Treating Chronic Fatigue Syndrome

Manage this mysterious malady with medicinal herbs.


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Chronic fatigue syndrome (CFS), also known as chronic fatigue immune dysfunction syndrome, bears a striking resemblance to fibromyalgia, a frustrating and debilitating syndrome characterized by musculoskeletal pain and fatigue.

Both CFS and fibromyalgia have substantially overlapping symptom patterns. In fact, many sufferers could properly be diagnosed as having either condition, depending on which specialist gives the diagnosis. Both syndromes are characterized by a broad spectrum of physical and emotional symptoms, and both are increasing rapidly in the population, attracting rising attention from the medical profession.

The reason for this increase remains unclear, but it may be linked to greater levels of stress, reduced sleep and chronic malnutrition in our culture.

What is CFS?

Patients with CFS have been fatigued for more than six months, even though they feel they’ve been getting enough rest and aren’t working too hard. They often report various nonspecific symptoms, including a sore throat, tender or painful lymph nodes in the neck or armpits, muscle soreness, unusual headaches, unrefreshing sleep, impaired memory and feeling very tired for more than 24 hours after normal exercise and sufficient sleep.

A 1994 study by medical doctor Debra Buchwald, probably the most notable CFS researcher in the United States, concluded that CFS, fibromyalgia and multiple chemical sensitivity syndrome have significant overlap and may even be one condition. She points out that 70 percent of people with fibromyalgia meet the official case definition for CFS. Buchwald followed up with a 2001 study in which she looked at studies from a variety of “unexplained clinical conditions” — those that share features, including symptoms of fatigue and pain, disability out of proportion to physical findings, inconsistent laboratory abnormalities and a connection with stress and psychosocial factors.

The researchers looked at CFS, fibromyalgia, irritable bowel syndrome, multiple chemical sensitivity, temporomandibular disorder (jaw problems such as TMJ), tension headache, interstitial cystitis (a chronic inflammatory condition of the bladder) and postconcussion syndrome (which occurs when a person has had a concussion and hasn’t recovered within a few months). The overlap between these mysterious diseases is substantial, according to the report. “The proportion of patients with one unexplained clinical condition meeting criteria for a second unexplained condition was striking,” researchers said.

Paul St. Amand, M.D., another leading fibromyalgia clinician and researcher, says the entire “myofascial pain syndrome” (which causes discomfort and disability in different areas of the body), CFS and systemic candidiasis are the same disease. He claims that people who get the CFS diagnosis are simply those who have higher pain thresholds and thus are more aware of fatigue and cognitive difficulties.

When all is said and done, these two diseases may be the same. From a natural healing point of view, these symptom clusters are just different ways of viewing the same underlying chronic body-wide degeneration that afflicts so many in our culture.

If CFS and fibromyalgia are in fact one and the same syndrome, the disease is alarmingly widespread and severe. In May 1995, several prominent physicians from the Centers for Disease Control and Prevention (CDC) and major research universities testified before Congress that CFS may be 50 times more prevalent than previously estimated by the CDC, concluding that this syndrome may affect some 76 to 220 per 100,000 Americans. The CDC added CFS to the list of “Priority-One New and Re-emerging Infectious Diseases,” along with E. coli and tuberculosis.

Ashwaganda: An Ideal Herb for CFS

Practitioners of Ayurvedic herbalism use ashwaganda (Withania somnifera) for general debility and exhaustion, emaciation, memory loss, nerve diseases and insomnia. It’s also helpful for CFS. Ashwaganda is one of the most promising herbs for building overall health. A scientific article published in 2000 by Los Angeles researchers reviewed a host of confirmed benefits: anti-inflammatory, antistress, antioxidant, immunomodulatory and rejuvenating properties. The scientists say the herb also appears to exert a positive influence on the endocrine, cardiopulmonary and central nervous systems.

Study after study continues to confirm the stress tolerance, performance and endurance-enhancing benefits of this herb. In fact, research shows ashwaganda to be superior to ginseng as an antistress remedy. A 2001 rat study indicated the herb reduced stress-induced brain damage by 80 percent.

Tests of the pharmacological and metabolic effects of ashwaganda were performed in 2000. Ashwaganda was shown to increase swimming time in rats in a physical endurance test. The herb also increased the size of the heart and the content of blood sugar fuel in the heart and liver.

An animal study conducted in 2000 demonstrated that an Ayurvedic formula containing ashwaganda was as effective as ginseng in a wide range of adaptogenic benefits. The medicine was tested in rats against chronic unpredictable stress behavior, depression, glucose metabolism, suppressed immune function and cognitive dysfunction. Stomach ulcers, adrenal gland atrophy, vitamin C levels and levels of stress hormones were also measured. The herb benefited them all.

Ayurvedic practitioners consider ashwaganda a “grounding” herb — one that nourishes and regulates metabolic processes and stabilizes mood. A rat study conducted in 2000 indicates these uses are valid. The researchers concluded, “The investigations support the use of Withania somnifera as a mood stabilizer in clinical conditions of anxiety and depression in Ayurveda.”

As the scientific name (somnifera) indicates, ashwaganda aids sleep. Ayurvedic herbalists use the herb to re-establish long-term sleep rhythms. Rather than making you sleepy when you take the herb, this remedy seems to regulate sleep cycles over time, facilitating more refreshing sleep. Ashwaganda has antioxidant activity in the brain, which may explain, at least in part, a host of its effects, including the reported antistress, immunomodulatory, cognition-facilitating, anti-inflammatory and anti-aging benefits.

Recent studies show ashwaganda to have immune-enhancing action. New scientific discoveries also show that ashwaganda has substantial anti-tumor effects, as well as enhancing the effect of radiation therapy in cancer, while protecting healthy cells.

A typical dose of ashwaganda is about 1 gram per day, taken over long periods (up to many years) as a rejuvenator. Because ashwaganda is very safe, larger quantities are often used short-term in Ayurveda. In India, the herb is given with pungent, heating herbs (ginger, pepper, etc.) to increase its tonic effects.

Licorice root (Glycyrrhiza glabra) is probably the most widely used herb for CFS. Sharol Tilgner, a naturopathic doctor and the founder of Wise Woman Herbals, recommends it highly. She points out that licorice is anti-inflammatory, antiviral, protects the liver and supports the immune system. CFS patients show a deficiency of glucocorticoid hormones, produced in the adrenal glands, which is improved with licorice root.

Maca (Lepidium meyenii) is a member of the mustard family, which also includes cabbage and broccoli. Maca is one of the few members of this genus to be domesticated in the Western Hemisphere. The herb is a wonder of biological adaptability that grows high in the Andes.

The medicinal part of the plant is the pear-shaped root (the hypocotyl — the bulblike, below-ground portion, like a radish, to which it is related), which is up to 3 inches in diameter and varies widely in color, from yellow and whitish red to black. In Inca society, maca was used to impart strength. The herb acts as an energizer and antistress agent. Some herbalists are reporting success with chronic fatigue syndrome and are using the herb as a general endocrine balancer.

Maca is becoming popular now, both in Peru and the United States, dried and encapsulated as a dietary supplement. Doses are typically about 3,000 mg per day, but based on native use, the dose could safely be much higher. The powder also is available, so you could experiment with using maca as a beverage as the Peruvians do.

Early CFS cases seemed to indicate an infection at work. But this line of reasoning has become less popular over the past 10 years. Not all people with chronic infections have CFS, and not all chronically fatigued people have an infectious disease. But CFS often does act like “the flu that wouldn’t go away.” In cases where folks have symptoms more like the flu, including fever, I often use a combination of black walnut hull (Juglans nigra) powder and benzoin gum — both powders are available in capsules. I have taught this remedy to hundreds of herbalists, and they uniformly report the same excellent results with treating the virus-like syndrome.

CFS and Physical Activity

The National Center for Infectious Diseases advises that an appropriate amount of physical activity is good for CFS patients, just like everyone else. But patients need to know how much to do and when to stop the activity; at all costs, they must avoid increasing their level of fatigue. CFS sufferers should pace themselves carefully and avoid unusual physical or emotional stress to prevent the “push-crash” cycle, typified by overexertion during times of better health and followed by a relapse from excessive activity. Some folks do well with activities such as aquatic therapy, light exercise (adapted to personal capabilities), stretching, yoga and tai chi.

The Road to Recovery

Although CFS may be complicated and frustrating, remember that it can be treated. A comprehensive program, tailored to the individual, will gradually restore balance. The treatment must address broad areas of lifestyle and physiological dysfunction. There is no magic bullet. Time and tenacity win the battle.

People often get much sicker while they search for a diagnosis. Frequently, it takes years to find a practitioner who can put all the details together and help with the various aspects of the disease. At times you will need to see several natural specialists, and conventional medicine definitely has a role to play, too. Each person and each syndrome has unique quirks, but overall, the slow-acting adaptogenic herbs are the pillars of natural treatment. During treatment, take it easy. Relapsing does not help, and can be discouraging. The progress is always almost rocky. You will have good weeks and bad weeks, but ultimately, the good will outnumber the bad.

Both CFS and fibromyalgia clearly stem, to some degree, from modern life. To avoid these syndromes, make your best effort to stay healthy and vital. Stay nourished. Reduce your stress. Keep your immune system in top shape. When you have mastery over your life, your health will be no mystery.

Karta Purkh Singh Khalsa is an adjunct faculty member in the botanical medicine department of Bastyr University. He is currently writing a book on Ayurvedic herbalism.

Ashwaganda Resources

Greenbush Natural Products
15532 Scorpion Dr.
Fountain Hills, AZ 85268

Himalaya USA
10440 Westoffice Dr.
Houston, TX 77042
(800) 869-4640

6662 Gunpark Dr. E. #102
Boulder, CO 80301
(303) 516-4848

Nature’s Formulary
14 Interstate Ave.
Albany, NY 12205
(800) 923-9338