I remember my first day interning at Hangzhu City Hospital in September 2003. As we entered the busy street, which was bustling with cars, cranes, trucks, bicycles, pedestrians, and ineffectual traffic police, the graduate student accompanying me on my walk grinned broadly and motioned for me to stop.

She pointed to a six-foot tall statue of Colonel Sanders, perched on a pedestal outside a Kentucky Fried Chicken restaurant. She asked if I wanted to eat there for lunch later. Even at 7:30 a.m., the smell of refried grease made my stomach flip. As we walked further, there was a Starbuck's coffee shop, with a line of people waiting for their morning cappuccinos and lattes. And, of course, there were the ubiquitous arches of a McDonald's, which held more people than my favorite place - Grandma's Dumpling House, which I had discovered on a previous trip.

Slowly but steadily, the population is growing. Still an anomaly, an overweight person stands out on the street, unlike in the United States, where our eyes have adjusted to the general largeness. As I watched the children board school buses, I noticed many more children than adults who were overweight. My friend said that the children are now under so much pressure to succeed, they spend their evenings and weekends studying or playing computer games rather than playing outdoors. Coca-Cola, Pepsi, Snickers bars (her son's favorite), Tootsie Rolls and Pop Tarts had insidiously found their way into this culture, and the belief was that because these items are Western ... well, they just have to be good!

According to Professor Dr. Fang Jianqiao, with whom I had the pleasure of working at the Zhejiang College of Traditional Chinese Medicine, acupuncture treatments for weight reduction have been practiced, studied and refined for the past five years. Except for the city hospital, which treated primarily wind stroke and hemiplegia, the satellite clinics of the TCM college all provided weight reduction acupuncture treatments. The course of treatment was 10 sessions, three times per week, until finished. Then a resting period of one to two weeks was given, and the course of treatment would begin again until the desired weight was reached.

Dr. Fang has stated clearly that acupuncture is a gradual reduction method. It takes time - a full year for some cases - and obesity is a complex, complicated problem containing both physiological and psychological components that must be addressed. Dr. Hao, a woman who treats many patients for obesity (when I asked, most women preferred to be treated by a female doctor), said that to lose weight from the abdomen is not enough. A good doctor knows that a patient will still have underlying problems contributing to overeating. The following is a list of common ailments most often accompanying obesity that can be remedied during the course of treatment:

• Irregular bowel movements (most often, constipation is a problem)
• Irregular menstrual flow
• Mood swings, depression, ambivalence, PMS
• Skin problems caused by toxic heat in the blood
• Fatigue

There seem to be no negative side-effects associated with this treatment, only positive ones. Studies show that while undergoing these treatments, problems such as hypertension and diabetes can be abated. No particular diet is recommended, nor is exercise a requirement; just acupuncture, herbs, and patience.

Acupuncture is primarily used to strengthen the endocrine and digestive systems. An herbal prescription is written by the doctor, and the patient fills at the pharmacy to be taken on a weekly basis. The prescription is revised as the patient improves. The theory is simple: by stimulating the digestive system, the stomach and spleen can become more efficient at transforming and transporting the food's qi, thereby decreasing appetite. Because the nourishment is more bioavailable, the person feel full more quickly. In talking with some patients, somewhere around the third and fifth treatments, it becomes impossible for them to eat as much as they once did. This is a strong psychological boost, adding confidence and hope into an equation that once was filled with frustration, disappointment and, in some cases, despair.

The kidney is included to boost the endocrine system; these points are used alternately with Stomach and Spleen points. The standard treatment is as follows:

Ren 4, 6, 9, 10, 11, 12
Stomach 24, 25, 26, 27
Spleen 15, 16
Kidney 15, 16, 17 (used alternately with Stomach points)

If this seems like a lot of points, it is. To these above points, electric stimulation is applied with a machine offering six leads and five different wave patterns. Pattern two is for stimulating; pattern five is used to break up the adipose tissue around the umbilicus. I witnessed softening of this tissue at the third treatment of a 48-year-old female, much to the satisfaction of the attending doctor. At this point in treatment, the herbal decoction must include herbs that drain damp, remove toxins, and move qi and blood to assist in the dispersion of the tissue. The stimulation is used for 30 to 40 minutes and adjusted to tolerance by the patient. It is turned up midway through the treatment, if possible. There is no crossing over the center of the body, but leads can be placed to Spleen, Stomach or Kidney points (I saw may variations on this) on either the left or right sides. Ren points are connected to other Ren points. Often, two needles placed very close together at Ren 12 are attached with one lead, and two needles placed close together at Ren 6 or 10 are attached to the other, thereby increasing the power of the stimulation in those areas.

Distal points are used and chosen according to the TCM diagnosis: Liv 11; St 36, 40; Sp 9, 10, etc. Ear points most commonly used are shenmen, endocrine, stomach, spleen, and internal genitalia, according to diagnosis. Ear seeds are used in between treatments, applied to only one ear at a time, alternating so as to maximize effectiveness of the stimulation.

I have had the opportunity to create a client base of approximately 30 persons who have been receiving this basic treatment. Early on, I learned quickly that I had to make significant changes for this population. First of all, two treatments per week (totaling 10) was not possible for most people. Either time or financial constraints were obstacles. Having said that, however, I found that this protocol was far too stimulating and aggressive for my patients. The first person I began treating started eating more, and the third person began binging after her fourth treatment. Others began having intense emotional reactions of anger, fear, sadness, and melancholy with this much stimulation to TCM organ systems. I began to pull back in a number of ways:

1. I created an option of two treatments per week: one is a front treatment with electric stimulation, and the second is a back treatment, using back shu Spleen, Stomach, Liver and Kidney points to soften and absorb the effects of the first treatment.
   


2. Another option that works is to do one treatment per week, beginning with four leads of electrical stimulation. Then, depending on the points' response, perform a back treatment with our without electrical stimulation on Stomach and Spleen back shu points, or perform another front treatment if the patient seems to have absorbed the effects of the treatment well.
   


3. After the fourth treatment, begin to increase the electric stimulation to five or six leads for a full 25 minutes. This is the time when many patients begin to notice a definite decrease in appetite, interest in food, or a shift in cravings.
   


4. For those interested in dietary changes and/or exercise, encourage, support and educate the patients.
   


5. Depending on the person's TCM diagnosis, herbal formulas can help a lot with accompanying symptoms.
   


6. Be honest about the possible bruising that can take place in the Stomach area, where the flesh is think with adipose tissue and the capillaries can break easily. Most do not object as long as they have been forewarned.

After 10 treatments, the patient takes a break from acupuncture, and may continue to take herbs for two weeks to a month. I think a month works better, because it allows more time to exercise, create healthier eating patterns and establish more confidence.

Somewhere around treatment six to eight, people begin to notice significant positive changes - less attachment to food, less eating, and less thinking about eating. Talking about food as an addiction can be appropriate here if the patient is open to it. Giving out samples of food - green tea, soy or rice cheeses, rye crackers, and alternative sweeteners like liquid stevia or luo han powder - are greatly appreciated by most. Looking at a few days of a food journal may be beneficial.

What you share with one patient will not always work with another. Some patients lose weight the first week; some don't lose weight until the eighth treatment; some don't lose weight at all; and some will call a month out and tell me they have started losing weight. No one I have worked with has gained weight while being treated.

I have begun using this protocol in my practice, seeing patients twice a week because it is not possible for most people to find the time or money for three sessions, as is done in China. I discuss food choices, including seasonal TCM choices, and explore possible exercise routines, but I do not force the issue. Most people already know what they should be doing and feel guilty enough without me adding my two yuan!

Around the fourth treatment, there is a remarkable occurrence - a decrease in overall appetite, a decrease in sugar cravings, or a shift to adequate protein intake - but it is significant. There can be bruising from the needles; the patient needs to be told this so he or she is not alarmed. Resting time is also part of the protocol; the body needs to assimilate and absorb the treatments. Herbs can be continued during this time, and I allow two weeks rest before another 10-treatment period is resumed.

The doctors in China say four out of five patients lose weight. Time will tell here in the West.

Mary K. Christian, LAc, Dipl. CH
Denver, Colorado

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