"I've been constantly tired lately."
This is something many people can relate to. You sleep, but don't feel rested. You try to recover at the weekend, but by Monday your energy is already depleted. On top of the physical tiredness, there may be poor sleep, difficulty concentrating, low mood, muscle aches, or a vague sense of inner tension.
Fatigue is not a disease in itself — it is a symptom. The causes can be very different: sleep deprivation, prolonged stress, infections, anaemia, thyroid disorders, medication side effects, psychological burden, or other physical conditions.
The frequently used term "sub-health" describes a subjectively perceived state between health and illness rather than a clearly defined medical diagnosis.
1. Not ill — but not truly well either
In modern everyday life, many people know a state where no obvious disease is present, yet the body doesn't feel truly capable or resilient. Work, family demands, constant connectivity, and psychological pressure consume enormous energy — while genuine recovery becomes harder.
Possible symptoms include persistent fatigue, sleep that doesn't feel restorative despite sufficient hours, difficulty concentrating, reduced motivation, muscle tension or diffuse pain, emotional fluctuations, and increasing attention to bodily changes.
This does not automatically mean "it's all psychological." Modern healthcare increasingly recognises that physical, psychological, social, and behavioural factors are interconnected. The WHO's concept of Primary Health Care encompasses not just treatment of existing disease, but health promotion, prevention, rehabilitation, and palliative care — centred on the individual person. [1]
Healthcare does not begin only when a disease has been diagnosed.
2. When is fatigue normal — and when should it be investigated?
Temporary tiredness is generally not a cause for concern. It becomes relevant when fatigue persists over a longer period and significantly affects work, movement, social activities, or daily life. Behind fatigue, there can be many different underlying causes.
Physical factors
Anaemia, thyroid disorders, infections, sleep disturbances, certain medications, or other chronic conditions can all manifest as fatigue.
Lifestyle
Chronic sleep deprivation, unbalanced diet, too little or excessive physical activity, and sustained high pressure can prevent adequate recovery.
Psychological and social factors
Long-term stress, anxiety, depressive symptoms, occupational overload, or difficult life circumstances can also affect sleep, energy levels, and physical resilience.
The first question should therefore not simply be:
"How do I get rid of this tiredness?"
But rather:
"Why am I fatigued?"
3. Chronic fatigue is not automatically ME/CFS
The term "chronic fatigue" can easily cause confusion. Not every prolonged tiredness constitutes Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS).
The WHO classifies ME/CFS in ICD-11 under 8E49 Postviral fatigue syndrome and acknowledges ongoing uncertainties regarding causes, diagnostic criteria, and a uniformly effective treatment. [3]
Post-Exertional Malaise (PEM)
A defining feature of ME/CFS is that after physical or cognitive exertion, symptoms do not simply worsen slightly — they can deteriorate significantly, sometimes only hours or one to two days later, with recovery taking days or longer.
The NICE guideline (NG206) lists PEM, significant fatigue, unrefreshing sleep, cognitive difficulties, and substantial reduction in activity as key features, while recommending medical assessment to exclude other possible causes. [4]
In people with ME/CFS, exceeding the individual energy threshold can worsen symptoms. The NICE guideline recommends individually tailored Energy Management rather than graded exercise.
4. Modern healthcare means more than treating disease
The WHO describes Primary Health Care as a continuous process:
Rehabilitation is not a "last step" that begins only after treatment is complete. The WHO positions rehabilitation as an essential health service alongside health promotion, prevention, treatment, and palliative care. [2]
For persistent fatigue, important questions beyond disease management include: Does sleep actually restore the body? Are work and rest in balance? Is physical activity appropriate? Is stress chronically high? Are there ongoing pain or muscle tensions? Is the body still recovering from a past infection?
5. Why chronic fatigue can lead to growing concern about one's own body
A frequently underestimated aspect of chronic complaints is increasing worry about the body. When someone has been fatigued for months without a clear explanation, bodily changes become more closely monitored — creating a cycle:
Investigate possible physical causes, and at the same time support the body's ability to recover.
6. What role can Traditional Chinese Medicine play?
This is where TCM can take on a complementary role.
The WHO's current strategy for Traditional, Complementary and Integrative Medicine (TCIM) 2025–2034 explicitly pursues an evidence-based approach, focusing on strengthening scientific evidence, safety, regulation, and appropriate integration into health systems. [5]
TCM should not be seen as a replacement for necessary medical investigation. For people whose relevant conditions have already been assessed and who still experience fatigue, poor sleep, muscle tension, or stress-related complaints, complementary treatment may be a useful addition — with the goal of enabling recovery, not merely suppressing a symptom.
7. How does TCM view persistent exhaustion?
In TCM, fatigue is not treated in isolation. Two people may both say "I'm always tired" — and yet present with very different patterns of complaints. TCM takes an individualised approach, considering sleep, stress, pain, digestion, mood, physical tolerance, and overall recovery capacity together.
Sleep problems
Fatigue despite seeming to sleep enough
Muscles & head
Fatigue combined with tension and headaches
Post-infection
Exhaustion that began after an illness
Stress-fatigue
Long-term pressure as the main driver
Acupuncture, Tuina, and other TCM methods can — depending on the individual situation — serve as complementary components of a treatment plan.
TCM does not replace necessary medical investigation. For newly occurring or worsening fatigue, or symptoms such as unexplained weight loss, persistent fever, breathlessness, chest pain, or neurological signs, a medical evaluation should come first.
8. The goal is not to never feel tired
Fatigue is not inherently negative. Being tired after physical activity is normal. Being tired after a long working day is normal. What matters is:
Can the body regenerate after appropriate exertion and sufficient rest?
Health does not mean maintaining 100% energy at all times. What matters more is a good capacity for recovery. When the balance tips — when demands consistently exceed the body's ability to recover — fatigue can become a health concern.
It is sometimes worth asking not only:
"Why am I so tired?"
But also:
"Why is my body no longer recovering the way it used to?"
Key Points
Chronic fatigue is not automatically ME/CFS.
Sub-health is not a medical diagnosis.
An unremarkable test result does not mean symptoms are not real.
For persistent fatigue, appropriate medical investigation comes first. Then sleep, activity, stress, movement, and recovery can be addressed in a targeted way. Under suitable circumstances, acupuncture and other TCM methods can play a complementary role. Modern medicine and traditional medicine do not need to replace each other.
Related conditions
View all conditions →References
- World Health Organization (WHO). Primary Health Care.
- World Health Organization (WHO). Integrating Rehabilitation into Health Systems.
- World Health Organization (WHO). Chronic Fatigue Syndrome – ICD-11 / Frequently Asked Questions.
- National Institute for Health and Care Excellence (NICE). Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management (NG206). 2021.
- World Health Organization (WHO). Global Traditional Medicine Strategy 2025–2034. 2025.
- World Health Organization (WHO). Global Research Priorities and Agenda for Traditional, Complementary and Integrative Medicine 2025–2034. 2026.