- Liver-Yang rising
- Liver-Fire
- Liver-Wind
- Phlegm
- Dampness.
The first four conditions all pertain to the Liver and all hinge around the Liver function of
ensuring the smooth flow of Qi. The last two conditions, Phlegm and Dampness, are very
frequent Excess-causes of chronic tiredness. Although they both derive from a deficiency of
Spleen-Qi which would cause tiredness in itself, Phlegm and Dampness also cause tiredness by
themselves because they obstruct the movement and transformation of Qi.
Having differentiated whether tiredness is caused by a Deficiency or an Excess condition, in the
case of Deficiency the next logical step is that of identifying the type, i.e. whether there is
deficiency of Qi, Yang, Blood or Yin. Differentiating these four types of deficiency is extremely
important to a successful treatment, particularly with herbs. Differentiating these four types of
Deficiency is, however, closely linked to identifying the organ involved, which is the third step
in diagnosing the cause of tiredness.
Of the Yin organs the one that is most frequently responsible for chronic tiredness is of course
the Spleen. A Spleen deficiency is often accompanied by a Stomach deficiency and the two are
the origin of Qi and Blood and therefore an extremely frequent Deficiency-cause of tiredness.
A Liver-Blood deficiency is also a frequent cause of chronic tiredness. The Liver regulates the
volume of Blood according to physical activity, flowing to the muscles and tendons during
exercise and flowing back to the Liver during rest. The flow of Blood back to the Liver during
rest has a tonifying effect on the body and helps us to recuperate energy. For this reason a short
period of rest lying down in the middle of the day helps the body to recuperate energy. This
concept appeared first in chapter 9 of the "Simple Questions" where it says that "The Liver has a
regulating function [literally 'is the Root of stopping extremes']...". 11(340)
Most doctors agree that this means the Liver is responsible for endurance when Blood is
abundant, and for tiredness when Blood is deficient.
The Liver is also responsible for chronic tiredness in Excess conditions such as Liver-Qi
stagnation, Liver-Yang or Liver-Fire rising and Liver-Wind, as explained above.
The Lungs cause chronic tiredness in case of Lung-Qi or Lung-Yin deficiency. Either of these
frequently follows a severe cold, influenza or upper respiratory infection.
Heart-Qi or Heart-Blood deficiency causing tiredness are often the result of long-standing
emotional problems such as sadness or worry.