Advances in Research of Simple Obesity and Its Manipulative Therapy in Recent Ten Years

Xiaochao GANG, Zhenxiang XIAO, Mingjun LIU, Jie LIU, Liang ZHANG, Jiashu ZHOU, Rong SHAO, Haixia TANG, Lijun ZHANG

Changchun University of Chinese Medicine, Changchun 130117, China

Abstract The simple obesity is a common clinical disease and its incidence is increasing year by year. With the increasing pace of work, increasing pressure, and changing eating habits, the incidence of simple obesity tends to be younger. Among the treatment protocols for this disease, TCM manipulative (Tuina) therapy has remarkable curative effect and few adverse reactions, and has been well recognized. Modern research has also proposed a variety of treatment protocols with different characteristics and good curative effects. This paper reviews the related literature on simple obesity and its manipulative therapy in the past ten years, and summarizes its disease name, etiology and pathogenesis, manipulation and related therapies, so as to provide new ideas and new angles for the treatment of the simple obesity.

Key words Simple obesity, Manipulative (Tuina) therapy, Review

1 Introduction

Simple obesity is the obesity with the intake of calories greater than the consumption, and the excess calories converted into a large amount of fat accumulation, making the weight exceed the normal standard. It belongs to non-pathological obesity and excludes other diseases. In recent years, simple obesity has become a common and frequently-occurring disease in China, and it is urgent to find a safe and effective treatment method. Through reviewing the literature, it is found that TCM manipulative therapy has a significant effect on simple obesity and has few side effects. Thus, we reviewed the advances in the research of simple obesity.

2 Advances in research of simple obesity

2.1 Origin of the disease nameAs recorded inLingshu:DisharmonyofDefensiveQiintheYellowEmperor’sClassicofInternalMedicine, the Yellow Emperor asked: what standard is used to measure a person’s fatness? Qibo replied: people differ in how fat, creamy, and fleshy. The Yellow Emperor asked: How are these three types different? Qibo said: the bulging muscles are firm and the skin plump and moist is the fat person. The bulging muscles are not solid, and the skin laxity is creamier, and the skin and the flesh are tightly adhered to each other. InPlainQuestions:TreatiseonStrangeDiseases, often eating luscious and fatty food will produce internal heat, and eating too much sweet will make the abdomen full. Although there is no independent disease name for obesity in ancient Chinese medicine literature, it only refers to fat people, greasy people, and plump people.

2.2 Etiology and pathogenesisAncient research on the etiology and pathogenesis of obesity was mainly started from five aspects: congenital endowment, living area, spleen and stomach disharmony, lack of labor and emotional disorder. (i) In terms of the congenital endowment, excessive endowment often leads to obesity[2]. As recorded inEffectivePrescriptionsforOneHundredIllnesses[3], the obesity is caused from deficiency of original qi. These demonstrate that congenital endowment is an important factor for obesity, which is also in line with the genetic theory of modern medicine. (ii) In terms of the living area,PlainQuestions:TreatiseonDifferentTreatmentMethodsstated that “the western region is full of mountains and wilderness, rich in gold and jade, and sand and stones everywhere. People living there have to eat delicious cheese and meat, so they often get fat”, and stated that the obesity may be related to living area, environment, and habits. (iii) In terms of the spleen and stomach disharmony,PlainQuestions:TreatiseonDeficiencyandExcessrecorded that the obesity is resulted from long-term intake of sweet and greasy food. According to records ofTreatiseonSpleenandStomach[4], in case of deficiency of spleen and stomach, eating less but getting fat, it will get obese but not being able to raise limbs. These indicate that spleen and stomach are disharmonic, body fluid produces phlegm pathogens and phlegm stays in orifices, and overflows the skin, then manifested as the obesity. (iii) In terms of the lack of labor,TreatiseonInquiringthePropertiesofThings:DifficultDelivery[5]stated that obese people are often deficient in qi, long time sitting will lead to poor flow of qi and blood, accordingly leading to weak qi. It also stated that lack of labor and long time sitting would harm the spleen, the spleen loses movement, and grease and dampness would accumulate, dampness overflows outside and grease is accumulated inside, leading to the obese symptoms. According toSynopsisofPrescriptionsoftheGoldenChamber:BloodImpedimentConsumptiveDisease[6], obese people often have weak bones but prosperous skin. Prosperous skin and weak bones are both antagonistic and unified. They are both caused by poor circulation of qi and blood, and are closely related to the lack of labor of those living a life of ease and comfort. (iv) In terms of the emotional disorder,PlainQuestions:TreatiseonAppearancestated that deficiency of the liver, kidney, and spleen can increase the body weight and lead to upset. If the patient is emotionally disturbed for a long time, the liver’s purging function will be out of balance, the kidney’s qi and water-dampening function will be incapable, and the spleen’s transport and transformation function will be insufficient, resulting in a disease of qi stagnation throughout the body, accordingly resulting in obesity.

In theGuidingPrinciplesofClinicalResearchonNewTraditionalChineseMedicinesintheTreatmentofObesityissued by the Ministry of Health of the People’s Republic of China[7], simple obesity is defined as five types: spleen-kidney yang deficiency type, spleen deficiency dampness type, and yin deficiency type with internal heat, liver qi stagnation type, stomach heat dampness stagnation type, indicating that the basic pathogenesis of obesity changes is qi block, spleen dampness, internal stagnation of phlegm dampness, yin deficiency and fire, stomach heat, and yang deficiency, which provides a theoretical basis for clinical syndrome differentiation and treatment. Tong Xiaolinetal.[8]divided simple obesity into two types: deficiency syndrome and excess syndrome. Among the excess patients, young men with strong body are the main incidence group, and the syndrome of internal obstruction due to phlegm turbidity is common. Deficiency patients are mainly middle-aged and elderly women with weak constitutions, and the etiology and pathogenesis are mainly water and dampness accumulation and blood stasis. Through clinical observation, Tan Limingetal.[9]divided simple obesity patients into three syndrome types: spleen deficiency and dampness obstruction type (the pathogenesis is spleen dysfunction, dampness stagnation in the middle energizer); disharmony of thoroughfare vessel and conception vessel (thoroughfare vessel is sea of blood, and conception vessel is sea of yin, disharmony of thoroughfare vessel and conception vessel would manifest syndrome of yin deficiency and internal heat, and blood deficiency and qi consumption); dampness-heat retained in stomach (the pathogenesis is excess heat in stomach, dampness heat is retained in the abdomen).

3 Advances in research of manipulative therapy in treating the simple obesity

3.1 Manipulative therapyChen Shaotaoetal.[10]used the characteristic manipulations of the Changbai Mountain Tongjing Tiaozang Manipulation School, which is a characteristic academic school of Jilin Province, to treat simple obesity model rabbits. The specific operations included five steps: massaging abdomen, moving abdomen, pushing abdomen, point-pressing abdomen, manipulating abdomen, and vibrating abdomen. By comprehensively using a variety of manipulative techniques, the operation direction was clockwise or from top to bottom. The operator used the palm surface, thumb pulp, and thenar muscle. The operation site was selected from the abdomen area with the animal’s umbilicus as the midpoint. The selection of meridians and collaterals and acupoints was mainly based on the abdominal meridians and acupoints in the height range between Shangwan acupoint and Zhongwan aupoint. The treatment cycle was 6 weeks, the frequency was once a day, 6 days a week. The animals in the control group were given sibutramine hydrochloride tablets by intragastric administration, and the frequency and cycle were the same as before. Liu Mingjunetal.[11]used acupressure to treat simple obesity model rats. The operation method was acupressure, the selected acupoints were Guanyuan, Tianshu, Zhongwan, and Zusanli, and the treatment cycle was one treatment per day for 6 consecutive weeks. Their results indicated that the body weight and other related indicators of the rats in the manipulation group changed significantly, and the expression of pro-inflammatory factors was reduced, and there was no significant difference compared with the Orlistat drug control group. Lu Wenhuietal.[12]used manipulation techniques such as thenar muscle rubbing method, palm massage method, abdomen trembling method and point-pressing method,etc.They selected acupoints including Tianshu, Zhongji, and Zhongwan in abdomen. The frequency of treatment was 6 treatments weekly and once a day. They found that the operation frequency of abdominal manipulation with rate of 120 times/min had the most significant effect. Li Pengetal.[13]used abdomen manipulation combined with liver meridians Shu and Mu (alarm acupoint and transport acupoint) massage. The manipulation method adopted thumb massage method, two palm pressing method, pushing manipulation, and massage method, which were separately acting on Zhongwan, Xiawan, Guanyuan, Tianshu, Shenque, Ganshu, Qimen, and upper and lower abdomen. The operation cycle was 6 weeks, and the frequency of operation was once a day, 5 days a week. Their results indicated that patients in the group of abdomen manipulation combined with liver meridians Shu and Mu acupoint massage had the most obvious benign changes in the BMI index and waist circumference compared with other treatment groups after treatment. Zhuo Yueetal.[5]used the method of transporting spleen to remove turbid: massage Pishu, Banmen, Sanyinjiao, and Yangchi acupoints, moving the internal Eight Diagrams and massage the abdomen in clockwise direction, and massage Zhongwan in counterclockwise direction, and pinch spine; the manipulation method adopted the meridians invigorating the spleen, and removing turbid through stomach, liver, and large intestine meridians. The operation lasted 15 consecutive days, with two days pause, and a total of treatment for 60 d, the frequency was once daily. For overweight and mildly obese subjects, the overall effective rates were 87.5% and 80%, respectively. Gao Qingshun[15]used pushing massage method, pressing massage, and pinching massage methods to treat the obesity, the operation sites selected Qihai, Shenque, and Tianshu acupoints in upper, middle abdomen, and lower abdomen, pituitary gland, endocrine glands, large intestine, stomach and other reflex areas of the feet, Zusanli, Sanyinjiao, and Neiting acupoints in lower legs and feet. The treatment cycle was 10 d for a course of treatment, and the frequency is once a day.

3.2 Manipulation combined with other treatment methods

Wang Wei[16]treated simple obesity with manipulation combined with acupuncture. The manipulation method adopted pushing method, rubbing method, and pressing method. Manipulation meridians selected large intestine, stomach, and spleen meridians. Manipulation sites selected acupoints in upper and lower abdomen and four limbs; acupuncture selected Fenglong, Zusanli, Tianshu,etc.The treatment cycle was 8 weeks. The results indicated that after treatment of manipulation combined with acupuncture, the patients in the treatment group had better body mass index (BMI) than the control group. Sun Jingyan[17]also used manipulation combined with acupuncture for treatment. The manipulation methods selected lifting massage and lifting twisting methods, and operation sites were both sides of the spine; acupuncture and moxibustion selected Zusanli, Tianshu, Sanyinjiao, Taibai, Taixi, Taichong, Pishu, Fenglong, and Ganshu acupoints. The treatment cycle of this combined method was 30 d, and the frequency was 3 times a week. The results showed that before and after treatment, the patient’s body weight, chest circumference, abdominal circumference and other indicators had different degrees of benign improvement. The number of markedly effective patients in the combined treatment group accounted for 66% of the total number of trials in the group, 30% effective and 4% ineffective, and the total effective rate was 48%. Zhang Xinlietal.[18]combined manipulation with acupuncture. The manipulation method adopted palm massage, point-pressing, massage and rubbing, and rubbing and pinching method. The operation sites abdominal acupoints around the umbilicus and part of the abdomen, bilateral rectus abdominis, waist and back. The treatment cycle was 33 d, and every 11 d was a course. The treatment frequency was within 11 d with 8 consecutive treatment days and then pausing 3 d. Acupuncture selected main acupoints such as Tianshu, Daheng, and Zhongwan, combined with Shu acupoints in bladder meridians in the waist, and waist, abdomen and sacral buttocks with much fat, and connected with electrical acupuncture for supporting treatment. The treatment results showed that the markedly effective rate was 57.14%, and the total effective rate was 91.42%. Yang Fang[19]treated the simple obesity by manipulation combined with acupuncture. Acupuncture combined with electro-acupuncture points were selected according to clinical syndromes: Tianshu, Ganshu, Pishu, Taibai, Taixi, Zusanli, Fenglong, Sanyinjiao, Taichong,etc.The frequency of treatment was 3 times a day for the first 3 d, and once every other day thereafter. The main method of manipulation adopted lifting and pinching, and the frequency of treatment was 3 times a week. The results showed that the total effective rate of the treatment was 95.83%. In the research of Liu Xiaetal.[20], the manipulation methods selected point-pressing, massage, rubbing, and lifting massage method. The operation site selected acupoints in abdomen including Liangmen, Zhongwan, Daheng and other acupoints. The meridians of the abdomen were selected from conception vessel, stomach meridian, and belt vessel. The acupuncture selected Tianshu, Liangmen, and Quchi acupoints. The treatment cycle was 21 consecutive days, once a day. Both body mass and BMI of subjects decreased after treatment. Chen Shunjin[21]treated the obesity by manipulation combined with electrical acupuncture. First, the acupuncture was combined with electrical acupuncture. Acupoints selected Sanyinjiao, Fenglong, Neiguan, Tianshu, and Zusanli,etc.This acupuncture treatment cycle was 30 d, and the frequency was 1 time on the first 3 d and 1 time on the subsequent 2 d. The manipulation method adopted lifting pinching method from bottom to top. The operation site was from both sides of the spine to the neck. The frequency of treatment was 3 times within 7 d, and the manipulation treatment cycle was 30 d. The results showed that the overall satisfaction and effective rate of patients after treatment were 93.33% and 96.67%, respectively. Xiao Zhe[22]treated the simple obesity by manipulation combined with acupuncture. The manipulation method adopted spinal pinching and alternately rubbing the abdomen in clockwise and counterclockwise directions. Acupuncture selected acupoints including Zusanli, Tianshu, Fenglong, Sanyinjiao, and Neiguan. The treatment cycle was 42 d, with 3 treatments every 7 d. The effective rate of treatment was 59.4%, and the body mass, BMI, and abdominal wall fat thickness of patients were significantly improved. Du Wei[23]used seeds ofVaccariasegetalisto bury auricular points combined with manipulation to treat the obesity. The main operation sites were secretions in the stomach, subcortical, lung, and cardia, all buried with seeds ofVaccariasegetalis. The manipulation method selected lifting pinching and massage. The operation site was the back spine area and the abdomen. The direction of the back treatment was to go up and down along the spine, and the abdomen treatment was centered on the umbilicus, alternately circling in clockwise and counterclockwise direction. The treatment cycle was 16 weeks, and the frequency was 3 d a week, once a day. The results showed that the symptoms of 10 patients did not change significantly, and the symptoms and body mass of the remaining 114 patients showed different degrees of benign improvement.

4 Conclusions

In summary, the TCM manipulative therapy has effects of clearing the meridians, diffusing qi and blood, and regulating functions of viscera and bowels in treating the simple obesity, has little side effects, and is easily accepted by patients. Different manipulation techniques such as point-pressing, pushing, pinching, massage, and rubbing,etc.are selected through dialectical differentiation to act on the corresponding operation site. In the local reflection area, the internal organs are connected through acupoints and meridians,etc., influencing the tissues and organs in the body, so as to regulate the upper, middle, and lower triple energizers, and viscera and bowels, the effect of treating the simple obesity is remarkable. In this study, we reviewed the related literature on simple obesity and its manipulative therapy in the past ten years, and summarized its disease name, etiology and pathogenesis, manipulation and related therapies, so as to provide new ideas and new angles for the treatment of the simple obesity.