Why am I still tired after a full night’s sleep?

The tradition does not think of sleep as a bank you pay into and draw from. It reads the day and the night as one rhythm, the nutritive qi and the defensive qi circling the body fifty times between dawn and dawn, and it says that when that circulation is thin or clogged, both halves fail together: you are not bright by day and not properly closed by night. So a person who sleeps eight hours and wakes tired is not, to a Chinese physician, a person with a sleep problem. They are a person whose qi or blood is short, or whose middle is damp, and the tiredness at eight in the morning is the same thing as the thin sleep at two.

There are four common pictures, and the plainest clue is what the tiredness does over the day. The qi-short person is worst on effort and better for rest. The blood-light person is worst on standing up and better for eating. The damp person is worst in the morning and in wet weather, and never really clears. The yang-short person is cold and slow at dawn and comes to life by afternoon.

The Lingshu’s chapter on the meeting of nutritive and defensive qi describes the strong and the old side by side, and gives the four-character phrase this page is named for. It is about age in the text, but every later physician read it as a description of any body whose qi and blood have run low.

The Suwen adds the line that surprises people. In its list of the five overdoings, lying too long is one of them, and what it injures is the qi. The person who answers tiredness with more bed is, by that reading, feeding the thing.

Four pictures. The tongue and the shape of the day usually decide between them, and they are given nearly opposite advice.

The floor, which is the same for all four, and which most people who ask this question are not standing on.

• A fixed rising hour, seven days a week, and no lying in to catch up. The Suwen’s long lying injures the qi is the reason; the catch-up morning is the one you feel worst after.
• Light on the face within half an hour of rising. The tradition wanted you in the courtyard; a window will do.
• A warm breakfast, eaten. The qi of the day is made from the first meal, and the person who skips it and drinks coffee is running on borrowed yang.
• Small labour, daily. The Qianjin Yaofang’s advice is to want a little work and never great exhaustion: a walk, not a race, and not nothing.
• A rest at noon of twenty minutes, not two hours.
• Supper small and early, so that the night’s repair is not spent on digestion.

None of that is a promise, and we make none. It is the floor, and the rising hour is the plank.

• Astragalus 黄芪, a few slices simmered in soup or with rice, for the thin-and-easily-spent picture. The materia medica lists it first among the qi-raising foods.
• Ginseng 人参, a small amount, for the same picture when it is marked; the Shennong Bencao Jing says it supplements the five organs and calms the spirit. Not for the heavy-and-foggy.
• Jujube 大枣 and goji 枸杞, simmered together, for the light-and-pale picture.
• Job’s tears 薏苡仁 and poria 茯苓 in a morning congee, for the heavy-and-foggy picture, with less sweet, less dairy and less bread.
• Ginger 生姜 in the morning cup, and cinnamon 肉桂 in the congee, for the cold-and-slow.

Four finger-widths below the kneecap, a thumb’s width outside the shin bone, is Zusanli, Stomach 36, 足三里, Leg Three Miles: the point the tradition presses to raise the qi of the middle, and the one the old walking texts say lets you go three more miles. Thumb pressure, a minute each side, in the morning.