Many friends who come to the clinic often ask me one question: why is it that even after sleeping eight or nine hours, I still feel dizzy and foggy during the day, with heavy eyelids, and I wish I could lie down on the desk and sleep again? This is indeed a common Affliction. In clinical practice of traditional Chinese medicine, dizziness and drowsiness often appear together, and may even be cause and effect for each other, but the mechanisms behind them can differ greatly and require careful differentiation.
1. Yang qi is the sun of the body—"When yang qi is refined, it nourishes the spirit"
In the Huangdi Neijing, Suwen, Chapter 3: Shengqi Tongtian Lun, there is a very important statement: "As for yang qi, when it is refined, it nourishes the spirit; when it is soft, it nourishes the sinews." These twelve characters are worth pondering repeatedly.
"When it is refined, it nourishes the spirit" means that when yang qi is properly distributed and flows smoothly, a person's spirit can be full and thinking can be clear. Yang qi warms the whole body like the sun. When it is sufficient and its pathways are unobstructed, clear yang rises to the head and eyes, and naturally the mind is refreshed and energy is abundant.
"When it is soft, it nourishes the sinews" emphasizes the gentle moistening and nourishing effect of yang qi. If the movement of yang qi is blocked or deficient, the nourishment of the head and eyes will be insufficient, leading to foggy thinking, poor memory, fatigue and lack of strength, and even sluggish limbs. This is closely related to the modern lifestyle of prolonged sitting with little movement, excessive mental strain, and irregular daily routines.
From a clinical perspective, among people who frequently experience dizziness and drowsiness, a considerable portion do indeed mainly have yang qi deficiency or yang qi stagnation. If they usually fear cold, have cold hands and feet, loose stools, and listlessness, then the pattern may lean toward yang qi deficiency, with clear yang unable to rise and nourish the head and eyes; but it may also be that yang qi is trapped by damp turbidity, just like dark clouds covering the sun, so that the more one sleeps, the more drowsy one feels, and the head feels as if wrapped in cloth upon waking in the morning.
Here one common misconception requires special attention: if dizziness and drowsiness are managed only with the idea of "tonifying," sometimes the condition may instead worsen. If the tongue coating is thick and greasy, the mouth is sticky, and the body feels heavy, then it may be damp turbidity clouding the clear orifices, and it is more appropriate to transform dampness and awaken the spirit rather than simply tonifying. In clinical practice, those inclined toward yang deficiency and those inclined toward dampness encumbrance have completely different directions of care and require careful distinction.
2. "Insufficient upper qi" and spleen deficiency with failure of clear yang to rise—the middle jiao is the pivot of ascent and descent
In the Lingshu, Chapter 28: Kouwen, it is said: "When upper qi is insufficient, the brain is not filled, the ears suffer from ringing, the head suffers from drooping, and the eyes suffer from dizziness." This sentence vividly depicts the intertwined state of dizziness, visual blurring, and tinnitus.
"When upper qi is insufficient, the brain is not filled" can be understood as insufficient essential substances being transported upward, so the brain orifices lose nourishment. "The head suffers from drooping" is a vivid portrayal of a heavy head drooping downward and difficulty staying awake—is this not the typical picture of daytime drowsiness?
What maintains the sufficiency of "upper qi"? The key lies in the middle jiao, the spleen and stomach. The spleen and stomach are the foundation of the acquired constitution and the source of qi and blood generation. After food is digested and absorbed, it relies on the spleen's function of raising the clear to transport essential substances upward to the head and eyes. If the spleen and stomach are weak and unable to raise the clear, clear yang will sink downward, and the head and eyes will not receive proper nourishment, naturally leading to foggy thinking and drowsiness.
If drowsiness is especially obvious after meals, with thin and loose stools, sallow complexion, and soft muscles, then it may be more appropriate to understand it from the perspective of "spleen deficiency with failure of clear yang to rise." However, it should also be noted that if there is simultaneously chest and hypochondriac distention, depressed mood, and a sensation of a foreign body in the throat, then there may also be liver qi stagnation and disharmony of qi movement ascent and descent—the spleen's raising of the clear and the liver's smoothing and coursing complement each other, and looking at only one organ while ignoring the rest can easily lead to one-sided conclusions.
Regarding diet, for this type of constitution, it is often recommended to eat regularly and avoid raw, cold, sweet, greasy, and alcoholic substances that damage the transforming and transporting functions of the middle jiao. In terms of daily routine, it is not advisable to immediately bend over a desk or lie down after meals; the middle jiao should be given space to digest. Emotionally, excessive thinking most consumes spleen qi, and learning to let go of "worrying" is also a form of care.
3. Damp turbidity encumbering the spleen and clouding the clear orifices—the mystery of feeling more drowsy the more one sleeps
The Suwen, Chapter 5: Yinyang Yingxiang Dalun says: "Clear yang emerges from the upper orifices, turbid yin emerges from the lower orifices." This classic statement outlines the basic pattern of qi movement in the human body—light and clear qi rises to nourish the head, face, and nine orifices, while heavy and turbid substances are discharged downward out of the body.
When this order of "clear rising and turbid descending" is disrupted, the pathogen of damp turbidity will rebel. Dampness is heavy, turbid, sticky, and stagnant. If the spleen's transportation is not healthy and water-dampness accumulates internally, damp turbidity may both encumber the middle jiao and rise along the meridians to cloud the clear orifices. This is like continuous rainy weather, when the sky is covered by dark clouds and dampness from the ground steams upward without dispersing, so the person's head and face naturally feel heavy and foggy.
This group of people has a very typical characteristic: the longer they sleep, the more drowsy they feel. Upon waking in the morning, they still feel heaviness in the head, aching limbs, and stickiness in the mouth, as if they had spent the whole night in a "swamp." In clinical practice, this situation is relatively common among people who live in damp environments for long periods or whose diet is greasy and sweet, and it is often accompanied by unformed stools, a tendency to be overweight, and a enlarged tongue with teeth marks.
If the tongue coating is white, thick, and greasy, it may lean toward cold-dampness; if the tongue coating is yellow and greasy with a bitter and sticky mouth, then damp-heat may already be present. The emphasis of care for the two is not the same—the former is suitable for warming and transforming, while the latter is suitable for clearing and draining. This is precisely the significance of "pattern differentiation" in traditional Chinese medicine: for the same dizziness and heavy drowsiness, the internal logic may differ entirely.
In terms of exercise and daoyin, appropriate activity is one effective way to uplift yang qi and help transformation, and can induce slight sweating, but care should be taken to avoid wind, and to dry off promptly after sweating. The intensity and duration of exercise should be determined according to individual physical strength and done within one's capacity. If dampness encumbrance has persisted for a long time, an overall judgment by a professional traditional Chinese medicine physician in combination with tongue and pulse may be needed.
4. Disturbance of the circulation of nutritive and defensive qi—why "not sleeping deeply" also causes drowsiness
In the Lingshu, Chapter 80: Dahuolun, there is a brilliant discussion of the mechanism of sleep: "As for defensive qi, during the day it constantly moves in yang, and at night it moves in yin. Therefore, when yang qi is exhausted, one lies down; when yin qi is exhausted, one wakes." The rhythm of defensive qi's emergence and entry day and night is the foundation of the human sleep-wake cycle.
If the movement of defensive qi is abnormal—unable to hide smoothly in yin when it should enter yin, or unable to reach outward smoothly when it should emerge in yang—then there will be shallow sleep at night, many dreams, easy awakening, and during the day, lack of spirit and drowsiness. This can be understood as a disruption of the body's "circadian rhythm," and modern medicine also believes that disruption of sleep rhythm can significantly affect daytime alertness.
If there are many dreams at night, or difficulty falling back asleep after waking, or extreme fatigue upon rising in the morning, then it may be considered from the perspective of "disharmony in the meeting of nutritive and defensive qi." But it may also be "non-interaction between the heart and kidney"—heart fire cannot descend to warm kidney water, and kidney water cannot rise to restrain heart fire, which can likewise cause a marked decline in sleep quality and further daytime foggy thinking.
Interestingly, this group of people often feels somewhat more energetic in the afternoon or evening, showing a different daily rhythm pattern from those with spleen deficiency and failure of clear yang to rise, who feel "the more tired, the more drowsy." In clinical practice, it is first necessary to distinguish whether the main issue is difficulty falling asleep, early awakening, or shallow sleep with many dreams; different sleep problems point to different emphases in the disease mechanism.
Regularity of daily routine is extremely important in this situation. Try to go to bed and get up at fixed times, and gradually adjust the body's rhythm. Reducing screen time in the evening and reducing the intake of stimulating drinks such as coffee and strong tea are basic measures to help defensive qi move in an orderly manner. Good sleep hygiene habits are the foundation of any traditional Chinese medicine care approach and should not be bypassed.
5. Directions for self-observation—looking for clues in the details of life
Pattern differentiation in traditional Chinese medicine is not mysterious; it is essentially an observation and reasoning about details.
Are the stools dry at first and then loose, or loose throughout? Is the tongue coating thin and white, or thick and greasy? Is there a bitter taste in the mouth upon waking, or a bland taste with no flavor? Is there a preference for warm drinks, or a clear liking for cold? Is the emotional state mainly irritable, or mainly low? These questions have no standard answers, but when combined, they form a complete portrait of the constitution.
Another key dimension is the "timeline"—on which days do symptoms worsen? Are they related to the female menstrual cycle? Do they synchronize with seasonal changes? For example, worsening during the plum rain season, or more pronounced dizziness in spring when liver wood is generating and rising—these are all extremely valuable pieces of information in pattern differentiation.
If, along with head and eye fog, there is also neck stiffness and dizziness worsens when turning the head, then the issue of qi and blood circulation in the neck region should also be considered, and not only the problem "above." In clinical practice, different locations of dizziness and heaviness, and different time points of drowsiness signals, all correspond to different organ and meridian logic. For example, discomfort in the back of the head extending to the nape is often related to the Taiyang meridian, while distending pain in the temporal regions on both sides may be related to the Shaoyang meridian.
Frequent dizziness and drowsiness is not a problem that can be solved by a "unified formula." Its answer is hidden in each person's life details, in differences of constitution, and in the wisdom passed down from generation to generation in the classics of traditional Chinese medicine. Rather than rushing to find a comprehensive answer, it is better to first learn to observe oneself—every signal the body gives us is telling its own story in detail.
References:
1. The original text of Huangdi Neijing, Suwen can be consulted in the database of ancient Chinese medical literature: https://tcmdata.cintcm.com/
2. World Health Organization strategy documents on traditional medicine: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine
3. Official website of the National Administration of Traditional Chinese Medicine: https://www.satcm.gov.cn/
Related Knowledge Q&A
1. What causes "yang qi is the sun of the body"?
Traditional Chinese medicine believes that "yang qi is the sun of the body" should be approached through overall pattern differentiation, using the four examinations of inspection, auscultation and olfaction, inquiry, and palpation in combination, and making a comprehensive judgment based on individual constitutional characteristics; it cannot be generalized. The specific direction of care must be determined by a licensed traditional Chinese medicine physician after face-to-face consultation.
2. How long is the care cycle for "insufficient upper qi" and the spleen?
The care cycle varies from person to person and is related to factors such as the individual's constitutional foundation and the degree of cooperation with lifestyle habits. Traditional Chinese medicine emphasizes gradual progress. The specific cycle must be evaluated by a licensed traditional Chinese medicine physician after face-to-face consultation based on the individual's situation. This material does not provide a commitment to a specific cycle.
3. What should be noted in daily life with damp turbidity encumbering the spleen and clouding the clear orifices?
In terms of daily maintenance, it is recommended to maintain regular routines, a balanced diet, moderate exercise, and emotional stability. Specific precautions should be flexibly adjusted according to individual constitution and seasonal changes. A licensed traditional Chinese medicine physician can be consulted for targeted advice.