吳擎添中醫師和吳宇琛中醫師，將會在節目中分享多年的臨床治療心得、介紹中醫保健養生知識、分享一些有特別意義的病例，重點介紹中醫骨傷科治療各種筋肌、骨關節創傷、勞損所致痛症的療效和心得，希望可以為受長期傷痛困擾的聽衆提供一些幫助。

淺談減肥

吳宇琛

SUM WU

Sum Wu

Registered Chinese Medicine Practitioner

Bachelor of Health Science in Traditional Chinese Medicine (UTS)

Bachelor of Science Majoring in Psychology (UOW)

Specialising in pain management and mental wellbeing through Tradition Chinese medicine in combination with modern science in mental health, dieting and nutrition.

吳宇琛，澳洲政府註冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，擅長用傳統針灸理傷手法和中藥治療各種新舊損傷痛症，特別採用中醫中藥和現代心理學、營養學相結合調理治療各種慢性病和亞健康。

I think one of the most frequently asked questions for anyone in the medical and health field is “how do I lose weight?” and modern science and society is on a never ending quest to solve this prevalent problem.

While we are currently still on the topic of food therapy I thought it would be amiss for me not try to at least touch on this subject as it is a very fascinating topic. I would like to devote this article and the next on this topic as it is a very dense subject. In this article I would like to introduce the concept of obesity and how it is viewed in TCM and how different patterns determine methods of treatment. While the next article will focus on how to approach this matter with food therapy.

我認為現在醫療和健康領域中最常問的問題之一是「我如何減肥？」現代科學和社會正在永無止境地尋求解決這個普遍問題。

雖然我們目前仍在討論食物療法的主題，但我認為或多或少我也應該涉及一下這個領域，因為這是一個非常有趣的主題。我想將這一輯節目和下一輯節目專門討論這個主題，因為這是一個非常有分量的主題。在這篇文章中，我想介紹一下肥胖的概念以及中醫如何看待肥胖，以及不同的模式如何決定治療方法，而下一篇文章將重點討論如何通過食療來解決這個問題。

According to the WHO “Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese， BMI is calculated by weight (kg) divided by height squared (cm x 2). The issue has grown to epidemic proportions, with over 4 million people dying each year as a result of being overweight or obese in 2017 according to the Global Burden of Disease.

Rates of overweight and obesity continue to grow in adults and children. From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5–19 years increased more than four-fold from 4% to 18% globally.”

根據世界衛生組織的說法：「超重和肥胖被定義為異常或過多的脂肪積累並對健康構成風險。體重指數 (BMI) 超過 25 被視為超重，超過 30 被視為肥胖，體重指數是體重除身高乘2。這一問題已發展成為全球流行病，根據全球疾病負擔報告，2017 年每年有超過 400 萬人因超重或肥胖而死亡。 成人和兒童的超重和肥胖率持續上升。從 1975 年到 2016 年，全球 5-19 歲兒童和青少年超重或肥胖的患病率增加了四倍多，從 4% 增加到 18%。」

There are many causes of overweight and obesity but the most common one are overconsumption of energy dense foods that are high in fat and sugars as well as a decrease in physical activity due to sedentary lifestyle which is promoted by modern conveniences such as ease of transport and fast foods. Other factors include medical causes such as hormonal imbalances as well as genetics and use of medication.

超重和肥胖的原因有很多，但最常見的一個是過度食用高脂肪和高糖的能量密集型食物，以及由於交通便利等現代便利設施所提倡的久坐生活方式而導致體力活動減少、快餐，其他因素包括荷爾蒙失衡等醫學原因以及遺傳和藥物使用。

In Su Wen it states that “if obesity occurs in the nobleman and rich people, they must be over consuming heavy and greasy foods” and historically ancient China knew about the links of obesity with other metabolic disorders such as diabetes and stroke.

在中醫典籍《素問》中指出：「肥貴人，則膏粱之疾也。」 （貴族、富人若出現肥胖，必定是飲食過多、油膩的食物），並且中國古代歷史上就已經認識到肥胖與糖尿病、中風等其他代謝性疾病的聯系。

One difference between the western and TCM perspective of weight is that in from the western theory is to exercise and eat a proper diet to target build-up of excess fat. TCM we do not directly treat excess weight but instead we need to look at the underlying body condition that lead to the weight gain and there is a saying “to treat the root to address the surface”. What this means is at the surface level we can only see the weight gain but the true cause, or the root, may not be a simple as lack of exercise or bad diet and once the body’s balance is restored then the body will function normally and weight will be lost.

西方和中醫對體重的看法之間的一個區別在於，西方理論是通過鍛煉和適當飲食來減少多余脂肪的積累。中醫不直接治療體重過重，而是需要看導致體重增加的內在原因，有句話叫「治本治表」。這意味著，從表面上看，我們只能看到體重增加，但真正的原因，或者說根源，可能不是簡單的缺乏運動或不良飲食，一旦身體恢復平衡，身體就會正常運轉，體重會減輕。

According to TCM, fat is classified as phlegm-damp and if you remember from the previous articles, the Spleen governs the transformation and transportation and this includes foods and body fluids, thus dampness. If the Spleen becomes damaged by eating excess of sweet food in combination with inactivity then its function to transform and transport is impaired. This means food and waste will linger and gather into dampness and over time it will congeal into phlegm and eventually fat.

We can further differentiate overweight and obesity into 4 types.

1. Excess internal phlegm and dampness
2. Stagnation of Qi and blood
3. Yang deficiency of Kidney and Spleen
4. Liver stagnation

根據中醫的說法，脂肪屬於痰濕，如果大家還記得之前的文章的話，脾主運化，包括食物和津液，脾虛則生濕。如果脾臟由於吃太多甜食加上缺乏活動而受損，那麼它的運化功能就會受損。這意味著食物和廢物會滯留並聚集成濕氣，隨著時間的推移，它們會凝結成痰，最終凝結成脂肪。

我們可以進一步將超重和肥胖分為4種類型。

1. 痰濕內盛
2. 氣血瘀滯
3. 腎脾陽虛
4. 肝郁

Excess internal phlegm and dampness

As mentioned earlier the spleen is in charge of moving dampness and when it is unable to it congeals into phlegm and turning into fat. The excessive internal phlegm manifests itself as excess weight, accompanied by tiredness, body heaviness, chest and stomach distension as well as poor appetite. To treat this pattern we need to harmonise the spleen and stomach to aid digestion with foods such as Hawthorn or using Yi Yi Ren and Fu Ling to make a soup or congee

痰濕內盛就像前面說過的，脾主運濕，不能運濕則凝結為痰，變成脂肪。痰濕過多表現為體重過重，並伴有疲倦、身體沉重、胸腹脹滿、食欲不佳等症狀。治療此病需調和脾胃助消化，可食用山楂等食物，或用薏苡仁、茯苓熬湯或煮粥。

Stagnation of Qi and blood

When Qi and blood is stagnant this leads to stasis in the vessels and blood thickens and the flow is impeded and over time can lead to arteriosclerosis or the thickening of the vessels and obesity. People suffering from this pattern may experience dizziness and numbness in the four limbs as well as low motivation, chest or breast fullness, insomnia, a dreamy state, menstrual disorder or amenorrhea and infertility. Red dates and Dang Gui are perfect for moving Qi and Blood.

氣血瘀滯

氣血瘀滯，血脈瘀滯，血液粘稠，運行不暢，久而久之，就會導致動脈硬化或脈管增厚，導致肥胖。患有此病的人會出現頭暈、四肢麻木、精神不振、胸悶、失眠、多夢、月經不調或閉經、不孕等症狀。紅棗和當歸最適合行氣血。

Yang deficiency of Kidney and Spleen

The spleen’s main function of transformation of foods to Qi is largely dependent on the Kidney Yang and conversely the Kidney Yang is dependent on the Spleen Yang. Without going into the intricacies of the spleen and kidney, we can summaries that if the kidney is weak then the spleen will be unable to provide Qi to the body and unable to move and transform the dampness. Congee with some easy to digest red meat is perfect to tonify the Spleen and Kidney Yang.

腎脾陽虛

脾主化食為氣的功能，很大程度上依賴於腎陽，反之，腎陽又依賴於脾陽。不說脾腎的複雜性，我們可以總結出，如果腎虛，脾就不能納氣，不能運化濕。粥配上一些簡單的紅肉，非常適合補脾腎陽。

Liver stagnation

Finally when the Liver Qi is stagnate this can lead to prolong periods of strong negative emotions such as anger and depressive symptoms. As the Liver Qi stagnates it will harm the Spleen and cause turbidity of Qi flow thus hindering the removal of dampness in the body. Tumeric, Ginger and sour foods such as lemon is great for moving Liver Qi.

肝郁

最後，當肝氣郁結時，可能會導致長時間的強烈負面情緒，例如憤怒和抑郁症狀。肝氣郁結，則傷脾而導致氣濁，妨礙體內濕氣的排除。姜黃、生姜和檸檬等酸味食物非常有助於疏肝理氣。

There are many more factors that can lead to overweight and obesity and patterns can also be slightly be different between different people but I hope this can provide everyone with a basic understanding of how we can address this issue with TCM. With some of the basics out of the way, next time we can have a look at how we might combat these problems with food therapy.

導致超重和肥胖的因素還有很多，不同人的情況也可能略有不同，但我希望這能讓每個人對如何用中醫解決這個問題有一個基本的了解。掌握了一些基礎知識後，下次我們可以看看如何通過食物療法來解決這些問題。

如有疑問想咨詢小吳醫師，可以在微信或whatsapp搜索0404836368，加小吳醫師微信或whatsapp，也可以發短信或致電0404836368作語音留言，小吳醫師有空就會回復。

（吳宇琛中醫師，澳洲政府註冊中醫師、針灸師，五龍崗大學心理學學士、悉尼科技大學中醫系學士，悉尼好思维松轩药行主治中医师，本文僅供參考，具體診療應諮詢專業人士。）