Sarah has been tired for four years. Every day she experiences a bone-deep fatigue that lasts from morning till night. Some days she barely leaves her bed. Every muscle in her thirty-four-year-old body aches, and grocery shopping leaves her exhausted. She has a constant sore throat, and her short-term memory and concentration are severely impaired. Despite her exhaustion, Sarah’s sleep is restless and shallow—every morning she wakes up still tired.
Before she got sick, Sarah was a busy, competent woman. She was working on a Ph.D., held down a part-time job, and was a single mother. She had many friends and had a hard time saying “no” when someone needed her. She was often tired, but she pushed herself to keep going. Then, four years ago, she caught what seemed like a bad flu and never got better. Sarah’s fall into chronic fatigue syndrome had begun.
Sarah is not alone. According to conservative estimates, 200,000 to 500,000 adults in the United States have chronic fatigue syndrome (also called chronic fatigue immune dysfunction syndrome, or CFIDS). Three out of four cases occur in women between ages twenty-five and forty-five, but the condition also occurs in children and the elderly and crosses all ethnic and socioeconomic lines.
CFIDS is a complex illness, the cause of which is unknown. Scientists have examined an array of factors that may be responsible: viral infection, immune system imbalance, altered brain biochemistry, blood pressure problems, red blood cell abnormalities, nutritional deficiencies, adrenal “exhaustion,” and so on. The truth is, all of these factors can be present, but none has been identified as the cause. Still, no one has been able to explain why the body’s normal functions are so profoundly disrupted.
The simplest holistic explanation—though as yet unsupported by science—is that CFIDS is caused by a depletion of qi. Qi, pronounced “chee,” is Chinese for “vital energy.” In the traditional Chinese medical system, diseases such as CFIDS are caused by a qi deficiency. In other words, if the body’s vitality is low, a person is more susceptible to disease. When the deficiency is profound, multiple organ systems become dysfunctional.
Who gets chronic fatigue? In my interviews with hundreds of patients, I’ve observed some general patterns. Many people who fall victim to CFIDS have sensitive constitutions and often put the needs of others before their own. A high percentage have histories of childhood trauma or abuse. They’re often intelligent and tend to stay “in the head” more than in the body. Before their illness began, most experienced prolonged stress or overwork and ignored the need to rest. Environmental pollution may also affect them more strongly than other people.
Treatment for people with CFIDS should focus on increasing vitality. In my experience, when energy levels rise, all associated symptoms also improve. Herbal medicines can help achieve this goal, but they’re not a quick fix—recovery can take many months and must be accompanied by lifestyle adjustments (see page 39).
When using herbs, follow the doses found in the “Treatment guidelines” box on page 41, unless otherwise indicated. When self-treating, play it safe: Start with low doses, increase gradually, and stop immediately if you have a bad reaction.
Resist the temptation to use stimulant herbs, such as ephedra (also called ma huang) or the caffeine-containing herbs kola nut, guarana, black tea, and coffee. Although these briefly boost energy, in the long run they can worsen fatigue by depleting the adrenal glands. Many products advertised as energy boosters contain stimulant herbs.
A better strategy is to increase the body’s vital energy slowly and gently, a process that a traditional Chinese practitioner would call “toning qi.” Reishi mushroom (Ganoderma lucidum) is a popular Chinese qi herb, used for centuries to treat many conditions. Astragalus (Astragalus membranaceus) tones qi and has the added benefit of being a tonic for the gastrointestinal tract and lungs. Astragalus is gentle and safe, even for children.
Adrenal tonics also help build energy. These herbs nourish and balance the adrenal glands, the “stress managers” of the body. Siberian ginseng (Eleutherococcus senticosus) improves stamina, energy, and ability to manage stress; spend a little more money for the best product available, preferably one with a guaranteed eleutheroside potency. Licorice (Glycyrrhiza glabra) nourishes and balances the adrenals and liver, fights viruses and inflammation, and is an expectorant and cough suppressant. Avoid it, however, if you have high blood pressure.
Although viruses haven’t been proven to cause CFIDS, they may contribute to symptoms. Chronic fatigue sufferers are more susceptible to new viral infections, as well as the reactivation of dormant viruses from previous infections. Viral symptoms include sore throat, swollen lymph nodes, and low-grade fever.
Research shows that Echinacea (Echinacea spp.) stimulates the immune system to fight infection. Take it at the onset of symptoms and use it continuously for short periods only (two weeks at most). The lichen usnea (Usnea spp.) also fights viruses with immune-stimulating polysaccharide constituents. Osha (Ligusticum porteri), a strong antiviral, is especially good for upper respiratory infections. Monolauren (glycerol monolaurate), a natural fatty acid found in vegetable oils, combats Epstein-Barr and herpes, two viruses commonly reactivated in CFIDS. However, monolauren is not effective against viruses that cause colds.
Many CFIDS patients have gastrointestinal complaints, such as bloating, gas, constipation, and diarrhea. If possible, a health-care provider should rule out dysbiosis (imbalance of normal bacteria) and specific infections, which may create similar symptoms. Meanwhile, probiotics such as acidophilus and bifidus may help. Insufficient “good bacteria” can affect digestion, nutrient absorption, detoxification, hormone balance, and proper immune system functioning.
Bitter herbs such as gentian (Gentiana lutea), wormwood (Artemisia absinthium), mugwort (A. vulgaris), and artichoke (Cynara scolymus) stimulate the production of stomach acid, digestive enzymes, and bile, thereby improving all digestive processes. Many bitters combinations are available in health-food stores, usually in liquid extract forms.
Digestion soothers heal inflammation, decrease gas, and calm the entire gastrointestinal tract. Herbs in this category include chamomile (Matricaria recutita), calendula (Calendula officinalis), meadowsweet (Filipendula ulmaria), peppermint (Mentha ¥piperita), fennel (Foeniculum vulgare), anise (Pimpinella anisum), mallow (Althaea spp.), marshmallow (A. officinalis), and slippery elm (Ulmus rubra).
Depression, anxiety, insomnia, poor memory, and difficulty concentrating are common problems for CFIDS patients. All of these symptoms relate to the nervous system. Altered brain chemistry reduces the ability to tolerate stimuli such as noise, light, and pain, and also contributes to exhaustion, as if the brain never really rests.
Oats (Avena sativa) are a soothing, nourishing nervous system tonic. They can help restore biochemical balance and ease depression, anxiety, and insomnia. St.-John’s-wort (Hypericum perforatum), a highly effective antidepressant, also helps some patients with biochemical imbalance, insomnia, and pain. Ginkgo biloba is extremely helpful for cognitive dysfunction in some individuals and may also help with depression.
Nervous system relaxants such as valerian (Valeriana officinalis), passionflower (Passiflora incarnata), kava (Piper methysticum), and skullcap (Scutellaria lateriflora) ease anxiety and insomnia and may help correct the imbalance that causes overstimulation in the brain. You can use these herbs singly or combined in teas, tinctures, or capsules.
Chronic muscle and joint pain contribute significantly to the distress experienced by CFIDS patients. St.-John’s-wort is helpful for some people, perhaps because it impacts serotonin levels. Antispasmodic herbs such as valerian, skullcap, and crampbark (Viburnum opulus) will ease muscle spasms and tension. California poppy (Eschscholzia californica) has mild pain-relieving effects and, unlike its cousin, the opium poppy, is not addictive. Capsaicin cream is made from cayenne peppers (Capsicum spp.). When applied externally, it reduces muscle and joint pain for some CFIDS patients. It may cause a burning or itching sensation, but that will pass.
In treating hundreds of people like Sarah, I have come to see CFIDS as a treatable if not always curable disease. Once qi begins to accumulate from a treatment that combines herbs, supplements, energy work, and lifestyle changes, all symptoms begin to improve. Many of my patients have completely recovered—but not to return to their previous busy lives. Instead, they honor their individual constitutions, abilities, and limitations. In so doing, they have found within themselves enormous resources for personal change, transformation, and creativity.
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