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Chronic Fatigue Syndrome & Fibromyalgia
CFS, Myalgic Encephalomyelitis
Chronic Fatigue Syndrome is a relatively new disease or group of symptoms. It is characterized by Fatigue which has remained for over 6 months, is not relieved by rest, and cannot be explained by other medical conditions.
Primary presenting symptoms of Chronic Fatigue Syndrome may include:
Fibromyalgia is likewise a relatively new disorder and has a similar set of symptoms to CFS–some have viewed them as one disorder.
Primary presenting symptoms of Fibromyalgia may include:
Their pathology and treatment is similar so we will consider them together.
Primary presenting symptoms of Chronic Fatigue Syndrome may include:
- Fatigue lasting more than 6 months
- Poor concentration, Memory loss
- Enlarged Lymph nodes
- Sore Throat
- Muscle and Joint Pain, Headache
Fibromyalgia is likewise a relatively new disorder and has a similar set of symptoms to CFS–some have viewed them as one disorder.
Primary presenting symptoms of Fibromyalgia may include:
- Fatigue
- multi-site pain in the muscles and bones (musculoskeletal pain)
- areas of tenderness
- sleep and cognitive disturbances, 'brain fog'
Their pathology and treatment is similar so we will consider them together.
Fatigue of a long-lasting nature can be associated with various other conditions such as Hormone imbalance, Cancer, Mononucelosis, Multiple Sclerosis, Depression or a number of other diseases, and these should be eliminated first.
There is no one cause of Chronic Fatigue Syndrome or Fibromyalgia and in many cases no definite cause can be established. Chronic Fatigue is often seen in patients after an acute Viral infection. The acute phase of the infection resolves, but the person may feel a long-lasting tiredness afterwards. Certain Viral infections such as Ross River Fever, Epstein-Barr Virus (EBV) and Rubella are often associated with a lasting chronic Fatigue. According to some studies around 10% of people who have had these viruses develop symptoms matching Chronic Fatigue Syndrome.
Likewise chronic Stress often depletes energy and in some cases the energy doesn't return, especially if they are not eating well, resting adequately or exercising enough.
In Traditional Medicine, Chronic Fatigue and Fibromyalgia are generally classed as diseases of deficiency, and specifically, deficiency of Qi, although other deficiencies such as Yin or Blood deficiency may be involved too. It has been established that there is a close relationship between immunity and our energy level. Modern research has shown that our Qi tonic medicines are particularly associated with improving immunity as well as a general sense of well-being which naturally includes a good sense of energy. Therefore we can see a direct correlation between someone having low energy and a lowered immune response, as well as someone who has had their immunity lowered during a prolonged viral disease and then feeling fatigued.
Therefore Qi tonic medicines are usually indicated. The most important aspect is in recognizing other pathogenic factors.
After an infectious disease, Traditional texts sometimes refer to 'Hidden Fever' or 'Residual Pathogen'. This concept suggests a lingering, remaining aspect that has not been resolved even though the initial acute phase of infection has passed. This can be viewed as a latent pathogen usually of Heat or Toxin. In some cases after Bacterial Infection a similar residual pathogen remains which is not due to active bacterial infection, but rather, to bacterial endo-toxins released from dead bacteria. Oxidative stress has also been suggested as a contributing factor in Chronic Fatigue too. All these cases require the addition of medicines to clear Heat and Toxin, administered along with Qi tonics.
Another classic pathology associated with Fatigue from a traditional viewpoint is Damp. Damp is a heavy, slowing and dulling pathogen that often makes people feel heavy. And by implication, the light, volatile nature of Qi is hindered, thereby causing a sense of heaviness with fatigue. This can sometimes be seen in the aftermath of certain infections, but is most commonly a result of poor diet or else having eaten heavy and hard-to-digest foods in the aftermath of an illness where the digestion is typically weak. In any case, medicines that tonify the Spleen Qi (Digestive energy) must be combined with medicines that resolve the damp, as well as aromatic Qi-moving medicines to mobilize.
The general principle of treatment is to tonify the Qi, increase Immunity, and remove lingering pathogens such as Heat and Damp. Therefore tonics are combined with medicines to clear remaining pathogen. The use of aromatics with fragrant, aromatic natures which have a high proportion of anti-oxidants can be useful in this case too.
In a Chinese review of Fibromyalgia, the largest percentage of cases were classified as Qi and Blood deficiency (46%) with Qi and Blood Stagnation accounting for 53% of secondary diagnosis. Liver Qi stagnation accounted for just under 20%, while Kidney Yin deficiency and Wind-Damp-Cold accounted for 3.6% and 1.8% respectively.
Diet & Lifestyle advice:
Other Therapies
There is no one cause of Chronic Fatigue Syndrome or Fibromyalgia and in many cases no definite cause can be established. Chronic Fatigue is often seen in patients after an acute Viral infection. The acute phase of the infection resolves, but the person may feel a long-lasting tiredness afterwards. Certain Viral infections such as Ross River Fever, Epstein-Barr Virus (EBV) and Rubella are often associated with a lasting chronic Fatigue. According to some studies around 10% of people who have had these viruses develop symptoms matching Chronic Fatigue Syndrome.
Likewise chronic Stress often depletes energy and in some cases the energy doesn't return, especially if they are not eating well, resting adequately or exercising enough.
In Traditional Medicine, Chronic Fatigue and Fibromyalgia are generally classed as diseases of deficiency, and specifically, deficiency of Qi, although other deficiencies such as Yin or Blood deficiency may be involved too. It has been established that there is a close relationship between immunity and our energy level. Modern research has shown that our Qi tonic medicines are particularly associated with improving immunity as well as a general sense of well-being which naturally includes a good sense of energy. Therefore we can see a direct correlation between someone having low energy and a lowered immune response, as well as someone who has had their immunity lowered during a prolonged viral disease and then feeling fatigued.
Therefore Qi tonic medicines are usually indicated. The most important aspect is in recognizing other pathogenic factors.
After an infectious disease, Traditional texts sometimes refer to 'Hidden Fever' or 'Residual Pathogen'. This concept suggests a lingering, remaining aspect that has not been resolved even though the initial acute phase of infection has passed. This can be viewed as a latent pathogen usually of Heat or Toxin. In some cases after Bacterial Infection a similar residual pathogen remains which is not due to active bacterial infection, but rather, to bacterial endo-toxins released from dead bacteria. Oxidative stress has also been suggested as a contributing factor in Chronic Fatigue too. All these cases require the addition of medicines to clear Heat and Toxin, administered along with Qi tonics.
Another classic pathology associated with Fatigue from a traditional viewpoint is Damp. Damp is a heavy, slowing and dulling pathogen that often makes people feel heavy. And by implication, the light, volatile nature of Qi is hindered, thereby causing a sense of heaviness with fatigue. This can sometimes be seen in the aftermath of certain infections, but is most commonly a result of poor diet or else having eaten heavy and hard-to-digest foods in the aftermath of an illness where the digestion is typically weak. In any case, medicines that tonify the Spleen Qi (Digestive energy) must be combined with medicines that resolve the damp, as well as aromatic Qi-moving medicines to mobilize.
The general principle of treatment is to tonify the Qi, increase Immunity, and remove lingering pathogens such as Heat and Damp. Therefore tonics are combined with medicines to clear remaining pathogen. The use of aromatics with fragrant, aromatic natures which have a high proportion of anti-oxidants can be useful in this case too.
In a Chinese review of Fibromyalgia, the largest percentage of cases were classified as Qi and Blood deficiency (46%) with Qi and Blood Stagnation accounting for 53% of secondary diagnosis. Liver Qi stagnation accounted for just under 20%, while Kidney Yin deficiency and Wind-Damp-Cold accounted for 3.6% and 1.8% respectively.
Diet & Lifestyle advice:
- avoid cold, raw, damp foods; eat foods cooked with herbs and spices
- avoid cold drinks, drink Ginger tea
- focus on good digestion–chew food well, no eating between meals, avoid overeating
- if Damp, eliminate Wheat, refined carbohydrates, Dairy and white sugar
Other Therapies
- Massage
- Cupping
- Moxabustion
- Yoga or Tai Chi
Western Tradition
Simples
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Chinese Classification
Simples
Formulas
A. Lingering Heat or Damp-Heat Fatigue, especially in the aftermath of recent viral attack, high colored urine, red tongue with yellow coating and a fast and slippery pulse Xiao Chai Hu Tang B. Damp Obstruction Fatigue, feeling of heaviness, fogginess in the head, poor appetite, loose bowels. Tongue is flabby with a damp or wet coating, pulse is low and weak. Xiang Sha Liu Jun Zi Tang Ban Xia Hou Po Tang C. Qi and Blood Stagnation Fatigue, widespread pain which may be dull or sharp, pain ease after gentle exercise, worse when stressed. If there is Depression or PMS, Liver Qi is stagnant. Xiao Yao San Dan Zhi Xiao Yao San D. Spleen Qi Deficiency / Qi & Blood Deficiency Fatigue, always tired, pale face, dull and diffuse pain, poor appetite and digestion, aching or tired limbs, worse after strenuous activity, pale tongue with a moist or white coating, slippery weak pulse Bu Zhong Yi Qi Tang Ba Zhen Tang Shi Quan Da Bu Tang Gui Pi Tang E. Wind-Damp Pain Fatigue with a predominance of aching in the muscles or joints, moving pain, worse in cold or damp, heavy feeling, foggy brain Juan Bi Tang F. Yin Deficient Heat Liu Wei Di Huang Wan Zhi Bai Di huang Wan |
Research:
1. Traditional Chinese Medicine for Fibromyalgia
2. Traditional Chinese Medicine for Treatment of Fibromyalgia: A Systematic Review of Randomized Controlled Trials
3. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools
4. Use of Complementary and Integrative Therapies by Fibromyalgia Patients: A 14-Year Follow-up Study
5. Acupoint Stimulation for Fibromyalgia: A Systematic Review of Randomized Controlled Trials
6. Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials
7. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial
1. Traditional Chinese Medicine for Fibromyalgia
2. Traditional Chinese Medicine for Treatment of Fibromyalgia: A Systematic Review of Randomized Controlled Trials
3. An overview of systematic reviews of complementary and alternative therapies for fibromyalgia using both AMSTAR and ROBIS as quality assessment tools
4. Use of Complementary and Integrative Therapies by Fibromyalgia Patients: A 14-Year Follow-up Study
5. Acupoint Stimulation for Fibromyalgia: A Systematic Review of Randomized Controlled Trials
6. Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials
7. Effect of tai chi versus aerobic exercise for fibromyalgia: comparative effectiveness randomized controlled trial