Case studies

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I knew I wouldn’t be taken seriously when I went in to the doctor after the news media began calling my ailment the ‘yuppie flu,'” Betty said during her first clinic visit. This deliberate woman had been dealing with chronic fatigue syndrome (CFS) for nearly ten years. She had been to see all manner of physicians and many other health practitioners–she’d tried chiropractic treatments, acupuncture and herbs, reiki, and a number of fairly heavy medical treatments, including several rounds of antiviral drugs. Some offered temporary results, but the results hadn’t lasted, and Betty found it difficult to get out of bed before noon.

When I asked her to talk about specific symptoms she had experienced with the ailment, she spoke as if reading from a list: “severe fatigue, memory problems, a feeling of spaciness or otherworldliness, persistent muscle aches, depression and sleeping problems.” She had obviously explained her symptoms numerous times. She managed a smile after about the twentieth symptom. “Sounds great, doesn’t it?” I felt sympathetic because I experienced about four to six months of similar symptoms years ago, when I was just beginning to shift my career from electronics to herbalism and natural health. It’s a feeling as if you will never get better, because you simply don’t have enough energy and enthusiasm to overcome such bad feelings.

Defining CFS

CFS, also called chronic fatigue and immune dysfunction syndrome, is defined as a debilitating and complex disorder characterized by profound fatigue, pain, and cognitive problems not improved by bed rest and that may be worsened by physical or mental activity. The syndrome can affect people from all walks of life and nearly any age. Those with CFS function at a substantially lower level of activity than they were capable of before the onset of the illness. CFS is often closely associated with two other syndromes: fibromyalgia and orthostatic intolerance. No sure cause has been identified.

CFS is a most complex disorder, and at first researchers and medical practitioners did not take people seriously who described the numerous symptoms, especially persistent, debilitating fatigue. Many theories exist to explain the origins of CFS. Among them are a genetic predisposition for immune suppression due to the plethora of new synthetic chemicals and modern stressors in our lives today, then infection from opportunistic viruses such as Epstein-barr or cytomegalovirus, perhaps; or a metabolic disorder related to a commonly observable orthostatic hypotension among chronic fatigue patients, a feeling of faintness when one stands up too suddenly. An ongoing study is following 150 twins, where one of the pair has CFS, to check for genetic predisposition.

One problem with CFS is the lack of medical tests to make a clear diagnosis. The common symptoms of persistent fatigue and muscle aches (and possibly hypotension) may be the clearest signs. In fact, the diagnosis of CFS is often made only when all other causes, such as diabetes, have been ruled out. Guidelines from the Centers for Disease Control and Prevention have physicians look for four or more of the following symptoms (that have persisted for more than six months) to make the diagnosis: impaired memory or concentration, sore throat, tender cervical or axial lymph nodes, muscle pain, multijoint pain, new headaches, unrefreshing sleep, and postexertion fatigue lasting more than twenty-four hours.

The TCM approach

Betty had done her homework and knew quite a lot about CFS, no doubt more than I did. She came to my clinic because she was interested in my approach, which is to blend an understanding of Western medicine with concepts from Traditional Chinese Medicine (TCM) and the use of Western and local herbs. TCM practitioners look closely and clearly at the individual and their imbalances through the experience of thousands of medical practitioners refined over thousands of years, rather than focusing broadly on a disease that medical science knows little about.

As I looked at Betty’s tongue, felt her pulse and abdominal region, and talked with her for forty minutes, a clearer picture of her condition began to emerge. She was obviously “deficient,” in the sense of depletion of body substances and vital energy. In TCM, a deficiency can occur of either yin (involving hormones, enzymes and neurotransmitters), yang (metabolic activity), qi (vital energy), or blood. In Betty’s case, her liver pulse was very weak, and the sides of her tongue were devoid of a normal white coating. Based on everything I observed, my first diagnosis was severe liver yin deficiency, which meant her liver was not working well to manufacture proteins, hormones and immune substances, and it was not efficiently helping her body eliminate certain waste products.

Betty’s program

Betty’s diet was fairly good, but a little deficient in protein and high in foods with simple sugars. This is common, because simple sugars often give chronic fatigue sufferers an immediate boost. Fish and a limited amount of organic meats are useful to provide protein building blocks for neurotransmitters and to repair body tissues.

As I do for any condition where immune weakness and energy are an issue, I strongly recommended bitter herbs to improve assimilation. Gentian root (Gentiana lutea), 2 to 4 capsules twice daily before meals, is the best choice. I also have people add other digestive aids when necessary, such as a good digestive enzyme supplement or warming digestive herbs such as ginger (Zingiber officinale) if they have gas and pain after eating or loose stools.

Because her liver was the main organ affected, I recommended an herbal formula to take for six weeks, which would help build liver yin, or support her liver’s ability to manufacture bile, proteins, hormones, and immune substances. The best herbs in this regard are ligustrum (Ligustrum spp.), American ginseng (Panax quinquefolius) and lychee berries (Litchi chinensis). I gave her a powdered extract in capsules that had these three herbs in equal proportions, and she took 3 capsules twice daily. These three extracts are available in 100-g bottles from Mayway (Plumflower Brand) and are quite affordable to use in this way. The powders can also be mixed together and blended into a little soup broth or ginger tea. Two-thirds of a teaspoon equals about three capsules, and this dose can be taken up to three times daily.

I had Betty eat foods that support the liver, such as aduki beans, several times a week. Soak the small red beans overnight with a little seaweed, then slow-cook them for at least an hour. Other beneficial foods include cooked yams, other beans, fish, and root vegetables such as burdock (Arctium lappa), parsnips and turnips.

Betty’s results

Betty began taking the herbs and added more liver-building foods to her diet. She came in each week for acupuncture, and I had a chance to encourage her to be faithful with the foods and herbs. Six weeks went by and although her symptoms were better, she told me she previously had periods of increased energy and less pain when she started a new treatment. But if the appearance of Betty’s tongue was any indication, we were on the right track. The sides were less red, and the coating was beginning to come back. Although her liver weakness was unlikely to be the key to all of her symptoms, I was convinced that helping to strengthen her liver would eventually bring Betty some real and lasting benefit. Complex ailments such as CFS are often a result of a few layers of imbalances, and it is important to start with the most clearly identifiable one. When this layer is resolved, one can go further.

After six months, Betty showed some lasting improvement despite a few dips along the way. When any ailment has persisted for at least ten years, it often takes time to unravel its mysteries, and I feel fortunate when a patient progresses in a positive way through the months.

With the clarity and wisdom of TCM and fresh, local herbs as allies, I always feel hopeful, even for so-called incurable diseases. I find that simplicity and clarity of treatment are best. Especially for something as complex as CFS, my strong council for Betty was, and continues to be, focus on a few health practices you can keep track of and feel comfortable with. The concepts about strengthening her liver, which in turn could positively affect her immune status, hormone balance, and nutrition, were ones she could relate to and that made sense to her. Over the years, I have found that liver weakness is likely to play a role for many people with CFS.

Christopher Hobbs’s case studies are gleaned from his thirty years of studying and practicing herbalism. Hobbs, a fourth-generation botanist and herbalist, is the creator of the new correspondence course Foundations of Herbalism. Visit his website at

“­Case studies” is not intended to replace the advice of your health-care provider.

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