Obesity a TCVM Approach CAPT R M Clemmons

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

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 In >> Out

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

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

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

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.

Damp-phlegm Herbal Formula Citrus Pinellia Poria Coix Atractylodes Areca Benincasa Alisma Plantago Cyperus Phlegm Fat Formula (Citrus-Pinellia Compound) Chen Pi Ban Xia Fu Ling Yi Yi Ren Cang Zhu Da Fu Pi Dong Gua Pi Ze Xie Che Qian Cao Xiang Fu 8% 8% 10% 20% 8% 10% 10% 8% Er Chen Tang Resolve Damp Liver Qi Master

Damp-phlegm Max Formula For lipomas Fritillaria Zhe Bei Mu Soften hardness and clear nodules Ostrea Mu Li Soften hardness and clear mass Prunella Xia Ku Cao Clear Liver Heat and resolve nodules Scrophularia Xuan Shen Clear Heat and cool Blood Trichosanthes Tian Hua Fen Clear Heat and promote body fluids Platycodon Jie Geng Open the Upper Jiao and transform phlegm Rhubarb Da Huang Clear stagnation/stasis and clear Heat Angelica Bai Zhi Clear Wind-Cold and relieve pain

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

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

Liver Qi Stagnation Herbal formula: Picrorrhiza Prunella Cassia Rehmannia Rheum Cassia Picrorrhiza Compound* Hu Huang Lian Xia Ku Cao Jue Ming Zi Sheng Di Huang Da Huang Pang Xie Ye 18% 19% 18% 15% 15% Clear Liver Nourish Yin/Blood Purge LI

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

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: Acupuncture: Invigorate Blood and transform damp BL-17/SP-10 LIV-3, GB-34, LI-4 ST-40/BL-40

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

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

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: Acupuncture: tonify spleen qi and transform damp ST-36/40/41, SP-2/3, and BL-20/21

Spleen Qi Deficiency Herbal formula: Nelumbo Alisma Poria Coix *Atractylodes Citrus Cassia Nelumbo Compound* He Ye (Lotus) Ze Xie Fu Ling Yi Yi Ren Cang Zhu Bai Zhu Chen Pi Jue Ming Zi 13% 13% 13% 12% 10% 13% Eliminate Damp, Strengthen SP Drain Damp Resolve stagnation, clear Liver Herbal Formula: Astragalus-atractylodes-lycium Astragalus Atractylodes Lycium Huang Qi Cang Zhu Gou Qi Zi 34% 33%

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

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

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

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

Constipation: a TCVM Approach CAPT R. M. Clemmons, DVM, Ph. D, CVA

Regulation of Colon Function • Colon is like the urinary bladder • Innervation by • Sympathetics from L 2 -3 • Parasympathetics from S 1 -3 • Filling Phase • Sympathetics • Yin • Emptying Phase • Parasympathetics • Yang Propranolol @ 0. 25 -0. 5 mg/kg TID

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

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

Differentiation HEAT Qi Stagnation Qi Deficiency Blood/Yin Deficiency Onset Acute Wood Person. Chronic Stool Dry On/Off Small/Thin Dry Mucus Yes No No No/Yes Thirst Yes No No Yes Urination Short Normal Long Short Abdm. Pain No Flank No No Mouth odor Foul No No Slight Preference Cool None Warm Cool Purple Pale/Red Tongue color Red T. Moisture Dry Normal Wet Dry T. Coating Yellow Normal No No Pulse Fast/Wiry Weak/Thready

Constipation/Megacolon Heat • Acute onset of colic • Hot ear & nose • Cool seeking • Thirsty • Foul breath • Swollen upper palate • Red & dry tongue • Fast pulse Da Chang Qi Tang Qi Stagnation • Sub-acute onset of colic • Bloat & abdominal fullness • Gaseous bowel movements • Anorexia • Purple or red tongue • Wiry, fast pulse Xiao Zhang San Qi Deficiency • Chronic constipation or colic • Anorexia • Loss of body mass • Weakness • Pale tongue • Deep & weak pulse Fan Xie Ye Yin/Blood Deficiency • Very chronic megacolon with impaction • Dry flaky skin • Weak or geriatric patient • Pale or red, dry tongue • Fast, weak & thready pulse Dang Gui Cong Rong

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 3 d 1 -3 times q wk 2 -4 times q wk 2 -5 times q wk 3 -7 times

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

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

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

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