An Appreciation of Professor Zhou Xiaozhai's Medical Case on the Treatment of Obesity

Professor Zhou Xiaozhai (1899-1989) was a native of Rudong County, Jiangsu Province, and served as an associate professor at Nanjing University of Chinese Medicine. Born into a family of physicians, he studied medicine from an early age under his grandfather and a clan uncle, and began practising independently at the age of 22. Owing to his remarkable therapeutic results, he later became a renowned physician of traditional Chinese medicine (TCM) in Jiangsu Province. After liberation, he was recruited by the government to engage in teaching and clinical work. He was one of the founders of Nanjing College of Traditional Chinese Medicine (the predecessor of Nanjing University of Chinese Medicine) and also one of the founders of Jiangsu Province Hospital of Traditional Chinese Medicine.

Professor Zhou Xiaozhai was one of the founding figures of modern TCM education in China. He was responsible for compiling and reviewing the national unified textbook for colleges of traditional Chinese medicine, Lectures on Formulas of Chinese Medicine (Fangji Xue). Throughout his life he never interrupted his clinical work; practising medicine for more than sixty years, he accumulated rich clinical experience.

On July 10, 1978, Professor Zhou Xiaozhai, then 79 years old, saw a patient suffering from obesity. The patient, Ms. Dong, a woman, was 38 years old at the time of the visit. Her chief complaint was that her body had gradually become obese over the preceding five to six years, accompanied by dizziness, amenorrhea and milk leakage; by the end of 1976 her weight had increased to 88 kg, after which it remained essentially stable at that level.

On examination, Professor Zhou found that the patient presented with generalized, uniform obesity, with dizziness and tinnitus, an unsteady gait and a tendency to fall, heaviness and stiffness of the limbs, a weak grip of the hands, occasional palpitations, and the expectoration of a large amount of white, thick, sticky, frothy sputum; when the sputum was expectorated, she felt mentally clear and refreshed. She had a dry mouth with thirst and a desire to drink, her menstrual cycle was often delayed or absent, her tongue coating was greasy, and her pulse was deep and slippery.

Through pattern differentiation, Professor Zhou Xiaozhai concluded that this patient suffered from a syndrome in which phlegm was formed from food and drink, with phlegm congealing, qi stagnation and blood stasis, and that it was appropriate to treat her by the method of fortifying the spleen, drying dampness and resolving phlegm.

The first prescription was as follows: cangzhu (Atractylodes lancea, stir-baked) 6 g, baizhu (Atractylodes macrocephala, stir-baked) 6 g, fa banxia (processed Pinellia) 9 g, chenpi (aged tangerine peel) 6 g, fuling (poria) 15 g, heidoupi (black-bean coat) 9 g, raw yiyiren (Job's tears) 12 g, shichangpu (grassleaf flagrhizome) 3 g, zhuru (bamboo shavings) 9 g, heye (lotus leaf) 15 g, and geng tongcao (rice-paper pith) 3 g.

After the patient took 17 doses of the medicine, her abdominal circumference visibly decreased, her dizziness and palpitations were relieved, and her bowel movements occurred once every three or four days; her menstruation, though delayed, arrived about ten days later with a rather heavy flow that ended after five days; the expectoration of sputum had lessened but was still present, and the sputum remained thick and sticky; the tongue coating and pulse were unchanged from before. At the second visit it was considered appropriate to add herbs that invigorate the blood and unblock stasis.

The second prescription was as follows: processed banxia (Pinellia) 9 g, fuling (poria) 12 g, chenpi (aged tangerine peel) 5 g, zhike (stir-baked bitter orange) 9 g, zhuru (bamboo shavings) 6 g, fengxiaoxiao (mirabilite, taken separately with the decoction) 4 g, quan gualou (whole snakegourd fruit) 12 g, huomaren (hemp seed) 12 g, chuanbeimu (Sichuan fritillaria) 5 g, taoren (peach kernel) 6 g, shichangpu (grassleaf flagrhizome) 3 g, and heye (lotus leaf) 15 g.

After the patient took 24 doses of the above prescription, her weight decreased to 76.5 kg, her limbs became agile, both hands could stretch and grip freely, and her physical strength increased. She then took the above prescription intermittently for another 30 doses; at her final visit she had no remaining complaints, and treatment was therefore discontinued.

TCM regards obesity as a condition of a phlegm-dampness constitution, best treated by the method of fortifying the spleen, dispelling dampness and resolving phlegm. Professor Zhou Xiaozhai's medical case adopted precisely this line of treatment, with its base formula being Erchen Tang (Two-Aged Decoction) with modifications. As the patient had dizziness, grassleaf flagrhizome (shichangpu) was added to Erchen Tang to treat the dizziness; as her sputum was profuse and sticky, bamboo shavings (zhuru) were added to eliminate the phlegm; the lotus leaf (heye) in the formula has the effect of transforming dampness and reducing weight.

At the second visit the patient had a problem of constipation, passing stool only once every three to four days, so hemp seed (huomaren), whole snakegourd fruit (quan gualou), peach kernel (taoren) and the like were added to this base formula to moisten the intestines and promote bowel movements, while the peach kernel (taoren) additionally invigorates the blood and resolves stasis.

After taking the medicine, the patient's weight decreased from 88 kg to 76.5 kg in about two to three months, a total loss of 11.5 kg, which was truly no easy feat.

In the 1970s living standards in China were low; even urban residents had no means to eat rich, greasy food as they do today. That this patient remained obese under such circumstances may have been related to her genes. Professor Zhou's medical case provides an important reference for the treatment of obesity with TCM.