Tiredness can manifest in many ways, including lack of physical and mental energy, poor motivation, excessive sleepiness, exhaustion, weariness, listlessness, feeling flat, or an inability to perform even simple tasks. In Chinese medicine texts, tiredness is often analyzed under the heading of "deficiency and overwork," a category of disease that includes conditions resulting from overwork, exhaustion, and chronic debilitating illness. Traditionally, this category includes patterns of deficiency, but clinical experience has shown that people who complain of chronic tiredness often have some sort of excess pathology.

While tiredness and fatigue can be symptoms of many different patterns of disharmony, there are some cases in which persistent tiredness is likely to be the main symptom or a major feature.

From a Western medical perspective, tiredness is often difficult to diagnose. Unless there is a clear pathology or positive investigative finding, this symptom is often left unexplored, and the source of the patient's suffering remains unknown. In such cases, patients may be diagnosed with "depression" or some other psychological disorder, or they may be considered malingerers.


Lingering Pathogens

Persistent fatigue commonly occurs after a poorly managed acute illness or immunization. The initial illness may not have been completely cleared, or may have damaged the body's qi and yin, leading to lingering pathogens. Those who ignore the initial illness or receive inappropriate treatment during the acute phase are more likely to develop persistent problems. Resting properly during the acute phase is important to prevent the weakening of the body's protective response. The use of certain treatments, such as purgation or emesis, can trap heat in the body and make the situation worse. Antibiotics may help to cool the heat of the illness, but they do not always effectively clear the pathogen and can cause side effects such as diarrhea and weakness.

Emotional Factors

Emotional stress can disrupt the functioning of the Liver, Spleen, and qi in the body. Anger, frustration, and repressed emotion can affect the Liver, while worry, obsessive thinking, and prolonged concentration can weaken the Spleen. Prolonged or extreme emotional distress can disrupt the relationship between the Liver and Spleen, leading to tiredness that fluctuates with emotions and activity. If left unchecked, this can weaken the Spleen and disrupt the production of qi and blood. This can lead to dampness and blockages in the flow of qi and blood, further contributing to feelings of tiredness. Prolonged sadness and grief can also deplete the Lung and Spleen qi, leading to dampness and impaired distribution of qi and blood. A sudden or severe shock can also damage yang qi and yin, leading to a loss of vitality in the Heart and Kidneys.

Diet and Medications

Inequalities and irregularities in diet and digestion can contribute to persistent tiredness. A diet lacking essential nutrients or that is not processed efficiently can lead to poor production of qi and blood. Inadequate protein intake, restrictive or fad diets, or excessive consumption of poor-quality fast food can lead to malnutrition and weaken the Spleen, reducing the production of qi and blood. Prolonged starvation or digestive problems, such as those experienced by people with anorexia nervosa or bulimia, can seriously damage the Spleen yang qi. Some drugs, such as heat-clearing herbs, purgative laxatives, antibiotics, and hypoglycemic agents, can also weaken the Spleen and cause tiredness. Many common medications can also cause tiredness. Consuming excessive amounts of food and alcohol, or a diet that is overly rich in heating or tonifying foods like meat and fat, can lead to dampness, heat, and phlegm. Food allergies, lactose intolerance, and celiac disease can also be contributing factors to chronic tiredness, especially when mild or subclinical.

Overwork, Exhaustion

Working excessively long hours or pushing oneself to the point of exhaustion can deplete Spleen and Kidney yang qi. This can happen when a person expends more energy than they take in through food, as is commonly seen in overtrained athletes. These individuals may be physically fit, but they are often chronically tired and vulnerable to repeated infections. Overwork can lead to a depletion of qi and essence, contributing to feelings of chronic tiredness.

Sleep Cycle

Insufficient sleep or a sleep cycle that is out of sync with the body's internal rhythms can contribute to tiredness. Sleeping too much or at irregular times can lead to qi stagnation, while not getting enough sleep or constantly staying up late can deplete yin and blood. This is commonly seen in people who work shifts or frequently travel across time zones. Maintaining a regular sleep schedule and getting enough restful sleep is important for maintaining overall health and well-being.

Constitutional Factors

Some individuals may have a genetic tendency to develop patterns that predispose them to tiredness. This can include deficiencies in the Lung, Spleen, and Kidney, as well as a tendency to develop phlegm and qi constraint. These tendencies may run in families and can be evident from an early age through respiratory weakness, asthma, digestive weakness and weight issues, developmental problems, and persistent bed-wetting. These may be signs of weakness in the body's source qi or difficulty in acquiring or producing sufficient qi.

Qi Deficiency

Qi deficiency is caused by poor production or excessive expenditure of qi in the body. Dysfunction or weakness in the Lungs or Spleen are major causes of qi deficiency, but weakness in other organ systems and excessive demand for or expenditure of qi can also place a burden on the Lungs and Spleen, gradually weakening them and reducing their ability to produce qi. An inappropriate or poor-quality diet can also contribute to qi deficiency. Maintaining a healthy diet and lifestyle can help to support the production of qi and prevent qi deficiency.

Blood Deficiency

Blood deficiency is a common cause of chronic tiredness and can be caused by poor nutrition, insufficient production of blood due to Spleen deficiency, or inadequate replacement of blood following a hemorrhage or pregnancy. New mothers who return to work too soon or are unable to rest adequately to replenish the blood used in pregnancy and breastfeeding are particularly vulnerable to blood deficiency and chronic tiredness. It is important for new mothers to take the time to rest and replenish their blood levels in order to maintain their health and well-being.

Yin deficiency

Yin can be damaged by a variety of factors, including overwork, insufficient sleep, febrile disease, inadequate hydration, drug use, and aging. Some drugs, such as amphetamines, cocaine, and steroids, have a warming or dispersing effect on the body and can deplete yin. Cannabis and ecstasy (MDMA) can also damage yin when used frequently or in large quantities. The improper use of hot, yang tonic substances and herbs, such as red ginseng and deer horn, in an effort to increase energy levels can also damage yin. Maintaining a balanced lifestyle and avoiding excessive use of drugs and tonic substances can help to preserve yin and prevent its depletion.

Yang Deficiency

Yang deficiency can result from the natural decline of yang that occurs with aging, a diet that is cold in nature or insufficient, excessive overwork that exhausts yang, or exposure to cold. Yang deficiency can lead to symptoms such as chronic tiredness, weakness, and a tendency to feel cold. Maintaining a balanced diet and lifestyle, avoiding excessive overwork, and protecting against exposure to cold can help to prevent yang deficiency.

Blood stasis

Tiredness that is caused by blood stasis can be associated with chronic pain, poor cardiac function, or depression. Blood stasis can be acute or chronic. Acute blood stasis can occur following trauma, hemorrhage, surgery, or a difficult labor, while chronic patterns of blood stasis can develop as a result of other prolonged health conditions. Cold and yang deficiency can cause blood stasis by "freezing and constricting" the blood vessels, slowing the circulation of qi and blood. Heat and yin deficiency can cause stasis by "evaporating" the blood, increasing its viscosity and stickiness. Chronic Liver qi constraint or qi deficiency can also prevent the proper movement of blood. Treatment of blood stasis may involve addressing the underlying cause and supporting the circulation of qi and blood in the body.