CFS

Rewaxing a Candle Burnt at Both Ends: Chronic Fatigue Syndrome and its Treatment in Chinese Medicine

 

Chronic Fatigue Syndrome (CFS) affects a large portion of the sick and undiagnosed population. It has gained traction as a diagnoses since first being documented in 1988, yet still there are many misconceptions surrounding the disease, as well as differing causal factors, yet one thing is always constant: severe, unrelenting fatigue experienced by the patient. And the label around the illness is an interesting one: often, patients are given the tag­CFS which serves the purpose to tell the patient "we know what's going on with you" (as well as be able to bill insurance) only to discover much later in the patient's journey what exactly was the underlying cause of the illness all along (viral, sub clinical hormonal, etc.) In other words, it is a functional diagnoses, not always an organic one. As acupuncture works on the body's qi, it often has a profound effect on functional disorders, and, with further diagnostic information, an even greater effect can be experienced by the patient as techniques and herbs can become further refined.

The symptom criteria for chronic fatigue syndrome include: mild chills or low grade fever, painful and swollen lymph nodes, sore throat, muscular weakness and/or pain, prolonged fatigue following mild to normal exertion, sleep abnormalities, visual disturbances, dull headaches with possible "band around head" sensations, joint pains, and psychological complaints such as depression or loss of concentration. Patients are expected to have eight of the above symptoms to officially have the diagnosis of CFS.1 Many physicians tend to make a diagnosis of anxiety or depression, based purely on observation of psychological complaints, but there is a clear distinction between these psychological disorders and CFS. And while CFS is a relatively new label for a phenomenon, it absolutely is not a new illness. Researchers such as Dr. Anthony Komaroff of Harvard Medical School were the first to label the disease as such in 1988, but throughout the 19th century doctors treated neurasthenia and reported similar symptoms. And in those times where vitalistic medicine still had sway amongst the day's doctors, neurasthenia was described as a "general depletion of the body's nervous forces", and was documented as common amongst the wealthier classes and "head workers" by George Beard, a prominent physician of the day.2

If “vitalistic medicine” has documented similar findings as Komaroff did in 1988­­and well over a century ago­­one naturally should ask the question: if such symptoms have been around for many years, have other cultures and medicinal systems such as Chinese Medicine, successfully treated such phenomena? The Chinese have long documented the phenomenon of qi and even possible yang deficiency, whose symptoms overlap the modern diagnosis of CFS. In severe cases of both "qi and yang deficiency" one would expect to find lowered white blood cell counts. In acupuncture, the point selection combination: P­6, LI­4, and St­36 have been studied for their immunological effects. According to the research from China, this combination results in an immune­stimulating effect within 30 minutes of needling. 24 hours later, white blood cells reach peak production and 72 hours later, levels taper back to the baseline.3 Timing, therefore, becomes crucial since patients would experience one step forward, one step back in their progress by coming in once a week. Immune­compromised patients must receive treatments once every three days, at minimum, to achieve optimal results. Most remarkably, this point selection is notable since only one point­­St­36­­is used as a tonification point. The other two points have a more dispersing effect and are not ordinarily associated with immunostimulation, which leaves the question: how much more powerful would the effects be if traditional qi stimulating points, such as Ren­17, 4,6, Du­20, UB­13, 20, 23, 43, Sp­6, and LI­10 were used in combination with St­36?

Fortunately there are studies with some, but not all of these points. In a double­blind study involving 40 participants with severe immunosuppression and malignancy, high increases in CD3+ and CD4+ T­lymphocytes as well as an elevation CD4+/CD8+ ratio following daily treatments of 30 minutes each using only PC 6, LI 4, ST 36, and CV 4 for ten days.4 5 In another study, similar findings were observed following acupuncture treatments using PC 6, LI 4, ST 36, and the addition of SP 6.6

According to Dr. Liu, moxabustion is the preferred treatment for immunostimulation, as its effects often far surpass acupuncture. In ancient China, it was said that "acupuncture moves the body's qi, but moxabustion gives the body new qi to move." Moxibustion, being “pure fire entering the body to boost the body’s yang” would be contraindicated in cases of yin deficiency, and acupuncture would be the preferred medium of treatment. Several studies have shown extremely positive responses to chemotherapy­induced leukocytopenia treated with moxabustion. Daily moxabustion treatments were applied to DU 14, LI 4, ST 36, SP 6, BL 17, BL 20, BL 21, and BL 23 when applied for 10­15 minutes, and following this modality an effective cured was observed with regard to leukocytopenia in 82% of 49 patients. DU­14 is a powerful point located below the seventh cervical vertebra which is typically needled or bled in order to quickly reduce fever, since all the body’s yang meridians meet at this point. Yet, moxabustion performed on this point, according to both the studies as well as Dr. Liu powerfully induces WBC production. In another study, dailly moxibustion of BL 17, BL 20, BL 21,

BL 23, and DU 14 caused an increase in leukocytes above the threshold of 4.0 x 109/L in 46% of patients following only 1­3 treatments. An equal number of the remaining patients met the threshold after 5­7 daily treatments. According to Dr. Liu, however, BL 23 is more often associated in modern Chinese literature with RBC production and its addition here is somewhat superfluous, unless the patient shows symptoms of microcytic anemia. According to Dr. Liu, the most effective points for boosting leukocytes with moxabustion are DU 14, ST 36, BL 21, and BL 43, all of which have been shown to elicit a powerful effect on the body’s WBC counts as well as a sharp reduction in fatigue.

Dr. Ted Allen, an Austin chiropractor who operated a primary care/general practitioner style clinic for many years, stated that all Chronic Fatigue patients would be thoroughly examined in his clinic for cervical subluxations. Dr. Allen noted that the cervical spine is referred to as the body's powerhouse, and adjustments here have a powerful effect on the thymus and thyroid glands which are often hypo­active in CFS patients. An acupuncturist might, therefore, do well to experiment with cervical jiaji points, or any of the "window of sky" points found on the neck, as these may affect local glandular tissue. Additionally, Dr. Allen recommended Immuplex by Standard Process as a powerful adjunctive which boosts the body global immune system.

C.H., a 21 year old female came to see me for a chronic sinus infection she had been experiencing for six months. Upon questioning, it was revealed that she had a significant amount of fatigue. Her phlegm was yellow, indicating an active heat infection. Her tongue coating was mapped, indicating a stomach yin deficiency, and her pulse was very thin and weak, indicating either blood or yin deficiency with underlying qi deficiency. Given that the primary complaint was phlegm in the sinuses, the decision was made to reduce phlegm, and points were subsequently selected to achieve this aim. Very little effect was experienced by the patient. Fortunately, she asked for a second treatment and this time, I asked more questions regarding the fatigue. It was quite significant: she hardly had the energy to get out of bed, she ahead to quit her job as a personal trainer, and it was "wrecking her life." It became apparent that the fatigue, not the sinuses, we're the real issue. Upon physical examination, slightly swollen lymph nodes were found. The patient denied ever having mononucleosis. I told her to see her doctor to get tested for the Epstein­Barr virus, and, it turned out it was present: she had an active mono infection and was told to "let it run its course."

Herbally, I treated C.H. with Bu Zhong Yi Qi Tang (BZYQT) to powerfully boost qi. Within one month of daily use, she reported to me to be asymptomatic. In a CFS study of 50 patients treated w/ Bu Zhong Yi Qi Tang, all 50 showed improvement.7 It has also shown a powerful antiviral and antibiotic effect. In mice, concurrent use of BZYQT with antibiotics completely eradicated what were once severe bacterial infections.8 Additionally, BZYQT showed marked effect on H. pylori bacteria both in vitro and in­vivo. Potent antiviral effect against influenza. In mice studies, a marked increase was noted in ability to tread water when threatened with drowninghasbeenshown.9 BZYQT also showed an antidepressant effect when given for 14 days and its immunostimulant effect is notable in that a two­fold increase in WBC counts in 2 weeks in 70/80 patients with Leukopenia when given modified BZYQT. 10 Other therapies such as food therapy and lifestyle modification are of primal importance for CFS patients. General guidelines for food therapy would mean total removal of processed foods, refined sugars, alcohol and caffeine during the recovery phase. For C.H., caffeine was the hardest to remove but I assured her that BZYQT, a well known qi tonic in Chinese Medicine11, would more than make up for any loss in energy she would experience by removing caffeine, but would give her the added benefit of immunostimulation and reduction in symptoms­­something caffeine couldn't promise.

Modern biomedicine is often mystified by CFS, but both literature as well as practical experience suggest that both acupuncture and herbal medicine have significant effects on a patient's ability to recover. Neitzsche, in his Will to Power,said that "what today is called healthy represents a lower level than that which under favorable circumstances would be healthy­­that we are all relatively sick" and that what mankind saw as "progress," Neitzsche saw as "that which hastens exhaustion"and all caused by the "onslaught of stimuli which reverberates (on man) like an overstimulated string vibrating continually."12 The irony is that Western society, in a comedy of errors, over analyzes the condition of CFS, continually looking for a "cause" or "explanation" and gets lost in the myriad of details, and exhausts its very ability to effectively treat the illness they, according to Neitzsche, caused. And the irony is further extended when a humble medicine from an Eastern culture which emphasizes the simple and the whole and relies on mere human observation to deduce a "qi deficiency" and treats it as such, can have a much more profound impact on the phenomenon known as Chronic Fatigue Syndrome.

Annals of Internal Medicine, “Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), (Vol 108), March, 1988, p.62
Ellenberg, Henri F., The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry, Basic Books, NY, 1970, p.242.

Bianchi M, Jotti E, Sacerdote P, Panerai AE. Traditional acupuncture increases the content of beta­endorphin in immune cells and influences mitogen induced proliferation. Am J Chin Med. 1991;19:101­104.
Zhou J, Li Z, Jin P. A clinical study on acupuncture for prevention and treatment of toxic side­effects during radiotherapy and chemotherapy. J Tradit Chin Med. 1999;19:16­21.

Dang W, Yang J. Clinical study on acupuncture treatment of stomach carcinoma pain. J Tradit Chin Med. 1998;18:31­38.
Yuan J, Zhou R. Effect of acupuncture on T­lymphocyte and its subsets from the peripheral blood of patients with malignant neoplasm [in Chinese]. Zhen Ci Yan Jiu. 1993;18:174­177.

Chen J, Chen T. Chinese Medical Herbology and Pharmacology.Art of Medicine Press, 2008, pp. 448­52. 

Ibid, p. 449
Ibid, p. 449­450

10 Ibid, p. 451
11 Bensky, et al. Chinese Herbal Medicine Materia Medica, 3rdEdition.Eastland Press, 2004, pp.333­36.
12 Neitzsche, Friedrich, The Will to Power, translated by W. Kaufman and R.J. Hallingdale, Random House, NY, 1969, p.430