| BackgroundObesity are very common diseases clinically. Simple obesity is defined as a kind of obesity not with obvious neural, endocrine, morphological and functional changes, but with the difficult adjustments in metabolic disorders. Other obesity resulting from diseases was called as secondary obesity. Obesity is a systemic endocrine and metabolic disease. The pathogenesis is very complicated, and it is often accompanied with abnormal metabolism of sugars, fats and proteins. Obesity is significantly related to diseases of the type II diabetes, cardiovascular diseases, hypertension, hyperlipidemia, certain cancers and sleep-disordered breathing. Before Han Dynasty, Chinese ancient books early have descriptions about obesity. In traditional Chinese medicine, people believe that the causes of obesity include improper diet, innate endowment, sedentary for a long time lying, indolent, and frail. The pathogenesis is major in yang-qi deficiency and phlegm-dampness excess. In ancient acupuncture literature, although no acupuncture treatment of the disease of obesity special disease record, but there are some treatment principles and treatment therapies in main symptoms of obesity. In western medicine, treatments of simple obesity are diet and exercise therapy, supplemented by medication; however, persisting diet and exercise adjustments for long time is difficult, so the efficacy of obesity therapy is poor. Traditional medications have many side-effects and complications, so its clinical application is limited. Acupuncture has the features of good efficacy, little pain and high security. Treating simple obesity of spleen deficiency and dampness obstruction through the freeing the vessel network by acupuncture and warming yang and eliminating dampness by moxibustion, it is benefit for the patient to restore normal physiological functions, to improve quality of life, and has important social significance.ObjectiveObserving clinical effects of warming needle moxibustion in patients with simple obesity of spleen deficiency and dampness obstruction, this study investigated the differences among warming needle moxibustion, electric acupuncture and moxibustion, and their curative mechanisms. The major goal of this study is the comparisons of Warming needle moxibustion, electric acupuncture and moxibustion clinically. The methods includes the clinical epidemiology, clinical research methodology, statistical analysis of mathematical methods, and study design followed by clinical randomized controlled.MethodsThe patients were selected from Taiwan Chengtai clinic during December2009to November2011. The important inclusion criteria is all patients with simple obesity resulting from spleen deficiency and dampness obstruction. Total90patients were included in three groups, the warming needle moxibustion group, the electric acupuncture (EA) group and the moxibustion group, they all were allocated randomly by the equal ratio to every group with30patients finally. The differentiation diagnosis referred to the TCM syndrome differential criteria in simple obesity that were agreed to two standards in the5th National Conference of obesity research in1997. As the western diagnostic criteria issued due to the simple obesity diagnostic efficacy standards which were agreed by the5th National Conference of obesity research in1997. All patients met the inclusion criteria according to design requirements, observations and treatments. Total two course Treatment, every course of treatment had three times per week for one month. Efficacy measurements include the clinical efficacy of TCM syndrome score, obesity indicators (such as measuring arm circumference, waist circumference, abdominal circumference, hip circumference, femoral circumference, fat percentage (F%), measured weight, calculate the waist/hip ratio, body mass index (BMI)). And the quality of life in obese patients was assessed by using WHO quality of life scale (WHOQOL-BREF). Evaluation standards majorly referred by the3rd National Conference on obesity research in1992and the WHO evaluation criteria for Asian adult obesity. Data was analyzed by SPSS13.0software for statistical analysis. Measurement data were presented by the mean±standard deviation (x±S), and the count data used in forming ration (%). Groups were compared using Ftest (variance using Kruskal-Wallis Hmissing rank sum test), LSD test, paired t test or Wilcoxon paired rank sum test. Segment information is used via χ2test, ranked data via Kruskal-Wall is H rank sum test. Making use of statistical software Graph Pad Prism4.03completed the statistical graphs.Results①The comparison of clinical efficacy of spleen deficiency and dampness obstructionAfter two courses, the effects in the EA group and the moxibustion group comparing with before treatment were significant statistically (p<0.05) The clinical symptoms score after two course treatment in the warming needle moxibustion group was significantly lower than those of before treatment (p <0.01). It suggested that factors improve the clinical symptoms in patients with spleen deficiency and dampness obstruction such as heavy body, edema, anorexia, abdominal distention, swollen limbs, and loose stool, etc. Warming needle moxibustion has a good effect and long-term efficacy. The treatment of electric acupuncture and moxibustion is not so obvious for the simple obesity patients with spleen deficiency and dampness obstruction.②The comparison of body mass index (BMI)After two courses, the BMI of warming needle moxibustion was significantly reduced compared with that of before treatment (p<0.01). BMI of EA group compared with that of before treatment was also significant statistically (p <0.05). Although the BMI score was lower than that of before, but it was not statistically significant (p>0.05). As paired comparison, efficacy of the warming needle moxibustion group was prominently significant (p<0.01) compared to those of the EA group and the moxibustion group. It predicted that the treatment of warming needle moxibustion can obviously lower the BMI score of simple obesity patients with spleen deficiency and dampness obstruction after two courses. The therapeutic effect of EA on treating simple obesity patients was not so obvious, but the BMI score after two month was lower than those after one month. The therapeutic effect of reducing BMI score via moxibution in patients with simple obesity was not so good.③The comparison of fat percentage (F%) After two course treatment in warming needle moxibustion group, the fat percentage (F%) was prominently reduced comparing to that of before treatment (p<0.01), and the fat percentage (F%) of the EA group and moxibustion group were statistically significant comparing to that of before treatment (p<0.05). By paired comparison, the effect of in warming needle moxibustion group was significant (p<0.05) comparing to those of EA group and moxibustion group. It meant that after two course of warming needle moxibustion therapy can obviously reduce the fat percentage (F%). The effect of warming needle moxibustion is better than those of electric acupuncture and moxibustion.@The comparison of arm circumference, abdominal circumference, waist circumference, hip circumference, femoral circumference, the waist/hip ratioThe arm circumference of after two course therapy in warming needle moxibustion group was lower than that of before (p<0.05). As above, there weren't obvious difference in EA group and moxibustion group, it comparing that of before treatment (p<0.05). It suggested that warming needle moxibustion can reduce the arm circumference of simple obesity patients with spleen deficiency and dampness obstruction. But the electric acupuncture and moxibustion didn't work for reducing the arm circumference of simple obesity patients with spleen deficiency and dampness obstruction.After two course treatment, the abdominal circumference of warming needle moxibustion group and EA group were lower than those of before treatment (P <0.05). The abdominal circumference of moxibustion groups was not obvious difference between after and before treatments (p>0.05). It indicated that warming needle moxibustion and electric acupuncture can reduce the abdominal circumference of simple obesity patients with spleen deficiency and dampness obstruction.After two courses, the waist circumference of warming needle moxibustion group and EA group were lower than those of before treatment (P<0.05). It indicated that after two course therapy, warming needle moxibustion and electric acupuncture can reduce the waist circumference of simple obesity patients with spleen deficiency and dampness obstruction.In warming needle moxibustion group, the hip circumference after two course therapy was lower than those before treatment (p<0.05). It indicated that after two courses, warming needle moxibustion can reduce the hip circumference in simple obesity patients with spleen deficiency and dampness obstruction.Two courses later, the femoral circumference of warming needle moxibustion group, EA group and moxibustion group were all lower than those of before treatment (p<0.05). It suggested that warming needle moxibustion, electric acupuncture and moxibustion can reduce the femoral circumference of simple obesity patients with spleen deficiency and dampness obstruction. But the comparison among the three groups were not significant statistically (p>0.05); it meant that the difference among three therapies was not obvious.Two courses later, the waist/hip ratio of warming needle moxibustion group was lower than that of before treatment statistically (p<0.05). It indicated that warming needle moxibustion can reduce the waist/hip ratio of simple obesity patients with spleen deficiency and dampness obstruction, but the efficacy of electric acupuncture and moxibustion was not obvious.⑤Comparison of the life qualityAfter two courses, the life quality in warming needle moxibustion group were higher than those in the EA group and moxibustion group (p<0.05). It indicated that warming needle moxibustion, electric acupuncture and moxibustion can improve the life quality of simple obesity in patients with spleen deficiency and dampness obstruction. Moreover, the efficacy of warming needle moxibustion is the best.⑥Comparison of curative effectsAfter two courses, the efficacy were significant statistically (p<0.05) in three groups by Kruskal-Wallis Hrank sum test,H=11.28, p=0.024. That was in the warming needle moxibustion group15people (50%) recovered and10people (33.33%) improved; The total effective rate was83.33%. In EA group,5people recovered (16.67%),17people (56.67%) improved, and4people were invalid (26.67%); The total effective rate was73.34%. In the moxibustion group6people recovered (20%),15people (50%) improved, and9people were invalid (30%); the total effective rate was70%. It demonstrated that the therapy of warming needle moxibustion was better than those of electric acupuncture and moxibustion for treating patients with simple obesity of spleen deficiency and dampness obstruction.ConclusionsSimple obesity is a chronic metabolic disease with high failure of treatment due to patients not persisting in long treatment period and easily relapse. Thus, an effective therapy for conquering long sustained program, keeping good patient compliance and increasing high efficacy has an important significance clinically. As for the different syndromes type of obese patients, it should be pursued more target treatments to obtain effects fast and well. The treatment principles of simple obesity in patients with spleen deficiency and dampness obstruction are warming yang-qi, tonifying spleen, eliminating dampness, moving qi and removing phlegm. In addition, obesity mostly accompanied with mild to moderate depression, stress, anxiety and other negative emotions which affect their quality of life. Therefore, the method of soothing heart and regulating gallbladder should be used too.Warming needle moxibustion is a therapy which combines acupuncture and moxibustion. Acupuncture can free the vessel network, and moxibustion can warm and dredge. The combination can induce diarrhea and facilities through the meridians to lipid-lowering weight decrease. Moxa has warm the meridians, qi and blood, reducing swelling of the role of light through the surface points after fumigation, and along the needle into the internal body heat to warm and stimulate the penetration of drug to achieve the effect.The warming needle moxibustion and electric acupuncture have certain curative effects in treating simple obesity patients with spleen deficiency and dampness obstruction, including lowering BMI, fat percentage, abdominal, waist and hip circumference, improving the clinical symptoms of spleen deficiency and dampness obstruction and increasing quality of life. Moxibustion could not improve these indexes of obesity obviously. The curative effect is obvious by Warming needle moxibustion therapy without medication in the patient with less pain.The treatments of warming needle moxibustion in patients with simple obesity of spleen deficiency and dampness obstruction could be valued as a weight decreasing with economic lasting non-toxic side effect clinically.
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