Chronic Fatigue Syndrome (CFS)
Chronic fatigue syndrome (CFS) cannot be explained by any specific medical condition, blood test or scan, because the cause is ‘unknown’ and diagnosis is made by excluding all medical possibilities. CFS affects up to 20 % of Australians, with 30 in 10,000 people meeting the main criteria which is ‘a debilitating fatigue for more than 6 months without medical cause’ (Murdock 2003). CFS has also been called myalgic encephalomyelitis (ME) and systemic exertion intolerance disease (SEID).
Extreme fatigue, fogginess, joint and muscle pain, memory loss, mood and sleep disorders, swollen glands, and low grade fevers are the most common debilitating symptoms of CFS, and the experience of overwhelming fatigue is generally made worse after exercise or mental activity. CFS does not improve with rest and, increasingly, the ability to socialise, work, or pursue personal goals and hobbies gradually decreases.
Risk Factors for CFS
The risk factors listed below include those factors proposed through biomedical research, as well as factors our Rozelle Acupuncture and Chinese Medicine Centre (RACM) team has consistently observed over nearly three decades.
- Extreme stress and anxiety,
- Sleep disorders,
- Sleep apnoea,
- A history of a virus such as flu, herpes, Ross river, Epstein Barr, and mononucleosis (glandular fever),
- Low grade undiagnosed infections,
- A history of tick or spider bite,
- Mould and damp in the home or work place,
- Digestive disorders, food intolerances and parasites,
- Heavy metal contamination and chemical exposure,
- Night shift work,
- Being unfit and overweight,
- Exercising too much or being underweight,
- Swollen glands and lymph nodes at the throat, armpit, and groin,
- Chronic headaches,
- Chronic pain,
- A diet high in sugar, refined foods, alcohol, coffee, and ‘damp foods’ and low in fresh vegetables, complex carbohydrates and legumes,
- A history of long term antibiotic use,
- Alcoholism and drug addiction.
Chinese Medicine (CM) theory fully supports expert opinion proposing CFS occurs as a result of a combination of factors, including a combination of any of the above.
CM theories suggest that all disease and ‘patterns of disharmony’ or ‘patterns of un-wellness’ occur as a result of eight main factors. These include: excessive emotional distress (sadness, grief, a sense of isolation, lack of joy, anger and frustration and obsessive thoughts), poor diet, extreme weather patterns, a person’s home, town and work environment, surgery, genetics, accident and injury, and a parasite or infection.
These eight factors allow our team to identify many combinations of ‘patterns of disharmony’ that cannot be categorised in medicine as a disease. This is an extremely useful tool that CM brings to the table and 'patterns of disharmony’ also potentially identify early risk factors for more serious disease. Keeping our clients well, and monitoring risk factors based on best scientific evidence as well as CM diagnosis, are some of RACM’s most important roles.
Our CM team diagnoses through touch and palpation, pulse and tongue observation, and a thorough medical history assessment that allows for a structured diagnostic process. We then provide acupuncture and Chinese herbal medicine to address all factors through an integrated approach, working with counsellors, doctors, and specialist to improve quality of life and reduce CFS symptoms (see also Chinese Medicine). Importantly, our RACM team also fully endorses and complements the national medical guidelines for CFS (The Australian Medical Journal, May 6th 2002).
Research in Chinese Medicine on CFS
While RACM practitioners provide a pragmatic or individualised treatment approach to CFS, participants in clinical trials generally receive the same treatment, regardless of symptoms, and this is problematic for best measuring the benefit of acupuncture and CM herbal medicine. Traditionally CM practitioners would not use a ‘one size fits all’ treatment, especially for a chronic condition such as CFS that may have different factors contributing to the illness of each participant in the study.
For this reason clinical evidence often varies but the clinical trials that have used a pragmatic approach show good outcomes. A pragmatic approach is a selection of specific herbal remedies and acupuncture point combinations for each client based on CM diagnosis. Importantly, practitioners with years of experience are best placed to make this complex assessment when dealing with CFS.
Despite these limitations, there has been a vast amount of clinical research in CM investigating the effectiveness of acupuncture and Chinese herbal medicine on CFS, and our references below list the most recent research in this field which shows promising evidence.
- Murdoch, JC. Chronic Fatigue Syndrome: The patient centred clinical method - a guide for the perplexed. Australian Family Physician 2003; 32: 883-887.
- Chronic fatigue syndrome: Clinical practice guidelines . The Medical Journal of Australia 6 May 2002; 176 (8 Suppl): S17-S55.
- Heim C, Wagner D, Maloney E, et al. Early adverse experience and risk for chronic fatigue syndrome. Arch Gen Psych 2006; 63: 1258-66.
- Lu C., Yang XJ, Hu J. Zhen Ci Yan Jiu (acupuncture research). 2014 Aug; 39(4):313-7. Article in Chinese; abstract accessed. Randomised controlled clinical trials of acupuncture and moxibustion treatment of chronic fatigue syndrome patients.
- Zhang W, et al. Zhen Ci Yan Jiu (acupuncture research) 2011 Dec; 36(6):437-41, 448. Article in Chinese; abstract accessed. Observation on therapeutic effect of acupuncture back shu acupoints for chronic fatigue syndrome patients.
- Yiu, YM, et al. Zhong Xi Yi Jie He Xue Bao (Journal of Chinese Integrative medicine) 2007 Nov; 5(6): 630-3. Clinical trial acupuncture for treating chronic fatigue syndrome in Hong Kong.
- Wang JJ, et al. Zhongguo Zhen Jiu (Chinese acupuncture and moxibustion) 2009 Oct; 29(10):780-4. Article in Chinese; abstract accessed. Randomised controlled study on the influence of acupuncture for life quality patients with chronic fatigue syndrome.
- Ng SM, Yiu YM. Alternative theories in health and medicine. 2013 Jul-Aug; 19(4):21-6. Acupuncture for chronic fatigue syndrome: a randomised, sham - controlled trial with single-blinded design.
- Lu et al., Zhen Ci Yan Jiu (Acupuncture research). 2014 Aug; 39(4):313-7. Article in Chinese; abstract accessed. Randomised controlled clinical trials of acupuncture and moxibustion treatment of chronic fatigue syndrome patients.
- Liu et al., Zhen Ci Yan Jiu (acupuncture research). 2012 Feb; 37(1):38-40, 58. Article in Chinese; abstract accessed. Effective acupuncture or serum malonaldehyde content, superoxide dismutase and glutathione peroxidase activity in chronic fatigue syndrome rats.
- Ling JY, et al., Zhongguo Zhen Jiu (Chinese acupuncture and moxibustion.) 2013 Dec; 33(12):1061-4. Article in Chinese; abstract accessed.Impacts on fatigue syndrome of qi deficiency syndrome and T cell subgroups in patients treated with acupuncture at selective time. Kim JE, et al., Trials. 2013 May 21; 14:147. An open label study of effects of acupuncture on chronic fatigue syndrome and idiopathic chronic fatigue: study protocol for a randomised controlled trial.
- Chen XH, et al., Zhongguo Zhen Jiu (Chinese acupuncture and moxibustion) 2010 Jul; 30(7):533-6. Article in Chinese; abstract accessed. Randomised controlled study on acupuncture treatment of chronic fatigue syndrome.
- Alraek T, et al. BMC complementary and alternative medicine. 2011 Oct 7; 11:87. Complementary and alternative medicine for patients with chronic fatigue syndrome: a systematic review.