Western And Traditional Chinese Medicine Diagnostic Criteria And Treatment Of Chronic Fatigue
Current diagnostic criteria for chronic fatigue are patient reporting of severe debilitating fatigue accompanied by four or more of the following symptoms. These must occur concurrently and for a continuous period of more six months:
impaired memory or concentration
tender cervical or axillary lymph nodes
When tested these patients have negative findings on all conventional medical lab and clinical tests.
Common treatments include non-steroidal anti-inflammatorys for headaches, pain and feverishness; Antidepressants for mood enhancement and in some cases to aid sleep and provide pain relief. Often tricyclics, older generation of antidepressant are used because of their effectiveness in treating sleep disorders and pain syndromes.
Some doctors recommend exercise programs such as gentle yoga or stretching. These have proven successful for some Chronic Fatigue patients.
There is no known causative factor for chronic fatigue. Many patients report having had a prior flu-like illness, which appeared to have resolved favorably and experience some form of stress related trigger. It had been thought that the Epstein-Barr virus was a factor, however, that theory has largely been rejected. The traditional Chinese Medicine approach is quite different. The fundamental principle is to treat the underlying cause of the condition. While a practitioner may treat some symptoms, to provide immediate relief, the ultimate goal is to determine the underlying cause and to treat that underlying cause.
TRADITIONAL CHINESE MEDICINE
While Chronic Fatigue is not, per se, a recognized disease pattern in Chinese Medicine, fatigue of the magnitude described by chronic fatigue patients is consistent with the kind of fatigue associated with particular Chinese medical patterns. In particular, severe Spleen Qi deficiency and severe Yang deficiency. (see below for an explanation of this conditions) While standing alone, Spleen Qi deficiency cannot explain all of the chronic fatigue patients’ symptoms, when considered as part of a combined disease pattern, chronic fatigue fits comfortably within well established and longstanding disease pattern combinations. Given the common feature of flu-like symptoms and apparent favorable resolution, (for further information click here) it is likely that many chronic fatigue patients contract an external pathogenic factor. That pathogen is not fully resolved and becomes latent. In TCM, the disorder is understood as an external pathogenic factor that is transmuted into a latent internal pathogenic factor — not unlike the western understanding of a virus. It remains in a latent state until it is triggered or awakened by a subsequent trigger. This trigger could be excessive work, poor diet, stress or another external pathogenic invasion. In other cases, the patient may be susceptible to the disease because he or she is suffering from general taxation. Whatever the cause, is it clear that many chronic fatigue patients suffer from a significant spleen Qi deficiency. That is a common feature of the condition manifesting as extreme debilitating fatigue.
SPLEEN QI DEFICIENCY AND THE PRIMARY CHRONIC FATIGUE SYMPTOMS
Consistent with a severe spleen qi deficiency pattern, these patients exhibit other classic spleen qi deficiency symptoms such as impaired memory and concentration, muscle pain, headaches and post-exertion malaise. The memory impairment and lack of concentration are classic spleen qi deficiency symptoms, which are explained by the lack of general nourishment (Qi) and its inability to rise to the head. This general deficiency is compounded by the inevitable damp accumulation which further impairs the ability of the Qi to reach beyond the center. Thus the brain is not properly nourished.
The occurrence of headaches is explained by the same pathomechanism, with the damp accumulation having a greater impact. Often these headaches are of the dull type which patients describe as a banding around the head. This is a typical manifestation of damp accumulation resulting from spleen qi deficiency.
As is the case with the memory difficulties and the headaches, muscles pain is a common symptom of spleen qi deficiency. The flesh is associated with the spleen and when the spleen is not functioning properly, the muscles are not properly nourished and pain is often the result. Similarly, postexertion malaise frequently occurs in the context of spleen deficiency. The exertion further depletes the already weakened spleen with the result that the limited qi is further taxed and disrupted. All in all, these patients present with primary spleen qi pathologies.
ADDITIONAL INVOLVED PATTERNS
As noted above, it is often the case that the CF patient has symptoms which are not readily explained by a spleen qi deficiency diagnosis, but in fact are the result of a combined pattern condition. Common patterns seen in these patients include damp heat and liver qi depression. Symptoms commonly seen in these conditions include digestive disorders, depression, feverish sensation, joint pain and insomnia.
Undoubtedly, other TCM pathology progressions may occur and provide explanations for CFDIS and the resulting symptoms. It is not the intention of the author to undertake a comprehensive analysis of all the pattern combinations which can occur in TCM that might explain CFDIS. The objective of this page is to provide an understanding of one possible disease pattern combinations, that occurs with many chronic fatigue patients. As is always the case, each patient must be assessed on an individual basis so that the practitioner can gain an understanding of the disease progression is that patient, and develop a treatment plan best suited to the individual patient.