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Why Am I Always Tired?
- 1 day ago
- 5 min read
Understanding Fatigue, Burnout, and Chronic Fatigue Syndrome Through Western Medicine and Traditional Chinese Medicine (TCM)
By Dr. Phumlarp Caulo, L.Ac., MAc. OM, DAHM
Caulo Care Acupuncture, Forest Hills, New York
Fatigue is one of the most common health complaints in modern society. Many people wake up feeling exhausted despite getting what seems to be enough sleep. Others struggle with brain fog, poor concentration, low motivation, muscle aches, and a persistent feeling that their energy never fully returns. While occasional tiredness is a normal response to physical exertion or lack of sleep, persistent fatigue may signal a deeper imbalance within the body.
From a Western medical perspective, persistent fatigue exists on a spectrum ranging from temporary exhaustion to burnout and, in some individuals, Chronic Fatigue Syndrome (CFS), also known as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Research suggests that many people suffering from chronic fatigue share abnormalities involving the body's stress-response system, particularly the Hypothalamic-Pituitary-Adrenal (HPA) Axis.
Understanding the Anatomy & Physiology of Fatigue
The human body relies on a complex communication network between the brain, endocrine system, nervous system, and immune system to maintain energy balance.
The HPA Axis consists of:
Hypothalamus (brain)
Pituitary gland
Adrenal glands
When the body encounters stress, the hypothalamus releases signals that stimulate the pituitary gland. The pituitary then communicates with the adrenal glands, which produce cortisol, the body's primary stress hormone.
In healthy individuals, cortisol follows a natural circadian rhythm. Levels rise in the morning to help us wake up and gradually decline throughout the day. This process helps regulate:
Energy production
Blood sugar
Immune function
Inflammation
Mood
Sleep-wake cycles
Cognitive performance
Under chronic stress, however, this system can become dysregulated. Initially cortisol levels may rise. Over time, prolonged stress may lead to a blunted or underactive stress response, sometimes called HPA Axis Hypofunction. Research has shown that many patients with Chronic Fatigue Syndrome demonstrate reduced HPA axis responsiveness and lower cortisol activity.
As a result, the body may struggle to produce energy efficiently, recover from exertion, regulate inflammation, and maintain normal physiologic function.
What Is Burnout?
Burnout is more than simply feeling tired.
Burnout is characterized by:
Emotional exhaustion
Mental fatigue
Reduced motivation
Decreased productivity
Difficulty concentrating
Sleep disturbances
Feeling overwhelmed
Loss of enjoyment in daily activities
Research suggests that burnout and Chronic Fatigue Syndrome share many overlapping symptoms and physiologic abnormalities, particularly involving the HPA axis and stress regulation systems.
Many individuals describe themselves as high achievers who continuously push through stress, responsibilities, and long working hours before eventually reaching a point where their body can no longer compensate.
What Is Chronic Fatigue Syndrome (CFS)?
Chronic Fatigue Syndrome is a disabling condition characterized by profound fatigue lasting longer than six months that cannot be explained by another medical diagnosis. Common symptoms include:
Severe fatigue
Brain fog
Impaired concentration
Memory difficulties
Unrefreshing sleep
Muscle pain
Joint pain
Headaches
Dizziness
Post-Exertional Malaise (PEM)
Post-Exertional Malaise is considered one of the hallmark features of CFS. Patients often experience a worsening of symptoms following physical or mental activity that previously would not have caused problems.
Research suggests that many individuals with chronic fatigue demonstrate abnormalities in stress regulation, autonomic nervous system function, immune system activity, and brain regions involved in fatigue perception.
Why Am I Always Tired?
Persistent fatigue can have many causes, including:
Medical Causes
Thyroid disorders
Iron deficiency
Vitamin B12 deficiency
Sleep apnea
Diabetes
Autoimmune diseases
Chronic infections
Heart disease
Lifestyle Causes
Chronic stress
Poor sleep habits
Excessive caffeine
Sedentary lifestyle
Overtraining
Poor nutrition
Psychological Causes
Anxiety
Depression
Emotional stress
Occupational burnout
Nervous System Dysregulation
Chronic activation of the stress response
HPA axis dysfunction
Autonomic nervous system imbalance
Many patients experience a combination of several factors rather than a single cause.
Traditional Chinese Medicine (TCM) Perspective
In Traditional Chinese Medicine, fatigue is not viewed as a disease but rather as a manifestation of imbalance. Several common TCM patterns may contribute to chronic fatigue:
Spleen Qi Deficiency
Common symptoms:
Fatigue
Poor digestion
Bloating
Loose stools
Brain fog
Weak muscles
The Spleen is responsible for transforming food into Qi and Blood. When weakened, the body cannot generate sufficient energy.
Kidney Qi or Kidney Yang Deficiency
Common symptoms:
Deep exhaustion
Low back weakness
Frequent urination
Feeling cold
Poor recovery
The Kidneys are considered the body's energy reserve and foundation of vitality.
Liver Qi Stagnation
Common symptoms:
Stress
Irritability
Mood swings
Insomnia
Tension headaches
Chronic emotional stress can impair the free flow of Qi and contribute to fatigue.
Heart and Spleen Blood Deficiency
Common symptoms:
Fatigue
Anxiety
Poor memory
Insomnia
Palpitations
TCM treatment focuses on identifying the individual's underlying pattern rather than treating fatigue as a single condition.
What Should You Do?
Recommended Strategies
Maintain a consistent sleep schedule
Prioritize restorative sleep
Manage stress proactively
Practice mindfulness or meditation
Engage in gentle exercise
Stay hydrated
Eat nutrient-dense foods
Pace activities appropriately
Seek medical evaluation if symptoms persist
Avoid
Overexercising during severe fatigue
Ignoring symptoms
Excessive caffeine dependence
Excessive alcohol use
Chronic sleep deprivation
Constant overwork without recovery
Research suggests that repeatedly pushing through severe fatigue may worsen symptoms in susceptible individuals.
Nutrition for Fatigue Recovery
Western Nutrition
Focus on:
Lean protein
Omega-3 fatty acids
Vegetables
Fruits
Whole grains
Adequate hydration
Nutrients commonly evaluated include:
Vitamin D
Vitamin B12
Iron
Folate
Magnesium
TCM Nutrition
Foods commonly used to support energy include:
Bone broth
Sweet potatoes
Pumpkin
Oats
Brown rice
Dates
Goji berries
Black sesame
Warm cooked foods
TCM generally recommends limiting excessive cold, raw, greasy, and highly processed foods when treating fatigue patterns involving Spleen Qi deficiency.
Home Care Strategies
Patients experiencing persistent fatigue may benefit from:
Structured daily routines
Regular sleep and wake times
Gentle stretching
Walking
Tai Chi
Qigong
Breathing exercises
Stress reduction techniques
The goal is to support recovery without overwhelming the body's capacity to adapt.
How Acupuncture May Help
From a Traditional Chinese Medicine perspective, acupuncture aims to restore the smooth flow of Qi, nourish Blood, support the Kidneys, strengthen the Spleen, and calm the nervous system.
From a modern biomedical perspective, research suggests acupuncture may help regulate autonomic nervous system activity, improve circulation, support relaxation, reduce pain, improve sleep quality, and modulate stress responses.
Patients commonly seek acupuncture for symptoms associated with fatigue including:
Neck pain
Back pain
Headaches
Muscle tension
Stress
Anxiety
Sleep disturbances
Burnout symptoms
At Caulo Care Acupuncture, treatment plans are individualized based on each patient's presentation and may include acupuncture, cupping therapy, gua sha, lifestyle recommendations, and Traditional Chinese Medicine principles. While acupuncture is not a cure for Chronic Fatigue Syndrome or burnout, many patients report improvements in pain levels, stress management, sleep quality, and overall well-being as part of a comprehensive care plan. If chronic stress, persistent fatigue, burnout, or unexplained exhaustion are affecting your quality of life, a comprehensive evaluation may help identify contributing factors and guide appropriate treatment options.
BOOK AN APPOINTMENT NOW!
Acupuncture Near Me in Forest Hills, NY
Caulo Care Acupuncture
Dr. Phumlarp Caulo, L.Ac., MAc. OM, DAHM
Doctor of Acupuncture & Chinese Medicine
By Appointment Only
+1 (929) 269-4549
Forest Hills, Queens, New York
Medical Disclaimer
This information is provided for educational purposes only and should not be construed as medical advice, diagnosis, or treatment. Every individual is different, and recommendations discussed in this article may not apply to your specific situation. Please consult a qualified physician or healthcare professional regarding any medical concerns, diagnosis, or treatment decisions.
Scientific Reference
Huibers MJH, et al. Fatigue, Burnout, and Chronic Fatigue Syndrome Among Employees on Sick Leave: Do Attributions Make the Difference? Occupational and Environmental Medicine. 2003;60(Suppl 1):i26–i31.
Jameson D. Persistent Burnout Theory of Chronic Fatigue Syndrome. Neuroscience and Medicine. 2016;7(2):43–55.
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