Excess weight and Wind (Was: Natural Thyroid?)

[Guest guest]

Chinese Traditional Medicine , " kurvenal " <kurvenal@a...>

wrote:

> " victoria_dragon " <victoria_dragon>:

> > Another common factor in excess weight is Interior Wind.

>

> I'm not familiar with Internal Wind as a cause of

> excess weight. Could you explain this one further?

> Thanks.

 

The reason Internal Wind is so often found in obese people and in

turn helps keep the obesity going has to do with the possible

underlying TCM patterns of obesity. Especially keep in mind the

possible Spleen and Kidney Deficiency and the section where Flaws

talks about Liver and Qi Stagnation in obesity.

 

The possible role of Qi Deficiency in obesity is very direct. Not

enough energy to exercise and be active enough to burn calories.

Plus, Flaws touches on what's happening digestion-wise when the

Spleen is weak.

 

The Spleen plays the major role in Qi accumulation in the body. But

the Spleen also plays a major role in the production of Blood. If

it's not making enough Blood, not enough Blood will be available to

other Organs and tissues. This includes the Liver. And this is one

of the bridges between the two sets of patterns - the 4 Spleen/

phlegm/ Kidney patterns and the 3 Liver/ Qi Stagnation patterns.

 

One of the possible causes of Interior Wind is Liver Blood

Deficiency. (Actually all 3 possible causes involve the Liver, but

it's the Liver Blood Deficiency that can be a bridge between the two

sets of obesity patterns.) The Liver is most vulnerable to Wind.

When there is Wind, the Liver is going to be imbalanced or further

imbalanced. Among other things, the Liver is going to be depressed,

restrained, blocked.

 

Also, Blood Deficiency can cause Blood Stasis. The analogy I use is

to think of the way a full stream of water rushes along, reaching

the banks, fully " moistening and nourishing " , and how slow and

inadequate a stream is that doesn't have enough water. Left

untreated, the Blood Stasis can trigger Qi Stagnation (and vice

versa).

 

Something else to keep in mind is that there are different types of

Phlegm. Dampness can team up with any other Pernicious Evil in the

production of Phlegm. Cold Phlegm, Hot Phlegm, Dry Phlegm, Damp

Phlegm, and Wind Phlegm. In Comprehensive Management Phlegm Fluid

(Tan Yin), C.S. Cheung, MD, LAc, points out in the section on Wind

Phlegm, " Patients are usually obese with cough and excessive sputum,

rattling sound in throat, stale greasy fur, a bowstring slippery

pulse. " (p. 21)

 

Something else to keep in mind is that the Kidneys also play an

important role in the production of Blood. When the person has both

Spleen and Kidney weakness, that's going to increase the chances of

a person developing Blood Deficiency.

 

http://www.acupuncturetoday.com/archives2002/oct/10flaws.html

 

Clinical Practice Issues

Bob Flaws, Dipl. Ac., CH, FNAAOM, FRCHM

 

New Approaches to the Chinese Medical Treatment of Obesity

 

(snip)

 

Although it is not easy to find obesity listed as a disease category

in contemporary Chinese medical books, based on their extensive

research, Philippe Sionneau and L Gang do present a pattern

discrimination of obesity in their book, The Treatment of Disease in

TCM, Volume 7: General Symptoms. In this book, Sionneau and L

identify four patterns of obesity: 1) phlegm dampness brewing

internally; 2) spleen qi vacuity; 3) spleen vacuity and stomach

heat; and 4) spleen kidney yang vacuity.

 

To understand these four patterns and their disease mechanisms, one

must understand that fat in Chinese medicine is considered a form of

phlegm turbidity, while phlegm is made from congealed fluids and

humors. According to Chinese medical theory, the three viscera that

control fluids and humors in the human body are the lungs, spleen

and kidneys. However, in terms of obesity, the lungs do not play an

important role. Instead, the emphasis within most Chinese medical

discussions of obesity is placed on the spleen. This is because the

spleen controls the muscles and flesh; controls the movement of

transformation of water fluids; and is the root of phlegm

engenderment. If the spleen becomes damaged, such as by eating too

many fatty, sweet foods and getting too little exercise, it will

fail in its duty to move and transform water fluids. Instead, these

will gather, collect and transform into evil dampness. If damp evils

endure, over time they will congeal into phlegm (or fat). Therefore,

all four of Sionneau and L's patterns of obesity involve phlegm

dampness and the spleen.

 

In pattern number one, phlegm and dampness are mostly due to

overeating phlegm- and dampness-engendering foods and not getting

enough exercise. Such foods include sugars, sweets, oil and fats. In

pattern number one, the patient's righteous qi is still relatively

replete, and spleen qi vacuity has either not yet occurred or is not

marked. In pattern number two, spleen vacuity is the main thing. All

the signs and symptoms in pattern two are either phlegm damp or

spleen qi vacuity symptoms. In pattern number three, the spleen has

become vacuous and weak, while the stomach, due to overeating in

general and overeating greasy, hot, fatty foods in particular, has

become hot.3 Stomach heat produces hunger and a tendency to overeat,

but spleen vacuity fails to disperse and transform the essence of

food and drink taken in by the stomach. Although stomach heat helps

explain the overeating, it is still the spleen that is the root of

phlegm production.

 

Likewise, in pattern number four, the kidneys play a secondary or

subsidiary role in the engenderment of phlegm dampness and,

therefore, fat. The spleen is the latter heaven root, while the

kidneys are the former heaven root. Former and latter heavens are

mutually independent. The spleen qi's function of digestion is a

type of warm transformation. Its role in digestion is likened to a

process of fermentation and distillation or cooking. However, it is

ministerial or life gate, i.e., kidney yang, which is the root of

all yang and heat in the body. Spleen qi vacuity may lead to kidney

yang vacuity, and kidney yang vacuity may lead to spleen vacuity,

but no matter which way it happens, if kidney yang becomes vacuous

and insufficient, the spleen qi will be even more incapable of

warming and transforming water fluids. In this regard, it is

significant that the most commonly used Chinese verb used to

describe the elimination of pathological phlegm from the body is

hua. This word means " to transform, " but it also means " to melt. " In

the case of spleen-kidney yang vacuity, there is not only not enough

qi to transform phlegm, but not enough yang to melt it.

 

Based on the above four patterns, the two main methods of treating

obesity in Chinese medicine are to A) transform phlegm and eliminate

dampness and B) to fortify the spleen and invigorate the kidneys. In

most cases, some combination of these two groups of treatment

principles is used. In addition, any other principles are added as

indicated by the patient's personal pattern.

 

A New Approach to the Pattern Discrimination Treatment of Obesity

 

In an article entitled " Luo Si-wei's Experience in the Treatment of

Obesity, " Guo Yi-ran describes his teacher Luo Si-wei's methods of

treating obesity.4 According to Guo, Luo Si-wei believed that this

disease is mostly due to phlegm obstruction, liver depression and

blood stasis. However, he related all three of these to qi

stagnation. If for any reason the liver becomes depressed, it fails

to course and discharge, and thus the qi becomes stagnant. Qi moves

both fluids and blood. If the qi becomes stagnant, it will not move

and transform water fluids. Instead, these may gather and collect,

eventually congealing into phlegm. However, phlegm itself is a yin

depression, which also obstructs the free flow of qi. Thus, qi

stagnation may lead to phlegm engenderment, and phlegm dampness may

cause or aggravate qi stagnation. In addition, since the qi moves

the blood, if the qi becomes stagnant, the blood will become static.

Because blood and fluids move together, fluids will likewise gather

and collect, eventually congealing into phlegm. Static blood is also

a yin depression that can obstruct the free flow of qi. Thus, qi

stagnation may cause blood stasis; blood stasis may cause or

aggravate qi stagnation; and both may engender phlegm dampness. This

is why, according to Guo Yi-ran, there is a common saying: " Obese

people are mostly (due to) phlegm and stasis. "

 

Based on the above theories, Luo Si-wei discriminated three patterns

of obesity: 1) phlegm obstruction and qi stagnation; 2) liver

depression qi stagnation; and 3) blood stasis and qi stagnation.

 

Phlegm Obstruction & Qi Stagnation Pattern

 

Besides having a fat body, these patients commonly have signs and

symptoms of phlegm exuberance, such as profuse phlegm; chest

oppression; slimy tongue fur; and a slippery, bowstring pulse. The

treatment principles are to sweep away phlegm and move stagnation.

Once the phlegm is swept away, the qi can course, diffuse, and flow

freely, smoothly and easily. The qi mechanism is free-flowing and

uninhibited. This promotes the sliding disinhibtion of phlegm

turbidity, and has the function of reducing fat and decreasing

obesity. The commonly used medicinals that Luo Si-wei used for this

purpose were bulbus allii (xie bai); bile-processed rhizoma

arisaematis (dan nan xing); fructus trichosanthis kirlowii (gua

lou); and pericarpium citri reticulatae (chen pi). Xie bai is acrid

and warm and frees the flow of yang. It has a tendency to scatter

congestion and stagnation. Dan nan xing clears, disinhibits, and

transforms phlegm. According to the Yao Pin Hua Yi (Medicinal

Ingredients Digested Meaning), " The bile clears the gallbladder qi,

while the arisaema sweeps away bound qi. " As the Ben Cao Yan Yi Bu

Yi (Addenda to the Extended Meanings Materia Medica) says, " It also

washes away slimy lumps from the diaphragm and chest. "

 

Liver Depression Qi Stagnation Pattern

 

Patients with this pattern of obesity typically have some sort of

emotional abnormality. Most patients have some degree of chest

oppression; rib-side distention; a bitter taste in the mouth; and a

bowstring pulse. Because the liver qi is depressed and bound, the

gallbladder qi is depressed and exhausted. Coursing and discharge

lose their command, and the qi mechanism does not flow freely. This

leads to clearing/cleaning, losing their duty. Hence, fat turbidity

is difficult to transform. Over time, this leads to obesity being

engendered. For this pattern, Luo Si-wei commonly used the treatment

principles of coursing the liver, disinhibiting the gallbladder, and

moving stagnation. As the Xue Zheng Lun (Treating on Bleeding

Disorders) says, " If wood's nature controls coursing and discharge,

water and food are transformed. " The liver governs coursing and

discharge, and the gallbladder, the bowel of the central essence. It

secretes essence juice, which enables the cleansing of fat and the

transformation of turbidity. The medicinals Master Luo used for

these purposes included radix bupleuri (chai hu); fructus immaturus

citri aurantii (zhi shi); rhizoma cyperi rotundi (xiang fu); radix

albus paeoniae lactiflorae (bai shao); and semen cassiae torae (jue

ming zi). According to the Ben Cao Zheng Yi (Correct Meaning Materia

Medica), chai hu is able to vitalize and lift clear yang. Hence, the

great qi performs its good offices, and accumulation and stagnation

are automatically transformed. It is also an essential medicinal for

coursing the liver and disinhibiting the gallbladder. When combined

with jue ming zi, these two medicinals clear and discharge liver-

gallbladder depressive heat. When combined with xiang fu, zhi shi

and bai shao, it is even better for coursing the liver and resolving

depression.

 

Blood Stasis & Qi Stagnation Pattern

 

Besides having an obese body, patients exhibiting this pattern have

dizziness; numbness of the four extremities; and a dark tongue with

possible static spots. This is because the movement of blood is not

smoothly or easily flowing. Rather, stasis obstructs the vessels and

network vessels, and the qi mechanism is inhibited. Therefore, fat

and turbidity collect and accumulate within the vessels. This makes

the blood more viscous. If this continues over time, it cannot help

but result in obesity combined with atherosclerosis. The principles

Luo Si-wei used to treat this pattern of obesity were to quicken the

blood; transform stasis; and move stagnation. For these purposes, he

usually chose xue fu zhu yu tang jia dan shen (blood mansion dispel

stasis decoction plus salvia). In that case, he used semen pruni

persicae (tao ren); flos carthami tinctorii (hong hua); radix rubrus

paeoniae lactiflorae (chi shao); radix ligustici wallichii (chuan

xiong); radix angelicae sinensis (dang gui); and radix salviae

miltiorrhizae (dan shen) to quicken the blood and transform stasis.

According to the Ben Cao Hui Yan (Collected Sayings on Materia

Medica), salvia " is a medicinal with a propensity for treating the

blood division, where it removes stagnation and engenders the new,

regulates the menses and normalizes the flow of the vessels. " Modern

pharmacodynamics show that dan shen can lower lipids and

triglycerides within the liver. Combining it with chai hu, zhi shi,

bai shao and xiang fu to course the liver, rectify the qi and move

stagnation, increases its effect of reducing fat and decreasing

obesity.

 

Conclusion

 

Based on my own 20+ years of clinical experience, I believe Luo Si-

wei adds an important view to the Chinese medical treatment of

obesity. In my experience, obese Western patients rarely have spleen

vacuity without liver depression, and rarely have liver depression

without spleen vacuity, especially if they are female, as are the

majority of Westerners seeking treatment with Chinese medicine. When

one combines the four patterns presented by Sionneau and L with the

three patterns favored by Master Luo, I believe one now can

discriminate and treat the overwhelming majority of patients

suffering from obesity. Some patients will exhibit more signs and

symptoms of the repletions of phlegm; dampness; turbidity; qi

stagnation; and blood stasis. Others will exhibit more signs and

symptoms of spleen qi and vacuity. Due to Lui Wan-su's theory of

similar transformation and Zhu Dan-xi's theory of the six

depressions, any of the above evil repletions may be complicated by

transformative heat. Thus, phlegm may become phlegm heat; dampness

may become damp heat; food stagnation may be complicated by heat; qi

stagnation may become depressive heat; and blood stasis may become

stasis heat. In addition, it is possible to have these types of

transformative heat even in the face of yang qi vacuity. Blood

stasis may also lead to blood vacuity, and either enduring heat

evils or blood vacuity may lead to yin vacuity with eventual flaring

of vacuity fire. Thus, the combinations of patterns in patients with

obesity include more than the seven patterns described above.

Nevertheless, if one understands these seven core patterns and their

ramifications, one should be able to diagnose and treat most obese

patients.

 

In closing, it is also important to note that it is impossible for

most people to lose weight and keep it off without eating less and

exercising more. Therefore, patients and practitioners should not be

seduced into thinking that taking Chinese medicinals or receiving

acupuncture without diet and lifestyle modifications are sufficient

unto themselves to lose weight and keep it off. As Sun si-miao is

reputed to have said, " First, modify the patient's diet and

lifestyle and only then, if these do not effect a cure, treat with

medicinals and acupuncture. "

[Guest guest]

I didn't see any statements in the quotes you provided

that referred to interal wind in relation to obesity.

Did I miss it? (If so, could you isolate those for me,

and post those?)

 

What symptoms of Internal Wind are you seeing as common

in people who are obese? Maybe if you could give some

of the symptoms of Internal Wind that are common to

those who are obese, I could understand the link

that you're making.

 

Are we perhaps defining Internal Wind differently?

 

Here is what Wiseman and Feng's Practical Dictionary

of says:

" Internal wind, i.e., wind arising withing the body

by the following pathomechanisms: LIVER WIND STIRRING

INTERNALLY, which occurs when liver yang and liver fire

transform into wind, manifesting in dizziness, tremor,

and convulsions; EXTREME HEAT ENGENDERING WIND, arising

in externally contracted diseases such as FRIGHT WIND

and manifesting in convulsions, stiffness of the neck,

arched-back rigidity, etc.; BLOOD VACUITY ENGENDERING

WIND, arising when great sweating, great vomiting,

great diarrhea, major loss of blood, damage to yin

in enduring illness, or kidney-water failing to moisten

liver-wood causes desiccation of the blood that

deprives the sinews of nourishment and insufficiency

of liver yin that leaves yang unsubdued and allows

liver wing to surry around internally. Vacuity

wind stirring within is marked by dizziness, tremor,

worm-like movements in the extremities, or

clouding collapse. "

 

(The upper case above is how it's presented in the book.

I'm not trying to emphasize anything.)

 

Other definitions of wind include " One of the

Six Qi " , a definition of external wind,

facial paralysis and hemiplegia, and a listing

of some diseases that include wind in the

disease name, such as LIP WIND, WHITE PATCH

WIND, etc.

 

Internal Wind, as I understand it, usually

has symptoms such as convulsions, tremor,

shaking of the head, dizziness, and wandering

pain and itching.

" Wind is swift and changeable " , (unlike obesity,

I'd add.)

 

Sorry to be slow at getting the connection

of Internal Wind as a common factor in

obesity, but if you give it another try,

hopefully I'll get it this time. If you

could provide the symptoms that you're

identifying as Internal Wind, maybe that

would help clarify it for me. I'd hate to

be overlooking something of relevance

in the clinic.

 

Jeri

[Guest guest]

Hey,

As I haven't followed the whole arguement, I am unsure of the

technicalities.

The only light I can shed on the topic of internal wind and it's link to

obesity, (and prevalence in obesity), is that in obese people, it is often

seen that the internal stagnation that causes excessive damp accumulation,

works much like a pressure cooker. When the stagnation increases the the

Middle Jiao, it will often cause the natural flow of Qi in the body to

counterflow, which draws wind behind it. The other factor can been seen that

in obese patients, the obesity is often caused by underlying Spleen Qi

deficiency, which allows the Liver to overact. When the Liver Qi overacts,

it will often become stagnant; as this gets worse, Liver Yang is often seen

to rise up, disturbing the Heart Shen, and engendering internal Yang Rising

Wind.

Hope this helps,

Benji-Yi.