1、.,1,肥胖的診斷方法 The diagnostic method of obesity,最常用的指標是體質(zhì)指數(shù)（ B MI） The common index is BMI. B MI=體重weight（ kg）身高2（ m2）height 腰髖周徑比值：腰部周徑是指在第12肋下緣水平，髖部周徑是指臀部最大周徑，此值大于 0 .72可診為肥胖 Ratio of waist-coxa girth: this ratio which is bigger than 0.72 can be diagnosed as Obesity. lumbar girth refers to the girth

2、encircling the lower of 12th rib. The sciatic girth refers to the longest girth of buttocks .,2,.,肥胖按發(fā)病機制和病因可以分為單純性（占95）和繼發(fā)性兩類：單純性肥胖包括體質(zhì)性和獲得性兩類 Obesity can be classified as simple obesity and secondary obesity according to etiology and pathogenesis. The simple obesity includes constitutional type an

3、d obtaining type. 體質(zhì)性肥胖是自童年起發(fā)病The constitutional obesity comes on from childhood. 獲得性肥胖包括產(chǎn)后肥胖，更年期肥胖 （性腺功能減退）等 The obtaining obesity includes post partum fatness and menopause fatness (hypogonadism) etc. 繼發(fā)性肥胖分為下丘腦病、垂體病、胰島病、甲狀腺功能減退癥、腎上腺皮質(zhì)功能亢進癥、性腺功能減弱癥等 The secondary obesity refers to fatness accompan

4、ying with hypothalamus disease, pituitary disease, pancreas disease, hypothyroid disease, -, hypogonadism disease.,3,.,取得良好療效的就診者情況是 the situation of patients who took good effect is the fact that: 單純性肥胖者中的體質(zhì)性肥胖占10.2,獲得性肥胖者占 35 .2；產(chǎn)后肥胖患者占 5 .7 The constitutional obesity accounts for 10.2 and the obt

5、aining obesity accounts for 35 .2 of simple obesity patients, post partum fatness accounts for 5 .7. 繼發(fā)性肥胖者中的更年期肥胖患者占10.3 The menopause fatness accounts for 10.3 of secondary obesity patients. 超重者占 33. 5 ，正常體重追求瘦身者，占 10 The overweight- patients account for 33. 5,the natural weight patients who want

6、to lose weight account for 10. 其它占5. 3 the others account for 5. 3,4,.,減肥機理-神經(jīng)功能調(diào)整the mechanism of losing weight-regulating the function of nerve,控制下丘腦攝食中樞，抑制亢進的食欲和胃腸消化力，減少進食量 control hypothalamus -centrum, restrain sthenic appetite and digestion of stomach and intestine, reduce quantity of food. 抑制

7、亢進的胃腸消化吸收機能，減少機體對能量的吸收，從而減少能量的攝入 restrain hyperfunction of digestion and absorbency of stomach and intestine, reduce absorption of organism to energy, so reduce the ingestion of energy. 促進能量代謝，增加能量消耗，促進體脂的動員及脂肪的分解 promote energy metabolism , increase energy consumption, promote mobilization and deco

8、mposition of fat.,5,.,減肥機理-內(nèi)分泌功能調(diào)整 the mechanism of losing weight- regulating the function of incretion,單純性肥胖多有內(nèi)分泌紊亂，各種激素，尤其是胰島素、性激素、腎上腺皮質(zhì)激素、瘦素等異常 The simple obesity has turbulence of incretion mostly and abnormity of every incretion especially for insulin, sex hormone, adrenaline,-.,6,.,減肥有一個過程，治療時

9、從調(diào)節(jié)食欲、調(diào)節(jié)體脂動員機制、建立和鞏固新建的代謝平衡點3個方面入手 Losing weight has a long term. We starts with three factors as regulating appetite, regulating mechanism of fat mobilization, establishing and consolidating new metabolism balance when treating. 制定一個循序漸進、療效逐漸積累的方案是實現(xiàn)這一目的的可靠保證 Formulating a scheme which proceeds in

10、an orderly way,- the effect accumulates gradually is reliable guarantee that achieve the goal.,7,.,針刺減肥療效是一個累積的過程，治療前后體重變化可分為三期: The effect of losing weight with acupuncture is a accumulative course. The change of weight can be classified as three stages around the treatment. 快速減重期（l4周）：迅速減少原體重的5 th

11、e stage of losing weight quickly(1-4week):losing 5 of former weight quickly 平臺調(diào)整期（412周）：體重變化不大，但其體內(nèi)的脂肪分布會有所變化，脂肪會減少 the stage of flat regulation(4-12week): The change of weight is not big, but distribution of body fat can have the change and the fat can reduce. 穩(wěn)定緩慢減重期（12周以后）：緩慢減少原體重的5 the stage of

12、losing weight steadily and tardily (after 12 week): losing 5 of former weight tardily.,8,.,初期治療 earlier treatment,針刺動員了機體的能量利用機制，使攝入的能量不再積聚，機體為了維持原有的代謝平衡，動員了積存的脂肪，使體重快速下降 The acupuncture had mobilized using mechanism of body energy, make the energy not accumulate. the body mobilizes accumulated fat

13、to make weight lose quickly for maintaining former metabolism balance .,9,.,平臺期治療 the treatment of flat stage,患者機體重建形成較高的代謝平衡點，進一步動員機體積存的脂肪，可相應(yīng)調(diào)整針刺治療的方案，增加13的刺激量，從而進入穩(wěn)定緩慢減重期 The organism reforms the higher metabolism balance, mobilizes accumulating fat farther, regulate the acupuncture treatment the

14、rapy correspondingly and increase 13 stimulation, so goes the stage of losing weight steadily and tardily. 在平臺期，食欲調(diào)整是關(guān)鍵，對于食欲未能控制的患者可增加耳針，一旦食欲下降，體重變化即可能進入第3期 At the stage of flat, the key is regulating appetite. It can add ear acupuncture to the patients whose appetite cant be controlled. Once the ap

15、petite is dropping, the change of weight can go into the third stage.,10,.,穩(wěn)定期 steady stage,機體形成較高的代謝平衡點，進一步動員積存的脂肪，從而進入穩(wěn)定緩慢減重期，收到持久的治療效果。 The body formulates the higher metabolism balance and mobilizes accumulating fat farther, so goes the stage of losing weight steadily and tardily and receives co

16、ntinuing effect finally.,11,.,辨證分型 differentiation,胃腸實熱solid heat of stomach and intestine 脾虛濕阻damp obstruction and deficiency of spleen 肝郁氣滯stagnation of liver qi 沖任失調(diào)disorder of chong ren 辨證分型意義：中樞機制在針刺減肥中起決定性作用，針刺脂肪堆積部位并不能起到應(yīng)有的治療作用 significance of differentiation :the mechanism of nerve centre pl

17、ay the determinative role in losing weight with acupuncture. Acupuncturing the parts which have accumulating fat cant have effect that should be gained.,12,.,辨證取穴 acupoint selection,經(jīng)脈meridian 軀干穴 point of trunk 四肢穴point of limb 胃經(jīng) 天樞、歸來、水道 梁丘、足三里、豐隆、 Stomach meridian 石門、滑肉門、 上巨虛、下巨虛、內(nèi)庭 脾經(jīng) 腹結(jié) 、大橫 陰陵

18、泉、三陰交、血海 Spleen meridian 肝經(jīng) 期門 太沖、曲泉 liver meridian 任脈 中脘、關(guān)元、氣海、 Ren meridian 中極、水分 督脈 肺俞、脾俞、胃俞、 Du meridian 膏盲俞 大腸經(jīng) 曲池 Large meridian 心包經(jīng) 內(nèi)關(guān) Pericardium meridian 膽經(jīng) 帶脈、日月、 Gallbladder meridian,13,.,行針方案 the scheme of manipulating the needles,在進針完成后即進行1次行針，確定針刺后所在穴位均處于得氣狀態(tài) manipulating the needles o

19、nce after the insertion of needles and be assure to attaining the needling sensation of every point. 以后每10分鐘行針1次， manipulating the needles once L every 10 minutes later, 起針前再行針1次manipulating the needles once before taking needles. 一次治療有4次行針，可以獲得并維持有效的刺激量。 Manipulating the needles 4 times in all can

20、gain effective stimulation that can be maintaining.,14,.,電針方案Electro-acupuncture scheme,腹部電針穴位 ：帶脈、天樞、水道、歸來 The point of abdomen with electro-acupuncture: GB26,ST25, ST29, ST28 疏密波，留針30分鐘 sparse-dense wave, the needles are retained for 30 minutes.,15,.,耳針 ear acupuncture,耳針是維持針刺治療期間有效刺激量的最佳措施之一 Ear

21、acupuncture therapy is one of best measures that can maintain effective stimulation at the period of treatment. 具體方法：每次針刺完畢后，在雙側(cè)的饑點、三焦、內(nèi)分泌、神門、脾等耳穴點貼壓王不留行籽，囑患者每次進餐前半小時自行按壓各穴50次 concrete method: stick and press -to hunger points, sanjiao points, Shenmen, Spleen, Endocrine points of two sides after acupuncture every time and tell the patients to press points 50 times half hour before eating.,16,.,穴位埋線 imbedding thread to points,專用一次