Western Differentiation

Chronic tiredness and debility can be due to many different causes, of which the seven most
common ones will be discussed here.

Chronic Nephritis

This can be pyelo- or glomerulonephritis. It consists in inflammation of the kidney pelvis or
glomeruli or both. The main manifestations are severe tiredness, oedema, nausea, frequent
urination and lower backache (see Chapter 22).

Glandular Fever (Mononucleosis)

This is due to an infection from the Epstein-Barr virus. It manifests with debility, poor appetite,
fever, swollen glands and, in prolonged cases, depression.

It usually occurs only in young adults and teenagers.

Myalgic Encephalomyelitis (ME)

This manifests with a general flu-like feeling, great tiredness, lethargy, muscle ache and poor
memory (see Chapter 25).

It is more common in young adults.

Carcinoma

Carcinoma of any part of the body or in any organ can cause tiredness and debility. Tiredness is
often the earliest presenting symptom. If it is accompanied by poor appetite, loss of weight and a
sallow complexion in a middleaged or elderly person, carcinoma should be suspected.

Addison's Disease

This is due to hypofunction of the cortex of the adrenal glands. It is characterized by severe
lassitude, poor appetite, nausea, vomiting, abdominal pain, giddiness, blurred vision, dyspnoea
on exertion, palpitations, craving for salt, pigmentation of skin, weight loss and a low systolic
blood pressure.