肥胖讲课课件

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:①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％.②继发性肥胖者中的更年期肥胖患者占10.3％

Themenopausefatnessaccountsfor10.3％ofsecondaryobesitypatients.③超重者占33.5％，正常体重追求瘦身者，占10％

Theoverweight-patientsaccountfor33.5％,thenaturalweightpatientswhowanttoloseweightaccountfor10％.⑤其它占5.3％

theothersaccountfor5.3％减肥机理-神经功能调整

themechanismoflosingweight---regulatingthefunctionofnerve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.①快速减重期（l－4周）：迅速减少原体重的5％

thestageoflosingweightquickly(1-4week):losing5％offormerweightquickly②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.③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

辨证取穴

acupointselection

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.