"I'm just tired. I sleep, and I'm still tired." A question that comes up often is this one, and it is a hard one to answer in a sentence.

The answer first. Tiredness that has run for weeks with no clear reason goes to a doctor first — the NHS patient page puts it this way: see a GP if you've been feeling tired for a few weeks and you're not sure why. [NHS-累] What the tests look for, and how to read the report, is section II.

The second step is the TCM consultation: the practitioner takes "tired" apart — when it hits, how much rest restores — then classifies it in TCM theory and talks about routine and direction.

What 「气」 and 「血」 refer to in the theory, and why that is not the blood test, is section III.

On routine, this article gives sourced numbers: at least 7–8 hours of sleep [AASM], and no caffeine four to six hours before bedtime [SG-HH-11]. When to see a doctor first is section IV. Set out in 6 points.

I. First: there are many kinds of tired, and the kind matters

The first step is always taking "tired" apart. In a consultation these are distinguished as different presentations:

• Tired on waking, or tired only by the afternoon
• Restored by rest, or no different however much you rest
• No drive, or a heaviness in the body
• Tired but unable to sleep, or tired and always sleepy

TCM theory sorts these differences into different patterns — section III explains what those pattern names mean.

Modern medicine first uses tests to rule out causes that need treatment — section II explains what the tests can show. The two paths do not replace each other, and the order is tests first.

II. Read the report first: what a blood test can tell you

Some of the causes of persistent tiredness can only be confirmed by tests. This section covers what a report can show, using the NHS's and the WHO's public material.

① When to get tested. The NHS patient page lists three situations for seeing a GP: you've been feeling tired for a few weeks and you're not sure why; your tiredness affects your daily life; you feel tired and have other symptoms. [NHS-累]

The examples the same page gives of "other symptoms" are weight loss or mood changes, or being told you're making gasping, snorting or choking noises when you're asleep. [NHS-累]

The same page says: do not self-diagnose — see a GP if you're worried. [NHS-累]

② What is tested. The NHS's words are: you may need tests, such as blood tests to check for anaemia, diabetes or hyperthyroidism. [NHS-累] Which tests, exactly, is the doctor's decision for your situation. If your company's annual screening report already has these items, bring it to the consultation.

③ First, what haemoglobin (Hb) does. The WHO's anaemia fact sheet puts it this way: anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. [WHO-Hb] Anaemia occurs when there isn't enough haemoglobin in the body to carry oxygen to the organs and tissues. [WHO-Hb]

The same page says anaemia causes symptoms such as fatigue, reduced physical work capacity and shortness of breath. [WHO-Hb] It describes the common symptoms of anaemia as non-specific. [WHO-Hb]

The page states what haemoglobin does (carries oxygen to the organs and tissues) and what anaemia looks like (fatigue); it does not write out the step in between — why less oxygen delivered feels like tiredness. This article stops where the page stops.

"Non-specific" is worth keeping: tired does not necessarily mean anaemic, and anaemia does not only show as tiredness. So the call rests on a number — the same page says anaemia is diagnosed based on blood haemoglobin concentrations falling below specified thresholds established based on age, sex and physiological status. [WHO-Hb]

④ How to read the haemoglobin line on your report. The WHO's 2024 guideline sets the cutoffs for anaemia in adults aged 15–65 at: nonpregnant women below 120 g/L, men below 130 g/L. [WHO-Hb] (If your report prints g/dL, that is 12 and 13.) Pregnancy and children have different cutoffs. [WHO-Hb]

The same guideline states that haemoglobin values should be adjusted for smoking, and for living at elevation. [WHO-Hb] So matching the number on your report against this line is a starting point; whether it is anaemia, and why, is the doctor's judgement.

The WHO's explanation also notes that anaemia is considered a symptom of an underlying condition. [WHO-Hb] In other words, a value below the line raises the next question — "why" — and that is the doctor's work.

⑤ Glucose and thyroid. These two are tests the NHS lists as ones a doctor may arrange. [NHS-累] This article does not give their reading thresholds; the glucose and thyroid figures on a report are for the doctor to interpret.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

III. What 「气」 and 「血」 refer to, and why that is not the blood test

Section II was about the haemoglobin line on a blood report. This section is about 「气」 and 「血」 in TCM theory — the same character 血, two different languages.

Everything below is TCM theory, defined from the WHO's 2022 standard terminology; the standard's entry numbers are in brackets so each line can be checked.

① Two words defined first. The WHO standard's description of qi is: the intangible, high-mobility nutritive substance that maintains vital activities (entry 224). [WHO-2022] Its description of blood is: the red liquid that circulates within the blood vessels to moisten and nourish the body — an essential substance to maintain life activities (entry 225). [WHO-2022]

Notice how both are written: each is defined by what it does — maintaining vital activities, moistening and nourishing the body. 「血」 in the theory is about a function, not a quantity a blood test can measure.

② Where qi and blood come from, in the theory. The standard's wording: "the spleen governs transportation and transformation" — the spleen digests water and food, absorbs and distributes nutrients and regulates water metabolism (entry 116). [WHO-2022] "Postnatal foundation" refers to the spleen: the spleen transports and transforms nutrients from water and food, the essential material foundation to maintain vital activities (entry 114). [WHO-2022]

"Qi engenders blood" — qi can transform into blood; blood is transformed from nutrients from water and food and ying-nutrient qi within the blood vessels (entry 251). [WHO-2022]

Put together: in the theory's model, both qi and blood come from food, by way of the spleen's transportation and transformation. That sentence is this article's summary of the definitions above, not the standard's own words.

This is also why the consultation in section VI asks a tired person about appetite, how they feel after meals and bowel habit — in the theory, that is where qi and blood come from. It is also why one of the three category names carries the word 「脾」 (spleen).

③ 「气虚」 and 「血虚」 are pathological states; 「气虚证」 and 「血虚证」 are categories. The standard describes qi deficiency (气虚) as: a pathological state of decreased zang-fu functions or body weakness due to deficiency of qi (entry 419). [WHO-2022] It describes blood deficiency (血虚) as: a pathological state in which deficient blood fails to nourish the zang-fu organs and meridians (entry 427). [WHO-2022]

After a consultation, the practitioner may place the tiredness under a pattern. The same standard lists:

• Qi deficiency pattern (气虚证) — its description mentions: often results from hypofunctions of the zang-fu organs (entry 1105). [WHO-2022]
• Blood deficiency pattern (血虚证) — its description mentions: often occurs when blood fails to nourish the zang-fu organs, meridians and other body tissues (entry 1112). [WHO-2022]
• Spleen deficiency with dampness pattern (脾虚湿困证) — its description mentions: often results from internal retention of turbid dampness due to spleen qi deficiency (entry 1205). [WHO-2022]

These three are the practitioner's categories after assessment — not a self-test, and not the whole list; the standard holds far more patterns than these. The same kind of tiredness can point to different patterns in the theory, and which one applies is decided after seeing the whole picture.

④ Why a pattern name is a category, not a cause. The standard's definition of a pattern (证) is: a pathological summarization on the disease location, etiological factors, nature, severity and prognosis in a certain stage (entry 548). [WHO-2022]

Its definition of pattern identification (辨证) is: the process of an overall analysis of clinical data to determine the location, etiological factors and nature of a disease at a certain stage (entry 550). [WHO-2022]

Both definitions carry the words "in a certain stage". A pattern name is the practitioner's summary of the whole picture at that time; when the stage changes, the category can change. "Qi deficiency pattern" tells you the conclusion of that summary — deficiency, of qi — not the thing that caused the tiredness.

The standard's own wording works the same way: each of the three pattern descriptions above ends with "often results from…" — a pattern has causes upstream of it. The name is the result of the sorting, not the cause itself. On how assessment works: what pattern differentiation is.

⑤ 「血虚」 is not anaemia: one is a category, the other a number. Start with how the standard itself files things. It defines a disease (病) as: the whole process of struggle between anti-pathogenic qi and pathogenic factors, yin–yang imbalance and progression, manifesting as specific symptoms and patterns; in a narrow sense, a disease has its specific name (entry 549). [WHO-2022]

In the standard, the entry that corresponds to iron deficiency anaemia sits in the diseases part: 「萎黄病」, whose English column reads iron deficiency anaemia, listed under spleen-system diseases (entry 1670, under 2.5 Disorders and 1625 Spleen system diseases). [WHO-2022] The blood deficiency pattern (血虚证) sits in the patterns part (entry 1112). [WHO-2022]

One is a disease name, the other a pattern name — in the standard's own architecture they were never on the same axis.

Now the blood-report side. The WHO's anaemia fact sheet says anaemia is diagnosed based on blood haemoglobin concentrations falling below specified thresholds established based on age, sex and physiological status, and that it is considered a symptom of an underlying condition. [WHO-Hb]

Set the two definitions side by side and two sentences follow. Both are this article's inferences from the definitions, not either source's words.

The haemoglobin on the report can be normal and the practitioner may still place the picture under the blood deficiency pattern — because that category is not defined by a number.

The number can be below the cutoff and the practitioner may not place it under the blood deficiency pattern — because the entries whose English column carries "anaemia" sit in the standard's diseases part (entry 1670, for one), not among the patterns.

Neither side is wrong; they are two instruments measuring different things.

What changes is what you do: hearing 「血虚」 does not mean buying iron tablets at the pharmacy on your own — the WHO fact sheet's line is that supplements are taken if a qualified health-care provider recommends them. [WHO-Hb] In this article's terms, that is the doctor who has seen the blood report.

And a normal report does not mean the TCM consultation has nothing to discuss.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

IV. See a doctor first in these situations

Persistent tiredness is sometimes one visible part of something that only tests can confirm. See a doctor for investigation first if there is:

• Weight loss you did not intend
• Breathlessness, palpitations or chest tightness, or getting winded by mild activity
• Pallor, dizziness, or noticeably heavier menstrual bleeding
• Persistent fever, night sweats, or a lump you can feel
• Tiredness alongside thirst, frequent urination or blurred vision
• Persistently low mood, loss of interest, or thoughts of harming yourself — call 999 now, or go to the nearest hospital emergency department. To talk to someone, the Ministry of Health's Talian HEAL 15555 is open every day from 8 am to 12 midnight, public holidays included [KKM-HEAL]; Befrienders KL is open 24 hours on 03-7627 2929 [BEF]. You can also contact your doctor.
• Tiredness severe enough to affect driving or work safety

These need medical tests and investigation — blood work, for instance — to establish the cause, and a TCM consultation does not substitute for them.

A safety note: TCM and Western medicine complement each other; it is not a choice between them. Persistent tiredness deserves to be taken seriously, and taking it seriously usually starts with tests rather than with TCM care.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

V. How to set your routine: TCM theory's position beside the public-health numbers

The situations in section IV go to a doctor first; once tests are clear, routine is one of the directions a TCM consultation talks about.

The TCM-theory positions below are defined from the Hong Kong Department of Health's public material; the public-health numbers each carry their own source.

① The routine TCM theory attaches to it. The Hong Kong Department of Health's sleep guide says: go to bed and get up at regular times; the actual amount of sleep varies by person, and should be sufficient without being excessive. [CMRO-睡眠]

It also favours the "midday and midnight sleep" (子午觉) — be asleep at the midnight hour (子时), and a short nap at the midday hour (午时) is also fine; a nap of about 15 minutes to 1 hour is considered suitable. [CMRO-睡眠] (子时 is 11 pm to 1 am.)

Before bed: drink less strong tea, coffee and other stimulating drinks, so as not to be too stimulated to sleep; keep the mind calm before bed — reading, a walk or a warm bath. [CMRO-睡眠]

② The public-health numbers. The American Academy of Sleep Medicine's advice is: set a bedtime that is early enough for you to get at least 7–8 hours of sleep; get up at the same time every day, even on weekends or during vacations. [AASM]

Singapore HealthHub's advice is: avoid caffeine, alcohol and big meals four to six hours before bedtime; avoid daytime naps — if you must, keep it within 30 to 45 minutes, and not in the evening. [SG-HH-11]

The two sources take different positions on naps: the Department of Health's sleep guide favours a short nap at the midday hour [CMRO-睡眠], while HealthHub advises avoiding daytime naps [SG-HH-11]. Which suits you is something to raise at the consultation.

The table below sets the TCM-theory position beside the public-health advice.

VI. What actually happens at the consultation

Once the situations in section IV have gone to a doctor and the tests are clear, this is how tiredness is handled in a TCM consultation.

① Questions from five directions.

• The shape and timing of the tiredness — when it started, which part of the day is worst, how much rest restores.
• Sleep — falling asleep, waking at night, hours, how you feel on waking.
• Eating and digestion — appetite, how you feel after meals, bowel habit, whether you are dieting. (Section III explains why the theory asks this.)
• Life and work — routine, commute, shift patterns, recent pressures and changes.
• Other bodily signals — weight change, menstrual picture, palpitations, breathlessness, dizziness.

② How to describe it usefully. Instead of "I'm very tired", say "mornings are alright; past two or three I can't keep going"; instead of "I don't sleep enough", say "a full seven hours and I wake as though I hadn't slept"; instead of "I've been off lately", say "it started about three months ago; it wasn't like this before".

Instead of "no appetite", say "eating less than before — a few kilos down over three months" — and that one falls under section IV: see a doctor first.

③ Bring the report, and say what you are taking. The company screening's blood results, prescribed medication, over-the-counter products from a pharmacy, a supplement marketed as "qi-boosting" that a relative gave you — say all of it at the consultation. Doing this safely depends on both sides knowing.

④ Assessment. Only after seeing the whole picture does the practitioner say whether this is the qi deficiency pattern, the blood deficiency pattern, spleen deficiency with dampness, or another pattern. That step comes after the consultation, not before it.

⑤ Then a direction, not a promise. The options a practitioner may raise include the kind of routine adjustments in section V, acupuncture, and herbal medicine. Which suits you, and whether to use any, is decided between you and the practitioner at the consultation. This article does not say "what the effect will be", because that belongs to an individual assessment, not to an article.

If you take prescribed medication, are pregnant or trying, are breastfeeding, are under 12, are a senior, have surgery coming up, or have a chronic condition under review — say so at the start of the consultation. Never stop prescribed medication on your own. On taking Chinese herbs alongside Western medication, see: can Chinese herbs be taken with Western medicine.

⑥ Keep a seven-day log before the consultation. One table is enough:

Seven days of notes beat recall. See also: what to prepare before an online consultation.

Fitting it into life in Malaysia

• Traffic commutes and shift work. Three hours a day in traffic, or long-term shifts, is itself information the consultation needs.
• Several kopi a day. No need to cut down first. HealthHub's advice is to avoid caffeine four to six hours before bedtime [SG-HH-11] — if you sleep at eleven, the kopi or teh tarik at the mamak after five falls inside that window. Say honestly how many and when.
• Your annual screening report. If the company screening includes haemoglobin (Hb), glucose and the like, mention it at the consultation. If you have had no screening, a doctor at a Klinik Kesihatan or a private clinic can assess whether blood tests are needed.
• Kopi or teh with the meal. The WHO anaemia fact sheet says tea and coffee slow down iron absorption when consumed with iron-rich foods [WHO-Hb]. That is one line from the source, not an instruction to give it up; whether to change anything depends on the report and the doctor's judgement.
• The nap in the air-conditioned office. The Department of Health's sleep guide adds that a nap should also guard against getting chilled [CMRO-睡眠] — keep a jacket on.
• Crunch season, exam season. Tiredness during a short high-pressure stretch and tiredness that has run for weeks with no clear reason [NHS-累] are different things; for the second, see section II.
• "Qi-boosting" supplements from a direct-sales friend or from family. Describe the contents and where they came from, and show them at the consultation.
• Keep a seven-day log before the consultation. Use the table in section VI. A week of notes beats recall.

Frequently asked

I sleep enough and I'm still tired — what is it? First confirm "enough": the AASM's advice is at least 7–8 hours, and getting up at the same time every day. [AASM] The NHS page puts it as: aim for 6 to 9 hours of sleep. [NHS-累] If you have slept enough and are still tired after a few weeks with no clear reason, the NHS's guidance is to see a GP. [NHS-累] Once tests are clear, the TCM consultation sorts which kind of tired it is (sections I and VI).

What should I get tested for tiredness? The NHS's words are: you may need tests, such as blood tests to check for anaemia, diabetes or hyperthyroidism. [NHS-累] The exact tests are the doctor's decision. If your report has a haemoglobin (Hb) line, the WHO's adult cutoffs are: nonpregnant women below 120 g/L, men below 130 g/L. [WHO-Hb] How to read the number is the doctor's judgement (section II).

Is it normal to feel especially tired at three in the afternoon? TCM theory has the 子午觉 idea: a short nap at the midday hour is fine, 15 minutes to 1 hour. [CMRO-睡眠] HealthHub's advice is to avoid daytime naps; if you must, within 30 to 45 minutes. [SG-HH-11] Also look at how many hours you slept the night before, and whether there was caffeine after lunch (the table in section V). If the afternoon tiredness has run for weeks and affects your daily life, see section II; if it affects driving or work safety, see section IV.

Is kopi a good way to stay awake? HealthHub's advice is to avoid caffeine four to six hours before bedtime [SG-HH-11]; the AASM's wording is to avoid it in the afternoon or evening. [AASM] Put another way, the morning cup and the evening cup mean different things for that night's sleep. No need to cut down before the consultation; log how many and when (the table in section VI).

Is the TCM "qi deficiency" just another word for tired? They are not the same kind of word. "Qi deficiency pattern" is the name of a pattern in TCM theory, and the WHO standard's description mentions that it often results from hypofunctions of the zang-fu organs. [WHO-2022] "Tired" is a presentation; after a consultation, the practitioner may place it under the qi deficiency pattern, the blood deficiency pattern, spleen deficiency with dampness, or another pattern — or under none of them. It is not a self-label. The difference between 「气虚」 and 「气虚证」 is in section III.

What should I record before the consultation? Seven days: time to bed, time awake, how you felt on waking, the worst part of the day, how many kopi and tea and when, overtime or exercise (the table in section VI). Add the company screening report and the medication you are taking. Never stop prescribed medication on your own because you are going to see a TCM practitioner.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

In closing

✅ Worth remembering:

1. Tiredness that has run for weeks with no clear reason — see a doctor first (you may need blood tests) [NHS-累]; what is tested and how to read the report is section II.
2. The haemoglobin line on your report: the WHO's adult cutoffs are 120 g/L for nonpregnant women and 130 g/L for men [WHO-Hb]; the reading is the doctor's.
3. Four things for the routine: a fixed wake-up time, at least 7–8 hours [AASM], no caffeine four to six hours before bed [SG-HH-11], short naps.
4. TCM theory sorts tiredness into patterns — names such as qi deficiency, blood deficiency and spleen deficiency with dampness (entries in the WHO standard [WHO-2022]) — and those are the practitioner's categories after assessment, not self-labels.
5. The TCM 「血虚证」 is a category reached after assessment (an entry in the WHO standard [WHO-2022]); "anaemia" on a report is a haemoglobin value against a cutoff [WHO-Hb] — two different things. Hearing 「血虚」 does not mean taking iron on your own. Whether iron is needed is the doctor's decision, from the blood report.
6. Persistently low mood or thoughts of harming yourself — get help immediately, do not carry it alone.

❌ Do not:

1. Write off months of tiredness as "just a busy patch" and keep putting it off.
2. Rely on TCM care alone when there is marked weight loss or breathlessness.
3. Stop prescribed medication on your own because you have started TCM care.

👉 If you are not sure "where to even start describing this kind of constant tiredness", you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in section IV applies, see a doctor first.

Written and reviewed by Tan Wan Yuet, a TCM practitioner registered with Malaysia's Traditional and Complementary Medicine Council under the T&CM Act 2016, practising in internal medicine, pain management and acupuncture.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

「医师，我就是很累。睡也睡了，还是累。」不少读者常问这句话，也是很难只用一句话回答的一句。

先说结论。 说不出原因、持续几个星期的累，第一步是看医生——NHS 的患者指引写的是：累了几个星期又不确定原因，请看医生。[NHS-累] 验什么、报告怎么看，在第二节。

第二步才是中医问诊：医师把「累」拆开——什么时候累、休息后恢复多少——再用中医理论归类，谈作息与方向。

理论里的「气」「血」指什么、为什么和验血报告是两回事，在第三节。

作息上，本文给的是有来源的数字：至少睡 7 至 8 小时 [AASM]、睡前四至六小时不碰咖啡因 [SG-HH-11]。哪些情况请先看医生，在第四节。整理成 6 个重点。

一、先分清楚：累有很多种，医师要先分出是哪一种

第一步永远是把「累」拆开。在问诊里，这些会被当作不同的表现来区分：

• 一早起来就累，还是到了下午才累
• 休息之后能恢复，还是怎么休息都一样
• 提不起劲，还是身体沉重
• 累但睡不着，还是累而且一直想睡

中医理论会把这些差异归到不同的证——第三节说明那些证的名称是什么意思。

现代医学则先用检查排除需要治疗的原因——第二节说明检查能看什么。两条路不互相取代，顺序是先检查。

二、先看报告：验血能告诉您什么

持续的累，有一部分原因只有检查能确认。这一节说明报告上能看什么，用 NHS 与世界卫生组织的公开资料。

① 什么时候该去验。 NHS 的患者指引列出三种情况请看医生：累了几个星期又不确定原因；累到影响日常生活；累的同时有其他症状。[NHS-累]

「其他症状」的例子，同一页举的是体重下降或情绪改变，或有人告诉您睡觉时会发出喘气、鼾声或哽住的声音。[NHS-累]

同一页也写：不要自我诊断——担心就看医生。[NHS-累]

② 验什么。 NHS 写的是：可能需要检查，例如验血查贫血、糖尿病或甲状腺功能亢进。[NHS-累] 具体验哪几项，由医生按您的情况决定。公司年度体检的报告若有这些项目，看诊时一并带上。

③ 先说血红蛋白（Hb）是做什么的。 世界卫生组织的贫血说明这样写：贫血是红血球数量或其中的血红蛋白浓度低于正常的状况。[WHO-Hb] 当身体的血红蛋白不足以把氧气送到器官与组织时，就会发生贫血。[WHO-Hb]

同一页写：贫血造成的症状包括疲倦、体力劳动能力下降与气促。[WHO-Hb] 它把贫血的常见症状形容为「非特异性」的。[WHO-Hb]

这一页说明了血红蛋白的工作（把氧气送到器官与组织）和贫血的表现（疲倦），没有写出中间那一步——氧气送得少，为什么会觉得累。这篇也停在这里。

「非特异性」三个字值得记住：累不一定是贫血，贫血也不只表现为累。所以判定靠的是数字——同一页写：贫血是依据血红蛋白浓度低于按年龄、性别与生理状态订定的界线来诊断的。[WHO-Hb]

④ 报告上的血红蛋白怎么看。 世界卫生组织 2024 年的指南把成年人（15 至 65 岁）的贫血界线定为：非怀孕女性低于 120 g/L，男性低于 130 g/L。[WHO-Hb]（报告若以 g/dL 显示，即 12 与 13。）怀孕期与儿童另有不同的界线。[WHO-Hb]

同一份指南说明：吸烟者的数值，以及居住在高海拔地区者的数值，需要调整。[WHO-Hb] 所以报告上的数字对照这条线，是一个起点；是否贫血、原因是什么，由医生判断。

世界卫生组织的说明也提到：贫血被视为某个潜在状况的一个症状。[WHO-Hb] 换句话说，验出来低于线，下一个问题是「为什么」——那是医生的工作。

⑤ 血糖与甲状腺。 这两项是 NHS 列为医生可能安排的验血项目。[NHS-累] 本文不写它们的判读数值；报告上的血糖与甲状腺指数，请由医生解读。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

三、「气」「血」到底指什么：与验血报告是两回事

第二节讲的是验血报告上的血红蛋白。这一节讲中医理论里的「气」与「血」——同一个「血」字，两套语言。

以下全部是中医理论的说法，用世界卫生组织 2022 年的中医术语标准来定义；括号里是标准的条目编号，方便查对。

① 先定义两个字。 世界卫生组织的标准对「气」的说明是：维持生命活动的、无形而流动性高的营养物质（条目 224）。[WHO-2022] 对「血」的说明是：在血脉中运行、濡润与滋养身体的红色液体，是维持生命活动的基本物质（条目 225）。[WHO-2022]

留意两个定义的写法：都是用「做什么」来定义的——维持生命活动、濡润与滋养身体。理论里的「血」，重点在功能，不在一个可以化验出来的数量。

② 理论里，气和血从哪里来。 标准的说法：「脾主运化」——脾消化水谷、吸收并输布营养，并调节水液代谢（条目 116）。[WHO-2022] 「后天之本」指脾：脾运化水谷精微，那是维持生命活动的物质基础（条目 114）。[WHO-2022]

「气能生血」——气可以化为血；血由水谷精微与血脉中的营气化生（条目 251）。[WHO-2022]

把这几条放在一起看：在理论的模型里，气与血都从饮食经「脾」的运化而来。这一句是本文对上面几条定义的整理，不是标准的原句。

这也是为什么第六节的问诊，会问一个很累的人胃口、餐后状态和大便——在理论里，那是气血的来源。三个归类名称里有一个带「脾」字，也是这个原因。

③ 「气虚」「血虚」是病理状态，「气虚证」「血虚证」是归类。 标准把「气虚」说明为：因气不足而使脏腑功能减退或身体虚弱的病理状态（条目 419）。[WHO-2022] 把「血虚」说明为：血不足、不能濡养脏腑与经络的病理状态（条目 427）。[WHO-2022]

问诊后，医师可能把「累」归到某个证。同一份标准列有：

• 气虚证——说明提到：此证常由脏腑功能低下所致（条目 1105）。[WHO-2022]
• 血虚证——说明提到：此证常因血不能濡养脏腑、经络与身体组织而起（条目 1112）。[WHO-2022]
• 脾虚湿困证——说明提到：此证常由脾气虚所致的浊湿内停而起（条目 1205）。[WHO-2022]

这三个是医师辨证后的归类，不是自测表，也不是全部——标准里的证远不止这三个。同一种「累」在理论中可能指向不同的证，哪一个成立是医师看过整体之后的判断。

④ 为什么证的名称是「归类」，不是「原因」。 标准对「证」的定义是：对疾病在某一阶段的病位、病因、病性、轻重与预后的病理概括（条目 548）。[WHO-2022]

「辨证」的定义是：全面分析临床资料，以确定疾病在某一阶段的病位、病因与病性的过程（条目 550）。[WHO-2022]

两条定义里各有「某一阶段」四个字。一个证的名称，是医师对当时整体情况的概括；阶段变了，归类可以变。「气虚证」说的是这个概括的结论——虚、在气——不是造成累的那个东西。

标准自己的写法也如此：上面三条证的说明，都以「常由……所致」作结——证有它上游的原因。名称是归类的结果，不是原因本身。辨证怎么做，可参考：辨证是什么。

⑤ 「血虚」不是「贫血」：一个是归类，一个是数值。 先看标准自己怎么排。标准把「病」定义为：正气与邪气相争、阴阳失调与演变的全过程，表现为特定的症状与证；狭义上，病有其特定的名称（条目 549）。[WHO-2022]

在标准里，与「缺铁性贫血」对应的条目在「疾病」那一部分：「萎黄病」，英文栏写的是 iron deficiency anaemia，列于脾系病之下（条目 1670，属 2.5 疾病、1625 脾系病）。[WHO-2022] 「血虚证」则列在证的部分（条目 1112）。[WHO-2022]

一个是病名，一个是证名——在标准的架构里，它们本来就在不同的轴上。

再看验血报告那一边。世界卫生组织的贫血说明写：贫血是依据血红蛋白浓度低于按年龄、性别与生理状态订定的界线来诊断的；它被视为某个潜在状况的症状。[WHO-Hb]

两条定义并排，可以推出两句话。这两句是本文从定义推出来的，不是任一份资料的原句。

报告上的血红蛋白正常，医师仍可能归到血虚证——因为这个归类不是用数字定义的。

报告上的数值低于界线，医师也未必归到血虚证——因为标准里英文栏带 anaemia 字样的条目，都列在「疾病」部分（如条目 1670），不在证的部分。

这不是谁对谁错，是两个工具在量不同的东西。

会改变的是做法：听到「血虚」，不等于该自行到药剂行买铁剂——世界卫生组织的说明写的是，补充剂在合资格的医护人员建议下服用。[WHO-Hb] 在这篇的语境里，那是看过验血报告的医生。

报告正常，也不等于中医问诊没有可谈的。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

四、这些情况请先看西医

持续的疲倦，有时是需要检验才能确认的状况的其中一个表现。以下情况请先就医做检查：

• 没有刻意减重，体重却明显下降
• 伴随气促、心悸、胸闷，或稍微活动就喘
• 脸色苍白、头晕，或经血量明显变多
• 持续发烧、夜间盗汗，或摸到不明的肿块
• 累的同时伴随口渴、频尿、视力模糊
• 情绪持续低落、对事情失去兴趣，或出现伤害自己的念头——请立刻拨打 999，或前往最近的医院急诊部。若想找人谈一谈，卫生部的 Talian HEAL 15555 每天早上 8 时至午夜 12 时开放，包括公共假期 [KKM-HEAL]；Befrienders KL 24 小时热线：03-7627 2929 [BEF]。您也可以联络您的医生。
• 累到影响驾驶或工作安全

这些情况需要西医的检验与检查（例如血液检查）才能确认原因，中医问诊不能取代这些检查。

安全提醒：中医与西医是互相补位的关系，不是二选一。持续的疲倦值得认真对待，而认真对待的第一步通常是做检查，不是先调理。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

五、作息怎么排：中医理论的说法与公共卫生机构的数字并排

第四节的情况先看医生；检查清楚之后，作息是中医问诊会谈到的方向之一。

以下的中医理论说法，用香港卫生署的公开资料来定义；公共卫生机构的数字各自标注出处。

① 中医理论附带的作息。 香港卫生署的睡眠篇写：应按时就寝和起床，实际睡眠时间因人而定，以充足而不过度为宜。[CMRO-睡眠]

它也主张「子午觉」——夜半子时应在睡梦中，中午午时也可小睡一会儿，午睡以 15 分钟至 1 小时为宜。[CMRO-睡眠]（子时指晚上 11 时至凌晨 1 时。）

睡前：少饮浓茶、咖啡等刺激性饮料，以免兴奋难以入睡；睡前保持心情平静，可阅读、散步或洗个热水澡。[CMRO-睡眠]

② 公共卫生机构的数字。 美国睡眠医学会（AASM）的建议是：把就寝时间定得够早，让自己至少睡 7 至 8 小时；每天同一时间起床，周末和假期也一样。[AASM]

新加坡 HealthHub 的建议是：睡前四至六小时避免咖啡因、酒精与大餐；白天尽量不午睡，若一定要睡，控制在 30 至 45 分钟内，且不要在傍晚睡。[SG-HH-11]

两份资料对午睡的取态不同：卫生署的睡眠篇主张午时可小睡 [CMRO-睡眠]，HealthHub 则建议白天尽量不午睡 [SG-HH-11]。哪一种适合您，看诊时可以谈。

下面这张表，把中医理论的说法和公共卫生机构的建议并排放在一起。

六、看诊时实际会做什么

第四节的情况先看医生，检查清楚之后，「累」在中医问诊里是这样处理的。

① 五个方向的问题。

• 累的样子与时间：什么时候开始、哪个时段最明显、休息后恢复多少。
• 睡眠：入睡、夜醒、时数、醒来后的感觉。
• 饮食与消化：食欲、餐后状态、大便情况、有没有在节食。（第三节说明了理论为什么问这个。）
• 生活与工作：作息、通勤、轮班、最近的压力与变化。
• 其他身体线索：体重变化、月经情况、有没有心悸、气促、头晕。

② 怎么描述才有用。 与其说「我很累」，不如说「早上还可以，过了两三点就撑不住」；与其说「睡不够」，不如说「睡满七小时，起来还是像没睡」；与其说「最近状态差」，不如说「大概从三个月前开始，之前不会这样」。

与其说「没什么胃口」，不如说「吃得比以前少，三个月瘦了几公斤」——这一句属于第四节的情况，请先看医生。

③ 带上报告，说明正在服用的东西。 公司体检的血液报告、医生开的药、药剂行买的非处方药、家人给的标称「补气」的补品——看诊时一并说明。两边都知道，才安全。

④ 辨证。 医师看过整体之后，才会说这是不是气虚证、血虚证、脾虚湿困证，或是别的证。这一步在问诊之后，不在之前。

⑤ 然后是方向，不是承诺。 医师可能提出的选项包括第五节那一类的作息调整、针灸、中药。哪一种适合您、要不要用，由医师与您在看诊时决定。本文不写「会有什么效果」，因为那属于个人评估，不属于文章。

若您正在服用医生开的药、怀孕或备孕、哺乳中、12 岁以下、乐龄人士、手术前，或有慢性病在复诊中——请在问诊一开始就说明。切勿自行停药。 中药与西药怎么并用，请见：中药可以和西药一起吃吗。

⑥ 问诊前记录七天。 一张表就够：

七天的记录比回忆完整。做法可参考：线上问诊前该准备什么。

大马生活里怎么安排

• 塞车通勤与轮班工作：一天通勤三小时，或长期轮班，本身就是问诊要了解的资讯。
• 每天几杯 kopi：不必先戒。按 HealthHub 的建议，睡前四至六小时避免咖啡因 [SG-HH-11]——十一点睡的话，五点以后 mamak 那杯 kopi 或 teh tarik 就落在那个窗口里。问诊时如实说几杯、几点喝。
• 年度体检报告：公司体检若有血红蛋白（Hb）、血糖等项目，看诊时一并说明。没有体检的，可请 Klinik Kesihatan 或私人诊所的医生评估是否需要验血。
• 饭配 kopi 或 teh：世界卫生组织的贫血说明写，与含铁食物同吃时，茶、咖啡会减慢铁的吸收 [WHO-Hb]。这是资料上的一句，不是叫您戒；要不要调整，看报告与医生的判断。
• 办公室冷气房里的午睡：卫生署的睡眠篇提醒，午睡也要防止受凉 [CMRO-睡眠]——披件外套。
• 加班季与考试季：短期高压期间的疲倦，和持续几个星期、说不出原因的疲倦 [NHS-累]，是两回事；后者请看第二节。
• 直销或家人给的标称「补气」的保健品：请说明成分与来源，看诊时一并出示。
• 问诊前记录七天：用第六节的表。一周的记录比回忆完整。

常见问题

睡够了还累，是什么问题？ 先确认「够」：AASM 的建议是至少 7 至 8 小时，而且每天同一时间起床。[AASM] NHS 同一页写的是：以 6 至 9 小时的睡眠为目标。[NHS-累] 睡够了、持续几个星期还累又不确定原因，NHS 的指引是看医生。[NHS-累] 检查清楚之后，中医问诊再分是哪一种累（第一节、第六节）。

累要验什么？ NHS 写的是：可能需要检查，例如验血查贫血、糖尿病或甲状腺功能亢进。[NHS-累] 具体项目由医生决定。若报告上有血红蛋白（Hb），世界卫生组织的成人界线是：非怀孕女性低于 120 g/L、男性低于 130 g/L。[WHO-Hb] 数字怎么解读，由医生判断（第二节）。

下午三点特别累，正常吗？ 中医理论有「子午觉」的说法：午时可小睡一会儿，15 分钟至 1 小时。[CMRO-睡眠] HealthHub 则建议白天尽量不午睡，若要睡，30 至 45 分钟内。[SG-HH-11] 也看看前一晚睡了几小时、午餐后有没有咖啡因（第五节的表）。下午的累若持续几个星期、影响日常生活，请看第二节；影响驾驶或工作安全，请看第四节。

kopi 提神好不好？ HealthHub 的建议是睡前四至六小时避免咖啡因 [SG-HH-11]；AASM 的写法是下午与晚上避免。[AASM] 也就是说，早上那杯与傍晚那杯，对当晚睡眠的意义不同。问诊前不必先戒；如实记录几杯、几点喝（第六节的表）。

中医说的「气虚」就是累吗？ 不是同一个层次的词。「气虚证」是中医理论里一个证的名称，世界卫生组织的标准说明提到：此证常由脏腑功能低下所致。[WHO-2022] 「累」是一种表现；问诊后，医师可能把它归到气虚证、血虚证、脾虚湿困证或别的证，也可能不归到任何证。它不是自我标签。「气虚」与「气虚证」的分别，在第三节。

问诊前要记录什么？ 七天：几点睡、几点醒、醒来的感觉、最累的时段、kopi 与茶的杯数和时间、加班或运动（第六节的表）。再加上公司体检报告与正在服用的药物。切勿因为要看中医而自行停掉医生开的药。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

结语

✅ 记住这几点：

1. 说不出原因、持续几个星期的累，先看医生（可能需要验血） [NHS-累]；验什么、报告怎么看，在第二节。
2. 报告上的血红蛋白：世界卫生组织的成人界线是非怀孕女性 120 g/L、男性 130 g/L [WHO-Hb]；解读由医生。
3. 作息四件事：固定起床时间、至少 7 至 8 小时 [AASM]、睡前四至六小时不碰咖啡因 [SG-HH-11]、午睡要短。
4. 中医理论把「累」归到证——名称如气虚证、血虚证、脾虚湿困证（世界卫生组织标准里的条目 [WHO-2022]）——那是医师辨证后的归类，不是自我标签。
5. 中医的「血虚证」是辨证后的归类（世界卫生组织标准里的条目 [WHO-2022]）；报告上的「贫血」是血红蛋白对照界线的数值 [WHO-Hb]——两回事。听到「血虚」，不等于该自行补铁。是否需要补铁，由医生按验血报告决定。
6. 情绪持续低落或出现伤害自己的念头，请立刻求助，不要独自撑着。

❌ 不要这样做：

1. 不要把持续几个月的疲倦当成「最近比较忙」而一直拖着。
2. 不要在有明显体重下降或气促时只靠调理。
3. 不要因为开始中医调理就自行停掉医生开的药。

👉 如果您不确定「我这种一直累，该从哪里说起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有第四节列出的情况，请先看医生。

本文由 陈奂仴 医师 撰稿审阅。陈奂仴 医师依 2016 年 T&CM 法令于马来西亚传统与辅助医药理事会注册执业，专长为内科、疼痛管理与针灸。

无论身在何处，与持证中医师对坐。

汉方现代中医