Acupuncture and TCM Approaches for Chronic Fatigue Syndrome

By Douglas Yi Wang, LAc, Dipl. Ac., MD (China)

Chronic fatigue syndrome (CFS) is the current name for a disorder characterized by debilitating fatigue and a variety of associated physical, constitutional and neuropsychological complaints.

The clinical manifestation of CFS includes fatigue, difficulty concentrating, headaches, sore throat, tender lymph nodes, muscle aches, joint aches, fever, difficulty sleeping, psychiatric problems (such as depression), allergies, abdominal cramps, weight loss or gain, rash, rapid pulse, chest pain, and night sweats.

Women are twice as likely as men to be diagnosed with CFS. Most patients with CFS are generally between 25 and 45 years old, although cases in childhood and in middle age have been described.

The diverse names for the syndrome reflect the equally numerous and controversial hypotheses about its etiology. It is often postinfectious, associated with immunologic disturbances, and is commonly accompanied by depression. Recent controlled studies of patients with chronic fatigue syndrome documented abnormalities in endocrine function consistent with reduced production of corticotropin-releasing hormone in the hypothalamus.

The typical case of chronic fatigue syndrome arises suddenly in a previously active individual. An otherwise unremarkable flu-like illness or some other acute stress is recalled with great clarity as the triggering event. Unbearable exhaustion is left in the wake of this incident. Other symptoms, such as headaches, sore throat, tender lymph nodes, muscle and joint aches, and frequent feverishness, lead to the belief that an infection persists, requiring medical attention. Over several weeks, the impact of reassurances proffered during the initial evaluation fades as other features of the syndrome become evident, such as disturbed sleep, difficulty concentrating, and depression.

Physical examination and routine laboratory tests are required to rule out other possible causes of the patient's symptoms. Prominent findings argue strongly in favor of other processes. However, no laboratory test, no matter how esoteric or exotic, can diagnose this condition or measure its severity.

Many symptoms of chronic fatigue syndrome respond to treatment. Nonsteroidal anti-inflammatory drugs can alleviate headaches, diffuse pain and feverishness. Antihistamines or decongestants may help allergic rhinitis and sinusitis in patients with CFS. Non-sedating antidepressants improve mood and disordered sleep and thereby attenuate the fatigue to some degree.

Typical TCM Patterns for Chronic Fatigue Syndrome

1. Spleen Qi and Yang Deficiency: occurs over a long-time, with fatigue for no clear reason, mental listlessness, poor appetite, bloated stomach, loose stools or diarrhea, cold extremities. Enlarged, pale tongue, with teeth-marked edges and thin white coat. Weak pulse.
2. Liver Qi Stagnation and/or Liver, Spleen, Stomach Disharmony: physical and mental fatigue, headaches, depression, sighing, chest tightness and hypochondriac distension, alternating loose stools and constipation, irritable bowel syndrome, bitter taste in the mouth. Tongue is dusky, with thin white coat. Pulse is wiry.
3. Heart Blood and/or Yin Deficiency: fatigue, palpitations, irritability, disorientation, forgetfulness, insomnia, dream-disturbed sleep, hot flashes, night sweats, pale face. Tongue is pale or has a slightly red tip, with thin white coat. Pulse is thready, rapid or choppy.
4. Kidney Qi and Yang Deficiency: fatigue, soreness or pain of the low back, weakness in the knees, cold sensation all over body, morning diarrhea, frequent urination, shortness of breath that worsens with movement. Men will have impotence; women will have irregular menses. Tongue is enlarged and pale, with scallops and a thin white coat. Pulse is thready, weak and deep.
5. Phlegm Obstruction and Dampness Retention: fatigue, listlessness, sleepiness, plum-pit qi, chest tightness, puffy face and legs, and overweight or heavy sensation of the body. Dusky tongue with moist or greasy coat. Slippery or full pulse.
6. Heat Toxicity: fatigue, whole body aches, sore and tender muscles and joints, sore throat, swollen lymph nodes around the neck, slight fever, and hot flashes. Tongue body and edges are slightly red. Pulse is floating or thready and sometimes rapid.

Acupuncture Points and Herbal Formulas for Treatment

No matter what the diagnosis is, use ST 36, Du 20 and PC 6. Ear points to be used are adrenal, subcortex and endocrine.

As we know, ST 36 is an extremely popular point to strengthen the spleen and stomach, and to benefit the qi to eliminate fatigue. Du 20 is the meeting point of all yang meridians. It can open the Governing Vessel and raise yang qi, as well as open orifices, calm spirits, and extinguish wind. PC 6 connects with the stomach, heart and chest through the yin-wei meridian. It can open the chest, regulate qi, calm the heart, and harmonize the middle jiao. These points are strongly recommended points for every CFS patient.

The ear adrenal point can stimulate adrenalin and adrenocortical hormone, and is used for inflammation, allergies, poisoning symptoms, fever, blood circulation, and respiratory function. The ear subcortex point can regulate excitation and inhibition of the cerebral cortex for insomnia and neunopsychiatric disorders. It is also used for inflammation, excessive sweating and pain. The ear endocrine point can regulate disturbances of endocrine function, and aid in the metabolic functions of absorption and excretion. It also has anti-allergic and antirheumatic functions. It is used for gynecological and urogenital diseases, dysfunction of the digestive system, and blood and skin diseases.

Treatment by Pattern

1. Spleen Qi and Yang Deficiency
   Acupuncture points: Ren 6, Ren 12, SP 6, UB 20, UB 21
   Formulas: si jun zi tang and bu zhong yi qi tang for qi deficiency; shi quan da bu tang for both qi and blood deficiency combined with cold sensation in extremities.
   
2. Liver Qi Stagnation and/or Liver, Spleen, Stomach Disharmony
   Acupuncture points: GB 8, GB 20, GB 34, LI 4, Liv 3, Liv 14, ST 19, ST 25
   Formulas: modifications of xiao yao san or yue ju wan are useful. From clinical research done in China, and my experiences and personal opinion, shu gan jian pi tang is very effective for this pattern of CFS. Shu gan jian pi tang includes the following herbs: chai hu, chen pi, sheng ma, zhi shi, ren shen, huang qi, dang gui, chuan xiong, bai shao, shi chang pu, yu jin, he huang pi, and yuan zhi. Modifications of shu gan jian pi tang should be made based on your patient's individual condition.
   
3. Heart Blood and Ying Deficiency
   Acupuncture points: HT 6, HT 7, SP 1, SP 6, UB 15, UB 17
   Formulas: gui pi tang modified with sha shen, mai men dong and wu wei zi. For sleeping problems, such as dream-disturbed sleep and hot flashes, add bai zi ren, lian zi xin and huang lian.
   
4. Kidney Qi and Yang Deficiency
   Acupuncture points: Ren 4, Ren 6, SP 6, GB 34, KI 3, Du 4, UB 23, ming men
   Formulas: you gui wan or jin gui shen qi wan, modified with ren shen and huang qi
5. Phlegm Obstruction and Dampness Retention
   Acupuncture points: SJ 5, ST 40, SP 9, Ren 22
   Formulas: modification of er chen tang and dan shen yin
   
6. Heat Toxicity
   Acupuncture points: DU 14, LI 4, LI 11, ST 44, Liv 2, SP 21
   Formulas: modification of qing hao bie jia tang and jia wei xiao yao wan

Some patients with weak constitutions get allergies easily. During the process of your effective treatments, allergies could make current symptoms worse and unfortunately might even rekindle previous symptoms. Therefore, one important treatment principle is to strengthen the patient's lung qi to boost their defensive qi. This can be done by using points such as LI 4, Lu 7, GB 31, and ST 36 more frequently, and by cupping Ren 8 to support and balance the patient's immune system functions.

Prognosis

Prognosis is dependent on the TCM diagnosis. Spleen qi deficiency, liver qi stagnation, heart blood and yin deficiency, and heat toxicity should have good results from the abovementioned treatments. Most patients treated for the above diagnoses can get rid of chronic fatigue syndrome in three months. Kidney deficiency and phlegm obstruction have a slower response to treatment, and may take longer than three months.

The results show more apparent effect in acute cases, which have a history of 2-3 months or less. Usually, during the process of treatment, the symptoms will improve by 70 percent to 80 percent in the first 1-1½ months. In the next 1½-2 months, the remaining 20 percent to 30 percent of the symptoms will go away.

Herbs are the most helpful treatment for CFS. If patients feel better after only two months and quit the treatments, in most cases, CFS will return. A regular program of at least three months is needed, followed by periodic visits, until all of the symptoms are gone. If a patient has had CFS for a long time (several years), the three-month treatment plan will need to be extended. In other ways, a balanced diet, multivitamins, minerals, and a moderate exercise routine, such as qi gong, tai ji quan and walking, will benefit everyone.

Reference

1. Harrison's Principles of Internal Medicine, 16th edition.

Acupuncture Today
August, 2005, Vol. 06, Issue 08