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August 24, 2010

TCM and Weight Management

By Tyehao Lu, LAC, MAOM

According to the World Health Organization there are 1 billion people globally that are overweight and 300 million that are clinically obese.1 According to the National Health and Nutrition Examination survey from 1999 to 2002, 65 percent of the U.S. population is obese or overweight and 30 percent are considered clinically obese.2

There continues to be an increase number of people that are becoming overweight or obese. The National Health Statistics reported that the body mass index (BMI) increased 30 percent in 1999-2000.3 What can we do to help with obesity and weight management? In a study that looked at the use of CAM for weight loss, 372  of 11,211 respondents used CAM for weight management within the past 12 months. Only 3 percent of the respondents in the study used some form of CAM therapy for weight loss and management.4

Western View

Obesity is excess fat within the body and tissues.5 There could be many reasons that lead to obesity and overweight, which may include genetics and environment.9 Researchers have found that certain genes may causes individuals to become more susceptible in becoming obese. Studies have shown the possibilities of hereditary factors being responsible for about 50-70% of the changes in weight. Genes can also contribute to where fat is stored and differences in metabolism.10

The environment has also been another major cause leading obesity and overweight. Researchers have found that environmental changes such as moving to a new country or city can lead to different eating habits which in turn have lead to weight gain.10 Eating habits have changed and there has been an increase of calorie intake and not enough exercise to burn the calories.9 The imbalance between energy input and output leads to excess accumulation of fat in the body.6,9

The environment can include many other factors that can lead to weight gain such as work, stress, and other lifestyle habits.1 Research have shown that job related stress can contribute to obesity and overweight.7 Another factor that the environment influences is the state of mind. Each individual person may have different problems in life that may also lead to psychological problems. When an individual has depression or other types of emotional disorders there may be a tendency to eat more that may lead to obesity.6 Research has shown that the main conclusion for the reason of obesity is the imbalance of consumption and expenditure of calories.

Cardiovascular disease is one of the major diseases associated with obesity. The excess fat in the body can put excess stress on the heart. The heart has to pump more blood causing it to become enlarged resulting in heart failure.9 Obesity can also affect the lung causing obstruction and difficulties in breathing leading to pulmonary complications. Diabetes is another major complication. Overweight people have a three times greater risk of becoming diabetic.11 The increase in fat will change endocrine function. It causes an increase in glucose and a resistance to insulin resulting in type 2 diabetes.9 Diseases such as gallbladder disease, osteoarthritis, prostate problems, and respiratory difficulties.13

Treatments. Weight loss programs can range from individual tailored exercises and diet plans to medical interventions such as surgery and weight loss medications. Whatever weight loss program individuals participate in researchers have concluded some key principles for weight management. In order to be successful in managing weight and obesity lifestyle change is in the heart of the matter.12 Behavioral changes and physical exercise have been the major contributing factors in treating obesity and overweight.

Besides behavioral changes, physical exercise is also a key factor for weight loss. In order to expend energy there has to be exercise. The American College of Sports Medicine recommends that adults expend 300 to 500 kcal per exercise session or 1,000 to 2,000 k cal per week.12 A weight loss program should start with losing 10 percent of weight from baseline within six months.13

The main goal for western treatment for obesity is eating fewer calories and having physical exercise. In extreme cases there could be surgery and also weight loss medications. Besides western intervention, complementary and alternative medicine is becoming more popular to help control weight and many individuals are looking for different interventions in losing weight.

Chinese Medicine View

Obesity was first mentioned in Chinese medicine in the Yellow Emperor's Internal Classic of Medicine: "When treating exhaustion syndromes, sudden syncope, hemiplegia, atrophy, or rapid respiration conditions that occur in obese patients, recognize that these are usually due to overindulgence in rich foods."14

The etiology and pathogenesis of obesity in Chinese medicine has four main factors. They include "righteous qi deficiency, improper diet, lack of physical exercise, and constitutional factors."15 Deficiency of righteous qi has many reasons. The result however is damage to the spleen. The spleen is in charge of transportation and transformation. When there is a dysfunction of the spleen there will be an accumulation of dampness and phlegm causing weight gain. Improper diet can also injure the spleen and stomach. When an individual eats too much greasy and rich foods overtime it will injure the spleen and stomach. The result of eating too much greasy foods will be an accumulation of damp-heat and phlegm. Lack of physical exercise can cause poor circulation within the body. Qi and blood are not able to flow in the body causing stagnation. The stagnation of fluids in the body can result into dampness and fat. Constitutional factors were noted in the Internal Classics. The physical appearance of being overweight can be inherited from parents and past generations.15

The main factors that cause obesity in Chinese medicine is phlegm and dampness.15 Bob Flaws noted that fat in Chinese medicine is phlegm and dampness.16 Because phlegm and dampness is the major contributor to fat in Chinese medicine, the spleen is the major organ because of the spleen's physiological function. However, there is also another factor that may cause obesity is qi and blood stagnation.15

Pattern Differentiation. Obesity and overweight in Chinese medicine is based on differentiation of syndromes. Although the main cause of obesity is phlegm and dampness there will be accompanying symptoms that will help differentiate obesity according to each individual's constitution. The main differentiation of syndromes for obesity are spleen deficiency with dampness accumulation, hyperactive stomach with hypoactive spleen, phlegm-dampness obstruction in the middle burner, qi stagnation and blood stasis, and spleen and kidney yang deficiency.

Obesity due to spleen deficiency with dampness occurs because the spleen is not able to transport and transform resulting in accumulation of dampness which will cause obesity. The accompanying symptoms include obesity or overweight with edema, heaviness of extremities, fatigue, abdominal distention, poor appetite, loose stool, pale and swollen tongue with soft thready or slippery pulse.15

Hyperactive stomach and hypoactive spleen is when there is too much heat in the stomach which will injure the spleen. The spleen becomes injured and not able to transport and transform dampness. The result will be an accumulation of dampness causing overweight. Some of the symptoms include excessive hunger, thirst, fever, constipation, abdominal pain, red tongue yellow coating, and rapid and slippery pulse.

Phlegm dampness obstruction in the middle jiao is a pattern that is related to the constitution of the individual. The main symptoms include improper diet eating rich and greasy foods, heaviness and numbness in limbs, dizziness, distention in the head. There is a greasy or yellow greasy tongue, wiry and slippery pulse.

Qi stagnation and blood stasis will cause accumulation. Accompanying symptoms will include stabbing pain in the chest or hypochondria, irregular menstruation or amenorrhea, dark or purple tongue, and wiry or choppy pulse.

Spleen and kidney yang deficiency is obesity with edema on the lower limbs. Some of the accompanying signs are fatigue, loose stool, cold hands and feet, sore knees and low back, pale tongue with white slippery coating, deep and thready pulse.

Herbal Treatment. The plan for treatment will be based upon each individual's constitution and differentiation of syndromes. The main focus for all treatment is to transform dampness and phlegm, tonify spleen, and facilitate the free flow of qi and blood.15

The following herbal formulas are suggested to use with the appropriate diagnosis. Sheng Ling Bai Zhu San is for spleen qi deficiency with dampness accumulation. A modified Zhi Shi Dao Zhi Wan is used for a hyperactive and hypoactive stomach and spleen. Er Chen Tang and Ze Xie Tang together are used for phlegm dampness obstructing the middle jiao. Chai Hu Shu Gan San is used for qi staganation and blood stasis. Zhen Wu Tang is used for spleen and kidney yang deficiency. There is also a suggested empirical Chinese formula for weight loss: da huang, bing lang, shan zha, yi yi ren, ze xie, chuan xiong, qing pi, ju hua, yin chen and e zhu.

Acupuncture Treatment. The acupuncture points are relatively similar for all of the different types of differentiation. The main points that are used are ST 34, SP4, ST 40, and ST 36. The supplement points for spleen and kidney yang deficiency used are Ren 4, KD 3, qi stagnation and blood stasis SJ 4, SP 10, and phlegm heat SJ 6, LI 11. The auricular points used are stomach, endocrine, spleen and shen men.15 The suggested empirical Chinese acupuncture point prescription is St 25, Sp 15, St 23, St 27, Gb 25, Ren 12, Ren 10, St 36, Sp 6, St 40, and Li 11. All of the points on the abdomen are connected to electrical stimulation.

As acupuncture and Chinese medicine has become more popular, there have been studies done on the effectiveness of acupuncture. There have been some studies performed looking at the treatment of obesity with acupuncture. One study demonstrated the effectiveness of electro-acupuncture for weight loss. There were 54 patients separated into two groups; one doing sit-ups and the other doing electro-acupuncture. The study lasted 13 weeks. The acupuncture points used were Ren 6, Ren 9, St 28, KD 14, St 26, St 40, and SP 6. The electrical stimulator was connected on the points on the abdomen. The results of the study showed that acupuncture was more effective than doing sit up exercise.17 Another study used auricular acupuncture for weight loss. The study was done using bilateral auricular acupuncture points with electrical stimulation. There were 55 patients studied and 63.6 percent showed a decrease of body weight.18

There continues to be many different studies that have shown the efficacy of acupuncture and Chinese medicine for the use of weight loss. Although there are many studies, there still is a need for more research on obesity in the United States using acupuncture and Chinese medicine. Acupuncture and Chinese medicine provide an alternative treatment to help control weight problems. Besides acupuncture and herbal medicine, individuals must also exercise and practice correct dietary guidelines. Acupuncture and herbal medicine combined with exercise and food therapy can greatly enhance the treatment of obesity and help individuals mange their weight. Acupuncture and Chinese medicine is an effective treatment for overweight and obesity.

References

  1. www.who.int/mediacentre/factsheets/fs311/en/.
  2. www.cdc.gov/nccdphp/dnpa/obesity/index.htm. 
  3. www.obesity.org
  4. Sharpe PA, Blank HM, Hoel J, et al. Use of complementary and alternative medicine for weight control in US. J Altern Complement Med 2007 March 13(2):217-22.
  5. Cabioglu MT, Ergene NE. Changes in serum leptin and beta endorphin levels with weight loss by electroacupuncture and diet restriction in obesity treatment. Am J Chinese Med 2006 34(1):1-11.
  6. Handy RC. Obesity: an epidemic. [editorial]. South Med J 2003;96(6):531-2.
  7. Schule, PA, Wagner GR, Gergory O, et al. Work, obesity, and occupational safety and health. Am J Public Health March 2007 97(3).
  8. Grant PG, Boersma H. Making sense of being fat: a hermeneutic analysis of adults' explanations for obesity. Counsel Psychother Res 2005;5(3):212-20.
  9. Conway, B., Rene A. Obesity as a disease: no lightweight matter. Obesity Rev 2004;(5)145-51.
  10. Wadden TA, Brownell KD, Foster GD. Obesity responding to the global epidemic. J Consult Clin Psychol 2002;70(3):510-25.
  11. Pi-Suyner, XF. How effective are lifestyle changes in prevention of type 2 diabetes? Nutr Rev 65(3):101-10.
  12. Walker S, Forey JP. Successful management of the obese patient. Am Fam Physician 2000;61(12):3615-22. www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/43.htm.
  13. Maoshing N. Yellow Emperor's Classic of Medicine: A New Translation of Nei Jing Su Wen. Boston: Shambhala Publications, 1995.
  14. Shi AS. Essentials of Chinese Internal Medicine. Walnut, Calif.: Bridge Publishing Group, 2003.
  15. Flaws B. New approaches to the Chinese medical treatment of obesity. Acupuncture Today 2002;10:(3).
  16. Hsu CH, Hwang KC, Chao CL, et al. Effects of electroacupuncture in reducing weight and waist circumference in obese women: a randomized crossover trial. Int J Obesity 2005;29:1379-84.
  17. Shiraishi T, Onoe M, Kojima TA, et al. Effects of bilateral auricular acupuncture stimulation on body weight in healthy volunteers and mildly obese
  18. patients. Soc Experiment Biol Med 2003;228:1201-7.

Tyehao Lu is a licensed acupuncturist, and kung fu and tai chi master. He specialize in pain management and internal medicine.

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