childbirth, often involving a substantial loss of blood. Indeed, there is a saying that declares: "A
miscarriage is more serious than childbirth". 9(338)
"Recreational" Drugs
Prolonged and continued use of drugs such as cannabis, LSD, cocaine or heroine is an important
modern cause of chronic tiredness and lethargy. Researchers have called the state deriving from
long-term use of cannabis "amotivational syndrome", consisting in a feeling of unease, a sense of
not being fully effective, and gross lethargy. 10(339)
Pathology
Although the term Exhaustion (xu lao) by definition implies tiredness deriving from a
deficiency, chronic tiredness can also result from an Excess condition as was remarked in the
introduction to this chapter. There are basically three possibilities:
- Deficiency
- Combined condition of Deficiency and Excess (e.g. stagnation of Liver-Qi
inducing a deficiency of Spleen-Qi and therefore tiredness) - Excess.
Whilst it is easy to understand how the first two conditions may result in tiredness, it may be
more difficult to see how an Excess condition can cause tiredness. It basically does so by
obstructing the proper movement, transformation and circulation of Qi and Blood. For example,
stagnation of Liver-Qi is a frequent cause of tiredness. How does it cause tiredness even without
a deficiency of Stomach and Spleen? The Liver ensures the smooth flow of Qi in all parts of the
body and all organs and it regulates the entering/exiting and ascending/descending of Qi. It is
easy to see therefore that if Liver-Qi is stagnant the proper direction of movement and
circulation of Qi is impaired, necessarily resulting in tiredness. One can understand this concept
by studying the herbal prescription Si Ni San Four Rebellious Powder (Chai Hu Radix Bupleuri,
Bai Shao Radix Paeoniae albae, Zhi Shi Fructus Citri aurantii immaturus and Gan Cao Radix
Glycyrrhizae uralensis), which resolves stagnation of Liver-Qi. One of the indications for the
use of this prescription is cold hands: the hands are cold not from deficiency of Yang but
because the stagnation of Liver-Qi obstructs a proper circulation of Qi. Exactly the same
thinking can be applied to the symptom of tiredness: it can derive not only from a deficiency but
also from the impairment in the movement and circulation of Qi caused by Liver-Qi stagnation.
The Excess conditions which are most likely to result in chronic tiredness are:
- Liver-Qi stagnation