Being Tired Is When to Look After Yourself

There is something I say often in the clinic. "Take particular care when you are tired."

It sounds obvious, but I have a reason for saying it. Fatigue is a sign that the body has loosened, and that loosening does not come from one place only.

Fatigue is not one signal

Behind the words "I'm tired" sit several different situations.

It may be tension that has run on a long time, or energy that has fallen short. Minerals, calcium among them, running low brings fatigue with it. So does blood not reaching tissue well. When an organ that governs regulation, such as the thyroid, is unsettled, fatigue and swelling appear together.

Different roads, and yet the face they wear is much alike. So fatigue is a symptom whose cause is hard to pin down and, at the same time, a signal that calls for looking at several places at once.

When tension runs long, the defences loosen

Of these, the one tied most directly to the body's defence is tension that runs on.

With continued tension the sympathetic nerve stays switched on. When that state lasts, the number and activity of the cells that handle immunity change. Cell-mediated immunity in particular — the side that recognises and deals with infected cells — is suppressed.

It is not that the body becomes unable to fight. It is that it cannot keep watch as closely as usual.

So there are illnesses that come when you are worn out

Shingles is the standard example.

After chickenpox in childhood, that virus does not disappear; it stays quietly in a nerve ganglion, for life. What holds it down is the cell-mediated immunity just mentioned. When that grip loosens, the virus wakes again.

"Shingles comes when you are run down" is not merely anecdote. In a study following people with sleep disorders over time, shingles appeared more often; the same held for people who reported feeling high levels of stress.

The common cold sits in a similar place. Meeting a virus and that virus becoming an illness are two different matters, and what divides them is the state the body is in at the time. (The Same Place Gives Way at Every Change of Season)

And some fatigue has to be measured

One thing I state plainly. Some fatigue has to be confirmed by testing.

Thyroid function, anaemia, the hormonal side — these cannot be known from the account alone; they have to be measured. Fatigue that does not lift with rest, fatigue that has run for months, is better checked first. Once that result is known, the place to work on becomes clear.

So I speak of sleep and meals before anything else

What I ask people to do when they are tired is, mostly, sleep and meals.

It sounds like thin advice, but there is a reason. Sleep is the time the defences are rebuilt, and meals are what supplies the material. A good many of the roads named above come back to these two — minerals, energy, and the letting go of tension alike.

And being tired is exactly when those two go first. Too busy, so late to bed; too busy, so a meal skipped. At the very moment the body is asking to be looked after.

So I do not pass lightly over someone telling me they are tired. That is the time to ease off and attend to the body.

When to be seen first

If a band of stinging pain or blisters appears on one side, be seen as soon as possible. Acting early and acting late differ greatly. If fatigue that does not lift with rest goes on, have it investigated first.

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There is this much behind the single word "tired."

Korean medicine holds an old view that trouble enters where one has grown weak. It saw illness taking hold not because something outside was strong but because the inside had thinned, and so it always warned about the aftermath of overreaching.

Today we can sketch the middle of that a little better. Tension that runs on suppresses the side that keeps watch, and what had lain dormant wakes. The virus did not grow fiercer; the guard grew thin.

I take this to be one of the places where that old view and present-day immunology come closest. Which is why I do not pass lightly over someone telling me they are tired.

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Sources

• A study following 131,001 people, finding shingles appeared more often in those with sleep disorders — Medicine, 2016
• A study finding higher shingles risk among people reporting high perceived stress, with suppressed cell-mediated immunity as the proposed route — British Journal of Dermatology, 2021

Written by Dr. Heo Ji-young (Ph.D. in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)