Traditional Chinese Medicine (TCM) principles of weight loss and prevention: Strengthening the body's resistance, resolving phlegm and dampness to achieve both symptomatic and root-cause treatment.

Traditional Chinese medicine (TCM) considers the human body to be an organic whole, centered on the five internal organs (Zang, Zang, and Fu). When the five internal organs function normally, the body's vital energy (Qi) is abundant, resulting in good health and the ability to resolve phlegm and dampness. Conversely, if the five internal organs are deficient or dysfunctional, it can damage the body's vital energy, impair health, and gradually weaken the body's ability to resolve phlegm and dampness, leading to an accumulation of phlegm and dampness and ultimately obesity. The *Fei Zuan* states, "Generally, those with a strong constitution have no major health problems, except for a significant amount of phlegm and dampness." The *Yi Zong Jin Jian* says, "A robust body produces much phlegm." The *Danxi Xin Fa* states, "Phlegm originates in the spleen," and "Obese people are lethargic and listless due to Qi deficiency." The *Su Wen Yi Pian* says, "When the spleen and kidneys are deficient in Qi, their function of transformation and distribution is impaired, leading to a mixture of clear and turbid substances, failure to transform essence and blood, and the accumulation of fat, phlegm, and turbidity, resulting in obesity." The renowned Qing Dynasty physician Chen Xiuyuan stated, "Obese people often have excessive phlegm, dampness, and Qi deficiency."

The *Suwen* (Plain Questions) chapter on "Strange Diseases" states, "Obesity causes internal heat, and sweetness causes fullness in the middle, thus the qi overflows upwards and transforms into diabetes." "Diabetes" refers to this condition. Modern medicine points out the close relationship between obesity and diabetes; however, our ancestors knew more than two thousand years ago that obesity could lead to diabetes. The *Suwen* chapter on "The Vital Energy Connecting Heaven" states, "Excessive sweetness causes shortness of breath, fullness in the heart, a dark complexion, and disharmony of kidney qi," indicating that excessive consumption of sweet foods, besides causing obesity, can also affect heart and kidney function, and easily lead to shortness of breath and a dark complexion.

Lack of exercise reduces calorie expenditure, leading to excess calories that accumulate in the body and cause obesity. The ancient medical text *Introduction to Medicine* discusses this, stating, "Prolonged lying or sitting weakens the body's vital energy, causing impaired digestion and disrupting the body's balance, resulting in the accumulation of fat and obesity." Modern research indicates that obesity can affect sexual function and reproductive capacity; the *Golden Mirror of Medicine* also points out that "obstruction of the uterus by fat membranes leads to infertility," being the first to suggest that obesity may cause female infertility.

The book *Traditional Chinese Medicine on Joint Pain* states, "Obese people with thick, weak pulses, shortness of breath, spontaneous sweating, joint pain, and inability to bend or stretch," and "The alteration of rich, fatty foods leads to boils on the feet." This indicates that obese people, due to excess fat and poor blood circulation, may experience symptoms such as insufficient heart qi, shortness of breath, spontaneous sweating, and joint pain; it also points out that frequently consuming fatty foods easily leads to boils. Consulting classical Chinese medicine texts reveals that our ancestors were already aware of obesity. Ancient records indicate that many Chinese herbs can be used to treat obesity, and weight-loss formulas are countless. It is believed that traditional Chinese medicine for weight loss has great potential for development in the future.

Traditional Chinese medicine (TCM) views the human body as an organic whole, centered on the five internal organs (Zang, Zang, and Fu). Each organ has unique physiological functions, but they do not operate independently. Instead, they interact through the five elements (Wu Xing) – mutual generation and restraint, mutual support and nourishment – ​​maintaining a balanced and stable physiological state. When the five organs are in harmony, normal physiological products are produced: Qi, blood, and body fluids. If bodily functions are imbalanced, pathological products such as phlegm, dampness, fat, and turbidity can be generated. As stated in the *Suwen* (Plain Questions) chapter "Lost Chapters": "When the Qi of the spleen and kidneys is deficient, the function of transportation and transformation is impaired, leading to the mixing of clear and turbid substances, failure to transform essence and blood, and the accumulation of fat, phlegm, and turbidity, resulting in obesity." The *Leizheng Zhicai* (Classified Treatments) states: "Without dampness, the spleen cannot produce phlegm."

When the internal organs function normally, the body's vital energy (Qi) is abundant, and pathological products such as phlegm, dampness, fat, and turbidity are not produced. Conversely, when the body's internal organs are dysfunctional and vital energy is deficient, pathological products such as phlegm, dampness, fat, and turbidity will inevitably arise. The more phlegm and dampness accumulate in the body, the more robust the physique becomes, and the more vital energy is depleted, leading to a gradual decline in the function of the internal organs. Vital energy and phlegm and dampness have a relative relationship of waxing and waning; when the body's vital energy is abundant, phlegm and dampness will subside; conversely, the more phlegm and dampness accumulate, the weaker the vital energy becomes.

Understanding the relationship between vital energy (正气) and phlegm-dampness (痰湿) clarifies the direction of weight loss. Treatment of obesity should address both aspects: boosting vital energy and regulating organ function, and resolving phlegm-dampness and eliminating fat. However, specific treatment methods must be tailored to the nature of the disease, the strength or weakness of the organs, the relationship between pathogenic factors and vital energy, and the severity of the root cause and symptoms. As stated in the *Ling Shu* (灵枢), "There are those who are fat, those who are greasy, and those who are fleshy... one must first distinguish their type, the amount of blood, and the purity or turbidity of their qi, and then regulate them."

Obesity is a very complex disease. Instead of spending money, time, and energy treating it, prevention is far better. Traditional Chinese medicine has always emphasized disease prevention, with the concept of "treating disease before it manifests" already proposed in the *Huangdi Neijing* (Yellow Emperor's Inner Classic). The *Suwen* (Plain Questions) states, "The sage does not treat disease that has already manifested, but rather disease that has not yet manifested; he does not treat disorder that has already arisen, but rather disorder that has not yet arisen... To administer medicine after disease has developed, or to govern after disorder has arisen, is like digging a well when thirsty, or forging a weapon when already in battle-is it not too late?" Therefore, those who have not yet gained weight or have already gained a little should take preventative measures to actively avoid developing obesity.

The saying goes, "Prevention is better than cure, and prevention is better than cure." Before obesity develops, it's essential to take preventative measures, including regulating one's mental state, increasing exercise, maintaining a balanced diet, balancing work and rest, nourishing the body, strengthening vital energy, and eliminating phlegm and dampness. If obesity has already developed, it's crucial to prevent its worsening. If obesity continues to worsen, in addition to an increasingly bloated physique, the imbalance of internal organs will also intensify, leading to a host of other health problems. Therefore, it's vital to "prevent the disease from worsening" and also to treat obesity appropriately.

Diseases can be categorized into their symptoms and root causes. The "symptoms" refer to pathological manifestations, signs, and symptoms, while the "root cause" refers to the fundamental reason for the disease. Traditional Chinese medicine (TCM) places great emphasis on the principle of "treating the root cause of the disease." In treating obesity, obesity is the symptom, a pathological manifestation of the accumulation of pathological products such as phlegm, dampness, fat, and turbidity in the body. The root cause of obesity is the underlying cause, such as deficiency of vital energy, imbalance of yin and yang, and imbalance of the internal organs. We must treat appropriately according to the urgency of the symptoms and root cause, as the saying goes, "treat the symptoms in urgent cases, treat the root cause in less urgent cases." However, the most important thing is still to "treat the root cause of the disease." In treating obesity, it is essential to find the fundamental cause of obesity in order to adopt the appropriate treatment method.

Obesity is a complex and ever-changing condition. It can be categorized by location of obesity (generalized obesity, localized obesity, upper body obesity, lower body obesity, central obesity, etc.), by syndrome type (simple obesity, secondary obesity, pancreatic obesity, postpartum obesity, etc.), by age of onset (congenital obesity, childhood obesity, adolescent obesity, adult obesity, middle-aged and elderly obesity, etc.), by organ system differentiation (all five organs and six bowels can contribute to weight gain), by the Triple Burner differentiation (upper burner disease, middle burner disease, lower burner disease, etc.), and by the Eight Principles differentiation (yin, yang, exterior, interior, cold, heat, deficiency, excess, eight major syndrome types). Due to the complexity and interplay of syndrome types, obesity cannot be treated with just one or two methods. Different syndrome types may require different treatments, or several methods may be used simultaneously.

The following six treatment methods are commonly used: (1) Sweating: This is to treat obesity by inducing sweating. Commonly used Chinese herbal medicines for inducing sweating include cinnamon twig, ephedra, kudzu root, notopterygium root, angelica root, saposhnikovia root, and schizonepeta. Sweating has the effects of promoting qi and blood circulation, clearing the meridians, harmonizing the body's defenses, and unblocking lung qi. The "Suwen·Yin Yang Ying Xiang Da Lun" says: "For those on the skin, sweating can induce sweating." Most fat is accumulated in subcutaneous fat tissue. Therefore, sweating can be used. Sweating can dissipate excess heat in the body, which has a heat dissipation effect and can also increase the consumption of calories, thus having the effect of weight loss.

(2) Laxative Method: This method is divided into two categories: "purgative" and "moistening laxative." The purgative method uses strong laxatives, often employing herbs such as rhubarb and senna leaves, to expel accumulated waste from the stomach and intestines. This method is quite harsh and can easily damage the body's vital energy; it should be used but not excessively. The moistening laxative method uses herbs that lubricate the intestines, such as honey and hemp seeds. These herbs moisten the intestines, thus having a mild laxative effect. The purgative method can expel accumulated waste or food residue from the stomach and intestines, providing immediate relief. Furthermore, because food is not fully digested and is expelled before being fully digested, the body absorbs less nutrition, thus contributing to weight loss.

(3) Diuretic and Dampness-Eliminating Method: This refers to using traditional Chinese medicines that promote diuresis and eliminate dampness, such as Poria cocos, Coix seed, Polyporus umbellatus, Alisma plantago-aquatica, Plantago asiatica, and red adzuki bean, to expel excess water and dampness from the body. These herbs have a diuretic effect. Because water and dampness are highly mobile and easily expelled, weight loss occurs immediately after the water and dampness are eliminated. Studies have shown that many diuretic and dampness-eliminating herbs also have lipid-lowering effects.

(4) Tonification: The human body revolves around the five internal organs and six bowels, which maintain balance through a mechanism of mutual generation and restraint. Weakness or deficiency in any organ can lead to a depletion of vital energy, resulting in phlegm and dampness, and ultimately obesity. Therefore, tonifying the deficient organs strengthens the five internal organs and six bowels, restoring balance to the body, boosting vital energy, and thus resolving phlegm and dampness. Commonly used tonifying herbs include ginseng, angelica, astragalus, ganoderma, cordyceps, morinda, eucommia, and deer antler. Besides tonifying the functions of the internal organs, most of these herbs also tonify fire and yang, enhancing the body's metabolism and increasing calorie consumption, thus burning fat.

(5) Clearing Method: This refers to preventing and treating obesity by clearing heat and purging fire. Because excessive heat in a certain organ can lead to obesity in addition to causing imbalance in the body. For example, stomach heat can easily lead to overeating, thus causing acquired obesity or hyperphagia-type obesity. Traditional Chinese medicines that clear stomach heat, such as gypsum, ophiopogon japonicus, and dendrobium, can be used. On the other hand, liver heat can lead to hypertrophic fat synthesis and metabolism-type obesity. Traditional Chinese medicines that clear and calm the liver, such as prunella vulgaris, achyranthes bidentata, and artemisia capillaris, can be used.

(6) Harmonizing Method: This refers to using methods of harmonization to regulate the body and prevent obesity. Obesity is a very complex disease. As the condition progresses, it can lead to imbalances in the internal organs, disordered qi and blood, and a mixture of cold and heat, deficiency and excess. Simply using a single Chinese medicine or treatment method may not be effective. Therefore, we may use multiple Chinese medicines or several treatment methods simultaneously to harmonize the internal organs. For example, Astragalus membranaceus combined with Coix seed can both replenish qi and lower lipids, and also promote diuresis and eliminate fat, making it suitable for people with water-dampness type obesity.

Sweating, purging, diuresis and dampness elimination, tonification, clearing, and harmonizing are all commonly used treatment methods. Each treatment method has its advantages and disadvantages and should not be used blindly. Only by applying various treatment methods under the principle of syndrome differentiation and treatment and prescribing the right medicine for the right symptoms can obesity be effectively prevented and treated.