Tired for months

The tradition’s word for tiredness that has settled in is two characters, and both matter. 虚 xū is emptiness: something that should be present in a body is running low. 劳 láo is taxation, the spending of it — through work, worry, grief, illness, or simply years. Put together, 虚劳 describes not a tiredness but an economy: a person drawing on an account that is not being refilled. The Neijing had already named five ways of overspending, and they read as if written this morning.

Two of the five are the modern working day — long looking at a screen, long sitting — and one, long lying, is the trap a tired person walks into: rest past a certain point is read as spending, not saving. Four centuries later the Jingui Yaolue gave depletion a chapter of its own, sorting it by what was running low and pairing it with the kitchen rather than with the needle, which is why so much of what follows is about food.

The third voice is Li Gao, in the Piwei Lun of 1249, with the sentence every Chinese physician can recite: when the spleen and stomach are wounded from within, the hundred illnesses arise from it. In the tradition’s map the spleen is the network that turns food into qi, and Li Gao’s argument is that most long tiredness begins there — in eating badly, eating cold, eating at the wrong hours, eating worried — and is refilled there.

The phrase most people arrive with is chronic fatigue, and it means two different things depending on who said it. Said by you, it means you have been tired for a long time and are worn down by it. Said by a clinician, it may be a specific name given after other things have been ruled out — usually after months, usually after blood tests. The second use is the one that matters here, because most long tiredness has a cause a page cannot see and a reading must not guess at, and the ruling-out has to come before anything on this page is safe to use.

We do not use the phrase in a reading. The tradition’s word, depletion, is not a translation of it; it is a different question. Not how long, but what is running low, and what keeps spending it. Are you cold or hot? Heavy or dry? Better for rest, or strangely no better? Wired at night despite being exhausted by day? Those answers, and the tongue, are what a reading is built from.

Depletion is the ground almost everyone with long tiredness shares. What differs is what has settled on it, and that is what decides the direction.

A fifth, blood deficiency, travels beside the first two more often than not — pale, dizzy on standing, dry, light sleep — and a reading usually names it alongside rather than instead. The tongue sorts the four faster than the story does, which is why one daylight photograph is asked for. A swollen pale tongue and a peeled red one are opposite pictures with the same complaint, and they are fed in opposite directions.

The thing that makes depletion heavier is the thing every tired person does: overdoing the good days. A day of feeling better spent catching up on everything, paid for over the three that follow, is the pattern the tradition calls taxation, and it is the single most common story in our clinic notes for this complaint. After that, the spleen’s complaints: cold food, raw food, food eaten late, skipped, or eaten standing up while worrying. Then the small hours: bed after midnight spends what sleep before it would have saved.

• Spend the good days at the same pace as the bad ones. The tradition counts depletion in months, and it is refilled by steadiness, not by bursts.
• Eat warm, cooked, and on time — breakfast above all. In Li Gao’s reading the spleen makes tomorrow’s qi from today’s breakfast, and cannot make it from coffee.
• In bed before eleven, up at the same hour daily. Long lying is one of the five ways of overspending; the lie-in on a bad day is not the rest it feels like.
• A short walk outdoors every day, even the bad ones, at a pace where you could still talk. Not exercise, which is spending; movement, which the tradition reads as the spleen doing its work.

This is the complaint the shared-origin kitchen was built for, and also the one where it is easiest to get wrong, because its most famous answers are warming and a good share of tired people are hot.

• Astragalus 黄芪, the root the Bencao Gangmu calls the elder of all supplementing things, simmered into the congee or the soup pot for the empty and the cold-and-empty pictures. Its entry explains the amount, and why it stays out of the pot during a cold or a fever.
• Ginseng 人参, in small amounts and not for everyone: right for the cold, empty, breathless picture, and wrong — sometimes sharply wrong — for the tired-and-wired one, where it adds heat to a body with nothing cool left. Its entry is mostly about who should not.
• Jujube 大枣 and goji 枸杞 in the morning congee, for the blood that travels beside depletion; the gentlest things on this list, and the safest.
• Ginger 生姜 and cinnamon 肉桂 for the cold picture only, in the morning, and nowhere near the hot one.
• Reishi 灵芝 as a bitter tea, which the tradition has paired with long depletion since the earliest materia medica.
• For the heavy picture, none of the above first: poria 茯苓, job’s tears 薏苡仁 and tangerine peel 陈皮, to move the damp off the spleen before anything is asked to refill it.

The order matters as much as the list. Refilling a spleen that is sitting under damp is pouring water into a full sink, and warming a body that is already hot is the commonest mistake people make with this kitchen when they choose from a page rather than from a reading.

The point the tradition pairs with depletion is the one it pairs with the spleen and stomach, and it is the most famous point on the body: Zusanli, Stomach 36, 足三里, a hand’s width below the kneecap on the outside of the shin. Its line in the song of the four command points is 肚腹三里留: for the belly, stay at Sanli. There is a farmers’ saying, older than any of the books cited here, that a person who keeps Zusanli warm eats well into old age; its entry explains how to find it and how long to hold.

Pressed with the thumb for a minute on each side, daily, after the morning meal. It is pressure, not a needle, and it is not a promise; it is what a physician in our clinic shows a tired person first, with her own hand, before she says anything about food.

Once those have been looked at, everything above still stands, and stands better for it. Depletion is a fair description of most long tiredness in people who have been examined. It is a dangerous description in people who have not.