Part 1 of 6 in the "always tired" series; the other five are listed at the foot.
"I'm just tired. I sleep, and I'm still tired." A question that comes up often is this one, and it is a hard one to answer in a sentence.
This part answers the first two things: which kind of tired you have, and what to do first.
The short version
- Tiredness that has run for weeks with no clear reason goes to a doctor first, and you may need blood tests — that is how the NHS patient page puts it.
- A consultation starts by taking "tired" apart: when it hits, how much rest restores, whether it is no drive or a heaviness.
- The tests the NHS gives as examples are blood tests. Which ones, exactly, is the doctor's decision for your situation.
- Anaemia occurs when there isn't enough haemoglobin in the body to carry oxygen to the organs and tissues — that is the WHO's anaemia fact sheet. That line on your report is set by the same body's 2024 guideline at below 120 g/L for nonpregnant adult women and below 130 g/L for men; reading the number is the doctor's work.
First, the things that cannot wait
Weight loss you did not intend, or breathlessness, palpitations or chest tightness alongside it — see a doctor for investigation first. The NHS states each separately: it is important to get it checked if you are losing weight without trying, and sometimes the cause can be cancer; and palpitations can be caused by a condition such as iron deficiency anaemia or an overactive thyroid (hyperthyroidism).
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.
The full list, and the reason for each, are in part 5. TCM and Western medicine complement each other; it is not a choice between them.
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. There are many kinds of tired: first work out which one
The first step is always taking "tired" apart. In a consultation these are distinguished as different presentations:
- Tired on waking, or tired only by the afternoon
- Restored by rest, or no different however much you rest
- No drive, or a heaviness in the body
- Tired but unable to sleep, or tired and always sleepy
Both paths use this sorting. TCM theory sorts these differences into different patterns — what those names mean is parts 2 and 3. Modern medicine first uses tests to rule out causes that need treatment — the next section covers what the tests can show.
The two paths do not replace each other, and the order is tests first.
💡 Remember: saying which kind, and at what time of day, is more useful than saying "very tired".
II. Read the report first: what a blood test can tell you
Some of the causes of persistent tiredness can only be confirmed by tests. This section covers what a report can show, using the NHS's and the WHO's public material.
① When to get tested. Three situations go to a GP: you've been feeling tired for a few weeks and you're not sure why; your tiredness affects your daily life; you feel tired and have other symptoms — those are the three the NHS patient page lists.
The examples the same page gives of "other symptoms" are weight loss or mood changes, or being told you're making gasping, snorting or choking noises when you're asleep.
The same page also says: do not self-diagnose — see a GP if you're worried.
② What is tested. You may need tests, such as blood tests to check for anaemia, diabetes or hyperthyroidism — those are the NHS's words, and the "may" is theirs too. Which tests, exactly, is the doctor's decision for your situation. If your company's annual screening report already has these items, bring it to the consultation; if you have had no screening, a doctor at a Klinik Kesihatan or a private clinic can assess whether blood tests are needed.
③ First, what haemoglobin (Hb) does. Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal; it occurs when there isn't enough haemoglobin in the body to carry oxygen to the organs and tissues — that is how the WHO's anaemia fact sheet puts it.
The same page also says anaemia causes symptoms such as fatigue, reduced physical work capacity and shortness of breath, and it describes the common symptoms of anaemia as non-specific.
The page states what haemoglobin does (carries oxygen to the organs and tissues) and what anaemia looks like (fatigue); it does not write out the step in between — why less oxygen delivered feels like tiredness. This article stops where the page stops.
"Non-specific" is worth keeping: tired does not necessarily mean anaemic, and anaemia does not only show as tiredness. So the call rests on a number — the same page says anaemia is diagnosed based on blood haemoglobin concentrations falling below specified thresholds established based on age, sex and physiological status.
④ How to read the haemoglobin line on your report. For adults aged 15–65 the cutoffs are: nonpregnant women below 120 g/L, men below 130 g/L — those are the figures in the WHO's 2024 guideline. (If your report prints g/dL, that is 12 and 13; the conversion is this article's own division by ten.) Pregnancy and children have different cutoffs.
The same guideline also states that haemoglobin values should be adjusted for smoking, and for living at elevation. So matching the number on your report against this line is a starting point; whether it is anaemia, and why, is the doctor's judgement.
The WHO's explanation also notes that anaemia is considered a symptom of an underlying condition. In other words, a value below the line raises the next question — "why" — and that is the doctor's work.
⑤ Glucose and thyroid. These two are tests the NHS lists as ones a doctor may arrange. This article does not give their reading thresholds; the glucose and thyroid figures on a report are for the doctor to interpret.
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 in this part
All three come from the WHO's two documents quoted above.
- Haemoglobin (血红蛋白; printed as Hb on a report) — what carries oxygen to the organs and tissues. That is how the WHO's anaemia fact sheet introduces it. You will see this line on a screening report.
- Anaemia (贫血) — a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal, diagnosed on haemoglobin concentrations falling below thresholds set by age, sex and physiological status.
- Non-specific (非特异性) — the word the WHO uses for anaemia's common symptoms. It means those presentations do not belong to one condition only, so you cannot reason backwards from them to a cause.
Frequently asked
I sleep enough and I'm still tired — what is it? First confirm "enough": the same NHS page puts it as aiming for 6 to 9 hours of sleep, while the American Academy of Sleep Medicine's advice is at least 7–8 hours — the two figures differ, and part 4 sets them side by side. If you have slept enough and are still tired after a few weeks with no clear reason, the NHS's guidance is to see a GP.
What should I get tested for tiredness? The NHS's words are: you may need tests, such as blood tests to check for anaemia, diabetes or hyperthyroidism. The exact tests are the doctor's decision. If your report has a haemoglobin (Hb) line, section II covers how that cutoff is read.
Do not: write off months of tiredness as "just a busy patch" and keep putting it off.
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
- 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 5: When to see a doctor first — each sign, and what it can indicate
- Part 6: What a consultation actually does, and the seven-day log to bring
👉 If you are not sure "where to even start describing this kind of constant tiredness", 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 "First, the things that cannot wait" above or in part 5 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/
- World Health Organization, Guideline on haemoglobin cutoffs to define anaemia in individuals and populations, 2024 — https://www.who.int/publications/i/item/9789240088542
- World Health Organization, Anaemia (fact sheet, page dated 10 February 2025) — https://www.who.int/news-room/fact-sheets/detail/anaemia
- American Academy of Sleep Medicine, Healthy Sleep Habits, updated August 2020 — https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/
- 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/
- 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/
