TCM Acupuncture and Massage

Chapter 55 Endocrine and Metabolic Diseases (2)
([-]) Etiology and pathogenesis

1. Understanding of obesity in modern medicine

(1) Genetic factors: This is closely related to the body shape of individual family members, especially the body shape of parents and grandparents has a great influence on offspring and grandchildren.Generally, if both parents are obese, the incidence of obesity in their offspring is as high as 70% to 80%; for those with obese single parent, the incidence of obesity in their children is about 40% to 50%.This family aggregation may be related to both genetic and environmental factors, because parents' diet and living habits will have a direct impact on their children.

① Genetic factors affect body mass index, subcutaneous fat thickness and visceral fat, and the effect on visceral fat is particularly important.

②Genetics not only affect the degree of obesity, but also have a strong influence on the type of fat distribution.

③ Obesity after overfeeding, that is, the sensitivity to weight gain after overfeeding is genetically determined.

④ The amount of personal physical activity is also significantly affected by genetics. Parents who like sports in the family will also like sports when their children grow up.

⑤ neuroendocrine factors: endocrine disorders.

(2) Dietary factors: High-fat and high-calorie diets have a direct impact on the occurrence of obesity, which has been confirmed by animal and human studies.It can be said with certainty that obesity is related to eating too much.The energy intake and expenditure of normal adults maintain a balance for a long time, so that the body fat mass remains constant and the body weight remains unchanged.However, if you eat too much and the energy intake exceeds the body's consumption, the excess energy can be converted into fat and cause weight gain.

(3) Behavioral factors:
① Insufficient exercise.

②Life style.

③Educational level and socio-economic foundation.

2. The understanding of obesity in traditional Chinese medicine. The formation of obesity is related to congenital endowment, overeating fat and sweet, lack of labor and exercise, excessive emotions, spleen and stomach disorders (spleen and stomach deficiency or both spleen and stomach), phlegm, drinking water and dampness.In short, the causes of obesity can be summarized into the following aspects:
(1) Overeating fat, sweet and greasy.

(2) Lack of labor movement.

(3) Injury to emotions.

(4) Prolonged illness and deficiency.

(5) Aging and frailty.

([-]) Diagnosis

1. WHO's diagnostic criteria In 1997, WHO released the BMl grading criteria for adults. In 1999, he published "Redefining Obesity and Its Treatment in the Asia-Pacific Region" for the characteristics of Asians. According to the BMI, WHO classifies obesity and assesses the risk of concomitant diseases.

(1) Height discount algorithm
At present, the method commonly used in China is: standard weight (Kg) - [height (cm) - 100] × 0.9
Mild obesity ≥ 20-30% of standard body weight

Moderate obesity ≥ 30-50% of standard weight

Severe obesity ≥ 50% of standard weight

(2) Chest and abdomen index method
Chest and abdomen index = bust (2cm circumference above the nipple) - waist circumference (navel circumference)
Thoracic abdominal index ≤ 15cm is mildly obese

Thoracic abdominal index ≤ 10cm is moderately obese

Thoracic abdominal index ≤ 5cm is severe obesity

(3) Body mass index method (BMI): body mass index (BMI) - weight (kg) ÷ height (m)2
Mildly obese with a BMI between 25 and 30

Moderately obese with a BMI between 30 and 40

BMI ≥ 40 is severe obesity

([-]) Type

1. Simple obesity (obesity in a narrow sense) has no obvious etiology of endocrine and metabolic diseases, which is mainly related to family history, genetic factors and overnutrition.It accounts for about 95% of obese people.

(1) Constitutional obesity (juvenile-onset obesity): related to genetics.

(2) Acquired obesity (adult-onset obesity): related to overeating and less exercise.

2. Secondary obesity (pathological obesity) Obesity is caused by primary disease, accounting for 5% of obese people.There are mainly the following primary diseases:
(1) Hypothalamic disease.

(2) Pituitary disease.

(3) Insulin disease.

(4) Hypothyroidism.

(5) Adrenal hyperfunction.

(6) Hypogonadism.

(7) Obesity caused by other diseases.

3. Inherited obesity with onset from childhood, growth retardation, low muscle tone, unsteady gait, dysplasia of sexual organs, polydactyly syndrome, etc. The level of sex hormones or gonadotropins is significantly reduced in laboratory tests.

([-]) Nursing prevention

1. Reasonable diet Pay attention to light diet, eat less sweets and delicious food, and mostly vegetarian. Do not reduce the total volume and quantity of the diet to reduce the patient's hunger.Poultry, lean pork, rabbit meat, milk, eggs, etc. are also indispensable. Avoid eating before going to bed, avoid alcohol and coffee, and eat less sweet and cold drinks in summer; must cooperate with exercise to lose weight to increase energy consumption and facilitate fat metabolism.

2. Aerobic exercise Aerobic exercise is an effective way to lose weight, such as aerobics, dancing, rope skipping, jogging, traveling, climbing, and doing exercises.At least three times a week, insist on 50-60 minutes of moderate-intensity exercise each time, and 30 minutes of moderate-intensity exercise can consume 250-300 calories. 3. Adjust the life and life to be regular, avoid excessive sleep, and maintain a happy spirit.Behavior therapy can be divided into two phases: addiction withdrawal and weight loss.During the detoxification period, patients must quit the food they depend on; during the weight loss period, in addition to not touching abnormal foods, they must also cooperate with regular exercise and work and rest.

4. Outline of diet and exercise prescription for weight loss
(1) Only eat three meals.

(2) Chew slowly.

(3) Drink the soup first.

(4) Fasting sweets.

(5) Mild dieting.

(6) Sleep less and move more.

(7) Physical exercise.

(8) Prevent constipation.

(9) Persistence is the most important thing.

5.21st Century Health Proverbs The best doctor is yourself; the best medicine is time; the best mood is tranquility; the best exercise is walking.

[-]. Acupuncture and massage
([-]) Acupuncture therapy

1. Select acupoints Shangwan, Shuishui, Huaroumen, Tianshu, Daheng, Daimai, Wailing, Shuidao, Zusanli, Sanyinjiao.

2. Locate the upper cavity—on the front midline, 5 inches above the middle of the navel.

Moisture—on the front midline, 1 cun above the middle of the navel.

Huaroumen—1 cun above the middle of the navel, 2 cun from the anterior midline.

Tianshu—level with the navel, 2 inches from the middle of the navel.

Da Heng—level with the navel, 4 inches from the middle of the navel.

Belt vein - the intersection point directly below the free end of the 11th rib and the plane of the umbilical cord.

refer to).

Wai Ling - 1 cun below the middle of the navel, 2 cun from the anterior midline.

Waterway—3 cun below the middle of the navel, 2 cun from the anterior midline.

Zusanli - 3 cun below the nose of the calf, a transverse finger apart from the front edge of the tibia (Middle Sanyinjiao - 3 cun above the tip of the medial malleolus, the posterior edge of the medial surface of the tibia.

([-]) Self-massage

1. Massage the abdomen in a clockwise direction around Shenque acupoint, with local fever as the degree, for 5 to 10 minutes.

2. Acupuncture Focus on the abdominal acupoints. You can use two middle fingers to overlap to increase the amount of stimulation. It is required to have a strong feeling of soreness in the local area, and each acupoint is about 1 minute.

3. Lifting abdominal fat Use the thumb and the other four fingers to lift the abdominal fat relatively firmly. It is required that the abdomen feels hot. The operation lasts for 5-10 minutes.

4. Clasp the abdomen with both hands and five fingertips, operate for 5 minutes.

5. Hit the abdomen with empty palms and clap the abdomen with empty palms with both hands for 5 minutes.

Hyperlipidemia

An overview of the disease

([-]) Relevant knowledge

1. What is blood lipid

Blood lipid refers to the general term of lipid components contained in blood.The main blood lipid components in blood are cholesterol, triglycerides, phospholipids, free fatty acids, trace steroid hormones and fat-soluble vitamins (such as vitamin A, vitamin D and vitamin E).They are normal components of blood and have important physiological functions.

2. What are the blood lipids closely related to atherosclerosis

Mainly including cholesterol (TC) and triglycerides (TG).The synthesis of cholesterol comes from two aspects: synthesis in the body, which can be synthesized by other tissues except the brain tissue, which can synthesize 1 to 2 grams per day. The liver is the organ with the strongest synthesis ability, and the synthesis amount can account for 3% of the total synthesis amount in the body. More than 4/[-], followed by the small intestine.Food intake mainly comes from animal foods such as egg yolks, animal offal, butter, and meat. Plant foods do not contain cholesterol, and excessive consumption can limit its absorption.Cholesterol mostly exists in low-density lipoprotein and is brought into tissue cells for further metabolism.In addition to its main physiological function as a structural component of cells, it can also be transformed into a variety of important steroid compounds (hormones).In addition, a part of cholesterol in the liver can be converted into bile acids to help digestion.Therefore, cholesterol is an indispensable important substance for human life activities.Atherosclerosis can only be induced when it is too high or there is abnormal low-density lipoprotein.

Triglycerides are the main component of fat and are the energy storage substances in the body.Its source also includes two aspects: exogenous, ingested from food, digested and absorbed in the small intestine and assembled with apolipoprotein synthesized in the small intestine to form chylogranules (containing 90% TG), and enter the blood through lymphoid tissue.Endogenously, the liver is the organ with the strongest synthesis ability, followed by adipose tissue. The TG synthesized by the liver is assembled with apolipoprotein into very low-density lipoprotein (containing 60% TG), which is secreted into the blood.

3. What is Lipoprotein

Various lipid components are insoluble in water like the oils seen in daily life, and are also extremely difficult to dissolve in blood. They must combine with a special protein (apolipoprotein) to form a water-soluble compound called lipid protein.Lipoproteins can be divided into five types: chylomicrons (CM), very low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low-density lipoprotein (LDL) and high-density lipoprotein (HDL).In recent years, a lipoprotein was discovered, named lipoprotein (a) [Lp (a)].The density of these five types of lipoproteins increases sequentially, while the particle size decreases sequentially.The key is that these five types of lipoproteins contain different amounts of cholesterol and triglycerides.

(1) Chylomicron (CM): It is synthesized in the cells of the small intestinal mucosa, and its main function is to transport exogenous triglycerides.Chylomicron particles are large and difficult to enter the arterial wall. They are not a risk factor for atherosclerosis, but they can easily induce pancreatitis.When chylomicrons enter the blood, they are decomposed into glycerol and free fatty acids, which are used as energy by tissue cells or stored in adipose tissue.

(2) Very low-density lipoprotein (VLDL): It is mainly synthesized in the liver.On the one hand, the liver esterifies free fatty acids into triglycerides, and on the other hand, converts some sugars into triglycerides. Triglycerides form very low-density lipoprotein particles with other lipids and apolipoproteins.Therefore, very low-density lipoprotein is the main form of transporting endogenous triglycerides.Very low-density lipoprotein transports endogenous triglycerides to surrounding tissues and blood, and decomposes to form low-density lipoprotein, which has a mild atherosclerotic effect, so it is also called an atherosclerotic factor .

(3) Low-density lipoprotein (LDL): It is the decomposition product of very low-density lipoprotein, mainly containing cholesterol and cholesteryl ester. Its function is to transport cholesterol to the body tissues to synthesize cell membranes and adrenal cortex hormones, and participate in the operation of phospholipids and the regulation of peripheral Tissues synthesize cholesterol.Low-density lipoprotein density is relatively small, can quickly pass through the arterial wall, enter the subintimal layer of the blood vessel, and stimulate the proliferation of smooth muscle cells in the arterial wall. When the concentration of low-density lipoprotein in the plasma increases, it exceeds the clearance rate of the arterial wall. Too much LDL builds up on the arterial walls, causing atherosclerosis.Thus, LDL is the primary atherogenic lipoprotein of all plasma lipoproteins.

(4) High-density lipoprotein (HDL): mainly composed of phospholipids and apolipoprotein A, with only a small amount of cholesterol.It is mainly synthesized by the liver and small intestine, and can also come from the breakdown of chylomicrons and very low-density lipoproteins.Functions: ① remove cholesterol from body cells, transport it to the liver for decomposition; ② compete with low-density lipoprotein, reduce the uptake of low-density lipoprotein by surrounding cells; ③ promote the hydrolysis of triglyceride; ④ inhibit the synthesis of cholesterol; ⑤ inhibit smooth muscle Cell proliferation and protection of endothelial cells from damage.High-density lipoprotein is considered to be an anti-atherosclerotic plasma lipid because it can transport intracellular cholesterol to the liver for metabolism, can also remove cholesterol in the arterial wall, and can inhibit the uptake of low-density lipoprotein by the arterial wall Protein is a protective factor for coronary heart disease.

(5) Lipoprotein (a) [Lp(a)]: It is synthesized in the liver and secreted by liver cells in human blood circulation. Lipoprotein (a) in the blood can pass through the arterial endothelium and enter the subintima to accumulate, and a series of Reaction, the formation of fatty streak lesions in the early stage of atherosclerosis, and further promote the formation of local thrombus, thereby promoting the formation and progression of atherosclerosis.Studies have confirmed that elevated plasma lipoprotein (a) is an independent risk factor for atherosclerosis, and high levels of lipoprotein (a) are closely related to coronary heart disease and stroke.Lipoprotein (a) participates in the formation of thrombus and atherosclerosis, and acts as a "bridge".

4. What are the lipoproteins related to atherosclerosis
Lipoproteins closely related to atherosclerosis mainly include low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipoprotein (a), and are also related to very low-density lipoprotein (VLDL).

Anti-atherosclerotic effect - high-density lipoprotein; promote the formation of atherosclerosis - low-density lipoprotein, lipoprotein (a), very low-density lipoprotein.

5. What is apolipoprotein plasma lipid
The protein part of the protein is called apolipoprotein.Apolipoproteins are like ships in rivers, carrying lipoproteins along blood vessels and sending them to tissue cells.In addition to transporting lipids, it also has many important physiological functions.It not only plays a decisive role in the metabolism of blood lipoprotein, but also has a great influence on the occurrence and development of atherosclerosis.There are many types of apolipoproteins, the main apolipoproteins are A, B, C, D, E, F, etc., and they are divided into several subtypes.The highest content in the blood is apolipoprotein A and apolipoprotein B, which are blood lipid items often detected in clinical practice.

(1) Apolipoprotein A (apo-A): It is positively correlated with high-density lipoprotein, which accounts for 80% of the total protein content of high-density lipoprotein. Determination of apolipoprotein-A can reflect the level of high-density lipoprotein.When the content of apolipoprotein A decreases, the content of high-density lipoprotein in the blood also decreases, which can accelerate atherosclerosis and easily lead to the occurrence of coronary heart disease.

(2) Apolipoprotein B (apo-B): mainly distributed in low-density lipoprotein, followed by very low-density lipoprotein.Its level reflects the level of LDL.When the level of apolipoprotein B increases, the risk of atherosclerosis and coronary heart disease increases.It is the most atherosclerotic of the apolipoproteins.

6. What is hyperlipidemia?What is hyperlipoproteinemia?
Normal blood lipids maintain a dynamic balance within a certain range.Hyperlipidemia refers to the abnormal increase of one or more lipid components in plasma, which causes a series of clinical and pathological changes.It can also be simply understood as a single or multiple increase in the levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in serum.Hyperlipoproteinemia refers to elevated levels of one or several lipoproteins in the blood.The content of the two is the same, but the formulation is different.

([-]) Clinical manifestations

Hyperlipidemia is clinically manifested as dizziness, fatigue, insomnia, forgetfulness, numbness of limbs, chest tightness, palpitations, etc., which are easily confused with the clinical manifestations of other diseases.There are also many patients with high blood lipids who are asymptomatic, and are often found during physical examination.In addition, hyperlipidemia is often accompanied by overweight and obesity.

Long-term high blood lipids, atherosclerosis caused by lipid deposition in the vascular endothelium, can cause coronary heart disease and peripheral artery disease, etc., manifested as angina, myocardial infarction, stroke, and intermittent claudication (pain after limb activity).

Lipid deposition in the dermis during hyperlipidemia can cause xanthomas.It manifests as abnormal localized skin protuberances, which can be yellow, orange, or brown-red in color, mostly in the shape of nodules, plaques, or papules.Xanthomas are generally soft in texture, without tenderness, and mostly occur on eyelids, palms, tendons and joints.

Marked hypertriglyceridemia can cause acute pancreatitis.

(End of this chapter)