| Obj ective:1.To investigate and analyze the constitution characteristics of obese patients and explore the relationship between BMI,waist circumference,hip circumference,waist-to-hip ratio,waist-to-body ratio,acanthosis nigricans,related biochemical indicators and constitutional types in obese patients,which can help us to focus on prevention and screening of high-risk constitution people with abnormal biochemical indicators in obese patients,early change lifestyle and intervene with drugs,correct their unbalanced constitution,improve the clinical efficacy of TCM,prevent or delay the development of cardiovascular and cerebrovascular diseases,diabetes and other related complications,provide new ideas and treatments for Chinese medicine to prevent and treat obesity.2.To observe the curative effect of traditional Chinese medicine on the treatment of obesity by the director Li Mingdi in outpatient clinic,summarnze her treatment expernence,and explore effective treatment methods of obesity.Methods:1.According to the assistance of an investigator with a bachelor degree or above in Chinese medicine,fill out the "Traditional Chinese Medicine Constitution Classification and Judgment Self-Testing Table"to determine the patient’s constitution type by the respondent or the investigator after inquiring in detail.2.Including 57 patients with obesity who were admitted to the Guang’anmen Hospital from September 2016 to January 2019,collect general data,medical history,signs and laboratory indicators within 2 weeks before and after the first visit,including liver function,kidney function,blood lipids,uric acid(UA),islet function and other physical and chemical indicators,and faithfully recorded the medical records.3.Standardize the collected data into the database,and analyze the collected data.4.Investigate the relationship between gender,age,BMI,waist circumference,hip circumference,waist-to-hip ratio,waist-to-body ratio,acanthosis nigricans,liver function,blood lipids,islet function and constitution types in obese patients.Summarize instructor Li Mingdi’s treatment experience in treating obesity with traditional Chinese medicineResults:1.The characteristics of obesity outpatients:obesity outpatients were significantly more women than men,with a male to female ratio of about 1:2,with an average age of 30.4±9.1 years,of which 44(77.19%)had uncontrolled dieters and 34(59.65%)did not exercise.There were 39 women,3(7.69%)of advanced menstruation,8(20.51%)of retarded menstruation,7(17.95%)with irregular menstrual cycle,and 23of dysmenorrhea.(58.97%).2.Distribution of TCM constitution in obese patients:only 3 of obese patients with single constitution,54 w:ith concurrent constitution,the ratio is 1:18,41 with Qi deficiency constitution(71.93%),40 with phlegm-dampness constitution(70.18%)),31 with damp-heat constitution(54.39%),29 with yin-deficiency constitution(50.88%),which were the most common four constitutions,and the balanced constitution was rare,only 6(10.53%).The proportion of Yang-deficiency,Qi-deficiency,stagnant Qi and inherited special constitution in female obese patients is significantly higher than that in males;the Yang-deficiency constitution ratio in 18-30 years old obese patients were greater than that in 30 years old and older;The distribution of stagnant Qi constitution in obese patients was less than that in obese patients with smaller WHtR;the proportion of Yin-deficiency constitution and damp-heat constitution in obesity with acanthosis nigricans group was higher than that in obesity without acanthosis nigricans group,and there was a statistically significant difference in the Homeostatic Model Assessment-Insulin Resistance Index(HOMA-IR)between the acanthosis nigricans group(20.29 in the average rank)and the no acanthosis nigricans group(average rank 11.25);the proportion of Qi-deficiency constitution in obese patients with high 2-hour INS after sugar loading(87.0%)was greater than that in obese patients with normal 2hINS(40.0%).3.Correlation analysis between related indicators and TCM constitution of obesity:Logistic regression analysis found that Yin-deficiency constitution was correlated with acanthosis nigricans,and the risk of acanthosis nigricans of obesity with Yin-deficiency constitution was 3.908 times that of non-Yin deficiency(OR=3.908;95%CI:1.116-13.689);Qi deficiency constitution is correlated with 2hINS,the risk of 2hINS of obesity with Qi deficiency constitution was 13.536 times that of non-Qi deficiency constitution(OR=13.536;95%CI:1.936-94.637);stagnant Qi constitution was correlated with BMI,WC,WHR andWHtR.4.Summary of tutor’s clinical experience:the common symptoms of obese patients in the outpatient clinic were:fatigue(90.48%),sticky stool(80.95%),sweating(71.43%),snoring(71.43%),swift hungering and increased appetite(57.14%),stomach or abdominal distension(57.14%),irritability(52.38%),and the incidence rate was high.Patients were treated by the instructor for 1-3 months,the scores of TCM symptoms were significantly reduced.According to the evaluation criteria for syndrome efficacy,the total effective rate was 95.24%.The score of TCM symptoms before treatment was 30.86±7.63,and that after treatment was 12.19±5.69;the weight before treatment was 96.48±20.11kg,the weight after treatment was 93.91±19.67kg,and the weight loss after treatment was 0-8.0kg,obvious effect in 6 cases,effect in 3 cases,no effect in 12 cases,with a total effective rate of 42.86%.The instructor mainly threated obesity by combining physique-disease-syndrome differentiation and paid more attention to the adjustment of physique.Conclusion:1.The distribution of TCM constitution types was related to gender,age,waist height ratio,acanthosis nigricans and insulin.2.Qi-deficiency and Yin-deficiency constitution in obese patients were correlated with 2hINS or acanthosis nigricans,likely which was high-risk physique for type 2 diabetes,cardiovascular disease,etc.stagnant Qi constitution was correlated with BMI,waist circumference,waist-to-hip ratio and waist-to-body ratio.According to the correlation between TCM constitution types and related indicators,it is possible to conduct targeted screening for high-risk physiques in obese patients which are prone to have abnormal indicators,and timely correct related unbalanced constitution,which is conducive to the primary prevention and secondary prevention of obese patients.3.The treatment of obesity by combining physique-disease-syndrome differentiation was effective,which can significantly improve the patient’s clinical symptoms,and the weight had a decreasing trend after treatment. |
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