Chronic Fatigue Syndromes

Paul Reller, L.Ac.

The patient with a symptom of chronic fatique must identify whether this symptom is caused by a health problem such as a clinical or subclinical hypothyroidism, adrenal insufficiency, depression, sleep disorder, anemia, liver disease or dysfunction, various chronic inflammatory diseases, neurological diseases such as multiple sclerosis or amyotrophic lateral sclerosis, various autoimmune disorders, hepatitis C or other viral disease, or even medication side effects. A thorough medical analysis and a number of tests should be conducted, and a careful differential diagnosis considered. When none of these causes or underlying conditions are evident a primary chronic fatique syndrome is suspected. Chronic Fatique Syndrome is not confirmed by objective tests at this time, but is a diagnosis of exclusion. Hence, this syndrome, or these syndromes, have been underdiagnosed and dismissed in standard medicine for a number of decades, despite growing evidence that they are increasing in occurrence in the population. Public health authorities worldwide are now seriously investigating the possible causes of these syndromes and research is revealing more and more each year. Since these chronic fatigue syndromes are so debilitating, many patients have become desperate, as their medical doctors have no effective therapy to offer them. Consequently, a number of causes of chronic fatigue have been touted as the probable culprit, some of which are themselves hard to objectively diagnose. It is improbable, though, that the growing large number of cases of chronic fatique syndrome are caused by just one pathogen, such as the spirochete bacterium Borrelia burgdorferi, now infamous as the cause of the tick-born infection in Lyme disease. A careful and persistent differential diagnosis is very important when assessing chronic fatique. If the actual factor or factors causing each individual case are not assessed properly, the best therapeutic protocol cannot be devised.

Since standard medicine has failed to properly treat so many patients with chronic fatique, more and more patients now are turning to an integrative approach with Complementary Medicine, especially with the array of therapies available in the specialty of Traditional Chinese Medicine. The professional Licensed Acupuncturist and herbalist is able to add to the professional diagnosis, offer a unique perspective that integrates well with standard medicine, and offer an array of evidence-based traditional and modern therapies, including herbal and nutrient medicine, acupuncture, instruction in diet and lifestyle changes, help with cognitive and behavioral changes, and physiotherapies. Each individual TCM physician offers a unique set of skills, knowledge and clinical experience, and many are able to provide an effective course of therapy in difficult diseases. In these chronic fatique pathologies the patient that takes a proactive approach and becomes the main director of a team of integrated physicians often achieves the best outcome. By becoming well educated to the suspected underlying pathology, and utilizing various physicians to provide their best skills and knowledge, these patients often overcome the difficulties seen in these often elusive and persistent diseases.

Chronic Fatigue Syndrome (CFS) has been an elusive health problem to understand and to define, yet the World Health Organization (WHO) and the National Institutes of Health (NIH) recognize this syndrome as a widespread, growing and cohesive syndrome of symptoms seen worldwide. The syndrome has also been classified as Neuroendocrineimmune Dysfunction and Chronic Fatigue Immunodeficiency Syndrome, and recently has been called Myalgic Encephalomyelitis after research has revealed more specific mechanisms of pathology. A term that is used by most experts to describe Chronic Fatique Syndrome today is an Encephalomyopathy, referring to a pathology of the brain stem physiology that affects the muscle function, nerve sensation and firing, or a functional somatic syndrome. Other functional somatic syndromes appear to overlap with CFS at an alarming frequency, suggesting perhaps a related underlying etiopathology. These include fibromyalgia, multiple chemical sensitivity, chronic pelvic pain syndrome, irritable bowel syndrome, temporomandibular joint dysfunction, and Gulf War illness. Current research more closely ties Chronic Fatique Syndrome with Fibromyalgia and implicates hypofunction of the hypothalamus adrenal axis, and well as more specific findings of neurotransmitter and neuroreceptor problems in the brainstem, especially a hyperserotonergic imbalance. As research progesses we may find that there are a number of roots of this elusive syndrome, though, and patients may be differentiated with greater clarity.

Chronic fatigue may be secondary to various health problems, or may be a primary functional somatic syndrome, perhaps related to other functional somatic syndromes, such as fibromyalgia, multiple chemical sensitivity, irritable bowel syndrome, or chronic pelvic pain syndrome. As research progresses scientists are more clearly understanding the key functional problems, which relate to the central nervous system, particularly the brainstem transmission, and the centers of control and coordination at the top of the brainstem, especially the hypothalamus, amygdala and hippocampus. Insufficiency of the hypothalamic adrenal axis, imbalance of inflamatory cytokines and the T helper cell 2 (Th2) dominance, an imbalance of serotonin over dopamine in both neurotransmitter production and receptors, and neurodegeneration with both loss of volume in certain sections of the brain and a decrease in mitochondrial function, are all hallmarks of Chronic Fatigue Syndrome (CFS). Obviously, a more complex and holistic treatment protocol is needed to restore health and function. Complementary Medicine should play a key role in the integration of standard medicine with such a comprehensive stategy.

The difficulties in understanding the complex multifactorial nature of functional somatic syndromes, as well as the overlapping dysfunctions in multiple systems, the central nervous, immune, and endocrine systems, has led to an understandable dismissal of these difficult to treat, and even more difficult to diagnose and understand functional pathologies. Without a clear disease classification in allopathic medicine, and without clear treatment options, most of these cases have been treated with a dismissive attitude. Restoration of normal homeostatic function, integrating Complementary Medicine into standard treatment protocol, is the answer to success in treating any functional somatic disorder. With a pathology that demonstrates no abnormality of structure to explain ill health, and is shown to include functional problems between multiple systems, a holistic approach to assessment and treatment seems logical. Complementary Medicine, especially Traditional Chinese Medicine, offers an arrray of treatment options that research is proving effective to restore homeostatic functional balance between the hypothalamus, amygdala, and hippocampus, restore immune function, and potentially treat the multiple underlying health problems with an individualized approach. Acupuncture, herbal and nutrient medicine, and even deep soft tissue physiotherapies are now shown to affect the central nervous system, immune responses, and bioavailability of neurotransmitter production to achieve greater success in restoration of homeostatic health.

There is a growing concern that standard medicine is not addressing this widespread problem of chronic fatique syndromes worldwide. Chronic Fatique Syndrome as an encephalomyopathy is still not being understood, diagnosed, and treated effectively. Many patients, desperate for a diagnostic answer to their debilitating disease, are convinced that they have Chronic Lyme Disease, or various other infectious or metabolic disorders, often without sufficient evidence to support the diagnosis. Of course, many patients with Lyme Disease or Post-Lyme Disease Syndrome have acquired a chronic fatique syndrome that is often quite debilitating, and a number of other chronic syndromes, such as Gilbert’s Syndrome, often go undiagnosed as well. These syndromes themselves may be complicated by a variety of health problems, though, that contribute to a multifactorial syndrome. The lack of sound scientific study of these various chronic fatique syndromes has prompted patient advocates to initiate legislative action on the subject of Lyme disease that now has created government guidelines advocating the use of extended antibiotic therapy that is not supported by various Lyme disease organizations, or by top university researchers. In fact, experts at Johns Hopkins University School of Medicine, Division of Infectious Diseases, suggested in 2007 that prolonged antibiotic therapy, or even the long course of initial antibiotic therapy, in Lyme disease, could be the cause, or a cause, of many chronic fatique syndromes with inexplicable musculoskeletal pain and neurocognitive dysfunction. Experts around the world, studying the rising incidence of Lyme Disease, have found that in almost all cases of definitively diagnosed Lyme Disease with symptoms, that a single short course of antibiotics effectively cured the infection, with only about 5% requiring a second course. These experts at Johns Hopkins suggested that the term “Chronic Lyme Disease” should be replaced with the term “Post-Lyme Disease Syndrome” to indicate that the chronic fatique syndrome following an episode of Lyme disease not be attributed to a current infectious state. The complexity of chronic fatique syndromes, and the systemic and holistic aspects to the disease, have resulted in an avoidance of a sound diagnostic and treatment regimen based on current scientific evidence.

As stated, a growing concern in medicine is that many patients with a chronic fatique syndrome, and possibly with a Post-Lyme Disease Syndrome, are being unnecessarily treated with a prolonged course of antibiotics that has not demonstrated success in treating these disorders, and itself may present side effects, or affect the symbiotic microbial balance in the intestines and allow other chronic infections, such as systemic candidiasis, to occur, which itself may create symptoms of chronic fatique. In such difficult and complex disease presentations, the patient should take a proactive approach, learn as much about these conditions as they can, and perhaps take a greater role in insuring that a logical and credible diagnosis and treatment plan is achieved. A patient that suspects that Lyme disease is the cause of his or her Chronic Fatique Syndrome should assess the initial presentation of signs and symptoms to see if there was indeed evidence of an actual Lyme disease preceding the onset of chronic fatique. Studies (cited below) have indicated, when an initial Lyme disease is definitively diagnosed, that the initial signs and symptoms include a red rash that resembles a bull’s eye or a moving red skin rash (erythema migrans), often mild, seen in about 90% of cases, headaches in about 31%, joint pain or inflammation in about 28%, peripheral neuropathies related to nerve root inflammation in about 11%, and cranial nerve palsies, or facial paralysis, seen in about 4.6%. The lack of initial signs and symptoms implies that the chronic condition may not have been caused by Lyme Disease, and that a number of other causes and physiological problems need to be fully explored. The desire to have a chronic fatique syndrome explained should not prompt an incomplete or erroneous diagnosis and course of therapy.

What is confusing is that many patients diagnosed with Lyme disease as a cause of chronic fatique have not clearly identified that the initial spirochete infection actually occurred. An optimized PCR test (polymerase chain reaction) can be ordered to definitively determine whether the spirochete is present in the body. Other tests are less definitive, and screening enzyme immunoassay tests may be falsely negative in about 39% of cases, and reference immunoblot tests falsely negative in about 31%. If this analysis is carried out, the patient can be reasonably assured that Lyme disease is present or not, although often these tests are not performed due to cost. If Lyme disease is not objectively diagnosed, one should look for other causes for the chronic fatique syndrome. Even if Lyme disease has been definitively diagnosed in the patient’s past, the chronic fatique syndrome is not necessarily linked to a present infection, and attempts to treat with this simplistic approach of antibiotics may be misguided. Research has shown that the pathology in chronic Lyme disease appears to relate to altered immune responses, especially an excess Th1 (T-helper cell) response with decreased IL-10 and increased IL-6, IL-12, and interferon gamma, and a dysregulation of TNF-alpha. This dysfunctional chronic inflammatory response is similar to those seen in various autoimmune disorders. Treatment with prolonged antibiotics may be too simplistic to correct this immune dysfunction. A thorough assessment, differential diagnosis, and most importantly a proactive approach on the part of the patient is recommended when uncovering the multifactorial causes of most cases of Chronic Fatique Syndrome. Other potential underlying causes of chronic fatique syndromes should also be adequately tested, diagnosed and assessed.

As research progresses, diagnostic differentiation is making progress. Large studies of patients with a definitively diagnosed Lyme Disease with chronic fatique, and patients without the positive diagnosis afforded by enhanced PCR, but with Chronic Fatique Syndrome, have identified a large number of differing proteins in the cerebral spinal fluids that distinguish the Posttreatment Lyme Disease Syndrome from Chronic Fatique Syndrome (CFS/ME), and from healthy control subjects. Presently, this data is being analyzed to discover reliable protein biomarkers that may distinguish these diseases. In addition, researchers specializing in syndromes related to Lyme disease are trying to find clinical guidelines and objective tests that will distinguish the various pathological manifestations of chronic conditions associated with Lyme Disease, including lymphocytic meningitis, multifocal inflammation of the nervous system, Lyme encephalopathy, Posttreatment Lyme Disease Syndrome, and Chronic Lyme Disease. Prominent medical doctors are also presenting evidence of the efficacy of integrating acupuncture, herbs and nutrient medicine into the treatment protocols for these various syndromes (Dr. Dillard at the 2010 Lyme Disease Association/Columbia University Scientific Conference). The persistence on the part of patients and their advocates is finally producing progress in distinguishing and elucidating various chronic fatique syndromes, distinguishing CFS/ME from Post-Lyme Disease Syndrome, and giving patients more guiding information on how to devise an effective and comprehensive treatment protocol.

This article is not about Lyme Disease, though, but about patient understanding of Chronic Fatique Syndrome. This introductory section alerts the patient to the growing problem of standard medicine now creating more and more clinics that simply prescribe long courses of antibiotics, rather than fully test, explore differential diagnosis, and more importantly explore an integrative approach to a full restoration of health and function. Complementary Medicine may be integrated into the treatment even when the prolonged antibiotic regimen is chosen, not only to restore health after a long antibiotic course, but to also address the many physiological dysfunctions seen in chronic fatique syndromes that the antibiotics do not address. A famous antitrust suit by the attorney general of Conncecticut, Richard Blumenthal, addressed the question of illegally denying a type of proven medical care by an array of standard medical businesses. This suit concerned the denial of Complementary Medicine by the medical associations and insurance companies despite evidence of efficacy, although it has been touted as a proponent of prolonged pharmaceutical antibiotic therapy, not Complementary Medicine. There is well-founded suspicion that the issue of prolonged antibiotic therapy, the lack of medical proof of benefit, and the denial of coverage for this treatment, has bee promoted in some sense to take the emphasis off the constitutional rights of patients to choose therapies in Complementary Medicine that are proven, and have them paid for. These expensive and elaborate tactics are not new in the business of medicine. The following article is not intended to guide therapy, but to merely contribute to patient education, and is by no means considered by the author to be a definitive last statement on the the enormous challenge of Chronic Fatique Syndrome. Other articles on this website provide information that may be valuable to the patient as well, with articles on Fibromyalgia, Neurodegenerative diseases, and Brain health and function, as well as articles on Irritable Bowel Syndrome, Piriformis Syndrome (Pelvic pain syndromes), Hormonal pathology, Superantigens, and Candidiasis.

Understanding the Pathophysiology of Chronic Fatique Syndromes

The array of presentations in Chronic Fatique Syndromes are confusing, and suggest that a single disease classification, or even the array of current disease classifications, are misleading, and often resulting in improper diagnostic analysis and individualized treatment protocols. A 2010 study by DePaul University Center for Community Health Research found that of all current standard university medical texts, even mention of Chronic Fatique Syndrome was seen in only 40% of texts, and of these, mention of the pathophysiology was found on only 0.09% of pages. The systemic and holistic nature of the pathophysiology does not suggest a standard allopathic approach to treatment. Instead, a growing field of holistic medicine in standard practice, sometimes called NeuroImmunoPsychology, is suggesting that the research evidence points to a complex interaction between the nervous and immune systems, resulting in autoimmune dysfunction with hormonal imbalance that affects the central nervous system.

Chronic Fatique Syndrome is often called Encephalomyelitis today (CFS/EM), based on research that has discovered mechanisms of dysfunction with inflammatory problems in the brainstem and spinal cord. These mechanisms of brain stem and spinal cord pathophysiology concern an overlap between the serotonin and estradiol2 systems, with CNS (central nervous system) neurogates normally relating to pain sensation and control triggered by either sufficient levels of serotonin or estradiol2, often with deficiencies of dopamine and progesterone. Imbalances of serotonin or estradiol may affect the control of pain sensation, as well as CNS regulation of fatique and other neurocognitive symptoms. Neurohormonal balance may be the important factor in Chronic Fatique Syndrome, and diagnosis and therapy should address this issue.

Some experts have estimated a 400% increase in this disorder in the last 10 years and the CDC (Centers for Disease Control) have acknowledged CFS as a growing health problem in the United States. Subsequently, many causes are being investigated, including increase in vaccinations, use of antidepressants, use of synthetic hormones, sterols in commercial products etc. Debate continues concerning the role of subclinical viral illnesses in the syndrome, with a chicken/egg controversy obscuring the health picture (do viral illnesses cause CFS or does CFS predispose to chronic viral illnesses?). The picture of pathophysiology suggests that a complex cascade of events is responsible, with individuals perhaps taking differing courses of trigger and dysfunction leading to a systemic and holistic dysfunction that affects the interrelationship of the immune, nervous and hormonal systems.

While fatique is the major symptom of concern, many other symptoms are associated with Encephalomyopathy. Depression, poor memory, slow mental and cognitive function, anxiety, irritability, mood fluctuation, transient visual disturbances, insomnia, sleepiness, headache, chronic irritated throat, swollen lymph nodes and glands, appetite loss, nausea, muscle ache and joint pain are all common symptoms. Fibromyalgia has been linked to or included in the syndrome by many medical experts, and research has revealed that this syndrome of dysfunction may also be an encephalomyopathy. The symptom presentation may be different from one case to another. This variety of symptoms indicates a wide variety of underlying health problems that could be associated with CFS. Individualized analysis and treatment protocol is thus important, and an understanding of not just one, but many potential aspects of pathophysiology is important to the patient and physician.

Recent studies have confirmed that a mitochondrial dysfunction and reduced ATP synthesis is seen in a large majority of patients with CFS. Mitochondria are the parts of our cells that efficienty produce energy, and ATP, or adenosine triphosphate, is both a source of energetic firing, and a coenzyme used in mechanisms of energy storage and transfer of cellular nutrients. Reduced production of ATP could explain an array of symptoms affecting both the central nervous system and the muscle function. Metabolic disorder, insulin resistance, and hormonal dysfunction could all contribute to likelihood of ATP dysfunction, and chronic low grade inflammatory states and inflammatory dysfunction are also at the heart of these, and other, health problems. This is why supplemental D-ribose, an important fuel for mitochondria, is often helpful in the treatment protocol to relieve fatique symptoms. This does not address the mitochondrial dysfunction, or array of potential underlying causes, though. Nutritional cofactors of ATP function are also helpful in the protocol for many patients, and these include a combination of Vitamins B-2 and B-3 in a sustained-release form. There are many chemicals in the vitamin families, and the terms B2 and B3 could refer to a host of chemicals. The correct forms are riboflavin and inositol hexacotinate (a form of niacin). A simple B-complex supplement may not have much effect. Many Chinese herbs have been proven to improve mitochondrial function as well, including a host of adaptogens, such as Astragalus, Rhodiola rosea, Siberian Ginseng, etc. Other nutritional supplements studied and found to benefit mitochondrial function and health include R-lipoic acid, and the combination of acetyl L-carnitine and L-tartrate. Coenzyme Q10, Gymnema sylvestre (Chi geng teng: rich in kaempferol and quercetin), and other herbs and nutrients are now clinically proven to help with mitochondrial dysfunction. A search on the NIH research database PubMed easily finds summaries of published studies confirming the efficacy of Chinese herbs and nutrient medicines. CoQ10 use is supported in human clinical trials in the treatment of mitochondrial encephalopathies. Often, the combination of nutrient chemicals used with CoQ10 are very important to an effective treatment result. A single part of this protocol may be only mildly effective, though, and a professional analysis and prescription is recommended. The knowldgeable Licensed Acupuncturist and herbalist is often the ideal professional to guide the therapy in Chronic Fatique Syndromes.

The exact pathophysiology of mitochondrial dysfunction is still elusive in 2010. The CFS/ME and Pain Research Center in Amsterdam, Netherlands, is a leading force in current clinical research, and has found that a shift in cellular energy metabolism is seen in Chronic Fatique Syndrome, with an increase in anaerobic metabolism over aerobic (oxygen utilization). Insulin resistance may be tied to this basic change in cellular energy metabolism, as Metabolic Syndrome and insulin resistance changes the way our cells utilize basic fuels, such as glucose and fatty acids. Researchers are looking to other health problems that create an excess of anaerobic cellular metabolism to find that answers to what could cause this dysfunction. Ketoacidosis is a condition that produces excess anaerobic metabolism. When a chronic state of acidity occurs, the liver shifts to a metabolism utilizing ketone anions (acetoacetate, beta-hydroxybutyric acid, and acetone) to furnish fuel for our cells, instead of relying on glucose and free fatty acids. A relative or absolute insulin deficiency is present in all cases of ketoacidosis. The term relative insulin deficiency may refer to a deficiency in the hormone insulin despite the normal production by the pancreas, and this occurs due to an increased need for insulin in cases of insulin resistance at the cells and muscle tissues. Insulin is not only used to regulate sugar and fatty acid metabolism, but is found to be integral to other metabolic aspects in the brain. Metabolic syndrome is the term typically used to describe insulin resistance states. Increased alcohol consumption may also contribute to ketoacidosis, especially when the liver is not functioning optimally. Accumulation of aldehydes in the liver are implicated in alcoholic ketaacidosis. Excess aldehyde accumulation is also seen in systemic candidiasis, and accounts for many of the fatique and foggy mental states seen in patients diagnosed with candidiasis. Often, the patient with Chronic Fatique Syndrome presents with a variety of underlying subclinical health problems that could be integral to the pathology. Improvement in all of these areas is a daunting task at times, but may be necessary to fully resolve the CFS.

Abnormal or defective adaptive responses to oxidative stress is also seen in a large majority of CFS/ME patients. Various adaptogenic marker molecules are being investigated to find a better diagnostic profiling to guide individualized therapy, including heat shock protein (HSP). This family of regulatory proteins is expressed in relation to various stressors, including elevated body temperatures, infection, inflammation, toxin exposure, starvation, hypoxia, nitrogen deficiency, or water deprivation. A combination of chronic stressors may be responsible for this dysfunction of protein signalling, and chronic inflammation, accumulation of heavy metal toxins, iron overload syndrome, autonomic dysfunction related to adrenal stress syndrome, and oxidative stress seem to be the likely culprits.

Dysfunctional immune responses to exertion have also been noted in studies of CFS patients, with exertion resulting in increases in circulating immune cytokines IL-6 and TNF-alpha, which are associated with a number of chronic diseases, including neurodegenerative diseases. The field of ImmunoNeuroPsychology has also identified that these cytokines have an integral relationship to neurotransmitter imbalances, hormonal health, and psychological disease. We see that much research is pointing to the need to restore homeostasis in a more complex manner to cure such diseases as CFS/ME. Restoration of homeostasis is the primary goal of Traditional Chinese Medicine, and a wealth of research is revealing how acupuncture, herbal and nutrient medicine works in specific ways to achieve this goal, which is traditionally called a balance of Yin and Yang, Qi and Blood.

The most important aspect of the pathophysiology of CFS/ME that is starting to be realized in standard medicine is that this syndrome is not a specific disease, but that a diverse array of disease mechanisms underly the syndrome, and the treatment and diagnostic approaches need to reflect this fact, rather than continue to seek one specific unifying allopathic medicine to treat it. Experts at the University of Groningen, in the Netherlands, in 2008, stated that it is clear that CFS is now recognized as a systemic, or medial, disorder, and that the variety of causes and divergent reactions to various therapies show that CFS is a syndrome defined by a diverse array of subgroups of patients. Individual analysis of patients is needed to devise an effective treatment protocol. These experts state that there are 4 main sets of identified underlying causes, including association with viral infection, anomalies of the HPA axis, immune dysfunction, and a psychiatric or psychosocial aspect. Oxidative stress and genetic and epigenetic predisposition are also identified. The challenge of addressing this array of problems in individual assessment and treatment protocol points to the need to integrate Complementary Medicine into the standard treatment of CFS/ME.

To date, there is no recommended treatment by the standard health community, except perhaps cognitive and behavioral therapy, although it is acknowledged that many patients have benefited by a holistic regimen of therapies. No single therapy has proven effective by itself. Obviously, this syndrome is a multifaceted health problem affecting various systems in the body. These various systems work as a network and dysfunction in one system leads to dysfunction in another. Improvement in the endocrine, nervous and immune systems is the best chance for cure or decrease in active symptoms. Attention to the various associated functional somatic disorders, including fibromyalgia, irritable bowel syndrome, chronic pelvic pain syndrome, temporomandibular joint dysfunction, and multiple chemical sensitivity may be very helpful if apparent. Treatment of sleep disorders, often themselves undiagnosed and ignored by the patient as well, could be helpul in individual cases. Some manifestations of sleep disorders include apnea, restless leg syndrome, and nocturnal teeth clenching and grinding (bruxism). A more restorative approach to anxiety and depressive disorders may also be important. Many of these health problems are addressed in articles to better educate the proactive patient on this website. A holistic medical approach seems mandatory for these functional somatic syndromes such as chronic fatique, though, and the search for the allopathic magic pill may only prolong the health disorder.

Theories

• Chronic Fatigue and Immunodeficiency Syndrome: Many experts contend that a lingering deep viral infection that is subclinical (no apparent symptoms directly attributed) stimulates a chronic immune response that depletes the body. Fungal overgrowth such as Candidiasis has also been implicated, as well as yeast overgrowth and Giardia infestation. Spirochete population, as in Lyme disease, has also been implicated. Overuse of antibiotics has been blamed for many of the health problems allowing these chronic subclincial and inflammatory states to exist, especially concerning imbalance of the symbiotic flora and fauna of the intestines, and in the stress engendered from the growing array of antibiotic-resistant strains of bacteria and other microbes. Whatever the cause or causes, it appears certain that a chronic CNS inflammatory state, Myalgic Encephalomyelitis results, and this is the widely accepted name for Chronic Fatique Syndrome today. Professional herbal medicine offers broad spectrum treatment of these deep-seated subclinical viral, fungal and parasitic infections that is supported by a growing array of scientific studies. Nutrient medicine and naturopathic research is also uncovering specific physiological mechanisms that perpetuate these systemic low-grade infections and offers more and more researched methods of countering the physiological dysfunctions and unwanted manifestations of such chronic inflammatory states.
• The Epstein-Barr virus has long been linked to Chronic Fatique and Immunodeficiency Syndrome, along with a number of other opportunistic viruses, including herpes 6, cytomegalovirus, coxsackie B and HTLV. The mechanisms of this immunodeficiency that allows the nervous system to be so adversely affected may lie in a number of systems in the body. Healthy liver function is necessary for the effective response to deep viral disorders by the cytotoxic immune system. The liver both detoxifies the blood and produces many of the cytokines needed. Many factors may stress the healthy liver function, including environmental chemicals, excess pharmaceutical drug use, hepatitis C viruses and poor dietary habits. Clearing of these deep seated viruses depends on health of both the liver and immune systems. When liver function is stressed, GI problems are often seen as a contributor. If the liver is inefficient in processing proteins, and/or the health of the GI membranes allows digestive protein fragments to bypass the liver (leaky gut syndrome), certain chemicals, such as nitrogen wastes from protein breakdown may accumulate in the blood, which is toxic to healthy brain function and the glutamine metabolism. Heliobacter pylori, a common GI bacteria that produces urease to break down these nitrogen wastes, often overgrows in the stomach and small intestine and creates further problems. Imbalances like these may lead to candida overgrowths that further stress the system.
• Mononucleosis is a disease that is now known to be chiefly caused by Epstein-Barr virus (EBV) and often leads to chronic fatique syndrome, yet EBV acute mononucleosis accounts for only a small percentage of the total number of chronic fatique syndrome cases worldwide. Mononucleosis is a term that refers to an infection of the immune monocytes, chiefly the B-cells, after an incubation of 4-7 weeks. The virus may first attack the membranes of the throat and upper bronchials, getting into the epidermal cells, but then moves to the B-cells as the body responds. The B-cells are part of the adaptive immune system, and the chief cells of the antibody system, so these are cells adapting to the new virus EBV, and trying to rid the body of the virus. EBV often produces very mild initial symptoms, compared to influenza viruses, but has acquired the ability to get into the immune cells. Mononucleosis is diagnosed when a percentage of circulating monocytes are derformed by this infection. Of course, in this scenario, we see how a virus could get into the whole body, and eventually infect the brainstem. In the United States, a high majority of the population tests positive for the EBV antibody, indicating widespread or universal infection. The difference between one patient and another appears to be the ability of a particular patient to respond with a strong immune reaction to control the EBV spread. Those patients with the mildest intial immune response, or no initial symptoms, but a weak complement response to a deep viral infection, are the patients most likely to be afflicted with chronic fatique syndrome.
• Retrovirus XMRV (xenotropic murine leukemia virus-related virus) was found in 68 of 101 patients diagnosed with CFS in a study published in 2009 in the journal Science, co-authored by researchers at the Cleveland Clinic, National Cancer Institute, and the Whittemore Peterson Institute, a nonprofit center devoted to the study of CFS. The lead author, Dr. Judy A. Mikovits, believes that this study, which found the retrovirus in only 3.7% of healthy subjects, finally proved that the syndrome was an infectious disease. This retrovirus is in the same family of viruses as HIV. Like Acquired Immune Deficiency Syndrome (AIDS), there may be underlying factors that make one prone to systemic infection by this RNA retrovirus. A retrovirus is composed of RNA, unlike a virus, which is usually composed of DNA. A xenotropic virus is a retrovirus that does not produce disease in its natural host, but replicates in cells derived of a different species, and the term murine relates to a family of animals, Muridae, related to mice. Leukemia, or cancer of the blood cells, has long been researched in light of a viral cause, and scientists agree that XMRV retrovirus is likely an oncovirus (causing cancer) via paraendocrine (hormonal) actions. The fact that this retrovirus in located in blood cells would explain the many symptoms found in chronic fatique syndrome, and the hormonal relationship of its RNA expression would also explain some of the mysteries of CFS. This retrovirus was discovered in cancerous prostate tissues and was found in 40% of men with a specific cell mutation (R462Q). A retrovirus is very difficult for the immune system to target, and a retrovirus carried in blood cells would be even more difficult for our immune system to remove. A subsequent study of XMRV in a CFS patient population at Brigham and Women's Hospital in Boston, Massachusetts, found no evidence of XMRV in 293 diagnosed patients, and in 2011 two more prominent studies, one from the University of California in San Francisco, also found that CFS patients previously tested positive for XMRV now revealed no trace of the virus in their blood, and that the retrovirus may actually be a recombination of two mouse leukemia viruses created accidently in the initial laboratory experiments. Still, the author of these studies stated that it would be wrong to surmise that CFS is not an infectious disease, especially as CFS patients appear to have signs of a robust immune response. A Th2 dominant immune cytokine response in CFS patients reveals the potential variety of underlying disease mechanisms possible in this elusive and confusing syndrome, including a superantigen response and an autoimmune like response. This demonstrates the need for a broad array of therapeutic strategies in treatment of CFS/EM and demonstrates the difficulty of allopathic medicine in devising specific cures.
• Investigations into XMRV retrovirus in CFS patients has led investigators to identify other related retroviruses that may be tied to CFS pathophysiology and cause. Research in 2010 at the Center for Biologics Evaluation and Research at Bethesda, Maryland (Lo SC et al, Proc Natl Acad Sci USA. 2010 Sep 7;107(36):15874-9) tested the blood of over 100 patients diagnosed with CFS and found that polymerase chain gene sequencing revealed a genetically diverse group of murine leukemia virus (MLV) related viruses in the blood samples. These MLV-related viruses occurrred in 86.5% of the CFS blood samples compared to only 6.8% of the blood samples of healthy controls. This confirms that these more unusual viruses are related to the pathology of CFS/EM, but that the subject of deep viral illness and effects in chronic disease are complex. Viruses are not living cells, but bits of genetic material encapsulated by protein and lipid membranes. The diversity of genetic variance and mutability of viruses and retroviruses is considerable, and constantly changing. The ability of allopathic pharmacological medicine to find specific chemicals to target this complex viral threat is unlikely. On the other hand, nature has evolved, and continues to evolve, many biochemicals that protect both plants and animals from this ocean of diverse strains of pathogenic viruses and retroviruses. This is the most compelling reason to utilize herbal medicine.
• Fibromyalgia and Chronic Fatigue Syndromes linked: recent studies show that there is a strong link of these syndromes in the subclinical hormonal deficiencies and immunological changes linked to endocrine, or hypothalamic dysfunction. The hypothalamus/pituitary is the central command center of the endocrine system, producing hormones that stimulate other hormone production in a feed back system. The hypothalamus is directly linked to the limbic system in the brain, which is intimately tied to emotional responses as well as many regulatory mechanisms.
• Fibromyalgia has been identified as a central nervous system sensory problem and past theories of definition of it as an inflammatory disorder or myofascial syndrome have been discounted, although concurrent myofascial disorder and chronic inflammatory states may occur. The recent evidence points to a link of the pain sensory nervous system dysfunction to both the serotonin and estradiol systems in the central nervous system (brain and spinal cord). Regulatory mechanisms of pain sensation are controlled by chemical gates that respond either to levels of serotonin or estradiol in the brain and spinal cord. These systems are also linked to a variety of regulatory mechanisms involved in the regulation of immune responses, inflammatory regulation, mood, sleep and the autonomic nervous system. Imbalance in this complex system would create the variety of symptoms seen in fibromyalgia and chronic fatigue syndromes. These syndromes have always disproportionately affected women, and a link to the female hormone balance has been investigated since the 1920’s. You should go to fibromyalgia on this website to explore further.
• Myalgic encephalomyelitis: this means that a chronic inflammatory state in the brain stem and spinal cord may be responsible for the pain sensation throughout the body. The GABA neurotransmitter is responsible for much pain modulation, which allows us all to function without the sensation of pain. To understand this, we must realize that pain is a neurological signal set off by threshold excess of a variety of normal chemicals in the body. Pain is not the actual injury. Tissue injury causes accumulation of chemicals that trip the pain signal. This pain signal may occur when these signals are not properly modulated by a variety of neurochemicals. Both the neurotransmitters and inflammatory mediators play a big role in this complex biochemical process. When something is out of balance pain signals may arise where they shouldn’t. When something is chronically out of balance, the body sometimes reacts badly.
• Candida is a common symbiotic microorganism in the human body, usually acting as a yeast that helps ferment food in the small intestine, and produces nutrient byproducts in the process. Unfortunately, when the complex balance of microorganisms in the intestinal tract is upset, candida may overgrow and many candida may assume its second form, which is a branching, or hypal, fungus, and cause an array of problems, not the least of which is a chronic fatique syndrome that is multifactorial, or attributed to a number of health problems generated by candidiasis. Systemic candidiasis may be the link between irritable bowel syndrome, chronic fatique, and aldehyde toxicity. Candida casts are found in about 65% of the feces samples of the population, and some scientists believe that the other 35% may have an immune and clearing response that eliminates the candida before it is excreted, with perhaps 100% of humans having a symbiotic commensal relationship with candida. Adverse pathology would occur only when the Candida overgrows in the hyphal, or fungal, form and disseminates in the blood or lymph. Candida is the fourth most common infectious agent found in blood samples in hospitals when sepsis is examined, and is thus not easily dismissed as a potential systemic pathogen. Overgrowth of candida may produce fatique in a variety of ways, but the chief mechanism is the excess amount of acetaldehyde that is produced from activity of candida. Acetaldehyde is a common chemical in our bodies, but excess, or poor rate of catabolism, causes such symptoms as we see in an alcohol hangover. In a hangover, excess alocohol that is insufficiently processed by the liver results in an excess of the alcohol byproduct acetaldehyde, and this excess acetaldehyde is thought to produce most of the symptoms of the hangover. Chronic fatique may be thought of as a chronic hangover. But a number of other mechanisms of candidiasis will also contribute to chronic fatique, including CNS dysfunction, hormonal dysfunction, and immune dysfunction. The increased stress on the organism from this array of dyfunctions is also tiring. You may go to the article on Candida on theis website to learn more.

Therapeutic Protocol for Chronic Fatique Syndrome or Myalgic Encephalomyelitis

A comprehensive approach is absolutely necessary in the treatment of this difficult health syndrome. The world health community has stressed that a number of health problems should be examined in these cases, including allergic disorders, hormonal imbalances, adrenal stress, liver dysfunction, lipid imbalances, constipation, acid imbalances, fungal and yeast overgrowths, and essential fatty acid imbalances and nutritional deficiencies.

This step-by-step comprehensive approach is often overlooked in the field of modern medicine, where doctor's visits are kept short. The TCM physician, or Licensed Acupuncturist, is the perfect person to integrate into the protocol to make a thorough review of these potential problems and come up with a holistic and multi-dimensional approach to treatment. Only when the patient takes a pro-active approach and shows a persistence and determination, working with a knowledgeable and competent physician of Complementary Medicine will the problem be solved. Acupuncture, nutrient medicine, herbal medicine and physiotherapy have all been proven to have some beneficial effect, and used together as a comprehensive treatment, the chance of success is greatly enhanced.

The therapeutic protocol needs to be individually tailored due to the variety of symptoms and stages of disease in chronic fatique. An acute or subacute case of Epstein-Barr virus mononucleosis could call for both specific antiviral herbs, and herbs to stimulate a stronger immune complement response. Viscum alba is an herb that stimulates a strong interferon response, for example, but does have a dose dependant mild toxicity, and thus should only be used with presecription and monitoring by a Licensed herbalist. In chronic cases, antiviral herbs may be of limited benefit, but therapy to increase immune health and response could benefit dramatically. Few herbal chemicals have been found to be specific to EBV, but European olive leaf tincture has been studied and found to inhibit certain amino acid processes in the viral membrane, making this herb a potential therapeutic that will be further studied. A variety of Chinese herbs have been found useful in study, including Ban lan gen (Isatis), Gan cao (licorice root), and Hu zhang (Bushy knotweed / Polygonum cuspidatum), the source of the now famous herbal chemical resveratrol. Echinacea is an herb found to have a variety of effects that potentially inhibit EBV indirectly, and indirect effects were also evident in studies of St. John's Wort tincture.

A variety of Chinese herbs have proven antiviral effects, and the ability of the Complementary Medicine physician to prescribe short courses of a variety of herbs in formula inexpensively provides the patient with a broad antiviral effect to counter the low grade deep viral infections associated with chronic fatique syndromes. There is no safe and effective antiviral course of therapy in pharmaceutical medicine. This aspect of herbalism makes the integration of the Licensed Acupuncturist, who is the primary professional herbalist in the United States, if herbal specialty is part of their medical school training, an essential part of treatment with CFS/EM. Current research is identifying very specific antiviral effects for various herbs to help guide therapy. Many of these effects are immunmodulatory of the innate immune system, and this is important, because the herbal therapy will help restore your natural homeostatic mechanisms, and not result in a dependency on chronic drug use. Since dysfunction of the innate immune system is a central aspect of the underlying cause of many of these chronic fatique syndromes, restoration of the immune complement system and its regulation is essential.

Traditional Chinese Medicine (TCM) has long utilized combinations of herbs to simultaneously promote and modulate the innate immune responses and stimulate antiviral and antimicrobial effects. Often, these herbal formulas also contain herbs that stimulate increased circulation and benefit the nervous system or production of white blood cells and immunomodulating cells, or help to promote healthy membranes. The allopathic system in standard medicine will target just one aspect of the pathophysiology of systemic conditions such as CFS/EM, but TCM will provide a broad array of benefits. Studies cited below prove that common herbs utilized by professional herbalism have specific effects that inhibit the key immune cytokines driving dysfunction in encephalmyelitis and chronic fatique. These herbs and herbal products must be of high quality, and the effects are dose-dependent, and for this reason, in a country that does not regulate the commercial herbal industry, utilizing a professional to prescribe is also essential.

Current research with Chronic Fatique Syndrome and Complementary Therapies

Because Chronic Fatique Syndrome / Myeloencephalopathy (CFS/ME) is such a complicated and systemic holistic health problem, an intelligent patient will quit looking for a simple treatment strategy, and instead look for a knowledgeable Complementary Medicine phsyician to utilize current research and devise a comprehensive treatment protocol. The combination of acupuncture, herbal and nutrient medicine, and even instruction in medical qigong practices, has been heavily researched, with promising results. This shows that the medical field has recognized the efficacy of these treatments. A single piece of the treatment protocol, though, may not be effective enough, and a more complex and thoughtful protocol is recommended. While complex treatment protocols are often avoided, a thoughtful patient realizes that incomplete treatment strategy may prolong the disease perpetually, while adoption of a more comprehensive strategy for a short time may result in less effort and money spent on care in the long run.

In complicated pathologies research identifying effective treatment strategies face enormous hurdles. The standard for modern research, the double-blinded placebo-controlled clinical human trial, is the end or the path of scientific study performed to judge safety and efficacy of new pharmaceutical chemicals. These new drugs are designed to perform one simple act to affect an allopathic effect on a specific disease mechanism. In chronic fatique syndromes the patients may have numerous biological dysfunctions that need correction, and we still do not know whether the syndrome now termed Chronic Fatique Syndrome / Myeloencephalopathy, or Myeloencephelitis (CFS/ME) is a single defined syndrome or a group of syndromes that are distinct. Using this type of research standard, the double-blinded placebo-controlled human clinical trial, to decide whether single treatments within the scope of a holistic treatment protocol in integrative Complementary Medicine is proven effective is perhaps irrelevant. Various treatments in Complementary Medicine should serve as adjuncts to care, to integrate with an allopathic medicine, and to improve the outcome or speed the cure. The problem in difficult and complex pathologies such as CFS/EM is that allopathic medicine has not found that single allopathic treatment protocol. There is no central modern treatment to integrate with. Obviously, the patients, in choosing their treatment protocol, and it is the patient that should choose in a free society, must look at other objective proof of treatment efficacy, and indeed, must look at a number of treatments that can be combined in an individualized protocol to best achieve realistic goals of restoration and relief from the chronic fatigue symptoms.

Utilizing acupuncture stimulation in the treatment protocol for CFS

Recent larger double-blinded placebo studies with acupuncture have yielded mixed results due to problems with the study design. A large Mayo Clinic trial with true placebo showed significant benefit in treating CFS with acupuncture, and little benefit from placebo, while subsequent trials have shown statistically equal positive effects from the acupuncture points selected compared to nearby points off the meridian, and points stimulated without a real needle. This presents confusing data to the patients as they read short study summaries and try to decide if acupuncture will help them. All of these clinical trials have demonstrated significant benefit from acupuncture, but the study design, using needle stimulation at points near the points being studied as a form of sham acupuncture, also demonstrated significant benefit, somewhat less than the primary points chosen, but not significantly different statistically. Other articles on this website, in the For Practitioners section, Research, for example, outline the problems with these double-blinded studies designed for assessment of pharmaceutical safety and efficacy. These problems have prompted the British Medical Service and the European Union to call for an end to the double-blind design for acupuncture and manual therapies, and instead use a therapy blinded only to the patient, with devices that conceal whether the patient has been penetrated with a needle. If the Chronic Fatique patient looks carefully at the full study results of acupuncture efficacy in CFS, they will see a promisingly significant reduction in pain and fatique, and improved sleep and quality of life measurement, from acupuncture therapy, even when performed with the constraints of study design that do not allow optimal point selection, needle manipulation, or the usual combination of therapies seen in actual holistic acupuncture practice. The scientific data shows that acupuncture holds much promise for these patients, yet the study authors, who are usually medical doctors with bias, often downplay the promise of acupuncture and the positive treatment results, usually stating that acupuncture did not statistically perform better than the treatment chosen as the sham or placebo acupuncture in the study design.

One example of acupuncture study in recent years elucidates the complexity of analyzing the true potential of a manual medical treatment in the treatment of complex pathologies such as Chronic Fatique Syndrome and Fibromyalgia. While acupuncture stimulates broad homeostatic modulating effects, these studies focus on just one or two outcomes, often designing the study to achieve negative analysis. In a study published in the Annals of Internal Medicine, sham needling, involving acupuncture points not of study designation as the primary points, which the treating acupucturist was unaware were not the studied points, showed a drop in pain intensity from an average of 7.2/10 to 4.8/10, and acupuncture using the chosen points showed a drop in pain intensity from about 7.8/10 to 5.4/10. Decreases in fatique intensity were similar. Both the so-called “sham” acupuncture points and the ones chosen as the primary points could be utilized clinically in the treatment of pain. The simulated acupuncture was performed on the chosen needle sites and involved use of a toothpick in a guide tube to stimulate the point and mimic therapy without actual metal needle insertion. In effect, the point was stimulated by a means of acupuncture used historically in China, where a number of types of the 9 classic needles did not penetrate the skin, but rather stimulated a surface trigger point. The point that must be considered is that acupuncture trigger point stimulation works by stimulating a response in the body and mind of the patient, not be a direct effect of the metal needle. The fine stainless steel needle was the product of the evolution of the technique, and before we had steel, acupuncture was successfully performed with needles of other design and make up, including shards of stone, bamboo, and cruder metals that could not be formed into fine filiform needles. Use of the early needles, even ones that stimulated the points without skin penetration, produced positive outcomes that sustained the practice of acupuncture over the thousands of years of its popular practice in medicine.

In these acupuncture studies with CFS/ME patients, manipulation of the needles was not allowed, although this is routinely performed in the clinic, and recent studies at Harvard have demonstrated the diverse effects of needle manipulations and differing sensations on even the central brain. Using needle manipulations complicate the variations in study and are usually not allowed in order to achieve uniform responses. Thus, the difference between the unmanipulated needle insertion and the so-called sham or placebo techniques is not a great difference. These simulated treatments also showed reduction in pain and fatique intensity, though, and improvement in sleep, and quality of life for the CFS/ME patients. Obviously, the so-called “simulated” or “sham” acupuncture stimulation had an actual effect. The research designers attribute the positive effects of treatment to placebo effect, and discounted the acupuncture benefits. Recent study of the placebo effect has shown that this effect is growing in efficacy over the years, and in fact, even in pharmaceutical studies, is now generally nearly as effective in therapy as the pharmaceuticals themselves. A placebo effect potentially achieves symptom relief, biological effect, and cure. Since acupuncture stimulation acts by stimulating normal homeostatic mechanisms in the body, the difference between an effective placebo response and an effective acpuncture stimulated response is a fine line.

Dismissal of acupuncture benefits as placebo effects does not diminish its efficacy. The question of study design in acupuncture, where the acupuncture and sham acupuncture both consistently generate significant benefit, has become more and more controversial. In the study of Chronic Fatique Syndrome, where the mechanisms of pathology are still unclear, but involve systemic factors and potential neurohormonal dysfunction, and standard pain medication has little positive effect, the patient welcomes improvement regardless of whether this is considered placebo effect or not. In addition, acupuncture in the clinical setting is most often combined with herbal and nutrient medicine, and sometimes with effective deep soft tissue pathology, providing a package of care that is greater than acupuncture alone. Acupuncture stimulation provides a potential for many positive effects for the CFS/ME patient, and is just one part of the treatment protocol, not the whole package. Complementary Medicine, and especially the treatments available in the specialty of Traditional Chinese Medicine offer many resources for the CFS/ME patient, and can be successfully integrated into the care from the M.D. or the Naturopathic physician.

In China, the study of specific acupuncture protocols in the treatment of CFS/ME continues to both show positive benefits and help guide the TCM physicians in point selection and needle manipulation techniques. Both manual stimulation and electroacupuncture have demonstrated benefits. A study in 2010 at Guangzhou University in China (PMID: 20862932) studied 90 patients that were randomly divided into groups receiving simple acupuncture at three points (DU20, DU16, and ST9), and patients receiving injection with a glucose and herbal solution at those points. A short course of therapy resulted in fatique scores reduced from averages of 9.37 to 5.41 with the acupuncture stimulation, and 9.08 to 7.34 with the injections of either sugar and herbal solution, based on analysis of parameters of function in the brain as well as physical fatique parameters. Both types of treatment showed significant improvement, and the acupuncture stimulation showed significantly better improvement than the herbal injections. The sophistication of the study, both in choice of comparative treatments, and in the measures of outcome, were much improved over earlier studies. Such studies provide excellent guidance for the TCM physician, and guide the use of various point selection groups and types of stimulation. Another study in 2010 at the Chengdu University in China (PMID: 20568438) studied the effects of specific electroacupuncture stimulation on restoration of the circadian rhythms in CFS/ME patients. This study analyzed P3a and P3b markers after stimulation with electroacupuncture at just two points (ST36 and UB23). The circadian rhythms of P3a and P3b latency were corrected by the treatments, and the cognitive scores of the patients improved.

Many scientific studies of acupuncture related to the various known biological dysfunctions in Chronic Fatique Syndrome have now been performed and meta-analysis of these various published studies have also been conducted. Much of this information is available to the public on the NIH scientific study database PubMed. A meta-analysis conducted by the China Academy of Chinese Medical Sciences in 2009 (PMID: 20209981) looked at 28 studies that met rigorous standards of modern medical research and concluded: “Acupuncture therapy is effective for CFS, but still needs to be confirmed by more high-quality studies.” Both funding and the problems of study design and controversies in this realm have presented problems in the completion of large high-quality studies, but the research continues. Whether the political and economic hurdles that have stymied the end stage human clinical trials of acupuncture will soon be overcome, and standard medicine, and subsequently government guidelines, will finally fully endorse acupuncture as a prominent part of the therapy in Chronic Fatique Syndromes, is still in question. What is not in question is whether the efficacy of acupuncture has been established. The individual patient must decide whether they want to utilized this inexpensive and simple, practical and effective treatment within a broad protocol of treatment to overcome chronic fatigue and pain.

Nutrient and herbal medicine in the treatment of CFS/ME

Even standard medicine now supports nutritional and herbal medicine in the treatment of CFS/ME. Numerous prominent medical websites and universities support this therapy, although their support is very limited, and cautious not to list many types of therapy being studied and proven effective. Once again, the political and economic factors and industry bias, in an industry that makes up over a fifth of our total economy in the United States, is considerable. The individual patients often need to look even beyond these small endorsements of nutrient and herbal therapy to find effective proven strategies. Study of nutritional deficiencies common to patients with Chronic Fatique Syndrome, and listed on standard medical websites, include CoQ10, L-Tryptophan, zinc and Vitamin B12 (methyl or hydroxycobalamin), which have been noted as deficient in a high percentage of patients studied. The use of L-Carnitine, Omega 3 fatty acids, folic acid, magnesium, and NADH have all been studied and shown to be effective on a percentage of patients. A 2006 study at the Fibromyalgia and Fatique Centers in Dallas, Texas, found that the supplement D-ribose significantly reduced symptoms of pain, fatique, insomnia and reduced mental clarity. D-ribose is a sugar metabolite that stimulates a high production of ATP, the main cellular fuel. B2 riboflavin and B3 inositol hexcotinate, in a slow release form, has also been proven to benefit mitochondrial health and efficient production of ATP to reduce fatique. While these various medicines alone may not exert a significant quick improvement in all individual patients, the combination of these various studied nutrient medicines cannot hurt the patient, and will only contribute to greater overall health. They may all be combined with effective acupuncture and herbal protocols.

Study of herbal medicines in the treatment of chronic fatique syndrome has been extensive in Asian countries, but studies published in Western medical journals have been limited. Benefit was seen with ginseng, echinacea, Siberian ginseng, St. Johns' Wort, Gingko biloba and bilberry extract in Western studies. These herbs are not the strongest herbs in the Materia Medica, though, and the professional herbalist looks to more effetive herbs used over centuries in TCM medicine and studied in modern scientific research. This research confirmation of many herbs is now extensive, but still mainly from China, Japan, and Korea. The data from these studies is too extensive to list in this article, and the patient should consult with TCM physicians to understand the specific herbal medicines that that herbal specialist chooses. A 2009 meta-analysis from the University of Alberta, in Canada, found that the problems of applying pharmaceutical research standards in human clinical trials, namely the randomization of a double-blinding and placebo process, was still problematic, and that none of the herbal studies in 13 research databases concerning herbal efficacy in CFS met these rigid standards, although over 2400 studies were analyzed. The authors stated that “methodological limitations resulted in the exclusion of all studies”. Randomly blinding both the treating physician and the patient to an herb with an obvious taste and appearance, and devising a placebo indistinguishable from the herb, is a design problem. Most of the Chinese studies still analyze the effects of specific herbal chemicals compared to no treatment. Since there are no pharmaceutical treatments, comparative studies are not performed in this regard. Since 2009, though, more rigorous studies in China have devised acceptable RCT studies, which have produced promising results. The main problem in these studies is that no specific Chinese herbal chemical is studied as a single medicine in the protocol. An array, or formulas, of chemicals will be utilized, and these formulas will contain hundreds of complement chemicals to achieve goals. Patients need to be aware of this difference between pharmaceutical medicines and holistic treatment protocols.

Herbal protocol is usually individualized to the patient and addresses a variety of concerns. In clinical practice the herbalist will prescribe formulas based on the individual's need and the goals of therapy. In Chronic Fatique Syndrome these goals could include hormonal balance, neurochemical balance, antioxidant therapy, health of the gastrointestinal system, liver detoxification help, and other protocols. The patient should stick to a professionally guided herbal therapy for some time to judge results.

Instruction in various therapeutic activities, incuding external qigong therapy, can be very helpful to the fibromyalgia patient. Qigong therapy in this form can be taught by a competent acupuncturist that is trained, and involves a variety of techniques that are simple and enjoyable. Read the study below that proved benefit.

Information Resources

1. A 2007 article from Johns Hopkins University School of Medicine, Division of Infectious Diseases, suggested that the chronic fatique syndrome frequently called Chronic Lyme's Disease was not a syndrome of prolonged infection with spirochetes, but rather a syndrome of complex neuroendocrine immune dysfunction that should be called post-Lyme Disease Syndrome to guide a more appropriate treatment protocol. These experts suggested that prolonged antibiotic use was perhaps a cause, within a set of causes, of the syndromes of chronic fatique, musculoskeletal pain and neurocognitive dysfunction that is frequently seen: http://www.ncbi.nlm.nih.gov/pubmed/17578771
2. A 2010 statement by the American Lyme Disease Foundation suggests that the use of a prolonged antibiotic regimen to treat so-called “Chronic Lyme Disease” is not based on scientific evidence and has been shown to be harmful and without benefit: http://www.ncbi.nlm.nih.gov/pubmed/20631327
3. A 2010 study in Great Britain found that a single short course of antibiotics cured Lyme disease in early stages in about 95% of cases, with only about 5% requiring a second course. No clear cases of chronic Lyme disease were found in the study. The symptoms of early Lyme disease are a moving red rash, sometimes seen with a central irregular spot and a red circle around it (Erythema migrans), seen in 91% of cases, systemic symptoms of ache and fatique in 62%, headaches in 31%, joint pain or joint inflammation in 28%, peripheral neuropathies with nerve root inflammation (radiculitis) in 11%, and cranial nerve palsies (usually facial paralysis, often misdiagnosed as Bell's Palsy) in 4.6%: http://www.ncbi.nlm.nih.gov/pubmed/21117376
4. The U.S. Dept. of Health and Human Services / National Institutes of Health outline the studies of long-term oral and intravenous antibiotic therapy for patients with a confirmed Lyme disease, which show limited or no benefits with a high percentage of serious adverse health effects: http://www.niaid.nih.gov/topics/lymedisease/research/pages/antibiotic.aspx
5. A 2010 study by DePaul University Center for Community Research found that only 40% of medical textbooks even mention Chronic Fatique Syndrome, and of these, content related to CFS was presented on only 0.09% of pages. Of the 129,527 pages of medical information reviewed, only 116 pages had information on chronic fatique syndromes, suggesting that Medical Doctors have virtually no medical training in this field: http://www.ncbi.nlm.nih.gov/pubmed/21128580
6. A 2010 study showed that a decrease in mitochondrial production of ATP is an integral factor in Chronic Fatique Syndrome, with a shift to utilization of a lactate energy metabolism explaining both fatique and central nervous system dysfunction: http://www.ncbi.nlm.nih.gov/pubmed/20937116
7. A 2006 study showed significant benefits from taking D-ribose supplement: http://www.ncbi.nlm.nih.gov/pubmed/17109576
8. A 2001 study showed significant benefits from taking a chemical antiviral related to D-ribose to reduce Epstein-Barr viral load: http://www.rt-pcr.com/showabstract.php?pmid=11464986
9. A 2006 study showed significant benefits from taking a common Chinese herb, licorice root, or gan cao, in limiting EBV reproduction; the study demonstrates how herbs may have effects limited effects, but taken together in the proper formula, may have a complete synergistic therapeutic effect: http://www.ncbi.nlm.nih.gov/pubmed/12834859
10. A 2006 study showed significant benefits from the practice of external qigong therapy in the treatment of Chronic Fatique Syndrome: http://ncbi.nlm.nih.gov/pubmed/17109575
11. A 2008 study showed that abnormal or defective adaptive responses to various metabolic stressors, especially oxidative stress, was integral to the easy physical and mental fatique seen in CFS, and that adaptive regulatory proteins may be overexpressed in this disease due to a variety of stressors and poor adaptogenic mechanisms: http://www.ncbi.nlm.nih.gov/pubmed/19032901
12. A 2009 study showed that defective adaptive responses to metabolic stressors, such as oxidative stress, are seen in study of CFS patients, and that defective immune responses, with cytokines overexpressed after exertion, such as IL-6 and TNF-alpha, as well as a reduced ascorbic acid metabolism: http://www.ncbi.nlm.nih.gov/pubmed/19457057
13. A 2008 study at the University of Texas Houston Medical School found that a combination of Goldenseal (Hydrastis) and Astragalus (Huang Qi) has immunomodulatory effects on the innate immune system (macrophage response) reducing the pro-inflammatory excesses of IL-6, TNF-alpha, IL-10, and IL-12 is a dose-dependent manner. Overexpression of IL-6 and TNF-alpha are seen in CFS/EM.: http://www.ncbi.nlm.nih.gov/pubmed/18800897
14. A 2006 review of standard research databases found that a number of commonly used herbs in professional herbalism have demonstrated effects on multiple immune modulators, or cytokines, that are proven to be at the core of underlying causes of chronic diseases, including Chronic Fatique Syndromes / Encephalomyelitis: http://www.ncbi.nlm.nih.gov/pubmed/16813462
15. A 2010 review of standard research databases found that a number of commonly used herbal formulas in professional herbalism have demonstrated effects on multiple immune modulators, or cytokines, with TCM (Traditional Chinese Medicine) providing the majority of these formulas in common use: http://www.ncbi.nlm.nih.gov/pubmed/19818374
16. Scientific study of herbal phytochemistry is prolific in China, and this is an example of the quality of scientific proof identifying objectively the effects of specific herbal chemicals on human immune cytokines http://www.ncbi.nlm.nih.gov/pubmed/12585195
17. A 2010 study at the Institute of Health Sciences Joint Immunology Laboratory in Shanghai, China, found that an herbal chemical, berberine, from many Chinese herbs, including Coptis chinensis, or Huang lian, was effective in treating encephalomyelitis: http://www.ncbi.nlm.nih.gov/pubmed/20622114
18. Scientific study of viral and retroviral infection in CFS patients in 2010 at Academy of Sciences Bethesda research facility found that a group of retroviruses are found in prevalence in CFS patients that could be tied to the pathophysiology of the disease: http://www.ncbi.nlm.nih.gov/pubmed/20798047
19. Scientific review of the pathophysiology of CFS continues to provide a diverse array of evidence that is often different in different studies. Groups such as this on at the University of Groningen, in the Netherlands, have realized that the problem is the persistence in identifying a unifying single etiology, or cause, for allopathic medicine, instead of focusing on the diverse array of causes that differ from one individual to the next. This supports the holistic focus of TCM and Complementary Medicine: http://www.ncbi.nlm.nih.gov/pubmed/17853290

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.