中医药防治肥胖的研究进展

Research Progress on the Prevention and Treatment of Obesity with Traditional Chinese Medicine

摘要: 肥胖已成为全球突出的公共卫生问题，易诱发胰岛素抵抗、血脂紊乱、慢性低度炎症，大幅提升2型糖尿病、心脑血管疾病及肿瘤发病风险。西医减重药物存在不良反应、易反弹等局限，中医药凭借整体辨证、多靶点调控、安全性高的独特优势，在肥胖慢病长期干预中优势显著。中医认为肥胖核心病机为本虚标实，脾虚为本，痰湿膏浊、肝郁气滞、肾阳不足为标，临床常见脾虚痰湿、胃热湿阻、肝郁气滞、脾肾阳虚四大证型。现代机制研究证实中医药可通过调节脂质代谢、改善胰岛素抵抗、抑制慢性炎症、重塑肠道菌群、调控脂肪分化与能量代谢、调和五脏机能多条途径干预肥胖。临床应用上，健脾化痰、清胃泻热、疏肝理气、温阳化浊类经典复方(参苓白术散、二陈汤、大柴胡汤、逍遥散、真武汤等)及针灸、温针灸、穴位埋线、腹针等外治法均表现出良好减重调脂、改善代谢紊乱效果。本文系统梳理肥胖中医理论认知、中医药干预分子机制、中药复方与中医外治临床研究现状，总结现有研究优势与不足，对中医药防治肥胖的发展方向进行展望，为肥胖中西医结合防治及新药、特色外治技术研发提供理论参考。

Abstract: Obesity has become a prominent global public health issue, as it can easily lead to insulin resistance, dyslipidemia, and chronic low-grade inflammation, significantly increasing the risk of type 2 diabetes, cardiovascular and cerebrovascular diseases, and cancer. While Western weight-loss medications have limitations such as adverse reactions and a tendency toward weight regain, Traditional Chinese Medicine (TCM), with its unique advantages of holistic syndrome differentiation, multi-target regulation, and high safety profile, offers significant benefits in the long-term management of obesity and related chronic diseases. According to TCM, the core pathogenesis of obesity is characterized by “deficiency at the root and excess at the branch”, with spleen deficiency as the root cause and phlegm-dampness, liver qi stagnation, and kidney yang deficiency as the manifest symptoms. Clinically, four major syndrome patterns are commonly observed: spleen deficiency with phlegm-dampness, stomach heat with dampness obstruction, liver qi stagnation, and spleen-kidney yang deficiency. Modern mechanistic studies have confirmed that TCM can intervene in obesity through multiple pathways, including regulating lipid metabolism, improving insulin resistance, suppressing chronic inflammation, reshaping the gut microbiota, modulating adipocyte differentiation and energy metabolism, and harmonizing the functions of the five zang organs. In clinical practice, classic formulas designed to strengthen the spleen and resolve phlegm, clear stomach heat, soothe the liver and regulate qi, and warm yang to transform turbidity (such as Shenling Baizhu San, Erchen Tang, Dachaihu Tang, Xiaoyao San, and Zhenwu Tang), as well as external therapies including acupuncture, warm acupuncture, acupoint thread implantation, and abdominal acupuncture, have all demonstrated effective results in promoting weight loss, regulating lipid levels, and improving metabolic disorders. This article systematically reviews the theoretical understanding of obesity in TCM, the molecular mechanisms of TCM interventions, and the current status of clinical research on TCM formulas and external therapies. It summarizes the strengths and limitations of existing research, outlines future directions for the prevention and treatment of obesity with TCM, and provides a theoretical framework for the integrated prevention and treatment of obesity using both Western and TCM approaches, as well as for the development of new drugs and specialized external therapeutic techniques.