Appreciation of Zhou Xiaozhai's Case of Treating Obesity

Zhou Xiaozhai (1899–1989) was a native of Rudong County, Jiangsu Province, and before his death an associate professor at Nanjing University of Chinese Medicine. Born into a medical family, he studied medicine from childhood with his grandfather and paternal uncle, began practicing independently at 22, and later, owing to his outstanding results, became one of Jiangsu's renowned TCM physicians. After the founding of the People's Republic, at the government's invitation he engaged 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 of Jiangsu Provincial Hospital of Traditional Chinese Medicine.

Professor Zhou Xiaozhai was one of the founders of modern TCM education in China; he was responsible for compiling and reviewing the national unified TCM textbook, Lectures on Formulaology. He never interrupted clinical work throughout his life, practicing medicine for more than 60 years and amassing rich clinical experience.

On July 10, 1978, when already 79, Professor Zhou Xiaozhai saw an obese patient. The patient, surnamed Dong, was a 38-year-old woman. Her chief complaint was that over five or six years her body had gradually grown obese, accompanied by vertigo, amenorrhea, and galactorrhea; by the end of 1976 her weight had reached 88 kg and basically stabilized there.

Professor Zhou found the patient to have generalized (uniform) obesity, vertigo and tinnitus, unsteady gait with occasional tendency to fall, heavy and sluggish limbs, weak grip, occasional palpitations, and coughing up large amounts of white, thick, sticky, fine frothy sputum that left her feeling clear and refreshed once expectorated. Her mouth was dry and she wanted to drink; menstruation was often delayed or absent; the tongue coating was greasy and the pulse deep and slippery.

Professor Zhou differentiated this as a pattern of phlegm generated from food and water, with phlegm congelation, qi stagnation, and blood stasis; treatment should fortify the spleen, dry dampness, and resolve phlegm.

The initial prescription was: Chao Cangzhu 6g, Chao Baizhu 6g, Fabanxia 9g, Chenpi 6g, Fuling 15g, Heidoupi 9g, Sheng Yiyiren 12g, Shichangpu 3g, Zhuru 9g, Heye 15g, Gengtongcao 3g.

After 17 doses, her abdominal girth had clearly shrunk, vertigo and palpitations had lessened, and she had a bowel movement every three to four days; menstruation came ten days late, was fairly heavy, and ended in five days; although sputum expectoration decreased, it persisted and remained thick and sticky; tongue coating and pulse were as before. On the second visit, he considered adding herbs that invigorate blood and unblock stasis.

The second-visit prescription was: Zhibanxia 9g, Fuling 12g, Chenpi 5g, Chao Zhiqiao 9g, Zhuru 6g, Fenghuaxiao (taken in divided doses with the decoction) 4g, Gualou 12g, Huomaren 12g, Chuanbeimu 5g, Taoren 6g, Shichangpu 3g, Heye 15g.

After 24 doses of the above, the patient's weight fell to 76.5 kg; her limbs became agile, both hands opened and closed freely, and her strength increased. She then took another 30 doses intermittently, and on her final visit had no discomfort. Treatment was therefore stopped.

TCM holds that obesity belongs to a phlegm-dampness constitution and should be treated by fortifying the spleen, draining dampness, and resolving phlegm. Professor Zhou's case follows exactly this approach, with a modified Erchen Tang as the base. Since the patient had vertigo, Shichangpu was added to Erchen Tang to treat it; since her sputum was profuse and thick, Zhuru was added to resolve phlegm; the Heye in the formula transforms dampness and reduces weight.

On the second visit, the patient had constipation with a bowel movement only every 3–4 days, so Huomaren, Gualou, and Taoren were added to moisten the intestines and unblock the bowels; Taoren also invigorates blood and resolves stasis.

After taking the medicine, the patient's weight fell from 88 kg to 76.5 kg in about two to three months—a total loss of 11.5 kg, which is no small achievement.

In the 1970s living conditions in China were poor; even city dwellers did not have the rich meat-and-fish diet of today. That this patient was obese under such conditions may have been related to her genes. Professor Zhou's case provides an important reference for using TCM to treat obesity.