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

Part 1 said that 「肝气郁结」 and 「心神不宁」 belong after a consultation. This part is about what that "after" looks like: the order it runs in, and what to bring.

Once the situations in part 5 are ruled out, this is how stress and poor sleep are handled in a TCM consultation.

The short version

• The order is routine first, then the pattern, then the direction. Reverse it and you have the mistake in the forwarded graphic.
• The practitioner first asks when you sleep and wake, whether you moved during the day, when the last coffee or tea was, what you do before bed. All of this is far more useful than "stressed".
• Then what you are taking: prescribed medication, over-the-counter products from a pharmacy, a supplement marketed as "calming" that a relative gave you. Doing this safely depends on both sides knowing.
• A direction may include acupuncture, herbal medicine or routine adjustments, decided between you and the practitioner at the consultation. This article does not say "what the effect will be", because that belongs to an individual assessment.

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.

First, the things that cannot wait

⚠️ 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.

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.

All seven items, and why each one means seeing a doctor first, are in part 5.

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. The order: routine first, then the pattern, then the direction

• Routine first, pattern later. The practitioner asks when you sleep and wake, whether you moved during the day, when the last coffee or tea was, what you do before bed, and whether this is crunch season or exam season. All of this is far more useful than "stressed".
• What you are taking. Prescribed medication, over-the-counter products from a pharmacy, a supplement marketed as "calming" that a relative gave you. Doing this safely depends on both sides knowing.
• Assessment. Only after seeing the whole picture does the practitioner say whether this is 「肝气郁结」, 「心神不宁」, or another pattern. That step comes after the consultation, not before it.
• Then a direction, not a promise. The options a practitioner may raise include acupuncture, herbal medicine, and the kind of routine adjustments in part 4. Which suits you, and whether to use any, is decided between you and the practitioner at the consultation.
• This article does not say "what the effect will be", because that belongs to an individual assessment, not to an article.
• Already seeing a doctor or a counsellor. Say so. A TCM consultation runs alongside counselling and psychiatric care; it does not replace either. Never stop medication your doctor prescribed because you have started TCM care.

Why the order runs that way: the WHO standard writes the liver qi stagnation pattern and the disquieted heart spirit pattern as the names of patterns. A pattern is the output of a judgement, not an input to it — that sentence is this article's reading of the usage, not the standard's own words. The routine, the medication and the whole picture come first; only then is there anything to judge.

On what a sleep consultation actually asks, see that part of the sister series: what is asked about the sleep itself and the daytime. On how assessment works: what pattern differentiation is.

Remember: routine first, then the pattern, then the direction. Reverse that order and you have the mistake in the forwarded graphic.

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. What to bring

These are the things that save the most time at a consultation:

• A list of your routine: the last week or two of sleep and waking times, whether you moved during the day, the time of the last coffee or tea, what you do before bed. Written down beats recalled.
• Everything you are taking: medication your doctor prescribed (the original packaging is clearest), over-the-counter products from a pharmacy, a supplement marketed as "calming" that a relative gave you, health products from a direct-sales friend — describe the contents and where they came from, and show them at the consultation.
• The "liver qi self-test" graphic a friend forwarded: a good starting point for a question, not a conclusion. Bring the screenshot and discuss it at the consultation.
• Already seeing a doctor at a Klinik Kesihatan or a private clinic, or seeing a counsellor: say so, including any medication.

That last item is not a courtesy. A TCM consultation runs alongside a doctor's diagnosis and treatment, and it is only safe when both sides know what you are using.

The words used in this part

• Inquiry (问诊) — the asking part of a consultation: the routine, the medication and the whole picture. It comes before the assessment.
• Pattern differentiation (辨证) — the step where the practitioner reaches a judgement after seeing the whole picture. 「肝气郁结」 and 「心神不宁」 are both terms from after that step; the definitions are in part 1.
• Over-the-counter (OTC) — medicine you can buy at a pharmacy without a prescription. It still needs declaring, because it is still something you are taking.
• Direction — the word this article uses instead of "course of treatment" or "result": what the practitioner raises is a set of options, the decision happens in the consultation, and the effect belongs to an individual assessment.

Frequently asked

Are the online "liver qi self-tests" accurate? They do not hold up. The same set of presentations can point to different patterns in TCM theory, which is exactly why a practitioner's assessment exists. Bring the graphic to the consultation as a question; do not use it to reach a conclusion.

What does a TCM consultation actually do about stress and poor sleep? It asks about routine and what you are taking, then assesses, and only then raises a direction — acupuncture, herbal medicine or routine adjustments — decided with the practitioner at the consultation. Section I above is the full order.

I already take medication my doctor prescribed. Can I still see a TCM practitioner? Yes, but both sides need to know. Say what you are taking at the start of the consultation, and never stop it or adjust it on your own because you have started TCM care. A TCM consultation runs alongside counselling and psychiatric care; it does not replace either.

Can an online consultation do all this? The routine, the medication and the whole picture can all be asked online. If anything listed in part 5 applies, see a doctor first — online or in person, that does not change.

✅ Worth remembering: 「肝气郁结」 and 「心神不宁」 are a practitioner's terms after assessment, reached after a consultation — not self-labels.

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 5: See a doctor first in these situations — seven signs, and the reason for each

👉 If you are not sure where to begin with your own stress and poor sleep, 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 in part 5 applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• World Health Organization, WHO international standard terminologies on traditional Chinese medicine, 2022 (entries 1161 · 1240) — https://www.who.int/publications/i/item/9789240042322
• 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 6 篇，共 6 篇。另外五篇的清单在文末。

第 1 篇说过，「肝气郁结」「心神不宁」这两个词属于问诊之后。这一篇讲那个「之后」长什么样：顺序怎么走，以及要带什么去。

第 5 篇的情况排除之后，压力与睡眠在中医问诊里是这样被处理的。

一分钟看完

• 顺序是先作息，再辨证，然后才是方向。反过来，就是网上那张图的错法。
• 医师会先问睡觉与起床时间、白天有没有运动、几点喝最后一杯咖啡或茶、睡前在做什么。这些比「压力大」有用得多。
• 接着问正在服用的东西：医生开的药、药剂行买的非处方药、家人给的标称「安神」的补品。两边都知道，才安全。
• 方向可能包括针灸、中药或作息调整，由医师与您在看诊时决定。本文不写「会有什么效果」，因为那属于个人评估。

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。

先说不能等的几件事

⚠️ 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。

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。

完整的七项，以及每一项为什么要先看医生，见第 5 篇。

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、顺序：先作息，再辨证，然后才是方向

• 先问作息，再谈证。 医师会问您的睡觉与起床时间、白天有没有运动、几点喝最后一杯咖啡或茶、睡前在做什么、最近是不是加班季或考试季。这些比「压力大」有用得多。
• 问正在服用的东西。 包括医生开的药、药剂行买的非处方药、家人给的标称「安神」的补品。两边都知道，才安全。
• 辨证。 医师看过整体之后，才会说这是不是「肝气郁结」或「心神不宁」，或是别的证。这一步在问诊之后，不在之前。
• 然后是方向，不是承诺。 医师可能提出的选项包括针灸、中药，以及第 4 篇那一类的作息调整。哪一种适合您、要不要用，由医师与您在看诊时决定。
• 本文不写「会有什么效果」，因为那属于个人评估，不属于文章。
• 已经在看医生或辅导的，请一并说明。中医问诊与辅导、精神科并行，不互相取代。切勿因为开始中医调理就自行停掉医生开的药。

为什么顺序是这个方向：世界卫生组织的标准把「肝郁气滞证」「心神不宁证」都写成证的名称。证是判断的结果，不是输入——这一句是本文对那个用法的说明，不是标准的原句。先有作息、用药与整体情况，才会有判断。

想了解睡眠问诊实际会问什么，可参考姐妹系列的那一篇：问睡眠本身与白天，是在问什么。想了解辨证是怎么做的，可参考：辨证是什么。

记住：先作息，再辨证，然后才是方向。 顺序反过来，就是网上那张图的错法。

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、带什么去

看诊时能省下最多时间的，是这几样实物与清单：

• 一份作息清单：这一两周的睡觉与起床时间、白天有没有运动、最后一杯咖啡或茶的时间、睡前在做什么。写下来比回想准。
• 所有在服用的东西：医生开的药（按原包装带去最清楚）、药剂行买的非处方药、家人给的标称「安神」的补品、直销买的保健品——请说明成分与来源，看诊时一并出示。
• 朋友转发的那张「肝郁自测图」：可以当作提问的起点，不要当成结论。截图带来看诊时讨论。
• 已经在 Klinik Kesihatan 或私人诊所看医生、或在做辅导：请一并说明，包括正在服用的药物。

最后一项不是客套。中医问诊与西医的诊断、治疗并行，两边都知道您在用什么，才谈得上安全。

这篇出现的几个词

• 问诊——看诊时「问」这一部分：问作息、用药与整体情况。它在辨证之前。
• 辨证——医师看过整体之后给出判断的那一步。「肝气郁结」「心神不宁」都是这一步之后的用语，定义见第 1 篇。
• 非处方药（OTC）——不需要医生处方、在药剂行就能买到的药。它也要说，因为它也是在服用的东西。
• 方向——本文用这个词，而不是「疗程」或「效果」：医师提出的是选项，决定在看诊里，效果属于个人评估。

常见问题

网上的「肝郁自测」准吗？ 不成立。同一组表现在中医理论中可能指向不同的证，这正是需要医师辨证的原因。自测图可以带来看诊时问，不能拿来下结论。

中医看压力和失眠，实际会做什么？ 先问作息与正在服用的东西，再辨证，然后才提出方向——针灸、中药或作息调整，由医师与您在看诊时决定。上面第一节是完整的顺序。

我已经在吃医生开的药，还能看中医吗？ 可以，但两边都要知道。请把正在服用的药在问诊一开始就说清楚，切勿因为开始中医调理就自行停药或自行加减。中医问诊与辅导、精神科并行，不互相取代。

线上问诊也能做这些吗？ 作息、用药与整体情况这几项都能在线上问。若第 5 篇列出的情况出现，请先看医生——线上或线下都一样。

✅ 记住： 「肝气郁结」「心神不宁」是医师辨证后的用语，出现在问诊之后，不是自我标签。

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 5 篇：这些情况请先看医生——七项信号，和每一项的理由

👉 如果您不确定「我这种压力大、睡不好，该从哪里谈起」，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；若您有第 5 篇列出的情况，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

• 世界卫生组织，《WHO international standard terminologies on traditional Chinese medicine》，2022（条目 1161 · 1240）— https://www.who.int/publications/i/item/9789240042322
• 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/