Obesity

WESTERN MEDICINE: Obesity is the physiologic state in which excessive fat is stored at various body sites. The incidence and etiology is due to the increasing availability of food and decreasing demand for physical activity. Ordinary obesity is common, especially in middle age. Extreme obesity with localized accumulation of body fat is less common and suggests an unusual etiology. Recently acquired obesity of middle age with predominantly central distribution is associated with greater disturbance of serum lipid and carbohydrate metabolism than is lifelong, more symmetrically distributed obesity of moderate degree. The capacity of the body to store protein and carbohydrate is limited; thus, excess food in any form is converted into and stored as fat. The immediate cause of obesity is an excess of caloric intake over caloric output, though recent evidence suggests that there may be variations in the pathways by which individual metabolize excess metabolic fuels. A variety of mechanisms may lead to such an imbalance or to a new equilibrium in which lipid storage remain excessive. There are four main ones:
hypothalamic and other CNS factors; metabolic factors; endocrine factors; behavioral factors.

SYMPTOMS AND SIGNS: Most obese individuals are asymptomatic except for primary or secondary emotional problems. In advanced cases, dyspnea, diabetes and arthritic symptoms are prominent. When insulin secretion becomes relatively reduced, diabetes may develop, as well as vascular disease. 

ETIOLOGY AND PATHOLOGY: Chinese medicine considers that obesity is caused by the following etiological factors: 

1. Excessive food intake or drinks
2. The retention of damp - phlegm due to the first reason, or spleen deficiency
3. Liver stagnation due to the prolonged strong emotions or depression which cause the disharmony between spleen and liver, thereby creating fluid retention
4. Spleen deficiency which can be the primary cause for damp fluid retention, or be the secondary result due to overweight or food damage
5. Kidney deficiency which loses its function of storing essence and promoting the water or fluids metabolism.

DIFFERENTIATIONS: 

1. Obesity due to the Excessive Food Intake:

Indications: Excessive food intake, or drinks, belching, gas, full sensation at chest or gastric region, overweight, heavy feeling of body or head, normal tongue, white thick or thin coating, slippery pulse.

Treatment & Formulas: Help the food digestion and eliminate the damp factor. 

Products:

• Ping Wei San (Magnolia and Ginger Formula, Item No. 2079): It dispels the dampness and regulates the circulation of stomach Qi.
• Jia Wei Ping Wei San (Magnolia and Ginger Formula Plus, Item No. 2067): It has a similar function as above, except it has two more herbs to help digestion. 

2. Obesity due to the Retention of Damp Heat:

Indications: Overweight, general heaviness, fatigue, laziness, fullness at chest or gastric region, or edema at local areas, dizziness, nausea sometimes. constipation, normal tongue, white or thin yellow coating, slippery or deep slippery pulse. 

Treatment & Formulas: Clear the interior damp heat and remove excessive fluid retention. 

Products:

• Fang Feng Tong Sheng San (Siler and Platycodon Formula, Item No. 2103, B3052) This formula has been very popularly used for obesity of strong body type by its laxative, diuretic and regulating functions. 
• Jia Wei Fang Feng Tong Sheng San (Siler & Platycodon formula Plus, Item No. D3015 B3015): This formula is an improved formula for people have weak or normal constitutions by adding some tonic herbs in the original formula.This formula is best recommended for weight loss in general case.
• Yin Chen Wu Lin San (Capillaris and Hoelen Five Formula, Item No. 2143): It clears the interior heat and eliminates the dampness through the lower burner. 
• Wu Ling San (Hoelen Five Herb Formula, Item No. 2043): It dispels the dampness or water retention by its diuretic and tonic function to spleen and kidney. 
• Ling Gui Zhu Gan Tang (Hoelen and Atractylodes Combination, Item No. 2130): It helps to dispel the dampness, or fluid retention by promoting the functions of spleen and stomach. 

3. Obesity due to the Liver Stagnation:

Indication: This type of obesity mostly shows at middle age. Obesity usually appears after some strong and prolonged emotions, emotions change quickly, depression, or easily angered, restlessness, insomnia, headache, full and extended sensation at chest or hypochondria region, or lower abdomen, irregular menstruation and pain during menstrual period in female, loose or hard stool in exchange, poor or excessive appetite, bitter taste in mouth, red or normal tongue, thin and yellow coating, wiry pulse.

Treatment & Formulas: Regulate the liver and harmonize its relationship with spleen and stomach. 

Products:

• Xiao Yao San (Tang - kuei and Bupleurum Formula, Item No. 2195): This is a typical formula for regulating the liver and harmonizing the spleen and stomach. 
• Jia Wei Xiao Yao San (Bupleurum and Paeonia Formula, Item No. 2068): It is used for liver stagnation plus the interior heat. 

4. Obesity due to the Qi Deficiency of Spleen and Lung:

Indications: Obesity, fatigues easily, spontaneous sweating, palpitation, shortness of breath, lower fever, loose stool, all symptoms worse after working or any activities, pale complexion, pale and swollen tongue, white coating, weak thready pulse. 

Treatment & Formulas: Tonify the Qi and promote the function of spleen and stomach. 

Products:

• Fang Ji Huang Qi Tang (Stephania and Astragalus Combination, Item No. 2102): This formula is very popularly used for obesity due to the spleen Qi deficiency causing fluid retention. It is also often used for edema, nephritis, eczema due to the spleen deficiency and fluid retention. 
• Liu Jun Zi Tang (Major Six Herb Combination, Item No. 2050): This is also a popular formula for obesity due to the spleen and stomach deficiency. 
• The following formulas may all be considered:
• Shen Ling Bai Zhu San (Ginseng and Atractylodes Formula, Item No. 2173)
• Chi Pi Wan (Ginseng and Hawthorn Formula, Item No. 2193)
• Gui Pi Tang (Ginseng and Longan Combination, Item No. 2261)
• Li Zhong Tang (Ginseng and Ginger Combination, Item No. 2129) 

5. Obesity due to the Kidney Deficiency:

Indications: Obesity, sore and weak sensation at lumbar regions, lower energy, frequent drowsiness, frequent and profuse urination, impotence, premature ejaculation in male, or infertility, irregular menstruation in female. Pale and enlarged tongue, or with teeth mark on the sides of tongue, thin coating, deep and weak pulse. 

Treatment & Formulas: Tonify the kidney and promote water or fluid metabolism. 

Products:

• Jia Wei Chang Chun (Ginseng & Codonopsis Combination, Item No. D3041 ): This is a typical kidney tonic. It can be used for obesity due to the kidney deficiency or combined with other formulas, such as the liver regulating formula Xiao Yao San or Jia Wei Xiao Yao San if patients have emotional problems, or combined with the Fang Feng Tong Shen San (see previous types) if patients are constipated. 
• Huan Sao Dan (Lycium Formula, Item No. 2264): It is also a tonic for kidney, spleen and heart, especially kidney. It owns the name as rejuvenation formula. 
• Chi Sheng Shen Chi Wan (Achyranthes and Plantago Formula, Item No. 2263): This is a kidney tonic with the function of diuresis. It is very good for obesity, edema, or chronic nephritis due to kidney deficiency. 
• The following formulas may be considered for use as kidney tonics: 
• Ba Wei Di Huang Wan (Rehmannia Eight Formula, Item No. 2011)
• Zhi Po Pa Wei Wan (Anemannen, Phellodendron and Rehmannia Formula, Item No. 2123)
• Ji Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia Six Formula, Item No. 2290)