Acupuncture on Spleen, Stomach, and Ren Mai Channel Points for the Treatment of Stomach & Intestinal Replete Heat Pattern Simple Obesity
abstracted & translated by
Bob Flaws, Dipl. Ac. & C.H, Lic. Ac., FNAAOM, FRCHM
Keywords: Chinese medicine, acupuncture, obesity
Obesity is a growing problem in developing countries around the world. Too many people are simply eating too much and exercising too little. As a result, the incidence of diabetes mellitus is doubling every 15 years, and, along with this, comes higher rates of various forms of heart and vascular disease, such as hypertension, arteriosclerosis, retinopathy, coronary artery disease, nephropathy, etc. In issue #1, 2003 of the Bei Jing Zhong Yi Za Zhi (Beijing Journal of Chinese Medicine), Zhang Lu published an article titled, “Acupuncture on Spleen and Stomach Channel and Ren Mai Channel Points in the Treatment of 40 Cases of Stomach & Intestinal Replete Heat Pattern Simple Obesity.” This article appeared on pages 41-42 of that journal and a summary of its main points is given below.
There were 33 females and seven males among the 40 patients described in this study. The youngest of these patients was 16 and the oldest was 47 years old, with an average age of 32.5 years. The shortest disease duration was two years and the longest was 18 years. All these patients were seen as out-patients at the Acupuncture Department of the Beijing Chinese Medicine Hospital. Diagnostic criteria was based on guidelines issued by the Chinese National People’s Ministry of Health & Hygiene in 1995 in Zhong Yao Xin Yao Zhi Liao Fei Pang Bing De Lin Chuang Zhi Dao Yuan Ze (Clinical References & Principles for the Treatment of Obesity with Chinese Medicinals & New Medications), second edition, pages 175-177. This included a body mass index of more than 20% over ideal with a percentage of fat of more than 30%. In terms of the pattern discrimination of replete heat in the stomach and intestines, the main presenting signs and symptoms included bodily obesity, excessive eating and easy hunger, oral thirst with a predilection to drinking, constipation, short, reddish urination, a red tongue with yellow fur, and a bowstring, rapid, slippery pulse.
The main points needled on all 40 patients consisted of: Tian Shu (St 25), Zu San Li (St 36), Nei Ting (St 44), Feng Long (St 40), Shang Ju Xu (St 37), Yin Ling Quan (sp 9), San Yin Jiao (Sp 6), Da Heng (Sp 15), Shang Wan (CV 13), Zhong Wan (CV 12), and Xia Wan (CV 10). If there was mainly lower abdominal obesity, Fu Jie (Sp 14) was added bilaterally. If there was mainly obesity of the thighs, Ji Men (Sp 11) was added bilaterally. Draining method was used on all points. This consisted of relatively rapid, large amplitude twisting and turning technique to produce a strong subjective needle sensation. In addition, most of the patients also received electro-acupuncture stimulation. Needles were retained for 30 minutes each treatment, and 10 days treatment equaled one course. Typically, treatment involved six such courses.
Clinical control meant that the body weight dropped to normal levels or was within normal parameters. Marked effect was defined as a drop in body weight of 5Kg or more and a reduction in percentage of fat of 5% or more. Some effect meant that body weight dropped 3Kg of more and percentage of fat and any associated clinical symptoms decreased. No effect meant that there was no reduction in either body weight or percentage of fat. Based on these criteria, after 1-4 courses of treatment, two cases (5%) were clinically controlled. These two cases had a percentage of fat reduction of up to 30%. Twenty-five cases (62.5%) were judged to have experienced a marked effect, with 13 cases seeing a 9-10% reduction in percentage of fat and 12 cases a 5-8% reduction in percentage of fat. Ten cases (25%) got some effect. These patients experienced a 2-5% reduction in percentage of fat. Three cases (7.5%) got no result. Therefore, the total effectiveness rate was calculated as 92.5%.
According to Dr. Zhang, many cases of simple obesity present a pattern of stomach-intestine replete heat. This is due to replete heat accumulating and stagnating in the intestinal tract. Therefore, treatment should mainly regulate and rectify the spleen and stomach. Such patients are habitually bodily yang exuberant and their digestive function is excessively strong. In this case, regulating and rectifying the spleen and stomach clears heat and downbears turbidity, frees the flow of the bowels and transforms fat. Zu San Li is the uniting point of the stomach, while Shang Ju Xu is the uniting point of the large intestine. Needling these two points at the same time drains heat from these two channels. Similarly, draining Nei Ting also drains stomach channel heat. Based on the saying, “Fat people [have] lots of phlegm [and] dampness,” Yin Ling Quan is used to drain dampness, while Feng Long in combination with Zhong Wan is used to transform phlegm. San Yin Jiao is chosen to regulate the three yin and thereby balance of the metabolism of the entire body. In addition, needling the three ducts (i.e., Shang Wan, Zhong Wan, and Xia Wan) regulates and slows the stomach’s peristalsis. Heavy hand technique and strong stimulation is used based on the saying, “All repletions [should be] drained.” This needling technique is also based on the saying from the chapter titled, “Normal & Counterflow, Fat & Thin,” from the Ling Shu (Spiritual Axis), “[For those whose] age [and bodily] substance are strong and large, [whose] qi and blood are full and exuberant, [whose] skin is drum-like, hard, and secure, [and whose disease] is due to the addition of evils, needling should be deep with retention, such as fat people.” At the same time as undergoing the above treatment, patients should be counseled to eat less high heat foods as well as less high fat foods. They should eat more greens, vegetables, and fruits. Likewise, they should lower their intake of salt and get more physical exercise. According to Dr. Zhang, when patients follow this regime, one can definitely improve the effectiveness rate of the above acupuncture protocol.
When the stomach is hot, it means its function is hyperactive. Because every person is different, some people constitutionally have hot stomachs. Stomach heat can also be created by eating foods that are greasy and fatty as well as foods which are acrid and hot in flavor and nature, such as many cooking spices. The stomach’s function is to rotten and ripen foods and liquids taken in and to downbear the turbid. The Chinese character for “ripen” is the same character for heat. Therefore, the function of the stomach is likened to the cooking of a pot, fermentation tun, or still. Because a hot stomach burns through foods and liquids more quickly than normal, the appetite is large. However, overeating leads to food stagnation which, in turn, increases the engenderment and transformation of depressive heat. Food stagnation jams the qi mechanism and impairs the spleen’s control over the movement and transformation of water fluids. Therefore, the clear and turbid are not completely and correctly separated and phlegm and dampness collect and accumulate. Since the spleen is averse to dampness, this internally engendered dampness damages the spleen. It is interesting that the average age of patients in this study was 32.5 years and that the majority of these patients were female. Females typically become spleen vacuous sometime in their mid 30s and are more prone to spleen vacuity than males due to the demands of menstruation, gestation, and lactation. Depressive heat damages fluids and engenders dryness, thus causing intestinal dryness and constipation. Patients with replete heat in the stomach and intestines also commonly have facial acne along the course of the hand and foot yang ming. Although Dr. Zhang focus his sole attention on the spleen, stomach, and large intestine, in real life, this scenario is commonly complicated by liver depression qi stagnation.
While most Western patients cannot afford 40-60 treatments over a three month period, this protocol can be combined with internally administered Chinese medicinals, in which case, this treatment might be reduced to three times per week instead of every day. In standard professional Chinese medicine, simple replete heat in the stomach and intestines is typically treated with Da Cheng Qi Tang (Major Order the Qi Decoction). If there is marked concomitant food stagnation, one can add Semen Raphani Sativi (Lai Fu Zi) and/or other appropriate food-dispersing, stagnation-abducting medicinals. If there is marked intestinal dryness, one can add Radix Scrophulariae Ningpoensis (Xuan Shen), Tuber Ophiopogonis Japonici (Mai Men Dong), and/or uncooked Radix Rehmanniae (Sheng Di). For transforming phlegm and eliminating dampness, one can add the main ingredients of Er Chen Tang (Two Aged [Ingredients] Decoction). If there is concomitant spleen vacuity, one may think about using Ban Xia Xie Xin Tang (Pinellia Drain the Heart Decoction) instead or some version of Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Er Chen Tang. Yet another famous Chinese medicinal formula to consider for those with a liver-spleen-stomach disharmony and stomach and intestinal replete heat is Fang Feng Tong Sheng San (Ledebouriella Communicate with Sages Powder) created by Liu Wan-su, father of the Cold and Cool School of Chinese medicine. Nevertheless, in my own clinical experience, one should definitely consider heat in the stomach and intestines as a potential disease mechanism of obesity, with or without liver depression and/or spleen vacuity.
Copyright © Blue Poppy Press, 2003. All rights reserved.
For more information on the Chinese medical treatment of obesity, see Philippe Sionneau & Lu Gang’s The Treatment of Disease in TCM, Vol. 7, available from Blue Poppy Press.