课件：肥胖讲课.ppt

肥胖的诊断方法 The diagnostic method of obesity,最常用的指标是体质指数（ B MI） The common index is BMI. B MI=体重weight（ kg）身高2（ m2）height 腰髋周径比值：腰部周径是指在第12肋下缘水平，髋部周径是指臀部最大周径，此值大于 0 .72可诊为肥胖 Ratio of waist-coxa girth: this ratio which is bigger than 0.72 can be diagnosed as Obesity. lumbar girth refers to the girth encircling the lower of 12th rib. The sciatic girth refers to the longest girth of buttocks .,肥胖按发病机制和病因可以分为单纯性（占95）和继发性两类：单纯性肥胖包括体质性和获得性两类 Obesity can be classified as simple obesity and secondary obesity according to etiology and pathogenesis. The simple obesity includes constitutional type and obtaining type. 体质性肥胖是自童年起发病The constitutional obesity comes on from childhood. 获得性肥胖包括产后肥胖，更年期肥胖 （性腺功能减退）等 The obtaining obesity includes post partum fatness and menopause fatness (hypogonadism) etc. 继发性肥胖分为下丘脑病、垂体病、胰岛病、甲状腺功能减退症、肾上腺皮质功能亢进症、性腺功能减弱症等 The secondary obesity refers to fatness accompanying with hypothalamus disease, pituitary disease, pancreas disease, hypothyroid disease, -, hypogonadism disease.,取得良好疗效的就诊者情况是 the situation of patients who took good effect is the fact that: 单纯性肥胖者中的体质性肥胖占10.2,获得性肥胖者占 35 .2；产后肥胖患者占 5 .7 The constitutional obesity accounts for 10.2 and the obtaining obesity accounts for 35 .2 of simple obesity patients, post partum fatness accounts for 5 .7. 继发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 ，正常体重追求瘦身者，占 10 The overweight- patients account for 33. 5,the natural weight patients who want to lose weight account for 10. 其它占5. 3 the others account for 5. 3,减肥机理-神经功能调整 the mechanism of losing weight-regulating the function of nerve,控制下丘脑摄食中枢，抑制亢进的食欲和胃肠消化力，减少进食量 control hypothalamus -centrum, restrain sthenic appetite and digestion of stomach and intestine, reduce quantity of food. 抑制亢进的胃肠消化吸收机能，减少机体对能量的吸收，从而减少能量的摄入 restrain hyperfunction of digestion and absorbency of stomach and intestine, reduce absorption of organism to energy, so reduce the ingestion of energy. 促进能量代谢，增加能量消耗，促进体脂的动员及脂肪的分解 promote energy metabolism , increase energy consumption, promote mobilization and decomposition of fat.,减肥机理-内分泌功能调整 the mechanism of losing weight- regulating the function of incretion,单纯性肥胖多有内分泌紊乱，各种激素，尤其是胰岛素、性激素、肾上腺皮质激素、瘦素等异常 The simple obesity has turbulence of incretion mostly and abnormity of every incretion especially for insulin, sex hormone, adrenaline,-.,减肥有一个过程，治疗时从调节食欲、调节体脂动员机制、建立和巩固新建的代谢平衡点3个方面入手 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. 制定一个循序渐进、疗效逐渐积累的方案是实现这一目的的可靠保证 Formulating a scheme which proceeds in an orderly way,- the effect accumulates gradually is reliable guarantee that achieve the goal.,针刺减肥疗效是一个累积的过程，治疗前后体重变化可分为三期: The effect of losing weight with acupuncture is a accumulative course. The change of weight can be classified as three stages around the treatment. 快速减重期（l4周）：迅速减少原体重的5 the stage of losing weight quickly(1-4week):losing 5 of former weight quickly 平台调整期（412周）：体重变化不大，但其体内的脂肪分布会有所变化，脂肪会减少 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. 稳定缓慢减重期（12周以后）：缓慢减少原体重的5 the stage of losing weight steadily and tardily (after 12 week): losing 5 of former weight tardily.,初期治疗 earlier treatment,针刺动员了机体的能量利用机制，使摄入的能量不再积聚，机体为了维持原有的代谢平衡，动员了积存的脂肪，使体重快速下降 The acupuncture had mobilized using mechanism of body energy, make the energy not accumulate. the body mobilizes accumulated fat to make weight lose quickly for maintaining former metabolism balance .,平台期治疗 the treatment of flat stage,患者机体重建形成较高的代谢平衡点，进一步动员机体积存的脂肪，可相应调整针刺治疗的方案，增加13的刺激量，从而进入稳定缓慢减重期 The organism reforms the higher metabolism balance, mobilizes accumulating fat farther, regulate the acupuncture treatment therapy correspondingly and increase 13 stimulation, so goes the stage of losing weight steadily and tardily. 在平台期，食欲调整是关键，对于食欲未能控制的患者可增加耳针，一旦食欲下降，体重变化即可能进入第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 appetite is dropping, the change of weight can go into the third stage.,稳定期 steady stage,机体形成较高的代谢平衡点，进一步动员积存的脂肪，从而进入稳定缓慢减重期，收到持久的治疗效果。 The body formulates the higher metabolism balance and mobilizes accumulating fat farther, so goes the stage of losing weight steadily and tardily and receives continuing effect finally.,辨证分型 differentiation,胃肠实热solid heat of stomach and intestine 脾虚湿阻damp obstruction and deficiency of spleen 肝郁气滞stagnation of liver qi 冲任失调disorder of chong ren 辨证分型意义：中枢机制在针刺减肥中起决定性作用，针刺脂肪堆积部位并不能起到应有的治疗作用 significance of differentiation :the mechanism of nerve centre play the determinative role in losing weight with acupuncture. Acupuncturing the parts which have accumulating fat cant have effect that should be gained.,辨证取穴 acupoint selection,经脉meridian 躯干穴 point of trunk 四肢穴point of limb 胃经 天枢、归来、水道 梁丘、足三里、丰隆、 Stomach meridian 石门、滑肉门、 上巨虚、下巨虚、内庭 脾经 腹结 、大横 阴陵泉、三阴交、血海 Spleen meridian 肝经 期门 太冲、曲泉 liver meridian 任脉 中脘、关元、气海、 Ren meridian 中极、水分 督脉 肺俞、脾俞、胃俞、 Du meridian 膏盲俞 大肠经 曲池 Large meridian 心包经 内关 Pericardium meridian 胆经 带脉、日月、 Gallbladder meridian,行针方案 the scheme of manipulating the needles,在进针完成后即进行1次行针，确定针刺后所在穴位均处于得气状态 manipulating the needles once after the insertion of needles and be assure to attaining the needling sensation of every point. 以后每10分钟行针1次， manipulating the needles once L every 10 minutes later, 起针前再行针1次manipulating the needles once before taking needles. 一次治疗有4次行针，可以获得并维持有效的刺激量。 Manipulating the needles 4 times in all can gain effective stimulation that can be maintaining.,电针方案 Electro-acupuncture scheme,腹部电针穴位 ：带脉、天枢、水道、归来 The point of abdomen with electro-acupuncture: GB26,ST25, ST29, ST28 疏密波，留针30分钟 sparse-dense wave, the needles are retained for 30 minutes.,耳针 ear acupuncture,耳针是维持针刺治疗期间有效刺激量的最佳措施之一 Ear acupuncture therapy is one of best measures that can maintain effective stimulation at the period of treatment. 具体方法：每次针刺完毕后，在双侧的饥点、三焦、内分泌、神门、脾等耳穴点贴压王不留行籽，嘱患者每次进餐前半小时自行按压各穴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.,穴位埋线 imbedding threa