Abstract: Primary obesity remains a major challenge confronting the medical community, and existing Western weight-loss medications fail to address the therapeutic needs of all obesity subtypes. Traditional Chinese Medicine (TCM) possesses a robust foundation of theoretical insights and clinical practices in the management of primary obesity, exhibiting substantial potential for further development and application. This article expands on the understanding of the three types of obesity—"Zhi Ren, Gao Ren and Rou Ren"—described in The Yellow Emperor's Inner Classic, adding "Xiao Gao Ren" and "Gao-Zhi Ren" types to construct a new five-type classification system for obesity, aiming to overcome the limitations of modern medicine's single-indicator approach to understanding obesity. In light of the heterogeneous nature of primary obesity, this study proposes a treatment strategy based on the pathogenesis of excessive stagnation and deficiency-related stagnation characterized by energy metabolism profiles. For excessive stagnation, Houpo Sanwu Decoction is employed as the core formula, with further differentiation and treatment tailored to three subtypes: gastrointestinal hunger type, emotional hunger type and cerebral hunger type. For deficiency-related stagnation, Liujunzi Decoction serves as the foundational prescription, with syndrome differentiation and treatment customized according to the characteristics of the hypometabolic type. By extracting core pathogenesis and refining core formulas, the precision of TCM treatment is improved, complementing existing Western weight-loss medications and enhancing the clinical efficacy of obesity treatment.