慢性疲劳 MANXING PILAO - CHRONIC FATIGUE SYNDROME

Chronic Fatigue Syndrome has been under-diagnosed and dismissed in modern medicine for many decades as it is a relatively new disorder that appears to be a by-product of other disorders. Its diagnosis is not confirmed by objective tests at this time, but as a differential diagnosis, or diagnosis of exclusion. Chronic Fatigue Syndrome (CFS) has been an elusive health problem to understand, yet the World Health Organization (WHO) and the National Institute of Health (NIH) recognize this syndrome as a widespread, growing syndrome of symptoms seen worldwide.

At one point it was thought the cause of CFS could be the Spirochete Bacterium Borrelia Burgdorferi that comes from a tick and causes Lyme disease, but it turned out not to be. The syndrome has also been classified as Neuro-endocrine-immune Dysfunction and Chronic Fatigue Immunodeficiency Syndrome. As research progresses scientists are more clearly understanding the key functional problems, which relate to the central nervous system, particularly the brain stem transmission, and the centers of control and coordination at the top of the brain stem, such as the hypothalamus, amygdala and hippocampus; and recently, CFS has been called Myalgic Encephalomyelitis, after research revealed more specific mechanisms of the pathology. Myalgic Encephalomyelitis is a chronic inflammatory state in the brain stem and spinal cord physiology that affects the muscle function, nerve sensation and firing, or a functional somatic syndrome that is responsible for the pain sensation throughout the body, and the term used by most experts today is Encephalomyopathy.

Other functional somatic syndromes appear to overlap with CFS at an alarming frequency, suggesting perhaps a related underlying etiopathology. These include fibromyalgia, multiple chemical sensitivity, chronic pelvic pain syndrome, irritable bowel syndrome IBS, temporomandibular joint dysfunction TMJ, and Gulf War illness. Current research more closely ties Chronic Fatigue Syndrome to Fibromyalgia and implicates hypofunction of the hypothalamus adrenal axis, as well as more specific findings of neurotransmitter and neuroreceptor problems in the brain stem, especially a hyper-serotonergic imbalance.

Patients with symptoms of chronic fatigue are likely to suffer other adverse health conditions such as hypothyroidism, adrenal insufficiency, depression, sleep disorder, anemia, liver disease or dysfunction, various chronic inflammatory diseases, neurological diseases such as multiple sclerosis, various autoimmune disorders, hepatitis C or other viral disease; even medication side effects, especially from statins and psych drugs, or from immune suppressing and steroidal medications. Serious chronic diseases that were unheard of a short number of years ago, like mitochondrial syndromes and the very latest in the year 2020, sequelae of COVID-19 on patients that have recovered from the viral infection, are now being diagnosed in cases of chronic fatigue.

Since standard medicine has failed to properly treat so many patients with chronic fatigue, more and more patients now are turning to an integrative approach with Complementary and Integrative Medicine, especially with the array of therapies available in the specialty of Traditional Chinese Medicine. The professional Licensed Acupuncturist and herbalist is able to offer a unique perspective that integrates well with standard medicine and offer an array of evidence-based traditional and modern therapies, including herbal and nutrient medicine,^* acupuncture, instruction in diet and lifestyle changes, help with cognitive and behavioral changes, and physiotherapies.

The complexity of CFS and the systemic and holistic aspects of the disease, have resulted in the avoidance of a sound diagnostic and treatment regimen based on current scientific evidence. Each individual TCM physician offers a unique set of skills, knowledge and clinical experience, and many are able to provide an effective course of therapy in difficult diseases. In the chronic fatigue pathology, the patient that takes a proactive approach and becomes the main director of a team of integrated physicians often achieves the best outcome. By becoming well educated to the suspected underlying pathology and utilizing the physicians at their disposal to provide their best skills and knowledge, these patients often overcome the difficulties seen in the often elusive and persistent disease that is CFS.

Diagnosis and clarification of the confusing array of potential causes of CFS is difficult, and often exhausting, eventually leading to a ‘diagnosis of exclusion’. Use of the functional PET scan to see if levels of neuroinflammation are present may be useful, and recent research has shown that analysis of the health of the Microbiome with stool analysis, and of bacterial endotoxins in blood circulation, could be useful markers. Of course, definitive tests for Lyme Disease, hormonal analysis, and other tests of immune response may all be helpful to both rule out causes and to add data to the differential diagnosis. After this process is completed, the team of physicians you select can be more specific in designing an individualized and holistic treatment protocol. If you do not have a team of physicians, but only a licensed Acupuncturist, the TCM physician will treat you with all the best resources at their disposal.

Balance of Yin & Yang is the primary goal of Traditional Chinese Medicine. A wealth of research has revealed that Acupuncture, herbal, and nutrient medicine are now shown to affect the nervous system, immune responses, and bio-availability of neurotransmitter production to achieve greater success in restoring homeostatic health, or Yin & Yang, Qi and Blood balance. Chinese herbal medicine and acupuncture have a proven track record in the improvement of the quality of life in patients suffering from CFS, given the very long experience in China on treating known and unknown infections and ailments that plague the poor and vast population in areas far and away from main cities and hospitals. 

PATHOPHYSIOLOGY OF CHRONIC FATIGUE SYNDROME

Not only chronic low-grade viral illness, but bacterial infection, is now considered a likely factor in the pathology of CFS. In 2016, a randomized controlled human clinical study of patients with CFS, at Cornell University, found that, compared to health controls, that CFS patients had significantly lower diversity of bacteria in stool samples, and higher levels of lipopolysaccharides LPS, which are common bacterial endotoxins, indicating that the gut Biome may be unhealthy, and that low-grade bacterial infection and a superantigen response could explain many of the symptoms. The lead author, Dr. Maureen R. Hanson, a professor of molecular biology, stated that this study could lead to a diagnostic marker as well as a new direction in complementary treatment, and that this study should dispel any lingering belief in the medical community that CFS is a psychosocial disease, or psychological illness.

For ages, TCM physicians have been using a broad array of protocols, including restoration of gastrointestinal health and the gut Microbiome, as well as clearing of inflammation. The study of Dr. Hanson should reassure patients that a persistent restorative treatment protocol that is comprehensive will yield success. Before Lectins were called Lectins, for many generations in China, physicians of Traditional Medicine have taken into account the consumption of those foods that contain the enzymes now known as Lectins to resolve a whole category of ailments resulting from an imbalance in the Microbiome. Healthcare in China, particularly the evolution of Acupuncture and Herbology has been achieved over millennia through trial and error. The foods containing lectins were grouped in the same way, trial and error, given that the artifacts to investigate the properties of foods did not exist. Gut microbiome health play a key role in ‘Difficult Diseases’ in humans, and the Chinese knew this just as a matter of course.

Recent studies have confirmed that a mitochondrial dysfunction and reduced ATP synthesis is seen in a large majority of patients with CFS, and more and more cases are finding that a mitochondrial disease related to the genetic code of the mitochondria may be involved. Advances in genetic testing have revealed the array of potential mitochondrial diseases that may be contributing to CFS, but even when these tests are negative, a disorder of mitochondrial dysfunction may still be occurring but not presenting the markers recognizable by the properties of the tests. Experts at the Oxford University School of Medicine showed that a 5-factor blood test for analysis of the degree of mitochondrial dysfunction is highly accurate in correlating mitochondrial dysfunction to the severity of the CFS, and in assessing the extent to which mitochondrial dysfunction plays in the fatigue.

Mitochondria are the parts of the cells that efficiently produce energy; and ATP, or adenosine triphosphate, is both a source of energetic firing, and a coenzyme used in mechanisms of energy storage and transfer of cellular nutrients. Reduced production of ATP could explain an array of symptoms affecting both the central nervous system and the muscle function. Metabolic disorder, insulin resistance, and hormonal dysfunction could all contribute to likelihood of ATP dysfunction, and chronic low grade inflammatory states and inflammatory dysfunction are also at the heart of these and other health problems. This is why supplementing with D-ribose, an important fuel for mitochondria, is often helpful in the treatment protocol to relieve fatigue symptoms.

Nutritional cofactors of ATP function are helpful in the protocol for many patients, and these include a combination of Vitamins B-2 and B-3 in a sustained-release form. There are many chemicals in the vitamin families, and the terms B2 and B3 could refer to a host of chemicals. The correct forms are riboflavin and inositol hexacotinate ─a form of niacin. A simple B-complex supplement may not have much effect.

Many Chinese herbs have been proven to improve mitochondrial function as well, including a host of adaptogens, such as HUANG QI Astragalus, HONG JING TIAN Rhodiola rosea, CI WU JIA Siberian Ginseng, DONG CHONG XIA CAO Cordyceps, a remarkable herb that combines the chemistry of animal and plant, and contains a number of key adenosine compounds. Cordyceps picked wild is now very expensive and in demand, but has been cultivated as well, which is not as potent, but very effective and affordable. Other nutritional supplements studied and found to benefit mitochondrial function and health include R-Lipoic acid, and the combination of acetyl L-Carnitine and L-tartrate. Ubiquinol, CHI GENG TENG Gymnema Sylvestre ─rich in kaempferol and quercetin, and other herbs and nutrients are now clinically proven to help with mitochondrial dysfunction.

NUTRIENT AND HERBAL MEDICINE IN THE TREATMENT OF CFS

The individual patients often need to look even beyond these small endorsements of nutrient and herbal therapy to find effective proven strategies. Study of nutritional deficiencies common to patients with Chronic Fatigue Syndrome, and listed on standard medical websites, include CoQ10, L-Tryptophan, zinc and Vitamin B12 -methyl or hydroxycobalamin, which have been noted as deficient in a high percentage of patients studied. The use of L-Carnitine, Omega 3 fatty acids, folic acid, magnesium, and NADH have all been studied and shown to be effective on a percentage of patients.

A 2006 study at the Fibromyalgia and Fatigue Centers in Dallas, Texas, found that the supplement D-ribose significantly reduced symptoms of pain, fatigue, insomnia and reduced mental clarity. D-ribose is a sugar metabolite that stimulates a high production of ATP, the main cellular fuel. B2 riboflavin and B3 inositol hexacotinate, in a slow release form, has also been proven to benefit mitochondrial health and efficient production of ATP to reduce fatigue. While these various medicines alone may not exert a significant quick improvement in all individual patients, the combination of these various studied nutrient medicines cannot hurt the patient and will only contribute to greater overall health. They may all be combined with effective acupuncture and herbal protocols.

 

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^*Nutrient or Nutritional Medicine is based on the principle that nutrients, including essential micronutrients, are required for the proper functioning of all the biochemical processes on which our bodies depend, these include Western and Chinese herbal supplements.
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-Above Article Written by Dr. Osorio, Gloria DAOM, L.Ac. 2020.