肥胖讲课ppt课件.ppt

肥胖的诊断方法Thediagnosticmethodofobesity 最常用的指标是体质指数 BMI ThecommonindexisBMI BMI 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Ratioofwaist coxagirth thisratiowhichisbiggerthan0 72canbediagnosedasObesity lumbargirthreferstothegirthencirclingthelowerof12thrib Thesciaticgirthreferstothelongestgirthofbuttocks 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Obesitycanbeclassifiedassimpleobesityandsecondaryobesityaccordingtoetiologyandpathogenesis Thesimpleobesityincludesconstitutionaltypeandobtainingtype 体质性肥胖是自童年起发病Theconstitutionalobesitycomesonfromchildhood 获得性肥胖包括产后肥胖 更年期肥胖 性腺功能减退 等Theobtainingobesityincludespostpartumfatnessandmenopausefatness 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Thesecondaryobesityreferstofatnessaccompanyingwithhypothalamusdisease pituitarydisease pancreasdisease hypothyroiddisease hypogonadismdisease 取得良好疗效的就诊者情况是thesituationofpatientswhotookgoodeffectisthefactthat 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 Theconstitutionalobesityaccountsfor10 2 andtheobtainingobesityaccountsfor35 2 ofsimpleobesitypatients postpartumfatnessaccountsfor5 7 继发性肥胖者中的更年期肥胖患者占10 3 Themenopausefatnessaccountsfor10 3 ofsecondaryobesitypatients 超重者占33 5 正常体重追求瘦身者 占10 Theoverweight patientsaccountfor33 5 thenaturalweightpatientswhowanttoloseweightaccountfor10 其它占5 3 theothersaccountfor5 3 减肥机理 神经功能调整themechanismoflosingweight regulatingthefunctionofnerve 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controlhypothalamus centrum restrainsthenicappetiteanddigestionofstomachandintestine reducequantityoffood 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restrainhyperfunctionofdigestionandabsorbencyofstomachandintestine reduceabsorptionoforganismtoenergy soreducetheingestionofenergy 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promoteenergymetabolism increaseenergyconsumption promotemobilizationanddecompositionoffat 减肥机理 内分泌功能调整themechanismoflosingweight regulatingthefunctionofincretion 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Thesimpleobesityhasturbulenceofincretionmostlyandabnormityofeveryincretionespeciallyforinsulin sexhormone 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Losingweighthasalongterm Westartswiththreefactorsasregulatingappetite regulatingmechanismoffatmobilization establishingandconsolidatingnewmetabolismbalancewhentreating 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Formulatingaschemewhichproceedsinanorderlyway theeffectaccumulatesgraduallyisreliableguaranteethatachievethegoal 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 Theeffectoflosingweightwithacupunctureisaaccumulativecourse Thechangeofweightcanbeclassifiedasthreestagesaroundthetreatment 快速减重期 l 4周 迅速减少原体重的5 thestageoflosingweightquickly 1 4week losing5 offormerweightquickly 平台调整期 4 12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thestageofflatregulation 4 12week Thechangeofweightisnotbig butdistributionofbodyfatcanhavethechangeandthefatcanreduce 稳定缓慢减重期 12周以后 缓慢减少原体重的5 thestageoflosingweightsteadilyandtardily after12week losing5 offormerweighttardily 初期治疗earliertreatment 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Theacupuncturehadmobilizedusingmechanismofbodyenergy maketheenergynotaccumulate thebodymobilizesaccumulatedfattomakeweightlosequicklyformaintainingformermetabolismbalance 平台期治疗thetreatmentofflatstage 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1 3的刺激量 从而进入稳定缓慢减重期Theorganismreformsthehighermetabolismbalance mobilizesaccumulatingfatfarther regulatetheacupuncturetreatmenttherapycorrespondinglyandincrease1 3stimulation sogoesthestageoflosingweightsteadilyandtardily 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Atthestageofflat thekeyisregulatingappetite Itcanaddearacupuncturetothepatientswhoseappetitecan tbecontrolled Oncetheappetiteisdropping thechangeofweightcangointothethirdstage 稳定期steadystage 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 Thebodyformulatesthehighermetabolismbalanceandmobilizesaccumulatingfatfarther sogoesthestageoflosingweightsteadilyandtardilyandreceivescontinuingeffectfinally 辨证分型differentiation 胃肠实热solidheatofstomachandintestine脾虚湿阻dampobstructionanddeficiencyofspleen肝郁气滞stagnationofliverqi冲任失调disorderofchongren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significanceofdifferentiation themechanismofnervecentreplaythedeterminativeroleinlosingweightwithacupuncture Acupuncturingthepartswhichhaveaccumulatingfatcan thaveeffectthatshouldbegained 辨证取穴acupointselection 经脉meridian躯干穴pointoftrunk四肢穴pointoflimb胃经天枢 归来 水道梁丘 足三里 丰隆 Stomachmeridian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Spleenmeridian肝经期门太冲 曲泉livermeridian任脉中脘 关元 气海 Renmeridian中极 水分督脉肺俞 脾俞 胃俞 Dumeridian膏盲俞大肠经曲池Largemeridian心包经内关Pericardiummeridian胆经带脉 日月 Gallbladdermeridian 行针方案theschemeofmanipulatingtheneedles 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manipulatingtheneedlesonceaftertheinsertionofneedlesandbeassuretoattainingtheneedlingsensationofeverypoint 以后每10分钟行针1次 manipulatingtheneedlesonceLevery10minuteslater 起针前再行针1次manipulatingtheneedlesoncebeforetakingneedles 一次治疗有4次行针 可以获得并维持有效的刺激量 Manipulatingtheneedles4timesinallcangaineffectivestimulationthatcanbemaintaining 电针方案Electro acupuncturescheme 腹部电针穴位 带脉 天枢 水道 归来Thepointofabdomenwithelectro acupuncture GB26 ST25 ST29 ST28疏密波 留针30分钟sparse densewave theneedlesareretainedfor30minutes 耳针earacupuncture 耳针是维持针刺治疗期间有效刺激量的最佳措施之一Earacupuncturetherapyisoneofbestmeasuresthatcanmaintaineffectivestimulationattheperiodoftreatment 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concretemethod stickandpress tohungerpoints sanjiaopoints Shenmen Spleen Endocrinepointsoftwosidesafteracupunctureeverytimeandtellthepatientstopresspoints50timeshalfhourbeforeeating 穴位埋线imbeddingthreadtopoints 专