Obesity: a TCVM Approach

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Obesity a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

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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

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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
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Obesity TCVM Etiology and Pattern

• Damp-phlegm
• Liver Stagnation
• Blood Stagnation
• Spleen Deficiency
• Kidney Deficiency

Excess
Deficiency
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Damp-phlegm
Etiology
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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 (F30 Hz) for local
swelling area 2) Message Abdomen and back,
twice a day.
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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
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Damp-phlegm
Max Formula
For lipomas
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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
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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
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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
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Blood Stagnation
Etiology
Other factors
Stress
Qi stagnation
Blood Stagnation
Qi-blood stagnation
Water/Damp retention in the body
Obesity
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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
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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
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Spleen Qi Deficiency
Water/damp from food or environment
Etiology
Overwork
Chronic illness
Spleen Qi Deficiency
Phlegm under the skin
Obesity
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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
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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
Herbal Formula
Astragalus-atractylodes-lycium
Astragalus Huang Qi 34 Atractylodes Cang
Zhu 33 Lycium Gou Qi Zi 33
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Kidney Qi Deficiency
Etiology
Other factors
Chronic illness
Ageing
Kidney Qi Deficiency
Water retention
Phlegm
Obesity
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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
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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
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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
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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
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Constipation a TCVM Approach

• CAPT R.M. Clemmons, DVM, PhD, CVA

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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 _at_ 0.25-0.5 mg/kg TID
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Constipation

• 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

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Stomach Heat
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Differentiation
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Constipation/Megacolon
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Acupuncture
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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
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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
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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
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Molly Rx
Acupuncture DN GV-20, CV-12, ST-25 EA (10
minutes _at_ 20 Hz 10 minutes _at_ 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