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Asclepius' Ampoule - Fatigue

Fatigue in Traditional Chinese Medicine

By Enrico Colmi, physician and Tai-chi-chuan and Baguazhang instructor


Fatigue cannot be considered from a general standpoint because it is a complex phenomenon, etiologically manifold, which can manifest in different shapes and forms. We can distinguish between physiological fatigue, physiological fatigue that becomes pathological and pathological fatigue.



From a physiological point of view, fatigue can be considered an alarm bell that snaps anytime the organism is getting closer to its limits.

This is physical fatigue and it appears after an intense and/or prolonged effort. It is common in sport activities (nowadays, thanks to various technologies, it is not common anymore in the work environment). It represents the limit that the athlete aims to push up toward ever higher levels, in order to improve his/her performances. It is one of the parameters to consider when putting together training methods and plans, where different techniques have to be examined with the aim to improve the athlete's resistance to effort and fatigue. We are talking about a specific sector that calls into play athletic trainers and coaches and it requires a particular competence on the physiological mechanisms at the base of each physical activity.

Mental fatigue is caused by an intense mental activity for study or work. The boundaries that define the normal manifestations of this kind of fatigue may vary: if the effort is pleasant fatigue does not occur (take, for example, writers, scientists, philosophers, etc. or people positively involved in their intellectual activity); instead, a student who has developed a negative approach toward study finds it quite hard to concentrate and, therefore, has a very low fatigue threshold.

Physiological fatigue can be easily detectable, does not produce any particular discomfort and is characterized by extremely fast recovery times (a short rest or a sound sleep can be enough to completely recover one's optimal conditions).



Normal fatigue becomes pathological when one exceeds his/her individual limits. A symptom of this is the worsening of the physical and mental performance. As far as athletic performances go, some consider that the more one works out, the better the results; others think that when one is tired it is better to rest. In reality, best results are achieved when the athlete is subject to the right amount of effort – in order to improve his performances – without reaching a level pathological fatigue. In both cases – for physical as well as mental fatigue – the approach is what makes the difference.

Signs that fatigue is about to become pathological are troubles to recover (rest is not enough anymore) and the appearance of negative symptoms that have the tendency to get worse and consolidate with the passing of time.



This is the most common form of fatigue. In most cases fatigue cannot be related to an objective justification in physical or mental efforts actually performed by the individual. Fatigue almost always involves an imbalance of the psycho-emotional sphere. The picture seems complex and of difficult interpretation: it is hard to rationalize the situation.

Some of the most common disorders are: being tired before starting a job; rest does not reduce fatigue and often, after having rested, one is more tired than before; insomnia appears; fatigue is not explainable through a rational analysis; vicious cycles appear, such as 'the less one does, the less one wishes to do'; a series of psychosomatic symptoms show up, which are difficult to frame down and take care of.

Often who suffers from this kind of fatigue does not recur to any treatment because he assumes that there are no remedies for something that cannot be explained and that does not fall into a specific pathology. In most serious cases the person goes to a psychologist or to a physician for a pharmacological treatment.

Traditional Chinese Medicine offers an interesting approach.



Traditional Chinese Medicine considers natural phenomena as the expression of a global form of energy, called Qi or (Chi) that pervades everything. In reference to human beings, if the natural order of things and the natural balance are respected, Qi can freely flow and the person lives in wellness (which should be his natural condition). When for internal or external causes that balance breaks down, a stagnation of Qi takes place, causing energetic excess states (full) or deficiency (empty) of the 5 organs of TCM. (*)

According to TCM, fatigue can represent an early symptom of the breaking up of internal balances or reciprocal relations of the 5 organs. Emotions too represent a particular form of energy and are related to the organs in a special way. If we identify the particular kind of fatigue and the emotions connected to it we are able to intervene not only by fighting the symptom (fatigue), but also going back to the cause of the imbalance, before it can provoke more serious damages.

Here is a short list of the emotions connected to the 5 organs and to the kind of fatigue they may cause.

LIVER The energetic dynamic connected to the liver is the beginning of an action, the start. If our initiatives and impulses are blocked at their birth by external situations (as well as by fears and internal blocks) a sense of frustration and helplessness takes over. The effort of producing an action from one end and resisting it from the other end generates a state of energetic breakdown, which results in fatigue. This is often accompanied by manifestations of intolerance: sourness, anger, rage, wrath, all of which end up worsening the overall condition by lowering even more the energetic level and increasing the sense of fatigue.

HEART In every tradition the heart is associated to love. It is easy to understand how states like being in love (as well as all other kinds of love, like mother-son) can be energetically recharging from one end, and from the other can lead to serious states of exhaustion if the relationship becomes complicated or breaks apart; the feeling of being emptied out and unable to perform any action marks the depletion of the person's energetic reserve.

LUNGS In TCM the lungs are the connection between the individual and his external environment. When that balance falls apart the person tends to close up onto himself and develop attitudes of rejection, melancholy, sadness and, at times, this can reach extreme levels like depression and suicide. In these cases an energetic annihilation takes place; fatigue grows deeper until a point of self-destruction.

KIDNEYS According to TCM, kidneys represent the reserve of our energetic resources, which we inherit from our parents and have the duty to manage throughout our life. This function can be compared to genetics in western medicine and it is also connected to the sexual sphere. From an emotional standpoint they express the individual's willpower as well as fear in all its forms. Kidney's energy is extremely important in TCM because it is more difficult to regenerate: in fact the progressive running out of this energy is considered the cause of aging processes. For this reason it is recommended to maintain a balanced sexual activity and a deep and intense work on kidney's energy and on willpower (for example through qigong exercises). Fatigue caused by kidney's energy exhaustion is the deepest one and the most difficult to heal.

SPLEEN-PANCREAS They represent the energetic center, the balancing point of the entire system and from an emotional standpoint they represent the tendency of keeping everything under control. Their balance is overthrown by multiple and complex external stimuli and when they try to restore the system's balance when one or more organs experience a lack of balance. Their corresponding entrails, the STOMAC, can present difficulty 'digesting', both in a physical and an emotional sense. In this case fatigue and progressive exhaustion are a necessity in order to face different needs and to keep the situation under control.


Obviously reality is much more complex and conditions can become nested one into the other. Analyzing the symptom 'fatigue' with TCM criteria we can identify eventual energetic imbalances and intervene to timely solve situations destined to worsen with time.

TCM can use various instruments, but the most effective one is certainly acupuncture, which is capable to restore the balance by tonifying (in case of deficiency) or dispersing (in case of excess) the interested organs.

QIGONG (or Chi Gung) is complementary to TCM. This term indicates a whole series of exercises aimed to restore the balance and/or strengthen the individual's vital energy. One of these is known as 'the 6 healing sounds' to balance out the emotions connected to the individual organs; another exercise is the 'breathing of the spine', to strengthen the global energy of the organism and fight fatigue related to the exhaustion of one's energies. (**)



Proper techniques (TCM and qigong) can be extremely useful to fight fatigue and prevent eventual consequences that may appear later. Improving the condition can stimulate the individual to develop a better and more balanced attitude toward facing eventual disorders and/or more serious issues.

Individual choices determine the development of each situation: if one keeps certain behaviors or makes specific choices, consequences will be inevitable. The external intervention of TCM and the practice of techniques like Chinese qigong can help us better understand and identify problems, but cannot help us solving them.


(*) this is an extremely schematic and limited presentation of TCM. It is not possible to resume in a few lines such a complex system as TCM.

(**) See my previous articles on Asclepius' Ampoule

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