Causes and Pathogenesis of Obesity in Traditional Chinese Medicine

Causes and Mechanisms of Obesity in Traditional Chinese Medicine (TCM)
Body Composition and Weight Gain Factors
Human body weight comprises different components: skeletal muscle, adipose tissue (fat), bone, visceral organs, and other tissues. In adults, weight gain is primarily due to fluid retention and increased fat deposition, caused by an imbalance between energy intake and consumption.

From a TCM viewpoint, obesity is not solely about “eating too much and burning too little,” but is intrinsically linked to dysfunction in the spleen, stomach, and kidneys—organs responsible for transforming and transporting food.


TCM Pathogenic Patterns of Obesity
TCM identifies four primary pathogenic patterns underlying obesity:
1. Blood Stasis (瘀, Yū)
Blood stasis may result from Qi stagnation or accumulation of phlegm and dampness. The Huangdi Neijing refers to turbidity in the blood as zhuó zhī (浊脂), or “cloudy fat,” which can hinder the circulation of blood. These two—fat accumulation and blood stasis—may influence one another. In gynecology, obesity linked with infertility is often due to fat accumulation obstructing the uterus, preventing conception. This is elucidated in Yizong Jinjian (《医宗金鉴》), stating:
“Some people are corpulent, with abundant phlegm and fat clogging the uterus, making it hard to conceive.”

2. Qi Deficiency (气虚, Qì Xū)
Qi is the driving force for blood, fluids, and excretion. When Qi is deficient, circulation slows, fluids are retained, and cold may congeal them into lumps. Weak Qi also leads to poor transformation of nutrients, resulting in accumulation of dampness and phlegm—contributing to obesity.

3. Phlegm and Fluid Retention (痰饮, Tán Yǐn)
The Shishimilu (《石室秘录》) observes:
“Obese people often have excessive phlegm.”
Phlegm and retained fluids arise when the lungs, spleen, and kidneys fail in their fluid-regulating roles:
Lungs fail to disperse fluids, causing retention and phlegm.
Spleen can’t transform fluids properly if weak, leading to phlegm buildup.
Kidneys with weak Yang fail to metabolize fluids, leading to retention and phlegm.
These accumulations obstruct Qi, impair digestion, and contribute to body swelling.

4. Internal and External Dampness (水湿, Shuǐ Shī)
Dampness arises from external sources (e.g., humid climate) or internal causes (e.g., greasy, sweet food, alcohol). It disrupts metabolism and leads to obesity. The bodily fluids—phlegm, retained fluid, and excess water—represent varying densities of “dampness.” When they accumulate, especially water, they result in “water-retention obesity.”


TCM Obesity Types
1. Deficiency-Type Obesity (虚症肥胖)
Signs: soft muscles, pale complexion, Qi deficiency (fatigue), labored breathing on exertion, easy sweating, cold sensitivity, cold hands/feet.
2. Excess-Type Obesity (实症肥胖)
Signs: frequent hunger and thirst, high food and fluid intake, poor sleep, dry mouth/tongue, abdominal fullness or discomfort, constipation, occasional dizziness or headache resembling hypertension.
Lifestyle Recommendations Based on TCM
A. Dietary Adjustments (饮食调养)
Favor warm, easily digestible foods: congee, brown rice, vegetable soups, mild broths.
Avoid cold, greasy, sweet, or raw foods (e.g., ice, ice cream, cold drinks)—they weaken the spleen and increase dampness.
Incorporate moisture-eliminating foods: red beans, barley, wax gourd, job's tears.
Eat moderate portions; avoid overeating.
B. Daily Habits (起居养生)
Ensure sufficient sleep, avoid late nights to allow spleen and kidneys to recover.
Maintain regular physical activity—brisk walking, yoga, Tai Chi—to stimulate Qi movement and expel dampness.
Avoid prolonged sitting; inactivity increases Qi stagnation and damp accumulation.
C. Emotional Well‑being (情志调养)
Stress and worry can cause Liver Qi stagnation, affecting the spleen and leading to dampness.
Practice relaxation: deep breathing, meditation, calming music.
Although heredity plays a role, modern lifestyle significantly contributes to obesity—from nutritional ignorance and poor metabolic habits to sedentary lifestyle and inadequate rest. Obesity increases the risk of cardiovascular and respiratory diseases, Alzheimer’s, osteoarthritis, and certain cancers. Effective treatment must match the patient’s body constitution with a personalized strategy.

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Article by:

张月芳 中医师
TCM Physician Kanittha Jaiyen Saengsakul (Zhang Yue Fang)