Chronic Fatigue Syndrome and Its Herbal Treatment

Townsend Letter for Doctors and Patients,  Nov, 2001  by Kerry Bone

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I received the following letter from a long-time patient: "I am writing to tell you that I have fully recovered from chronic fatigue syndrome. After my last consultation with you, I resumed paid employment -- initially part-time and then full-time. Recently I commenced a new position working as an accountant -- my area of employment prior to my illness! I now enjoy an active social life and exercise in the forms of yoga and ice skating. I have learnt to take time out to relax and rejuvenate myself, so that I don't reach energy sapping levels of fatigue. The help that I received from professionals (such as yourself), friends and family, enabled me to take control of and rebuild my life. I would like to thank you for your help."

Fortunately Michelle's story is not an unusual one. Over the years I have seen herbal treatments cause substantial changes for the better in chronic fatigue syndrome (CFS), with many patients completely recovered and returned to full and productive employment, but it does take time! Often patients with CFS are their own worst enemies, switching from one treatment to the next, following every fad and consequently never allowing the gradual restoration of normal energy that herbs can slowly bring about.

What is CFS?

Although the name might be new, chronic fatigue syndrome (CFS) is not a new disorder. While the affliction described as 'neurasthenia' in Victorian times does not necessarily represent an early forerunner, the 'bed cases' or 'sofa cases' reported among middle-class women in the period from 1860 to 1910 probably were CFS. [1] By the time of World War I, a syndrome resembling CFS was a common complaint in Europe and North America. [1] CFS is also known as post-viral fatigue syndrome or myalgic encephalomyelitis (ME).

CFS can occur in epidemics. In the June 1951 edition of the Medical Journal of Australia, Dr Richard Pellew reported an epidemic of 800 cases in South Australia. Patients complained of headaches, joint pain, fatigue, depression, lack of concentration and a general feeling of malaise. He called his paper "A Clinical Description of a Disease Resembling Poliomyelitis," an association which has more recently been emphasized by British scientists who believe that enteroviruses are involved in CFS.

Although the orthodox medical profession was reluctant at first to recognize CFS as a physical disorder, rather than a variant of depression or neurosis, recent scientific evidence supports a physical etiology. Nonetheless, treatment of CFS as a psychiatric problem is still relatively widespread. The scientific community is now showing a great interest in CFS. More than 1000 papers have been published on this topic, many of these in the last three years. A research journal devoted exclusively to the study of CFS was launched: the Journal of Chronic Fatigue Syndrome. The general impression is that the incidence of CFS is increasing, but this may be due to better diagnosis stemming from increased understanding of the disease.

Medical research has now identified a number of abnormalities in CFS. Such research tends to support some of the naturopathic understanding of the disorder. These two approaches can be combined to provide a rational and effective approach to the phytotherapy of CFS.

CFS was formally defined in 1988 as disabling fatigue of at least six months' duration of uncertain etiology. [2] Additional symptoms can include mild fever, sore throat, painful lymph nodes, weight gain, exertional malaise, muscle weakness, muscle and joint pain, headaches, depression, light-headedness, anxiety, visual and cognitive impairment and disturbed sleep patterns. It usually has a relatively definite onset which resembles influenza. Six of these additional symptoms must be present, plus two or more of the following signs: low-grade fever, nonexudative pharyngitis, and palpable or tender lymph nodes. [2]

This clinical definition of CFS has a number of weaknesses, particularly the six months 'qualifying period', but currently there is no accepted biochemical test for the condition. Another problem is that the definition is somewhat restrictive. Many patients with chronic, unexplained fatigue and typical symptoms of CFS may not exactly fulfill the above definition.

What Causes CFS?

Viruses

The fact that CFS can occur in epidemics has always pointed to an infectious origin. However, despite the fact that various researchers have implicated a number of viruses, a clear association with a single viral infection has not been established. Originally Epstein-Barr Virus (EBV) was thought to be the cause, since CFS can follow mononucleosis. More recently, associations with Human Herpes Virus 6 (HHV-6) and Coxsackie B viruses have been studied.

A review of some of the research demonstrates the confused state of our understanding of the role of viruses in CFS. For example a Canadian study found no difference in EBV antibody titers (levels) between CFS patients and controls, [3] but a US study found antibody evidence of active EBV infection in some patients with CFS. [4] A majority of a group of US Army reservists who developed CFS after active duty in Saudi Arabia tested positive for either acute or reactivated EBV infection. [5] However, positive EBV antibody profiles found in many CFS patients are not necessarily indicative of active infection. [6] Association between CFS and HHV-6 is no clearer, with some studies finding a positive association, [7-9] and as many other studies finding no evidence of HHV-6 involvement in CFS. [9-12]