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Ninety cases of simple obesity treated with the combined therapy of penetration needling, flash-fire cupping method and auricular acupuncture
Accepted Manuscript
Ninety cases of simple obesity treated with the combined therapy of penetration needling, flash-fire cupping method and auricular acupuncture Juan WANG , Yan LI , Xuan ZHANG , Mei-na WANG , Long CAO , Na NU , Yuan LI , Gui-lan LI PII: DOI: Reference:
S1003-5257(18)30150-8 https://doi.org/10.1016/j.wjam.2018.12.005 WJAM 63
To appear in:
World Journal of Acupuncture – Moxibustion
Please cite this article as: Juan WANG , Yan LI , Xuan ZHANG , Mei-na WANG , Long CAO , Na NU , Yuan LI , Gui-lan LI , Ninety cases of simple obesity treated with the combined therapy of penetration needling, flash-fire cupping method and auricular acupuncture, World Journal of Acupuncture – Moxibustion (2018), doi: https://doi.org/10.1016/j.wjam.2018.12.005
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Clinical Report Ninety cases of simple obesity treated with the combined therapy of penetration needling, ☆
flash-fire cupping method and auricular acupuncture
Juan WANG (王娟), Yan LI (李岩), Xuan ZHANG (张玄), Mei-na WANG (王美娜), Long CAO (曹龙), Na NU (努娜), Yuan LI (李媛), Gui-lan LI (李桂兰) *
China (天津中医药大学附属保康医院，天津 300193,中国) ARTICLE INFO
Supported by Program of Standardization of Traditional Chinese Medicine, the State
AN US
☆
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Baokang Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin 300193,
Administration of Traditional Chinese Medicine: SATCM-2015-BZ (275) *Corresponding author: E-mail:[email protected]（G-l .LI）
M
ABSTRACT
ED
Objective: To observe the clinical effects on simple obesity treated with the combined therapy of penetration needling, flash-fire cupping method and auricular acupuncture.
PT
Methods: In 90 patients of simple obesity, the Bo’s abdominal acupuncture therapy was adopted. Taking Shénquè (神阙 CV 8), the points 2 cun directly below CV 8 and 2 cun directly above CV 8
CE
as the landmarks, 3 cun bilateral to each of the above three points, and penetrated through to the conception vessel. Then the electroacupuncture apparatus was connected, with the
AC
disperse-dense wave for 30 min. After acupuncture, the glass cup of the middle size was used to stimulate the selected points with the flash-fire cupping method. The cupping stimulation stopped when the skin turned to be slightly red. One treatment was given each day and every other day after 5 days. The 10 treatments made one course. In the auricular acupuncture therapy, Jīdiăn (饥点), Shénmén (神门 TF4), Nèifēnmì (内分泌 CO18) and Sānjiāo (三焦 CO17) were selected. The auricular acupuncture therapy was given once every two days and 10 treatments made one course. After 3 courses of treatment, the waist circumference, hip circumference, body
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weight and body mass index (BMI) were observed. Results: Compared to before treatment, after 3 courses of treatment, the waist circumference of patients was (92.3 ± 2.4 vs 80.4 ± 2.3) cm, hip circumference (110.6 ± 2.3 vs 99.2 ± 2.5) cm, body weight (74.2 ± 3.1 vs 68.2 ± 2.4) kg and BMI (29.8 ± 3.1 vs 25.2 ± 2.1), they were all reduced obviously, indicating the significant differences (all P<0.05). Seventy-nine patients lost three to
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five kilograms, accounting for 87.8%. Conclusion: The combined therapy of penetration needling at abdomen, flash-fire cupping method and auricular acupuncture achieves the significant therapeutic effects on simple obesity. Keywords:
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Simple obesity Penetration needling Abdominal needle therapy
ED
Auricular acupuncture therapy
M
Cuppping
In recent years, with the rapid economic development in China, the economic condition, living
PT
condition as well as the material needs of people are increased year by year. Consequently, more and more patients suffer from simple obesity. Obesity is complicated commonly with
CE
osteoarthrosis, diabetes mellitus, hyperlipidemia, hypertension, etc. [1]. The morbidity of simple obesity is 28% in aged people, 18% to 32% in adult, 21% in juvenile and 4% to 9.5% in children. In
AC
clinic, there are many therapeutic regimens for simple obesity. The authors believed that the penetration needling at the points, flash-fire cupping method and auricular acupuncture therapy had the satisfactory therapeutic effects on obesity in clinic. This combined therapy had been adopted in the treatment of 90 cases of simple obesity and the clinical therapeutic effects were analyzed in terms of the changes of waist circumference, hip circumference, body weight and body mass index (BMI) before and after treatment. The report is as follows. Clinical data
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General data A total of 90 outpatients of simple obesity were collected in the Department of Acupuncture-Moxibustion, Baokang Hospital Affiliated to Tianjin University of Traditional Chinese Medicine. Of them, 34 cases were maleand 56 cases female, aged in the range from 16 to 58 years, with the average age of (36 ± 1.8) years. The duration of sickness was ranged from 0.5 to
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20 years, with the average duration of (4 ± 1.1) years. Inclusion criteria
① In compliance with the diagnosis criteria of simple obesity [1]. ② Signed the inform consent, agreeing to be participated in the trial and cooperating with the clinical data collection. ③ The
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eligible subjects aged 18 to 60 years. ④ Having not received any measures for reducing body weight within 3 months before participating in the trial. Exclusion criteria
① Suffering with psychopath. ②Females in lactation or in pregnancy. ③ Complicated with the
M
primary diseases, such as cerebrovascular disease, diabetes and hematopoietic dysfunction.
PT
Acupoint selection
ED
Methods
① Main points: according to the Bo’s abdominal acupuncture therapy [2], taking Shénquè (神阙
CE
CV 8), the points 2 cun directly below CV 8 and 2 cun directly above CV 8 as the landmarks, 3 cun bilateral to each of the above three points, and the needles were inserted transversely from the
AC
sites, penetrated through to the conception vessel. The points were selected bilaterally. ② The main points of the auricular acupuncture therapy: Jīdiăn (饥点), Shénmén (神门 TF4), Nèifēnmì (内分泌 CO18) and Sānjiāo (三焦 CO17). ③ Syndrome differentiation in traditional Chinese medicine (TCM): for the cold damp blocking the meridians and collaterals, manifested as heavy body, numbness or swelling, aversion to cold and cold limbs and white and sticky tongue coating, the treating principle was to disperse cold and activating blood circulation to remove the blockages in meridians and collaterals. Sānyīnjiāo (三阴交 SP 6), Xuèhăi (血海 SP 10), Guānyuán (关元 CV 4) and Qìhăi (气海 CV 6) were added. Gān (肝 CO12 ), Pí (脾 CO13), Shèn (肾 CO10 ) and
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Luăncháo (卵巢 TF2) were supplemented in the auricular acupuncture therapy. For the damp blockage in the middle jiao, manifested as overweight, heavy feeling on the head, lassitude, epigastric fullness, abdominal distention, sticky feeling in the mouth and thirst, preference for hot drinks, scanty and deep red urine, thick and white or stick tongue coating), the treating principle was to resolve damp and promote qi circulation. Zhōngwăn (中脘 CV 12), Yīnlíngquán (阴陵泉 SP 9), Fēnglóng (丰隆 ST 40) and Zúsānlĭ (足三里 ST 36) were added. CO13 and Wèi (胃 CO4 ) were
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supplemented in the auricular acupuncture therapy. For the intestinal dryness, manifested as constipation, dry stool, difficulty in bowel movement, pale tongue with thin and white coating, the treating principle was to moisten the intestine to promote bowel movement. Zhīgōu (支沟 TE 6), Tiānshū (天枢 ST25) and Hégŭ (合谷 LI4) were added. Dàcháng (大肠 CO7), Xiăocháng (小肠
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CO6) and Fèi (肺 CO14) were supplemented in the auricular acupuncture. For the spleen and kidney yang deficiency, manifested as chills, pale complexion, soreness and weakness of the lumbar region and knee joint, cold and painful feeling in the abdomen, difficult urination and edema, pale and swollen tongue or with teeth marks and white tongue coating, the treating
added. The CO13, CO10
M
principle was to warm the spleen and tonify the kidney. CV 4, Tàixī (太溪 KI 3) and ST 36 were and Pízhìxià (皮质下 AT4) were supplemented in the auricular
ED
acupuncture therapy. Manipulations
PT
At all of the body points, the acupuncture needles, No. 30, 0.3 mm × 75 mm, Huatou brand
CE
was used after the routine skin sterilization. At the main points, the needles were inserted and penetrated toward the conception vessel and the reducing technique was given by twisting the
AC
needle. Afterward, the electroacupuncture apparatus was connected, with the disperse-dense wave, at 100 Hz in frequency. The electric intensity was adjusted by the subjects’ tolerance. At the supplementary body points, the needles were inserted perpendicularly and the intensity was determined by the subjects’ feelings as soreness and distention. The needles were retained for 30 min. After acupuncture, the glass cup of the middle size was used to stimulate the selected points with the flash-fire cupping method. The cupping stimulation stopped when the skin turned to be slightly red. One treatment was given each day and once another day after 5days. The 10 treatments made once course.
ACCEPTED MANUSCRIPT
In the auricular acupuncture, the auricular points are localized in reference to the national standard, Nomenclature and location of auricular points (GB/T 13734 - 2008). Firstly, the auricular point detector was adopted to probe the sensitive sites of the selected auricular points. Secondly, the points were sterilized with iodine. The filiform needle for single use, 0.20 mm × 25 mm was adopted. Fixing the ear with one hand, the acupuncture physician held the needle with the thumb and the index figure with another hand to insert the needle perpendicularly at the
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sensitive site of the auricular point. The needling depth was 1 to 3 mm and controlled without penetrating the skin on the opposite side. The auricular acupuncture therapy was given once every two days and 10 treatments made one course. The therapeutic effects were observed after 3 courses of treatment.
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Observation of therapeutic effects Observation indexes
The self-control design was adopted. The values of the waist circumference, hip circumference,
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body weight and the body mass index (BMI) in the subjects were compared before and after treatment.
ED
Measuring method of the waist circumference and hip circumference: the subject was in supine, with the lumbar and hip regions exposed, the legs closed and the hands placed on the bilateral
PT
sides of the thighs. The subject was advised to keep relaxing. The waist circumference was measured at the horizontal midway between the lower border of the 12th rib and the inferior
CE
border of the iliac crest, and the hip circumference was measured at the horizontal level 2 cun below the umbilicus. The waist circumference and the hip circumference were measured twice,
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the measurement unit was centimeter (cm), and the error was less than 1 cm. Evaluation criteria of therapeutic effects Remarkably effective: the body weight was reduced by over 5 kg after treatment, the waist circumference and the hip circumference were reduced by over 5 cm and the symptoms disappeared. Effective: the body weight was reduced by over 3 kg after treatment, the waist circumference and the hip circumference were reduced by over 3 cm and the symptoms were alleviated. No effect: the body weight was reduced by less than 2 kg after treatment, the waist
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circumference and the hip circumference were reduced by less than 2 cm and the symptoms had not been relieved. Statistical methods SPSS 21.0 software was adopted in the statistical analysis. The measurement data were expressed with the mean ± standard deviation (x ± s). The pared sample t test was adopted in the
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comparison of the data before and after treatment and P<0.05 indicated the significant difference. Therapeutic results
After 3 courses of treatment, all of 90 subjects were included in the statistical analysis. Of the
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subjects, 47 cases were remarkable effective, accounting for 52.2%, 32 cases effective, accounting for 35.5% and 11 cases no effect, accounting for 12.2%. The total effective rate was 87.7%. The results of the waist circumference, hip circumference, body weight and BMI after treatment were all reduced obviously as compared with the data before treatment, indicating the significant
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differences (all P<0.05). See Table 1.
Table 1 The comparisons of the waist circumference, hip circumference, body weight and BMI of
Waist circumference
Hip circumference
Body weight
（cm）
(kg)
74.2 ± 3.1
a
68.2 ± 2.4
(cm)
Before treatment
90
92.3 ± 2.4
110.6 ± 2.3
90
80.4 ± 2.3
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PT
Patients
AC
Time
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the simple obesity patients before and after treatment (x ± s)
After treatment
a
99.2 ± 2.5
BMI
29.8±3.1
a
25.2±2.1
a
Note: a Compared with that before treatment, P<0.05 Typical case A male patient, Mr. Wang, 38 years old, the first visit in August 2017, 175 cm in height, weight increased obviously in recent 5 years from 73 kg to 90 kg, exceeded to the normal body weight by
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22.5 kg. The body weight was gained because of overeating greasy and sweet food. He had dry mouth, no desire to drink, lassitude, abdominal distention, slight red tongue with white and sticky coating, rolling pulse. BMI was 29.39, the hip circumference 116 cm and the waist circumference 102 cm. The diagnosis was mild obesity. Based on the symptoms, the case was differentiated as obesity due to dampness blocking the middle jiao. The treating principle was to resolve damp and phlegm, regulate qi circulation and remove masses. Taking Shénquè (神阙 CV
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8), the points 2 cun directly below CV 8 and 2 cun directly above CV 8 as the landmarks, 3 cun bilateral to each of the above three points, the needles were inserted transversely from the sites and penetrated through to the conception vessel. The points were selected bilaterally. The electric stimulation was attached, with the disperse-dense wave and the intensity based on the
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patient’s tolerance. The supplementary points were CV 12, SP 9, ST 40 and ST 36. The needles were retained for 30 min. After acupuncture, the selected points were stimulated with the flash-fire cupping method. The cupping stimulation stopped when the skin turned to be slightly red. In the auricular acupuncture therapy, Jīdiăn, TF4, CO4 and CO13 were selected. The
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treatment was given once every two days and 10 treatments made one course. After 3 courses of treatment, the waist circumference, hip circumference, body weight and BMI were all decreased,
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in which, BMI was 26.1, the hip circumference 110 cm, the waist circumference 92 cm and the body weight 80 kg, reduced by 10 kg. After the follow-up visit for half a year and the dietary
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Discussion
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regulation, BMI was getting normal (18.5 to 23.9).
Simple obesity is induced by the excessive fat accumulation in the body caused by various factors
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and the chief pathological property is the root deficiency and branch excess. The pathogenesis includes the spleen dysfunction in transportation and transformation, excessive phlegm and damp and qi and blood stagnation. The water metabolic disorder can be induced by lung dysfunction in dispersing and descending, the spleen dysfunction in transportation and transformation, the failure of stomach qi in descending as well as the kidney dysfunction of qi activity. As a result, the water and food essence is distributed abnormally. Hence, obesity occurs and it is commonly combined with shortness of breath, dislike to speak, lassitude and dizziness. TCM believes that the back of body refers to yang and the abdomen to yin. In terms of the theory
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of meridian and collateral, the three yin meridians of foot, the conception vessel which is the sea of yin meridian, the stomach meridian of foot-yangming as well as the gallbladder meridian of foot-shaoyang all run through the abdomen. The belt vessel communicates with the bladder meridian of foot-taiyang and the governor vessel at the abdominal region. The yang Heel Vessel and the yin Heel Vessel are distributed in the abdomen. The front-mu points are those acupoints on the chest and abdomen where the qi of the respective zang or fu organ is infused and
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converged and reflect the corresponding zang and fu disorders. It is clear that the abdominal region is the place where qi, blood, yin and yang are converged and in the pathological condition, the pathologic phlegm and damp is apt to be accumulated in this region. Consequently, the abdominal obesity occurs. According to the main symptoms of obesity in patients, the
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acupuncture and cupping methods were adopted, acting on resolving damp and phlegm, strengthening the spleen, benefiting qi activity, promoting urination, tonifying the spleen and stomach, ascending the clear qi and the descending the turbid, as well as enhancing the body function on water metabolism. The modern medicine researches [3-5] showed that acupuncture
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regulated the network system of nerve-endocrine and immunity. Through the secreted cytokines and neurotransmitters, acupuncture enhanced the sympathetic nerve function, regulated
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neuroendocrine system, strengthens the two systems, i.e. sympathetic-adrenal medulla system and the hypothalamus–pituitary gland-adrenal gland system, reversed the abnormal metabolism,
PT
and improved the metabolic function. Rich nerves are distributed in the auricle, such as sympathetic nerve and vagus. The stimulation with auricular acupuncture therapy generated
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neural signals that were transmitted to the hypothalamus through nerves to block hunger information and resist against the excessive appetite. It worked on the insulin and inhibited
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appetite so as to reduce the over intake of food [6-8]. In summary, in this research, the combined treatment with body acupuncture, cupping method and auricular acupuncture achieves the satisfactory effects on simple obesity. After 2-week treatment, to different degrees, in all of the subjects, the appetite was reduced, the defecation promoted and the spirits improved. This therapeutic regimen is characterized as the precise point selection, strong needling sensation, rapid qi arrival and easy acceptance by the patients. Hence, this therapy is applicable to be promoted in clinical practice.
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Reference [1] Chenji S K. Cross-sectional analysis of obesity and high blood pressure among undergraduate students of a University Medical College in South India[J]. Family Medicine & Community Health, 2018,6(02):63-69. [2] Bo ZY. On Abdominal Acupuncture Therapy [J]. Chinese Acupuncture & Moxibustion,
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2001,21(08):27-29.
[3] Wang LH, Li J, Huang W, Wang L, Yang DY, Zhou ZY. Electroacupuncture reduces body fat by down-regulating IL-6 and vimentin in abdominal white adipose tissue of diet-induced obesity rats. Acupuncture Research,2018:1-5[2018-06-29].https://doi.org/10.13702/j.1000-0607.170359.
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[4] Li CY, Yu SY, Guo BJ, Li WY, Yang J, Hu YP. Analysis on randomized controlled trials for acupuncture treatment of simple obesity collected from PubMed. Acupuncture Research, 2018, 43(04):269-273.
[5] Si YC, Miao WN, He JY, Ding WJ. Effects of electroacupuncture on free fatty acids,
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apolipoprotein A1 and apolipoprotein B in lipid metabolism of obese mice [J]. Lishizhen Medicine
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and Materia Medica Research, 2018, 29(03):739-741. [6] Luo XG. Effect of ear acupuncture and Chinese materia medica on serum leptin, NPY and
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leptin-receptors in arcuate nucleus of the hypothalamus in female castrated obese rats [A]. The Article Abstract Collection of the 20th Anniversary of Foundation of World Federation of
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Acupuncture-Moxibustion Societies (WFAS) and International Acupuncture Congress [C]. World Federation of Acupuncture-Moxibustion Societies, World Health Organization, China Academy of
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Chinese Medical Sciences, Beijing Administration of Traditional Chinese Medicine, 2007:2. [7] Xu HW. The clinical study of auricular acupuncture for type 2 diabetic patients with overweight or obesity [D]. Nanjing University of Traditional Chinese Medicine, 2017. [8] Jiin Kim, Kien V. Trinh, Jaroslaw Krawczyk, Enoch Ho. Acupuncture for obesity: a systematic review [J]. Journal of Acupuncture and Tuina Science.2016,14(04):257-273.
Ninety cases of simple obesity treated with the combined therapy of penetration needling, flash-fire cupping method and auricular acupuncture Juan WANG , Yan LI , Xuan ZHANG , Mei-na WANG , Long CAO , Na NU , Yuan LI , Gui-lan LI PII: DOI: Reference:
S1003-5257(18)30150-8 https://doi.org/10.1016/j.wjam.2018.12.005 WJAM 63
To appear in:
World Journal of Acupuncture – Moxibustion
Please cite this article as: Juan WANG , Yan LI , Xuan ZHANG , Mei-na WANG , Long CAO , Na NU , Yuan LI , Gui-lan LI , Ninety cases of simple obesity treated with the combined therapy of penetration needling, flash-fire cupping method and auricular acupuncture, World Journal of Acupuncture – Moxibustion (2018), doi: https://doi.org/10.1016/j.wjam.2018.12.005
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Clinical Report Ninety cases of simple obesity treated with the combined therapy of penetration needling, ☆
flash-fire cupping method and auricular acupuncture
Juan WANG (王娟), Yan LI (李岩), Xuan ZHANG (张玄), Mei-na WANG (王美娜), Long CAO (曹龙), Na NU (努娜), Yuan LI (李媛), Gui-lan LI (李桂兰) *
China (天津中医药大学附属保康医院，天津 300193,中国) ARTICLE INFO
Supported by Program of Standardization of Traditional Chinese Medicine, the State
AN US
☆
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Baokang Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin 300193,
Administration of Traditional Chinese Medicine: SATCM-2015-BZ (275) *Corresponding author: E-mail:[email protected]（G-l .LI）
M
ABSTRACT
ED
Objective: To observe the clinical effects on simple obesity treated with the combined therapy of penetration needling, flash-fire cupping method and auricular acupuncture.
PT
Methods: In 90 patients of simple obesity, the Bo’s abdominal acupuncture therapy was adopted. Taking Shénquè (神阙 CV 8), the points 2 cun directly below CV 8 and 2 cun directly above CV 8
CE
as the landmarks, 3 cun bilateral to each of the above three points, and penetrated through to the conception vessel. Then the electroacupuncture apparatus was connected, with the
AC
disperse-dense wave for 30 min. After acupuncture, the glass cup of the middle size was used to stimulate the selected points with the flash-fire cupping method. The cupping stimulation stopped when the skin turned to be slightly red. One treatment was given each day and every other day after 5 days. The 10 treatments made one course. In the auricular acupuncture therapy, Jīdiăn (饥点), Shénmén (神门 TF4), Nèifēnmì (内分泌 CO18) and Sānjiāo (三焦 CO17) were selected. The auricular acupuncture therapy was given once every two days and 10 treatments made one course. After 3 courses of treatment, the waist circumference, hip circumference, body
ACCEPTED MANUSCRIPT
weight and body mass index (BMI) were observed. Results: Compared to before treatment, after 3 courses of treatment, the waist circumference of patients was (92.3 ± 2.4 vs 80.4 ± 2.3) cm, hip circumference (110.6 ± 2.3 vs 99.2 ± 2.5) cm, body weight (74.2 ± 3.1 vs 68.2 ± 2.4) kg and BMI (29.8 ± 3.1 vs 25.2 ± 2.1), they were all reduced obviously, indicating the significant differences (all P<0.05). Seventy-nine patients lost three to
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five kilograms, accounting for 87.8%. Conclusion: The combined therapy of penetration needling at abdomen, flash-fire cupping method and auricular acupuncture achieves the significant therapeutic effects on simple obesity. Keywords:
AN US
Simple obesity Penetration needling Abdominal needle therapy
ED
Auricular acupuncture therapy
M
Cuppping
In recent years, with the rapid economic development in China, the economic condition, living
PT
condition as well as the material needs of people are increased year by year. Consequently, more and more patients suffer from simple obesity. Obesity is complicated commonly with
CE
osteoarthrosis, diabetes mellitus, hyperlipidemia, hypertension, etc. [1]. The morbidity of simple obesity is 28% in aged people, 18% to 32% in adult, 21% in juvenile and 4% to 9.5% in children. In
AC
clinic, there are many therapeutic regimens for simple obesity. The authors believed that the penetration needling at the points, flash-fire cupping method and auricular acupuncture therapy had the satisfactory therapeutic effects on obesity in clinic. This combined therapy had been adopted in the treatment of 90 cases of simple obesity and the clinical therapeutic effects were analyzed in terms of the changes of waist circumference, hip circumference, body weight and body mass index (BMI) before and after treatment. The report is as follows. Clinical data
ACCEPTED MANUSCRIPT
General data A total of 90 outpatients of simple obesity were collected in the Department of Acupuncture-Moxibustion, Baokang Hospital Affiliated to Tianjin University of Traditional Chinese Medicine. Of them, 34 cases were maleand 56 cases female, aged in the range from 16 to 58 years, with the average age of (36 ± 1.8) years. The duration of sickness was ranged from 0.5 to
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20 years, with the average duration of (4 ± 1.1) years. Inclusion criteria
① In compliance with the diagnosis criteria of simple obesity [1]. ② Signed the inform consent, agreeing to be participated in the trial and cooperating with the clinical data collection. ③ The
AN US
eligible subjects aged 18 to 60 years. ④ Having not received any measures for reducing body weight within 3 months before participating in the trial. Exclusion criteria
① Suffering with psychopath. ②Females in lactation or in pregnancy. ③ Complicated with the
M
primary diseases, such as cerebrovascular disease, diabetes and hematopoietic dysfunction.
PT
Acupoint selection
ED
Methods
① Main points: according to the Bo’s abdominal acupuncture therapy [2], taking Shénquè (神阙
CE
CV 8), the points 2 cun directly below CV 8 and 2 cun directly above CV 8 as the landmarks, 3 cun bilateral to each of the above three points, and the needles were inserted transversely from the
AC
sites, penetrated through to the conception vessel. The points were selected bilaterally. ② The main points of the auricular acupuncture therapy: Jīdiăn (饥点), Shénmén (神门 TF4), Nèifēnmì (内分泌 CO18) and Sānjiāo (三焦 CO17). ③ Syndrome differentiation in traditional Chinese medicine (TCM): for the cold damp blocking the meridians and collaterals, manifested as heavy body, numbness or swelling, aversion to cold and cold limbs and white and sticky tongue coating, the treating principle was to disperse cold and activating blood circulation to remove the blockages in meridians and collaterals. Sānyīnjiāo (三阴交 SP 6), Xuèhăi (血海 SP 10), Guānyuán (关元 CV 4) and Qìhăi (气海 CV 6) were added. Gān (肝 CO12 ), Pí (脾 CO13), Shèn (肾 CO10 ) and
ACCEPTED MANUSCRIPT
Luăncháo (卵巢 TF2) were supplemented in the auricular acupuncture therapy. For the damp blockage in the middle jiao, manifested as overweight, heavy feeling on the head, lassitude, epigastric fullness, abdominal distention, sticky feeling in the mouth and thirst, preference for hot drinks, scanty and deep red urine, thick and white or stick tongue coating), the treating principle was to resolve damp and promote qi circulation. Zhōngwăn (中脘 CV 12), Yīnlíngquán (阴陵泉 SP 9), Fēnglóng (丰隆 ST 40) and Zúsānlĭ (足三里 ST 36) were added. CO13 and Wèi (胃 CO4 ) were
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supplemented in the auricular acupuncture therapy. For the intestinal dryness, manifested as constipation, dry stool, difficulty in bowel movement, pale tongue with thin and white coating, the treating principle was to moisten the intestine to promote bowel movement. Zhīgōu (支沟 TE 6), Tiānshū (天枢 ST25) and Hégŭ (合谷 LI4) were added. Dàcháng (大肠 CO7), Xiăocháng (小肠
AN US
CO6) and Fèi (肺 CO14) were supplemented in the auricular acupuncture. For the spleen and kidney yang deficiency, manifested as chills, pale complexion, soreness and weakness of the lumbar region and knee joint, cold and painful feeling in the abdomen, difficult urination and edema, pale and swollen tongue or with teeth marks and white tongue coating, the treating
added. The CO13, CO10
M
principle was to warm the spleen and tonify the kidney. CV 4, Tàixī (太溪 KI 3) and ST 36 were and Pízhìxià (皮质下 AT4) were supplemented in the auricular
ED
acupuncture therapy. Manipulations
PT
At all of the body points, the acupuncture needles, No. 30, 0.3 mm × 75 mm, Huatou brand
CE
was used after the routine skin sterilization. At the main points, the needles were inserted and penetrated toward the conception vessel and the reducing technique was given by twisting the
AC
needle. Afterward, the electroacupuncture apparatus was connected, with the disperse-dense wave, at 100 Hz in frequency. The electric intensity was adjusted by the subjects’ tolerance. At the supplementary body points, the needles were inserted perpendicularly and the intensity was determined by the subjects’ feelings as soreness and distention. The needles were retained for 30 min. After acupuncture, the glass cup of the middle size was used to stimulate the selected points with the flash-fire cupping method. The cupping stimulation stopped when the skin turned to be slightly red. One treatment was given each day and once another day after 5days. The 10 treatments made once course.
ACCEPTED MANUSCRIPT
In the auricular acupuncture, the auricular points are localized in reference to the national standard, Nomenclature and location of auricular points (GB/T 13734 - 2008). Firstly, the auricular point detector was adopted to probe the sensitive sites of the selected auricular points. Secondly, the points were sterilized with iodine. The filiform needle for single use, 0.20 mm × 25 mm was adopted. Fixing the ear with one hand, the acupuncture physician held the needle with the thumb and the index figure with another hand to insert the needle perpendicularly at the
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sensitive site of the auricular point. The needling depth was 1 to 3 mm and controlled without penetrating the skin on the opposite side. The auricular acupuncture therapy was given once every two days and 10 treatments made one course. The therapeutic effects were observed after 3 courses of treatment.
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Observation of therapeutic effects Observation indexes
The self-control design was adopted. The values of the waist circumference, hip circumference,
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body weight and the body mass index (BMI) in the subjects were compared before and after treatment.
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Measuring method of the waist circumference and hip circumference: the subject was in supine, with the lumbar and hip regions exposed, the legs closed and the hands placed on the bilateral
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sides of the thighs. The subject was advised to keep relaxing. The waist circumference was measured at the horizontal midway between the lower border of the 12th rib and the inferior
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border of the iliac crest, and the hip circumference was measured at the horizontal level 2 cun below the umbilicus. The waist circumference and the hip circumference were measured twice,
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the measurement unit was centimeter (cm), and the error was less than 1 cm. Evaluation criteria of therapeutic effects Remarkably effective: the body weight was reduced by over 5 kg after treatment, the waist circumference and the hip circumference were reduced by over 5 cm and the symptoms disappeared. Effective: the body weight was reduced by over 3 kg after treatment, the waist circumference and the hip circumference were reduced by over 3 cm and the symptoms were alleviated. No effect: the body weight was reduced by less than 2 kg after treatment, the waist
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circumference and the hip circumference were reduced by less than 2 cm and the symptoms had not been relieved. Statistical methods SPSS 21.0 software was adopted in the statistical analysis. The measurement data were expressed with the mean ± standard deviation (x ± s). The pared sample t test was adopted in the
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comparison of the data before and after treatment and P<0.05 indicated the significant difference. Therapeutic results
After 3 courses of treatment, all of 90 subjects were included in the statistical analysis. Of the
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subjects, 47 cases were remarkable effective, accounting for 52.2%, 32 cases effective, accounting for 35.5% and 11 cases no effect, accounting for 12.2%. The total effective rate was 87.7%. The results of the waist circumference, hip circumference, body weight and BMI after treatment were all reduced obviously as compared with the data before treatment, indicating the significant
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differences (all P<0.05). See Table 1.
Table 1 The comparisons of the waist circumference, hip circumference, body weight and BMI of
Waist circumference
Hip circumference
Body weight
（cm）
(kg)
74.2 ± 3.1
a
68.2 ± 2.4
(cm)
Before treatment
90
92.3 ± 2.4
110.6 ± 2.3
90
80.4 ± 2.3
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Patients
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Time
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the simple obesity patients before and after treatment (x ± s)
After treatment
a
99.2 ± 2.5
BMI
29.8±3.1
a
25.2±2.1
a
Note: a Compared with that before treatment, P<0.05 Typical case A male patient, Mr. Wang, 38 years old, the first visit in August 2017, 175 cm in height, weight increased obviously in recent 5 years from 73 kg to 90 kg, exceeded to the normal body weight by
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22.5 kg. The body weight was gained because of overeating greasy and sweet food. He had dry mouth, no desire to drink, lassitude, abdominal distention, slight red tongue with white and sticky coating, rolling pulse. BMI was 29.39, the hip circumference 116 cm and the waist circumference 102 cm. The diagnosis was mild obesity. Based on the symptoms, the case was differentiated as obesity due to dampness blocking the middle jiao. The treating principle was to resolve damp and phlegm, regulate qi circulation and remove masses. Taking Shénquè (神阙 CV
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8), the points 2 cun directly below CV 8 and 2 cun directly above CV 8 as the landmarks, 3 cun bilateral to each of the above three points, the needles were inserted transversely from the sites and penetrated through to the conception vessel. The points were selected bilaterally. The electric stimulation was attached, with the disperse-dense wave and the intensity based on the
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patient’s tolerance. The supplementary points were CV 12, SP 9, ST 40 and ST 36. The needles were retained for 30 min. After acupuncture, the selected points were stimulated with the flash-fire cupping method. The cupping stimulation stopped when the skin turned to be slightly red. In the auricular acupuncture therapy, Jīdiăn, TF4, CO4 and CO13 were selected. The
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treatment was given once every two days and 10 treatments made one course. After 3 courses of treatment, the waist circumference, hip circumference, body weight and BMI were all decreased,
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in which, BMI was 26.1, the hip circumference 110 cm, the waist circumference 92 cm and the body weight 80 kg, reduced by 10 kg. After the follow-up visit for half a year and the dietary
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Discussion
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regulation, BMI was getting normal (18.5 to 23.9).
Simple obesity is induced by the excessive fat accumulation in the body caused by various factors
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and the chief pathological property is the root deficiency and branch excess. The pathogenesis includes the spleen dysfunction in transportation and transformation, excessive phlegm and damp and qi and blood stagnation. The water metabolic disorder can be induced by lung dysfunction in dispersing and descending, the spleen dysfunction in transportation and transformation, the failure of stomach qi in descending as well as the kidney dysfunction of qi activity. As a result, the water and food essence is distributed abnormally. Hence, obesity occurs and it is commonly combined with shortness of breath, dislike to speak, lassitude and dizziness. TCM believes that the back of body refers to yang and the abdomen to yin. In terms of the theory
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of meridian and collateral, the three yin meridians of foot, the conception vessel which is the sea of yin meridian, the stomach meridian of foot-yangming as well as the gallbladder meridian of foot-shaoyang all run through the abdomen. The belt vessel communicates with the bladder meridian of foot-taiyang and the governor vessel at the abdominal region. The yang Heel Vessel and the yin Heel Vessel are distributed in the abdomen. The front-mu points are those acupoints on the chest and abdomen where the qi of the respective zang or fu organ is infused and
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converged and reflect the corresponding zang and fu disorders. It is clear that the abdominal region is the place where qi, blood, yin and yang are converged and in the pathological condition, the pathologic phlegm and damp is apt to be accumulated in this region. Consequently, the abdominal obesity occurs. According to the main symptoms of obesity in patients, the
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acupuncture and cupping methods were adopted, acting on resolving damp and phlegm, strengthening the spleen, benefiting qi activity, promoting urination, tonifying the spleen and stomach, ascending the clear qi and the descending the turbid, as well as enhancing the body function on water metabolism. The modern medicine researches [3-5] showed that acupuncture
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regulated the network system of nerve-endocrine and immunity. Through the secreted cytokines and neurotransmitters, acupuncture enhanced the sympathetic nerve function, regulated
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neuroendocrine system, strengthens the two systems, i.e. sympathetic-adrenal medulla system and the hypothalamus–pituitary gland-adrenal gland system, reversed the abnormal metabolism,
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and improved the metabolic function. Rich nerves are distributed in the auricle, such as sympathetic nerve and vagus. The stimulation with auricular acupuncture therapy generated
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neural signals that were transmitted to the hypothalamus through nerves to block hunger information and resist against the excessive appetite. It worked on the insulin and inhibited
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appetite so as to reduce the over intake of food [6-8]. In summary, in this research, the combined treatment with body acupuncture, cupping method and auricular acupuncture achieves the satisfactory effects on simple obesity. After 2-week treatment, to different degrees, in all of the subjects, the appetite was reduced, the defecation promoted and the spirits improved. This therapeutic regimen is characterized as the precise point selection, strong needling sensation, rapid qi arrival and easy acceptance by the patients. Hence, this therapy is applicable to be promoted in clinical practice.
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