exercise. If Liver-Fire is caused by deep emotional problems, it may be necessary to recommend
counselling.
Tiredness is one of the most common presenting symptoms in Western patients. Very often it is
the main or only symptom of which a patient complains. Tiredness as a main presenting
symptom is discussed in Chinese Medicine under the heading of "Exhaustion" (Xu Lao). The
very term "Exhaustion" describes not only a symptom, i.e. tiredness, but also its underlying
cause, i.e. a deficiency of the body's Qi. In fact, the term Xu Lao, derived from xu meaning
"deficiency" and lao meaning "tiredness", means literally "tiredness from deficiency". However,
tiredness is not necessarily always caused by a Deficiency; it can, sometimes, be caused by an
Excess condition. A very simple example is the kind of tiredness which is experienced during a
cold or influenza, i.e. an invasion of exterior Wind-Cold or Wind-Heat which are, by definition,
Excess conditions. Of course, in many cases tiredness can be the result of an interaction of
Deficiency and Excess. In this chapter, I will therefore also discuss some Excess causes of
tiredness in addition to the Deficiency causes normally considered under "Exhaustion".
The "Classic of Difficulties" discusses the "five depletions" (wu sun) in chapter 14. It says:
In depletion of the skin [i.e. Lungs], the skin contracts and hair falls out; in
depletion of the blood vessels [i.e. Heart], these become deficient and Blood
cannot nourish the internal organs; in depletion of the muscles [i.e. Spleen], these
become thin and food cannot nourish them; in depletion of the tendons [i.e.
Liver], these weaken and cannot support the body and the hands cannot grasp; in
depletion of the bones [i.e. Kidneys], these wither and the person cannot get up
from bed .... In depletion of the Lungs tonify Qi; in depletion of the Heart
harmonize Defensive Qi and Nutritive Qi; in depletion of the Spleen regulate the
diet and protect the body from extremes of cold and heat; in depletion of the Liver
soothe the Middle [with sweet herbs]; in depletion of the Kidneys nourish the
Essence.1(329)The concept of "depletion" is similar to that of "exhaustion".