Tiredness & Fatigue: Causes, Diagnosis & Treatment from TCM Acupuncture & Biomedical Perspectives
- Ben Elliot
- Apr 2
- 9 min read
Updated: Apr 28
Tiredness and fatigue are hugely relevant to modern health. There are dozens of conditions and illnesses that cause tiredness and fatigue, not to mention the effects of modern living, stress, and the expectations of work and social lives.
In this post:
Information on conditions relating to tiredness and fatigue with 'Differential Diagnosis' - A simple guide that will help you or your patients understand what may be causing tiredness and if further medical advice is needed.
Discussion on how TCM Acupuncture theory views tiredness and fatigue - How to diagnose and identify which TCM patterns are most relevant to yourself or patient using differential diagnosis.
Advice and suggestions for the controllable elements that contribute to fatigue - How we can best provide an environment that doesn't deplete us over time.
Everyday Causes of Tiredness & Fatigue
Common reasons for a lack of energy can be simple factors that we have some degree of control over. It may mean changing some lifestyle habits, but it will help you feel more energised in the long term.
Overexerting
Simply doing too much and not giving yourself time to rest and recover. It might be extended work hours, deadlines, a busy social life, or a heavy exercise routine. Over-stretching ourselves can lead to fatigue and even burnout. We only have a certain amount of energy to spend each day, and this varies from one person to another.
Poor diet
The obvious factors are processed food and excess sugar, but each person has different needs when it comes to diet. TCM dietary advice can fit neatly with your acupuncture treatments, though nutritionists and dietitians can also help provide tailored advice.
Poor Sleep
If we are not sleeping well, then we are not recharging well, which, over time will lead to lower daily energy reserves. It's not only the length of sleep, but also the quality of sleep that affects our ability to recharge. Making sure your body is in rest mode as you go to bed is vital, which means avoiding alcohol and caffeine, and any other stimulants such as phones in the hours before bedtime.
Stress
When we feel stressed, we release stress hormones into our bodies. These hormones activate our 'fight or flight' response, and we use up a lot of energy preparing to deal with the stressful situation. This worked well in the past as danger tended to be more fleeting. In today's world, this stress can be prolonged due to issues such as financial troubles, work deadlines, or relationship struggles. These stress hormones keep on pumping through our bodies and use up energy over a prolonged period. After a while, our bodies are unable to recoup this energy, and our day-to-day energy becomes depleted.
Hormonal changes
The hormones in our bodies change on a daily, weekly, and monthly basis. Over longer periods of years or decades, our hormone balance alters too. This could be related to your menstrual cycle, jet-lag or menopause. Many of these things are natural fluctuations or alterations of hormone levels in your body. However, treatments can still be sought, and changes made to lifestyle to help balance these hormones and relieve symptoms such as tiredness or fatigue.
Medical Conditions That Cause Tiredness and Fatigue
Many conditions can cause us to feel tired, fatigued, or exhausted. While the above examples are things we can have some degree of control over, or are natural bodily processes we can try to manage holistically, some conditions may need medical intervention in the form of medications, interventions or integrated therapies. As tiredness is a common symptom of many conditions, diagnosis is often accomplished by a blood test. However, medical professionals will use 'differential diagnosis' to determine exactly what to test for. Differential diagnosis collects a wider range of information on symptoms to determine or rule out an issue. Examples of what other symptoms a medical professional may look for to help with differential diagnosis are outlined below.
Common Conditions That Cause Tiredness & Fatigue
Iron Deficiency - Tiredness with shortness of breath, pale skin, palpitations
Low Vitamin D - Fatigue with body aches and brain fog
Diabetes - Tiredness with feeling very thirsty, weeing more than usual, weight loss
Hyperthyroidism - Fatigue with restlessness, anxiety, irritability, muscle weakness
Chronic Fatigue/Fibromyalgia - Long-term extreme tiredness with issues with memory or concentration, feeling flu-like symptoms
Depression & Grief - Tiredness with low mood, poor appetite, loss of libido
Gluten Intolerances - Sluggishness with bloating, digestive issues.
Post-viral fatigue - Long COVID probably has the biggest limelight when it comes to post viral fatigue, but let's not forget this idea has been around for a long time. Glandular Fever and any Flu has been known to leave us feeling wiped out for long periods.
Other issues that can cause fatigue are Adrenal insufficiency, Amyotrophic lateral sclerosis (ALS), Anemia, Anxiety disorders, Cancer, Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Chronic infection or inflammation, Chronic kidney disease, COPDCOVID-19, Diabetes, Heart disease, Hepatitis A B and C, HIV/AIDS, Hyperthyroidism (overactive thyroid), Hypothyroidism (underactive thyroid), Inflammatory bowel disease (IBD), Liver disease, Low vitamin D, Lupus, Mononucleosis, Multiple sclerosis, Parkinson's disease; Physical or emotional abuse, Polymyalgia rheumatica, Rheumatoid arthritis, Sleep apnea, Traumatic brain injury, some medications.
Clearly, there are an endless number of conditions that can make you feel tired, sluggish, fatigued, or exhausted, so if your symptoms persist for a few weeks or more, it's always worth getting investigated by your GP.
How TCM Acupuncture Approaches Tiredness & Fatigue
Energy levels in Acupuncture or Traditional Chinese Medicine (TCM) terms are related to the concepts of Qi and other fundamental substances. Suppose the idea of Qi is a difficult one to get your head around. In that case, I'd recommend reading this blog post first and then reading the next section with that information in mind - https://www.benelliot.co.uk/post/qi-unravelling-the-mystery - much like other posts, I have included a brief guide to the TCM Acupuncture ideas and concepts relevant to this topic. Please remember that terms used relate to Chinese Medicine theory, and many examples are not instrinsicly related to the physical organs and anatomy we are familiar with in Biomedicine.
Much like Biomedical diagnosis, Acupuncture and TCM practitioners also use differential diagnosis to determine the best treatment. Acupuncture treatments can be helpful as a standalone treatment or in conjunction with medication or other treatment methods. To create a diagnosis and treatment plan, Acupuncturists will use TCM theory that is underpinned by primary principles such as whether there is too much (Excess) or too little (Deficiency) of a fundamental substance, or if a substance becomes stuck and doesn't flow (Stagnation).
In Traditional Chinese Medicine (TCM), the fundamental substances are the essential components that sustain life and maintain balance in the body. They include:
Qi (氣)
Qi is the substance that powers all physiological functions in the body. It has different forms, including:
Yuan Qi (Original Qi) – Inherited energy from parents, stored in the Kidneys.
Wei Qi (Defensive Qi) – Protects against pathogens, associated with immunity.
Ying Qi (Nutritive Qi) – Circulates in the meridians, nourishing the organs.
Gu Qi (Food Qi / 谷气) - Is extracted from the food we eat and so partially responsible for our day-to-day energy levels and closely related to our digestive system.
Zong Qi (Gathering Qi) – Derived from air and Gu Qi, supports respiration, digestion and circulation.
Blood (血, Xuè)
Blood in TCM nourishes the body, moistens tissues, and supports the Shen (mind/spirit). It is mainly produced by the TCM Spleen and stored in the TCM Liver. Blood deficiency can lead to dizziness, pale complexion, and insomnia. Blood is Yin in nature.
Jing (精) – Essence
Jing is the essence of life, associated with growth, development, and reproduction. There are two types:
Pre-Heaven Jing – Inherited from parents, stored in the Kidneys.
Post-Heaven Jing – Acquired through diet and lifestyle. Jing depletion can lead to aging, infertility, and weakness.
Shen (神) – Spirit/Mind
Shen represents consciousness, mental clarity, and emotional well-being. It resides in the TCM Heart and is closely linked to Blood. Disturbances in Shen can manifest as insomnia, anxiety, or emotional instability.
Jin-Ye (津液) – Body Fluids
Jin-Ye includes all bodily fluids and plays a role in hydration, lubrication, and nutrient transport.
Jin (Thin Fluids) – Light, clear, and circulates in the skin and muscles (e.g., sweat, tears, saliva).
Ye (Thick Fluids) – Heavier and nourishes deeper organs and joints (e.g., synovial fluid, cerebrospinal fluid). Deficiency can lead to dryness, while excess can contribute to dampness or phlegm.
Dampness (湿, Shī)
In TCM, Dampness is not one of the fundamental substances but is an important pathological factor that affects the body's balance. It is often linked to the TCM Spleen, which is responsible for transforming and transporting fluids. When the TCM Spleen is weak, it fails to properly process fluids, leading to the accumulation of Dampness.
How Do The Fundamental Substances Relate To Tiredness & Fatigue?
Too much or too little of these substances creates an imbalance and can cause illness. The feeling of tiredness correlates with not having enough of something - in this case, we don't have enough energy. So in TCM diagnostics, we would commonly see that having a deficiency of either Qi or Blood will manifest as tiredness and fatigue as there is not enough of the substance to nourish areas of the body.
However, several other components can affect our energy levels from the TCM diagnostic perspective. Stagnation of Qi and Blood can lead to a lack of energy as these substances are not able to flow freely and nourish areas of the body. This stuckness can be emotional or physical. As we have already established, both emotional turmoil (Shen Disturbance) and physical pain or stiffness (Stagnation in the Channels) can be very depleting of our energy resources.
Dampness also causes a lack of energy, more so in the form of sluggishness and heaviness. Accumulation of dampness is often caused by foods we eat and the environments we exist in, so it can be managed by lifestyle changes.
We also need to account for the levels of individual types of Qi, and this can help us determine how quickly someone would expect to see improvements when having treatment.
Our Zong Qi accounts for our day-to-day energy, combining energy from the food we eat and the air we breathe.
Our Yuan Qi & Jing have aspects to them whereby we are born with maximum levels and these levels will only deplete throughout our lifetime - never replenishing.
Zong Qi can be replenished by resting, eating well and fewer acupuncture treatments.
Yuan Qi & Jing take much longer to replenish, and some elements will never recover and can only be managed my more severe lifestyle changes and longer term treatment.
If you are lacking Zong Qi you might find you get more tired as the day goes on, or have symptoms that relate to TCM Spleen and Lung impairment eg. shortness of breath, digestive issues.
If you are lacking in Yuan Qi or Jing, you'd expect to see more chronic health issues and developmental issues as an extreme example. These aspects are related to TCM Kidney impairment.
In TCM terms, Qi is Yang in nature so a deficiency of Qi can cause symptoms related to a lack of Yang in our systems. Yang is warming and moving in nature.
TCM Patterns of Disharmony for Tiredness & Fatigue
To create a diagnosis, an Acupuncturist or TCM practitioner will take all your symptoms and signs and match them as a group to one or more patterns of disharmony. This will take into account which fundamental substances we are treating, whether we are treating a deficiency, or an excess, such as stagnation. It also guides us to which TCM organs we need to focus on. The TCM organs are named the same as biomedical internal organs, but the functions and processes of each can vary from what we understand from biomedicine. All these factors combined allow us to determine our treatment principles and select appropriate acupuncture points and advice for the patient's individual set of symptoms and circumstances.
Below are the patterns that relate to tiredness and fatigue, along with the additional signs and symptoms we would use to determine our diagnoses.
Qi Deficiency
Spleen Qi Deficiency: Tiredness, poor appetite, loose stools, bloating, weak limbs, pale complexion.
Lung Qi Deficiency: Shortness of breath, weak voice, spontaneous sweating, frequent colds.
Heart Qi Deficiency: Palpitations, shortness of breath on exertion, pale face, mental fatigue.
Blood Deficiency
Heart Blood Deficiency: Insomnia, palpitations, poor memory, dizziness, pale complexion.
Liver Blood Deficiency: Dull headache, dizziness, blurred vision, scanty periods, numbness in limbs.
Yang Deficiency
Kidney Yang Deficiency: Cold sensations, weak lower back/knees, frequent urination, low libido.
Spleen Yang Deficiency: Loose stools, cold extremities, bloating, poor appetite.
Heart Yang Deficiency: Palpitations, cold hands, chest discomfort, breathlessness.
Yin Deficiency
Kidney Yin Deficiency: Night sweats, dry mouth, tinnitus, insomnia, hot flushes.
Heart Yin Deficiency: Palpitations, anxiety, insomnia, dry mouth/throat.
Lung Yin Deficiency: Dry cough, hoarseness, night sweats, dry skin.
Dampness & Phlegm
Dampness Obstructing the Spleen: Heavy limbs, bloating, sluggishness, loose stools.
Phlegm Obstruction: Brain fog, lethargy, dizziness, heaviness.
Liver Qi Stagnation
Emotional tiredness, stress, irritability, mood swings, sighing, distension in the chest/ribs.
Blood Stasis
Chronic fatigue with sharp or fixed pain, dark complexion, purple tongue.
Tiredness & Fatigue - Final Thoughts
I'm hoping this post will at least highlight the complexities of diagnosing chronic tiredness and fatigue conditions, whether that be from an acupuncture or biomedical standpoint. I also hope it gives some hope and motivation to anyone suffering, that there are things we can do to help, even if we have not had a formal diagnosis. That said, fatigue is complex matter and if you have been suffering for a long period, or fatigue is a new symptom for you, please do visit your doctor. If you wanted to discuss or have treatment from the more holistic perspective, you can contact me at benelliot.co.uk/contact
