Study On The Clinical And Metabolic Mechanism Of Moxibustion Combined With Lifestyle Intervention In The Treatment Of Abdominal Obesity

Background:Abdominal obesity,as a common chronic metabolic disease in clinical practice,is characterized by the accumulation of adipose tissue in the abdomen or internal organs,and patients often have a thick waist and narrow hips.Compared with overall obesity,abdominal obesity is more harmful to human body,and often leads to a significant increase in the risk of cardiovascular and cerebrovascular diseases such as hypertension,type 2 diabetes,dyslipidemia,arteriosclerosis and stroke.Traditional Chinese medicine therapy in the treatment of abdominal obesity has the characteristics of individual syndrome differentiation,low side effects,low price,long-term efficacy,and is widely used in clinical practice.However,the advantages of different therapy in the treatment of abdominal obesity are not the same,and the mechanism of action is unclear.This project intends to explore the better treatment of abdominal obesity from four aspects of TCM syndrome elements,data mining,clinical observation and mechanism research,and verify its effectiveness and safety,and further explore its potential mechanism of action,so as to better guide clinical practice.Research Contents:Part Ⅰ:A Study on the Distribution Characteristics and TCM Syndromes of Abdominal ObesityObjective:To analyze the syndrome differentiation of patients with abdominal obesity based on the study of TCM syndromes,summarize its internal development rules and influencing mechanism,and provide a breakthrough point for subsequent clinical intervention methods.Methods:Based on the application of epidemiology,a cross-sectional survey was designed and 240 patients with abdominal obesity were selected in Acupuncture-moxibustion department and Obesity Specialist clinic of Hubei Provincial Hospital of Traditional Chinese Medicine as the research objects.The general information,medical history,diet and exercise,and four diagnosis information of traditional Chinese medicine were collected in a standardized manner.By referring to the "simplified measurement"method in Syndrome Element Differentiation written by Zhu Wenfeng,syndrome elements were determined so as to clarify the disease location and characteristics of syndrome elements in patients with abdominal obesity,and to analyze the distribution characteristics of TCM syndrome elements in patients with abdominal obesity.Result:A total of 230 effective cases were collected in this study.(1)Dietary habit:The proportion of people who preferred fatty,sweet and fried diet was the highest,accounting for 76.96%;(2)Daily exercise:The proportion of people who didn’t exercise was the highest,accounting for 48.70%;(3)The distribution of symptoms and signs(except tongue and pulse):"careless diet(overeating)" was the main cause,and"increased eating with rapid hungering","tiredness and fatigue",and "oversweating on summer day" were the most frequent factors,accounting for 73.48%,61.30%,57.39%,respectively.(4)The nature and fur of the tongue and pulse condition:The frequency of tongue fat,tongue light,and tongue edge tooth imprint was higher,accounting for 50.43%,31.30%,and 27.83%,respectively.The frequency of greasy tongue coating,white tongue coating and thin white tongue coating was higher,accounting for 37.83%,33.04%,26.09%,respectively.The frequency of pulse chord,pulse weight,pulse fine,and pulse number was higher,accounting for 55.65%,42.17%,42.17%,and 37.39%,respectively.(5)The distribution of syndrome elements:The disease location syndrome factors decreased in order of frequency is spleen,liver,kidney,lung and stomach.The distribution of disease syndrome factors was ranked according to the frequency of occurrence,that was dampness>phlegm>qi deficiency>qi stagnation>yang deficiency>heat>blood stasis>food stasis,with the highest proportion of dampness and phlegm.In terms of TCM syndrome type,the frequency of phlegm dampness syndrome was the highest,accounting for 27.83%.Conclusion:The pathogenesis of abdominal obesity is generally intermingled deficiency and excess,and the main sites of the disease are spleen,liver and kidney.Dampness and phlegm are the core of the disease.The most common syndrome is phlegm dampness and internal excess.Moxibustion therapy in TCM external treatment has the functions of warming the spleen and kidney,strengthening the spleen and dispelling dampness,warming the meridians and collaterals,regulating the three jiao,improving water and reducing swelling.It has unique effects in eliminating phlegm and dampness and regulating the zang-fu organs,so it has significant advantages in the treatment of this disease.Part Ⅱ:An Explorion on the Rules of Clinical Acupoints Selection in the Treatment of Simple Obesity with Moxibust ion based on Data Mining TechnologyObjective:To explore the acupoint compatibility scheme for simple obesity patients treated with moxibustion based on data mining technology.Methods:Through systematic review of modern Chinese and English literature on moxibustion in the treatment of simple obesity from the establishment of the database to May 2022.Relevant literature was screened out strictly according to the inclusion and exclusion criteria in the whole process,and the obtained literature was screened and information extracted,and then EXCEL and SPSS modeler were used as research tools.Data mining technology was used to deeply explore the rules of clinical acupoint/meridian/part selection of moxibustion in the treatment of simple obesity,and the optimal matching scheme of acupoints was obtained.Results:A total of 129 moxibustion prescriptions were collected in modern literature,covering 59 acupoints.The highest frequencies of acupoints were Guanyuan(CV 4),Zusanli(ST 36),and Zhongwan(CV 12).The selected acupoints mainly belong to conception vessel,stomach meridian of foot-Yangming and bladder meridian of foot-Taiyang.The selected acupoints were mainly located in the abdominal area,leg area and back area.The selected specific acupoint categories are mainly the confluent acupoints,the mu-front acupoints and back-shu acupoints.Association rule analysis showed that Pishu-Shenshu,Zusanli-Qihai,Guanyuan-Zhongwan were high-frequency acupoint combinations.Through cluster analysis of acupoints with frequency≥10,the acupoints can be divided into two major clusters:Guanyuan(CV 4),Zusanli(ST36),Qihai(CV6),Zhongwan(CV12),Tianshu(ST25),Shensh u(BL23)and Pishu(BL20)as the first major category,and other acupoints as the second major category.Conclusion:The point selection of moxibustion in the treatment of simple obesity reflects the law of matching points up and down,matching points in front and back,matching points near and far,and paying attention to the use of specific points.Based on the results of this part of data mining,and combined with the summary of the supervisor’s clinical work experience of more than 30 years,for obesity patients with phlegm-dampness syndrome,the selected points in the third part of clinical research are determined to be Guanyuan,Zusanli,Zhongwan,Pishu,Shenshu and Shenque,a total of 6 points.Part Ⅲ:Clinical Efficacy and Safety Evaluation of Moxibustion comb ined with Lifestyle Intervent ion in the Treatment of Pat ients with Abdominal ObesityObjective:To observe the clinical efficacy and safety of moxibustion combined with lifestyle intervention in the treatment of patients with abdominal obesity through a randomized controlled trial.Methods:Based on the method of randomized controlled clinical trial,100 patients with abdominal obesity were randomly divided into 2 groups according to the ratio of 1:1.The moxibustion+lifestyle intervention group was given moxibustion therapy combined with lifestyle intervention,and the lifestyle intervention group was only given simple lifestyle intervention.Obesity-related indicators,four items of blood lipids,TCM syndrome scores,the IWQOL-Lite scale,and Emotional and Psychological Assessment scale were evaluated before and after treatment for the assessment of the clinical efficacy,and adverse reactions during treatment were recorded to evaluate the safety of treatment.Results:A total of 94 effective cases were finally included in the statistical analysis,including 48 cases in the moxibustion+lifestyle intervention group and 46 cases in the lifestyle intervention group.(1)Baseline information:There was no significant difference in gender,age and obesity course between the two groups before treatment(P>0.05).There was also no significant difference in obesity-related indicators,blood lipid indexes,TCM syndrome score,the IWQOL-Lite scale,and Emotional and Psychological Assessment scale scores between the two groups before treatment(P>0.05).(2)The levels of obesity-related indicators,four items of blood lipids,IWQOL-Lite scale scores and Emotional and Psychological Assessment scale scores:Intra-group comparison:Compared with baseline,the indexes of obesity-related indicators,blood lipid indexes,the IWQOL-Lite scale,and Emotional and Psychological Assessment scale scores in the moxibustion combined with lifestyle intervention group and the lifestyle intervention group improved significantly at the end of 8 weeks and 12 weeks(P<0.05).Inter-group comparison:the indexes of obesity-related indicators,blood lipid indexes,the IWQOL-Lite scale,and Emotional and Psychological Assessment scale scores in the moxibustion combined with lifestyle intervention group at the end of 8 weeks and 12 weeks were significantly improved than those of the lifestyle intervention group(P<0.05).(3)The levels of the TCM syndrome score:Intra-group comparison:Intra-group comparison:Compared with baseline,the TCM syndrome score in the moxibustion combined with lifestyle intervention group was decreased significantly at the end of 8 weeks and 12 weeks(P<0.05),while the TCM syndrome score in the lifestyle intervention group did not decrease significantly at the end of 8 weeks and 12 weeks(P<0.05).Inter-group comparison:the TCM syndrome score in the moxibustion combined with lifestyle intervention group at the end of 8 weeks and 12 weeks were significantly decreased than that in the lifestyle intervention group(P<0.05).(4)The curative effect:After 8 weeks of treatment,the effective rate of the moxibustion combined with lifestyle intervention group was higher than that of the lifestyle intervention group(P<0.05).(5)The compliance:All patients had good acceptance of this therapy,and there was no significant difference in compliance between the moxibustion combined with lifestyle intervention group and the lifestyle intervention group(P>0.05).(6)Safety evaluation:There were no adverse reactions or other special situations.Conclusion:Moxibustion combined with lifestyle intervention can significantly improve the level of obesity-related indexes and blood lipids,regulate the clinical symptoms of traditional Chinese medicine,and improve the quality of life,relieve emotional and psychological discomfort in patients with abdominal obesity.Part Ⅳ:Study on the Regulation of Serum Related Metabolites and Metabolic Pathway of Moxi bustion combi ned with Lifestyle Intervent ion in the Treatment of Pat ients with Abdominal Obesity Objective:In this study,metabolomics technology was used to compare serum metabolites of patients with abdominal obesity before and after treatment,and to find different metabolites and related KEGG signaling pathways,for further exploring the mechanism of moxibustion combined with lifestyle intervention in the treatment of abdominal obesity from the perspective of metabonomics.Methods:A total of 20 subjects with waist circumference improved after moxibustion combined with lifestyle intervention and lifestyle intervention were selected.Serum samples of these patients were collected before treatment and 8 weeks after treatment,and serum samples of 10 healthy subjects were collected.Based on the detection techniques of ultra-high performance liquid chromatography and tandem mass spectrometry,serum metabolites of patients with abdominal obesity were analyzed before and after moxibustion combined with lifestyle intervention and lifestyle intervention,and compared with the serum metabolites of healthy people.The potential biomarkers of moxibustion combined with lifestyle intervention and lifestyle intervention in the treatment of abdominal obesity patients were screened,and the metabolic pathways involved were analyzed.Results:A total of 30 effective cases were finally included in the statistical analysis,including 10 cases in the moxibustion+lifestyle intervention group,10 cases in the lifestyle intervention group,and 10 cases in the control group.(1)Baseline information:There was no significant difference in gender and age between the three groups before treatment(P>0.05).(2)Different metabolites and metabolic pathways in the moxibustion+lifestyle intervention group:Moxibustion combined with lifestyle intervention can adjust 9 serum differential metabolites,including 3-(imidazol-4-yl)propionic acid,7-Methyluric Acid,D-Mannose,L-Gulose,L-Dihydroorotic Acid,L-Valine,Benzo[a]pyrene-4,5-oxide,Androstenediol,and Thymidine-5’-triphosphate.The metabolic pathways involved include histidine metabolism,caffeine metabolism,nucleotide sugar biosynthesis,amino and nucleotide sugar metabolism,ascorbic acid and alnus acid metabolism,purine metabolism,cofactor biosynthesis,valine,leucine and isoleucine degradation,cytochrome P450 allogeneic organisms metabolism,steroid hormone biosynthesis,ovarian steroid production,purine metabolism,nucleotide metabolism.(3)Different metabolites and metabolic pathways in the lifestyle intervention group:Lifestyle intervention can adjust 9 serum differential metabolites,including(R)-(+)-3-phenyllactic acid,isoniacylglycine,L-arabinol,thromboxane B2,n-acetyl-d-phenylalanine,methoxyindoleacetic acid,xanthine-5’-triphosphate,formyl-5-hydroxycanine urea,and L-serine.The metabolic pathways involved are phenylalanine metabolism,drug metabolism-other enzymes,pentose and glucuronic acid conversion,arachidonic acid metabolism,serotonergic synapses,biliary secretion,D-amino acid metabolism,purine metabolism,nucleotide metabolism,tryptophan metabolism,glycine,serine and threonine metabolism.Conclusion:There are differences in the regulation of metabolites and metabolic pathways in patients with abdominal obesity by moxibustion combined with lifestyle intervention and lifestyle intervention.Moxibustion combined with lifestyle intervention in patients with abdominal obesity may promote lipid metabolism by regulating the level of amino acids in the body through regulating L-valine.Lifestyle intervention in the treatment of abdominal obesity patients is to promote energy consumption by up-regulating L-serine and correcting the state of amino acid metabolism in the body.