Part 5 of 6 in the "Stress, sleep and TCM theory" series. The list of the other five is at the foot of this part.

The first four parts cover how the theory reads stress and sleep, and the general daily arrangements. This part is about something else: when that road should not be taken any further, and a doctor comes first.

Each item carries one reason, taken from that condition's own NHS page. A reason tells you what a sign can indicate; it does not tell you what you have.

The short version

• The seven signs are in section I, word for word as the approved article has them.
• Each reason comes from that condition's own NHS page, not from the page about stress.
• Three places where this part stops: two items deliberately carry no reason, and on one the NHS page covers only one direction. Section II says so.
• Three of the NHS pages cited are past their own next-review date, and the body says which.

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.

I. See a doctor first in these situations

TCM vocabulary does not substitute for a diagnosis. Seek professional support if there is:

• Persistently low mood, or loss of interest in things you used to enjoy — the NHS depression page puts it this way: when you're depressed you feel persistently sad for weeks or months rather than just a few days, and the symptoms range as far as losing interest in the things you used to enjoy; the same page also says a low mood may improve after a short period of time, rather than being a sign of depression. Telling those apart is a doctor's work, and the page's own line is that it is important to seek help from a GP if you think you may be depressed.
• Anxiety that is hard to control and affects daily life or work — this is exactly what the NHS generalised anxiety disorder page gives as the main symptom: feelings of stress or worry that affect your daily life and are difficult to control. The same page says most people feel anxious sometimes and that it does not always mean GAD; its own distinction is feeling anxious most of the time and it affecting everyday life.
• Long-standing insomnia, or needing medication to fall asleep — the NHS insomnia page puts the line in writing: less than 3 months is short-term insomnia, and insomnia that lasts 3 months or longer is called long-term insomnia. That page lists conditions and medicines that can cause insomnia, among them an overactive thyroid, and states that many medicines can also cause insomnia.
• Thoughts of harming yourself — this is not something to wait on. 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; Befrienders KL is open 24 hours on 03-7627 2929. You can also contact your doctor.
• Panic attacks: sudden palpitations, breathlessness, trembling, intense fear — the NHS panic disorder page describes a panic attack as a rush of intense mental and physical symptoms that can come on very quickly and for no apparent reason, with symptoms including a racing heartbeat, shortness of breath, trembling and a feeling of dread. The same page goes straight on to say that most of these symptoms can also be symptoms of other conditions or problems. Its own line is to see a GP if you have been experiencing symptoms of panic disorder.
• You take psychiatric medication — follow your doctor's treatment, and never stop or adjust it on your own
• Marked weight change, palpitations or tremor alongside it — testing may be needed. The NHS overactive thyroid page lists difficulty sleeping, sensitivity to heat, an irregular and/or unusually fast heart rate (palpitations), twitching or trembling, and weight loss in one symptom list, and says that if a doctor thinks you might have a thyroid problem they can arrange a blood test to check how well your thyroid is working. The NHS heart palpitations page separately states that palpitations can also be caused by iron deficiency anaemia, an overactive thyroid, a heart rhythm problem, or other heart problems such as heart valve disease.

A safety note: TCM and Western medicine complement each other; it is not a choice between them. Difficulties with mood and sleep have a layer that needs professional assessment, and a TCM consultation does not substitute for that assessment. Asking for help is not weakness — there is professional support for this.

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 NHS page, not from the page about stress: the condition's name and its description sit on its own entry page.

Three places where this part stops:

• The fourth item deliberately carries no reason. What it gives is a route to help, not a condition's name — and attaching a condition's name to that line does not help someone who needs a phone number right now.
• The sixth item deliberately carries no reason either. It is written at the scope of psychiatric medication as a whole. The NHS antidepressants page does say not to stop taking one suddenly or without talking to your doctor first, but that page is about one class of medicine; importing it would narrow this item to a class the approved article does not name. So the existing line stands and the reason is recorded as a gap.
• Weight gain has no page behind it. The seventh item's sign runs in both directions, but the relevant NHS pages write only "weight loss". So the reason covers only that direction; the other one is recorded as a gap and is not filled by inference.

Two further notes:

• The NHS heart palpitations page puts a more urgent tier on its own page: palpitations that do not go away, together with chest pain, shortness of breath, feeling faint or fainting, sit at 999 on that page. The seventh item above does not include those, so it stays at the see-a-doctor tier; if your palpitations come with chest pain, breathlessness or near-fainting, follow that page's tier and do not wait.
• Three pages are past their own next-review date: the NHS depression page (marked 5 July 2026), the panic disorder page (marked 22 August 2026) and the overactive thyroid page (marked 11 April 2026). The sentences quoted were still on the pages when this part was checked line by line on 2 October 2026, but all three are worth another look before publication.

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.

The words used in this part

• Long-term insomnia — the NHS insomnia page's usage: lasting 3 months or longer. Less than 3 months is short-term insomnia.
• Overactive thyroid (hyperthyroidism) — the NHS's description: where the thyroid gland produces too much of the thyroid hormones. Its symptom list holds difficulty sleeping, sensitivity to heat, palpitations, twitching or trembling, and weight loss together.
• Blood test — the NHS thyroid page says a doctor who thinks a thyroid problem is possible can arrange a blood test to check how it is working.

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.

Frequently asked

When should I see a psychiatrist or a counsellor? If any item above appears, see a doctor first. A TCM consultation runs alongside psychiatric care and counselling; it does not replace them. To talk to someone first: Talian HEAL 15555, or Befrienders KL 03-7627 2929.

Which of the seven means calling 999 straight away? Thoughts of harming yourself — call 999 now, or go to the nearest hospital emergency department. The rest are "see a doctor first": arrange it soon, rather than waiting for the next check-up. If any of them worsens suddenly or frightens you, do not wait at home.

✅ Worth remembering: persistent low mood, uncontrollable anxiety, long-standing insomnia — see a doctor first.

❌ Better not to: stop psychiatric medication on your own because you have started TCM care; or carry thoughts of harming yourself alone — reach out immediately: 999, Talian HEAL 15555, Befrienders KL 03-7627 2929.

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.

The other five parts in this series

• Part 1: What 「肝气」 and 「心神」 mean — two definitions, and what they are not
• Part 2: What "liver qi" models — one concept, three threads
• Part 3: The two languages side by side, and one crunch-season week
• Part 4: What TCM theory arranges day to day — six habits in one table
• Part 6: What actually happens at the consultation — routine first, then the pattern, then the direction

👉 If you have read this part and are not sure whether any of it applies to 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 here applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• NHS (UK), "Overview — Depression in adults", page last reviewed 5 July 2023 (next review due 5 July 2026 — past due) — https://www.nhs.uk/mental-health/conditions/depression-in-adults/overview/
• NHS (UK), "Generalised anxiety disorder (GAD)", page last reviewed 22 October 2024 — https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/
• NHS (UK), "Insomnia", page last reviewed 19 March 2024 — https://www.nhs.uk/conditions/insomnia/
• NHS (UK), "Panic disorder", page last reviewed 22 August 2023 (next review due 22 August 2026 — past due) — https://www.nhs.uk/mental-health/conditions/panic-disorder/
• NHS (UK), "Overactive thyroid (hyperthyroidism) — Overview", page last reviewed 11 April 2023 (next review due 11 April 2026 — past due) — https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/
• NHS (UK), "Heart palpitations", page last reviewed 17 March 2026 — https://www.nhs.uk/symptoms/heart-palpitations/
• Ministry of Health Malaysia, Hospital Pendang (Kedah State Health Department), Info Kesihatan 2024 (the Talian HEAL 15555 number and its hours) — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur (the 24-hour line) — https://www.befrienders.org.my/

本文是「压力、睡眠与中医理论」系列的第 5 篇，共 6 篇。另外五篇的清单在文末。

前面四篇讲的是理论怎么读压力与睡眠，以及一般的作息安排。这一篇讲的是另一件事：什么时候那条路不该走下去，要先看医生。

每一项后面加了一句理由，取自那个状况自己的英国国民保健署 NHS 页面。理由告诉您这个信号可能指向什么；它不会告诉您您有什么。

一分钟看完

• 七项信号在下面第一节，和已批准文章里的写法一字不改。
• 每一项的理由来自那个状况自己的 NHS 页面，不是来自讲压力的那一页。
• 有三处本文停住了：两项刻意不加理由，还有一项 NHS 的页面只写了一个方向。第二节说明。
• 其中三个 NHS 页面已经过了它自己标示的下次审阅日期，本文在正文里写出来。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、这些情况请先看医生

中医的术语不能取代诊断。以下情况请寻求专业协助：

• 情绪持续低落，或对原本喜欢的事失去兴趣——NHS 的抑郁页写的是：抑郁时会持续数周或数月感到悲伤，而不只是几天，表现包括对原本喜欢的事失去兴趣；同一页也说，心情低落可能过一段短时间就好转，不一定是抑郁。分辨这两者需要医生，该页的指引是：如果您觉得自己可能有抑郁，向家庭医生求助很重要。
• 焦虑难以控制，影响日常生活或工作——这正是 NHS 广泛性焦虑症页写的主要症状：难以控制、并影响日常生活的压力或担忧感。该页也说，大多数人有时会感到焦虑，不一定就是广泛性焦虑症；它的分辨是多数时候都焦虑并影响日常生活。
• 长期失眠，或需要依赖药物才能入睡——NHS 的失眠页把界线写明了：持续不到 3 个月是短期失眠，3 个月或更久称为长期失眠。该页列出可能造成失眠的状况与药物，其中包括甲状腺功能过度活跃，并写明许多药物也可以造成失眠。
• 出现伤害自己的念头——这不是可以等的事。请立刻拨打 999，或前往最近的医院急诊部。若想找人谈一谈，卫生部的 Talian HEAL 15555 每天早上 8 时至午夜 12 时开放，包括公共假期；Befrienders KL 24 小时热线：03-7627 2929。您也可以联络您的医生。
• 恐慌发作：突然的心悸、气促、发抖、强烈的恐惧感——NHS 的恐慌症页把恐慌发作描述为一阵强烈的精神与身体症状，可能来得很快、也可能没有明显原因，症状包括心跳加速、气促、发抖与强烈的恐惧感。同一页紧接着写：这些症状大多也可能是其他状况或问题的症状。该页的指引是：出现恐慌症的症状，去看家庭医生。
• 正在服用精神科药物——请以医生的治疗为主，切勿自行停药或自行加减
• 伴随明显体重变化、心悸、手抖——可能需要检验才能确认。NHS 的甲状腺功能过度活跃页把难以入睡、对热敏感、心跳不规则或异常快（心悸）、抽动或颤抖、体重下降列在同一张症状表里，并写着：医生若认为可能是甲状腺的问题，可以安排血液检查看甲状腺的功能。NHS 的心悸页另外写明，心悸也可能由缺铁性贫血、甲状腺功能过度活跃、心律问题，或心脏瓣膜疾病这类心脏问题引起。

安全提醒：中医与西医是互相补位的关系，不是二选一。情绪与睡眠的困扰有需要专业评估的层面，中医问诊不能取代那个评估。寻求协助不是脆弱，这是有专业支援的范围。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

二、理由是怎么来的，以及它停在哪里

上面每一项的理由，来自那个状况自己的 NHS 页面，不是来自讲压力的那一页：病名与说明写在各自的条目页上。

三处本文停住了：

• 第四项刻意不加理由。 那一条给的是求助路线，不是病名——把一个病名贴在那条上，对一个此刻需要电话号码的人没有帮助。
• 第六项也刻意不加理由。 上面写的是「精神科药物」这一个范围。NHS 在抗抑郁药的页面上确实写着「不要突然或在未与医生谈过之前停药」，但那一页讲的是其中一类药；把它搬上来，会把这一条收窄到已批准文章没有点名的一类药上。所以这里只保留原来的指引，理由记为缺口。
• 体重增加没有页面支持。 第七项的信号两个方向都包括，但 NHS 的相关页面只写「体重下降」。所以理由只说下降那一边；上升的那一边记为缺口，不凭推测补。

另记两笔：

• NHS 的心悸页把更急的一层写在它自己的页面上：心悸不停，又同时有胸痛、气促、头晕或昏倒，该页放在 999 那一层。上面第七项不含这几样，所以留在「先看医生」这一层；若您的心悸伴随胸痛、气促或快要昏倒，请按那一页的层级处理，不要等。
• 三个页面已过自己的下次审阅日期：NHS 的抑郁页（标示 2026 年 7 月 5 日）、恐慌症页（标示 2026 年 8 月 22 日）与甲状腺功能过度活跃页（标示 2026 年 4 月 11 日）。引用的句子仍在页面上（本文于 2026 年 10 月 2 日逐句核对过），但发布前值得再看一次。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

这篇出现的几个词

• 长期失眠（long-term insomnia）——NHS 失眠页的用法：持续 3 个月或更久。不到 3 个月是短期失眠。
• 甲状腺功能过度活跃（overactive thyroid / hyperthyroidism）——NHS 的说明：甲状腺分泌过多甲状腺激素的状况。它的症状表里同时有难以入睡、对热敏感、心悸、抽动或颤抖与体重下降。
• 血液检查（blood test）——NHS 的甲状腺页说，医生若认为可能是甲状腺的问题，可以安排血液检查看它的功能。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

常见问题

什么时候该看精神科或辅导？ 上面列出的任何一项出现，就先看医生。中医问诊与精神科、辅导并行，不取代。想先找人谈谈：Talian HEAL 15555，或 Befrienders KL 03-7627 2929。

这七项里，哪一项要立刻打 999？ 出现伤害自己的念头——请立刻拨打 999，或前往最近的医院急诊部。其余各项是「先看医生」：尽快安排，不等下一次体检。若任何一项突然加重或让您害怕，不要在家里等。

✅ 记住： 持续低落、难以控制的焦虑、长期失眠——请先看医生。

❌ 不要这样做：不要因为开始中医调理就自行停掉精神科药物；不要在出现伤害自己的念头时独自撑着——请立刻求助：999、Talian HEAL 15555、Befrienders KL 03-7627 2929。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

这个系列的另外五篇

• 第 1 篇：「肝气」与「心神」是什么——两个定义，和它们不是什么
• 第 2 篇：「肝气」在理论里是怎么一回事——一个概念，三条线
• 第 3 篇：两套语言并排看，和加班季那一周的读法
• 第 4 篇：中医理论怎么安排作息——六个习惯的一张表
• 第 6 篇：看诊时实际会做什么——先作息，再辨证，然后才是方向

👉 如果您看完这一篇，不确定自己算不算其中一项，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有本文列出的情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 英国国民保健署 NHS，〈Overview — Depression in adults〉，最后审阅 2023 年 7 月 5 日（标示下次审阅 2026 年 7 月 5 日，已过期）— https://www.nhs.uk/mental-health/conditions/depression-in-adults/overview/
• 英国国民保健署 NHS，〈Generalised anxiety disorder (GAD)〉，最后审阅 2024 年 10 月 22 日 — https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/
• 英国国民保健署 NHS，〈Insomnia〉，最后审阅 2024 年 3 月 19 日 — https://www.nhs.uk/conditions/insomnia/
• 英国国民保健署 NHS，〈Panic disorder〉，最后审阅 2023 年 8 月 22 日（标示下次审阅 2026 年 8 月 22 日，已过期）— https://www.nhs.uk/mental-health/conditions/panic-disorder/
• 英国国民保健署 NHS，〈Overactive thyroid (hyperthyroidism) — Overview〉，最后审阅 2023 年 4 月 11 日（标示下次审阅 2026 年 4 月 11 日，已过期）— https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/
• 英国国民保健署 NHS，〈Heart palpitations〉，最后审阅 2026 年 3 月 17 日 — https://www.nhs.uk/symptoms/heart-palpitations/
• 马来西亚卫生部，Hospital Pendang（吉打州卫生局），Info Kesihatan 2024（Talian HEAL 15555 的号码与开放时间）— https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur（24 小时热线号码）— https://www.befrienders.org.my/