Chronic Fatigue Syndrome 
A Holistic Herbal Treatment Approach
 

This disease is technically known as Myalgic Encephalomyelitis or M.E. Symptoms of it were first recorded in the 1940's but it was not recognized as a disease in its own right until the 1970's and even today there are still some medical professionals who do not recognize it. In all cases there is haematological evidence of chronic infection with Epstein Barr Virus, or occasionally with Cytomegalovirus. Both of these are of the herpes family which is notorious for it's ability to remain latent in the body for extended periods, only manifesting and causing problems when the general health falls below par. In fact 99% of people by the age of 20 will have Epstein Barr Virus in their body but only a few of them will go on to develop M.E. Thus M.E. appears to be indicative of an impaired or compromised immune system rather than any single disease process.

The symptoms of M.E. tend to be disseminated throughout the body including the central nervous system. Because it is a indication of impaired immune function there are often one or more co-existing diseases which confuse the picture and make diagnosis difficult even for the doctor. Candida albicans and multiple allergies are frequently seen in cases of M.E. and symptoms of Fibromyalgia are also common.

Below is a list of the most frequently encountered symptoms with approximations of the percentage of sufferers of M.E. who experience them.

Fatigue (95%), usually made worse by physical exercise. This may be extremely severe and very disruptive to the normal life style of the patient.

Cognitive function disorders (90%)
* Attention deficit
* Calculation difficulties
* Memory disturbance
* Spatial disorientation
* Language confusions

Psychological disturbance (80%)
* Depression
* Anxiety and panic attacks
*Personality changes especially worsening of previously mild habits
* Emotional lability or mood swings
* Psychosis (1%)

Other nervous system disorders (75%)
* Sleep disturbance including nightmares
* Headache
* Changes in visual acuity
* Seizures or fits
* Numb or tingling feelings
* Disequilibrium
* Lightheadedness or feeling 'spaced out'
* Ringing in the ears
* Paralysis
* Severe muscular weakness
* Blackouts
* Intolerance of bright lights
* Intolerance of alcohol
* Alteration of taste, smell or hearing.

Recurrent flu-like illness (75%) often with chronic sore throat.

Lymphadenopathy (60%) especially in the neck and axillae. May be painful.

Allergies (40%) especially catarrhal symptoms, and frequently exacerbation of pre-existing problem.

Weight change (70%) usually gain.

Muscle and joint pain (65%)

Digestive disturbances (50%) 
* Diarrhoea
* Nausea
* Irritable bowel syndrome
* Gas and abdominal bloating
* Colicky cramping pain.

Low grade fevers (70%) chronic feeling of excess heat.

Night sweats (40%)

Palpitations (40%)

Severe Pre-menstrual syndrome (70% of women)

Herpes simplex or Shingles (20%)

Other symptoms seen in less than 10% of sufferers:
* Painful or frequent urination
* Prostate gland dysfunction
* Rashes
* Hair loss
* Impotence
* Chest pain
* Dry eyes and mouth
* Cough
* TMJ syndrome
* Mitral valve prolapse
* Mouth ulcers
* Cold extremities
* Rhythm disturbances of the heart
* Carpel tunnel syndrome
* Pyriform muscle spasm causing sciatica
* Thyroiditis
* Various cancers especially of the immune system 

(Thanks to Dr. J.A.Goldstein MD of Los Angeles for the above information).

Chronic Fatigue Syndrome or M.E. is commonly preceded by an acute viral or bacterial throat infection which presumably lowers the immunity sufficiently to allow the EBV or CMV to proliferate. In many ways the symptoms are remarkably like those of Infectious Mononucleosis except that they are worse and last longer. M.E. can seriously disrupt a persons life for as long as 6 years and occasionally even longer. It does appear, though, to eventually burn itself out and the person is left with virtually no residual dysfunction. However, with diet and natural remedies it is often possible to speed up the recovery time as well as to help to minimise some of the symptoms. No practitioner will be able to 'cure' M.E. but effective symptomatic treatment will minimise the adverse effects and improve the overall quality of life.

The first and foremost mode of treatment in this condition is rest. It is imperative that the person be enabled to rest as much as they need. Indeed there is often no choice in the matter, they simply can't get out of bed! Very gentle exercise such as yoga, Tai Chi, swimming or slow walking will also be helpful to encourage lymphatic flow and circulation of blood.

Stress reduction techniques and positive creative visualisations may also be helpful. The patient should be encouraged to take up meditation, yoga, biofeedback, to go for counselling or to join a self-help group.

DIETARY TREATMENT OF M.E.
This focuses on enhancing the immune function and optimising overall health. A cleansing and detoxifying diet which rebalances acid and alkalinity in the system will be useful at the outset of treatment as a means of relieving stress from the liver and immune system. This cleansing diet should consist of a modified fast: 3 or 4 days on a mono-food program eg. apples or carrot & beet juice or green grapes etc. This is followed by 4 days of raw fruits and vegetables before moving onto a fairly strict maintenance diet. The on-going maintenance diet after the period of detoxification should be strictly animal free, organic and primarily consisting of raw foods to minimise toxins entering the system and to provide cooling forces to the body. No commercial meat or dairy products should be used because their lacing of antibiotics will significantly impair the immune function. There should be no refined carbohydrates, caffeine or alcohol consumed. Organically grown fruits and vegetables are recommended to lessen the load on the liver and immune system. The patient should be encouraged to drink plenty of spring water.

If Candida albicans is a problem then a dietary program specially designed for Candida should be used. If allergies are a problem then minimise exposure to allergens by following a 4 day rotation diet.

SUPPLEMENTS IN M.E.
A high quality multi vitamin and mineral supplement should be used daily. Added to this should be the following items:

* B complex 100 mg three times daily
* Zinc 30 - 50 mg daily 
* Selenium 200 mcg daily 
* Evening Primrose or Blackcurrant seed oil 500 mg. three times daily
* Vitamin C to bowel tolerance
* Beta carotene 15,000 iu. daily
* Garlic capsules (Kyolic) 2 caps three times daily.
* Chlorophyll: Wheat Grass, Barley Greens, Chlorella, Blue Green algae etc.

Vitamin B complex acts as a tonic for the nervous system and aids in dealing with stress. Zinc and vitamin C enhance the immune response and assist in fighting viral or bacterial infection. Vitamin A enhances the immune system but, as well, it acts as an anti-oxidant to fight free radical damage. Selenium and beta carotene also work as powerful anti-oxidants, the selenium being part of the glutathione peroxidase pathway. Garlic and chlorophyll both help to remove toxins from the body and the chlorophyll boosts energy because of its very close chemical relationship to hemoglobin.

HERBAL THERAPEUTICS

Immuno-modulators
These are herbs which stimulate and regulate the immune response. Some have a general tonic property while others may have a more specific action on only certain aspects of the immune system. 

Bitter digestive tonics
These will enhance digestion and assimilation of food and aid the body in obtaining all the essential nutrients from digestion. They may be especially useful in cases where there are co-existing food allergies. They also stimulate the liver which enhances filtering and cleaning of the blood and boosts immune function. 

Adaptogens
These are herbs working mostly on the adrenal glands which aid the body in adjusting to stress. They are especially indicated where there is any long term debility and weakness. 

Stimulants
A pure stimulant such as Centella asiatica or Kola vera should not be used because, while the person will get energy for a while, the overall effect is to drain bodily resources and to worsen the situation. Mild stimulants working as adrenal or nerve tonics or as nutritive agents may be appropriate even for long term use. 

Sample combinations for CFS 

 As will be seen by the case history descriptions below, the great art of phytotherapy is in the blending of the correct herbs for each individual client. The herbs must be chosen with care to accurately address the symptoms as well as the underlying cause. In the case of M.E. where the root cause is ambiguous then symptomatic herbal treatment will only be effective where it accompanied by proper lifestyle adjustments, most particularly in regards to the diet and the level of toxins in the system.

Individualised herbal prescriptions provide room for continuous assessment of the whole patient picture and subtle adjustments can be made as the patient progresses and the symptom picture.

RETROSPECTIVE CASE ANALYSIS (page 2 of 2)

Case 1
Mrs A. first attended the clinic in May 1992 when she was 44 years old. She complained of bouts of low energy which had been present on and off for 2 years but more recently had become almost continuous. She had been undergoing a lot of personal stress and had had to cease paid employment some 3 months earlier although she did try to do some voluntary work every week. The sleep pattern was good with about 8 hours per night, but she never woke feeling rested. Mental processes, memory and concentration were all poor and there was sometimes depression and especially a feeling of guilt for the burden she was becoming on her husband. The medical diagnosis she had been given was "either Chronic Fatigue Syndrome or Fibromyalgia" and she had been prescribed amitryptyline which she had not taken. 

Apart from endometriosis in her 20's, Mrs. A. had been in remarkably good health all her life. The only known allergies were to wasps and bees. She had never been pregnant and at the time of the first consultation the endometriosis was completely asymptomatic. She exercised a little (as much as the level of fatigue would allow) and her diet was extremely good although she did not drink enough water. She was also taking the following supplements daily: vitamin E 800 iu., beta carotene 25,000 iu., zinc 15 mg., B complex, selenium 100 mcg every other day, vitamin C 300 mg. every other day and calcium-magnesium at certain times through the month.

The recommendations given to her included that she completely avoid all cheese, milk and other dairy products, that she minimise her intake of meats and that those she did eat were certified organic, that she boost her water intake and that she increase her vitamin C to bowel tolerance. It was also recommended that about 50% of the dietary intake be in the form of fresh vegetables, raw wherever possible and that she make beans a main source of protein.

She was given blue green algae capsules 2 to be taken tid.

The herbal formula given to Mrs. A consisted of the following herbs:

The Ginkgo was given to improve circulation to the brain; the Avena and Turnera were given as tonic, stimulating nervines and thymoleptics; the Taraxacum was given to improve liver function and enhance the cleansing of toxins from the system; the Kola was used in a very small dose as a pure stimulant; the Zingiber was used as a warming circulatory stimulant; the Fucus was used to enhance the metabolic process and provide essential trace elements; the Urtica was used as a blood cleanser and blood builder and to provide energy in the form of chlorophyll and iron.

Mrs. A. returned to the clinic a month later reporting a definite and consistent increase in energy levels, more clarity of thought processes and improved concentration. She had followed all the dietary recommendations to the letter. The herbal formula was repeated for another 5 weeks and this time she was also given the following Bach Flower Remedies in a separate bottle, 4 drops to be taken 4 times a day: Aspen, Centaury, Cerato, Clematis, Elm, Scleranthus, Olive. These were chosen for emotional states of fear, vacillation, lack of confidence in herself, difficulty making decisions, day dreaming, mental exhaustion and emotional lability.

On her third visit Mrs. A. was continuing to find a steady improvement in her symptoms. She had 2 days of very low energy following a head cold but had picked up again quite quickly. There had been some mood swings (hyperactivity and depression) which she related to being "hard on herself" about having been sick. She had been craving licorice. After this visit the formula was changed slightly to include the adaptogenic Glycyrrhiza glabra that her body was craving, and to eliminate the Kola vera which, if taken long term may ultimately cause adrenal and nervous exhaustion.

The Bach Flower Remedy and the blue green algae was repeated.

On her next visit 6 weeks later Mrs. A. reported significant improvement such that she was no longer needing to take an afternoon nap, was taking a computer course and was doing yoga daily. Her emotions were more stable and she felt optimistic of total recovery for the first time. At this time the formula was repeated for 8 weeks along with the Bach Flower Remedy and the blue green algae. 

On her last visit Mrs. A. reported that she felt "almost back to normal" and that she was returning to part time work. Although she flagged towards the end of the day, her overall energy level was good and she was able to concentrate easily and remembered things well. At this time the formula was changed slightly and was dropped to twice a day for 6 weeks.