1. Lishui Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang Chinese Medical University, Lishui, Zhejiang 323000, China; 2. Laozhu She Ethnic Township Central Health Center, Liandu District, Lishui, Zhejiang 323000, China
Abstract：Obesity is characterized by a body weight exceeding a certain range and a corpulent physique, often accompanied by symptoms such as dizziness and fatigue, lack of energy and motivation to speak, reduced physical activity, and shortness of breath. The core pathogenesis of obesity lies in the dysfunction of the spleen and stomach in transporting and transforming nutrients, leading to abnormal metabolism of water and grain essences and the subsequent accumulation of pathological substances such as phlegm-dampness and "Gaozhuo" (greasy-turbid substances). Traditional Chinese Medicine emphasizes that "spleen deficiency is the root cause, while phlegm-dampness and Gaozhuo are the manifestations", forming a dialectical system encompassing theories on spleen-stomach transportation and transformation, phlegm-dampness pathogenesis, Gaozhuo pathogenesis, and constitutional differentiation. Traditional Chinese Medicine plays a crucial role in preventing and treating obesity through interventions such as herbal medicine, external therapies, and dietary adjustments. This article systematically reviews classical Chinese medical texts, focusing on the etiology, pathogenesis, theoretical origins, and prevention and treatment methods of obesity, so as to provide references for modern Traditional Chinese Medicine approaches to obesity prevention and treatment.
[1] 中华人民共和国国家卫生健康委员会.中国居民营养与慢性病状况报告(2020年)[J].营养学报,2020,42(6):521. National Health Commission of the People's Republic of China.Report on the nutrition and chronic diseases status of Chinese residents 2020[J].Acta Nutr Sin,2020,42(6):521.(in Chinese) [2] SUN X M,YAN A F,SHI Z M,et al.Health consequences of obesity and projected future obesity health burden in China[J].Obesity,2022,30(9):1724-1751. [3] PAN X F,WANG L M,PAN A.Epidemiology and determinants of obesity in China[J].Lancet Diabetes Endocrinol,2021,9(6):373-392. [4] KIVIMÄKI M,KUOSMA E,FERRIE J E,et al.Overweight,obesity,and risk of cardiometabolic multimorbidity:pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe[J].Lancet Public Health,2017,2(6):277-285. [5] 侯瑞芳,陶枫,陆灏,等.肥胖的中医治疗进展[J].中华中医药学刊,2015,33(8):1959-1962. HOU R F,TAO F,LU H,et al.Progress of traditional Chinese medicinal research on obesity[J].Chin Arch Tradit Chin Med,2015,33(8):1959-1962.(in Chinese) [6] 高艺玮,郭洪波.中医药防治肥胖的研究进展[J].中国药物与临床,2025,25(9):573-578. GAO Y W,GUO H B.Research progress of Traditional Chinese Medicine in preventing and combating obesity[J].Chin Remedies Clin,2025,25(9):573-578.(in Chinese) [7] 黄帝内经素问[M]黄帝内经素问[M].田代华,整理.北京:人民卫生出版社,2017. [8] 张仲景. 金匮要略[M].何任,何若苹,整理.北京:人民卫生出版社,2017. [9] 李杲. 脾胃论[M].北京:中国中医药出版社,2019. [10] 史周莹,陈积宏,李慧欣,等.朱丹溪辨治肥胖症学术思想探析[J].中华中医药杂志,2024,39(8):4406-4409. SHI Z Y,CHEN J H,LI H X,et al.Analysis of ZHU Danxi's academic thoughts on the differentiation and treatment of obesity[J].China J Tradit Chin Med Pharm,2024,39(8):4406-4409.(in Chinese) [11] 张介宾.景岳全书(上)[M].李继明,整理.北京:人民卫生出版社,2017. [12] 陈士铎. 石室秘录[M].王树芬,裘俭,整理.北京:人民卫生出版社,2006. [13] 祝成,张进军,王小庆,等.张进军运用调肝化痰法治疗肥胖经验[J].河南中医,2024,44(4):525-528. ZHU C,ZHANG J J,WANG X Q,et al.ZHANG Jinjun's experience of treating obesity by regulating the liver and resolving phlegm[J].Henan Tradit Chin Med,2024,44(4):525-528.(in Chinese) [14] 陈汉旭,刘家祺,杨水浩,等.国医大师邓铁涛基于“五脏相关”学说辨治肥胖症经验[J].中国中医药信息杂志,2022,29(12):133-135. CHEN H X,LIU J Q,YANG S H,et al.Experience of national TCM master DENG Tietao in treating obesity based on the“five viscera related”theory[J].Chin J Inf Tradit Chin Med,2022,29(12):133-135.(in Chinese) [15] 田晓燕,孙升云.从肝论治腹型肥胖[J].四川中医,2008,26(4):15-17. TIAN X Y,SUN S Y.The liver-oriented therapeutic approach for abdominal obesity[J].J Sichuan Tradit Chin Med,2008,26(4):15-17.(in Chinese) [16] 朱震亨. 丹溪治法心要[M].北京:人民出版社,1983. [17] 杨玲玲,倪诚,李英帅,等.王琦治疗肥胖经验[J].中医杂志,2013,54(21):1811-1813. YANG L L,NI C,LI Y S,et al.WANG Qi's therapeutic approach to obesity:a summary of clinical experience[J].J Tradit Chin Med,2013,54(21):1811-1813.(in Chinese) [18] 徐珊珊,龚美蓉,孙亦农.从脾胃论治单纯性肥胖[J].辽宁中医杂志,2015,42(3):628-629. XU S S,GONG M R,SUN Y N.Simple obesity treatment from spleen and stomach[J].Liaoning J Tradit Chin Med,2015,42(3):628-629.(in Chinese) [19] 周雯,陆霖峰,叶佳超,等.基于中医“痰湿”理论的肠道菌群及其代谢物与肥胖关系探讨[J].世界科学技术-中医药现代化,2024,26(8):2081-2088. ZHOU W,LU L F,YE J C,et al.Discussion on the relationship between intestinal flora and its metabolites with obesity based on the theory of“phlegm-dampness”in Chinese medicine[J].Mod Tradit Chin Med Mater Med World Sci Technol,2024,26(8):2081-2088.(in Chinese) [20] 王士艳,陆清波,华文进.苍附导痰汤加减辅助治疗脾虚痰湿型女性肥胖的疗效观察[J].辽宁中医杂志,2025,52(10):121-124. WANG S Y,LU Q B,HUA W J.Therapeutic effect of the modified Cangfu Daotan decoction in adjunctive use for female obesity with spleen deficiency and phlegm-dampness constitution[J].Liaoning J Tradit Chin Med,2025,52(10):121-124.(in Chinese) [21] 傅山. 傅青主女科[M].北京:中国中医药出版社,2019. [22] 喻松仁,王萍,舒晴,等.肥胖痰湿衍变规律探析[J].中华中医药杂志,2018,33(4):1483-1485. YU S R,WANG P,SHU Q,et al.Analysis of the evolution of phlegm-dampness in obesity[J].China J Tradit Chin Med Pharm,2018,33(4):1483-1485.(in Chinese) [23] 吴玉琦,王琦,姚海强,等.从后生元的角度探讨痰湿体质脾失健运易发代谢紊乱的内在机制[J].中华中医药杂志,2022,37(12):7455-7458. WU Y Q,WANG Q,YAO H Q,et al.Discussion on the mechanism of spleen dysfunction easily leading to metabolic disorder in phlegm-dampness constitution from postbiotics[J].China J Tradit Chin Med Pharm,2022,37(12):7455-7458.(in Chinese) [24] 虞晓含,朱燕波,王琦,等.体重指数与中医体质类型的对应分析[J].中医杂志,2015,56(2):105-107. YU X H,ZHU Y B,WANG Q,et al.Analysis on relationship between body mass index and traditional Chinese medicine constitution type[J].J Tradit Chin Med,2015,56(2):105-107.(in Chinese) [25] 张介宾. 类经[M].北京:中版集团数字传媒有限公司,2020. [26] 马一铭,徐云生,王新陆.王新陆基于“血浊”辨治代谢综合征经验[J].中医杂志,2023,64(22):2287-2290,2299. MA Y M,XU Y S,WANG X L.WANG Xinlu's experience in treating metabolic syndrome based on“blood turbidity”theory[J].J Tradit Chin Med,2023,64(22):2287-2290,2299.(in Chinese) [27] 王键. 中医基础理论[M].2版.北京:中国中医药出版社,2016. WANG J.The foundation of traditional Chinese medicine[M].2nd.Beijing:China Press of Traditional Chinese Medicine,2016.(in Chinese) [28] 魏静. 从“膏浊致病”理论浅析肥胖症[J].安徽中医药大学学报,2021,40(2):7-9. WEI J.A brief analysis of obesity from the perspective of the“Gaozhuo pathogenesis”theory[J].J Anhui Univ Chin Med,2021,40(2):7-9.(in Chinese) [29] 秦培洁. 消膏降浊方对高脂饮食诱导的肥胖大鼠的蛋白质酪氨酸磷酸酶1B-胰岛素抵抗通路的影响研究[D].北京:中国中医科学院,2010. QIN P J.The research on protein tyrosine phosphatase 1B-insluin resistance pathway of diet-induced obese rats by resolving paste and turbidity[D].Beijing:China Academy of Chinese Medical Sciences,2010.(in Chinese) [30] 张仲景. 伤寒杂病论[M].北京:北京简读互动文化有限公司,2024. [31] 黄元御. 金匮悬解[M].麻瑞亭,孙洽熙,校注.北京:人民卫生出版社,2024. [32] 尹艳,王世燕,孙志新,等.1 554例超重/肥胖人群的中医体质类型分析及临床防治思路探索[J].中医药信息,2020,37(2):64-69. YIN Y,WANG S Y,SUN Z X,et al.Types analysis of TCM body constitution of 1 554 cases of overweight/obese people and exploration for clinical prevention and treatment[J].Inf Tradit Chin Med,2020,37(2):64-69.(in Chinese) [33] 朱震亨. 丹溪心法[M].王英,竹剑平,江凌圳,整理.北京:人民卫生出版社,2017. [34] 王琦. 9种基本中医体质类型的分类及其诊断表述依据[J].北京中医药大学学报,2005,28(4):1-8. WANG Q.Classification and diagnosis basis of nine basic constitutions in Chinese medicine[J].J Beijing Univ Tradit Chin Med,2005,28(4):1-8.(in Chinese) [35] 孙思邈. 备急千金要方[M].影印本.北京:人民卫生出版社,2022. [36] 中华中医药学会《中医体重管理临床指南》专家组,广东省针灸学会肥胖专病联盟.肥胖症中医诊疗方案专家共识[J].北京中医药大学学报,2022,45(8):786-794. Experts group of Clinical Guideline for Traditional Chinese Medicine Weight Management of China association of Chinese medicine,Obesity specialty alliance of Guangdong provincial association of acupuncture and moxibustion.Expert consensus on diagnosis and treatment of obesity in TCM[J].J Beijing Univ Tradit Chin Med,2022,45(8):786-794.(in Chinese) [37] 陆佳雯,朱国琴,高崎,等.中药活性成分基于3T3-L1细胞系模型干预肥胖及相关脂质代谢疾病的分子机制研究进展[J].中华中医药杂志,2025,40(4):1860-1867. LU J W,ZHU G Q,GAO Q,et al.Research progress on the molecular mechanism of active ingredients of traditional Chinese medicine in the intervention of obesity and related lipid metabolic disease based on 3T3-L1 cell line model.[J].China J Tradit Chin Med Pharm,2025,40(4):1860-1867.(in Chinese) [38] 灵枢经[M]灵枢经[M].田代华,刘更生,整理.北京:人民卫生出版社,2017. [39] 李柏旻,文茜,张银,等.单纯性肥胖的针灸治疗原理与疗效[J].当代医药论丛,2025,23(8):23-26. LI B M,WEN Q,ZHANG Y,et al.Princinples and curative effects of acupuncture in treating simple obesity[J].Contemp Med Symp,2025,23(8):23-26.(in Chinese) [40] 包鹃,卓少元,廖彩云,等.固本培元、健脾和胃针刺法对肥胖大鼠肝组织Leptin介导的JAK2/STAT5α/PGE2信号通路的影响[J].世界科学技术-中医药现代化,2025,27(9):2753-2760. BAO J,ZHUO S Y,LIAO C Y,et al.Effects of“gubenpeiyuan,Jianpi hewei”acupuncture on JAK2/STAT5α/PGE2 signaling pathway mediated by leptin in liver tissue of obese rats[J].Mod Tradit Chin Med Mater Med World Sci Technol,2025,27(9):2753-2760.(in Chinese) [41] 马永利,李华南,马菲.中医外治法治疗单纯性肥胖的临床研究[J].西部中医药,2019,32(7):58-61. MA Y L,LI H N,MA F.Clinical study on TCM external therapy in the treatment for simple obesity[J].West J Tradit Chin Med,2019,32(7):58-61.(in Chinese) [42] 黄宫绣. 本草求真[M].北京:北京简读互动文化有限公司,2024. [43] 李时珍著. 本草纲目——金陵版排印本[M].3版.王育杰,整理.北京:人民卫生出版社,2023. [44] 赵鹏葳,简敬一,任孟月.药食同源中药治疗肥胖症的有效成分和机制研究进展[J].广东药科大学学报,2021,37(3):141-149. ZHAO P W,JIAN J Y,REN M Y.Progress on effective components and mechanism of medicinal and edible traditional Chinese herbs in treating obesity[J].J Guangdong Pharm Univ,2021,37(3):141-149.(in Chinese) [45] 陈净殊. 中医传统运动处方治疗代谢综合征的临床观察[D].北京:北京中医药大学,2017. CHEN J S.Clinical observation on traditional Chinese medicine exercise prescriptions for treating metabolic syndrome.Beijing:Beijing University of Chinese Medicine,2017.(in Chinese) [46] 付雅鑫,张洁,李盼,等.中医传统运动养生功法对机体的调节作用[J].黑龙江科学,2021,12(16):82-83. FU Y X,ZHANG J,LI P,et al.Regulating effect of traditional exercise regimen of traditional Chinese medicine on body[J].Heilongjiang Sci,2021,12(16):82-83.(in Chinese) [47] 靖林. 《庄子》释义[M].北京:新华出版社,2016. [48] 吕不韦. 吕氏春秋[M].臧宪柱,译.北京:北京联合出版公司,2015. [49] 刘涛,白石,张荣超.健身气功八段锦对肥胖中年女性糖尿病患者相关指标的影响[J].中国应用生理学杂志,2018,34(1):19-22. LIU T,BAI S,ZHANG R C.Effects of Health Qigong Baduanjin on diabetes related indexes in middle-aged obese women[J].Chin J Appl Physiol,2018,34(1):19-22.(in Chinese)
