Chronic fatigue syndrome (CFIDS) is an immune system dysfunction characterized by severe unrelenting fatigue, low body temperature, sore throat, lymphadenopathy, arthralgia, fibromyalgia and various neurological and mental symptoms. One day while browsing the shelves of the local university library, I was fortunate enough to happen upon perhaps the first book ever written about chronic fatigue. Chronic Fatigue Intoxication: a heretofore inadequately described affection, by Edward H. Ochsner, MD, was published in 1923. (go here and you may be able to get a copy.) Here you can read some. The author pointed out that chronic fatigue occurred primarily in sensitive, overworked people, and he clearly outlined the existence of what are now called trigger points. Dr. Ochsner considered the trigger points to be toxic accumulations from overwork and long time stress (especially in sensitive people - those with a Vatic nature according to Ayurveda), and his primary treatment protocol involved bed rest, dietary modification and massage.
As it happens, the good doctor was also a rancher, and in one fascinating set of experiments he tested his theories on plow horses. He made them plow long hours, week after week, without allowing for adequate rest. The more sensitive horses were always first to succumb to a chronic fatigue type of condition, exhibiting prominent symptoms of acidic breath and poor digestion. In each case, a good long rest proved to be an effective cure. Today we see what appears to be the same syndrome in CFS, also called myalgic encephalomyelitis (ME) in the United Kingdom. Results of a 1997 study in England suggested that as many as 11% of patients visiting primary care facilities had symptoms of chronic fatigue (Wessely et. al, 1997). Rest is thus a number one treatment, often neglected or impossible.
The medical community now recognizes several potential causes of CFS, though no one claims to fully understand the causes or the nature of the illness. It is interesting to note that many of Dr. Ochsner's early insights still apply.
Following are some of the more common possible causes of CFS:
• Severe emotional or physical stress
• Lack of physical tone, or poor metabolism due to lack of exercise
• Digestive problems and intestinal infections resulting from poor diet
• Metabolic or environmental disturbances that exhaust the glands or the cellular mitochondria that produce the body’s energy
It is likely that viral illness, emotional stress, or exposure to environmental toxins act as triggers of CFS. Onset is typically sudden, presenting with symptoms that follow a variable course, often characterized by a pattern of alternation between relapse and remission. Symptoms include, but are not limited to debilitating and persisting fatigue, low-grade fever, sore throat, fibromyalgia (muscle pain), sleep disorders, and mental fogginess. Most cases of CFS involve a low-grade fever along with immune deficiency. Consequently, CFS patients experience numerous changes in immune parameters, often exhibiting lower levels of natural killer cells (NK), antibodies, and important cytokines (Vanderhaeghe and Bouic, 1999). They may also present with evidence of considerable neurological stress and symptomology. Symptoms are often made worse by exercise.
Pretreatment of CFS
A large percentage of CFS patients suffer from specific metabolic problems, and there are many signs of toxicity. I would estimate that more than 40% of the CFS patients I have seen require pre-treatment for these conditions before I can begin to treat their fatigue. For example, excretion of certain urinary metabolites definitely increases in CFS cases (McGregor et al., 1996), and there is a high incidence of chronic candidiasis (Cater 1995). Thyroid imbalance is also a common problem (Bland, 1999), as is blood sugar imbalance.
For these reasons, I have found it an important first step to treat these problems individually, especially in the GI tract, before treating CFS directly. Such an approach can often provide very quick relief, offering a noticeable reduction of symptoms. Liver detoxification and elimination of food allergies is another useful starting strategy favored by holistic doctors and Naturopaths (Bland, 1999), as is use of low-dose cortisone, about 2.5-5 mg. per day (Cleare et al., 1999).
Direct Herbal Treatment of CFS
One major prong of treatment is the use of a tonic formula or a combination of tonic herbs like ginseng root, astragalus root and white atractylodes. Other tonics include ashwaghanda root, shilajatu, mica oxide bhasma, wild asparagus root, dang gui, schisandra berries, codonopsis, Siberian eleuthero root bark, maitake mushroom, ganoderma mushroom, licorice root, guduchi stem and amla fruit. These herbs work directly against any hidden infection, and tonify depressed immune cells, including NK cells.
Of course it is essential to choose tonic herbs in a balanced fashion, based upon the patient’s signs and symptoms. For example, ginseng and astragalus root are more heating and energizing, while ashwaghanda root and ganoderma mushroom are more calming and neutral in energy, while dang gui is more nourishing to the blood.
A second prong of treatment is the use of herbs known to reduce low-grade fevers. Such herbs include isatis root and leaves, raw rehmannia, qing hao herb (Artemisia annua), bupleurum root, dandelion root, tulsi, cat's claw (uña de gato or Uncaria tomentosa), elderberrry, pau d'arco inner bark (Tabebuia species) and wild indigo root tincture (Baptisia tinctoria).
After choosing a group of perhaps three to six tonic herbs, comprising about 60-70% of the formula, I would make some of the following modifications, either to fill our the formula, or as separate concomitant formulas:
• If there are signs of dampness or mucus, such as a greasy tongue coating or nausea, add a small amount of drying herbs like black atractylodes, poria mushroom, pinellia tuber, and dried tangerine peel to your formula.
• If there are signs of coldness, you can add a few warming herbs like dry ginger root, prickly ash bark or cinnamon bark. Always ask first if the patient can tolerate spicy foods.
• For nervous system agitation, be sure to use wild milky oat seed tincture, scullcap tincture and/or ashwaghanda root.
• Cases in which the sides of the tongue are red or the patient is irritable, require additional herbs that remove toxins from the liver and blood. Such herbs include bupleurum root, dandelion root and wheat sprouts.
• In cases where the patient presents with a pale tongue and severe exhaustion, add nourishing herbs like dang gui root or cooked rehmannia root.
• It is imperative that CFS patients get plenty of daily rest and good sleep. Herbs like valerian root, kava root, or scullcap tincture can be useful if patients have difficulty sleeping.
• Studies indicate that short bursts of daily exercise (not for extended periods of time) can be of great benefit for CFS patients. Researchers recommend beginning slowly, with 10-minute rounds of activity, and slowly working up to longer periods of exercise (De Lorenzo et al., 1998).
Nai-shing recalls a young female CFS patient named Dina, who had been suffering from severe chronic fatigue for almost ten years. She was also cold all the time, even though her thyroid function was normal. We counseled her on necessary dietary changes, and identification of food allergies. Nai-shing then prepared for her a simple tonic of astragalus root, ginseng root and white atractylodes to tonify the vital energy, some dry ginger and purified aconite to warm the body, and some dang gui root and cooked rehmannia root to nourish the blood. Within two weeks Dina’s energy increased dramatically, and she continued to improve steadily during a four-month course of herbs. She recovered completely within six months.
Fibromyalgia, a condition characterized by chronic muscle pain, is a sister disease to CFS. I rarely see a CFS case without this chronic muscle and fibrous tissue pain.
In addition to the CFS protocols discussed above, I recommend the following treatments for fibromyalgia.
• Over the years, natural medicine practitioners have had much success with the simple combination of malic acid (about 1200 mg per day) and magnesium (about 30-400 mg) for pain relief. A placebo controlled double blind study confirmed the efficacy of this combination (Russell et al. 1995). Both malic acid and magnesium are available in many health food stores.
• To reduce inflammation, you can add boswellia gum or turmeric root to your herbal formula.
• Moving blood herbs such as dang gui root, salvia root and red peony root have also proven to be effective treatments for fibromyalgia.
• It is important to remember that toxic accumulations in muscle tissue take time to remove, and verious detoxification protocols involving the lymphactic system, the blood circulation and the liver or kidneys should be considered.
• Massage or other forms of bodywork are essential, and add considerably to the above treatments.