Here is an article from the Chinese Medicine Times, 2007, on ME. It is written by the Traditional Chinese Acupuncuturist who treated me in the 1980s. After a couple of years of his treatment with acupuncture and Chinese herbs I was 90% recovered and stayed that way for most of the next 12 years.
I would go back to him like a shot, but his practice isn't so convenient now as he's moved from the UK to the US (Santa Barbara)!
Jenny
http://www.chinesemedicinetimes.com/section/215/1/chronic_fatigue_syndrome
Chronic Fatigue Syndrome
by Giovanni Maciocia
From a western perspective chronic fatigue syndrome (CFS), which used to be called M.E. (myalgic encephalomyelitis), is a relatively new disease and it is unclear what the causative agent might be. Indeed, in Western medicine there is no general agreement that it is a separate disease at all. Even its name is not generally agreed upon as it is variously called post-viral syndrome, chronic post-viral fatigue syndrome, chronic mononucleosis, chronic Epstein-Barr virus disease, and, especially in the USA, chronic fatigue immune deficiency syndrome
Western medicine pathophysiology
The reason there is no general agreement on the nature and causative agent of this disease is that there is no conclusive test which is specific to CFS. There is no blood test that would conclusively prove a patient suffers from CFS in the same way there is for, say, mononucleosis. Current research, however, does show that CFS might be caused by an enterovirus and specifically, the Coxsackie sub-group of enteroviruses. In the USA, research seems to be oriented towards the Epstein-Barr virus (the one that causes glandular fever or mononucleosis) as a cause of CFS Enteroviruses entry via the mouth causing sore throat and enlarged glands. Immune response can be compromised by physical or mental stress, immunosuppressive drugs, pregnancy, malnutrition or surgery. If primary immune response fails, enteroviruses can pass to lungs or large intestine producing a chest infection of gastroenteritis. Inside the intestines, the enteroviruses remain and multiply forming a reservoir of infection. From here, they can spread via the blood stream to other tissues including nerve, muscle and endocrine glands. Enteroviruses have a particular tropism for muscles and nervous tissue: this explains the clinical manifestations of CFS, i.e. the muscle ache and changes in brain function. Chronic Fatigue Syndrome patients recognize the virus and respond to it but without eliminating it for extended periods. As we shall see, from the Chinese perspective, this inability of the patient to rid themselves of the virus is due to a deficiency of the bodys Qi.
Chinese medicine pathophysiology
Although modern Chinese books do not discuss CFS, Chinese medical books have, since very early times, described the cause, diagnosis and treatment of conditions similar to Chronic Fatigue Syndrome. For example, the clinical manifestations of Li Dong Yuans theory of Yin Fire deriving from a deficiency of the Original Qi resemble quite accurately a situation of CFS.
The five main conditions with which CFS can manifest are:
Residual pathogenic factor
Latent Heat
Lesser Yang pattern
Yin Fire
Deficiency
a) Residual pathogenic factor
One of the main conditions leading to post-viral fatigue is that of residual pathogenic factor. If external Wind invades the body and is not cleared properly, or if the person fails to rest during an acute invasion of Wind, the pathogenic factor may remain in the Interior (in the case of CFS usually as Dampness).
After an invasion of a pathogenic factor, the pathological development can have three possible outcomes:
the pathogenic factor may be expelled completely
it may become interior
it may appear to have been expelled, but a residual pathogenic factor has been formed
The residual pathogenic factor can be formed however, after an exterior pathogenic factor has become interior. Therefore, a residual pathogenic factor may be formed at the exterior or interior stage; from the perspective of the Four Levels, a residual pathogenic factor may be formed at the Wei or Qi level.
A residual pathogenic factor is simply a left-over pathological product when the patient appears to recover after an acute invasion of an exterior agent but the illness persists. Once formed in the Interior, a residual pathogenic factor continues to produce symptoms and signs or, it predisposes the person to further invasions of exterior pathogenic factors because it obstructs the proper diffusing and descending of Lung-Qi and the ascending and descending of Spleen-Qi and Stomach-Qi. It will also tend to weaken Qi and/or Yin, establishing a vicious circle of pathogenic factor and deficiency.
Residual pathogenic factors frequently manifest with Dampness and/or Phlegm. This occurs because external Wind and its resulting residual pathogenic factor disrupt the ascending of Spleen-Qi cannot descend, turbid fluids are not transformed, and because Spleen-Qi cannot ascend, the clear fluids cannot be transformed; this leads to the formation of Dampness and/or Phlegm. Also, heat burns the body fluids which can then condense into Dampness or Phlegm. Once formed, Dampness and/or Phlegm are rather self-perpetuating. In fact, Dampness and Phlegm impair the Spleens transformation and transportation which in itself leads to more Dampness of Phlegm being formed, thus establishing a another vicious circle.
Five main causes that favour the formation of a residual pathogenic factor:
weak constitution
exposure to cold, dampness or wind too soon after an invasion of external Wind
irregular diet
not taking care during an acute illness
antibiotics
In the case of CFS, the residual pathogenic factor is nearly always Dampness (with or without Heat) and is typically in three locations.
head (causing poor memory and concentration)
stomach and Spleen (causing digestive problems)
muscles (causing muscle ache, fatigue and heaviness)
b) Latent heat
Symptoms of CFS, appearing without an acute infection can be explained as a manifestation of Latent Heat. The concept of Latent Heat is very ancient and originally, it was used to explain the manifestations of acute Heat as a transformation of Cold. The Simple Questions in chapter 3 says: if Cold enters the body in wintertime, it comes out as Heat in springtime. Wang Shu He says: In Winter Cold attacks causing Shang Han disease; if a person does not fall ill, the Cold hides under the skin and in springtime it changes into Heat, and Ye Tian Shi says: Warm disease in Spring is due in every case to pathogenic factor lurking in Winter. This means that under certain circumstances, a pathogenic factor (which may be Wind-Cold or Wind-Heat) can enter the body without causing immediate symptoms. It then incubates inside the body for some time, turning into Heat which later emerges towards the Exterior causing a person to feel suddenly very tired with weary limbs, slightly thirsty, hot and irritable. He or she would not sleep well and the urine would be dark. At this time the pulse feels fine and slightly rapid and the tongue is red. This condition is called Latent Heat or Spring Heat, although it can occur in any season and not just in springtime.
Clinical manifestations
weary limbs
irritability
insomnia
slight thirst
slight feeling of heat
lassitude with sudden onset
dark urine
red tongue
rapid-fine pulse
Besides causing the above symptoms and signs, Latent Heat will also tend to injure Qi and/or Yin, thus establishing a cycle of Heat and deficiency. Latent Heat occurs when an individual suffers an invasion of exterior Wind without developing immediate symptoms and the pathogenic factor goes into the interior where it turns into Heat and comes out months later. The underlying reason for this is usually a Kidney deficiency. If the body condition and the Kidneys are relatively good, a person will develop symptoms at the time of invasion of external Wind. This is a healthy reaction. If the Kidneys are weakened by overwork and excessive sexual activity, the bodys Qi is too weak even to respond to the invading external Wind. This causes the Wind to penetrate into the Interior without the person developing exterior symptoms. Once in the Interior, it incubates and turns into Heat to come out some months later.
Ancient doctors believed that if the Essence is properly guarded and not dissipated, pathogenic factors will not enter the body and Latent Heat will not develop. The Simple Questions in chapter 4 says: The Essence is the root of the body, if it is guarded and stored; Latent Heat will not appear in springtime. It also says: In Winter, Cold attacks; in Spring, Heat attacks.
c) Lesser Yang pattern
Exterior Wind-Heat (or Wind-Cold) can sometimes lodge itself in an energetic niche which is in between the Interior and Exterior (called Half-Exterior/Half-Interior in Chinese). In the scheme of the 6 Stages patterns and specifically of the three Yang stages, the Greater Yang (Tai Yang) stage is the most exterior, the Bright Yang (Yang Ming) the most interior and the Lesser Yang (Shao Yang) the hinge between the two. Sometimes, exterior Wind invades the body through the Greater Yang stage and then lodges itself in the Lesser Yang stage: when this happens, the pathogenic factor is trapped between the Greater Yang and Bright Yang stages: it somehow bounces back and forth between the Exterior (Greater Yang) and the Interior (Bright Yang). When it bounces towards the Greater Yang, the patient experiences aversion to cold; when it bounces back towards the Bright Yang, the patient feels hot (subjectively hot).
Clinical manifestations
feeling hot and cold in alternation
fullness of the hypochondrial region
poor appetite
irritability
dry throat
nausea
bitter taste
blurred vision
white-sticky tongue coating on one side only
wiry pulse
d) Yin fire
The concept of Yin Fire was introduced by Li Dong Yuan in his book Discussion of Stomach and Spleen (Pi Wei Lun, 1246). Dr Li says that as a result of improper diet and overwork, the Original Qi (Yuan Qi) becomes weak in the Lower Burner and the Stomach and Spleen are weakened in the Middle Burner. This causes the patient to feel tired and often cold. When the patient is also subject to emotional stress, the Ministerial Fire is stirred, it becomes pathological and it leaves its place of concealment in the lower Dan Tian
As the Ministerial Fire and the Original Qi reside in the same place in the lower Dan Tian, the pathological Ministerial fire displaces and weakens the Original Qi even more. Dr Li said that pathological Ministerial Fire becomes a thief of the Original Qi. The arousal of the pathological Ministerial fire upwards causes some Heat and mouth ulcers. This he called Yin Fire. Yin Fire is neither Full Heat nor Empty Heat but simply a different kind of Heat that derives from a deficiency of the Original Qi and of the Stomach and Spleen. Yin Fire is not treated by clearing Heat or draining Fire but by tonifying the Original Qi and gently clearing Heat upwards.
The pathology of Yin Fire is further complicated by Dampness and by a pathology of the Middle Burner as well. When the Spleen is deficient, Dampness is formed and this infuses down to the Lower Burner. Here it swamps the Original Qi and the Ministerial Fire displacing the latter from the place (the Lower Burner) where it should be concealed. The Middle Burner has Dampness too; Spleen-Qi (or even Spleen-Yang) is deficient and fails to rise. For this reason, Bu Zhong Yi Qi Tang Tonifying the Centre and Benefiting Qi Decoction is used to raise Spleen-Qi and warm Spleen-Yang so that Dampness no longer infuses downwards to the Lower Burner. When the Lower Burner is opened and unblocked from Dampness, the Ministerial Fire will return to its place of concealment in the Lower Burner, thus eliminating the symptoms of Yin Fire.
Bu Zhong Yi Qi Tang eliminates Yin Fire by tonifying the Original Qi with Ren Shen Radix Ginseng and by lightly clearing Heat upwards with Chai Hu Radix Bupleuri and Sheng Ma Rhizoma Cimicifugae. The remedy Tonifying Qi and Ease the Muscles is a variation of Bu Zhong Yi Qi Tang.
Clinical manifestations
feeling of heat in the face
red face
mouth ulcers
occasionally a low-grade fever
dizziness
weak voice
depression
muscle weakness
exhaustion
feeling cold in general
loose stools
cold feet
spontaneous sweating
shortness of breath
pale tongue
weak pulse
e) Deficiency
In addition to the above four factors, in CFS there is always an underlying deficiency of the bodys Qi which favours the formation of Latent Heat, a residual pathogenic factor, or of Yin Fire. The deficiency may be of Qi, Yang, Blood or Yin although a deficiency of Qi is the most common. The organs involved are mainly the Spleen, Lungs, Liver and Kidney; of these, the Spleen is the one most commonly involved. In the development of Latent Heat and Yin Fire, a deficiency of the Kidney is a particularly important. As we have seen above, in Latent Heat a person is subject to an invasion of Wind without developing acute symptoms. The pathogenic factor penetrates into the Interior and it lurks inside to emerge later as Latent Heat. The reason for this pathology is primarily a deficiency of the Kidney.
I personally consider the essential manifestations of true Chronic Fatigue Syndrome to be in four main groups:
pronounced muscle fatigue and ache
poor memory and concentration
exhaustion
persisting, intermittent, general flu-like feeling
Summary of TCM aetiologies
overwork
irregular diet
excessive sexual activity (in men)
emotional stress
excessive physical work and sport
antibiotics (in the case of residual pathogenic factor)
immunizations (in the case of Latent Heat)
Clinical note
In order to distinguish full from empty conditions of CFS, I attach great importance to the tongue and pulse.
If the tongue has a thick coating and the pulse is Full and Slippery, the condition is predominantly full. If the tongue has a thin coating (or no coating) and the pulse is weak in general, then emptiness predominates. In summary, the following are the features of full and empty conditions of Chronic Fatigue Syndrome.
Full conditions
Dampness in the muscles
Lesser Yang pattern
Yin Fire
Empty conditions
Qi deficiency
Yang deficiency
Blood deficiency
Yin deficiency
a) Dampness in the muscles
pronounced ache in the muscles
a feeling of heaviness of the limbs
muscle fatigue on slight exertion
tiredness and sleepiness
feeling of heaviness of the body or head
no appetite
feeling of fullness of the chest or epigastrium
a sticky taste
poor memory
lack of concentration
a muzzy (fuzzy) feeling of the brain
dull headache
Tongue: a sticky tongue coating.
Pulse: slippery
In case of Damp-Heat
feeling of heat
thirst but without desire to drink
bitter taste
slightly dark urine
yellow vaginal discharge
loose stools with offensive odour
yellow tongue coating
Treatment principle
Resolve Dampness and if necessary, clear Heat
Herbal prescription
LIAN PO YIN
Coptis-Magnolia Decoction
ZHI SHI DAO ZHI WAN
Aurantium Eliminating Stagnation Pill
HUO PO ZIA LING TANG
Pogostemon-Magnolia-Pinellia-Poria Decoction
GAN LU ZIAO DU YIN
Acupuncture
SP 9 Yinlingchuan
SP 6 Sanyinjiao
BL 22 Sanjiaoshu
CV 12 Zhongwan
CV 9 Shuifen
LI 11 Quchi
SP 3 Taibai
ST 8 Touwei
TB 7 Huizong
GV 14 Dazhui
b) Lesser Yang pattern
There are two types of patterns pertaining to the Lesser Yang channels; one from the 6 Stages (from the Discussion of Cold-induced Diseases by Zhang Zhong Jing, c. AD 200), and the other from the 4 Levels (from the Discussion on Warm Diseases by Ye Tian Shi, 1742). They essentially describe the same pattern, the only difference being that the pattern from the 4 Levels involves more Heat.
Treatment principle
Clear the Lesser Yang
Herbal prescription
XIAO CHAI HU TANG
Small Bupleurum Decoction
HAO QIN QING DAN TANG
Artemisia-Apiacea-Scutellaria Clearing the Gall-Bladder Decoction
Acupuncture
TB 5 Waiguan
GV 14 Dazhui
c) Yin fire
feeling of heat in the face
red face
mouth ulcers
occasionally a low-grade fever
dizziness
weak voice
depression
muscle weakness
exhaustion
feeling cold in general
loose stools
cold feet
spontaneous sweating
shortness of breath
Tongue: pale
Pulse: weak
Treatment principle
Tonify the Original Qi (Yuan Qi), clear and subdue Yin Fire, raise Qi, resolve Dampness
Herbal prescription
BU ZHONG YI QI TANG
Tonifying the Centre and Benefiting Qi Decoction
Acupuncture
GV 14 Dazhui
TB 5 Waiguan
LI 11 Quchi
LU 10 Yuji
HT 8 Shaofu
SP 6 Sanyinjiao
d) Spleen and Kidney Yang deficiency
tiredness which is worse in the mornings
slight ache in the muscles
muscle fatigue after slight exertion
slight epigastric and abdominal distension
loose stools
lower backache
weak knees
frequent-pale urination
dizziness
tinnitus
feeling cold
cold feet
Tongue: pale
Pulse: weak and deep
Treatment principle
Tonify Spleen-and Kidney-Yang, resolve Dampness
Herbal prescription
YOU GUI WAN plus LIU JUN ZI TANG
Restoring the Right (Kidney) Pill plus Six Gentlemen Decoction
Acupuncture
BL 20 Pishu
SP 6 Sanyinjiao
BL 23 Shenshu
GV 4 Mingmen
CV 4 Guanyuan
KID 3 Taixi
KID 7 Fuliu
BL 52 Zhishi
GV 20 Baihui
Moxa should be used
f) Liver Blood deficiency
tiredness
muscle fatigue on slight exertion
slight muscle ache
blurred vision
numbness of limbs
dizziness
scanty menstruation.
Tongue: pale and thin
Pulse: choppy or fine
Treatment principle
Nourish Liver-Blood, strengthen the sinews, resolve Dampness
Herbal prescription
BU GAN TANG
Tonify the Liver Decoction
Acupuncture
BL 18 Ganshu
BL 20 Pishu
BL 17 Geshu
LIV 8 Ququan
ST 36 Zusanli
Sp 6 Sanyinjiao
CV 4 Guanyuan
Moxa can be used
g) Yin deficinecy
The symptoms vary according to the organ involved. The three organs which most frequently suffer from Yin deficiency in CFS are the Lungs, Stomach and Kidneys. Combinations of two or even all three organs are common.
Lung-Yin deficiency
dry throat
dry cough
exhaustion
breathlessness
hoarse voice
feeling of heat in the afternoon
night sweating
Tongue: without coating (possibly only in the front part), there may be cracks in the Lung area
Pulse: floating-empty
Treatment principle
Nourish Yin, generate fluids, and strengthen the Lungs
Herbal prescription
SHA SHEN MAI DONG TANG
Glehnia-Ophiopogon Decoction
Acupuncture
LU 9 Taiyuan
CV 17 Shanzhong
BL 43 Gaohuangshu
BL 13 Feishu
GV 12 Shenzhu
CV 12 Zhongwan
ST 36 Zusanli
SP 6 Sanyinjiao
GV 20 Baihui
No moxa
Stomach-Yin deficiency
dry mouth
no appetite
tiredness
dry stools
slight epigastric pain
malar flush
thirst with no desire to drink or desire to drink only small sips
Tongue: normal body-colour, midline crack in the centre, rootless coating or no coating in the centre, transversal cracks on the sides indicating chronic Spleen-Qi and Spleen-Yin deficiency
Pulse: floating-empty on the right middle position
Treatment principle
Nourish Yin, strengthen Stomach and Spleen
Herbal prescription
YI WEI TANG
Benefiting the Stomach Decoction
Acupuncture
ST 36 Zusanli
SP 6 Sanyinjiao
CV 12 Zhongwan
ST 44 Neiting
GV 20 Baihui
Kidney-Yin deficiency
soreness of the lower back
exhaustion
depression
lack of drive and will-power
weak legs and knees
dizziness
tinnitus
deafness
dry mouth and throat which are worse at night
night sweating
disturbed sleep (waking up during the night)
thin body
Tongue: without coating
Pulse: floating-empty
Treatment principle
Nourish Yin, strengthen the Kidneys and firm Will-Power
Herbal prescription
ZUO GUI WAN
Restoring the Left (Kidney) Pill
Acupuncture
KID 3 Taixi
LU 7 Lieque & KID 6 Zhaohai together
CV 4 Guanyuan
SP 6 Sanyinjiao
BL 23 & BL 52 together
GV 20 Baihui
End notes
1. Shepherd C 1989 Living with M.E., Cedar, William Heinemann Ltd., London, pp. 14-16
2. Ibid., p.889
3. 1979 The Yellow Emperors Classic of Internal Medicine-Simple Questions (Huang Di Nei Jing Su Wen), Peoples Health Publishing House, Beijing, first published c. 100 BC, p.21
4. Ibid., p.24
5. Ibid., p.24
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