Acupuncture therapy for obesity caused by spleen deficiency and phlegm-dampness accumulation

2. Spleen Deficiency and Digestive Dysfunction Type. [Clinical Manifestations]Obesity in this type is often accompanied by a bloated physique, fatigue, heaviness in the body, drowsiness, normal or reduced appetite, a history of overeating, mild edema in the limbs (worse in the evening and milder in the morning), difficulty urinating, loose stools or constipation, pale and swollen tongue with teeth marks on the edges, thin white or greasy white coating, and a weak and thready pulse. [Treatment Principle]Strengthen the spleen and replenish qi, promote diuresis and eliminate dampness. [Basic Prescription]Daheng (SP15), Fujie (SP16), Daimai (GB20), Zusanli (ST36), Taibai (SP3), Gongsun (SP4), Pishu (BL20), Shenshu (BL23).

[Acupuncture Points and Prescriptions] For poor appetite or abdominal distension after meals, add Zhongwan (CV12); for severe edema of the face and limbs, add Qihai (CV6) and Guanyuan (CV4), moxibustion may be added; for loose stools, add moxibustion to Taibai (SP3) and Shenshu (BL23); for fatigue and weakness, and heaviness in the limbs, add Qihaiyu (BL67) and Guanyuanyu (BL40); for drowsiness, add Shenmai (BL62). [Procedure] Depending on the thickness of the patient's abdominal fat, use 30-gauge 1.5-2 inch filiform needles for abdominal acupuncture, and 1.5-inch filiform needles for acupuncture points on the limbs and back. Disinfect the selected acupoints routinely with 75% alcohol or povidone-iodine. For acupuncture along the Dai Mai meridian, the needle tip should point towards Shenque (CV8).

After inserting the needle, perform a twisting manipulation until the sensation radiates around the Shenque acupoint. For other acupoints on the abdomen and limbs, use a straight insertion method, followed by a lifting, thrusting, and twisting manipulation. The manipulation should be gentle until the patient experiences a tingling, numb, and qi-de-sensing sensation. Depending on the patient's specific condition, select 2-3 acupoints for 1-2 moxibustion cones. Manipulate the remaining needles every 5 minutes, retaining them for 30 minutes before removal. Treat once daily for 5 consecutive days, then every other day. 10 treatments constitute one course. [Explanation] The Daheng and Fujie acupoints are located on the Spleen Meridian, which can strengthen the spleen and promote digestion, thus enhancing the spleen-strengthening and fat-reducing effects.

The Dai Mai acupoint is located in the middle of the waist and abdomen, starting from the side of the lower abdomen, below the ribs, encircling the body, passing through the waist, and binding the meridians like a belt. Obesity, especially abdominal obesity, is often related to a decline in the binding function of the Dai Mai acupoint, hence its selection. Zusanli is the lower He-Sea point of the Stomach Meridian of Foot Yangming. Acupuncture at Zusanli can regulate the Qi of the Yangming Meridian and harmonize the stomach and intestines. Taibai, the "Yuan-Source point" of the Spleen Meridian of Foot Taiyin, and Gongsun, the "Luo-Connecting point," are selected to tonify the spleen and replenish Qi, strengthening the spleen and stomach. Pishu and Shenshu, the back-shu points, are selected to nourish the acquired constitution.

The combined use of these acupoints achieves the effects of strengthening the spleen and replenishing qi, promoting diuresis and eliminating dampness. 3. Phlegm-Dampness Accumulation Type. [Clinical Manifestations]Obesity in this type is often accompanied by a bloated body, soft and thick abdomen, weak and sagging muscles, lethargy, facial distension, chest tightness, excessive phlegm, fatigue, drowsiness, dizziness, reduced thirst, excessive phlegm in the throat, excessive vaginal discharge, irregular bowel movements, a large and pale tongue with a white and greasy or slippery coating, and a slippery pulse. [Treatment Principles]Dry dampness and resolve phlegm, regulate qi and eliminate fullness.

[Basic Prescription]Zhongwan (CV12), Shuifen (CV9), Daimai (GB25), Zusanli (ST36), Yinlingquan (SP9), Fenglong (ST40), Taibai (SP3), Taiyuan (LU9), Feishu (BL13), Pishu (BL20), Shenshu (BL23). [Additional Acupoints]For abdominal distension, add Jianli (CV11); for poor sleep, add Neiguan (PC6); for irregular menstruation, add Sanyinjiao (SP6); for shortness of breath and fatigue, add Qihai (CV6) and Guanyuan (CV4); for chest tightness and fullness, add Sanjiaoshu (BL22); for upper abdominal obesity, add Huaroumen (ST22) and Fuai (SP1); for lower abdominal obesity, add Fujie (GB1); for upper limb obesity, add Binuo (LI1) and Shouwuli (LI5); for lower limb obesity, add Futu (ST30) and Liangqiu (ST34). [Procedure]Based on the thickness of the patient's abdominal fat.

For abdominal acupuncture, use 30-gauge, 1.5-2 inch filiform needles; for acupoints on the limbs and back, use 1.5-inch filiform needles. Disinfect the selected acupoints with 75% alcohol or povidone-iodine as usual. For abdominal and limb acupoints, use the straight insertion method, followed by lifting, thrusting, and rotating manipulations using a balanced tonifying and reducing technique until the patient experiences a sensation of soreness, numbness, and obtaining the qi. Depending on the patient's specific condition, select 2-3 acupoints for 1-2 moxibustion cones (warm needling). Connect the remaining abdominal and limb acupoints to an electroacupuncture device using a sparse-dense wave at a frequency of 10-15 Hz, with the intensity adjusted to the patient's maximum tolerance. Retain the needles for 30 minutes before removing them.

Treatment is administered once daily for 5 consecutive days, followed by treatment every other day. A course of treatment consists of 10 treatments. [Explanation of the Formula] The "He-Sea" points Yinlingquan and Zusanli of the Spleen and Stomach Meridians regulate the Qi of the Spleen and Stomach, improving their digestive and absorptive functions, thus distributing fluids and eliminating phlegm and dampness. The "Mu-Point" Zhongwan of the Stomach and the "Luo-Connecting" point Fenglong of the Yangming Meridian are used in combination to regulate the Qi of the Spleen and Stomach in the middle Jiao, eliminating phlegm and turbidity. The "Yuan-Source" points Taibai and Taiyuan of the Spleen and Lung Meridians are also used to regulate the Spleen and benefit Lung Qi, dispelling dampness and resolving phlegm. Shuifen is a key point for promoting diuresis, and the back-shu points Feishu, Pishu, and Shenshu are used to regulate the three organs simultaneously.

When used together, these acupoints work synergistically to dispel dampness and resolve phlegm.