Tuesday, September 30, 2014

I've Fallen and I Can't Get Up



Imagine sleeping all day and still feeling exhausted. Imagine days filled with headaches, confusion, muscle and joint aches, trouble concentrating, possibly even fevers and sore throats without any possibility of relief. This is what life is like for people suffering from chronic fatigue syndrome. The leading causes of chronic fatigue syndrome are the Epstein-barr virus, the human herpes virus-6 and inflammation in the immune system (2). Upon initial onset, symptoms present mimicking the flu (1). It is more commonly seen in women age 30-50 and risk factors increase with prior illness, stress, genetics and environmental factors (2).
Western medicine has no cure for chronic fatigue syndrome at the present time (2). It also runs the risk of being improperly diagnosed considering the signs and symptoms will often overlap with those of fibromyalgia (3). The ways to manage symptoms include a healthy diet, cognitive behavioral therapy, a regulated sleep schedule, and medicines to reduce pain, anxiety and depression. A doctor may also suggest the patient to rest when feeling worn out, breaking larger tasks into smaller ones that are easier to manage, balancing life between activity, rest and sleep, and tackling larger tasks over the course of the week instead of all at once. Ways to reduce the pain are with relaxation techniques such as biofeedback, deep breathing, hypnosis, massage therapy, meditation and yoga. Some people recover within six months to a year, and some people never quite recover (2).
Traditional Chinese Medicine sees chronic fatigue syndrome in terms of six different patterns: Spleen Qi and Yang Xu (fatigue over a long period of time); LQS overacting on the Spleen/Stomach (alternating loose stools and constipation); Heart Xue/Ying Xu (palpitations and insomnia); Kidney Qi and Yang Xu (morning diarrhea and frequent urination); Phlegm Obstruction and Damp Retention (plum pit qi and a heavy sensation); and Heat Toxicity (sore throat and swollen lymph nodes).
The basic prescription regardless of the D&D is ST36, DU20 and PC6 along with the auricular points; adrenal, sub cortex and endocrine. For Spleen Qi and Yang Xu the points Ren 6,12 SP6, and BL 20,21 should be added and the formula Shi Quan Da Bu Tang should be employed. For less cold symptoms, the formulas Si Jun Zi Tang or Bu Zhong Yi Qi Tang should suffice. For LQS overacting on the Spleen/Stomach the points GB 8,20,34 LI4, LV 3,14 and ST 19,25 should be added along with the formula Xiao Yao San, or Yue Ju Wan if there is more constrained Qi. Heart Xue/Ying Xu should be treated with the points HT 6,7 SP 1,6 and BL 15,17. A good base formula to be administered in this case would be Gui Pi Tang. For Kidney Qi/Yang Xu the points Ren 4,6 SP6, GB34, KD3, DU4, and BL23 can be used along with the formula You Gui Yin, or Jin Gui Shen Qi Wan. Phlegm Obstruction and Damp Retention would require use of the points SJ5, ST40, SP9 and Ren22 in addition to the formula Er Chen Tang or Ban Xia Hou Po Tang. Heat Toxicity would benefit from the points DU14, LI 4,11 ST44, LV2 and SP21 and the formula Qing Hao Bie Jia Tang or Dan Zhi Xiao Yao San can be enlisted to help (1).
One other thing to keep in mind when treating chronic fatigue syndrome is that often people with such suppressed immune systems will also suffer from hypersensitive allergic reactions. These kinds of reactions can halt progress towards recovery. In these cases strengthening the LU Qi is going to be of upmost importance on the road to recovery. This can be helped with the points LU7, GB31 and cupping on Ren8 (1).
Commonly, treatment needs to be continued for a minimum of three months to maintain lasting results (1). During this time it is important to educate the patient on lifestyle changes as well as dietary changes to ensure their continued recovery after discontinuing treatments. Being that the word "chronic" is in the name of the disease, this usually tells us that it took a while to come on. This can lead us to expect that it will take an equal amount of time to fully recover. It is important that the patient realizes that it will be a slow process and is willing to commit to, and be proactive in their own recovery. As practitioners, we have to give patients the tools as well as the knowledge on how to use them, and then the rest is up to them.
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