xiang 19% Typha Pu Huang 1 9% Rheum Da Huang 18% Move Qi & Blood Purge LI

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

  16. Spleen Qi Deficiency Symptoms: • Overweight • Diarrhea, or dry feces • Hyperlipemia • Eexercise intolerance, lassitude • Pulse: Weak and deep • Tongue: pale with coating or without coating Treatment strategy: tonify spleen qi and transform damp Acupuncture: ST-36/40/41, SP-2/3, and BL-20/21

  17. Spleen Qi Deficiency Nelumbo Compound* Herbal formula: 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% Eliminate Damp, Strengthen SP Drain Damp Resolve stagnation, clear Liver Astragalus-atractylodes-lycium Herbal Formula: Astragalus Huang Qi 34% Atractylodes Cang Zhu 33% Lycium Gou Qi Zi 33%

  18. Kidney Qi Deficiency Etiology Other factors Chronic illness Ageing Kidney Qi Deficiency Water retention Phlegm Obesity

  19. Kidney Qi Deficiency Symptoms: . 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 Treatment strategy: tonify Kidney qi and transform damp Acupuncture: Bai-hui, Shen-shu, Shen-peng, Shen-jiao Bl-23/26, SP-6 and Kid-3

  20. Kidney Qi Deficiency Psoralea Pill Herbal formula: Psoralea Bu Gu Zi 32% Notoginseng Tian Qi 9% Rheum Da Huang 30% Cassia Fan Xie Ye 29% Tonify Kid Qi/Yang Move Blood Purge LI

  21. Kobe 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 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 bladder • Innervation by • Sympathetics from L2-3 • Parasympathetics from S1-3 • Filling Phase • Sympathetics • Yin • Emptying Phase • Parasympathetics • Yang Propranolol @ 0.25-0.5 mg/kg TID

  25. Definition: Constipation Infrequent or incomplete bowel movements Feces are drier or harder Obstipation Intractable constipation Impossible defecation Patterns Heat Qi Stagnation Qi Deficiency Yin/Blood Deficiency Constipation

  26. Pathogenic Heat Yin Deficiency Stomach Heat channel grandchild Gums organ child Cystitis Ulcer Colitis or Constipation Stomach Heat

  27. Differentiation

  28. Constipation/Megacolon

  29. Acupuncture

  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 Weak pulse Anorexia Decreased thirst Dryness Red & dry tongue Earth element (SP/ST) Yin Deficiency 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) 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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