How Does TCM View Obesity and Its Causes?

As early as in the Han dynasty, TCM practitioners recorded the symptoms, mechanism and risk factors of obesity. The Suwen (The Book of Plain Questions) states in chapter 28: "If obesity occurs in the nobleman and rich people, they must be over consuming heavy and greasy foods." Similar to the modern understanding of obesity, associated risk factors include undesirable eating habits, under exercising, body constitution and mental state. The ancient Chinese also knew obesity has close links with metabolic disorders such as diabetes and other conditions such as stroke or chest pain.

The spleen is said to be at the root of all phlegm production.

TCM does not treat "excess weight" per se; rather it deals with the underlying body condition that may have led to the excess weight. Once the body's balance is restored, the metabolism will process food properly and excess weight should no longer be a problem provided correct foods are eaten in moderate quantities. Specifically, TCM holds that fat or adipose tissue is mostly due to phlegm and dampness evils. The spleen is said to be at the root of all phlegm production and is involved in the transportation and transformation of body fluids and foods. If the spleen becomes damaged by eating too many sweet foods and getting too little exercise, it will fail in its duty to move and transform waste fluids and foods. Instead these metabolic wastes will gather, collect and transform into dampness evils. If dampness evils endure over time, they will congeal into phlegm, and become fat tissue.

TCM takes a holistic approach to obesity by focussing on the underlying changes in the body. According to TCM principles, development of obesity is due to the following pathological changes.

1. Dyspepsia causes stomach heat and poor spleen functioning

Over consumption of heavy, greasy and spicy foods or alcohol facilitate production of heat evils in the stomach. Meanwhile, inadequate exercise after eating these types of foods damages the spleen function. The over-heated stomach will ripen an excessive amount of food.Therefore, the stomach will digest food easier and make an individual feel hungry, but the spleen cannot handle an excessive food load causing it to under function and be unable to carry out its transformation and transportation functions properly. As a result, the spare metabolic products turn into turbid fluid and phlegm which intermix with blood and qi (vital energy) filling up the organs, bones and muscles.

2. Exogenous evils giving rise to obesity

Invasion of exogenous evils or over consumption of greasy foods leads to poor transformation and transportation functions of the spleen. Dampness evils then begin to accumulate in the middle burner, which is part of the triple burner (the passage through which water, food and fluid are transported). When dampness and turbid fat enter these passages, they are further distributed by the lungs, allowing penetration into all the organs internally. Additionally, exogenous evils can also penetrate the skin, subcutaneous tissue and muscles through the body's surface giving rise to obesity.

3. Qi (vital energy) stagnation causes turbid phlegm accumulation

For those who are emotionally disturbed, experience trauma, have menstruation problems or are elderly, the liver can fail to regulate qi (vital energy) flow which in turn affects digestion and blood flow. The resulting sluggish qi (vital energy) and blood flow tend to block the meridians. Therefore, in these people, dampness is likely to endure in the body. Over time, this will congeal into phlegm and result in obesity.

4. Kidney essence exhaustion leads to disharmony

Lifestyles, which consume kidney essence, such as being sexually over active can lead to the excitation of the internal ministerial fire. The excessive ministerial fire is a kind of "evil fire" which makes the body produce an over abundance of heat. This "evil fire" affects the middle burner, leading to a malfunction of the stomach and spleen. When this persists over a long period, the vaporization processes in the bladder and triple burner are impaired causing more evils to accumulate and worsen the obesity condition.

From TCM experience, the clinical status of a person with obesity can change leading to a complex diagnosis during consultation. The above causes of obesity can appear together or separately. In short, the fundamental causes of obesity are spleen and kidney deficiencies, which manifest as an overflow of body fluids, accumulation of dampness and phlegm evils and stagnation in blood flow. Sometimes stomach heat and qi (vital energy) stagnation are associated. Moreover, improper vaporization of body fluids by the triple burner may also appear. All of these factors play an important role in the development of obesity.

The pathological changes in obesity. A. Dyspepsia causes stomach heat and poor spleen functioning; the spare metabolic products turn into turbid fluid and phlegm. B. When dampness and turbid fat enters the water passages, they are further distributed by the lungs, allowing penetration into all the organs internally. C. The liver can fail to regulate qi (vital energy) flow that in turn affects digestion and blood flow. The resulting sluggish qi (vital energy) and blood flow tend to block the meridians. D. Kidney essence exhaustion leads to disharmony; the vaporization processes are impaired causing more fluid accumulation.