TCM Acupuncture and Massage

Chapter 56 Endocrine and Metabolic Diseases (3)
([-]) Diagnosis

1. Diagnostic criteria
The diagnostic criteria for hyperlipidemia determined in the recommendations for the prevention and treatment of dyslipidemia formulated in my country in 1997 are:

合适范围：血浆总胆固醇（TC）＜5.20毫摩尔／升（200毫克／分升），血浆甘油三酯（TG）＜1.70毫摩尔／升（150毫克／分升）；边缘升高：血浆总胆固醇（TC）：5.21～5.69毫摩尔／升（201～219毫克／分升）；高脂血症：血浆总胆固醇（TC）>；5.70毫摩尔／升（220毫克／分升）或／和血浆甘油三酯（TG）＞1.70毫摩尔／升（150毫克／分升）；低高密度脂蛋白胆固醇血症：＜0.91毫摩尔／升（35毫克／分升）
2. Who needs routine blood lipid testing

Blood lipid testing should be routinely performed for the following groups of people:
(1) Patients with coronary heart disease, cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm, and symptomatic carotid artery disease.

(2) People with a family history of atherosclerosis or coronary heart disease, especially those with early onset in immediate family members.

(3) Those with xanthoma.

(4) People with high blood pressure, diabetes, smoking and obesity.

(5) People who have been in a state of mental tension for a long time.

(6) Those with familial hyperlipidemia.

(7) Men over 40 years old and menopausal women can routinely undergo blood lipid testing.

3. Matters needing attention in blood lipid examination
(1) In order for the measurement results to reflect the stable state of the patient, the original regular diet should be maintained for at least 2 weeks before the first measurement, the weight should be kept stable, and any lipid-lowering drugs and hormones should be stopped.

(2) Patients are required to perform blood lipid test on an empty stomach, and avoid high-fat food and alcohol in the dinner the day before blood drawing, so as to avoid the influence on triglyceride.

(3) The patient should keep a comfortable sitting position for 5 to 10 minutes during blood collection, because changes in posture can affect plasma volume, thereby changing the levels of cholesterol and triglycerides.

(4) If abnormal blood lipids are found, reexamination should be performed within 4 to 8 weeks, and if the results are still abnormal, hyperlipidemia can be diagnosed.After abnormalities are found, further examination should be done under the guidance of a doctor to find out the cause and carry out corresponding treatment.

([-]) Related factors of hyperlipidemia
1. Relationship with gender and age There is no significant difference between men and women in infancy; cholesterol and low-density lipoprotein levels are similar between men and women when they are 20 to 50 years old; after 50 years old, women are significantly higher than men.The high-density lipoprotein of women before menopause is significantly higher than that of men, so the risk of suffering from coronary heart disease is much lower than that of men; after menopause, due to estrogen deficiency, it can lead to abnormal blood lipids and susceptibility to coronary heart disease.In addition, hyperlipidemia is more common in the elderly, which is because the body's ability to catabolize low-density lipoproteins decreases.Plasma cholesterol levels increase with age, peaking at age 65 for men and 70 for women.Since then, due to the reduction in the body's absorption of cholesterol and the decline in the ability of the liver to synthesize cholesterol, the plasma cholesterol level no longer increases or decreases.The influence of blood lipid levels on men and women is not exactly the same.At the same high cholesterol level, the risk of coronary heart disease in female patients is much lower than that in men; and 90% of women with elevated triglycerides are likely to suffer from coronary heart disease.Therefore, elevated triglycerides are probably the most risk factor for coronary heart disease in women; elevated cholesterol levels are the most risk factor for coronary heart disease in men.

2. Closely related to diet The incidence of hyperlipidemia has increased in recent years, and it is called "disease of affluence".Diet has a particularly pronounced effect on plasma lipids and lipoproteins.For example, animal protein, alcohol, and saturated fatty acids can lead to increased low-density lipoproteins; excessive intake of sugars can increase insulin, further accelerate the synthesis of very low-density lipoproteins in the liver, and finally form hypertriglyceridemia; cholesterol and animal Excessive fat intake can also cause hypercholesterolemia.

3. Relationship with drinking Alcohol has a relatively clear impact on blood lipid metabolism, which is related to the amount and type of drinking.Drinking a small amount of alcohol every day (no more than .50 grams) can improve lipid metabolism, reduce blood low-density lipoprotein, increase high-density lipoprotein, prevent lipid deposition, prevent arteriosclerosis, and reduce the incidence of coronary heart disease.Heavy drinking (more than 500 grams of alcohol per week) can increase blood very low-density lipoprotein and triglyceride, and accelerate atherosclerosis.

In addition, studies have shown that strong alcohol is more harmful to the human body, while red wine has a significant preventive effect on coronary heart disease.

4. Closely related to obesity Triglyceride, cholesterol and low-density lipoprotein cholesterol in obese people are significantly higher than normal people, while high-density lipoprotein cholesterol is significantly lower.Obesity can promote the liver to export apolipoprotein B, which increases the production of low-density lipoprotein and cholesterol.In addition, obese people are prone to hypertriglyceridemia due to fat accumulation.

5. Related to smoking Smoking can increase serum total cholesterol and triglyceride levels, and is positively correlated with smoking volume; smoking can lower blood high-density lipoprotein cholesterol, and is negatively correlated with smoking volume.This effect is mainly related to the increase of nicotine and carbon monoxide concentrations in the blood after smoking, which stimulates the sympathetic nerves, increases plasma free fatty acids, and releases lipids from adipose tissue.

6. Exercise and physical labor related to exercise can increase calorie consumption, increase the activity of lipoproteinase, accelerate the decomposition and clearance of lipids and lipoproteins in the blood, and finally make plasma cholesterol, triglycerides, low-density lipoprotein and very low-density lipoprotein Lipoprotein content decreased, high-density lipoprotein significantly increased.In addition, exercise also has the effect of losing weight.Generally speaking, the blood lipid level of mental work is higher than that of manual labor, and the blood lipid level of urban residents is higher than that of farmers, which is the reason.

7. Hyperlipidemia and cardiovascular diseases mainly invade large and medium arteries, leading to atherosclerosis (a disease in which the intima of the arterial lumen thickens and hardens, and the lumen narrows).In the early stage, it can be asymptomatic, and in the middle and late stages, arteries (coronary arteries, cerebral arteries, renal arteries, limb arteries, aorta) are involved.

([-]) Treatment

The prevention and treatment of hyperlipidemia is all about persistence, which is generally diet adjustment + smoking cessation, alcohol abstinence + exercise + drugs.

1. Diet therapy is the first step in treatment and should run through the whole process.The purpose is to reduce the intake of saturated fatty acids and cholesterol, increase the proportion of unsaturated fatty acids and polyunsaturated fatty acids; supplement the body's essential protein; control total calorie intake and increase physical activity to achieve calorie balance.The goal should be to prevent blood lipid elevation, reduce elevated blood lipid levels, and maintain reasonable nutritional needs.Reasonably allocate three meals a day, generally breakfast and dinner each account for 30%, and lunch accounts for 40%.Develop good eating habits such as balanced meals, regular meals, and chewing slowly.Overcome bad eating habits such as overeating, partial eclipse, irregular diet, alcoholism, night food, and fast food.Usually after 6 weeks of dietary therapy, the blood lipid level is rechecked.If it is not effective after strict diet control, drug treatment should be considered.

2. Exercise therapy Patients with hyperlipidemia should pay attention to choosing appropriate exercise and have a certain amount of exercise when exercising.Exercise forms generally include aerobic exercise and anaerobic exercise:

(1) Aerobic exercise Aerobic metabolism provides energy and consumes fat, such as walking, jogging, cycling, swimming, climbing, rope skipping, dancing, etc.

(2) Anaerobic exercise Anaerobic metabolism provides energy and consumes carbohydrates, such as weightlifting and sprinting.

高脂血症宜选择有氧运动。原则：有节律呼吸；缓慢而持续运动并保持一定强度；强度以运动时心率在100～125次每分钟，运动后心率不超过运动前50％为宜；每次时间在45～60分钟，每周4～5次。一般最宜选择步行和慢跑。

[-]. Point massage

([-]) Acupuncture therapy

1. Select acupoints Zhongwan, Fenglong, Neiguan, Fengchi, Yanglingquan, Yifeng, Zusanli.

2. Locate Zhongwan—on the front midline, 4 inches above the navel.

Fenglong—8 cun above the lateral malleolus, two transverse fingers outside the anterior crest of the tibia.

Neiguan—2 cun above the transverse crease of the wrist, between the flexor carpi radialis tendon and the palmaris longus tendon.

Fengchi—directly below the occipital tuberosity, in the depression between the sternocleidomastoid muscle and the upper end of the trapezius muscle.

Yanglingquan - in the depression below the head of the fibula.

Yifeng—between the mastoid process and the angle of the mandible, in the depression behind and below the earlobe.

Zusanli - 3 inches below the calf's nose, one transverse finger (middle finger) outside the anterior crest of the tibia.

([-]) Self-massage
1. Push the head with two palms and four fingers on the ventral side, push from the front hairline through Baihui point, to the back hairline, then pass through Dazhui point, and press more forcefully on Baihui point and Dazhui point.Then push the Gallbladder Meridian of Foot Shaoyang on both sides of the head, from the front hairline to the back hairline, emphatically push the Fengchi point in it.Finally, wipe the forehead with four fingers, from Yintang to temple.Push each part for 5 minutes.

2. Push the back and reverse the hand, use four fingers to push the bladder meridian of the foot sun on both sides of the spine from top to bottom, first push 1.5 inches away from the spine, and then push 3 inches away from the spine.

Then press the Shenshu and Mingmen points.Push each meridian for 5 minutes, and press each point 18 times.This method can be performed by another person with the help of another person.

3. Rubbing the abdomen Put the right hand on the abdomen, cover the left hand with the right hand, rub the entire abdomen with the palm for about 5 minutes.

gout
An overview of the disease

([-]) Relevant knowledge

Gout is a disease caused by long-term increase of blood uric acid.Uric acid is the final product of purine metabolism in the human body. It has no use value for human beings and can be regarded as the "garbage" of the human body.The long-term increase of blood uric acid will deposit in the joints and surrounding tissues, causing gouty arthritis. Gout most often affects the joints at the base of the big toe.Visceral damage can also occur in gout patients, the most common being uric acid deposition in the kidneys causing gouty nephropathy and gouty kidney stones.Gout is a chronic lifelong disease, the course of which can last for decades, and has the characteristics of intermittent attacks. When it does not attack, it can be the same as a normal person. Patients often don’t care about it. Even many clinicians don’t know enough about gout and misdiagnose it. And misdiagnosis occurs from time to time.Gout is rare in developed countries, but it is often seen in our country, so the knowledge of gout prevention and treatment urgently needs to be popularized. Ninety-five percent of people with gout are men, and the onset usually occurs in middle age.Female patients are rare and often develop after menopause.The reason for the gender difference is not very clear. It may be that men have more social activities, drink alcohol and eat meat, so they are prone to gout.Because estrogen in the body can promote the excretion of uric acid, women rarely suffer from gout before menopause, but after menopause, due to the sharp drop in estrogen levels in the body, the incidence of gout is close to that of men of the same age.Due to the continuous improvement of my country's living standards, gout-prone groups are not in the minority from former cadres, teachers, doctors, engineers, etc., to workers and farmers now.

([-]) Etiology and pathogenesis

The occurrence of gout is mainly related to hyperuricemia.The daily production and excretion of uric acid in the body are approximately equal. One-third of uric acid comes from food, two-thirds is self-synthesized in the body, and the excretion route is one-third from the intestines, and one-third The second is excreted from the kidneys.As long as there is a problem with any of the above-mentioned pathways, the uric acid metabolism will be out of balance, and the uric acid will accumulate in the body, resulting in an increase in the uric acid level in the blood. This is the so-called hyperuricemia.

The reasons for the increase of blood uric acid mainly include the following three aspects: increased uric acid production in the body; renal insufficiency, decreased renal excretion of uric acid; both increased production and decreased excretion.According to the cause of hyperuricemia, gout can be divided into two types: primary and secondary.The former accounts for the vast majority, about 90%, and has a certain family genetic tendency; the latter is about 10%.Both are caused by excessive production and decreased excretion.

([-]) Clinical manifestations

Gouty arthritis may involve any joint in the body, but the joints of the lower extremities are the most common sites. In 83% of patients, the first acute gouty arthritis occurs in the joints of the lower extremities, especially the distal ends of the lower extremities. The metatarsophalangeal joint (that is, the joint between the big toe and the dorsum of the foot) is the most common joint site for gout attacks.

Acute attacks are mostly without warning.Severe pain often occurs suddenly at night, and the pain site is concentrated and severe.At the same time, the affected joints showed redness, heat, and swelling, and the local skin was shiny and tender.Most gouts recur, initially sporadically, often in one joint.Each attack lasts for several days, and then the symptoms disappear completely until the next attack.However, as the number of attacks increases, the symptoms will last longer.The more frequent the attacks, the more joints are affected.Gout can become chronic as multiple joints are affected at the same time.Repeated attacks can cause permanent damage to the joints, including long-term pain and stiffness, limited mobility, and joint deformities.

Acute attacks of gouty arthritis are triggered by factors that include: high-purine diet, excessive fatigue, alcoholism, trauma, surgery, mental stress, exposure to cold, taking certain drugs, hunger, local joint damage, infection, wearing tight shoes , walk a lot and so on.Among them, high-purine diet and excessive fatigue are the most common predisposing factors, and many patients cannot find the predisposing factors.

([-]) Clinical staging

Gout is a lifelong disease. If gout is allowed to develop without treatment, it usually occurs in the following 4 stages in sequence:
1. Symptomatic hyperuricemia refers to patients who have never had a gouty arthritis attack, but a high uric acid level in the blood is accidentally found during a routine blood test.

2. The acute attack period of arthritis is the early stage of gout.

3. The intermission period of gout refers to the period without any symptoms after the onset of gouty arthritis.However, most patients will have a second attack within 1 to 2 years. If they do not continue to receive treatment, the frequency of attacks will increase over time, and the position of the painful joint will become fixed. Finally, tophi will form and enter a chronic disease. Tophi period.

4. In the chronic tophi stage, tophi usually appears in the subcutaneous tissue in the joint or next to the joint. After appearing, it gradually grows from small to large, but it does not necessarily cause pain. In the end, it may lead to joint deformation, affecting appearance and function.Except for the brain, uric acid crystals may precipitate in all organs of the body, especially the kidney is the main organ that excretes uric acid, and it is easy to precipitate and damage its structure and function.

([-]) Diagnosis

Most gout can be confirmed by its specific symptoms.Checking the concentration of uric acid in the blood is very helpful for diagnosis, and it is convenient and easy to do.Clinical diagnosis is based on performance and combined with inspection.But sometimes blood uric acid does not necessarily increase when gout attacks, on the contrary, arthritis accompanied by elevated blood uric acid is not [-]% diagnosed as gout.In addition, the most reliable way to diagnose gout is to extract a small amount of fluid from joints or gout stones during an attack and examine it under a microscope. If urate crystals are found, the diagnosis of gout can be made.The possibility of gout should be considered when:
1. Recurrent joint redness, swelling, heat and pain, the typical site is the metatarsophalangeal joint.Early attacks can be relieved without treatment, and the intermittent period is asymptomatic.

2. The treatment of arthritis with colchicine has special effects.

3. There is a clear family history of gout.

4. Middle-aged and elderly men, overweight or obese, with a history of high-purine diet.

5. Blood uric acid level is higher than normal.

6. If nodules are found under the skin around the joint or in the auricle, milky white toothpaste-like liquid will flow out when punctured.

7. Gout-related diseases, such as obesity, high blood pressure, coronary heart disease, arteriosclerosis, hyperlipidemia, and diabetes.

8. Unexplained urinary system stones, especially multiple kidney stones or bilateral extensive kidney stones.

([-]) Treatment

1. Principles of treatment
Reasonable diet control, adequate water intake, regular life regime, effective drug treatment, regular follow-up review.

2. Purpose of treatment
(1) Reduce uric acid synthesis, promote uric acid excretion, and correct hyperuricemia.

(2) Prevent acute attacks of gout and minimize the number of attacks.

(3) Prevention and treatment of tophi, gouty nephropathy and gouty urolithiasis.

(4) Prevention and treatment of diseases related to gout.

(5) Conduct health guidance scientifically to improve the quality of life.

(End of this chapter)