Q. I want to know why I keep gaining weight. How can I identify the cause of my obesity?

The reason you keep gaining weight is not simply about how much you eat. In TKM, when the flow of Qi, Blood, and Body Fluids is not smooth, metabolism slows and waste accumulates, leading to weight gain. Early in my practice, I wondered why some patients ate little yet didn't lose weight, until I realized each case needs a pattern-based approach. First, **Spleen Deficiency** (脾虛, biheo) – the Spleen’s job is to digest food and distribute nutrients. When weak, food is not processed properly and stored as fat. Symptoms include poor appetite, bloating, loose stools, and weight gain despite eating little. **Phlegm-Fluid** (痰飮, dameum) – this is the clumping of metabolic waste and water. Signs are morning facial puffiness, numb extremities, a white greasy tongue coating, and feeling heavy and easily fatigued during exercise, leading to a vicious cycle of reduced activity. **Blood Stasis** (瘀血, eohyeol) – stagnant blood circulation. Indicators include severe menstrual pain, dark protruding sublingual veins, rough skin, easy bruising, and localized fat (especially lower abdomen and thighs) because poor blood flow hinders fat burning. **Liver Qi Stagnation** (肝氣鬱結, gangi ulgyeol) – closely linked to stress. The Liver regulates Qi flow; when frustration builds, Qi blocks and digestion suffers. This causes stress-related binge eating, cravings for sweets, epigastric stuffiness, and weight gain. Patients often report a 'burning sensation' in the stomach. Lastly, **Kidney Deficiency** (腎虛, shinheo) – common with aging or overwork, lowering basal metabolism and leading to fat accumulation especially around the lower back and legs. Frequent urination, cold knees, and sensitivity to cold suggest this pattern. These categories are for reference. In actual diagnosis, pulse, tongue, and abdominal examination are combined. For example, a pale tongue with weak pulse indicates Spleen Deficiency, while a purplish tongue with wiry pulse points to Blood Stasis. Most patients have 2–3 mixed patterns. After self-checking, consulting a nearby Korean medicine clinic will help you find a personalized approach.