Chronic Fatigue Syndrome
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Chronic Fatigue Syndrome

I wrote this long article because many women were approaching me for help related to complaints of fatigue. Yet, they did not present with the Chinese medicine diagnosis I expected. Some were self-treating with substances [including Chinese herbals] that were dis-harmonious with their constitution, making accurate diagnosis and treatment difficult. While women are mostly impacted by CFS, 20% of sufferers are men who remain undiagnosed [Clayton, 2015, p. 9). Men are less likely to seek treatment and are harder to diagnose using the Western screens because they are less likely to complain of disabling fatigue.

After I started screening for CFS, I found that that many fit the Western criteria for CFS with very complex Chinese Medicine diagnosis. I now prefer to approached CFS from the broader scope of chronic fatigue immune dysfunction syndrome [CFIDS], which captures all the complexities associated with a Chinese medicine diagnosis. It also captures men who may not present with  Vacuity Taxation or Lily Disease [fatigue, weakness, dryness etc.] as much as "Ascendant Liver Yang Hyperactivity & Internal Wind Harassing Above" [vexation, agitation, irritability]. This is because constitutionally, females are vulnerable to diseases of yin & blood, while males are vulnerable to diseases of qi & yang. 
 
What Causes CFS?
Many things are proposed as the cause and sequel of CFS.  Bacteria & virus can remain dormant in the body long after an acute illness. These bacteria & virus can later resurface as chronic fatigue syndromes. Immune dysfunction may be cause or sequel of CFS. It  may be triggered by virus, chronic sinusitis, vaccination, chemical exposures, Hepatitis B vaccine and silicone breast implant reactions (Van Benschoten, 2015). While neuro-chemical, hormonal, and gastro-hepatic-immune axis sequela occur, the hypothalamus-pituitary-adrenal axis [HPA axis] is of most concern.

Herpes virus' & mycoplasma
In one study, 90% of people with CFS have had a virus in the Herpes virus family. with Human Herpes Virus 6 [HHV6] implicated in CFS. HHV6 causes Roseola, a common childhood illness [and different than the Herpes causing oral & genital sores].  In another study 70% of those with CFS had Mycoplasma [a bacteria similar to TB] in their bloodstream. Mycoplasma causes common and run-of-the-mill upper respiratory infections and walking pneumonia. The Lyme disease spirochete [Borrelia] notoriously carries Mycoplasma as well as some of the viruses associated with CFS. Lyme can mimic [or cause CFS], as well and many other diseases. 

EnterovirusesPolio virus'
Enteroviruses, such as coxsackievirus, form a reservoir in the GIT. From here, they display affinity for peripheral nerves, muscles and the brain. The enteroviruses discovered in the last 30-40 years are no more than variations of the poliovirus. A study revealed the presence of enterovirus RNA in the muscle biopsy samples of 140 CFS patients [p = <0.00001. Eneterovirus cause different symptoms- even no symptoms at all. Other organisms implicated include the Cytomegalovirus [CMV], a Parvovirus, and Epstein Barr Virus [which causes mononucleosis], 

Diagnosing CFS in Western Medicine
There are no specific lab tests for CFS, and it is only somewhat helpful if a persons has had viral antibody screening. This is because most people test positive anyway for common viruses that are implicated in CFS. However, there are diagnostic criteria that must be met before someone is diagnosed with true CFS [CDC]. 

The  main diagnostic criteria is that profound fatigue & weakness be accompanied by some degree of cognitive dysfunction such as poor memory & concentration, or fogginess. Otherwise, different causes must be ruled-out, or one is simply diagnosed as having a "post-viral-syndrome". And CSF must also be differentiated from Fibromyalgia if body ache is present.

A patient will be classified as having CFS if s/he meets the following 3 Western criteria:
  • Severe chronic fatigue for 6 or more consecutive months that is not due to ongoing exertion or other medical conditions associated with fatigue (these other conditions need to be ruled out by a doctor after diagnostic tests have been conducted).
  • The fatigue significantly interferes with daily activities and work. 
  • The individual concurrently has 4 or more of the following 8 symptoms:

  1. Post-exertion malaise lasting more than 24 hours
  2. Un-refreshing sleep
  3. Impaired short-term memory or concentration without longterm memory problems. 
  4. Muscle pain
  5. Multi-joint pain without swelling or redness
  6. Headaches of a new type, pattern, or severity
  7. Tender cervical or axillary lymph nodes
  8. Frequent or recurring sore throats 

Many experience these symptoms:
  • feeling as if in a mental fog
  • neural mediated hypotension with difficulty maintaining an upright position, dizziness, balance problems or fainting
  • allergies or sensitivities to foods, odors, chemicals, medications, noise
  • irritable bowel or excessive GI permeability [leaky gut syndromes]
  • chills and night sweats
  • visual disturbances (sensitivity to light, blurring, eye pain)
  • depression, stress, or mood instability (irritability, mood swings, anxiety, panic attacks)
  • Muscle pain is more diagnostic of fibromyalgia; muscle fatigue of CFS.
  • Remote history of upper respiratory or urinary tract infection
  • Verbal dyslexia
  • Crimson Crescents  [a purple/crimson discoloration near the tonsils]
  • Tender moveable cervical, axillary [especially left axilla] or inguinal lymph nodes.
  • Reactive trigger points for fibromyalgia [e.g. SP21], even though CFS and FM rarely coexist.
  • Diagonal crease on ear lobes [decreased blood flow to brain]
  • Chronic candida infections

It becomes so clear that there are many ways normal physiologic function is high-jacked with CFS, with each person having a different presentation according to Chinese Medical Theory.  Each organism also has its own 'red flags". For example, post-nasal drip  and a chronic dry cough are red flags for Mycoplasma; Crimson Crescents with HHV-6; and CMV has an affinity for causing muscles weakness. Organisms that have an affinity for weakening the heart [e.g. cardiomyopathy & congestive heart failure and myocarditis etc] include:

  • Coxsackievirus B
  • HHV-6
  • Epstein-Barr virus (EBV
  • Parvovirus
  • Mycoplasma 
  • Streptococcal & Staphylococcal bacteria 
  • Borrelia (Lyme disease) spirochete

Lyme testing
The serology tests for Lyme, are complex to interpret and should be done through a specialty lab [e.g. IGenex Inc]. Grisanti [2015] recommends a CD57 Panel (LabCorp: 505026), Complement C4a (LabCorp: 004330), and IGeneX  IgM Western Blot [positive if 2 of the following bands are present: 23-25, 39, and 41 kDa]. A positive tests only suggests exposure to Lyme disease; diagnosis is based on history of exposure and symptoms. 

Obscure and/or specialty tests ior Lyme include electro-dermal scanning, which checks different body systems for Lyme, and adrenal depletion; and genetic testing for mutations in genes that decrease enzyme activity and increase fatigue (Lee, 2015).

CFS vs. SEID vs. CFIDS
Clayton (2015, p.1) wrote that in March 2015, the Institute of Medicine recommended changing the name Chronic Fatigue Syndrome to Systemic Exertion Intolerance Disease (SEID] with a new set of diagnostic criteria that classifying it as a disease vs. a syndrome. Others further refine it as a chronic neuro-immune disease, preferring to call it Chronic Fatigue Immune Dysfunction Syndrome [CFIDS]. 

CFIDS is thought to be caused by an infectious disease that triggers immunological dysregulation, such as interferon [cytokine] system or between the hypothalamus, pituitary, and adrenals [HPA-axis]. Yet, immune assays have no consistent pattern. There may be hyperfunction [up-regulation/ excess] or hypofunction [down-regulation/ deficiency] with a wide variance in abnormal inflammatory markers. In general, there will be deficient natural killer cells [NK] and increased levels of antibodies indicating remote infection with a specific virus or intercellular bacteria.

Immune Dysregulation
An important part of treating CFS  is regulating immune responses. This is because the virus" can deactivate the immune response that actually attacks them [TH1, NK cells, and normal inflammatory responses]. While augmenting that which allows them to thrive [TH2, allergic, and anti-inflammatory response]. 

While those with CFS may have low immune response across the board, in Chinese Medicine it is suggested that boosting the immune system too soon may make matters worse [Maciocia, 2010). The immune system is therefore regulated, and excess conditions reduced first. Not so ironically, Western Medicine has determined that there is a component of auto-immune dysfunction associated with Coxsackievirus B (CVB), and Borrelia burgdorfeii (Bb)[Ercolini & Miller, 2009).

Cognitive Dysfunction
Cognitive dysfunction is a major criteria for diagnosing CFS. As cited by Kaplan (2001), one reason for "brain fog" is a coagulation disorder whereby the blood becomes thicker, and/or there develops a fibrin coating on vessel walls [Phlegm]. Thickened blood and vessels impairs transport of nutrients and oxygen throughout the body [blood stasis?]. In addition, viruses and bacteria may be hidden under the fibrin layer, hiding them from pharmaceutical and herbal antimicrobials [Retained Pathogen, or Pathogen Held in Divergency?].

Chinese vs. Western Medicine Options
Even when someone is diagnosed with CSF, there is not much in the Western Medical arsenal to treat it.  Chinese medicine on the other hand documents the diagnoses & treatment of similar syndromes, dating as far back as the 2nd Century. Three significant syndromes are Gu Syndrome  [Fruehauf, 1998] , Vacuity Taxation, and Lily Disease

The diagnosis & treatment can also be based in Wen Bing Xue [infectious & febrile diseases theory], in which CFS has its roots in some type of infectious or febrile disease with a "Retained Pathogen", "Remnants of Pathogen", "Latent Heat" or  "Lurking Warmth" disease phase  (Liu, 2001). So, there are ancient treatment protocols that can be successfully applied to a modern disease.  Some treatment goals that I add to them, based on modern research are:

  • Protect & boost mitochondria & RNA function [Jing]
  • Protect the heart muscle & function [H / GB Harmony]
  • Dissolve fibrin & biofilm that hides organisms from the immune system [disperse formed & formless qi stagnation and phlegm]
  • Improve circulation & oxygen supply to vital organs & tissues [Blood Stasis]
  • Manage viral dormancy vs. breaking dormancy [Divergency]
  • Regulate the immune response [Harmonize]

It is fascinating to know how the Chinese herbals that I would prescribed anyway based on a person's individual presentation, inherently achieved the above therapeutics, according to modern research.

Feeling Lousy?
Some patients may be satisfied with a minimal degree of "feeling better" with as little effort as possible. This is because compliance with a treatment plan is difficult when feeling lousy for so long. In order to want to be complaint with a treatment plan, a patient has to be able to grasp to some degree the complex patho-mechanisms involved in CFS.  A patient also has to realize that they have a disease [known cause] vs. a syndrome [unknown cause]. 

There are few practitioners to be found who approach CFS as a disease, leaving patients with the message that it is a psychosomatic problem: "It is all in your head" & "Get it together on your own". This is a shame because in severe cases, a person may no longer have the energy or endurance to act on their own behalf. Surely, they feel as if struggling to exist. There is so much Chinese Medicine has to offer! 

Clinical Experience
Treating true CFS is complex and herb intensive. I change or modify 2 to 4 herbal formulas frequently over the course of treatment. These formulas encompass: preparing the constitution, ameliorating major symptom(s), and anti-viral herbs. Then there are the recovery & maintenance herbals. It is also necessary to prepare a person with substances to help self-manage healing crisis or detox reactions. All this requires communication with my patient to coach them through the processes. Patient engagement means being willing and able to do some very important things on a consistent basis- or having someone close to understand and help. 

It has been rewarding learning to treat Chronic Fatigue Syndrome [CFS] by combining Chinese and Western Medicine. This is because people suffer various degrees of CFS without ever being diagnosed & treated. I've been blessed with CFS patents- which has helped me refine an Integrated Treatment Protocol that I can not claim cures CFS, but definitely has improved & maintained patent's quality of life. See also Lotus Institute. 


Sources
Clayton, E. (2015). Beyond myalgic encephalomelitis/ chronic fatigue syndrome: An IOM report on redefining and illness.  Journal of the American Medical Association 313(11), 1102-1102.

Ercolini, A. & Miller, S. (2009). The role of infections in autoimmune disease.
Clinical and Experimental Immunology 155(1), 1–15. doi:  10.1111/j.1365-2249.2008.03834.x. Retrieved from www.ncbi.nlm.nih.gov. 

Fruehauf, H. (1998). Driving out demons & snakes: A forgotten clinical approach to chronic parasitism. Journal of Chinese Medicine 57, 10-17. Retrieved from www.biroco.com/yijing/Gu_syndrome.pdf

Greenlee, J.  & Rose, J. (2000). Controversies in Neurological Infectious Diseases. Seminal Neurology 20(3). retrieved from www.medscape.com/viewarticle/410864_3. 

Grisanti, R. (2105). Lyme Disease: The diagnosis and treatment. The American Chiropractor: Integrative Care. Retrieved from www.functionalmedicineuniversity.com/LymeArticle.pdf 

Kaplan, M. (2015). Hypercoagulation: The CFS/FM plot thickens. The Carousel Network News, 8(5). Retrieved from www.anapsid.org.

Lee, G. (2015). Why Lyme disease adrenal fatigue exhausts you and four ways to replenish your vitality. In Goodbye Lyme. Retrieved from https://mail.aol.com/webmail-std/en-us/DisplayMessage?ws_popup=true&ws_suite=true.

Liu, G (2001). Warm diseases: A clinical guide. Seattle, WA.: Eastland Press.

Maciocia, G. (2010). Myalgic encephalomyelitis (ME). Retrieved from

Shi Xue-ying. [2007]. The therapeutic effects of treating liver depression-spleen vacuity pattern chronic fatigue  syndrome with Xiao Yao San (Rambling Powder) in patients with immune function disturbance. Journal of Chinese Medicine 7, 394-395. Retrieved from www. bluepoppy.com.

Van Benschoten. (2015). Chronic fatigue syndrome. In Lotus Institute. Retrieved from www.elotus.org/article/chronic-fatigue-syndrome.










































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