Part 5 of 6 in the "always tired" series; the other five are listed at the foot.
This is the part of the series to read first. It is not meant to frighten anyone — the opposite: knowing what a sign can point to is what gets it dealt with while it is still mild, instead of at two in the morning.
The reason attached to each item comes from that condition's own NHS page. The signs themselves, and how urgent each one is, are word for word the list this article already carried.
The short version
- Persistent tiredness is sometimes one visible part of something that only tests can confirm.
- Seven items below go to a doctor for investigation first; one of them means calling 999 now.
- The point of adding reasons is so you know what a sign can point to: the NHS writes these signs up on its pages for unintentional weight loss, heart palpitations, iron deficiency anaemia, swollen glands, night sweats and sleep apnoea, plus the one cited for item 5.
- These need medical tests and investigation to establish the cause, and a TCM consultation does not substitute for them.
- For persistently low mood or thoughts of harming yourself, get help immediately, do not carry it alone.
I. See a doctor first in these situations
The reason given for each item says which category of problem a doctor would investigate — it does not say that you have it.
Persistent tiredness is sometimes one visible part of something that only tests can confirm. See a doctor for investigation first if there is:
- Weight loss you did not intend — the NHS's unintentional weight loss page defines it as losing weight without changing your diet or exercise routine. The causes it lists include hormone conditions (such as an overactive thyroid or type 1 diabetes) and heart conditions (such as heart failure); it also says that sometimes weight loss and loss of appetite can be caused by cancer, so if you are losing weight without trying it is important to get it checked.
- Breathlessness, palpitations or chest tightness, or getting winded by mild activity — the NHS's heart palpitations page states that palpitations can be caused by a condition such as iron deficiency anaemia, an overactive thyroid (hyperthyroidism), a heart rhythm problem, or other heart problems such as heart valve disease; finding the cause may involve a test called an electrocardiogram (ECG).
- Pallor, dizziness, or noticeably heavier menstrual bleeding — the NHS's iron deficiency anaemia page lists "paler than usual skin" and "tiredness and lack of energy" among its symptoms, and states that heavy periods and pregnancy are very common causes of it. To confirm it, the GP will usually do a blood test called a full blood count (FBC) to find out whether the number of red blood cells is normal.
- Persistent fever, night sweats, or a lump you can feel — the NHS's swollen glands page explains the mechanism of this sign: glands swell near an infection to help your body fight it. It lists both "they feel hard or do not move when you press them" and "you're having night sweats or have a very high temperature" as reasons to see a GP, and says: do not self-diagnose. The NHS's night sweats page separately says to see a GP if you have night sweats and you're losing weight for no reason.
- Tiredness alongside thirst, frequent urination or blurred vision — the NHS's diabetes page states that the most common symptoms are feeling thirsty all the time, peeing more than usual, feeling very tired and losing weight without trying, and that diabetes is caused by the body not making enough insulin, or the insulin not working properly. It also says not everyone with diabetes has symptoms, so it is important to get checked out.
- Persistently low mood, loss of interest, or thoughts of harming yourself — call 999 now, or go to the nearest hospital emergency department. To talk to someone, the Ministry of Health's Talian HEAL 15555 is open every day from 8 am to 12 midnight, public holidays included [KKM-HEAL]; Befrienders KL is open 24 hours on 03-7627 2929 [BEF]. You can also contact your doctor.
- Tiredness severe enough to affect driving or work safety — the NHS's sleep apnoea page states that the condition is breathing that stops and starts while you sleep, and that during the day you may feel very tired and find it hard to concentrate. "You always feel very tired during the day" is one of the items it routes to a GP, and it says the condition can be serious if it is not diagnosed and treated.
These need medical tests and investigation — blood work, for instance — to establish the cause, and a TCM consultation does not substitute for them.
A safety note: TCM and Western medicine complement each other; it is not a choice between them. Persistent tiredness deserves to be taken seriously, and taking it seriously usually starts with tests rather than with TCM care.
A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.
II. Where the reasons come from, and where they stop
Each reason above comes from that condition's own page, not from the page about tiredness. The reason is practical: the NHS's tiredness page lists the situations that go to a GP but names no condition at all; the names and the mechanisms sit on the individual condition pages.
This article stopped in two places, and here is where:
- Dizziness is not in the symptom list on the page cited for item 3, so the reason for item 3 does not include dizziness. The sign itself stays.
- Blurred vision is not among the common symptoms on the page cited for item 5, so the reason for item 5 does not include it. That sign stays too.
One item deliberately carries no reason: item 6. For low mood and thoughts of self-harm, what this gives is a route to help, not a condition name — attaching a condition name there does nothing for someone who needs a phone number right now.
💡 Remember: a reason tells you what a sign can point to. It does not tell you what you have. That takes tests.
The words in this part
All four come from the NHS pages quoted above, and you are likely to meet each one at a clinic or on a report.
- Unintentional weight loss (非刻意体重下降) — the NHS's term: losing weight without changing your diet or exercise routine. It is a reason to see a doctor in its own right, not "I've slimmed down a bit".
- Full blood count (全血计数; printed FBC) — the NHS's iron deficiency anaemia page says the GP will usually use this blood test to find out whether the number of red blood cells is normal. Your screening report very likely has this line.
- Electrocardiogram (心电图, ECG) — the NHS's heart palpitations page says you may have this test to help find the cause: small pads are stuck to your skin to check the electrical signals from your heart.
- Sleep apnoea (睡眠呼吸暂停) — the NHS's description: breathing that stops and starts while you sleep, with the daytime effect that you may feel very tired and find it hard to concentrate. If someone has told you that you snore, gasp or choke in your sleep, mention it at the consultation — that is this article's suggestion.
Frequently asked
Which of these means calling 999 right now? Persistently low mood, loss of interest, or thoughts of harming yourself — call 999 now, or go to the nearest hospital emergency department. The rest are "see a doctor for investigation first", which means arranging it soon, not waiting for the next screening. If any of them comes on suddenly or frightens you, do not wait at home.
I already see a TCM practitioner — do I still need the tests? Yes. A TCM consultation does not substitute for medical tests and investigation, as stated above. Running both is fine — take the report to the consultation, and take what you hear at the consultation back to your doctor. Never stop prescribed medication on your own because you have started TCM care. On taking Chinese herbs alongside Western medication, see: can Chinese herbs be taken with Western medicine.
Do not: rely on TCM care alone when there is marked weight loss or breathlessness.
The other five parts
- Part 1: First, which kind of tired; then what a blood test can tell you
- Part 2: What 「气」 and 「血」 refer to in TCM theory, and where they come from
- Part 3: 「血虚」 is not anaemia — one is a category, the other a number
- Part 4: Setting your routine: TCM theory's position beside the public-health numbers
- Part 6: What a consultation actually does, and the seven-day log to bring
👉 If you have read this part and are not sure whether any of it describes you, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything listed above applies, see a doctor first.
Sit with a licensed TCM practitioner from wherever you are.
HansMed Modern TCM
For general wellness education only — not medical advice. Consult a registered TCM practitioner for personal guidance.
Sources
- NHS, Tiredness and fatigue, page last reviewed 02 June 2023 — https://www.nhs.uk/symptoms/tiredness-and-fatigue/
- NHS, Unintentional weight loss, page last reviewed 28 July 2025 — https://www.nhs.uk/symptoms/unintentional-weight-loss/
- NHS, Heart palpitations, page last reviewed 17 March 2026 — https://www.nhs.uk/symptoms/heart-palpitations/
- NHS, Iron deficiency anaemia, page last reviewed 26 January 2024 — https://www.nhs.uk/conditions/iron-deficiency-anaemia/
- NHS, Swollen glands, page last reviewed 29 September 2023 — https://www.nhs.uk/symptoms/swollen-glands/
- NHS, Night sweats, page last reviewed 09 November 2023 — https://www.nhs.uk/symptoms/night-sweats/
- NHS, Diabetes, page last reviewed 26 June 2025 — https://www.nhs.uk/conditions/diabetes/
- NHS, Sleep apnoea, page last reviewed 11 May 2026 — https://www.nhs.uk/conditions/sleep-apnoea/
- Ministry of Health Malaysia, Hospital Pendang (Kedah State Health Department), Info Kesihatan 2024 — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
- Befrienders Kuala Lumpur — https://www.befrienders.org.my/
