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Acupuncture Today
October, 2001, Vol. 02, Issue 10
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How Do You Treat Chronic Fatigue Syndrome in the Clinic?

By Andrew Gaeddert, BA, AHG

Most patients respond favorably to Chinese herbal remedies to treat chronic fatigue immune deficiency syndrome (CFIDS). Those with mild conditions may report marked improvement within a week or two of starting on herbs, but it should be noted that many persons will be on herbs for several months before their symptoms take a significant turn for the better.

Practitioners must keep in mind that each case should be approached individually. The common symptoms of CFIDS are extreme fatigue; sleep disturbance; difficulty concentrating; memory loss; anxiety; depression; irritability; fever; sore throat; swollen lymph nodes; digestive disorders; sensitivity to heat and light; headaches; spasms; aching muscles and joints; recurrent infections (especially of the respiratory tract); and loss of appetite. Quite a number of people also suffer candidiasis, and some even have parasitosis.

To address the chronic fatigue in these patients, I suggest the use of "power" mushrooms, or other mushroom extracts; most CFIDS patients feel more energetic after taking these formulas. Medicinal mushrooms may have anti-viral effects as well. For some yin-deficient individuals, the mushroom formulas may be too warming; therefore these patients should be monitored closely if they are to take these remedies.

Many CFIDS sufferers have digestion problems, especially those due to dampness and food stagnation. Thus, before starting these individuals on other formulas, a two-week regimen of a digestion formula will usually help them handle the other herbs that are to come. Ordinarily, this digestion formula, consisting of poria (fu ling); coix (yi yi ren); shen chu (shen qu); magnolia (hou po); angelica (bai zhi); pueraria (ge gen); red atractylodes (cang zhu); jurinea (mu xiang); pogostemon (huo xiang); oryza (gu ya); trichonsanthes root (tian hua fen); chrysanthemum (ju hua); hallosyite (chi shi zhi); citrus (ju hong); and mentha (bo he), is taken between meals, but if the condition is more serious, the dosage should be increased to one tablet before and after meals. This initial step with the digestion formula can be bypassed if the digestive symptoms are mild or absent altogether.

Yeast infections such a vaginal candidiasis or oral thrush should also be treated. Even though there may be no obvious symptoms, if the patient has been on long-term antibiotics or oral contraceptives, the possibility that candida is present is high. A phellodendron formula, comprised of phellodendron (huang bai); codonopsis (dang shen); atractylodes (bai zhu); anemarrhena (zhi mu); plantago (che qian zi); pulsatilla (bai tou weng); capillaris (yin chen hao); cnidium fruit (che chuang zi); houttuynia (yu xing cao); dioscorea (shan yao); licorice (gan cao); and cardamon (bai dou kou) is quite effective in addressing candidiasis, as herbs in this formula have been shown through laboratory studies to possess anti-candida properties. In Chinese medicine, the pattern of candidiasis fits that of damp heat lodged in the spleen/stomach and intestines. This may be the causative factor of the aching muscles and joints experienced by CFIDS sufferers. Other symptoms of damp heat in the spleen/stomach and intestines are abdominal discomfort; diarrhea; mucus and blood in the stools; sweating; and thirst. The phellodendron formula is ordinarily taken for several months and can be combined with acidophilus, pharmaceuticals, and other formulas.

For viral infections, an isatis formula composed of isatis extract (da qing ye and ban lan gen); astragalus (huang qi); bupleurum (chai hu); laminaria (kun bu); codonopsis; epimedium (yin yang huo); lycium fruit (gou qi zi); dioscorea (shan yao); broussonetia (chu shi zi); atractylodes (bai zhu); and licorice, has proved effective not only in treating chronic viermia, but also in resolving kidney yin and yang deficiencies, since any type of chronic condition will affect the kidney. Individuals with active viral symptoms, however, should be given 1-3 tablets three times daily of a heat clearing formula [consisting of isatis extract; oldenlandia (bai hua she she cao); lonicera (jin yin hua); prunella (xia ku cao); andrographis (chuan xin lian); laminaria; viola (zi hua di ding); cordyceps (dong chong xia cao); and licorice, since they usually present a pattern of heat and experience fever; a sensation of heat or burning in the muscles and joints of the extremities; a red tongue; and a rapid pulse. We have received reports that patients who have taken this heat clearing formula experience a dramatic reduction in joint and muscle pain when it is due to viral infection. It is suggested that the heat clearing formula be taken with the isatis formula, which protects the spleen/stomach from the heat clearing formula's cooling herbs. It should also be noted that even though some CFIDS patients do not exhibit outright signs of viral infection, it is advisable that they still be administered an anti-viral remedy.

Following a severe viral infection, many persons will suffer extreme yin deficiency. This is manifested by chronic sore throat; thirst; ulcers of the mouth; facial flush; afternoon fever; night sweats; and burning palms and soles. For these patients, a tea, a modified version of liu wei di huang wan, consisting of rehmannia (shu di huang and sheng di huang); dioscorea; poria; cornus (shan zhu yu); moutan (mu dan pi); alisma (ze xie); dendrobium (shi hu); scrophularia (xuan shen); and ophiopogon (mai men dong) helps tonify the yin and is the primary formula, although the isatis formula may still be taken to eliminate residual viremia. An important ingredient in this tea is scrophularia, which helps relieve lymph node swelling. Practitioners must be vigilant of CFIDS patients who have difficulty digesting yin tonics, since these remedies can be cloying. If this is so, a loranthus formula comprised of loranthus (san ji sheng); ligustrum (nu zhen zi); glehnia (sha shen); cuscuta (tu si zi); pseudostellaria (tai zi shen); shatavari (tian men dong); tang kuei (dang gui); white peony (bai shao); lycium fruit (gou qi zi); poria; ashwagandha (withaniae somniferae); melia (chuan lian zi); baked licorice (zhi gan cao); placenta (zi he che); and false unicorn (helonias diocia/liliaceae) may be substituted.

If there are no signs of active viremia, the isatis formula can be administered alone, or in combination with formulas that address specific symptoms. For example, mental depression with cold signs is treated effectively with an aspiration formula [which includes polygala (yuan zhi); vervain (herba verbenae officinalis); gambir (gou teng); gardenia (zhi zi); albizzia flowers (he huan hua); damiana (folium turnerae aphrodisiaciae); white peony; tang kuei; pinellia (ban xia); poria; and aquilaria (chen xiang)]; however, depression with heat signs and anxiety is better resolved with a calming formula [containing biota (bai zi ren); tang kuei; fu shen (fu shen); polygala; zizyphus (suan zao ren); peony; ophiopogon; codonopsis; succinum (hu po); peroxidase (horseradish root); catalase (aspergillus niger); amylase; protease; lipase (aspergillus oryzae); taurine; magnesium aspartate; cerecalase; alpha-galactosidase; glucoamylase; cellulase; and malt diatase. High levels of liver enzymes are also common in CFIDS patients, in which case an eclipta formula consisting of eclipta concentrate (han lian cao); milk thistle (sylibum marianum); curcuma (yu jin); salvia (dan shen); lycium fruit; ligustrum; bupleurum; schizandra (wu wei zi); tienchi ginseng (san qi); tang kuei; plantago seed (che qian zi); and licorice, may be administered.

For PMS and menstrual cramps, a bupleurum formula [made from bupleurum; tang kuei; white peony; salvia; poria; atractylodes; cyperus (xiang fu); citrus; moutan; gardenia; ginger (gan jiang); and licorice] and a cramping formula [consisting of cramp bark (viburnum opulis); cinnamon twig (gui zhi); achyranthes (niu xi); red peony (chi shao); moutan; leonorus (yi mu cao); corydalis (yan hu suo); tang kuei; persica (tao ren); zedoaria (e zhu); sparganium (san leng); cyperus; jurinea; and carthamus (hong hua)] may be used respectively. For obvious cold patterns, an astragalus formula, containing astragalus; ligustrum; ganoderma (ling zhi); eleutheroginseng (ci wi jia); codonopsis; schizandra; licorice; oryza; and malt (mai ya) is effective since it tonifies the spleen and lung qi.

For long-term therapy, an enhancement formula, consisting of ganoderma; isatis extract; milletia extract (ji xue teng); astragalus; tremella (bai mu er); andrographis (chuan xin lian); lonicera (jin yin hua); aquilaria; epimedium (yin yang huo); oldenlandia (bai hua she she cao); cistanche (rou cong rong); lycium fruit; laminaria; tang kuei; hu chang (hu chang); American ginseng (xi yang shen); schizandra; ligustrum; atractylodes; rehmannia; salvia; curcuma; viola; citrus; peony; ho show wu (he shou wu); eucommia (du zhong); cardamon; and licorice, which was developed for HIV patients, can be alternated with the isatis formula since it is generally beneficial to alter formulas after a period of using the same one(s). The enhancement formula also contains herbs that remove blood stasis, which is often a resultant of protracted illness.

Biomedical scientists are uncertain what virus (or combination of viruses) causes CFIDS, although some of these patients do exhibit high levels of the Epstein-Barr virus. CFIDS is a complex condition for which there is no single remedy. Overcoming it requires a multi-pronged approach. While herbal treatment is important, the patient's diet is just as significant. Practitioners should counsel their clients about a well-balanced diet that includes cooked foods, grains and fresh vegetables, and that minimizes sweets, greasy and cold foods. Also, nutritional supplements (e.g., vitamins and otherwise) are generally warming in nature, and can lead to yin deficiency and even damp heat. Thus, CFIDS sufferers should either avoid these products or use them only under the supervision of a knowledgeable practitioner or physician.

Patients should also be cautioned about rebound symptoms: the result of "overdoing it." That is, just as they are beginning to experience a return to health, they over-exert themselves, causing a relapse. Gentle exercise is the key. Finally, collaboration with a supportive medical doctor is helpful, particularly in diagnosing to rule out other conditions such as infectious and endocrine diseases, anemia and parasitosis.

Reprinted from: Chinese Herbs in the Western Clinic, A Guide to Prepared Herbal Formulas, Indexed by Western Disorders & Supported by Case Studies.

Click here for previous articles by Andrew Gaeddert, BA, AHG.


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