Chen R, Moriya J, Yamakawa J, Takahashi T, Kanda T. Traditional Chinese medicine for chronic fatigue syndrome. eCAM. 2010;7(1):3-10. doi:10.1093/ecam/nen017.
Chronic
fatigue syndrome (CFS), a multi-symptom condition with multiple contributing
factors, has recently been recognized by conventional Western medicine. It is
poorly understood and imperfectly treated. The authors investigated the
potential value of remedies for fatigue syndrome (FS), a condition recognized
by traditional Chinese medicine (TCM) since ancient times, in CFS.
CFS and FS
have many similar general, nervous system, digestive, musculoskeletal/locomotion,
respiratory, circulatory, and urinary tract symptoms. However, TCM links
several genital symptoms and also bloody stool and urine to FS—symptoms that
are uncommon in CFS, and suggest that different infections triggering bowel and
bladder inflammation are more common in FS than CFS. The Center for Disease
Control (CDC) definition of CFS includes six months of unexplained, excessive
fatigue and four or more other symptoms.
Conventional
medicine treats CFS with antidepressants, stimulants, sleep and pain
medications. Western holistic practitioners treat with the SHINE Protocol
(Sleep, Hormonal support, Infections, Nutritional support, and Exercise) which
results in an average 90% improvement in published randomized and placebo
controlled research.
The authors
searched over 600 electronic TCM sources for "fatigue syndrome." Pujifang, a "monumental"
prescription book from the Ming Dynasty (1368-1644 C.E.), has 975 entries for
FS. Over 50 ancient sources named crude drugs used in FS. With these materia
medica, the authors compare frequency of use of ingredients to invigorate qi and yang, nourish yin and
blood, adjust abnormal sleep and emotion, and clear heat-producing pathogens. Meals
used for FS patients were also analyzed for main ingredients: mutton, in 23 of
25 meals, twice as many as next-most-frequently-recommended fermented soybean (Glycine max) and chicken meat. However,
unfermented soybean appears in other recipes, as do several types of poultry and
meats; if viewed together, meat and soybeans are clear favorites.
Some
ancient TCM prescriptions for FS are still used today. The authors report on
studies of efficacy. At this point in the article, they begin to use "CFS,"
and it is unclear if modern practitioners use TCM definitions of FS or the
CDC's definition of CFS. Some studies were on populations not diagnosed with
either CFS or FS, but with similar symptoms; in others, CFS patients were
studied. No standard TCM remedy is named in connection with more than one study.
It is encouraging to see several randomized, controlled trials (RCTs), but the
authors note that anecdotal, non-randomized trials remain the norm in TCM
publications on CFS. All studies cited found some treatment benefit, from improved
cognitive ability or psychological symptoms to restored ability, in some, for
patients to resume normal activities.
Of specific
herbs – usually used in complex formulas – the most studied, Asian ginseng (Panax ginseng), had mixed results. Some
studies found it effective in relieving fatigue, while others did not. Enhanced
cognition was claimed in one RCT, but it was found no better than placebo for
sleep disorders. Other Chinese herbs used in CFS are little studied. Poria (Wolfiporia cocos) may help relieve
neurasthenia and improves sleep. Desert broomrape (Cistanche deserticola) and Chinese licorice (Glycyrrhiza uralensis) root also have beneficial effects on some symptoms.
In mice,
dong quai (Angelica sinensis);
aatalpol, from rehmannia (Rehmannia glutinosa)
root; and peony (Paeonia lactiflora)
root relieved symptoms like some of CFS. An ingredient in polygala (Polygala tenuifolia) improved cognition.
Extract of fossilia mastodi ossis ("dragon bone"; the skeleton of an
extinct mammal) elicited GABA receptor-mediated anxiolysis, potentiated
pentobarbital, and reduced locomotor and anticonvulsive activity. Magnetite improves
muscle fatigue and can lower pentobarbital's threshold and sleep incubation time.
Not all recorded TCM drugs are useful; some may worsen CFS, such as the mineral
fluorite. Also, alleviating symptoms of CFS is not the same as treating CFS.
TCM posits
deficiencies in five organs (including qi,
blood, yin, and yang), from pathogens, physical strain, mental stress, or improper
diet, as underlying FS, and treats symptoms and causes. Five models are
accepted. Depending on the zheng
(pathogenesis) of the condition, treatment is designed. Diagnosis involves pulse
and tongue observation and symptoms.
Today, in
conventional medicine, the role of infections and immune system dysfunction are
being explored as significant underlying causes of CFS. TCM drugs to invigorate
qi and tone the spleen are often used
for CFS, boosting immune status. In human and animal studies, TCM drugs decrease
spleen weight; reduce interleukin (IL)-10 mRNA expression; inhibit tumor
necrosis factor-α, IL-6, IL-10, and transforming growth factor-β1; increase
interferon-γ in peripheral blood mononuclear cells; and raise natural killer
cell function and cellular immunity. Another research focus is on regulating abnormal
hypothalamic-pituitary-adrenal (HPA) axis activity. Results are promising, particularly in
underlying causes of CFS-related depression. Oxidative stress has also been
proposed as a cause of CFS, and natural antioxidants, e.g., ashwagandha (Withania somnifera), quercetin,
Evidence-based
trials and RCTs are needed. TCM formulas and drugs used to clear heat
pathogens, used in viral and bacterial infections, may help in early stages of
CFS, but no one has studied this issue. The authors call for quantification of
clinical CFS data, in order to formulate definitive diagnostic and treatment
guidelines.